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'VOMES. 4:U> CHILBRM WfS tot ^4 fmxULm, 'i*** H'i: Ijjifj; ...i^,;, % .<^.Jl 'ig; pcltt, ^nlargelr anir Jebiseb €Mm OF WARREN'S HOUSEHOLD PHYSICmi FOR THK i;sK or PHYSICIANS, FAMILIES, MARINERS, AND MINERS. BEINO A *. BHIi:r DESCKIPTION, IX PLAIN LANGUAGE, OF ALL THK DISEASES OF MEN, WOMEN, AND CHILDREN, WITH THK LATEST AND MOST APPROVED METHODS OF TREATMENT. IRA WAKREN, A.M., M.D., FelUnc (if the MaMachunett-i Medical Snctelij, etc. AND A. E. SMALL, A.M., M.D., President of the Hahnemann Medical Cnltege, Chiaii/o, lU. ILLUSTRATED BY THIRTY-SIX FIGURES ON EIGHT SPLENDID COLORED LITHOGRAPH PLATES^ AND THREE HUNDRED AND THIRTY-SIX ENGRAVINGS. TUB RIQUT or TRANSLATION IS RKSKRyBD. iia-A. B la -A. x) Xj E "sr & co. 168 Washington Strbbt, BOSTON. 1884. EiitiTvMl iKrconliiig to Act of CoiigresH, in tlie year 1850, by IMA WAUUEN, in the Clerk's Office of the District Court of the IMstriet of MnfisnchuBOtta. Entered aecoriliiitr to Act of Congress, in the year 1863, by IRA WAKUKX. It UieCleikV Office of the District Court of tlic l)istrict of Nf assachuiette. Entered according to Act of Congress, in the yen' 1870, by CllAKLES ROBINSON, Jr., In the Office of the Librarian of Congress, at Washington. PREFACE. This book is written for the people. It is based on tlie assumption that every man — the mechanic, the farmer, and the day laborer, as well as the professional man — has a right to all the knowledge he is capable of acquiring, en all sub* jects, — medicine not excepted. The book aims, therefore, to popularize, and adapt to the many what has been claimed as belonging only to the few. I do not hesitate to avow that my sympathies, as a man, are with the great masses, who may be called the bone and muscle of the race. They are, in the main, more shrewd, more endowed with common sense, more simple and true in their natural instincts, and consequently less perverted, than those who claim more refinement and a higher place in the social scale. "All men," says Hippor-ates, one of the great fathers of medicine, "ought to be acquainted with the medical art. I believe that knowledge of medicine is the sister and companion of wisdom." Such knowledge would shield the many from the impositions of quackery. No one, I venture to say, who reads this book thoroughly, will be often imposed upon thereafter by quack nostrums, or quack doctors. Every man's physical organization is his own ; and he is charged with the responsibility of taking care of it. To do thl i properly, he needs knowledge of it; and to withhold this from him, is another form of the old oppression, which decreed knowledge and power to the few, and ignorance and obedience to the many. In accordance with the design of the work, it has been written in plain, simple English, and brought within the comprehension of all who have medium powers of mind. It has not been thought needful to reduce its language to the simper- ing style of baby-talL ; that is done only by those who don't know much about the people. In preparing this book, a great number of authors have been carefully consult- ed, to whom I acknowledge large indebtedness ; yet the work is not a mere compi- lation. With the exception of a few minor parts, as those on Hydropathy, the Management of the Sick-Room, the Symptoms cf Diseases, and, as in all medical works, a portion of the recipes, it has all takeu shape, coloring, character, and language, in my own mind. In dealing with each disease, I have aimed to sketch a brief pen-and-ink portrait, eo like it that every reader shall know th« IV PREFACE. original whenever he sees it ; and then to give, in the fewest words, the best treatment. No work of the sort has ov(!r explained the reasons, or given the whys and wherefores of medicine to anything like the extent of lu.., , nor has any one been so extensively illustrated. The engravings amount to two hu/idrod tnd thirty-six in number, and have been, with few oxceplions, done expressly for this work. Of the colored lithographs, there are Thirty-six Figure-^ on eight splendid plates. They are inserted at groat expense, and add much to .'he value of the book. L W. SECOND PREFACE. The Household Physician was written in the belief that the people were ready and waiting for a popular medical work based on liberal principles ; and that one hundred thousand copies have already found a welcome home, in as many Amer« ican families, is a sufficient evidence that the belief was well-founded. I say welcome home ; and with very little stretch of modesty I might emphasize the word, for the popularity of the book has far outrun the author's hopes — many persons assuring the author and the publishers that fifty or one hundred dollars would be no temptation for them to part with the copy they have if they could not obtain another. Such an extensive sale of so large a book, with the demand constantly increasing, has been quite unexpected. For these evidences of public favor the author is not ungrateful or unmindful of corresponding duties on his part. A chapter is now added, therefore, on " Old Age and its Diseases," — a subject never before introduced into any popular treatise on medicine, and very rarely, indeed, into any medical book. I have taken great pains in preparing it, and sincerely hope that many Fathers and Mothers will, in future years, be kindly remembered in consequence of the suggestions it contains. I also hare the pleasure to present, from the pen of Dr. Dio Lewis, a very valuable contribution upon his new popular Gymnastics, illustrated with many cuts. With these and some smaller additions, — improvements I think I may call them, — I submit the work again to the popular judgment. I. W. GENERAL INTRODUCTORY REMARKS. Progress of Medicine. Medicine may be divided into a science and an art. It is a science as it presents facts and evolves principles ; an art as it consists of rules for practice. For its present attainments, it is indebted partly to researches scientifically conducted, und partly to empirical and hap-hazard discovery. As a science, medicine is chiefly indebted, and must ever be, to the members of what is culled the "regular profession." This body of men, while it contains numerous persons whose talents and attain- ments do not raise them above the merest quacks, docs yet embrace large numbers of men who are alike ornaments of the race, and lights of their profession. It is to the writings of this class that every stu- dent must go who would qualify himself for the proper discharge of the duties of a physician ; and he who attempts the practice of medi- cine without a knowledge of standard medical writings is either a fool or a knave — either without the brains to understand science, or destitute of the honesty to deal fairly with men. While this is said, however,- it must be granted that a respectable portion of the facts which make up the science of medicine have been contributed by the industry of men who have not had what is called a regular standing in the profession. I am sorry to be obliged to add that the great body of this class have been quacks and charlatans, while only a few of them have had talents and acquirements. Nevertheless, they have been too indiscriminately condemned. Their labors have been useful iu various ways, and have contributed to the advancement of medical knowledge. A regard for truth; not less than justice to these persons, requires this statement. One-Idea Hen. — The "irregulars," as they have been called, have generally had their hobbies, which they have ridden with singular diligence, and often in little better than John Gilpin plight. Yet they have drawn attention to great truths, which the regular profession either did not see, or would not commend ; and they have done this by dwelling incessantly upon some single idea. The one-idea men, of every class, have been ridiculed in all ages ; and indeed have always exhibited some singular obliquities. Yet when they have been men of learning and talents, they have accom- plished great things, either for good or evil. \i 6 GENERAL INTRODUCTORY REMARKS. Martin Luther was strictly a one-idea miin. The whole force of his oxtruordiniiry charucter was given to the propagation of the single doctrine of justification by faith ; and by the incessant efforts ho made for this purpose, he sank the doctrine deeper into the heart of Europe than a hundred equally powerful men could have done by giving it only an ordinary share of attention. William Ellery Clmiiniiig was a one-ideaist. Man, tiio noblest work of creation, to be developed, educated, adorned, loved, made like unto (Jod, was the thought of his life, — a thought wliich ho em- bellished and moulded into all the forms of beauty which our flexible language is capable of producing. Under the mild promptings of his genius, and the workings of this thought, philanthropy, quick- ened into a new life, spread out her arms, and embraced the world. Sir Jsaac Newton, was a one-ideaist. So entirely did ho devote hia great powers to astronomy and the higher mathematics, that ho be- came unfitted for the duties of social and domestic life — s», uiititted, that when induced by his friends to give a little attention to courtship, he fell into one of his abstractions, and detected himself in using his lady-love's fore-finger to poke down the ashes in his pipe ! But, Sir Isaac advanced mathematical science to a point far beyond its previ- ous attainments, and laid it under such obligations as no general scholar could have done. It is in this way, thou;jh in a vastly less degree, and without the scientific method, that one-ideaists in medicine benefit the world. They seize upon some single remedy, — generally one which has been overlooked, — and usmg it themselves to the exclusion of all others, they press it upon the world as the panacea for all its ills. With them disease is a unit, and they have found its one all-important remedy. Thus convinced, they press it upon others with the enthu- siasm of fanatics. Testing it in all cases, they develop all its virtues. Those who have the good sense to turn their attention to it have only to use it in those cases for which its adaptation is proved. It is in this way that these men become, incidentally, medical dis- coverers ; and not being burdened with modesty, they never with- hold their importunities till the world acknowledges whatever value there is in their discovery. And although they may do some mis- chief with the single-edged tool which thoy handle so industriously, I doubt if they do much more than many better workmen who use too many. At all events, wise and generous men thank them for their gift to the profession, small, though it may be, and use it in the light of a clearer knowledge. Hydropathy. — As an illustration of what I have just been saying, I may reter to hydropathy, or the plan of treating all diseases by water. The singularly careful avoidance, by the whole medical faculty, for many ages, of the article of pure water as a medicinal, or, rather, health-imparting agent, was anything but creditable to the profession. It is now admitted by all sensible men that water, cold and warm, used at proper times and to a reasonable extent, has great power over GENERAL INTRODirCTOKY REMARKS. several diseases, and is a powerful promoter of hoalth. No physicians, except those who are too indolent to know wlmt is f^oing on in the world, or too fast locked in old prejudices to touch new things, now omit its use in mawf cases. How warm and sincere my own approval of water as a remedy is, ahnost every page of this volume will attest. Indeed, it may honestly be allowed that the hydropathists have fairly drowned the almost criminal professional prejudice against water. They are in all the nn)re need of this concession, since in their absurd zeal to cure all diseases by water, and make aquatic ani- mals of men, they have also drowned their own common sense. Homeeopatliy. — -This mode of practice is of comparatively recent origin ; but it has already sunk itself deep into the popular heart, and has drawn to its support many of the wealthy, tiio cultivated, and the intelligent, in our most refined communities. I do not pro- fess to comprehend and appreciate its principles, no- would it be honest in mc to pretend to see how its infinitesimal u - der what lis miud, ith some but what e a medi- nnd fluids mbr.ting. Uie fluids lents and Ise where. )eral and t attested hese factf but must stitioners, progress, jrove the sioa into il, physi- -)W preju- examine ir notice, ictive by- ffhts, and the nar- le who is his feet n escape ^it, in the stand at Ian exact settled — as seda- I muscles, isiveness [e healing can sub- GENERAL INTRODUCTORY REMAUKS. 11 mit its purity to equally certain tests, it will appear in better taste for them to grow exclusive. Until then, the most becoming badge they can wear is the Christian direction : " Let each esteem others better than himself. " Medical societies, with liberal by-laws, are fitted to do good ; but it would be hard to show that those with stringently-restrictive rules can operate otherwise than as aliecks upon progress. In truth, they are apt to become mere catacombs in which to embalm dead ideas. They are very liable to be made the instruments for accomplishing the ambitious purposes of a few leading men. They tend to sifippress all sympathy with everything outside their organization ; iv.v\ they beget a feeling like that which would forbid the fixed stars to drop their light mto our atmosphere without first coming down and joining the solar system. Conservative Lenders, — There are no influences which hold so steady a check upon medical progress as the conservative leaders in many of our medical associations. Not that they are opposed to im- provement in the medical art, or would object to any amount of dis- covery, if it could come to the profession through channels which they have the honor of opening. But against all light from outside, or from obscure sources, tliey will draw down the cintains, and close the doors ; and, if it chance by any means, in spite of them, to get within the sacred enclosure, they will call it darkness, and, as priests of the temple, will attempt to atone for the indignity offered to the god of medicine, and fill the whole sky with murky clouds from their altars. These men have strong faith in caste, and in the right of the few to govern the many. In the low places of society, they look for nothing but ignorance and poverty. Notwithstanding that the light of every natural day l)re,aks in the horizon, and ascends, they so far despise analogies as to insist that all medical light breaks at what they call the zenith of the profession, and comes dovm. With them the temples of Esculapius are all rebuilt, and they are the priests ; and to offer in sacrifice the smallest medicinal plant is a sacrilege, unless it be entrusted to their hands. Such persons measure and weigh a man by the amount of money he has. Property is their god, which gives laws to everything. \^''lth them, knowledge, like property, goes to posterity by will, — they being the principal testators. Like their money, too, it goes chiefly to their sons, and to certain favored institutions, by whom, and in which, it is to be hoarded, and whence it is to go out only in certain approved channels, weighed and stamped, like coin from the mint. These are the men who regard knowledge as a contraband article, unless regularly entered at the custom-house, with bills of lading properly certified by the conservative magnates at some other me- tropolis. With them, knowledge is not like the Avost wind, fanning the brow of the peasant as gently as that of the king, — not like the light of heaven, entering the small, clean window of the hut, as readily as the larger one of the palace ; not a boon which comes alike freely to all, and which is to be everywhere amplified, changed aa Ill i :c 12 GENERAL INTSODUCTORT REMARKS. oirciiniBtances and conditions require, and especially adapted to the present hour. It is rather, as they too often view it, like litho- graphed letters of advice, printed upon stamp paper, and carefully sealed up and addressed to posterity. And then, if they can be made the mail-carriers, and be permitted to pass, unchallenged, with the precious bag, from post to post, and pass it over, carefully sealed, to the next generation, they will think it has done its work, and that they have fulfilled their mission. I would not be unjust or severe, but I cannot but remark further, that these men present but one vfew of humanity. They are monot- onous objects of inspection. Look at them a thousand times, and you see only the same unaltered phase of life. To the mariner on life's ocean, they are not safe lights. If he approach them on the dark side, they remain black as night to him, until he comes round to their shining front. They are not revolving lights. They have light ; it may be bright and genial ; but it gleams out upon the waters only in one direction. It does not sweep round, and throw its rays upon every mariner's path. Such men are useful, but only to a certain class. They have in them no true omnilogy — they are not all-teaching. Their lives are instructive to their friends, their clique, their party, their school ; but a stumbling-block, a hindrance, an oppression, an offence to every- body else. They are like porcupines, with fronts smooth and easy of access ; but their backs bristle with quills to stick into those on the wrong side. They are not whole men. Humanity has infused into them only one or two of its elements. They have length, but no breadth. They are citizens of Boston, New York, Philadelphia, or Cincinnati, but not cf the world. Within certain circles, they are genial friends, but cynics and haters outside of them. From their high places, they come down to their humble followers with tokens of friend- ly recognition ; upon others they frown and lower like armed castles. The True Physician. — How different the character of the true man abd physician ! He is genial in his disposition. He has no dislikes and antipathies, and hates no men except tyrants. He accepts knowl- edge, though it come from the humblest source ; believing there is no experience but will repay a study of it, and no husbandman's plough- share but turns up a soil worth analyzing. He belongs exclusively to no party, and can be approached easily by respectable men of every stamp. Whether belonging to tlie same society with him, or not, you may take hold of his nature and draw it out, without hav- ing it slip from your fingers, and spring back from your presence into a thousand kinks, like an overtwisted thread. He is a whole man. Grod made him for the world, and not for a party. By some strong influence you may possibly, for a time, draw him from the world into some narrower sphere, but not only will his reluctant nature, like a retiring tide, run back continually to embrace the continent, but will soon break from its confinement, and like a full sea, come back, boil- ing and running over. What is now Wanted. — The foregoing remarks indicate one great, It is high leading want, in order that medical knowledge may increase. liberality, in the true and full sense. We want true men in places, who will not only let their own light shine everi/where, but will cease to hinder other men's light from shining. Beyond this, and of nearly equal importance with it, we want medi- cal knowledge diffused among the people. We want — what the world has never seen — a popular medical literature. We want the temples of Esculapius pulled down, and the priests turned into the streets to become teachers of the nuiltitude, rather than worshippers in the iiu^er sanctuary. I know this want will be stoutly denied, but not, I think, on well- considered grounds. We do not think it necessary to confine a knowl- edge of the soul to the ministers of religion. There is no branch of theology which we do not deem it proper for laymen to study ; we even jiopularize it for our children. In the obscurest towns of New England, laymen who follow the plough or push the plane, become, in many cases, eminent theologians. Why should they not study the lower science which relates to the body ? They have not been able to heretofore, because its mysteries have been purposely hidden under technicalities. These coverings should bo torn off. It is said that those who begin to read upon medicine are very apt to imagine themselves afflicted with the various symptoms thoy find described. To some small extent this is true ; but it is also true that the ligiit they obtain relieves them from many apprehensions which thoir previous ignorance allowed to prey upon them ; as boys lose their fears when the light of the morning changes to some familiar object the ghost of the preceding night. Physicians oppose the popularizing of this kind of knowledge too often, I fear, upon the sordid ground of self-interest. They think their own services will be less sought. Wo do not dispense with the services of ministers because the people study theology, neither shall we cease to employ teachers and practitioners of medicine when each man and woman is wise enough to study the healing art. The principal change we shall witness will l>e much larger attainments in knowledge among practitioners, — just as the ministers of religion now know, and are obliged to know, ten times as much as in those darker periods when the people received all o^.iJtual knowledge from their mouths. The teachers of any art or science are obliged to keep in advance of their pupils. ' Let medi- cine become a popular study, and we shall have very few ignorant physicians, and quackery will become one of the impossibilities. Horaoeopathists, Eclectics, Hydropathists, and Physiologists, believe in scattering medical books, stripped of their technicalities, among the multitude, and their people purchase very few secret, advertised medicines ; — these being chiefly bought and consumed by the fol- lowers of those who believe this kind of reading fosters quackery I L=_- m 1 -|'! A.3Sr A. T O M Y. Akatout describes the structure and oi^anization of living beings. Special Anatomy treats of the weight, size, shape, color, etc., of each organ separately. General Anatomy investigates the tissues or structures from which organs are formed. Surgical Anatomy or Regional Anatomy considers the relations of organs to one another. Physiological Anatomy treats of the uses or functions of organs in health. Pathological Anatomy describes the alterations made upon different organs by disease. We shall here introduce a very brief compendium only of Special Anatomy. It is of great cousequence that every person should have some knowledge of anatomy and physiology. Self-knowledge ought to extend to the body as well as the mind. To know one's self, physi- cally, is to gain a new insight into that wonderfully skilful adjustment of means to ends which is never absent from the works of God. Without this knowledge, one cannot know how to take care of the health ; and without health, life loses most of its value. Structure of the Body. The human body is composed of solids and fluids. The fluids are most abundant in children and youth. It is this which gives softness and pliancy to their flesh. In old age the fluids are less abundant, and the flesh is more hard and wrinkled. The fluids contain the whole body, as it were, in a state of solution ; or rather, they hold the materials out of which it is manufactured. Chemical Properties of the Body. The four elements, oxygen, hydrogen, carbon, and nitrogen, make up nearly the whole bulk of the fluids and soft solids of the human body. A number of other elements, chiefly in a state of combina- tion, and in much smaller quantities, enter into several of the tissues. Binary Compoands* — Thus, we have carbonic acid in blood, urine ANATOMT. 15 and sweat ; and we have water universally diffused through the sys- tem, —each of these substances being a binary compound, that is, composed of two elements. Componnds of more than two Elements arc widely distributed over the body ; as, Carbonate of Soda in serum, saliva, bile, mucus, sweat, and tears. Carbonate of Lime in cartilage, bone, and teeth. Phosphate of Lime in bones, teeth, and cartilage. PhospJiate of Iron in blood, gastric juice, and urine. Chloride of Sodium in blood, brain, muscle, bone, cartilage and pigment. Chloride of Potassium in blood, gastric juice, milk, and saliva. Chloride of Calcium iu gastric juice. Sulphate of Potassa in urine, gastric juice^ and cartilage. Sulphate of Soda in sweat, bile, and cartilage. Sulphate of Lime in bile, hair, and scarf-skin. Oxide of Iron in blood, black pigment, and hair. Organized Compounds. — Beside the above inorganic elements and compounds, several organized substances, or proximate elementSy as they are called, exist largely in the body. The chief of these are albumen, fibrine, gelatine, mucus, fat, caseine, and osmazome. Others need not be named. Albumen is found in great abundance iu the human body. It is the raw material out of which the flesh and other tissues are made. The white of an egg, which is nearly pure albumen, is a good speci- men of it. librine, when removed from the human body, changes from a solu- ble to an insoluble state. In other words, it coagulates in a kind of net-work. Nearly the same thing takes place constantly in the living body, when the liquid fibrine leaves its soluble state, and is deposited as solid flesh. Fibrine bears the same relation to albumen that wool- len yarn does to wool ; it is spun from it in the busy wheel of or- ganic life. And the flesh or muscle is related to fibrine as the cloth is to yarn ; it is woven from it in the vital loom. Fibrine has been called liquid fesh. Gelatine exists largely iu the ligaments, cartilages, bones, skin, and cellular tissue. When dissolved, five parts in one hundred of hot water, it forms a thick jelly. Isinglass is a form of gelatine obtained from the air-bladder of the sturgeon and the cod-fish. Glue is still another form of gelatine. It is extracted from the bones, aud parings of hides, and the hoofs and ears of cattle, by boiling in water. Black silk, varnished over with a solution of gelatine, forms court-plaster. Hncns is a sticky fluid secreted by the gland-cells. It is spread over the surface of the mucous membranes, and serves to moisten and I defend them from injury. Fat consists of celb held together by cellular tissue and vessels, I and contains glycerine, stearic acid, margaric acid, and elaic acid. It w 16 ANATOMY. !i I J") ill< I;! has no nitrogen. If tho stearic acid be in excess, the fiit is hard ; if the eliiic acid preponderate, it is soft. The stearine extracted from fut is used for mukiiig very hard candles. Casfine is abundant in miiic and constitutes its curd. It is held in solution in milk by a little soda. When dried, it is cheese. It is found in blood, saliva, bile, and the lens of the eye. It forms the chief nourishment of those young animals which live on milk. It is found in peas, beans, and lentils. Vegetable and animal caseihe tiro precisely alike in all their properties. Fibrine and albumen contain almost exactly the same amount of oxygen, hydrogen, carbon, nitro- gen, and sulphur, vtrhich is found in caseine. This latter, when taken into the stomach, therefore, goes, without much change, to the formation of the albumen and fibrine of the body. Physical Properties of the Body. The Tissues. — The solid organized substances of which the human body is composed, are called tissues. There are various kinds of tissues. The Cellular Tissue, commonly called areolar, is made up of small fibres and bands woven together into a sort of net-work, with numer- ous little spaces opening into each other. These spaces are filled with a watery fluid ; and wlien this is greatly increased by disease, so as to cause the parts to swell, and the skin to shine, the person has ana- sarca, or cell dro2)sy. Tho uses of this tissue are to give parts and organs a kind of elastic cushion to rest upon, so that they may not bo bruised and injured by the shocks of life ; to make a kind of safe highway for delicate vessels to pass from one part of the body to another ; and to furnish a beautifully arranged lodgment for the wa- i tery fluid which gives such roundness, smoothness, and grace to the > human form. The opening of the cells into each other explains the i reason why feeble persons have >)welled feet and ankles in the even- ing, and not in the morning, — the fluid settling down from cell to cell, into the lowest parts, while they are up during the day, and running I back to its proper place while they are lying down during the nigjit. The Hncous Tissue, or mucous membrane, lines all the cavities which communicate with the air, as the mouth, stomach, bowels, lungs, etc. It is supplied with numerous small glands which secrete a sticky kind of fluid called mucus, to protect the surface from any injury which might be inflicted by air, or by irritating substances suspended in it. The Serous Tissue, ov membrane, lines all the cavities which do not communicate with the air, that is, all those which are shut, and have no outward opening. The skull, the chest, and the belly are lined by this kind of membrane. The membrane itself forms the closed sack, — one layer of it being attached to the cavity it lines, whilo the other is folded back upon and around the contents of the cavity, which are left outside of the sack. A watery fluid oozes from the inner surface of the sack, to make its sides glide easily upon each other. When ANATOMY IT some disease causes this water to be puured out too freely, so as to fill or partly till the cavity, we have dropsy of the braiu, or chest, or belly, as iho case may be. Tlie Dermoid Tissue covers the whole outside of the body. "Wo call it the skin^ or cutis. It is similar in structure to the mucous mem- branes, which are a mere continuation of it. It is harder than the mucous membrane, because more exposed to injury. In health, it never ceases to secrete and throw off a fluid which we call insensible perspiration while it in in the form of an invisil)le vapor, and perspira- tion, or sweat, when it is so increased ar to be seen. So great is the sympathy between this dermoid cavering of the body and the mucous membranes, tliat when it is chilled so as to stop the invisible perspira- tion, the internal membrane becomes afiected, and we have a soro throiit, or diarrhoea, or running at the nose ; that is to say, when the skin cannot sweat, the raucous membrane begins to sweat. The Fibrous Tissue consists of closely united fibres, and for what- ever purpose used, forms a fine, dense, and enduring body. In some cases it takes the form of a membrane, as the dura mater, which lines the interior of the skull and spinal column. The ligaments which hold the bones together, and the tendons or cords, which fasten the muscles to the bones, are fibrous bodies. It is this firm substance of whick rheumatism frequently takes hold, and this is the reason why it lingerft, so much about the joints. It sometimes takes hold of the ligament which fastens the deltoid muscle to the bone of the upper arm, about two-thirds of the way from the elbow to the shoulder. This muscle lifts up the arm. In tiiis form of rheumatism, therefore, the arm hangs helpless at the side. The Cartllat^inons Tissue covers the ends of the bones where they come together lo make a joint. It is well fitted to make the joint work easy, being smooth, hard, and elastic. The Osseous or Bony Tissue varies in its composition, density, and strength, according to the age of the person, and the uses of the bone. The Muscular Tissue, or muscle, being made for a great deal of pulling and lifting, is formed some- thing like a rope, except that there is no twisting. Many small fibres or filaments unite to form fasciculi. A fasciculus is a bundle of fibres sur- rounded by a delicate layer of cell tissue called sarcolemma, — just as a cord is a number of smaller threads of cotton or hemp bound together. A number of these fasciculi united to- gether, make a muscle, — just as sev- eral chords, called strands, twisted together, make a rope. Figure 1 gives us a good view of the fibres and bundles, highly magnified. 3 Via. 1. I ,[',J li 18 ANATOMY. The Adipose Tissue is tho material which the human body works up into pots and cells containing fal. It is found chiefly under the skin and muscles of the belly, and around the heart and kidneys. By the increase of this tissue, persons may become enormously en- larged without having their muscles at all increased in size. Such a condition is to be deplored, — the body having become merely the store-house or depot of myriads of pots of fat. The Nervous Tissue is composed of two distinct kinds of matter, — the one gray and pulpy, called cineritious, the other white and fibrous, called medullary. The external part of tho brain and Ihe in- ternal portion of the spinal cord are composed of the gray or ash- colored tissue ; the nerves are made only of the white or fibrous matter* and are inclosed in a delicate sheath called neurilemma. Vital Properties of the Body. Bodies begin their growth with a simple ce7Z, which is a delicate little bladder or shut sack. Cells take their rise in that portion of the blood which is capable of being organized, and which is called Wa»- tema. In animal bodies, each cell generally begins as a minute point in the blastema, and grows until a transparent bladder or vesicle springs out from one side of it,and soon appears to enclose it. The bladder is then called the cell, and the point or dot is \ts nucleus. Within this nucleus appears another dot, which is called the nucleolus. When fully rinened, the cell bursts and sets the nucleus free, and this, in its turn, matures and yields up its contents. Thus all cells have their origin in germs produced by previously existing parent cells. They are multiplied with great rapidity. Having grown to a certain extent, they lose their fluid contents, and their walls collapsing or coming to- gether, they form simple membraneous discs. In this way, with some variations, the simple tissues of the body begin to be, and the foun- dntion is laid for the noble structure of man. Anatomy of the Bones. The human skeleton is composed of two hundred and eight bones, the teeth not included. When fastened together by natural ligaments, the bones are said to form a natural skeleton; when attached by Avires, an artifidal sTcele- ton. In Figure 2, — 1, 1, represent the spinal column ; 2, the skull ; 3, the lower jaw ; 4, the breast bone (sternum) ; 6, the ribs ; 7, the col- lar bone ; 8, the bone of the upper arm (humerus) ; 9, the shoulder joint ; 10, the radius ; 11 , the ulna, 12, the elbow joint ; 13, the wrist ; 14, the hand ; 15, the haunch bone ; 16, the sacrum ; 17, the hip joint ; 18, the thigh bone ; 19, the knee cap (patella) ; 20, the knee joint; 21, the fibula ; 22, the tibia ; 23, ankle joint ; 24, the foot ; 27, 28, 29, A\ ■ ANATOMY 19 the ligaments of the shoiiUler, elbow, iiikI wrist; 30, the large artery of the arm; 31, the ligaments of the hip joint; 32, the large blood vessels of the thigh ; 33, the artery of the leg ; 34, 36, 36, the liga- ments of the knee cap, knee, and ankle. Fifl. 2. The protuberances or swellings in certain parts of bones are called processes, and are the points to which muscles and ligaments are fastened. The bones are supplied with nutritive vessels, and, like other parts of the body, are formed from the blood. At first they are compara- tively soft, and cartilaginous. After a time, in the young animal, they begin to change to bone at certain places, called points of ossiji- cation. They are covered with a strong fibrous membrane called the periosteum. A somewhat similar covering upon the cartilages has the name of perichondrium, and that which covers the skull is the pericra- nium. The bones are compounded of earthy and animal miatter* From ! : i' 1 ■. ti'lil 20 ANATOMY. th<3 former, — phoaphute aud curbunato of limo, — they receive their strength ; from the latter, — cartilage, — thoy derive their life. Put a bono for a few days into diluted muriatic acid, — one part of acid to six of water, — and the phosphate and carbonate of lime will all bo removed, while the bono will remain the same in shape. It Fio.3. will now bo comparatively soft, and may bo bent, or even tied into a knot, with- out breaking. Place a simi- lar bono in tho fire for a few hours, and it will also retain its shape, but tho cartilagi- nous portion will be gone. It is now brittle, and may be picked in pieces with the fin- gers. The bones are divided into those of the head, thirly; of tho body, fifill-four; of the upper limbs, siidy-four; and of the lower limbs, »ixty. Fio. 4. Bones of the Head. The bones of the head are divided into those of tho .s^■u?2, the &ir^ and the /*ace. The skull has eight bones. They are composed of two plates, one above the other, with a porous partition between. These two l)latps are capable of giving tho brain very powerful protection against injury, the outer one being fibrous and tough, — the inner one, hard and glasH-lilce, and hence called vitreous. The middle layer has tho name of dtploe. Its spongy nature deadens the jar from a blow inflicted upon the outer table. In early life, when the bones are tender and yielding, this porous layer is not needed, and is not found. That the bones of the skull may not easily slip by each other, and get out of place, they are dovetailed together in curious lines called sutures. In advanced years, these generally close up, the bones uniting firmly together. In early life they are quite open, the firm bones not covering the whole brain. Tho opening of the coronal suture in childhood is called a fontanelle. It presents a soft place up- on the top of the head, where the finger could be pressed down into the brain. In Figure 4, — 1, 1, show the coronal suture on the front and upper part of the skull ; 2, the sagittal suture on the top of the skull ; aud 3, 3, the lambdoidal suture, running down on each side of the back part of the skull. ANATOMY. 21 Figure 5 shows the skull bonos separiitcd from each other iit the *^«- '>• sutures : 1 , the frontal bono ; 2, the parietal ; 3, the occipital ; 4, the temporal ; /), the nasal ; 6, the malar; 7, tlie su- perior maxillary; 8, the unguis ; 9, the inferior maxillary. Arnott has domonst rated that the form of the skull is the best possible for sustain- ing weights, and resist- ing blows. The summit of the head is a complete urch, like that of a bridge. The ear has four small bones, which aid the sense of hearing. The bones of the face are fourteen in number. They hold the soft parts in place, and aid in grinding the food. Bones of the Trunk. In the trunk there are twenty-four ribs ; twenty-four pieces in the Iwick bone or spiiiiii column ; four bones in the pelvis and hips ; one breast bone, cal' d sternum; and a bone at the base of the tongue, called OS hyoidi.s. They are so put together as to form two great cavities, namely, the thorax or chest, and the abdomen or belly. . The 1-ibs, connecting with the back bono behind, and the breast bone in front, form the thorax. lungs and Km. 6. which contains tlu! heart. The Figure (5 simws tlio natural form of the healthy chest : I, is the spine ; 2, 2, the collar bones ; 3, 3, the seven upper, or true ribs ; 4, 4, the tivo lower or false ribs ; f), the breast bone, to which the true ribs are united ; G, the sword-sliaped cartilage which constitutes the lower end of the breast bone, called eiuHiform car- lilage; 7, 7, the upper part of two lungs; 8, 8, the right lung , seen between the ribs ; i), 9, the ^k ' left lung; 10, 10, the heart; 11, II, the diaphragm, or midriff; 12, 12, the liver; 13, 13, the stomach, 14, 14, the second stomach, or duodr -um; 15, the transverse colon; 16, the upper part of the colon on right side ; 17, upper part of colon on left side. 22 ANATOMY. Fig. T. Each piece of the spinal column is called a vertebra. Upon every one of these are seven projection?, called processes, — a part of which are for linking the bones together, and the rest to furnish attachments for the muscles of the buck. The projections are linked together in such a way, that a continuous channel or opening runs down through the whole, in which is lodged the spinal cord, or medulla spinalis. This nervous cord is connected with the base of the brain, and is a kind of continuation of it. Between all the vertebra) arc certaiii' car- tila^nous cushions, which, when compressed, spring back, like India rubber, and thus protect the brain from being injuriously jarred by tunning, leaping, or walking. ^hepelvis has four bones ; the two nameless bones, — Inaominata, — the sacrum, and the coccyx. In the side of each (jf the nameless bones is a deep, smooth cavity, called the ace/abuluin. Into this the round head of the thigh bone is nicely fitted. When the bone is thrown out of this cavity, the hip is said to be out of joint. The sacrum took its name from the fact that the hfathens used to ofter it in sacrifice. With them, it was the sacred bone. The coccyx is the lower termi- nation of the back bone. These bones are represented in Figure 8 : 1,1, being the innr)minata ; 2, the sacrum ; 3, the coccyx ; 4, 4, the acetabulum ; a, a, the pubic portion of the nameless bones ; d, the arch of the pubes ; c, the union of the sacrum and the lower end of the spinal cohunn. Bones of the Upper Extremities. The shoulder blade (scapula) , the collar bone (clavicle) , the bone of theupper arm (humerus), iha two bones of the fore-arm (ulna and ra- dius), the bones of the wrist (carpal bones), the bor\es of the palmt> cf the hand (metacarpal l)ones), the bones of the thumb and fingers (phalanges), — these are the bonos of the upper limbs. The collar hone is fastened at one end to the breast bone, at the other end to the shoulder blnde. It keeps the shoulders from drop- ping forward. Many persons allow it to fail of this end by getting very much l)ent in early life. This liappensat school, when children are allowed to sit in a stooping posture. In the French, a race re- markable for a straight, upright figure, this bone is said to be longer than in any other people. ANATOMY. 2a The shoulder blade lies upon the upper part of the back, forming the shoulder. It his a shallovr cavity (glenoid cavity), into which is inserted the head of the upper arm bone. Several strong muscles are attached to the elevations of this bone, which keep it in its place, and move it about as circumstances require. The upper arm bone has its round head fastened in the glenoid cav- ity, by the strong capsular ligament, forming a joint capable of a great number of movements. At the elbow it is united with the ulna of the fore-arm. It is a long cylindrical bone, represented by Figure 9 : 1, is the shaft of the bone ; 2, the large, round head which fits into the glenoid cavity ; 3, the surface which unites with the ulna. Of the two bones of the fore-arm, the ulna is on the inner side, and unites with the humerus, making an excellent hinge-joint. The other bone of the fore-arm, the radius, lies on the outside of the arm, — on the same side with the thumb, — and unites, or articulates, as we say, with the bones of the wrist. In Figure 10 : 1, is the body of the ulna ; 2, the shaft of the radius ; 4, the articulating sm'face, with which the lower end of the humerus unites ; 5, the upper extremity of the ulna, called the olecranon process, w hich forms the elbow joint ; 6, the point where the ulna articulate with the wrist. Fig. 9. Fio. n. Fig. 10. The eight bones of the wrist or carpus are ranged in two rows, and being bound close together, do not admit of very free motion. In Figure 11 : s, is the scaphoid bone ; l, the semilunar bone ; c, the cuneiform bone ; p, the pisiform bone ; t, t, the trapezium and trape- kiuid bones ; m, the os magnum ; u, the cuneiform bone. The last four form the second row of carpal bones. 11, 11, are the metacar- pal bones of the hand ; 2, 2, the first range of the finger bones ; 3, 3, the second range of finger bones ; 4,4, the third range of finger bones ; 5, 6, the bones of the thumb. 4 is ' -t .u TTW" 84 ANATOMY. i Of the five metacarpal bones, four are attached below to the first range of the finger bones, and the other to the first bone of the thumb, while the whole are united to the second range of the carpal bones above. I .■ •:: I Bones of the Lower Extremities. These are the t?n(/h bone (femur), the knee pan (patella) , the shin^ bone (tibia), the stnall bone of the leg (fibula), the bones of the instep (tarsal bones), the bones of the middle of the foot (metatarsal bones), and the bones of the toes (phalanges). The thigh bone is the longest bone in the system. Its head, which is large and round, fits admirably into the cavity in the fio.h. innominatum, called acetabulum, and forms what is called a ball-and-socket joint. In Figure 12 : 1, is the shaft of the thigh bone (femur) ; 2, is a projection culled the trochanter minor, to which some strong muscles are attached ; 3, is the head of the femur which fits into the acetabulum ; 5, is the external projection of the femur, called the external condyle ; 6, the internal condyle ; 7, the surface which articulates with the tibia, and on which the patella slides. The knee pan or knee cap (patella) is placed on the front of the knee, and being attached to the tendon of the extensor n^uscles alove, and to the tibia by a strong ligament below, it acts a^; a pulley in lifting up the leg. The shin bone (tibia) is the largest of the two in the lower leg, and is considerably enlarged at each end. The small bone of the leg (fibula) lier jn the outside, and is bound to the larger bone at both ends. Figure 13 shows the two bones of the leg : 1, being the tibia ; 5, the fibula ; 8, the space between the two ; 6, the junction of the tibia and fibula at the upper extremity ; 3, the internal ankle ; 4, the lower end of the tibia that unites with one of the tarsal bones to form the ankle joint ; 7, the upper end of the tibia which unites with the femur. The instep (tarsus) has seven bones, which, like those of the wrist, are bo firmly bound together as to allow but a limited motion. The metatarsal bones, coi'responding with the palm of the hand, are five in number, and unite at one end with the tarsal bones, and at the other with the first range of the toe-bones. The tarsal and metatarsal bones are put together in the form of an arch, the spring of wuich, when the weight of the body descends upon Xt'va. walking, prevents injury to the organs above. (Fig. 14.) The phalanges have fourteen bones. The groat toe has Fig. 13. IHATOMT. 25 Figure 15 gives a two ranges of bones ; the other toes ha'^a three. view of the upper surface of the bones of the foot ; 1, is the surface of the astragahis where it unites with the tibia ; 2, the body of the Fio. 16. Vlo.li. astragahis ; 3, the he^l bone (os cnlcis) ; 4, the scaphoid bone ; 5, 6, 7, the cuneiform bon«s ; 8, the cuboid ; 9, 9, 9, the metatarsal bones ; 10, the first bone of the great toe ; 11, the second bone ; 12, 13, 14, three ranges of bones forming the small toes. The Joints. That bones may be of any use, they must be jointed together. Joints are of the greatest importance. It is necessary they should be so constructed that there shall be no harsh grating of the bones upon each other, and no injurious jars in walking, etc. To prevent these things, a hard, smooth, and yet yielding, cushion-like substance is required between them in joints. Such are the cartilages. Figure 16 Fia. 16. gives a specimen of these intervening cartilages. D, is the body of a bone, at I the end of which is a sock- I et ; C, the cartilage lining the socket, thick at the sides ' and thin in the centre ; B, the body of a bone, at the end of which is a round head ; C, the in- vesting cartilage, thin at the sides and thick in the centre. Cartilage grows thinner, harder, and less elastic in old age. Hence old people are not quite as tall as in middle life, and a little stiffer iu their joints. The synovial membrane is a thin layer covering the cartilage, and being bent back upon the inner surface of the ligaments, it forms a closed sack. From its inner surface a sticky fluid oozes out, which helps the joints to play easily. ft ■ ;s 'J I'i: ■m 'i: ^1;!i Pli 26 ANATOMY. There are other smaller sacks connected witb the joints, called bursa mucosae. They secrete a fluid similar to that from the syno- vial membrane. The ligaments. To retain the bones in their places at the joints, some strong, flexible straps are required to stretch across from one to the other, and to firmly unite them. Such are the ligaments. They are the' pearl-colored, lustrous, shining parts about the joints, in the form of straps and cords. I'here are a number of them so woven together as to form a complete covering of the joint, called a capsular ligament. In Figure 17 : 1,2, are ligaments extending from the hip bone, 6, to the femur, 4. In Figure 18 : 1, is the socket ai Fio. IT. Fio. 18. Flo. 10. the hip joint ; 2, the head of femur, lodged in the socket ; 3, the ligament within the socket. In Figure 19 : 1, is the tendon of the muscle which extends the leg ; 2, the knee cap (patella) ; 3, the ante- rior ligament of the patella; 6, the long external lateral ligament; 4, 4, the synovial membrane ; 5, the internal lateral ligament ; 7, the anterior and superior ligament that unites the tibia with the fibula. Uses of the Bones. The bones are to the body what the frame is to the house. They hold up and retain the other parts in their proper places. They fur- nish points of attachment for the muscles, to hold the body together, and to give it motion. They also furnish strong, bony cavities for the lodgment and protection of such delicate organs as the eye, the brain, and the heart. A single bone, examined by itself, might not seem to have much beauty or design about it ; it might even look clumsy and misshapen. But when all the bones are inspected with reference to each other, we immediately discover a general plan upon which they are made, and are compelled to admire their beautiful harmony, and the symmetrical gcace with which thev act. They show us that God can command our wonder, even in the bony frame of our bodies. ANATOaiY. The Muscles. That part of the animal's body which we call lean meat is com- posed of muscles. "We have already explained that muscles are com> posed of threads, etc. , put together in great numbers, forming bundles. So numerous are these threads and bundles in some cases, that the mus- cles which are composed of them have a strength truly wonderful. Toward the end of the muscle, the fibres cease, and the structure is so modified f.s to become a white cord of great density and strength. This cordy substance is fastened to the bone so strongly, that it is impossible, except in some rare case, to detach it. Generally the bone will sooner break than this attachment will give way. Some- times this cord spreads out like a membrane. It is then called yascea or aponeurosis. The fibres of a muscle have the peculiar property of contracting under a nervous stimulus sent to them by the will. These contrac- tions cause them to act as pullies, and to move the bones, and conse- quently the limbs and body, in such direction as the will commands. This is the special use of the nuiscles. All our movements are caused by them. They pull us about, not blindly and at random, but under the direction of an intelligent will. The manner in which a muscle acts, with the cord attached, may be seen by examining the leg or " drum-stick "of a fowl. If the cord on one side be pulled, the claws are shut ; if that upon the other side be drawn, they will open. If both be pulled, they are held fast in one position, neither opening nor shutting. An examination of a piece of boiled lean meat, will show the threads of which it is composed . With proper instruments, these may be unravelled, as it were, until fibres will be found not larger than a spider's web. These, covered with sheaths of great delicacy, Extend beyond the deshy fibre, and with the cell substance connecting the fibres, are condensed into tendon. Millions of these sheathed fibres are gathered into a bundle, and covered Avith a sheath, and thus form what is called n fasciculus. A muscle is a number of these fasciculi made into a bundle, and covered with a sheath called & fascia. (Fig. 1.) The arm is a number of muscles bundled together, and covered, likewise, by a fascia. The fibres in a fasciculus being parallel, act together. Butthefas- ciculous bundles, which make up a muscle, act in various ways. FlO.90. Shape of tbe Muscles. — Some muscles are fusiform or spindle- shupud, so that the attachment occupies but a small space. (Fig. 20.) Othermusclesare radiate or fan-shaped. (Fig.21.) Such is the temporal muscle, the thin edge of fig. 21. which is attached to the side of the head, without producing an elevation or deformity. In some cases the fasciculi are arranged upon one or both sides of a tendon. In this way a •; t, I Bri i i ' t< >■ t! 28 ANATOMY. great number may oo; icentrate their action upon a single point. Such muscles are called pe: iniform, — being shaped like • fio. 2x the feather end of a pen. (Fig. 22.) In other instances, the fasciculi form circular muscles, — orbiculares, or sphincters, as they are called. These sur- round certain openings into the body, which they are designed to Pio. 23. close, either in whole or in part. They surround the eye- lids, the aous, the mouth of the womb, etc. (Fig. 23.) In still other instances the fasciculi are ranged side by side in rings, forming muscular tubes. By the successive contrac- tion of these rings, any substance is driven through the tube, — as food or drink through the fio. 24. gullet of a cow. Figure 24 is a section of the gul- let : a, 6, show the circu- lar fibres ; c, the longitudinal. Sometimes the fasciculi curve around in parallel layers, or interlace with each other, forming a bag or pouch. By the contraction of these fasciculi, the contents of the bag will be turned from side to side, as in the case of the stomach, or driven out, as in that of the heart. Figure 25 shows the mus- cles of the stomach ; l, represents the fibres running in one direc- tion ; c, in another ; e, lower end of gullet ; o, pylorus ; d, begin- ning of duodenum, or second stomach. Fig. 26. Number of Nasdes. — The muscles of the body are as numerous as the ropes of a ship, — there being five hundred or more. Some anatomists reckon more, some less. They are divided into those of the head and neck, those of the trunk, those of the upper extremities, and those of the lower extremi- ties. They are too numerous to be named and individually described in this brief account of them. A part of them are voluntary, that is, under the control of the will ; while another part are involuntary, moving without reference to the will. The heart is of the latter kind, it being necessary for it to keep moving when the will and mind are asleep. On the back there are six layers of muscles, one above another. Such a number are necessary to perform the numerous movements of the back, neck, arms, etc. Every expression of the human face, as joy, Borrow, love, hate, hope, fear, etc., is produced by the gentle pul- ling of muscles, made expressly to indicate these emotions. The diaphragm is a large flat muscle, reaching across the great cavity of the body, and dividirig the chest from the belly. It is poo- t. Such 2X ^^ eso sur- ^ned to the eye- ANATOMY. etrnted by the food-pipe going to the stomach, and by the great blood- vessels leading to and from the heart. It is shaped like the covei of a dinner-dish, the convex surface being turned up. When the breath is drawn in, it sinks down towards a level, thus enlarging the chest at the expense of the belly. When the breath is thrown out, the reverse takes place. node of Action. — The conlraclihility of a muscle, of which I have spoken, is simply its power of shortening itself. The hand is raised by the shortening of a muscle in front, attached to the bono above Fio. 26. the elbow, and to a bone be- low the elbow. The con- traction of an antagonistic muscle behind, also attached above and below the elbow, brings the hand back to its place. Figure 26 shows how all joints are moved: 1, is the bono of the arm above the elbow ; 2, one of the bones below the elbow ; 3, the muscle whicb ' ends the elbow ; 4, 5, attachments of muscles to bones ; 6, the muscle that extends the elbow ; 7, attachment to elbow ; 8, weight in hand. The muscle, 3, contracts at the central part, and brings the hand up to 9, 10. The complication, variety, and swiftness of motion, executed hy muscles, are past conception. Every movement which a human be- ing makes, from the heavier motions of the farmer in cultivating his fields, up to the magic touches of the painter's brush, and the method- ical frenzy with which the groat master's fingers sweep the piano, are all made by muscles obeying an intelligent will. The Teeth. The teeth are not like other bones, either in composition, method of nutrition, or growth. When broken they do not unite, not being fur- nished with the necessary power of reproduction of lost parts. Both the upper and lower teeth are set into bony sockets, called alveolar processes. These, with the fibrous gums, give the teeth a very firm setting. Origfin The teeth have their origin in little membraneous pouches within the bone of the jaw ; and in their interior, have a fleshy bud. From the surface of this the bone or ivory exudes. The tooth and the bony socket are developed and rise up together, — the former, when sufficiently long, pushing itself through the gum. Number. — The first set of teeth are only temporary, and are called milk teeth. There are but twenty of them. Between the age of six and fourteen, these become loose, and drop out, and the permanent teeth appear in their places. Of these there are thirty-two, sixteen in each jaw. II' 1^ m. 80 ANATOMY. Wames. — The four front teeth in each jaw, a, b, Figure 27, are the euUing teeth (incisors) ; the next one, c, is an eye tooth (cuspid) ; the Fio. *T. am m next two, d, e, are small grinders (bicuspids) ; the last three, y,^, A, are grinders (molars). One appears late on each side, from the age of twenty to twenty-four, and is called loiadom tooth. Composition. — A tooth is composed of ivorj/ and enamel. The internal part is ivory, which is harder than bone. The coating Bpon the surface is enamel, which is still harder than ivory. That part which rises above the jaw bone is called the crown; it is this only which is covered with enamel. The part within the jaw is called the root or fang ; this is composed of bony matter, through which small vessels pass in to nourish the tooth. Small white nerves also pass into the tooth, — of the presence of which we have terrible evidenco in tooth-ache. Use of the Teeth. The incisors cut the food asunder; the molars break down its solid parts, and grind it to a fineness which fits it for the stomach. In masticating the food, the lower jaw has two movements, the up and down motion, like a pair of shears, and the lateral or grindii)<; motion. These two movements are performed by different sets ot muscles. Flesh-eating animals have only the up and down motion , vegetable eating animals have only the lateral or grinding motion ; while man has both the up and down and the lateral. This seems a pretty clear intimation that he is to eat both flesh and vegeta- bles. The teeth aid us in articulating words, and they give a roundness and symmetry to the lower part of the face. When well formed, and kept in good condition, they idd much to the beauty of the face, and their decay is an irreparable loss. Their proper care and treatment are spoken of in another place. ANATOMY. 31 Fia.28. The Digestive Organs. The alimentary organs are the mouth, the teeth, the salivary glands, the pharynx, the stomach-pipe (oesophagus), stomach, bowels (intes- tines), chyle vessels (lacteals"), thoracic duct, liver, and sweet bread (pancreas). The preparatory process of digestion, the mastication of food, takes place in the mouth, where the food is mixed with saliva, p secretion of the salivary glands. Of these glands there are six, three on each side. The Parotid Gland lies in front of the external ear. It has a duct opening into the mouth opposite the second molar tooth of the upper jaw. This is the gland that swells in the disease called mumps. Hence the disease is also called parotitis. The Submaxillary Gland is inclosed within the lower jaw, in front of its angle. Its duct opens into the mouth by the side of the bridle of the tongue (frtenum linguse). On each side of this string or bridle, and under the mu- cous membrane of the floor of the mouth, lies the avblinr gual gland, which pours its saliva into the mouth through seven or eight small ducts. A disease called the frog, consists in the swel- ling of this gland. Figure 28: 1, the parotid gland; 2, its duct ; 3, the submaxil- lary ; 4, its duct ; 5, the sublingual. The Pharynx is a continuation of the mouth, and is the cavity just below the soft palate. The two passages going to the nose (posterior nares), the one gping to the stomach (cesophagus) , and the one going to the lungs (larynx and trachea) , all meet in this cavity. In Figure 29 : 1, is the trachea ; 2, the larynx ; 3, the ceso- phagus ; 4, 4, 4, muscles of the pharynx ; 5, muscles of the cheek ; 6, the muscle which surrounds the mouth ; 7, the mus- cle forming the floor of the mouth. The Stomach Pipe is a long tube, like the fireman's hose, descending behind the wind-pipe, the lungs, and the heart, through the diaphragm into the stomach. It is composed of two membranes laid together, like two pieces of cloth. The inner one is mucous, the FlO.20. !■ 1' ■•{■■:. n '' ;i .! Af 11 ill 32 ANATOMT. outer muscular. The two sots of fibres composing the muscular coat are arranged circularly and longitudinally. (Fig. 25.) The Stomach lies in the upper part of the belly, to the left, and di- rectly under the diaphragm. It has an upper opening, where the stomach-pipe enters it, called the cardiac orifice. This is the larger end of the stomach, and lies on the left side ; the smaller end con- nects with the upper bowel, at which point it has an opening called the pyloric orifice. In addition to mucous and muscular coats, simi- lar to those Avhich com[)oso the cDsophagus, the stomach has still another over both, a serous coat, very strong and tough, to give this working organ additional endurance. Within, it has many glands to secrete the gastric juice. The Intestines, or alimentary tube, or bowels, are divided into the small and the large intestines. The small intestine has a length of about twenty-five feet, and is divided into three parts, — the duodenum i\\G jejunum ixwiX the ileum. Of these three divisions, the duodenum is the largest, and is about a foot in length. It begins at the pyloric orifice of the stomach, and passes backward to the under surface of the liver, whence it drops down perpendicularly in front of the right kidney, and passes across the belly behind the colon, and ends in i\\e jejunum. Tlie Jejunum continues the above, and terminates in the ileum. The Ileum is a continuation of i\\G jejunum, and opens, at an obtuse angle, near the haunch bone, into the colon. A valve is located here, to prevent the backward passage of substances from the colon into the ileum. At this point the large intestines begin, and here is situated the caecum^ a blind pouch, or cul-de-sac, attached to which is the apperi' dix vermi/ormis, a worm-shaped tube, of the size of a goose quill, and from one to six inches long. The Colon, or large intestine, is divided into the ascending colon, thd transverse colon, and the descending colon. The Ascending Colon rises from the right haunch bone to the under surface of the liver, whence it bends inward, and crosses the upper part of the belly, below the liver and stomach, to the left side. This portion which crosses over is the transverse colon. From this point, on the left side, it turns down to the left haunch, and has the name of the descending colon. Here it makes a curve like the letter S, which is called the sigmoid flexure. The Rectum is the lower portion of the large intestine, terminating at the anus. The Lacteals are small vessels which begin in the villi, upon the mucous membrane of the small bowels. From here they pass be- tween membranes of the mesentery to small glands, from which larger vessels run to another collection of glands ; and after passing, for a Bpace, from one collection of glands to another, at each stage of their progress increased in size and diminished in number, the lact«als pour ANATOMY. 33 Fio. ao. Fio. 81. their contents into the thoracic duct. This having passed up through the diaphragm, out ot the belly, makes a sudden turn downward and forward, and empties its burden into a large vein which ends in the right heart. Figure 30 : 1, is the bowel ; 2, 3, 4, the meaenterio glands through which the lacteals pass ; 5, the thoracic duct ; 7, the spinal column ; 8, the diaphragm. By the help of a magnifying glass, an infinite number of these small vessels may be seen starting from the rough, shuggy in- ternal coat of the bowel. The mesentery is a thick sheet of menr brane, formed of several fold* of the peri toneum, and spread out from the vertebrie like a fan. The bowels are attached to its edge, and are held by it in their place, and at the same time, have free motion. Between its layers are a great number of glands, which sometimes become diseased and swollen in childhood, and prevent the chyle from passing along to the thoracic duct. Thus affected, children are not nourished, and waste away with a disease sometimes called mesenteric consumption. The Liver is a large gland, lying under the short riba on the right side, below the diaphragm, it is convex on the upper surface and concave on the under, and is composed of several lobes. Its office is to secrete bile. It weighs about four pounds, be- ing the largest organ in the body. Figure 31 represents the liver : 1, being the right lobe ; 2, left lobe ; 3, 4, smaller lobes ; 10, gall bladder ; 17, the notch into which the spinal column is fitted. The Gall-Bladilfr lies on the under side of the liver, and receivea it is supposed, the surplus bile, which is reserved for sjiecial occa^ sions. It opens into the gall duct, which carries the bile along, and pours it into the duodenum. The Paiierens, Figure 32, is a long, flat gland, something like the sail. j.jg 32_ vary glands. It lies trans- versely across the back wall of the abdomer. behind the stomach. It secretes a fluid called the pancreatic juice^ a peculiar kind of saliva, the oflice of which is to emulsion fat, so that the I' Will! /actuals can absorb it. This fluid is carried by a duct, and poured into the diiodtMium just where the bile dnc^t enterH. Tlie Spleen or milt, has an oblong, flattened form. It lies on the left side, just under the diaphragm, e.nd close to the stomach and pan- creas. It is supposed to be a reservoir for holding the surplus blood of the liver. It was thought by the ancients to be the seat of melan- choly. The blood in passing through it h)aes a portion of ita red globules. The Onieiitum or caul is a doubling and extension of the peri- toneum. It is a kind of fatty body, which lies upon the surface of the bowels, and is attached to the stomach. Its use sf^ems to be to lubricate the bowels, and especially to protect and keep them warm. Hence it is often called the apron. The Urinary System. The organs of this system are devoted to separating the urine from the blood, arid carrying it out of the body. These organs are the kidnei/s, the ureters, the bladder, and the urethra. Tlie Kidneys lie one on each side of the back bone, in the lumbar region, behind the peritoneum. They are four or five inches long, and two and a half broad. They are in shape like the kidney bean, and weigh about half a pound each. In the centre there is a bag calleu the pelvis, which tapers like a funnel, and forms the ureter which conveys the urine to the bladder. The texture of the kidney is dense, presenting in its interior, two structures, an external or cortical, and an internal or medullary. The cortical portion has the blood vessels, the medullary is condposed of tubes which carry away the urine. The Ureters are membranous tubes of the size of a goose quill, and eighteen inches long, which run down the back wall of the abdo- men, behind the peritoneum, to the bladder, into each side of which they empty their contents. The Bladder is located in the pelvis or basin, in front of the rec- tum. It is composed of three coats ; the external is serous, the middle muscular, and the internal mucous. Trie external coat is strong and fibrous ; the internal is drawn into wrJnkic /, which makes it thick and shaggy ; it secretes a mucus which prevents it from being injured by the corrosiveness of the urine. The uvin 3 is retained in the bladder by means of a circular muscle, called a sphincter, which draws the mouth of the organ togetlier. When the quantity of urine is so increased as to give some uneasiness or pain, this muscle, by a sort of instinct, relaxes and lets it out. The bladder is attached to the rectum, to the hip bones, to the peri- toneum, and to the navel, by several ligaments. In the female the bladder has the womb between it and the rectum. This organ is wisely provided as a receptacle for the urine ; which, without it, would produce great inconvenience by being constantly dribbling away. ANATOMY. 30 The Urethra is a membranous canal which leads from the neck of the bladder. It is componed of 1\vo hyrrs, a mucous, and an elas- tic fibrous. Through this channel, which is curved in its course, the urine passes out of the body. ^ '^i; The Respiratory Orgfans. These organs consist of the wind-pipe (trachea) ; divisions and sub- divisions of the wind pipe (bronchia) ; air cells ; and the Linffs or liffhts. Tlie Windpipe (trachea) extends from the larynx, — the seat of the voice, — to Ihe third dorsal vertebra, where it divides into two tubes, called bronchia. It runs down the front part of the throat, with the oesophagus behind and between it and the spinal column. It is com- posed mainly of rings of cartilage, one above another. Tlie Rroiieliial Tiilien are, at the division of the windpipe, two in nuinlHT, but tiicy ilivide and subdivide until they become very nu- merous. Tlie Air Tells or Vesleles av. small, bladder-like expansions at the ends of the tubes. They are elastic, and swell out when the air passes in. The Iiiiiis:$i fill the greater part of the chest, the heart, being the only other organ which occupies much space in the cavity. The size of these organs is large or small, according to the capacity of the chest. Each lung, — for there are two, — is a kind of cone, with its base resting upon the diaphragm, and its apex behind the collar bone. They are concave on the bottom, to fit the diaphragm, which is (ton- vex on its upper side. There are two lungs, a right and a left. These are separated from each other by a partition formed from the pleUra, and called the 7ned- [iastirmm. Two portions of the pleura, coming oflf from the spine, I form this partition ; and the heart, covered by the pericardium, lies in the centre, between them. The right lung is divided into three I lobes ; the left into two. Each lobe of the lungs is divided into a great many lobules, which lare connected by cellular tissue. These lobules are again divided linto very fine air-cells. Beside these, the substance of the lungs if [composed likewise of blood vessels, and lymphatics, and is well sup Iplied with nerves. In the fetal state, before the lungs have been filled with air, they lare solid and heavy, something like other flesh, but after all their cells have been filled with air, and breathing has been established, they are joxceedingly light and spongy, and float upon water. In cases where the murder of children is suspected, and where it is icsirablc to know whether they were still-bom, or born alive and hilled ifterwards, the specific gravity of the lungs, compared with watei; " often BTtdo the question. d6 ANATOMY. Ill I ! The Organs of Circnlation. The food having 'jeen digested, changed to chyle, absorbed by the lacteals, carried to the veins, poured into the right heart, sent up to the lungs, and prepared for nourishing the body, will still be useless, if no i distributed to every part of the system. The organs for effect- ing this distribution, are the heart, the arteries, the veins, and the cap- tilaries. Tlie Ilenrt is placed obliquely in the chest, with one lung on each *ide, and is enclosed between the two folds of the mediastinum. Its form is something like a cone. Its base is turned upward and back- ward in the direction of the right shoulder ; the apex forward and to the left, occupying the space between the fifth and sixth ribs, about three inches from the breast-bone. It is surrounded by a membranous case or sac, called the pericardium. The heart is a muscular body, and has its fibres so interwoven that it is endowed with great strength. It is a double organ having two sides, a righ"" and a left, which are divided from each othci by a mus- cular partition, called a septum. The right heart sends the blood to the lungs; the left heart distributes it to the general system. Each side is divided into two compartments, an auricle and a ventricle. Tlie Auricles have thinner walls than the ventricles, being only reser- voirs to hold the blood until the ventricles force it along to other parts. The Veiitricles have within them fleshy columns, called columrue carnefc. The walls of the ief*; ventricle are thicker than those of the right, being required to contract with more force. Each of the four cavities will contain from one and a half to two ounces of blood. Tlie Tri-ctiLSpid valves are situated between the auricle and ventricle On the right side, and consist of three folds of a thin, triangular membrane. The mitral valves occupy the same position on the .left side. Small white corf's, called chorda: tendince, pass from the floating edge of these to the coiumnae carneap, to prevent the backward pressure df the blood from carrying the valves into the auricles. The pulmonary artery is the outlet of the right ventricle ; the large: artery, called aorta, of the left ventricle. At the opening of these arteries, are membranous folds, called semilunar valves. Figure 33 gives a fine view of the heart : 1, is the right auricle ; 2, the left auricle ; 3, the right ventricle ; 4, the left ven- tricle ; 5, 6, 7, 8, 9, 10, the vessels which bring the blood to and carry it away from the heart. The Arteries are the round tubes which carry the red blood frt)ui I he left side of the heart to every part of the body. The sides of .irteries are stifl' and hard, and do not fall together when empty. They may often be seeji Oj,. n in a piece of boiled beef. The '•rteries have three coats, — an external, which is cellular, firm and strong ; a middle, which is fibrous and elastic ; and an internal, which is serous, and smooth, being a continuation of the lining of the heart They are surrounded by a cell Testment called a sheath, which separates them from surrounding organs. The Pulmonary Aitei^ starts from the right ventricle in front of the opening of the aorta, and ascends to the under surface of the aortic arch, where it parts into two branches, sending one to the right, the other to the leR lung. Having divided a id subdivided to a great extent, they end in the capillary vessels, unitiig, joining their mouths, and becoming continuous with the pulmonary veins just whe*^ they pass around the air-cells. • The Aorta is the largest artery in the body. It takes a slight turn in the cheat, called the arch of the aorta, from which are given ofT the arteries which carry the blood to the head, etc. ; thence it descends into the belly along the side of the back bone, and at the bottom of the abdomen it divides into two arteries, called the ilia^s — one going to each of the lower limbs. The branches the aorta gives off supply red blood to every part of the body. The Veins carry the dark or purple blood. Being made red .md vits.1 by meeting atmospheric air in the lungs, and then conveyed to every part of the body in the arteries, the blood loses its redness in the capillaries, and comes back to the heart in the veins, dark and purple, and unfit to support liff. The veins are more numerous and nearer the surface than the arteries. They have, likewise, Lhiriner walls, and when empty, they collapse or fall together. They begin in the small capillaries, and rur.ning together, they grow larger and larger, and finally form the great trunks which pour i.he dark blood into the right auricle. The veins are composed of three coats, similar to those of the arteries, with the exception of being thinner and more delicate. These vessels have valves all along their inner surface, to aid in circulating the blood. The large vein which receives all t.^e dark blood from above, and pours it into the right auricle, is ealkd the vena cava descerulens ; the one which takes it from below, and Ji'sposes of it in the same manner, is the vena cava ascendens. The pulmonary veins bring the red blood from the lungs to the left aur'cle, and thus are exceptional in their use, — being the only veins K^hich carry red blood. . Tlie Capilluries are the extreriely fine net-work of vessels between the ends of the arteries on tho one side, and of the veins on the other. They inosculate, or join their mouths to the very small arteries at one end, and to the equally small veins at the other. They are the industriov,g little builders, of the human frame. Receiving the blood, red, and full of life, from the terminal extremities of the arteries, they take the living particles out of ?■; and apply them to the renewing and vitalizing of XAe body, and then pass it along into the hair-like beginnings of the veins, dark and bereft of vitality, to be tarried up for I ! i'li' 38 ANATOMY. ill m m ! :^ 'i Fia 34. anothpr frpight cf chyle, uviu Lu be a^aiu viiaiized b^ being touched in the lungs by the breath of heaven. In Figure 34 we have a good ideal illustration of the whols circu' lation. From the right ventricle of the heart, 2, the dark blood is thrown into the pulmonary arte- ry, 3, and its branches, 4, 4, carry it to both lungs. In the capillary vessels, 6, 6, the blood comes in contact with the air, and becomes red and vitalized. Thence it is returned to the left auricle of the heart, 9, by the veins, 7, 8. Thence it passes into the left ventricle, 10. A forcible contraction of this sends it forward into the aorta, 11. Its branches, 12, 13, 13, distribute it to all parts of the body. The arteries terminate in the capilla- ries, 14, 14. Here the bK)od loses its redness, and goes back to the right auricle, 1, by the vena cava descendens, 15, and the vena cava ascendens, 16. The tricus- pid valves, 17, prevent the reflow of the blood from the right ven- tricle to the right auricle. The semilunar valves, 18, prevent ths blood from passing back from the pulmonary artery to the right ventricle. The mitral valves, 19, pre- vent its being forced back from the left ventricle to the left auricle. The semilunar valves, 20, prevent the backward flow from the aorta to the left ventricle. By a careful examination of this diagram, with these explanations, the reader may understand the circulation very well. The passage of the blood from the right heart, through the lungs, and back to the left heart, is called the lesser, or pulmonic circulation ; its passage froin the left heart through all parts of the body, and back to the riglit heart, is the greater or systemic circulation. The Absorbent Vessels. The vessels which absorb the chyle from the small intestines, and convey it onward towards th(! blood, are the lacteals. They have been described. The veins are also supposed to have the power of absorption, particularly the small commencement of the veins. These have likewise been described. The Lymphatic vessels resemble the lacteals. They abound in the skin, the mucous membranes, and the lungs. They are very small at their origin, and, like the veins, they inciease in size, as they d.im'Hisb w w: ANATOMY. 39 Fio. 35. in numbers. Like the veins, too, they travel towards the heart, and their contents are poured into it. Their walls are composed of *wo coats ; the external is cellular, and distensible ; the internal is folded into valves, like that of the veins. These vessels, on their way to the heart, pass through soft bodies., called lymphatic g-lands, which bear to them the .elation that the mesenteric glands do to the lac- ' teals. These glands are a collection >of small vessels. The jyniphalic glands are most numerous in the neck, chest, abdomen, armpits, and groins. They are also found, to some extent, in other parts of j-j^ gg the body. Figure 35 shows a single lymphatic vessel, much magnified; Figure 36 exhibits the valves along one of the lymphatic trunks ; Figure 37 sl.ows a lymphatic gland, with •: vessels passing thmugh it. Fio. 36. Fio. 37 Figure 3;, .fpresentn the lymphatic vesiH'ls and glands. 1, 2, 3, 4, 5, 6, show tiiese ves- sels of the lower limbs; 7, the inguinal glands ; 8, the com- mencement of the thoracic duct, into which the contents of rl' lymphatics are pouied; 9, I'o '•'« ohatics of the kid- neys ;, ■'>. !,ci*v^ of the stom- i*cri; XI. those of the liver; 12, is, those of the lungs; 13, 14, 1'j, those of the arm ; IC, 17, 18, those of the face and neck ; 19, 1 1 -'>'! 40 ANATOMY. Fio. sa 20, the large veins ; 21, the thoracic duct ; 26, the lymphatics of the heart A cold will often cause lymphatic glands to swell. These swell- ings are called kernels. They often swell, also, without the irritation from cold, and become very much and permanently enlarged, particu- larly in scrofula. In scrofulous subjects they sometimes suppurate and break, forming bad sores upon the neck. The Organs of Secretion. Thk exhalants, the follicles, and the glands are the organs of secre- turn. Tlie Exhalants are the sweat-glands. These have external termina- tions upon the skin, thus communicating with the air, and internal terminations upon the surfaces of organs not having an outward ex- posure. The Follicles are svt >' ^f-'s, located in the true skin and mu'ous membranes. The pores* > skin, are the mouths or outlets of these little bags. Veins and or^. \ nection with the bone of the tongue above, and with the cricoid car- tilage below. The Cricoid Cartilage is shaped like a ring, and hence its Greek name. It is narrowest in front, and broadest be- hind. It connects with the thyroid cartilage above, and with the first ring of the trachea below. Fig- ure 40 gives a side view of the cartilages of the larynx : 1, bone at the base of the tongue (os hyo- ides) ; 2, the ligament connecting hyoid bone and the thyroid cartilage ; 3, the front of the thyroid cartilage ; 4, the thyroid cartilage • 6, the cricoid cartilage ; 7, the windpipe. Figure 41 is a back view of the cartilages and ligaments of i' larynx: 1, is the back surface of the epiglot- tis ; 3, 3, the os hyoides ; 4, 4, the lateral ligaments connect- ing the os hyoides and the thyroid cartilage ; 5, 5, the back face of the thyroid cartilage ; 6, 6, the arytenoid cartilages ; 7, the cricoid cartilage ; 8, the first ring of the windpipe. Tlie Arytenoid Cartilages are upon the back part of the cricoid, and are connected with the thyroid cartilage by the vocal cords. Tlie Epiglottis is a fibro-cartimgmous lid, shaped like a leaf of parsley, which covers ihe upper open- ing of the larynx. It is connected by k cartilage to the bone of the tongue (os hyoides) and to the thyroid cartilage. Breathing opens and shuts it; and in swallowing, it clos i down upon the top of the larynx, to prevent food and drink from passing down the windpipe. The Vocal Cords are two ligaments, formed of elastic and parallel fibres, enclosed in a fold of mucous mem- brane. They are about two lines in width, and inserted behind into the anterior pro- jection of the arytenoid canilages, and passing forward, are fixed to the anterior angle of the thyroid. There ar? four liga- ments crossing the larynx, two superior, and two inferior, — the latter being called vocal cords. The interval between them is the glottis. The ligaments themselves are sometimes called the lips of the ^hUis. The depression between the superior and inferior ligaments is the ventricle of the larynx. Figure 42 represents a view of the larynx from above : o, 6, c, the thyroid cartilage, enclosing the ring of the cricoid ; A, A, e, e, the FlQ. 42. J) ! f % ™ ■ \ \ \ i' i ' \% Wt)) '■i I T:i ■1! ,=!■ 'rH( arytenoid cartilages c^onnected by the transverse arytenoid muscle ; t, t, the vocal cords ; o, o, the crico-arytenoid ligaments. The mupcles which are attached to the cartilages, have the power of pulling tliein about so as to change in various ways the shape of the laryngeal cavity ; to enlarge or diminish the size of the glottis ; and to relax or tighten the vocal cords. By these means, and some others, the sounds of the voice receive their various modifications. Tightening the cords, for example raises the pitch. The Skin. The skin is a membrane composed of two layets, covering the entire person. The outer layer is the scarf-skin or cuticle ; the inner is the true skin or cutis vera. These layers differ in their structure and uses. The Scarf-kSkiu, called also cuticle, and epidermis, is a thin mem- brane, partially transparent, like a thin shaving of horn. Having no blood vessels or nerves, and conse- ., „ quently no feeling, it appears to be a simple covering to protect the true skin from injury by external agents. It is thickest on those parts most exposed to friction. The scarf-skin is the production of the true skin, — an exudation from it in the shape of a fluid which is spread out as a thin layer, and dries up into flattened scales. The cuticle is composed chiefly of these scales, and is constantly be- * \ ing rubbed oft' as scurf, while new layers are forming underneath. The lower, softer, and more newly-formed layers of the scarf-skin, are the seat of color. In this part, the cells contain a pigment, incor- porated with the elementary granules, which gives to the various races their several shades of color. The depth of hue is dependent entirely on the amount of this coloring matter. Some physiologists describe the skin as composed of three layers — reckoning this colored part of the cuticle as one, and naming it rete mucosum, or the mucous coat. Tlie True Skin, which is called cutis vera, and corium, is a kind of web, woven of small fibres collected into strands. In the upper por- tion, the web is fine and firm, but grows coarser below. Connected with its under surface is a fibrous web in which the fat is deposited. Upon its upper surface is the sensitive or papillary layer, composed of blood vessels and nerves, doubled into loops, which give little prominences called papillee. Figure 43 gives an ideal view of these clevaiions, composed, as they are, of a nerve, an artery, and a vein, lying side by side : 1, 1, represent the true skin ; 2, 2, the papillary ANATOMT; 43 layer ; 3, 3, the arteries ; 4, 4, the veins ; and 5, 5, the nerves of the papiliee. The arteries, veins, and nerves are spread over the true skin in great numbers, — so profusely, that it is impossible to push the point of the finest needle into it, i/ithout piercing a blood vessel and a nerve. Figure 44 gives a view of the skin : o, a, the c^cicle ; b, b, the col- ored layer of the cuticle ; c, c, d, d,, the true skin ; e, e, e, fat cells, ff fff, sweat tubes. Fia.45. The lymphatics are very numerous in the skin, beside which there are oil glands and tubes, and sweat glands and tubes. The Oil Glands are imbedded in the skin, and communicate with the surface by small tubes. They are most abundant on the face, nose and ears, ^^igure 45 shows an oil gland, — a, being the gland, b, the tube, and c, its mouth. The Sweat Apparatus consists of small tubes which pass dowq : : 1., 1 . ! ■ ■' wM ' •;; ' 'K\ I i\ • ^ ft r' ^i:;l throagh the trae skin, and terminate in the meshes at the bottom, where it coils upon itself into a kind of baudle, called the perspirik' tory gland. Figure 46 gives one of these tubes, with the gland, mag- nified forty diameters: 1, beins the coiled tube or gland; 2, 2, the two excretory ducts from the ^and. These uniting, form one spiral tube, which opens at 4, which is the surface of the cuticle ; 3, are the fat cells. The hair and the nails are appendages of the skin. The Neryons System. The IVeiTons System consists of the brain and spinal cord, connected with each other, and called the cerebrospinal axis ; the cranial nerves ; the spinal nerves and the sympathetic nerve. The Brain is that mass of nervous matter lodged within the skull bones. It is made up of three parts, — the cerebrum, the cerebellum, and the medulla oblongata. These are nicely covered and protected by three membranes, the dura mater, the arachnoid, and thepta mater. Figure 47 shows a considerable portion of the brain, — the skull bones and membranes being re- moved. The scalp turned down is Fio. 47. represented by a, a ; e, i^;, k, show the cut edge of the bones ; c, is the dura mater, drawn up with a hook ; F, the convolutions of the brain. Tlie Cerebrum is the upper and larger portion of the brain, and is divided into two hemispheres by a fissure. A portion of the dv^a mater dips into this cleft, and from its re- semblance to a sickle, is called the falx cerebri. The design of this seems to be to support each half of the brain, and to prevent it from pressing upon the other half when the head reclines to one side. . The undulating surface of the cerebrum is produced by what are called convolutions. The lower surface of this organ is divid'^d into three lobes, — the anterior, the middle, and the posterior. The surface of the cerebrum is of a gray color, called cortical, or dneritious ; the central portion is white, and is called meduUarj/. The Cerebellnm is about one-sixth the size of the cerebrum. It lies just under the posterior lobe of the cerebrum, and is separated firom it by an extension of the dura mater, called the tentorium. It is composed of white and gray matter ; when the former is cut into, there is presented the appearance of the trunk and branches of a tree, tailed arbor vitce. ui; ANATOMY. 46 The Medulla Oblonjpata is the top of the spinal cord ; but being with- in the enclosure of the skuii, it passes for a portion of the brain. It consists of three pairs of bodies, united so as to form a bulb. The Dura Hater is a strong, fibrous membrane which lines the skuU and spinal column, and sends processes inward to support the brain, and forward, ac sheaths for the nerves which go out from the brain and spinal cord. The Arachnoid is a serous membrane, and like all other serous mem* branes, is a closed sac. It is reflected upon the inner surface of the dura mater. The Pia Hater is a vascular membrane, and lies next to and invests the whole surface of the brain, — dipping into its convolutions. . It furnishes nutriment to the brain. The Cranial Nerves which go out from the brain are in twelve pairs. In reading a description of them, let the reader keep his eye on Fig- ure 48. The First Pair, olfactory (6), passes through several small open- Fw« 48. ings in the ethmoid bone, and is distributed to the mucous membrane which lines the nose. Destroy • this, and the sense of smell is gone. The Second Pair, optic nerve, (7), passes through the base of the skull, and enters the I cavity of the eye where it is 'expanded upon the retina. It is a disease of this nerve which occasions a gradual loss of sight, called amaurosis. The Third Pair, motores oc- ulorum (9), passes through the sphenoid bone to the muscleB of the eye. The Fourth Pair, patheticus (10), passes to the superior oblique muscle of the eye. The Fifth Pair, trifacial nerve (11), like the spinal nerves has two roots, and divides into three branches, one going to the eye, fore- head!, and nose, and called the opthalmic branch ; another going to the eye, the teeth of the upper jaw, etc., called the superior maxillary ; and the third going to the ear, the tongue, and the teeth of the lower jaw, and called the inferior maxillary. It is a painful condition of the branches of the fifth pair, which constitutes the terrible neuralgic affection called tic douloureux. The Sixth Pair, abducentes (12), passes through the opening by which the carotid artery enters the cavity of the skull, and goes to the external straight mascle of the eye. I, .1 1M' •1 I ; „,',''il(l 46 ANATOMY. The Seventh Pair, portio mollis (13), is distributed upon the inter- nal ear. Tlie Eighth Pair, facial nerve (14), is distributed over the face. It sends nervous filaments to the muscles. TTie Ninth Pair, giosso-pharyngcal nerve (14), passes through the same opening with the jugular vein, and is distributed upon the mu- cous membrane of the tongue and throat, Tlie Tenth Pair, pneumogastric nerve (15), sends its branches to the pharynx, larynx, stoniach-pipe. lungs, spleen, pancreas, liver, stomach, and bowels. Tile Eleventh Pair, spinal accessory nerve (16), connects with the ninth and tenth pairs, and is distributed to the muscles of the neck. Tlie Twelfth Pair, hypo-glossal nerve (17), goes to the tongue, and is its motion-producing nerve. It is a nerve of great energy in those who talk much. Tlie Spiiiiil Cord extends from the medulla oblongata, where it is in wnnection with the brain, down to the second lumbar vertebra. The upper end of the cord presents a bulbous swelling, or enlargement. Another swelling is found where the nerves are givan off which go to the upper extremities ; and a third near the end of the cord, where the nerves begin which go to the lower extremities. Fif sures dip into the cord before and behind, and divide it into two lateral parts, which are united by a thin layer of white substance. These lateral columns are divided by furrows into anterior, lateral, and posterior columns; — the anterior being supposed to be the motor column, the posterior that of sensation, and the lateral divided in function between motion and sensation. The Spinal IVerves, connecting with the cord, are in pairs, of which there are thirty -one. Each pair has two roots, — a motor root, C, Figure 49, arising from the anterior columns of the cord, and a sensitive root, D, springing from the posterior columns. ^ A, is a section of the cord, surround- ed by its sheath. B, is the spinal nerve, formed by the union of the motor and sensitive roots. After the union, the nerve, with its motor and its sensitive filaments, divides and subdivides as it passes on, and is distributed to the tissues of the several organs. The thirty-one pairs of spinal nerves are divided into eight pairs of cervical, twelve pairs of dorsal^ five pairs of lun^ar, and six pairs of *acral nerves. Fia. 49. ANATOMY. 47 Figure 50 t^ives a view of the brain and spinal cord, with the nerves given off by the latter : 1, 1, being the two hemispheres of the brain ; 3, 3, the cerebeUum ; 4, the olfaetorj nerve ; 5, the optic; 7, the third pair; 8, the pons varolii, so called; 9, the fourth pair; 10, the lower jartion of the medulla oblongata; II, II, the spinal cord; 12, 12, the spinal nerves; 13, 13, the brachial olexus; 14, 14, the lumbar and ■acral plexus. Fid. ea Fiu. r,i. The Bracliial Pleins is formed by the interlacing of the four lower cervical and upper dorsal pairs of 'nerves. It gives off six nerves, which are distributed to the muscles and skin of the upper extremities. The Lumbar and Sacral Plexus is formed by the last dorsal and five lumbar nerves, from vrhich nerves go to the muscles and skin of the lower extremities, and the last lumbar and four sacral, from which nerves are sent to the muscles and skin of the hips and lower extremi- ties. The Sympathetic Nerve consists of a series of knots (ganglia), lying along on each side of the spinal column, and fonning a knotted chain. There is a knot for each intervertebral space, the neck excepted. These knots are composed of both cineritious and medullary matter. ■in*;; !1^ Fill. mm I ■'•■ i.: 48 ANATOMT. Each knot is a distinct centre, and gives off branches upward, downward, externallv, and internally. All the internal organs are supplied with branches from the Hympathetic nerve. It is called the nerve of organic life, and is supposed to preside over nutrition, secre- tion, etc., as the nerves of the brain and cord preside over motion and sensation. Figure 51 is a fine represei.tation of the great sympathetic, with its knots, and connections with other nerves. A, A, A, is the semilu* nar ganglion and solar plexus, lying just under the diaphragm and behind the stomach. Its presence in this region is the reason why a blow upon the pit of the stomach sometimes destroys life. D, D, D, are the thoracic ganglia ; E, E, the external and internal branches of the same ; G, F, the right and left coro- nary plexus upon the heart; I, N, Q, the inf(!rior, middle, and superior cervical gan- glia; ], the renal plexus around the kid- neys ; 2, the lumbar ganglion ; 3, the inter- nal branches ; 4, the external branches ; 5, the aortic plexus. Figure 52 represents a plexus, showing how the filaments of one*nerve pass to be enclosed in the sheath of another. In this way they change at once the direction of their jour- ney, and their companions upon the way. Fio. 62. Fio.68. The Organs of Sight. The organs of vision are the optic nerve, the globe of the eye, the muscles of the eye, and the organs of protection. The Optic Nerve begins by two roots at the base of the biain, the fibres from each of which meet, as they come forward, and some of them cross each other. The two nerves then sepa- rate, and enter the back part of the globe of the eyes, and then spread out into a kind of membrane. In Figure 53 • 1, 1, show the globe of the eye ; 2, the crossing of the optic nerve ; 8, tba origin of two pairs of cranial nerves. The Glohe of the Eye is a better con- structed optical instrument than man ever made. Its interior is filled with what are called refracting humors or mediums, wh'f'h are surrounded and held in their place by membranes, called coats. The Coats are the sclerotic and cornea; the choroid, iris, and ciliary processes ; and the retina. The Sclerotic Coat is a fibrous membrane, covering the largest portioq ANATOMY. 49 of the gl()b«'. To this the muscles are attached. It ia the part which is called the tvhile of the eye. It has a beveled edge iu front, into which the cornea is fitted. The Cloriiea is a transparent layer which projects in front, and forma about one-lift h of the globe. It ia shaped like a watch glass. ltd bicod-vessels are too small to receive the red particles of blood. The Choroid Tout is a vasrsons. It is the partition between the antt'rior and posterior cham* bers of the eye, and has a circular opening in the centre called the jwpil. Of its two layers, the fibres of the anterior one are radiating, and dilate the pupil, while those of the other are circular, and cauao its contraction. The CiliHr}' l»roces.ses are a number of folda formed from the intei<- nal layer of the choroid coat. The Rethia has three layera. The external ia extremely thin ; the middle is nervous, being an expansion of the optic nerve ; the internal is vascular, and consista of a ramification of minute blood vessels. The divided edge of their coats, may be seen in Figure 54, namely, the sclerotic, the choroid, and the retina; 2, is the pupil; 3, the iris ; 4, the ciliary process ; 5, the scolloped border of the retina Fia.5t. ria.Hk The Humors of the Eye are the aqueous^ the crystalline, and the vitremiK. The Aqueous or watery humor ia situated iu the chambers of the eye. It is an albuminous fluid, with an alkaline reaction, and a sp». cific gravity a little greater than distilled watei i f If . I ■lil.-i 50 ANATOMY. The Crystalline H^iinor is immediately behind the pupil. It is a lens, and is convex both on the posterior and the anterio) ;urface. The Vitreous Humor hi also an ;iIbuminous fluid, something like the aqueous humor, but more dense. In Figiire 55 we have in E a good view of the cornea fitted into the scleroti'-; coat ; A, is the choroid ; B, the pigmentuni nigrum ; C, the retina; K, the vitreoas humor; D, the opt^c nerve ; 1, the lens ; C, the iris, painted on the back sids with [)igment ; F,'the aqueous humor. The muscles of the eye, six in r umber, are attached to the bones of the orbit behind, and to the .-ornea in front, by their tendons. These tendons give the eye its pearly appearance. In Figure 56, five of the muscles are indicated by a, b, c, d, e; /is the optic nerve. If the internal muscle be ""' '^■ too short, the eye is drawn! in towards the nose, and thel squinting called " cross eye "] is produced. The Orbits are bony sock- ets which enclose the eye. Thcl optic nerve passes through a\ large hole at the bottom. The Eyebrows are the pro-J jecting arches above, covered Avith short hair. They prevent the sweat from running down into the eyes, and also shade them from strong liglit. The Eyelids are the curtains which rise and fall in front. The smooth membrane which lines them is called the conjunctiva. It secretes a fluid which makes the eyelids opeh and shut easily. The Lachrymal Gland is at the upper and outer angle of the orbi • . Several small ducts open from it upon the I upper eyelid, through which the tears run down I upon the conjunctiva. The Lachrymal Canals begin near the ititer- Inal angle of the eye, i»y two small tear points, which communicate witl) the sac at the upper I part of the nasal duct. The Nasal Duct is a canal al)out three-r|uar- Iters of tm inch long, which runs down to the I inferior chan;;el of the nose. Figure 57 shows these organs: 1, bemg I the lachrymal gland; 2, the ducts loading to the upper eyelid ; 3, 3, the tear points (puncta lachrymalis) ; 4, the uaaal sac; 5, the termination of tho nasal duct. Fio. fi7. ■ ANATOMY. 51 The Organs of Hearing. The External Ear is composed of the pavilion of the ear (the pinna), and the auditory canal (th«' meatus anditorius externus). The IMuna surrounds the entrance to the auditory canal. It stands out from the head, and is in connnon lanc^uage called the ear. 'file Meatus- Anditorius is a canal ahont an inch long, ))artly bony KiG. 58. i«iid partly cart ila'i;i nous, which goes iVom the pavilion of the cur to iIk' (Inini of the ear. Tlie Dniui of the Ear (m(M>i- hnina lynipani) is an oval-shaped thin Mienihranc, inserted into a groove around the auditory ca- nal. The Tvni{|ianu»i is a cavity within the ttmporal bone. The Eustiii-hiaii Tuhe is a chan- nel o^'comnMUiication between the tymp.iiiiin;, and the upper part of the pharyn <. The object of this is to convey air lo ihe drum of the ear, as withou air, no sound can be prochiced. Tlie Lahvriuth is a serits '"' "^ of chM;",bers through the petrnua bone, — embracing , the vestibule a three-cornered cavity within the tympanum ; the semi-circular canals, com- 1 municating with the vesti- bule, and the cochlea, which] makes two and a half turns UTound an axis, called the modiolus. In Figure 5S, a, is the pavilion of the ear; c, the auditory canal; ^, the mei.'i- brana tymj)ani; A*, the tym- paiiuai; e, the bones of the car; b, the senucircuhr ca- nals;/, the cochlea; A, the vestibule ; t, the ensta( liian tube ; yrinth laid open, and highly magnified: 1, 1, being the cochlea; '■Z,\\, the chaimels that wind around the ce jfral point (5); 7, 7, the vestibule; 8, the foramen Irotundum ; 9, the fenestra ovalis ; 4, G, JO, the Beniicircuhir canals. '■%'. I 'Hi ■■': i ;n ,ii! (. ■■ H 4 r .. 1 U' PHYSIOLOGICAL LAWS OF LIFE AND HEALTH....HYGIENK 'M Life-, the Infancy of Being. It may be stated as a general truth that man has but just learned to live when he is ready to die. We expend a large portion of our lives in searching out our mistakes, and in striving to undo the niis« chiefs they have occasioned. This is true in reference both to our moral and our physical life ; and I draw from it the conclusion that the present must be cmly the infancy of our being, and that our blun- ders and consequent sufTerings here, will cause us, in the great here- after, to place a higher value upon knowledge, and to struggle with new fortitude to rid ourselves of every bondage. A life which has just begun to take shape and symmetry, cannot be permitted, I think, under the rule of a benevolent Creator, to be- come extinct. We shall certainly be permitted to take up the broken thread of life, and, in the clearer light of the future, with the warning experience of the past, and surrounded by better guards, to try again. In the mean time, while here, the sooner we become acquainted with the laws of life, and the better we obey them, the more, we shall ea* joy- The Nervous System. Man is brought into connection with the outwari world through the senses of feeling, seeing, hearing, etc. These communicate with the brain and mind through the nerves of sensation. The nervous system is divided into two greptt central portions, the brain and the spinal cord; and these together are called, by the learned, the cerebrospinal centre. There are numerous pulpy white cords, called nerves, which at one end are connected with this great axis or centre, and from thence run to all parts of the system. A portion of these nerves start from the base of the brain and run to the eye, the ear, the tongue, etc. (Fig. 48.) ; while another, and a larger part spring from the cord which runs through the back-bone, and are distributed over the body, and the lower extremities. (Figs. 50 and 60.) One portion of these cords produce feeling ; another Eart, motion. The former we call sensitive ; the latter, motor. Both inds are widely distributed over the body. Those which spring from the soinal cord have two roots, one uniting with the backf the HTOIENE. 53 Fio. aa Other with the front part of the cord. Cut off the back root, and the part to which it is distributed loees its feeling. As we say in com- mon language, it be. comes numb, though it may move as wen as before. Cut the front root, which is motion- producing, and the part to which it goes cannot move. It is palsied, though it may stil! feel acutely. The numerous nerves that spring from the spinal column are pretty well represented in cut 60. If the cranial nerves of motion which go to the face be cut, no emo- tion or passion can be expressed. The features will all be immovable, like statuary. To smile, 'to laugh, to frown, to give expression to the feeling of pity, or an- guish, or love, is alike impossible. And yet a breath of air upon the face wil' /r// as readi- ly as bciuit Paralysis, or palsy, ao it is caiUd, partial or general, i ihe result of injury upon few or many of these motion- producing nerves. Neu- ralgia, tic douloureuX| etc., arise from some dis- ease, pi'rhaps inilatnma- tion, of the nerve* of sensation. How the Mind Gets Knowledge. — Everything the mind knows of the external world, it learns through the organs of sense, which com- municate with it through these nerves. Thus, the nerves are acted on by external agents, and then they act on the brain and cause sen- sations. When the hand is burned the nerves of sensation run with the intelligence to the brain, which, quick as thought, through the nerves of motion, despatches orders to the muscles to repel the iiyury. Comparison. — The arrangement and operation of the nervous sys- I L 54 HYGIENE. tern are like those of the electric fire-alarm system of Boston. The brain is the intelligent centre, like the central office at City Hall. Th? nerves of sensation which carry to the brain, with electric speed, in- telligence of what is going on outside, arc like the wires which run to the City Hall from the several station-boxes. The quick carrying to the brain of any information of injury done to some part of the body, is like i:'mding to the City Hall from a station-box the intelli- gence of fire in one of the districts. The rapid transmission of orders from the mind to the muscles, is like flashing the alarm over the wires to every part of the city. And, finally, the powerful action of the muscles ui warding off danger, is like the dashing of firemen over the pavements, and the energetic plying of the engine**. Sensations. An effect, produced on the mind through a nerve, is called a sensa- tion. Hunger is a sensation. It is an efi'ect produced upo!j the mind through a certain nerve by the condition of the stomach. Thirst, pain, heat, cold, arc sensations in a similar sense. Nausea is a sensa- tion produced by some injurious substance acting upon the coats of the stomach. StreiigtJi of Sensation. — Some sensations are mud- stronger than others ; some are very intense. A very strong sensation is called a feeling. It is common to say, " I feel cold," or, •' 1 fet;! hot.'' We simply mean by this, that the temperature of the weather makes a very powerful impression upon us. Kinds of Sensation. — Sensations are either pleasurable or painful. Pleasurable sensations arise from the proper exercise of some healthy part of the body ; and they are a suitable reward for any care the mind may take of the corporeal organs. The sensations arising from a proper amount of exercise are pleas- urable. The muscles hnd a sort of enjoyment in action. He who leads a sedentary life, either from choice or necessity, loses much enjoy- ment. Hence there is ])leasure in labor; and the working man, though often pitied by the wealthy, is geiierjilly tiie happiest of men. The eye and the ear, when directed to ariceable sights and sound.s, derive the most agreeable sensations from exerci.se. The air of a beautiful spring morning gives imj)ressioiis which none can describe, but whi«!h all know to be delightful. These impressions are well fitted to reward us for taking at that season, in the open air, the ex- ercise we so much need. Mornl Uses of Sensations. — How little we reflect upon the amount of happiness it is in our po\^er to create by making agreeable impres- sions upon others. A civil and polite address makes a pleasant im- pression. A kind word, fitly spoken, makes the hear glad. Heads of families might do much to increase the happiness of their domes- tics in the kitchen by meeting them with a plea.sant countenancte, and dropping in their ear, now and then, a word of approval. Such little acts of b( agreeable of life, — and whic us like sp In aimi be govern of happir stairs, — i refining ii or for reel to wear a flowers o: Every ism of wl urable or life, it she Wives n lion of t h'-diC of 1 the husbi pressions fully. M the heads .raying, oi other. ^ loved eitl who desi life, the v sions upc li.M: HYGIENE. 55 acts of benevolence are easily performed, and tliey make the most agreeable and lasting impressions upon persons in the lower stations of life, — creating attachments*, i;i fact, which end only with death, and which in hours of future sorrow, which come to all, may refresh us like springs of water in the desert, f Full many a shaft at random sent, Finds mark tho an-her little meant ; , Full many a word at random spoken. Ma) Ir'al a wounded heart that's broken. WALTBlt Scf>TT. In aiming to make agreeable impressions upon domestics, we should be governed by the simple desire to create hapi)iness. Their sources of happiness are comparatively few. They spend their dayts below- stairs, — shut out from a portion of the light of day, and from the refining influences of the drawing-room, — having little time for rest or for recreation. How unfeeling to treat such persons with harshne.s.s, to wear a frowning face in their presence, and thus wither the few ilowers of happiness which bloom around them ! Evtry human being is endowed with the beautiful nervous organ- ism of which I have spoken, and I3 daily receiving impressions, pleas- urable or painful, from thousands of sources. In all the relations of life, it should be our aim to touch delicately this sensitive structure. Wives may ad<[ much to the happiness, and I may say, to the affec- tion of their husbands, by always wearing a pleasant face ; and the h-"-iix of the wife may be made light and glad by gentle words from the husband. We cannot but love those who make pleasurable im- pressions upon us, and we necessarily dislike such as impress us pain- fully. Most of the coldness and alienations which grow uji. between the heads of families, spring from the habit, of one of the parties, of .laying, or doing, or looking something which painfully impresses the other. A. woman who habitually wears a' " sour " face, cannot be loved either by her husband cr her children. The man or the woman who desires to be loved, must cultivate a manner, a look, a speech, a life, the whole scope of which is fitted to make pleasurable impres- sions upon others. It is against nature to love what gives us pain. Ag:reeable Seiiisations, a Source of Health. — Pleasurable stMisations not only beget love, and increase happiness, but tl y add much to health. They exhilarate the spirits and drive away melancholy. Travelling promotes health and prolongs life, by the number and variety of the pleasing impressions it makes upon the uiind. Cure of the Sit'k. — If the above statements be correct, how im- portant that the sick should be so dealt with as to have none but agreeable sensations made upon them. Many a life has been sacri- ficed to the peevish temper of a nurse. When the nerves are weak from disease, even slight causes make powerful impressions ; and if these impressions are of a painful kind, the results are mpst deplora- ble. To treat harshly the sick, espeeiallv those whose nervous system is broken, implies either great thoughth uess, or extreme cruelty. A ■J! 1 i •■■! ■ 56 HYGIENE. single harsh word, which would scarcely move one when well, may 8end the same person, when sick, almost to distraction. Every word spoken to persons in sickness should, therefore, be gentle and sooth- ing. Every feature of the face should express either cheerfulness, or tenderness and pity. As the painful impressions, which disease is making, tends to de- press the spirits and create melancholy, it is not expected that persons when sick will exhibit as amiable tempers as when well ; and for this, all due allowance must be made. Effect upon the Disposf^f^n. — This leads me to say that pleasura- ble sensations improve the i> mper and disposition. This is a fact of very great importance, and parents should never lose sight of it in dealing with their children. There are few children but would grow up amiable and useful members of society, were they dealt with in the gentle and tender manner which their young and impressible natures require. From the moment the young mind wakes to intel- ligence, it will be occupied with something. Parents and guardians should aim, therefore, to turn it to all those things which will impress it pleasantly, and at the same time do it no harm. Exercise, songs, playthings, flowers, — to the and other entertainments it should be led by gentle hands. No thoughtful parent will ever pain a child by harsh threats and denunciations, or shock it by an oath. Bad Effect of Unpleasant Sensations. — If pleasurable sensations improve the health and temper, unpleasant ones do just the opposite. They break down the health, and spoil the disposition. They are intended to give us a warning of impending injury. Thus, we have painful sensations when we have overworked the body or mind. The sensation of weariness tells us that the muscles have worked as long as their good requires, and that they need rest. Were this sensation unheeded, exhaustion and entire prostration would be the result. When fatigue begins to be felt, either of body or mind, the sensa- tion may be dissipated by strong tea, or intoxicating drink, or opium ; but to drive it away in this manner, for the purpose of working longer, is wrong, and leads, in the end, to disease or exhaustion. It is said ihat one of the most brilliant advocates of our time is dependent upon opium for the stimulus to carry him through his extraordinary flights of eloquence ; but his restless motion and nervous face remind us that he has bent his bow very nearly to the snapping point, and that a sudden collapse of his vital powers, at no distant day, may be feared as the result of such tension. Persons in aflliction, whose spirits are depressed and broken by sorrow, should have their thoughts turned away from all sombre ob- jects and contemplations. They should be taken into the open sun- light, and be diverted by the beautiful things of nature. They should visit cheerful society, and open their hearts to pleasurable impres> sions. When we permit any part of the body to remain idle, neglecting to use it as much as we ought, unpleasant sensations remind us of HTOIENS. 57 our fault The muscles, when unused, waste away and become feeble. This is sure to produce an uneasy, nervous state of feeling, which says to us as plainly a i a sensation can, that the muscles are hungry for exercise, and that it is injurious to let them rest longer. Need of a Healthy Brain. — In order that we may get correct ideas of the external world, it is necessary that the brain, the nerves, and the organs of sense through which sensations are made upon the mind, should be in a healthy condition. It is evident that if the in- struments of sensation be diseased, the sensation cannot be natural, and will make a false report to the mind. It is of the highest impor- tance, therefore, that the brain should be sound. Improper Intemiarriages. — This organ, like every other, may in- herit disease from parents. Insanity, which spring.^ from a diseased brain, h often hereditary. When both parents are diseased, the off- Bpring are of course more liable to partake of their dettots. Among the wealthy, and particularly among the royal families in Europe, nervous diseases and sterility are very common. This arises, in a great part, from intermarriages among blood relations, — a practice under which any people will degenerate, and finally perish. The wisdom of the Old Testament prohibition of marriage within certain degrees of consanguinity, has been established by the observations of philosophers, and the experience of mankind. When a man commits the folly of marrying his first cousin, he generally either his no issue, or his children are afflicted with deafness, or some shocking form of nervous disease. Let those who will transmit to their descendants a sound mind in a sound body, observe the laws of life, and avoid all marriages with blood relations. Need of a Good Supply of Blood. — For a proper performance of its duties, the brain requires and receives a larger supply of blood than any other part of the system. One tenth of all the blood goes to this important organ. If the quantity or qualify be materially lessened or changed, great disturbance of the brain follows. A large loss of blood occasions dizziness and fainting. If an atmosphere charged with too much carbonic acid gas be breathed, as in a deep well, the blood is not vitalized in the lungs, so as to sustain the brain, and unconsciousness soon follows. If the air be vitiated in any way, or have its oxygen extracted, as in la.gt assemblies, where it is breathed over several times, it becomr^s unfit to support the brain, and the result is languid feelings, inability to apply the mind, headache, fainting, hysterics, and other nervous manifestations. Yentilation. — This shows the great necessity of having dwellings, churches, and school-houses well ventilated. Were a good system of ventilation adopted in all our churches, ministers would seldom preach to sleeping audiences. A congrega- tion sitting in one of our places of public worship, where the air in a single afternoon is as many times used over as the minister's sermons are in a lifetime, can neither hear with attention, nor comprehend with clearness. m 68 HTOIENE. In our schooKhouses, the ventilation is quite as bad, and the conse- quencea worse, because they are occupied six hours in the day instead of three, and six days in the week in place of one. In the small school- houses which our children filled to overflowing in former years, in which there was no ventilation, unless they happened to be blessed with an old-fashioned chimney and fire-place, the effects upon the nervous system of the children was deplorable. Many of the dis- eases which afllict the present generation of men and women, had their origin in the bad air of those crowded nurseries of education. Our dwellings were partly ventilated in olden time, when the oiwn fire-place received the " back-log," tlie " top-stick," the " fore-stick," and other sticks to match ; but since we have been warmed by the stove and the furnace, we have known little of the luxury of pure air at the domestic hearth. l^eed of Exercise for the Brain. — Health requires that the brain should be properly occupied with vigorous thought, Tl\e same rea- sons may be given for this as for the exercise of the mi scles. It is governed by the same laws which apply to other parts of the system. Use improves its strength and vigor, — idleness causes it to grow feeble. Of course the labor it is put to should be only reasonable in amount, and should not be too long continued at any one time. With the weakening of the brain, the whole bodily forces, and indeed the whole mental and moral character, fall into feebleness and decay. It is a great mistake to suppose that the cultivation and even vigorous use of the mind, impaits health.and shortens life. Just the opposite is true. Many of the most eminently intellectual men, who have worked their brains hard all their lives, have been distinguished for long life. Bad Effects of Change in Circnnistanees. — No class of persons suffer more from nervous diseases and general ill health, than those who, having worked hard in early life, with little or no cultivation of the mind, are suddenly raised to wealth, and immediately drop all exercise, and fall into habits of indolence and luxury. The condition of such persons would be much less pitiable, did they take up books when they lay by the hoe or the broom. But they seldom do this. Many a woman, in early life, has felt the glow of health in every limb, and a thrill of pleasure, too, while scrubbing the floor upon her hands and knees, who has, in subsequent years, reclined »n misery upon her damask-covered lounge, and wondered that she could not have the health of other days. Let her cultivate her brain, live tem- perately, and exercise in the open air, and life may again have real pleasures for her. Discretion in EYercisiun^ tlie Brain. — In exercising the brain we must use discretion. We must not sit down in the morning, and ply it with work during the whole day, without rest. This would soon bring upon it. disease, or premature decay. It should be worked only until it begins to show symptoms of fatigue. Then it should be per- mitted to rest ; or, what is better, be turned to some new subject, of HYGIENE. 59 a lighttT, or a different character. This often rests the brain better than to entirely sustpend its action. Overworkiiup the Brain In Cliildliooil. — Grout care should be used not to exorcise the bruin too much in early life. Like other parts of the systoiii, it is tender in childhood, and will not boar prolonged ex- ertion. As a general thing, children are put to school too early, and made to work their brains too hard. Great mischief arises from this tiource. Cliildron are born with larger brains now than formerly; and it is no uncommon thing to see upon a child of ton years, a head e{|nal in size to that of an adult. Children run to brain. I^rooocity ill d(!Vol()|)ment of brain and mind is conunon. The results of stim- uiatiiig and hastening the unfolding of such minds are deplorable. Ill such cliildron, the brain should bo the last thing to be cultivated. We need not urge its growth. It will come for\vard fast enough in spite of us. Our oliiof aim should ho to harden and fortify the general constitution, so that the noble brain which it is required to bear up and sustain, may long be its crown and glory. Yet parents are proud of their precocious children, and often reverse this rule. They do it thoughtlessly, and would be terribly startled, could they suddenly look into the future, and see the results of their folly. Could they do so, they would see inflammation and softening of the brain, epiloj)sy, insanity, paralysis, apoplexy, with all the horrors of undescribed and indescribable nervous affections, which, though without a name, have a terrible reality. Old People's Bniins. — Persons in advanced life should be particu- larly careful not to overwork the brain. In middle life it recovers easily from great fatigue. In the decline of life, its powers of recov- ery are feeble. A single exhaustion may cause its fatal collapse. Old age should be distinguished for gentleness and moderation. The journey of the down-liill of life should be made by short and easy stages, through regions of diversified beauty. A Supiily of B1(NmI. — Every part of the system, when hard at work, needs and must have a very largt; supply of pure blood. Without this, it is torpid and inactive. To cause the blood to flow to any particular part, it must "be exorcised. The lumberman, when in the forest in extreme cold weather, stamps his foot violently upon the ground, or boats them against a log, and whips his hands around his body; and in this way makes them rod and warm with a now supply of blood. The stomach, when it has received a supply of food, be- gins earnestly to turn it over; and by this exorcise, and the stimulus which the food supplies, it invites large ({uantities of blood to its vessels, and thus increases its power to work. But just in |)roportion that it draws the vital current to ilself, and augments its own vital, force, it diminishes the blood in other organs, and, for the time being, unfits them for work. The same may be said of tne brain and all other working organs. From this it follows that only one organ, or set of organs, can work effectively at the same time, and that it is improper to put the brain to hard work immediately after a full meal, bt^cause the stomach then ■^\f 60 HTOIENB. wants the blood to enable it to digest the food ; and if the blood be called off to the brain, digestion will stop. Nor should the stomach be loaded with food directly after long and hard thinking; for the brain will yield up the blood to it only after its own excitement has had time to subside. Sympathetic Nervous System. The object of this system seems to be to bind all parts of the body together, and to combine and harmonize their actions. It takes cure that no part of the system acts in such a way as to injure any other part It exerts a controlling influence over digestion, nutrition, al> sorption, the circulation, etc. These are natural processes which need to go on while the brain is asleep and cannot attend to them. The nervous system, of which I speak, presides over all those func- tions which are called involuntary, — so called because no act of tlie will is needed for their performance. Secretion, absorption, digestion, and the circulation of the blood, all have to go on while we sleep, a» well as while we wake. Were an act of the will necessary to their performance, as in walking, eating, conversing, etc., then they would have to cease the moment ihe brain fell asleep, and death would be the result. The sympathetic nerves apprize each part of the system of the condition and Wants of every other part. When the lungs are in- flamed, the stomach seems to be aware of it, and will receive no food, because this would aggravate the disease of the neighboring organs. Well would it be if human beings would exercise a like forbearance, and abstain from those acts of self-gratification which they know wili injure their neighbors. Effects of IVervous Diseases. — Before closing these observations, 1 wish to add a few words respecting the terrible effects of nervous dis- eases which characterize the present time. That they are far more numerous and afflictive than in former years, must be apparent to the most careless observer. They are nothing more nor less than the price we pay for a high civilization, and especially for our republicanism. Among us, every man feels hh | individuality, and has a motive for thinking and doing his best . Thought and action are here unfettered ; and if the race is not to the swift, nor the battle to the strong, every man acts as though he thought it was. The great excitement which the struggle for wealth kindles and inflames, deranges and shatters the nervous system to a shocking degree. And wealth, when obtained, does its full share to weaken the nerves. I It brings with it high living, indolence, loss of energy, dissipation, and a weakening of the whole moral and physical powers. It need not | do this; but, in most cases, it does. The result is, that, at least, every other person has some nervous I disease, which makes life a misery rather than a blessing. The brain and nerves are too much developed in comparison with the develop- 1 1 ■ ■ ■■^■;.:V- inoiit of the muscles. Half our boys and girls have heads as large as men and women. It is common to see a boy or a girl at ten talk- ing and acting like a man or woman. I do not mean by this, that they imperfectly imitate the actions of older persons. It seems to be natural to them. Their brains are prematurely developed, and their acts and thoughts have the maturity of adult life. What Is ComiiiK? — What will be the result of this state of things, no man can predict. I sometimes think the race will break down; that that wliic^h was intended to be its ornament and strength, will be its destruction. I hope not. Yet there is danger of it. Nothing c in save us but the wisdom to adopt such means as will develop all parts of the system alike. No race of men can stand for many generations such a strain upon the nervous system, unless better means are adopted to counterbalance its evil effects than are now used in the United States. We have got to pause in our swift career, and look after our health, or we shall become a nation of maniacs. No proof is needed of what is here said. There is scarce a man or a woman but has jn their own person the foreshadowing evidence of our impending (loom. Hopeful Considerations. — It is proper to say the considerations here presented, terrible as they are, are mitigated in some measure by others of a more hopeful character. Physiology and the laws of life are now better understood than at any former period. These subjects are getting into our common K-tiools, and are engaging the attention of our youth. Declining health has already made us think more of the means of preserving it, — such as diet, exercise, bathing, travelling, and amusement To encourage and intensify this hopeful direction of the public mind, I propose to devote a few pages to these subjects. Food and Digestion. From the earliest dawn of existence to the last moment of life, our bodies are constantly changing. Old particles of matter, when they are worn out, leave their places and are thrown out of the system. Were this the whole of the matter, our bodies would soon waste away, and that would be the end of us. But as fast as the old mate- rials are thrown away, new ones take their places ; and it is solely out of our food that these new materials are formed. In order that the food may be well digested, it must first be broken , into small particles in the mouth. The act of chewing it, is called nias- tication. During this act, if it be well performed, a large quantity of spittle, called saliva, flows out of a number of glands, called salivary glands, and mixes w'ith the food, forming with it a soft mass. Tr. this condition, it is thrown backward into the top of the throat, called the pharynx. Here, a little cartilage, called the epiglottis, drops down upon the opening into the top of the windpipe, and prevents its en- trance into the breath passage ; and it is pushed along into the gullet, a tube which runs down behind the windpipe and lungs, and which ! i;, r I- ■ ' I I r, X'i iili Tl ■ 1 ll I' I- '■ 'm T- 62 HYGIENE. physlrinDs call tin- (rsophagUH. Ilrre a succt'ssion of musfular bands, III circulitr sluipc, contract u|H)ii it, one ul'tcr uiiuther, and furcu it down into the stoinacli. It is important tliat two tliriif^rt ^'llolJl(^ be secured while the food is in the mouth, namely, that it sh«)ul(i be reduced to a ^ood deforce of Bnoncss by chewing, and that a proper amount of saliva should be mixed with it. If the chewing wore not necessary, teeth would not have been given us ; and the salivary glands would certainly not Irnvo been put in the vicinity of the mouth, if the mixing of water with our food would servo the purposes of digestion as well. Eating too Rapidly. — The Americans have fallen intQ a pernicious error in eating their food too rapidly. Time is not given to chew it sufficiently to excite a full flow of saliva ; and as it cannot be swal- lowed in a dry state, it is not uncommon to see persons taking a sip of water after every second mouthful to enable them to force it into the stomach. It ib -i habit we Americans have of cheating ourselves both of the pleasures j\nd the benefits of eating ; for the only real pleasure of eatuig arises from the flavor of food while retained in the , mouth, and the only benefit we cun derive comes in consequence of its proper digestion. The food when received into th(^ stomach is in the same condition as when taken into the mouth, except that it is, or should be, ground fine by the teeth, and well mixed with saliva. The GuKtrie Jiikr. — The stomach, like the mouth, the windpipe, and the gullet, is lined by a mucous membrane. The chief office of this membrane is to secrete, or take out of the blood, a fluid which we call gastric juice, which means stomach juice ; for the Greek name of stomach is yaaryp (gaster). This fluid has not much smell or i^ste, and looks like spring water. It has a powerful effect upon food, which, when mixed with it, soon undergoes an important change, whiv^h is apparent to the taste, the smell, and the sight. What the nature of the gastric juice is, or how it produces its effect upon food, is not certainly known. Too Mucii Cold Water at Meals. — There are some interesting facts connected with the formation of this fluid, of which it is important that every person should be apprized. Its quantity and quality depend on the amount and healthfulness of the blood which flows to the stomach during the first stage of digestion. It is, therefore, injurious to drink large quantities of very cold water with, 'or immediately after, our meals ; as this will chill the stomach, and repel the blood from its vessels, so that but little of the juice can be formed. Digestion, in such case, must be imperfect. Tliis Fluid not Secreted Without Limit. — This fluid does not flow into the stomach continuously, but only when we swallow food, and then, not as long as we please to eat, but merely till we have taken what the system requires. If, in the amount we take, we go beyond the wants of nature, there will not be fluid enough formed to dissolve it, and the whole will be imperfectly digested, and be a source of in- HYGIENE. 63 jury rather thai' bnicfit. Thin should teacli \in to be carrfiil that our food he only reasonable in amount. !\ot S^rreted in SickllCHS. — When v/e are sick, the gastri(r jiiice in either not formed at all, or only in small <|uantities. Whatever may be our feelings of lassitude, and however much we may appear to aeed food, at smrh times, it is useless to taki ,t, for it eannot be di- gested, and will only aggravate our tlisease. If the illness l)e only slight, the fluid will bo formed to some extent, and food uiay be taken ill proportion. Us SvvirtUm Fjiyored by riicerfiiliiess. — A eheerful disposition, and a happy, livefy frame of mind, are highly favorable to the production of the gastric juice; while melancholy, and anger, and grief, and intense thought of business at the hour of nn-als, greatly hinder ita natural flow. This .should loach us to go to our mculs Avith light hearts, and to I make tl^o family board a place of cheerful conversation, and of a light and joyous play upon the mirthful feelings of all present. Should any of the family circle be in the habit of using vinegar as a condi- ment, we should never be guilty of compelling them to extract it from our faces. A vinegar face is not easily excused anywhere ; at the table it is unpardonable. A single countenance of this description will throw a gloom over a tableful of naturally cheerful persons ; and if habitually present at the board, may finally spoil the digestion of [half a dozen, and entail dyspepsia upon them for life. The s( machs of the sick pour out but very little , of this fluid, and I they I. n ♦ ke but a small amount of food. It is cruel to deprive them of the povvers of digesting that little by treating them harshly, and filling them with gloomy and desponding feelings. I therefore repeat the substtince of the advice given on a previous page : Deal gently [with the sick. How all tlii» is Kiio^vn. — As the stomach is wholly concealed from view, the reader will very naturally ask how it is known that the gas- I trie juice is poured into it in certain states of the mind, etc., and with- held in others. It certainly could not have been so accurately known, I had it not been for an accident which opened the living and working stomach to the inspection of Dr. Beaumont, a United States Surgeon. K young man by the name of Alexis St. Martin, a Canadian by birth, but then in the State of Michigan, had a large part of his side torn away, and a hole of considerable size made into his stomach, by the acci. I dental discharge of a gun. To the surprise of his surgeon, St. Martin I recovered J and the edges of the wound in the stomach refused to i grow together, preferring rather to fasten themselves to the borders of the breach in the side, thus leaving the passage open. A kind of cur- tain grew down over this, which prevented the food from falling out. 1 Dr. Beaumont, taking advantage of this state of things, instituted a j series of valuable experiments, by lifting the curtain, and insertuig various articles of food, and witnessing the process of digestion. ■oTcment of the StomaclL — The presence of food in the stomach ill i\ i!- .'t'-.l |-;i Ui .■ t *i t','' 64 HTOIENB. causes its muscular coat to contract and throw it about from side to side, mixing it thoroughly with the gastric juice, and reducing it to a pulpy mass, called chyme. This, as fast as it is properly prepored, pjisHfs through the pylorcs into the upper bowel, or duodenum^ called also the second stomach. Chyme. — A certain witty professor of anatomy and physiology, is in the habit of asking his class if they ever saw any chyme; and when they -^nswer no, as they often do, he calls their attention to what they occasionally see in the morning, upon the sidewalks, where drunken men have held themselves up by lamp-posts, and left ihe contents of their stomachs. The pylorus, or opening into the bowel, has a very singular and wise instinct, which is worthy of remark. When a piece of food, which has not been digested, attempts to pass into the bowel, the moment it touches the inii«r surface of this orifice, it is instantly thrown back by an ene-getic contraction ; though a portion of well- |)repared chyme touching the same opening immediately after, is allowed to pass on unchallenged. Chyle. — The chyme, when it reaches the duodenum, seems to cause the liver to secrete bile, and the pancreas to produce the pancreatic >nice. These two fluids are conveyed into the upper portion of the second stomach, and are there mixed with the chyme, and cause it to separate into a delicate, white fluid, called cAy/e, and a residuum, which, being worthless, is pushed onward, and thrown out of the body. Bile in the Stomach. — Most persons suppose that bile is generally found in the stomach; but this is a mistake. It is thrown up by vomiting, because in that act, the action both of the first and the second stomach is reversed, and the bile is forced up from the duodes num, — taking a direction the opposite of its usual course. Destination of the Chyle, — The chyle being separated from the dregs, is pushed onward in its course by the worm-like motion of the in- t'istine ; and as it passes along, it is gradually sucked up by thousands of very small vessels, whose mouths open upon the inner siirface of the bowel. These little vt^ssels are called lacleals, from the Latin word laCy which means milk, because they drink this white, milky fluid. Fig- ure Gl shows a .•section of the siT\all bowel, turned inside dut, and covered with the villi, or root-like filaments, closely set upon its surface, for ab- sorbing the chyle, and at the bottom of which, the lacteals t-ake their rise. In these lacteals, and in the mesenteric glands, the chyle in gmdo- Fia. 61. HYGIENE. 65 ally changed, so as to approach nearer and nearer io the nature Fio, 63. ^^ the blood ; but precisely what the change is, or how it is effected, i ■ not known. Several men have published their theories upon these points, and the writer has opinions upon them ; but it is not wortli while to trouble the reader with them. It is sufficient to say that (he fluid is carried by the lacteals to the thoracic duct, through which it is conveyed into a large vein at the lower part of the neck, where it \a poured into the blood, and becomes, after going through the lungs and ex- periencing another and a vital change, the material out of which our bodies are daily and hourly new-created. Figure 62 gives a general idea of the stomach, bowels, etc. : 9, being the stomach; 10, 10, the liver: 1, the gall bladder; 2, the duct which conveys the bile to 4, which is the duodenum ; 3, is the pancreas ; 5, the oesophagus ; A, the duodenum ; B, the bowels ; C, the junction of. the small intestines with the colon ; D, the appendix vermifor- mis ; E, the ctecum ; F, the ascending colon ; (i, the transverse colon ; H| the (If'ftcending colon ; I, the sigmoid flexure ; J, the rectum. Nature and Destination of Food. The food which man requires for his support and development is of +WO kinds, the inorganic, and the organic. The first of these em- braccs f^ertain mineral substances, as common salt, sulphur, phospho- ms, iron, :ind lime, either in combination or separate. These art: not generally reckoned as aliments, and yet no human being can live witiiouc them, lik their absence, the body decays, dis- intf'gratcs, and oerishes. Conm-'On salt is composed of muriatic acid and soda. Th'J first is an impt>rtunt ingredient in the g,..stric juice, mid the latter promotes the si-cretion of bile. Sulphur is found in wv<>raS of the tissues, particularly ii5 the muscles. Phosphorus united to fatty matter, is highly honored in forming a portion of the brain and nerves, and is also combined with oxygen and lime to make the •'arthy or hard part of bones. Found in FimmI. — 'I'hese articles it is not necessary often to intro- •luce into tin- systcMii in a separate state. They arc contained, in liirger or smaller proportions, in most articles of fiK>d ; and man always •^utfers, as all animals do, from their absence, ('ommon salt is found 9 ir^r f 1 I HI 1 (','■■■ ! ■ Pi, I"' ./■ 66 hygiene; in the flesh of animals, in milk, and in eggs. It is not very abundant in plants ; and we all know how eagerly domestic animals devour it when it is given to them, and how constantly wild cattle resort to the salt springs, which, in the great "West, are called " buffalo licks." Lime exists in nearly all animal and vegetable substances. In wheat flour we get it in combination with phosplioric acid, that is, as phois- phate of lime. Lime exists, too, in ihcj state of carbonate and sul- phate, in all hard water. Iron is found in the yolk of eggs, in milk, in anim«l flesh, in potatoes, pears, cabbages, nnistard, and other arti- cles. Svlphur we get in flesh, eggs, and milk ; and, as sulphate of lime, in pring and river water. Phosphorus is derived from eggs and milk ; a id flesh, bread, fniits, and busies of grain, commonly called bran, contain even a larger proportion than we need in our diet Orjpiiiic Food. — The organic elements of man's food, which in bulk embrace almost the whole of it, remain to be considered. In the animal economy they serve two great purposes. A part of the arti- cles which compose them are blood-formers, out of which all the tissues are made, — the other part produce fat, which serves to warm the body by being burned with oxygen. These articles are derived partly from the vegetable and partly from the animal kingdom. - For convenience, these articles may For the first, Fio. 68. Divided into Four Groups. be divided into four groups, fiugar stands as a type. We therefore call it the saccharine group. It embraces starch, gum, and the fibre of wood. These arti- cles may all be converted into sugar by a simple chemical process. Figure 63 gives a microscopic view of the granules of stdrch. The second grovp we call the olea^iiKms. It is composed of oily substances, from whatever source derived, whether the ani- mal or the vegetable world. The third fi^royp is the albuminous. A good type of it is the white of egg. 'i'\ie fourth is the gelatinous., ox jelly group. First iinii Second Gronps, Supporters of Respiration. — The articles composing the first and 8«'cond groups are analogous in composition, all containing oxt/g-en, hydrogen, and carbon. They are what Liebig calls supporters of respiration ; the meaning of which is, in nio'o comprehensible terms, that they are supporters of combustion. They are the fuel which warms us. They keep the fires going, from whici arises all the heat we have in our bodies. But they are destitute of nitrogen, and, on this account, they are not blood-formers, and cannot be worked into flesh. Hence, man caiuiot live on them. The food articles embract^d in the third and fourth groups, also contain oxygen, hydrogen, and carbon ; and to these they add nitro- gen. This fourth component part, which forms only a small portion of them, gives them, for some reason never explained, the peculiar ri^ ,;t, HYGIENE. 67 qualify of prodnring blootl and flesh. Thoy are the raw materials, out. of which our btKlies are n'consfrutrted from day to day. Feed a man ev«*r so largely u|:k)u sugar, starch, gum, and oils, and he will starve as certainly as if he were allowed nothing but water. Names of Tno firejit Divisions of F^ Rtness of an article for diet, depends very much upon the ease or iilficulty with which it is digested and assimilated. If an article, laving a great deal of nitrogen, and being very nutritive, is with jreat dilficulty redu habit, peculiar to itself, of rejecting, or refusing to digest, some one, or more, articles which are acceptable to all other stomachs. Thii | HYGIENE. 69 table shows the length of time required for digesting the several arti- cles in the stomach of St Martin, as shown by the experiments of Dr. Beaumont : Articles. Rice Pi(^8 feet, soused .... Tripe, soused Trout, salmon, fresh . . It It ti Apples, sweet, mellow Venison, steak Sago Apples, sour, mellow Cabbage, with vinegar CodHsh, cured, dry . . Eod '^.(stanl Chicken, full-grown . Apples, sour, hani . . Oysters, fresh Hiuss, striped, fresh. . Bi'cf, fresh, lean, rare " steak Corn cake Dumpling, apple. . . . Kg'.'i*, fnisli Mutton, fre&hi PreparatlonR. Boiled .... Boiled .... Boiled . . . . Boiled Fried Riivt Broiled. . . . Boiled Raw 2 Raw 2 Boiled 2 Raw 2 Broiled. . . . 2 Boiled 2 Boiled 2 Raw 2 Roasted . . . 2 Boiled 2 Roasted . . . 2 Baked 2 Boiled 2 Roasted . . . 2 Warmed. . Broiled. . . Roasted . . Baked . . . Riiw Boiled . . . Baked . . . Fricsisseed Raw Raw Broiled. . . Roa.sted . . Broiled. . . Baked . . . lioiU^d . . . Boiled soft Broiled. . Boiled . . . Time. h. m. 30 SO 30 35 45 15 18 25 30 30 30 30 2 30 30 30 30 30 30 4.T 45 50 55 Artielea. Pork, recently salted Soup, chicken Oysters, fresh Pork, nscently salted Pork steak Corn bread Mutton, fresh Carrot, orange Sausage, fresh Beef, fresh, lean, dry Bread wheat, fresh. . Butter Cheese, old, strong . . Eggs, fresh PreparationB. Time. ti. m. Flounder, fresh. . . . Oysters, fresh Potatoes, Irish .... Soup, mutton " oyster Turnip, flat Beets Corn, green, and beans Beef, fresh, lean . . . Fowls, domestic . . . Veal, frtish Soup, beef, vegeta- ) bles, anlf. Exercise to be CoiLsidereil. — In deciding the diet, the amount of exercise is not less important to be considered than the health. The farmer, who works in the open air, and uses his muscles a great deal, wants considerably more nutritive, as well as more combustive, food than one who leads a sedentary life. Of course there is a great deal more waste of the tissues, and he requires more of the flesh-forming articles ; and as he breathes deeper, and tak'js in more oxygen, he needs more of the supporters of respiration, — the sugars, oils, and starchy aliments. Beans. — By ttirning to the table which shows the amount of nitro- gen in the different food-articles, the reader will see that beans are rich in this below fine wheat flour ; but. in fat. it is cxeefdi'd only t»y Indian corn. 'I'his grain is likewise eonsoeried Ipr^ely by the ScotAth, — a people whose claims to shrewd connnon s«'i»se are well supported by, as their hardy eoiisti- tntion.-i vindicate, the chi lee. This grain might well be pertnitted to lake the place of riee. Jt aftords several times as much nutriment, while it costs only aluMit one-iifth as much. There is good reason why the horse should thriv(> Uj)oti oats. Most stable-ket'pers think their i)(»rsrs will do more work upon torn-meal, but this nujst be a mistake. In using oats ftir horse-feeding, a large portion of the nu- triioeut is lost by not g-riudin^ +hem. Ryt'. — This ia also a grain of considerable nutritive value. It is msKij cheaper than wheat; and rye meal has long been a standard arricle of diet in Xew Knghuid, — pf.i-licularly in connectiorj with Indian meal, as •' brown bread." It is us<'fnl for relieving costivencss, in Ih' form of "hasty-pudding,'' with molassesj. Iiid!iin <'oni. - This staple article of American produce needs no praise from me. It is tiomparativeiy cheap, nutritive, arid wholeaoiric. It abounds in fat and starch, and has a fair amount of albumen, though not as much as the oat, the barley, or the wheat. In salts, it is rather deficient. Indiiui corn is strictly an Amerit^an plant, and is perhaps the most j)opular grain in the country. It has emphatically a. national reputation, and is perhaps work(xl n|) into more savory dishes than any other. At the Soiith it is an institution. It is there made intti lax; cake, corn cake, batter cakes, batter bread, mudins, corn pone, et<;. At the North, we have jonny cake, Indian and pumpkin cake, baked Indian pudding, boiled Indian pudding, beside the well- known rye and Indian bread, and other- preparations, CJive an i;i- genions Southern or Northern housewife a few simple adjuncts, sut-h ab lard, milk, sugiir, eggs, cream of tartar, and soda, and she will make a pretty respectable larder frcna this single grain. If mola.-ses be substituted for sugar, and a. little stewed pumpkin be thrown in by way of garniture, we may have several preparations which are very nourishing as well as clu-ap. ilUf^Kwheilf. — Poor in nutritive matter, fat, starch, and sugfir, buT tolerably well supplied with salts. It will do very well for batu i ctjkes in winter. Whi'U brought smoking up^^n the table, and servi-o with sugar or mola-sHcrt and i)urter, these 'lakcii are a luxury, in which the rich may indulge if dtey choose ; but for the poor, the amount (J. nourishment they afford is too small for their corft. Jllee. — Much lik; buckwheat, except that it has more fat, s gar, and s'arch, and less salts. As an article of diet, it has had too liigii areputalion. Those who would live on small means cannot afford it. Boiled in plain vater, it is excellent for a rela.xed state of tlu' bowels ; and this is about all the comme.idation to which it is entitled. IkuJiS. — The richest in nutritive matter of all vegttable substan- ces, except cabbage and oats. They have more albumen than wheat, IlVr.iKNE. 79 or I'orn, or barloy, or oats; but in fat and starch, iliry are lowor in the scale. Add to thciri salt pork", and the liighcst of all nutrient compounds is obtained. During not less than four generations, pork ;uu! l)eans, as the principal dii't, nourished an iron-sided rac«' of nieii ill New I^jngland, Bean-porridge was like honey U|K)n the tongue of the f«)unilers of N«nv England institutions. They ate it morning, )u>oM, and night; and thanked God for it every time. And well they ji;i^ht thank Him; for, with Indian corn, it furnished them with a dirt better adapted to their condition than any other. IViis. — Not quite as rich as beans in albumen, but more rich in starch ; of about the same value on the whole. The Canadian French III liowcr Canada, feed on peas to about the same extent that the New Kiiglanders did on bv,'ans. Pea-soup, as prepared by the best i«)oks among them, is a dish of great nutritive . rcellence ; and, in my judgment, more palatable than bean-soup. Tlie Potato. — Three-quarters of this root is water, and it is poor in all the elements of nutrition. It is a palatable article, and most |)r in nutritive qualities. They serve to please the palate by furnishing a variety ; but in our city markets, they are expensive, and do not furnish an economical diet. Cabbage. — It is interesting to observe how the instincts of me« have in all ages led them to select those articles of diet which their circumstances have demanded. The poverty of the Irish has led th(?m \o subsist largely upon the potato, — a root which the soil of their country yields profusely. But as this root has but little nutritive matter, necessity required that it should be united with some other vegetable. The natural instinct selected the cabbage ; and when cheviiieal science came, at length, to pass judgment upon the correct- ness of this instinc:t, it turns out that the cabbage is the richest in albumen of any known vegetable. -The cabbage, then, is the natural eoinplement of the potato; and the Irish had the sagacity, without K'iiujce, to bring the two tog(!ther. It is said the Irish have a dish iiain<'d "kohl-cannon," consisting of boiled and mashed potatoes and cabbage, seasoned with pork fat, pepper, and salt,, and that it is a truly savory dish. It certainly is a nourishing, and a cheap one. The ambassador who was sent to tamper with the patriotism of a Roman who had dined on beans, was asked if he was silly enough to think ^o\i\ and silver could bribe a man, who was satisfied with so plain a lure, and desired no other. We come tt) the eonelnsion, then, that Ijcan porridge, pea soup, suet pudding, swe<'leiied with molasses, oat meal, and barley bread, with " kohl-cannon " for those who can digest dO HYGIENE. it, will furnish, for hard-working men, the most substantial diet^ at the smallest possible ex|)ense. To render these dishes savory, and to make the table on which they are spread an inviting board, the deft housewife must empioy her best skill in serving them. With the thousand " fixings," with which a New England matron knows how to garnish them (or would know how if they came within her culinary operations), they are well fitted to leave savory impressions u[K)n tongues which would praise them to the end of life. J speak of the»« articles as furnishing a cheap diet for working men. The indolent, the sedentary, and the effeminate from various causes, could not digest them. The Amoant of Food Taken. We have already explained that this should be governed, in part, by the amount of exercise taken, by the condition of the health, by the state of the mind, by the climate, by the season, etc. It temuins to add a few words, in a general way, respecting the absolute amount required by an udult man. It is plain enough that most men eat too much. We come very near, in this country, bi'ing a nation of gorniands. A principal reason of our over-eating is, that we eat so fast. Wiien tlx; food is well and slowly masticated and swallowed, the gastric juice has time to mix with it; and at the proper moment, the apjwtite ceases. But wlie/i our food is bolted rapidly, n.*ture, finding her laws disregarded, and all her purposes frustrated, stands back, and lets us learn to stop, too intc, alas I from a sense of fulness ni a stretched and abused stomach. It has already been stated, that Lewis Cornaro lived lifty-eight years, namely, from the age of forty-two to one hnndretl, on twelve ounces of solid food a day, with about the same amount of light wines. At the age of eighty-four, he wrote a book, in which hi-. praises "divine temperance" in terms which are sometimes eloquent, and often enthusiastic. Indeed it is very rare that a man at that age retains such clearness of intellect, and especially such freshness of feeling as he evinces in his book. Probably but few could live on tlie amount of food which he found sufficient. Yet it is said the distin- guished John Wesley lived on sixteen ounces a day, which, as he Uwk no wine, and had to derive the combustive materials for warming tin* body from the food, was quite as scanty a fare as that of Cornaro. Ck)nsidering that he led a most extraordinarily active life, both of body and mind, being half his waking hours in the saddle, and preaching almost daily, this is probably the most remarkable case of abstemi- ousness on record. Jonathan Edwards did not, I think, exceed the same amount of food, but he was not so active a man. Putting aside such exceptional cases as these, we may say in round numbers, that a laboring man requires, to keep him in health, about two to two and a half pounds of solid food per day. For minister.", lawyers, doctors, authors, and merchant.-, one pound and a half is amply .'tuflicient. The amount should bt> increased a little by a se- lection from sofue of the fuel^rmers, if no &>rmeuted or alcoholic- drinks be is, that tl to be dri> nishes no be had in Dyspepi health; a of a pers( the in fori sfldoni b( wh.'U. am for life is it cries ft enjov any niie": To only an oi It has subsi.st oi staiieert. pliys! ' tabit ([.> that aniiii duly slim rhfKus, eh shortens I this eoun any othei is not SI enormcus cattle rail the demai ket at tv blood-fon Facts a aione, or 8ub!\i* palo, feeble, and nervous. The books arc biained and oeuwa^ aside for what the dishes have done. The doctor is called in, and assured that the dear child can eat nothing but a little fat broth, a custard, or cake; and if he prescrilM* a s with active and finely moulded forms, live oi: bread and potatoes. These facts do not aflord ground for altogether rejecting animal food, any more than Bayard Taylor's statement respecting whole tribes in Africa who live upon flesh, furnishes a reason for excluding vegetable aliment. Man may live and enjoy health upon either, but liL* organ- ization implies the use of both. Proportions of Animal and Vegetable Food. UroN this subject, it is impossible to fix any absolute rules. This is a point which must be determined by the temperament, the state of the health, the constitution, etc. Persons of a scrofulous hnbit, should eat freely of animal food. But an inflamed stomach should never be tormented with flesh. Meat is stimulating, and will l)e al- most sure to do mischief when there is heat and tenderness at the pit of the stomach. There are cases of inllammation of this organ, ia which it may be necessary to live on bn'ud and milk, with articles of the starch ffroup, for months, and even for years. On the other hand, when the system has rim low fr<»ni some ex- hausting disease, which excites no feverish action, it nuiy be necesary at times, to take a diet almost exclusively animal. It is absurd to talk of the same diet as adapted to all pci>on», even when in health. As well might we expect one shtx' to tit every f»*ot, or one coat every back, or one color every eye, or one dot-trine every mind. Temperance the Wain Tiling. — After all, the great thiiu^ to be aimed at is temperance. It is not so necessary to reject one article mill use another, as to partake of all with inoileration. " 1 di» not live to eat and drink ; I eat and drink to live," said a wise pliiloso pher of the olden time. One would think the moderns had reversed this rule. A imnlern table has the ap|)earanee of being spread for the i>ur|x>se of inducing men to eat all their stomachs will liold. A man wl'i) can dine daily, for half a dozen years, ai one of our first elatw- hoteis, and then find himself free of tlys|)e|»r,ia, and all other diseases, must have a fine ctmstitution, as well as iiu>st iiduurable control over Ms ippetite. Mr. Aildi^on said, " When ! iM-hold a full table set out in all its magnifieeiu-*', I fancy 1 see gout, ch»)lic, fevers, and lethargies 'r ii :■:'!!?§ /rrj 84 HYGIENE. lying in ambusoadc among the dishes;" to which he adds, with much truth, in another place, " Abstinence starves a growing distemper." Good Results of Temperance. — A temperate diet has rrlways been attended with excellent results, and always will be. There are times of great anxiety, when abstinence should be pushed to the extreme verge of endurance. During the siege of Gibraltar, Liord Heath- field, its gallant defender, lived eight days on four ounces of rice per day. Dr. Franklin, when a journeyman printer, livod two weeks on bread and water, at the rate of ten pounds of bread a week, and waa stout and hearty. Dr. Jackson, an eminent physician in the British army, says, " I have wandered a good deal about the world, and never followed any prescribed rule in anything ; my health has been tried in all ways ; and by the aids of temperance and hard work, I have worn out two armies, in two wars, and probably could wear out an- other before my period of old age arrives." Lord Bacon was right in the opinion that intemperance of some kind or other destroys the bulk of mankind, and that life may be sus- tained by a very scanty portion of nourishment. Cornaro, whom I have before mentioned as having lived fifty-eight years on twelve ounces of solid food a day, wrote as follows respecting himself in his eighty-fifth year : " I now enjoy a vigorous state of body and of mind. I mount my horse from the level ground ; I climb steep ascents with eas(? ; and have wrote a comedy full of innocent mirth and raillery. When I return home, either from private business or from the senate, I have eleven grand-children, with whose education, amusement and songs, I am greatly delighted ; and I frequently sing with them, for my voice is clearer and stronger now, than ever it was in my youth, in short, I am in all respects happy, and quite a stranger to the dole- ful, morose, dying life of lame, deaf, and blind old age, worn out with intemperance." Howard, the philanthropist, fasted one day in the week ; and Napoleon, when he felt his system unstrung, suspended hia meals, and took exercise on horseback. Nothing can be plainer than the duty of fasting, when the stomach, having bevt\ overworked, is disinclined to receive food. Brutes in- variably follow this suggestion of nature ; they never eat when sick, — probably because they have no silly nurses to coax them to swal- low stimulating aliments. The habit of putting high-seasoned food into the stomach when it is inflamed and feverish, is about as wise as directing streams of blue, violet, or red light into the eye when it is red and swollen with inflammation. Tea and Coffee. It is proper before closing this chapter upon diet, that something should be said respecting the beverages of tea and cotl'ee. Some twenty years ago, more or less, a meeting was held by the leading physicians of a city in the old world, in which the merits of tea and coffee were discussed. In this discussion each man first stated his experience in the use of these articles, and then con- structed what th( used tea formly it cofl'ee sh and fouii while tea was a be —that r them to to indiilf! from eve The d men who miserably no more daring it ing all m The tri of the efii waste in are used. persons, I not coflec neither. is his owi or atnios iVoiii exp( bilious iii of tea. are tracer I'm K RE ol it. In wiiiler, in itoiUiU'll, iTpellJiig ever tnan either in or lakes ; poriodieal ill nature none mor PureU •)ofh in it I'ure wall fluids is will be a by this h /rr_ HYGIENE. 85- Btructed his argument according to that experience. The amount of what the reader could learn ''rom the discussion was, that Dr. A. had used tea all his life, and been benefited by it, while cofi'ee had uni- formly injured him ; and that he thought tea should be used, while cofl'ee should be rejected ; — that Dr. B. had taken coffee at breakfast, and found it an excellent support to the stomach and nervous system, while tea had disturbed his digestion and his mind ^ and that tlie former was a beverage of excellent (jualities, while the latter was detestable; — that Dr. C. had always drank both tea and coffee, and recommended them to everybody; — and that Dr. D. had himself never been able to indulge either tea or coffee, and would have them both expelled from every liousehold. The discussion was not creditable to the learnetl and really able men who participated in it. The arguments were all based upon the miserably narrow basis of single indiviilual experiences. They were no more valid than that of the man who should hold up a shoe, de- claring it fitted his foot the best of any he ever had, and recommend- ing all men to have their shoes made upon the same last. The truth is, there is but one thing which can be affirmed universally of the eflect of tva and coffee. They both, when taken, tend to prevent waste in the body, and, consequenlly, less focMl is retpiired when they are used. This may be affirmed of them in their applicability to all persons, but nothing further. The truth is, some can drink tea but not cofl'ee, and sonie coffee but not tea ; some can use both, and some neither. Every man's susce[)tibility to the elfects of these Ix-verages is his own, as nmch as his susceptil)ility to the effects of light, or heat, or atmospheric changes ; and these etfeet.-<, j'aeli person nmst learn from ex|)erience. Cofli'e often produces, and generally aggravat«'s, a bilious habit, — an effect which eaimot, I believe, be traced to the use of tea. I hava no doubt but that many cases of confirmed dyspepsia are traceable to the use of coffee alone. Water. I'nRRR is one universal beverage; it is water. All men are fond ol it. In sickness and in health, in joy and sorrow, in sinuiiier :tii..M ' I 86 HYGIENE. procuring pure water from great distances. The strong aqueducts through which, for many miles, large streams of water are at this day poured into fallen Rome, attest the freeness of the expenditures she made for this purpose in the day of her renown. We may pity the ancient Romans for being governed in their military operations by the opinions of augurs ant' soothsayers, and certainly these things were silly enough ; but in other things, at first view equally superstitious, they showed practical wisdom. Vetruvius reports that in selecting the sites of their cities, they inspected the livers and spleens of animals to learn the salubrity of the waters and the alimentary productions of the region. The size and condition of these organs do in fact indicate the nature of the pasturage and the qualities of the wat(?r with which animals are supplied. No people can enjoy good health, when sub- jected to the double influence of bad water and impure air. Division of Water. — The simplest division of water is into two kinds, soft and hard. Rain, river, pond, and snow water is soft : well and spring water is generally hard. Soft water contains but little impu- rities, and when used for washing, forms a good lather with soap. Hard water contains at least one of the salts of lime, often Uiore ; mixed with soap, it curdles and turns white. The reason of this is, that the oily acids of the soap unite with the lime, and form a com- pound which the water will not dissolve. Such water is not suitable for domestic purposes. Cliemical Nature of Water. — Water contains, reckoning the ele- ments of which it is composed in volumes, one volume of hydrogen, and half a volume of oxygen. These two gases, the unlearned reader will please to remember, are highly subtle bodies, not visible to the eye ; and yet, when chemically united, they form a lic^uid which covers two-thirds the entire surface of the globe, — floating upon its bosom the navies and merchant ships of all nations, and, by its un- measured depths, and vast breadths, and sublime movements, fills the thoughtful mind with conceptions of creative Power, which words never attempt to oppress. Should the two gases which compose this vast body of water cease to love each other, and fall asunder, the first lighted taper would set the world on fire, and not a living being upon its surface could escape destruction. Impurities iu Water, — It is not surprising that a fluid with as great a solvent power as water, should often dissolve and hold in .solu- tion a great many impurities. In passing along through the earth, before it comes up in springs and wells, it is filtered through various mineral earths, and becomes contaminated accordingly. In running through beds of limestone, it takes up a little carbonate of lime. Salt beds impart to it common salt (muriate of soda), while sulphur and other ores tinge it with salts of various kinds. Water from the wells of Boston, formerly used by the inhabitants, was largely imj)regnated with common salt, and other mineral substan- ces. So marked was the saline taste, from this cause, that the New- Yorkers and Philadelphians used to say the Bostouians, when visiting their cities, had to salt their water. ' HYGIENE. 87 Cocliituflte Water. — These wells, which so long yiehled up brack- ish water to offend the palates of strangers, are now abandoned, and Boston is blessed by a copious stream of pure soft water, drawn through a fine aqueduct from Cochituate Liike, twenty miles distant This water is distributed to about every house and shop in the city. The result is, that the health of the citizens has been materially improved. Fevers, particularly thosti of the typhoid type, have dimin- ished, both in preval«;nce and fatality. The decaying vegetable and animal matter, so nmch of which gets into the connnon sewers, and which, in former years, sent up poisonous gases to attack tin; life of the citizens, are now washed away by the soft water, which is daily and hourly dropping through the sinks of all the dwellings of the city. Scliiiylkill niul Crotoii Wrtters. — The Schuylkill water, introduced into Philadelphia, and the Croton, brought from quite a distance to New York, are both good waters ; though neither, as chemical analy- sis has shown, is (juite as jmre as the Cochituate, of Boston. Lead Pljies. — In each of these three cities, water is conveyed through the dwellings in leaden pipes, — a practice fraught with a danger to which the inhabitants should not expose themselves. That lead does often become oxidized and impart its ])oisonous properties to water when long in contact with it, is a well-known fact. Let a number of persons drink every morning from the first water drawn from the pipes, and a portion of them will be attacked with some form of lead disease. The pipes should be emptied every morning, before using the water for domestic purposes ; and then, it is true, •there is little danger. But where the work in the kitchen is done by hired persons, who have no appreciation of the danger, how is it to be known whether this act of safety is always carefully performed ? Water pipes should certainly be made of some other material. Physical and Other Properties of Water. — Good water is without smell, is perfectly clear, and in the mouth, has a soft and lively feel. When poured from one vessel to another, it should give out air- bubbles. Boiled and distilled waters have a vapid, flat taste. This is owing to their containing no carbonic acid gas or atmospheric air, — these being driven otf in the act of boiling and distilling. A hun- dred cubic inches of good river water contains about 2^ of carbonic acid, and 1^ of common air. Carbonic acid is what gives to mineral, or soda water, its brisk and even pungent taste. Without a portion of this acid and atmos- pheric air, water is perfectly insipid, and not fit to be used as a bev- erage. Hence, if it be boiled or distilled to clear it of earthy matters, we must expose a large surface of it trf the air, and shake it, that it may re-absorb from the atmosphere, what it has lost, and thus recover its taste. Rain Water is tlie Result of Distillation on a large scale, and wouid be insipid, like other distilled water, only that, after being distilled ctl Jf 1 .LM. di m I :l i !> ,, I <1 88 iiygip:ne. from the waters upon the surface of the earth, it recovers*, while as- cending as vapor, the carbonic, acid and atmospheric air. Fishes breathe air as well as land animals, and hence, lakes upon the tops of high moimtains, where but little oxygen can be absorbed into the water from the air, are not inhabited by the tinny tribes. Tlie SnltiiesH of the Oceiiii is simply the accumulation of the saline substances washed out of the bowels of the earth. The water which for thousands of years has been distilling off as vapor, from the surface of the ocean, is nearly pure. Being carried by the winds to the continents, it falls as rain, sinks into the earth, is fdtered through mineral substances, comes to the surfaces in springs, is colh?cted into rivers, and, with all its freight of mineral salts, is borne back to the ocean. Everything that water can dissolve, and carry dt)wn from the continents, nnds a great depository in the ocean; and as this has no outlet, the accumulation must go on without limit. Rivers which flow into the ocean, contain from ten to fifty grains of salts to the gallon, — composed chiefly of common salt, sulphate and carbonate of lime, magnesia, soda, |wtash and iron ; and these are the constituents of sea-water. The time must come, in the history of our globe, when these salts will render the water of the ocean so dense that a man caa no more sink in it than a cork can sink in fresh water. Cleaiisjii«ir of Ini|rare Water. — Impure waters should be cleansed before being used for domestic purposes. Distillation is the most perfect method of purification. Filtration through sand is a good method. It removes all suspended vegetable or animal matter, and all living animals. Boiling likewise kills all animals, ami throws to the bottom carbonate of lime. It is this which constitutes the crust which lines tea-kettles in all regions where limestone exists. Settlers in a new country, should make it a prime object to find good water. This is of great moment. Their own health, and the health of their posterity is dependent upon it. Any soil, good or bad, is not worth half price, if it yield impure water. RensoiiH for Prizing Water. — Finally, we ought all to prize water very highly, for it composes nearly eight-tenths of our entire bodies^ in- cluding our flesh, blood, and other fluids. Nay, we owe to it the very softness, delicacy, and smoothness of our persons. Our muscles, nerves, blood-vessels, glands, cartilages, etc., all play smoothly upon each other in consequence of water. Take all the water out of us, and we should be dry sticks indeed. All our comelinc&s would be gone. Nobody would or could love us. We should be walking reeds, shaken and sported with by every wind. Let us never forget how much we are indebted to water. Exercise. Animal life is conditioned upon exercise. Without it health can- not exist, or life itself be continued for any great length of time. 1 ^H Proper 1 ^^m it. It ex the motic 1 ^H the ccntr ' ■ nutrition H tions and 1 A disti sarv to th ■ finest tail ■ for wit ho 1 ^H energy; i great tale a larger h ! ^1 The ar 1 ^H facilities 1 ■ H fetters of 1 ^H by leapin fetters of ; 1 Must b 1 lar, — not morrow ; 1 with intei ' 1 Must be H some pics : ■ should ca an interci ! ^1 pursuits. ^^H to a solits- j H HI list IK ; H to produc ' H ercise, esp ' H little. 1 HB No clot ; H ofl" by sitt H low this \ ■ Xot to B mediately R DJained. Hi muting, wi H V liat tho!- H ■ot labor B Active H passive. ^B etc., are a ^B passive. ^v active anc H A few H practical ' . |i HYGIENE. 89 Proper exercise communicatcH motion to every part Husceptible of it It expaiuln the breast, contracts and relaxes the muscleH, quickens the motion of the bl,. ling, dancing, gardening, various sports, etc., are active. While iai!i)t^, swinging, and riding in carriages, are passive. Riding on hon -bac'^ is of a mixed nature, — being both active and passive. A few remarks upon these several kinds of exercise, will have a practical value to some ot the readers of these pages. k^V^ I-, Ki'M IMAGE EVALUATION TEST TARGET (MT-3) 1.0 !!: I.I 11.25 ■ 50 ™^« •^ 1^ 12.2 •",3, L 1^ li£ IIIIIM 18 14 111.6 ^ "w /: >/ > Photograpiitc Sciences Corporation 33 WEST MAIN STREET WEBSTER, NY. MS80 (716) 873-4503 m w ...... . _ 1 1 96 HYGIENE. little fire i» the bed-chamber, in cold weather. For those in good health, a cold room is preferable. Open Windows in Sleepin^^ Rooms. — In the hot weather of sum- mer, it is better to keep the windows open to some extent, through the night, but not on opposite sides of the room so as to make a draft across the bed. There is a difference of opinion as to the safety of this practice," but the experience of those who have used it prudently and perseveft ingly, has generally sanctioned its employment. It is presumed that night-air is made to be breathed ; and if we breathe it habitually, there is no good reason why it should be considered hurtful. At all events, we have got to do one of three things, — either breathe it, or be poi- soned by air which is breathed several times over, or use very large sleeping rooms, and thus lay in a stock to last over night. An Open Firepluce in a bed chamber will do much towards its puri- fication. It carries off foul air. But many persons board up this outlet as if bad air were a friend, with whom they could not think of parting. At the same time, they will carefully close all windows and doors, as if fresh air were an enemy not to be let in. Beds. — It is a pleasant thought that while so many things which injure health are coming into fashion, some which have a like effect are going out. Among tlr^ injurious things which are silently with- drawing, are feather beds. In earlier times, a bed made of eider-down was thought to be a great luxury, to be carefully preserved, and handed down from mothei to daughter. Beds made of ht ns' feathers, and other coarser kii ds, were thought to be only fit for children. With «lue deference to these earlier judgments, it must be said that feather beds, whether downy or coarse, are not even fit for children. They are composed of ani- mal matter, and by a slow process of decay, are always, when stirred, sending up an exhalation which it is not healthful to breathe. By their softness, too, they increase the general tendency to effemi- nacy. In warm weather, they are too heating. To sink down into them, and lie nearly buried all night, is to insure a feeling of lassitude and debility in the morning. Only the strongest persons can endure it without being made conscious of the evil effects. Beds mnst not be too Hard. — On the other hand, it is almost equally unwise to choose a bed of absolutely unyielding hardness. When very tired, we may rest even upon a board; but sleep will go -''rally be more sound as well as refreshing, if the bed be some- what J 'elding. The hair mattress is the very best bed yet used. It ia healthful and easy. No person once accustomed to it, will ever return to feathers, bi summer, it is a luxury ; in winter, it is suffi- ciently warm, though a little more covering is needed than with feathers. Beddins:. — In hot weather linen sheets are preferable to cotton, and of course will be used by those who have ample means. But HYGIENE. 97 cotton ones are good enough, and in winter are decidedly the more desirable of the two. Cotton is best, too, for those who sufler with rheumatic atiections. For external covering, comfortables are objec- tionable, becausf' they do not let the insensible perspiration pass off as freely as it si'ould. They are light, however, and so are rose biaiiivcts, which have the additional good quality of being povoua. We should sleep under as few clothes as possible, consistently with comfort. Xiftiit Dress. — The flannel, cotton, linen, or silk, vorn nrent positions, and to change occasionally from side to side. U|on the back is not so easy a position. To lie in this way obstructs the cir- culation of the blood, by the pressure of the stomach, bowels, etc., upon the large blood vessels which |)ass down and up in front of the back bone. It. is very tiresome and injurious to lie with the hands above the hea .' Amount of Slee|>. — The average amount of sleep required by per- sons in health, is from seven to eight hours. Occasionally we find persons who get along very well with six, or even five hours ; while some, even in health, require nine. There is no absolute standard for all persons, in the amount of sleep, any more than in that of food. It depends on the temperament, th^ constitution, the amount of exercise, and the exhausting nature of the mental application. The object of sleep is to repair the ejiergies ; the extent to which they are wasted, and the recuperative powi?r possessed, will measure the amount required. Late Suppers. — These are a bar to all sound and healthful sleep. The last meal should always be taken at least three hours before re- tiring, and should be light. During sleep, the stomach should have a chance to rest. It will work the better on the morrow. Some per- sons boast that they can sleep perfectly w^ell after a heavy supper. Perhaps they can; but, as Franklin has wisely suggested, they may by and by " have a fit of apoplexy, and sleep till dooms day." This will be sleeping too ivefl ! Preparation for Sleep. — Dr. Franklin left behind the record of a wise life, as well as many excellent moral and philosophical direc- tions. A good conscience was his prescription for quiet sleep and pleasant dreams, — a most excellent direction. Sleep is promoted, 13 111 r i': It ii llj- i 98 HYGIENE. too, by withdrawing the mincJ, a short time before retiring, from al\ hard study, and exciting themes of conversation ; and turning it to calmer subjects of reflection, such as the ...--al attributes of God, — particularly his love and paternal character. Objects of Clothing. The clothes we wear are intended, or should be intended, to secure three objects, — warmth in winter, coolness in summer, and health at all times. It has already been shown that our bodies are. warmed by their own internal fires. In the lungs, in the skin, and indeed in all parts of the body, oxygen unites with carbon and other combustible mat- ters, producing heat in the same way that it is produced in a grate where anthracite coal is burned ; and as our temperature always needs to be kept up to about 98*^ of Farenheit, it follows that this combustion must always be going on. Now, the atmosphere which surrounds us is always receiving into itself the heat which comes to the surface of our bodies, and thus robbing us of our warmth. In summer, the atmosphere, full of the rays of a burning sun, may impart heat, instead of taking it away; while in winter, it takes more than it gives, and would cause us to perish with the cold, were it not for the protection afforded by our clothing. Clothes, of course, have no power to manufacture or impart heat. They only retain, and keep in contact with our bodies, that which is generated within us. If we have on a single garment which is made tight at the bottom and top, so that no current can pass up or down, there will be a layer of air between it and the body, which, becoming immediately heated, and being retained there, helps keep us warm, or rather, prevents us from being cold. With every additional garment put over this, there is another layer of heated air, adding still more impenetrable guards against either the intrusion of cold, or the escaj)e of internal heat. Bad Conductors of Heat. — But, that our clothes may thus retain our warmth, and prevent its dispersion, they umst be bad conductors of heat, — that is, they must not readily take up the heat and convey it away from the body. They must slowly absorb the caloric into their own substance, and then retain it tenaciously. Linen, which is so universally popular in temperate climates, as an article to be worn next the skin, is unfortunately a good conductor of heat. It does not afford a warm garment. It conducts heat rapidly away from the body. Hence it always feels cool to the touch. It is really no colder in itself than other kinds of cloth, but it is solely the rapidity with which it conducts heat away from the body, that gives it the feeling of coldness. It has other qualities which compensate, in some Fro. 67. measure, for this defect. The fibres of which it is composed, are %f: HYGIENE. 99 Fio 08. roun«l and pliable, whii-li inako linen cloth snuujtli and soft, and the soMsation.H produced by it, upon th»! s*l\in, altoi^ether agreeable. Figure 67 represents a fibre of linen, as it appears under a niieroscopt! wliieh magnilies it 155 times. Cotton is warmer than linen, because it is a worse cnmluctnr of heat. The perfection to which its manufacture has been carried, makes it almost a rival of linen in softness and ])liability. It do<^8 not absorb as much moisture as linen, and therefore better retain* its powers as a non-conductor. But then the libres of cotton are not round and smooth, like those of linen, but flat and spiral, with sharp edges Figure 68 represents two of its fibres, iiiagMilie. 155 times. This renders cotton irritable to sonu; very delicate skins. This is the reason why linen is better than cotton for binding up wounds, where there is tenderness of the surface. Silk has a round fibre, like linen, which is even softer and smaller. It absorbs less moisture than cotton, and in its power of communi- cating warmth, it is superior to both the preceding. It forms the most desirable fabric for clothing that we have ; but its cost makes it inaccessible to the great body of the people, except as a holiday dress for the ladies. Its culture in our own country, if once exten- sively established, would be a source of national wealth. The Fibre of Wool is quite rough, almost scaly, and highly irritative to delicate skins. Figure 69 shows fibres magni- fied 310 times. It is not possible for some per- sons to wear it next the skin. But where this cannot be done it may be worn outside the linen or cotton; and being a good non-conductor^ it will in this way preserve the warmth of the body, without either irritating the skin, or disturbing its electricity. Wool, in cold climates, is one of the very best materials of which clothes can be made. In New England, and, indeed, in all cold and temperate regions, it should be worn by delicate persons, in the form of thick or thin garments, al! the year round. It does not readily absorb moisture, and is a dry, warm, and wholesome material for clothing. Hair. — Though not precisely in the line of these remarks, hau may as well be introduced here. Wool is in fact hair. Every part of tne skin, with the exception of that upon the soles of the feet, and the palms of the hands, is intended to produce hairs. On most parts of the body, they are short and fine, hardly rising above the surface. Upon the head and the face, they grow to considerable length. Hair, like wool, is a bad conductor of heat ; and, as growing upon the head and face, is doubtless intended for some useful purpose. That it was designed as a warm covering, can hardly be doubted. The beard, when permitted to grow, is a natural respirator, guarding Fio. 69. -m : rlnf". rl! M ■H: .\ . ■' ,'t M M ml 100 IIYOIKNE. the lungs against cold and dust. Mr. Chadwick noticed that black, smiths who allowed their beards to grow, had their niustachioa discol- ored by iron dust, which lodged among the hairs, and very justly in- ferred that the dust must have found its way into the lungs, and done mischief, had it not been arrested by this natural respirator. That the beard, when long, does ward olt" a great many colds and thvoat ails, is too well known to be denied, it has required moral courage on the part of those who have broken away from the univer- sal practice of shaving, for which they should be hon- kio. 70. ored rather than ridiculed. For those who do not suH'er from throat or lung complaints, especially if they are jetting advanced in life, it may not be thought worth while to abandon the razor. Vet the change would not be regrettetl. Figure 70 is a human hair, magnitied 250 times, show- ing its scaly surface. The Color of our Clothiiijr is a matter of some moment. The dark colors absorb the light, the sun's rays, and heat, much more than the lighter ones ; and as those bodies which absorb heat well, are like- wise good radiators, the dark colors have the hig'hest ratliatiriff power. White reflects heat, and rays '^f light, and is a bad absorber and bad radiator. In slimmer it prevents the sun's rays from passing inward to heai; the body, and in winter, interrupts the heat of the body in its passage out. In summer, it makes the coolest garment ; in winter, the warmest one. These facts can be very simply illustrated, by lay- ing, side by tiide, upon the snow, when the sun shines, two pieces of cloth, the one black, the other white. Lifting them up, after a time, the snow will be found considerably me/ted under the black cloth, but not under the white. It is now seen that the object of clothing is not to impart heat to the body, but to prevent its loss ; that it is not to create it, but to furnish the occasion for increasing its degree. It appears further, that clothing protects the body against the evil effects of changes of tem- perature, and that white garments, by reflecting, instead of absorbing heat, guard it against the heat of summer. Clothhi? should be Porous. — All articles used for garments, should be porous, and permit the free passage of insensible perspiration. The skin receives oxygen through its pores, and gives back carbonic acid. It performs a sort of subordinate respiration. India rubber garments worn next to it, interrupts this, and must do mischief. Shoes made of th'.o material, soon cause the feet to become damp and cold. The dampness is occasioned by the insensible perspiration, which cannot escape through the rubber. Such shoes worn in the open air, should be immediately taken off* on entering the house. Thin Shoes. — The defective way in which American females pro- tect their feet from cold and wet, is a sore evil ; and. he who persuades them to adopt a wiser fashion, and cover their feet with better guards against colds and consumptions, will deserve the gratitude of the nation. We are in many things too fond of copying foreign fashions : 1^ 'A mm JOW- but if our ladies would, in this matter, follow tho excellent example of English women, they would live longer, and leave a hardier pos- terity behind them. The shoes worn by our females, high and low, rich and poor, are not thick enough to walk with safety upon a painted floor, hardly upon a carpet in an unwarmed room ; and yet tliey walk with them upon cold brick side-walks, upon damp and frozen ground, and even in mud. The result is, that they sufTer from colds, sore throats, pleurisies, lung fevers, sjippressions, inllammations of the womb, and many oilier ailments, which in early life, rob them of their freshness and beauty, of their health and comfort, of their usefuhu-ss to tlicir household and the world, and leave them helpless in the arms of their friends, with a patrimony of snflering for themselves while they live, and a legacy of dis(!ase to hand down to their children. Wo ild that they were wi.,e in season I Some, to their honor be it suii have already adopted a safer course. It is hoped the evil will be gnulaully corrected. IVever afteiiipt fo iiioiihl the Form by IKess. — Parents commit a great error when they atti^mpt to rno' ' i the iorms of their children, particularly their daughters, by their dress. This cannot l)e done. 1. i^ the work of nature, and she wants nc assistanc(^ in it. Tiii; great object of dress in childhood as \yc11 as in adult life, is to pro- mote health. Willi litis, there is not much ditliculty in |)reserving tlie symmetry ; irillioiU il, deforuuty is almost a mailer of course. The fact cannot be too often repeated, nor too seriousl) urj.'ed upon parents, that while the foundation of all graceful and just proportion of the ditlerent parts of the body nuist be laid in inlancy, it cannot be done by tight bands, and ligatures upon the chest, and loins, and legs, and arms. Upon all these points, the garments of children should set easy, leaving the muscles at liberty to assume the line swell and dev«'lopment which nothing short of unconstrained exercise can give. Could infants tell all the horrors they suttL'r from the re- straints put upon them by tight dresses, it woukl make niany a moth- er's heart bleed. In these brief remarks, the principles are given which should guide us in the selection of our clothing, able, very easily to fdl up the outline. The intelligent reader will be Bathing and Cleanliness. Aristoti.k calls cleanlmess one of the half virtues ; and Addiscu, in the Spectatt)r, recommends it as a mark of politeness, and as analo- gous to purity of.mind. Both in the Jewish and Mohanunedan law, it is enforced as a part of religious duty. Its recpiirement as a prerequi- site to christian communion, would l)e wiser tlian the demands some- times made. A dirty Christian may perhaps be found, but not among those who mean to be intelligent. The importance of keeping the skin clean is not generally appre- ciated. The motive for cleanliness is often a lower antl meaner one ■:3E=sB!r!;sn=!= than should be allowed to have place in the mind. Many persons would ' >e mortified to have their hands, or face, or neck dirty, who do not wash their w'.iole body once a year. That they may appear wet in the eyes of others, is the only motive with such for keeping clean. Offices of the Skin. — If we look a little at t!ie offices of the skin, we shall better understand the need of keeping it clean. The skin is not merely a covering to protect us from the wealner. It is a living structure, curiously wrought, with a large extent of sur- face, and having important duties to perform in the animal economy. Its structure is more particularly explained under the head of " Anat- oiny" and " Skin Diseases." It has been already said, that it helps the lungs in breathing. It does many other things on which the health is dependent,. Xumbcr of Perspiratory Tubes. — The skin performs several kinds of secretion, — that is, it separates several things from the blood, — one of which is the perspiration, or sweat. The sweat is formed in small glands, situated just under the skin, and is brought to the surface in small ducts, or tubes, like the hose through which firemen throw water. These little tubes are spiral, as seen in cut 44, and run ujv through the two skins. These spiral canals are very numerous, covering every part of the human frame, — there being about 2800 of them upon every square inch, throughout the body ; and as a man of ordinary size, has about 2500 square inches '^ surface, the number of tubes in the skin of one man is seven millions. The mouths of these tubes are called the pores of the skin. Each one of these tubes is extended just below the skin ; and there, among the cells where the fat is deposited, it, or rather the two branches into which it is divideXi, are wound into a coil, called the suucriferons, or sweat gland. These ducts are each about a quarter of an inch ;;• length, wliich makes an aggregate length of tubing in the human skin of about tw^enty-eigl'.t miles. Insensible Perspiration. — Through each of these seven million of quarter inch hose, there is poured out, day and night, as long as a man lives, a stream of sweat in the form of vapor. When this is thrown oil" very rapidly, as happens when active exercise is taken, it accunmlates in drops, and is called sweat. Ordinarily it does not thus accumulate ; it is then called insensible perspiration, — not being ircognized by the senses. This transpiration may be proved very beautifully by inserting the naked arm into a long glass jr.r, and closing up the space around it at the mputh so that no air can get in. The inside of the glass will Foon be covered with a vapor, which will grow more and more dense until it is converted into drops. Boerhaave says : " If the piercing chill of winter could be introduced into a summer assembly, the insensible perspiration being suddenly condensed, would give to each person the appearance of a heathen deity, wrapped iu bis own sepa- rate cloud." Now, this continual exudation of sweat through these millions of tubes is for a wise and necessary purpose. It is to take out of the blood and other Huids various salts, which would do mischief if allowed to remain longer, and particularly carbonic acid, which is poisonous, — the same matters, in fact, which are thrown out by the lungs. The skin, in truth, is a kind of helper of the lungs ; and a lady, by covering herself With garments which have no pores, and will neither admit air nor let off insensible perspiration, may be stran- gled almost as certainly as by putting a cord around her neck, and closing her windpipe. Almost twice as much tiuiJ passes otV through the skin as through the lungs. Keep the Pores 0|ieii. — It is obvious from what has now been said, that the pores of the skin should be kept open to preserve health. When bathing is neglected, and the under garments are not changed sufliciently often, the insensible perspiration accujnulates and dries up upon the skin, mingling with the oily matter secreted by the oil glands, and with the shreds of the scarf skin, and forming a tenacious gluey matter, which closes up the pores. By this misfortune, that large quan- tity of worn-out matter which usually goes oil' with the fluid through the pores, is retained to poison and embarrass the living current of blood, or seek an outlet through lungs or kidneys which are already burdened with quite as nmch as they are able to do. How impor- tant, then, that these channels through which the body is purified, should be kept open ! that the skin should be kept healthy and in working order ! The Bath, the Great IMirifier. — But this can only be done by daily washing. The bath is the great purifier of the human skin. The antiquity of bathing is very great. The practice is supposed to reach back to the infancy of the race, or certainly to a very early period. The inhabitants of middle Asia are said to have been the first to use the bath for the specific purposes of purification and health. Domestic baths are represented as having been used by Diomed and Ulysses. Andromache prepared warm water for Hector on his return from battle. Penelope banished sorrow by unguents and baths. The Baths of the Wedes, the Persians, and tlie AssjTians were much celebrated. Alexander, though familiar with the voluptuous baths of Greece and Macedon, was astonished at the magnificence of those of Dnrius. Itoman Baths.- — As luxury and refinement advanced, the means of luxurious bathing were multiplied, until establishments were built by the Romans, the very remains of which exttite wonder at this day. Among these are the ThernifB of Agiippa, of Nero, of Vespasian, of Titus, etc. One of the halls of the building constructed for baths by Diocletian, forms at this day the church of the Carthusians, one of the most magnificent temples in Rome. IVuniber and Character. — According to Pliny, baths were intro- duced into Roni9 about the time of Pomjjey ; their first erection Dion : 1 ^ '1 1 hf II '1 i t 1 .1 104 HYGIENE. attributes to Maecenas. Agrippa increased their number to one hundred and seventy ; and within two hundred years they were mul- tiplied to about eight hundred. These establishments were so vast that one writer compares them to provinces. They were paved either with crystal, or mosaic, or plaster, and were adorned by sculpture and painting to the very highest degree. They added not merely to the health and luxury of the people, but contributed to their culture in the highest departments of art and taste. IVnnies of Biitlis. — To the apartment of their dwelling in which •hey washed their bodies in warm or hot water, the Romans gave the iiiMie of balneum^ or bath; to the public establishments, that of balnea, or baths. The apartment which held the vessels was called vasariuni. hi this were the three immense vessels which contained the cold, warm, and hot water. There were instruments of bone, ivory, and metal, for scraping the skin, with a groove in the edge, through which the impurities of the skin mi^-^ht run off. On the north front of *^he thermfB was a reservoir of cold water • large enough for swimming, called by Pliny the younger,' baptisteium. In the centre was a spacious vestibule, and on each side, warm, cold, and vapor baths, with apartments for cooling, dressing, and refresh- ments. There was the fri<>'idaiiim, a vaulted room, a cooling room midway between the warmer and the open air ; the tepidanum, with a temperature widway between the above and the hot bath ; and the co/idarium, or the vapor bath. Then there was the room where the body was rubbed over with a great immber of ointments and essences of the most precious kinds ; and another in wmch it was sprinkled over With powder ; and also a room which held the clothes, in which the bathers undressed and dressed at pleasure. All these apartments were double, the two wings being appropri- ated to the sexes. Open to uU. — These baths, thus numerous and magnificent, were open to all classes of the people, and contributed largely to the gen- eral health and physical endurance for which the Romans were con- spicuous. The Bntli ^'ejclerted iinder the Chrisfijin System. — When Jesus of Nazareth came into the world, he found man's nature cultivated in a most defective way. The moral element had sunk down to the low- est place, while the physical had risen to the highest, — just the reverse of the true order of things. This Divine Teacher came, not to re- commend a neglect of the body, but a new cure for the imperishable part. Mankind were for the first time systematically taught to forgive injuries. Prostrate liberty, and degraded woman, became the wards of Christianity. Unfortunately, under the new order of things, the lower element of man, which had been exalted and worshipped, was cast down and abused. What the Pagan had pampered, the Christian persecuted. The body, whi(;h had been bathed, and scrubbed, and anointed, and HYGIENE. 105 perfumed, was thenceforward, in consequence of the improper inter- pretation of certain texts, scourged, and fasted, and clothed in rags. Thousands believed, and thousands do to this day, that to torment the body is to please God. Under this feeling, the public and private baths were neglected ; and to this day, no christian nation has fully appreciated the necessity of cleanliness, and of sanitary measures for the maintenance of the public health. To a considerable extent, the body is still under disabilities ; still the subject of persecution ; and where this is not the case, it is too often regarded only as a loose out- side garment, to be thrown over the traveller to the celestial city, and is expected to be well soiled with mud and dust. The teachings of ,lie Great Master will by and by cease to be perverted, and will be applied to raise up man's body, as they have raised his mental and moral nature, and will make a well-developed and harmonious being. In the mean time, it is the duty and the privilege of the physician to urge a return, not to the magnificence of the ancient regimen for training the body, but to its real efficiency in a simpler form. Cold Batllillj^. — Water applied to the skin at a temperature below 75° of Farenheit, is called a cold bath. If appl'ed to a person with sufficient constitutional energy to bear it, if is a decided and very powerful tonic. By this is meant that it promotes the solidity, com- pactness, and strength of the body. The first effi^'ct of the application of cold water to the ski i, is the sudden contraction of all its vessels, and the retreat of the blood towards the internal organs. The nervous system, feeling the shock, causes the heart to contract witli more energy, and throw the blood back with new force to the surface. This rushing of the blood back to the skin, is called a reaction ; and when it occurs with some energy, it is an evidence that the sys- tem is in a condition to be much benefited by the cold bath. When this does not take place, but the skin looks shrunken, and covered with "goose flesh,"^and a chilliness is felt for a longer or shorter time after bathing, then the inference should be, either that the water has been used too profusely, or that the bather has too little reactionary |)ower for this form of the bath. -The latter conclusion must not be iKicepted until cold water has been tried with all possible guards, — tiuch as beginning with tepid water, and gradually lowering the tem- perature ; bathing for a timt^, at least, in a warm room ; beginning the practice in warm weather ; and applying the water at first with a Bponge, out of which most of it has been pressed by the hand. With some or all of these precautions, most persons may learn to use the ex)ld bath. It is always to be followed by brisk rubbing with a coarse towel or flesh-brush. The Spondee Bvitli. — A wet sponge is the simplest, as well as the best mode of applying water to the surface of the body. With persons who are feeble, a part only of the body should be exposed at a time, — which part, having been quickly sponged and wiped dry, should be covered, and another part exposed, and treated in a like manner. In this way, all parts of the body may successively be H' i> I ,ti i!{ I i t! 1 1 1 ' subjected to the bracing influence of water and friction, with little risk, even to the most delicate, of an injurious shock. The only fur- niture required for carrying out this simple plan of bathing, is a eponge, a basin, and a towel. There is no form cf bathing so uni- versally applicable as this, or so generally conducive to health. The Shower Bath requires a brief notice. The shock to the nervous Bystem produced by it, is much greater thaii that from sponging Beside the sudden application of coldness, there is a concussion of the skin by the fall of the water. This form of the bath is excellent for those who are strong and full of vitality, but is fraught with some danger for the feeble and delicate. This, however, depends on the judgment with which it is used. In the form of a delicate shower and with tepid water, the frailest body might bear its shock. The Warm Bath. — A temperate bath ranges from 75° to 85° ; a tepid bath, from 85° to 95° ; a warm bath, from 95° to 98° ; a hot bath, from 98° to 105°. A warm bath is of the same temperature with the surface of the body. Of course it produces no shock. To those who are past the meridian of life, and have dry skins, and begin to be emaciated, the warm bath, for half an hour. tvVice a week, is eminently serviceable in retarding the advances of age. It is a mistake to suppose the warm bath is enfeebling. It has a soothing and tranquillizing effect. It renders the pulse a little slower, and the b-feathing more even. If the bath be above 98°, it becomes a hot one, and the pulse is quickened. The temperature of the warm bath, as of the cold, should be made to range up and down according to the vigor of frame, and the circu- lation of the individual. The aged and the infirm, whose hands and feet are habitually cold, require it to be well up towards the point of blood heat. The pulse should not be made to beat faster by it, nor should sensations of heat or fulress be induced about the temples and face. The Vapor Bath. — This differs from the warm bath in being ap- plied to the interior as well as to the exterior of the body. The warmth is inhaled into the air tubes at the same time that it env^'l- ops the external person. The first sensation of the vapor batli is oppression, and causes some difficulty of breathing ; but this pussei of!" as soon as the perspiration begins to flow. From the slciiin chamber, the bather should step into a tepid bath, and after remain ing a short time in this, wipe himself thoroughly with dry towels. Cold Affusion immediately after either the warm or the vapor bath, is excellent. In Russia it is common, after the vapor bath, to pour upon the head of the bather, a bucket of warm water, then one of tepid, and lastly one of cold ; and to finish with giving him a good towelling. It is even said that the natives leave the steam and the hot bath, and roll themselves in the snow. No danger need be feared from cold affusion when the skin is red and excited by the warm bath, provided the nervous frame is not in a depressed condition. If the body is chilled, and the nerves pros- trated by may do § water app nothing b tage on ri time is ai power is i Reactio importanc and imprc motion ol the skin. Variou! it by a kii attendanti warm wa He cracki then plac seizes you vertebrte, parts, thei "This pn hour, aftei being." 1 « If life b with whic that, in th number oi Tlie Coi appliance! tion. Fo the bathei duces pal) the reacti( Restora tlie bath i among ai s()\irce of IH'ople wi The atter has a bit < that watt and physi should CO times be i A peop very natu clean am HYGIENE. 107 trated by disease or fatigue, the application of cold water to the skin may do great mischief, and should in no case be hazarded. Cold water applied to a hot skin, cannot do harm ; to a cold skin, it can do nothing but harm. Hence, the cold bath may be used with advan- tage on rising in the morning, while the body is warm. Another good time is at ten or eleven o'clock in the forenoon, when the nervous power is advancing towards its height for the day. Renctioii Necessary. — As a means for promoting cleanliness, the importance of the bath can hardly be overstated. For tlie support and improvement of health, it is equally important. But for the pro- motion of the latter, one prerequisite is essential, — the reaction of tlie skin. Various means are resorted to, to secure this. The Hindoos secure it by a kind of shampooing, thus described by a writer : " One of the attendants on the bath extends you upon a bench, sprinkles you with warm water, and presses the whole body -in an adminible manner^ He cracks the joints of the fingers, and of all the extremities. He then places you upon the stomach, pinches you over the kidneys, seizes you by the shoulders, and cracks the spine by agitating all the vertebrte, strikes some powerful blows over the Heshy and muscular parts, then rubs the body with a hair-glove until he perspires, etc." "This process," says the writer, "continues for three-quarters of an hour, after which a man scarcely knows himself ; he feels like a new being." Sir John Sinclair speaks thus of the luxury of the process : "If life be nothing but a brief succession of our ideas, the rapidity with which they now pass over the mind would induce one to believe that, in the few short minutes he has spent in the bath, he has lived a number of years." Tlie Course Towel, the horsehair glove, and the flesh-brush are the appliances commonly used for stimulating the skin, and causing reac- tion. For tender skins, the towel is sufficiently rough. With this the bather should rub himself, unless he is weak and the exertion pro- duces palpitation. The muscular exertion necessary for this will help the reaction. Restoration of the Bath desirable. — It is greatly to be wished that the bath might be restored to something like the importance it held among ancient nations. It is a luxury, a means of health, and a source of purity both of body and of mind; for the morals of any IH'ople will rise where the use of the bath is regular and habitual. The attempt to cure all diseases by what is called the " water-cure," has a bit of fanaticism about it, which will cure itself in time. But that water, used judiciously in the form of baths, is a potent moral and physical renovator of the race, is not to be doubted ; and this should commend it to all sensible people, even though it should some- times be abused by excess, as all good things are. A people with clean hands, and clean bodies, and clean health, will very naturally come to like clean streets and clean cities, and finally, clean consciences. A fondness for cleanliness in one form, almost 3' ' I, I ' i I ! t 1 !, ' ' I ip ! I!' VA ,5, i!il' III 108 HYGIENE. nece.ssarily runs into a like fondness for it in other forms, until the purifying desire pervades the whole nature, moral as well as physical. Air and Ventilation. Water and air are fluids. Water covers two-thirds the surface of the globe, having a depth, in some places, of ^.*e miles or more. Air covers not merely the remaining third of the earth, but the water as well. It embraces the entire globe, pressing alike upon land and water, and having a depth of about forUf-fwe miles. This is a sea of such magnitude, that the Atlantic or Pacific shrinks to a very small lake in the comparison. Man has his residence, and walks about at tiie bottom of this ocean. He has no means of navigating it, and, therefore, never rises to its surface ; but, with his natural eyes, and with telescopes, he dis- covers objects which lie millions and billions of iniles beyond it, and even acquires much exact and useful information respecting them. This vast ocean of air we call an almosp/iere, from two Greek words signifying vapor, and a sphere, — it being an immense fluid- sphere, or globe. Pressure of the Atmosphere. — This atmosphere presses upon man and upon every object on the surface of the earth, with a force ecjual to fifteen pounds to every square inch ; and as a man of average si/e has a surface of about 2500 square inches, the air in which he livos, presses upon him with a weight of eighteen tons. This would of course crush every bone in his body, but for the fluids within him which establish an equilibrium, and leave him unoppressed. The Philosophy of Brenthniii^ canijot be fully explained in the brief space allotted to this subject ; it is enough to say, that, upon the at- tempt being made to draw in the breath, the muscles of the breast draw up the ribs, the diaphragm or midrifl' at the same time contract- ing, — the whole movement being such as to create a vacuum in the lungs. The air, pressing upon every part of the surface, as mentioned lungs being above, instantly rushes in and fills the vacuum. The filled, the contraction of the muscles of the belly causes the dia- phragm, which has sunk down towards a plane, to rise up into the form of an umbrella, and squeeze the air out of the lungs. This is about all that need to be said of the method of getting the air into and out of the lungs. The whole process is under the con- trol of that part cf the nervous system called tlie medulla obfungala, or top of the spinal cord. Objects of Breathing. — There are at least three objects to be ac- complitihed by breathing ; the renewal of the blood and the taking of impurities out of it ; the warming of the body ; and the finishing up of the process of digestion, and the change of chyle into imtritive blood. There is no ^ood reason for attempting here to explain the last of these objects. To give any idea of the first two, it is necessary to furnish a very brief explanation of the circulation of the blood. HYGIENE. 109 Fio 71 The heart is double. There are in fact two hearts, a right and a left, joined together. The right heart receives* the blood from the veins, and forces it up into the lungs, whence it is brought back to the left heart, and by this is driven through the arteries into every part of the body. When received into the lungs, the blood is of a dark purple color, and is loaded with carbonic acid and some other impurities. It has also been deprived, during its circulation through the body, of most of its oxygen. The small, delicate vessels which convey this dark and impure blood through the lungs, pass directly over the air cells ; and at this moment the carbonic acid and water pass through the blood vessels and air cells, and are borne from the body on tiie outgoing breath ; while the oxy- gen enters. the blood through the walls of the same vessels ; and thi.s exchange, which takes place with every breath, alters the blood from a dark purple to a scarlet red. Figure 71 shows at 1, a bronchial tube divided into three branches ; 2, 2, 2, are air-cells ; 3, branches of the pulmonary artery winding around the air- cells with the dark blood to be reddened. That carbonic acid and water are borne out of the lungs with every breath, may be easily proved. If we breathe into lime-water, it will become white. This is owing to the carbonic acid in the breath uniting with the lime, and producing carbonate of lime. Then, if we breathe upon a piece of glass, it becomes wet, showing that there is watery vapor in the breath. That the blood receives oxygen from the air we breathe is proved by the fact that the ingoing breath has one-fourth more oxygen in it than the outgoing. The lungs, then, take out of all the air we breathe, one-fourth of its oxygen. If we breathe it over a second, a third, and a fourth time, it not only has less oxygen each time, and is less useful for the pur- poses of respiration, but it becomes positively more hurtful by reason of the poisonous carbonic acid which, at every outgoing breath, it carries with it from the lungs. Effect of Sleeping; in a Small Room. — Now, consider the effect of sleeping in a small room, seven feet by nine, not furnished with the means of ventilation. A pair of lungs, of ordinary size, take in, at each breath, about a pint of air. Out of this air one-fourth of its oxy- gen is extracted ; and when it is returned from the lungs, there comes along with it about eight or nine per cent, of carbonic acid. As it is not safe to breathe air containing more than three or four per cent, of this gas, the pint which the lungs take in and throw out at each breath, is not only spoiled, but it spoils something more than another pint with which it mingles; and as the breath is drawn in and thrown out about eighteen times per minute, not less than four cubic feet of air is spoiled m that time by one pair of lungs. This is two hundred and forty feet an hour ; and in eight hours, the usual time spent in the sleeping room, it amounts to one thousand nine hundred and twenty cubic feet. During the hours of sleep, theiefore, one pair of ;'ii!1'^ I i, w 110 HYGIENE. lungs SO spoil one thousand nine hundred and twenty cubic feet of air that it is positively dangerous to breathe it. In a room seven feet by ten, and eight feet high, there are five hun- dred and sixty cubic feet of air, a little more than one-quarter the amount spoiled by one pair of lungs during sleeping hours. In a room of this size, there is not air enough to last one person three hours ; and yet two persons often remain in such rooms eight or nine hours. Why then do they not perish ? Simply because no room is entirely air tight. Fortunately, all our rooms are so made that some foul air will get out, and a little that is pure will find its way in. Were it not so, no man who closed the door behind him, for the night, in a small bed- room, would ever see a return of day. Suppose fifty children are confined in an unventilated school-room, twenty feet by thirty, and ten feet high. These children will spoil about one hundred and fifty feet of air in one minute, or nine thou- sand feet per hour, or twenty-seven thousand feet in three hours, — a usual half day's session. But the room holds only six thousand cubic feet of air, — the whole of which these children would spoil in forty minutes. These simple facts show the absolute necessity of ventilation. Yet how poorly it is provided for in our sleeping rooms, our sitting rooms, our school houses, our churches, our court houses, our halls of legis- lation, and even in our anatomical and medical-lecture rooms ! In sick-rooms, ventilation sliould receive special attention. — Every disease is aggravated by the breathing of bad air. Yet It is common to close all the doors and windows of rooms where sick persons are confined, lest the patients should take cold. This is a bad practice. The sick should have a plenty of fresh air. Their comfort is pro- moted by it, and their recovery hastened. It is strange that human beings should be afraid of pure air. It is their friend and not their enemy. Impure air only should be shunned. The supply of gooside the unseen forces, which tend to oppose anu destroy our success in life. I hardly need say that money or other property should never be staked upon a game of cards, or upon any other game. Gambling is one of the meanest as well as nu>st destructive things in which men can engage. It raises the hciilthfid excitement of these innocent amusements, — innocent when pro|)erly pursued, — into raging i)!is- sions, which, when defeat comes, as coine it will, sink into remorse and bitterness as terrible as the mind can conceive. I warn young men as they woiild escape the pangs of a hell on earth, and the U)«s of character, happiness, and probably health for life, to avoid any 8ucl' abuse of cards. Chess, Chequers, etc., appeal likewise to the fondness of competi- tion, which is common to all men. But they cultivate in us a little more of the mathematical element. As they require yery close appli- cation of the mind, they are not suitable for persons of sedentary em- ployments, or whose daily avocations require a constant use of the mind. Such persons should choose lighter and more active arause- ments. Lij^hter Aniliseiiieiits. — Beside these higher amusements, there are a great number of lighter and more childish ones, which should not be overlooked. Some of these are merely physical, involving a trial of strength, tleetness, action, etc., as the games of ball, cricket, etc. Others are domestic in their nature, involving mirth, and various other of the lighter excitements, as blind-man's bufT, puss in the corner, hole in the wall, fox and geese, hunt the slipper, hurly-burly, roll the platter, etc. In fashionable American households, these simple domestic plays have in a great measure, gone out of use, — being deemed vulgar, and below the dignity of ladies and gentremen. I am sorry to say this ; for the vulgarity, in my judgment, is in those who reject them, and not in the plays. The officer of our navy, whose visit to the mansion of Lord Hard- wick 1 have spoken of on page 90, reports that on the evening of one of his visits, the play of blind-man's buff was engaged in by the whole party; and that his Lordship in attempting to make a short turn during th" play, fell upon his back, when one of his daughters, who was blinded, caught him by the heels, and being assisted by others, drew him stern-foremost half the length of the hall, amid the shouts of the whole party. This would have been deemed very vul- gar by fashionable people in this country. But to me, who am no believer in any nobility which Lord Hard wick can receive from kings or queens, this simple narrative raised him at once to a peerage in nature's realm. With* \t doubt, he is one of nature's noblemen. A man in his station, am' ^ith his wealth and temptations to snobbery, who can preserve sucn simplicity of character, must have a warm as well as a noble heart in his breast. mm^ 116 HYGIENE. Value of Domestic Amusements. — I remark here, that in all our amusements, we should am far as possible, seek those of a domestic character. They are more simple and childlike in their nature, and preserve in us, even to old age, the ueshness of feeling, and truthful simplicity, which spread so beautiful a greenness over the autumn of life. Simple domestic amusements, too, are always gotten up on a cheap scale ; they do not encourage costly extravagance, and can be indulged in by the poor as well as the rich. But more, and belter than all, they keep young men and old men, and young women and old women, at home, by making the domestic circle the centre of attraction. They draw the seekers of pleasure around the hearth-stone, instead of outward intd the world. They incline young and old to look to the family circle as the centre of the most pure, because the most simple and natural, enjoyments. They teach us to look to home as the centre of life, and to all outside as only its appendages. It has been said that homes are f^und only in England; that in other countries, life wanders, houseless and shelterless, abroad, seek- ing happiness, it knowj not where, while in England it nestles warmly in the bosom of home. To whatever extent this is true, — and I be- lieve there is truth in it, — it is owing to the simple household amuse- ments of England. An American Want. — One of the great wants of this country is a more liberal provision for amusements. We attach here too much value to wealth ; and we purt^^^ue it with an intensity altogether in- compatible with health. We cannot take time for recreation because we are in so great a hurry to be rich. • If we would save ourselves from a total wreck of health, we must takp broader and better views of life. We must value it for its solid comforts, rather than for its glitter and show. We need quite an increase in the numbe'* o^ our holidays, — days on which the people can give themselves up to sportive recreations. Some progress has been made in this dirercion of late. Washing- ton's birlli day has very nearly fixed itself among us as a holiday ; the claim of Lafayette's to a similar observance is beginning to be acknowledged. Quite a number more, scattered through the year, are much wanted. They would save hundreds of our population annually from insanity. Contrary to the general belief, insanity is very j^revalent among seamen and farmers. The former lead a life of dreary solitude upon the ocean ; the latter, one, if not of equal, certainly of very objectioa- able solitude upon the land. The sailor who does business upon the great st-a, should provide himself with great numbers of games to amuse him in his wanderings. The farmers of our land shouiu culti- vate more of the sociabilities of life. Let them meet together in the fine summer evenings, like the peasants of France, and dance gayly upon the green lawns before their cottages. They will till their lands more cheerfully for it ; enjoy better spirits and health ; and live to greater age. W' ':7)'SS' HYGIENE. 117 Completeness of Life. — Amusements are necessary in order to give a completeness to life. The faculties of the human mind are nuruor- ous. It is only when they are all exercised, in their due proportion, that there is a harmonious beauty in our lives. The customs of soci- cty twist us all out of shape, — perverting up mentally, morally, and physically, and robbing us of every manly and healthful quality. Getting out of the ruts of fashionable life, we must come back to tlif simple paths of nature. I would strongly impress upon parents, teachers, and guardians the importance of studying well the yarious temperaments, physical and mental peculiarities of their children, in order to judge wisely of the kind and amount of recreation required by them. Instance : a pale, delicate child of ten to twelve or fourteen year.s, with clear complexion, flaxen hair, blue eyes, slender frame, and a nervous, sensitive orginization, with strong mental cast, requires much more recreation and oni-of-door exercise than a full-blooded, robust chilu of that age ; a fact not at present duly considered, as a general thi'jff, m\ 1 Mv .n m m wM ■ TEMPERAMENTS, CONSTITUTION, AND SYMPTOMS. Man has thinking; warming; nourishing; and moving- powers. For the performance of each of these great functions, he has organs of the best possible construction. For Tliinkiiiji^, he has a drain. If this be large in proportion to his other organs, it gives a character, a cast, a peculiarity to his whole organization. Everything about him is subordinate to his brain. We recognize him, at once, as a thinking and a feeling being. He has an intellectual look. There is a delicacy, a refinement, a sensi' tiveness, a studious habit, an air of tho aghtfulness about him, which determine his traits, his tone, his temper, his whole character. Hence it is prop'ir to say he has a cephalic or thinking temperament. The Luiig'S and Heart, devoted to renewing and circulating the blood, are placed in the chest or thorax. If these be large in man in proportion to other organs, he is charar prized by great activity of cir- culation, by a large supply of red blood, and by the general indica- tions of a full, warm, and bounding life. This activity gives him his tone and temper, and shows that his is the thoracic or calorific temper- ament. In tlie Great Cavity of the Abdomen is done the work of receiving, digesting, and disposing of the materials which nourish the body. If tlie organs which do this work be large in proportion to others, the body is fed to repletion, and the whole organization speaks of the table. The habit, the look, the temper, are all sluggish. This is the abdominal or alimentary temperament. The Bones and jWuscles are instruments by which the movements of the body are performed. If these be the largest, in proportion, of iuy In the body, then the locomotive powers are in higher perfection tlian any others. There is largeness of person, energy of movement, • and greatness of endurance. The whole cast of the person partakes of the strength and coarseness of bone and muscle. This is the mus- cular or locomotive temperament. This gives us four temperaments, as follows : I. Tlie Cephalic Temperament, denoted by large brain, activity of mind, and general delicacy o.'^ organization. mm TEMPERAMENTS, CONSTITUTION, AND . SYMPTOMS. 119 IT. The Tlioiacic Temperament, indicated by a large chest, force of circulation, redness of skin, great activity, vrarinth of temper, and fulness of life. III. The Abdominal Temperament, denoted by a large develop- ment of the stomach, liver, bowels, and lymphatics ; by a fulness of belly, fondness of high living, and a disposition to float sluggishly upon the current of the world, rather than to struggle against it. IV. Tlie Muscular Temperament, indicated by largeness of frame and limbs, coarseness of ^structure, and ^eat power of locomotion and endurance, • There are some reasons for reckoning but three temperaments in- stead of four, by reducing the thora ic and abdominal to one, after the manner of the jjhrenological Fowlers, — especially as the organs ill the chest, and their appendages, take an important part in the pro' cess of nutrition. But as the heart and lungs are placed in one cavit'', and the stomach, liver, etc., in another; and as one set ot these organs may be largely developed, and the other defectively, I ha ve thought it most convenient, on the whole, and quite as philosophical, to retain the four temperaments. These temperaments seldom or never appear single and pure. They mix and cross with each other in all possible v/ays. Medication and Temperaments. The object of speaking of temperaments in this work, is to make the reader acquainted with the principles upon which remedies are to be adapted to their development. The philo8ophical-mi!yled physi- cian will, in prescribing, always keep the temperament in view. Persons of a Cephalic Temperament cannc*, bear powerful medi- cines, — particularly drastic purges. Their fine, delicate and sensitive organizations would be torn all to pieces by doses which would hardly be sufficient in a fully-developed muscular temperament. This should always be borne in mind in prescribing for persons of a large brain and delicate organization. In this temperament, too, fevers, instead of running a high and fiery course, take the low typhoid type, the patient becoming pale, and showing a constant tendency to sink. Such patients would be killed by purging, leeching, "cupping, sweating, and starving. They want tonics, stimulants, and every kind of support, which the case will possibly permit. Persons of a Thoracic Temperament, having a rapid circulation, and a fulness of blood, are most liable io inflammatory diseases. When fever attacks them, they have what is called a " high fever." If rheu- matism comes, it is acvte rheumatism. Disease takes hold of them smartly. As they do everything with emphasis and energy when well, so, when ill, they make a business of it, and are sick with all their might ffl ™? ■: in m I'i th £1 120 TEMPERAMENTS, CONSTITUTION, AND SYMPTOMS. Stimulants and tonics generally make such persons worse. They want isedatives, and diaphoretics, and sweats, and purgatives, and leeches, and cups, and low diet, and cold bathing, and whatever else will slacken the ferocious swiftness of their circulation. Those of the Abcloininal Teinperaiiient are not particularly subject either to very high fevers, or to those typhoid forms which produce sinking. As in the two temperaments noticed above, their com- plaints chiefly attack the organs most largely developed. Their dis- eases affect the stomach, the liver, the spleen, and the bowels. These are the largest organs in their bodies, and are most used ; and, being overworked, they fall into disease. As these persons are slothful in all their habits, so their diseases run a sluggish course. They are not so liable to sudden death as persons of either of the preceding temperaments. They have all sorts of chronic diseases which linger a great while, and are cured with much difliculty. These persons will bear larger doses of medicine than either of the preceding. Neither do their constitutions respond as readily to medicine. A physician will be disappointed if he expects to see them recovering as fast under its use. Those of a Muscular Temperament, having little fonJness for any- thing but a hardy, active life, are much exposed to the elements. Though strong and long-enduring, the hardship of their lives often breaks them down, and when felled by disease, they are oftentimes shockingly racked and torn by it. These persons bear large doses of medicine, and when sick, need to be treated with an energy proportioned to the strength of their constitution. Rheumatism, which aflects the joints, the ligaments, and the tendons, is an affection from which they suffer severely. V The Constitution. In prescribing for disease, it is of very great importance to take notice of the constitution. This Is a different matter from the tem- peraments. Persons of the same temperament are often quite unlike in the strength of their constitution. And those having good natural constitutions, frequently abuse them by improper habits and Indul- gences, and at length come to have broken and very feeble constitu- tions. Some persons' muscles and other tissues are put together as If they were intended never to come apart. Like some of the woods of the forest, — the lignum vitae for example, — they are fine-grained and tough. A real smart boy will wear out an iron rocking-horse sooner than one of these persons can exhaust their constitution by hard work. Others, to outward appearance equally well made, have very little endurance, break down easily under hard work, and lose their flesli from trifling causes. The state of the constitution, therefore, should always be learned before much medicine is given ; for what a person of a strong consti- ',*!■ TEMPERAMENTS, CONSTITUTION, AND SYMPTOMS. 121 tntion will need, may greatly injure a feeble person, even of the same temperament Habits. — These must likewise be attended to. Persons using stimulants require larger doses of medicine to affect them than other persons. Climate. — Medicines act differently on the same persons in sum- mer and winter. Narcotics act more powerfully in hot weather and climates than in cold, and must be given in smaller doses. Idiosyncrasy. — Medicines of only ordinary activity, act very power- fully, and even violently on some persons. This is owing to a pecu- liarity of stomach, or constitution, called idiosyncrasy. It makes the person, in this particular, an exception to the general rule. And no physician can know beforehand in what particulars this exceptional disposition will show itself. Persons, however, learn their own idio- syncrasies, and should make them known to those who prescribe for them for the first time. The Sex. — The peculiarities of each sex should never be forgotten in prescribing for the sick. Males are not so sensitive as females. They will bear more medi- cine, and their nervous system is not so readily excited by it. Influence of Age, — Human life is divided into infancy, childJiood, yowth, manfiood, and old age. Each of these periods has peculiarities which modify disease. Tlie First Periotl, extending from birth to the age of seven years, is marked by tenderness and excitability, and is alive ir every irrita- tion. Teething and other disturbances occur at this period, and need careful management. Tlie Second Period extends from seven to fourteen, and is quite subject to disease, including the second dentition. During these two periods, there is no great difference between the sexes ; both are ten- der, and need careful watching. During; tlie Tliinl Period, the changes occur which mark and sepa- rate the sexes. This is a developing period, when the functions become established, and the frame acquires form, proportion, and strength. At this time, hereditary tendencies to disease, latent till now, begin to show themselves, and call for every possible endeavor to break thoin up, and fortify the constitutioii. Tlie Fourth Period embraces the vigorous maturity of life, when the powers of body and mind, in both sexes, are at the summit of their excellence; The functions are now well established. It is dur- ing this period that the female is subject to most of the harassing ailments peculiar to her sex. So numerous are these complaints, and 80 large and valued the class of persons affected by them, that he who treats them with the greatest skill, and with the delicacy which their nature demands, maj« be said to be at the head of his profession. 1 1 15 ! % M:- The Fifth Period is that of old age, when the functions are declln-r ing, and the frame is bending under the weight of years. Old age begins earlier with females than with males. Many ailments are common to this period, which require peculiar management, both medicinal and hygienic. Proper Frequency of Dose. — Each succeeding dose should be given before the effect of the preceding is gone. If this rule is not attended to, the cure does not advance. What is gained by each dose is lost by the rallying of the disease in the interval. Care must be taken, however, not to apply this rule too strictly with very active medicines. How to Examine a Patient. When p* patient is presented for examination, having observed the temperanfient, constitution, sex, and age, 1. Learn the causes of tlie disease, whether local, specific, or gen- eral, and ai^o its history. 2. Search out its nature and character, whether febrile or other- wise. 3. Take notice of the whole train of symptoms, — embracing the pulse, the condition of the mouth, tongue, and digestive organs, the breathing, the urine, the fecal discharges, the condition of the brain and nervous system, the state of the skin, etc. Brief Table Explanatory of Symptoms. GENERAL APPEARANCE OF PATIENT. 1. Tonic spasm of the trunk. 2. Distorted features, altered position, and impaired motion of limbs. 3. Irregular and perpetual motion. 4. Entire and absolute immobility. 5. Great and unnatural boldness. 6. Great and unusual languor. 7. Ability to lie only upon the back. 8. Lying upon the face. 9. Lying upon one side. 10. Maintaining the sitting posture only. 11. The head thrown back. 12. Restlessness and tossings. 18. G«oeraI enlaigemen*; of body. 1. Lot'ked jaws. 2. Paralysis of one side. 3. St. Viius's dance. 4. Catalepsy. f>. Insanity or delirium. 6. The beginning of an acute diseasft, or the progress of a chronic one. 7. Apoplexy. Oriianie disease of tlie brain or spinal marrow. Acute inHcUnma- tion of the lining of the abdomen. Kiieu- matism of the jomts. 8. Several kinds of cholics. 9. Pleurisv, or inflammation of the lungs. When one lung only is aflfected in con- sumption, the patient generally lies on tlie diseased side. 10. Disease of the* heart or lungs, whicL interferes with breathing. 11. Severe diseases of the larynx and windpipe. 12. The beginning of acute inflamma- tion. Fevers. Delirium, and acute mania. IS. Cell-dropsy. EmplijrMina from • wound of the chut TEMPERAMENTS, PA^JSTITUTION, AND SYMPTOMS. 123 Head, Face, and Neck. 1. Head bent to one side. 2. Head increased in size. 3. Swollen scalp. 4. Dull expression of face. 5. Full, red face, with blood vessels of eyes inje(!ti^d. 6^ Pinched, contracted countenance. 7. Pinched nose, sunken eyes, hollow temples, skin of forehead tense and dry, complexion livid. 8. Wrinkles across the forehead. 9. Wrinkles from forehead, vertically, to root of nose. 10. A white line from inner angle of the eye to just below the cheek bone. 11. White line from the upper border of the wing of the nose (ala nasi), c"''ved to the outer margin o|" the orb of tl .ye. 12. The wjiite line in children from an- gle of mouth to lowor part of face. 13. A white line external to the last two, in a semicircular direction towards the chin. 14. Swelling of face and eyelids. 15. Transient redness or flushing of face. 16. Hectic flush. 1 7. Paleness of face. 18. Dingy, white, or gree;iish face. 19. Yellow tint. 20. A citron tint. 21. A bluish tint. 22. Perpetual motion of eyelids. 23. Forcible closure of eyelids. 24. Eyelids remaining open. 25. Balsy of the upper lid. 26. Flowing of tears over the cheek. 27. Nostrils dilating forcibly and rapidly, 28. Itching of nostrils in children 1. Convulsions. Paralysis of one-half the body. Dislocation of bones of neck. Swelling of glands of neck. ?. Chronic hydropholiu. Enlarged brain. 3. Erysipelas. Small pox. 4. Typhoid fever. 5. Swelling of heart Congestion vf brain. 6. Acute inflammation of peritoneum. Exposure to severe cold. 7. Chronic disease just before death. 8. Excessive pain arising externally. 9. Distress, anxiety, and severe inter- nal pain. 10. In children, a brain or nervous af- fection ; in adults, abuse of the generative organs. 11. In consumption and wasting of flesh. The lower part of the line indicates dis- ease of stomach; the upper part, some affec- tion of upper part of bowel. When united with the white line named above, and with a drawing in of the cheek, fixed eyes, and a wan complexion, it implies worms. 1 2. An affection of the chest, with diffi- culty of breathing. 13. Chronic and obstinate disease in the chest or belly. ^ 14. Albumen in the urine. 15. Suffering from the monthly irregu- larity. 16. Consumption. Chronic aflfections. 1 7. Cold stage of fever. Acute inflam- mation. Chronic diseases, especially Bright's disease, during recovery. 18. A low and deficient state of blood. 19. Jaundice. 20. Cancerous disease. 21. Poor circulation in the veins. Chol- era. Typhus fever. Blue disease. 22. Mania and idiocy. 23. Intolerance or dread of light. 24. Orbicularis palpebrarum. Paralysis of the muscle which closes the eye. 25. Injury of the third pair of nerves. 2(5. Obstruction of the lachrymal duet 27. Difliculty of breathing. 28. Worms in the bowels. The Tongue. 1. Surface of tongue coverengue smooth, red, and tender. 4. Tongue slightly white from small white points, and sometimes covered with fur, like the fibres of coarse velvet. 5. Tongue pale, tumid, clean, and very mooth. 6. Tongue /urrcrf and rfry. 7. Tongue white and loaded, with much tliirst. 8. As above at first, — afterwards clean, red, and dry. 9. Tongue white and loaded, with dry- ness. 10. Tongue drv, parched, tender, and dark brown or mack. Pushed out with great difficulty and trembling. 11. Tongue loaded with white, through which numerous elongated, very red pap- illas protrude their pomts. 3. Acute dyspepsia. Asthma. S. Severe cases of acute dyspepsia. 4. Chronic dyspepsia. Some afiection of the liver, if the fur be yellow. 5. Chlorosis or green sickness. 6. Violent local inflammation. Irrita- tion in bowels. 7. Inflanmiatory fever. 8. Protracted inflammatory fever. 9. Mild typhus fever. 10. Severer forms of typhus fever. 11. Scarlet fever. The Throat. 1. Throat enlarged. 2. Violent pulsadon of carotid arteries. 3. Pulsation of the nameless artery (arteria innominata) above the breast bone, and to the right of the windpipe. 4. Circumscribed swelling about throat. 1. The approach of puberty in females. 2. Acute mania. Inflammation of brain. Enlargement of heart, and dilation of right ventricle. Anemia. 3. Regurgitation from aorta. 4. Enlargement of glands. 1. General enlargement of one side of chest. 2. Bulging at the base of a lung. 3. Bulging at front upper part of chest. 4. Bulging right hypochondrium (See 7ig. 96). 5. Bulging in region of heart. 6. Tumor where the third rib joins the breast bone. 7. Tumor between the base of the shoul- der blade and the spine. 8. Depression or retraction of one side of chest. 9. Breathinw increased in rapidity. Gen- erally, in healtn, about twenty breaths are taken in a minute. 10- Breathing diminished in rapidity. The Chest. 1. Large effiision of water from pleurisy. 2. Water from pleurisy settling to the bottom. 3. Emphysema. 4. Enlargement of liver. 5. Water in heart-case. Enlargement of heart. 6. Aneurism of the ascending aorta. 7. Aneurism of the descending aorta. 8. Consumption. Absorption of fluid, effused by pleurisy. 9. Spasmodic asthma. ' 10. Pleurisy. Paralysis of respiratorj muscles. Inflammation of lungs. Emphy- sema. Pneumothorax. Consumption. 11. Jerking respiration. 1 2. Breathing with muscles of ribs only. 11. Spasmodic asthma. Obstruction in larynx and windpijie. 12. Abdominal inflammation. Inflam- mation of diaphragm. The Belly. 1. Increased size of belly. 2. Enlargement in epigastrium. Fig. 93. S. Enlargement in hypogastrium. Fig. 95. Enlargeme 4. Belly diminished in size. m bowels. Inflam* Obstruction ia 1. Drorsy. Wind mation Oi peritoneum, bowels. Hysteria. 2. Hysteria. Cancer of stomach. S. Distension of bladder. Ovarian tu- mors. Accumulation of feces in bowels. 4. Chronic dysentery. Lead colic. Aim in most chronic diseases. Private Organs. 1. Enlai^ed penis in children. 2. Drawing up of testicles. 3. Enlargement of scrotum. 1. The limbs immovable. 2. Limbs contracted and rigid. 't. General swelling of limbs. 4. Swelling of joints. 5. Limbs diminished in size. 1. Stone in bladder. Masturbation. 2. Stone in iiidneys. 3. Hydrocele. I^matocele. Sarcocele. The Litnbs. 1. Paralysis. 2. Softening of the brain. 3. Defective circulation of blood. 4. Rheumatism. Water in the Joints. White swelling. 6. Paralysis. The Nervous System. 1. Morbidly increased sensation. 2. Tensive pain. 3. Dull, heavy pain. - 4. Smarting pun. fi. Shooting, tearing puna. 6. Boring pains. 7. Contusive pains. 8. Itching. Sensation as of ants creep- ing over the skin. 9. Exaltation of vision. 10. Black flecks floating before llie eyes. 11. Painfully acute hearing. 12. Dull hearing. 13. Increase of ttrengtL 14. DebiUty. and 1. Acute inflammation 6( brain spinal marrow. Fevers. Hysteria. 2. Phlegmonous inflammation. 3. Enlaraed internal organs. Internal tumor. Enusion of water into cavities lined with serous membranes. Felt in the loins previous to discharge fttun menstruac tion, and from piles. 4. Scarf skin removed- Neuralgia. Cancer. Constitutional syphilis. Bheumatim Inflammation of periosteum. Bruises. Acute diseases. Several diseases of the skin. S. 6. Gout 7. 8 9. Ophthalmia. Inflammation of bnup- Some nervous diseases. 10. Aflections of the brain and optic nerve. Dyspepsia. 11. Inflammation of brain. Hysteria. 12. Typhus fever. 13. Delirium. Inflammation of brain. Mania. 14. Most diseases. ''II k 1^ s ii.'.L I i '■ iiiMiii 15. Trembling, 16. Ri^dity of upper extremities. 17. Cramp. 18. Temporary spa^m. 19. Pain at extremity of penis. 20. Pain in rifrlit shoulder. 21. Pain in left shoulder. 22. Exaltation of aiTectiona. 23. Loss of moral sensibility. 24. Exaltation of intellect 1 5. Cold stage of fever. Nervous affec- tions. Old age. Action on the system of lead, mercury, strong coffee, alcoholic drink, tobacco, opium. 16. Soflening of the brain. InfiltratioQ of blood into the brain. Hysteria. 17. Pregnancy. Hysteria. Painters' colic. 18. In convulsions of children. Somt affections of the brain. 19. Stone in bladder. 20. Congestion of liver. 21. Diiwrdercd stomach. 22. Hy])ochondria8is. 23. Mania. Typhus fever. Masturba- tion. 24. Melancholy. Sometimes indicates close of life. The Breathing. 1. Stiffness of chest. 2. Pressure upon parts. 3. Obstruction of air-tubes. 4. Compression of lungs. 5. Pain in parts moved in breathing. 6. Paralysis of muscles of chest 7. Spasm of muscles of chest 8. Deficiency of red blood. 1. Cartilages turned to bone. Pleura hardened. Distortion from rickets. 2. Tumors. Dropsy of belly. 3. Spasm of glottis. Spasm near the small ends of bronchial tubes. Mucus, etc., thrown out upon the inner surface. 4. Effusions in pleurisy. Water in chest Air in substance of lungs. Aneu- rism and other tumors. 5. Pleurisy. Inflammation of perito- neum. 6. Injury of spinal marrow. 7. Locked jaw. Spasmodic asthma. 8: Aneemia. Chlorosis or green sickness. The Cough. 1. Hollow and barking cough. 2. Sharp, ringing cough. 3. Hoarse cough. > 4. Wheezing cough. 5. Belching cough. 6. Cough in paroxysms. 7. Cough sounding harsh and concen- orated when listening with the stethoscope. 8. Cough sounding hollow, -when listen- ing with me stethoscope, as though it came from a cavern. 9. Cough having a metalic or ringing sound when listening with the stethoscope. 1. Last stage of consumption. Chronic bronchitis. Some nervous affections. 2. Croup. 8. Beginning of oold. Chroniclaryngitil. 4. Asthma. 5. Some diseases of larynx, fi. Hooping cough. Hysteria. 7. Consumption. Inflanunation of the lungs. Pleurisy. Enlargement of bron- chia tubes. 8. Tuberculous cavity. Enlarged broo- hial tubes. 9. Large tabercnloas caTiij. The Expectoration. 1* Scanty expectoration, t. Copious expectoration. 1. First stage of acute diseases of the lungs. 2. Decline of acute diseases of air pas' sages and lungs. 8. Watery expectoration 4. Mucous expectoration. 5. Expectoration of pus. C. Expectorated matter shaped like coin (nummular). 7. Muco-purulent, floculent expectora- tion. 8. Tubular expectoration, 9 Whitish or greenish expectoration, that t'linijs to the vessel. 10. Yellow expectoration. 11. Rustjf expectoration. 1 2. Putnd smell of expectoration. 13. Faint and sweetisu smell of expec- toration. 14. Expectoration smelling like garlics. 3. Beginning of bronchiti*. Conge». tion of lungs. Vesiciilar emphysema. 4. Bronchitis. Inflammation of lungs. 5. Consumption. Third stage of in- flammation of lungs. 6. Tubcntular consumption. Bronchi- tis of measles. 7. Consumption far advanced. 8. Plastic bronchitis. Pneumonia. 9. Acute affections of lungs, particu* larly bronchitis. 10. Chronic bronchitis. Other chronic afiections of the lungs and throat 11. Inflammation of the lungs. 1 2. Gangrene of the lungs. 13. Bronchitis. First stage of consump* tion. 14. Broncbo-pleural fistula. 1. Dull, heavy, aching pain at the base of the chest. 2. Soreness about the breast bone, and between the shoulders. 3. Sharp, sudden, tearing pain below the nipple. 4. Pain darting from front part of chest to between shoulder blades. 5. Constant pain between the shoulders. Pain. 1. Acute bronchitis. 2. Acute bronchitis. 3. Pleurisy. 4. Consumption. 5. Consumption. Green sickness. Otbei chronic diseases. The Pulse. 1. Strong pulse, resisting compression by the finger. 3. Weak pulse, easily pressed down. 3. Full pulse, as if the artery were in- creased in size. 4 Small pulse, opposite of full. 1. Hard, sharp, contracted pulse, — vi- brating like a cord under the finger. 6. Soil pulse, yielding readily to pres- sure. 7. Frequent pulse. 8. Slow pulse. 1. Inflammatory affections, especially of the substance of large organs, as the liver, tie. 2. Prostration from disease. Nervous and chronic affections. Fear. Diseases of women and children, and old persons. 3. Congestion Disease of heart 3. Congestion of brain. t poplexy. 4. Inflanmiations of stomach, bowels, bladder, etc. Hysteria, and other nervous affections. 5. Inflammation of membranes. Active bleedings. Lead colic, etc. 6. Afiections vharacterized by debility. 7. Inflammatory diseases. Hemorrhages. 8. Apoplexy. Sometimes in disease of heart i-ii l._ Tongue trembling and dry, and di minished m size. 2. Voracious appetite. Belating to Digestion. 1. Typhoid and other low fevers. 2. Pregnancy. Hysteria. Insanity. Sometimes in dyspepsuu / '; ; !■ f .i:,,a 3. Diminished appetite. 4. Inereaoed thirst 5. Thinit gone. 6. Vomiting. 7. Pain increased by pressure. 8. Pain relieved by pressure. 9. Urgent desire to go to stool. iO. Watery stools. 11. Mucous stools, like white of egg. 1 2. Hard and lumpy stools. 1 3. Clay-colored stools. 14. Yellow or dark-brown stools. 15. Dark-green stools. 16. Stools red, and streaked with blood. 1 7. Pitchy black stools. 1 8. Stools pure blood, with no colic. 1 9. Stools like rice-water. 20. Black stools. 21. Shreds of false membrane in stools. 22. Fat with stools. 23. Fetid stools. 3. In most acute diseases. 4. Acute affections of stomach and bowels. 6. Cerebral disease, with coma. 6. Early pregnancy. Colic. Disease of brain. Jnffamniation of stomach. Hernia. 7. Inflammation of internal organs. 8. Over-distention of bowels. Neural- gia. Colic. 9. Dvscntery. Sometimes in diarrhcsa. 10. Diarrhcsa. Cholera. 11. Chronic inflammation of colon. 12. Constipation. Colic. Cancer of stomach. 13. Deficiency of bile. Too m?icn bile. Bile from children after taking cal- 1. (Jim •i. Kxt ;i. ll(it 4. Hot 6. Skii «. liar 7. Acr ippl i(it hot. 7. Acrid heat, burnin;j thu hand whun iud. Chills. Low t^'nipcratiire. Cold handit and fueL uy 17 I. Fovdps. '2. Inllaniniation. ». Hfaitachc. 4. Disease of brain. 5. lofianiuiatioii in chMt. 6. Consiniiption. 7. Typhus fever. 8. Beginning of fever. 9. Poor circulation. 10. Nervous diseaaeu. Dyspepsia, state of the bloud. Low i| SKIN DISEASES The skin is the soft and pliant membrane which covers the entire surface of the body. The interior, like the exterior, is likewise covered by a skin, which, from its always being moist, is called a mucous membrane. At the various openings of the body, the outer and the inner skins are united, — forming one continuous skin, — like the same piece of silk turned over the border, and covering both the out- side and inside of a bonnet. From this continuity or oneness of the skin and mucous membrane, springs an important medical law, namely, that a disease of the skin may spread to the mucous membrane, and a disease of the mucous membrane may spvead to the skin. We see this illustrated by the breaking out arouiid the lips which follows colds, and the itching of the nose of ch-'-xrcn when the mucous membrane of the bowel is irri- tated by worms. , The Skin i;* Composed of T^vo Layers. — These are separated from each other by the action of. a blister. The thin portion which is raised up by the fluid of a blister is called the sca/fs/iin, the cuticle, or the epidermis ; that vvhich remains in connection with riie body i^ the senailive skin, the cutis, the derma, or the true skin. The two skins have very difierent .offices to perform. The scarf-skin is horny and insensible, and serves; as a sheath to- protect the more sensitivr skin under it. Were the scarf-skin taken ofl", we could not bear to have anything touch us. The derma, or true skin, and its glands, etc., are the seat of all tlic cutaneous diseases. These may be separated into four great divis- ions, — namely, diseases of the true skin, diseases of the sweat g'lawls and tubes, diseases of the oil glands and tubes, and diseases of th« hairs and hair glands. The:a the diseases of the true skin are divided into Injiamfnatio'n of the true skin ; Enlurgenient of the papillte of the true skin ; Dist )rders of the vessels of the true skin ; Dis'irders of the sensibility of the true skin; Disorders of the color-producing' function of the true skin. The inflammation of the true skin is conveniently di dded into two groupt, — namely, lis <" \M ir 1 1 in^: I i hTHS # fi skj'w diska*?^:}?. i'M • a -w, an' nuirked by intlfimniati^'U <■>( the dp^ma. and raucoiis iranes, wfV/i >;u/ s.'Uut.ional i://>rfi/oms fff » !>/>eci/it- Vt»* . Measles. — P.nhcAa. HEAsr.Es is :i!i acutt' iidiarnuiatiou of the entirp skin, botli external j intprual, associated v/ith an iiiiection.« and cofttugJouK fover. Mmi^tonis.. — Tlie dihoiisf soiH> in with eiiills, su(C<;.-.dt'«i by bun-.l-M-T .;% lisii( -.s.-iiK'ss, !,uiguor, drow^intifti.s ; puiiis in tlie head, back, and •jurt , frei|Uont pnlsc ; horenoss of thi; throuf ; tliirsr, nuiis'ca, youiit- !<, fifqucut dry (.ougli and hi^h-colored urine. Thiise »yinptoiiid easi' in viou'rii.e fof lour day-^. On thu thiiJ dav the ev'^s bi.eorue ;l:ui;id, cannot bear the Hglil. and })our fourtii h prolusion of \v:\v^. is last, .syrnpton; is railed coryzn. The nu.HO likewi-ie di.«liafge8 a ^■ff". iju;;:itify of watery secr'Mirn, ami Hn^czin^ is freqncn!. '.rhf .^nXj windpip", and brujichi-.d tuLxs beeonia iidiatuwi, os)'i ho.ir.-r- >*!», «rrreuc..s of the breast, etc., aw 1i»(! nv^ult. TtU' rednesb of the skin iuid brt-»>:"!i;2 »iui a; j.>t.- 'C iiimu!: sim* fourth Icy, and prodn< e lieal and it'-iilug. This breukihif i>«t i« eharaeier- ..*d by a pntchy ic.dne.*«s, which, on t'lose 5nf*pt'er.iofi, i<* foun«t to eonsist ninni;Rrle.-i!s nunute n*tl pi^intj*. )»nd ptutpiej*, coIW'UhI inJo patehes K d'gi fhnpo of a half or q(iHr»er tiuv,)fi. I'iity apppe;^r i;«|toii the bo'; lcgi«. The. color uf thf siiUt \vhei» the inll.tmtuatiou i-« fc (;a;itt, is* of a bi'i^'kl rashb^rn) red. The flecJine of tlie ra^h ee in the .same order in v.-hicU ii ti -!»'>$ onl. The n-dness hv bi.xth day upon the face: oh tlie tevtroth. upon Mm li -^ ' h; Op Uie eighth, upon the bf cik* <'*f |;V» ?;;»»4»«, Tit*^ ei>f . • , ••—Re. Meo(ij< ri,"Mii>'" •tnmation di.^;:, i>, scurf, The ani.sr. hat gi.cn a ,?ood picture of the disease in the .fn; \ cohi-isl lid-«"ra;)ii. l^i \ ^ I, Fig. 1. This ])Iate is adtni« iou' •^nu'iit. — When the. di' . ise is mild and regular in its eou..se, ^.tiyihing will be rei.iired, except mild diet, slightly acid '■^h ilnx-fieed tt h, islippery elm, or some equivalent, to quiet ;>ponging with tepid water, if done with frequency, mod* '.t,i^i l\\ i'l '\ I ;f;r: ■ / -| to #* 1- ,.fe.- \\ -if^Jt . .,.j«itf:- ■■• i'^iH" '.li.Vl!: .■.:i ■■*^iii%^' '.^•'■ .>fv*«*;>it,. ■■1^. *&' # ■■'*,i«i^'^''' ;r SKIN DISEASKS. 131 Such as are marked by inflammation of the derma and mucous membranes, with constitutional symptoms of a specific kind, and Such as are distinguished by inflammation of the derma, wUhoiU constitutional symptoms of a specific kind. Congestive Inflammation of the True Skin. Tlie First of these Groups, — those characterized by inflammation of the cutis, with constitutional symptoms of a specific kind, — embraces measles, scarlet fever, varioloid, small-pox, and cow-pox. Measles. — Rubeola. Measles is ap ^ cute inflammation of the entire skin, both external and internal, associated with an infectious and contagious fever. Syiliptoilis. — The disease sets in with chills, succcedt^d by burning heat, listlessness, languor, drowsiness; pains in the head, back, and limbs ; frequent pulse ; soreness of the throat ; thirst, nausea, vomit- ing, frequent dry cough and high-colored urine. These symptoms increase in violence for four days. On the third day the eyes become inflamed, cannot bear the liglit, and pour fourth a profusion of tears. This last symptom is called coryza. The nose likewise discharges a large quantity of watery secretion, and sneezing is frequent. Tho larynx, windpipe, and bronchial tubes become inflamed, and hoarse- ness, soreness of the breast, etc., are the result. The redness tf the skin and breaking out appear about the fourth day, and produce heat and itching. This breaking out is character- ized by a patchy redness, which, on close inspection, is found to consist of numberless minute red points and rimples, collected into patches in thf shape of a half or quarter moon. They appear iirst on the forehead and front of the neck, then upon the cheeks and around the nose and mouth. On the fifth day they reach their height in „'.ns region, and then appear upon the body and arms, and on the sixth day, upon the legs. The color of the skin wheji the inflammation is at its height, is of a brig'hl raspberry red. The decline of tiie rash takes place in the same order in which it comes out. The redness fades on the sixth day upon the face ; on the seventh, upon the body and limbs ; on the eighth, upon the back& of the hands. The coryza, the hoarseness, and the cough, decline about the seventh day, while a diarrhoea comes on about the eighth or tenth, — showing that the in- flammation of the mucous membrane is subsiding. When the in- flammation disappears, the whole scarf-skin peels off in the form of a scaly scurf. The artist has given a good picture of the disease in the beautifully colored lithograph, Plate I, Fig. 1. This j)late is admi< rably done. Trentiiieut. — When the disease is mild and regular in its course, scarcely anything will be recjuired, except mild diet, slightly acid drinks, with flax-seed tea, slippery elm, or some equivalent, to quiet the cough. Sponging with tepid water, if done with frequency, mod* :iy; i::! 1' erates ihv fever, uiul adds to tlie eorufort. of the patient. If the fever ruiii~ high, take half an ounce of roehelle salt, and use recipe 51. Should the eruption "strike in," apply leeches or cups, over the inter- nal organ allected, if any, and recall the rash by a mustard bath. Those who have been exposed to th(! contagion, and are liable to have the disease, should avoid all unnecessary exposure to wet or cold, — keeping the feet warm and dry, and the whole body well clad. With these precautions, and a mild, unstimulating diet, much of the force of the disease may be broken. During the first stages of the disease, bathing the feet once or twice a day witli hot water, and freely using warm, sweating drinks, as saftVon, summer-savory, pennyroyal, balm, and mullein tea, and put- ting mustard drafts to the feet, will hasten the coming out of the eruption. Should the breaking out be delayed by excessive fever, give full doses of tincture of veratrum viride, or nauseating doses of ipecac, antimony, lobelia, or hive-syrup, and teaspoonful doses of comj^ound tincture of Virginia snake-root. Beside the milder forms of the disease, cases occur, chiefly in broken- down constitutions, in which the rash delays its coming out till the seventh day, and is then mingled with dark and livid spots, which remain, often, for ten or twelve days. The fever is of a low, typhoid kind, and the patient is extremely weak and languid. In this condition of things, the patient must be supported by tonics (49), and stimulants (134), and expectoration promoted by some ap- propriate remedy (106), (124). If at any stage of the disease, there should be fixed pain in any part of the chest, which is made worse by coughing, or by taking a full breath, we 'lay conclude there is some inflammation of the chest; and it must be treated as directed for pneumonia. Scarlet Feyer. — Scarlatina. This is likewise an acute inflammation of the entire covering of the body, bofh external and internal, connected with fever which is infectious and contagious. Syiiijitoiiis. — The fever comes on somewhere between the second and tenth day after exposure. On the second day of the fever, the eruption comes out in the form of very small points and pimples, which appear either in patches, or constitute a general redness, of a brig-ht scarlet color. In Plate I, Fig. 2, the artist has given a fine picture of the disease. The disease begins with languor, pains in the head, back, and limbs, with drowsiness, nausea, and chills ; and these are followed by heat, thirst, etc. When the redness appears, the pulse is quick, and the pa.'cnt is anxious, restless, and sometimes delirious. The eyes are red, the face swollen, the tongue covered in the middle with white mucus, and is studded with elevated points of extreme redness. The tonsils are swelled, and the throat red. The greatest degree of yui. redness is reaehetl on the evening of the third or fourth day fronfi its beginning, when a gentle moisture a[)|)ears, the disease begins to deehne, with itehing, and the scarf-skin fails ott' in branny scales, A swelling or putHness of the flesh, which spreads out the fingers in a singular manner, seems to he peculiar to scarlet fever. Jn tiie lirst stage of the complaint, the tongue, as stated above, is covered with a fur; but as it advances, the tongue often becomes wuldenly clean, and presents a glossy, fu^ry-red surface, which is nometimes, with llu; whole lining of the mouth, raw and tender. It is peculiar in This complaint, that the inflammation. of the throat, almost always runs into a state of ulceration. As far as can be seen, on pressing down the tongue, the throat is swollen and of a deep, florid red ; anti on the tonsils may be seen while or gray ulcers. This makes swallowing very dilficult, and aggravates the surterings of the patient. Tlu; great amount of mucus in these parts causes also a continual rattling in the throat. The eustachian tube, which extends up to the ear, is apt to get involved in the inflammation, and cause swelling and pain in thar region. The glands under the ear and jaw sometimes inflame, and after a time, they oe casionally break. Abscesses formed in the ear, frt^quently produce some deafness which is not easily cured. In the cell-dropsy, which sometimes appears after scarlet fever, the crystals of nrate of ammo'iia may often be found in the urine with the microscope (Fig. 72). This disease resembles measles ; but may be distinguished from it by the absence of cough ; by the eruption being Jiner, and of a more scarlet color (see jilate) ; by the rash coming out on the second day instead of \\w. fourth ; and by the ulceration in the throat. Treatllieut. — In ordinary cases, the treatment should be very simple. The apartment should be kept cool, and the bed-covering light. Tlie whole body should be sponged with cool water as often us it is hot and rfry, and the patient be permitted to take cooling drinks. Beside tlii.--, in many cases, very little is needed, except to give a few dro])s of the tincture of belladonna, night and morning. In some cases where there is a good deal of fever and soreness of throat, give tincture of veratrum (1^4) often enough to keep down the j)ulse. It would be well also to begin the treatment of such cases with an emetic, (1) (4) (2). In addition to this, the feet and hands should be soaked in hot water, with a little ground mustard, or pul- verized cayenne, stirred in. This bath should be continued twenty minutes, twice a day, for two or three days. The cold stage iiaving passed, and the fever set in, warm water may be used without the mustard, etc. If the head be aflec^ted, put mus- tard drafts upon the feet. Should the bowels be costive, they may be gently opened by some very mild physic. ' 'i'l ■ ri ■l ■1 [ '>: :f !:i'i;l' ISi SKIN DISEASES. No solid food should be allowed ; but after the first shock of the disease is passed, drinks, in reasonable quantities, will be advisable, — such as cold water, lemonade, barberry and tamarind water, rice water, balm or flax-seed tea, and some thin water gruel. To i)romote the action of the skin, the spirits of nitre, with other articles (125), adapting the dose to a child, will be found usi^ful. The nitrate of potash is useful, given in one to three-grain doses, dissolved in water, every three or four hours. j The muriatic acid, forty-five drops in a tumbler filled with water, and sweetened, and given to a child in teaspoonful doses, is a good remedy. In very violent attacks, the system sometimes inclines to sink im- mediately ; typhoid symptoms show themselves ; there is great pros- tration ; the eruption strikes in ; the skin changes to a purple or mahogany color; the tongue is of a deep red, or has a dark-brown fur upon it, and the ulcers in the throat become putrid. This is called scarlatina jnaligna; but it is only a severer form of the same disease. The treatment of this form must be ditferent from that recom- mended above. It must be tonic. Quinia (65) must be freely given. Wine whey, mixed with toast water, will be useful. Tincture of cayenne, in sweetened water, may be given often in small doses. Ammonia (135) may likewise be given as a stimulus. Gargles (245) (244) (243) are also required. A dropsical allection is one of the most frequent results of scarlet fever. It is believed that this seldom occurs, if the warm bath is daily used, as soon as the skin begins to peel off. After the dropsy has set in, give the warm bath twice a week, and encourage perspira- tion by the compound tincture of Virginia snake-root, and similar articles. The child should have a gene'roua diet, at the same time, to bring up its strength. - , ' Small-Pox.— F«no/lfl5. This is another disease characterized by acute inflammation of the entire skin, both external and internal, connected with infectious and contagions fever. The eruption has the form of red ))oints, which !-()oi) become pimples, then vesicles, then flattened and scooped-out vesicles, then pustviles, and finally hard brown scabs. These last fall otl from tho- eleventh to the twenty-fifth day, and leave behitid them small pits and scars. The fever is remittent, and precedes the eru|)- tion some three or four days, — ceasing when the eruption is devel- oped, and returning when it has reached its height. The period between exposure and the attack of the disease, called incubation, is from five or six to twenty days, — being short in the severe cases, and longer in the milder ones. Syni))toiii$. — The disease begins with languor ana lassitude, with shivering, and pains in the head and loins ; with hot skin, and quick- ened pulse and breathing ; with thirst, loss of appetite, and furred tongue ; with nausea, vomiting, constipation, restlessness, and uai- ,liM SMATI ^OT PI 'm i^* ■■-*; ^r^% ;^ V •k'ld /V^m; ^"Mii/ .>'.''t/m/ J^tJm ehy //^hffVf \\ RKTIS 3»TF!EAS1''H liiil I '10 s.jiid ui(.,« .•'Uuuli.i i.'V ;i:iovv<-d ; tuji hUih tht,' I'irsi yhock of r.lip ii^")! i-, T. ;■•*.• I. drinks, in reasunutiU' quanutio.s, will be ativiaable, — 1 Iter, IttmonfHJ* , bitrb^rry and tarnarirui water run WiiJiM, K^,%,iH i>r ilttx-sot'd U;i, and souu; Ihia wati-r grn«;l. 'fVi iinnnnte Ihi- action of the "kin, tfu? ^pirii:? uf nitre, with other r\-! ■ . ii'io), adapting the dt>«w^ Ui a child, will he lound viwfnl. Th<> "TftU" of potabli ih useful, givfo in one to three-grairj doses, dissolved ♦!. water, evtny three or I^Mirfumrs, " • ^ The i-nnriatic acid, forry-five tnopM in a turnbler filled with waiter, and .'iwect^Jied, and given t«"u chikl m tRaspoonful do!M:», is a good in vf>ry viol'?nt «ito«'.k», the 8y»ti*tti ioinetinns incliu"** to sink im- ]' "diateiy; iyphwtd 3ymptom» show theniaelv !i . • >-.■ i.,;r pros- 1 ration : th*- e-ntption »trikt»j m ; i«h skin {i.'mii'^es to a purple or iuahogany iX)U» \ the loiigii' fur upon It, and the (dt'e*'^ \r seariatinM nud^r'ia ; ' 'Vh(i.ir< ■•'••■'■'■ inemli"'! .V \V ». deep H:d. or hat a dmk-brown -tat it/!H-oine p«(rid. Tiii- \a called !' form of the same dineafte. ' fvTfut from ihat reeon?- >) um it be. frei'Iy givcji. "• MJriefni. Tincture of cfivvuiuv '.vaui. ;au, v«' ii.A\eit ot'ieij in ^•-alajl do'/ opsual I'liriion is ftnc of the mo^t frequent rci^ukss of Ntrirlet li )■■ iM'iie' eti that this seklora oecur», it tt'e V: ni, '1 ;.th ir, .. HB JMJon as iiie skin begin* to ]>eel off, Aftt ; ,; droj>rty give tho warm bwth twice a wr- !. : vjiuage pt-tHpira- he cottipfmnd tincture of Vir;j:in.;i :-■;.»;•' -root, and sinul-j-r 't'he ehilfl .■■Ijoidd have a generous tlict, at the t» tion some three or iVuir day!*, — (■«':.>!»;?«; wH«e»4^3? sfeort la the Wivere cases, imd '•-.:: ' U-i: ones. . ! «54Mtt». <• — The di>■:: ,;^r"^;tp, add h>" 'pat;i'iu r-i' ,-:. .- • .,, ;'. SMALLPOX P1.2. «?; it t «>*^:?*- ■**• I ..ss of the mouth and throat (243). Cold sponging may be considered as highly bene- ficial, in both the i)rimary and secondary fever. The belladonna like- wise is a useful remedy, used in the same way as in scarlet fever. The plaster 288, applied to the face, will, it is said, arrest the formation of matter, and prevent the unsightly scars which so often cover the face of persons who have suffered from small-pox. Paint the face once or twice a day with glycerine, which will eflfectually prevent pitting. Varioloid. — Varicella. Varioloid, or modified small-pox, begins with symptoms similar to those of small-pox, but nmch milder in degr(?e. These symjitoms are feverishness, nausea, vomiting, pains in the loins and head, and a quickened pulse. The eruption comes oat on the third or fourth day, and looks like that of small-pox. It reaches its height the fourth or fifth day, and then declines without any secondary fever. The pus- tules dry up and form brown scabs which fall oft" in a few days, and leave slight pits, and a few red or purple spots. Varicella appears under a variety of forms, called "hives," "swine- pox," " chicken-pox," " horn-pox," etc. Bu^^^ they all have a family likeness, and need not be described. The treatment of all these forms must be conducted on the same principles with small-pox. Sponging i <1 H 136 SKIN DISEASES. the skiii in all these inflammatory conditions has the happiest effect, and should seldom be omitted. Cow-Pox. — Vaccina. Tht3 disease exists to some extent among lower aninials, and is identical wi*h small-pox in man. The immortal Jenner tanght tlio world that the pus, taken from the cow having this disease, and inti\^ duced under the skin of man, wonkl produce an eruption similar to that of small-pox, ar.d that this would protect the system from the I it'T disease. This was an immensely important discovery, and will render the name of Jenner famous through all time. It is a question of great importance how far vaccination, or inocu- lation with the matter of cow-pox, does, in fact, protect the system, from small-pox. That it is a protection, to a certain ex.ent, is doubted by none. That in some instances it protects through life, is likewise generally admitted. Is it a protection in all cases, and through the whole life ? Perhaps not, though this is a disputed point. Proba- bly the mild form of th(; vaccine disease does not impress the system powerfully enough to last more than a certain number of years. Most thinking physicians now believe it is wise to revaccinaic occasionally, to make sure of the protection. It i . done with little trouble, and may save a terrible inlliction. Platk II, Fig. 4, gives a good idea of tiie appearance and progress of the eruption. The 8cconil Group of diseases, characterized by inflammation of the true skin, without constitutional symptoms of a specific kind, are Erysipelas, Nettle-Rash, False- Measles, and Inflammatory Blush. Erysipelas. — St. Anthonys Fire. Erysipelas is a diffused inflammation of the skin, afTecting only a part of the surface of the body, and i^ accompanied by a fever, which is generally thought to be infectious and contagious. The local in- flammation is disposed to spread ; it extends deep, and is attended by swelling, a tingling, burning, and pungent heat, and by a redness, which disappears when the skin is pressed by the finger, and returns tfn remitting the pressure. Syniptoiiis. — The constitutional symptoms are chillinee.j and shak- ing, succeeded by heat; lownese of spirits, lassitude, pains in the back and limbs, pains in the bead, quick and hard pulse, thirst, losa of appetite, white and coatt d tongue, bitterness of mouth, nausea, vomiting, pain in stomach, t nd costiveness. These symptoms go before the local inflammation several days; they increase with the redness of the skin, and disappear upon its decline. The nervous system is sometimes severely aftected, and indicated by low, muttering delirium. At the close of the inflam- mation there is generally a relaxation of the bowels, and the seait- skin peels off. Sometimes matter forms under the skin, and occa- sionally mortification occurs. The face is the most frequent seat of EBr^IPELAS ns. .jllfj-te^ig JO!^,... , , '•*'WVi 1r^ S?^' ■ ./-•-»*«/'■. ••■■•'v., ^; 1 J^^^A. ii.I v.^ ■.::"^' ft %l r,j SKIN i>Ii>i;A.31iS. I tlie skin in ;jll thene inrtammatory lomJiuonft U*» .'M liuppiest etfect, and fthoiili! seldosa be omittoti U^^ Tina f.li-sr'ipo oxis's to sonw exft'nt furnjoinery, and will render the iiiune nl' Jeniior tamoui* thnmgtkiiily mm. If. U ii. que- 'ion of pT<"«t imjiortatjce how »*'.f ^U!"^'»nation. or inocn- Irtiio)^ v.iih thf" ntarter of cow-pov, dvW^t^ Mi -i!i|p<,n proi* ct Ihe syri»et>i, tro'vi small- pox. That it if a prbfectton. iott <»rtairt exteni; is dciuhn-d by worn;. 'Fhnt in sorn^j instanoeB it pTtiifvfs iliroxgh iito, i^ HKowis**' gVneraUy adinttted. lb ii a Tjrotfctioii m nil case-^ and iLraugh the whole lite.' Perhaps* not, thougli this is n dispir«:'»:l poim. Proba. biy the nslkl rorri*; t-f the vij^^diic Uise;ii-ie dov'ii iioi; imprrss the systi-m po\vfi*?3i|iv ettout'h ^*i hi-ii mavtx thnn a certain ntnnbt'r oi yearf, Mtwl ihitikiHg pi>y«i<.-i*»i'.H wow h«»}ie'.'r-; it. is wi.sc lo rovacH;inau?. occasionally, !«?^»» *^?f' fjrf ;»>>«' p; ■ i;u It (,-5 do ae with ii'tk; troiibU-, ant'. coay ttrVT ,, ■;i'?;/t»»4' loMui loij. VhvvK i I, Fig. 4, givi':} a good id»-a of 5ti*i npftj' .311.1. ; H'id progress (>f the. f-ruptiou. fiiif .H4'«;*m«^ iKffU}) .of disca&ea, oharaoterizcd by iunanuuaTiou t#!" Crysipoias. >«euie-Hnah, Fabe-Measles, and hifiamniato'y Blvfeh. IljrjBipelAa. — St. Antktfny.'i Fire. EKvstJ'via.^s y a ditfus* d p»fli!ii;nnt«tioM. of the J^kin, af^ctintr oft'y a part of th«i i^ori'ueo of thr^ bcM.v. !:«.;j :^ml couta^ions. The Un'mt tn- llafoniation is di.»«inst dor-p, and i^ attr-m^vd hy swelling, a iio^liiiig, bwriiing, HttjJ 4,»sw.'!ifB»f hi-at. h'hI by a rca!td s>y tlie linger, and roturiv* o\< ■' :■■■,■ . !!• presaiiTB, ^ ■ ■•<> ^ '■'-■■, Synmtmns. - - Ihn const itutiojial 8yrfti»:itvi* «re chillinf*BH and #hn,k« tag, f^dciatcded by htial; ; Iowih's^ f)f S|'! bvu.k and linibs, j)aiMs in the hvad. quiei of .ipfK'tiU', white and coated touijiic, tl • i.i - ng;, pain i\\ sinnafh. anvi coH/is- lii ••: ^ o.ipioius go hck»rc fh*' «•( they with the redness oi iii k dci '''*■■ a«pvou» f^vstem is shows' )«ij .^^ . _f h?"" '''Mitenitg deliriuni m%ti*'a there i» '!y a rolaxatiti. ' , .•."els otf. t' . (lies mutter foroi;'. i..it;»i.lv nortjficis.jon .tfX'Urs. Tl,e fi «^itnde. pain*? in ihe ' ir<.i jjnJM', thir.'it. \om ■ ■■• 9I month, luujsea, ninwtion wverai days: . ] disappear up-jo A-* ! Iv alTeeie'l, and . — " of the ndlatn- V 1^^ and the N-arf- in« nUin, and oeca- i EBYSIPELAS ~"*«-^, ;l; SKIN DISEASES. 137 the disease. It commonly begins 0!i one side of the nose, and soon spreads over one side of the face, closing up the eye, and changing the features in a shocking manner. See Platk III, Fig. 1. Somewhere about the third, fourth, or fifth day, very minute blisters appear on the inflamed parts, filled with water, which increases until the bliscers break and let it out. The disease comes to a head on the eighth or ninth day, when the blistered parts drv; and the skin begins to peel off". Treatment. — In the treatment two things are to be done, — to sub- due the fever, and the local inflammation, ^'he fever is nssuaged by rest, mild diet, gentle laxatives, (26) (21), etc.; and by the use of tincture of veratrum. For the local inflammation, various things have been advised, but nitrate of silver, on the whole, has the prefeience. First wash the inflamed part with soap and water to remove any oily substance, and wipe the skin dry. Then moisten the inflamed and surrounding skin, and pass over it a stick i)t" nitrate of silver, touching not only the inflamed- part, but going even an inch beyond it on all sides. Or, a solution of nitrate of silver and nitric acid, (214) will in many cases, according to Dr. Iligginbottoni. do ev(Mi Ix'tter. A solution of coj ^'ras (215) is a good ap|)lication. So is 30o. In mild cases, flour may be dusted on the inflamed part from the dredging-box. Warm fomentations arc al.-o useful, and elotlis wet with water, and laid on. A solution of per. cliloride ot" iron, applied to the inflamed skin, is much used now. In erysipelas tlie powers of the system are generally reduced, and tonics, such as quinine, wine, ctv., are generally required. Dr. Robert Williams, — high authority in these matters, — says he puts his pa- tients upon milk diet, gently opens the bowels, and gives them, daily, from four to six ounces of port wine, together with sago, and tliat he seldom has to change this course, whatever the symptoms. For the inflamed skin, a tea made of buckwheat meal, is a good wash. Alcohol and water, or new rum, may be used for the same purpose. $ ii ^i' i\>' \*¥ Nettie-Rash. — Urticaria, Nettle-rash begins with fever, v^hich lasts two or three days, when wheals of various shapes, rouiid, oval, and oblong, appear in the midst of red, slightly elevated patches, attended by great itching and tingling, as if the common nettle had been applied to the skiiL The wheals go ofl* during the day, and come again at night. The •^ruption is often a symptom of other diseases, or of mental anxiety. Sometimes it is the effect of articles of diet. Children have it tM-ca- sionally while cutting teeth. A lighter form qf the disease (.'xists, in which the wheals appear and disappear at short intervals, according to the heat of the weather, the exercise, diet, etc. Treatment. — The treatment varies according to the cause of the disease. If this be anytl ig offending the stomach, es|H'cially if it be putrid fish, an emetic (2) (4) will be required, followed by brisk 138 SKIN DISEASES. physic (29). After which take a few doses of quinine (67). For exter- nal application, the lotion (216) or common vinegar and water ^215) will be useful. Dr. Wilson recommends corrosive sublimate, etc. (217) as the very best lotion to apply outwardly. The diet should be simple and cooling, all stimulating food and condiments being avoided. Rose Rash. — Roseola. — False Measles. Synip^ii \s. — The summer rose rash appears first on the arms, face, knd neck, thence it spreads over the whole body, producing tingling and itching. It is usually )ireceded by the symptoms of fever-chills, succeeded by flushes of heat, languor, pains in the head, back, and limbs, restlessness, quick pulse, and thirst. The rash appears in small irregular patches, paler than those of rheasles, and of a more roseate hue. There is some hoarseness from inflammation of the throat. The rash never continues more than five days, unless it be merely partial, in which case it sometimes comes and goes at intervals for weeks. If it "strike in,' it generally produces disturbance of the stomacli, headache, and faintness, wliich are relieved by its reappearance. The autumnal rose rash is in more distinct patches than the for- mer, of a circular^figure, slightly elevated, and of a dark damask-rose hue. Seldom any fever, or itching and tingling. Treutliieilf. — For the first-described form of the disease, light diet, acid drinks, and gentle laxatives ; for the second, recipe 59, or 51, ac- cording to convenience. Inflammatory Blush. — Erythema. What is called marginated inflammatory blush, is a mottled, red, smooth fulness of the skin, occurring on the extremities and loins, in irregular patches, bounded on one side by a hard, elevated, red border. This species of the disease attacks old people, and indicates some internal disorder, which is dangerous. Another form of the complaint appears on the arms, neck, and breast, in extensive, bright-red, irregular patches, slightly elevated. The redness, at its height, is very vivid, and continues about a fort- night, when it assumes a purplish hue in the centre. Treiltiiieut. — Light diet, gentle purgatives (21), opiates (218) lo allay the tingling and secure sleep, and the mineral acids (63), with bitter tonics, comprise all that is required, except sponging with water, and friction. Watery Pimples. We now come to a class of diseases characterized by watery pim- ples. Wilson says they are distinguished by " effusive inflammation of the derma," which means that there is inflammation of the trui- vkin, which causes water to be poured out on top of the derma, and undernea of smf,ll pies 'A ti this fluid scales off An en head, fille erally a i faiiitne.ss, Anothe tion of v( These vei curs only In .still itching, ill the blister skin, whic with a thi Tretitnu baths. In corrosive s of the afit After of small, times wit on the ex little largt days, the crusts, w irritable, and restle lierpes, in Treatm vanced in applicatio (174), or Toth j rnon tha i whose CO IS n SKIN DISEASES. 139 underneath the scarf-skin, causing the latter to be lifted up in the form of smf.ll or large blisters, or vesicles. At first the fluid in these pim- ples 'A transparent, but in a short time becomes milky. Sometimes this fluid absorbs ; at other times, it dries up, and with the cuticle, scales off as scurf. Salt Rheum. — Eczema. An eruption of minute, round pimples, about the size of a pin'« head, filled with a colorless fluid, and terminating in scurf. It is gen- erally a symptom of a feverish state, and is preceded by languor, faiiitnes.s, perspiration, and a pricking and tingling of the skin. Another species of this disease is called' sun heat, which is an erup- tion of vesicles without any redness, of a white or brownish color. These vesicles generally terminate in Lrownish-yellow scp.bs. It oc- curs only in summer, and atTects those parts which are uncovered. In .still another species, the eruption is attended with pain, heat, itching, intense smarting, and a swelling of the affected part. When the blisters break, the water which runs Oiit irritates and inflames the skin, which be(;omes red, rough, and thickened, — covered sometimes with a thick crust. Trentnieilt — Low diet, cooling drinks, gentle purgatives, warm baths. In old chronic cases, apply externally either lime water, or corrosive sublimate (212) in solution. In ihe second and third forms of the affection, apply externally, a solution of nitrate of silver (219). Tetter— Shingles. — Herpes. After a slight feverish attack, lasting two or three days, clusters of small, transparent pimples, tilled sometimes with a colorless, some- times with a brownish lymph, appear on the cheeks or forehead, or on the extremities, — and at times on the body. The pimples are a Jittle larger than in eczema, — about thv size of a pea. After a few days, the vesicles break, pour out their fluid, and form brown or yellow crusts, which fall oif about the tenth day, leaving the surface red and irritable. The eruption i-: attended with heat, itching, tingling, fever, and restlessness, especially at night. Ringworm is a curious form of ht-'rpes, in which the inflamed patches assume the form of a ring. Treatment. — Light diet, gentle laxatives. If t' ■ patient be ad- vanced in life, and feeble, a tonic (64) will be desirable. For external application, white vitriol (220), or an ointment of sulphuret of litn** (174), or elder-flower ointment, etc. (175). Itch. — Scabies. To this disease all classes are liable, though it is much less com- mon than in former years. It is found frecjuently among the poor, whose condition in life does uot give them the means to guurd at all I /" , 140 SKIN DISEASES. points against it; but it is most common among such as neglect per- »onul cleanliness. Syiiiptonis. — An eruption of distinct, cone-like, wat«ry pimples, which are transparent at the summits, and are accompanied by an excessive itx;hing, which is made worse by high-seasoned food, bv drinking liquor, and by the heat of the bed. When these pimples an* scratched and torn, a sticky, watery fluid is poured out, which forms small scabs; and, in time, if the disease is not cured, these scabs being often torn off, extensive sores are made. Cnu.se. — It will excite the wonder of many readers to state that animals of so small a size as scarcely to be seen with tiic naked cyt- exist in the skin of man. Yet such is the fact; and it is the presents of these minute creatures, or the effect of their presenct^, which con- stitutes the disease called itch. The little creature (acariis saihici, by name), a species of mite, is one seventy-seventh part of an inch in length; and when closely inspected under the microscope, is really a beautiful, 1 may say an elegant, animal. Here are a front, a side, and a back view of him, well done by the artist. Fig. 73. Fig. 74. Fio. :.■). His Method of Attack. — When placed upon the skin, the little fellow, like the squirrel and other ground animals, sets himself to make a hole through the scarf-skin with his head and fore feet. Into this he pushes his whole body. He then begins to burrow himself in the derma or true skin — making a channel many times his own length. at the end excavating a chamber where he sleeps, and whence he goes out to do his day's work at mining, or boring for food. When tired of this sleeping apartment, he digs onward and scoops out another. This travelling, and boring, and turning about in an organ as sen.si- tive as the true skin, must, of course, occasion a tickling and itching: and from this circumstance the disease took its name of itch. Bur this itching is not painful. James the First is said to have remarked that the itch was fitted only for kings — so exquisite is the enjoyiiieiit of scratching. Probably it is a royal luxury. Be that as it may, most persons would cojisent to have it all done by royal fingers. They have been used for meaner purposes. Treiitiiiciit. — Whatever will kill the little animal described above, will cure the itch. Various agents have been employed for this purpose, hut none have been found equal to sulphur. The compound sulphur ointment is a sovereign remedy for the disease. Four ounces of this should be well rubbed into the skin, before the fire, morning and even- ing, for three or four days. This will put an end to the whole colony of these sovereign squatters upon forbidden soil. Two ounces of sulphuret of potash, and the same amount of soft soap, dissolved in a pint of water, and applied well to the skin, is used ill many cases with good effect. I Caustic potash, one part to twelve parts of water, applied in a sim- ilar way, is said to be a pretty sure remedy. A solution of the chloride of lime, used as a wash, will often eftect a cure. The ointment of the American hellebore sometimes does well. Before applying any of these preparations, let the skin be washed with warm water and soap, and well dried. Rnpia. This is from a Greek word which means dirt, from the dirt-colored cnists which are formed after the breaking of the large watery pim- |)l('s. 'J'he vesicfes are like those of eczema and herpes, except that ilu-y are /ar^er. This is distinguished from all other skin diseases by ilic formation of unln-althy, foul, and burrowing sores, which pour out a reddish matter in such quantities that it collects and dries upon the soiv, and forms a crust of great thickness, — sometimes of the size of an oyster-shell. Rupia has its origin in a weakly and debilitated constitution, and cannot be cured without renovating the whole sys- tem. Treatment. — Warm baths once or twice a week, with generous and nutritious diet. Tonic medicines (63) (51) (67) (61) (65) will be required. For external treatment, dust the surface of the ulcers with cream of tartar, or apply nitrate of silver (214) (219) (220), white vitriol, etc. Pemphigus. — PomphoUa;. The first of these terms is from the Greek, and means a bubble ; the second, -pompholix, is from the same language, and means a vmler- bubble. This is still more applicable to the disease in hand, which consists, in fact, in the raising up of the scarf-skir* in the shape of bubbles, containing a watery fluid. These bubbles are just like com- mon blisters. They vary from the size of a split pea, to that of a hen's egg. They rise up very rapidly, and break in two or three days, leaving a raw surface which soon becomes covered by a thin crust. Treatment. — Similar to that for Rupia, with the addition of iodide of potassium (140), and applying the stick nitrate of silver to the I'.t ■'I I 142 SKIN DISEASES. whole surface of the ulcer, and a short distance beyond it on all sides, or the ointment (176). Mattery Pimples. Another natural group of skin diseases are distinguished by an eruption of pimples, Hlled, not with water, like those just describee), but with matter. The pimples of this class are not transparent, or whitish, but opaque and yellov) from the first. The matter is pouii'd out upon the true skin, and raises up the searf-skin, in the same way as the watery pimples. As in the preceding diseases, too, the dryiiii,' up of the matter forms crusts. But these pimples are never so suiull as those of eczema, nor so large as those of pemphigus. : Crusted Tetter. — Impetigo. This eruption consists at first of slightly-elevated pustules or pim- ples, closely congregated, with an inflamed border. These break, aiul the surface becomes red, excoriated, shining, and full of pores, through which a thin, Xiuheaithy fluid is poured out, which gradually hardens into dark, yellowish-green scabs. These scabs sometimes look like a dab of honey dried upon the skin. This has given impetigo the name of " honey disease," or honey scab. This honeyed look is well represented in the crusts which form on the lips and ears of children. Sometimes these scabs cover nearly the whole face, and are called tlic milk crust. This is putting the agreeable words milk and lumen to rather questionable uses ! When this crusted tetter invades the licad or scalp, it causes the hair to fall, and becomes what is called a scall. Treatment. — The vapor bath, and water dressing. The following ointments are useful : oxide of zinc, white precipitate, or diluted nitrate of mercury (178). Hydrocyanic acid (221), applied externally has a fine effect. The crusts should first be removed by a weak lye made from hard-wood ashes, or potash ; then, after applying one of the ointments above, or the lotion, cover the part with oil-skin. If the crusts are on the head, the hair should be cropped off before the remedies are applied. Papulous Scall. — Ecthyma. The mattery pimple called ecthyma is developed on a highly in- flamed skin. The bladders are about the size of a split pea, and are surrounded by a broad ring of redness. They are generally separate, not clustered like impetigo. They are scattered over various parts of the body, and are followed either by a hard black crust, or by a sore. The disease is either acute or chronic. The latter attacks weakly children, and persons reduced by sickness or low living. Treatment. — For the acute form, low diet, gentle laxatives, with ointment (176), and the cold sponge bath on the sound parts. For the chronic form, (140) (()0) (63) (61) (48) to be taken internally, and (176) (175) (214) (211) for external applioation. Scaly Eruptions. The scaly eruption is called dry tetter. It is an inllainmation of the true skin, and in distinguished from the rashes and pimples by the alteration of the searf-skin. The diseases forming this group art* three in immber, — lepra, psoriasis, and pityriasis. Leprosy. — Lepra. In this disease, the eruption makes its appearancic as a small, salmon-red spot, raised a little above the surrounding skin, and con- stituting, in fact, a flat pimple, almost as large at the top as at the bottom. On top of this pimple, the scarf-skin becomes rough, and after a little while, a thin scale is produced. New layers are added to its under surface, and it accordingly grows thicker. It has a bright, silvery lustre. These scaly spots multiply, and become tiit; form of leprosy called lepra guttata, from the Latin viutta, a drop, the scales looking like drops of water on the skin. But the eruption more frequently spreads out into circular patches, of the size of a fifty cent piece. These generally appear below the elbows and knees, and on the breast and shoulders, and buck of the hands. Sometimes the entire band is covered with scales of a |)ecu- liar silvery whiteness. These patches heal from the centre. Psoriasis. This differs from lepra in the eruption being more irregular. The spots sometimes come out in thick clusters, and blend in various ways. Instead of appearing in distinct circular forms, as in leprosy, the patches are irregular, and of every size. Instead of one well-formed and thick scale, there are many small and thin ones. And instead of a depressed centre with rising edges, the surface is level. While lep- rosy is a circular dry tetter, this is an irregular dry tetter. Pityriasis. This is much like the two preceding, except that it gives rise to a copious production of very small bran-like scales. Indeed, its name is from the Greek, and means chafi' or bran. It is a bramiy tetter. It may occur on any part of the body. Treatiiieut. — When the skin is highly inflamed, and stiff with heat, pain, and itching, the diet should be light, and the drinks of a cooling and unexciting kind. The warm bath, and gentle friction of the skin are useful. Laxatives or tonics may be employed, according to the indications, — frequently laxatives first, and tonics afterwards. The specific remedies for curing the disease are, corrosive sublimate (139), I'! ', 1 ;i^.: odidc of potassium (140), arscniato of iron (08), Fowl(!r'» solution, ill t\v(» (Iroj) (loses, ihrvv, times a day; or ])t)iiovair.s solution, in live drop doses, tlirv.'c tim«\s u day. For external u|)plication, use a nap- th.iline ointintMit (177), zinc ointment, white precipitate ointment, diluted nitrate of mercury ointment, or solution of corrosive subli* mute {2L'2). Dry Pimples. Tmk.sk are distinguished by the high degree of irritation of the skin which they create. They are exceedingly troublesome, not only from the distress and itching they occasion, but because they are likely, in con>sorHward, iliey carry the scarf-skin along with them, which is thickened; and tDgether they form what is called ivarls. Corns are formed by a somewhat similar growth of the papilUe, brought about by the pre«- MU'C and friction of tight boots and shoes. TreittiiK'iit. — For warts, take a piece of diachylon plaster, cut a iiole in the centre the size of the wart, and stick it on, the wart pro- jecting through. Then touch it daily with aqua fortis. Nitrate of f-ilver sometimes answers well for touching it. They may be taken ctf very neatly, sometimes, by tying a string tight around them, t'orns should be shaved down close, after being soaked in warm water and soap, and then covered with a piece of wash-leather, ot luickskin, on which lead plaster is spread, a hole being cut in the Iffither the size of the corn. They may be softened, so as to b** ciisily scooped out, by rubbing glycerine on them. Manganic acid de- stroys warts and corns rapidly. Bunions, which affect the joint of the iricat toe, must be treated with fomentations, and sugar of lead water (■2','4), when there is consideral^le inlhunmation, with rest and a hori- zontal position. But the best cure for corns and bunions, is to put liwav tight shoes. 19 II i!tJ .* ' Ih 1,; . I '*™ ^ ammww 1:1 146 SKIN DISEASES. Mother's Marks. — Nevus. The small vessels of the skin, called capillaries, suffer certain alter- «-ions of structure which pass under the name of mother's marks. These marks are simply a great dilatation of these minute blood vessels. These marks vary in size from a uu're point to a patch of several inches square. The smallest of all is the spider mark. It is a small red point, from which several little straggling vessels s[)read lut on all sides. Sometimes this is of the size and appearance of ii j-ed currant; at other times, of a strawberry or raspberry ; and occasir nally it is even much larger, ai' 1 is compared to a lobster. When ihe circuhiTion is active through them, or Ihc individual is excited by exercise, or by moral causes, these marks an; of a bright red color. Some are naturally livid and dark-coloretl, and look like blackberries, and black currant'*. The blueness of these is owing to the vessels being still more stretched and dilated, anil to the conse- quent slower passage of the blood through them, wincli gives more time for its change from the arterial red to the venous blue. Trcsetmeiit. — Jf the mark is not making progress, it had better be let alone, or only subjected to gentle pressure by putting a piece of soap plaster over it. When its course is threatening mischief, it is .•sometimes cured by pencilling a small portion of its siwface, from time to time, with nitric acid. Disordered State of the Nerves of the Skin. Itchin)(. — Pruritus. This is supposed to be dependent on an altered condition of the nerves of the skin, and consists in a painful sensation of itching. There is no perceptible alteraiioii i:; the ap- pearance or structure of the skin. This itching is thought, I'eneraliy, to be a result of sympathy, through the nerves, with souir cli. I'ascd and excited condition of a distant part. The itching is broiighi mh by the most trifling causes, and for hours may deprive the sulli'rrr tW every particle of repose. It more frequently allecta the fundain«'iii. or the |>rivatt; parts, particularly the scrotum. Treiltiiieilt. — As this disease is only a symptom of several other-;, the constitutional treaiment belongs under tin; heads of these other diseases. The local applications for relieving the itching are, a solu- tion of svigar of lead (224), of white vitriol (220), of corros^ive subli- mate (212), diluted nitrate of mercury ointment, and poppy fomenta- tiona. Also (223). Disorders Affecting the Color of the Skin. Colored Putclies. — Macuke. The depth of color in the skin W ' Moth or '3 M nioth<^r'H marks' 'kin'*.'. HJarks arc sijnply u f:,r('at (lilui:sjf5<»n of' Uif.fe rniimte hloot ve»3i(>l!', T'lCtaC rnark.s vury in si/.o from 4 :t;veic Vfoiiit I0 u patch 0/ 8t^vt.'rul iiKihtM sqnnre. : The .sniaHejit of all i,< tlif- spkkr mark h >''■ i miuW red poin* from whif'h ^*:-\'- ml iii'ie 8iragf?lin.2; vi!»f«ir* »p,r» aJ out on nil n-'iiit^. S<.>itiK jiui'.-'. ihi«( irf of th(! ^i7X'. aiK? ajjipeasaiict' 1- u r<- or ra^tpl-^rVy ; W**!- ^v ra^jorially it is evoj. Miij"!i iari^ir, uiwi i--^ coiiipajred to ;.. l-<.b;'ir=-ii; \V|jf?u ihc cii-cuiafit-n i» ;»vtivv rhix-u^ii TlrRinr, or thf* iiidivitloaj » ■ ciifti by excTcisfi^cf by mc^ml ftatt''e«, tin'w iX'^rks un »)f h briii^ .r^: luiiiiraUy livii^ and d«rk-<'')lof"(!, -irid look lis. blaciib^Tvics a!id bliu% <".irraiiVs. Tlie bluvMi'^vij of tlu'rf*- is owin-;- rhc vf's^cls being m\i inon? sfr»,'TohP«i Uml iliinieii, and to Ihe con** qticm -'.uwer pasfaieo of the blcH>ti thjrowKh *^h<^"!i, wliich givna nuv ti'iK* lor m c-rauge from tfe*' wre^fM?.! i^-d to ih« vt-uojis bliio. • Tr»^.Mrtif«t — If thp i-K.': uk-o«r, vf «>nly H.il-.if;. '. u to gontk-. pre^.-ur^; by putting ;.i pi«-'f;< ;. Kip pUt!*tk";r over b When i'-i?' coors*^ ia thrcatouini; init^chief, i: sosuctisn*'- i;arcv p»in illing a s'tnatl jwrtloii of itis hiirfa<-c, ffn. s iituH 'c tUDe, wtth nitric ucid. Djaordernd State of the Serves of the Skin. it'tiiimg. — PrnrUux. Tlu.^ is f>!ipjx)si>d to in? um* dii^n • and excited fot-.dirion o( k distant pnrt. The jtrhioij i;* l'M>n^^»t bv the mo!r Konrs may deprive tiie >nlHf every parti*!.** of te(K»i^e h »jv>r6 i'rt'vjriently att'MU the funda •• or the private partii, partjeaiariy th<« f'.otcui'. ' ;, Tk utuii'ut — As this disease in only « -unpfcsn of severt' thi- coustitutional trentment belongs io. -> -r ihe head? of the . e Disofders Affectirjg f U»f C«>m he Skin. r:oU»r.'»eilt, — It is generally best not to meddle with a mole. If it be very unsightly, let it be removed by two incisions, taking out an elliptical portion of skin, and closing the wound with sticking plaster. In the case of bleached places, apply the shower bath, tonics, and a stimulating liniment (163) to the faded spots. For the change of color called sun-burn, a liniment (191) of lime water, etc., is the best pre- paration. For freckles, use lime water (191), or. perhaps, still better (222). Disorders o? the Sweat Glands. Thk perspiration is sometimes greatly increased above nature's de- sign. This is, technically, idrosis. In other instances there is too little sweating. This is called nnidrosis. Sometimes the perspiration is so altered in its physical qualities as to have some peculiar smell. This is osmidrosis. In some rare instances, according to old writers, she sweat was changed in color. This was chromidrosis. And now and then a case occurs of bloody perspiration, of which, the luost memorable case on record, is that of the Redeemer of men, who, in the garden, sweat great drops of blood. Several cases of this are recorded in medical books. It is called hfcmidrosis. The proper action of the skin b(ung so vitally important to health, these changes often involve very serious consequences. Vii I r;j.!i !' :i I !- n-\ I M i' !' I if?:: 148 SKIN DISEASES. Tretitiiieiit. — EifluT too much or too little sweating can generally be corrccited by the cold or warm bath, friction, tonics, and proper clothing. Disorders of the Oil-Glands and Tubes. That the skin may be limber, healthy, and fit for use, it is neces- sary to have it oiled every day. For this object, the Creator has wisely provided, by placing '"\ the true skin a large number of very small glands and tubes, whose ofUce it is to prepare and pour out upon the siiiface the prop* . amount of oil. The gland, regular little oil-pot, is in the true skin; and from it a piece of hose or tube runs up thioiigh the scarf-skin, through which the oily Huid is poured out. Some of these tubes are spiral, others are straight. On some parts these vessels do not exist; on others they are quite abundant, — as on the face, nose, ears, head, eye-lids, etc. I^hey produce the wax of the ears ; and on the head, they open into the sheath of the hair, and furnish it with a hair-nil or pomatum better than the chemist can make. These little vessels are always at work, when the skin is healthy; and no persons need be afraid to wash all over every day, lest, as the Boston Medical JoK ma/ taught, the skin will be injured by having the oil removed from it. You might as well be afraid to eat a meal of victuals, lest the saliva should all be swallowed with it, and none be left for future use. There is oil enough where that upon the skin comes from, and the vessels which produce it are in < injured by work, any more than the ivuiscles of the legs are by walking. Cil'llbs or Honns. — But, unfortunately, the skin is not well taken care of in all cases, as in cities and towns where sj'dentary habits pre- vail. Here, the actions of the skin, instead of being regular and com- plete, are often sluggish and imperfect; and the contents of the oil- cells and tubes, instead of flowing easily, become hard and impacted, and the vessels are not emptied. "When this matter becomes station- ary, dry, and hard, it distends th(» tube, and fills it to the surface; and then coming in contact with the dust and smoke of the atmosphere, the ends K». 77. become black, and look like the heads of worms. These s|)ots an; conuuou on the nose and face of persons who have u sluggish skin. They may be squeezed out by pressing the nails on each side of them. These are called tr-rubs .ind worms, or, technically, comedones. When this matter ))ro(luces inflairunation of the tube, there is then a l)lack spot in middle of a red pimpfc, and the disease is called spotted acne. Now and t the oily matter becomes very hard, ducing spine-like growths, and even lects and forms soft tumont, as we SKIN DISEASES. 1^9 called encysted tumors. Sometimes the action of the glands is too great, and oil is poured out so profusely that the face shines with it. At other times there is so little that the skin is dry and harsh. In the hardened, oily matter, which constitutes grubs, are foiuid small animals, which Dr Wilson calls the " animal of the oily product of the skin. ' Here are three views of him. Fio. 79 Fici. 80. Trciifiiieiit. — For roughness and harshness of skin, wash with soap and water every night, and rub well into the skin after the bath, and in the morning, the ointment (ISO), and take a dose of sulphur, v\v. (:23), twice a week. Or, nih the skin every morning with a damp sponge, dipped in line oat-meal, anil after drying the surface, the liniment (104) may be a|)plied. The spinous varii'fy, or porcupine disease, reipiires washing witli a quart of warm water, havhig a huge tcaspoonful of saleratus dissolved in it, and the use of the ointmcMt (181) twice a day. For grubs, stimulate the skin, by wu: hing it witli strong soap suds, twice a day, and rubbing briskly with a ct)a"se towel ; and by using tin; corrosive sublimate {2'2't) as a lotion. A spare diet will do much towards improving the skin in many cases. Barbers' Itch— Jackson's Itch. — Sj/co. SIS. This is very much like acne, — only dilFering from it in its location. It appears chiefly on the hairy parts of the face, — the chin, the upper lip, the region ^of the whiskers, the eyebrows, and the nape of the neck. It consists in little conical elevations, which maturate at the top, and have the shaft of a aair j.assing through them. These pim- ples are of a pale yellowir h color. In a few days they burst, and the matter running out, form > into hard, brownish crusts. These crusts fall off in one or two weeks, leaving purplish, sluggish pimples behind, which disappear very slowly. I 'H4 150 SKIN DISEASES. The eruption is preceded by a painful sensation of heat, and tight- ness of the skin. The disrase is supposed to be brought on frequently by using a dull razor in shaving. It is very obstinate, — often lasting for many months, and even for years. Trentnieilf. — The most important part of the treatment is the re- moval of the cause. Tlie beard must not be pulled with a dull razor; the shaving had better be discontinued altogether, and the beard be mertdy cro|)ped ott' with scissors instead. All intemperance in eating and drinking, and exposure of the face to heat, must be avoided. A light, cool diet will do much towards curing the disease. The nitrate of mercury ointment, and a solution of oxalic acid, aro the best applications. If one does not succeed, try the other. Disorders of the Hair and Hair Tubes. The hair is an appendage to the sc^arf-skin, and is intended to bo both useful and ornamental. It is sul)ject to several disorders. It may grow too long, or too thick, or it may appear in an improper place. This last happens ii! the case of those little spots and patches, which disfigure the face, and are called Jiio/es. The hair may be defective in its growth, or may fall off prematurely from various causes, or in the natural course of things from old age. This last is called calvilies. It may change its color, too, under a great variety of circumstances, and at nearly every age. It is not very uncommon to find a single lock varying in color from that which surrounds it. Old age, the winter of life, nat- urally brings the frosted locks ; but they frequently appear also upon the heads of younger persons. Strong mental emotions, such as fear, grief, or sorrow,may bring a bleaching o the hair in a brief period, or even suddenly. Byron, in his " Pri .ner of Chillon," beautifully refers to this fact : " My hair is gray, but not with years, Nor grow it wliito III a single night, As men's have grown from sudden fears." I*orri}»'0. — There is a troublesome disease of the hair and hair tubes called pon'i^o. It begins with the formation of a ihin layer of scurf either around single hairs, or in ])atches which enclose several. These patches fre<|ueiiily have a circular form, which give to the allection the character of a rin>cw()nti. The hair tubes are generally a little elevated, in the shape of pa|)illffi, which gives to the diseased seal|) the a])pearance of " goose-dcsh." These hairs, losing their proper nour- ishment and healthiness, brejik olf at unequal distances from the skin, leaving thi-ir rough ends, twisted, and bent, and matted into thick grayish and yellow crusts. Upon the surface of these crusts may generally U; seen the ends of a few hairs, looking like the fibres of hemp or tow. The scratching causes iuHammation of the skin after u time, and matter is poured out, which still further mats the hair, SRIN DISEASES. 151 and thickens the crusts. There are several varieties of this disease, differing slightly from each other ; but this general description will answer all practical purposes for this work. The reader will often notice a disease of the hair-glands, character- ized by a yellowish and dirty-looking powder, covering the scalp and hairs. This matter is collectt'd at the mouths of the follicles, and considerable of it is strung upon the hairs like beads. Pull out a hair, and the root will be fonnd thin, dry, and starved in its appearance^ In this disease, it is difTicult to keep the hair cleansed, or to i)revent its failing olK Fiivii.s. — Still another disease, called favus, is known by the collec- tion of a yellow substance, at first, around the cylinder of the haiii This substiince, after a time, spreads out upon the scarf skin, and dries into yellow crusts, in the forin of a cup, around the base of each hair, A intnilur of these cups, collected together, look like the cells of a honey-comi). 'J'liis disease is contagious, and is conuimnicable by contact to any part of the skin. Treatlllt'llt. — For removing the hair from particular parts of the scalp, it is common to resort to depi/d/orics. Of these, the recipi-s 200, 261, 262, are frequently used, and are as good as those adver- tised ; indi>ed, they are the same. To prevent loss of hair, and to restore it when lost, the circulation should be stimulated in the small vessels of the scalp. With this view, washing tlu^ head every morning with cold water, drying it by friction with a rough towel, and brushing it to reilness with a stilf hair-brush, are excellent. To these should be added some stimulating ointment (183), or liniment (2o7) (258) (2;')9). These last are about the best known preparations for causing the growth of the hair. Rin^ivoriii of the scalp requires attention to the diet, and such rem- edies as will improve the general health, with stimulating applications externally (257) (258) (259). To color the hair, several preparations are used. Of these, 263 is about the best. It produces a beautiful black. A preparation of sul- phur and sugar of lead (264) is the famous compound reconnnended by General Twiggs, and extensively used. Preparatit)ns of nitrate of silver (265) (266) (311) are much in use in some (piarters. Tliey perhaps give a liner black to the hair, but they render it dry and crisp, and they will stain the skin, if care is not used in applying them. Ill Favus, the two great objects to be gained are, to remove all local causes of irritation, and to excite the diseased hair glands to healthy action. The first object is effected by cutting olf the hair with the scis- sors, and removing the crusts by washing the scalj) with castile soap and water. It may be well first to wet the crusts through with corro- sive sublimate (212), in weak solution. The washing with soap and water should be repeated every day, and be followed by rubbing into the scalp a stimulating ointment (183). A very weak solution of the acid nitrate of mercury (226), applied every other day, with a camel's hair brush, sometimes produces excellent effects. '"'i' .1,' I ' VI DISEASES OF THE BRAIN AND NERVES. The brain and spinal cord are the great centres of the nervous system. The brain produces sensation, thought, and voluntary) motion. When thift organ is diseiV( h Softening of the Brain. — RamolUssement. Inflammatiox of the brain, when it has run its course, sometimes leaves this organ, or portions of it, in a softened condition. The same mischief may happen to the brain from the blood-vessels which run to it being diseased, so as not to be able to carry blood for its proper nourishment. §( ^f'^^nr DISEASES OF THE BRAIN AND NERVES. 153 SyRiptoills. — The most n'rnarkablp symptom of th?'* diHeusr is the rigid coiitmction of the iiiuselos which draw up the limbs ; the huiid nii.y Ix' ficnelied and pressed against tlie shouldtT, or the heel earried up to the hip. Tlie other symptoms are various, — fiiigling and luniibness in the ends of the fingers; perverted vision, and sometimes blindness; paraU ysis of one limb, or lialf the body; diliiculty of answering (piestions ; forget fulness, making it dillieult, at times, for the patient lo nua-mber his own name. Suppuration and Abscess of the Brain. Wmkn a diseased l)rain is examined after deatli, sometimes matter is found mixed in with the softened portion. This shows that suppu- ration took plaee. At other times, the matter is found in a cavity, whieh shows that an abseess had formeil during life. The symptoms of these; mischiefs arc convulsions in the earlier stages, and palsy in IIk; latter. Induration of the Brain. Instead of softening the brain, inflammation sometimes (U)es the very opposite, — it hardens it, — producing a change something like that which happens to white of egg when dipped in hot water. Convulsions ap|)ear as the result of tiiia change, as in suppuration and abscess ; palsy much more seldom. « Tumors of the Brain. Tumors infect the brain, occasionally, — growing around it, on all sides, pressing themselves into its substance, and causing many dis- turbances. Cancers and hydatids are found there. Tlu; signs which these irritating bmlies produce, are like those of other diseases of the brain, and therefore caimot be distinguished during life. Delirium Tremens.— Drunkards' Delirium. Mania a Putn. This is often mistaken for brain fever; but it is quite a difTerent disease. It is not the result of injiammaliua of the brain, but of irritation. It is important to distinguish it from inllaiimiation, be- cause the remedies which are employed for that would be injurious if used for this. Tlie Syiii|itoiils are incessant talking, fidgeting with the hantls, trem- bling of the limbs, a rapid pulse, profuse sweating, utter sleeplessness, and a mingling of the real with tlie imaginary in the busy talk. The patient is apt to think somt; one is about to do him a great injury, yet is unwilling to be alone. His face is pale and sallow (sometimes red and flushed), his eye is rolling, quick and expressive, his speech <[!■'}■ n 1.'; ;i- «[ 156 niSKASRS OF THK HKAIN AND NEKVES. % :..« situtterincr uikI inarfii'iilatc. — bodily and imMiliilly, ho l* hnsi/ day ami night, and can with dilliciilty bv. conlined to hi.s bed or room. As tin' discv'sc advancer^, and lie Una born long without nJccp, ho iniagints vonniti to b< crawling uj)on his scalp and body; troops of rats run across !i\s bed, or look at iiim out of the wall ; giant boxers oonlVoni hiiri, and he squares olf for a round at fisticuffs ; animals, figures of a'l sl)a|)es, and horrible monsters, frighten his imagination ; tleviU langii at him, and dance before him. In long and sleepless hours, he talks a)id chaitiTs with tliese sp(ctral phantoms, — now beekoniiii.' them, now ^llrinking from them, till Ik; wears out and sinks from ex- haustion. This is a disease of drunkards and opium eat<'rs, 'F'lic aitack generally occurs in "•onsequence of the withdrawal lor three or fouv days of the accustomed stimulus. Tresitiiient. — Opium am! its preparations are the sovereign remedv. Giv<; one-third of a grain of morphia; if this does not (piiet tin- |)atient-. give thirty drops of huiuamuri every two hours, till slee|) is produeevl. Sleej) will cure him, and nothing els(> will. A draught or two of his a( customed drink, l)randy, gin, or whatever it may be, will also generally dispose him to slei-p. R(>cently, a very efil-etual n rnedy has been found in the use of tepid baths, j)r<)long<'tl from four to ten hours, in toime -tion with cold aitphcaiions lo the In-ud. In connection wi'.ii this. snn»ll dwsc- of opium are recpiinid ; but tin" treatment ma\ yet prove to bi- vitv vaiuabie by tMiabling ns to dispense- with excessive doses of oj)ium. m Enlargement of the Brain. — Ifi/perfrop/n/. Tms is cnielly a disease. t»f ciiildliood. it <-onsisls in an unnatural growth o!" the brain. Sometimes the sfuill grows with it, and liierc may not !>e any, or only slight, symptoms of disease. The c()i(i|)iaint is sometimes congenital, — the child being boni with a head !ar above the natural standard of size. Sonnciimes a child's licail, from this disease, will reach the size of an adnlt'.^', I)V llw tim(! it is live or six years old. This is not necessarily a disfasr, though children that snll'er from it are very apt to die linallv of soin»' atieclion of the brain. M)lHj>t«llls, — Dulness of iatelh'cr, indillerein e to (>xternal object^, great irriiability of temper. ':Ordii',ate a|)petit<', gic'diness, and an lia- biViial headache, which ai liinc''. is very severe. In additi«)n to taese, there are, at times, convulsions, epih-ptic fits, iiml idiocy. There is a peculiar pfojection of the parietal bones, which serves well to di.^lia- gui^h tills disease from acute hydrocephaln^. TroitllM'llt. — Ah far as possible, suspend and rcjiress all exercise of the mind. Take the child fnnu scht)ol as soon as the di.seasc is dis- covered, and |)UT it, to the most acttive imiscular xerci.se in the opt-n air. The moment there is any excitement of the brain, or heat on Ihe top of tlic head, apply cold water, ice, or cold evaponuing ](;tioiis. If. HI-" the child grows up, the signs of mischief increase, the diet m'! til.' 'i.' IllfS DISKASKS OF THK BKAIN AND NKRVKS. 157 1)»> simple, and carefully regulated. Bread and milk only is some- I lines advisable. Shrinking of the Brain. — Atrophy. I'ms is a disease in w liicli the volume of the brain is diminished. There are two forms of it ; one is congenital, the brain not being properly developed at biriii : the other occurs in consecpicnee of dis- I ;ise cither in tin- nicnibrancs or the arteries. The symptoms are not (listingnishiil)lc during life from those; of other brain allcctions, and therefore it can only be treated according to general principles. Water in the Ke&d.~- icKte IIj/drorepfKdus. 'J'liis, like eidargement of the brain, is likewise a disease of child- hood, and often attacks srmfiihus children. Being an inllunimaiory disease, it is im|)ortant to have early notic' c'f its existence, !ind. if possible, to be aware of its approach; which we may be, fretiuenlly, by observing the following pretnonitori/ Syiiiptoilis; nnmely, a disturl)anee of the disgestive functions, indi- (iitcd by a capricious appetite, — the food at one time being disliked. ;it another devtMircd urccdily; afoul tongue, ollensive breath, enlarged ::n(l sometimes tender , belly, torpid bowels, stool^ light-colored from liiivim; no bile, or daik from vitiated bih*, fetid, sour-snu'lling, slimy and lumpy. 'I'lie child loses its healthy look, and grows paler and ihiimer. lis customary spirit and activity are gone; it is heavy, lan- guid, dejccicd ; it is fretful, irritable, uneasy; and sometimca is a little tt)ttcriiig in its gait. After these warning sym))tonis, the disease may begin in one of three ways : 'J'he pains in the head become more severe and frequent, and are sharp and shooting, causing the lifth* patient to wake and shriek out. As the drowsy state advances, the shrieking gives place to moaning. Heside these symptoms, there are stillness in the back of the neck, pain in the limbs, great tenderness of the scalp, vi^miting, sighing, iiitoleraMcc of light, knitting of the brows, increased tlisturbaiice of ^toinacli and l)owels. This stage may last ten to fourteen days, the child growing more weak and p<'cvish. Another form of atta('k is marked by acute pain in tin; head and high fever, convulsions, flushed face, brilliant eyes, intolerance of light and 5ound, pain and tenderness in the belly, stupor, great irritability of stomat;h, causing retching and vonuting upon every attempt to sit up in bed. The third mode of attack is very insidious, — the early symptoms being mild and hardly notic<>!d)le, or not even occurring at all. In such case, the; convulsions or palsy come suddenly, without notice, bringing swift and unexpected destruction. This lias sometinies been called water-stroke. ! i fl'ii ' 'I 158 DISEASES OF THE BRAIN AND NEHVES. Tlie First Stiijife is the period of increased sensibility and excite- ment, caused by inHamrnation, in which the pulse is quick antl irreg- ular. TKe S«*coild Stslge is one ot" diminished sensibility, or lethargy, dur- ing which water is elluscd upon the brain, and the pulse is slow. Tlu' Third IVriod is one of palsy and convulsions, with squinting of the eyes, rolling ot" the head, stupor, and a rapid, thread-like j)u1m'. Trciltllicilf. — III the first or iullaiiiiiiatory st;ige, purging is very important, and it must l)e coiitiiiiird for three or four days. Scaiii- iiioiiy and crotoii oil (:j:i) may l)e chosen for this piir|)osc. Apply cold water, ice, etc., to the head. In the second stage, ])ut l)listcrs upon the back of the iieik, and one upon the bowels if tht-v are very tender. • In the third stage, ellusion having taken place, use the warm bath, or the vapor bnili, — also di<,'italis, scpiills, and iixlid*' of potassium, (Ml) (l-J.s) (:JO:i) (i:JO). Coiilint? the child to a darkened room, of moderate temperat\U'«.', — exchidiiig all noise and causes of excitemciit. and let him lie upon a hair mattress, with his head somewhat elevated. IMft, — Gruel only (luring the stagi' of excitement, — during that of collapse, it should be nourishing, but mild iind easy of digestion, as l)eef tea, j)lain chicken or mutton broth, and animal jrllies. At the same time, support the patient by the cautious use of the aro- ruatic spirit of anmioiii t, ten drops every four hours, valerian, wine whey, and infusion of gentian, columbo, or (piassia, (04) (t)()). Dropsy of the Brain. — Chronic Uj/drocep/ialus. Acute hydrocephalus is an inflammation ; chronic hydrocepiialn?. now to be considered, is a dropsi/. It often begins before birth. It con- sists in the acciunulation of enormous (piantities of water within the brain, sometimes within its ventricles, at other times, upon its surface. When it occurs soon aftt^r birth, it advances slowly, and impercepti- bly, — the enlargeuuMit of the head being the first thing noticed. The skull being tender in infancy, it separates at the fontanelles, as the fluid accunuiiates, and the head, at times, attains an enormous si/e, — so great that the child cannot carry it upright, but lets it droop laterally upon the shoulder, or forward upon the; breast. As the disease advances, the senses become blunted, the child jp deaf or blind, the intt licet is weakened, perhaps idiocy appears, the flesh and strength pass away, convulsions and paralysis coine in their turn, and a stupor is apt to occur which euds in death. 'rreiitiiimt. — The remedies may be external, or internal, or both. IiiteriDil KeiiiedirN. — These should be purgatives (88) (31), ordi' uretics and aitcrativi-s (30:2) (145) (144). EvtiTiml Rfint^dicM. Apply nn ointment of the iodide of uota?- MUiu lo the stiiip I'very night ( ]«>">). A tight bandage appLiea over tlie whole head will sometimps have a favorable eflect. Another ex- pc'lieiit is to puiuture the skull and draw oH' the water. Tapping the brain has elleeted a cup: mi many carte.s, and perhaps proinisies the most relief of any remedy we have. Diseases of the Spinal Cord. Fm. 81. Tnr.nr, are few diseases ujore interestinjc^, as a study, tiian those which ail'cct llic nervous cord winch rmis throu!^h the centre of tlic Imck-honi-. This cord is ;i ii)iilinniition, an !i|)pcndai'' ^1-) It is the s<'at and centre of c plu< c which arc not under the control of the will. In order that we may feci wliat takes place in any part of tlic body or limbs, and that the will may have powiT to move sncii part, it is necessary tiiat nervous matter should be continui)ns and mibrokcn lj(>tweeu the part in (pu'stion and the l)rain. If the spinal cord be cut, broken, or crushed at anv point, all those parts which n'ceive nerves from he/oir the injury, lost; their power of motion and their fecl- mg. When the injury is in the upper pint of the cord, the brcathin:; and the circulatit)n will stop, and death is the innncdiate eonseipicncc. If the miildle portit)n of till- cord be the seat of the injiu'y, the bowels and other organs may lose their motion and feeling; if the lower |)ortion, then the lower limbs only will be the sutfcrers. Disease or injury in the upper j)art of the cord is therefore much more dangerous than the samo thing owunring in the lowe.- Inflamn ation of the Spinal Cord. Tuf, membranes wl'ic h surround the cord may be inflamed jtist as those arc which 'iieiose the brain; but as the cavity running through the spine is (piite Hmall, there cannot very well be inflammation of the membranes without its involving the cord at the same time. Symptoms. — Pains, often int<'n.se, running along the spine, cxteni>. The pain which is felt along the eord is aggravated by rapping upon the spint;, but not by pressur'" # - m. ;';l' ' I'VQi The above symptoms are supposed to be the result of iiiflammation predoniiiiating in the membranes. When its seat is more particularly ill the substance of the cord, the symptoms are, — convulsive afiec- tions of the head and face, inarticulate speech, loss of voice, squint- ing, and (iilliculty of swallowing, if the extreme upper part of the cord is iiiHained; if the disease be slightly lower, ditliculty of breath- ing, irregular action of the heart, and tightness of the chest ; if lower si ill, vomiting, pain in the belly, sensation of a cord tied round the abilomen, pain and heat in passing water, retention of the urine, ina- bility to retain the urine, desire to go to stool, or involuntary stools. Spasm and stifiness, then, are the results of indammation of the membranes; convulsions and palsy, of the same alfection of the cord. .. Treii fluent. — When the inflammation is acute, apply a few leechi's /)r wet cups along the sides of the spine. In chronic inllammation, powerful friction, or mustard draughts, stimulating liniments (190), or plasters, will generally answer the purpose. Apoplexy. Ai'opi.F.xv is that condition in which all the functions of animal fife are suddenly stopped, except the pulse and the breathing; — in which there is .leither thought, nor feeling, nor voluntary motion; in which the person falls down suddenly, and lies as if in a deep sleep. diodes «f Attack.— There are at least three ways in which this fcrriblc disease may make its assault. The First Form of attack is a sudden falling down into a state of insensibility and apparently profound sleep, — the face being generally rlushed, the breathing stertorous or snoring, the pulse full and not frecjuenl, with occasional convulsions. From this mode of attack some die inunediately, others get entirely well, and others get off with the exception of paralysis on one side, or the loss of speech, or some one of tlu' senses. The Second mode of attack begins with sudden pain in the head. The |)atient becomes pale, faint, sick, and vomits. — has a cold skin and feeble pulse, and occasionally some convulsions. He may full down, or be only a little confused, but will soon rwuver from all ilie symptoms, except the headache, — this will eontiimet and the patient will sooner or lat<>r beeome heavy, forg«'tfnl, unabli- to connect ideas, and finally sink into insensibility, from which he never rises. This mode of invasion, though not aj)[X!»ring 't.' frightful as the first, is of nmcli more serii-uis impv)rt. In the Third form ot" arrack lliere U sudd»'« Ian-s of power on one side of the body, aiul also of speech, hi>t not t>£" «HmM'iousness. The patient retains his mi-id, and answers c;««^f»o*»s either by words or signs. This may l)e ealled ])ara!\tic :»i>'*plr\y. The patient miy either die so«)n, or get well, or live for v«>ars with imperfect speech, or a leg dragging after him, or an amilMngmg useless at his >ide. DISEASES OF THE BRAIN AND NERVES. 161 Tlie Person!} Attacked are apt to have large heads, red faces, short and thick necks, and a short, stout, square build, though it occurs often aniong th<»se who are thin, pale, and lall. The tendency to it increases ifi advanced life. The Forerunners of apoplexy are headache, vertigo, slight attacks of palsy, double vision or seeing two objects when there is but one, faltering speech, inability to remember certain words, sometimes a sudden forgetful ness of one's own name, a frequent losing of the thread of ideas attempted to be pursued, and occasionally yn unac- countable dread, for which no reason can be given- Exciting Causes. — Whatever hurries the circulation of the blood, as strong bodily exercise, is an exciting cause. So are all those things which cause the blood to flow towards tho head, as couching, sneez- ing, laughing and crying, straining at stool when costive, lifting heavy weights, singing, and playing on wind instruments. To these may be added, ex|X)sure to the sun, the bad air of crowded rooms, holding the head down, or turning it around to look backward, tight cravats worn about the neck, and exposure to severe cold. Treatment. — If the patient have the appearance of surtering from fulness of blood in the head, as «!vinc<*d by redness and turgescence of the face, and throbbing of the temporal arteries, and if the pulse be full and hard, feeling like a tense vibrating rope untler the fuiir«'r, phic»! him in a half-recumbent posture, with his head raised ; UKustMi his (;lothes, particularly his ncek-cldtli and shirt collar, and whatever may press upon the neck, and tluMi as quickly as possible apply cold wet cloths to his head, changing them oi't«'n. Ire is still better, if it may be had. Vpply wet cups to th«> nape of I'c neck, and mustard draughts to the soles of the fret, — at the same time applying tight ligatures aroimd the limbs, to prevent the blood from n^turniiig rap- idly in the veins. Tlu' ligatures should l)e gradually n>moved when the patient recovers his eonseiousness. Also administer c. stinmlating, purgative injection (^46), and plaeu two drops of cn»to«i oil, rubbed up with a little pulverized loal wugar, far )>a(k upon the tuMigur. Re- peat the injection every tifteen nunule>. till the Ik)w«'Is are thoroughly moved. If tho patient be old, and the pulse small and fe«'hle, with no ful- ness or beating of the temporal arterit's, or swelling of tin- veinn of the neck and forehead, the (H)untenan«-e l*« «ng |>intlif(i. and the ^+kin bloodless and cool, \hv. cup|)ing, purging, and applying the ligaturt; nmst be omitted. In this case it will be bctT.-r to appiv wartii Ha > nels and hot bricks to the surface, and administer annnonia aru CAmphor ('2^:}) (135) int«*rnally. To prevent Inture attacks, gentle tonics should fce and, and the skin should be kept healthy by daily bathing and itmtiBn. The bow- els nmst not be permitted to become costive. T%b diet should be light, chiefly vegetable, and almost tyitin-ly so in l*ot weather. The food should be well ch«>wed. Tlu> mind shouhl ix- kept cheerftil and hojH'ful, and free from great excitement. The sexual passion nhouki he rwtrainvd, and very mrelv indulged. Intoxicuiting drinks should b« 21 i 162 DISEASES OF THE BRAIN AND NERVES. abandoned, if used, and all tight cravats be discarded from the neck. Direct rays of the hot sun in summer should be carefully shunned. No food should be taken for three hours before retiring, and a mat- tress only, of some degree of hardness, should be slept upon, — the head being always well elevated. To these precautions, T would add, dipping the feet every night, before retiring, in cold water; and, if any tendency to cold feet be experienced, dusting pulverized cayenne in the bottoms of the stockings. Sunstroke. — Coup De Soleil This is much like apoplexy; in fact, it is a kind of apoplexy. It occurs in warm climates, or in very hot days in temperate regions, by exposure to the sun. It begins by headache, thirst, dizziness, and sometimes difficult breathing and bilious vomiting. The patient drops down senseless, as in apoplexy, and unless immediate relief is obtained, soon dies. Treatment — Take the patient immediately into the shade, and employ about the same remedies as for apoplexy. Palsy.— Paralysis. Palsy is a loss of the power of voluntary motion and feeling, one or both coming on, sometimes gradually, but more often suddenly, and extending at one time to a part, at another time to the whole body. It is a kind of station-house on the way to apoplexy, where passengers stop, not merely to stay over night, but to rest many days, or even yerrs. A great injury inflicted upon the brain, either by pressure, or other cauHe, will induce a complete loss of motion and feeling, and this ex- ti^nding to the whole structure, brings likewise a loss of conscious- ness, which is apoplexy. A smaller degree of pressure, or a less injury u|X)n the saitu' brain, would occasion a loss of motion only, or, if a loss of feeling were experienced also, it would only extend to a part of the body, and consciousness would remain. This would hf palsy. Tlie disease is like apoplexy in kind, but stops short of it in degree. Hemiphlegia. When palsy affects an entire half of the body, dividing it through the centre of the face, neck, body, etc., from head to foot, it is called hemiphlegia. It is more nearly allied to apoplexy than any other form of the disease, and is generally ushered in by pretty well-marked apoplectic symptoms. Symptoms. — Sometimes there are no premonitory symptoms ; but often before the attack there are (lushed face, swelling of the vein? about the head and neck, vertigo, a sense of fulness, weight, and •ometimes pain in the head, ringing in the ears, drowsiness, indistinct M DISEASES OF THE BKAIN AND NERVES. 163 articulation of words, or even loss of speech, confusion of mind, loss of memory, and change of disposition, — amiable persons being made sullen and peevish, and irritable ones tnild and simpering. After the attack, the countenance generally acquires a vague expression ; the mouth is drawn to one side ; the lower lip on the palsied side hangs down, and the spittle dribbles away. The speech is altered, and the mind is generally impaired. In some instances, the patient recovers in a /onger or shorter time* in others, little or no improvement takes place, and the patient, aftei remaining helpless, often for a long time, dies either from gradual exhaustion, or suddenly from apoplexy. Crtiisfs. — llemiphlegia and paraphlegia, are caused by pressure npon the brain, by the etl'nsion u|H)n it of blood or water, by a tumor, by iTH'chanical mjnries, by the striking in of eruptions, and by intem- perance in eating and drinking. Paraphlegia often results from dis- •ase or injury of the spinal marrow. Paraphlegia. This form of palsy divides the body transversely, at the hips, and confines itself to the lower extremities, and to the parts about the pelvis. Symptoms. — When it arises from affections of the brain, it is at- tended by pain in the head, giddiness, drowsiness, dimness of sight, and impaired memory. Numbness is sometimes felt in the upper extremities as a forerunner of this form of palsy. At first there is a slight stiffness and awkwardness of the motions of the legs, which continue to increase till a cane is needed to balance the body and make it steady. From a paralysis of the neck of the bladder, the stream of urine grows more feeble, and finally dribbles away involun- tarily. The bowels are for a time costive, but when the circular muscle which closes the fundament becomes palsied, the feces pass without consent of the will. When disease of the spinal cord is the cause of the complaint, it is apt to come on gradually, languor and weakness are felt in the knees, the legs are not easily directed in walking, — being thrown across each other, causing tripping and stumbling. By dcgre**."* the loss of power increases in the thighs and legs, until at length the whole lower extremities become palsied and useless. Local Palsy. Palsy is called local when it is confined to a single limb, or muscle, or locality. One of these forms is called facial palsy. It affects one half of the face only, and is a good specimen of these affections. It removes all power of expression from one half of the face, and leaves the features still, blank, and unmeaning. With the affected side of the face, the patient cannot laugh, or weep, or frown, or ex- press any feeling or emotion, while the features of the other side are in full play. Among the ignorant, who do not comprehend the extent of the evil, the droUness of the expression excites laughter. l!'f i'! tl 'c^fi H.;r£ •M', I 1 H;. 1 > ■ IM. M 'W Jif:>f • 't'f-. f-'.' !-;f !"• , Shaking Palsy. The nature of this form of palsy is well expressed by its name. Symptoms. — The first symptom of this complaint is a weakness and tremor of the head or hand. In about a year the other hand, or the lower extremities become affected ; and the patient begins to lose his balance in walking. Then the trembling becomes per|>etual ; no limb or part remains still. Reading and writing are no longer possi- ble, and the hand cannot even carry the food to the mouth. The balance cannot be maintained in walking ; there is a tendency to fall forwards, and to avoid it, the patient is obliged to run or move quicker, and upon the toes. At a later period, the tremor continues during sleep ; there iai in- creased weakness ; the body is bent forward, the speech becomes indistinct, swallowing difficult, and the bowels torpid. At last, the urine and feces pass involuntarily, and delirium and coma bii.ig life to a close. Lead Palsy. In this disease the muscles of the forearm are palsied, so that the wrists " drop," as it is said, and the hands hang down when the arms are stretched out. It is caused by the gradual introduction of lead into the system. It is a disease, therefore, peculiar to painters, — particularly those who use carbonate of lead, or white lead, as it is called. It is generally the sequel of painter's colic. Treatment. — A sudden and severe attack of palsy vequires ther same treatment as apoolexy. When the bowels are obstinately con- stipated, they must be purged by seammony and croton oil (31) (32,) and by injections (246). When all the symptoms of determination of blood to the head have disap|)eared, and the disease has become strictly chronic, ex- citing remedies must be employed, as frictions, stimulating liniments, blisters, stimulating baths, cold affusion, and electricity. Among the internal remedies, strychnine has the best reputation (85) (86). The tincture of the poison oak is well recommended (284). An altera- tive (145) should likewise be ysed. Apply counter-irritants along the track of the spine, such as blis- ters, the moxa, the compound tar plaster, and the pitch plaster. At first the diet should be light ; but after the more active symp toms have disappeared, it should be nutritious^ and sometimes stimu- lating. Flannel under-clothes should always be worn next the skin. For lead palsy, the best remedies are iodide of potassium, or sul- phuret of ^xitassium. The dose of either of these is from three to ten grains, three times a day, dissolved in water, one ounce of the salt to six ounces of water, and taken in simple syrup. The affected limb should also be soaked an hour each day in a gallon of water, with half an ounce of sulphuret of potassium dissolved in it. Hydrophobia. — Rabies. Thk bite of the mad dog, or mad wolf, or other hydrophobic ani- mal, is the most dangerous of all poisoned wounds, because it is apt to be followed by a disease for which there is no certain remedy. Fortunately, the human subject is not as susceptible to the effects of the poison as some of the lower animals; for only about one-tenth of those bitten are attacked by hydrophobia. ; Syiii|itoiiis. — Tlie interval between the bite and the appearance of the disease, varies from twelve days to two months. The wound heals like any other bite of a similar animal. After a time, the scar begms to have darting, lancinating pains, which, if it be a limb that was bitten, run up towards the body. Sometimes it feels cold, or stiff, or numb, or becomes red, swelled, or livid, and occasionally breaks ojX'n, and discharges matter. The patient feels a strange anxiety, is depressed in spirit, has an occasional chill, and disturbed sleep, and spasmoilic twitches. The pulse is above its natural state, both in quickness and strength, and the nervous system is very im- pressible. The senses are all more acute ; trifling noises produce agitation, and the eyes are so disturbed by the light that the patient sometimes hides himself in a dark place. The appetite is lost. This is the first stage. Thirst now appears, and he attempts to drink. But the moment water ap[)roaches his mouth, a spasmodic shudder come's over him ; he pushes it back with horror ; the awful fact of his condition flashes upon him ; and he cries out, " What 1 have dreaded has come upon me." Thenceforward he can swallow no fluids; complains of pain and stiffness about his neck ; is thrown into convulsions by the sight of water, or even the sound of liquids agitated in a vessel, or by a breath of air blowing upon him, by a bright light, or the glare of a mirror. His throat is full of a viscid, glairy matter, which he continually tries to clear away. Thus, between convulsions, in which he struggles, and sometimes strives to bite his attendants, and comparative still- ness, during which he suflers great depressioii of spirits, he passes three or four days, and then dies either in a spasm, or from exhaus- tion. Treiitiiieilt. — Cut off the bitten part, or apply dry cupping, or auc- tion, at once. Also the caustic potash. The internal remedies here- tofore employed have had little success. Perhaps nothing now known promises more than to keep the patient, for a long time, under the influence of chloroform or ether. The tincture of scullcap, in two or |t- 1 : ;;-^ ;i^ If 4[ii^:; ;lk three dram dosrs, will allay the nervous agitation, and ia always worth using. It has been proposed to elear the throat of the tough mucus by cauterizing it with a strong solution of nitrate of silver (219), applied with a sliower syringe. The remedy is worthy of a trial. Some of the Western physicians declare thi; red chicUweed, or scarlet pimpernell, to be an absolute reint'dy for this disease, and cite some quite remarkable cases of its success. Four onn<'«'s of this plant, in tin; dried state, are directetl to be boiled in two (piurts of strong l)eer or ale, until the licpiid is reduced one half. 'The li(|uid ia to be pressed out and strained, and two drams of laudaniiiu added to it. The dose for a grown person is a wine-glassful every morning for three mornings. A larger dose is reipiired if the diseas*' have begun to show itself; and if the case be fully developed, the whole may be taken in a day. The wound is to be bathed with the same decoction. The medicine, it is said, produces profuse sweating. It is worth a trial. Consi(lerai)le has been said of late of a remedy used in some parts of Europe, and said to be ert'ectual. It is tlit; "golden cenotides" (celoHia aurufu), or common rose ln'ctle, found in large (piantities on all rose trees. A similar insect is said to infest the geranium |)lant. When collected, they are dried and powdered ; and given in this form, relieve excitement (so it is said) of the brain and nerves, and throw the patient into a sound sleep- Muscular and Nervous Derangements from Wounds. In some persons, a very small local injury will produce violent dis- turbance of the nervous system. Some will faint and be thrown into (K^nvulsions and vomiting from causes scarcely grc^ater than the prick of a needle ; and, before Morton gave the world the boon of ether, it was not very uncommon for persons to die under the knife of the surgeon. One of tlu; most serious disturbances from wounds, of a nervous and nmscular character, is Locked Jaw. — Tetanus. Tnis is spasmodic contraction, with rigidity, or stiffness, of the voluntary muscles. Sometimes this rigidity is partial, at other times, universal throughout the system. Tetaims is produced by two causes, exposure to cold (idiopathic), and bodilij injuries, |)articul:irly the injur// of a nerve (traumatic tetanus). This last is the most frequent, — perhaps the only form of the complaint. The Syiiiptoiiis are long-continued, violent and painful contraction or cramp of the voluntary nmsdes. At first there is difficulty and uneasiness in turning the head, with inability to open the mouth easily, — then the jaws close gradually, but with great firmness; swal- lowing now becomes difficult, and a pain, starting from the breast- bone, pi(!rces through to the back, — probably caused by cramp of the DISEASES OF THE BRAIV AND NERVES. lOT diaphragm or midrifl! The cramps now extend to the musele« of the body, the limbs, the face, the tongue, ete., which continue in a state of rigid spasm, — being swelled and hard in the centre, — till the disease yields, or the patient dit's. At times the abdominal muscles are so tense as to make the belly as hard as a board. Occasionally the patient is drawn backward into th(! shape of a hoop, so as to n-st on jiis head and beds (rpist/iofonos) ; at other times he is drawn forward in the shape of a ball {cinprostho/onos). All the contractitms are at- tended with intense pain. It is th«? racking of the entire body with c-ramps like tho.se which sometimes attack the calf of the leg. So violent are thi^ contractions that the teeth are sometimes broken l)y thr, taken either into the stomach, or by inhalation, in (juantities siillicient to control the spasm, and to be pursued as long as tln'y continue to o<;cur. The eostiveness must hv reMU)ved by one or two dro])3 of croton oil, administered in a s|)oonful of gruel. Epilepsy.— Epileptic Fits. Thi« disease has been sometimes called the fulling sickness, but generally passes under the more vague title oi Jits. S>lll|)toill.s. — The disease is charaeteriztid by a temporary loss of consciousness, strong spasms, and intervals between the tits. The attack is sudden, generally without warning, and attended with a loud cry, ■when the patient falls down, is senseless and convulsed, strug- gles violently, breathes with embarrassment, has a turgid and livid face, foams at the mouth, bites his tongue, has a choking in the wind- pipe, and app(v,irs to be at the point of death. Presently, in from five minutes to half an hour, and by degrees, these symptoms diminish, and at kfngth cease; and the patient falls into an apparent sleep. In a short time more he recovers, and is apparently well. The?^e attacks come again anil again, and at irregular intervals. This is the worst form of the disease ; there is another class of cases in which the syinptoms an> much lighter, — there being no tur- gescence of tlu^ face, no foaming at the mouth, no cry, no convul- sions ; but merely a sudden and brief suspension of consciousness, a fixed g;'/>\ . feeling of confusion, or a totter, from all of which the recovery is .-,ieedy. . Caust'-, — These are numerous, — as worms, disturbance from indi- gestible lood in the stomach and bowels, difficult teeth-cutting, ner- vous initation, either direct or by sympathy, sexual excesses and masturbation, disease or injury of the brain or spinal marrow, gall (tones in the excretory duct of the liver, stone or gravel in the kid- 'If l! 1 + !' 11. i II h i '■ f; ,isi ■,'iu 1 ^# ^. "^^.^^^ ,^l s>^. \^>T.% IMAGE EVALUATION TEST TARGET (MT-3) fe A :/ V] ^/^ >> ^-1 c^ 1.0 1.1 |50 "^* ^i- lis ill 10 2.5 2.2 Photographic Sciences Corporation 18 IL2I IIIJA IIIIII.6 23 WEST MAIN STREET WEBSTEi.N.Y, MS80 '71«) 872-4503 iV \\ ^v^\. ^\ Wk\ ^^ ■^ ji<^ ^ %^\. &j <<% o'^ 168 DISEASES OF THE BRAIN AND ^ERVES. neys and bladder, fright, distress of mind, pass.i- bath frightens the patient, or is not otherwise well borne, take the sponge bath. Chronic Chorea. This can hardly be said to amount to a disease. It consists rather in uncouth tricks, arising from some slight disorder of particular muscles, and grown into a fixed habit, such as shaking of the head every three to twenty seconJs, repeated squinting of the eyes in con- nection with a peculiar knitting of the eyebrows, wrinkling of the nose, shrugging of the shoulders, lifting the ears up and down, or even moving the whole scalp back and forth. These movements are commonly made without a consciousness of it ; and generally there DISEASES OF THjfl BRAIN AND NERVES. 171 is no power to suspend them without a painful eflbrt which cannot be easily continued. No medical treatment is of any avail. These tricks can only be corrected by great watchfulness and effort on the part of the person sutfering from them, and in many cases, not even by such means. Cramps. Cramp is experienced in the calves of the legs, the thighs, the stomach, the breast, the womb, etc. It is a very painful, sudden, and violent contraction of one or nion; muscles. Thv part is sonietimes, as tiie phrase is, "drawn up into knots." Wlicn it attacks the btom- acli, it is a very dangerous atl'cction. Women are subject to it about the third or fourth month of pregnancy. C-'ailses. — Drinking cold water when very hot and perspiring, ex- t)osure to damp night air, debility, indigestible food, and excesses in c'ating and drinking, and particularly overstraining the muscles. Trentllieut. — Moderate the excessive labor and straining of the muscles which produce the cramps. "When an attack occurs in the legs, tie a cord or handkerchief tight around the leg above the affected muscle. This will generally produce instant relief. Also rub the part with spirits of camphor, or paregoric, or laudanum. When it occurs in the stomach, a|)ply warm fomentations, or what is better, a mustard paste (165). Then make one grain of morphine into four pills, and give ono. If this does not bring relief, repeat it in half an hour. The bowels, if confined, should be opened with an injection. Cramps of the limbs which afflict women in the family way, can only be mitigated, not cured, till after confinem>^nt. As a palliative, high cranberry bark, scuUcap, etc. (87), will be found useful. Pain of the Nerves. — Neuralgia. This disease affects one tissue only, — the nervous; and has one symptom, — pain. In upop/e.r/j, the nerves, rendered powerless and senseless by an external force, are like a man under a bank of earth which has slid down upon him. In palsy, they are suddenly bereft of feeling and motion by a blasting scourge within, — as one is smitten down by a pervasive charge from a magnetic battery. In epilepsy, the nerves are grasped and for a time held senseless by an unseen power, in which they struggle, as a man strives in the folds of the anaconda. In catalepsy, they are suddenly Stiffened into senseless strings, for snch automatic use as the bystander may, for the time, choose to make of them. In chorea, they are set to dancing by an invisible exhilaration, as a man is crazed by brandy. In neuralgia, the nerves are neither crushed, nor collapsed, nor restrained for a time, nor stiffened, nor exhilarated. They simply have their sense of feeling intensely exalted; they are filled with pain. 1 1 ,. \\'v'' M II I , i 1::^ Illtv^ (l* The pain is generally of a peculiarly darting, piercing character. The patient sometimes calls it tearing paiu. It comes on in sudden par oxysms, with intervals of freedom between. The attacks are some times like an electric shock, and are so agonizing as to bring a tern porary loss of reason. Occasionally there is great tenderness of th« parts affected, and some fulness of the blood-vessels in the neighbor hood ; but generally the signs of inflammation are all absent, excep pain. Neuralgic pains occur in almost every part of the system. One of the most familiar forms of the disease is known under the name of Tic Douloureux. It occurs in those branches of the fifth pair of ncrvef?, wMch go to the face. (See Fig. 82.) Sometimes one, sometimes all of 'he three branches are affected, but more often, no. 82. the middle branch only. When the up- per brand' is the seat of the disease, the pain is in the forehead, the brow, the lid, and somi4HBji DISEASES OF THE BRAIN AND NEUVES. 177 fltomach can digest food well, or than one with inflamed eyes can see well. f tllMCH of Intimity. — Hereditary predisposition; painful subjects' of thought or feeling long revolved in the mind ; injured feelings which cannot be resented, mortified pride, perplexity in business; disappointed affection or ambition ; great political, religious, or social ex(ritements ; sudden and heavy strokes of misfortune in the loss of property and friends; and in general, whatever worries th(! mind foe 'I long time, and creates a deep distress, may be a cause of insanity. But one of the most prolific causes, and worthy of special mention, in masturbation, or self-pollution, — a vice contracted by thousands of young people, both male and female. Beside the above, I may mention several physical causes, as con- vulsions of the mother during gestation, epilepsy, monthly disorders of women, blows upon the head, fevers, loss of sleep, syphilis, exces- sive use of mercury, worms in the bow !.•*, and apoplexy. €hanceH of Cure. — Idiotism is never cured. Melancholy and monomania are cured when recent, and do not depend upon organic disease. Dementia is sometimes, though seldom, cured. Chronic insanity, of long standing, is not easily cured. Insanity which has been produced by moral causes, acting sud- denly, are generally curable ; if the causes have acted slowly and long, the cure is more doubtful. Excessive study causes insanity whieh is hard to cure. If caused or continued by religious ideas, or by pride, it is not often cured. Insanity caused and maintained by masturbation, is cured with great difficulty. TreatineHt. — The treatment of the insane is now almost confined, as it should be, '.o public hospitals. In these institutions, all the means are provided which humanity has been able to devise, to lift from these unfortunate beings the terrible shadow which is upon them. Here they have safety, comfort, recreation, friendly guardians, rest, and medicine. They have safety from the annoyances which well-meaning but mistaken friends at home almost always commit in contradicting, and reasoning with, persuading, and threatening them ; for only in these humane institutions has it been well learned that to do so is no wiser than to persuade, scold, or threaten a neuralgic pain in the face, an inflammation in the stomach, or a felon upon the finger. They are safe, too, from the impertinent scrutiny of neighbors, the hootings of unthinking boys in the streets, and especially from the causes, what- ever they are, which have produced the disease. And so far, this is just the treatment they want, — no contradiction, no impertinent scrutiny from neighbors, no abuse in the sl.reets, and a withdrawal of the causes which have produced the disease. In these institutions, too, they have comforts. They have clean 23 Um i-iii^i ■ i rooms, p;alIories, lodges, bntliirifj^-rooms, yards nnd jrardciis for cxprciHc and walking, safe, (iiiiet, \v»'ll-aircd hcd-nunns, and clean and cotii- fortahlc beds ; clu'crliil dining rooms, and plain, wliolcsom*', and nutritions food. And this, liUrwisc, is tlw treatment they re(|uire. They have reereation, — dances, eards, haek-gaimnon, ehe(juers, chess, billiards, nine-pins, walking parties, riding parties, gardening, and an inchdgence in those arts of painting, music, drawing, and architecture, for which they may have a taste. And such recreations are powerful instruments in the cure of all disorders of the nervous system. Here, too, they have friendly guardians, who have long studied their complaints, and have imbued their souls with a sympathy which goes down into the deptlis of their suft'erings, and allies itself with all their sorrows; — men and women who are willing to act the part of guardian angels ; to b(^ their friends ; who know how to gain their confidence ; and who use the influence acquired by love, in leading them back towards health and happiness. And this, too, in curing the insane, is of great consequence, for none can do tiiern good till they have their confidence, and this can be gained only by love and wisdom. In these insane asylums, they find rest. When the brain is hot from inflamma<^ion, and tliey are raving from delirium, they are here withdrawn from vhe noisy crowd, and shielded from the rude slioi^ks of the world. If need be, they are placed in solitary rooms, where silence spreads its sootning stillness through their excited brains. And it is of the greatest importance that the sore and torn feelings should rest ; for rest allays excitement, and brings sleep ; and without a proper amount of sleep, rtjcovery is not possible. Finally, in these institutions, they receive the best medical treat- ment. They have warm and cold bathing, judiciously administered ; they have simple cathartics when the bowels are bound, as salts, cas- tor oil, and magnesia; tonics for debility, such as quinine, iron, quas- sia, columbo, and chamomile ; and quieting medicines for their ex- citement, such as opium, morphine, cicuta, hyoscyamus, belladonna, stramonum, scuUcap, and valerian. Prescription 74 is a combination much used. Here, too, broth, gruel, and milk, are administered by the forcing pump to such as take a fancy not to eat, — an expedient "which has saved many lives. Fruits of all kinds, as strawberries, cherries, currants, plums, apples, peach(!s, and grapes, are allowed freely. Cold water, sweetened or otherwise, is the drink. To these things are added lively conversation, and whatever will divert the mind from reflection, and internal imaginings and revery. Thus I have indicated, very briefly, the treatment which the insane receive in public institutions. That the chances of recovery in these humane retreats is much greater than at home, does not admit of a doubt. When it is not convenient to send an insane person to a hospital, the treatment should be as nesur like the one here sketched as circumstances will permit. '!) '«■' Hypochondria. TiiK cominoti naiucK of this disease nrc lefnl |)nrsnits of life, beeonio insipid, tasteless, and even irksome to the hypochondriac. Ills mind is full of the belief that sonu'thing dread- ful is about to befall him. lie is either going to be sick, or to die r lose his pro|)erty or friends. II(! has no mind to engager m any busi- ness, nor does he wish to go anywhere, or to see anybody. Night and day his spirits are down tt) zero, and his heart has a load too heavy to bear. He is wholly occupi<'d witli his troubles, and his feel- ings. He thinks he has various diseases, and wears oMt his friends by talking of his stdl'erings. He feels of his pidse if* en, looks at his tongue in the glass, and several times a day asks a ii\' nd if lie does not look pale or sick. The external senses manifest symptoms of dcf'igcment as well as the thoughts, feelings, emotions, and passions. ' jere are roarings in the cars, like -y waterfall, or the noise of a distant carriage. Floating black specks, jr bright sparks, are seen before the eyes. These indi- cate a slight fulness of the blood vessels, and ])erhaps, in some in- stances, sparks of electricity ])assing to or from the eye, and are in no proper sense subjects for the alarm Ihey cause. At one time the person will feel as large as a barrel, at other times not larger than a whip-stock ; the head will feel light or heavy, large or small. The skin will twitch in different parts, or feel numb, or have the sensation of spiders crawling on it. ' The smell and taste become perverted ; the hypochondriac will smell odors and flavors, at times, where there are none. These errors of the senses are all owing to some slight disorder of the organs of sense ; and they are no more wonderful than that the mind should perceive personal danger, poverty, and death itself, when none of these things are impending. These persons are subject to fainting turns, when the breathing will appear to stop, the body become cold, the face pah; ; there will be distress in the region of the heart, which will apparently stop beating, and the person will feel as if dying. At the «ame time the mind will remain clear. These nervous spells are alarming, but pass off' with out danger. These persons become changed in their moral dispositions. They are jealous, take a joke as an affront, and feel the greatest distress at any apparent lack of attention or neglect on the part of friends. They put the worst construction upon the actions of friends. They are irritable, fretful, peevish, and fickle. The complaint is distressing, but does not appea'- to shorten human life. The seat of the disease is in the brain and nerves. It is caused by anxiety, care, disaippointment, working the brain too hard, diseases of W'' t'i ■;,!', ",;• i>!' nil 'm .. 180 DISEASES OF THE BRAIN AND NERVES. the liver and stomach, costiveness, sedentary habits, excessive venereal indulgence, and masturbation. Treatment. — This disease is more easily prevented than cured. It would be almost entirely prevented in this country if in childhood we were all taught to be contented with humble competence, to love active labor, and to think it honorable, inst«!ad of struggling after wealth, and falling into unhappiness when it does not come. Remedies. — Of all the remedies for this complaint, that which is most important is active employment out of doors. The human body was made for motion. Without it the blood cannot be dis- tributed to the several organs. The senses, — the eye, the ear, the touch,- — should be much in communion with nature. In this way they are strengthened. Nature is their great physician. Man is a creature of sensation ; and if too much occupied' with feelings, thoughts, and deep reflections, the nerves will be irritated, and begin to give deceptive sensations. A very nervous man should fly to some active occupation, if he would be rid of suffering. The open, fresh air is very important to restore the system to soundness. Temperance, both in eating and drinking, will do much for this class of patients, yet they are the very persons who eat largely, and they often fly to the excessive use of stimulants to drive away their sorrow. By so doing, they aggravate the disease. Amusements are very important for hypochondriacs. Lively com- pany, cheerful and witty conv' 'vtion, with mirth and laughter, lively songs and instrumental music, are all desirable ; and so are gunning, fishing, riding, billiard-playing, and travelling. iVever allow these patients to be alone, and to have time to brood over their misery. See that they go early to bed, and rise betimes in the morning. 'J'he warm bath, the cold shower, or sponge bath, with brisk friction, are not on any account to be omitted. The diet should be light, nutritious, and generous ; but fats, acids, licjuors, and coffee, must be forbidden. But little medicine will be required. If there be costiveness, let the cracked wheat be eaten ; if this do not answer, a little rhubarb and bicarbonate of potassa (35), or leptandrin, podophyllin, etc. (36), may be given as required by the symptoms. A teaspoonful of calcined magnesia once a day, or the infusion of thoroughwort, drank cold, will often answer an excellent purpose. A bowl of warm mother- wort tea, with a teaspoonful of spirits of camphor in it, will do well in fits of fainting when there is a sensation of dying. A teaspoonful of sulphuric ether may be given at the sa.me time. If there be debil- ity, tonics are sometimes useful (50) (49) (54) (55). Hiccough. — Singultus. This is a sudden, jerking spasm of the midriff, occurring every few moments in bad cases, causing the air to be driven out of the Innga DISEASES OF THE BKAIN AND NERVES. 181 with such suddenness as to produce a noise something like the invol- untary yelp of a .>uppy. It is generally caused by acidity of the stomach, which irritates the nerves distributed to its neighborhood, and is not difficult to remove ; but when it occurs towards the close of some acute and grave disease, it is sometimes a sign that dissolu- tion is at hand. Treatment — Startle the person suffering, by exciting surprise, or fear, or anger ; or, let a few small draughts of cold wat«r be taken in (|uick succession ; or, let the br(;ath be held as long as possible. It' the stomach is sour, take a teaspoonful of bicarbonate of soer as if he were awake, and he tries to do just what he would if awake. Sometimes the sensation is that some heavy weight, or perhaps some horrible monster, is upon the breast, nearly pressing the breath out of the body. At times, the power of motion is not absent, and then disturbed dreams may cause one to talk, or to rise and walk, or run. Children will laugh, or cry, or scream, which shows that their minds are agi- tated by different passions. Persons \v\\q idulge gloomy and troub- lous thoughts in their wakiug hours, are apt to be disturbed with sleep-walking, sleep-talking, and frightful dreams, as of falling down precipices, during the hours for repose. There is nothing very wonderful about these disturbances of sleep. It is only necessary that there should be an unusual sensitiveness of the brain, or tliat a hearty supper, eaten late, should irritate the nerves of Uiv. stomach, and that distressing thoughts should be dwelt upon during the day and evening, in order to produce all the walk- ing, talking, dreaming of hobgoblins, shipwrecks, fires, and polar bears, which distress so many unfortunate sleepers. In night-walking there is simply a little more wakefulness than in night-talking, and in this latter, more than when one falls from a high place, and in this perhaps slightly more than in real incubus, when one is in the greatest peril, but camiot move at all. Treutiiieiit. — When sleeping persons groan, or make any noise indicating nightmare, shake them, and they will come out of it at once. As these troubles are often caus(!d by a weakened state of the nerves, much out-door exercise should be taken. The diet should be simj)le, and well regulated. The suppers should be light, and wm DISEASES OF THE BRAIN AND NERVES. 183 never taken late. The evening should be spent in some pleasant amusement, which will diive away care ; and the last hours of wake- fulness be occupied with pleasant reflections. One afllicted with nightmare should not lie upon the back, nor with the hands over the head. Acidity of the stomach, and costiveness, if they exist, should be removed by the neutralizing mixture. Headaches. These are not always caused by disorders of the brain and nerres, but they frequently are, and this seems the proper place to speak of them. It is unwise ever to neglect headaches. They are sources of great suft'ering, and often lead to serious derangements of the health In childhood they have a more serious meaning than in adult life. The^ often indicate the approach of scarlet fever, or measles, or of other diseases. Headaches are more common among the civilized than the uncivil- ized ; more frequent among females than among males ; among those of sensitive feeling than among the more obtuse ; among those who think much than among those who think little ; among the sedentary than among the active. Causes of Headaches. — They are dependent on various causes, as derangement of the circulating system, of the digestive organs, of the nervous system, etc. Among those dependent on disturbance of the circulation, are Plethoric Headaches. — These are dependent on a general fulness of blood They are of two kinds. One is occasional, and lasts but a few hours. The other lasts for days or weeks. It occurs most often in the night or morning. Persons whose occupations require stooping have it most, A little dizziness is generally felt on rising up from a stooping posture. It is brought on by the bad air of crowded rooms, and is attended by costive bowels, short breath, and a white fu/red tongue. The persistent headache is accompanied by a sense of fulness, and sometimes of throbbing over the brows and temples, with a sensation of dizziness, and of mist before the eyes. The surterer fears exertion, and is constantly looking for a rush of blood to the head. Nature sometimes relieves this form of headache by a diarrhcea, or by bleed- ing from the nose. There is another form of plethoric headache, diff"ering slightly from the above, in which there is too much blood, and it is made too fast, but it does not circulate so rapidly. The muscles are not very firm, and the heart does not propel the blood with much force. This form of headache is cotmected with congestion. Headaches of Indig:estion. — These are caused either by taking im- proper articles of food, or by eating too much of those which are proper. The sensation in the head is not always a pain, but boiae- '1 i m m I'fe "■'))• •■■'3 184 DISEASES OF THE BRAIN AND NERVES. times only a dull weight, attended by languor and disinclination for exertion ; a tongue white in the centre, and pale red at the tip and edges ; cold and numb fingers ; slight nausea ; languid and feeble pulse ; dim and indistinct sight ; eyes aching when employed ; and difficulty in fixing the attention. Sick Headache. — This has received its name from the constant nausea or sickness at the stomach which attends the pain in the head. This headache is apt to begin in the morning, on waking from a deep sleep, or after sleeping in a close room, and when some irregu- larity of diet, has been committed on the day before, or for several previous days. At first there is a distressingly oppressive feeling in the head, which gradually merges into a severe, heavy pain in the temples, frequently attended by a sense of fulness and tenderness in one eye, and extending across the forehead. There is a clammy, un- pleasant taste in the mouth, an offensive breath, and the tongue covered with a yellowish-white fur. The sufferer desires to be alone, and in the dark. The hands and feet are cold and moist, and the pulse feeble. Accompanying these symptoms, there is a depressing sickness at the stomach, which is increased by sitting up, or moving about. After a time, vomiting comes, and relief is obtained. Bilious Ileailache. — This is most common in summer and autumn. It afflicts persons of dark complexion, with black hair and melancholy dispositions. There are two kinds ; one is due to an accumulation of bile in the system ; the other to a large secretion of bile. In the first variety the skin is dingy and sallow, the spirits do- pressed, the bowels costive, and there is wind in the stomach, with a dull, aching pain on the right shoulder. The pain is in the forehead, eyebrows, and eyelids, and the " white of the eye " is a little yellow- ish. The tongue has a brown fur, and h cracked in the centre. There is a bitter taste in the mouth on waking in the morning, after restless nights, and frightful dreams. In the second variety, which is due to an "overflow of bile," the symptoms are much like those of the first kind, but tiie pain is not so continuous. In addition to the symptoms named, there is a throb- bing, rending pain in the head, the skin is hot and the face flushed, the limbs are sore, and there is a luminous lialo or ring around Objects looked at, and a feeling of giddiness. Nervous Headaches. — These are more common among females than males. They occur most frequently among persons of high susceptibility, who are easily elevated, and as easily depressed. They are often coimected with indigestion. The pain is usually acute and darting, and is made worse by light, with a feeling as if the temples were being "pressed together," and a "swimminess" in the head. There is sometimes a sense of sinking, w'th a dread of falling, and great despondency and restlessness. The bowels are generally costive, and the sight dim. The pain comes ■- "^ too much blood in the head, and it inclines to stagnate. The feet and hands are cold ; and gloves and stockings of wool, and other bad conductors of heat from the body, must be worn. Occasionally a little gentle physic (319) is desirable to induce the bowels to act every day. If there is great debility, iron (71) (74) (75) (320) will be required. Headache of Iiidiisrestioii. — If the pain come immediately after a meal, and can be traced to something eaten, an emetic (2) may be taken, if the person be tolerably strong. If the pain come oi;. some hours after eating, take rhubarb and magnesia (28) (14), (;r Hnid magnesia. When the system is debilitated, take a warm draught (322) in the morning after a light breakfast, or twice a day, a bitter with an alkali (323). If the stomach be very irritable, bismuth, at meal times (324) (326). "When it occurs after a debauch, take recipe 325. Sick Headaclie. — When it results from food taken, a draught of warm chamomile tea, or a little weak brandy-and-water, will generally give relief. If the sickness continue, soda and water, with a little ginger may do well, or a mustard poultice upon the stomach (165) may be required. As soon as it can be kept on the stomach, a dose of physic (326) must be taken ; and if relief does not come after the operation of this, give a bitter and an aromatic (327). The patient must have perfect rest. If there be great lack of tone in the system, the mineral acids (328) (329) will be excellent. The diet must be carefully regulated, as in plethoric and congestive headaches. Bilious Headaclies. — These are generally connected, more or less, with some affection of the liver. During an attack, if the suffering be great, attended by nausea, give an emetic (2). In milder cases, give recipe (321). If there bo costiveness, give recipe (330) at night, and (7) in the morning. A few doses of podophyllin, leptandrin, etc. (34) (36) (39), to re- lieve the liver when the bile does notdow fast enough, will diminisli the frequency and force of the attack. The fluid extract of dandelion, taken for some time, often does good service. The diet should be light, and chiefly vegetable, and exercise in the open air must not be omitted. The daily sponge bath, with friction, is excellent. Kenous Headaclies. — The first thing to be done is to relieve the pain, and this may generally be accomplished either by preparation (331), or (332), or (333), or (88), or (93), or two or three drops of tincture of nux vomica in a spoonful of water, taken three times a day. In simple nervous headache, diet is of the greatest importance ; in hysterical cases, exercise ; in headaches from exhaustion, tonics (81) (79) (63) (73) (64) (61) (60). DISEASES OF THE BRAIN AND NERVES. ISl Rheumatic Headaches. — Take a light diet, with but little animal food. Wear warm clothing, and avoid exposure to wet feet and dampness generally, and go to a mild climate, if convenient. When the local pain is great, apply hot fomentations, or a stimu- lating liniment (334), or a mustard poultice, to the back of the neck. Ill the beginning of the treatment, a little physic at night (335) ia useful. Before closing this chapter on headaches, let me enter a respectful protest against the indiscriminate use of the thousand and one reme- dies advertised to cure headaches ; for in a great majority of cases it is merely a symptom of some other disease ; instance : Indigestion, Fever, Bright's Disease, Softening of the Brain, Diseased Liver, etc. j aiid the use of these remedies serves rather to increase tbau '^88611 'he difiicalty. : oL 'IK' m DISEASES OF THE THROAT. Thr diseases which seat themselves in the throat, and in the great cavity of the chest, have occupied a large share of my attention for the last ten years. My practice in these complaints has been large, — being drawn from every part of the United States, and the British Provinces. No class of diseases from which men suffer are more nu- merous than these, and none have so generally baffled the skill of the profession. For this reason, I wish to present here a brief, practical, and common-sense view of these complaints, which shall be of real value to the thousands of families, who, I trust, will consult these pages. Increase of Tliront Diseases. — A striking increase in the number of throat diseases has been witnessed within the last few years. A person suffering from any of them will find, on speaking of his com- plaint, that a number of his neighbors are afflicted with troubles of a similar kind. I have thought that in some of their forms these dk- eases have fastened upon the throats of not less than half our popu- lation. And when it is considered that they are the natural, and if unmolested, the certain harbingers of lung disease, it is wise to make a note of the above fact. As I shall describe them in the nasal cavities, the pharynx, the fauces, etc., they all have a natural proclivity downwards. From these upper cavities they pass, by one short step, into the larynx, — the cavity where the voice is formed, — and then, by another equally short and easy stage, into the body of the wind- pipe. It is a singular fact that their progress is always from the upper breathing passages downward, and never from the lov/er pas- sages upward. They afford a parallel to the order of progression in the moral world, in which evil tendencies are toward a lower depth. A mistake Corrected.— -Before describing the several diseases which belong to this family, T wish to correct the mistake which so generally classes them all under the term Bronchitis. They all consist in a simple inflammation, acute or chronic, either of the mucous membrane lining the several cavities to be spoken of, or of the small glands or follicles connected with that membrane; and each disease takes its name from its particular location. Thus, the inflammation of the membrane lining the upper part of the throat, or pharynx, is called Pharifngitis. Inflammation in the top of the wind- DISEASES OF THE THROAT. 189 pipe, or larynx, is Lari/ngitis. In the windpipe, or trachea, it is Tra- cldtis. In the bronchial tubes, it is Bronchitis. As the bronchial tubes exi t nowhere except in the lungs, below the division of the windpipe, there can be no Bronchitis in the throat. Nevertheless, it is the same disease with Laryngitis and Pharyngitis, and difl'ers from them only in being in a more dangerous place. As the windpipe descends into the chest, it divides below the top of the breast bone into two brfinches, one going into the right, the other into the left lung. These branches divide and subdivide very minutely, and send their rainilicutions into every part of the pulmon- ary tissue. Thus situated, Meckel has comparea the windpipe to a Fio. 83. hollow tree with the top turned downward, — the larynx and trachea representing the trunk, and the bronchial tubes, with their innumera- ble subdivisions, the branches and twigs. (Fig. 82.) If the reader will now understand that the trunk and branches of this bronchial tree are hollow throughout, and lined with a delicate and smooth mucous membrane, and that the diseases lo be described are inflammations either upon this membrane or the small glands connected with it, causing swelling, redness, unhealthy discharges, roughness, etc., he will have a good general idea of them. Nasal Catarrh. I TAKE these diseases in the order of their location. Nasal Catarrh consists in inflammation, which begins behind and a little above the veil of the palate, and extends upward from thence into the nose. It , Tii ; \'' :| ! I.. m ^m'i II \m % .'^ 190 DISEASES OF THE TIIHOAT. is an cxccrdinf^ly troublesome complaint, and alllicts great numbers. It passes nnder the name of Catarrh in the IltMid. The inflammation is not confined to the nasal cavities. It extends frequently to the air cavities, called anf.nutis and sinuses, which cover a considerable portion of the face, and extend to the lower part of the fon-hcad. Persons sometimes feel as if their whole face were involved in the disease, and were almost in a state of rottenness, — so great is the amount of matter discharged from th(! head. Such free discharges cainiot be wondered at when we reflect that all the air cav'.ies in the face are lined with the same mucous membrane which lines the nose, and that they all communicate with the nasal cavities. The '^ horn ail," among cattle, is a similar inflammation of the inner surface of horns; and the "horse distemper" is an inflamma- tion of the air cavities in the head of the horse, and is much the same disease with our catarrh in the head. The catarrh often creates a perpetual desire to sivalhiv, and gives the feeling, as patients express it, " as if something were sticking- in the upper part of the throat^ When the inflammation has existed a long time, and ulceration has taken place, puriform matter is secreted, and drops down into the throat, much to the discomfort of the patient. Indeed, this is one of the most distressing features of the complaint, as this matter often descends into the stomach in large quantities, causing frequent vom- iting, and a general derangement of the health. Many times the suHerer can only breathe with the mouth open. Upon rising in the morning a great efibrt is required to clear the head and the extreme upp^r part of the throat. There is oc-^sionally a feeling of pressure and tightness across the upper part of the nose ; and the base of the brain sometimes suflers in such a way as to induce headache, vertigo, and confusion. The smell is frequently destroyed, and sometimes the taste. The inflammation sometimes gets into the eustachian tubes, the mouths of which are behind and a little above the veil of the palate, and extends up the lining membrane to the drum of the ear, causing pain or deafness, and occasionally both. In addition to this catalogue of evils, there is often added inflammation and elon- gation of the uvula or soft palate. Treatment. — The following is a fair illustration of my mode of treatment : On the 12th of December, 1852, Mr. , of this city, came under treatment for a bad case of catarrh in the head, complicated with follicular disease of the pharynx, or upper part of the throat. In addition to nearly all the symptoms mentioned above, he had a stench from the nose exceedingly offensive to all about him. So much had the disease worn upon him that he had become bilious, sallow, de- jected, and low in strength and flesh. When it is said that to all this were added a cough and loss of appetite, with insidious ap- proaches of hectic, it will not be surprising that his friends saw the most serious results impending, even though assured by me that the disease had not yet taken firm hold of his lungs. The first thing (lone for him was to cut ofT the nvnla. Five days after, I began to blithe tlie wliole nasal cavity, three times a week, with a siiower syring«', by pushing the smootii bull) up behind the veil of the palate, and throwing instantanet)iisly a most delieate shower of medicated jliiid up both sides of the septum. The upper jjart of the throat was likewise bathed by the use of a shower syringe made expressly for that part, and the larynx, or place where the voice is formed, by a i)ng, bent instrument made to reach this part of the throat. The solution used consisted of half a dram of crystals of nitrate of silver dissolved in one ounce of soft water. The nitrate of silver powder was inhaled once a day with the powder inhaler. In this way the nasal cavities and throat were kept cleansed, and the articles used gradually subdued the inllanuuation, setting up a new and healthful action in place of the diseased one. The stom- ach was relieved of the offensive matter which had daily and nightly gone down into it, and the system of the poisonous effects of its absorp- tion. The great ('anger which threatened the lungs, and which would soon have been realized in their destruction, passed away. The skin gradually assumed its proper color; the appetite, ffesh, spirits, and strength came back, and Mr. B. has been since in the enjoyment of good health, pursuing his business cheerfully. When the above treatment fails, as it does occasionally, I. am in the habit of changing the solution, using, souietimes, a weak solution of acid nitrate of mercury, twenty drops to an ounce of water. In other cases, a solution of sulphate of zinc serves a good purpose. A dilution of the tincture of arnica flowers is a preparation of some value in these cases. There are other preparations, too numerous to mention, which I am in the habit of using. 1 will add, that the nitrate of silver powder, snuffed once a day, a pinch at a time, is far more successful than any other snuff ever made. Inflammation of the Pharynx. — Pharyngitis. This is an inflammation of the upper and back part of t throat, or all that part which can be seen when the mouth is stretched open. It cavises a redness of the mucous membrane lining the part, which is deep in proportion to the intensity of the inllammation. This complaint is generally connected with the one I am »bout to describe; ; and since the treatment is the same, the reader is referred to what next follows. . . , Clergymen's Sore Throat. — Follicular Pharyngitis. This disorder made its appearance in this country in 1830, and the attention of the profession was first drawn to it, as a distinct disease^ in 1832. Some have supposed its origin to have had a hidden con- nection with the epidemic influenza, which spread over the civilized world in 1830, and affected all classes of persons; but this is only conjecture. In its early developments it attracted notice chiefly by its visitations upon the throats of the clergy. Hence its popular H^^ : 'l li : i I liiii 'fl il:i ''J9p Hij ' \ hk ^m M.^:^.- hji^;^^ i -I' -■■ Mi li 192 DISEASES OF THE THROAT. name of Cler^ymen^s Sore Throat. It was soon found, however, to uttafk all classes of persons indiscriminately, whether engaged in any calling which required a public exercise of the Toice or otherwise. It was noticed more by public speakers and singers, on account of the greater inconvenience it gave them. The dis(!ase consists in a chronic inflammation of the mucous fol- licles, or glands coimected with the mucous membrane which lines llie throat and windpipe. The office of these little glands is to secrete a fluid to lubricate the air passages. When inflamed, they spread an acrid, irritating fluid over surrounding parts, which excites inflannna- tion in them. Hence a general inflammation of the up|)er part of th<' throat, or pharyngitis, usually attends the follicular disease, and \ shall speak of the two together. This inflammation of the glands and the membrane, being neglected, as it generally is, lingers on from month to month, or from year to year, making in some cases slow progress, in others more rapid, — made a little worse and its step slightly quickened by every fresh cold, and finally results in ulcera- tion. The expectoration thenceforward becomes puriform, and finally undistinguishable from that of consumption, with all the symp- toms of which the patient finally dies. Indeed, before its nature was understood by the profession, it was considered the most fatal form of consumption, because it could be afl'ected only in a very small degree, if at all, by medicines taken into the general system. Inflammation of Mucous Membrane and Glands of Larynx. Follicular Laryngitis. A FEW strong and beautifully forrried cartilages unite to form a curious and convenient box or cavity at the top of the windpipe, called the larynx. Across this enclosure are stretched two remark- able cords, called the vocal ligaments. They are from half to three quarters of an inch in length, and are rendered more or less tense by the small muscles with which they are connected. Just above these cords are two cavities, which, with the ligaments, act an important part in the formation of the voice. Here is produced the sound, which is modified and articulated by the tongue, the lips, and the nasal cav- ities. When disease reaches this cavity, and the fluid secreted to lubricate these cords becomes acrid, the voice, from this and other causes, ia made hoarse ; and when, at length, these ligaments are altered \p structure by inflammation and ulceration, the voice suflfers a gradual extinction. I have treated a large number suffering entire loss of voice, and am happy to say it has been generally restore.^, where the lungs have not been involved in the disease. There is often also a little sensitiveness, or even soreness, in some cases, in the region of the larynx, which may be felt by pressing upon that prominence in front of the throat, called Adam's apple. DISEASES OF THE THROAT. 193 Inflammation in the Windpipe. — Tracheitis. This coiiipliiint and the one j)rccoding it diifer only in their locality from those described in the u[)|)er cavities ; and they are more alarm- ing, because two removes nearer the citadel of life, lla^jpily, we know that the seat of these disea-ses may be easily reached, and we have a shower syringe, constructed by me in 1849, so arranged as to pour the remedial agent directly upon them, without any lacerating dis- turbance of the parts. NyiliptoiilS. — The approach of these disorders is often so insidious as hardly to attract notice, — sometimes for months, or even year.«ij giving no other evidence of their presence than \\\r annoyance of something in the throat to be s-' vallowed or hawked up, — an in- creased .secretion of mucus, and a sense of wearisomeness and loss of power in iIh; throat, after public speaking, singing, or reading aloud. At length, u|)on the taking of a severe cold, the prevalence of an ej)i(lemic inlluenza, op of an unexplained tendency of disease to the air ))assages and lungs, the throat of the pati-^nt suddenly becomes sore, its secretions are increased and rend(*ret! more viscid, tlie voice grows hoarse, the dilliciilty of speaking is aggravated, and what was only an annoyance, becomes an alllic on., and a source of alarm and danger. These diseases clearly belong to the family of consumption, and need early attention. Caus<'>. — It is amusing to reflect upon the theories which writers were in the liabit of constructing, a few years since, to account for the throat aft'ection among the clergy. It was attributed by some to speaking too often, by others to speaking too loud. One class of writers thought it arose from high, stiff neck-stocks ; another, from a strain of voice on the Sabbath to which it was not accustomed on other days. The cause lies deeper than any of these trilling things. As it con- cerns ministers, it may generally be expressed in two words, — labor, anxiety. The clerical order are placed just where they feel the force of the high-pressure movements of the age. They are the only class of recognized instructors of adult men, and are obliged to make great exertions to meet the wants of their position. The extremely trying circumstances in which they are often placed, too, in these exciting times, by questions which arise and threaten to rupture and destroy their parishes, weigh heavily upon their spirits, and greatly depress the vital powers. And when we add to this the fickle state of the public mind, and the shifting, fugitive character of a clergyman's dwelling place, and the consequent liability to poverty and want to which himself and family are exposed, we have a list of depressing causes powerfully predispo 'ng to any form of disease which may prevail. It will be pardoned me, I think, if I suggest here, that the nature of a clergyman's calling is of so serious a character, that he some- 25 iir m 194 DISEASES OF THE TIIUOA'l. ^ .... ' ; ' times carries himself with too much sedateness, keeps himself too much braced up, and does not allow himself hours enough of that cheerful, light-hearted abandon, which is essential to the health of every sedentary man of mental habits. The hard-thinking and hard- working minister, who will retain his health, and . ave his throat, must have some moments, at least, when the weighty responsibilities of his olHce arc lifted up from his soul, and lie becomes, for the hour, the jocund, playful lioy of earlier days. How far he can consistently relax and let himself down, or in my view of tiie matter, raise him- self up to the simplicity and mirth of childhood, lie alone can be the judge. As a physician, I prescribe ; as a minister, he must decide flow far my prescri|)tion can be foll-^vved. llesuliii<^ Sei'iiioiis. — There is one practice, which, tliough it has not much to do with inducing this disease, does freciucntly aggravate it when once e !ablished; I mean the habit of reading sermons from manuscripts, — especially when it is done in a sort of mechanical way. Every person who has suffered from throat ail, has doubtless noticed that to read aloud, for half an hour, from a book, occasions more fatigue and irritation in the throat than extcivporaneous speak- ing, in the same tones, for one or two hours. The reason is, that in the latter case the mind conceives the thought in season for the organs of speech to fall into a natural attitude, and utter it with ease. The two work harmoniously together, — the instruments of articula- tion following the mina, and easily and naturally uttering its concep- tions. Whereas in the case of reading, the mind itself is, at least partially, ignorant of what is coming until it is just upon it, so that the organs of spe(;ch, being warned of what is to be done only at the moment their service is required, dq their work under a perpetual surprise and constraint. The difference is, in some res|K'cts, like that between walking fre(>ly at large, without regard to wiiere the feet are put down, and being obliged to step exactly in the footprints of some traveller who has gone before. In the latter case, the muscles tire much sooner, because they work in fetters. I have thus spoken particularly of the clergy, though it is not by any means they only, but all classes of people who are afflicted wiili this dangerous malady. These diseases often begin with a cold. But colds are seldom taken except when the nervous system is depressed, so that they are, in fact, to be traced back to the same cause which I have assigned to catarrhal or throat complaints themselves. These Complaints Worse at IViglit. — It is worthy of note, that all these complaints, and many others, are worse during the night. This is easily explained when we remember that the atmosphere has the least amount of electricity in it at three o'clock in the morning, and that the first minimum atmospheric pressure, which happens twice a day, occurs not far from tlie same hour. From three to four in the morning, therefore, the neriu -power sinks to its 'owest ebb ; and those diseases which owe their existence to anxiety, overwork, etc., ■ulfer, at this time, their greatest daily aggravation. Death occurs, DISEASES OF THE THROAT. 195 too, more often during these hours, than in any other portion of the twenty-four. Treiltmenf. — Some years ago these diseases were thought to be incurable ; and by all the appliances of medical art then known, they were so. But time has brought a successful method of treatment, as well as a clearer knowledge of their nature. This treatment consists in what is called topical nu'dieation, or the applying of the medicine directly to the diseased part. The medici- nai ag(Mit more extensively used than any other is a solution of crystals of nilrale of silver. This substance is not, however, adapteJ to ercry case, — other articles succeeding better in some instances. Modern chemistry has given us a variety of agents from which tin skilful physician may select a substitute, should the nitrate of silver fail. The operation of applying this and other substances to the air passages, is a delicate one, retpiiring tact and experience. Surgeons had supposed it an anatomical impossibility to introduce an inst u- nient into the larynx ; but this has been practically demonstrated to be a great mistake. Insfruiiieilts. — The instrument devised and used by Dr. Horace Green is a piece of whalebone, bent at one end, to which is attached a small, round piece of sponge. This, dipped in the solution, is dex- terously intrtKluced. into the laryngeal cavity, and applied directly to tiie diseased part. I formerly used this instrument myself, and am happy to know, that notwithstanding its defects, it was generally successful. Yet where the larynx was highly inHamed, with a swollen and ulcerated condition of the epiglottis and lips of the glottis, I am sure I some- times had the singular powers of the nitrate of silver put at defiance by an irritation evidently produced by the sponge of the probang. Upon its introduction, in such case,,, the parts contract upon and cling to it, and suflier aggravated irritation, almost laceration, upon its withdrawal, however carefully eftected. Laryngeal Shower SjTinge, — Such defects in the probang led me to contrive an instrument, which I call a Laryngeal S/iower Syringe. It is in the form of a syringe, the barrel and piston of which are made of glass, silver, or gold, as may be desired. To this is attached a small tube, made; of silver or gold, long enough to reach and enter the tliroat, rnd bent like a probang, with a g-lobe or bulb at the end, from a quarter to a third of an inch in diameter, pierced with very minu;e holes, which cover a zone around the centre about one-third of an inch in breadth. This silver bulb I daily introduce into highly inflamed and vdcer- ated larynges, generally without any knowledge of its presence on the part of the patient, until the contained solution is discharged. The instrument, being charged, is carried to the proper place, when a delicately quick pressure upon the piston causes very fine streams to flow through the holes in the form of a delicate shower, and all sides of the walls of the larynx are instantaneously bathed. 1 ■ ■■!' ! 1 1 V' ■.i i! 0'- n t '.i i i 1; ■ 1 ^1 ' : .it!"-, ■ " ■ ■ ■ ^ii :ja- J-.'Uii Mft How Introduced. — The introduction of this instrament into the larynx is easy. Upon the approach of any foreign substance, the epiglottis instinctively drops down upon the entrance to the larynx, guarding it against improper intrusions. It has been found, however, that when the root of the tongue is firmly depressed, this cartilage cannot obey its instinct, but stands erect, its upper edge generally rising into view. Availing himself of this, the surgeon has only to depress the tongue with a spatula, bent at right angles, so that the Jeft hand holding it may droj) below the chin out of the way, and as the epiglottis rises to view, slip the ball of the instrument over its upper edge, and then with a quick yet gentle motion, carry it down- ward 2Lnd fonvard, and the entrance is made. I have often admired the faithfulness of this epiglottic sentinel, who, when overborne by superior force, stands bolt upright, and compels us to enter the sacred temple of speech directl// over his head! Pharyngeal Shower Syrnige. — For washing the upper part of the throat, I construct the instrument with a sfraig-ht tube, with holes over the outer end of the globe, and extending to the centre. This washes instantaneously the fauces and pharynx, but does not throw the solution back upon the tongue. Its main advantage over the probang is, that it bathes every part of the fauces and pharynx in- stantaneously, r nd does not subject the patient to the coughing and gagging which fo'low the slower and rougher process of drawing the sponge from side to side across the cavity of the throat. Kasal Shower Syringe. — Inflammations in the back passages to tho nose, called catarrh in the head, have been a aost inaccessible by any reliable healing agent, and consequently incurable. The probang could only reach a short distance, and occasioned great suffering. I have had a syringe constructed with the tube bent at an angle of forty-five degrees, and the globe, very small, pierced with a few fine holes at the upper end. Carrying this globe up behind the velum palati, with a single injection I wash both passages clear through. I have had the pleasure of curing a large number of bad cases, of many years' standing, to the surprise and delight of the patients. About nineteen twentieths of the physicians who have examined these instruments, and so far as my knowledge extends, all who have used them, think them much better than the probang. As to patients, I have yet to see one who will allow the sponge to be used after try- ing both. Have Superseded the Prohang. — In my own practice the syringes have superseded the probang altogether. My reasons may be briefly stated. I have already said there is less irritation produced. A piece of sponge drawn over an inflamed surface, especially when clung to by the irritated and quivering parts, must necessarily, in some cases at least, aggravate the symptoms of disease. To this consideration add the comfort of the patient during the operation. It is so quickly and delicately done with the syringe, that it is scarcely known when the act is performed. The straight syringe does not touch the throat DISEASES OF THE THROAT. 197 at all. On touching the probang to the throat, the nitrate of silver unites with the mucus upon the surface, instantly covering the sponge with an albuminous pellicle, something like that which lines the shell of an egg, preventing, in a degree, the further pressing out of the solution, and rendering its contacts with other parts of the surface comparatively powerless. For this reason, the sponge pushed down into an ulcerated bronchus, as Dr. Green recommends, must be utterly valueless as a remedial agent. Mopping, as it does in its whole course, a larynx and trachea, lined in some cases with puriform matter, and generally with mucus, every inch of its descent doubles the gravity of this objection. Let it be considered, too, that in apply- ing the remedy to an ulcerated larynx, the sponge cauterizes ths healthy parts above, in its descent, and thus unfits itself for dcing much for the diseased part ; whereas the syringe retains its solution till it reaches the atiected place, and then pours a clean shower di> rectly upon it, and upon no other part. Considering these manifest advantages of the syringes, T am sur- prised that any physician should still use the probang, — especially ts one of these instruments, the Nasal Syringe, accomplishes an object which the probang cannot effect at all, not even in a rough way. I have wondered, too, how any parent can allow a child, sutiering with croup, to be tormented by having a sponge pushed down its throat, when a syringe would give it so much less pain. 1 will mention briefly one or two cases ot croup and diphtheria, se- lected from a great number treated by me for the last few years, wfiere the syringes were successfully used, after several attempts to use the probang had been made, and failed, and where the pain caused by using was so small, and the relief so instantaneous and complete, that the patients were anxious for my return to use it again. On the 25th of November last, I was called to see a little boy of Mr. R., five years old, who had had an attack of membraneous croup some days previous; and when I saw him the voice had sunk to a whisper, and the cough was entirely mutlled, so that I had no doubt of the fatal termination of the case, and expressed my opinion to that effect to the astonished parents. The probang had been used by the physcian in attendance, which had caused so much suflcring that for the two days previous the parents had prohibited its use. It had w> doubt increased the irritation, besides nearly causing strangulation. It was, therefore, with great reluctance that they consented to et me use the syringe, which I did, to the great relief of the little suf- ferer, and to the entire satisfaction of the parents. The strength of the solution of the crystals of the nitrate of silver used was 20 grains to the ounce of water, which I injected freely, once in three hours for the first day, and then two or three times a day for two or three days. His recovery was rapid and complete. I will now mention the case of a young woman, with diphtheria, where the syringe was used with success. On the evening of the 10th of September last, I was called to see Miss T., of this city, who had an attack of diphtheria the day previ- ous. Found her in bed, very much prostrated, breathing with gr ;at '5; 3 ?n m 1 :Mi W 1 ! .Hi 't( , 198 DIoIiASES OF TlIK THROAT. difficulty, and nttering at every inspiration a croupal sound, which at times was followed by a short convulsive cough. The face waa flushed, pulse 124, small and feeble, and she complained constantly of a sense of suffocation and of great distress in the laryngeal region. On inspecting the throat, the fauces and the pharyngeal, membrane as far down as it could be seen, presented the appearance of a high degree of inflammation. One of the tonsils was nearly covered with the diphtheretic membrane, and the upper and back part of the throat were thickly studded with small white or cream-colored spots. The physician in attendance had tried first, a swab, or mop as she termed it, and then the probang, which gave her so much pain that he was obliged to give it up. He then gave up the case as hopeless. At my earnest solicitation she consented to the use of the syringe. "With a solution of the crystals of the nitrate of silver, of the strength of 60 grains to the ounce of water, I injected freely the fauces and the upper part of the cavity of the larynx. For a few moments the dilK- culty of breathing and feeling of strangulation was increased, but very soon a large amount of viscid, ropy mucus was discharged. In the course of half an hour after the use of the syringe, the symptoms Had improved, the respiration was less laborious, so that in a short time the patient obtained some sleep. I was afterward called, n she thought herself wor.se, but found that an application of the caustic ovith a syringe was all that was required. There was no further trouble with the case. Several parties in this country have got up imitations of these syringes, and have made them- selves liable for damages under Fu». H4. the patent ; but they are pen-sons of little or no res|)onsibiIity, and I have not as yet brought the law to bear u|H)n tlicin. Those who pnrehast' and use thost' imi- tations, should bear in mind ihat they :ire also liable for damages, as they lie in a case. [Patented iMxember 6, 1853.] Figure 84 represents these syringr.i Mode of rsill^'. — The glass barrel and piston of my instrument.s are delieule, but they need not be broken. I handle them with tin? t.ame ease that I do a spoon in feeding myself, and not in a very dis- similar way. The last three lingers are placed on the under sitle of the barrel, with the thumb on the upper side, — the iiulex finger beintj poised over the end of the piston, ready to drive it home at the proper instant. The motion of the piston should be quick, so as to eaus( the streams to leap out in jets ; yet delicate, that they may not im- pinge with too much force upon the diseased surfaces. They should be rinsed with water immediately after being used But even with this precaution, a small residuum of the nitrate re- mains and crystallizes, and after a time partially closes the holes. They must then be picked out with the |K>int of a needle. When the silver tube becomes detached from the glass, it may be fastened on with common sealing wax ; first melting the wax and DISEASES OF THE THROAT. 199 sticking it around the glass ; then heating the silver over a lamp, and pressing it on. Amount of Solution to lie Used. — The amount of solution to be used should be snnali. Half a dram is enough. The piston of the syringe need b.' drawn up only from ^n eighth to a third of an inch. Strangling is not often produced by these operations ; but to make its prevention still more sure, let the patient be directed to fill the lungs with a long inspiration while the operator is depressing tha tongue. Strenj^h of Solution. — The strength of the solution in ordinary cases of chronic folliculitis, etc., should generally be about forty grain;i of the crystals of the nitrate of silver to the ounce of water. But in all acute diseases of the air passages, it should be considerably stronger, — varying from one to two drams. A preparation of this strength is powerfully antiphlogistic and sedative. In those cases of chronic disease, where the intlarnmation is of a low grade, and the mucous membrane is in a relaxed, atonic condition, looking either sodden and pale, or of a dark color, like the cut surface of beef, some days exposed to the air (as is often the case in throats of liierary dys- peptics), then a solution of fifteen to thirty grains to the ounce, is sufficient. This strength acts as a stimulant, and is well suited to throats in such condition, but would be injurums in high grades of inflammation. Catarrh in the head generalln requires only about this strength. I am sorry to say, the topical mode of treating throat a|]<'c- tions has been in some places injured, in tlie public estimation, by a lack of knowledge and judgment on the part of the operator, in choos- ing the strength of his solution. To determine the proper freqiiencif of the operation^ also requires judgment and experience. In an ordinary case of chronic disease, the treatment may begin by showering the throat once a day for a week. Then the operation should be repeated three times a week, for a shorter or longer period ; then twice a week, and at last once a week. Attendant Diseases. — Among the persons I am trtniting for diseases of the air passages, many are dyspeptic and suffer with drjrression of spirits. So often does this symptom present itself, that I regard it as almost one of the pcujiiirities of throat disease. Persons tints de- pressed generally have the dark and dingy look of the face which indicates functional derangenient of the liver. They are ot'ten ema- ciated, nervous, hypochondriacal, irritable in temper, and are ex- hausted by an excessive secretion of urea. The urine of such per- sons is always acid, and loaded with crystals of oxalate of lime. An explanation of this fact has been attempted, by supposing that the oxydation of carbon (of which these persons have a superabun- dance), imperfectly accomplished in inflamed respiratory organs, is vicariously effected in the capillaries of the kidneys, — oxalic acid (C2. 02.)'instead of carbonic acid (C. 02.) being the result. The crystals of oxalate of lime are octahedral in form, and, in the field of a good microscope, a,re beautiful objects for inspection. mm illi m i Mil r «!l|p . % ll (I iV !i f ; 2J0 ] »ISEASES OF THE THROAT. Lawyers, clergymen, statesmen, and, in general, those who labor hard mentally, witn but little bodily exercise, and who have a great weight of care resting on them, are the persons who suffer most from this complication. Generally, the inflammation in the throat is of a low grade, and must not be treated with a very strong solution of nitrate of silver. Of course when these attendant diseases exist, something more is needed than the local treatment. For the troubles just described, the treatment for hypochondria and dyspepsia will be proper. Elongation of the Uvula. The uvula is the small teat-like or pendulous organ which hangs down from the palatine arch, just over tlie root of the tongue. It is very apt to get inflamed, and its parts becoming relaxed, it stretches out lengthwise, so that its lower extrem- j.,g gg, ity sometimes rests upon the tongue. (Fig. 85.) When this happens, it flaps about, backward and forward, and to the right and left, — touching the throat at various points, and by the tickling sensation produced, exciting a most in- cessant, uncontrollable, and racking cough. Some of the most distressing coughs I have ever heard, have been produced and kept up by this cause alone. Mmy a fatal consumption has begun in this way. When long in- flamed, it often gets much out of shape, being sometimes bent nearly double. Treatment.— In some cases,the uvula, thus elongated, may be reduced back to its natural size, by an astringent gargle, composed of an infusion of white-oak bark, with a little alum dissolved in it (232) ; but it will generally stretch out again and again, upon the appearance of any fresh cold, and, therefore, the only certain cure is to cut it off. To do this, take hold of it with a pair of common forceps, and having stretched it down a little, clip it off above the forceps, with a pair of curved scissors. Nearly the whole of it should generally be removed. To take off a part only, leaves a stump, which is often mure objectionable than the whole organ. Its removal never injures the speech in the least. In many cases of nasal catarrh, this organ is a sort of diseased centre, from which the inflammatory action spreads upward into the nasal cavities, and no medicine or power on earth can effect a cure until thit) offending member is snipped off. ! 'if 'W )■', DISEASES OF TFP THROAT. 201 Acute Inflammation of the Tonsils. — TonsiliHs. The tonsils are chiefly a collection or mass of small mucous folli- cles or glands. They secrete a portion of the fluid which keeps the throat moist. There is a class of persons who sufler about every winter, some- times oftener, with an attack of acute inflammation of these glands, which causes great suft'ering for several days. The trouble begins with a slight soreness and swelling in these glands, which gradually increase until the mouth can scarcely be opened, and the act of swal- lowing is attended with indescribable suffering. At length, in from four to ten days, an abscess forms and breaks in one or both glands, which produces immediate relief. Treatment — The inflammation may sometimes be cut short by thrusting a lancet into the tonsils, and bleeding them freely, and then steaming them by the inhalation, by means of an old teapot, of the steam of mullein leaves and hot water. But the only cure is to be found by cutting off the tonsils, after the inflammation has subsided. This will put an end to the attacks a nee. Tonsils vrhich are subject to these periodical attacks of acute inflam- mation are always more difficult than others to operate upon, as they are almost invariably bound down very tight to the throat, and cannot be raised up for convenient excision. Chronic Inflammation of the Tonsils. In many of the fallicular diseases of the throat, these glands are affected by a chronic inflammation, and are found enlarged, and sometimes very much hardened. In such cases they secrete a thin, unhealthy, irritating, fluid, which is spread over the throat, increasing and perpetuating its disease. Much of this secretion, finds its way into the stomach, and thence into the circulation. In the throats of many young persons and children, these glands are permanently so large, as nearly to fill the fauces. The respiration of many children thus afflicted, is difficult, and when asleep they can only breathe with the mouth open. The defective breathing of such children often occasions contraction of the chest, and thus lays the foundation for consumption. From these diseased parts, the inflam- mation often spreads upwards, into the posterior nares, and many times enters the eustachin tubes, causing deafness or pain in the ears'. Such children often breathe as though they had a bad cold in the head. Their health and safety require an immediate attention to this state of things. Iteatment — It is customary to attempt to reduce enlarged tonsils by astringent gargles, by repeated applications of a solution of nitrate of silver, and by other remedies, and particularly by brushing them over with the tincture of iodine. As a general thing, these applica- tions are useless, ending in disappointment. As with the elongated Hi I, ;..;;* I . I' I III:::' ■^\. uvula, the remedy is found only in excision. Cut them off. The throat seldom gets well until they are removed. The speediness of the recovery after the removal is often surprising. Improved Tonsil Instrnnieiit — For the excision of these glands, I found the same lack of instruments as for making topical applications to the throat. The only one which had any c-laims to regard, was the guillotine instrument. It had, however, no facilities for drawing the tonsil forward. Generally, all that could be done with it, was, to trim the gland, which did little good, for it became again enlarged. I have prepared an entirely original instrument-, with which the extir- pation of these glands is easy and expeditious. It has two cutting blades in the shape of crescents, ria. 86. which, when open, leave a [Patented January 1 7, 1854] proper space for drawing the tonsil between them. Two pol- ished guards which I formerly had made of steel, but now of German silver, protect the upper and the under surfaces of the crescentic blades, and ruiuiing back, are fastened by the common rivet, which holds together the shanks, so that, when open, the blades are concealed under the guards. The tenaculum rests upon the rivet, as upon a fulcrum, and, dipping between the blades, takes hold of the tonsil, and draws it up for excision. Cutting, as these blades do, the entire circumference of the gland first, and at the same instant, and the central portion last, the operation can never fail. The entire ton- sil, even when much hardened, is swept off with a cleanness and ease, which, at the first trial, surprises the 'operator not less that the patient. The pain of removing these glands is so trifling, as scarcely to be thought of ; and the piotence that evil consequences follow their re- moval, is the oflspring of great ignorance of the whole subject. To operate easily, take the instrument in the rigiit or left hand, ac- cording to the side to be operated upon ; take the forceps in the other hand, and running them through the open blades, into the mouth of the patient, take firm hold of the tonsil; then slide the instrnmeiit down over the forceps, and lifting the gland up between the bladi's cut it quickly off. I am aware that a few irregular practitioners, who stand outside the profession that they may act without responsibility, have declared that mischievous results follow this operation upon the tonsils. Their reasons for so declaring are manifest. They have never performed the operation, and have not the skill to do it if they would. They expect, too, that those nervous persons who dread the operation, will, when told by a physician that it is necessary, strive to evade it by seeking their advice. Such practitioners are shrewd, but neither honest nor wise. Thej defeat their own purpose in the end. I have again and again had patients leave me when this operation was urged upon them, and finally return and submit to it, after nearly losing their lives in the hands of dishonest quacks. A few of these practitioners have taken tlie same course in regard to the use of ni- trate of silver, and for similar reasons. Curability of Throat Diseases. — I have dwelt somewhat upon the preceding forms of throat disease, not so much because they have [)cv.n a speciality with me for the last ten years, as because they pre- vail to a fearful extent, and are, in thousands of cases, but the nrst stages of fatal disease of the lungs. Jf not connected with lung dii^ease in the beg-inni i^, my experience in treating them enables me to say, emphatically, they are generally curable. But patients often put the question to me, — " If cured, will I ever liave the complaint again ?" My answer is, — "Unless I can plant in your constitution a better protection than your Maker put there at your creation, you will of course be liable to a second attack." But then, where the lungs have been entirely free from disease, I have jiever yet seen a case of simple throat complaint relapse and become dangerous after proper treatment with the syringes. Let not those, therefore, who have been benefited, but not entirely cured by this treatment, undervalue what has been done for them. Even in such cases, the advantage derived to them amounts to just the value they attacli to — tlie continuance of life. Dailj^ers of Deliiy. — In closing these remarks, losing it to be inilauuiiation of th(! windpipe. From their very ch-ar description of the symptoms, we now know it to have been an acute iidlammation of the epiglottis and glottis. From the rapid inllammation of the e|)iglottis, water is etiused into this cartilage, so as to putF it up, and prevent it from shutting down in the a'^t of swallowing. The iips of the glottis are swollen from the same cause, and brought so near to each oth«;r that air passes through to the lungs with great dilHculty, and unless relief is soon obtained, the patient is strangled. SviliptoillS. — The disease begins with a severe chill, accompanied with some pain, and a sense of stricture or tightness in the upper and fore part of the throat. There is cough, with ditK(-ult and some- times painful swallowing. These symptoms are soon followed by quick and laborious breathing. Speaking aloiul is from the first dilh- cult, and soon becomes impossible. As the complaint runs its rapid course, the breathing grows more dillicult, and death soon results from complete strangulation. Treatment. — Apply immeiiiately to the parts, a strong solution of nitrate of silver. The solution should be of the strength of jiinety to one hundred and twenty grains to the ounce of soft water. It should be applied every hour or two till the feeling of suffocation sub- sides, and should be done with the laryngeal shower syringe, though if this is not at hand, the sponge probang may be used. While this local treatment is being employed, liberal dosci*, from five to twenty drops of tincture of veratrum viride should be given every hour, watching the efTect, and discontinuing when the pulse sinks too low. Hot fomentations applied externally, and filling the room with iteam, as recommended in cases of croup, would be useful. ■ lis:' 'Hk' ■ t Mumps. — Parotitis. This disease appears most often among children ; but as it is not confined to them, I have not placed it among their complaints. Symptoms. — It begins with soreness and stiffness in the side of the neck. Soon a swelling of the parotid gland takes place, which is painful, and continues to increase for four or five days, sometimes hh^" ]! 1 1 208 DISEASES OF THE THROAT. becoming very large, and making it difficult to swallow, or open the mouth to receive food. After the fourth or fifth day the swelling subsides, and disappears in from seven to ten days. Both glands generally swell about the same time, but sometimes the swelling appears in one only after it has subsided in the other, and occasionally the swelling is wholly confined to one side. When the swelling is great, there is heat, and sometimes fp.ver, with dry skin, quick pulse, furred tongue, constipated bowels, and sc«»nty and high-colored urine. The affection is sometimes translated, as we say ; that is, in fe- males, the breasts swell, and in males, the testicles become swollen and painful. This accident generally happens in consequence of tak- ing cold from some imprudence. The disease is contagious ; that is, it Is communicated from one person to another. Treatment. — In mild cases, very little treatment is required. Keep- ing the face and neck warm, avoiding exposure to cold and damp, drinking warm iiifusions of balm, spearmint, or sage, and taking oc- casionally, if there be some severity of symptoms, four to six grains of Dover's powder ; or the compound powder of jalap, if there be costiveness, is about all that is required. The diet should consist of rye hasty pudding, or brown bread and sweetened water. If the case be severe, and other glands swell, physic must bs freely used, leeches must bo applied, and cooling lotions, or poultices. Sweating must also be induced by the compound tinctxue of Ver- giuia snake root, or by '. vapor bath. -^ i uit*"'^ DISEASED OF THE CHEST. Consnmption. — Phthisis. At the head of the diseases of our climate stands Consumption,- ^t their head both as it respects prevalence and fatality. Small pox,, yellow fever, and cholera, are terrible in their visitations ; but what are all their aggregated slaughters compared with the ct>aseless, silent iiijiich of this fell disease, which steals away in their fresh prime the briglitest and the best? Boston, from it;* population of 160,000, loses by consumption about iit'teen per wcu'k, sixty-live per month, or about seven hundred and eighty [)er annum. An equal mortality from any disease not often among us, would send our citizens in terror to the country, and cause the stoutest hearts 'o feet that " in the midst of life we are in death." Massachusetts loses about 6000 per ammm ; New England, not less than 20,000 ; and with the St.ite of New Yovk added, the victims of this single disease swell to 40,000 a year! What an army! Picked from the choicest! All sundered from l.fe untimely, and leaving more blight and sorrow behind than would perhaps twice or thrice the number whom any other pestilence would have selected. The magnitude of the evil places the question of the remedy before all others that pertain to the healing art. nethodH of Exaniiiiiiiji: the Chest. — Before speaking further of con- snmption, I propose to do what has never been done, namely, to instruct the general reader, very briefly, in the method of examining the chest to learn ihe existence of disease. Perhaps this will bo a)n- sidered a departure, in some slight degree, from my purpose to make this entire book intelligibl': co the general reader. If so, my reply is, that there are tnani/ H.-iiool teachers, mechanics, masters of vessels, and farmers, who h^vre inquiring minds, and sagacity enough to learn the physical signs of chest disease, and to make them, in many cases, practically useful ; and that even readers of little reflection cannot fail to comprehend a |)ortion of my explanations. Position of the Ptitient. — In performing percussion upon the front of the chest, the patient should be required to sit in a square position, with thb arms hooked over the corners of the back of the chair, and the head thrown a little back. 27 ill'' yi: '■■ j iS' :'.-■. i.3 ' I 210 DISEASES OF THE CHEST. 1 Instrnment with which to Tlmmp. — The index and middle fingera of the right hand are to be brought together, into a line, and used as the percussing instrument. The blow given with these is to be smart and quick, rather than heavy. Medium to Tliunip Upon. — Either the index or middle finger of the left hand is to be pressed firmly upon the surface of the chest to be percussed or struck, and thus used as a plcximitcr. Aiisciilttitioil. — Listening for the purpose of hearing within the chest the sounds produced by breathing, talking, coughing, etc., is called auscultation. liistniineiits witli which to Listen. — The naked ear is generally considered best for hearing low and delicate sounds ; but for hearin^^ loud and rough ones, it is not so good as the stethoscope, repre- sented by Fig. 87. A. still better instrument is the double-eared steth- oscope. Fig. 88. It magnifies the sounds very much, and is apt to confuse an examiner not accustomed to it; but wiieii the ear is onc«^ familiar with it, the aid it affords is very valuable. Fiu. 87. Fio. 88. The examiner should pass from side to side, continually compann'^ the sounds upon one side, with those upon tlic other. The patient mui^t be calm, and the exaniiner in no hurry. Healtliy Sounds. — To become skilful either in percussion or aus- cultation, the examiner's ear must first be trained to healthy sound.s. These are best heard in the child, in whom they are louder than in the adult. In describing the healthy sound? in the different regions of the chest, I shall ref(!r the reader constantly to Figs. 89 and 90. Clavicular Region. — This, in Fig. 89, is represented by 1, 1. Upon thumping upon the collar-bones, the sound given out at th'^ breast- bone end should be very clear ; less clear in the middle ; and dull at the shoulder end. DISEASES OF THE CHEST. 211 SnlK'Invinn Rp r!; is hollow, and the sound is generally quite loud. iu. *v?e ^'Jtcriial Rejrioii, 5, fi, 7, which covers the breast-bone, the :'<".! I i jiMieniliy clear. The i ?uury Ut^.ioii, 8, 8, is in the arm-pits. In this the sound should Ix' clear. , Tlie Latenil Region, 9, ■» is immediately bel« w the al)ove, and jields, likewise, a clear soun-i. #' Tlie Lower Lateral RejrhHi, gives a dull sound on tl«' righ't side, and on the left a very hollow one. Fig. 90 represents the back pr.rt of the chest In l(H>king at this, ' ree the ^js iri'i;)! Re|(ion, represented by 11, 11. In this space the sound ). V jU, but it has not much meaning. » Th«» Scapular Region, 12, 12, covers the part occupied by the shoul- der-blades. It gives rather a dead sound. :i.,. ;■ ! 1 i ft m The Intra-Scapular Rei^ion, 13, 13, lies between the shoulder-blades, on each side of the back bone. If the patient's arms are crossed, and the head bent forward, a clear sound will be obtained. The Dorsal Region, 14, 14, covers the base of the lungs, and, in health, gives a clear sound. Observation. — If, now, on thumping upon the chest, we find a dull, dead sound in any spot where a clear one ought to be yielded, we ara to conclude that underneath there is not the usual quantity of air; but we cannot tell merely by percussing, whether tubercles are depos- ited there, or the lung has become solid by inflammation, or water tonis. — A quickened |)ulse ; slight fever towards evening. Great susceptibility to the effects of cold, and liability to take cold easily. Bowels generally costive. The eye Ikis a peculiar whiteness and lustre. The skin and mouth become dry in the afternoon ; chills occur about midday, followed by fever, during which the cheeks are Hushed. As the second stage advances to its c'ose, a dry, burning heat afflicts the palms of the hands and soles of the /net. Night-sweats occur at this time. Oltservations. — A hollow, elastic body, containing air, gives, when struck, a clear sound. The dulness of sound on percussing the chest, arises from the absence of air in the air-cells, — these having been pressed together, or obliterated by the deposit of a mass of tubercles. I'm; i i \: ■/h lt,i:| m %\ II, m 1 I,.' •* in i€ 4 i!E i The destruction of these cella causes the cessation of the respiratory murmur. Thio dtage of the disease is often accompanied by an inflammation of the mucous membrane lining the air tubes. The air, pushing its way through the mucous secretions in these tubes, forms bubbles, the bursting of which causes the rattle. The crepitant rattle is produced by inflammation around the tubercles. The moist, crackling rattle is caused by the softening of the tubercles. The lungs, rendered more solid by the deposit of tubercles, become better conductors of sound ; and this causes the beating of the heart to be iieard as far off" as under the collar bones. Bronchial respiration gives the idea of air blown through a tube ; cavernous respiration, of air passing into a large enclosed cavity. Third Stage. Physical Sij^iis. — In this stage cavities are formed. If the cavities' be small, and considerable tuberculated lung surrounds them, tho sound, upon percussion, is still dull. If the cavity be large, and near the surface, there is occasionally a tympanitic sound. Sometimes a sound is heard like striking a cracked pot. Cjurgling; cavernous rattle; cavernous breathing; aiii|)lioric breath- ing; now and then, metulic tinkling; pectoriloquy; cavernous cough. Geiienil 8yiliptoillS. — Great loss of flesh, and weakness: diarrh'ca and night-sweats; swelling of the feet and legs; sore iiiondi; and rais- ing of matter with specks of tubercle in it like, crumbs of cheese. Observatiuiis. — The gurgling rattle is caused by air displacing liquids, and the forrMition and burstiiig of bubbles. It resembles the sound produced by l)l()wing through a tube immersed in soivp-suds. Cavernous breathing is nothing more nor less than tli'j sound pro- duced by air, breatlu-d in and out, entering and retiring from a cavity. The air appears, soinelinies, to one listening with the stethoscope, as if it were sucked into his ear during inspiration, and blown back again during expiration. Amphoric respiration is simply an aii^metUalion of cavernous breathing, and results, of course, from an increase of size in the cavity. In pectoriloquy, words uttered by the patient, seem to pass through the stethoscope, into the ear of the listener. The cavity should be empty, moderate in size, and have dense walls, in order to furnish the best specimen of this sound. Air suddenly driven backward through the windpipe, and out of the mouth and nose, by smart raps upon the chest over a cavity, gives the sound of the cracked pot. It is best heard when the patient's mouth is partly open. The same sound is produced, on the same principle, by locking the fingers of the two hands, and joining the palms, so as to leave a small space or cavity between them, and then expelling the air from that cavity, by gently striking the back of one hand upon the knee. AlV'li^Si DISEASES OF THE CHEST. 215 Causes of Consnmptioii. — Tlie human constitution as shown by Liebig, in his profound work on Animal Chemistry, is governed by two forces, the nervous and the vegetative. The former disposes the particles composing the body to a state of motion ; the latter inclines them to a position of rest. In vegetative life there is motion in one direction only, so to speak; that is, motion which tends to the opposite of motion, namely, rest In vegetables, whose life is wholly under this power, there is no waste; for here, all ultimate particles, having once taken a place of rest, remain undisturbed. In a tree, a layer of matter once deposited, always remains. Hence there is g-roioth as long as the tree lives There is no power to break up and destroy. But in the animal body there is motion in two directions, or a circuit of motion. Particles which under the vegetative force have been put to resit, are perpetually being displaced by the nervous energy, and. reduced to unorganized amorphous compounds, to be burned in warming the system, or cast out by the several exi-rctory processes. So constant is the action of these two forces, that John Hunter compared the human system to a whirlpool, into which the particles of matter are perpetually poured, under the influence of the vegeta- tive power, ami out of which they are as constantly whirled by the nervous force. By a little reflection upon tliese antagonisms, the reader will see tliat it is just when the vegetative force transcends the nervous, that the body increases in weight, and acquires that state in which the blood corpuscles abound, and the tendency, if to disease at all, is to that of the inflammatory kind. It is th'^ tonic condition of the sys- lom. Nutrition is more rapid than destruction. New particles are laid down faster than old ones are taken up. The body g-rows. On the other hand, when the nervous force overmasters the veg(^ta- tive, when the outward or centrifugal motion of the whirlpool prevails, then it is that the bodv is attenuated, the blood thinned and made serous, and the consumptive or atonic condition is established. Noin^ there is too uuieh motion. The nutritive particles, instead of tending to a state of deposit for the re-sni)piy of waste matter, become fugi- tive in their habits, perpetually fleeing, like convicts escaped from prison. Introduce this power, in excess, into \\w vegetable kingdom, and the matter deposited upon the tree, instead of remainitig to swell its bulk, would be driven otl" by the nervous force ; and the tree, in- stead of growing, would be aiumally lessened, become sickly, and die of consumption. In Tubercular Consumption, the system is like a field deluged with a flood : nothing can take root. The repeated shocks of the nervous battery sent to the absorbents so quicken them in their work of re- moving waste matter, that they dislodge much which is not yet worn out, and a?sist in casting out of the system not a little designed to be used in its renewal. A healthy deposit is thus prevented, and nutri- tion is at an end. The nutritive arteries, those little builders of the human frame, are overmastered by the stimulated lymphatics ; the constructive material is wrested from them, and borne beyond their N m^\ . ' ii ; : I ■ t •i :' 216 DISEASES OF THE CHEST. reach, and the body wastes from want of nourishment. The blood becomes thin and watery; and from, the increased serous portion, chiefly albumen, are depoited upon the lungs and other tissues the albuminous tumors called tubercles. Here is found the cause of that peculiar smallness of bone and muscle, and thinness and tallness of person, so peculiar to consump- tives. The absorbents, under the power of a very active nervous system, take down "the house we live in" faster than the nutritive arteries, confused by the motion around them, can effect its recon- struction. It is simply an unbalancing of the antagonistic forces, which build and pull down our earthly tenement. The men that de- molish are more numerous and better fed than the artisan builders. It is this destructively nervous force which gives to consumptive persons their proverbial mental activity ; which causes them often to dazzle the world with the splendor of their gifts, and to bless their friends with the warmth of their affections. They are usually the choice spirits, the idols of their relatives, and the favorites of the com- munity in which they live. Their mental movements, and the exer- cise of their affections, are characterized by brilliancy and warmth. Of all persons, they are best fitted to enjoy life, and tx> impart happi- ness. Loving all, they are by all loved in return. They are speci- mens of partially etherealized humanity, stepping lightly across the earth, to whom friends passionately stretch out their arms, and em- brace — their shadows ! These views will appear the more reasonable, if we consider that in children the vegetative power is very active, while the nervous- energy is comparatively weak. The preponderance of the former over the latter causes the rapid growth of children. The little arterial builders work faster than the lymphatic demolisiaers. This explains why so few children die of consumption. But from the age of seventeen to thirty-five, when the vegetative power is losing something of its extraordinary activity, and the nerv- ous force is showing its highest capabilities, — then it is, as this theory indicates, that tubercular consumption does its dreadful work, — then, that. the outward whirl of this physiological Maelstrom casts upon the shores of mortality so many thinned, tjxhausted, and lifeless human forms. More than three fourths of all wlio sink under this disorder die between the ages just named. The brain, between these points of time, acquires its full size and force. This disease prevails most, too, in those countries where an enlight- ened civilization gives to the nervous system its fullest development, as in Great Britain, France, and the United States, and in those where the nutritive process is most retarded by a relaxing climate ; and it is carcely known among those people who are but little en- lightened and have small brains, and among those who live in high and invigorating latitudes. As the most enlightened, however, are generally found in temperate climates, and those with the least culti- vated brains in low latitudes, the rule is not perfectly explained by facts ; yet it shows itself sufHciently to establish its validity, and to afford another proof of my theory. blood ortion, ea the le and laump- ervous itritive recon- forces, hat de- lers. mptive >ften to 53 their illy the le com- ic exer- varmth. happi- e speci- •oss the ind em- jer that nervous former arterial explains getative le nerv- as this ul work, 3m casts i lifeless uler this en these enlight- lopment, in those climate ; little en- e in high ever, are ast culti- ained by y, and to DISEASES OF THE CHEST. 217 Bronchial Gonsumption. The persons exposed to bronchial consumption are generally of an opposite habit to those described above, — having the nervous force, in health, well subordinated to the vegetative, the assimilation good, and the blood well supplied with red globules. They have usually a full habit and an active circulation. The absorbents, and other ves- sels in the lungs, working in the midst of a large amount of caloric evolved by an energetic respiration, often take cold, which brings on lung fever and pleurisy, and these lay the foundation for the ultimate destruction of the lungs. For the same reason, the skin of this class of persons becomes diseased, and more often the inner skin, or mu- cous membrane, and most often that portion of mucous membrane which goes down into the lungs and lines the air tubes. It is inflam- mation of this which constitutes bronchitis, and which lays the foun- dation for true bronchial consumption. As that class of persons who are exposed to the tubercular form of the diseijse suffer a general loss of carburetted hydrogen in its several forms, colliquative diarrhoea, sweats, increased breathing, and all con- ditions that carry fat out of the system, so those who sufler from attacks of the bronchial type of the disorder are generally afflicted with the opposite condition. They have too much carbon. It is well ascertained that carburetted hydrogen, accumulated in the system, acto as a poison. And that class of bilious persons who are subject to this disease often have their excretions badly performed. For this reason, carbonaceous compounds accumulate in the system, and give rise to the symptoms of morbid poison circulating in the blood. This led Dr. Madden to suspect the presence of such poison in the blood of all consumptive persons. He saw the evidence of it in numerous cases, and not distinguishing the one class from the other, he inferred its presence in all. Constitutional Difference. Thk constitutional dllFerence between the two forms of consumf)- tion appears to be this : the tubercular type is usually attended, in its origin, by a tolerably good state of the digestive function, in connec- tion with bad assimilation ; while the bronchial form generally has its foundation laid in coimection with bad digestion, accom|)ani(.'d with healthful assimilation. In the former case, the food is well di- gested, the pabulum is properly prepared, but the nutritive arteries do not use it for renewing the tissues. In the latter case, the digestion is bad, the pabulum poorly elaborated ; but the re-constructive vessels, under the control of a well-developed system of organic nerves, use it to the best advantage. In the one case there are good hnck-makcrs, and lazy hxxck-hiyers ; in the other, the reverse. It happens, however, that before the fatal close of the disease, tu- bercular patients usually become afflicted, more or less, with bad digestion, and bronchial patients with defective assimilation ; so that, 1^ II \^ fTOJ ■i)i\ tr- 218 DISEASES OF THE CHEST. in the end, they present us with much the same class of symptoms. Starting from opposite poles in life's celestial sphere, they meet at the culfninating point of death, and disappear under identical aspects of the heavens. Exciting Causes of Tubercular Consumption. Thr preponderance of the nervous force being the state which pre- disposes to disease, whatever unduly excites the nervous energy in- vites an attack. These causes njlate, mostly, to the prolonged exercise of the intellect, the passions, and the sentiments. Few are aware of the mischief done by excessive stimulation of the mind during the most active period of life, — especially if th(i muscular system bo left half developed. Here is where ambitious students commit gn^at errors. The constant plying of the riKMital powers, in the present modes of educating children, leads to a dreadful abridgment of human life. Better to train the bodily powers first, an(". let the menriil culture come in later time. lie who would build a lasting structure must lay a solid foundation. The age in which we live ai)onnds in the causes of excitement. The world is trembling with excess of mental life. The pine trees burned by the steam engine are scarcely more numerous than the human constitutions consumed by the train of thought it has set on fire. Nor are the passions and sentiments less exercised, or less destruc- tive. Briefly, the causes of consumption embrace all those things which bring a destructive force against the digestive and assimilative func- tions, as insufficient and improper food, debaucheries, night-watches, sedentary habits, anxiety of mind, etc.; rnd those which act injuri- ously upon the breathing organs, as impure air, inflammation of tho lungs, pleurisy, measles, hooping cough, etc. ; and such as disturb tht; sweating process, as insuflicient clothing, sudden changes of temper- ature, sleeping in damp sheets, etc. Tliese exalt the nervous force, or depress the vegetative, or inflame the mucous lining of the air tubes, or the substance of the lungs, or the membranous sack whicli encloses them, so as to induce one form or other of consumption on the principles I have explained. Can Coiisiiiiiptioii be Cured ? — In many cases it can. It may he cured, first, by tho absorption of the tubercles. The celebrated John Hunter shows, in his work on the blood, that the absorbent? vessels have a sort of elective affinity, by which they take up and remove " all adventitious new matter, as tumors," (tubercles are albuminous tu- mors,) more easily " than those parts which were originally formed." Were this not so, an activity in these vessels equal to the removal of tubercles, would cause them to waste all the tissues, and aggravate rather than cure cokisumption. Probably this does occur where proper hygienic means are not used to quicken the excretions. This DISEASES OF THE CHEST. 219 hygienic treatment, to be spoken of hereafter, is not generally em- ployed, — certainly not as eft'ectually as it should be. Here is the source of Laennec's fatal remark, so often quoted and so widely en- dorsed, that " nature's efforts towards effecting a cure are injurious, and those of art are useless." Laennec's position cannot be true, if Hunter's statement is correct. If the absorbents, by an elective in- stinct, take up adventitious matter rather than the natural tissues, then the reason why they reverse this rule in consumption is, that by a weakened state of the constitution, the ultimate particles are not well put together, and are more easily taken apart than those of the adventitious tubercular tumors ; and if we would restore these vessels to their natural activity, we must improve assimilation, and knit the aiiloving molecules into a firmer brotherhood. We must make the (lesh hard, so that the absorbents cannot pick it to pieces. Do this, and "nature's etlbrts to effect a cure," will not "be injurious." A second form of cure is the reestablishment of the assimilative function, the building up of the general heallli, the arresting of tlu; tubercular deposit, the reducing of tubercles already formed to an in- 'jolent state ; and then, by a strict observance of the laws of health, keeping them in that condition through life. A third mode of cure is the healing of the cavities after the tuber- cles have softened, broken down, and been expelled in the form of expectoration. A fourth method of cure is a change of tubercles to calcareous mat- ter. 'J'liese calcareous tubercles, Laennec says, "are conseciuent to tuberculous affections that have been cured.^'' And Andral, at one time, hoped to learn how to etlect cures by changing tubercles to "the calcareous phosphate." I have had several cases of cure by this last method, and have quite a collection of calcareous substances which my patients have coughed up, — one of which was raised in my presence by a lady who was a few years before in hopeless consuni])tion, but is now in good health. Treatllieilt. — This should be of two kinds, local and general. The local treatment of consumption is by the inhalation of vapora and powders into the lungs. It has been |)rii('tised, more or less, by in- dividuals, for many years, partieularly in Europe ; hut for some unac- countable reason, the profession generally have never used i* -ud do not know much about it. I had the honor, some years age ' ' bring it freshly before the American public, in some articles written for popular reading, since which time it has been rapidly gaining public confidence, and is now attracting much attention. Conveying the remedy directly to the diseased parts, it strikes the common-sense mind as eminently reasonable and necessary. I shall speak of inhalation, therefore, very earnestly, not as a pallia- tive of consumption only, but as far more, as a remedy. After long and patient use, my experience allows me to say, that I know it, in many cases, to be such ; and knowing this, I should be crimhisl not to press it upon the public ; for it is the great multitude of sufferers, ' 'ifH i 1 '^N' li f 1 % i I I 1 i \ h?r: I' ■ . ii!^:lii;' Mi :'W> pressing fast through the gate of death, who need to hear words of hope. Connunptlon a General Disease. — It is not denied that consump- tion is a general disease, needing constitutional treatment ; but it has also a local development in the lungs, first in the form of albuminuud tumors, called tubercles, and then, after the softening, breaking down, and discharge of these, in the more formidable shape of ulcerous ciiv- ities, which, beginning at the summit, devour the lungs down to the base. Can it be reasonable to apply no remedy directly to this local disease ? Not so does our profession deal with other local diseases. To an inflamed skin we apply pouhices, cold compresses, solu- tions of acetate of lead, nitrate of silver, etc. ; to leprous or scaly art'ections, sulphuret of potash, bichloride of mercury, zinc ointment, nitrate of mercury ointment, sulphur, creosote, etc. ; to weak and inHamed eyes, sulphate of copper, sulphate of zinc, nitrate of silver, and opium; to chronic ulcers upon the skin, tannin, pulverized rhubarb, opium, or cinchona ; and to an inflamed throat, nitraie of silver and other articles. These are but specimens of the thousand cases in which we use local remedies. Why, then, when the mucous membrane, which lines the air tubes, becomes inflamt'd through all its branches, should we neglect, by the inhalation of medicated vapor, to apply a remedy directly upon the whole inflamed surface? V'^v, when tubercular matter is beginning to be de|)osited upon the s o of the air cells, and of the small bronchial tubes, should not the go right to those parts, and cause, as it would, the immediate expul- sion of this offending and dangerous matter? Uneducated common sense sees the reasonableness of these sug- gestions at a glance. Many a person, with pulmonary disease, dies of suflbcation, not because there is not muscular strength to expel the matter which is strangling him, but because the huigs below the large pellets of mucus, which plug up the bronchial tubes, cannot bn inflated, and have therefore no means of driving out the oH'ending substance. Yet a proper medicated vapor, drawn in with the breath, would either dissolve the mucus, or rouse up the expiring membrane to cast it off. If the reader were to place one end of a stethoscope directly over the disease upon the breast of a person in the third stage of consump tion, and should then ask him to talk, the words spoken would seem to rise up through the instrument, and enter, well articulated, into his ear. This, in technical language, is called pecloriloqvy, — a word signifying chest-talking. It implies a cavity in the lung. If now the patient be asked to cough, a gurgling and splashing sound will be i card. This denotes that the cavity is partly filled with fluid, which iij dashed about by the air explosively driven through it by the portion cf lung below. Here we have an excavated ulcer, with all its filthy contents, composed of pus, mucus, serum, and dissolved tubercles, lying in it day and night to aggravate its unhealthy condition. What more reasonable, what more necessary, than that a soothing, altera- tive, or astringent vapor should be drawn into this cavity, to cause its m sides to heal, and its absorbents to remove this fluid ? A surgeon who should permit an ulcer upon the surface of the body to remain ill tliat condition without a local dressing, would be deemed unfit to practise his profession. Both in tubercular disease and in simple bronchitis, the bronchial tubes almost aways sutler some physical change. The mucous mem- brane lining these tubes is generally softened. At other times the tubes become enlarged through their whole length, so that many of them, from the size of a (juill, rciu-li the bigness of the tinger of a glove. In still other cases, the straining produced by congiiing causes a tube lo belly out at some point, forming a sack, which is generally fdlcu with mucus or purulent matter. At still other times, a tubercle will press against a tube so as to flatten it and convert it into a musical instrument, the air, as it is drawn laboriously through, |)ro(lu{'iiig a high or low note, according to the size of the pipe. These pliysieal (changes are all produced by causes which the inhalation of a suitable vapor, at the proper time, would altnost infallibly remove. How strange that this remedy, — so simple, so ellljctual, so easily compre- hended, — should have been so little used ! Right at this vital point in the lungs, where the blood runs in a ceaseless current, — where the whole of it goes even/ two minules to renew its vitality l)y contact with atmospheric air, — we have, in llionsands of cases daily occurring, inllamination with roughening oi softening of membrane, with its consequent harsh breathing; we have mucus, tough or glairy, to impede and interrupt respiration ; we have tubercles in the hard or soft state, adding to the general embarrass- ment, and not only lessening the vitality of the blood, but disturbing all the sympathies of the system; — and yet the practice has been, and is, to attack these central disturbers of life only through the cir- cuitous path of the stomach, lacteals, etc. Since 1849, my undivided attention has been given to the study and application of this mode of treatment. This is two years in advance of any other physician in this counky. I have investigated faithfully the effects of the various substances proposed for inhalation by European physicians, and have explored a wide field of new rem- edies, not before used, several of which have proved to have qualities of great remedial power. Thus much I have thought it proper to say in behalf of this mode of treating consumption, the most successful yet employed, not be- cause it needs defence, but because the great body of the profession are ignorant of it, and what is worse, are indifferent. The chief remedies I employ for inhalation are the following : Alterative Inhalant, composed of iodine, six grains ; iodide of potas- sium, twelve grains ; tincture of ipecac, one ounce ; tincture of bal- sam of tolu, six drams ; ethereal tincture of conium, one and a half drams ; alcohol, half a pint. These are to be mixed. The dose ia one to two teaspoonfuls, to be inhaled ten or fifteen minutes, in about a gill of hot water. The ethereal tincture of conium is made by keeping a dram of I powdered conium in one ounce of sulphuric ether a week. I I 11^ WT^^ 222 DISEASES OF THE CHEST. I %^ The abo'.e inhalant is used in the tubercular forms of consumption, particularly that of the scrofulous kind, and in lany cases of bron- chitis. Expectorant Inhalant. — Take pleurisy root, half an ounce; squill, one ounce ; ipecac, two drams ; black cohosh, two ounces ; queen's root, one ounce and a half; American hellebore, two drams ; diluted alcohol, one pint. Grind the roots, etc., and add the alcohol. Let the whole stand one week, shaking or stirring daily. Draw off and filter through paper. Two teaspoonfuls make a dose, to be inhaled same as preceding. This ?s to be used wher the cough is hard and dry, and the expec- toration diificult. It makes the raising easy, lessening the soreness of the chest, and the harshness of the cough. S evolved within a few years, a correct and partially demonstrative system of medication. In consumption, all the inorganic bodies represented by the above figures, with the exception of oxygen, are deficient in quan- tity. By reflecting upon the proportions of theae several bodies, par- ticularly upon the large amount of chlorine and soda in the plasma, and of potaaaium in the corpuscles, the mind can hardly fail to obtain useful hints. I have not hesitated to make one of these hints the 29 i iSk m ■il |l ■ 1 t ■ 1 i 1 I'-! >- li ' '' M I ; '' I,.-;', Kl'.i 1» 1 226 DISEASES OP THE CHEST. gronnd of a very free use of alkalies, — particularly in the form of bathing. Su^r of Milk. — There is one other medicinal article which I deem worthy to be made prominent, and to be placed side by side with cod liver oil and the hypo-phosphites. I refer to sugar of milk. It belongs to t.h?t class of non-nitrogenized articles which Liebig has denominated supporters of resj)iration. Its great affinity for oxygen is well worthy to be taken into the account, in considering its value in consumption. So great is this attraction, that with ammonia and other alkalies, it has the power of reducing some of the mctalic oxides. When taken into the stomach, it is rapidly absorbed into the blood, which, being an alkaline fluid, augments its great de-oxydating power to a consider- able degree. It unites rapidly with oxygen after entering the blood, forming carbonic acid and water. A part of it, however, does not enter the blood in an uncompounded state, but is changed in the stomach into lactic acid ; and this, in the blood, becomes an alkaline lactate. But the portion thus changed, appears also verv useful ; for Lehmann says : " We know of no substances which could better act in the blood as food for the rer^piration, than the alkaiine lactates." Corroborative of these views, is the fact that all those kinds of milk, such as goat's, ass's, etc., which contain the largest amount of sugar of milk, have at different times, and in various countries, ob- tained a reputation for curing consumption. Goat's whey, in which this article abounds, and from which it is largely manufactured, has been celebrated for its virtues in this line. Ancel speaks of it as an excellent remedy ; and Pcreira says, " Sugar of milk, m consumptive cases and chronic diseases of the digestive organs, is a most valuable aliment." One of the best forms of taking sugar of milk is tb.at of a gruel, which is quite palatable, and may be freely eaten by consumptive persons. Tlie Coui^li. — The best article 1 have ever used for fiis, is the " Pul- monic Cherry Cordial." 1 was five years in compounding this arti- cle to suit me, and I believe it to be the very best cough preparation ever made. Dose, from one to two teaspoonfuls. See page 710. When a more quieting effect is needed, a little morphine may be added to this preparation; if a more expectorant influence is required, add a few drops of the tincture ol veratruni viride. For the great majority of cases, it will be found to be right without any addition. When this is not at hand, any of the preparations (108) (112) (10^>) (113) (110), etc., may be used. Mljflit Sweats. — The very best preparation for these sweats, is a com- pound of the oxide of zinc, one dram ; extract of conium, half a dram ; to be made into twenty pills, of which one or two are to be taken every night The sponge bath also does murh to check these sweats. Diarrluea. — This is a most exhausting symptom in the latter stages of consumption. The only remedy which lus much effect in control- ling it, is the iris-nitrate of bismiUh. This should be given in doses of ^m /' li DISEASES OF THE CHEST. 227 fi 'll thirty grains immediately after, or at the time of each meal. These doses are much larger than used to be given ; but they will do no harm. Given to rhis extent, I find the bismuth very efl'ectual. Iron. — This preparation, in some of its forms (316) (73) (61) (84) (102), is almost always needed in consumption. If the scrofulous habit be strongly marked, give syrup of iodide of iron, in thirty-drop doses, three times a day. It should be taken in a glass of water. External Irritants. — These are needed where there is much infl'^ h mation ana soreness of the chest. Blisters should very t^eldom oe used. Croton oil, from two to half a dozen drops, rubbed over the sore part, generally answers very well. Sometimes the mustard paste, applied to the extent of producing redness, two or three times a week is sufficient. Nitric acid, reduced with water to a strength a little above the strongest vinegar, answers a good purpose for keeping up an irritation. Atmospheric Inhalation. — It has been said by Laennec and others, that asthma has sometimes the effect of arresting tubercular con- sumption. Dr. RaiTiadge thought this was efTected by "n expansion of the vesicular structure of the lungs ; and he reasoned that the same expansion by i-iCchanical means, would secure a similar end. To eflfect this, he made his patients take long breathe through a tube constructed for the purpose. It is manifest that the philosophy of atmospheric inhalation was not understood by Dr. Ramadge, nor has it been by any of his fol- lowers in this country. Rokitansky thinks the tubercular habit depends upon the excess of fibrin in the blood ; and says that the reason of consumption being arrested by pregnancy is, that this condition otters a mechanical ob- stacle to the transmission of blood through the lungs, — thus prevent- ing its excessive oxydation, and keeping it in a venous state. This destroys the fibrinous condition, on whicli he thinks tuberculosis depends. Now this is precisely what is done by atmospheric inhalation. The trachea divides on its entrance into the lungs, into two branches which again divide and subdivide until the tubes become smaller than can be seen, each terminating in a minuie air-cell. Over this entire sur- face the air is intended to be brought ir ■> communication with the blood for the purpose of oxydating it. hy forcible inhalation, the air vesicles are inflated to the extent of their capacity, by which means the extreme branches of the pulmonary arteries are so ttattened be- tween these extended . cells, as to be able to convey but a small amount of blood, and but little is oxydated. This furnishes a me- chanical obstruction to the transmission of the blood, and secures the defibrination of which Rokitansky speaks. This is my view of the philosphy of atmospheric inhalation. The benefit results, not from a larger amount of oxydation, as is gener- ally supposed, but from a smaller. Asthma does the same thing by producing spasmodic contract i»m of the extreme bronchial tubes, and preventing air from entering ti. cells. " .1'!' If (13* Is'*! ■x~ I^T 228 DISEASES OF THE CHEST. The same end is gained in part by certain kinds of employment, as' glass-blowing, playing upon wind instruments, and the like. Writers of distinction mention cases of recovery front incipient consumption by a vigorous use of the lungs in singing. Dentists subject their lungs to a similar process of expansion in the use of the blow-pipe; the writer has known several instances in that profession, in which recoveries have taken place. , , The Conclusion to which I cume is, that atmosphe^rjipi inhalation may be used with great advantage in some cases, but should never be resorted to ex(;oi)t under the direction of a competent physician. In a congested stai*' -r the lungs, with haemorrhagic tendencies, or with inflammation and aoreness, it is well fitted to produce fatal bleeding, and is of course dangerous. Externnl Vse of Water, — As a relaxation from severe exertions, the ancients had frequent recourse to bathing. Those who contended in the race, throwing the javelin, and wrestling, at Rome, plunged into the Tiber while warm and panting with their efforts. That this promoted prowess and physical endurance, none can doubt. Louis, the great French authority on pulmonary diseases, lays down several rules to be observed by consumptive patients, and par- ticularly mentions cold bathing. Few things give tone to the capillaries of the skin like cold water, systematically applied. It rallies the powers of the constitution, and improves assimilation. And by it another object is gained of scarcely *ess importance, — that of guarding the system against taking cold. Those in the daily habit of applying cold water to the whole person, seldom suffer from colds and catarrhs; and they generally become hardened so as to endure the assaults of the eliements. Consumptive persons should generally use the sponge bath, with cold water, if it can be endured, otherwise the tepid bath, to be fol- lowed, ill all cases with brisk rubbing, with a coarse toWiei. If a sisnae of chilliness and discomfort follows the bath, a large portion 6f the water must be sque6zcd from the sponge, so as to u!se but very little, and the washing must be speedy, and the rubbing more lively than usual, — beginning with tepid water, and gradually lowering the tem- perature, till it can be borne cold. A large tea;spoonftd of saleractus to each quart of water should be used. Diet. The diet, like all oth*ir piurts of the tfeatiiieht, must HaVe referen'oe to the present cdndition of the patient. If the disease take the bron- chial form, and rapid breathing, and other conditions calculated to carry fat out of the system have not yet supervented ; or if the patient have thirst and hectic, the diet must be spare and simple, — consist- ing chiefly of milk and farinaceous substances. But in all cases where the disease is tubercular, or, being bronchial, ha's reachied the stage of emaciation, the very earliest moment at which the fever can be subdued, sliould be improved to bbild up thb ?fnm DISEASES OF THE CHEST. 229 |;)fttient with a generous diet. I have seen cases where the stuffing i^ometines resorted to for fattening turkies for Thanksgiving, would seem io be almost justifiable. A good rule is to give the most gc-ner- ous diet that can be taken without disturbing the stomach, or increas> ing the feverish symptoms. Animal food, with a good quantity of salt, should be freely taken. Fat meats, if well received by the st<"»m- ach (and they generally are if taken cold), are particularly useful The same is true of sweet butter and cream. Oat-Door Exercise. — Without exercise, as a general thing, the con- sumptive patient will die. Exercise involves muscular exertion, i^hich is attended by the tension, compression, and greater compact- ness of the muscles used. This connpression of the muscles within ^e sheaths (fasciae) which enclose them, sends out their blood, and pushes it forward towards the surface. Reaching the extremities of the arteries, the blood passes through capillary tubes, almost incon- S^ivably fine, into the capillary veins, of f imilar fineness, whence it ows through larger and larger veins back to the heart. At the mo- ment of its passage from the capillary arteries to the capillary veins, it ceases to be red or arterial, and becomes purple or venous blood. The oxygen in the arterial and the carbon in the veaous blood unite, forming a literal combustion, just such as we produce in our stoves and grates by bringing together the carbon of the wood and the oxy- gen of the atmosphere. By this combustion our bodies are warmed, and the^ little secreting, exhalant, and other ve'jsels, are raised to a temperature that enables them to work. Every muscular contraction and compression helps pu^• water, rice-water, and a solution of gum arabic. Chronic Bronchitis. This is an inflammation of the mucous membrane of the air-tubes, which continues a great length of time, without any sudden or re- markable changes. Physical Sifns. — The percussion-sounds are similar to those of acute bronchitis. When a bronchial tube is dilated, we sometimes have dulness around the dilated part. The breathing murmur is always accompanied by a mucous, sono- rous, or sibilant rattle, — sometimes by a subcrepitant When dilatation of the tubes exists, the intensity and duration of the sound of the ingoing breath is decreased, — of the outgoing increased. In this state of the tubes, we also have cavernous breathing, bron- chophony, sometimes pectoriloquy, and bronchial or cavernous cough. General Symptoms. — A cough is generally present, which is in- creased in wet weather, and by every slight cold. This comes on in paroxysms ; is generally worse in the morning ; and is relieved by raising freely. The matter raised is generally yellowish, but some- times whitish and sticky ; and in the latter stages, is thick, and some- times very much like that of consumption. Indeed, the disease often ends in bronchial consumption. Remarks. — The breathing is bronchial or cavernous when the di- lated portion of the tube is empty; — if it contain fluid, the mucous rattle will be heard. Dulness on percussion will exist if a dilated tube press upon the surrounding portion of lung so as to condense or make it solid. Dilatation of the tubes occurs only in chronic bronchitis of long standing. Its physical signs are much like those of a cavity in ad- vanced consumption. The examiner may learn to aistingaish them by considering that in consumption, dulness precedes the avitp, while in bronchial dilatations, the cavity precedes dulness. The dilatation or swelling out at some point of a bronchial tube, is caused by obstructions to the passage of air through it, — just as an India-rubber tube, partially closed up at a given point, will bulge out H ij^ 111 :i*: ■!> n< »f ]^ J . ■ 234 DISEASES OF THE CHEST. Fi(*. i»2. [Patentid March 16, 1852.] f? \l just in front of the obstructed place, when air is forcibly blown through it, and just as the left ventricle of the heart enlarges when the blood is obstructed in its passage through the aortic valve. Causes. — It often occurs as the result of acute bronchitis, and also of measles, hooping-cough, etc. But tiking cold, and damp and change- able weather, are more frequently its causes. It most often follows chronic inHamihations of the throat, which, being neglected, gradually creep down the windpipe into the tubes, and become very obstinate in their character. Treatment. — Medicinal inhalation is one of the best remedies for this complaint. The inhaling powder has, in many cases, great eili- ciency. The dose is iibt)ut what can lie on a ten cent [)iece. It, should be used once a day, in an instrument represented in the cut. This inst. inent I had constructed in I80O. It consists mainly of a glass tube an 1 a receiver, — the latter being something like a tube vial, pierced witl> fmc holes around the lower end. The powch^r is poured into the receiver, which is placed in the larger tul)e, and twirled between the timmb and finger while inhaling. When the powder cannot be easily got down into the tubes in the lungs, — as often happens, — the inhalation of niedictated vapor will do better. If the expectora- tion be dillicult, the expectorant inhalant, described under " coiisiuii|)- tion," should be used ; if the expectoration be too profuse and free, the astringent inhalant must be taken. The cough preparations recommended for consumption, also (113) (112), will be the proper ones in this complaint. The daily alkaline bath, and brisk friction, are particularly service- able. Out-door exercise is almost as necessary in this disease as in con- sumption. Enlargement of the Air Cells. — Emphysema. This disease consists in enlargement of the air cells, the obliteration of their vessels, and the wasting of their walls. Physical KSi|t;ns. — Thumping upon the chest gives a clearer and louder sound than natural, — one which is tympanitic, or drum-head like. The murmur of the ingoing breath is diminished both in duration and intensity, — of the outgoing breath, it is increased. Dry, crepitant rattle attends the ingoing breath only ; occasionally, sibilous rattle. General Symptoms. — Habitual shortness of breath, and very great difficulty of breathing, occurring in paroxysms, which cause the pa- tient to rush to the open window for air. IS 111 con- I DISEASES OF THE CHEST. 23-1 There is generally a cough, and the matter raised is frothy, liquid, and mucous, or watery. The face has a peculiar dusky color, and the countenance an anx- iouH, melancholy expression. The nostrils are thick, and the lower lip full. The muscles of the nw^k an; large, and the gait of the pa- tient is stooping. The strength is wasted in proportion to tlie diffi- culty of breathing. Emphysema tends to produce discat-.n of the heart, Bright's disease, and venous coiigi^stions in the head. OIlMTVations. — Tlie tympanitic sound is caused by the increased amount of air in the cells. The air cells having lost their elasticity, the air, in a great degree, remains in them, — not passing in and out, — henec the absence of the vesicular murmur. The crepitant ratlle attends the ingoing breath only, and is sup- posed to arise from the expansion of lungs which are in a drier stat(^ than natural. It has be(!n compared to the sounmpt«ms, — (ireat oppression of the chest, and diificuUy of breathing ; generally attended by palpitation of the heart, anen8 to be higher than the orifice, the air, when it enters at each . '■:7.r;p-iwtiwm ept where -in which I space, lophony in ir-cella are lere, closes the feeble- risc to the , tightness, or streaked Jug. This ^ Jisea.-ie. y upon the :^r-irritatiou awels by a has an ex- vity of the t the same kver part of the upper thing niur- tallic tiah- 1 difficulty rt, and fro- "ected side. and cannot n the othet kvljich gives d-soundiiij? )rodaced by nt tinklini; in. pleura hap- ers at each DISEASES OF THE CHEST. 237 in-drawn breath, forcesj its way up through the fluid, in the shape of bubbU's, and, bursting at the'surface, gives the tinkling i^ound. This ;si)und is sometimes produced, too, by the falling of Irops of liquid fr*un the upper part of the cavity, uj)on the surface of the flu.'d. The amphoric breathing is like the sound produced by blowing obliquely into an empty cask. One writer says he heard the same .sound when out shooting in a rough day, produced by the wind blow- ing sideways into the gun-barrel. Treutllieat. — T would recommend the use, two or three times a (lay, of the antiseptic inhalant, mentioned under the head of con- >ii;tipti()n. To tlii.s should be added dry -cupping over the whole chest, which iiciierally gives great relief. Blisters may also be used. Sweating must be encouraged in the manner recommend^ under acute bronchitis. For the difficulty of breathing, give half grain doses of cannabis iiidica, or five drop doses of tincture of aconite, or one-si.\th of a grain dose^. of morphia. Extract of belladonna, or of stramonium, is also worthy of trial. Water in the Chest. — Ili/drothorax. Tnis disease consists in a collection of water in the cavity of the pleura. IMiyslCiil Si«nis. — There is a dull sound over the eflfusion. The breathing nuirmur is diminished, and gradually disappears altogether over tlie space occupied by the effiision. Wrnnehial breathing is heard in the same part. When the amount of fluid ia small, egophony ia heard in the mid- dl*. icgiona of the chest. Bronchophony is heard when the effusion is larger. General Symptoms. — Eithef upon lying down, or using active bodil^ exercise, the patient finds his difficulty of breathing increased, Wheli in bed, he lies with his head and shoulders raised, which, by causing the fluid to settle at the bottom of the cavity, prevents, in a measure, its pressure upon the lungs, and gives him a little rest. His sleep ii«' intenupted by sudden starts, with alarm and terror. The pulse i* hard, ihe thirst great, ihe urine scanty and high-colored, and has a Bedim. mt. After a time, the feet swell, the face is pallid and livid, and Uie countenance expresses anxiety and alarm. There is a short," dry cough. When the quantity of fluid in the chest becomes large, the patient cannot lie down at all, and only gets short and disturbed naps in the sitting posture. Of all the .symptoms, the starting in sleep is the most certain sign' of the disease. Causes. — In some rare cases, this may occur as a primary diseaae, — that is, as a disease not dependent uuun an- other as it» cause. * If ,• s l..t. 238 DISEASES OF THE CHEST. The greater number of cases, however, are secondary. They arise from organic disease of the heart, or liver, or stomach. Inflammation of the pleura is a very frequent cause. A plethoric, or full state of the system, predisposes to this com- plaint, — particularly in those persons who indulge freely at the table. It may arise, too, from the striking in of skin eruptions ; from the free use of liquors ; and from frequent excessive bleedings or purg- ings. Treatment. — Dry-cupping is a valuable remedy, and should always be practised. The chest should be painted with the tincture of iotline, and a good degree of substantial soreness be kept up. The internal remedies are purges (31) (14) (30), and diuretics (128) (129) (130) (131). The iodide of potassium, in doses of five or six grains, once in three or four hours, is an excellent remedy. The following is a good form of taking it, — iodide of potassium, one once ; fluid extract of pipsissewa, two ounces ; water, half a pint Dose, one teaspoonful. The skin should be bathed and rubbed daily, three or four times, with much friction. Pleurisy. — Pleuntis. Pleuiusy, or pleurisy fever, as it is sometimes called, is an inflam- mation of the pleura, or the membrane which lines the chest, and, at the same time, is folded back so as to cover the outer surface of the lungs. The pleura, as is elsowiiere explained, is a short sac or bag, whose inner sides are kept inoist, so that they may slide easily upon each other as tliey are moved by the alternate contractions and expan- sions of the lungs in the act of breathing, and whose outer sides are made to grow, — one to the inside of the chest, and the other to the outside of the Inngs. Pleurisy and lung fever, then, must be kindred diseases, and exist, more or less, together. In truth there is almost always some aHectioii of the pleura in lung fever, and some afiiH^tion of the lungs in pleu- risy. The pain in lung fever is owing to some inflannnation of the pleura ; and the appearance of the rusty-colored phlegm in pleurisy indicates that the lungs have been reached by the inflammation of the membrane v^hieh covers them. Physical Hifm. — Dulness on percussion, at the lower part of the chest, which ciscends as the eft'usion of water increases. If the efl'used fluid is not great, there is puerile breathing at the top of the lung. , Friction sound is heard occasionally. Ego[)hony is heard when the amount of fluid in the pleura is Bmall. As the amount of water increases, bronchophony appears. ¥ DISEASES OF THE CHEST. 239 Cieneiul Symptoms. — This disease is most frequently introduced by skiverings, which are soon succeeded by high fever, with a pecu- liarly hard, resisting pulse ; sharp, stabbing pain in the side, — gener- ally just below the nipple, but sometimes extending to the shoulder, arm-pit, and back ; hurried and interrupted breathing ; and a short, dry cough. The pain is greatly aggravated by motion, coughing, or an attempt to take a long breath. It holds the patient under constant and power- ful restraint. We find him lying upon his back, or his well side ; his countenance full of anxiety, — fearing to move, cough, or even breathe needlessly ; and often crying out from the keen torture these neces- sary acts inflict in spite of all his caution. At a more advanced stage, when the tenderness has somewhat abated, he will prefer to lie on the diseased sid<;, as this leaves the healthy lung more at liberty. Observations. — The first effect of the inflammation of the pleura ib to dry up the moisture with which its inner surfaces are lubricated, or made smooth and slippery. As a consetiuence, these surfaces be- come rough, and rub harshly upon each other, and produce a sound, in the early stages of pleurisy, like that of rubbing two pi.'tiIn(^s lie feels that he must liave fresh air, and, nif ling to a window, puts his head far out, to catch a stirring breeze. The li; nd ai.d feet aro cnll, the f.ice haggard and distressed, — sometimes a little rdl a itl swollen, l)ut more gt ncnilly pale and shrunk, — the body wet with persp ira ion, the pulse irregular, ftH:i)le, aiul small, though sometimes not disturbed. Tl eso symptoms continue for some liours, more or less, when tlie breath, ug bi co.ncs more easy, and there is a little phlegm mised, sometimes consi Icr ihl •. This ccssnli!)ii of ditlicult breathing may be complete, or only ^larlia) ; a ul asts for a longer or shorter period, wheu the attaclv again recurs. Causes. — It Is well known that Ast.'imn has its cause mainly in the nervous system. Tlie air tubes are encircled willi a series of little bundles of fibres, wliidi are, in fact, muscles, and lik-j all otlier muscles, liave the power of contracting or sliortening tliemselvts. These muscles, too, like all others, have nerves distributed to them; and wlien these nerves become diseased or irritable, they will become disturbed on certain occasions, and cause these small, circular puckering strings to contract and close up the air tubes near ^heir termimations, very mucli as tlie puckering string closes the mouth of the work-bag, so that very little air can pass into the air cells, and that little with ^reat difficulty and slowness. When tlieso contractions take place, and the air is thus shut off, the result is a fit of asthma. This disease may be brought od oy any of those states of the atmosphere which disturb or irritate the broii- chial surfaces, or by any of the numerous causes which mysteriously unbalance the nervous system. A fit may be brought on by whatever disturbs the midd. Treatneat. — The disease has been regarded as >- .:tremely difficult of cure. There are certain remedies, however, which have f emarkable control over it, and if skilfully used, will frequently bring it to » complete termination, and even in the worst cases, to a state of very great mitigation and improvement. Inhaltttion. — The most important and certain remedy is the us6 of tke Alterative Inhalant, described on page 221. I have with this article alode effected some surprising cures; yet it is well to combine other treatment With it I have had several cases of a most distressing character, — the attacks con- tinuing night and day, — in which the inhalation, judiciously administered, has caused the disappearance of the complaint within twenty-four hours, and in which no return of suffering has occurred for several weeks, and then only in a modified form. This remedy should be used four or five times a day. Iodide of potassium is a most valuable internal remedy in this complaint, indeed, in a certain sense, it is almost a specific. It should be used (prescrip- tions 101, 138, 140, 151) at the same time with the inhalation. The following preparation is a very good remedy for this disease: Ethereal tincture of lobe; lia, two ounces; tincture of asafoetida, one ounce; laudanum, one ounce; iodide of potassium, two ounces; simple syrup, four ounces. Mix. Dose, from a teaspoonful to a tablespoonful, every hour or two. Several other remedies are used for asthma, with more or less success, — ' 'mm euch as electro-magnetism, smoking stramonium leaves, burning paper dipped in a strong solution of nitrate of potash, and inhaling the f)n\oke, etc., — but none of these have us much value as the two remedies first named. In as grave a complaint as a severe case of asthma, it is always well to seek the aid of a physician. I intended to have given some interesting cases, but want of space forbids. Hay-Asthma. — Hay-Feyer. This is a very troublesome complaint, which seems to combine the peculiar- ities both of asthma and of influenza. Fortunately, it attacks but few persons, and those only at particular seasons of the year, — namely, while hay is inblos* . jKKD , and during |>ay-n»pkipg. 8yMpC*Bt. — These are a combination of the symptoms of the two diseases above named. There is great irritation of the eyes, with sneezing, and a free discharge from the nose. There is tightness across the chest, difficulty ttt 'bseathing, and a pricking sensation in the throat These symptonui pften ^pear in great severity, making the complaint a really distressing one. Caue. — This disorder spears to have but one cause, — namely, some sort ()f emanations from the grasses, flowers, etc., while in blossom; which emanations come in contact with the mucous lining of the eyes, nose, and throat, producing very great and teasing irritation. IraatBCBt. — One of the best remedies for this troublesome complaint is to avoid the cause, by removing, during the flowering and haying season, to some large city, or, still better, close down to the seashore, where flowers and hay do not grow. Qf mediciues, the tincture of lobelia, taken in moderate doses, is a very good remedy. Quinine and iron, given in combination (75), are valuable preparar tions. Strychnine and nux vomica, in connection with iron, or otherwise (316), (83), (84), (85), (86), (95), are very useful. Iodide of potassium (101), (138), (140), is.also worth a trial. Another very good remedy is the chloride of ))ine, or the chloride of soda, placed in saucers about the sleeping-room. Pieces of cotton cloth may also be dipped in one of these solutions, and hung about the apartments of the house. The hands and face may likewrise be W^hed, once or twice a day, in a weak solution. The oxide of zinc and the extract of nux vomica, made into pills, two grains of the zinc to half a grain of the extract to each pill, and one pill taken moa»> ing fmd ttveiiing, should not be forgotten. 1 I W ' ^ i i. MM U>'"i: JVV -I' ^ "ft iK " • i i : .• 'i.l.' HEART DISEASES. r.-t » t Life rests upon a tripod, — the brain, the lungs, and the heart These are equally important to its well-being and continuance. In substance, the human heart is a bundle of muscles, so put to- gether as to bear the greatest possible amount ol" work. In size, shape, and look, it is much like the heart of the hog. I wish it never had a likeness to it in its moral nature. ♦ The heart is cncloscfl in a case or sac, called the pericardium. It lies between the two lungs, a little to the left side of the chest. Its point is under the sixth rib on the left side, and its low- r surface rests on the diaphragm^ — a horizontal partition between the est and belly. The heart is double. It has four cavities, — two foi receiving the blood, which are called auricles, and two for driving it out, called ventricles. The venous, or dark blood, is brought from all parts below, and emptied into the right auricle through the ascemling^ vena cava^ and from all parts from above, and poured into the same cavity through the descending vena cava. From this it passes into the right ventri- cle, which contracts, and forces it through the pulmonary artery into the lungs, where it becomes red, and passes into the left auricle through the pulmonary vein, thence into the left ventricle, which con- tracts, and throws it out through the great aorta to all parts of the body. Fig. 93 gives a good idea of the circulation through the heart and lungs. The heart is divided into two sides, which are separated from each other by a muscular partition, — each side 'having an auricle a.nd a ventricle. The auricles have comparatively thin walls, as they are only used for reservoirs. The walls of the ventricles are much thicker, being used, — particularly that of the left side, — for forcing the blood over a large surface. BetwtHMi the auricle and ventricle on the right side, are three folds of triangular membrane, called the tricuspid valves. Between the auricle and ventricle on the left side, are three valves, called mitral. At the beginning of the pulmonary artery, and the a^rta, are three half-moon shaped folds of membrane, called semilunar valves. The office of all these valves is, to close after the blood has gone through, and prevent its flowing back while the cavity is being agaia filled. They do the same duty, in fact, au the valves of a pump. heart HEART DISKA8ES. 247 Through this heart, thus constructed, nil the blood in the body, — about twenty-eight pounds, — passes once in about one minute and a half. This is r. pid work ; and when we consider that the heart works in this way through the whole life, resting not, day or night, we cannot wonder that it gets out of order. Fio 96. The whole heart is seldom affected. to disease than the right The left ^ide is more liable Impulse of the Heart. The ear when placed over the heart, feels, at each beat, a slight shock. This is felt at the same time the first sound is heard. This impulse is caused by the apex or point of the heart being thrown up against the ribs by the contraction of tiie ventricles. It is felt best between the cartilages of the fifth and sixth ribs on the left side. The Sounds of the Heart. On applying the ear to the chest just over the heart, two sounds are heard. The first one is dull and slightly prolonged ; the second is a shorter and smarter sound, having u sort of clack. These occur in pretty rapid succession, and then comes a lirief interval. And this round of action, first a long and dull sound, then a short and smart one, and then an interval, — called the heart's rA/////m, — is repeated continually. If the space of time occupied by the rhythm be divided into five parts, the first sound will take about two parts, the second one, and the interval of repose, the remaining two. The first sound is heard about the time of the contraction of the ventricles, and is therefore called the systolic sound the second is synchronous with ■ I' w i ii. 1 m, .in 248 HEART DISEASES. the opening of the ventricles, and is called the diastolic sound. The syllables too'to — too-to, very fairly represent the two sounds of the heart These sounds are heard over the largest space in lean persons. Pereuiiion Soandi. If the ends of the fingers be struck upon the chest over the heart, a dull sound will be heard over a space from one and a half to two inches square, — beginning at the fourth rib on the left side, and ex- tending down neany to the sixth. The dulness is diminished by lying upon the back, and increased by leaning forward, and by taking a fuU breath. The deadness of sound is caused by the heart being a parliaily solid body. The lungs which surround it, yield a clear sound. If a solid substance, as large as the heart, were placed on the inside of a drum, against the head, only a dead sound would be obtained by striking on that spot ; everywhere else, the sound would be louder. Altered Soan48 of the Heart. These sounds are changed by disease in a variety of ways, both as to their character and duration. One or both sounds may be turned I into a noise like the blowing of a pair of bellows. This is called the bellows sound. When this sound is very harsh, it may become like the noise of a rasp, or file, or saw. These altered sounds are all pro- duced by an altered condition of the valvular passages through whjch the blood passes. If you build an aqueduct of equal dimensions throughout, and smooth on the inside, you may send a certain vol- ume of water through, at a given speed, without noise. But if you make sudden contractions in the aqueduct, or allow large stones to project into it, and then attempt to send through the same body of water, at the same rate of speed, you will hear all sorts of noises. Enlargement or Hypertrophy of the Ventricles. This is simply a thickening, or an increase of bulk, in the walls of the ventricles. The muscles composing the walls of one or both of these cavities, grow thick and large. Physical Si^S. — Impulse stronger than natural. When consider- able, it is accompanied with a lifting and heaving of the parts. Dull sound on percussion over a larger space. First sound of heart pro- longed ; second sound feeble. The interval of silence, shorter than natural. In bad cases, the second sound is nearly extinguished. General Symptoms. — Hypertrophy of left ventricle gives a strong, prolonged, and tense pulse. Palpitation more constant than in any other disease of the heart. In advanced stages, the patient is easily out of breath. There is a rush of blood to the head on making exer- BEART DISEASES. 34U )S. tion, or stooping, with more or less throbbing and lancinating head* aches, which are aggravated by suddenly lying down or rising up. There are vertigo, ringing in the ears, sparks of light and other illusions before the eyes; aJHO a purplish, violet or livid color upon the chpeks, nose, and lipn. In many cases there is a dull, severe, aching pain in the region of the heart, and extending towards the shoulder and the inside of the arm. When the rig^ht ventricle is enlarged, there is a swelling of the ex- ternal jugular veins. Causes. — The walls of the heart are thickened by overwork, |p the same way that the blacksmith's arm is made muscular and large. All mi^Bcles grow in the same way. More action sends more blood to them, and this causes an increase of nutrition. Whatever interposes an obstacle to the passage of the blood through the valvular openings, will cause fibe ventricles which force it through tp work harder. Hence, obstructions in the semilunar valves cau/|C hypertrophy of the ventricles. Any excitement of the mind, or any great exertion, which causes th^ heart to beat harder and faster, if it be often repeated, will induce a thickening of the ventricles. Treatmeilt. — First, remove, as far as possible, all causes of excite- ment which produce palpitation. If the head is much aflected, apply wet cups to the back of the neck. The same may be applied over the heart This will generally improve the symptoiiia at once. A blister placed over the heart will likewise make a favorable impression. The meals should be taken at regular intervals, and should be very light. The food should be plain and simple, and composed much more of vegetable than of animal food. In fact, the diet should be 80 spare as slightly to reduce the strength. The patient should be careful never to take violent exercise, or, in- deed to be in a hurry about anything. In bad cases, walking up hill, or against a strong wind, is often out of the question, and must in any case be attempted with great caution. Stair-cases are to be shunned as enemies. An attempt to run, even to avoid being left by the cars, might, in some cases, prove immediately fatal. Carriage riding is not objectionable. The passions must be held in the most thorough subjection. Ex' citements of all sorts are dangerous, and must be avoided. For the first week or two of treatment, active purgatives will be useful. For this purpose, epsom salts and senna will answer a good purpose, and should be used so as to procure two or three watery stools a day. In addition to this, some sedative to lessen the force of the heart's action, is generally needed, — especially when there is considerable palpitation. For this purpose, tincture of black cohosh, and tincture of scullcap, or the former with tincture of digitalis (285) (94), are quite useful. Three to ten drops of tincture of the American helle- bore (veratrum viride) will reduce the action of the heart perhaps more effectually than any other medicine. ,1 . :s-«C i Dilatation of the Ventricles. The several cavities of tlifi heart hold about one and a half ounces ealling of the. feet and h'gs ; purple, violet, or blue color of cheeks, nose, lips, and especially around the eyes; feeble and oppressed palpitation; various disturbances in the head ; bleeding from the nose, stomach, bowels, and womb ; and fre(iuently enlarge- ment of the liver. Explanations. — The first sound of the heart is short and not well marked, in consequence of the Tuuscular walis of the ventricles \\\ this disease being thin and in a weakened condition, so that every stroke they make is short, (juick, and spasmodic, instead of strong and lifting, as in hypertrophy. For the same reason, the impulse is a brief blow dealt the walls of the chest, which gives a slight shc-ck, but has not power enough to lift the chest up. The blow is quick, be(!auae the nmscle is thin and can contract quicker than a thick one. Dilatation, by thinning the walls of the cavities, enleebles the heart, and shows us an obstructed circulation. Accordingly the blood is not transmitted by the left ventricle, and being rc^tained in the lungs, it causes a crowded state of the vessels, and difficulty of breathing; also congestion of the brain, with terrific dreams, etc. And this en- gorgement of the Inngs, being propagated backwards to the riji^hl heart, great veins, and all their ramifications, produces dropsy of tht* feet and legs, discoloration kA the face, passive hemon'hag«\H, and con- gestion of the brail!, liver, and imMiibranes. Fig. 93 gives an ulen of how ail this happens. Treatineiit. — As in many other diseases, search on:, the causes, and remove them. If it be obstruction of the circulation in the lungs l)y bronchitis, or other complaint, that n-'cds the Iirst attention. If it Ix' caused by violent exercise, by strong emotions of the mind habittially indulged, or by drunkemu'ss, or any other irregularity of life, thiise habits nmst l)e corrcetcfl without delay. If it be caused l)y organic disease of the valves of the heart, relief cannot be so n'tulily obtiiined ; but even in thes cases, it is to be nought and expected. The circulation is to be kept as tranquil as possible by a strictly quiet and orderly life, and a plain, moderate, unstlmulating diet« Jn ,-Ji HEART DISEASES. 251 this disease, however, it should be more nutritious, and composed to a larger extent of meats, than in hypertrophy. In some cases the general health and tone of the system will need to be improved by bitters (50) (67) (64) (69) (79), mineral acids (60), iron (269) (61), and aromatics (115). The compound mixture of iron is a good preparation when this miiu'ral is called for by a low state of the blood. The stomach should be kept in the best possibh; condition, as a very small disturbance of it, even from acidity, will set the heart to bt'iiting very violently. If hystericfvl symptoms are present, the compound galbanum pill, and valerian (97), and other nervines will be called for. In attai'ks of great dlHiculty in breathing, immerse all the extremi- ties in warm water, and throw a blanr'i around the patitnt to |)ro- inote sweating, — at the same time admitting fresh air to satisfy the desire for breath. (»iv(? a draught, composed of ether, laudamuji, ammonia, etc. (I'ii)). This may be repeated two or three times, at intervals of half an hour, or an hour, according to the urgency of the case. Hypertrophy with Slight Dilatation. This is one of the most connnon complications of heart disease. It consists both in a thickening of the walls of tin; heart, and an en- largement of the cavities, — the former being more marked than the latter. Physical Hif^»» — Both sounds are louder than in any other disease of the heart, and are heard sometimes over the whole chest. The impulse is strong and heaving, with an abrupt back-stroke. In bad cases, the whole person, antl even the bed, is shaken by it. The dull sound on percussion covers a large space. (•euenil Myiiiptonis. — The same as those of the two diseases of which it IS compos''d, slightly modii cd by the action of each upon the other. Dilatation with Slight Hypertrophy. This is an enlargement of the cavities of the heart, with a slight thickening of its walls; the dilatation being the predominant disease, <»r greater than hypertrophy. PliyHicul Ni)(li8. — Percussion gives a dull soimd in the region of the heart, in proportion to its size. The first beat resembles the scvond. Th«; second beat is louder than natural. The impulse is a short, quick stroke, which contrasts strongly with the slower and heaving one of hypertrophy with dilatatit)n. The general symptoms and the treatment are a modification of thovse of the two diseases united in it. It is, however, to be kept in mind that the dilatation takes the lead; and, furnishing tlu- predomi- nant symptoms, is specially to be regarded in the treatment. ii i: f1 Aneurismal Tumors of the Heart. When, from some obstruction in the valves, the blood cannot easily pfkBS out of an auricle or a ventricle, its inner walls may beconie unable to bear the distending force, and giving way, let the blood through against the outer coats, which stretch, and swell out into the ^Ijape of a tumor, — the inside of the tumor becoming a regular sac. ^uch a state of things constitutes an aneurism of the heart Of course it is a grave disease. Softening of the Hei^rt. In this disease the substance of the heart becomes soft, and easiW ;|^roken. It is generally the result of some form of inftamrnation. Physical Slfus. — The contractions of the heart being weakened bv softening, the impulse is reduced in force, and both beats are weaker, and often they are intermittent The first beat becomes short and flapping, like the second. CSeneral Symptoms*— A quick, feeble, small, and faltering pulne, great anxiety, and a disposition to faint. (General languor ; a sallow, bloodless, withered complexion, with a purple, livid tint of the lips and cheeks, and frequently, general dropsy, from the inability of the heart to propel its contents. Treatment. — When accompanied by acute inflammation, softening is to be treated un the same principles as iiitlHinination of the heart- case. If it be a re^sult of chronic inflanunation, it calls for iron, bitters, nutritious animal food, and good air. Induration of the Heart. The muscular substance of the heart sometimes undergoes a hard- ening process. It is occasionally so much hartlciH'd as to sound. when struck, like a hollow horn vessel. The disease is rare. It increases the heart's impulse, like hypertrophy ; and it requires fifiout the same treatment with that disease. Fatty Degenerations of the Heart. The heart sometimes becomes overloaded with fat, which is depos- ited between the heart-case and the muscular substance, — covering the organ all over externally, and in some cases penetrating to some depth into its substance. The muscular walls themselves become thin and Habby. SymptomH. — The soun^jK of the heart are diminished, — especially the firs* The pulse is irregdlar Fain, and a feeling of oppression in the region of the heart, v*ith gfti^rdl tigns of retarded circulation, '^•m^ HEART DISEASES. 25H such as congestion of the brain and liver. There is occasionally gid- diness, loss of memory, and palpitation. Treatment. — Exercise, mentnl excitement, and stimulating drinka must be avoided ; and the pationt must live for one or tw^o years on a very light diet, taking but v.ry little animal food. Bony and Cartilaginous Productions in the Heart. TiiKSK productions in tlie heart are fortunately rare. Yet they occur; aud the point of the heart, in its wliole thickn«'ss, is some- times cliani^ed to cartilage. 'I'lie ventricles are sometimes so ossified as to n'semble the bt)nes of the head. The symptoms of these degenerations are obscure; and as such cases are not curable, it is of lest consecpuMu^e that we sliouid be able to know their pn>eise nature during the life of (he patient. The treat- incut can only all'ord temporary relief, and should be such as is pre- scribed in other heart diseases with similar .symptoms. Shrinking of the Heart. — Atrophy. Thk heart, like any other n)uscl(', is liable to defective nutrition, and in consequence of it may become small. It shrinks, in some eases, to the size of an infant's heart. The conjplaint is generally craused by whatever reduces the general llcsli, as (^ousum|)tion, diabeU-s, chrotiic dysentery, cancer, and exces- sive loss (if bl(.M>d. It can hardly be called a disease. Persons who have it are less subject, to indamrnatory diseases than others, though they faint from slight causes, and have nervous att'ections. Treatment. — If its causes can be discovered, treat tiiem ; if not the treatment should be the same as for dilatation. Aeate Inflammatio i of the Heart-Case. — Pericarditis. Thk pericardium, or h'.ar*-case, is a membranous sac, in which the heart i« contained, it x* compos««d of two layers. The outside one mfibraus, dense, and white ; the inside one is serous. The serons layer forms the lining of the tibrous one, and then is reflected over the heart, and the roots of the large blood-vessels. When t\v' pericardium \n-cnnu'H acutely inllamed, it throws out, both lymph, and w lum or water. Th< lymph often causes the two layers of »he sac to y/o// together. PiiysH'rii Sigftg. — The iinpidf>«' ix ulrong when the elTusion of water is small, feeble and uneqiiiil when it is larg«\ Hercussion yields a dull sound in proportion t<; the amount of (Initl in the sac. When listening with the stethow »pe, a rough noise is heard, resem- bling either the rasping of wmd, the gratmg of a nutmeg, the rustling 'ji silk, or the cnulding of parchment. SometimeH it is softer, likfl : r ii!i il the blowing of a pair of boUowrt. Occasionally, it resembles the creaking of a new shoe-sole, or has a low creaking, like the tearing of linen cloth. When there is effusion, the ordinary beats of the heart sound dull and distant. • General SyiiiptmilH. — Acute inflammatory fever generally preceded by chills, with pungent pain in the region of the heart, shooting to the left shoulder-blade, shoulder, and upper arm. Pain increased by taking a full breath, by stretching the left side, by percussion, and by pressure between th(! ribs over the heart. Soine- times the pain is in the epigastrium, or left hypocondrium. Inability to lie on the left side. Explanation. — The noises mentioned above, are produced by the rubbing together of opposite surfaces of the heart-case, made rough by the exudation of iyiiiph. The rasping is supposed to be caused hy firm and rvffg'ed lymph ; the rustling and creaking, by soft and wet lymph ; the bellows nuirmur, by soft and dri/ lymph ; the creaking, croaking, and crackling, l)y drt/, Unis^h lymph, 'fhese sounds may ail be imitated by rubbing a damp finger upon the back of the hand, while listening with the stethoscope applied to the palm. Chronic Inflammation of the Heart-Case. "When acute pericarditis runs for more than ten days or a fortnight, it becomes chronic. It is chronic from the begiiming, when it runs a slow, insidious course, without marked or violent symptoms. The symptoms are much the same in kind with those of the acute form, only less in degree. This. low grade of the symptoms of the disease renders it inore obscure than the acute. Treatment. — In the acute form of the disease, apply wet cups over the region of the heart, or apply from a do/en to forty leeches to the same parts. At the same time, move the bowels freely by an injection (247), or by a purgative pill (31). The strength and amount of the remedies einpU)yi'd in each cas*', must be in proportion to the vigor of the patient's constitution. It is of great importance that the treatment slioui* I be active and prompt, and that the disease should be broken down tarhj. Diluent, cooling drinkn (132) (129) (298) (299) should be allowed as freely as the patient desires, in order to dilute the blood, and ren^ der it less stimulating to the heart. At the same time, live to fifteen-drop doses i>f tiiX'^Mre of veratruin viride should be given every hour, to bring dowH tl» action of the heart Let the diet be wholly oi bariey-waKT, thit fwe^ weak tea, or aiTow root During recovery, the diet must bt spam. «nd the greatest tranqniV lity of mind and body be preserved. '.;TTi5II^lj IIEAKT DISEASES. 25o In the treatment .of ehronic cases, when the cavity appears to con- tain fluid, counter-irritation is suitable. Blisters, croion oil, the com- pound tar plaster, and especially the tincture of iodine. The diet may be a little more nutritious than in the acute form of the disease, — embracing light animal food and broths. Inflammation of the Heart. — Carditis. This is an inflammation of the muscular substance of the heart When existing alone, it is a very rare disease. Being mixed up with other forms of heart disease, it does not require any separate account of its symptoms or treatment. Acute Inflammation of the Lining of the Heart. Endocarditis. The heart is one of the citadels of life. Disease attacks it on all sides. In this complaint, it has entered the fort, and taken possession. The inflammation is on the lining- membrane. Physicnl 8i^ns. — The impulse is violent, abrupt, and regular, as long as the circulation through the heart is free, but when this is im- peded, it is at first a confused tumult (which generally happens when a fort is first taken), and gradually sinks to a feeble fluttf-r. The dull sound upon percussion covers a space of from three to seven square inches. The beats of the heart are generally accompanied or marked by a bellows murmur, — the loudness of which depiMids on the strength of the heart's action. General Symptoms. — Inflammatctry fever. The action of the heart being generally violent and ;ibrupt, the pube I'orresptJnds with it, and is strong, full, and nan}; Eiplanation. — The bellows sound is supposed o depend on the inflamed and swollen condition of the valves. The duhit'ss on percussion will b«' slight when the circulation through the heart is free; — more distinct and marketi when it is obstructed. Dr. Hope says the disease may be anticipated, if a person be sud- denly attacked with these three signs : namely. f«'ver. violent action of the heart, and a murmur which did not exist before. This disease, like inflammation of the heart-case, »s often produced by, and is intimately connected with, acute rheumatism. Ghronio Inflammation of the Heart's Liaing-. Physical Signs. — The impulse more perceptible and iifFused than natural. The dull sound upon percuasion covers a space of from four to •ight square inches. 1 »'.".. i 256 HEAUT DISEASES. There is a sawing, rasping, or filing sound. This sound may cover one or botli beats of the heart. Sometimes these unnatural sounds arc double ; in whieh case, the first is caused by an obstruction to the natural flow of the blood forward ; the second, by the regurgitation or retrograde flow of the blood from some defect in the valve, — just as a pump valve may get out of order, and allow the water which has gone through to flow back. Ei'plniiutioii. — A variety of organic changes occur in the valves, which give rise to the umrmurs. Inflammation of the lining mem- brane of the heart, reaches the valves, causes puckering, thickening, vegetations, cartilaginous, bony, and fat-like degenations, which obstruct the blood in its onward flow, or prevent a closure of the valves, and allow it to flow" back ; tiie ft)rmer causing the first sound, the latter the seciond. If the unnatural noise be synchronous with the first beat of the heart, it implies disease in either set of the semilunar valves, or an impossibility of closing the auriculo-ventricular openings; if it accompany the second beat, it signifies that cither set of the semilu- nar valves may be open. A murmur attending the first beat of the heart, must be caused by a current of blood from a ventricle ; one attending a si'cond sound, by a like necessity, is produced by a current into a ventricle. Treatment. — The same as that for pericarditis. It should be equally prompt and vigorous. It must not be forgotten that this disease leads to various organic diseases of the valves of a very grave character, and that such mischiefs can only be escaped by cutting the disease short in the very beginning. Disease of the Semilunar Valves. The inflammation of the lining of the heart makes sad work #ith the valves. The semilunars are subject to various changes in their ■tructure. Physical Sig^s. — Obstruetlve ttturmiir. — In disease of the semilu- nar?, the first beat of the heart is accompanied or obscured either by the bellows murmur, or a sawing, rasping, or filing sound. The un- natural murmur, whatever it is, appears superficial or near. The second beat is natural. When the opening into the aorta is ciontracted, or in any way ob- structed by unhealthy growths, so that the blood is subjected to more than a natural degree of friction in passing, this sound will be heard. It is caliJ'd obstructive, because it arises from the obstruction of the blood in its- forward course. Reg^Ul^itfliit murmurs. — First beat of heart natural. Second beat accompanied or replaced by bellows murmur. There is sometimes a musical murmur. Explanation. — The regurgitant murmurs arise from the valves be- ing too small, or defective in some way, and allowing the blood to flow back through the orifice. >le^ T^yrra l HEART DISEASES. 257 7 This murmur is loudest opposite the semilunar valves, and is more audible ab'jt'e thuse valves than below them. When the aortic valves are contracted or shortened, and the open- ings are not guarded by them, so as to prevent the backward passage of the blood, there is a double bellows murmur, — one when it ia drive Hthrotiffh the orifice, and another when it /lows back. Disease of the Mitral Valves. Physioal Sijfiis. — Ohstnu'tlve Ifliiniiiir. — First beat of heart natu- ral. Second beat accompanied or replaced by bellows murmur R<'2iii'it;it)iiit raiiriiiiirs. — The first beat of the heart accompanied by a loud and rough bellows murmur. This sound is like sawing or iiliiig. It ii loudest above or below the nipple, between the fourth and .•««'v«'iitli ribs. There is occasionally a musical murnnir. Th") vcond beat of the heart is natural, yometimes there is a purring tremor. General Syiiiptoins of Valvulnr Disease. — Cough, in many cases with watery expectoration; dilliculty of breathing; frightful dreams, and starting from sleep; congestion of the lungs; expectoration Btained with dark and grumons blood ; swelling of the jugular veins; a livid look of the face ; a feeling as if a cord were tied tight around the lower part of the chest, general dropsy, of the legs and feet in particular ; j)assive hemorrhages from the mucous membranes ; en- gorgement of the liver and spleen ; congestion of the brain, with feel- ings of oppression. When the mitral valve is contracted, admitting regurgitation, the pUlse is small, weak, irregular, and intermittent. These are the worst symptoms of an advanced stage. Explanntiuiis. — The examiner will distinguish the various sounds thus: The murmurs generated at the origin of the arteries, spread their sonorous currents upwards along- these arteries. Those produced in the auricular orifices, will be conducted into the auricles, and propagated downwards towards the apex of the heart. Which Set of Valves, — To learn in which set of valves it origft> nates, therefore, find its seat, and trace its direction. Finding the murmur to be in the aortic orifice, it is then known to be obstructive, if the first sound is morbid, and the second sound natu- ral; and regurgitant, if the first sound is natural, ami the secotul sourui morbid. But if the murmur be in the mitral orifice, it is obstructive when the first beat of the heart is natural, and the second beat morbid; and re- gurgitant, when the first beat is morbid, and the second beat natural. The Pitch or Key of a murmur depends on the distance of its seat from the ear of the listener ; — nearness giving a high, and distance a low key. Thus, a murmur seated in the orifice of the pulmonary artery, being riearer the surface, has a ' igher pitch than any othec i: III..: lit i . :.' hk m ii« I'l- S'h, V, H II ^; H ^'^B'' IB ' 1^1 ' M 1' Hi 11 1 W'll iii II ;i 258 HEART DISEASES. It is on about the samo key with a whispered s, — soirn'iimes a little lower, and depending sotnewiuit on the strength of the current of blood, — a strong current elemiting-y and a weak current depressing the tone. The mitral orifiee is situated opposite the junction of the c^artilajEja of the third rib with the left side of the breast bone. The aortic orifice is about half an inch to the right of tiiis, and the same dis- tance lower. It is known by the key being lower, — about like a whispered /•, which is the ordinary type of tlie sawing sound. Murmurs from pulmonic and aortic reg-urf>Uafions, are about two tones lower, in consecpunice of the currents of the l)lood bying weaker. They are like whispering awe by inspiration ; and if the click of the valve be heard, the sound will be changed to pair. Murmurn in the mitral valve, being more deeply seated, are about four tones lower, and are like a whispered v:ho. The tricuspid murmurs are higher than the mitral, because nearer the surface. The musical murmur has been compared to whistling, the cooing of a Jove, and the mewing of a kitten. It generally results frt)m re- gurgitation. The purring tremor is caused, generally, by regurgitation through Ihe fm'tral valve. Otlicr SyiiiptoiiiH Explained. — The diflleulty of bn'athing, frightful dreams^ congestion of the lungs, hemorrhages, engorgements, etc., mentioned above, all proceed from such valvular stitlenings, pucker- ings, ossifications, enlargements, and contractions, as occasion a decid- edly obstructed circulation. The small, weak, irregular, and interrupted pulse, is caused by con- traction of th(; mitral valve, which' occasions an insuflieient or irregu- iar supply of blood to the ventricle, and causes the ventricle, by losing the retiistancc of the valve, to expend its force in a backward as well a forward direction, — th".3 sending but little blood into the arteries. Treatmeilf. — The tendency of valvular disease is to produce hyper- trophy and dilatation. The strong and ceaseless efibrts of the ven- tricle to drive the blood through, an orifice obstructed by valvular disease, will of course make the walls grow thick, which is hypertre- phy ; and at the same time, the accumulation of blood which cannot be driven lorward fast enough, must Umd to swell and enlarge the cavity, — which is dilatation. The great object of treatment, therefore, is to diminish the force and activity of the circulation, — to induce the heart to cease striving to do what cannot be done. To accomplish this, give sedatives (285) (94) (124). The hellebore and cohosh will be found particularly serviceable. The tincture of the American hellebore is about the best of all Purgatives may be given according to the strength of the patient. When there is dropsy, and a scanty secretion of high-colored urinej diuretics, or medicines to increase the action of the kidneys, are very important. For this purpose, digitalis and acetate of potash (130) frightful II its, etc., pucker- a decid- •e hyper- ilhe'vfii- v'dlvular Ih cannot jarge tlio the force striving I hellebore Lst of all Itient. ted urinej r are very wh (130) are excellent. Should this not succeed in redut^ing the dropsy, an active purgative (31) may accompany it. Diaphoretics, or medicines which promote perspiration, are also useful. This opening of the skin, however, is generally brought about by the hellclKni', etc. (124). The diet should Ih' unstinailating, and yet should be sufliciently ncMirishing to prevent th<' patient from running too low. Animal f(Kxl of the most digestil)le kind may bi; taken once a day ; though there are many cases reijuiring its entire rejection. The passions should be kept in the most perfect su!)jec tioii, and t/ie life should be as tranquil as jiossiltlv. Nothing- must be done in a hurry. Water in the Heart-Case. — Ilydropericardmm. This disease is common as an attendant of g(!neral dropsy. Pllj'sic'iil Si|ni!i> — The impul.'^e is undulatory, as if transmitted through a lluid, and it is not always of the same strength. The dulness extends upward in a conical form, in proportion to the amount of fluid ; — sometimes rising ns high as the .second rib. The impulse does not coincide with the first beat of tin- heart. flieiieriii Syiiiptoiiis. — The jiatient has a sensation of the heart being in a floating state. The pulse is small, frequent, and intermittent. Explniltitioil. — The reason that the impul.se does not occur at the same time with the first beat of the heart is, that the apex does not immediately strike the walls of the chest, — some time being required to push it up through the fluid. The beats of the heart sound more distant than natural in conse' quence of the organ being pushed away from the walls of the chest by the fluid. Palpitation.— Nervous Palpitation.— Anaemic Palpitation. There is a great deal of palpitation of the heart dependent on dyspepsia, hypochondria, hysterics, mental agitation, excessive study with deficient sleep, venereal excesses, and masturbation. Palpitations likewise occur from what is called antemia, or a low Bnd deficient state of the blood. Physical Sij^ns. — The impulse is weak, fluttering, or tumultuous, — generally increased by trifles. The beats of the heart are increased in frequency, and sometimes marked by intermission. Now and then they are accompanied by a bellows murmur. There are musical murmurs in the jugular veins, —loudest a little above the collar bones. General Symptoms. — The complexion is generally pallid and blood- less ; the lips and the inside of the mouth partaking of the same pale- i 1 r I 'n If r.«!,' I ness ; the pulse quick, small, weak, and jerking ; and during palpita- tion, it Hoiiirtiincs has a thrill. Slight causM'si produce breath lessneHs and faintncss. A disliki^ of animal food, and a fondness for acids. The monthly dischurm' in females ia delioicnt, and the whites take its pliU'e. Hometimes the menses are too profuse, lasting for several days, and consistiuii; only of hloml. In this state of things there is great feebleness both of mind and liody, with rushing noises in the ears. Expltllitltioiis. — The murmurs de|x*nd on a lack of blood. The con ditions of their existence are, thinness of blood, n swift and spasmodic 'urculation, and j)articularly an unfilled comUtioii of the bloixJ-vessels. A brook is the more babbling in projjortion as its water is more shallow. It is a law in j)liysics, that ln!aviness of freight gives st^^ad- iness of motion ; and lightness of freight gives misteady motion. The fireman's hose trembles and vibrates when only half full of water. In like manner the blood-vessels are agitated when imperfectly filled. Treutllieilt. — This is to be governed altogether by the cause of the trouble. If it be dyspe|)sia, hypochondria, hyst«!rics, etc., these sev- eral diseases reipiire their usual treatment; wlu'U they are cured, the palpitation will stop. But when it is caused by a low state of the blood, then give for several weeks, iron, the compound mixture, and (31()) (5U0). The food must likewise be nourishing, — tender meat, beef and mutton, with broths, etc. Gentle exercise will be required, and much exjjosure to a bracing, out-door air. Neuralgia of the Heart. — Angina Pectoris. This is a strictly nervous disease. It begins with a sensation of pain and constriction in the region of the heart. This pain is accom- panied with more or less pain and numbness in the left arm. In females it is not uncommon for it to be attended by great sensitive- ness and pain of the breasts. When the attack is violent, the pain in the heart is excruciating, and even terrific. There is attending this a feeling of great oppression in the chest, amounting, in the worst cases,' to a sense of suffocation. The heart palpitates violently, the brain is oppressed, and fainting sometimes occui-s. The disease is brought on, in nervous subjects, by over excitement of the heart. Walking up hill, against a strong wind, may bring it on. If walking at the time of the attack, the patient is compelled to stop, {^nd stand still till the pain subsides. The disease is often connected with organic changes in the heart's structure, such as ossifications, and other alterations. Treatment. — When the complaint depends on organic disease of the heart, the treatment must be directed to the cure of these dis- eases. To relieve a severe attack, the patient should be instantly placed in a quiet position; wind in the stomach, if present, should be ex- [ nalpita* ll(u88lie8S i 'or acids. i take its •ral days, in great ! ears. The con pasiitodic d-vcsaels. is more res stead- motioti. of water. ;tly filled. ISO of the hewe sev- :;ured, the I give for beef and a bracing, nsation of is accom- arm. In sensitive- t, the pain tiding this the worst (lently, the jxcitement ly bring it mpelled to the heart's disease of these dia- itly placed uld be ex- pelled by poppormint or anise water, or ether, or (ll**)), or some other arotiiutii*. if there is acidity or soijriicss of the stomach, it must be corrected by a tcaKpooiiful of soda in half a tumbler of water; and if the stomach bv. full of undigested food, let tin; patient take a table- spoonful of ground naistard, stirred up with a teacupful of warm water. This will cause almost instant vomiting. These things being done, give some (juicling, or antispasmodic medicines, as on I i.i i i V'i I '.If 1 l^^i' 1 1 "'« ,<*: '!*'« if 268 DISEASES OF THE AMDOMINAL CAVITY. An infusion of thoroughvvort, drank freely every day, is a valuable remedy. The inner bark of the barberry steeped in cider, or this arti- cle compounded with others (286) (287) will be found excellent. The diet should be plain, wholesome, and nourishing, but com- posed mostly of vegetable articles, particularly green vegetables and berries when they are to be had. Cold water should be the principal drink ; or drink and mediciiu' may be combined in the shape of five drops of muriatic acid, ami three drops of nitric acid, dissolved in a tumbler of water slightly sweetened. This is generally a pleasant drink, and will assist very much in the cure. The warm bath once or twice a week, and the alkaline sponge bath every day, with smart friction, must not be omitted. When jaundice is caused by the passage of gall-stones through the bile duct, there is sometimes terrible pain and suftering, — the stone. occasionally, being as large as a nutmeg, and forcing its way through a quill-sized tube. So great is the distress that the patient sometimes rolls upon the floor in agony. To alleviate this pain, large doses of opium, laudanum, or morphine, are required. A large teaspoonful of bicarbonate of soda dissolved in a tumblerful of hot water is an ex- cellent remedy if drank at a single draught. It relieves the acidity of the stomach, and acts as a fomentation to the internal seat of the pain. Mustard poultices, or warm fomentations, over the seat of the pain, are required. The warm bath is excellent. The acid bath, made by mixing three parts of muriatic acid with two parts of nitric acid, and adding as much of this mixture to water as will make it about as sour as weak vinegar, is valuable in jaundice. Only a quart of water need be taken ; and the solution should be applied with a sponge. It is of the right strength, if it produce a sUght tingling of the skin. Gall Stones. — Biliary Calculi. These are concretions, or hardening of bile into masses of all sizes from that of mere grains, to that of a nutmeg. Fig. 97 is a specimen of them. They are found in the gall bladder, the cystic duct, the hepatic duct, and are sometimes precipitated from the bile after it has passed into the bowels. In pass- ing through the ducts, if of considerable size, they produce intense pain, particularly if they are jagged upon their ^ .^ x^ surface. Mflb These stones, so called, are composed, chemically, of^^^ cholesterine, bile pigment, choleic acid, choleate of soda, mucus, earthy salts, and margarin and its compounds. A nucleus seems to be first formed, and then a gradual accumulation takes place upon its surface. Fig. 97. Symptoms. — An almost constant uneasiness in the right hypochon- driac region, with spasms of pain, coming on suddenly, and lasting for a time with great severity, and then subsiding. The pain is caused assist verv in is caused DISEASES OF THE ABDOMINAL CAVITY. 26J» by a stone being suddenly forced into the duct and moving forward in it, and it subsides when the stone either stops, or gets through the duct. When the stone reaches tiie bowels, it passes oft with the stools. The patient generally hiis a pale, sallow complexion, a small, feeble pulse, and often suffers fn.in nausea and vomiting, and from restless- ness and hurried breathing. Treatment. — To reduce the spasm, give Dover's powder in full doses, or chlorodine. Also, apply mustard over the right hypochon- driiun and stomach, and follow it with hot fomentations with hops, or use wet cu|)s. If the stoni..ch is irritable, give the neutralizinnf mixture until it moves the bowels. A v/arin infusion of thoroughv^ort, given to the extent of producing vomiting, will sometimes do well, and lobelia enough with it to relax the duet may be useful. To relieve the acidity on which the formation of these stones so often depends, a neutralizing preparation {'.i-iS) may be given for a long time, the diet, in the mean time, being well regulated. The sponge bath, with saleratus and water, should be taken daily, followed by brisk rubbing; and free exercise in the open air should on no account be omitted. Acute Inflammation of the Stomach. — Gastritis. This is a rare disease. It is generally induced by irritating and corrosive substances taken into the stomach. Poisons, as arsenic, aquafortis, corrosive sublimate, and the like, are the most common causes oi it. Blows, sudden stoppage of sweat, and excessive use of ardent spirits, may also excite it. Symptoms. — It is marked by burning pain in the stomach, thirst, restlessness, anxiety, constant vomiting, prostration of strength, a quick, hard, and small pulse, incessant retching, a sunken counte- nance, hiccough, cold hands and feet, and a damp skin. Treatment. — If the inflammation be excited by poison, the reme- dies named under antidotes for poisons must be hrst employed. The poison bemg neutralized or thrown off, the inflammatory con- dition must be combatted with the remedies usual for such states. Mustard poultices to the feet, along the spine, and particularly over the pit of the stomacb) will be among the first things to be employed, and should be followed by hot fomentations of stramonium leo.ve.* or hops, — both the fomentations and the poultices to be repeated as oc- casion may require. Dry cupping over the region of the stomach is useful. Drinks. — Cold water, bread-water, rice-water, arrow-root gruel, in- fusion of slippery elm bark, and of marshmallow. These should be taken in very small quantities, — say a teaspoonful at a time, — about twenty drops of tincture of aconite root being added to half a tum- blerful. Lumps of ice may be held in the mouth, and occasionally swallowed. • 1 ■ lull 1 jl 1 ' ^ ^#. i: i M tf W '1 ' < s! . 1 ■'."!"' 270 DISKASKS OF TIIK AUDOMINAL CAVITY. Injections. — Emetics and physic are not proper, but injections (248) (2o3), or simply soap suds, will be re(iiiired. The remedies must be pursued until "U tenderness has disappeared from the pit of the stomach. While the patient is recovering, great care mi^.;-«t be taken not to overload the stomach with food. Arrow-root, sago, and milk are among the first articles to be allowed. After these, will come grad- ually beef-tea, chicken broth, soft-boiled eggs, and 'jeef-steak, until the whole diet can be restored. Chronic Inflammation of the Stomach. This is a much more common disease than the preceding; indeed it is very common. Though it does not put life in immediate danger, it perverts the feelings of the stomach, and causes many of the symp- toms of indigestion. Dyspepsia, however, is a different complaint, and not necessarily connected with inflammation. Symptoms. — There is generally pain in the stomach, which is in- creased by the presence of food, and by external pressure. The pain is sometimes felt only during digestion. The fermentation of the food in the stomach generates a gas, which is frequently belched up. This is what is meant in common language by having "wind in the stomach," and "belching wind." The meals are frequently vomited up ; the appetite is fickle, sometimes voracious, and again nearly ab- sent ; the thirst is likewise variant ; the tongue is white in the centre, and red at the sides and tip, — sometimes smooth and red all over, like a slice of raw beef. The urina is scanty and high-colored. The disease is very liable, if badly managed, to lead to ulceration of the coats of the stomach, and thence to a fatal end ; for an ulcer may penetrate the walls of the stomach, and let its contents into the abdominal cavity, which would excite an immediately fatal inflamma- tion. Treatment. — If there be much tenderness, we may apply leeches over the stomach. With less tenderness, counter-irritation will an- swer, — as blisters, croton oil, mustard poultices, the compound tar plaster, or dry cups. The skin of the whole surface should receive special attention. 'The warm or the cold bath should be used often, according to the strength of the patient. When the reaction is good, a cold compress bound upon the stomach every night, will do much to bring relief. The diet cannot be too carefully managed. While there is consid- erable tenderness, the nourishment must be of the most simple and unirritating kind, — consisting of little more than the most bland nutritive drinks ; and even these should be taken in small quantities at a time. Gum arable water, rice-water, barley-water, arrow-root gruel, tea, and toast without butter, will be amply sufficient to keep soul and body together, and will, in two or three weeks, generally starve the enemy out of his quarters. After this, a more nourishing diet may gradually be resumed. imm DISEASES OF THE ABDOMINAL CAVITY. 271 Indigestion.— Dyspepsia. Dyspepsia ia a disease of civili/atioti. Savages know nothing of it. It is the costly price we pay for hixnries. All civilized nations Bufler from it, more or less, but none so much as the jx-ople of the United States. It is here, in the new world, that the disease has b.'- eoine domesticated, and we, as a people, who have threatened to monopolize its miseries. F'ew disorders indict upon their victims greater sullering; yet it is not particularly dangerous, and it is even doubtful whether it tends very much to shorten life, unless the length of life be judged to con- sist in the sum of happiness enjoyed, — in which case, few complaints shorten it more. Symptoms. — These vary very much in different stages of the dis- ease, and in different persons. In general the complaint begins with a sense of fulness, tightness, and weight in the stomach, sooner or later, after meals, and a c^-angeable, diminished, or lost appetite. Occasionally, the appetite is craving, and when, in obedience to its promptings, a large meal is taken, there is pain in the stomach, with general distress and nervousness, and sometimes vomiting. Flatu- lency and acidity are common, with sour and oflensive belching of wind; and very often there is a water-brash, or vomiting of a clear, glairy fluid when the stomach is empty. Diziness is a prominent symptom. There is a great deal of what patients call an " all-gone '* feeling at the pit of the stomach, — a vvH'akness so great at that par- ticular spot, that it is very hard to sit up straight. There is a bad taste in the mouth ; the tongue is covered with a whitish fur ; there is headache, heartburn, palpitation at times, high-colored urine, and tenderness, now and then, at the pit of the stomach. The bowels are generally irregular, sometimes very costive, at other times loose, when portions of food are passed off undigested. ]Vervous Complication. — Such are the symptoms in a case of sim- ple disorder of the stomach, when no other part of the system is materially involve^. This is indigestion, well-marked, and distressing enough ; but it is only a part of what is understood by a case of modern dyspepsia. In //its, either the indigestion, in its course, dis- turbs and involves the nervous system, or the nerves become them- selves disordered, and produce the indigestion. Sometimes one hap- pens, sometimes the other, it matters not which ; both are present, — the affection of the stomach and- of the nerves, in a case of thorough dyspepsia. To make out a full case, in its tormenting completeness, we must add to the above symptoms, great depression of spirits, amount- ing at times to complete hopelessness and despondency ; a dread and fear of some impending evil ; a lack of interest in passing events ; un- willingness to see company or to move about ; an irritable and fretful temper ; a desire to talk of one's troubles, and nothing else ; a sallow, haggard, sunken, and sometimes wild expression of countenance ; a 'Iry, wrinkled, and harsh skin, ^ith unrefreshing sleep, disturbed by IH: ^^olarized light, they appear beau- tifully colored and striated. (Fig. 100.) The urate of ammonia, and uric aci<^I gravel, are likewise found in large quantities, in the urine of many dyspeptics. Some are exhausted by them, and reduced almost to skeletons, and to a wretched state of health, — having boils, eruptions, etc. To find the urates, put a little of the urine containing the deposit in a test tube, and warm it gently over a lamp. 1/ the deposit readily dissolve, it is probably urate of ammonia (Figs. 101 and 102), and may- then be examined under the microscope, to make the matter sure. Fio. 101. Fia. loa. To find uric or lithic acid, let morning urine stand until a solid deposit has sunk to the bottom ; then pour off the liquid, and place some of the solid portion upon a glass, and examine it with a micro- scope, and if this acid be present, its peculiar crystaline forms (I^ig. 103) win be discovered, either alone, or mixed with urate of amrildriia. In tho^6 cases in which there is a great prostration of the nervim* =) 274 DISEASES OF THE ABDOMINAL CAVITY. FlO. 103. system, with a loss of sexual power, bad feelings in the head, perhaps pain and weakness across the loins, and a tendency to consumption, we may suspect the presence of the triple phosphates in the urine. Phosphorus is one of the elements of the brain and nerves, and when there is a constant drain of this element through the kidneys, the nervous system is gradually exhausted. To find the triple phosphates, put some morning urine in a glass vessel, and let it stand till a sediment has gone to the bot- tom. Put some of the sediment in a test tube, and warm it gently over a lamp. If the warmth do not dissolve the deposit, add to it a little acetic acid ; if the de- posit dissolve in the acetic acid, it proba- bly consists of earthy phosphates. This is then to be examined under the micro- scope to ascertain whether it is the phos- phate of lime, the triple phosphate, or a mixture of both. Fio. 104. Fio. 106. Fio. 106. Fro. 107. Fig. 104 shows us the prismatic crystals of the triple phosphate. In a few rare cases, these are penniform (Fig. 105). Fig. 106 gives us another specimen of the crystals of the triple phosphates, as they appear under the , microscope, mixed with amorphous particles of phosphate of lime. If an excess of am- monia be added to the urine, the crystals become star-like, and foliaceous, as in Fig. 107. Treatment of Dyspepsia. — As there are few complaints which distress the patient more than dyspepsia, so there are few which give the physician more trouble. Generally our art has failed upon it because too much has been required of us. We have not merely been asked to cure the disease, but to do it while the patient continues the indulgence of his appetite, or his excessive application to business or study. It has jerhaps nnption, le triple lorus is lin and tit drain eys, the hausted. lit some nd let it tlie bot- in a test a lamp. I deposit, f the de- it prohor This is le micro- the phos- jhopphato. 106 gives ed to cure ilgence of been expected of us, that with medicine we should contravene the la'vs of nature, and restore health while the causes of disease are in full activity. This complaint is often brought on by not keeping the bowels open. To cure it, therefore, one of the first things to be done is to remove costiveness and regulate the bowels. One of the very best articles I know of to remove constipation is Mettauer's Aperient. I have placed it in the department of Phar- macy ; it ought to be in the United States Dispensatory. Taken immediately after meals, in doses of a teaspoonful, it corrects acidity of the stomach, it gently opens the bowels, and when its action is over, will be found to liave diminished the costiveness, rather than in- creased it, as most kinds of physic do. It is excellent in the bilious forms of dyspepsia, — acting finely upon the liver, — particularly if a few drops of aqua regia in water be taken before meals, — the ape- rient being taken after. If piles exist, this mixture will be objectionable on accoimt of the aloes, and the fluid neutralizing extract may take its place. Sweet tincture of rhubarb and soda (37) is sometimes preferable to the ape- rient. Several other preparations (38) (289) (39) (290) will be found use- ful to remove costiveness and debility of the stomach. For acidity, beside the remedies already mentioned, prepared char- coal may be used, in teaspoonful doses, or carbonate of magnesia, or fluid magnesia, or trisnitrate of bismuth. A good remedy is pulver- ized guaiacum, rhubarb, prepared charcoal, and carbonate of mag- nesia, equal parts ; also (2b) (37) (38) (42). If crystals of oxalate of lime be found in the urine, give a few drops of aqua regia, in water, three times a day. Hyj^ienic Treatment. — The diet must be managed with great pru- dence. Food must be taken in such quantities only as the stomach can digest, however small that quantity may be ; and it must be taken slowly, and well chewed. No article should be touched, or thought of, which disagrees with the stomach. Costiveness may frequently be entirely removed by eating no bread except that made from un- bolted wheat flour, commonly called Graham bread, or by making one of the three daily meals of boiled cracked wheat, with milk or molasses. If the triple phosphates be found in the urine, there is a spticial reason why the unbolted flour, or the cracked wheat should be ujjed. The wheat grain abounds in phosphorus, the largest por- tion of which is in the bran, and this is much needed when the kid- neys are robbing the brain of its phosphoric element Not too r^isch Brain-work. — It is important that the brain and nervous sysvcm should be relieved of the burden of too much work, and that Lhe thoughts should be turned into the most agreeable chan- nels. If the patient would get well, the disinclination to move about, and see company must be resisted. In many cases, dyspeptics are like sea-sick persons, — feeling as though they would rather go over- board than move. In such instances, friends must not be harsh with 1' ; 11 liH V 1 MlHn 1.' ■ .' 11 •■ I I ! I I I 'Ah ;;.t m 1 ■ii.> ', 'r^wi them, and frown upon their listlessness aa if it were a fault ; bul rather treat them affectionately, and beguile them out by all sorts of pleasing enticements. Exercise must be had, every day, and be coh* nected, if possible, with an object, so that it may be performed ch^fer- fuUy. It is important to engage the mind in the exercise; and for this purpose, some contested game is very useful, as playing at billiards, rolling nine-pins, pitching quoits, or, where the strength will permiti playing ball. Cheerfulness. — Nothing does more to drive away dyspepsia than a cheerful, lively, and even mirthful state of mind. AH the nervous in- fluences sent from the brain to the stomach should be of the most agreeable kind. Some people think it vulgar to laugh. Let such stand with long faces in life's shadows, if they choose. As a general rule, the best men and women laugh the most. Good, round, hearty, side-shaking laughter, is health for everybody ; for the dyspeptic, U is life. Dyspeptics who h&ve a taste for it, and can endure the expense, should travel. A voyage to Europe, and a year spent in seeing the wonders of the old world, will generally cure the most stubborn case of indigestion. This, however, depends upon circumstances. For those having the finer organizations and the higher natures, extensive travelling is sometimes indispensable. The narrow circle of thoughts, associations, and things, in their own neighborhood, do not fill the compass of their wants ; their many-sided faculties need to be drawn on by the large variety to be found only in travel. Their large and impressible natures want to be filled full in order to drive out disease, and it takes -^ world, or a considerable part of it, to fill them. The dyspepsia of such natures is not comprehended by the multitude, and even physicians are often amazed that their narrow prescriptions do not reach it Heartburn. — Cardialgiai This is a gnawing and burning pain in the stomach, attended by disturbed appetite. It is generally caused by great acidity of the stomach, and is a symptom of dyspepsia, and often afflicts pregnant women. Whenever too much food is taken, it is liable to ferment, and become extremely sour, — causing heartburn. In such cases, vomiting often occurs; and what is thrown up, is sour, and some- times bitter. Treatment. — Immediate temporary relief may be obtained by swal- lowing a teaspoonful of soda, magnesia, or chalk, in a tumbler of cold or watm water. Fluid magnesia, or lime water, will answer the same purpose. If there is wind in the stomach, as well as acidity, a teaspoonful of the aromatic spirit of ammonia, or (135), will often still the utieiisiness in a moment To cure the complaint, the stomtieh must be streflgthetied by the refliledies 'directed for dyspepsia. Spasm or Cramp in the Stomach. — Gastrodynia. Though generally of shorter duration, this is more violent than heartburn. It is attended by a sense of fulness, by anxiety, and by great restlessness. In females, hysterical symptoms are often coupled with it Great quantitiefe of air or gas are generally expelled, and the pain shoots through to the back and shoulders. Treatment. — A strong purgative injection (248) will often bring immediate relief. The sweet tincture of rhubarb and soda (37), with a few drops of tincture of cayenne mixed A^ith it, will often bring speedy relief. So will a mustard poultice laid upon the stomach. The mustard poultice is a remedy of great excellence, in many cases. It deserves to be called the poor man's friend. Water Brash. — Pyrosis. This consists in a discharge from the* stomach, generally in the morning, of a thin, .glairy, watery fluid, sometimes insipid, at other times, sweetish, and at still others, sour. A burning heat or pain in the stomach attends, and seems to be the immediate cause of the discharge. The discharge appears to be the natural mucus of the stomach, wliich is poured out in large quantities in consequence of a kind of catarrh of its mucous lining. The amount thrown up varies from a spoonful to a pint or more. The complaint is caused by a poor innutritious diet, or oy whatever causes the blood to become thin and watery. Trentment. — Ten or fifteen drops of water of ammonia, in half a tumbler of water, will quiet the distress, and check the discharge. The most eil'ectual remedy I am acquainted with for breaking up the discharge, is the trisnitrate of bismuth, taken at meal times, in from twenty to thirty-grain dosets, three times a day. The eoinpound pow- der of kino is a valuable remedy. The compound tincture of senna and the tincture of balsam of tolu, in equal parts, and administered in tablespoonful doses, are sometimes useful. The tincture of nux vomica is a good remedy. To restore the blood, sojne of the various preparations of iron (74) (80) (73) (316) will be reciuired. The diet should consist of easily-digested, nutritious food, — a» soups, broths, fresh meat, potatoes, and unboltc^d wheat bread. Vomiting. This occurs under a great variety of circumstances. It may be induced by acidity of the stomach, by irritability of the stomach, by distress of mind, by injury of the brain, by otlensive odors, and by all organic diseases of the stomach. Treatment — Generally, it is cured by treating the disease which induces it But in many eases, it persists very obstinately, and may become the chief thing to be attended to. In such cases, it may re- quire a sixth or quarter of a grain of morphia to check it But gen- ■ '"'W ■|!' " ' !1 t' . 1 ; !i LI'Wt I : ii 278 DISKASKS OF THE ABDOMINAL CAVITY. erally some aromatic, as ginger, spearmint, peppermint, or spice tea, will put an end to it. Some cordial or stimulant, as brandy, cham* pagne, tincture of ginger, paregoric, elixir solutis, or cherry brandy, will answer well. Strong coffee, without sugar or milk, will, in some cases, act like a charm. If it is dependent Oii acidity, the remedies are given under "dyspepsia." If caused by irritability of stomach, a pill of extract of belladonna and ipecac (339) will do well. While vomiting, the patient should lie still in bed, and in bad cases^ a mustard poultice should be placed upon the stomach. The vomiting of children may sometimes be stopped by wetting a piece of cloth with laudanum, and laying it upon the pit of the stomach. Seasickness. This is the great terror of persons, who, for the first time, cross the ocean. It is said that dark complexioned persons suffer more from it than others. If it cannot be entirely prevented, it may be mitigated by lying flat upon the back. To lie on deck, in the open air, is much better than lying in the close air of the cabin, or state room. A wineglass of brandy, or from ten to forty drops of laudanum will relieve the sick- ness very much. For a child, it is sometimes sufficient to wet a cloth with laudanum, and lay it upon the pit of the stomach. Morphine is sometimes even better than laudaimm. Creosote, one drop at a dose, made into a pill, is excellent Ten drops of hartshorn, in half a tumbler of water, is good for some. But the best known remedy is chloroform, taken in doses of from forty to eighty drops, suspended in water by means of a little gum arable. Milk Sickness. This disease prevails in the West, chiefly in the neighborhood of level, heavily-timbered, rather wet oak land. The cattle, horses, and shvjep, which range in these lands, are fre- quently attacked by a disease which the people call the trembles. It is supposed to be produced by eating some plant growing upon those lands, as cattle which feed in the neighboring regions are free from it until they find their way into these low grounds. It has been sug- gested that the offl'uding plant may be the poison ivy {rhus toxicoden- dron). Be this as it may, the calves, soon after sucking cows which have run in these grounds, are seized with trembling, and frequer .^ die of the disease. Dogs which lap the milk, are affected in a similar manner. Children drinking it, leave the table and vomit. Upon grown persons the effects are more severe, but not so sudden. The eating of the beef, mutton, or veal, of atfected animals, bii'igs on the same disease. Symptoms. — The disease sets in with sickness at the stomach, which is preceded by general debility, more particularly of the legs. There is nausea, vomiting, and the breath is so offensive and peculiar that those acquainted with the complaint immediately recognize it from this smell. if spice tea, idy, cham- ■y brandy, 11, in some ! Temediea f stomach, 1. bad cases^ wetting a e stomach. :;, cross the ore from it y lying flat )etter than iaeglass of e the sick- wet a cloth Morphine J drop at a n, in half a 1 remedy is , suspended iborhood of ids, are fre- <-embles. It upon those e free from LS been sug- s loxicoden- cows which I frequer .^ in a similar mit. Upon dden. The i'lgs on the " le stomach, of the legs. md peculiar recognize it DISEASES OF THE ABDOMINAL CAVITY. 979 These existing for weeks, constitute, in some cases, the whole of the symptoms. In other cases they are more severe, being attended by chills and flushes, great oppression about the heart, anxiety, deep breathing, heat in the stouiacli compared to fire and boiling water, violent retching and vomiting, alarming beatings of the heart, and throbbings of the large vessels, and cold extremities, — producing, all together, extreme distress. In most cases, the vomiting returns every hour or two, attended by great burning at the pit of the stomach, the substance thrown up liaving a peruliar bluish-green color, and a sour smell. As soon as Ihis discharge takes place, the patient falls back upon the pillow, and lies easy until another turn comes round. The tongue is covered with a whitish coat, the bowels are obstinately costive, and the pulse is small and quick. Treatiiieiit. — It is believed that the neutralizing mixture, given in tablespoonful doses every time the nausea and burning sensavion are felt, is the most effectual remedy yet used. It reli<'ves the acidity, and seems well adapted to allay the irritation. Some antibiiious physic (40) to move the bowels should also be given. Beside these remedies,' a mustard poultice should be put upon the stomach, and hot bricks to the feet, and the patient be kept still for some hours. The diet should be very mild, only toast water, rice water, or thin gruel. Acute Inflammation of the Peritoneum. — Peritonitis. This disease affects the extensive membrane which lines the whole inside of the belly, an extension of which forms the omentum or apron. It is an inflammation to which women are much exposed after confinement, and is known, in such cases, as child-bed fever. It 18 common among men, also, and is a grave disease. Symptoms. — Like other forms of fever and inflammation, it is pre- ceded by chills, with increased heat of surface, thirst, full, strong, and frequent pulse, flushed face, and red eyes, dry tongue with red edges, dry skin, restlessness, short quick breathing, nausea and vomiting. The pain is increased by the patient sitting or standing up, — the bowels being thus pressed against the inflamed membrane. Lying upon either side is painful for the same reason. To lie flat upon the back, with the feet drawn up, is the only endurable position. The pati(3nt lies stiU^ for all movements give pain. The pam in this disease is generally sharp, cutting, and prickings but is not always equally intense. It is aggravated by the passage of wind along the bowel, by which the inflamed membrane is slightly stretched. When the disease is advancing towards a fatal termination, the belly becomes greatly swollen and tense, — having to the hand a peculiarly tight, drum-head feeling ; the pulse is rapid and feeble ; the counte- nance is full of anxiety, apd \» piiictied and ghastly ; and a cold sweat breaks out. i^. I -■■ I, t r i ■' ■ ' i'i m.\.yv& 4 .til! 280 DISEASES OF THE ABDOMINAL CAVITY. Treatment. — Small doses of antimony, lobelia, or ipecac, to jro- duce nausea, and a moisture upon the skin, is generally among the first things given. The tincture of veratrum viride, in five to ten- drop doses, repeated every hour, will accomplish the same thing more effectually than any other known article. For such purposes, I give it the first place among medicines. A large poultice of white bread,, rye meal, or flax-seed, may be spread over the belly ; or cloths wet with cold water, will be still better, if the patient be full-blooded, and naturally strong. The bowels should be moved at once by some active physic, as butternut, salts, m&gnesia, castor oil, or cream of tartar (20) (17) (18) (27), or by podophyllin, etc. (40) (41) (31). The drinks should be lemonade, soda water, tamarind water, current jelly dissolved in water, and preparations (298) and (299). Indian meal gruel, toast-water, barley gruel, and the like, are the only allow- able diet Chronic Inflammation of the Peritoneum. When the acute inflammation of the peritoneal membrane is not successfully treated, it may run on for a time, and then subside into a lower grade of inflammation, called chronic, and in this state remain for an indefinite time. But it often arises independently of the acute disease, and attacks persons of botli sexes, and of all classes and ages. Scrofulous children have it, and, wasting away under it to mere skel- etons, are said to have consumption of the boivels. Symptoms. — These are sometimes very obscure, and the advances of the disease stealthy. At first, there may be only a little soreness of the belly, so slight as not to be noticed except after hard work, or upon some wrenching motion. Generally, there is a sense of fulness and tension of the belly, although it may not be incrciised in size. After a time, it enlarges a little, and its tension or tiii;litiiess increases, especially towards evening. By pressing carernlly with tlie hand, a deep-feeling tension may be detected, giving to the hand a sensa- tion as of a tight bandage underneath, with the skin and integu- ments sliding loosely over it. If water has bren poured out into the abdominal cavity, its fluctuation may frequently be detected by press- ing upon one side of the belly with the palm of one hand, and strik- ing the other side with the ends of the fingers. As the disease goes on, the features become sharp and contracted, and the countenance grows pale and sallow. Costiveness comes on, sometimes chills and fever, with debility, loss of flesh, cough, diflicult breathing, hectic, and swelling of the legs. Treatment. — Costveness, if present, may be relieved by Mettauer's aperient, or the neutralizing mixture, assisted by coarse bread, and boiled cracked wheat. Daily bathing is specially necessary, particularly the alkaline sponge bath, with vigorous friction over the bowels. The warm bath once or twice a week will be useful. In some cases, the wet towel laid >"m ■ l|!.l integu- DISEASES OF THE ABDOMINAL CAVITY. 281 upon the bowels over night, and well covered by flannels, will afford relief; or the compound tar plaster may occasionally be used. If there be dropsy of the belly, iodide of potassium (138) should be taken freely, and the skin made sore over the inflamed part, by tincture of iodine, well rubbed in, once a day. If the patient be pale and bloodless, give iron, quinine, etc. (74) (75), and let the diet be nourishing; and if nervous symptoms be connected with the debility and paleness, add some nerve tonic (93) (81) (316). Acute Inflammation of the Bowels. — Enteritis. Bt inflammation of the bowels is generally understood an inflamed condition of the mucous membrane which lines them ; but this, most commonly, is only a part of the disease ; it involves, more or less, beside this mucous lining, the whole substance of the bowel. Symptoms. — The disease begins with a chill, and with uneasiness and slight griping pains, which increase in severity until they are in- tense and burning. Pressure aggravates the pain, which is most intense about the navel, but extends more or less over the whole bowels. From the beginning there is sickness at the stomach, and some- times vomiting; there is loss of strength, eostiveness, great anxiety, thirst, heat and fever, dry, furred, and red tongue, and but little urine, with pain in passing it. The matters passed from the bowels are dark and fetid ; and the » Iiole belly is tender and sore to the touch. The pulse is quick, hard, and small. The stomach will be but little aflected, comparatively, when the disease is at some distance from it in the lower portion of the bowels. Indeed, the nearness of the inflammation to the stomach, or its re- moteness from it, may be judged pretty correctly by the degree of disturbance in that organ. The length of time after drink and medi- cines are swallowed, before they are vomited up, is a pretty good measure, likewise, of the distance of the disease from the stomach. Hoif to Discriminate. — This disease is Jiable to be confounded with colic, and with inflammation of the peritoneum. It is important to distinguish it from colic, particularly, for the treatment for that would aggravate this. In this disease, the pain is increased by pres- sure ; in colic, it is not, but is rather relieved. In enteritis, the pain remits, but never ceases wholly, as it does in colic. In enteritis, the knees are drawn up, and the breathing is short ; in colic, it some- times gives relief to stretch the feet down, and the breatliing is not altered. To distinguish it from inflammation of the peritoneum, take notice that diarrhoea is much more common than in this latter complaint, while the pulse is not as quick, nor the pain as severe. Treatment — This should be very much the same as that recom- mended for inflammation of the peritoneum. Perhaps in both dia- =^> I i '■ ■ ::\ , t w [! I ^l # !!:,!■. 1*1 II"!:' 5 ' 282 DISEASES OE THE ABDOMINAL CAVITY. eases, it might be woll to begin with covering the belly all over with leeches. As for taking blood from the arm, in large quantities, as recommended in most of the. books, I cannot think it necessary. The tincture of veratrum viride, in full doses, so as to keep up a free perspiration, cold compresses, mustard poultices, hot fomentations, poultices, blisters, soothing and quieting injections, and demulcent drinks, as slippery elm, marshmallow, flax-seed, etc., if jud ' ciously ap- plied, will do about all that we have it in our power to E.ccomplish; and under such treatment, the patient will recover faster, and get up better, than when blood is freely drawn. In this disease it is well to inquire if the patient has a hernia, for if ao, it is liable to become strangulated without his knowledge. A strangulation of the gut may be the cause of the disease. When this happens, the complaint is very unmanageable. The bowel may pos- sibly, in such case, be disentangled by applying a targ-e dry cup ; or, what is better, a number of small ones ; but the tenderness of the belly makes the use of this remedy difficult. Chronic Inflammation of the Bowels. Like other chronic inflammations, this may follow the acute form, but it also results from various other causes, as unripe fruit, taking cold, drastic physic, and improper treatment of other diseases. Symptoms. — Red end and borders of the tongue, dull pain in belly, increased by pressure and rough motion, abdomen either swelled or flat, skin dry and husky, feet and hands cold, small frequent pulse, thirst, loss of flesh, low spirits, urine scanty and hiirh-colored, and dirty, slimy discharges from the bowels, from one to four times a day. Treatment. — To begin with, blisters, or croton oil, or mustard poul- tices, or dry cups, if the tenderness is not great, or leeches if it is. If the bowels are hot and feverish, bind a cold compress upon the belly over night, — covering it well with flannel. The warm bath should be used twice, a week. The diet must be of the most simple, unirritating kind, — beginning with a solution of gum arable, rice-water, barley water, arrow-root or sago gruel, and gradually rising, as the symptoms improve, to beef tea, mutton and chicken broth, tender beef steak, etc. When the strength will permit, gentle exercise must be taken in the open air, but not on horseback, or in hard, jolting carriages. As soon as the inflammation is subdued, some mild laxative (35) may be given, in connection with an infusion of wild-cherry bark, geranium, and Solomon's seal, equal parts. Wind Colic— riatulent Colic. — Interalgia. This is a severe and distressing pain in the bowels, — sometimes a stoppage, and a swelling about the pit of the stomach and the navel. ,What children call belly ache is a mild form of it.. The wind passing i DISEASE* OF THE ABDOMINAL CAVITY. 283 from one portion of the bowel to another, causes a runnbling noise. The pain is not increased by pressure ; and this distinguishes it from the pain of inflammation. It moves about, too, from plai;e to place, and is much relieved by the escape of wind u|) or down. The complaint may be caused by a weakness in the digestive or- gans, by eating indigestible food, or unripe fruit, by costiveness, and by taking cold. Some persons always have the colic excited by eat* ing certain kinds of fruit. Treatment. — When the complaint is caused by an indigestible sub- stance taken into the stomach, the offending matter should be thrown otr by an emetic as soon as possible. If this does not bring relief, let it be followed by a dose of salts, salts and senna, compound infu- sion of senna, elixir salutis, elixir pro., or sweet tincture of rhubarb. If there is no sickness of the stomach, a little essence of peppermint or spearmint in hot water, or brandy, gjn, or whiskey, in hot water, may prove sufficient to expel the wind, and relieve the pain. Ginger and hot water does well with some. If there be costiveness, and the pain is obstinate', let the bowels be unloaded by a stimulating injec- tion (248) (249) (250). Air-SwellingfS. — Tympanites. It is quite common for persons in delicate health, — ^particularly females, — to have their stomach and bowels swell up, sometimes slowly, sometimes suddenly, so that they cannot bring their clothes together. They do not know what to make of it ; it sometimes alarms them ; and they ask their medical adviser what it means. Explanation. — This is the meaning of it. It is neither more nor less, in many cases, than the air within the muscles and membranes swelling up and distending them in consequence of their being in a weakened condition. There are two ways in which the flesh may be caused to bloat. It may be caused by placing a cupping glass over it, and taking off the external air. When this is done, the air within seeks to fill the vacuum above, and lifts up the flesh. So, likewise, if the parts are weak, and lose their tone, they give way, and let more air into their substance, and they stretch and puff" up. But these swellings may occur from an accumulation of air within the bowels, and also within the abdominal cavity. This latter gives the belly a peculiarly hard feel, like the head of a drum, and when it is pressed upon with the fingers, no indentvition remains. Treatment — If the air be in the intestinal tube, a stimulating in- jection may bring away the wind. It may be composed of one pint of infusion of peppermint, one gill of tincture of prickly ash berries, half a gill of tincture of castor, and a teaspoonful of ginger. The bowels of the patient should be rubbed for a long time ; and in all forms of the complaint, it would be well to do this every day. Some- times the wind may be drawn off* by inserting into the rectum a long gum-elastic tub6. ilM ! I W'A I' ' *, 284 DISEASES OF THE ABDOMINAL CAVITY The best constitutional remrdies are tonics, — iron, quinine, minerul acids, and bitters, (48) (55) (59) (60) (62) (63) (&4) (71) (73). Exercise in the open air, and a careful regulation of the diet will do much towards removing these troubles. Costivtuiess must be care- fully guarded against. Bilious Colic. This is a dangerous disease. There is pain of a griping, twir*tii)jr(, tearing kind, — what the ancients called a/rorfows /jam. It is ehirtly about the navel, but sometimes tortures the whole belly. It cotnes and goes in paroxysms. Sometimes the abdomen is drawn in, i«t other times it is swelled out, and stretched like a drum-head. At first the pain is relieved by pressure ; after a time the belly is tender fo the touch. There is thirst and heat, and a discharge of bilious mat- ter from the stomach. In the worst cases, the pulse is small, the face pale, the features shrunk, and the whole body covered with cold sweat. While the head is hot, the feet are cold. In advanced stages of the disease, the action of the bowels is sometimes reversed, and the fecal matter forced up through the mouth. Causes. — Costiveness, irritating substances in the bowels, thick, vitiated bile, long exposure to cold, torpidity of the liver and skin, great unna*^ ..al heat, with dampness, etc. Treatment. — Administer an active purgative injection immediately (251) (252). Internally, dioscorein, camphor, etc. (340), every fifteen minutes, till relief is obtained, — at the same time covering the whole belly with a large mustard poultice A strong decoction of the wild yam root, drank freely, is a mediejne of some value, — so is a decoc- tion of scuUcap ar)d high-cranberry bark, equal parts. This latter article is excellent in spasmodic anections, on which account, it has gained the name of cramp bark. The sickness at the stomach may be allayed frequently by ellervescing drafts, to which twenty-five or thirty dro|)s of laudanum are added. Croton oil, given in one-dro') d'jses, done up with crumb of bread, will sometimes succeed well as a purgative medicine; or castor oil and spirits of turpentine, equal parts, iu two great spoonful doses, may be tried before the croton oil. The warm bath is worth remembering, and trying, too, if the means are at hand. Hot fomentations of the bowels with a decoc- tion of poppy leaves, stramonium leaves, hops, wormwood, boueset, or peppermint leaves, should not be overlooked. Bottles filled with hot water, or hot bricks rolled in fiannel, should be placed at the back and feet, to promote perspiration. Persons subject to this complaint, may derive advantage from one pill composed of extract of high cranberry bark, etc. (100), taken after each meal for some months. At the same time a reasonable amount of exercise should be taken out of doors, and a sponge bath, with friction, be employed daily. Care should be taken not to be often exposed to the hot sun. !, mineriil )• diet will t be care- tvvistiiir(, it* fhiclly It C'OIIU'S WW in, iit lead. At teiidtT to ious inat- , the face ;vith cold ed stages jrscd, and els, thick, and skin, mediately ery tifteen the whole f the wild s a decoc- .'his latt<'r int, it has nach may ity.five or I one-droj) d well as tine, equal :he croton 00, if the h a decoc- 1, boiieset, filled with t the back J from one aken after le amount bath, with ) be often DISEASES OF THE ABDOMFNAL CAVITY. 285 Painters' Colic. — Colica Pictonum. This form of colic is caused by the slow introduction of lead into the system, — generally the carbonate of lead. It passes under the different English names of painters' colic, Devonshire colic, and dr/ belly-ache. The first of tliese is the name by which it is most com- monly known, from its frequent occurrence among painters, who use white lead (carbonate of lead) a great deal in the preparation of their colors. * Symptoniit. — The disease generally cornea on in a very gradual way. At first, the appetite is impaired, there is slight nausea, belch- ing of wind, languor, very obstinate costiveness, transient pains, with a feeling of weight and tightness in the belly, and a disinclination to make any exertion. By degrees, the pain in the bowels, and particularly about the na- vel, becomes more severe, and has a twislinili tlir whole person with soap once or twice a week, and with clear wafer, or sul- eratus and water, once a day. Their working clothes should be of a kind to admit of being washed once or twice a week, and they should be put otf for others when out of the workshop. A paper cap should be worn while at work. The food of the workmen should not be ex- posed to the vapors or floating particles of lead, and consequently should not be carried into the shop ; and when much of the poison is floating in the air of the work room, it is a good plan to wear a mask to prevent its being drawn with the breath into the throat and lungs. It has been said that those who eat freely of fat meats, butter, and other oily substances, are not attacked by the disease, though exposed to the poison. I know not what protection this can give, unless the skin is in this way kept more oily, w hicth prevents the absorption of the poison. This would seem to afford a hint in favor of anointing the whole person once or twice a week with sweet oil. CostivenesB.— Constipation. Few disorders are more common than costiveness. By this term I mean a sluggish state of the bowels, which causes them to retain the feces longer than is wananted by health. In this complaint, the discharges from the bowels are not always less frequent than they should be, but they are less in quantity, are compacted and hard, and are passed by hard straining, and sometimes with considerable pain. Symptoms. — Headache, dizziness, feverishness, bad feelings in the head not easily described, loss of appetite, sometimes nausea, but little desire to go to stool, a weight and heaviness about the lower part of the belly, and a sense of confinement over the whole body. Causes. — Sedentary habits, particularly when connected with close application of the mind ; astringent articles of medicine ; stimulating diet, composed chiefly of animal food ; various diseases, particularly those of a nervous character, and especially, a neglect to evacuate the bowels at proper periods. All these causes tend to weaken the bowels, and gradually to arrest that peculiar undulatory movement, or worm-like action, called the peristeltic motion of the bowels. It is this continual contraction of the muscular ^bres of the intestines from above downward, which pushes the contents steadily along; and whatever weakens the force of this vernicular play of the intestinal "walls, brings on constipation. Treatment. — One of the first things to be done is to establish the 1 I; ? habit of attempting' to evacuate the bowels at a particular hour every day. The best time for inuat petHoiiM in Hoon after breakfast in the morning. Whether successful or not, the attempt to procure an evac« nation should on no at^count be omitted. This regularity will often do much to break up the costive habit. Diett — To this nhould be added a careful regulation of the diet. The quantity of food taken should be ik) greater than can be easily digested. Full meals which distend the wtomach and caust; it to press upon the bowels embarrass their movements. Bread made from line wheat Hour is an abomination in this disorder. Eat only that from unbolted Hour. Cracked wheat, prepared as directed among dietetic preparations, is excellent for the cure of costiveness. Fresh vegeta- bles, as peas, beans, potatoes, scpiashes, and ripe fruits, in their sea- son, are all wholesome, and tend to relieve costiveness. But rich pies, puddings, cakes, doughnuts, and all that sort of trash, increase the disorder. Water Injections, etc. — One of the best remedies is water, cold or tepid, according to the condition of the patient, injected into the bow- els with the domestic syringe. The best syringes for this purpose are Mattson's, and Davidson's, one of which should be in every family. Water used externally, in the form of the sponge bath, is also useful. Medicines. ■- All the above measu" 's having failed to give relief^ take Mettauer's aperient, or the neutrali/ing mixture. If these fail, podophyllin, etc. (36), may have a trial. A cold decoction of thorough- wort, drank daily, sometimes has an excellent effect. It must be re- membered that medicines may make matters worse, and they should be used cautiously. All the causes of the disease must of course be avoided. Piles.— Hemorrhoids. There are few complaints more common than the piles, and scarcely any which cause more trouble and misery. They consist in a fulness of blood, and languid circulation in the lower portion of the lower bowel or rectum. In consequence of this congestion, either the veins of the gut become enlarged or varicose, or the blood gets infil- trated into the cells beneath the ijfiucous membrane, and collects so as to form bloody tumors. These tumors, which are seldom absent, are the leading features of the piles. They sometimes appear externally, around the anus ; this is external piles. At other times they are within the bowel ; the com- plaint is then called irUernal piles. They are called bleeding' piles when blood is discharged, and blind piles when it is not. Symptoms, — Usually there is a sense of weight and weakness in the lower part o' the back and loins, with a painful itching about the anus. On goin^ o stool, there is a burning, cutting pain experienced, which is foUowe' by bearing down and tenesmus. If it be bleeding [I M4 H: ' -' 1,1. , I,' vi- - ■'i * :ir- I -. ' •^ f ■' V !:m '■'' s 288 DISEASES OF THE ABDOMINAL CAVITY. piles, the little tumors will bleed at every motion of the bowels. There are frequently disagreeable sensations in the head, general las- situde, an irritable state of mind, and a sense of fulness and anxiety in the stomach. The pains experienced range all the way from the slightest twinges up to the most t ..rible sufferings, which appear like tearing the body asunder. Causes. — Everything that irritates the lower bowel, and causes a determination of blood to the part. All drastic physic has this effect, — particularly aloes, which acts especially upon the rectum. Habit- ual costiveness, straining at stools, riding much on horseback, sitting a great deal, tight lacing, high-seasoned food, and stimulation gener- ally, lifting and carrying heavy weights, and indurations of the liver. Females during pregnancy are much afllicted with piles, which are induced by the costiveness so peculiar to their condition, and by the pressure of the enlarged womb upon the veins of the pelvis. Treatment. — This should be medicinal and diptetic. Great care must be observed nut to push medication too far. Ac- tive purging will do great mischief. Yet costiveness must in some way be corrected. For this purpose, no remedy that I have ever tried has done better in this complaint than an electuary composed of confection of senna, flowers of sulphur and cream of tartar (6), taken in ''^oses just sufficient to procure one natural motion of the bowels each day. Pills made of extract of thoroughwort are said to do well. If the liver be in a congested state, take some of the arti- cles recommended in the chronic inflammation of that organ. For the local treatment, nothing is better than two ounces of lard and one dram of the flowers of sulphur mixed, and rubbed betWteen two plates of lead until they are well blackened. This ointment' is not only soothing, but curative, both in the bleeding and blind piles. An ointment of almost equal excellence may be made from one hand- ful each of witch hazel bark, white oak bark, and sweet-appletree bark, boiled together in one pint of water down to one third of a pint. Then strain, and add two ounces of lard, and simmer away the water, — otirring continually before and after removing from the fire, till it cools. If there is much inflammation and distress, an emolient and sooth- ing poultice should be applied, composed of slippery elm bark and stramonium or poke leaves. Steaming thB parts is sometimes useful, by sitting over a hot decoction of hops, stramoniun, and poke. Piles may often be cured by the use of the domestic syringe, Daily injections of cool or cold water will do much to strengthen the bowel, and restore the dilated veins to their natural condition. The food should be of a laxative nature, corn bread, rye pudding, bread of unbolted wheat flour, mealy potatoes, ripe fruit, {.'jdding and milk, buck wheaV cakes, broths, and a Utile tender liieat once a day. DISEASES OF THE ABDOMINAL CAVITY. 289 Looseness of the Bowels. — Diarrhoea. Looseness, or relax of the bowels, is manifested by frequent, copi- ous, and thin, or unusually liquid discharges. The excessive discharge may be caused either by irritating and unwholesome food, by inflam- mation and ulceration of some portion of the bowels, or by debility. Symptoms. — Rumbling noise in the bowels, with more or less weight and bearing down, and uneasiness in the lower part of the bowels. This pressing down and uneasiness are relieved as soon aa the evacuation takes place, but returns when another is near at hand. (Jriping is generally present, the strength is reduced, and the skin is pale, dry, and, after a time, sallow. Treatment. — When the complaint is caused by irritating food, it will geiierally stop as soon as the offending substance is removed, and not much medicine will be required. To neutralize any acidity, to remove wind, allay irritation, and strengthen the stomach, the compound syrup of rheubarb and potassa is well adapted, given in tablespoonful doses, every hour, till it oper- ates. A little paragoric added to it occasionally, or essence of pep- permint, or spearmint, may aid its good effects. If nausea and vomiting are present, put a mustard poultice upon the stomach, and give a few drops of laudanum. If there is much griping, give an injection (248), wi-h twenty drops of laudanum in it. A common diarrhoea may generally be arrested at once by prescrip- tions 159 or 162, in teaspoonful doses, afier each discharge. When there is inflammation and ulceration of the bowel, the treat- ment must be similar to that for dysentery, — fomentations exter- nally, and the occasional use of starch injections, mild cathartics (9) (10), and Dover's powder internally. Chronic Diarrhoea. The acute form of diarrhcea, not being properly managed, often runs on, and becomes chronic, and is at times exceedingly difficult to cure. Symptoms. — Frequent discharges, generally with some pain and griping, restlessness, thirst, poor appetite, debility, loss of flesh, dry, rough, pnd somewhat sallow skin, and tongue dry and dark-colored. The food often passes through the bowels pretty much in the condi- tion in which it was swallowed. The liver ia generally out of order, and the bowels are frequently afflicted with a low grade of inflam- mation. Treatment. — In this form if the disease, astringents and tonics will generally be required. Sometimes a teaspoonful of brandy, in a little sweetened water, or in clear water, several times a day, will effect a cure. Good cherry brandy is a valuable remedy ; so is blackberry \ i 'iil^^ ■ II iCi t ' hill brandy. Many of the worst cases have been cured by taking no nourishment, for a long time, except milk, with a little lime water in it. When the liver is involved in the complaint, as evinced by light- colored stools, leptandrin, geranium, etc. (341), may be given with advantage. In some instances, when there is considerable debility, pills of quinine, catechu, etc. (342), will do well. A sponge bath must be taken daily, and the skin be well rubbed after it Cholera Morbus. The above name is given to a disease common in warm weather, and characterized by sudden attacks of bilious vomiting and purging, with severe pain in the belly, cramps, and general fever and subse» quent prostration. The great amount of bile secreted and discharged has given it the name cholera, from choler, bile. Symptoms. — The disease begins by sickness and distress at the stomach, which is succeeded by violent gri pings, with vomiting of thin, dirty-yellowish, whitish, or greenish fluid, with discharges from the bowels similar to that vomited The nausea and distress, with some few exceptions, continue between the vomiting and purging, and the pain, at times, is intense. The pulse is rapid, soon becoming small and feeble, the tongue dry, the urine high-colored, and there is much thirst, though no drink can be retained on the stomach. It is to be distinguished from diarrhoea by the biliovs dischargt^s. Treatment. — Apply a large mu> .,ard poultice over the stomach and liver, and give tablespoonful doses of compound powder of rhubarb and potassa, every half hour, until the vomiting and nausea are checked, adding to each dose five to ten drops of laudanum, if neces- sary. Perhaps it would generally be best, however, to give liberal draughts of warm water, at first, or flax-seed tea, that all the solid con- tents of the stomach and bowels may be washed out. A t^aspoonful of laudanum in a wineglassful of flax-seed tea, given as an injection, every two hours, will sometimes do excellently well ; or a tea made of chamomile flowers, or Colombo, and made sour by a few drops of nitric or sulphuric acid, and given internally, will sometimes succeed better than most other things. One grain of morphine and thirty grains of bicarbonate of soda dissolved in an ounce of sweet tincture of rhubarb, and given in teaspoon ful doses, every half hour will often have a fine effect. The prescription 162 is also valuable. Hot bricks should be applied to the feet, and warm flannels, or other kinds of dry heat, to the whole body. Asiatic Cholera. Beside the above name, this fearful disease has been called epi- demic cholera, malignant cholera, spasmodic cholera, and cholera ing no ! water »y light- en with pills of 1 rubbed weather, L purging, nd subse' [iacharged ;ss at the uniting of irges from ,tress, with d purging, I becoming nd there is ach. It is ;omach and of rhubarb nausea are n, if neces- give liberal e solid coii- d tea, giviMi itly well ; or )ur by a few I sometimes rphine and ce of sweet y half hour valuable, flannels, or .. called epi- and cholera asphyxia. It first attracted notice in Bengal, in 1817, whence it spread westward through Europe, and in June, 1832, it reached Que- bec, on this continent. Symptoms. — First Stajfe. — The first, premonitory stage, is marked by derangement of the digestive organs, rumbling in the howels, paiii in the loins or knees, twitehings of the calves of the legs, impaired appetite, thirst, and especially, a slight diarrhoea ; and these symp- toms continue from a few hours to several days. I should add to these symptoms what is said to have been recently discovered, namely, that for several days befot'e the attack, the pulse is down to forty or fifty beats in a minute This, if it prove to be reliable, is a very valu- able symptom. Second Stil<|^e. — This stage is marked by vomiting and purging a thin, colorless fluid, looking almost exactly like rice wator ; by severe cramps in the calves of the legs, which soon attack the bowelb and stomach. These cramps are excessively painful, and draw the mus- cles into knots. The tongue is pale and moist; the pulse feeble, though sometimes full and firm ; the breathing hurried, with distress about the heart ; great thirst ; a feeling of internal warmth ; and the secretion of urine entirely stopped. These thin, colorless discharges by vomiting and purging, are the serum or watery portion of the blood, which oozes through the sides of the blood-vessels, and runs off rapidly, leaving the crassamenium, or red, solid part of the blood, stranded upon the inner surfaces of the arteries and veins. When so much of this is discharged that the blood cannot circulate freely, the patient sinks into the Third Sta^e, which is characterized by great prostration ; pulse hardly perceptible ; skin cold and clammy ; face blue or purple, and eyes much sunken ; hands dark-colored and sodden, looking like a washerwoman's ; breathing short and laborious ; a sense of great heat in the stomach ; and intense thirst. Recoveries from this stage sel- dom take place. Treatment — In the first stage, the diarrhoea should receive the most prompt attention. From five to ten drops of laudanum, re- peated a few times, every three hours, will generally put a stop to it. Morphine (162) is also a suitable remedy. The compound syrup of rhubarb and potassa, with some other articles (343), in tablespoonful doses, every hour, till it operates genily, is worth a irial. The diet should of course be very carefully regulated at such a time, though not particdlarly changed, except to leave oft' any indigestible article which is known to be injurious, and to be made a little more sparing than in a time of perfect health. When the second stage has set in, or the stagt, of vomiting, purg- ing, and cramps, the treatment must be energetic. The sinking pow- ers must be sustained by chloroform, opium, and ammonia (119), or by camphor, opium, and cayenne (344), giving one pill every hour. Brandy may also be given freely. II '^ It ill! H.I i ; \ 1 ft I ^1 III in i i; 1 .\W :f.' fe. The warmth of the surface must be promoted by all possible means, hot bricks and bottles, tincture of cayenne, friction, elc. In the third stage, the remedies recommended above are to be pur- sued >yith incieased energy, particularly the stimulants, and the enorts to promote the warmth of the surface. Dysentery.— Bloody Flux. — Colitis. This is an inflammation of the mucous membrane lining the lower or large bowels. The small bowels begin at the stomach, and are eight or ten yards long ; beipg largest near the stomach, and dimin- ishing in size as they approach their termination at the caecum. The lower or large bowels are two or three times as large as the small ones, and from their junction with the latter, they extend about six feet to the outlet, or anvs. The large bowels are composed of the csBcum, the colon, and the rectum. The rectum is about one foot in length. In most cases of dysentery, the rectum, and about half the adjoin- ing portion of the colon, experience the chief force of the inflamma- tion. Sometimes the whole of the colon and caecum are affected. Sometimes the mucous membrane lining these ii ulcerated, and, be- coming wholly disorganized, passes off" in shreds. Symptoms. — The disease cQmes on with loss of appetite, costive- ness, lassitude, shivering, heat of skin, and quick pulse. These are followed by griping pain in the bowels, and a constant desire to pass their contents. In general the passages are small, composed of mucus mixed with blood. These passages are attended and followed by severe gripings and inclination to' strain, learnedly called tormina, and tenesmus. They are sometimes, in the early stages, attended by nau- sea and vomiting. The natural feces, which do not pass off" much, are small in quantity, and formed into round, compact balls, or irreg- ular, hardened lumps. This tenesmus, or great desire to strain, will continue, perhaps increase, for several days, — the discharges being mostly blood in some cases, and chiefly mucus in others. Having, generally, but little odor, at first, these discharges become, as the dis- ease advances, exceedingly offensive. Causes. — Dysentery is very frequently caused by sudden changes from hot to cold, by which sweating is suddenly checked, and the blood repelled from the surface. Hot climates, and dry, hot weather are predisposing causes. All green, unripe, and unwholesome food ; and all indigestible food of every sort, may induce it Treatment. — In mild cases, give a tablespoonful of castor oil and two teaspoonfuls of paragoric, mixed, once a day. Sometimes, in place of the above, a dose of rochelle powder, dissolved in water, with thirty or forty drops of laudanum, may be taken. A moderate quan- tity of flax-seed or slippery elm tea, may be taken as a drink, and the bowels be well emptied by an injection of starch. When there is much pain in the bowels, a mustard poultice Itaid DISEASES OF THE ABDOMINAL CAVITY. 29;i upon them, will have a good effect. The starch injections should, in such case, have half a teaspoonful of laudanum mixed with it. The compound syrup of rhubarb and potassa will often act favorably, given in tablespoon ful doses. If there is reason to suppose the liver is affected, give podophyllin, etc. (46). The patietit should not be allowed to sit up, and must be kept very still, and be allowed only a very scanty diet, as flour porridge, well boiled, rice water, etc. Chronic Dysentery. When dysentery "runs on" for some time, it may become chronic. Symptoms. — Looseness of bowels, — the discharges being un- healthy, more or. less bloody, attended by bearing down, or a desire to strain, and being in number from two to forty a day. There is great debility, the pulse is weak and quick, the tongue slightly furred, the appetite lost, the face pale and sallow, and the skin dry and parched. Sometimes the relax alternates with costiveness. Treatment. — In this form of the complaint, astringents will be necessary (159) (161) (162) (345) (346) (347). Injections may be used, if necessary, composed of nitrate of sil- ver, fifteen grains to the ounce of water, or an infusion of golden seal, with a little tincture of prickly-ash berries added to it. The diet must be very light, easy of digestion, and nutritious. In some cases, it should be composed chiefly of wheat Hour porridge, or boiled milk and boiled rice. In other cases, a littie tender beef steak should be taken once a day. Worms. — Vermes. The intestinal canal is subject to various disturbances from the presence of worms. Of these troublesome tenants, there are three principal varieties. The Ascaris, or pin-worm, called also maw or thread worm, is a small, whi^e, thread-like worm from half an inch to an inch in length. These worms live, in great numbers, in the rectum, where they excite great irritation and itching. Tbe Liuiibriciis, or ascaris lumbricoides, is a round worm, about an eighth of an inch in thickness, and from an eighth to a quarter of a yard in length. Its color varies from a niilky whiteness to a deep red. It generally occupies the small bowels. The Tenia Soltinuni, or tape-vmrm, is a flat worm, with four suckers at the head, is from a few iv.vi to some hundreds in length, and full of joints. It dwells in the small bowels, and feeds on the chyle as it comes along, before it is absorbed by the lacteals. lu this way, it n^'a '•> m 11 'H' 294 DISEASES OF THE ABDOMINAL CAVITY. Ki robs t \e body of nourishment, and produces great loss of flesh, and an enc rmous appetite. , Symptoms. — In the grown person the symptoms of worms are quite obscure, except an intolerable itching within the anus, which generally indicates pin-worms. In children worms are indicated by paleness, itching of the nose, grinding of the teeth and starting in sleep, irregular appetite, bad breath, swelled upper lip, picking of the nose, hard swelled belly, and one -cheek constantly flushed. Treatment. — For expelling worms various articles have been used. Among these spirits of turpentine (155) has a high reputation. The following preparation does well : Spirits of turpentine, half an ounce ; essence of anise, half an ounce; castor oil, one ounce; worm-seed oil, one ounce. Mix. The dose for a child one or two years old, is ten to twenty drops, every two or three hours. In two or three days, a brisk physic should be given. The worm powder is quite success- ful. One of the most popular remedies is the pink-root. It should be united with a purgative. The following is a good preparation : Fink- root and .senna, each half an ounce ; bitartrate of potasaa, one dram ; pulverized jalap, half a dram ; cardamom seeds, half a dram ; extra(!t of liquorice, two drams. Mix, and add half a pint of boiling water. Let the whole steep an hour. Give a tablespoonful or two, occasion- ally, till the worms are expelled. An injection composed of quassia (66), or aloes (22), or oC, simple sweet oil, is very effectual in removing pin-worms from the lower bowel. So is an injection composed of the red iodide of mercury, one grain ; iodide of potassium, half a grain ; and two pints of water. Most of the above preparations are thought to be successful in ex- pelling all kinds of worms ; but for the tape'ivorm, no other remedy h^-s yet shown itself as eflectual as jmmpkiri'Seeds. The seeds should be well bruised, and steeped in water. This should be drank freely for several days, if need be. It is believed to be a sure remedy, even in cases of several years' standing. In all cases of worms, the diet should be carefully chosen, and be connected with proper exercise, pure air, frequent bathing, and all those measures which tend to improve the general health. After the expulsion of the worms, tonics should always be taken to strengthen the bowels, that the same evil may not return. Acute Inflammation of the Kidneys. — Nephritis. Before speaking of this disease, I wish to give the reader a general idea of a kidney, and shall do so by the use of two cuts. Fig. 108 presents the external surface of the right kidney, with its renal capsule mounted on top ; t, being its upper edge ; /, «, superior and inferior branches of the emulgent artery ; c, d, e, three branches of the emulgent vein ; a, the pelvis of the ureter ; 6, the ureter. f flesh, and worms are inus, which >f the nose, petite, bad i beJly, and been used, tion. The an ounce ; worm-seed f^cars old, is three days, ite success- should be ion : Fink- one dram ; in ; extract iling water. ), occasion- T oi simple the lower )f mercury, o pints of !ssful in ex- ler remedy ?eds should rank freely medy, even sen, and be ig, and all 3 be taken rj. phritis. sr a general ey, with its h^ superior e branches reter. DISEASKS OF THE ABDOMINAL CAVITY. 29.J Fig. 109 is the same kidney laid open ; 1, being the supra renal capsule ; 2, the vascular portion ; 3, 3, the tuberlar portion, consisting of cones ; 4, 4, two of the calices receiving the apex of their corres- p'bnding cones ; 5, 5, 5, the three infundibula ; 6, the pelvis ; and 7, the ureter. Fio.108. \tm.\m. The kidneys are glands, and their office is to draw or strain off from the body those effete or worn-out particles, or products of decay which contain nitrogen^ while the liver takes away those carbonaceous matters which have no nitrogen.. These useless substances which go out through the kidneys are generally in the form of urea. In carry- ing off these matters, the kidneys may have more to do than properly belongs to them ; and may be so stimulated, or irritated, or injured in some way, as to become inflamed. Symptoms. — Like most other inflammatory diseases, it begins with cold chills and rigors, especially in the back and loins, followed by fever and pain. The pain frequently extends to the bladder, the loins, and the thighs, and is of a severe, lancinating kind, — though some- times obtuse. Pressure, motion, straining, or taking a full breath, add to its pungency. The urine is scanty, high-colored, sometimes bloody, and can only be passed drop by drop. In the loins there is a sense of heat, gnawing, and constriction ; the bowels are eirher constipated, or relaxed by diarrhoea. A numbness of the thigh, and drawing up of the testicle on the'affected side, are marked and peculiar symptoms. In some cases, there are nausea, vomiting, oppression at the stomach, faintness, hiccough, drum-head distention, and rumbling of the bowels. The skin is hot and dry, the pulse hard and frequent Causes. — The use of cantharides, oil of turpentine, and other di- uretics, taking cold, violent exercise, mechanical injuries, the transla- tion of rheumatism or gout, the striking in of skin eruptions, and gravelly formations in the kidneys or ureters. Wt^ ;>96 DISEASES OF THE ABDUMINAL CAVITY. Distinctions. — This disease is to be distinguished from colic by the pain being increased by pressure, and by the frequent but difficult discharge of red urine ; from lumbago, from its being confined fre- quently to one side, and also by the urinary troubles, and by the nausea and vomiting ; and from all other diseases, by the numbness of the thigh, and the drawing up of the testicles. Tenniuntions of tlie Diseuse. — It runs a rapid course, and may teruiinate by resolution, or by suppuration. When the latter happens, it is indicated by the decline of the more violent symptoms, a throb- bing and a sense of weight, with chills, followed by nushes of heat, and sweating. The matter formed, generally small in quantity, may pass into the cavity of the kidney, and thence through the bladder to a natural outlet with the urine. Treatment. — Either put the feet into a hot mustard bath, or put mustard drafts upon them. At the same time apply a large mustard poultice upon the small of the back, and follow it up with hot fomen- tations of stramonium leaves and hops, or stramonium and worm- wood or tansy. Let perspiration be induced as soon as possible by five to ten ten. drop doses of tincture of veratrum viride, repeated every hour, or by teaspoonful doses of the compound tincture of Virginia snake-root, given every half hour. If costiveness exist, the bowels must be opened by epsom salts, cream of tartar, or salts of tartar ; or by copious injections of warm water, containing a few drops of the tincture of arnica leaves. Such injections not only unload the bowels, but act as a local bath, by lying in the bowel near the inflamed kidneys. The drinks must be mucilaginous and diuretic. The marshmal- low root and peach leaves, slipjx'ry-elm bark, Hax-seed, mullein, elder blows, haircap-moss, and cleavers, are all valuable. If the disease is caused by gravel, twenty drops of liquor potasste, largely dilated with flax-seed and upland-cranberry tea, and taken freely as a drink, is excellent. Chronic Inflamm-ation of the Kidneys. This is frequently the result of the acute form of the disease, but is also produced by injuries, and other causes. Symptoms. — A weakness in the small of the back, and a dull, heavy pain in the kidneys. The urine is passed often, and in small quantities. It is alkaline, — sometimes white and milky, — and has in it deposits of phosphate of lime, and triple phosphates. Treatment. — Infusions of pipsissewa, uva ursi, trailing arbutus?, wild carrot, queen of the meadow, buchu leaves, or foxglove are use- ful diuretics, and may be taken with advantage. The boweli- must be kept open with some gentle physic (18), if they are costive ; and the alkaline sponge bath, with friction, be used daily. colic by difficult ned fre- , by the [imbness nd may happens, a throb- of heat, ity, may [adder to li, or put mustard »t fomen- d worm- » ten ten. ar, or by lake-root, r>m salts, of warm s. Such , by lying jarshmal- ein, elder lisease is y dilated a drink, se, but is d a dull, in small -and has arbutus, are use- c (18), if 1, be used DISEASES OF THE ABDOMINAL CAVITY. 29: An eruption may be brought out upon the small of the back by rubbing on a few drops of croton oil ; or, if the patient prefer it, a mustard poultice may be applied two or three times a week. The food should be nutritious, and easily digested, and a little exer- cise be taken daily in the open air. Acute Inflammation of the Bladder. — Cystitis. This disease affects the lining membrane of the bladder, — some- times its muscular substance. It may attack the upper portion, the middle, or the neck of this organ. It runs a rapid course. Symptoms. — Burning, piercing, and throbbing pain in the region of the bladder. The pain extends to the perineum, and in some cases, to the testicles and thighs, and is much increased by pressure. The perineum, the space between the fundament and testicles, feels sore to the touch. The desire to pass urine is incessant, but the effort to do so is mainly ineffectual. The water passes off' drop by drop, with great pain, or is entirely stopped, — causing enlargement of the bladder, and great distress. Mucus from the inflamed lining of the bladder passes off with the water. Nausea, vomiting, and great anxiety are common. The bowels are bound, and when the disease is on the side next the lower bowel, there is a desire to empty the bowels; and if the inflammation be in the neck, there is great pain in the perineum, and frequently an entire retention of the water. The pulse is full, hard, and frequent, the skin hot and dry, the thirst urgent, and the patient restless and dejected. Causes. — This disease may be produced by taking cantharides and turpentine ; by irritating substances forced into the bladder with a syringe, or by pushing bougies or catheters into it ; by gravel stones in the bladder; by retained urine; by external injuries; by gonor- rhoea ; and by cold applied to the feet, or to the lower portion of the abdomen. Treatment. — If the urine be retained, it is of the utmost impor- tance that it be early drawn off with the catheter, lest a distention of the bladder bring on raortificatioii. Great care is required not to pro- duce irritation by any roughness in introducing the instrument. Leeches^ should be applied upon the lower part of the bowels, the perineum, and around the anus. When these are removed, warm poultices should be applied. Cold compresses will often do as well. The bowels must be opened with epsom salts. Injections of warm water, with a few drops of tincture of arnica leaves, will act finely as a local bath, — the water being retained as long as possible. The tincture of veratrum viride will be required in fivie to ten-drop doses, or the compound tincture of Virginia snake-root, to induce perspiration. Dover's powders may sometimes be used for the same purpose. Drinks must be taken very sparingly. A small amount of cold in- fusion of slippery elm bark, or marshmallow and peach leaves, or 1 w iii|H iil ! ■ :J' cleavers. This mueilaginoua drink must be the beginning and the end of the diet during the active stage of the disease. Chronic Inflammation of the Bl&ddeT. — Ci/stirrhcea. This is much more common than the active form of the disease. It often arises from the same causes which produce acute inflamma- tion of the bladder. It often passes under the title of " catarrh of the bladder." It is a chronic inflammation of the mucous lining of the bladder, and is a very common and troublesome art'ection among old people. Symptoms. — Slight lancinating pains, with a feeling of heat in the region of the bladder, and a sense of weight and tenderness in the perineum ; frequent and tormenting desire to pass water, with occa- sional spasmodic action of the bladder. The urine is loaded with tenacious mucous, just as the expectoration has large quantities of mucus in it when there is inflammation of the membrane lining the windpipe and bronchial tubes. When the water has stood a while, this mucus settles at the bottom of the vessel, leaving the fluid clear above. Great quantities of this are sometimes passed, — amounting even to pints in a day. The triple phosphates of magnesia and am- monia are often found in the water. Frequently there are derangements of the appetite and digestive functions, a white or brown fur upon the tongue, a harsh, dry skin, with thirst and general debility, — especially in the back and loins. Sometimes there is a little fever. Treatment — To reduce the inflammation, apply leeches, or mus- tard, or croton oil, or a cold compress every night. As a diuretic, give an infusion of buchu, uva ursi, trailing arbutus, queen of the meadow, etc. Tincture of veratrum viride and sweet ^irits of nitre (125) is a good remedy. The compound infusion of trailing arbutus is well recommended. So is the compound balsam of sulphur. An infusion of the pods of beans has been well spoken of. An injection into the bladder, once a day, of a tepid infusion of golden seal root, with much care, may be of great service ; or an infusion of equal parts of golden seal, witch hazel, and stramonium It may be done with a gum-elastic catheter, and a small syringe. The bowels must be kept open with the neutralizing •rnixtuie, or some other mild physic ; and the skin bathed with saleratus and water once a day, and rubbed well with a coarse towel. Should there be any scrofulous, or gouty, or rheumatic condition of the system, the remedies for those complaints may be used in addition to the above. Disease of the Supra-Renal Capsules. The supra-renal capsules are small bodies situated above the kid- neys. (Fig. 109, 1.) Their office is not well understood. It has Isi-v wm n been found of late that they are subject to a disorder, Imving peculiar symptoms. This is a new disease. Symptoms. — The most marked L^ymptom is a peculiar change in the color of the skin, called "bronzing." This bronzing process be- gins in patches on those parts exposed to the sun, and to friction, as the neck, the backs of the hands, the fronts of the thighs, and the arms. These patches look, in color, like spots upon a bronze statue, deprived of their gloss. Another marked symptom is a peculiar dehUili/, which comes on without any a|)pan'nt cause, — there being, generally, no evidence of organic disease, and no loss of flesh, — and is attended with faint- ings, loss of energy both of body and mind, a peculiar (labbiness of llesh, and an early death, apparently from sheer weakness. Tlie blood becomes early depraved, and loses its coloring matter, as shown by the paleness of the skin where there is Jio broiizing. The pulse is generally very soft and compressible. The stomach is irritable, the appetite gone; there is nausea, and sometimes vomiting, with pain and a sense of sinking at the pit of the stomach. Fre- quently there is costiveness, sometimes diarrhoea, and pains in the back an«l loins. In some cases there are epilejjtic fits, failure of memory, change of temper, or a numbness of the fingers, legs, etc. Treatment. — The disease is a peculiarly fatal one. As no mode of treatment has yet proved successful, it is well to observe caution in prescribing. The treatment prescribed for chronic inflamr.iation of the kidneys, would perhaps be as safe as any that could at present be proposed. Bright's Disease of the Kidneys. — Albuminuria, This peculiar disease was first explained to the profession in 1837, by Dr. Bright, of England, whose name it took. It consists of a dis- order of the kidneys, — probably a congestion and an obstructed cir- culation in them, from which arise two most important effects ; first, albumen, an essential alimentary constituent of the blood, is secreted and passed off", in larger or smaller quantities, in the urine; and sec- ondly, urea, the worn-out matters in the blood which the kidneys are made expressly to carry off', is permitted to remain. If the urine of a person having Bright's disease be examined, therefore, albumen, which should not be there, will be found, and urea, a natural constitu- ent, will be absent. • . Method of Examination, r— To discover albumen in urine suspected to contain it, place a little in a test tube, and boil it over a spirit lamp. If albumen be present only in minute quantity, it may cause only a delicate opalescence ; if in larger quantity, it may separate in curdy flakes, and fall to the bottom as a more or less abundant white precipitate. If very abundant, the liquid may become nearly solid. The albumen is the same as the white of an egg, and the boiling has the same effect in whitening and hardening it, as upon that substance. *l : I I ■ Ill iU'm > 1 . ',:i ■Ml f W *''' '' ^''iH p4 .i«H ll h'^- f «• ' .t|v ^'^.iH ;'■;* ' *^:'- . 8U0 DISEASES OF THE ABDOMINAL CAVITY. Albumen is sometimes found in the urine in a coagnlnt(Ml stnto, and having llie shape of tube« or worms. (Fig- 110.) This is quite common in Bright's disease. The deposit seems j.^, no. to be made up of fibrous casts of the uriniferous tubes of the ki(hicys. Symptoms. — The two unnatural conditions mentioned above, give rise to the symptoms of Bright's disease. One of them, however, is it- self the most constant and characteristic symp- tom of the disease, namely, the presiMice of al- bumen. This, too, being one of the nutritive construents of the blood, its abstraction thins the serous portion of the blood, and causes it to filter out of its vessels into the cells, — causing dropsy of the cells, usually called celluliir dropsy, or anasarca. This general dropsy begins freciuently in tli? face, and spreads rapidly over the whole body and limbs. In add). tion to this, there are pains in the back and loins, a gradual failing ot strength, and a derangement of digestion. The skin becomes dry, with a pale and bloodless appearance, and there are frecpiently thirst, nausea, and vomiting. The urine frequently has fat, blood, epithelial scales, mucus, blood discs, fibrous casts of the uriniferous tubes, and saline sediments ; and is generally lighter by weight than in health, and less in quantity, and is apt to be red, brown, or dingy in color. The retention of urea in the blood acts as -a poison, and causes, toward the latter end of the disease, when aceunuxlated in large quan- tity, drowsiness, convulsions, and apoplexy. A frequent desire to make water, with a shifting back and forth of the bowels between costiveness and diarrhcea, are conmion symj)- toms. • Treatment. — The results of treatment in this disease are often un- satisfactory. Yet if taken in season, investigated with proper care, and treated with due diligence, much may be done for its cure. It i» one of those harassing complaints, which physicians in family prac- tice seldom have the patience to investigate and manage with sutR- cient care. Let the healthy an-l active condition of all the vessels of the skin be the first object aim;u! i '. This will relieve the laboring and falter- ing kidneys of a portion of their burden. The alkaline sponge bath with vigorous friction every day, will secure this object. In the next place, the skin being put in a working condition, should be made to work by some internal diaphoretic,.,-^ as the tincture ot veratrum viride, in doses of from five to ten drops, or the compound tincture of Virginia snake-root, in teaspoonful doses. The kidney may be still further relieved, especially when there is considerable tenderness, and other signs of inflammation, by cupping, leeching, mustard poultices, and croton oil. The bowels should be regulated by some gentle physic, as cream of tartar dissolved in flax-seed tea, or rochelle powders, or epsom salts, the lenitive electuary, or the white liquid physic. In some cases, itrd statr, ii» is quitr no. its vessels I'd cellular itly in til? In addi. I failing ot romes dry, ntly tiiirsr, , epithelial tubes, and 1 in health, in color, ind causes, arge quan- : and forth nion syinj)' •e often uii- iroper care, cure. It is ainily prae- ! with sutli- of the skin and falter- ponge bath Hon, should tincture of compound en there is jy cupping, 18 cream of psom salts, lome cases. podophyllin and leptandrin (40), or the compound powder of jalap (41), are useful. When there is dropsy of the cells, elaterium may ho. used a« physio (31), or the kidney may be jogged by digitalis (VM) (129), its eftcctn JH'ing carefully watched. Cider, freely drank, has been found useful in some cases. To restore the blood, iron (73) (93) (74) (7r>) (72) (71) is the essen- tial article. "When there is considerable debility, some of the vegeta- ble bitters, as quinine, (juassia, gentian, Colombo, etc., may be used daily. Coffee, and all indigestible articles of food, as rich pastries, new l)read, high-seasoned meat, and fats must be avoided, — in a word, nothing nmst be taken, either in kind or quantity, which the stomach cannot easily digest. Diabetes. This disease h a kind diarrhcea of the kidneys. The amount of urine secreted and discharged is large, sometimes enormous in quan- tity, — amounting even to several gallons in twenty-four hours. Everything taken into the stomach seems to run off by the kidneys. The for..! and drink being mostly converted into urine, do but little good. The kidneys having got into an exalted stale of action, do too /nurh, — just as the mucous membrane of the air tubes does in bron- chitis. .\»tiire of the I'rliie. — Not only is there too much urine discharged, but, instead of being lighter than healthy urine, as in Bright's disease, it is heavier, and instead of holding albumen in solution, it contains grape svgar. To Detect Su^ar.-^Put a little of the suspected urine in a test tube, — add to it a drop or two of solution of sulphate of copper, which will give the fluid a pale blue tint. Now add liquor potassa in excess; if sugar be present, this will throw dov/n a pale blue precipitate (hy- drated oxide of copper), which will immediately re-dissolve, forming a purplish blue liquid. Boil this over a lamp ; if there be sugar, a reddish or yellowish-brown precipitate (sub-oxide of copper) will be thrown down ; if no sugar, a black precipitate (common oxide of copper) will fall to the bottom. Another Test. — Place a little urine in a test tube ; add to it half its volume of liqubr potassa, and boil five minutes. If there be sugar present, the liquid will take a brownish or bistre tint Growth of Tonda as a Test — Place a portion of sacharine urine in a warm place, and a scum will soon rise, as if a little flour had been dusted on it This, when examined under the microscope, proves to be minute oval bodies. These expand and dilate the vesi- cle containing them, into the form of a tube. They still cont*i»ue to enlarge, and project from the parent Uadder, like buds. The whole I) <' Fio. m. then resembles a jointed fungoid growili (Fig. Ill), which finally breaks up, and falls to the bottom, as a copious deposit of oval vesi- cles Of spores. Other Symptoms. — Great thirst, craving ap- petite, dry skin, a sense of weight and uneasi- ness in the stomach after eating, dry and parched mouth, white and foul or clean and red toiigii.., wasting of flesh, languor and aversion to ; xer- cise. debility, pain and weakness in the loins, costiveness, loss of the sexual feeling, and cold feet. As the disease draws towards a fatal end, the gums become spongy, the breath fetid, sometimes smelling like urine. Treatment — The skin should have about the same treatment as that recommended in Bright's disease. Also, the same counter-irrita- tion over the kidneys. The bowels must be kept open by some gentle physic (13) <12) (15). Tonics. — These will be required to restore the tone of the system, particularly iron, — same preparations as recommended in Bright's disease. Astringents to check the flow of urine will be needed. Alum, in three-grain dose-;, three times a day, or sugar of lead, or white vitriol, or clear opium,, will be serviceable. Creosote, in one or two-drop doses, and t'lcture of cantharides, have each cured cases. One scruple of Peruvian bark, one scruple of wild cr \nberry leaves, powdered, und half a grain of opium, mixed and taken three times a day, is a good remedy. All articles which contain sugar and starch must be forbidden in the 'Uet. Bread and potatoes contain a large amount of starch ; and beets, parsnips, and some other vegetables, have sugar. It is best to confine the patient almost entirely to tender, fresh meats ; and the drink, notwithstanding the great thirst, must be restricted to a very small quantity. Bleeding^ from iLe Kidneys, etc. — H 1 !. ; MiinVi l^f the pcisop.ous n;?.ttcr retained may be got out through the skin, by a free use of the compound tincture of Virginia snake-root or tincture of veratrum viride in full doses. Although the symptoms, in the earlier staj'es of this complaint, may not attract much attention, or be thought worthy of notice, yet the treatment should be prompt and energetic, as a fatal termination is sometimes reached in the brief space of forty -eight hours. Retention of Urine. This disorder is often confounded with suppression of the urine, but it is different in every respect. In suppression., the urine is not formed by the kidneys ; in retention, it is formed, and, in some cases, poured into the bladder, but is retained on account of soiae inability to pass it. Iscliuria. — This is one of the forms of retention. In this complaint, the urine has pai^wed from the kidneys to the bladder, but from some cause, generally palsy of the muscles of the bladder, it i aimot be passed ofli In this i-ase. there is no pain, but the tu-r .;n f" prater ilows off" with slower and nlower pdce,--the patient ha ';;,( land a long time, and ii» .rc tires. )mr. eff'ortt* with the abdomiiial muscles to get tlK' bl ukL) enif.tied. As the quajitity discharged diminishes, the desire to urinate j^tows niore ujgent. Pressure just above thj puoes, gives pain, anrl the bladder feels und^r the hand like a large hard Lumor. DysiUMa.-- In this form oC the complaint, the water is passed to some exten", but with pain and heat along the water-pipe. This is generally cau'sed \>y some inflammation along the urethra. StraJigfury. In this, the water is only passed, drop by drop, and with great burning, scalding, and tenesmus in the neck of the bladder. "When there is considerable inflammation, the skin becomes hot, the pulse hard and quick, and the tongue covered with a white fur. Causes. — These several forms of the complaint are caused by pcL / of the bladder, gonorrhoea, inflammation in the neck of the blat Icr or the water-pipe, mechanical injuries of the bladder in child-bearUij,' or otherwise, by tumors pressing upon it, by irritation from gravel or stone within its cavity, by stricture or partial closing up of the urethra, by disease of the prostate gland, by taking spirits of turpentine or cantharides, or by the absorption of this latter article when used as a blister. Treatment. — It is obviously necessary in this complaint, that treat- ment, in order to be of any avail, 3hould be prompt ; for when the retention is complete, the bladder will burst in from two to five ' ys, and cause the death of the patient. The treatment must vary according to the cause of the retenti-j If it be caused by palsy of the bladder, the common flexible catice, yet nination le urine, le is not ne cases, inability oniplaint, om some an not be f water t p.- Land I muscles iminishes, above thi.- ke a large passed to This is drop, and e bladder. 3 hot, the ur. le by pc 1^ ' blat U.' d-bearunj gravel or le urethra, lentine or used as a that treat- when the five. ' ys, etentir iule cttut) ' their lost DISEASES OF THE ABDOMINAL CAVITY. 30S power. When much irritation is caused by introducing it, it is better not to withdraw it, but to close its external orifice with a small plug, which the patient can remove as often as necessary to let on the urine. To remove the paralysis, the electro-magnetic machine iii worth a trial, — the current being passed through the bladder. At the same time let the patient take strychnia (85) (86) (83) (95). Cantharides, in the form of tincture, or in connection with strychnia (291), is often useful. If the retention be caused by inflammation of the neck of the blad* der, leeches should ho. applied to the perineum, and three or four drops of croton oil may be rubbed on just above the pubcs to bring out an eruption. Warm fomentations will also be serviceable, and warm hip baths. Cooling diuretics, as infusions of marshmalJovv, cleavers, pumpkin seeds, buchu, sweet spirits of nitre, etc., must not be omitted Inability to Hold the Urine. — Enuresis. This complaint, generally called incontinence of urine, is quite common among children. In some cases the child has no ability to hold its water at any time; but generally it is only passed off invol- untarily at night while in bed. In adult life it is less frequently met with, except among the old. Causes. — Irritation of the roots of the spinal nerves which go to the bladder, mechanical injuries of the bladder, palsy of the bladder, particularly in old people, debility of the neck of the bladder, a gen- eral weakness of the nervous system, worms in the bowels, piles* whites, gravel or stones in the bladder, etc. Treatment* — As a general rule, the change of constitution which occurs at purberty cures this complaint. But as this does not always happen, it is important that pare nts do everything in their power to break it up early, lest it become an atlliction for life. Children who suffer from this disorder are apt to drink largely. This; habit should be restrained. But little drink should be allowed, whatever the desire for ;t Care should be taken that the child make water before going to bed, — also that it be roused at a late hour for the same purpose. The skin should be washed all over, every day, with cool or cold wat'jr, and vigorously rubbed with a coarse towel. This will cause the excess >■" Huids to pass cfF through the skin, and lessen the action of the kid. v ' In some ii.. i-ances children urinal e in bed through carelessness, — being half con;.oious of what is occurring, but not caring enough to rouse themselves. In such cases, they are often cured by some de- cided correction, — the impending act of passing water, connecting itself In their minds with the correction, and recalling them instantly to full consciousness. Of co'irse this mode of relief should be resorted to with great judgment and caution. When the complaint proceeds from debility or relaxation of the iieck of the bladder, the comix>und infusion of trailing arbutus, and 39 ( i: 'iii S'.-'^ I '■' ' !-■ ■■ the isinglass custard found among dietetic preparations, may be used freely. The tincture of cantharides, from ten to forty drops to chil- dren, may be given, and increased gradually to a hundred, or until slight difficulty is felt in passing the water. Then stop, and give the articles mentioned above. Spirits of turpentine is useful to some extent, given also in small doses, and continued for some time. If the disorder be caused by irritation of the spinal nerves, cold water douched upon the back, or croton oil rubbed along the spine, or a warm stimulating or irritating plaster upon the lower part of the back, will be reouired. The electro-magnetic m?chine may do well in ^oine cases. li% Urinary Deposits.— Gravel.— Stone. Unnatural, deposits in urine are to be regarded simply as cvi- d n^^es of changes which disease is making in the body. As such tb J valuable, — more valuable, in many cases, than any or all othc, iptoms we can study, and most valuable from the ease with which i,.ey may be investigated. Yet, but very few physicians, com- paratively, pay any special attention to them, or make any effort u) acquire the small amount of knowledge needed for their detection. Sources of tlie Urine. — The urinary secretion has three sources. The largest bulk of it comes from the superabundance of drink taken into the stomach. This is shown from the free flow of pale urine after taking copious drafts of water or other fluids. Such quantities of water as an; often drank, would embarrass the functions of animal life, were it not pumped ofl" by the kidneys. A second source of supply for the urinary secretion, is to be found in the elements of imperfectly digested food, and also some abnormal elements arising from incomplete assimilation. Oxalic acid is a specimen of the latter, being sometimes largely excreted, in dyspep- sia, soon aft( r a meal. The third source of urine is found in those old and worn-out atoms of the system, which can serve no further useful purpose in the ani- mal economy, and which cannot be got rid of by the lungs or skin. It is only, however, one portion of the dead tissue, namely, that which is rich in nitrogen, ^vhich goes out through the renal strainer, — an- other portion, which has a preponderance of inflammable elements, carbon, hydrogen, and perhaps sulphur, takes the outward channol through the liver, as bile. Characteristics of Urine. — Healthy urine has a light amber color, ia transparent, and has different degrees of density, — its specific gravity varying from 1.003 to 1.030. It hasi an aromatic, violet-like smell, and a bitter, disagreeable taste, like salts. That which is passed a little time after drinking largely, is pale, and has a low specific gravity, varying from 1.003 to 1.009, and is called urina potus. That passed soon after the digestion of a ivill meal, is called urina chpli, or urina cibi; it has a specific gravity from V.020 to 1.030. That which is secreted from the hlood^ and is passed ly be used ps to chil- iintil slight ;he articles JIG extent, erves, cold the spine, part of the lay do well ply as cvl- . As such any or all e ease with icians, com- .ny effort tO letfiction. ree sources. drink taken f pale urine h quantities of animal to be found ne abnormal acid is a in dyspep n-out atoms in the ani- mgs or skill. , that which rainer, — an- e elements, ard channel iber color, is cific gravity t-like smell, gely, is pale, .009, and is on of a 1 til gravity from id is passed DISEASES OF THE ABDOMINAL CAVITY. 307 before eating or drinking in the morning, is called urina sanguinis ; and has a specific gravity from 1.015 to 1.02o. This is the best specimen of the average density and nature of healthy urine. Healthy urine contains urea, uric acid, sulphuric acid, phosphoric acid, lime, magnesia, phosphate of soda, etc. It is only when these are discovered in excess, that they indicate disease. Examination of Urine. — Let a piece of blue litmus paper be first dipped in the urine ; if it be acid, the color of the paper will be changed to red, or reddish-brown. Should the bine color remain un- changed, then use yellow tumeric or reddened litnuis paper ; if the urine is alkaline, the tumeric \:\\\ become brown, and the reddened litmus will be changed to blue. If the color in both cases remains unaltered, the urine is neutral ; that is, neither acid nor alkaline. This bein.T done, let the specific gravity be taken. This is easily done by the urinometer (Fig. 113). This instrument is known also by the names hydrometer, and gravimeter. It is generally fio. \n. made of glass. When placed in distilled water, it will sink to a certain point; and iis all bodies immersed in fluid dis- place a bulk equal to themselves, it follows that in a fluid denser than water, the instrument will not sink so deep. The space above the large bulb is marked off into degrees corres- ponding to difFerent densities. When this instrument is im- mersed in urine, and has come to rest, the nuinbei on the graduated scale, which stands at the surface of the liquid, when added to 1000, will represent the specific gravity of the fluid, ir. At example, the surface of the liquid corresponds with 9 on th^ scale, the specific gravity of the urine will be 1.009 ; if at 25, it will be 1.025. By attending to the specific gravity of the urine, the phy- sician may often gain important i; 'brmation respecting his patient, as it may be made to show him how much solid matter is daily car- ried out of the body through the kidneys. This, at the bed-sid , may often give useful hints in regard to treatment. The following table, constructed by Dr. Golding Bird, shows at a glance the amount of solid matter in 1000 grains of urine of different densities : BpeoiUo Gravity. Solid8.| Water. Specific Gravity. Solids. Water. auec.iflo Gravity. Solids Water. Specific Gravity. Solids. Water. 1001 2.33 997.67 1011 25.63 974.37 1021 48.93 951.07 1031 72.23 927.77 \002 4.66 996.34 1012 27.96 972.04 1022 51.26 948.74 1032 74.66 925.44 1003 6.99 {993.01 1013 80.29 969.71 1023 53.59 946.41 1033 76.89 92.i.ll 1004 9.32 990.68 1014 32.62 967.38 1C24 55.92 944.18 1034 79.22 920.78 1005 11.65 988.35 1015 34.95 965.05 1025 58.25 941.75 1035 81.55 918.46 1006 13.98 986.02 1016 37.23 962.72 1026 60.50 939.42 1036 83.88 916.12 1007 16.31 983.69 1017 39.61 960.39 1027 62.91 937.09 1087 86.21 913.79 1008 18.64 981.36 1018 41.94 958.06 1028 65.24 934.76 1038 88.54 911.46 1009 20.97 i979.03 1019 44.27 955.73 1029 67.57 932.43 1039 93.87 909.18 1010 23.30 976.70 1020 46.60 953.40 1030 '69.90 930.10] 1040 9320 906.80 The mode of using the above table is this. Having learned the density of the iirine passed in twenty-four hours by means of the ^i 1 iHJ 1 1 ^1 1 1. ' i: ' ,11' ■>l;„ 5 •■ urinometer (Fig. 113), a glance at the table will show the proportion of solid matter and water in 1000 grains of the urine. Then, by weighing the whole quantity of urine passed in twenty-four hours, the weight of solids drained off by the kidneys, may be determined by the simple rule of proportion. Symptoms of (iraVel. — A sudden attack of pain in the region of the kidneys, so acute and severe, frequently, as to cause fainting, and even convulsions. The pain runs down to the groin and thigh, caus- ing a numbness on the affected side, and a drawing up of the testicle. The pain is excessive at times, and then remits. Finally it stops sud- denly. Leading from the kidneys to the bladder are two small tubes about the size of a goose-quill, called ureters, — being the appointed chan- nels of the urine. The pain, of which I have spoken, is caused, gen- erally, by the passage of a stone along one of these small tubes. If the stone happen to be a little too large for the tube, or uneven or ragged upon its surface so as to bruise and tear the delicate lining of the ureter, severe pain is the result. The pain is intense when the stone moves along ; remits when it stops ; and suddenly ceases alto- gether, when it gets through, and drops into the bladder. Sometimes there is no pain, the gravel being so fine as to pass through the ureters very easily. It then passes through the urethra also, and is found as a sediment of the urine at the bottom of the vessel. These urinary deposits are various, and quite unlike each other in kind. They indicate different states of health, and require to be spoken of separately. Urio-Acid Gravel. This form of deposit passes indifferently under the name of uric acid gravel, or Hthic acid gravel. The person who is in the habit of passing this kind of deposit largely, ia said to have the Uthic or uric acid diathesis or condition. Fia. 114. Fro. 115. The urine of persons in this state lets fall after it has stood awhile, a reddish sediment, like brickdust. This consists chiefly of urate of ammonia (Fig. 114 and 115), tinged with certain coloring matters. \m DISEASES OF THE ABDOMINAL CAVITT. 309 proportion Then, \>y hours, the ned by the 1 region of inting, and high, cau9< ;he testicle, stops 8ud- ubes about nted chan- aused, gen- tubes. If • uneven or icate lining e when the ceases alto- as to pass the urethra ttom of the ch other in juire to be ime of uric he habit of ithic or uric tood awhile, of urate of ing matters. This coloring substance may be more or less abundant, and give to the deposit various shades, as dirty-white, yellow, pink, and red. The Fio. H6. pure uric acid sometimes ap))ears as fine sand, or large crystals (Fig. 116). The urine is of a dark copper color, about like brown sherry, and is more scanty than in hoalth. It is also higlily acid, giving to litmus paper a dccjicr shade of red. Persons who pass this kind of gravel largely, are apt to he troubled with in- flammatory complaints; with acidity of stomach and heartburn ; and some of them with gout and rheumatism. Placed under a blowpipe, uric acid is decomposed, and gives out an odor like that of burnt feathers, combined with the oil of bitter almonds. It is dissolved by liquor potassa, from whi(;h muriatic and nitric acids precipitate it; and by sulphu- ric acid, from which it is preci|)itated by water. Acetic, nitric, and muriatic acids, alcohol, ether, and water, do not dissolve it. Causes. — Uric acid is the .form in which nitrogen and the effete compounds which contain it are got out of the body. It is the result of the decomposition of the tissues of the body. Its gravelly particles are the sands of life daily washed out of us, — reminding us always that we are wasting away. Whatever causes the body to waste rap- idly, produces it in excess. We find it, therefore, in the urine of those who suflcr from gout, rheumatism, dys|)(!psia, fevers, debility of the genital organs, straining of the loins, etc., which produce loss of flesh. Treatnirilf. — The remedies for this uric acid gravel are the alkalies, bicarbonate of potash, bicarbonate of sodiA and magnesia. The first named is generally the best. It may b(! used in the form of the neu- tralizing extract, — especially if there be costiveness. If the bowels do not need physic, let the potash be taken in the shape of lye made from hard-wood ashes (:300). Fluid magoesia is an excellcMit remedy; BO is licjuor potassa, taken in tw(!nty or tliirty-drop doses. Tll(^ urine must be watched, and these remedies discontinued when it becomes alkaline. At the same time the stomach should be supported by some hitter tonic, as the infusion of quassia, gentian, columbo, Peruvian bark, etc. Iron is, in many eases, not to be overlooked. If the patient be pale and bloodless, some of the preparations of this metal will be needed (61) (78) (74). Acids must be carefully avoided, both in food and drink. The diet nmst be plain, digestible and nourishing, and quite mod- erate in amount. The qvality is of less consetjuence than the f/uantit//. Exercise is of great consequeaice, and must be regular, and, if pos- sible, in the open air. 1 1 m\ k /' iJ. I "! i 310 DISEASES OF THE ABDOMINAL CAVITY. The skin must receive daily attention in the shape of an alkaline sponge bath, with friction. This will throw upon the skin much of the labor done by the kidneys. Phosphatic Deposits. Thesk deposits are indicated by a state of the urine just the oppo- site of that which contains the uric acid gravel. They are contained in urine which is either alkaline when passed, or becomes .so very soon by standing. As the urine cools, a white sand falls to the bottom, and frequently a film forms upon the surface of the water. Looking at this film in different lights, you may see in it the several colors of the rainbow. Skim off" tnis pellicle, place it upon paper, and let it dry ; and you may then see the little shining crystals. This urine quickly grows putrid and offensive. Sometimes it smells strongly of ammonia. The more phosphates it contains, the sooner it becomes alkaline. These deposits are generally the triple phosphates. Healthy urine contains the phosphate of magnesia in a state of solution. Under some circumstances, the urea of the urine is decomposed in the kid- neys, and ammonia is disengaged. This combines with the phosphate of magnesia, and forms the triple salt of the phosphate of ammonia and magnesia, which is not soluble. Symptoms. — A sallow complexion, a languid, spiritless state of mind, and an exhausted, debilitated condition of body. The urine is pale, rather copious, slightly turbid, has a low specific gravity, and smells unhealthy, having sometimes the faint odor of weak broth. There is generally derangement of the digestive organs, windy stom- ach and bowels, nausea, constipation, or diarrhtEa, stools of various colors, and sometimes, in diarrhoea, resembling yeast, and an aching pain and v.eakness in the loins. Causes. — These" deposits are produced by great debility of the constitution, by injuries of the spine, dyspepsia, defective assimula- tion of food, bad diet, irritation of the neck of the bladder, and or- inranic diseast^ of the kidneys. But they are caused more es|iecially by whatever wears and exhausts the nervous st/stem, as heavy cares, de- pression of spirits, sedentary habits, great mental exertions, mastur- bation, and venerea! excesses. Treatment. — These deposits being connected with great debility, care must he taken not to make the matter worse by taking active purgatives, by extreme fasting, or by any means which will increase the weakness. On the contrary, the strength must be supported by all the mean.'* that can be commanded. With this view, the citrate of iron P5} may be taken. Morphia combined with iron (80), to allay irritability, and impart strength at the same time, may be used. The valerianate of iron (93) is excellent for the same purpose. Connected with a state of urine just the opposite to that which rery soon increase DISEASES OF TlIK ABDOMINAL CAVITY. 811 holds the uric acid deposits, this form of gravel calls for the opposite rt'tnedies. Instead of the alkalies, the acids are wanted. The nitric and muriatic acids, with a vegetable tonic (76), may be used. Opium is spoken of in high terms, and is thought by some to have great |M)vvcr in turning alkaline urine acid. The compound balsam of sul- phur is highly spoken of, and the compound infusion of trailing arbu- tus is also mentioned with approbation. It is all-important to throw off care, and to give the mind a chance to rise up with all the elasticity it has. To bring this about, journeya and amusements are useful. The society of livt-ly, laughing, witty friends will do a great deal to give the spirits a rebound, and the whole health an upward movement. Such jjersons an; a blessing to the world ; and he who reckons a few of them atnong his friends will live the longer for it. The skin should have the benefit of tiie daily tonie effect of a sponge bath, with water at first tepid, and afterwards cool ; and exer- cise, out of doors, should be habitual, and connected, as mueli as pos- sible, with objects of pleasure. The drinking of hard water is highly injurious; and if none other can be had, it should be distilled, and then spread out to the atmos- phere, in shallow vessels, that it may recover its pleasant taste by reabsorbing air and carbonic acid. Oxalic Deposits. Oxalate of lime in the urine is the cause of this kind of gravel It appears in the form of dumb-bells, and octahedral crystals. (Figs. 117, 118, and 119.) Fio. 117. Fio. U8. Fio. lift The urine has a specific gravity of 1.015 to 1.025, and is generally of a dark amber color, and clear, and bright ; it is generally acid, though occasionally alkaline or neutral. Urea is generally found in it, and epithelial cells (Fig. 120). Unlike the uric and phosphatic urines, it is quite free from sediments, except, as often happens, there is a large amount of urea in it, in connection with the oxalate of lime. When the urate of ammonia is combined with the oxalate of lime, it often happens that the latter has to be dissolved with a little liquor potassa, before the former can be seen with the microscope. ' I r m >\ ; w H ,V. '■'•'■1-f"' i 312 DISEASES OP THE ABDOMINAL CATITY. Fio 120. Symptoms. — Great depression of spirits, excitable state of the ner- vous system, painful susceptibility to external impressions, dyspeptic symptoms, and disturbances of the liver, a fear and dread of consumption, emaciation, inability to make exertion, — the smallest exertion caus- ing fatigue, — in men a doficient sexual power, a pain and weiglit across the loins, and some irritability of the bladder. Causes. — These deposits are supposed to re- sult, like most other deraiigeinents connected with loss of Hesh, in too great a degree of oxi- dation. Vegetables produce oxalic acid by just the opposite proc(;ss, namely, dcoxidation. Whatever depresses the vital powers, may generate this deposit t as mental depression, overwork of the brain, burdensome cares, idle- ness of mind or body, masturbation, debaucheries, intemperance, vene- real excesses, and injuries of the spine. This deposit may also be produced by certain articles of diet, which contain the oxalic acid. Among these may be named the rhubarb plant, which in summer is largely used for tarts ; and sorrel. Treatment. — The treatment for these deposits should be very much like that for the phosphatic. The stomacli and livpend on the al>- sence of food having a good share of nitrogen. Tin; urine of vege- table eaters contains it in largest quantiti(!s. Treatnieut. — The only treatment required is a diet composed in good proportion of animal food, a j)roper attention to the skin by bathing, etc., and when debility exists, tonic medicines, as iron and bitters, with out-door exercise enough to keep the muscles in working order. B14 DISEASES OF THE ABDOMINAL CAVITT. Cystine Deposits. The«e do not occur in healthy urine, and rarely as an clement in diseased action. They contain twenty-Hix per cent oi sulphur. Urine which contains cystine in of a pale yellow color, and has a low specific gravity. It frequently has an oily appearance, and its smell is peculiar, resembling that of sweet brier. Sometimes its odor is fetid, like putrid cabbage. On being kept for a short time, it has its surface covered with a pellic^le which looks oily, and consists of a mixture of crystals of cystine, and the phosphate of. ammonia and magnesia. The cystine deposit apj)ears to be diffused through the urine, which is alway^ turbid when boiled. It is a white or fawn-colored powder, and falls to the bottom as a seidment. It undergoes no change by warming the urine, and this distinguishes it from white urate of am- monia. It is not soluble in diluted hydrochloric or strong acetic acid, which distinguishes it again from the earthy phosphates. To test this deposit, add licpior ammonia to u portion of it, and shake them. If the deposit be cystine, it will dissolve readily. Allow a few drops of the solution to evaporate on a slip of glass, and the six-sided tables of cystine will remain, which may be examined under the microscope. (Fig. 124.) Fio. 124. Fia.126. rxr 1» • o It is to be remembered that occasionally the chloride of sodium or common salt crystalizes in octahednil forms (Fig. IS-'}), whi(tli, in some positions, may look very much like cystine. Tlie ready solu- bility of the chloride in water, and the absence of all color when they are examined by polarized light, will prevent mistaking these crystals for cystine. If urine containing common salt be quickly evaporated on a slip of glass, and be then examined, instead of the octahedrons, we find crosslets and dagsfcrs. (Fig. 126.) *&&'• Causes. — An excess of sulphur in the tissues, a scrofulous consti- tution, and hereditary predisposition, with defective oxidation, and torpidity of the liver. It is often found in the urine of girls who have the green sickness.- * * . Treatment — The great object is to improve the general health, which is to be done by attending to the skin, and the administration 'P \ .: i:::l OI8EASRS OF THE ABDOMINAL CAVITY. 316 of iron and bitters, and also alteratives. The syrup of iodide of iron is a valuable remedy. Podopliyllin and leptandrin (34) are wanted to regulate the liver. The nitro-niuriatie ac^id (7()) should be tried. The daily sponge bath, and daily exercii^e, us in niUiiit chronic com- plaints, muat on no account be neglected. Stone.— Calculus. It often happens that the proper treatment for removing urinary deposits is not adopted in s(;iison. In such cuscjh, gravelly particles, tinding a lodgment for u time, in the kidneys or bhidder, are apt to draw other particles to themselves, which become fast^MU'd to them, and form a layer quite round them. Over this, other layers form in succession, until a stone is produced so large that it eannot pass oiX. These grow to various sizes, — being sometimes so large as to till the bladder. Uric Acid Calculus. — The most common of these formations i« tlie uric acid calculus. It is generally smooth or slightly tuberculated on the surface, and varies in color from a pale yellowish-fawn, to a red- dish-brown. When sawn through the centre, its layers will be found tolerably regular, but of diHerent thickness. (Fig. 127.) To test it, place a small fragment upon platinum foil under the blowpipe. If uric acid, it blackens, and gives out an odor like burnt feathers mixed with the oil of bitt< . almonds. Flo. 137. Fio. 128. Fio. 129. Mixed Cillfulus. — These calculi are frequently composed of two or more ditl'erent kinds of matter arranged in irregular layers. Fig. 128 is a mixed calculus, — the dark layers being oxalate of lime, the light ones, uric acid. In testing such, fragments of each ingredii^nt should be separately examined. Urate of Ammonia Calculus. — We occa.sionally meet with a caK cuius composed of the urate of ammonia. These calculi, vvhen found, are generally small in size, smooth or slightly tuberculated upon the surface (Fig. 129), and of a pale slate or clay color. When heated before the blowpipe, it gradually disappears. Phosphate of Lime Calculus. — This has a smooth polished surface, and quite regular layers, which separate easily when the calcubis is cut asunder. It has a pale fawn or stone color. (Fig. 130.) \ ■ -ri' ■ ! 1 i i !i' ( . I ( I, !^ ii^^ !i I IT* 7S^. ^ chars before the blowpipe, and gradually becomes white as the carbon burns away. Diluted nitric o" hydrochloric acid dissolves it without efFervescence. Oxalate of Lime Calculus. — This is frequently met with unconi- bined with others, but more generally its nucleus is uric acid or unite of lime. It commonly li:xs a brown, dark olive, or dirty-jMirpie color. Its sui-face is irregular and somewiiat rough. It looks like the fruit of the mulberry, tind is known as the mulbern/ calculus. (Fig. lol.) It dissolv'K without ctiervcsccnce, in dilutc^d nitric or hydrochloric acid. When f^ius dissolved, the addition of a little anuuonia will cauise it to fall vo the bottom as a white precipitate. '' Fio. lao. Fia. 131. Fio. 132. Fusible Calculus. — This is a mixture of phosphate of lime, and thr phosphate of ammonia and ma^.'csia. It is the most common of all the calculi, except the uric acid. It has an oval, irregular form (Fig. 132), and is white, soft, and ''riablc, like chalk. tSometimes it is hard. It may be known by the readiness with which it melts down before the blowpipe, without being consumed. Causes. — The causes of the diHerent kinds of gravel Lave been already explained. (Generally stones of the bladder are formod in the kidney, and descending through the ureters into the; bladder, are pre- vented from passing out through the water-pipe by an enlarged pros- trate gland. Remaining in the bladder, they soon get encrusted over by other matters in the urine, and grow by accretkin to be stones. Syniptoiais. — When a stone in the bladder reaches a certain size, especially if it is rough, it always produces sutlcring. A dull, annoy- ing pain is felt at the end of the penis. Th'^ desire to make water y frequent, and there is a siMise of wcMglit in the perineum. Sometime;^ the stream of urine is suddenly stopped by the stone falling on the orifice of the urethra. As the bladder becomes ni!iu-ly emptied, it embraces the stone, and the pain is increased. Jolting in a carriage cau.ses great pain. Mrcus pas.ses off with the urine, and soiaetimes blood. Art(>r a time, the appetitt; fails, hectic sets in, albumen ap- pears in the urine, and the patient sinks under inllummation of the bladder. These symjjtoms being found in diseases of the kidneys and blad- der, no one is authorized to pronounce upon the existence of stone, until tfie stone has been touched by a inetalio sound introduced into the bladder. ^^•«: i»'J:ii^ ite as thf issclves it 1 uncom- .1 or uriito r|)lc' color. 1li«! fruit ii,'. 135.) (Irocliloric loiiia will 'I o. 132. ' '■'■'^S'; ■? e, and tht iininoii ot" ular form times it is wii before Lave hoen iw(] ill the r, are pre- rged pros- usted over itOlKJS. rtain size, ill, annoy- e water if iometime^ Hi; on the 'mptied, it a carriage soiuetimes mnien ap- ion of tlie and blad- i of stone, lueed into Treatment- — The only effectual treatment is a choice between two operations, — lithotrity and IWiotomy. The former consists in introducing an instrument, a kind of forceps, into the bladder, through the urethra, taking hold of the stone, ana crushing it. The preparatory treatment consists in correcting the un- healthy state of the urine, and the frequent introduction of bougies or sounds to enlarge the water-pi [je for the easy entrance of the crush- ing forceps. The after treatment consists in diluent drinks to increase the urine, injections of warm water to wash out the fragments, with hip baths, soothing injections, and leeches or cupping upon the peri- neum. Lithotomy consists in making an incision into the bladder through the perineum, and taking out the stone or stones whole. Dropsy of the Belly. — Ascites. This is a collection of v/ater in the cavity of the belly; sometimes the fluid is outside of the peritoneum, and next to the muscles. Symptoms. — An enlargement of the belly, with a sense of disten- sion and weight, — particularly on the side on which the patient lies. When the collection of water is large, the breathing becomes short and ditlicnlt, and the swelling is uniform over the whole aodomen. In some insti^uces the iluetuation of the water may be distinctly heard when the patient moves about, — just as we may hear the water in a half-filled barrel when it is rolled over. This sound of the fluid, when heard, distinguishes the complaint from pregnancy, and from the drum-head state of the bowels. This fluctuation mi*y some- times be produced by pressing upon one side of the belly while the patient is standing or sitting, and striking the other side with the enrls of the fingers of the other hand. In some cases, there is loss of appetite, dry skin, costiveness, scanty urine, oppression of the chest, cough, colic pains, and variable pulse. Causes. — A frequent cause of this complaint is chronic inflamma- tion of the serous membrane which lines the abdomen, — I mean the peritoneum. It may also be produced by scarlet fever, fever and ague, disease of the heart, particularly dilatation of the right cavities/ and diseases of the liver, particularly the shrivelled, hobnail condition of the liver, — in short, whatever <: auses a pressure upon the portal veins, and obstructs the venous blocd returning from the intestines. Treatment. — The remedies i.ir this disease are mainly diuretics and purgatives. The bowels may sometimes be reduced in a few days from an enormous size, by medicines which excite the action of the kidneys. Digitalis, combined with acetate of potash, etc. (130), forms an excellent pniparation. The patient should have as a con- stant drink, a strong infusion made from two parts of h.*".-cap moss, and one each of juniper berries and dwarf elder bark ; also an infu- sion of queen of the meadow. The purgatives used iu this complaint are those which produce n I. \M\ 318 BWRASRS OP THE ABDOMINAL CAVITY. watery stools. One of the best of these is elateriurn. It will some- times carry off the water with great rapidity ; combined with some active cathartics (31), it will have all its good effects without the griping it is apt to occasion alone. Cream of tartar, taken in large doses, every day, will sometimes do well. Epsom salts produces watery stools, and is a good remedy. For promoting absorption of the fluid, the iodide of potassium, taken in from three to ten-grain doses, three times a day, is a valua- ble medicine in many cases. The compound infusion of parsley is said to be still better. The skin must receive careful attention. The alkaline sponge bath, with friction, will increase the transpiration of fluid through that organ. Exercise does much to keep up an active circulation, and to lessen dropsical effusions. The strictest temperance, both in eating and drinking, must be observed. A light and nourishing diet, with water, tea, and the diuretics named above for drinks ; beyond these the patient must not go. A kneading and shampooing of the bowels once a day has an ex- cellent effect ; it gives activity to the circulation in obstructed veins. A bandage tied close around the bowels, and tightened as the water diminishes, has an effect upon the sluggish vessels similar to that of the laced stocking in varicose veins of the legs. It lessens the liabil- ity of a return of the complaint. Dropsy of the Cells.— General Dropsy. — Anasarca. Just under the skin is a membrane composed chiefly of cells, called the cellular membrane. When a considerable part, or the whole of these cells are filled with a watery fluid, we call the complaint ana- sarca, or cell dropsy. If, beside this, there is a collection of water in the large cavities, we give it the name of general dropsy. Symptoms. — The disease generally begins with a swelling around the ankle and leg, which is more visible at night after standing and walking, and is less perceptible in the morning in consequence of the horizontal posiiion of the night. To the touch of another person, dropsical feet and legs feel a little colder than natural; and when hard pressed with the finger, a pit will be sunk in the flesh, which remains some time before it fills up. As the disease advances, the skin of the legs becomes smooth, shining, and sometimes even cracks open to let out the water. The limbs, and indeed the whole person become stift^ heavy, and clumsy. As the disease advances, and ascends to the belly and chest, there is shortness of breath, a sense of suffocation on moving or lying down, a tightness and distress across the epigastrium, thirst, dryness of skin, wakefulness, loss of appetite, scanty and deep-colored urine, and a slow fever. Causes. — General dropsy is caused by whatever weakens the gen- eral system, and by such circomstances as obstruct the circulation in mm 11 Bome- th some lout the times do ledy. itass'mm, a valua- >arsioy is ige bath, ugh that 1, and to must be and the ;nt must 18 an ex- ted veins, he water ;o that of the liabil- isarca. Us, called whole of aint ana- water in g around ding and ice of the r person, /hen hard 1 remains tin of the 36 n to let ome stiflj lest, there or lying t, dryness red urine, s the gen- alation in DISEASES OF THE ABDOMINAL CAVITY. 319 the veins. The most frequent causes, therefore, are certain diseases of the heart and kidneys. Explanation. — Modern physiology has demonstrated that the veins do a certain part of the work of absorption. The serous membranes which line the larger cavities of the body (exhale watery fluid enough, and no more than enough, to keep them moist, and cause? the organs within to play smoothly upon their surface. If the fluid were not taken away as fast as it is poured out, the cavity, — being a shut sac, • — would become full, and we should have dropsy. It is the office of the veins to absorb this fluid and convey it away in the general cur- rent of the blood. This is the method of their doing it : The walls of the veins are so constructed as to permit watery fluids to pass throij^'h thevi, either in or out. When they are comparatively empty, or only moderately full, fluids on the outside pass in, and mingle with the contents. Thi« is called endosmOsis. When they are very full, the watery portion of the blood will filter through, and pass out. This is called exosmosis. Now, if the reader will think a little, he will easily see that if the veins are barely full enough not to allow any fluid to pass in, ' iie natural exhalations of the shut sacs would bring on dropsy ; but if the veins are so full as to cause water to flow out, then the dropsical accumulation will be still more rapid. Such being the office and nature of the veins, the reader may learn how disease of the right side of the heart will cause dropsy. When the right ventricle is so dilated and weakened that it cannot send the blood forward to the lungs, of course the veins which bring' it to the right side of the heart, will become full, and greatly distended. Exosmosis will then occur; the wiiu-ry portion of the blood will begin to run out, either into th large cavities, or into the cells, and dropsy, either general or local, wut he the result. Treatment. — This must be governed very iimch by the cause of the disease. In dropsy from disease of the heart, we may use diuretics and such other measures as are recommended for dropsy of tlu' belly. If the urine is strongly acid, depositing the brick-dust s. liment, the alkaline diuretics will be the best, as the acetatr and bicarbon- ate of potash combined, and dissolved in water. 'J'lie bitartrate of potassa, to act upon the bowels, is a proper remedy. If the disease arise from general debility, the following powder will be useful : digitalin, three grains ; cinchonia, half a dram ; phosph;i i> of iron, half a dram ; and white sugar, one dram. Mix, and t r ate ; divide into sixteen powders, and give one, in pumpkin-seed tea, four times a day. ! !! i' I ■ I !. 4 ; . ( A-^- m if -]:.'% U,}r, ■i;*'...-.;,- ; ., VENEREAL OR SEXUAL DISEASES. Or all the diseases to which flesh is heir, none bring so mach misery, moral and physical, as those called sexual or venereal. To the physician, they are the source of the greatest anxiety and per- plexity. They bring him into possession of the most delicate secrets, — secrets which invjlve the peace of families and neighuorhoods, — secrets which his honor as a man, and his truth as a physician, compel him to lock fast in his own breast, and hold sacredly apart even from his nearest companions, — secrets which, if revealed, would fill domes- tic circles with unutterable bitterness and heartburnings, and whole neighborhoods with scandal and immorality. These secrets are often a burden to him. They are in his breast like undigested food in the stomach, — disturbing the whole nature. The patient, if a man of sensibility, suffers even more, cf course, than his physician. In many cases, he in a man of virtuous inten- tions, and perhaps of religious habits, who has fallen in a moment of temptation ; and he fears that the' effect of his sin. will spread itself through his whole system, and extend to the end of life ; or, still worse, that having poisoned the fountain of his life, it will go down as a heritage of misery to his offspring ; or, what he would deprecate '\s almost equally calamitous, that the partner of his bosom may be- come the innocent partaker of his disease. In this state of apprehension, he turns to his physician, not merely to keep his secict, but to cure his disease. How great a pity, that in such circumstances, he does not always fly immediately to an honor- able physician, instead of seeking the advice, as many do, of those miserable quacks, who lure him to their dens only to get his money, having no intention or ability to cure his complaint. These diseases are dividea into two great branches, characterized, in part, by different symptoms, and generally held to be entirely dif- ferent complaints. The first to come under consideration is Pox. — Syphilis. This disease had a very early origin. It was known among the Jews, as we learn very clearly from the 15th chapter of Leviticus. Dr. Adam Clarke's Commentary upon this chapter, at least, makes it apparent. David, the king of Israel, has unconaciously left on record. VENEREAL OR SEXUAL DISEASES. 321 in the XXXVIII Psalm, a most graphic description of Tertiary Syphilis, experienced in his own person. Dr. Clarke says : " It is most likely the Psalm was written in reference to some severe afHic* tion that David had, after his illicit commerce with Bathsheba ; but of what nature, we are left to conjecture from the third, fifth, and seventh verses." The Psalm is dated not quite a year after the act alluded to, — about the right time for the terrible symptoms David describes to make their appearance. The term syphilis is from a Greek word signifying filthy. There lb one unvarying sign of this disease, — the existence of an ulcer or ulcers, usually upon the genital organs. The French call this ulcer a chancre. The conmion name is simply venereal sore, or ulcer. A pimple first appears ; on the summit of this a pustule forms ; then the rupture of the top of this, brings to view the ulcer or sore. This ulcer is shallow, more or less circular or oval in form, bounded by a perpen- dicular and slightly jagged border, and furnished with a smooth, yel- low base, moistened by an imhealthy secretion. The skin around the sore is a little thickened and inflamed. This is a simple venereal ulcer. It generally lasts about five weeks, and then heals. But it is not always thus simple. It may be an inflammatory chancre, attended by excessive inflammation. It may be what is called a stoug-hing" chancre, characterized by the perishing and falling oft' of large parts of flesh. It may.be gang-tenons, or marked by a ♦^en- dency to mortification. It may be plugedeuic, or eating, — being dis- tinguished by a rapid loss of substance, or eating away of flesh. Or, finally, it may be indurated, — being noted for the peculiar hardness of the base, and of the flesh immediately around it. A venereal sore is the result of impure connection with a person having the syphilitic disease. The poisonous secretion of a sore, applied to the skin of a healthy person, produces inoculation, and a new sore upon the previously healthy person is the result. This chancre appears in a few days after coition, — a certain time being required for it to produce its eftect, as in the application of vaccine matter to the arm. BabOi — The nert symptom in the order of occnrrence, which fre- quently follows the ulcer, is the bubo. It is nan'ed from a Greek word which means groin, -from its usually appearing in that part. It is a painful swelling of th inguinal gland in the groin, and is caused by the absorption oi /irus or poisonous matter from the chancre. This gland is one of the lymphatics, a class of vessels a£ numerous, all over the system, as the veins and arteries. They are Ukewise called absorbents. Those that originate . from the private parts, absorb the poison from a venereal sore, and convey it to the glands in the groin, which, being poi.- is little uneasiness, and no pain ; though there is sometimes a sliglit itching. The first breaking out is usually of a copper color, some- what paler than it subsequently is. The eruption is often in the form of blotches, — elevated only a very little above the skin. They are composed of small prstules, with a little fluid in them, which soon dries away, and the whole may be rubbed off like bran. This may leave the skin looking tolerably sound, and inspire the belief that no further mischief is to be experienced. No hope can be more delusive. Parts affiicted with this complaint, show no tendency to heal The first crop of pimples is soon followed by-a second, which pro- duces a thicker crust, and yields a larger amount of bran. This rubbed off, small ulcers appear underneath. Tesicular Eruptions. — There is another syphilitic affection of the skin, which appears in the shape of vesicles, like small-pox. These dry and leave a scab. . They ^re enis, and on re found at 'agina itself. e what are I, the consti- ear. But a le treatment The poison Die constitu- ted on and this reason, bones, etc., >pear imme- after those al ; the con- itional corn- It has a red- irst, the skin ounding the themselves. 3 membrane I to appear ; tertiary, be- Ird class. tional erup- small space, rms are not ptions, then* mes a sliglit color, somo- jften in the skin. Thcv them, which bran. This e the belief can be more lency to heal , which pro- bran. I"hi9 sction of the pox. These f'i ■! t 1 1* *>ki,'l iw F'''l N.'v , I ^ 1 \f If • f *.* VKXEkEAL OH gBXCAl. PISRASKK. «rt*]y Frnptlons. — Thrre is i«^i^ .iinttw.- uik-ciiuii, •. ;"<'hidiii \hv i<-M (»f Hulcs, iUfi onr scale \v>il ;«■ j.»IUm] u|>r-n Hiitji'h'-r. It b- ;,i!i«t '\ an eruption of etipper'folorfvv iilcerri nrr left viih copfKrt-rnl.ored cU|j%JS. (Fig. iii'i.* 'I'hi^ rtiiibborn form. i^.»i — i r ^ v 1 >«d<'i'cnliir fcni|aiii«>i. hi anoifw r varic'ty >•!' 0»c d;^<;aj«:, oroacl, •(.. «i.>pp>'r-c(j|o«'d !uby Jtep ulcors. t>-rpiii\fniiig" jii :cais. Tl i*^ is an unfjivomble 'ioan of tin- tlisrastu-aiKi u^uaUy appears sorrir (m*i c" apt to inrni . ti UH' tongtie, unrt afUT a time, l>rf.'ak, di»e:io*i?jg rigged, orjing"^- olorevlulcer?. J*i.Air, VI F«5f. f? Many other formi? < »«i(»t} bui In a pf^pukjr Wv»^Ji U^e '•J5i. it vould be ii.^«.w- ; - ;:. '.»»i ;h« ntcA.- d»»timfkMit» wfek-fe thfi"" >-5»cTipuon would {Fi;{iiif<*, Some of the svor«t fonns oi the sff«ndtt»*v *ffci.'tious, are fouad •ithMi the mucous rncnibran** of iitf' nu-iuh a:i'l lhrt>.it. Thctte tKl,-iii Dumber ••in\ kind, with tii*- Rli-r-iioh-' of ihc skin. Thrv Jit'ct thcvlip.1, iht! iirtvmai suh's of the checks, the ti^ngutf, febt* toritiii^ •>t»j phnrynx. tho .-ol? p;dau%the najrai cavilled, cfr% 'rh<»y ar*- tMTJb •■'S'Iriu'iivH ill th'ir • Hocts, —running j^Mjjing ulcers, and < atino; det;p' , ;rU> the parts. Ti;v->y otl.en n«akt shik kin^' vnrk in the wlml'- inont.. !id rhroat; and. vvlion atti nded vtjth tviHidftmbh* intia!nmRfi<;»u tAkc it almost iinpossibl'? to swaiiov\. ■.iiiyth!%". nr "V^n to ojxir;- •.outh. I h.vve oftrii wf!) breai!it'« turouc'b tiu" psdatirit^ U'^h (Vi.A'y> VI, Fig. 1), and «^vou th<^ Avholo arch destroy*?;! (B*.*tk VJ, Fig. 2) " r'()!)rt havf' often ditd frorn starVkilion. — flot linn^ alile ♦'> PWaTlow ■ ulcem soinetime.'? take hold nf i.: tojj.sii.. und ' d*" them o.i*- ft«< ' n were done with a punch." !'h(et»e uireratious nffect ihi; r'.'K'Olli^ n itc'tv ui >vm- gtnirai -v'^ans. In lite finuah;, tht-y oft< n v,iTec« ttw -:♦<».' ' '' Mu- neck of - wnmb (Plait, VII, Fig. 2) ; hvA thvm m«v » ^ • ihtasfthuo, « }* !!. . i«! r»! "■it-^ ■•••?; ass^' f VKNKREAL OR SEXUAL DISEASES. 32:i Scaly Eruptions. — There is still niiotlnT affection, which ia in the form of wales, and one scale will he piled u|)()n another. It begins with an eruption of copper-colored blotches, which become covered with scales ; these are succeeded by scabs, and when these fall off, shallow ulcers are left with copper-colored edges. (Fig. 133.) This is a stubborn form. Fio. 133. Tiiberfiilnr Eniptions. — In another variety of the disease, broad, red, copper-colored tubercles, or hard elevations appear, most com- monly about the sides of the nose, or on the cheeks. Gradually, they suppurate, and are succeeded by deep ulcers, terminating in scars. This is an unfavorable form of the disease, and usually appears some considerable time after the primary symptoms, in persons whose con- stitution has been shattered. Platfc V. This rather belongs to the tertiary form of the disease; and in addi- tion to the above, patches of unhealthy inflammation are apt to form on the tongue, and after a time, break, disclosing ragged, orange- colored ulcers. PLAiii VI. Fig. 2. Many other forms of eruption exist ; but in a popular work like this, it would be useless to make the nice distinctions which their description would require. Some of the worst forms of the secondary affections, are found upon the mucous membrane of the mouth and throat. These corres- pond, in number and kind, with the affections of the skin. They utl'ect the lips, the iuternal sides of the cheeks, the tongue, the tonsils, the pharynx, the soft palate, the nasal cavities, etc. They are terribly destructive in their effects, — forming gaping ulcers, and eating deeply into the parts. They often make shocking work in the whole mouth and throat; and, when attended with considerable inflammation, make it almost impossible to swallow anything, or even to open the mouth. I have often seen breaches through the palatine arch (Plate VI, Fig. 1), and even the whole arch destroyed (Plate VI, Fig. 2). Persons have often died from starvation, — not being able to swallow. The ulcers sometimes take hold of the tonsils, and "dig them out aa if it were done with a punch." These ulcerations affect the mucous membranes of the genital organs. In the female, they often affect the vagina, and the neck of the womb (Plate VII, Fig. 2) ; and thus may exist for a long time, as the cause of whites, without being suspected n-.. such. Thay affect also the mucous lining of the fundament and the large bowel. They sometimes exist in the ear, and more often in the eye. This latt-er affection pa&ses under the name of syphilitic iritis. Li Plate V, ( \ i i ! I , 1 h' : t\ the arti»t hus well represented this form of constitutional distease in the eye. The disorder, having, by frightful ulcers, run riot upon the delicate structures of the skin and mucous membranes, advances boldly on- ward, attacking the muscles, the tendons, the hard covering of the bones, and the solid bones themselves. No part of the human frame, — not even the skt'lcton, — can escape this devouring complaint. The bones of the nose and l".»ce are generally the first to be attacked. These perish slowly, — falling away, piece by piece, — the nose, in the mean time, sinking down nearer to a level with the cheeks. From these parts, the disease may spread to the bones of the whole system. Tiiese affections of the bones, are attended by pains of almost every kind and degree. These pains are sometimes fixed in one place ; at other times, wandering, — the whole skeleton b«*ing painful. In these latter cases, they seem to the sufferer to reach the very mar- ro\.. Sometimes when the pain is fixed in one place, the feeling is such a.i might be supposed to be ex|)erienced if the bone were 'xhig bored. These pains are most terrible during the night. Upon those pavts where the skin is near the bone, as the forehead, or shin, syphilitic nodes or tumors often appear, which are hard, like cancerous iumors. Beside the above, there are the loss of the hair (alopecia), blindness, deafness, and various other mischiefs, resulting from syphilis which need not be described. Is the Constitutional Disease Coiiiinunicable ? — Many believe, — even among those who are eminent in the profession, — that the f^on- stitutional forms of the disease are not communicable. A few yefirs ago, indeed, this latter opinion wad generally received. It is row quite extensively doubted, or rather, disbelieved. Facts are con- stantly occurring under the eye of unprejudiced physicians, which make it very evident that the constitutional disease may be commu- nicated from one person to another. The Disease Hereditary. — It is no small amount of suffering, bodily and mental, which the individuals endure who contract this disease. But the inflictions visited upon them, severe as they are, are small, compared with the aggregate of ills entailed by it upon the long line of their posterity. Whether it be the man or the woman whom the syphilitic virus has inoculated, if it be allowed to be absorbed, so as to affect the constitution, it will be very likely to be sent down to the children, and children's children. The divine law which links the sins of the fathers with the sufferings of even the third and fourth generation, is nowhere more painfully illustrated than in the scourg- ing descent, through many generations, of this terrible disease. It may be passed down to posterity by either of the parents ; but if both be diseased, its transmission will be the more certain. If the mother be infected, she will infect the child while carrying it. If the father's constitution be poisoned, the child will receive the infec- tion from him, through the semen, and will be likely, while in the womb, to infect the mother. I recollect but one author of note i!.:ILl ^il l( '4l liAcase in ) delicate oldly on- rig of the an frame, omplaint. attacked. B nose, in le cheeks, the whole of almost •d in one ig painful, very mar- feeling is vere ' u ing I forehead, ! hard, like )f the hair 3, resulting believe, — it the ron- few years t is row are con- ans, which je comma- ring, bodily lis disease. are small, long line whom the rbed, so as own to the . links the and fourth the scourg- lisease. It Its; but if in. If the ing it. If the infec- hile in the or of note (Ram^botham) who has mentioned this mode of infection. I have myself seen two cases of it. This constitu ioiial disease, whether it exist in the mother, or be communicated lo the child, and thence to her, by an infected father, is a frequent cause of abortion. Throughout nature, blight is the re- sult of a diseased parentage. Mature fruit is seldom obtained from infected seed. Is the Constitutional Disease Curable? — No (lucstion connected with the complaint possetM!s a greater interest than this. None is pressed more earnestly upon the physician. In a certain sense the disease is curable. Its outward manifestation may be wholly re- pressed. The health of the person suffering from it may be restored, and become, in an important sense, good. But this eyre is never brought about by nature ; it maif be, and is often effected by medicine. I have never failed to effect such a cure in any case which has come under my treatment. Such results may properly, in general terms, be called cures. Yet there is a sense in which a cure never occurs. It is a well- attested fact, that a system once thoroughly pervaded by the poison, is never completely purged of it. It may be shorn of all its active malignancies ; but it has too intimately permeated the tissues and solid bones, to be wholly expelled. Pursue it as we will with the remedial forces of our art, it still takes refuge in the most subtle pro- cesses of animal life, — still infects the currents of being, and finds expression in the scrofula, in the lupus, and in the scaly atfections of other generations. Dr. Erasmus "Wilson, the great authority in skin diseases, says : " I feel convinced that a considerable proportion of those diseases which pass under the name of scrofula, are the produce of the syphilitic poison, — are, in fact, not scrofulous, but syphilitic." Astruc thought the same, and suggested, what is doubtless true, that the transmission of syphilis must occur through several generations before it becomes scrofula. Bierchn, Camper, Stoll, Portal, Hufeland, and Alibert, have all advocated the same opinion. This is doubtless right, though there are many authorities on the other side. He must be a poor observer who cannot discover a prob- able filial relationship of scrofula to syphilis. A variety of facts, admitted by the whole profession, go far towards demonstrating this relationship. Scrofula is always hereditary. It is a disease of the parent, imparted to the offspring. But there is scarcely any disease so certainly sent down to posterity as syphilis. Scrofula is like syphilis in many of its characteristics. It is like it in its power of propagating itself from parent to child. It is like it in affecting nearly all the children of diseased parents. It is like it in the variety oi the structures it attacks, — affecting the skin, the mucous membranes, the bones, etc. Like syphilis it produces nard tumors, ulcers of the skin, abscesses, and decaying of the bones. And finally, the great remedy for tertiary syphilis, iodide of potas- sium, is likewise the great remedy for scrofula ; and, indeed, almost every remedy which acts favorably upon one, is found useful for the I i ! '^ ' I f I '^tb i 32« VENEREAL Oil SEXUAL DISEASES. other. This could hardly occur were not the diseases identical in nature. We can scarcely be surprised that u disease so widely diffused as scrofula should be the product of syphilis, when we reflect how fright- fully [^""evalent were the causes of this latter affection during the earlier and liie middle ages of the world. To pass over the records of earlier times, with merely mentioning Abraham, and Lot, and Jacob, and Reuben, and Samson, and David, and Solomon, and numerous females, of whom some singular things are written in the elder scriptures, mvl omitting all mention of the incredible and almost miiversal debauciery and prostitution of Greece, and Rome, and Persia, and Media, and Egypt, I may say that Europe, in the middle ages, was loeU-nigh converted into a vast broth' l. Foremost in the race of profligacy, were the priests, bishops, kings, and emperors. The licentiousness of Childeric knew no bounds. He carried off and violated the wives and daughters of his vassals, with- out regard to any right, human or divine. His successors were gen- erally a race of lecherous men, who spread debauchery on every hand. The French monarchs, from Pepin and Charlemagne, were a race of debauchees. Their courts were national brothels, in which the finest women in the land were trained in the arts of seducrion and lust. Francis L. in 1515, endeavored to invest prostitution with elegance and chivalry, and even to ennoble it, by abandoning the public women of the palace to his subaltern orticers, and subsrituting for them, ladies of noble blood. In this movement, the nobles and the clergy gave the king their support. The right of sleeping with their female vassals the first night after marriage was ndigiously insisted on by bishops and abbes, as high barons, and exercised as their privi- lege. The inferior clergy were content to haunt the taverns ar.d stews, and the monks paid their pimps with the wealth of the church. The grand vicar, in some dioceses, sold indulgences to rommit adul- tery for a year ; in others, a cask of wine j)aid for the right of forni- cation for a lifetime. Brantome justifies Francis in his selection of girls of noble blood, on th(^ ground that " they could not communicate the venereal dis- ease to the noblemen of the courts, like the common prostitutes.' But the king, who was previously diseased, infected them ; and these noble women, so called, passing from the arms of the prince to those of the courtiers, presented to them the fatal infection received from the king. The way in which Francis himself was infectefl, illustrates, in a most shocking manner, tl'.e moiuln of the times. Mis illicit loves v.jtli the Belle Ferronit^re, wer*^ not (concealed from her husband, who, though obliged, outwardly, to regard the dalliance of iiis wife with the monarch as an honor, was inwardly indignant, and determined to become infected himself, and thus disease liis wife, and revenge himself upon tlu? king. Th'-' ,)lan was suggeated to him by a monk, who had another motive, namely, that of punishijig Francis for his liberality to the Lutheraiis. " How," said the husband, when the ^irwf dentical in diffused as how fright- during the Bentioning msoii, and lie singular .11 mention )roHtitution ('pt, I may rieil into a lopa, kings, )unds. He Sisals, witli- . were gen- :very hand. e a race of 1 the tinewt 1 and lust, h elegaiuie the public ituting for >s and the with their ly insisted their privi- verns aiicl he church, unit adul- it of forni- )ble blood, iiereal Jis- •ostitutea. ' and these e to those ^ived frotu rates, in a OV«'H ^Vlth iJiid. v.'lio, wife witli erermined d revenge y a monk, cis for his when the VENEREAL OU SEXUAL DISEASES. 327 suggestion was made, " shall I give this disease to my wife, when we are both sound?" " Go visit an infected girl," said the monk, "and to render the matter certain, as I am inftjted, I will see your unfaithful wife." The result was such as the husband desired ; and in 1547, Francis I., t'le gay and chivalric monarch, perished of the most foul and loathsome of all fliseases. Debauchery did not die with him. It was cherished by his succes- sor, Charles IX., and his mother, Catherine de Medicis, and his grand- son, Henry HI. The reigns of Henry IV., Louis XIII., Louis XIV.. the Regency, and of Louis XV., were stained by the same licentious- ness and disregard of public decency, until the whirlwind of the revo- lution came to purify the moral atmosphere. The reader will now, I think, be in no mood to wonder that the kings and queens of Europe, and the whole royal progeny, whether the dishonored occupants of thrones, or the moi*e private recipients of the public bounty, are a scrofulous and degenerating race. Nor need it be much wondered at, that so large a portion of men and women everywhere have more or less scrofula in their frames. Happy are those who can find no trace of this complaint in their constitu- tion! They should rise up and call their virtuous progenitors blessed. They should especially thank God that they have sprung from the loins of a race more noble and kingly in the eyes of Heaven than all the royal lines of all Europe. Ti'eatmeiit of Syphilis. — In the treatment of this disease, the first thing which requires attention is the pimple, pustule, or sore. This irust be instantly touched with caustic. There should be no delay, ior if the sore be not syphilitic, the caustic will do no harm ; and if it be, the most terrible results may be averted. The general b«;lief is that poison remains in the sore for a time before it is absorbed into the constitution. It is of the utmost importance that it be destroyed before the absorption takes place. The caustics used are nitrate of silver (stick nitrate), nitric acid, chloride of zinc, potassa with lime, caustic potassa, and the painless caustic. The nitrate of silver is much used, but the best surgeons now re- gard it as useless. It does not prevent the absorption of the poison. The caustic potassa, the potassa with lime, and the painless caustic, are the sure remedies, — that is, if applied in season. But they must be employed with caution. It will not do to trust them in bungling liands. A little vinegar and water must l)e immediately used to neu- tralize the caustic when it has accomplished what we desire. After the sore is cauterized, a piece of lint, dipped in a solution of watery extract of opium, one dram to four ounces, should be laid on it ; and the organ inv. J J* C ^-' ;-< 1 ^^, w Ri^4 m^ a tablespoonful of (20). In some cases, a piece of lint, wet with the tincture of muriate of iron, diluted and kept upon the chancre, will cause it to heal kindly, and with safety to the patient. If this treatment be adopted early and properly^ the patient is cured, and nothing further is needed. But time is generally lost. The poi- son is absorbed before the patient is seen by the physician ; and the .juestion then is, how it is to be driven out. To accomplish this, the diet should be regular and unstimulating ; alcoholic drinks and tobacco should be forbidden ; the mind should be kept at rest ; a cold or tepid bath should be taken daily ; the ac- tion of the bowels and kidneys should be kept properly regulated. These things will put all the expelling agencies in proper condition for work ; and no single medicine will put them all into action like mercury. For this reason, no other single drug has enjoyed a repu- tation for curing pox so wide as this. But it must be used with judgment. No remedy is more safe, if judiciously employed, or more destructive, if abused. The profuse and ill-considered way in which it was used in former times, raised a prejudice against it, which is unreasonably cherished at the present day. Abuse made mercury a cur^e; judicious use makes it a blessing, -—at least in this disease. The blue pill is one of the best forms of it (148)^ combined with extract of henbane. One pill at night is the usual amount to be taken. Some prefer the mercury with chalk (149) ; others, the corro- sive sublimate (150) ; others, the proto-iodide of mercury (136). Some one of these should be given about five days, in the doses named under the recipes, — being careful not to produce salivation. After the fourth or fifth day, we can generally inerease the frequency of the dose. Should salivation be accidentally induced, it should be arrested l:)y a solution of chlorinated soda (205), one part to twelve of water. The mercurial treatment should continue for a week after the sore has disappeared ; and in the case of the indurated sore, as long as there is any hardness. Water should be taken freely, and various diluent drinks. They wash the poison out through the millions of avenues, called pores, just as we wash filth out of cities by pouring water into the sewers. Recently, Rieord, the great French authority on tliis subject, has introduced a new treattnent of syphilis by iron. One part of the potassio-tartrate of iron is dissolved in six parts of water, and two teaspoonfuls are given three times a day. The same solution is ap- plied to the external sore or chancre. Rieord says that no secondary symptoms have been known to occur after this treatment. The Lon- doa Lancet sanctions this treatment as being capable of doing all that Rieord claims. Should its success prove equally great in this country, it will take rank among the greatest gifts to the profession. I sincerely hope that in a future edition . of this book, a full trial of the remecly on this side of the Atlantic will permit me to record such success. I should mention that there are those who claim to cure the disease with other remedies, without mercury, and I am not disposed to be ni J-vS vith the ' ere, will .0 #^ f.^r^ ~''':it'.*».x; . ,:o4**. .^•^ tv^,-. 1 I "*^'.> **3 „* _-#' „4iC^' ■ ^' ^f ^''Sfe .- ... ((f* "-''!*???'i3?'2.!^i" S*** W ' h'j A^' ',vi^ VT.''TF;KliA!. UK SL^i'AL DISKASKS. .'nufnl i>f »!^), In wme ciisef, a piece of Jint, v.'( > ;^ '^" ol" rrtnr»ui-e t»f \xov..^ dilutrd antl kt-pt upon Ihc chiK!*::- ;t to henj ' udlv, and with .•^afcty to tiif patient. '.'=} tr«;iiaa«'nt be adupti d tarlij a»>d properlij, Hj»' putit-nt »» v ??•*«*. f.iMl nothi'-rT fu rrhi*- is jie«^dt'd. But tirne is g'Micrally Jo^t. 'i\ •otj ift ai».*;'rt:>td iw-ibro the patient i^ st mi by the phy!*i«;iaa; ^Vm -. •4uc'.*t,i»>n tb<'ti is, how it i--- to ini driven out, 'A» ac-.-Drnplirth this, the diet should hr rpgular and ^ln^li^itna^?^»^j; , aKX'!i()hf. drinks and Uih',\oi<) .-hoiild !>p furhitldpu : the mmu .-i.-ti/-;' b«> iitjpt at H'at; a <'«)id or tepid hath ^h'-.rdd be taken daily. U -r. ■■ tion of fh<' howeln aud kidneys !?h:'Uld be kept proptrly rei^ui^t usa. Tlie.H tiiiiigs will pnt ViW th« «»rpelit>j«; f^gtMiric?* in proper *orhiiiMt«» fur work ; nud no tjM;!;ic medit-rif v-. il! j>ut them all into actioij lik« nificnrv. For this rt-anop. mo uitwr tsinglu diug hasi «^nji)yeprit. No rrrriPtly is more «(rtf . i* jn(1i«iou;^-v '^^'MipMr,* d, r nj!'-: ■f*-'Htrue.tivc. if uhu.-..i!ig. -- «t kMsr in thi/- dt"?aii^:. Th'j W(w» piU i» •uu'of the best forrn^^ of it (I 'S), couibined with exlfnis of h»>nbane. ("5^' pdl at niyht i--- the ii-^uai aaiount to t>e take.!. Borne prtfor die mercury with ehalk {i4M); others, the corro- sive subiir'.atc {ioO] ; others, the proto-iodide of mereury ( VM). Some one of Uiese shonlfl be :jiv(;n abon. five days, in the di>ses named under the reeipes, — ••bt-ing e-irefnl not to produce salivaiton. Alter the ^oarth or liftli day, w»^ .dti generally increarte the frequency of th»? dof'\ ShouJd ^iiUvation be aeeidetitt\llv induced, it should t>t; arre:«f VVater sh.iutd be taker fntly. arwl various ililueni drinkH. They v.'tisjj the poison out througli tite iHiUionii of avenues*, called pore*, just a-> we was!; ftlUi out of eittes by |^)Ufirts» wat-r uito 'lie Mons tbi? treatment :i^ b«'?)g eapabl-' '^f doinf i ■ .;(ifns. Should its Himens prf-vn equally great in ' n > ill take rank among the «^«^ate«t. gifts to th« protee^j" ■pc !: in cf (hi'» book, a full U' :<*) i;- . .id ' o\ th. ■ Atl ) ■ ■■ '< 'It, P'Tllll \. r-Ae to reo>M ' • 8u. I sho^ fii. it th er "* *.^ ■'ho » t ^ pvr ■• !:rv. If •1 ' un •lot di , lU-et' , . . . .. .-!•'>■ imn V 1.^ PI 6. ^ 1 1 In 1 f 1 i 1 if I VENEREAL OR SEXUAL DISEASES. 829 dogmatical, and say it cannot be done. For this purpose, perhaps as good a recipe as has been proposed, is the compound'syrup of stillin* gia, tincture of poke root, tincture of sheep laurel, each four ounces^ mixed ; of which, from a teaspoonful to half a tablespoonful is to taken three times a day. I think well of this remedy, especially if it be in connection with a small amount of mercury. The Bnbo, if not attended with pain, may be treated with compres- sion ; by a piece of plaster of ammoniac with mercury ; or by touch- ing it with nitrate of silver. Should there be inflammation, and the formation of matter be inevitable, the bubo should be opened by touching it with the caustic potassa ; and the resulting sore must be treated with the solution of opium and water dressing. Should the sore need stimulating, it may be touched lightly with nitrate of silver. Eruptions upon the Skin. — In treating the disease after it appears upon the skin, etc., we shall derive great advantage from the use of either the warm or the vapor bath once a day. With this, if the case be not very old, we may employ (148) or (150) ; but if the disease be an old one, showing itself in the throat, or attacking the bones of the face, we must give iodide of potassium (138), combined with com- pound decoction of sarsaparilla. This is the great remedy for tertiary syphilis ; but when the case is obstinate, it may sometimes be discon- tinued, and the corrosive sublimate (139) be substituted for it. It is to be observed that the older the disease grows, and the more chronic its character, the more does mercury lose its control of it In the first attack, the blue pill is the best ; in the second, as a gen- eral thing, the iodide or the biniodide of mercury ; in tiie third, the corrosive sublimate ; in the attacks, subsequent to this, particularly in the tertiary form of the disease, the iodide of potassium. When the throat and nose are so ulcerated as to make a case absolutely terrible to contemplate, it is surprising to see how rapidly the recovery will often take place under the influence of this latter remedy. For syphilitic iritis, apply frictions twice a day on the eyelids and eyebrows with ointment (172) (173) ; and admi..-:ter internally two pills of (136), daily. Case I. from the - Mr. — State of -, aged sixty, was sent to me by his physician, . He had deep and extensive ulcers in the upper cavity of the throat, extending to the tonsils, and to the arch of the palate. Swallowing had become very difficult, and much fear was felt both by the patient and by his physician, that death would follow at no distant day, from absolute inability to swallow at all. The ulcers had the peculiar yellow color which so clearly marks these sores. I informed him that his disease was tertiary syphilis. lie said he had once had the disease, many years before, but had sup- posed himself cured. The letter brought me from his physician, a most respectable man, shovved that he also had no suspicion of tlie real nature of the complaint. This case is well represented by Platk VI., Fig. 1. St , - * < 1.1 . Ati sso VENEREAL OR SEXUAL DISEASES. I put this patient upon a preparation of iodide of potassium, and several other articles, which I keep on hand, and syringed his throat once a day, with a weak solution of the acid nitrate of mercury (226), and in one week, he swallowed his food easily. In three weeks, he went home, his throat was nearly well, and his bodily health, which had been much shattered, restored. His physician, much astonished at his altered condition, wrote immediately to know what I had done for him. This patient, though in humble circumstances, has ever since, sent me an annual present, which, though not of great value, is highly prized by me as evincing a gratitude not forgetml of peculiar benents. Case II. — In the summer of 1856, a gentleman of distinction came to me from a distant state ; and, being so much reduced as to make it doubtful whether he would ever reach Boston, he brought his family physician with him to render him assistance on the journey in case of possible emergency. His voice was reduced very nearly to a whisper. I found a breach through the palatine arch, and considerable ulceration in the back of the pharynx, though not as much as is represented in Plate VI., Fig. 1. He was harassed with a cough, and his flesh and strength were so far reduced that his high official duties had been fo*- some time laid aside. He was supposed by his friends to be verging tow- ards the last stages of consumption ; and their consent was gained for his journeying to Boston, only because, as they supposed, no hope opened to him in any other direction. My pronouncing it a case of tertiary syphilis surprised the very excellent physician who came with him, and who failed to recognize the nature of the complaint only because he had not been accustomed to seeing cases of the kind. The disease was of eighteen years stand- ing, — being the lingering constitutio"il result of a case of g-oforrhcBa (and I have seen several such resul* of gonorrhoea, whatever Ricord may say to the contrary), contractet in a single lapse from virtue in early manhood. The treatment was almost identical with that in Case I., except that tonics, — particularly some of the preparations of iron, — were required to bring up the strength. The iodide of potassium showed its usual specific power, and I had the pleasure to send the patient home in a tolerably good state of health. Case III. — One of the worst cases I have ever treated was pre- sented in the person of Mr. , who came from a considerable dis- tance to consult me in reference to a badly ulcerated throat, for which all tried remedies had proved useless. The first glance at the throat, showed the ulceration tp ])e syphilitic. The uvula and the entire palatine arch were gone ; the ulceration had gone deep into the phar- ynx. These two circumstances made swallowing extremely difficult ; indeed, nothing could be swallowed, except the most bland liquids, and death by starvation was near at hand. No time was to be lost. I put the patient upon large doses of of VENEREAL OK SEXUAL DISEASES. •Ml iodide of potassium, with compound infusion of gentiiai'. and fluid extract of sarsaparillu, and showered the throat every other day with a weak solution of acid nitrate of mercury (226), and in ten days, tender beef steak was chewed and swallowed with comfort. This patient stayed in Boston six weeks, and went home with ten pounds more flesh than he brought with nim; and by using the above remedies six months, has regained excellent health. Plate VI., Fig. 2, is a representation of this throat as it appeared when it came under treatment. Fortunately, these cases, terribly destructive as they are. are almost always curable, if properly managcl Clap. — Gonorrhoea. — Blenorrhagia. The reader is aware that the nose, mouth, and lungs, are lined with a mucous membrane, which is liable to become inflamed from various causes. This inflammation we call a cold or catarrh. During its continuance, mucus, and other matters of different color and degrees of consistency, are more or less freely discharged. The nmcous membrane of the private parts of both sexes, iS just like that of the mouth and throat, and subject to similar inflamma- tions and discharges. But these inflammations of the private parts, instead of being produced by changes of weather, etc., generally result from the application of the specihc poison of gonorrhoea. When a woman abandons herself to unlimited intercourse with different men, the private parts become stimulated to so unnatural an extent, that the secretions of the parts, which are largely augmented, at length become altered in their nature, acrid, and finally poisonous, — so acrid and poisonous that they cause inflammation of the parts, and when applied to the male organ, in the sexual act, they poison and inflame that. This is the shortest and plainest explanation I can give of clap. From this explanation, one may learn why a man will sometimes take a disease from a woman who has never had any evidences of being diseased herself. If she have indulged her sexual propensities unreasonably, though not enough to produce inflammation upon herself, her secretions may yet have become acrid enough to poison one whose organs are delicate and sensitive. And more than this. The secretions of a female may become aCrid and poisonous from other causes than excessive venery. The discharges in bad cases of whites will sometimes irritate and inflame the male organ, and induce a disease which has evefy appearance of gonorrhoea. A husband, in great distress of mind, sometimes submits a case of this sort to the physician's inspection, and lays upon him the delicate and resix>n8ible duty of deciding whether the wife has been unfaithful. No act in a whole professional life can be more momentous than a decision of this sort. If a man be well skilled in his art, he may give an answer in such case, which shall dispel the most terrible apprehensions, and save the peace of a loving family. The poison when applied by a diseased person to the male or >'t. If!' ''-'• 'M ' 'i f , afl n ■ tn 1 ' f: #»- .'I female organs*, requires a certain time to produce its peculiar effect, — generally from three to eight days. SyiiiptomSi — The first symptom of the disease is uneasiness in the end of the penis, accompanied, generally, with a little redness, and difficulty in passing water. The color of the first dit^charge may be white or straw-colored. There is tenderness where the parts are retl. Scalding in passing water is sometimes, not always, present at first. This is the beginning, or first stage of clap. Now is the time to cure it easily. But, unfortunately, the physician seldom sees a cast> in this early stage. Before he is allowed to inspect it, the secoiui stage has generally appeared, which is known by violent scalding when water is passed, by chordee, or painful erections of the ponifi, and by an increased discharge of greenish matter often tinged with blood, and coming from much farther down the urethra, or water- passage. The matter sometimes comes from as far down as opposite the scrotum, or bag which holds the testicles. There is more or less pain in the loins and back. The whole body of the penis may be- come affected, and abscesses form. A third and more terrible stage of the disease begins when the in- flammation has reached the lowest part of the water-passage, just where it enters the bladder. Around this part of the passage, and lying upon the bladder, is a gland in size and >hape like the largest chestnut. It is called the prostate gland. On ther side of it, lie the receptacles of the semen, each of which sends s duct into the water- passage. When the inflammation extends through this gland, it irri- tates the neck of the bladder, and causes a distressing desire to pass water ; and from its proximity to the larger bowel, it sends its irrita- tion thither likewise, and impels a terrible effort to evacuate the the bowels, called tenesmus. It is the same awful feeling experienced in dysentery. Few things can be more terribie than these two dis- tressing feelings conjoined, — the desire to pass water and to empty the bowels. Racked with terrible pains, and awful tenesmic dis- tresses, and often with painful erections, the patient passes back and forth between the bed and stool, — often vowing, in the sincerity of his heart, that if he can but recover from this, he will never be caught again. The enlargement of this prostate gland may become chronic and permanent, and be the affliction of a man's life. Stricture. — One of the most troublesome and persistent conse- quences of gonorrhoea is a partial closing up of the water-pipe, at- tended generally by quite a serious obstruction to the passage of the water. It ia called stricture. The mucous membrane which lines this passage, being long inflamed, becomes thickened and less pliable or elastic. The tissues which lie underneath this membrane, also become swollen and hardened, and, pressing upon the water-passage, lessen it still further, — making the stricture more difficult of cure. In stricture, the stream of urine is altered in size, length, and force. Its course is changed, when the stricture is lateral. The stream is often flattened, like the blade of a pen-knife, or twisted like a gimlet, or forked, — one stream reaching beyond the other. Inconsequence I I ■^^HB m VENEREAL 01'. SEXUAL DISEASES. 333 of obstruction, the bladder is not entirely emptied, and the desire to urinate immediately returns, and is very urgent. Gleeti — Another very troublesome result of gonorrhcEa is ffleet, — a thin, colorless discharge, which persists, in a chronic form, after all active inflammation has subsided. It is very annoying, and very ob- stinate. It is often dependent on the altered condition of the mucous membrane occasioned by stricture. O^cliitiii. — Another very severe result of clap is swelling of the tt sticles, called orchitis. It begins frecpiently with cliills and fevor, with a feeling of weight in the sirotnin, and pains in the loins. The swelling rapidly increases, and reaches its height in from three to five days. Reside the above, there are still other mischiefs, which follow this disease, such as inflammation of the prostate gland, already described, of the bladder, and of the kidneys. In the female, gonorrhceal inflammation affects the external geni- tals called the vulva, the water-pipe, the vagina, and the neck of the womb. There is a difference of opinion as to whether gonorrhoea ever pro- duces secondary or const itntional sy'..,,>(onis. Ricord, the great French authority on this subject, affirms, and with him a great num- ber of followers, including most of the profession in this country, that constitutional syniptonis never follow clap ; that they never re- sult from anything but a sijpkililic ulcer. Vidal, a French authority, safer, in my jtidgment, than Ricord, though not as renowned, says, on I he contrary, that secondary and tertiary complaints do follow viru- lent gonorrhcea. "Wilson, the highest Euglish authority, and many others, agree with him. Unprejudiced observers feel well tionvinced that this latter opinion is right. I have myself seen not less than half a dozen cases of secondary and tertiary syphilis, which were preceded by gonorrhoea, and nothing more. Case I. was of this kind. Treatment — In the first stage of the disease, there are two meth- oda of treatment, either of which may be adopted with success. The first, which has many advocates, is the local treatment. An injection, with a glass syringe, is immediately made, of a solution of nitrate of silver, of the strength of five to ten grains to the ounce of water. It should be retained from one to five miimtes, by pressing the head of the penia between the thumb and finger. If doiie before the third day, this will generally cure the disease. The physician should have entire control of the patient, and com- pel him, if possible, to keep his room, and live for a few days on crackers and water, or something equally simple. All meats and atimulating drinks are to be excluded. The other mode of treatment, which is perhaps the more commonly adopted, ia more general in its nature. It embraces the use of warm baths, warm sweating drinks, and rest If the patient is full of blood, and strong, from five to fifteen leeches are applied to the space be- tween Hie scrotum and fundament.* These things, with a low diet, Hi ! 'fi' n it -i:i: ' I I K I i Mr »" 334 VENEREAL OR SEXUAL DISEASES. will frequently reduce the disease in a few days. If the discharge Hhould continue, after a fair trial of the above, then copaiba and eubebs (272) are to be used. Several articles are added in the above prescription, to make the copaiba acceptable to the stomach. This preparation can De takoi, by most persons, and generally produces very gratifying results. Vidal strongly reconuuends an electuary, or thick paste (273), of wliieh a piece twice as large as a nutmeg is to be taken in the eours«; of the day. The prescriptions wliicli contain copaiba and cubebs are numerous ; but the above two are as gotnl as a hundred. With these articles, the baths, the leeches, and the repose, are to be united. Vidal says he never resorts to injections first, but employs the anti- inflammatory course first. If that fail, then he uses the injection (207)^ three or four times a day; and if he employs the nitrate of silver at all, it is only as an astringent (208). Prescription (304) is a valuable injection. When the second stage sets in, and the symptoms become more violent, injections must not be used. For the very severe scalding in passing water, whicli is now felt, take thirty drops of a solution of potassa in half a tumblerful of water, twice or three times a day. Persons of full habit, may be benefited by dissolving a grain or two of tartar emetic in a tumbler of water, and taking to the extent of producing a little nausea. Relief is occasionally obtained by holding the penis for some time in warm water. For the painful ehordee, or erections, camphor and opium (120) are required, — from one to three pills a day. Thirty drops of laudanum may be given when the patient retires. Cold applications to the gen- ital organs, or walking barefooted upon the ci^ld lloor, will frequently give relief. WIhmi other things fail,- three })ills a day may be taken of extract of hyoscyamus, containing from one to four grains each. The quantity of drinks must be diminished, and cold lotions must be applied to the penis on going to bed, — the patient covering himself lightly. Gleet is generally very obstinate, and often requires a very pro- tracted treatment. If there be any tenderness along the under side of the penis, it is well to apply three or four leeches. Occasionally recipe (272) will have an excellent effect. But gleet is an unhealthy action, sustained by habit, and may often be cured by simply exciting a new action which shall break the old habit. It is always well, therefore, to resort to injections. Sugar of lead and sulphate of zinc (207) answer a good purpose; or sulphate of zinc and tannin ^209) may be tried. Chloride of zinc (210) does well in some obstinate cases. But gleet is often dependent on stricture, and when this is the case, we must learn the location of it by exploring the water-pipe with a bongie. When the instrument reaches the constricted part, the pa- tient feels pain, or tiie surgeon meets an obstruction, — often both. When the stricture is found, it is either to have the solid nitrate of silver applied to it with an instrument called the parte caustique^ or a VENEREAL OU SEXUAL DISEASES. 335 solution of nitrate of silver (211), or of acid nitrate of inorcury (226), with a shower syrinc(> which I have had prepared for the pur|)08e. When these means Tail, we must pass a srrall bongie gently through the stricture ; then a lurger, and then a still larger one, mitil the ol)- structlon be removed. They should Ix* ust'd once or twice a day, and not be retained long in the passage. They freciucntly have to ^te used ten or twelve weeks, and should not In? discontinued till the cure is complete. Put no coniidence in those quacks who promise to cure these old troubles in a few days. They want your money, 'Ut have no expectation or ability to cure you at all. For inflammation of the t*.'sticles, apply leeches at once. To this should be added warm fomentations, and poultices. If these means fail, more serious measures are to be adopted, which it would be out of place to describe in this book. Inflammation of the prostate gland is also to be treated with leeches and poultices, — likewise a warm hip-bath. The water must be drawn otf with a catheter until it can be passed in the natural way. Prevention of Sexual Disennei^. — I have several times been in doubt as to the best method of presenting some of the topics which the wide scope of this book has brought before me , but no one subject has perplexed me like the one announced in the above heading, — not that it is not easy enough to furnish the rules for preventing venereal disease, but that it is a grave (juestion in morals whether to instruct the world in the methods of such prevention is right. Is it proper to give any other advice than the simple direction to abstain from all liability to disease ? That is the question. If such advice would be heeded, of course no other should be given. But it would not. If the person disregarding it Would alone sufl'er the penalty of the trangression, it might then be best to embody the whole advice in the simple imperative word, abstain! But this can- not be. The infection will be imparted to a third |)crson, and onward to thousands ; and many of these thousands will be iimocent wives, who will perish of the disease, or send the infection down to the second, the third, the fourth, and to all generations ! While a strict morality might seem, therefore, at first view, to forbid the inculcation of rules for avoiding infection, the good of the race would appear to justify and require it The first requisite for prevention is cleanliness. Frequent washing is of prime importance. The precautions should not be the same before and after the vene- real act, when a person is about to expose himself to risk. Before the act, the parts should be carefully examined, to see if there be any break in the skin. The least breach in this covering of the penis greatly promotes contagion. Before coition, there should be no wash- ing with soap, for this deprives the parts of the mucus and oil, — thus rendering the naked and exposed skin liable to infection. On the contrary, to apply a solution of alum, tannin, or a decoction of oak bark, or aromatic wine, constringes or hardens the covering of the 336 VENEREAL OR SEXUAL DISEASEa ll m organ, and renders contagion more ditlicuit. An article called con- dom is often used to ward ort disease. It is a sack made of gold Lw^ater't* rtkin, and is drawn over the pt'nis like a glove over the finger, and tiius protects it from cf>ntact with jjoisonous matter. or stiii greater importance are prompt measures of prevention after the acL Ixuion? «hould b<' immediately applied to every part of the organ, and in the ease of females, should be U3«?d as injections. These lotions slionld be acids or alkalies. A mixture of vinej/ar and water h is been recommended as an exceUent wash. Record reeom- uu'IkIs aromatic wine ; Malapert, coiTosive sublimate ('212), in the form of -••oiution. ]*robably the l)est preventive is com|K)sed mainly of alcohol ami noap (213), as reconnnended by Langlelwrt. An expo.-.<(l person, n^ing any one of these solutions, particularly the last, or, m th«' absence of all these, washing thoroughly with soap and water, will be likely to escape contagion. 9l(Mli('iill l*oli<'t». — What is called general prophylaxis, or prevention, or medical |M)liee, is not a subject of legislation in this country. The moral sense of llie Amerieim people doi-s not admit its necessity. In Eurojx*, the autliorities walcli ov<'r prostitution. They even go so far as to regulate it. They appoint practitioners, wlu)se duty it m to act as a sort of medical poli<'e, and particularly to visit housci of prostitution once or rwice a wi-ek. and examine all the iraTiates. When a girl is found discaKcd, she is innnediafely removed to a hos- pital, and not \)ermitted to return until she is weli. hi'- !i Self- Pollution. — Masturhation. — Onanism. Tar, HE is probably no vice to which so many boys and young men, and even girls and younp; women, are addicted, and from which so many constitutions break down, as self-pollution. Suiall boy« and girls learn i\w vile practice of the larger ones at school, and generally continue it up to maturity, without the h.'ast suspicion that they are inflicting upon themselves either a moral or a physical injury. This comrs of the false modesty and b^istard morality which with- holds frt)m the young all knowledge of the pro|)er functions of their sexual organs, and of the ineon'.;eivable tnisehitf resulting from their abuse. A gentleman of distinction lately said to me : " \ ii.struct my boys as faithfully on ih' "subject as u|>on any other moral or physical question, and I t(;ll my wife it is her duty to do the sauie with the girls." This is w^ise. Yei, how few parents ever speak to their boys or girls on the subject, or give them the least reason to suppose there is any better rule for tiieir conduct than their own desires ! SjTWptcnis. — These are very numerous. The principal are, head- ache, wakefulness, restless nights, indolence, indisposition to study, melancholy. desjK)tKlenoy, forgetfulncss, weakness in the back and private organs, a lack of confidence in one's, own abilities, cowardice, mability to look another full in th«? face, and, among females, hysterics, whites, and a desirt; Ibr seclusion from society and solitude. r VENEREAL OR SEXUAL DISEASES. 337 ack and vartUce, lysterics, I have already spoken of the receptacles of semen, lying on each side of the prostate gland. From the fore part of these receptacles, the M>m(.>n passes through two duets, about a finger's breadth in length, into the urethra or water-pi|>e, just in front of the prostate. From excessive s(>lf-pollutioii, these ducts become very irritable, and also debilitated and relaxed, — so much so that they will not retain the s(>men ; and during lascivious dreams, it flows off. These semi- nal lossijs are called " nocturnal emissions." S<> constant is the drain tht!y keep up u|X)n many young men who have abused themselves exct!S!*ively, that the whole man, mentally, morally, and physically, lx*('oiiM'H ii v/nu'k. There are few objects njore pitiable to b<;hold than a young man in this condition, — his nervous system feeble, treiiiulous, and broken ; his memory weakened and fading out ; his eyr- UMt^teady and incapa'.'e of looking a friend in the face ; his loins and h\wk wj'akcned, givin-; aim the feeble gait of old age; his once en'ct form cowed ano bent; his high sense of manliness all oozed out of him ; his mind taking up and dropping th<' simplest threads of thouglit, losin^its way in the plairjest paths of reflection, and often starting back affrighted at the glimpse of chaotic insanity opening Ix'fore him, — turning here and there for relief, but finding little hope of recovery, excj'pt in marriage, and yet knowing himself unfitted to be the husband of an intelligent woman ! Tretltnieilt. — Every kind of treatment, no matter how judicious or well applied, will be uiisuceessful, unless the vice which has prmluced the disease? be absolutely and entirely abandoned. This is the first thing to be secured. It may be extremely difficult for the patient to do this, with bis mental and moral nature all broken and in ruins, — with no heart to feel, and will to execute ; and yet it must be done, or a cure cannot be eflV'(;ted. To bring this about, everything must be done by the physician to strengthen the moral nature of the patient, and to raise his self-respect and hope. The most careful directions nuist be given for restraining the imagination. The p;«tient must be directed and encouraged to drive out from the mind, instantly, and upon all occasions, every lascivious thought ; to cultivate the society of the most intellect- ual and virtuous females; to make himself 6M.vy with useful and, if [x>ssible, agreeable employment ; to avoid solitude ; and to sleep with some friend. He should sleep on a mattress, and never on feathers. Where there is considerable debility, tonics will be required, as the mineral acids ((iO) (62) (78), and bitters (77) (07) (Gti) (.09), and strychnine (83) (9rj) (8^j), and iron (80) (93) (72) (73) (71). In addi- tion to some of the above preparations, the syrup of the hypophos- phites should be taken ft)r some time. The food should be nutritious and easy of digrstion, and the cold alkaline spong*- bath should be taken once a day, with brisk rubbing; and the private parts should particularly be washed daily with ooid water. In conclusion, I say emphatically to parents, do not let your aoru 43 ^1 ! S38 VENEREAL QR SEXUAIi DISEASES. and daughters remain ignorant on this subject. It is plainly your duty to enlighten and to warn them. It is a matter in which young persons are generally disposed to do right, if rightly instructed, ^vqil yourself of your right to give counsel, and* if need be, to us«' authority. ainly your ich young instructed, be, to us«' iPfi FEMALE DISEASES. In addition to +he diseases common to both sexes, women are subject to a class of distressing complaints peculiar to themselves, and denominated, in general terms, female diseases. Involving con- siderations of a delicate nature, these complaints have too genemlly and too long been shut out from works intended for popular distribu- tion. Hence there is a general ignorance of a class of diseases which are fast imfitliiig woman for the high duty of continuing the race; and the subjects of these maladies are generally themselves so unin- formed of the true nature of their suflerings, that they are neither prepared to "^eck relief in the prop<'r direction, or to submit tt) the remedy, if it chance to be proposed. It is intended here to sp«'ak of these disorders, as I have done of all others, in a plain and simple way, to describe them, so far as the present state of medi(;ine permits, just as they are, and to make known the only modes of treatment which have been found available for their cure. The sutl'erings of woman recpiire this ; the interests of humanity recjuire it; and the writer is impelled to it, as he thinks, by a just sense of responsil)ility. Physicians, in my judgment, are chargeable with a great wrong in e4)ncealing • ithin their own breasts information U|K)n what are called delicat** sulje -ts, — information which the good of the worhi requires should Yh^ f'ivulged, and whieli they ought to pour into the public mind, and nkake common, and which they would thus |)opulari/e, but for their stiti' oride and conservaTlsm. The id«-d that our knowh-dge cannot be impart<'d to the world without injuring the public morals, is simply absurd. We are more a/raid of bringing the conunon people t(X) near to u.s, of letting down our dignity, and of o|X'ning our profound secreets to |Mipular eyes. The re.>hysieian.s a wide b«Tth, and to have; nothing to do with them, unless i»*-^*>.s.sity eoin|)els. Tict doctors .strip off their reserve, and while th«^y remain genilenien, become likewise companions, impart- ing their knowledge frrtdy and familiarly to all, and the public eon- fidence, now '/>nsiderubiy shaken, will be frankly restored to the pro- fession. It should be *hv obj< ct of a good physician to know all he can, and to irnptrt his knowledge to as many as |K>ssible. Knowledge is not H' m merely power ; it is happiness, it is wisdom, it is health, it is virtue ; yes, it is always virtue, except in some rare instancf^s, where the worst natures pervert it. No physicians are so much loved as those who are frank, and have no concealments. The day for mysterious nods of the head, and rollings of the eyes, and shrugs of the shoulder, has gone by. Men, and women too, (or those of them who are wise), wish to know distinctly what their diseases are, and what ia ueoe&> sary, not to palliate and prolong, but to cure them. Time wlipu Female Diiiea.se8 Begfin. — Female complaints begin to make their api>earance at the period of life called puberty, — the time when the girl passes from childhood to womanhood. This is the period when menstruation is established, which consists of a discharge from the genital organs, com|M)sed of blood and mucus, and which occurs, when regular, every four weeks. Up to this period, the system of reproduction has remained dormant- By the intervention of thb mysterious function, the young female becomes a new being. The heart unfolds itself to new emotions ; the mind assumes a solidity before unknown, and even the body acquires btsauty from a sudden rotundity of form. This is the jMiriod when the great question of fiMuale health is very apt to be settled once for all, and for life. The girl who is well trained at this time, generally has a foundation laid for health and character, which is worth more to her than riches. At no time does the mother need so much wisdom and knowledge as now. To es- tablish the health and develop the aflfections of tlie daughter at this ciitical period, is a sacn-id trust which she can devolve upon no other being; nor can she meet her responsibilities at this time, unless better informed than most mothers are. , The general apathy in regard to this maternal duty is deplorable. 4 False Delicacy. — The refined delicacy which withdraws these sub- jects from the public gaze, is commendable, for it casts a beautiful chann over s#x;iety ; but when carried so far as to spread a veil even over the eyes of mothers, it is quite unnatural, and leads to the wont results ;' for in the bad management of girls at this critical period is l:iid the foundation of many of the disea.ses which shatter the consti- tution of so many women. For this bad management, it is not mothers alone who are t« be blamed. The neglect of the medical profession t^i furnish the neoassary information should come in for its full shan; of reproaci'. Tlie liNtalilislinieiit of the Heiuifit. — Nature always comes slowly and by degrees to the inauguration or establishment of any of her great functions. It is «> in regard to meustruaisHi, or, as it is variously called, "the menses.* "the courses," "tli*» «*vMige," "the flowers, " nature," etc. Fur ?*>me time before tiw ik^ be;gins, there are cer- tain symptoms, or p»f monitions, whick t© tiie eve of the physician, plainly enough f'lretelt the i.npendNi|( el i ny . To the laothi^r the«e signs would be equally intiilligibii^ 'i wwe slie as well infoniHxl as she ■bould be. It is plainly her dut* «o be intelligent enough to assist virtue ; le worst ose who )us noda dcr, has e wise), a neoe»> begin to the time a is the idchargc d which i system II of thb ig. The solidity \ sudden h is very ) is well alth and iiie docs Toes- r at this no other !ss better regard to lese sub- jeautiful veil ev«n le wont period is e consti- it is not medical in for its IS slowly her great variously JUnvers, are oer- hysician, Wt the«»e I vi as she to assist f^ FKMALE DISEASES. 341 natnre in the establishment of this important function. Rut how often, either from ignorance, or from false ideas of delicacy, does she fail to interfere, and allow the daughter to be taken by surprise, and perhaps frightened and thrown into convulsions! From inquiries made of about one thousand women, a distin- guished English physician found that about one quarter were unpre- pared for the appearance of the menses. Some of the girls were frightened and went into hysterical fits ; others thought they were wounded, and washed with cold water. The flow was stopped in several cases ; and in some, never restored ; while the health of all in whom it was interrupted, was seriously impaired. Symptoms of the First Menstmation. — A variety of symptoms pre> cede and foretell the first menstruation. Headache, dizziness, slug>- gishness of thought, and disposition to sleep; — these, occurring in a girl, may be taken as hints that the " change " is at hand. If to these be added pains in the back and lower limbs, the intimations will be still more significant At this time a girl loses a relish for the society of children ; she is apt to acquire a taste for solitude ; her temper becomes wayward and fretful ; her eyes acxjuire a peculiar lustre ; she becomes a sort of mystery to her friends and herself, — not her physical frame only; her whole character is changed. She is about stepping into a new life. Her emotions, thoughts, anticipations, retrospections, are all new to her, and her outward manifestations are new to her fr>*-tids. An in- telligent mother will not fail now to prepare her mind for the impor- tant event close at hand. Tlio Hfpe nt Which tliis chanfff ttikes pltice, depends very rrmch upon a variety of cirenm^faiuvs^ It occurs much earlier in warm than in cold climates. It is hastened by high livinjif; b) the whir!, and bustle, and exciteiiietit of city life ; by reading novels which are full of love incidents; by attending l)alls, \heutres. and parties; and by mingling much in the society of gentlemen. Early UleiistnDititHi not Hesirxhle. — It is a law both in animal and VI ^j^table lil'e, that the later th»' periml at which marurity is warhed, the greater th«' st)li(lity i tlu' body, and the longer it livj's. liiris who menstruate early, tlo so becaus<» the body if< weakened l)\ clmnate or luxury, and the nervous system ufiduly «ievelop>miiiihtKKl. hav«- tinner constitutions, enjoy better health, and live lonpT. Those riiothcrs, t her lore, com- mit great errors, who an' anxious and A«lminister 'M'oreing i.ediemes,'* becaus(> their daughters do not menstruate at foorteeu or 'itieen. If girls are sutlering tVom no special ill health, no a: i * need be felt if "the custom of women" tlo not cohk; to tti'-r' \\ ,iX'' <»f eighteen, or even twenty. The delay should r\i\ lai ulness rather than regret. It shows that the constitution ha^ not in it the seeds of eartv dissolution ; that it is lortifyinir itself againsi future disease. Girls who ctime thus tardily to maturity, are much nu*re "fr^ukir" in after life. They bear children with fewer accidents, and are af- *^ ^ *^'- mi: m^ a42 FEMALE DISEASES. flicted much leas with female diseases. The duty of mothers is plain; it is to bring their daughters forward as late as possible, by refusing their early aamission to society, by withdrawing from them all excit- ing reading, by prohibiting their early attendance at concerts and theatrical entertainments, by prescribing for them the most unstimu- lating diet, and by requiring a large amount of exercise in the open air. A wide investigation has shown that the first menstruation occurs, in hot climates, at the average age of thirteen years and nineteen hundredths ; in temperate regions, at fourteen years and seventy-four hundri^dths ; in cold latitudes, at sixtc?en years and fifty-three hun- dredths. Und(?r the hot-house culture of modern society, and espec- ially among the wealthy classes, where indolence, luxury, and excite- ment, unite to weaken the constitution, this change is constantly occurring at a more tender age. How Femtile Diseases are Induced. — AH living things have their origin in fferms. The germ from which the higher animals spring, man included, is an ovum, or eg-g: Every animal and every vegetable is provided with an organ for the production of germs. In woman, this organ is called ovary. There are two ovaries, about half an inch in length, — one lying on each side of the womb, to which they are attached by ligaments, or cords. The ovarian btKlies contain vast numbers of vesicles, or cells, or eggs, whii^h are the true germs of human life, and the only sources from which it can spring. Between the ages of fourteen and forty-five (s^ieaking in general terms), every healthy woman matures and dejMisits an ovum once in twenty-eight days. This vesicle, some time bt^fore the monthly flow, begins to germinate and swell, and after a time, like a grain of wheat in the eartli, it bursts its covering, and springs forth. It then passes through what is called the fallopian tube into the womb, whence it is cast o^. During the swelling and bursting of this vesicle or germ, the ves- sels «f the ovaries, and womb, and, particularly, of the membrane lining the womb and its neck, are so crowded with blood as to pro- duce in th«' parts a state of congestion. If the parts be examined with a Mp<'culuin at this time, they will be found red, sensitive, and almost indaiiu'd. So great is this congestion, that the woman often compliiiiis of pain in the ovaries and the womb, — and a general sens*' of liciit, aching, and dragging down in the lower part of the bowels. The pain often* extends to the back, the groins, and the thighs. This ronditioii llepented Everj' .fioiitli. — When we consider that thifc stati^ of things is n'pcated every four weeks, and that the con- gested or c'-owded state of the vessi^ls begins some days before the monthly How, and lasts, in all, some ten days, making about one third part of every month, we need not wonder that inHammation so often supervenes, with all its attendant ill health and suHerings. Iiirreased hy Various faiises. — If we reflect, further, that this con- >. 't' m la ■\ FEMALE DISEASES. ^43 g(>iiio <.r» rach si^Ic of tW Pig. \'M givfir weiy (iK-a «»i i,|if:.o, or^iUU- A,]i« ihf! Ixxly of tli pvor ^r , iJ, tir^ neck '■<( the •.'■uiit! (.', t\ £h<: voci;; i : !'),*»»( of th» «.>vrtr"'# ; J'\ F, tht lalkipia.] tuix-H ; K, li, jIm* HtahriattMi < \ir«(n^ liPH G, 111 • 8m»JI iigiijiio'H a(tiu:hini? tbo ;iinl»natt'f tlic woiat' i«4 u ' Mni|/;iii .i\», Iv :>n di!».>r .niri i? ««' , •..vh»-iJ feiii.»ii'- sifk r* hrf for Mliifea, for painful ir>eii- aiTrujitJ<>ii, tiif HiopjUi^' of '.bi. MH-nf«€!», *»r I'V^n . >r vha ''I'y nup;>o!*i' i<^ he ftt!litig^'.>f th« v»o«i'. J. ■••af'"fu) jwf)!' ij(rtti i iji K< i-'d.v itf fwi'keU 'irdamniaitjiiiiit i«t of ni).'..(lu(r uli:<'r«'i ? The wfutf. , «i h'>y t'otihnnc, ^vitluuil i»i- U':nni»wK)i». f •>!!■{ ■■'■{ • MK-auti'tm} i'ow lo aii'ulu') tn- ninoHi Hlw;»yH \w 'iMiit of ot«. o'' l^K"^'«.• coiKli-ioi.'f- 'jf ♦!v uteiuu'' itt*<'k- il vouli! 'iumfO itiOr> p» f*'..t(» 4 rj» of i\\i mi^riivil profes'siiJn. 'tw! .-...iiy pnvi'i* tail-, 'v« ! i»<',u iio«,v )ari»'' a p<>|K>rrnau, an-l ^.• f)lcti'!y Khnttti- her •.*o:i:"^ii!itioi), arc 'I'lu-mli'i't U»r Anh «:>!;«'- i <; (tJpKiii a (-itoplf lot.-,)' jiiHcii!iniati'iij, ciihir i.i ilii? luci: of *.k<' »v -us, nr in one or bufh of l!.." ov.iries. M' liy ;i fei\in!e h,iH Uf yf. « HUKeml agorii«s pfrrater iliaii tho'-.* of tlcatli lU-tOf, ari.<' (•?, •» «hiii *:« iu(la» hI f[M>t ■^liicb .rnnild J>e covon-d by th*" ir.fll u'' tho liiigtrr. iH'^\ I'iifo of S>urlUiMr tU-rmt DisttwM. - - T!»<^ tn<-t;< xtatHd ai>i>» liavt) \h 'n hot. a xhirt ii.';** lut'.nvii l.o iukSu ivi ini ii : aiKl to kr?i>; {iU!Jit?«"rK of ^he ori,>ir^«Kion, nrv r.jti!l unkdowo. Tin- rnueion Is, thh' v<-ry ••*ru w abmtJuU^ ■lavf, «,totHl irr th« ■?:\\' of ^'•. »i!}iug the di.sr';t.v*. of V.'«>. ('•'^ Tb«> iJ'wltions which wcrr. not pr(>fi«re, tiw-rupBtoiiiily senftitlvc lo!*t it' k<.- 'vid H«ll ail intrn'tf'ppir.g ■"/•I'l'm delicute incio*^ Iwr*' (' timfc;* past. jni-takfJi ili* t o ■ '• bv iiii«iutfrnr<-^ti*>. iC i)*«ii'-st dtniciu-y. V, >« ! t/>f»niiiiUniv »ot linl<'licatet- - Bii,l4ly vW-ved, no i-Kp ,u UP' indrlicatt' whiiMi a J"' t:r-Hf«r.5*ary to a fall n ' 'i^, li' ' , ,,vfur<^ of clitoii-*', nci ^.^bicin An: nrjtidc. with 'ivj \ V IMAGE EVALUATION TEST TARGET (MT-3) k A / Va 4e. 1.0 I.I 11.25 IM Hi £f ijj U. ■ 1.6 7 Sdehces Corporation 23 WIST MAIN STREET WEBSTER, N.Y. 14580 (716) 872-4503 .A* %> 6^ I 4 ■ r Ml If 'J ».' ft''' »it iWi •m FEMALE DISEASES. 345 sole purpose of rendering its cure possible. I agree with Dr. Meigs^ the eider, that the delicacy or indelicacy of examining the persons of females for the purpose of exploring disease, depends on the motive with which it is done. To pure-minded persons, it is never, I think, a source of impurity. On the contrary, the self-restraint, the honorable feeling, and the nice sense of delicacy which it calls into exercise^ oflen heighten the tone of a man's virtue, and certainly increase a true woman's respect for it. Unfortunately there is now and then a gross- minded man in the profession, who, in these investigations, will vio- late the most sacred of all trusts committed to his hands ; but such monsters, — few in number, — soon find their level, and are shunned as the most vile of the race. It is now so well understood that these investigations do not lead to imr^oralities, that the most highly ec'acated, intelligent, refined, and virtuous females, almost invariably raise the fewest objections to such examinations as a physician of character may propose. Hethods of Investi^tln^ Female Diseases. — The symptoms of these complaints will be spoken of in their proper place, as the several diseases come under a brief review. I merely wish to allude here to the methods of physical exploration which modern practice has called to its aid. The Toncli. — These methods consist, first, of what is called the touch, which is made either externally upon the bowels, or inter- nally, with the index finger, through the vagina, or passage from the external genital organs to the neck of the womb. The Speculum. — In the second place, of ocular inspection of the vagina and neck of the uterus, through an instrument called the spec- ulum. By this instrument, the eye, as well as the finger, is made to assist in learning the real condition of the parts. The finger informs us whether there is any deviation from nature in the bulk, the firmness, the smoothness, or the sensibility of the parts ; while the siffht, through the speculum, affords absolute cer- tainty as to whether the parts are suflfering from inflammation, ulcer- ation, abrasion, or eruption. The following is the best form of spec- ulum yet used. » Fio. 185 The end is so shaped as to catch the neck of the womb, and then by drawing the instrument forward slightly, the diseased surface is ptesented for as perfect inspection as if located externally. :s^ 11 h « f; ■.IH- ?.. IT r 846 FEMALE DISEASES. Inflammation, Ulceration, and Enlargement of the Neck of the Womb. Inflammation of the neck of the uterus is very common ; ulcera- tion and permanent enlargement (technically called hypertrophy), are its results, when it is not arrested in due time. These affections, in fact, and the same troubles rm they affect the ovaries, make up the bulk of female diseases, — being the real causes of the most of thoee symptoms which have passed under the name of whites, suppression, painful menstruation, sterility, general debility, etc. The neck of the womb, when healthy, is soft and smooth. No hardness or condensation of tissue can be felt by the finger, on press- ing over it. It is elastic, too, and feels unctuous to the touch. This latter sensation is communicated by the layer of mucus which covers it. Pressure upon it produces no pain. Platk VII., Fig. 1, is a fine specimen of the size, shape, color, and appearance of a healthy womb. Inffammation, when found in this part, may begin in the mucous membrane which covers the neck, or in that which lines its cavity, or in the small glands in the body of the organ. Symptoms. — Inflammation of the mucous membrane covering the neck of the uterus, destroys the unctuous feel which it has in health. It also causes the neck to swell, its vessels being crowded full of blood. If the body of the organ, as well as the surface, be. reachcAi 6y the inflammation, it will be hardened, as well as enlarged; and in consequence of its increased weight, it is apt to drop down somewhat into the cavity of the vagina. In married ladies, it is often, by physi- cal prcvssure, pushed a littk; backward, or retroverted. Examination with the speculum, shows the inflamed neck to be of a vivid red, instead of a pale rose-color. It may be covered with red or white pimples, which are glands enlarged with muco-pus. In the healthy state, the mouth of the womb is so much closed as to be just perceptible when the finger passes over it. Inflammation causes it to be more or less open, and its lips to be parted. Inflammation Followed by Ulceration. — In a majority of cases, in- flammation of the neck of the womb and of its cavity, is soon fol- lowed by ulceration, which generally appears first around the mouth, and just within the cavity of the neck. From thence it spreads both inward and outward. Plate VII., Fig. 3, furnishes a good speci- men. Various Deg^rees of Ulceration, etc. — Of course ^ these inflamma- tions and ulcerations mix and run into each other in all possible forms, — presenting excoriations, or raw places ; granulations, or pim- ply surfaces ; ai.d indurations, or hardened parts. Sometimes these pimply patches will be red and hard, and again the whole surface will be spongy, and will bleed upon the slightest touch. In many cases, these ulcerations make wretched work with the of the ; ulcera- phy), are ctions, in e up the ; of those jpressioti, •oth. No on press- ch. Thia ich covers g. 1, is a a healthy B mucous cavity, or • irering the in health, pd full of e. reache-d d; and in somewhat by physi- amiiiation vivid red, or white closed as ammation cases, m- soon fol- he mouth, reads botli ood speci- inflamma- II possible IS, or pim- mes these arface will : with the FEMALE DISEASES. 347 mouth of the womb, eating deeply into the cavity, and giving it a ragged and unsightly appearance. Plate VIL, Fig. 4, may be talen as a sample. Velvety Feel from IJlceriitioii. — Ulceration generally gives to the surface on which it exists, a soft, velvety feel, which the finger gener- ally recognizes. This velvety sensation, with the open state of the mouth, are the most important evidences we can derive from the touch, of this form of disease. The Disehiir^e from these Ulcers is always Pus, or, in common language, matter. It is sometimes poured out scantily, at other times, very freely. It may be thick and yellow, or thin, and of a lighter color. The inflammatory and ulcerated condition of the neck of the womb, often gives rise to pain ; and when the seat of the disease has not been examined, as it should be, this pain has frequently been called neuralgia. In this way, ignorance has compelled neuralgia to stand sponsor for a great many pains with which it has had nothing to do. These Ulcers Disturb Menstniation. — Menstruation is generally changed, more or less, in its character, by the presence of inflamma- tion or ulceration in the neck of the womb. It usually becomes more painful. In some cases it is made more profuse, in others more scanty. It may come on more frequently, or it may be postponed, protracted, or abridged in its continuance. There is generally pain of a dull, aching kind, low down in the back. There is often a feeling of fui- ness, pain, and a sense of bearing down in the lower part of the bowels ; sometimes the pain extends to the groins and thighs. Eitensive Disturbances from the^^n^ Inflammatious, etc. — The nerves, with which the womb is liberally supplied, belong to those of the sympathetic system. Hence, the condition of the uterus influences a wide circle of sympathies. By these nerves this organ is brought into close relationship with the organs of animal life. If the former suf- fer, the latter suffers also. The stomach, being intimately connected with the womb, physically, feels keenly these inflammations and ulcerations of the uterine neck. At times, the pain, debility, general disturbance, and dyspeptic state of the stomach are such as to cheat both the doctor and the patient into the belief that this organ is the seat of the disease. But in such cases, the symptoms of stomach disease will all disappear the moment the local affection is removed from the neck of the womb. The liver, too, often participates in these troubles, and becomes sadly deranged. It is sometimes even greatly enlarged and congested, and patients frequently have the various symptoms of what are called liver complaints. Severe pains are sometimes felt under the breast bone, and over the chest generally, making the patient apprehensive of disease of the lungs ; and indeed consumption is not a very unfrequent result of uterine diseases. i. : ; Pains are often felt in the region of the heart, which organ is often harassed with palpitations. The flesh is apt to waste under the symptoms excited by these in- flammatory and ulcerative processes in the uterine neck ; and even the brain, though lying in some measure beyond the circle of influ- ences set in motion by the organic nerves, suffers dis^turbance ami pain. Even the special senses of sight and hearing may oe drawn into this general vortex, and both be much impaired. And to crown this catalogue of ills, it may be mentioned that those distressing things called hysterical fits, proceed from the same local disorders. In brief, there is scarce a point in the hunmn body to which these inflammatory and ulcerative conditions of the uterine neck may not send their sympathetic pains and aches, and where they may not in time induce real disease. This is the reason why so many women Buflering from these local complaints, tell the phyif cian, when consult- ing him, that they are " diseased all over." If asked where the com- plaint is located, thoy will answer — " It is everywhere." In the most <;arnest manner the assurance will be given — ^^ Doctor, there isn't any well part about me." \f ^ Treatment. — It is just as unreasonable and useless to treat these inflammations and ulcerations through the stomach, as it is an in- flamed or ulcerated throat. Thei/ are local diseases, affecting- a par- ticular part, and the remedy must be local. Like all other affections, these can only be managed intelligently after their nature is well understood. Nothing can really be done to- wards a cure, until it is known what the matter is ; and no competent physician will move a single step in jthe treatment of one of these cases, until he has made a thorough examination. He owes this to himself and to his patient, — the more so as the neck of the womb may be as easily examined as the upper part of the throat, and the local remedy may be almost as readily applied in the former case as in the latter. < If, upon the introduction of the speculum, the uterine neck be found simply inflamed and enlarged, the application of a strong solution of nitrate of silver, once in five or six days, will often prove sufficient to reduce both the inflammation and the swelling. If it should not, tho Bolid stick should be lightly applied. IJf thif* should not succeed (though it will in most cases) then introduce a speculum, and when tiie neck of the womb is fairly lodged in its extremity, drop in two or three leeches and allow the m to fill. If ulceration be present, the solid nitrate of silver must be applied to the ulcer once in five days. One who is not accustomed to treat these affections in this simple way, will at first be surprised at the rapidity with which the local trouble will disappear, and with it, the thousanu and one aches and pains which torment the whole body. As the terrible pains in the whole face and head, which are produced by a single tooth, all instantly come to an end when the tooth is extracted, 80 oo the bad feelings all over the body subside as fast as the local ;an is often >y these in- ; and even jle of influ- rbance and drawn into crown this sing things vhich these ■ck may not may not in any women len consult- •e the com- In the most re is n't any treat these it is an in- ;ting- a par- intelligently be done to- ) competent me of these )wes this to f the womb jat, and the ■mer case as • ck be found solution of sufficient to >uld not, the not succeed t, and when jp in two or le applied to o treat these the rapidity le thousanu dy. As the jduced by a is extracted, as the local ailments of the uterine neck are cured. There is no exception to this rule, except wher^ the sympathetic affection has become fixed by long neglect of the primary uterine disease. It is, therefore, surprising that so many excellent women, whose lives are of the greatest value to themselves anij friends, should be permitted to perish of these ail- ments, when the cure is so simple, and many times so entirely within the reach of the most ordinary skill. It is a reproach to the profes- sion which should be wiped away. If there are a hundred motives for gaining the mastery over other diseases, there are a thousand for learning to control these. More than any other disease, or all others, they make the homes of men desolate, by robbing them of woman, their ornament and solace. The physician who neglects to make himself acquainted with all there is to be known of these complaints, shows himself not only unfit for his profession, but deficient in some of the prime elements which combine to make a true man. Ilardeninjc of the Uterine Neck. — In many cases the uterine neck is not only inflamed and enlarged, it is indurated and hardened. At times, it is enlarged and hardened on one side, and not much on the other. In still other cases, there are enlarged spots, or nodes, giving the whole neck a knotty feel under the finger. These hardened conditions of the uterine neck proceed from vari- ous causes, and are more difficult to cure than the ordinary inflam- mation, or even tilceration. They sometimes indicate cancerous dis- ease, and then, of course, involve the most serious considerations. In nany of these cases, nitrate of silver fails to produce its usual effects. We then have to resort to the acid nitrate of mercury, or, as it is often called, Bennet's Caustic. No definite rules can be given as to the extent to which this article should be reduced. It is sometimes applied very strong, and immediately neutralized by the application of water. Uterine Syrlnj^. — For applying the several remedies to the inter- nal cavity of the uterine neck, I have contrived a silver syringe, which ia bent a little at the extremity, and pierced with fine holes all round. With this instrument, the remedy is carried directly to the di&sased part» and applied instantaneously to every side of the cavity. Beside these local applications, it is frequently necessary to resort to soothing or astringent injections into the. vagina, hip baths, and injections into the bowels, some mild physic, and rest in a horizontal* position. These matters will all be judiciously regulated by the at- tending physician, if he is master of his business. Case I. — Mrs. F. applied for relief from incessant bearing down, pains ir the back and hips; pressure upon the top of the head, palpi- tation of the heart, bad appetite, the whites, and a brick-colored de- posit in the urine, after standing a time. I made an examination, lind found the neck of the womb enlarged and ulcerated, as in Plats VIL, Fig. 4. There was no doubt as to the treatn*ent required. I applied the 1 1 1 i "f: I ".'■■ l>. solid nitrate of silver to the ulcerated surface once in five days, for three montlis, — at the same time, building up the health, which was much broken, by iron and other tonics (75) (63), by a generous diet, and by gentle exercise in a carriage. The appetite and general health came back, the whites and pains all disappeared, and the patient felt, as she said, " like a new being." Case II. — Mrs. C, the mother of two children, had t^utl'cred, sir/,e the birth of the second child, great pain low down in the bsick, with bearing down, and a distressing desire, a good part of the time, to pass water. She had a continual discharge from th(^ vagina, of fi cream-like matter, which very much reduced her strength. Besidn these symptoms she had pains everywhere, particularly in the head. An examination revealed that the neck of the womb was much enlarged and hardened, and badly ulcerated about the mouth. , (See Plate VII., Fig. 3.) Once in six days, the solid nitrate of silver was applied to the ulcerated surface. This was dene fire times, which caused the ulcer to heal, but did not reduce the size of the neck, or diminish its hard- ness. To effect these objects, I touched 'the whole hardened surface with acid nitrate of mercury, and immediately pressed upon the cauterized surface a sponge saturated with water. I re|}eated this twice, that the acid might not penetrate too deep. These operations were re- peated once a week, for six weeks, — thirty-drop doses of syrup of iodide of iron being given, in the mean time, three times a day, with a vegetable bitter and mineral acid (63). At the end of this time, the hardness had given way, and the uterine neck was brought down to near its ordinary size. The other symptoms disappeared, and the patient has had no return of her sufferir>gs. Inflammation, etc., of the Ovaries. — Ovaritis. The inflamed condition of the ovaries is indicated by increased heat, and pain upon pressure. The pain in the ovarian region is sometimes intermittent, sometimes constant, and occasionally passes down to the loins and thighs. There are acute and chronic inflammations of the organs ; but it will be sufficiently accurate, in a work of this kind, to treat of them as essentially one. The effects of inflammation upon the ovaries, as upon other bodies, are various, sometimes enlarging and hardening, at other times, col- lapsing and blasting them. This last effect, it is hardly necessary to s^y, cuts off* all hope of bearing children. The Causes of ovarian inflammation are numerous. One of the most important causes has already been noticed, namely, the conges- tion of the parts, for several* days, at every menslVual period. This, amounting as it does almost to inflammation, is often intensified by other causes, such as wetting the feet, taking sudden colds, excessive fatigab from dancing, and exuting drinks. days, for /hich was !rous diet, ind pains T being." •rt'd, sir/.e )!ifk, with L> time, to gina, of a Besidi' le head, vas much ith.. (See ed to the the ulcer h its hard- irface with cauterized twice, that s were re- ■ syrup of day, with 3 time, the t down to i, and the ritis. increased region is illy passes ins ; but it t of them ler bodies, times, col- cessary to )ne of the he conges- od. This, insified by Sexual indulgence oftjn proves a cause of inflammation in the i bodies. It is particularly apt to have this efll'ct in the uewly-marrK I female, with whom it is a novel stimulus, and often applied with in moderate excess. In late marriages, when the stimulus to the ovarii has long been denied, its sudden presentation is liabU; to make an in flammatory impression. Its entire absence, too, in persons of stror . passions, may result in ovarian disease. This inflammation may be produced by the new state of thing? existing at the critical period called the turn of life, when it reacts o . the womb, pu^Jucing the floodings which often bring menstruatio to a close. The congestion, too, which has been present every monti for many years, does not immediately cease at this change ; and nc finding relief by the accustomed flow, the ovarian bodies are expose ! to inflammation. In all large cities, the pest-houses of civilization, where the womcfy are more numerous than the men, there are many females whose vir« ginity is a burden, and numerous others who give themselves up to sexual excesses ; — to both these classes, the turn of life is very liabl to promote these ovarian disorders. There is another class of cau ^es, which, though not so easily re- cognized, are equally cogent in exciting this form of disease. I mear< all those excitements which arise from unbridled thoughts, from books; of questionable character, from music, social intercourse, and stimu- lating food and drinks, — all which promote and intensify burning desires, which, though natural and proper in themsislves, cannot law- fully be ^ratified in a community where the female sex greatly pre- ponderates, numerically, over the male. When we consider how powerful within a woman's breast the conflict often is between the impulse of passion and the dictates of duty, and how strongly this conflict must react upon the sexual organs, and especially upon the ovaries, the centre of the sexual system, we can easily see in how many cases they may becc"ie inflamed. Another cause of this disease is suppression of the menses. The engorged and crowded state of the vessels of the womb, of the ute- rine neck, and of the ovaries, not finding vent in the accustomed flow, inflammation in any one of these organs is a very natural result. The inflammation of these ovarian bodies is a frequent result, too, of a similar condition, previously existing in the neck of the womb. In passing from the uterine neck to the ovarian bodies, the infla:Tin.a- tory condition often fastens itself upon the broad ligament, the fallo- pian tubes, and their fimbriated extremities. (See Plate VIII., Figs. 1 and 2.) The whole, it will be seen, presents an amount of disease which it is painful to contemplate. ' The womb being turned over, and pressing against one of the ovaries, may cause it to inflame by mechanical irritation. Pessaries, injudiciously used, may do the same thing. Symptoms. — The first and most obvious symptom is a pain a little to ^e right or left of the womb. This pain is almost always increased by walking, riding, or by external pressure. It is especially augmented I! Ff f,R !■ *s«&*U ny straightening the thigh, by which the parts over the inflamma- tio?i are put upon the stretch. When standing up, ladies suffering fr'»in this disease, are generally compelled to rei»t the foot on a stool, 8(. as to bend the thigh, and relax the muscle; . Th'J pains radiate iroin the ovaries, and go down to the loins and thighs, and sometimes '• the fundament. They are of a dull, dragging:, heavy nature. Sometimes the ovarian bodies become vere much enlarged, and d )pping down, somewhat, press upon the lower bowel, causing con- ■ pation, or upon the neck of the bladder, creating a frequent desire urinate, and an inability to pass the water freely Treatment. — As inflammation of the ovaries is always increased during the menstrual flow, it is not proper to meddle with it at these nionthly periotls, lest the trouble be aggravated. Immediately after one of the turns has passed, from six to eight leeches should be ap- plied over the diseased ovary. When the bites are healed, a blister may be used in the same place. The scarf-skin should not be re- moved, and the irritated surface must be healed as soon as possible. The blister should Le camphorated to prevent strangulation. The purt should next be rubbed for a few minutes, night and morning, with an alterative and amxlyne ointment (169). After the next menstruation, the same things should be repeated, and again after the next, and so on, for five or six months, or even longer, if need be. The already bloodless condition of the patient may require, however, that the leeches should not be applied more than once, or, at most, twice. The bowels should occasionally be opened by some simple cathartic, for the purpose of removing all hard substances which may press against and fret the inflamed ovaries. The purgatives employed should be of the most cooling kind, such as salts or oil ; while aloes> and all harsh cathartics must be avoided. Injections of tincture of belladonna and hyoscyamus are useful for quieting neighboring parts, and warding off external disturbances. They act like soft substances thrown upon the pavement in front of a Mck man's house. The patient should be kept, as much as possible, in the recumbent position, lying upon the bed or the lounge, and should only be per> rnitted to ihove about to such extent as will not irritate the inflamed parts. Case. — Miss R. M. B. suffered a great deal of pain every month while menstruating. She had also a great tenderness upon pressure just at the left of the upper part of the womb, and at times a severe (ain in the same region, which often extended down into the grpin uad thigh. The left ovarium was so much enlarged that it could be distinctly felt through the walls of the bowels. Immediately after the next monthly period, I applied six leeches over the inflamed ovarium, and when the bites were healed, put a blister over the same region. After this healed, the same space was riibbed, twice a day, with an ointment (169). Immediately after the J... e inflamma- ie» Huffering )t on a stool, tains radiate d sometimes lature. nlarged, and causing con- quent desire ys increased th it at these ;diately after lould be ap- iled, a blister [1 not be re- 1 as possible, lation. The nd morning, be repeated, nths, or even the patient ppliecl more pie cathartic, may press !S employed while aloes, ire useful for disturbances, in front of a ; recumbent only be per* the inflamed jvery month pon pressure [Ties a severe to the gipin be distinctly six leeches ealed, put a le space was ely after the FEMALE DISEASES. 353 oouraes, the same thing was repeated for four months, — the patient, each time, being kept quiet for a few days, and then permitted to take gentle exercise out of doers. The diet was generally nourishing. I'he patient was well at the end of four months, and has had no return of the inflammation. This was a simple case, requiring only the most simple course of treatment ; but it furnishes the general outline to be pursued in all cases of inflamed ovaries. Whites. — Leucorrhoea. — Fluor Albus. Lbucorrh(ka is from two Greek words, Xev^o^ and ^o), and fluor albus from two Latin words, albus and fluo, having precisely the same meaning as the Greek, namely, a white discharge. Hence, in popular language, the disease is called the ^^ whites;" it is also called *^ female weakness^ These terms are well enough, perhaps, if we have in mind that they convey to us only the idea of a symptom of disease. They all mean, with the exception of the last, a white discharge from the female genital organs. They are slightly inaccurate, as the discharge is sometimes yellow, or green, or otherwise variant from white. Any discharge from the female genital or^ns which is not bloody, comes under the term " whites." k Symptom Only. — As the name of a disease, the term whites has no specific meaning. It does not designate any particular complaint. It is a symptom, just as the matter expectorated and raised in lung diseases is a symptom ; and as such only should it be regarded. When persons cough and raise a great deal, they do not, on consult- ing a physician, say they have got the expectoration ; but they say they fear they have some disease of the lungs, because they expecto- rate. They look upon the expectoration as the sign or symptom of disease. So females, and physicians too, must learn to look upon the whites, not as a disease, but as the sign or symptom of disease, which sign they should become skilled in interpreting. There is no reason why the discharge from the genital organs should not be as well interpreted as the expectoration or discharge from the throat. The parts from which it comes, may be about as easily and as well inspected. Ko Female Ailments so Common. — There are no female troubles to which the attention of the physician is so often called as these aimoy- ing and debilitating symptoms called whites ; and th(!re is no depart- ment of medical practice, in which the really able, as well as conscien- tious and j)ainstaliing phyt^ician, is so well tested. If, regarding these discharges as they are, simply as signs, he searches faithfully for their cause, he will be led to a treatment which in a great majority of cases will be successful. And surely no success in life can be more prized by a right-minded phvsician. It procures health, the highest 45 ii.. 354 FEMALK DISEASKS. earthly boon, for snflbring womnn, and gratitude, the most prized of all rewards, for himself. Tliere nre Four KIikIh of DiscliiirpTPH from the female genital or- gans, — inucua, pus, mucus and pus eonibined, and the watery. The first, muuus, does not, in itself, im|)ly disease ; but when pus is dis- charged, we know that inflammation exists, because such a cause sdone can produce it. Seat of the INsense. — The cause which produces the whites may have its seat either in the vagina, or in the neck of the womb; and in practice, it is of course quite important to know where its location is. The charaettir of the discharge generally scuttles this |x)int. If it be thin and watery, or thick and cream-like, it is from the vagina or passage which lea(ls to the womb ; if ropy, gluey or albuminous, like w^hite of cgrt, it is from the cavity of the uterine neck. Treatment. — Some physicians always prescribe the same remedy for the whitt^s. They might as well have but one prescription for expectoration. The remedy must have reference to the cause of the discharge ; until the cause be searched out, every prescription is a mere trial at guessing, — a sort of practice well enough adapted to quarks, but not becoming scientific men. When a ci'su of whites is brought before a physician who under- stands his business, he makes no prescription until he hiis discovered what the diseases !?••, Having determined this point, his remedies have an intelligent beariuf^ upon the case. This being so, I have no reme- dies to set dowji for whites, simply as such. 1 shall proceed, there- fore, to speak of several other complaints which bear more or less upon this. For trcatmoiit, see page 390. Absence of the Menses. — Amenorrhcea. The absence of the menses is divided into two kinds, — retention and suppression. It is retention when the monthly flow has never appeared, — suppression, when, having been established, it is, by one cause or another, stopped. Retention Explained. — The ovaries, as we have before said, are the centre of the female sexual system. It is the swelling or ripening of an ovum or egg, every four weeks, which causes the large now of blood to the parts, and the consequent menstrual discharge. But it sometimes happens that ihe ovaries are not developed at the ttsual time of life. The monthly evacuation does not then appear. There is retention. There may be retention, too, from other causes, after the ovaries are matured. Costiveness may sometimes occasion it, — so may a degenerated and low state of the blood. There may be mechanical causes of retention. The mouth of the womb may be entirely closed, or the neck may be so constricted aa to close the passage through it, leaving no outlet for the monthly accu- mulatioa The hymen, also, may have no opening through it When prized of 'enital or- ery. The )us Ih dis- h a cause hitcs may oinb ; and t3 location )int. If it i vagina or linous, lilte ne remedy •ription for luse of the iption is a adapted io vho under- discovered pedies have e no reme- ceed, there- ore or less — retention has never is, by one e said, are or ripening rge now of oped at the len appear, her causes, es occasion outh of the istricted as mthly accu- it When FEM.VLE DISEASES. 3;5o these mechanical obstructions exist, there are sometimes large collec- tions of fluid in the womb, which cause enlargement of the body, and in some instances, painful suspicious that the sutt'erer has committed imprudences, and is in the family way. Physicians should be on their guard lagainst falling into such errors, and lending the sanction of their name to these blasting mistakes. Suppression Expliliiieii. — Suppression, — a stoppage after flow has been once established, — may be caused by itilhinnriation of the ova- ries, — the bloofi, in this diseased condition, being drawn so entirely to these swelling and germinating bcxlies, that the accustomed flow from the womb does not take place. Inflammation in the neck of the womb may also cause a stoppage. So may a fright, as from a fire occurring in the neighborhood, or a cold taken by being caugiit in a shower. Girls sometimes, in their utter thoughtlessness or ignorance, dip their feet in cold water, wher. their courses are u|)on them, and briif' on a suppression of a most dangerous character. The most lovely ,1.1) innocent girls have done this for the purpose of attending a party ; and, in some instances, the stoppage induced has ended in den^h witliin a few hours. The pro- found ignorance of their own mecl ism, and of the laws which gov- ern it, in which girls are kept who are just budding into life, is a seri- (lus reproach both to parents and physiriaii.s. Suppression may be induced by whatever reduces the quantity or quality of the blood, as consumption, or by great depression of spirits. With some rare exceptions, women have not their turns w^hile in the family way. Treatment. — Before anything can be done in the way of treatment, the case must be thoroughly investigated, and the specific cause of the disease searched out. If it prove to be retention, and arises from a bloodless condition, and an undeveloped state of the ovaries, iron is the proper remedy, (61) (73) (74) (75), with a generous diet and exercist ^^ of doors. If caused by an inflammatory state of the uterine neck or ovaries, the proper treatment has been already indicated. If from costiveness, relief may generally be found from prescriptions (5) (9). The me- chanical causes alluded to above, when found to exist, must be removed by gently dilating the mouth of the womb or the uterine neck, with bougies, beginning With the smallest, and increasing the size, or by puncturing the hymen, as the case may require. In Treating Suppression, it should be borne in mind that at a cer- tain time each month, nature makes an attempt to restore the lost function. Even when she is not successful, probably an ovum is ma- tured and in some way disposed of. The intelligent physician will of cpurse avail himself of this favorable moment to try his skill in bring- ing about the desired regularity. When this time arrives, he should order three or four leeches applied to each groin at night. The next night, he should direct the use of a pungent foot bath (242) ; also (1 6) as a cathartic 1 ■ 1 ii !■■ ',! W: m «" ill 356 FEMALE DISEASES. When suppression exists, it is not always proper to try in this direct way to bring on the turns. There may be no blood to spare ; an(< this may be the sole reason why the courses do not appear. When this is the case, nothing is to be done but to build up the health as rapidly as possible, and when this is sufficiently established, the courses will be all right. Profuse Menstruation. — Menorrhagia. Menstruation may continue too lonff, or occur too often, or be too jrofuse while it lasts; or all these irregularities may be experienced by the same person. Any one of them will prove a serious irritation, and a drain upon the constitution ; the whole together, if not arrested, will undermine and destroy it. The Cause of this, like the sourse of all other female diseases, is, in a great majority of cases, overlooked. It is not to be attributed, as so many suppose, to a congested state of the womb ; but is rather the result, in a great many instances, of the inflammatory or ulcerated condition of the uterine neck. In still another large number of cases, it arises from a succession of ovarian abortions. When the blood has run low, and imtrition is defective, as in the consumptive habit, the ovarian vesicles fail to reach maturity. Like other products of the economy, they become blighted, and abort And as these blights occur often, nature is busy every two or th -^e weeks in casting them off. Hence, the menses ap|)ear often, luty come and go without order, because they "spring from a process which is a contraversion of nature's laws. Explanation. — It is not easy to explain how inflammation and ulceration of the uterine neck should in one case produce suppression, and in another profuse menstruation. Yet it is a settled truth, that such opposite results do come from one and the same apparent cause. Probably the explanation is to be found in the difl'erent degrees of inflammatory action, in the varieties of constitution, and in the vari- ant degrees of tenacity with which the vessels hold the blood. Bleeding from the female genital organs may be produced by a •variety of causes which have nothing to no. 136. do with menstruation. Such bleedings are propmly uterine or vaginal hemor- rhages^ and not profuse menstruation. Tliey ure the result of inflammations, or tuniDrs within tiie uterine neck (Fig. 136), or wt"ciknoss. The wonjb may bleed for days, or even for months, from pure debility. Treatment. — As profuse menstruation and uterine hemorrhage spring from a variety of causes, so the remedies are various. Here again we are confronted with the same absolute necessity to investigate accurately try in thU I to spare; not api^ar. dikl up the established, en, or be too terienced by [s irritatiorv lot arrested, diseases, is, jested state nstances, of a succession nutrition is icles fiiil to hey become ^ture is busy the menses they "spring mation and suppression, truth, that arent cause. degrees of in the vari- o-.»t'.NORRHa?A is from three Greek words Bvt, fir)v, and ^ew, which tnean, literally, a difficult monthly Jloio. These words do not precisely descritvc the complaint ; for it consists not so much in a difficult, as in b /irtunful flow. Hymptoms. — This affection is always marked by more or less pain I iw 358 FEMALE DISEASES. while the courses are on, — especially during i.ie first day or two. The pain sometimes begins two or three days in advance of the evac- uation. It extends over the whole lower part of the belly, — running down, at times, to the thighs, and causing great distress in the back. it is frequently so violent as to resemble the pains of labor, compell- ing the sufferer to take the bed, and drawing from her tears and groans, and occasionally throwing her into spasms most painful to witness. So terrible are the monthly sufferings which some women experience from this cause, that the anticipation of it destroys much of their peace, even during the intervals of respite. The Causes of this complaint are very numerous. There is, doubt- less, such a thing as pain in the womb from rheumatism, and espec- ially from neuralgia, though these are much rarer forms of the com- plaint than many suppose. Pains at the monthly periods are often induced by a displacement of the womb. If the organ fall over backward or forward, its nerves are pressed upon in an unnatural way, ai;d when the parts are crowded with blood, :t is very natural for painful sensations to be excited. In these caset, the neck of the organ is bent at right angles, and the canal which piisses through it is of course strictured, so that the evacuations are necessarily made with difficulty. And this leads me to remark, that the passage through the uterine neck, becomes, occasionally, from inflammation or other cause, almost closed. The result is, much difficulty and great pain in passing the monthly secretion. There are no causes which excite painful menstruation more often than inflammation in the uterine neck and the ovaries. An increased flow of blood .o an inflamed part always causes pain. An inflamed foot or leg has to be laid up in a chair, because it aches when put down. The reason is, that when hanging down, it is more full of blood, and the sensitive nerves are painfully compressed. When the finger is hot with inflammation, we assuage the pain by holding it up for the blood to run down. For the same reason, the infiamed ovaries and uterine neck ache when the blood flows to them, in large quan- tities, at the menstrual period. Congestion of the lining membrane of the womb itself is a frequent cause of painful menses. It is a condition of the membrane of the womb, similar to that of the larynx in membranous croup. There is the same pouring out of what physicians call coagulable lymph, which forms itself into a membrane. This membrane the womb strives by strenuous contractions to throw off, and finally succeeds in expelling it, not whole and entire, but in shreds and patches. These shreds, which women sometimes call skinny substances, are characteristic of the disease. The efforts to expel them cause pains very much like those of natural labor, and sometimes almost as severe. Treatment. — Painful menstruation, excited by the falling over of the womb, backward or forward, is cured, of course, by putting the organ back into its proper position. Pains caused by stricture of the canal through the iiterine neck, are day or two. of the evac- i'^, — running iu the back. )or, compell- ;r tears and t painful to ome women stroys much re is, doubt- , and espec- of the com- isplacement d, its nerves e parts are itions to be •ight angles, ired, so that the uterine luse, almost passing the more often n increased in inflamed when put lore full of When the olding it vp ned ovaries quan- large 1 a frequent ''ane of the ?here is the nph, which ) strives by 1 expelling ese shreds, cteristic of much like ing over of (utting the e neck, are cured only by enlarging the passage. This is effected by introducing at first a very small bongw, and then a larger and a larger, until the passa^ is of the usual size. It is a delicate operation, quite success- ful in careful and skilful hands, but liable to produce mischief when improperly conducted. In all the forms of this disease, the treatment should aim, not merely at palliation, but at a cure. And generally, 1 am happy to say, a cure is attainable. Yet how many women suffer for years, until health has fled, and life has become a burden, — receiving from their medical attendant the assurance that .palliation only is pos- sible! It is necessary at each monthly turn, to do something, in these cases, to quiet the pain. For this purpose, twenty drops of lauda- num, in a wine glass of tepid water, throv^n into the bowel, will be highly serviceable. For a like purpose, one pill (116) may be taken twice a day, beginning one day before the menstrual flow. A bella- donna ointment (170) may be rubbed upon the neck of the womb with great advantage. In the congestive form of this disease, — that in which the membrane is formed on the internal surface of the womb, and thrown off in frag- ments, — the liquid acetate of ammonia, or spirits of Mindererus, is a very valuable remedy taken in two teaspoonful doses, in a table- spoonful of cold water, three or four times a day, while the pain lasts. Case I. — Miss E. S. of B., aged twenty-two years, applied, in 1856, for relief from great suffering at her monthly periods. Her menses had been disturbed some time before by taking cold, since which time, her mother stated, her pains, for a short time before the flow began, and during the first day, had been terrible, not much less severe, indeed, than those of natural labor, or child-bearing. The pains, at these times, had been of a terribly bearing-down kind ; had frequently been preceded and accompanied by sickness, vomiting, and fever ; and finally, what came from her at first was not so much blood, as a kind of skinny svbstance, in shreds and patches. It was immediately evident that this was a case of painful men- struation (dysmenorrhoea) of the congestive kind. The womb was every month too full of blood, — its internal surface, in fact, if not its whole substance, inflamed. Hence, a false membrane like that of croup, was formed, which the womb contracted and struggled hard to throw off', and finally tore to pieces, and expelled in shreds. Of course this local inflammation was to be reduced, which wai« done by first giving a brisk purge (31), which was followed by apply- ing half a dozen leeches directly over the womb. On the following day, a blister was raised in the same place. In two weeks, three leeches were applied, and again followed by a blister. These appli- cations were repeated every fortnight, for three months, being careful not to use them within three days of the monthly turns, either before or after. The pain, at each turn, was assuaged, by" injecting into the bowel twenty drops of laudanum in a gill of tepid water, by rubbing upoii 360 FEMALE DISEASES. the mouth of the womb some of the ointment (170), and by giving two teaspoonful doses, in a little cold water, of the liquor of acetate of ammonia, three times a day. The patient was cured in three months, and has since had easy and natural menstruation. Case 11. — Mrs. L. C. was treated for a case of painful menstrua- tion, in 1857. The lady also had terrible pains, attended by forcing down as if her bowels were all coming out of her. Yet she had but a very scanty discharge. Every month she was made literally sick, and was obliged to take to her bed. On examination, it was found that the great difRculty in passing the menstrual fluid, as well as the scantiness of the quantity, was owing to the smallness of the passage through the neck of the womb ^ this passage was nearly closed up ; it was strictured. There could be no doubt as to the treatment required. Medicines could do no good. This passage must be gradually opened. To do this, I introduced a small metallic male catheter into the strictured passage, and, gently turning it once or twice round, withdrew it This was done once in three days, for three months, — using each time a slightly larger instrument. Thenceforward, her menstruation was natural and easy. She was well. Chlorosis. — Green Sickness. Before the age of puberty, the girl is only a child. She has withia her only the elements of a woman. The change to which she is des- tined, brings with it a wonderful development both of body and mind. To effect this development, and bring out the new being in the perfection designed by the Creator, a large amount of hidden nerve power is required. She requires o have been born with a well-vital- ized constitution, and to have been physically trained in a way to harden and energize it. Without these antecedents, her develop- ments at puberty will be feebly and imperfectly made. Her devel- opment and evolution of germs will be ao defective as to cause her ' . enstruation to be only partially established, or to fail altogether. Symptoms. — Where the inherent powers of the system are just sufficient to bring about a first menstruation, it often happens that they seem to be spent by the effort, and that the evacuation fails to appear again for several months. Indeed, the whole organization may break down at this point, and become blasted, as it were, like a blade of wheat which has grown well for a time, but which fails to develop the kernel. The blood at this period, may become impoverished, and fail to distribute adequate nourishment and development to the various tis- sues. When this occurs, it loses a part of its red globules, and in- creases its watery portion. As a result, the skin becomes pale, and m FEMALE DISEASES. 361 ' giving acetate asy and enstrua- ivn aa if a very ick, and passing ity, was ; womb ; [edicine» To do trictured idrew it. ing each struation IS within e is des- ody and ig in the en nerve ^rell-vital- 1 way to develop- er devel* ;au8e her sther. are just jens that fails to ition may e a blade develop id fail to irious tis- i, and in- pale, and sometimes of a yellowish hue; the bowels become torpid and con- fined ; the nervous system sensitive and weak ; the digestion is im- paired ; the appetite is either lost, or perverted, — longing for unnatu- ral food ; the tongue is white ; the heart palpitates ; the spirits are depressed ; the temples and ears throb ; the head occasionally aches and whirls with dizziness ; the sleep is disturbed and abbreviated ; and hysterics are now and then superadded to close the catalogue of ills. This is Chlorosis, briefly depicted in its origin and its symptoms. The word is from the Greek ;^\a>/309, which means green and pale. By ifUrses it is called the " green sickness." Its €aii!iies are quite numerous, among which may be reckoned im- poverished diet, damp atmosphere, sedentary habits, long confine- ment indoors, overworking the mind in childhood, constipation of the bowels, and an inherited feeble constitution. - Treatment. — Chlorosis, as a general thing, is connected either with retention or suppression of the menses ; and in treating it, physicians are too much in the habit of resorting indiscriminately to forcing medicines, called emmenagogues. From such practice, great injury often results. It is not always sufficiently considered that a woman fails to men- struate, or ceases to do so, becau^se she is sick ; and if we would cause her courses to return, we must restore her health. To do this should generally be the great object of treatment. Let the health be restored, and the menses will come back. The only philosophical treatment is that which will invigorate the system. In chlorosis, the vital powers are in a state of dilapidation. How can they be roused ? By exercise on horseback and on foot ; by wear- ing clothing enough to keep warm ; by a tepid bath two or three times a week, and brisk rubbing with a coarse towel ; and by a generous diet, composed of tender meats, animal broths, etc. This treatment, however, should be preceded by unloading the Dowels with prescription (35) or (40), according to choice. One pill should be taken at night. When the liver is considerably deranged, prescription (40) will be particularly serviceable. Half a pint of tepid water thrown into the bowel, night and morning, will help relieve costiveness. The bowels having been well opened, give a tablespoonful of pre- scription (59), two or three times a day ; or, of prescription (60), a teaspconful, the same number of times, each day. In the treatment of this disease, iron, in some form, is almost al- ways needed. Prescriptions (61) (71) (73) (74) (75) (80) and (316) are suitable preparations. A girl suffering from this disease should always be tak6n out of ■chool. The mind should be divided between rest and recreation. Case. — Miss J. T., aged nineteen, was treated by me for this como plaint in 1858. She had always been delicate. Her first menstruation was at the III- Ii ■fi.^'l I* ii'l-. age of fourteen ; but it was quit« defective in quantity, and was imperfectly repeated two or three times, at irregular periods, when it stopped altogether, and had not again appeared up to the time of her being brought to me. She was very pale, and a little yellowish, — her lips being nearly white. She was very costive, — habitually so, — was without appe- tite, and her tongue was coated white. She had dizziness, palpita- tion of the heart, neuralgic pains in various parts, and was extremely nervous and irritable. Having, in addition to the above symptoms, a pretty constant cough, her friends feared consumption, and brought her to me from some distance for that reason. I found no physical signs of lung disease, and had no difHcuIty, therefore, in making it out to be a case of chlorosis, — particularly as there was no expectoration attending" the cough. The parents were chiefly anxious to have the menses brought on. With me, this was of minor consequence ; the main thing was to rally the prostrate powers of life, and restore the blood to health. To do this, it was necessary to rouse the liver, for which I gave leptandrin, etc. (34), which I ordered to be taken once a day, namely, at bed-time. This not only caused a flow of bile, but the scutelarine calmed and strengthened the nervous system. It was necessary, too, to correct the habit of costiveness. To effect this, she was ordered to take two teaspoonfuls of Mettauer's aperient, after breakfast and dinner. To restore the blood, iron was ordered, particularly the citrate of iron and strychnine (316). This had a fine effect to raise the blood and support the nervous system. She was ordered a generous diet of tender meats, broths, etc., and to take unrestrained and free exercise out of doors. Her improvement was immediate and visible, and was not inter- rupted during the three months of her stay in Boston. Soon after her return home, her menses appeared, and she has since enjoyed pretty good health. Cessation of the Menses.— Turn of Life. There is probably no period in woman's earthly existence which she approaches with so much anxiety as that which she is in the habit of calling " the turn of life." The anxiety is not without some reasonable- ground for its existence. She has been accustomed, for thirty years or more, to lose, every four weeks, a certain amount of blood. When this evacuation stops, disturbances of the system may well be expected. So well is this understood, that this climacteric has come, by general consent, to be called the " critical period " in female life. If it be well and safely passed, the health is generally better than before, and a " green old age " is likely to follow. But if the seeds of disease are in the system, — if there be a tendency to cancer or other malignant disease, which has been held in check by the monthly flow, it now takes up its destructive work, and shows itself; or, if 'iu and was s, when it me of her ing nearly lout appe- is, palpita- extremely mptoms, a d brought difficulty, icularly as •ought on. aa to rally ch I gave y, namely, scutelarine tiess. To Mettauer's citrate of the blood 3, etc., and not inter- Soon after se enjoyed e. nee which is in the iiout some tomed, for mount of stem may limacteric period^^ in etter than the seeds cancer or e monthly jelf ; or, if there be a predisposition to apoplexy or congestion of any organ, it is more likely to become active, now that the accustomed waste-gate is closed. A distinguished writer has said that about half the deaths among women, about the age of forty-four, are from cancer. ]Vervous Coiiiplicatioiis. — It is the duty of the physician to look carefully after those females who come under his care at this critical time. For, in addition to the organic and malignant diseases which attack her at this time, she is exposed to a host of nervous irritations, which, if neglected or badly managed, make her life a cross and a burden. The symptoms of these irritations are in number, legion. A^e at which tlie turn of life comes. — As a general rule, the turn of life comes between the ages of forty and fifty ; but occasionally occurs at other periods, varying from thirty to seventy. If the menses appear early in life, they terminate early. . . Symptoms. — When there is a tendency to corpulency at this period, the symptoms are headache, dizziness, and a sense of suffocation. It is common, when the period of cessation approaches, for deviations from regularity to occur. At one time the menstrual discharge will be profuse ; at another, scanty. It will now disappear for a time, and be replaced by the whites. Then it will appear for a few times with considerable regularity. Next will come a suspension for sev- eral months, to be followed by a flow of such profusion as to amount almost to flooding. Mixed up with these irregularities, will be palpitations of the heart, constipation of the bowels, a variable appetite, and broken sleep, weakness and inquietude, timidity, a dread of impending evil, irritability of temper, hysterical attacks, bad feelings in the head, with sounds in the ears, as of the rolling of carriages, sparks before the eyes, and an unsteady gait. Treatment — If there be at this' period, fulness of habit, with diz- ziness, headache, sparks before the eyes, a sense of suflbcation, etc., there is a plain indication that the brain is oppressed with too much blood. I am not much in favor of bleeding, but this is a case in which from a gill to a half pint of blood may, if ever, be drawn from the arm with }K)sitive advantage. Cups applied to the back of the neck will also be useful. Give at night, also, three of the compound cathartic pills, and then keep the bowels regular with prescription (18), — a wine-glassful to be taken occasionally. The diet should be spare, and strictly vegetable : — to which should be added much daily exercise. Purging should not, in any case, be carried too far. If nervous affections show themselves, with disturbance of the digestion, and general debility, even leeches would be improper, and physic should be swallowed very sparingly. When serious organic disease is suspected, — as cancer, — it is the duty of the physician to investigate the case very thoroughly, and to give the patient the advantage of the most prompt ancf decided treatment. That treatment is six>ken of in the ]>roi)er place. 364 FEMALE DISEASES. Hysterics. — Hysteria. The name of this complaint is from a Greek word, signifying the womb. It took this name from the belief that this organ is the seat of the irritation which produces the hysteric disturbance. This belief is correct, if we include with the womb, t le ovaries, and the other sexual organs. The sexual system is doubtless ths centre of the reflex nervous derangement, called hysteria. It has been sufficiently demonstrated that hysterics are dependent for their existence either upon organic disease, or upon simple irrita- tion of the sexual organs. Sir Benjamin Brodie mentions cases of the hysteric paroxysm, produced by pressing upon an inflamed and tender ovary. Symptoms. — An attack of hysterics is generally preceded by de- pression of spirits, restlessness, and a frequent desire to pass water. It is sometimes marked by convulsions, or fits ; at other times, it is not. At times, the attacks are local, and are manifested by spasms of the throat at the top of the windpipe, or in the bronchial tubes *, the patient feels a ball rise up in her throat (globus hystericus), her heart beats violently, and she laughs and cries by turns. When the disease is more general, the muscles of the limbs are thrown into spasms; the patient struggles violently; rising up in a sitting posture, and then throwing herself back; twisting the body from side to side, clenching the hands, and throwing the arms about, so that she is with difficulty held by persons much stronger than her- self. Soon after these paroxysms, the patient generally passes a large quantity of very pale urine. The Causes of this complaint are as numerous as the causes of female diseases, for in truth there is no female complaint which may not produce it. Whatever develops and excites the sexual system, and at the same time weakens the constitution, lays the foundation of this malady. Nervous women are much inclined to it. In large cities there is more of it than in the country, because there is more excitement and luxury, and more of their consequences, — nervous and female diseases. Treatment. — To treat this complaint successfully, it is necessary to search out its cause, and remove that. Like the whites, it is not so much a disease in itself, as a symptom. The first inquiry to be made should have reference to the iea\ origin of the complaint Is it dependent upon inflammation of the ovaries or the womb, or to displacement of this latter organ ; or does it arise from the low state of the blood, and the weakened condition of the nerves, acted upon by some irritation or heightened sensibility of the sexual organs. If dependent upon inflammatory disease, that is to be treated ac- cording to directions elsewhere ; if upon falling of the womb, no remedies will avail, until that is put in its proper place. If diluted pfiifying the is the seat t'.ie ovaries, iibtler^s the dependent mple irrita- )s cases of flamed and ded by de- pass water, times, it is by spasms hial tubes; ericus), her '. limbs are ng up in a ; the body irms about, r than her- jses a large causes of wrhich may iial system, foundation :, In large re is more — nervous ecessary to it is not so to the leai tioii of the m ; or does i condition sensibility treated ac- womb, no If diluted i •'m R0. 2. ic m'^ohI hy.-ttfisi i- 'loi/btii ■»* ths ewitff^ of tlv rcik'x iu'.rvcn'.«« •l«mngeii."Mir, chIM h)*Unn. Jt hfiji btH-i) siiOk hntly d?n)OMsfn\T«..» thiit h/sterifH ar«> di |»«-iuici «. for tlK'ir ixistcmx eiiheV upon org:in»'. dii+<'a.'<-, or iipun simplt- irrifa- ihf. hysteric puro\yHra, prcxiufed ;y pr<"Hs«iMg ihh'H 'I'l indaiicJ uiiU teiuier ovary. ;^yju]if^itiiif4. An iU(«t*k of hyul.rirw if gfnrtR'.li^ jm'Cf'dfd hy tlr- ,4rphiUij; ••t' jHTitj-. h.'eik-'vi'at'M, ai)d a fmjuenv U'-'k' to puoii wntcr fc ui »i>iti'-iffiiet> nmrkc'l oy tonviilsioi;s <>r fite ; at otlur timfs^ ii. k not. At tirncH, the oft«<'Kiii are i'.i;al, ttud 3.ro rnaiiitVsUHl by siiupius of the t;;rout nl iiw h>|> of '^t- \i?i'H»;.»jiJH. .^ m ih>' biiMicl>iiil uv«'*''h; 'l/iir fyUicfd /nn/ l* I'vi// r».^i' 'if i» ^-t iArm/i (.f U-Uns hystrriouH). vrt heart j^wH?/! via^flwth, isjicJ »l>' i**J^«« «»Ki <■"«*•» tjv iurnf>. \V>it«ic ilw i;U-«<-*^* i« v.'^r. gciwrai, ui? -inu' h stTon^^'r 'h:ia j'-^t wlf. S<)«.ti {iftx r th.i:^c pan)xy:-inr, the patient generally p:^s«e^ -a iarg«i% (luant'iy ut' vt^ry pale tumc. , ^ # Tlif CijsiNi'H of tiiif ':'pmr.i]aint are ai^ n\im«'rous fis the ciiujV":" of li-nirtb di5»^as*v, for iit J-.tilli ^acre is jk> !>m;i.l»! cnnjplaiut which nuv, not produce i(, Whattiver ri<*v«dop^ f^nd oxcitcs lh< s^isuai .]<^ri' c:vcitv;rtn-nt aiul liixitry, and more of ihcir couse.qa<:i)cfs, — jarvou- mid feiuaK* diveases. TstatiitK'Ui. - To irv.iit this • . . ■ -4 dJi'Pase^ in Jtwlf, as a symptom. . :• firiil inquiry "to he mldc should htivc referrnce to the re«d it t:>f the (XM'n[)lat,'»t. h it dep^-ndorit npcui iuiiairjmatJon of ftn' ;)» o,' lhf» vvoinb. vr io dispiaficin^jiit uf thin lart^-.r orgrm ; or ikw**- . •:••* from tlie low ytaie of tbf bioiKJ, And the >veakfrj'>d c*^ !'.!} nerves, ftitcxi upon by iome irrii«?it>n or if-K i{|?ht4»ned 8<'nsibJhSj :fi ilt>.c &sbXvt;tl organ.*. l! dvjW'rdeju ',i\K>n inllainmatoi-y di»tn»ej that is to 1:>e treaUd n'•• l;;<■>rdin^ : "' dirr^e»?(»m elsewnere; if U]>Ott ftUSkg of the womb. w;>.m<-d*«-: : .-ii„uiitii ihat. i;-! put jo il* j>fa|>f"r place. If 'HhiU' .11 ifying tht ' i MfAi tl>£5 ! i; iljUMUlfl;'. I ipl«- jrrifa- , I'd hy ci<- iiMf's. I). IS iiU Uift^*:*: rioiw), vKT iirubft art;? fj up iii a tlie f.« viy hi eh ittttv M' !■ tut ion lit l:ii'g' id mon* • rvou" .jie refd ■ of th\- aud Ski* If 'Mhitt"! PL8 Fig. 3. •«l^:-.^«»^^ .', «if.^ iii V . ii-.^; i I . I ■ I 1 • i mk blood and weakened nervea be the cause, iron and quinine are the remedies. When the complaint arises from deficient menstruation, iron and aloes (47) will be serviceable. The nervous spasm can sometimes be broken up by pouring cold water upon the head, ot face, or limbs of the patient. Tlie Hyfienlc and Nortil Treatment are of great consequence. The complaint is very much under the control of the will. Whatever tones the moral nature, and strengthens the will, tends to subject this disorder to the control of the patient. Plain wholesome diet, exercise, bathing, and the enforcing, as far as possible, of a rugged, self*reliant habit, generally go far towards breaking its force. Polypus of the Womb. This is simply a foreign body, or tumor, growing either within the womb, or in the vagina, and attached to the uterine neck. It is rather a serious affection. These tumors vary in weight from half an ounce and less, to many pounds. They are, in color, whitish, re<', brown, and even black. They have almost every consistence, — being soft, spongy, gristly, and hard. The Syni;)tonis of polypus are vr ions, lesembling those of almost every other womb complaint. It is c.ften mistaken for displacement of the womb, for dropsy of this organ, and for pregnancy. These tumors are apt to give rise to dangerous bleeding from the womb, and other discharges which greatly weaken and derange the system. They are liable to terminate in cancer. In pregnancy, they may produce miscarriage. When they are suspected, therefore, the utmost scrutiny should be employed to search them out. This is especially desirable, since the fallen or inverted womb may carelessly be taken for a polypus, and be operated on as such. Treatment. — This is of two kinds, medical and surgical. The first consists in means of supporting the strength of the patient, and checking the discharges by means of injections, rest, etc., and in en- deavoring to cause the removal of the tumor by absorption. This last object is sometime efTected by an unstimulating diet; and by the use of iodine (101) for some time. This treatment does not often succeed, however, and cannot be relied upon. If the polypus be within the womb, of courrtc it cannot be reached. The only thing to be done, in such case, is to cause its expulsion. This is sometimes eifected by causing the woinb to contract by the . use of spurred rye (267), or by the use of the electro-magnetic machine. Tins latter remedy can do no harm, and had better be tried first. When the oolypus is outside the womb, the methods of removing it are various It is sometimes done by cauterization, or burning it off by hot iroi or caustic. This is a harsh method, and not resorted to by skilful g urgeons. Another method is that of crushing the tumor ill I'f \ ■< w ' 366 FEMALE DISEASES. with an instrument- Another still is that of torsion, or twisting it off. And still anothear, that of applying a ligature, or tying .a string around the neck of the tumor, and strangling it by preventing the blood from going to it. By this means it falls off in a few days. There is one other method, that of cutting the tumor away with a knife, or with a pair of curved sci:,.iors. These three last methods are the chief ones now used by skilful surgeons. Case I. — Mrs. J. W. H., from one of the cities in New England, applied for treatment for an affection of the lungs, from which she had suffered for several months. She was thin in flesh, feeble, and pale from loss of blood ; for she informed me that her courses had been upon her a large part of the time for several months. 1 tried the usual remedies for profuse menstruation (for she at first declined an examination), but without effect. The hemorrhage was unabated, and she rather lost ground. I again proposed an examination, and apprized her that upon it hung the only hope of my being able to do anything for her. She assented without further hesitation. Upon introducing the speculum, a pendulous tumor, hanging from the mouth of the womb, immediarely dropped into it, precisely like that in Plate VIII., Fig. 3. I immediately put a ligature around its neck, and in a few days it came away. Upon being apprized of this, I applied to the root a small amount of acid nitrate of mercury, with a camel's hair pencil, and immediately after pressed upon the cauter- ized surface a small velvet sponge, thoroughly wet with soap suds. By this last application, the acid was decomposed, and prevented from spreading. The bleeding stopped at once. Under the use of iron, and a thoroughly rallying treatment, the lady began to come up. The affection of the lungs, no longer encouraged by the drain upon the system, gradually yielded, and she recovered. Case II. — An unmarried lady, from an interior town in another state, sought relief for a throat disease, complicated with a sUght affection of the lungs. As my custom is, I inquired respecting her menses, and learned that her " turns," as she said, came upon her every tw6 weeks, or oftener, — indeed, that she was seldom entirely free from some flow. Upon making an examination, — to which, like a sensible woman, she assented without hesitation, — I found about the mouth of the womb, as in Plate VIIL, Fig. 2, several small projecting tumors, looking like ripe, red currants. With the fcrceps, 1 took hold of them, and in a few moments, without pain to the patient, I twisted them all off; and then made il.'i same apphca- tions as in the preceding case. The bleeding was ended at once; and the patient got well, not only of the hemorrhage, but of the throat and lung complaints. Uterine Hydatids. This name is given to a bladder-like substance, occasionally found growing in the womb. It is filled with a white or yellowish fluid. i Hi' FEMALE DISEASES. 36/ Sometimes a bundle of them grow together, like a bunch of grapes. Some are elongated, like a bean, and have a sort of claw, by which they are attached ; others are shaped like an egg. Those with a claw are generally supposed to be living beings, like worms, in the bowels. When expelled from the womb, they move about if placed in warm water. The Causes which produce these singular growths, are obscure. Probably whatever improperly excites or irritates the uterine organs may produce these vesicular bodies. The Syiiiptonis may be easily mistaken for those either of preg- nancy, or of water or inflammation in the womb. From the growth of these bodies, the bowels may enlarge, the breasts swell, and the menses stop. If to these symptoms be added sickness at the stomach, the woman, if married, feels confident she is in the family way. There is no certain method of correcting this mistake, until the collection of bladder-like bodies is expelled from the womb. It is rare that these bodies appear in the virgin woman. They are supposed to be connected, ir some way, with imperfect conception. Treatment. — No very exact directions can be given in regard to treatment, because we can seldom say absolutely that hydatids exist, until we see them expelled. Whatever will produce contractions of the womb, will cause their expulsion ; but it will not do to give these remedies indiscreetly, lest the caub^ be one of real pregnancy instead of hydatids. Inflammation of Womb. — Metritis. This disease very often follows delivery, and is connected with child-bed fever. Various Causes also produce it in the unimpregnated state. The inflammations of the ovaries, or of the uterine neck, may extend to the womb. Falling of the womb may cause it to be irritated by being placed in a new position, and thus bring on inflammation. In some temperaments, marriage may produce this disease ; in others, singleness. It may also be brought on by painful menstruation, by forcing medicines, by constipation, by tight corsets, by solitary vices, and by excited sexual feelings. Symptoms. — When the membrane lining the womb is involved in the inflammation, the symptotns are dull, constant pain in the region of th6 womb and in the loins. The passage of water or feces causes pain. There is a sense of weight which causes the patient to bear down and strain, as in labor. The belly swells, and is painful and tender, not bearing even the weight of the clothes. There are chills, fever, and sometimes even delirium. Treatment — In this, the aim must be to reduce the inflammatioa ..' I' ■J ^* ' I ^.? I 368 FEMALE DISEASES. The bowels must be opened with some saline medicine (18^, perapi. ration must be induced, and the hands and feet must be made wami. A large meal poultice should be put upon the belly, and leeches or cups on the inside of the thighs. The patient should lie upon the back with her knees raised so as to keep the clothes from pressing on her. If the purgative medicine does not operate, an injection (349) should be used. The food nmst be reduced almost to entire abstinence, and no stim- ulants whatever should be taken. The room must be well ventilated, and kept still. Falling^ of the Womb. — Prolapsus Uteri. The womb is often found out of its natural and proper place. There are certain ligaments and muscles intended to act as stays, and hold it up in its position. These, from various causes, become rlaxed. It then, losing its support, drops down into the vagina, be- tween the bladder in front and the large bowel called rectum, behind. It is then said to he fallen, ox prolapsed. The womb of married women is more apt to become prolapsed than that of the unmarried, because it is more liable to have its weight increased by congestions. The Symptoms are dull pain in the small of the back, a dragging sensation in the groin, and a feeling of fulness around the funda- ment. Treatment. — The complaint is easily cured if the remedies be applied early. If the falling be o« asioned by a relaxed and weak- ened condition of the parts, a very effectual relief may sometimes be derived from simple injections of cold water into the front passage, ■ alternating them sometimes by an infusion of white oak bark, or of nut galls, or a solution of tannin. If the womb have been long down, these simple remedies will not be sufficient to restore it. It is then necessary to put it back in its 1>lace, and employ some mechanical means to keep it there, until the igaments and muscles recover their strength so far as to hold it. For this purpose, passaries, of various styles and materials, are employed. Palling Over of the Womb. Anteversion. — The womb sometimes falls over forward upon the bladder, towards the pubes. This is called anteversion. The top is turned forward to the bladder ; the mouth, back towards the large bowel. (Fig. 137, b.) Retroversion. — When the womb falls over backward, between the rectum and the vagina, it is said to be retroverted, d. This is just the opposite of being anteverted. In this displacement, the mouth is turned forward, the top backward. This displacement may occur suddenly or gradually. If the former, •iiiii FEMALE DISEASES. m9 thexe is generally great distress, and the organ should be immediateljr put back in its place ; if the latter, the pain will be less intense, land the replacement must be efTected by pessaries, — particularly with the ring pesi^ary, made from India rubber. tio. 137. Anteflexion and Retroflexion. — When these occur, the womb is doubled upon itself, the mouth of the organ not being tilted up before or behind, but retaining its natural position. These flexions are rep- resented by a, c, and e. Beside these more common displacements of the womb, there are several slighter deviations which it is scarcely necessary to describe. There is the obliquity of the womb, which is simply a leaning of the organ backward or forward, or to one side. There are still other more serious troubles, which are so very rare as not to require me to dwell upon them, such as the inversion of the womb, or turning it wrong side out, like the finger of a glove ; and the hernia of the womb (hysterocele), which is like that of the bowel. ' . • Inflammation of the Vagina. This may be produced by many of the same causes which induce inflammation of the uterine nock. It may follow tedious child-bear- ing, — especially if instruments have been ustvl. Marriage is not an infrequent cause of it, — so may a pessary be, if an improper one. Tlie Symptoms are pain in the groins, a feeling of heat and tight- ness in the passage, and a difliculty in passing water. In a few days a discharge, like gum water, begins to flow, v/hich gradually becomes thicker, like cream, and is green or yellow. Sometimes the disease gets well in a few days; at other times, it degenerates into the chronic torrasi and lasts a long time. It should be cured as soon as possible, 47 ri- i ^1 I- r \ .b> n^ 370 FEMALE DISEASES. lest the inflammation cause the walk of the passage t-o grow together, and make a stricture, as in Fig. 138. In this Figure, b, represents the mouth fio. iss. of the womb ; a, is the lower entrance to a narrow passage in the vagina, called a stricture. It is caused by inflammation, which so thickens the walls of the vagina as to bring their inner surfaces near to- gether. In examining a case of this sort, a practitioner needs to be on his guard lest he mistake the entrance to the stricture, a, for the mouth of the womb, b, — a mistake which might lead to evil consequences as well as seriously damage his professional character. Treatment — The diet should be light and unirritating. The bowels should be kept open. A cooling wash (207) (218) should be used several times a day, until the discharge becomes thick, — then employ injections (232) (202) (244) (243) of a more astringent nature. Let the marriage bed be abandoned till the recovery is complete. When the discharge arises from small granular elevations upon the inner surface of the vagina, the whole diseased surface should be painted over with a solution of nitrate of silver, twenty grains to the ounce of water, — the disease being brought to view by the use of a speculum. This may be done every other day. Itching of the External Parts. — Prurigo of the Vulva. This complaint is apt to attack females abojit the cessation of the menses, though they are liable to it at other jjeriods. It is a most annoying and distressing aftection. So terrible and tormenting at times, is the itching of the external genitals, that the woman is una- ble to avoid rubbing and scratching, and she is occasionally compelled to absent herself from all society. She feels, as she says, as though she should tear herself to pieces. Sometimes this irritation of the sexual organs excites venereal thoughts so dominant and controlling as to constitute a real mania, called nympho-mania, from the name of a part involved. This complaint generally indicates some disease of the womb, or its appendages, or of the bladder. When this is the case, of course it cannot be cured without seeking out and removing the disease, of which it is a symptom. gether, Vulva. >n of the a most inting at is una- )i:npelled though venereal 1 mania, iromb, or if course Isease, of Treatment. — To alleviate the local Buffering, the lotion (223), or the ointment (171), may be applied to the parts several times a day. I prefer the lotion. A weak solution of nitrate of silver (211) will sometimes do well. When the disease is brought on by masturbation, as it sometimes is, this habit must of course be broken off before a cure can be effected. In this case, also, cold water must be applied to the parts several times a day ; some of the preparations of iron should be taken, and some active employment be engaged in, which shall absorb the ener- gies of mind and body. Sterility or Barrenness. It has doubtless occurred to every person who nas thought upon the subject, that there must be some special reasons why so many women do not and cannot bear children. These reasons I propose now to explain as simply and as plainly as the nature of the subject admits. To this explanation, I shall add some remarks upon treat- ment ; for, in nine cases out of ten, barrenness is completely curable. Reproduction. — Throughout nature, life is perpetuated by repro- duction. Tlie vegetable and the animal die ; but before death comes, they reproduce the g-erm of a new thing or being, which lives after them. The law of reproduction, throughout the realm of nature, is one, and but one. All living things have male and female structures. Every new being is evolved from an egg, the product of an antece- dent parent. Reproduction consists in the growth of an egg or germ in connec- tion with some living part, until it is capable of independent exist- ence. This germ or egg is the product of the female parent, and will abort or perish unless brought in connection with a fructifying fluid from the male. Thus, two palm trees, growing about forty miles from each other, the one without stamens (the male organs), the other without pistils (the female organs), bore no seed for many years; but when they had risen in height above all intervening and obstructing objects, the winds bore the pollen from the stamens of one to the pistillate * flowers of the other, which immediately began to produce fruit. A knowledge of this great law, as applicable to all living things, enables horticulturists to raise such varieties of fruit as they wish, Ijy shaking the blooming male branch, which has stamens, over the female flowers, supplied with pistils. Sometimes the male and female flowers are upon the same plant, — at other times, upon differ- ent ones. The strawberry is of the latter kind, — the pollen being found only on the plants which have the largest flowers, — the pistil- lated flowers being only on the smaller plants. The pollen, or dust, is carried from the male to the female plant on the feet of honey-bees, as they fly from flower to flower. It has been recently discovered that the reason why many beds are unfruitful (strawberry beds, I mean) is that the large male plants are allowed to monopolize the beds to the exclusion of the smaller female plants. The plants with MiiiJi liii \[ ' 3-^ FEMALE DISEASES. laise flowers should be thinned out, leaving only a few to furnish pollen for the females, which are the real bearers. A New Branch of Industry. — It is only quite recently that* this law has been understood in its wide applicability. How wise and nu;rciful an arrangement of Providence that an unseen hand should turn for man the mystic leaves of knowledge at the very time when he is most in need of the instruction imparted ! At this very moment^ the more complete knowledge of this great law is opening a new branch of industry and a new suppiy of food, and is thus helping the solution of the great problem of how the increasing inhabitants of civilized countries are to be worked and fed. I refer to the propaga- tion and culture of fish. A committee appointed by the legislature of Massachusetts, in 1855, reported very ably upon this subject. It appears that the eggs of the fish may be fecundated almost as easily as the pistillate flowers of the plant. It is only necessary, when the eggs of the female are mature, to hold her over a basin of water, and make gentle pressure upon the belJy, when the eggs will pass freely into the water ; then to pass the milt of the male into the same water, and shake them thoroughly together. By this means, the eggs are impregnated, and fish may be raised to any extent. The egg of the higher animals is inore difficult to fecundate, and that of the human female, most difficult of all ; for in nature as in art, the more perfect structures are begun and reared with less ease. Propriety of Imparting this Knowledge. — Men are naturally curi- ous, and love to understand the mystery of their own origin ; and yet there is scarcely any subject upon which they have so little reliabl* information. It has been held that this is a kind of information which it is not proper to impart to the multitude ; that the curiosity which seeks this knowledge is based upon improper feelings ; and that to gratify it by imparting what is sought, would lead to immor- ality. I do not believe it. Such ideas are based upon a shallow philoso- f)hy. They overlook the fact that nothing excites the imagination Ike that which is covered with mystery. It is because the immensely important subject of the procreation of the race is so carefully hidden from the public eye ; because it is purposely buried so deep in obscu- rity, that any allusion to it, excites improper thoughts. If the subject be properly viewed, it is no more indelicate to explain the mode of reproducing a human being, than to explain that of propagating a plant or a lish. Both are effected in the same way, under precisely the same natural law. True, the propagation of the human being involves moral laws likewise ; but these relate only to the social relations in which it may take place, and do not affect in any way the propriety of making u Understood by the people. •The Germ Famished only at Certain Periods. — These general re- Qiatrks bring me to the immediate subject in hand. Throughout ii'lilll •ill;:': ! III!!! I few to furnish icently that 'this How wise and en hand should very time when lis very moment^ opening a ne\r thus helping the y inhabitants of ' to the propaga- ;husetts, in 1855, ; the eggs of the te flowers of the lale are mature, ressure upon the then to pass the hem thoroughly and fish may be 3 fecundate, and nature as in art, I less ease. ^ naturally curi- origin ; and yet 90 little reliable of information at the curiosity feelings ; and ead to immor- r shallow philoso- le imagination the immensely arefully hidden deep in obscu- If the subject n the mode of propagating a under precisely 'es moral laws II which it may ,y of making in ese general re- Throughout FEMALE DISEASES. 8T>J riQ.iaa. animated nature, the female furnishes the mature germ or egg^ only at certain periods. The healthy human female, — as I have already explained, — matures a g^rm once in four weeks. The.se germs or eggs are constantly advancing, in succession, from the rudest beginning, to a state of ripeness, or maturity. Every person must have seen the eggs taken from the hen when killed in the laying season. Fig. 139 furnishes a good illustration. They are in all stages of pro- gress, from the invisible germ, up to the nearly mature egg. Such is the progress of the human egg, — only that it does not attain to any such size. So far as the maturing is con- cerned, it occurs in the same gradual way. CcMiceptioii or Impreg;nntioii can take place only when a germ or egg is ripe ; and as an egg ripens, bursts, and passes into the fallopian tubes leading to the womb, only at the time of menstruation, it is plain that conception must happen somewhere in the neighborhood of this period. Intercourse with the male may take place at interme- diate times ; but, except in some rare instances, conception will not occur, because there is no mature egg to be impregnated. Now, as every healthy woman T)rings to maturity a germ or egg at the time of every monthly flow, and as every ripened egg is capable, under favorable circumstances, of being fecundated, it follows that every woman who menstruates, and is well, can, under certain cir- cumstances, be impregnated. To eflect it, it is only necessary that the vivifying portion of the male semen, called spermatozoa, come into union with the ripened egg. This union (for, that men and women may have a chance to know as much about them- selves as they do about fishes and plants, I propose to make the whole subject plain) takes place in the following way. In the act of copulation, the male organ penetrates the va- gina, and deposits the sperm, spermatic fluid, semen, or, as the scriptures call it, the " seed," directly at the mouth of the uterine neck. Some suppose that when the sensation of the female is at its height, the womb opens to receive the injected semen. But this is uncertain. This spermatic fluid is composed, in a large part, of mucus. A smaller portion of it is secreted by the testicles, and is the true semen, | Fig. 140. III' ■il 'fr 'I > t ;>1 ft-*' IV' .^: 'ii IS 374 FEMALE DISEASES. or life-giving principle. This last portion is composed, almost en- tirely, of fertilizing filaments or vesicles, which look like small ani- mals (Fig. 140), and for a long time, were supposed to be animalcules. They are generally called spermatozoa. By some mysterious law of , their nature, they are endowed with the power of motion ; and when deposited near the mouth of the womb, they immediately begin to move, as if by instinct, in search of Km ui a ripened egg. Passing through the uterine neck, they enter the womb, and thence glide onward into the right and left fallopian tubes, and through these to the ovaries. If an egg be found, in its ripened condition, either in the womb, or the tubes, or about leaving the ovarian bundle, they im- mediately embrace it, and, in some mysterious way, mingling their own fluid contents with the contents of the egg, they impregnate or fertilize it Fig. 141 shows the womb divided lengthwise. A, is the internal nunUh (os internum), or point where the canal through the uterine neck enters the body of the womb ; B, is the ex- temal mouth ( os externum) ; the space between A and B, the passage through the neck ; and C, C, the points where the fallopian tubes begin. By looking back now, and examining Fig. 134, the whole thing wHl be understood. * This is a very brief and simple account of impregnation. It ia supposed to be capable of taking place either a little before or a little after the monthly flow, and not at int«rtnediat« times, for the reason already stated. There are some reasoiio for believing that the same egg or germ, if fertilized just before the courses, will grow to be a male, while, if fecundated after the turns, it will be a female. One reason for this supposition is, that plants may be made to bear male or female flowers by simply subjecting them to different degrees of heat. If there be more heat than light, male flowers are produced ; If more light than heat, female flowers are the result. The heat of the female generative organs is raised to its highest degree about the time the egg bursts its covering, which is just before the beginning of the flow. It has been thought that the right ovary produces males, and the left ovary females ; but this theory is not supported by any facts, and is probably not true. Causes of . terility. — From what has been said, it would appear that to ensure childbearing, it is only necessary that semen or seed, containing spernoatozoa, come in contact with a germ vesicle or egg, ^^^■-r-^^^ \ r^ >^ - |p 1^ 3 ^^^^ yi .^^- i ~ "~ ^I/^ y L . - .?K / V 1 / \ 1 - / \ i 7 \ — fl — fl k— j[b— -^ FEMALE DISEASES. 375 at the right time ; that there be no hindering disease ; and that the parties cohabiting be adapted to each other. It is evident enough that a want of adaptation between the parties, physical or moral, or both, is often an absolute bar to conception. A lack of moral adaptation was probably the obstacle in the case of Napolnon and Josephine, — her marriage with a previous husband, and his with a subsequent wife having both been fruitful. It is certain that indifference on the part of the wife towards the husband, and especially repugnauoe, may. prove an obstacle. A mere lack of sexuiil feeling does not necessarily prove a bar, though it probably lessens the chances of a fruitful union. Conception may fail to take place from the diminutiveness of the male organ, — the semen not being deposited in the right place; or, from its excessive largeness, — penetration of the vagina bring impos- sible. In some rare cases, the womb is absent. The inflammation of the ovaries often prevents the ripening of eggs. The fallopian tubes occasionally get diseased and plugged up, so that no egg can pass to the womb. Inflammation in the cavity of the uterine neck is probably the most frequent of all the causes of sterility. The viscid, gluey matter which is secreted in inflammatory conditions of this part, plugs up the passage, so that no spermatozoa can pass up in search of the egg. The acrid discharges in most of the cases of whites destroy the fertilizing spermatozoa, and render conception im- possible. All the, displacements of the womb may act as bars to impregnation. If it fall over backward or forward, the mouth is tilted up before, or down behind, and is not in the right position to receive the semen es, and the Treatment. — Judicious treatment will, in most cases, remore ster- ility, and open that "well-spring of pleasure," which the poet has so felicitously described as — "a baby in the house." The obstacles to conception, stated above, are chiefly those diseases which had been previously described. To cure those diseases, is to remove the obstacles. When it is dependent on the causes which produce painful menstruation, or profuse menstruation, or a suppres- sion of menstruation, the remedies are the same as are pointed out for those complaints. If inflammation of the ovaries be the cause, a cure may be effected, provided the inflamed condition be removed before the bundle of eggs be destroyed. If inflammation or ulcera- tion of the neck of the womb be the obstacle, the remedy may be found in the treatment recommended for those affections. Sterility depending on the causes just mentioned, I have had the pleasure of curing many times. When dependent on a lack of phys- ical or moral adaptation between the parties, it does not, of course, admit of relief. It is a misfortune to be borne in silence. It has happened, perhaps, through a lack of judgment or care in selecting a partner, and is one of the mistakes of a lifetime which a lifetime cannot repair. When this want of adaptation is not complete, a rem- edy may frequently be found. Unfortunately, many females do not regard sterility as an evil to f;!iiii i\ 376 FEMALE DISEASES. be deplored, but rather as a blessing to be Uesired. Life, to them, has no high aims or duties, — it is a round of fashion and pleasure. To bear and rear children interrupts their frivolities, and they seek to escape such abridgment of their pleasures. This is wrong. Life is a great theatre, in which all should strive to act some worthy part, and feel that, upon retiring, it would be wrong to leave their garments upon the vacant stage, with none to put them on, and continue the drama. Case. — In 1854, a lady, twenty-five years of age, was brought to me by her husband, in the hope that some relief might be obtained for some female complaints, from which she had suffered for a num- ber of years, and which threatened to make a wreck of her health, if not to destroy her life. Having come with the full purpose of having the case properly in- vestigated, both herself and husband readily assented to an examina- tion, which revealed a highly inflamed and swollen condition of the neck of the womb, with a small ulcerated patch immediately around, and extending some half inch within the cavity. She had for a long time suffered severe pain at her ntonthly turns, with great and dis- tressing bearing down both before and after her menstrual flow ; her back was weak and painful, making it impossible to walk out of duors, or to stand much upon her feet. She had become nervous and much debilitated, and had pains at times in her chest, her liver, her head, and limbs ; was distressed by all sorts of disturbances of the stomach ; and had become, as she said, about as thoroughly un- fitted for all the useful purposes for which human beings are made, as she well could be. She had been married five years ; but, as might be expected from the condition of the uterine neck, she had no children. Introducing a glass speculum, I took a caustic holder, with a piece of stick nitrate of silver in it, and touched the whole surface of the ulcer in the mouth of the womb as far as it could be reached. I di- rected her to take one to two teaspoonful doses of the tincture of scuUcap every night, to quiet the nerves and promote sleep, and re- quested her to come to me again in a week. At the next visit I reached the upper part of the ulcer in the uterine neck with a delicate silver syringe, and threw a fine shower of a strong solution of nitrate of silver upon all sides of the ulcer, and prescribed, in addition to the scuUcap, pills of iron, etc. (75), to be taken three times a day. I directed her to see me once a week, which she did for four months. The improvement, after the second week, was gradual and steady, — so much so, that little variation was required in the treat- ment. At the end of four months, the inflammation and ulceration had both disappeared ; her pains and aches had all silently with- drawn ; she could walk, ride, and stand upon her feet ; and, in brief, she has since, to the delight of herself and husband, borne two chil- dren, and enjoyed tolerably good health. I' I. 'M' Midwifery. A STOPPAGE of her courses is most commonly the first notice a woman has of her being in the family way. This is perceived two or three weeks after conception, when she begins to experience other feelings peculiar to the situation. These feelings are nausea and vam- t/tng', or a decided languor, in the morning; swelled and sometimes painful breasts ; the areoloB, or colored rings around the nipples darker than usual ; pain in the lower part of the back ; and, occasionally, a good deal of spitting of a frothy, cotton-like substance. These symptoms are more or less severe in difterent cases, and under different circumstances, according to the state of the patient's bowels, and her habits of exercise. Ordinarily, she suffers most during the second and third months, on account of the Sinkiuf Down of the Womb, which, from soon after the period of conception, is gradually increasing in size and weight As it grows larger and heavier, it sinks lower in the cavity of the pelvis, until about the fourth month, when, becoming so large that it cannot longer be accommodated within the narrow limits of this unyielding box of bones, it is obliged to mount higher to find room in the ampler and more distensible belly. This low position of the womb in the early months of pregnancy, occasions many disagreeable sensations, — as pain in the lower part of the back, and sickness at the stomach. The Costiveness, too, from which women suffer so much at this time, is often caused, in part at least, by the pressure of the enlarged womb upon the lower bowel. Costiveness, thus induced, at length becomes itself a cause of serious mischief. The lower bowel, filled and enlarged with its hardened contents, reacts upon the womb, crowding it still lower in its narrow quarters, and greatly increasing its excitability. The enlarged bowel and womb combined, make constant pressure, sometimes upon the urethra, or water-pipe, causing pain and difficulty in making water, and alioays upon the ascending veins, checking the return of blood, and producing congestion in the lower bowel, manifested by troublesome piles. Treatment of Pregnancy. — When the pregnant woman first recog- nizes her situation, she should determine to "observe moderation in all things." Let her avoid violent and sudden exertion, and move about more calmly and evenly than usual. By this is not meant that she should give up her customary occupation ; but that she should pursue it with becoming carefulness, resolved in no case to hazard over-exertion, and rather leaning to the side of indolence. This would not be real indolence, for sh i is doing a great work internally, and should not unduly withdraw her energies to external affairs. Let her not be too much in the erect position. If of delicate constitution, and not in vigorous health, she should make it a point to lie down several times during the day. The standing position, continued for a long time, especially if it be under circumstances 'A ijiii. 'I 1 =r^' li;:-;! il'M"! I n IP' -•/: i&j .■ ■ I J V I 378 FEMALE DISEASES. to induce fatigue, greatly favors the descent of the womb, — while a frequent rest in a horizontal position, may enable it to keep its place. An Objection. — It may be objected by some, that a large majority of the mothers in the world are working women, and obliged to con- tribute by their industry to the support of their families; and that they cannot atlbrd, therefore, to lie still, and mind directions. To this it may be answered, that it is a great advantage to under- stand the best way, so as to have the privilege of at least aiming at it. Much is accomplished, in all circumstances, by aiming at doing the best thing ; and few womtMi are so situated that they could not go favor themselves as to obt!y the laws of health a little more per- fectly, if they thoroughly understood them. All can better aflbrd to avoid sickness, than to be sick; Many occupations, also, unless money tempt to excessive application, become, when steadily fol- lowed, comparatively easy and unexciting. Thus, most people can go through their usual round of duties, because they have got used to it. Indeed, there is nothing but indolence itself, to which we may not become accustomed. The difference between the laboring and the privileged classes is more imaginary than real. All must work. None can escape the primeval decree — " In the sweat of thy face shalt thou eat bread." Many women, when they find themselves in the family way, will observe no cautions, but work all the harder, and even use other means for the purpose of bringing on abortion, and preventing an increase of children. This unnatural and wicked, but too prevalent, disposition, results sometimes from a fear of the pains of child-birth, sometimes from a desire to avoid the necessary care and confinement connected with raising children, but mOst often from a wish to escape the expenses which the prevailing fashions and customs of society connect with a large family. The cost of a shattered nervous sys- tem, rnd of a body weakened and poisoned by powerful drugs, is not considered, because not understood ! Hence the success of those quack advertisements, impudently professing to cure female diseases, but whose chief object is disclosed by the insertion of the hypocritical caution — " Be careful nc^ to take this medicine during pregnancy, as U will be sure to produce au* jrtion.'" It seems as if the world would never learn that God loves children^ although since Abrrxhari's day he has said so much about them in his word, — although His Son, sent into the world on purpose to show the disposition of the Father, took them up in his arms, and blessed them, — and although He has implanted a most wonderful love of them in the soul of man. Costiveness and Piles. — Let the pregnant woman use all proper means to keep her bowels in order. She will thus greatly diminish the distressing nausea, and may entirely prevent the accession of piles. To accomplish this object, the saline aperients (7) (5), or, oc- casionally, other mild cathartics (10) (12) (14), may be used. But more important than either or all of these is the frequent use of a mm FEMALE DISEASES. 37» 3, — while keep ita B majority ;d to con- and that to under- aiming at ; at doing could not more per- ■ aHbrd to .so, unless eadily fol- )uo|)le cati s got used ih we may oring and lust work, f thy face way, will use other renting an prevalent, child-birth, >nfinement 1 to escape of society rvous sys- ugs, is not » of those } diseases, ypocritical gnancy, as s children. it them in )urpose to arms, and wonderful all proper Y diminish cession of (5), or, oc- ised. But t use of a good self-injecting family syringe. An injection of half a pint of cold water every morning, will do much towards regulating the bowels, and preventing or curing piles. NaiLSea. — If, as sometimes hnppens, there should be persistent nausea after the first three niontlis, it will need to be coinbutted by mild tonics -and stimulants, as chiiruoniile tea, or clove tea (58) (ll4), and by seeking a kind of dlr-t wlii(!lj will be agreeable both to the palate and the stomach. Dr. Mtigs speaks of champagne as a remedy, and mentions some serious cases entirely relieved by it. The ^'ipplc.H. — During the last month, particular attention nhould be paid to the nipples. Untold misery often results to the young mother from sore nipples ; and it is well worth her while to une every precaution against them. The nipples are of course in an excitable state during the whole period of gestation, and at length frequently become irritable and tender. Let them be daily bathed, for three or four weeks be''ore confinement, with some astringent and cooling lotion, as oak-bark decoction, borax water, alum water, or a solution of tannin (200) (201) (202) (203). The object of treatment, in this case, is to toughen them, and ren- der th' .n less susceptible, so that they may not be made tender by the subsequent application of the child's lips. • When a woman is peculiarly liable to this trouble, the further pre- caution of having them gently drawn, by some friend, every day, during this last month, would be of great service. At all events, let no pains be spared to guard against this evil ; for sore nipples make sore breasts; and sore breasts make broken breasts; and broken breasts are terrible things. They make the mother sick; and if the mother is sick, the child is sure to be sick ; and all hands soon get sick and worried ; and the whole business of having children, and taking care of them, is deprived of its peculiar joys and consola- tions, and brought into undeserved disrepute. Whereas, under wise and prudent management, there is something delightful to the young mother in yielding sustenance to her dependent ofispring. For, when her nipples and breasts are in a healthy state, she can say with the poet, as " The starting beverage meets its thirsty lip, 'T is joy to yield it, as 't is joy to sip." Swathing. — In advanced pregnancy, much assistance in supporting^ the burden is sometimes derived from swathing the bowels. Healthy and vigorous women, however, need no such assistance ; it is chiefly applicable to cases of debility, either constitutional, or resulting, from neglect, or from over-exertion during former pregnancies. Cramp in the Stomach is sometimes very severe, and if allowed to continue, may kill the child. The best remedies are warm carmina- tives (114) (115), or anodynes, etc (121) (122), or antispxumodies (90) (94). •> J i ,i% til .:ii. 4 lit 380 FEMALE DISEASES. Headaches. — These may be relieved b^i antispasmodics, etc. (90) (94), or anodynes (121 )• Palpitation of the Heart may prove very distressing to delicate women. The remedies are the antispasmodics, with rest. Some- times tonics are useful, such as the muriated tincture of iron (73). The bowels should be carefully regulated. Fainting, which occurs before or at the time of quickening, is some- times very troublesome. The proper treatment is ti»a avoidance of fatigue, and, during the fainting fit, the recumbent posture, cool air, application of cold water to the face, and ammonia to the nose. Cough is sometimes present. It is caused by the upward pressure of the diaphragm against the lungs, by which they are irritated and convulsed. The remedies may be selected from the cough prepara- tions among the prescriptions. Varicose Veins. — These cannot be removed during pregnancy; but they may be relieved by great care of the bowels, and by wearing tight bcmdages, or elastic stockings. Swelling of Lower Limbs is caused by pressure of the enlarged womb upon the veins ; and may be relieved by care of the bowels, and diuretics (130). Itching of the Genitals may be much relieved by borax, morphine^ etc. (204). Miscarriage.— Abortion. When a woman in the family wav throws off the contents of hei womb, or loses her child, during the first six months, the accident is a miscarriage, or abortion ; when the same thing happens during the last thv: :; months of her term, it is a premature labor. Symptoms. — If abortion occur during the first month after concep- tion, the symptoms may not attract much attention, or, may be re- garded only as an irregularity of menstruation. Occuring at later periods, it is frequently indicated by some feverishness, coldness of the feet and legs, a puned-np condition of the eye-lids with purplish discolorations, shooting pains in the breasts, which become soft, pains in the back, bearing-down pains in the lower part of the bowels, which come and go, and at length take the character of real labor pains. As these pains increase, blood begins to appear, and, sooner or later, the bag of water breaks, and the fetus is thrown off. Causes. — These are very numerous. Some of the principal are, displacement of the womb ; ulceration of its neck ; syphilitic disease of the fetus received from the parent ; too much exercise ; heavy lift- ing ; falls, particularly when the woman comes do vn upon the feet, and ib heavily jarred ; emetics; powerful purges; and too much nup* tial indulgence. SJ^ Treatment — Where the symptoms are but slight, nothing may be required more than a little caution for a fev days, and rest in the horizontal posture, using cold drinks, and taking for two or three nights, at bedtime, perhaps, a pill composed of oii? g'ain of opium and two grains of sugar of lead. Beside these remedies, it may be well to put a nmstard poultice low down upon the b.tck. If, notv/ithstanding, flooding comes on, and the symptoms of mis- carriage increase, a napkin wetted with cold water, or vinegar and water, or a bladder partly filled with ice, should be laid upon the ex- ternal genitals, and pulvt;rized alum, mixed up with a little honey, must be given internally, every half hour ; and if the flooding still increase, it may be proper in some cases to resort to the tampon or plug. To do this, take either lint, or old pieces' of calico, or a piece of hne spoiige, and having soaked it full of a strong solution of alum, or tannin, or, sdll better, Monsel's persalt of iron, one part to six parts of w^ater, — tiU the vagina full, and then place a fold of linen in the genital fissure, and apply a bandage. This will generally stop the flow ; but the plug must be removed in from five to ten hours. If the abortion cannot be prevented, — especially in the latter months of gestation, then the case is to be permitted to go on, and to be treated the same as a natural labor Labor.— Delivery. The expulsion, at full term, of the child, the after-birth, the mem- branes, and the fluids, constitutes labor, or delivery. It is supposed to occur about two hundred and eighty days after the last menstrua- tion ; but authors reckon it diffe'cntly; in truth, it is not possible to fix it exactly, for it evidently varies in difl'erent cases. When the time of her lying-ia arrives, let every woman meet it with calmness and undoubting confidence. There is every reason to encourage this state of mind. Think of the vast multitudes of people in the world. Each one once existed in the womb of a mother, and had to pass through its narrow portals to be admitted to the light. Successful delivery is the rule, the world over ; and it should be the rule to confidently expect it. In the midst of thej)ains of labor, nothing does more to bring a favorable result than courage and patience. Patience is able calmly to survey all the difliculties before iier, becau:^e she never attempts to encounter but f^ue at a time. There is much philosophy in the story of the '■^ di^'jutcrUcd JH ndiilum^'' which got discourai^od, one morning from re'lccting how many millions ol t'lues it would have to swing duririg succeeding yeai-s, but became reassured upon considering that a single stroke cost but a very trilling effort, and that it really had to make but one at a time. So it is with labor; its pains, which are really severe and agonizing, will beCvMne comparatively tolerable, if the whole attention of the woman be confined to present suflering, and her vv hole stock of courage and patience be brought to bear U[/on one panff at a time. Let her resist the temptation to a feeling of haste. Nature will n ' ' i If Tit-" . I m 382 F.'.MALE DISEASES. ^_rAt'\, lA piL»i;cuu more evenly, and more ?ipeedily, if allowed to take her own time. A hurry to get through is a great obstacle to successful delivery ; it always puts things back. . . Symptoms. — Omh of the first indications that labor is about to begin is, that the woman finds herself smaller- — the child having sunk down lower in the abdomen, and she accordingly breathes easier. The genital organs become relaxed and moist, and mucus escapes, whirh is called " the shows." The woman finds herf^elf dis- posed to be nervous and fidgety, and perhaps a little depressed in spirits. "When labor has fully set in, it is marked by lowness of spirits, flashes of heat and cold, a great desire to empty the bowels and to make water, and grinding, cutting pains, which grow stronger and more continuous, with intervals of ten or fifteen minuves' ease be- tween. Vomiting in the early stages of labor often occur^;, and may be regarded as favorable, — indicating the softening and opening of. the mouth of the womb. Treatment of Labor. — When labor begins, the attention shtnld be directed to the state of the bowels and bladder. Th- vhu head begins early to press upon the bladder and lower bowe.^ jun i.ig the desire to make water, etc. ; and these should be immediately emptied to make room for the head to pass more easily. The bowel may be freed by a dose of castor oil (10), if there is time for it to operate, — but more sun.'ly, and more satisfactorily, by an injection. lielief in the bladder may, perhaps, be obtained by a different position of the woman in the act of making water. It is the pressure of the child's head upon the water-j)ipe which causes the t.ouble ; and to relieve it, the v.'^oman should get upon her hands and knees, with her shoulders lower than the iiips, so as to throw the child upward and forward towards the cavity of the abdomen. Thus situated, she may often find it easy to make water, when in the ordinary position it would be impossible. If, however, this manoeuvre does not succeed, and the bladder becomes greatly diste.ided, the catlieter must be used. 'riie Bed ami lliibilimeuts. — In the next place, fix the bed, f.L the patient's habiUments. Reject feather beds; use th*^ matl,: s- Cover this with a rubber cloth, if convenient, and then with lolu H sheets to absorb the discharges, and protect the bed. Let the woman be arrayed in the same garments she expects to wear after the com- pletion of the labor, and let these be well tucked up under her arms, and let the lower portion of her body, from the waist downwards, be enveloped in a sheet. This sheet can be easily removed, and the clean clothes pulled down without greatly disturbing the patient when in the exhausted state which follows labor, and when it would subject her to great fatigue to be obliged to sit up in bed to have her clothes changed. Let her lie up<.»n her left side, with her body shorten:^ ^ V/ bending forward, so that the muscles may be relaxed; let her h« li'I ?>» J)laced in the middle of the bed, and her feet press against the f ' t bot-post. Around tbis post a shawl or towel may be fastened, upoa which she may be allowed to pull during the pains. It h ake her ccessful bout to having areathes , mucus self dis- etsscd in f spirits, I and to iger and ease be- ind may ening of bonld be '\ head : liig the emptied 1 may be jerate. -- llelief in )n of the le child's relieve it, houlders forward lay often ATould be and the bed, ?'■ I. mati/i S' th loiti ^-^ li woman the com- her arms, ^vnwards, , and the ent when d subject r clothes teiio^ V/ r hiiil ■'' the r > led, upoa i The Presentation. — An examination with the finger is to be made to learn the presentation, — that is, to learn which part of the child comes first into the mouth of the womb. Head Presentation. — If the head present, the labor will probably go on without the need of medical aid. But \n all labors there is a liability to dangers from unforeseen accidents, which renders the at- tendance of an intelligent physician highly prudential. Breecli or Feet Presentation. — If the feet or breech present, it is desiiable to have the first part of the labor proceed slowly, so that the passage may become well dilated, and prepared for a more rapid delivery of the head. If the breech present, do not pull down the feet ; let the child come double : it will make more room for the head. If the feet present, let there be no pulling upon them to hasten the birth of the breech. After the feet and breech have fully cleared the external orifice, the delivery may be judiciwu.^'ij hastened for the purpose of prevent- ing the death of the child from pressure on the umbilical cord, before its head is brought to the air, and the act of breathing thus permitted. For after the pulsations of the cord cease, the child must either breathe or die. In this kind of presentation, therefore, the child's life is in great danger. After the birth of the lower half of the body, the cord ex- perience's sei'ere pressure, sufficient to interrupt if not wholly prevent its pulsations. It then becomes necessary to hasten the birth of the upper extremities and head by all prudent means. Violence is never in order in midwifery; but considerable for'.e, skilfully directed, may sometimes be safely used. After the shoulders are delivered, the pas- sage of the head may be facilitated by carefully pulling down the arms. Then, as soon as possible, introduce the finger into the mouth of the child. This will serve ^he double purpose, perhaps, of per- mitting a little air to make its way into the child's lungs, and of fur- nishing a hold by which its head may be gently drawn along into the world. If there is iimch deliy at this juncture, perhaps in some cases the child's life may be preserved by inserting into its mouth one end of a male 'jatheter, — thus furnishing an open tube for the pas^:age of air, until more vigorous pains shall introduce it into the full liberty of the atmosphere. While the head is yet undelivered, great care should be usee to ke ~ the child's body warm by covering it with flannel, and also to kt ) i' in a correct relativ3 position with the head. If the body be inca. o.ously tu.u°d round, ^f course the neck will be twisted; and the child' r' subsequent d"llvoiy with a broken neck will be the miserable result, — bringing confusion to the medical attendant, &nd unhappiness to all concerned. Arm or Shoulder Presentation. — If the arm or shoulder present, the child will probably have to be turned. In case this cannot be effected, its chest must be opened and emptied of its contents, that there may be room to bring down the head. It is barely possible to avoid a resort to art in this presentation. 384 FEMALE DISEASES. Floodinjif or Hemorrhage, occurring to an alarming extent, is hiip- pily one of the rare incidents or consequences of labor. But when it does occur, it demands the most serious and prompt attention. Profuse bleeding from the womb is most commonly owing to a partial separation o( the placenta, or after-birth, from its attachment to the internal cavity ; and it has recently been observed that the flow proceeds more rapidly from the detached portion of the after-birth than from the corresponding exposed surface of the womb. A knowl- edge of this fact has an important practical bearing; for if, in severe cases of Hooding, the partial'y detached after-birth can be entirely separated, the bleeding will often be speedily arrested. The most dangerous floodings occur in cases of placenta previa, when the after-birth is over the mouth of the womb. In such cases, when the labor commences, and the womb begins to open itself, the after-birth must of course be partially separated. These cases, unless p: n ptly relieved by art, may prove fatal iv a few minutes. Yet, tht t rdinarily sufficient time, if it .be impicved, calmly to choose and J .e the proper treatment. If the flooding be immediately dangerc.j to life, the child must be turned and delivered, or the tampon or plvg" b3 applied, as directed under the head of abortion. This expedient is used when, through rigidity of the mouth of the womb, the delivery is inadmissible. Before Delivery. — In all cases of flooding, we prescribe quiet, the recumbent posture, cold applications to the abdomen and the external genitals, and the internal administratioi; of astringents and anodynes (152). After Delivery, our object is to promote contraction of the womb by cold applications and frictions externally, or, if necessary, by the introduction of the hand into the womb, for the purpose of removing the after-birth, clearing out clots, or stimulating it to shut itself up for the expulsion of the offending substance. Until this contraction is secured, the plug should not be used, lest internal bleeding into the enlarged and expanded womb should be profuse, and fatally exhaust the patient. After the Child is Bom, our first duty is, if possible, to see that it breathes. In the vast majority of cases, the well-known cry, whicli salutes the ear, gives proof that the duty is unnecessary. But some- times we fail to hear this welcome sound. The umbilical cord may be once or repeatedly wound around the child's neck, and must be immediately removed to prevent strangulation ; or, the child's moutli may be filled with phlegm, or some sticky mucus, which must be poked out with the finger, and its exit favored by turning the face downward ; or, after tedious labors, the child may be born in a very feeble state, and may need the stimulus of cold water thrown sud- denly, in small quantities, upon its chest and. body, with considerable rubbing, and perhaps the inflation of its lungs with air blown into .'ts mouth. Tyini; the Cord. — When breathing is established, a piece of narrow FEMALE DISEASES. 385 « of narrovf tape or eommon twine is to be tied tight around the navel-string, about two inches from the child's navel, and the cord is then to be cut off, with a pair of sharp scissors, from half to three quarters of an inch outside the place wiiere it is tied. The child is then to be delivered to the nurse. Wai»hiiiff the Child. — The child is now, while the physician is at- tending to the mother, to be washed and dressed by the nurse. Its skin is at this time covered with a suet-like substance, called the vernix caseosa. To remove this, it should be washed all over gently with warm water and castile soap. It is not material that this coat- ing should be absolutely all "emoved at the first washing ; but the soap and water should be again gently applied in eight or ten hours from their first use. It is improper to use spirits fo* this cleansing. All rougl' jbbing must be avoided as injurious to the delicate skin of so tender an infant. Washing with cold water would lower the temperature to a dangerous degree, and should in no case be allowed. Removal of the After-Birth. — The woman having rested fifteen or twenty minutes, a little gentle soliciting or pulling with the cord will generally bring away the after-birth. If, however, any serious obsta- cle prevent its expulsion, it may be slowly and cautiously taken away by the hand introduced. €leansiii(^ the Ited, and Applying tlie Swathe. — Upon the removal of the after-birth, a cloth is immediately applied to the external or- gans, a Hrink of water or tea is administered, and another rest of an hour or uore allowed. The woman may then be conveyed to a neighboring bed, sofa, or easy-chair, for the purpose of cleansing the bed, adjusting her clothes, and applying the swathe. This last men- tioned application may consist o*" a towel pinned snugly around the body, or of a cloth, cut and fitted exactly for the purpose. Its object is to afford a firm and steady support to the contracting womb. If a chair is occupied while the bed is being arranged, it L,iiould be well tipped back, and the woman's feet supported on a high stool, as it is of great importance, so soon after delivery, to keep her either entirely or very nearly in the recumbent posture, to avoid dangerous fioodings. The Dressing for the Child's ^avel should be so fixed that the njivel-string or cord will not be left in contact with the healthy skin. To effect this, make a hole large enough to admit the cord in the centre of a piece of linen cloth four inches square; pull the cord through this hole, leaving the cloth lying flat upon the child's belly ; then, having bandaged the cord down to the belly, fold the cloth over it, and apply the belly-band. The interposition of these dressings will thus keep the cord, which is dead and in process of decomposition, from irritating, and perhaps excoriating the living flesh, with which it must otherwise be in close contact. Nourishment of the Child, etc. — After being dressed, the child should be kept next the body of the mother or nurse, that it may 49 1 pi I receive the natural warmth thus to be derived. Its nourishment should be obtained exclusively from the mother's breast. If it is hungry, be sure and keep it so. There is nothing more appropriate than a hungry child all ready to take hold and exhaust the full and almost bursting breast on the third day, when the milk has come. Alas ! How many children have been fed on sweetened water, and on milk and water, till they have lost all instinctive idea of, and all appetite for, nursing! and how many bowel complaints and broken breasts have been the miserable consequence! But meddlesome friends are afraid the "little dears" will starve; and therefore they must first be made sick by unnatural diet, and then for their cure be treated to that filthy, harsh, and indecent substitute for medicine, " chamber-lye and molasses.'" But it may be asked, " must not the ohild be fed at all, if it is hun- gry, and cries a great deal, and there is nothing in the mother's breast for it?" Such cases will be exceedingly rare, if t lie breasts have been properly solicited from the first by a hungry child. When they do occur, being themselves exceptions, their treatment mr.,^t be ex- ceptional ; but, even then, only so far as is absolutely necessary. If fed at all, the child should not be fed to satiety, but as little as the circumstances will possibly permit. The great rule remains: keep the child as hungry as possible till the milk comes. "When it has to be fed, imitate the mother's milk as nearly as possible in the preparation of the artificial diet. A little sweet cream, warm water and sugar, should be so mingled, that in warmth, richness, and s'veetness, the mixture may closely resemble human milk. Diet of the IWuther. — For the first few days after confinement, the most appropriate diet for the mother, is gruel, cocoa, rice-water, crust coffee, oi" some similar liquid nourishment. DifTerent constitutions, however, need somewhat different management. A woman naturally robust, and of full habit, should confine herself more strictly, and for a longer time, to this light diet, than one who is more slender and feeble. In some cases, weakly women require the juice of meat, and even wine or ale, as early as the second or third day. If she be subject to canker, or nursing-sore mouth, a generous diet is particularly serviceable. After the first week, she may gradu- ally return to her customary diet. Costiveness may be treated with the usual remedies. It was an old rule to give a dose of castor oil on the third day, when there is a little increase of excitement in the system, from the filling of the breasts. This is not always necessary, and in most cases an injection would be far better. The Perpendicular Position. — During the first month, let the woman avoid being often or long on her feet. This is a very essential caution to avoid prolapsus, or falling of the womb, with all its attendant weak- nesses and pains, and to ensure a good " getting up," with a sound womb, in the right place, and subsequent months of health and enjoy- ment. ishment If it is ropriate full and iS covne. iter, and , and all I broken Idlesome ore they r cure be nedicine, it is hun- r's breast ists have hen they „^t be ex- ssary. H tie as the : keep the , has to be reparation md sugar, etness, the iment, the ater, crust listitutions, ne herself 111 one who Ion ri-quirc lid or third generous lay gradu- It, was an there is a Ting of the In injection the woman lial caution Idant weak- \th a sound land enjoy- FEMALE DISEASES. 387 Milk Leg. — Phlegmasia Dolens. — Cniral Phlebitis. The popular idea is, that in this disease the woman's milk has fallen into her leg, which has inflamed. This is of courHc absurd. As to the real nature of the complaint, there are various opinions, — some holding it to consist in inflammation along the sciatic, crural, and pubic nerves; others, that it is an inflammation of the lymphatics of the groin which causes it ; others, that it is an inflammation of the crural veins. Probably this latter view is the correct oix*. SyniptoniS. — The disease beg-ns in from two to seven weeks after delivery, with pain in the lower bowel, groin, or thigh. The pain is more violent when the thigh is extended. T>i a day or two, the pain diminishes, and the limb begins to swell, frequently in the calf of the leg first, thence extending upward, but generally in the groin, and extend- ing gradually down. The skin becomes entirely white, smooth, and glossy, does not pit when pressed, is painful to the touch, and is hotter than the skin upon the other limb. In connection with this local disease, there is general fever, with small and rapid pulse, thirst, etc. Treatiiieiif. — The patient must lie flat upon her back, with the swelled limb placed upon pillows, or a bolster, raised so that the foot shall be a little higher than the hip, and then charged not to put her foot down upon the floor, until she is very nearly well. Apply a narrow blister along the course of the crural vein. When this is removed take a large piece of flannel, — Dr. Meigs says an old flannel petticoat, with the h*^m and the gathers cut ofl', — and dip it in vinegar and hot water, equal parts; wring it out, and cover the whole limb with it. Put a piece of blanket or oiled silk over it to keep it from wetting the bed. Repeat this, and keep it up for six hours. When it becomes tedious to the patient, remove it, and bathe the limb with warm sweet oil, two parts, and laudanum, one part, and cover it with flannel. In two or three hours, return to the first appli- cation of hot water and vinegar. Continne this for five or six hours, and then take warm sweet oil and laudanum ; and thus pass from one to the other until the inflammation is subdued, or, as Dr. Meigs says, till the calf of the leg can be shaken. If the bowels are confined, let them be gently moved by some gen. tie physic (13) (14) (18) (25) (27) (41). In many cases, diuretics and cathartics combined will be proper (302), or diuretics only (128) (130). While the inflammation lasts, and there is fever, the tincture of veratrum viride must not be forgotten. If recovery does not take place after the active inflarrmation has subsided, the limb should be bandaged from the toes to the groin. Child-Bed Peyer. — Puerperal Fever. Few complaints more justly excite the dread of the practitioner than this. It cuts down woman at a time when she can least of all 388 FEMALE DISEASES. be spared by her young offspring, and at a moment when she most excites the love and sympathy of her whole family. It is a terrible disease. It consists of inflammation of the peritoneum or lining of the ab- domen ; also, frequently inflammation of the ovaries, of the womb, of the veins of the womb, or of the absorbent vessels of the womb. Its symptoms have already been described, on page 277, under the head of inflammation of the peritoneum. The treatment is, likewise^ there given. I may mention here, however, that an infusion of cham> omile flowers is lately spoken of as a powerful means of preventing suppuration in this complaint. There is a diversity of opinion as to whether this disease is conta- gious, though the best medical testimony seems now to be on the aflirmative side of the question. The physician or midwife having a case of child-bed fever in charge, should not for some time attend cases of midwifery. Nursing Sore Mouth. Nursing women sometimes suffer terribly with this complaint It begins with a scalding sensation upon the tongue, a pink color in the roof of the mouth, and a hot, watery discharge from the mouth. After a few days, small ulcers appear on the tongue, and in the throat Costiveness is generally present ; but when the ulceration extends to the bowels, diarrhcea occurs. It comes to an end upon weaning the child. Treatment. — To relieve costiveness, give some gentle .cathartic (12) (15) (25) (34) (36). Iron in some of its forms and combinations is highly necessary (61) (71) (73) (349). Gargles will frequently do much good (227) (229) (230) (235) (243) (244) (347) (350). The diet must be simple, nourishing, and digestible, consisting of stale bread, potatoes, tender beef steak, roast beef, broths, etc. Inflammation of the Breast.— Broken Breast. Mammary Abscess. The mammary gland, or gland which secretes milk in the human breast, consists of a number of ducts, passing inward from their ter« minatioii in the nipple, and then spreading around like the roots of a tree, and terminating in minute glands. The mammillary tubes are straight ducts, ten or twelve in number, having their mouths at the centre of the nipple, dilating at its base into larger reservoirs, which extend some distance into the gland. (Fig. 142.) When milk is first formed, after confinement, these tubes and res- ervoirs sometimes get so full and hard that they crowd and compress each other, making it difficult to remove the milk, and uuder these circumstances, the breast will inflame. FEMALE DISEASES. 389 FlO. 142. Symptoms. — The inflammation generally begins with a chill, fol- lowed by fcver, and pain of a shooting kind, which is much increased by pressure. An examination will generally reveal a circumscribed, hard, and painful tumor, even be- fore there is any redness on the surface. After a time, the swelling spreads, the skin becomes of a dusky red, is hot and shining, will frequently pit a little Oil pressure, and soon gives a sense of fluctua- tion. Upon the formation v)f matter, the fever is increased, the breast is enlarged, and there is local tenderness and throbbing pain. This complaint may be caused by taking cold, irregularities in diet, or by mental emotion ; but more commonly it is caused by accumulation of milk within the ducts. Treatment. — These afllictions may generally be prevented by keeping the breasts well drawn. It is the duty of a nurse to look well after this matter, and see that the breasts do not get hard and distended with milk. But when the inflammation has fairly set in, the first aim should be to prevent, if possible, the formation of matter. Active purging should be resorted to at once (29) (32). Sweating should be encouraged by the tincture of veratrum viride. If the object be to prevent the formation of matter, cold lotions, or cold water compresses, should be used freely ; but if two or three days have passed before active treatment, the suppuration will go on, and it is better to use warm applications. Dewees says warm vinegar is the most beneficial as well as the most comforting. Poultices and warm fomentations are much used. Some apply stimulating lini- ments, made of essential oils, etc. (195) (198). Leeches are often used with advantage. They should be applied, not upon the breast, but just below it. During the progress of the disease, especially after the abscess is opened, the breast should be supported, and prevented from hanging down, by long strips of adhesive plaster carried below and around it. By this means a gentle pressure is kept up by which the matter is more easily evacuated. The breast should be opened with a lancet as soon as the abscess points, or fluctuation is discovered. Should the ulcer not heal, an astringent wash, as a weak solution of nitrate of silver (211) may be applied to it once or twice a day. During the discharge of matter, the system of the patient should be supported by a nourishing diet, and by wine, tonics, etc Sore Nipples. Women suffering from excoriated nipples are apt to keep the infant chiefly to the healthy breast, and only to apply it to the tender side for the purpose of obtaining present ease from the pain of over-dis- I i- 390 FEMALE DISEASES. tension. In this way the ducts remain always full, and are apt to get inflamed. Sore nipples, therefore, are to be attended to as nmch on account of the evils to which they lead, aa of the suflering they directly occasion. The excoriation of the nipples begins as a chap. This buows no tendency to heal ; and the child's mouth being often applied, rubs off the skin around the crack, and this naked surface soon becomes an ulcer. These ulcers arc sometimes only on the surface ; at other times they are profound, going deep into the substance of the nipple. Treatment. — These excoriations and ulcers might be easily healed, were it not that the newly-formed skin is apt to be continually rubbed off by the child's mouth in the act of sucking. Two things are there- fore to be done, — to favor the healing, and to protect the tender part from renewed injury. For the first object, a strong infusion of green tea or port wine may answer very well in ordinary cases. A littie alum or borax, dissolved in rose water, or water (201) (202), is often used. A weak solution of sulphate of zinc, or sulphate of copper, or nitrate of silver (209) (211). But one of the very best articles is composed of glycerine and tannin (306). To protect the teat from injury in the act of sucking, use a shield made of India rubber. When the infant is not at the breast, the nipple should be covered by a metal shield. Whites. — Leucorrhcea. — Fluor Albus. Though leucorrhcea is only a symptom of disease, — as I have stated on page 353, — yet I think, on further rellection, remedies should be given for it, and I accordingly insert them here. If the discharge be of a ropy, tenacious character, one of the best remedies is a strong solution ot nitrate of silver, used as an injection with a female syringe, once a day (254). Of this, not more than two teaspoonfuls should be used at a time ; and great care should be ob- served not to stain the under-clothes with it. When the discharge is either yellow and thick, or lighter colored and watery, some one of the following (200), (202), (203), (207), (209), (220), (230), (232), (243), (244), may be used with advantage as an injection, twice a day. An infusion of the white pond lily, one ounce to the pint of water, or two drams of the fluid extract of the same in four ounces of water, makes a very excellent injection, which may be used twice a day. A very simple injection, and sometimes quite effectual, is a strong infusion of green tea. Some one of the above remedies will generally afford some relief; but if whites exist in a somewhat aggravated form, they furnish evi- dence of some serious disease in the vagina, or neck of the womb, and the case ought to be submitted to a competent physician. t\ — CARE OF CHILDREN AND THEIR DISEASES. Pure Air. — The first want of a child is a plenty of fresh air ; and this want never ceases to the end of life. Impure air kills thousand^' of infants. Out of 7,650 born in the lying-in hospital of Dublin 2,944 were destroyed by impure air within two weeks after birth. Children should be kept in the open air as much as possible, and in well-ventilated rooms when indoors. It is wrong, when infants arc sleeping, to cover their faces with bed-clothes, or draw curtains around their cots, or to envelop their heads in blankets and shawls when carried in the open air. The Skilli — The health of infants requires that their skin should be kept clean. Unless this is done they are liable to suffer much from cutaneous and other diseases. The skin of a new-born child is cov- ered with a white, unctuous matter, called the vernix caseosa. It is injurious to let this remain for any length of time after birth. To remove this, Dr. Dewees recommends that the child be smeared with hog's lard, and then washed with soap and water. Dr. Eberle says, smear with yolk of eggs, and then wash with simple warm water. The young child should be washed every day with warm water, — then, after a time, with tepid water, then with temperate, and finally, after it is some months old, with co'd water. This, if persevered in through childhood and youth, will ward off* a thousand ills and sick- nesses to which the young art liable. Tlie Clothing of Cliildreii should be so adjusted as to give their limbs ample play, and should be thick enough to keep them warnu They ought to have flannel next the skin in winter, and cotton in summer. At the risk of wounding some i u j people's feelings, I must add that the fashion of a child's clothes o not important. Tlie Food. — The natural and proper food of a young child is its mother's milk. To this it should be confined, unless prohibited by imperative circumstances, until a portion of the teeth are cut. When the mother cannot nurse her child, the breast of a suitable nurse should, if possible, be supplied. If the infant need any more food than is supplied by the breast, give cow's milk and water, sweetened with a litUe loaf sugar. The sucking-bottle, if used, must never be permitted to get sour. ^ttM, ff k') :V 392 CARK OF CHILDREN AND THEIR DIREASES. Health of a IVarsinf Woman. — During nursing the greatest atten> ^ion to health is required by the mother or the nurse. A woman of a consumptive constitution should never nurse an infant. Nourished at the breast of such a mother, the child, who has inherited her con- stitution, will be the more likely to fall a victim to her disease. Passion.s of a NurHiii}^ Woniun. — Let the woman who imrses a young child be careful of her passions. An irritable disposition, giv- ing rise to gusts of violent passion, may so alt«r the character of the milk as to throw the child into convulsions. Grief, envy, hatred, fear, jealousy, and peevishness, unlit the milk for nourishing the child, and often cause the child's stomach to be much disordered. The Diet of the Nurse should receive strict attention. It should be plain and wholesome, and the amount should never be excessive. Her drink should be simply water. She should take gentle daily ex- ercise in the open air. ' Weaninf. — At the end of twelve months, the first set of teeth are generally so far cut that the child can manage most kinds of plain food ; and it may now be taken from the breast. Should the teeth appear earlier, and the infant be healthy, it may be weaned even at the end of the tenth month. Never take the child from the breast in the midst of summer heat. A disordered state of the bowels, or cholera infantum, would be likely to be the result. The spring and the autumn are the proper periods for weaning. If for some months, it have been accustomed to other beside the milk of the mother, it may be taken suddenly from oreast. It must not have any amount of solid food it may crave immediately after weaning. It should still be kept, for some time, upon a simple, bland, half-fluid aliment, taken in moderate quantities, and at proper intervals. At first, the food should be bread and i.;ilk, boiled rice and milk, soft-boiled eggs, roasted potatoes and milk, oat-meal gruel, plain rice pudding, preparations of irrow-root, tapioca and sago, simple mr.at broths, mixed with crums of bread or grated crackers, or in which rice ox barley has been well boiled. From this it may pass gradually to a more solid diet ; though, until the age of puberty, the principal part of the diet should be milk, the farinaceous articles, and vegetables. Sugar has been thought to be injurious to children. It is not so. If taken moderately, at meal times, it is wholesome. Whatever be the food allowed to children, it should never be taken in excess; and to prevent this, they ought not to take their meals alone; for they have very keen appetites, and if permitted to do so, they will |*enerally form hab.Us of gluttony. Three or four light meals a day is enough. Their drink should be water simply, — nothing else. If parents would observe these rules, and enforce them strictly, they would confer blessings upon their children greater than riches. They would send them into the world with health and good constitutions, and would save them from untold misery and an early death. Such a course would evince more love for their children than those weak CARE OF CHILDREN AND THEIR DISEASES. 393 oonoessions which aliov tea and coffee, and all sorts of food, in quan- tities to suit, which occasion early disorders of the stomach and bowels, and bring later derangements of the nervous system, with all its regrets and horrors. Sleep of Children. — During the first period of its existence, an in- fant sleeps a large portion ot the time. This is a wise provision of nature. It withdraws the young child, for a time, from those outward exciting agents, which would too much disturb tht; nervous system of so tender a being. Whenever a young infant is restless or wakeful much of the time, we may feel sure it has had too much food, or is in some way disturbed by it, or by tight clothes, or that some other cause is giving it uneasy sensations. Its sleep should be the promptings of nature, and should never, except in rare instances, be brought about by opiat^^s. It is wrong and sinful for a mother or nurse to put an infant to sleep with an opiate, merely that she may gain time for pleasure, or even for other duties. The Infant should be kept warm while Sleepinn;. — During the first few wfteks it should sleep with its mother, — especially if the weatheh be cold. After that, it may be in a cradle or cot. The covering should be warm, but lig'ht, so as not to press heavily upon its tender limbs. If laid upon its back, the fluid of its mouth and throat may get into the windpipe, and obstruct the breathing, or produce coughing. It is better, therefore, to lay the infant upon its side, — taking care not to produce distortion of the spine or limbs by always laying it upon the same side. Children should not be allowed to sleep either with the aged, oi with sick persons. It is not healthful for them to breathe the exhala- tions from the bodies of such. For a somewhat similar reason, some kinds of plants, and flowers generally, should be excluded from their sleeping rooms. Their beds should be so placed as to turn their faces away both from the sun-light which comes in at the windows, and from the artificial light in the room. They should be taught to retire early at night, and to rise imme- diately after waking in the morning. This habit will be worth much to them through life. After the meconeum has passed, the bowels of an infant should be opened from two to four times in twenty-four hours. If the stools are less frequent than tvice a day, or, if they are Vimpy, some gentle cathartic is called for. From half a dram to a dram of fresh castor oil, or a dessert-spoonful of mixture (24) an- swers a good purpose. During childhood, the bowels should be moved once or twice a day. When a cathartic is required, a table spoonful txf mixture (25), or a teaspoonful of (17), will be found very excel- lent •» Exercise. — During the first few weeks of an infant's life it requires but little exercise ; indeed its organization is not sufficiently settled and compacted to permit much without injury. A little gentle rub- bing with the hand over the whole body, is about all it needs or will =s^ k 394 CABE OF CHILDItKN AND TIIEIR DISEASES. \f^c. To dandle and toss it about, and especially to set it upright, b injurious and wrong. Ita bones are i ' soft, and will not endure to be much twisted about, and its spine is not stiff enough to bear up the weight of its head. After u fevr weeks, riding in a carriage drawn by a careful and trusty nurse, is both a healthful and pleasurable exercise for children. Learning to Walk. — At the end of the ninth or tenth month, a child may begin to learn to walk. It is not safe to teach it this exer- cise much tari'er than this, as the bones, being soft, may be bent by the weight of he body, and the limbs be permanently deformed. As soon as ilne child has learned to walk alone, it should be allowed perfect freedom of exercise. Thenceforward, the open air is its proper place during the day ; and such an unrestrained use of its limbs as its own instincts may dictate, is its proper calling. For five years after it has learned to walk, it should do little else than to use its limbs out of doors, as it pleases. The books and the school-room will be in season after that. First compact the body, — then bring out the mind. The mind is of no use without the body, — the body must be developed first, or never. Moral Treatment. — We charge upon nature many of the bad pa«- «?ions which we ourselves implant in children. The moral treatment of children in generally bad. We arfl apt to begin by either making them our masters or our slaves. Sometimes we do both, — allowing them to govern us for a time, and then, getting into a passion, or a mood for playing the tyrant, we turn upon, and govern them as if we were autocrats. We submit to their whims until we grow irritable, and then, by way of retaliation, we compel them to s'ibmit to ours. This is all wrting. Children should be governed always, but with an even, a gentle, and a loving hand. They should early be subjected to habits of self-control, and of regularity in eating, and sleeping; and should be taught absolute and continued obedience. All this can be brought about only by firmnet^s, self-control, anc' ^reat gentleness on the part of the parents. If they would makv^ a child cheerful and happy jn its disposition, they must themt^elves be cheerful, and never let it see anger, passion, and fretfulness, marring their conduct. Nothing is more injurious to the health of a child than a peevish, complaining, and soured disposition ; and these vicci are seldom ac- quired, unless seen in the lives of parents. How to Nurse Sick Children. As the educL'tio'i of the young, whether religious, moral, or intel- lectual, is more important than that of adults, so. is the care of their physical life of more importance. Death aims to "out- Herod Herod," and seeks the life of all infants, male and female, and in fact destroys one half of all below the age of five years. But few know how to train and take care of children. It is a still more rare gift to know how to nurse them when sick. No persons 1 !''t CARE OF childrp:n and their diseases. 395 t upright, b )t en'lure to ti to bear up areful and or children. th rnonth, a it this exer* be bent by 'orraed. 1 be allowed is its proper its limbs as ►r five years an to use its school-room -then bring — the body the bad pas- al treatment ther making , — allowing passion, or a lem as if we ow irritable, lit to ours. %?/&, but with be subjected leeping ; and 11 this can be ;entlencss on cheerful and ul, and never leir conduct, m a peevish, e seldom ac- :)ral, or intel- care of their erod Herod," fact destroys It is a atill No persons can properly nurse sick children who are in feeble health, or have fretful tempars, or are low-spirited ; for they can neither endure the fatigue, nov bear the trials, nor hear the prattle which such a respon- sibility would bring. Some will manage a well child very well, who are not fit to have the care of a sick one ; for there is a great differ- ence between a child when well, and the same child when sick. When well, and full of fun, and frolic, and life, laughing, and jump- ing, and shouting aloud for very joy at being alive, it is an easy thing for a person or' even a morric temper to attend upon them. But when sickness comes, and the child's playfulness is all laid aside; when it becomes so fretful thr.t nothing goes right with it ; when it crJUje to be laid down, and then cries to be taken up ; streiches oui its haAd for drink, and pushes away the cup when it is presented, — apparently made more angry by your attempts to serve it ; — when these things are repeated, day and night, until the nurse is weary and exhausted, and even a change of disease and amendment only brings a crcs'< and fractious temper, it is only by possessing peculiar qualifica- tions, that the nurse can maintain an even and unrulHed disposition. Wh'Je passing through such scenes, it is hard for the nurse to re- member that sickness does not destroy the little loving heart, but only hides its affection for a short time. Sijfiis of Btsease in Children. — It is important that the nurse of sick children should know what to observe, and the meaning of the signs of disease. A biby has only cries to express its sick feelings. To one person, these cries inean no more than that the baby has some sort of illness. To another, with more experience and bette/ powers of observation, they point to the head, or chest, or stomach, as the disorder. A baby with the stomach-ache, utters long; loud, and pas- sionate cries, and sheds tears plentifully. Suddenly it stops for a mo- ment, and then begins again, — drawing up its legs to the stomacti, and as the pain passes off, stretching them out again, and with many sobs, passing off into a gentle sleep. If there be inflammation in the chest, it neither cries aloud, nor sheds tears, but after every long breath, or hacking cough, it utters a short cry, which is cut off before it is half finished, — apparejitly be- cause crying is jjainful. If the disease be in the head, the cries will be sharp, piercing' shrieks^ with hw moans ami trails between. Or, there will be quiet dozing, interrupted by startling pains. When a child is tak<'n ill, what- "er the disease which is impending, there is always a change of som' sort, which soon attracts attention. It either loses its appetite, or is fretful, or soon tired, or sleepy, or restless, or thirsty, or has a hot skin, or, rather, has a number of these symptoms. It vomits, or is purged or bound in its bowels. It loses its merry laugh and cheerful look ; it no longer watches its mother's or its nurse's eye, as before, but clings to her more clo.i '.y, and will not be out of her arms a moment. If lulled to sleep in her arms, it wakes immediately on being placed in its cot. Such symptoms often continue a day or two before it can be de- a. n S^ * " ff 39H CARE OF CHILDBEN AND THEIR DISEASES. termined what disease is impending. An intelligent nurse may do much towards solving the question. It is frequently proper at such times to place the child in a warm bath. When stripped for the bath, it should be carefully examined to see if there is any rash upon its body. If it be a rash from which it is about to suffer, the bath will help bring it out. The rash should be looked for at least every twelve hours, until the nature of the disease is determined. The Appearance of the Different Rashes may be distinguished with a little care ai.id experience. Measles has a number of dark red spots. in many places running into each other, and is generally seen first about the face, and on the forehead, near the roots of the hair, and is preceded by running at the eyes and nose, and all the signs of a severe cold. Scarlet fever does not show separate spots, but presents a general bright red color of the skin, much like a, boiled lobster. At firdt there is more of it about the neck and chest than on the face, and it is preceded by a sore throat Chicken pox is attended by fever, but not so much running at the nose and eyes as in measles, nor is there so much cough. The spots, too, are smaller, and are not BO much run together ; and they come out more over the whole body. They appear a few hours earlier on the body than elsewhere ; and in a day or two they are found to be enlarged, and turn into little blad- ders of water as big as the head of a shawl-pin. And now a few Words as to what should be Done in the sick-room of a child. The room should be kept cool, and its temperature should be measured by a thermometer. This instrument, when hung away from the nre, should show a temperature of about 55°. That is about the right degree of warmth. Sick-rooms are generally kept too hot. The room should be darkened ; not' made totally dark, but its light shaded down by closing the outside blinds, or by dropping the cur- tains, so as to give a kind of twilight ; and the cot should always be so placed as to turn the little one's face away from the light. The room should be kept quiet ; and this requires attention in the whole house, as well as among the persons in the room. Those present should never whisper, but speak in low and gentle tones, — should not walk on tip-toe, but move about carefully. There is a.fussi/ quietness which disturbs the sick far more than noise. The child must be spoken to, and roused from its slumbers, and turned from side to side, and raised for its food or medicine, with a soothing tenderness, and a delicacy which never forgets itself. In applying leeches or cold to a child, judgment is needed, to suc- ceed well. The leeches should be put either behind the ear or on top of the head, so that the child cannot see them. Cold is best applied by means of a couple of bladders half filled with powdered ice, and wrapped in two large napkins ; one of them should be placed under the child's head, the corner of the napkin being pinned to the pillow- case to prevent its being disturbed, while the other is allowed to rest upon the head, with the corner of the napkin again pinned to the pillow, to take off the greatt;r part of its weight In this way the child urse may do jper at such for the bath, »sh upon its le bath will every twelve ifuished with rk red spots. ly seen first hair, and is ! signs of a but presents lobster. At on the face, attended by in measles, and are not whole body. ere ; and in ) little blad- le sick-room ature should hung away hat is about ept too hot. >ut its light ing the cur- Iways be so The room /hole house, sent should lid not walk itness which 3 spoken to, , and raised a delicacy ded, to suc- ir or on top est applied ed ice, and laced under the pillow- wed to rest ned to the ly the child PARE OF CHILDREN AND THEIR DISEASES. 397 will not be wetted, or irritated, as by the changing of wet cloths, nor will the cold applications get displaced by its movements. A word should be said respecting the nursing of children in cases of lung-inflammation, — an affection from which they often suffer. The lungs are much like two large sponges, and the air enters them through the windpipe ; and passing through smaller and yet smaller tubes, it comes at last into tiny cells, so small that they can only be .seen by a magnifying glass. When the lungs are inflamed, some of the tubes become stopped up ; and the very small cells are pressed on by the flow of more blood than natural to the part ; and so the air enters less easily, and in smaller quantities, than it should. If now you let the child lie flat, it is not only less able to draw a deep breath, and fill the lungs, but the blood also flowing to the inflamed portion oi the lung, returns less easily than if the child were propped up in bed. When a whitlow is on the finger, if the hand be hung do'.vn, the inflamed finger will become redder, and will beat and throb so as hardly to be endured, while, if the hand be raised, the pain will abate. The same increase of pain does not follow an accu- mulation of blood in an inflamed lung, because the lung is not as sensitive as the finger ; but the consequences are very serious. The air-cells being more and more pressed upon, the admission of air is more and more difficult, until, at length, a large part of the lungs is rendered useless, and the child dies. In this disease, the temperature of the room needs attention. The air should not be quite so cool as in other diseases. From 60° to 65° is about right. Of course crying will irritate inflamed lungs, and it is all important that a child sick with this disease shi)nld be soothed and quieted as much as possible. Every good nurse knows how to do this better than any rules can teach her. Sometimes sickness and v ting, from which a child may suffer, are increased by want of judgiiKnt in givine^ lood and drink. ^Vhen there is nausea, the stomach will brar only very small quantities of food at a time, while cold drinks are almost always borne much bet- ter than warm. When there is nausea, it is best, for ai, hour or two, not to attempt to give any food or drink. After the stomach has been thus%!ompletely rested, give a single teaspoonful of ro/r/ ' iter. If this is not thrown up, it may be succeedetl, in ten or tiftrcui miimtes, by a second or a thinl. If this is borne, give a litih; water thickened with isinglass, or cold barley water, or cold milk and water; and then, with the same precautions, and in very small 4u;>iitities, beef tea, or chicken broth, or whatever else the doctor in att- .dance may direct. The smallness of quantity, the coldness ol' articles, and the giving it without moving or disturbing the child, if pc^sible, are the important points to Ix^ attended to. It is of great conse(]uence that children suffering from diarrhoDa should have their skin kept very clean. The pores should be kept well open, so that the fluid matter which is passing off by the bowels, and through the mucous membrane or inner skin, may be diverted to the outer skin. In this disease, the skin of children is apt to become i irritable, or even sore. In these cases, soap and water are quite apt to increase the soreness, while a little starch, made as for use upon clean clothes, though much thinner, will, if used in place of soap, very- much soothe the inflamed skin. A child much exhausted by diarrhoea, or other disease, should be moved or lifted out of its cot or cradle as little as possible. Suddenly moving it when very weak, may cause fainting, or even convulsions. Let it be sponged and cleaned by mere'y turning it, with great gentle- ness, from side to side. In such cases, too, the child hould be supported witii proper nour- ishment. When worn down by diarrhoea, its desire for food may be nearly lost. Though at one time it cried much, and seemed to suffer, it will, in this condition, grow quieter, and doze, and even sleep on for hours, appearing fretful only when roused. If, in such cases, the child be allowed to go without food because it does not seek it, or declines it when offered, it will sink into a deeper and deeper sleep, and finally into a stupor which will end in death. To give a little arrow-root, or wine, or broth, inay now require troubl.: anJ. persever- ance ; but it must be done, for upon it depends the child's life. The effort to administer fcod must not be abandoned because opce c twice, or several times unsuccessful, for the food which is refusea one minute, may be accepted five minutes after. In the various rashes from which children suffer, there is a very general fear of washing the surface lest the rash be driven in. Tnere is no ground for this fear, unless it be in measles ; and even in this complaint, there is no danger if lukt-warm water be used. If only a small part of the body be sponged at a time, there is nothing to fear even from frequent washing ; and the passing of a wet sponge fre- quently over the surface is a great comfort wiien the skin is burning with fever. The same remark applies to the changing of the linen. The same kind of objection, and with no better reason, is often urged against cold water in fevers, though it is most refreshing, and if taken in small quantities, and often, never doe;3 harm, but often much good. The Warm Bath. — The best method of giving a child a warm bath is a matter of importance. There should be as little pyade about it as possible. If the child sees the bath prepared, is taken out of bed, undressed and put into it smoking before its eyes, it may be much alarmed, and cry so passionately as to be really injured by it. The bath should be prepared out of its sight, and brought to the bed- eide with a blanket spread over it to hide the steam. The child should then be laid upon the blanket, and gently let down into the water, and then set to play with a couple of corks with feathers stuck in them. Inflammation of the Mouth. — Erythematic Stomatitis. This is a simple inflammation of the mucous membrane of the mouth ; and is very common during infancy. It may be confined to the tongue, or spread over the whole mouth. It is sometimes very CARE OF CHILDREN AND THEIR DISEASES. 399 quite apt use upon oap, very ihould be Suddenly ivnlsioiis. [it geiitle- per nour- d miiy be to suffer, sleep on cases, the jeek it, or per sleep, ve a little persever- ife. The i onr^e c • fusea or.e is a very 1. Tuere en in this If oily a \g to fear longe fre- burning the linen, tea urged g, and if ten much a warm le p^ade taken out ,t may be ired by it. :> the bed- rhe child n into the lers stuck matitis. ne of the onfined to imes very severe, going down into the gullet and stomach, and into the wind- pipe. It occasions redness and pain in the mouth, and fretfulness of the infant. — causing it to quit the nipple suddenly when sucking. A frequent result of this inflammation is the secretion and exudation upon the surface, of a white, matter-like curd. It appears in small ptiints and patches. This is the thrush, or what nurses call children's wre mouth. It is commonly confined to the period of suckling. Treatment. — For the simple inflammation of the mouth, a wash .rade by infusing the inner bark of slippery elm in wattT, answers a good purpose ; and in more severe cases, a wash made of sugar of lead (227) will be found useful. In some mild cases of curdy exudation, this last wash will do well, if united with the daily use of the warm bath, and proper care of the diet. But in the more severe cases, a little pulverized borax and white sugar or honey (274) (275), placed occasionally on the infant's tongue, will do good service. A decoction of equal parts of blue cohosh and golden seal is a good remedy. When the curdy patches are large, touch them with a mixture of hydrochloric acid and honey (276). If the exudation have a look as if mortification were taking place, use a wash of chloride of lime (228), or chloride of soda, etc. (229), or creosote and mucilage (230), or alcohol and vinegar (231), or nitrate of silver (211). When diarrhoea is present, with acidity, /jive (26). In the more severe cases, when appearances of mortincadon are seen, quinine (69) should be administered. Follicular Inflammation of the Mouth. — Aptha. This disease attack.3 the little glands of the mouth, called follicles, and appears about the time of cutting teeth. Small white specks, a little elevated, first show themselves on the lips, insides of the cheeks, and under side of the tongue, etc. The specks enlarge, a whitish, curdy matter flows out from their centre, and ulcers are formed, with elevated edges, surrounded by a red, inflamed circle. Sometimes, instead of curdy matter, a bloody exudation takes place, and dark- colored crusts are formed which are mistaken for mortification. In bad cases, there is great resdessness, with hot mouth, dry skin, thirst, and diarrhoea, with green stools, and sometimes salivation. Treatment. — The milder forms of this disease are treated like simple inflammation of the mouth. If there is thirst, give several times a day, a spoonful of cold water, with a little gum arable dis- solved in it. If the child be weaned at this, time, its food should be barley or rice-water, sweetened with loaf sugar. An occasional' doso of magnesia, with or without a little rhubarb, will remove the acid which abounds in the bowels. After ulceration has taken place, borax (274) will do well. When watery discharges from the bowels, and griping pains appear, preparation (28) shotfld be used. If th« strength be reduced, give (69). 4«0 CARE OF CHILDREN AND THBIK DISEASES. 1 Inflammation of the Gums. — Gengivitis, During the cutting of teeth, the guni» are apt to be inflamed, red or livid, swelled and painful. The child is languid, with a hot and dry skin, small and quick pulse, little appetite, much thirst, and a tongue covered with a thick, yellowish fur. When ulceration takes place, and is allowed to go on, the teeth become loose, black, and rotten, and often soft and pulpy ; a flow of fetid spittle takes place, the breath of the child becomes oflensive, and its countenance pale and Sii »w. The gums bleed under the least pressure, and a profuse diarrhceci Ills up the list of ills. Treatment. — In the first stages, mild washes to the gums, such as (227), will do well. Clear out the bowels once with magnesia and rhubarb (26). After ulceration has taken place, use oak bark (232), or chloride of lime (228), or diluted hydrochloric acid (233). A daily tepid bath. If the strength be reduced, use an infusion of Peruvian bark, or quinine (69), Gangrene of the Mouth.— Canker. — Cancrum Oris. This disease attacks weakly children, of a lymphatic temperament, and having inflamed gums. It often follows intermittent, remittent, or bilious fever, and is also frequently connected with disease of the stomach and bowels. Symptoms. — It is attended with languor, listlessness, indisposition to play or move about, thirst, loss of appetite, peevishness, and ina- bility to sleep. The countenance is "pale and sunken, and there is a peculiar puckering of the cheeks about the corners of the mouth. The breath is bad, the gums have the appearance of salivaiion, the teeth become loose and fall from their sockets, or, if they remain, they become covered with a thick coating of a dirty white or ash color. A few ash-colored \yater pimples appear upon the gums, which en- large, run together, and finally break, — presenting a black appearance of mortification. The gangrene, sooner or later, goes to the lips and cheeks. Treatment. — When bowel complaints exist, they are to be treated with the usual remedies, such as (70) or (156). If there be active inflammation of the gums, at first, leeches may be applied, after which, the inflammation being subdued, a wash of &ak bark (232), will be in place, with quinine given internally (69) to ward off the mortification. As a wash, too, a strong solution of sulphate of cop- per (234) is excellent, — so is white vitriol (235), and nitrate of silver (219), and creosote (336). The diet should . be beef-tea, plain beef or mutton broth, with rice, milk and rice, tapioca, sago, and the like. CARE OF CUILDUEN AND THEIR DISEASES. 401 lamed, red a hot and rst, and a tion takes black, and kes place; lance pale [ a profuse IS, such as rnesia and t)ark (232), . A daily f Peruvian m Oris. nperament, , remittent, ease of the disposition and ina- there is a ne mouth, vaiion, the main, they ash color. which en- ippearance le lips and be treated be active )lied, aft«r )ark (232), art! off the ite of cop- te of silver , with rice, Difficult Teeth-Catting. Teeth-cutting generally begins between the ages cf five and seven months. It is indicated by redness, heat, and tenderness of the gums, an increase of saliva, and, occasionally, redness of the cheeks, water- ing of the eyes, thirst and fever, with fretfulness, disturbed sleep, and more frequent motions of the bowels, a little more fluid than usua^ and sometimes of a greenish hue. As the tooth comes near the sup* face, the child holds its fingers in its mouth, and presses the gums harder upon the nipple when sucking. Boside these milder symp- toms, there are sometimes ulceration of thf mouth, gangrene, exten- sive and long-Qontinued diseases of the bow^lf., — and even disorders of the brain, convulsione, and palsy. Treatment. — Watch the gums, and the moment they are swollen by the teeth pushing them up, lance them at the elevated points, cut- ting entirely down to the adv^.ncing teeth, — so that no tough mem- brane shall cause pain by imneding their growth. These incisions often prevent fatal disease of the brain, and sometimes almost in- stantly relieve the most threatening symptoms. Before the teeth are far enough advanced for lancing, some soothing wash may be applied to the gums, or a leech or two to the angle of the jaw. For obsti- nate diarrhoea, with watery stools and griping, use prescription (157). If the child be drowsy and starts from sleep, and has heat and red- ness, with enlargement of the blood vessels about the head, put three or four leeches behind the ears, and make cold applications to the head. At the same time, open the bowels with castor oil (17). When there is difTiculty of passing the water, ^ive flax-seed tea ; and if the pain be considerable, an opiate (351). Croup. This is one of the scourges of childhood. Jn ten years prc'ous to 1845, no less than 1150 children were destroyed in Philadelphia by croup. During the year 1840, the large number of 4,336 died of the same disease in England. Croup is an inflammation of the mucous membrane of the larynx and windpipe. It causes to flow out upon the surface of the mem- brane, a peculiar flaid, which stiffens into a membrane, or skin-like substance, and adheres to the inner surface of the wind-pipe, and sometimes extends through the whole of t* o bronchial tubes. This is membranous croup, — the worst and most fatal form of the disease. Dr. John Ware of Boston has shown that there are other forms of croup, not so fatal, because not attended by the formation of a mem- brane upon the nmcous surfaces. The Syiiiptoiiis of croup are, difTiculty of breathing, hoarseness, and a peculiarly loud and ringing cough, with fever. In the membranous and worst form of the disease, the breathing is not, at first, so labo- rious, and the symptoms generally not so violent and alarming as in 51 n Iff !•' i 402 CARE OF CHILDREN AND THEIR DISEASES. the less fatal but more inflammatory type. This latter kind, though generally causing great alarm, like a highway robber, by the sudden ereeness with which they seize the throat, are yet much less fatal, and of course less to be feared, than the membranous form. The disease is pretty much confined to children between the ages of one and eight years. Treiitiuent. — The old and usual mode of treatment is first to bleed, and then to place the patient in a warm bath ; and, after the child is returned to the bed, to give nauseating doses of tartar emetic (105). In Boston, this treatment is now nearly discarded, as being too active, and possibly a cause of evil rather than good. The following is a safer and more successful treatment. Give, every three hours, Dover's powder and calomel (352). Sponge the neck often with water, and apply a liniment (192). It is some- times proper to give a gentle emetic, — say, two drams of wine of ipecac. A flax-seed poultice applied to ,he neck is also excellent. If the child be large enough, let it inhale frt^quently from an old tea-pot, the vapor of hot water and miillein leaves ; and if it be too young to do this, keep the room full of watery vapor, by throwing water upon hot bricks. If the bowels need moving, give a dose of castor oil (17). In addition to these measures, a strong solution of nitrate of silver (219) should be thrown into the throat with one of my laryngeal shower syringes, and repeated every two hours till the membrane is discharged. Spasm of the Glottis. — Larpigismus Stridulus. This disease consists in a sudden shutting up of the glottis, or pas- sage to the windpipe, which creates a feeling of strangulation, and a difficulty of breathing so great that the drawing in of the breath causes a peculiar crowing sound. There is no fever. The child, upon taking food or drink, or upon being irritated or teased, is taken sud- denly with an impossibility of drawing in its breath. Alter struggling convulsively for a time, its head thrown back, its nostrilr-) dilated, its mouth open, its eyes rolled up, its face pale, its legs and arms stitV, it begins to breathe with a shrill crowing sound. The disease i>; sometimes mistaken for croup, and for hooping cough. It is strictly spasmodic in its nature. Treatment — During the paroxysm, set the child in an upright pos- ture, with the head leaning forward, exposed to a full draft of cool, fresh air, and sprinkle cool water upon the face. Let nothing be tight about the neck. Slap the child slightly on the back, and apply fric- tion along the spine. If these means do not succeed, pla'^e it in a warm bath ; while in the bath, sprinkle cold water on the face. When the fit is over, examine the gums. If they are swollen, lance them down to the coming teeth. The bowels should be moved daily with some gentle physic, but not irritated by severe purging. If the stools are light colored, use prescription (142), with warm water in* jections. !;?' % '%\ I, though J sudden ess fatal, m. The es of one to bleed, ; child is !tic (105). oo active, iving is a , Sponge ; is some- f wine of L-llent. If d tea-pot, » young to ater upon )r oil (17). e of silver laryngeal smbrane ia ilus. tis, or pas- tion, and a le breath lild, upon i\ken sud- truggling ilated, it^ arms stiH, disease i>i is strictlv jright pos- ft of cool, ng be tight apply fric- a-^e it in a ace. oUen, lance loved daily g. If the water in* Hpoping Cough. — Purtussis. This is a contagious disease, peculiar to childhood, and occurring but once in the same individual. It is characterized by a convulsive, paroxysmal cough, which is attended by long-continued hissing, con- vulsive breathing, with rattling in the windpipe, which is succeeded by several short efferts to expel the breath, following each other in quick succession. The long, convulsive breathing, attended by the hooping sound, is immediately repeated ; and these paroxysms con- tinue until a quantity of thick, slimy, ropy mucous is thrown up', by expectoration or vomiting, when the breathing is again free. These paroxysms have all the appearance of impending suffocation, redness of the face, shedding of tears, sweating about the head and forehead, and such agitation of the whole body that the child lays hold ot something for support. Blood sometimes starts from the nostrils, and the child involuntarily passes w^ter, or evacuates the bowels. In spring and autumn, the disease most prevails. It is not generally dangerous. Treatment. — First give an emetic, — say, two drams of wine of ipecac. Afterwards, give small doses of ipecac and sulphur (277). From six to fifteen grains of sulphur alone, three times a day, is an excellent remedy. A liniment of olive oil, oil of amber, etc. (1913), applied to the spine, is useful. Belladonna (278) is a good remedy. Prussic acid (96) is strongly recommended by many, and is worthy of a trial. Lobelia (lOG) is a valuable remedy. Alum (279) is well recommended. Sulphuric ether, a little being spilhid in the nurse's hand and held to the child's nose, generally shortens the paroxysm, and frequently abridges ihe disease. A solution of nitric acid in water, as strong as lemon juice, and sweetened, is a very valuable remedy, — breaking up the disease in two or three weeks. The child may drink it freely, a little further reduced with water. Looseness of the Bowels. — Diarrhoea. Infants and chilhren are more liable to diarrhoea than adults, and this is the reason for speaking of the disease here as well as elselly, is the surest sign of this disease. When the complaint is long-continucnl, the child loses all its flesh, and dies in almost a complete skeleton state. Treatment. — If there is inflammation or other disorder in the stomach or bowels, attend to this first. Then put the patieirt on a generous diet, such as meat broths, etc. (jive bicarbonate of pot4.ssa, dissolved in 'the infusion of columbo or quassia, and when' there is costiveness, add rhubarb to the preparation. For the enlargement of the glands, apply, externally, an ointment (184) of the iodide of lead, or of the iodide of potassium (185). Give an ioduretted bath, daily, which is formed by adding one grain of iodine and two grains of iodide of potassium to each gallon of warm water. The syrup of iodide of iron should be given, internally, three times a day, in a little water, or the iodide of potassium, and compound infusion of gentian. Daily sponging the body in salt and water, and exercise in the open air, are important. Rickets. This is also a disease of scrofulous children. By some bad proces.s of nutrition in such children, there does not enough phosphate of lime enter into the bones to harden them, and the weight of the body, or the pulling of the muscles, or the pressure of the clothing, bends jind distorts them in all manner of ways. The heads of the thigh bones are pushed nearer together, making the lower belly narrow ; the back bone is so curved as to lessen the height ; the shoulder blades stand up like wings when flying is contemplated; and the shoulders are so lifted up that the head seems only a little higher than the elevatioiu on each side. Treatment. — A good, generous, wholesome diet, properly regulated; out door exercise ; the tepid or cold salt water sponge bath, with fric- tion, and but little medicine. The hypo-phosphite of lime, iii two- grain doses, given in a little sweetened water, three times a day, or the syrup of the hypo-phosphites, in half-teaspoonful doses, three times a day, may be given with advantage. tiifc 408 CARE OF CHILDREN AND THEIR DISEASES. The Blue Disease. — Cyanosis. This disease is known by a blue, purple, or leaden tinge over the whole body. The warmth of the body is reduced, there is difficult breathing, Wiuv-I* is increased by quick motion or by crying. The disease is generally fatal. The bluei.ess is occasioned, either by the passage between the right and left side of the heart remaining open after birth, so as to let the blue, venous blood run through and mix with the red arterial blood, thus making the whole blue, or by the obstruction of the pulmonary artery, which withhoids the blood from the lungs, and does not allow it to be arterial3z(>,d and reddened. This latter opinion is the more general one now. Treatment* — Keep (he patient, as much as possible, in a state of rest, so that the circulation may not be hurried. Allow a pure fresh air, easily-digested food, and protect the body from cold and damp- ness. ]lold the infant near the fire, and apply gentle friction over the head and body with a warm, soft cloth. Pits. Most persons have seen a baby in fits ; and it is a sad sight, — its little face all distorted and livid ; its eyes rolling and squinting fright- fully; its hanr hold on li draw the ; will quiet leasles are Having now treated of those disorders which affect the skin, the brain and nerves, the throat, the lungs and their appendages, the heart and its covering, the abdominal cavity and its lining membrane, the sexual organs, and those complaints peculiar to females and children, it remains to speak of those others, — fewer in number, — which are not specially developed in any particular part, but disturb the whole system. Fever. FyvER is a disease which affects the system generally, and is char- aetarized by more or less excitt^ment of the circulation, increased heat, diminished strength, and, oftentimes, unnatural thirst. The degree of excitement is measured by the state of the pulse. Of this state, there are two characteristic indications : namely, frequency and hard- ness. A pulse is frequent when its rapidity exceeds that of health ; it is hard when its stroke resists the pressure of the finger with unusual force. In health, the pulse of an adult beats from sixty to eighty times in a miimte ; that of children is more frequent. The pulsations of the heart of the unborn infant, as heard through the body of the mother, art; one hundred and fifty in a minute. After birth, the pulse varies from one hundred and forty down to the standard of adult age. To appreciate hardness of pulse, experience is absolutely necessary. The great activity of the circulation, in fever, is intimately con- nected with the heat and thirst, and tends directly to waste the ener- gies, and consume the strength of the patient. The heat of fever lessens or dries up the secretions, or different fluids of the body, which, in a state of health, arc separated from the blood for various purposes. This is the cause of the dry skin, .scanty urine, etc. A crisis of fever is that pericnl in its row Ave when unfavorable symf>- tiims give place to those of returning health. A course of fever ^ or, in common language, a run of fever, is dis- tinguished by a great variety of symptoms, which will be more par- ticularly spoken of in the pages which follow. Typhoid Fever. Op the different kinds of fever, this is one of the moat common and widely prevalent. The name ti/phoid is from two Greek v^rords which mean IVce typhus, or similar to typhus. The word typhus, from a Greek word signifying stupor, means stupid, dull, or low ; and, when applied to a fever, implies that it is low, or characterized by great nervous depression. Typhus and typhoid fevers, if not identical, are so similar in history and treatment as to make unnecessarv their consideration under sep- arate heads. The following is one of the differences claimed to exist between the two : namely, in typhus fever, the belly is flat ; there is no marked disease of the bowels, and generally no diarrhoea until the second or third week. In typhoid fever, on the contrary, sonie small glands, called Peter's ^/anrf.s, situated in the lower part of the small intestines, are always inflamed, and sometimes ulcerated ; and, con- sequently, among the symptoms most frequently noticed, are diar- rhoea, and drum-like swelling of the belly, called tympanites. Symptoms. — The disease often has precursory symptoms. For several days before its actual beginning, the patient droops. He may attend to his various duties, but does not seem well ; he is low-spirited and languid ; is indisposed to any exertion of body or mind ; has pains in the head, back, and extremities ; loses his appetite ; and although dull and perhaps drowsy in the day time, his sleep is inter- rupted and unrefreshing at night. The immediatt? harbinger of the fever is a chill, often so marked as to cause violent shivering. The history of the first week shows increased heat of the surface ; frequent pulse, ranging from eighty to one hundred and twenty ; furred tongue ; restlessness and sleeplessness ; headache and pain in the back ; sometimes diarrluea and swelling of the belly ; and some- times nausea and vomiting. The second week is frequently distinguished by an eruption of small, rose-colored spots upon the belly, and by a crop of little watery pimples upon the neck and chest, having the appearanei; of minute drops of sweat standing on the skin, and hence called suiUimimi, or sweat drops ; the tongue is dry and black, or red and sore ; the teeth are foul ; there may be delirium and dulness of hearing ; and the symptoms generally are more serious than during the first week. Occasionally, at this period, the bowels are perforated or ate through by ulceration, and the patient suddenly sinks. If i!ie disease proceeds unfavorably into the third wee^k, there is low muttering and delirium ; great exhaustion ; sliding down of the patient towards the foot of the bed ; twitching of the muscles ; bleed- ing from the bowels ; and red or purple si)ots upon the skin. If, on the other hand, recovery takes place, the countenance bright- ens ; the pulse moderates ; the tongue cleans, and the discharges assume the appearance they have in health. Treutmeut. — Give the patient good air, and frequent spongings mon and ds which I a Greek 1 applied ; nervoua n history ider sep- 1 to exist there is until the Me small :he small and, con- are diar- ns. For He may v-spirited ind ; ha.s tite ; and is inter- er of the surface ; twenty ; pain in lid soine- ption of e wat«ry f minute amirui, or the teeth and the st week. through there is n\ of the bleed- bright- ischarges pongingrt with water, cold or tepid, as shall be most agreeable to his feelings. Keep the bowels in order; by which is meant, be more afraid of diarrhcea than of costiveness. Diarrha>a should be restrained by a little brandy, or by small and repeated doses of Dover's powder (153). For costiveness, give injections, or the mildest aperients (7) (10) (12). To lessen the frequency of the pulse, reduce the f«n-er, and pro- duce perspiration, give from three to ten-drop doses of the tincture or fluid extract of veratrum viride, every hour. This remedy has grea*" power in fever. Great wind-swelling of the bowels may be relieved by fomenta- tions, or hot, steaming applications. Sometimes the wind may be let olF by introducing into the bowels a long gutta percha tube, — thus reducing the swelling, and greatly promoting the patient's com- fort. If pain in the hoad be severe and constant, let the hair be cut short, and the head be frecjuently bathed with cold water. Let the strength be supported by light nourishment; and in case of bleeding from the bowels, or great debility, by broth and winei For foul mouth, the weakest possible infusion of old hyson tea is valuable. Good nursing is eminently desirable. If the fever runs a low course, the patient being much prostrated, quinine, even in large doses, may be given from the beginning. Bilious Remittent Fever. There are three principal varieties of periodica/ fever,-w\uch,thongn varying considerably from each other, in 8«?veral particulars, are yet essentiuUy, in their substance, but one disease. These are Bilious Remit lent Fever, Pernicious Intermittent or Congestive Fever, and lelermittent Fever or Fetter and Agve. According to the custom of most writers, I sliall treat them separately, beginning with Bilious Remittent Fever. Symptoms. — The attack is generally sudden and well marked. Some writers say it has no premonitory symptoms ; others, that it has. The more general understanding is, that for a day or two, or even longer, before the onset, there is a sense of languor and debility, slight headache, lack of appetite, furred tongue, bitter taste in the mouth in the morning, pains in the joints, and general tineasincss. The formal onset is nearly always marked by a distinct chill, or rigor, — sometimes slight and brief; at other times severe and prolonged^ The chill may begin at the feet, or about the shoulder blades, or in the back, and thence run like small streams of cold water poured in every direction through the whole body. There is ^'•ewem% but one well-marked chill, the returns of the paroxysms of fever being seldom, after the first, preceded by the cold stage. At certain periods of the day, there is an increased intensity in the symptoms of the disease, occasionally preceded, though generally not, by the chill. Between this period of severity in the feverish symp- toms, and a similar period which follows it, there is generally decrease i^-_- 412 DISEASES OF THE GENERAL SYSTEM. in the violence of the symptoins, during which the fever moderates, but does not, as in fever and ague, entirely go off; has distinct remis- sions, but not complete intermissions. During the hot stage, the pulse is up to one hundred and twenty, or one hundred and thirty. There are pains in the head, back, and limbs, of a most distressing kind. The tongue is generally covered with a yellowish, or a dirty-white fur ; and in bad cases, in the advanced stage, is frequently parched, brown, or nearly black in the centre, and red at the edges. There is no appetite for food, and generally nausea and vomiting ; and usu- ally there is pain and tenderness in the epigastrium. The bowels are at arst costive, but afterwards become loose, and there are frequent evacuations of dark, offensive matter. Causes. — This disease is produced by malarial exhalations from the decomposition of vegetable matter. It is most prevalent in hot climates, and in the summer and autumn. Treatment. — If the fever be in the formative stage, and have not folly developed itself, give an emetic (1) (2), and follow it with a mild cathartic (7) (13). If the disease be already developed, sponge the body, all over, sev- eral times a day, with cold or tepid water, accor^iing to the feelings of the patient, and give cooling drinks (132) (133) (298) (299). To moderate the fever, give three to ten-drop doses of tincture, or fluid extract ot veratrum viride. The compound powder of ipecac aixl opium is a valuable preparation for the same purpose. Give cold water as drink if desired >^y the patient, or let him eat ice. When the headache is very severe, let wet cups be applied upon the temples, or behind the ears;. and the same remedy to the pit of the stomach, when there is great tenderness, is often desirable ; though a mustard poultice will sometimes do better. During the remissions of the fever, quinine, and other tonics are to be given, as in fever and ague. Congestive Fever.— Pernicious Intermittent Fever. This is the pernicious, or malignant form of malarious fever. It is marked, either in the earlier or later stage, by a rush of blood towards one or more organs, by which they are crowded full and congested, — hence its title of congestive fever. Symptoms. — It may be intermittent, or remittent, — more com- monly, it is the former. It may assume any of tha types of peri- odical fever, but it is most frequently quotidian or tertian. The first attack does not differ very materially from a common attack of simple intermittent The first paroxysm is simple, exciting but little attention. The second is always severe, producing great coldness, and a death-like hue of the face and extremities. The advancement of the disease brings dry, husky, parched, and pun- gently hot skin, followed, after a time, by a cold, clammy sensation^ loderates, ict remis- wenty, or nd limbs, rty-white parched. There is and usu- owela are frequent ons from nt ill hot have not ith a mild over, sev- B feelings !99). To , or fluid ecac aiKl jrive cold upon the pit of the though a lies are to Fever. ^er. It is 1 towards jested, — ore corn- 8 of peri- common ', exciting ing great les. The and pun- sensatioa* DISEASES OF THE GENERAL SYSTEM. 413 The eyes are dull, watery, and sometimes glassy; the countenance dull, sleepy, distressed ; the tongue, at first white, changes to brown or black, and is usually tremulous ; the breathing is hurried and diffi- cult. Pressure over the liver, stomach, or bowels, produces pain. The mind is often disturbed, and falls into lethargy and stupor, or is delirious. Treatment — This should be very much like the treatment of the bilious remittent fever. While getting up from the fever, the diet must be light and nutri- tious at first, but may be increased in quantity as the strength returns. Exercise out of doors must not be omitted. If recovery be slow, some mild tonic, or a little wine, or ale, or brandy, may be taken two or three times a day. Fever and Ague. ^Intermittent Fever. This is a kind of fever in which there is a succession of attacks with equal intervals, and intermissions that are complete but unequal, on account of the uncertain duration of each fit An interval is the poriod of time between the beginning of one fit, and the beginning of the next. An intermission is \\w period of time between the close of one fit, and the beginninji; of ihe next. The diflerent varieties of ague take their designation from the lon«rth of the interval in each case. Th(! interval of a quotidian, or daihj ague, is twenty-four hours The interval of a ttrtian, or third-datj ague, is forty-eight hours. The interval of a quartan, or fourth-day ague, is seventy-two hours. SymptoniH. — The disease first develops itself by an agve fU. This has three stages, the cold, the hot, and the sweating. The cold stage is very marked. The patient ha a sense of a debility, yawns, Btretches, has no appetite, and does not wish to move. The face and extremities become pale, the skin shrinks, causing universal horripila- tion, or goose-Jlesh ; the patient shakes, and his teeth chatter. After a time, these symptoms decline, and the hot stage comes on, which is characterized by high fever, with its various uncomfortable sensations. When this fever passes off, it is followed by the sweating stage, during which a moisture breaks out which increases, frequently, to a profuse sweat; the body returns to its natural temperature, thu pains and aches disappear, and a f(;eling of health comes back. During the cold stage, the blood is driven inward from the surface, and particularly o|)presses the spleen, which, in eases of long standing, becomes swelled and permanently enlarged. This swelling may be plainly felt, and is often quite perceptible to the eye. It is called o^'-we cake. Agub fits begin at different hours of the day, and generally termi- nate in tho evening. A. !(" I: Is s>^ ■ i I :^V 'f I 414 DISEASES OF THE GENERAL SYSTEM. A quotidian usually begins in the morning ; a tertian at noon ; and a quartan in the afternoon. The cold stage is shortest in the quotidian, and longest in the quartan. Thus the longest fit has the shortest interval, and the shortest cold stage ; while the shortest fit has the longest interval, and the longest cold stage. There are also double tertians and double quartans, wliercin the fits repeat themselves, — sometimes the same day, at other times on alternate days. To these varieties, the terms postponing and anticipating are ap- plied, according as the intervals a* j growing longer or shorter. When a person is recovering from ague, the interval may gradually grow longer, the attack being pat off., or postponed. But if the disease be increasing in severity, the attack may anticipate its usual period, mak- ing the interval shorter. Tertians are more common than either quotidians or quartans. Agues are more prevalent in spring and autumn. Fall agues are most severe and dangerous. Causes. — Exlialations from the soil, called malaria, arising from decomposition of vegetable matter in new countries, or from low and marshy districts in which the land is alternately covered with water, and again left dry and exposed to the sun. In districts where it prevails, high hills are exempt^ and even the upper stories of houses are more healthy than the lower. Treatment. — First clear the bowels with the fluid ex "-act of senna (15), or the preparation (21). Then, in the cold stage, ^'ive hot, and in souie cases, stimulating drinks. Administer hot foot baths, and, putting the patient in bed, apply bottles filled with hot water to the feet, sides, and back, and in every way try to excite warmth and comfort. In the hot stage, give cooling drinks, and opium (117) (118) in de- cided doses ; or, what is better, quinine (67) in two teaspoonful doses every half hour, at the same time giving five-drop doses of tincture or fluid extract of veratrum viride every hour. During the sweating stage, stop the veratrum, and rub the patient with dry towels. In the intermission, give quinine (62), in three-grain doses, once in three or four hours, and continue it, gradually increasing the dose, a fortnight after the cessation of the attacks. The following is a good preparation: quinine, one scruple; elixir of vitriol, one dram; dis- solve the quinine in the elixir, and add tincture of black cohosh, four- teen drams. Twenty drops are to be given, in a little water, once an hour. The web of the black spider, rolled up into five-grain pills, and taken, one pill at a time, once in two hours during the intermission, is said to cure many cases. It is important^ in fever and ague districts, to avoid the hot sun, and the damp evening and morning air. *il on; and t in the est cold I longest rt'in the times on are ap- When lly grow laease be od, niak- ans. igues are mg from low and :h water, even the of senna hot, and ths, and, r to the mth and ) in de- ul doses iicture or patient once in dose, a a good am; dis- >sh, four- once an tills, and -mission, hot sun, DISEASES OF THE GENERAL SYSTEM. 415 Tellow Fever. This disease belongs to warm climates, being most prevalent in Sonthern cities. It makes its appearance chiefly in the latter part of summer, and disappears upon the approach of frosty weather. Symptoms. — The complaint begins, generally, with a chill, which JB sometimes severe, though commonly moderate, of short duration, and rarely repeated. Following this chill, there is moderate fever, and a little heat of surface ; but this rarely rises to any considerable height, and only continues to the second or third day, when, in fatal cases, it gives place to coldness of surface, etc. In many cases there is sweating. The pulse is peculiar, — not easily described, — generally not rising above one I indred in a minute, — a kind of bubble under the finger, which breaKS and vanishes before it can be fairly felt. The tongue is moist and white in the first and second days, but red, smooth, shining, and dry, as the disease advances towards the close, having a dry, black streak in the middle. The most striking symptoms are nausea and vomiting. The vom- iting, in fatal cases, is generally very persistent, and towards the ter- mination, the yellowish or greenish matters thrown give place to thin and black fluid, having a sediment looking like coffee-grounds. This is called the black vomil. The bowels are generally costive, with frequent epigastric tender- ness and distress. There is generally severe headacht;, and a pecu- liar expression of countenance, in which the lips smile, but the rest of the face is fixed and sad, sometimes wild. The patient continues wakeful, night and day. There are discharges of blood, often, from the nose, the gums, the ears, the stomach, tlie bowels, and the urinary passages. Treatment. — First, move the bowels with some mild physic (40) (18) (19) (41) (37). During the chill, put the feet in a mustard bath (242), g, 'e warm cordial drinks, and apply hot bottles etc., externally. Cups may be applied to the back of the neck, or over the stomach, according to circumstances. During the second stage, or stage of calm, nothing is to be done but give some light stimulants, and to promote sweating by warm lirink.', and tincture of veratrum viride ; and also quinine (02). The third and severest stage is to be met by stimulants, as brandy, freely given, with a continuance of the quinine. During the fever stage, and for the vomiting, give creosote, twenty drops to six ounces of spirits of Mindererus, and alcohol enough to dissolve the creosote. The dose is half an ounce every two hours. Said to be excellent for putting o -cop to the retching and vomiting. Cleanliness, temperance, and cheerfulness, are essential in warding off the disease when one is exposed to its cause. 416 DISEASES OF THE GENERAL SYSTEM. Rheumatism. This is an inflammation of a peculiar character, being caused by acid or poisonous matter in the blood, and having for its seat the fibrous tissue^ or that thready texture which enters largely into the composition of the cords and muscles of the human body. The synovial, or lining membrane of joints, is also peculiarly subject to rheumatic inflammation. Hence the terms, fibrous rheumatism, and synovial rheumatism. There are also acute and chronic rheu- matism. Acute Rheumatism Is a very painful aflection. It is most frequently brought on by exposure to wet and cold after violent and fatiguing exercise of the muscles. Symptoms. — Its principal characteristics are, high fever, with a full, bounding pulse ; furred tongue ; profuse sweat, which has a sour smell, and seems to increase the weakness without relieving the pain ; scanty and high-colored urine, with brick-dust settlings ; and swelling of the joints, with slight redness, great tenderness, and severe pain, which is particularly agonizing when the patient attempts to move. This aflection often changes suddenly from one part of the body to another, or from one set of joints to another. This sudden shifting, termed metastasis, is peculiarly dangerous ; for sometimes the inflam- mation, seeming to regard the constantly moving heart as a large central point, suddenly seizes upon its lining membrane, and occasion- ally proves speedily fatal. Treatment. — It is well first to open \.ie bowels freely with the compound powder of leptandrin, or the compound powder jalap. Then give tincture of black cohosh and tincture of veratrum viride (124), and push the preparation to the extent of producing sweating. This, if no evil effects seem to result from it, that is, no prostration or bad feelings in the head, may be kept up till the violence of the dis- ease abates. Sometimes opium, nitrate of potash, etc. (127), administered one or more times, will have a good efl'oct. The tincture of black cohosh root, two parts, and the tincture of colchicum rpot, one part, and given in doses of forty drops, is a valu- able remedy. For articular rheumatism, iodide of potassium, one dram, and morphia, one grain, dissolved in one ounce of water, and given three or four times a day, in two teaspoonful doses, are said to have the power of shortening the disease. It is a valuable treatment, after clearing the bowels with salts and senna, to give equal parts of wine of colchicum and spirits of tur- DISEASES OP THE GKNKUATi STii^TEM. 417 pentine in doses of ten drops every two or three hours ; and after a clay or two, to give, in connection with the above, at intervals of five hour8, tincture of chloride of iron, ten drops, with ten to twenty drops of laudanum. Fomentations of hops and cicuta, or stramonium leaves, placed upon the inflamed and swollen joints, will have a good eflect in relieving the pain. The recent leaves of stramonium, pounded, mixed with a little water, and laid upon the joints, is said to act very favorably. (See p. 880.) Chronic Rheumatism. Thk chronic form of rheumatism may follow the acute as its conse^ quence, but is more oftvith little •emission, xpericnce Lse, which er similar lumber of icrease in cks come shrinking m peeling id supple , the joint of lithic 143. generally, local mis- tmper, un- lincomfort- jmonitory I subject to and even DISEASES OP THE OENEllAL SYSTEM. 41H Causes. — Luxury and indolence, — particularly the former, • regarded as the principal causes of gout. aru Treatment. — Colchicum is the remedy for gout It removes the disease by exciting the kidneys to action, so that the poison is con- veyed ..way in tlie urine. Perhaps it acts in some other unexplained way, as an antidotes to the disease. One teaspoonfid of the wine of colchiciun may l»t tala-n two or three times a day, until relief is ex- perienceil. It should then be contiinied, in ten-drop doses, for a few days longer, to prevent a relapse. The colchicuni may be taken in the form of prescription (oOl). Codec, drank freely every day, is said to be a sov«!rei<^n remedy for gout. It is also declared to be excellent for jj;ravcl, — a fact which i forgot to mention when treating of the ailections of the kidneys, etc. The bowels must be kept in order, but not actually purged (3-1) (40). 'J'lie diet nmst be simple and unstimulating. Let the indamed joint be bathed often in a saturated solution of bicarbonate of soda in soft, warm water. Colo applications should not be made, as there is danger of provoking a sudden change of the inflammation to some internal organ. Scrofula.— King's EviL This disease was once thought to be peculiar to swine, and hence derived its name from scrofii, a sow. It shows itself in various forms, — as hip disease, white swelling, rickets, salt-rheum, etc Persons aflfeeted by it are subject to swelling of the glands, particularly those of the neck. Symptoms. — In the beginning of the disease, small, hard, movable kernels appear about the neck, just under tlie skin. These are lym- phatic glands, and the swelling generally takes place long before there is any soreness, or perceptible redness. Tliey may be felt under the skin ; and, in the course of six months or a year, may grow to the size of a filbert, or even a hen's egg. Sometimes they are much larger even than this, and very hard. They may appear in many other parts beside the neck. After a time, though very slowly, they come to a head, and break, — discharging a wat,ery fluid, or a mixture like whey and curd. They are seldom very sore. When they heal, they are apt to leave a puck- ered condition of the skin, and ugly scars. The scrofulous humor may sometimes afTect the eyes, when the lids will become red and thick, and discharge mucus and water ; — the under lid sometimes turning out, and presenting a shocking spectacle. The scrofulous condition is generally supposed to be indicated by a white, delicate skin, thick lips, light hair, and a delicate constitu- tion ; but these signs are not worthy of much confidence. The disease often attacks the cellular tissue, causing numerous 420 DISl^ASKS OV TIIK OKNKRAL SYSTEM. »*t; Buppurationn and abi^cRssng. It abo affects the bones, producing cari(>t«, necroHis, uiid other affections. It tthows itHelf in certain in> flainmations of the vyen, in the formation of running tioruii in the ears, and in various otht'r ways. CaUMeM. — It is contended by some, that Hcrofula is in all cases inherited ; that we receive it iroiii our progenitors, as we do their other constitutiotuil peculiarities ; that the disease is everywhere, and in all time, one and the same, wliicrh shows it to come from within, and not from without ; that were it dependent on external causes for its existence, it would be greatly modified by temperature, climate^ and the pecruliarities of the races affected by it. They assert that though the causes which are usually assigned for scrofula, such as livmg in cold, damp, and impure air, and the lack of suliicient food, connected with filthy habits, often have a powerful effect in developing scrofula already existing in the con- iititution, and of aggravating it when already developed ; it never produces it. How far these statements are to be received, I will not undertake to judge. It is certain that the disease is often inherited ; and if we admit that the other caus(!s named have some share in its production, it is possible we may not go entirely astray. Yet my own strong suspicion that scrofula arises from the animal poison of syphilis, fii- tered through the blood of many generations, inclines me to the adop- tion of the above views. Treatment. — In olden times of superstition, this disease was be- lieved to be cured by the patient coming into the presence of the king, and being touched by his royal hand. The ceremony was called the *< sacred touch." It was from this that the disease took its name of ** king's evil." This superstition reached its height in the reign of Charles II. After the Restoration, the numbers who flocked to Whitehall and Windsor to receive the " touch," are said to have been immense, — no less than ninety-two thousand in twelve years ; and the writers of that day declare that none failed to receivo benefit In modern times, believing that the ceremony of the touch waa best adapted to the period when kings were thought to have sacred persons, we rely for the cure of this disease, upon rational medicinft and hygiene. The medical treatment of it is constitutional and local. Iodine is the great remedy for scrofula. Dissolve one scruple of iodine and two scruples of iodide of potassium in seven teaspoonfuls of water. Of this, give ten drops three times a day, in a little water, gradually increasing the (lose to once and a half or twice that amount The iodide of potassium, as in prescription (101), is a good remedy. Where there is considerable debility, the iodide of iron, in doses of twenty-five or thirty drops, in water, three times a day, is a good preparation. roducing Tlaiii in- ;i} in the all caaes do their here, and n within, lauses for I, climate, assigned , and the ti have a the con- it never undertake and if we roduction, vn strong ^philia, fii- the adop- wa» be- ice of the nony waa tease took height in nben who ire said to in twelve to receive touch waa ave sacred il medicintt scruple of >aspoonful8 in a little f or twice (101), is a n, in doses f, is a good The compound syrup of yellow dock root, and the compound syrnp of stiilingia, taken sometimes ulune, and at other times, with two to five grains of iodide of potassium in each dose, arc both ex- cellent medicines for stTofulu. The bowels nmat be kept open by laxative food, or in the failure pf this, by some gentle physic (12). Medicinal springs, pariieularly those confaining io like, are among the very b(\st things v , ii tlity can be had. Lemon jiv'T. |(r(xluces the happiest cireels. I'ot.Uoes are iuuong !hc very L,^-* renu tlies, — |/articularly if snaped and ate raw. They ar«! al.so valu- able when cookcil. Spriic(^ beer is a go«»d antidote; and may be made .!t, sea from the essence. Many kinds of beer may \>r brewed at sea, whieli are valual)le. When the bowels are coslive, ci't'am of lartar, dissolved in wafer, and draidv f«'eeiy, will be f(»uud tin; best remedy. If there be loose- nes.s of iIh^ bowels, morphine, laudamun, a tea madi of log\vtx)d, or geniniuui, or the tincttiron the skin of iwo kinds of spots; ihe oik; kind are siiiall, round, bright-red points, even with the surface, and changing in a day or two to a pur- ple or livid color, which are yellowish brown when about to disap- pear. 'J'his vari(>ty of the purpl(>s is quite simple, attacking, geuerally, youtig persons, and in warm weather. It is soinetiuies tedious in its conrs«', l)ut never dangtirous. It recjuires little treatment; — pure air, wholesome tliet, with quinia and the mineral acids, make up the chief part of it. It may be known by the spots not disappearing when pressed upon by the finger. The other and more dangerous variety of the disease is attended, generally, by faintness, wandering pains, great debility, and the ap- pearance upon the legs, arms, and body, of dark-red spots, and irreg- ular, livid patches, looking just like the marks of n'cent bruises. These marks are caused by the effusion of blood in patches under the skin ; and in this respect, thi^y are just like bruises, only they are pro- duced by dillercnt causes. In the rapid progress of the disease, dark venous blood freipjently oozes from the tongue, mucous membrane of the mouth, nt)se, l)reath- ing tubes, ears, vagina, womb, slomaeh, etc. The oth(>r symptoms vary in difVercnt cases very much, but generally indicate great dis- turbance of the system. It often runs a very rapid course, but sometimes remains for months. Trentinoiit. — The bowels are to be kept regular by gentle physic (20) (21) (I-J) (10). Iron is a valuable remedy (73). Astringents generally have a good en'<'et (150) (109) (279) (305). The best astringent in this complaint, is gallic acid, taken in live- grain doses, every three oi four hours. 424 DISEASES OP THE GENERAL STSTEIL The sponge bath, twice a day, with tepid or cool water, and fol- lowed with gentle rubbing with a coarse towel, will do much to irestore and equalize the circulation in the skin. During the active stage of the disease, the diet should be very light, — simple toast-water, rice and arrow-root gruel, and either alum or wine whey. While getting well, the patient may have a more nourishing diet, consisting of tender fresh meat, broths, etc. ; and must take gentlfl Exercise in the open all". nd fol- uch to »e very ;r alutn !g diet, gentle SURGICAL DISEASES. U Inflammation. Every par! of the body, which has vessels and nerveia, is liable to inflammation. Where there are no nerves, it cannot exist. Many diseases are caused by it. Mechanical injuries", such as cuts, bruises, and fractures, produce it. And many other disorders, not caused by or causing it in the beginning, become entangled with it in their pro- gress. It is very important, therefore, to understand tlie nature and management of inflammation. It is not always to be looked upon as a disease ; it is frequently a simple process of repair, whereby nature restv)res injured parts to health. Tlie Si*»;iis of lllflillllllliltiuil arc redness, pain, heuL and swelling, though in soitie eases, these do not all .i|)p('!ir. Acilte lulliliilliiatioii. — When th' redness, the pain, th<' heat, and the -welling, are clearly marked, aiii! the irifhimmation is so rapid, that it either subsidts in ii few days, or (piickly l)rings on suppuration^ or ulceration. t)r morti/ieation., ii is said to l>e aeute. Chronic IlltlilllllllUtioil. -- When it is less painfnl, and slower in its progress, beginning very gratluullv- .md lingcnug u long tiav, it is tlien chronic. €0111111011, or Siiiiph\ or lleuithy liitlamtMurion uslMknttcfa is not mixed up wiih any di&^t ai»e, but is t"»tablislied by nature foi some salutary purpose. I^llhcilltliy Illftailiniilth'l is that whk-h has been caumeti by some other disease, and is unl. Specific Illfluillllliltion is that which seeins tt) vary from si! ordinary cases, being dependent on a particular j«tat.e of the syh;em, on an animal poison, or si princi|)l(! of eoiitagion or mitstnum, and a power of propagation from on»' person to anoth'-r Some of these produce such perrnaiMau, effects, that thoitc hanoK them are not liable to a second attack. ^ Inflaiiiiiiiition is l*riiiiary, or, as the doctors say, idiapatkm^ when it ia the original disease. J 426 SURGICAL DISEASES. Inflammation is Secondary or Sympathetic when it is the result of some other disorder, which goes before, and produces it. It has been explained elsewhere that the different parts of the body are connected by little threads or nervous strings which run from one to the other. If one part of the body become injured or disordered, it uses these nervous threads, as telegraphic wires, to tell other parts of its misfortune ; and it sometimes happens, that when the intelli« gekice conveyed is of a sad and alarming character, the part receiving the news is so excited and distressed as. to become inflamed. Nothing can be more pro|x*r thiui to call this sympathetic inflammation. "When the inflammation is violent, and is seated upon some impor- tant part, the sympathetic action is so great as to disturb the whole constitution ; and this general disturbance is sympathetic or symptoni' otic inflammatory fever. Tlie Symptoms are quick and strong pulse, dryness and heat of skin, parched mouth, gri-ut thirst, scanty and high-colorcd urine, cos- tiveness, disordered nervous sysleiii, loss of appetite, iuixitsty, restless- ness, sleeplessness, hciuiiiche, wanderinfj; and coiifiisioM of mind, and sometimes delirium. This fever John Iltuiter ciilled a universal sym- pathy of the body with the disturbed condition of a pjirt of it. It is only by inflammaticMi that a wound is healed, or a broken bone re|)aired. Upon the surface of a wound nature pours out a fluid called plastic lymph. This is composed of /76rmc, — the material of which flesh is made, — united with a little of the watery part of the blood, chiefly albumen. The watery part disappears sot)n after it is poured out, and the fibrine hardens into a kind of membrane. Through this, nature sends small nerves, arteries, and veins, which she uses as tiireails to seio vp the wound. Fibrine being the chief material with which nature constructs our bodies,' she of course; uses it to repair them when wounded, — just as a carpenter, who constructs a floor with planks, uses planks to mend it when it is broken through. In the case of highly inflamed and swelled tonsils, nature some- times becomes alarmed, and, for once making a mistake, she rushes in with her material for repair, and fills up all the interspaces with fibrine, — thus hardening the glands, and making their cure irnpossi« ble without cutting them off. But in most cases, nature is right, and cures the injury by inflammation. llufT> ('out of the Blood. — The efTects of inflanunation extend to tlie blood. This fluid, when drawn from the veins of a person suffer- ing from an inflatuination active iuiough to disturb the constitution, \)rms a clot in the basin inon; slowly than usual, but the clot is jarder ; and a layer of fibrine is left upon the surlace of a yellowish jnjf color^ looking like sizi; or glue, and called the bnjlfy coal. The clot is also scooped out in the (H-ntn;, and the blood is said to be cupjKd. Coin Discs. — It is another pecallarily of inflamed blood, that if a drop of it be examined under a powerful microscope, its globules, 1 II SURGICAL DI&KASKS. 427 cos- or di8c:^, which are very numerous, will be found standing on their edges, and leaning against each other, like a row of copper or silver coip«. (Fig. 144.) Inflammation may end in one of four different ways. I. By Reiwlutioii. — Suppose a large splint of wood be stuck into t!ie hand of a healthy man. It causes redness, heat, swelling, and pain ; and these, cornbined, are inflammation. The splint is pulled out, and the hand well done up with a water dressing, and properly cared for. The redness fades, the heat declines, the swj'lliiig sub- sides, and the pain disappears ; the inflammation is ended, and the hand is well. Coming to a fortunate end in this way, inflammatio se are very useful applications; and they are to be pursued as long as (here is any hope of break- ing up the inflanunation, or causing it to end by resolution, lint when this is no longer tt) be expected, and it is Ibuiul that it will go on to suppuration, then apply wmrn fomentations and poultices. These will mollify and soften the parts, and cause the suppurating, or, in conunon language, the rotting process, to go on more rapidly, and with less pain. Count«r-Irritiition. — The other method of removing the blood from the inflamed part is by what is called counter-irritation. People are apt to think it very absurd that inflammation should be induced in one place to relieve or cure it in another. But it is not absurd. It relieves or cures on the principle of sympathy, which I have already ex|)lained, We put croton oil, or tartar emetic, or Spanish flies, or cayenne pepper, or mustard, upon the surface of the bowels when the internal parts are dangerously inflamed, and what dead and :)rocess is separated the name Dmetimea ^ prcM-ess, n, ulft-ni- uml <>ii- n which ing sub- idder by \un must If the the diet stcr. If iMtcrnai t otr the d loenh- S which H-v., etc., •utioris ; break- I. Rut will iTo II It ices, irating, rapidly, blood »uld be t is not iiich I ^tic, or of the I what SURGICAL DISEASKS. 429 is the, result ? Why, the terrible smarting and pain alarms nature, and she rushes up to the surface with a large amount of the blood around the inflamed parts, and there, for hours, perhaps for days, struggles to beat down ihe new mischief at the surface; and, in the mean time, the internal parts, relieved by the removal to the surface of so large a quantity of hot blood, make a long stride towards re- covery. A popular orator is speaking to a multitude in a hall which ia thronged to excess, and a few feeble persons faint, and are likely to l)e sulloeated and trodden upon in the dense mass. A person at the door, seeing what has happened, cries "y?re." The crowd rush out; the fainting persons get breath, and arc saved. So, when the thou- sand streams of blood rush through their channels upon an inllamed and fainting internal organ, crowding and o|)pressing it, we set the skin on fire with some inflammatory substance; the blood rushes to the new point of excitement, and the oppressed and fainting organ recovers. Cupping and leeching, which are often necessiiry, are n to be resorted to in very debilitated constitutions. In some persons, h'cch- ing produces erysipelas. Costiveness is always produced by the symptomatic fever which often results from inflammation. This should be removed by saline purgatives, such as rochelh", cpsom salts, glauber's salts, salts of tartar, tartrate of potassa, and the tartrate of soda (9) (7) (12) (14) (18) (20) (25) (27) (41). Sometimes more active purgatives are required, and then the compound extract of colocynth, etc. (29), will be excellent, or, five grains of blue pill, at night, followed by (299), may be used. As a drink, cream of tartar (298) will be found cooling and re- freshing. In all inflammations, the diet must be light and unstimu- lating. Snpparation and Abscess. An abscess is the collection of pus or matter in the substance of some part of the body. When the matter is poured out from some part, the process is said to be suppuration; when it collects in a tissue, it is an abscess. When the matter collecting in some orgtfn, comes towards the surface, and a place in the centre rises above the surrounding skin, and turns white, the abscess is said to point. Some abscesses point and break in a week ; others of a more chronic char- acter, will linger on for months. Fluctuation. — Before an abscess points, a fluctuation may generally be felt in the swelling, which is one of the surest signs that it con- tains pus. Sometimes this fluctuation may be felt even when the matter lies very deep in the flesh. And when it is so deep that it cannot be felt, if a sudden cessation of the symptomatic fever should occur, and shiverings or rigors should come on, attended by coldness in the aflected part, we may reasonably suspect that pus is formed. It is not easy, at times, to say whether matter is really present ; and 430 SURGICAL DISEASES. great care should be used not to plunge in a lancet where noDu exists. Treatment. — When the abscess is completely formed, and there is no longer any doubt of the presence of matter, it should be opened at once. To let out the conHned pus alleviates the pain, and lessens the inflamruution. If tlic matter lie close to a bone, the opening shotild bo mjule without delay. I'lu! opening should bo larg«! enough to lot the matter out tVcely. It is a rule to keep the incision ofien till the cavity of tin; aljscoss is so far filled up that another coUoition of pus is not likely to occur. If the niHttcr do not readily get to the s)irfacrogrcs8 of mortification, we miiHt remove its cause. If it be inflammution, treat that according to the prii)cipl(>.s laid down, though leeching, purgatives, etc., should he used sparingly, as mortifi- cation reduces the constitution so rapicjiy that it docs not bear rechic- ing as well as usual, and sonietinics not at all. As soon as the in- (lainmation has subsided, particularly if the system bi; weakened, tonic bitters and a nourishing diet must be had. Wlien there is fever, with great excitement i»f the nervous system, delirium, picking of the bed-clothes, etc., the patient slioidd hav(' anodynes (l"Jl)and antispasmodics («7) (91) (90), with blisters upon the back of the neck, drafts upon the feet, and such other local nunedies as the case may recpiire. It is of little use to put anything upon the mortified part, except with a view of lessening the stench. For this purpose, lay upon the part lint soaked in a solution of chloride of lime or soda, or a solution of pyrolignet)ns acid, or of creosote. Very little can be done to hasten the s«'paration of the dead part from the living; but while it is taking place, a conunoa llax-seed poultice, mixed with a little powdered charcoal, may be kept on it The ulcer left after the separation is to be treated like other ulcers. Ulceration and Ulcers. When the small particles composing the body have been used awhile, they wear out, and become useless. Over the whole body are distributed a rrmltitudc of small vessels, called absorbents, whose business it is to pick up these worn and loosened particles, and carry them away. There is another class of small vessels, haying just the opposite duty, — namely, to bring new particles of matter, and put in the places of those taken away. These are arteries. Tlu^y are the natu- ral artisans, who construct our bodies. The absorbents are the de- molishers who pull them down. Under these two forces, our existence is, for a timt^, a drawn game between life and death. The absorb- ents, like myriads of hungry insects, eat us up, — the constructing arteries, like faithful builders, reconstruct us. The work of the ab- sorbents, is called absorption ; that of the constructing arteries nutri- tion. When nutrition partially ceases, and absorption continues una- bated, we grow thin, or lose flesh. This happens in consumption, if nutrition should stop altogether, absorption going on as usual, our be.ilie^ would be quickly destroyed. We should be wholly devoured by thiv.e little absorbent vessels. This would be ulceration applied to vh»^ w'lole body. But it does not appear in so general a form. It c -nfisj' 3 itself to particular parts. When nutrition entirely ceases in any portion of the body, the absorbents devour all the skin, flesh, and vessels of the part, — leaving IMAGE EVALUATION TEST TARGET (MT-3) h ■I // {./ yii^ y. 1.0 ."ffi^ III I.I 2.5 45 .If 1^ t I4£ IlilM IL25 ■ 1.4 !!l.6 V] <^ /a / ^^ ^ 4 '/ /A Photographic Sciences Corporation 23 V#eST MAIN STRIET WCQSrCrN.Y. )4SiO (716) 8/ ■ 103 # A^ '^^ N> ^q> V o^ <> •%" .5%. Mp H 432 SURGICAL DISEASES. an open cavity. The process of taking away the flesh, etc., is ulcere^ tioriy — the cavity left is an ulcer or sore. Natural Surgery. — Ulceration sometimes acts the part of a natural surgeon. When a pa.'t dies from mortification, it is necessary to have it removed ; so nature sets up, directly around it, an acute in- flammation, in which all nutrition stops, and absorption goes on rapidly. In this way, a complete dike is in a short time made around the dead mass, and it is as handsomely amputated, or cut off", as any surgeon could do it. When the ulceration is going on, and the blood-vessels are being cut off' by it, the blood coagulates or curdles iu them for a short dis- tance back from the breach, which prevents bleeding. This is as good as tying the arteries. Some textures ulcerate more easily than others, — the akin and mucous membranes most easily of all. Ulcers are divided into healthy , unhealthy^ and specific. A Healthy ulcer is a simple sore, not showing any bad symptoms, '"ut rather a kindly disposition to heal. It is generally small in size, of a florid-red color, and has upon its surface, little elevations, pointed like cones, called granulations^ which are not so apt as in the case of unhealthy ulcers, to rise above the level of the surrounding skin. Unhealthy Ulcers comprise those called irritable, indolent, and pAo- ffedenic, etc. Indolent Ulcers are numerous. The edges of the skin around them are generally thick, prominent, and rounded. The granulations are pale, smooth, large, and flabby, with a peculiar gloss upon them. These ulcers form most often on. the leg; and the nearer they are to the ankle, the harder they are to cure. Phai^edenic Ulcers are those which look as though they literally eM away the parts. Their surface has a livid appearance. The matter formed is small in quantity, and is frequently tinged with blood. Specific Ulcers embrace scrofulous, cancerous, venereal, scorbutic, and others. They are called specific because they are produced by par- ticular diseases, and states of the system. Treatment — The first thing to be done is to remove the exciting cause. A venereal, or a scrofu! jus, or a scorbutic ulcer, cannot be cured, unless we first lessen the force of the disease in the general system. If the continuance of a sore depends on bad digestion, Mife cannot expect to cure it, tiU we put the stomach right. Healthy ulcers want no treatment, except some simple dressing, such as marshmallow or spermaceti ointment It is well, in some cases, to touch the granulations near the surface, with lunar caustic Ulcers upon the legs and ankles do not heal well if the patient walks about much, or even allows the legs to hang do'vn a great deal SURGICAL DISEASES. 433 acute in- Vm. 14G. Indolent ulcers are to be touched by lunar caustic stick, or by diluted nitric acid. Tlie diluted ointment of the nitrate of mercury is also often used with benefit. So is the com- pound tincture of benzoin; the basilicon ointment, [etc. Or, apply a bread and milk poultice to the ulcer, and keep the ])alient twenty-four hours in bed. Then apply the lunar caustic stick to the whole sore, and to the skin around it. Afterwards cover the ulcer with sticking plaster, and a bandage. The following is the b(id kills everything as it goes. Next, in fatal cases, come great restlessness, faintings, sunken countenance, dry skin, dry brown tongue, despondency, delirium, and death. It is supposed gimerally not to arise; from ccnstitutional causes, but to be produced by a specific poison applied to the skin, or by eating the flesh of e^tt'c which die of gangrenous diseases. The disorder is probably the same with the pestilential carbuncle. Treatment. — Deep incisions, and the application of the most pow- erful caustics, as the caustic potash, etc., and tincture of peruvian bark, quinine, aromatic sulphuric acid, wine, ether, and opium. Probably the best treatment is to surround the pustule with a thick layer of ointment ; then to fasten some lint to the end of a stick, wet it with nitric acid, and press it upon the pustule. Now apply cloths, wet with cold water, and when the slough comes off", dress with simple ointment, or touch occasionally with weak solution of nitrate of silver (211). Chemical Injuries. These are of two kinds, produced by causes of an exactly opposite nature. The first are Burns and Scalds. A bum is the effect of concentrated heat acting upon living tissues. The effects are inflammation, and sometimes complete disorganization and destruction of the parts. A scald is an injury produced by applying hot water or other fluid, to the skin or mucous membrane. The natural temperature of the human body is ninety-eight degrees ; that of boiling water, two hun- dred and twelve degrees Bringing the skin in contact with a fluid heated so far above it, produces redness and pain ; and when nothing is done instantly to ward off" the injury, the scarf-skin \s raised from the true skin in the form of a blister, filled with water. The degree of danger from a burn or scald, depends upon the ex- tent of the injured surface, and also upon the depth of the injury. An extensive scald or burn may prove fatal in a few hours, — the patient never rallying from the first prostration. These injuries are most dangerous when upon the head, neck, chest, and belly. Old persons, and those who are feeble, and have shattered constitutions, will sink under burns and scalds, from which robust persons will suffer but little. Treatment — For slight burns and scalds, make cold applications. \'3iS SURGICAL DISEASES. Put the injured parr, in very cold water, or lay upon it pieces of linen, or lint, \v(?t witii vinegar and water, or rof^e water and sugar of lead (238), or diluted solution of aeetate of ammonia. When these are not to 1)0 (juieldy had, lay on scraped potatoes. The object is to reduce the inlluuuuation, and to prevent blistering. They must, therefore be put on very soon. If the scald be extensive, and on the bod?/, — producing shivering, faintness, paleness, and coldness of the skin, and a small pulse', — cold applications ar(! not proper. In such case we may use warm fomentations, or, in the case of a child, the warm bath. A liniment of spirits of turpentine, linseed oil, etc ( 194), makes an excellent application. Raw cotton, s|)read out thin, and laid upon a burn, is a -jfood dress- ing, and one which is much used. So is flour sprinkled upon the injured surface with a dredger. For loosening the flour when it is to be taken off, poultices are useful. Keep the air from the wound as much as possible. With this view, do not remove the dressing often, and when a cold lotion is used, merely pour it upon the rags, letting them remain undisturbed. Effects of Cold.— Prost-Bite. Cold is a relative term. The same temperature may be called hot or cold, according as it is compared with a hotter or colder tempera- ture. If we warm one hand by a fire, while we lay the other upon ice, and then plunge them both into cold water, the water will feel cold to the one which has been by the fire, and warm to the one taken from the ice. The warmth of the body being ninety-eight degrees, any tempera- ture below this may be said, in a certain sense, to be cold. let a temperature much lower than this, namely, from sixty to seventy, is the most agreeable and invigorating, because it takes away the heat just about as fast as it is produced in a healthy body. The first effect of cold applied to the body is to weaken the cirou- lation in the small blood-vessels of the skin. When applied with some intensity, the heart and arteries in general are weakened,; the blood is delayed in the vessels near the surface, and not being changed to a red color in the lungs as fast as it should be, the fin- gers, ears, etc., become blue or livid ; and» if the cold be continued sufliciently long, the circulation stops in these parts ; heat ceaf^es to be evolved, and mortification or death is the consequence. Parts killed in this way are said to he frost-bitten. A free circulation of red blood is essential to the continuance of sensibility. Hence, when the circulation 's seriously impeded by cold, the body becomes numb, — it loses its leeling; the muscles act feebly ; a languor and torpor follows ; drowsiness comes on, followed by sleep, from which there is no waking. Drowsiness, during expos- ure to extreme cold, indicates great danger. Treatment. — It is a great principle in restoring frost-bitten parts, and persons benumbed with cold, to communicate heat in the most SUIIGICAL DISEASES. 437 gradual manner. Mr. Hunter says the degree of external heat should be in proportion to the quantity of iife. When life is weakened and nearly destroyed by frost, therefore, Ihe warmth imparted must be small, and rise no faster than life returns. To restore a frozen limb or part, rub it with snow, or place it in cold water for some time. When feeling begins to return, still keep it in cold water, and let heat be added in a very gradual manner, by poring in, now and then, a very small quantity of warm water. If a person be reduced by cold to insensibility, and apparenlhj frozen to death, take his clothes oil", and cover him all over with snow, except the mouth and nostrils. If snow is not to be had, put him in water as cold as ice, and let him lie for some minutes. Then rub him with cloths wet with cold water. When the body is thus 1 hawed by degrees, and the muscles begin to relax, dry the body, and placing it in a cold bed, rub with the warm hands, only under the clothes. Contiime this for hours. If signs of life appear, give a small injec- tion of camphor and water, and put a drop of spirits of camphor on the tongue. After a time, rub with spirit and water, and finally with spirit, and give tea, or coft'ee. or brandy and water. Mechanical Injuries. Wounds are divided into several kinds. Incised Wounds are very common. Being made with sharp instru- ments, they ..re cuts, and have no laceration or tearing about them. Stabs, or Punctured Wounds, form another class. They are made with pointed Vv^'apons, as bayonets, lances, swords, and daggers. They are more dangerous than tlie former, because tlicy penetrate to a greater depth, — injuring blood-vessels, nerves, bowels, and other organs. Contused and Lacerated Wounds form still another class. They embrace gun-shot wounds, and all those produced by blunt instru- ments. They tear, and bruise, and mash the llesh. Poisoned Wounds form yet another class. They are sueli as ire united with the introduction of some venomous poison into the in- cised, or punctured, or contused part. Stings and bites of venomous insects and snakes are of this class, — also the wounds made by poi- soned arrows. Simple Wounds are such as are inflicted on a healthy subject with a clean sharp instrument. Complicated Wounds are those inflicted when the state of the whole system, or of the wounded part, is such as to make it neces- sary for the surgeon to deviate from the treatment needed for a simple wound, — as, for example, when there is bleeding, or nervous symptoms, or great pain, or locked-jaw, or much contusion, or ery- sipelas. 43b SURGICAL DISEASES. Sympathetic Fever. — All large wounds are followed by symptom- atic fever, which comes on from sixteen to thirty-six hours after the accident. This is generally of the inflammatory kind, and is indi- cated by greater warmth of the skin, a more frequent and stronger pulse, anxiety, thirst, and loss of digestive power. Where much blood is lost, and the constitution is feeble, the pulse is more quick than strong, and the fever of a lower and more typhoid type. In this case, bjood must not be drawn. Lacerated wounds are more dangerous than incised ones, because the parts arc stretched and otherwise injured, besides being separated. A very small wound upon the brain, the spinal marrow, the bowels, or the heart, will often prove fatal, because the functions of these parts arc iiitimati-ly connected with life. Wounds of young persons heal much more rapidly and kindly than those of old persons. Incised Wounds. When the flesh is divided with a cutting instrument, the cut edges separate, and the wound has a gaping appearance. This drawing apart happens in coiisecjuence of the elasticity of the skin. It often happens that vessels of considerable size are cut, so that bleeding is the principal thing to receive attention. Treatment of ]Ieniorrh!(«>:e. — Bleeding is stopped by the tourniquet^ by tlie lig-ature, by compression^ by the application of cold water and tee, and by astringents and styptics. The Toiiniiquet. — This instrument consists of a band and btickle, a pad, and two brass frames, the upper of which is furnished .vith two small rollers, and the lower with four, over all of which the band plays. When the handle is turned to the right or left, the band is tightened or relaxed to just the extent required. (Fig. 147.) The band is buckled round the limb in such a manner that the pad is placed exactly over the artery. When an artery is cut, it is known by the blood being very red, and spirlin.g' out in jets ; and in this case, the instrument must be placed upon iIk; limb above the wound, or betweiMi it and the heart. Fio 147. The Lipiture. — When an artery is divided, the surgeon lay& hold of the end of it with his forceps, and ties a thread tight around it This is called a ligature. By it, the bleeding is instantly stopped; tf SURGICAL DISEASES. 4sy and long before the thread becomes loose, the opposite sides of the vessel have grown together, and all danger of a renewal of the bleeding is over. Application of Water and Ice. — This is done by saturating with cold water several folds of linen rags, or lint pads, and applying them to the wound, remoistening, and reapplying them as fast as they be- come hot, till the pain and inflammation subside. Compression. — When the blood does not come from any largt vessel, but from several small ones, compression is snUicitMit. It con- sists in placing the opposite sides of the woup ' together, if pssible. and then laying compresses over, and apply! a bandage with mod- erate tightness. Astrinr when the wound is exposed. Put the patient in the most easy position, that he may not be need- lessly fatigued during the dressing. If the bandage, plaster, and other dressings, have become hard, and glued together, and to the skin, by blood or matter, soften them with warm water, which is to be pressed ovit of a sponge, — a basin being held below the part to catch the water as it falls from the dressing. The strips of adhesive plaster are to be removed by pulling gently at one end, and then the other, — each to be drawn towards the wound, so as not to ])ull its lips apart. In large; wounds, take oil" one, or at most, two slrijis of plaster at a time. Cleanse, wipe dry, 'And again support this part of the wound with new strips of plaster, before; any more are taken oil". This will prevent the wound being torn open by t!ie weig!it of its parts. If the wound be large and deep, its sides should be su|)ported by an assistant wiiile clianijins^ the dressinsjfs. If there are several wounds, dress but one at a time, that there may be rr> needless exposure to the air. Pay the utmost attention to cleanliness. The frequency of the dressing iriust depend on the amount and quality of the discharge, the situation of the injuiy, the climate and season of the year, the eflect produced by the dressing, and by the feelings of the patient (See p. 878.) The Way in which Wounds Unite. When the two surfaces of a wound are brought together, they be- come impervious to the blood, but not to coagulable lymph, or fibrine. This, — the material of which all flesh is mar^-.., — flows out upon the two surfaces, and becomes a bond of union between them. Into this layer of fibrine, the small blood-vessels, — arteries and veins, — which have been cut asunder, push themsvuves with open mouths, and, meeting in the centre, they inosculate, or grow together, and the blood resumes its circulation through them. SURGICAL DISF^ASES. 441 By this method, incised wouiida of moderate size are often healed in forty-eight iiours. This method of healing by the first intention is always to be brought about, if possible. Punctured Wounds. These are produced by swords, daggers, etc. Great swelling and iiifluiiiuiatioii, large abscesses, erysipelas, the wounding of large arteries, and the consequent extravasation of blood, Bymptomatic fever, and lock-jaw, are the fretjuent results of punc- tured wounds. They are, therefore, more dangerous and hard to cure than cuts. Treatment. — For the first twenty-four hours, use superficial dress- ings of lint, wet with a solution of sugar of lead dissolved in cold water, or with cold water simply, and a loose bandage. If, after this, pain and swelling should increase, leeches iwu^; be applied to the neighborhood of the wound, and fomentations, or poultices, be put in place of the cold water, — placing a small linen rag, spread with sper- maceti cerate, over the wound. When the pain and inflammation are great, saline purgatives (7) (18) (25) (27), and opiates are oftiMi called for. Contused and Lacerated Wounds. These are produced by cudgels, stones, bullets, or whatever else of a blunt nature, tears asunder the muscular fibres, leaving jajLrgcd anil uneven surfaces. Tliey are rarely lu^ali'd v/itliout snppiu'atioii, and are frequently followed by violent iiillaininalion. Th(!y suppurate and slough, but they do not bleed umch, — not even, sojuetimes, when large arteries are lorn asunder. Whole limbs are oeeasionally lorn away without hemorrhage. In warm climates, loik-jaw is a frequent consequence of them. Treatment. — Draw the edges of the wound loosely together, and retain them with a few strips of adhesive plaster. Sometimes a suture, here and there, will be proper. If a great deal of indamma- lion ensues, take away the adhesive plaster and the stitches, and apply a poultice, or water dressing; and if there be much fever, rest- lessness, or delirium, saline purgatives (18) (25), ojjium (118), and i^ery low diet, will be needed. The wound having thrown off its sloughs, suppurated, become clean, and formed granulations, the poultices are to be taken otl", and simple dressings substituted. These should be adapted to the condi- tions of the sore, according to the directions for treating ulcers. When the wound is so severe that extensive mortification will be sure to follow, the limb must be immediately taken ofT, to save the life of the patient 442 SURGICAL DISBA8E& Qrannlation and Scarification. Suppurating wounds heal in the same way with ulcere. The chaam is filled up by the appearance of little soft elevations of new substance, which originate at all points, and meet at the centre, draw- ing the sides nearer together, and raising the bottom towards the surface. This ia called granulation, because these elevations look like grains ; and the result is a new tissue, of a peculiar character, which constitutes the cicatrix, or scar. Reproduction of Lost Parts. Among some of the lower animals, whole limbs which have been destroyed, are easily reprodiicrd. It is not so with niiiii ; though cer- tain parts, when only piirliiilly destroyed, are soiiu'tiiiics n-generatod. Thus, portions of skin, of eonsidi^rable ext(Mit, arc; often niproduced ; and so are the whole of some long bones, when destroyed by necrosis. The same is true, to some extent, of liguiuents. But portions of brain, and spinal marrow, and muscle, and mucous membrane, when once removed, are never regenerated. Gunshot Wounds. At a time when fire-arms are so much carried about the person, and so often used for purposes of duelling, and murder, it is proper that every person should know something of the modes of treating gunshot wounds. Treatment. — It is often proper to make a gunshot wound larger at the orifice. When this is done, it is generally on the side where the bullet has passed out, if it has gone entirely through. A bullet ia always to be removed, if it can be felt. The dressings are at first to be superficial, light, and unirritating. The common tepid water dressing, covered with a piece of oiled silk, is one of the best. Some use pledgets of simple ointment, poultices, and fomentations. These latter are generally employed during sup- puration ; but during the first two or three days, cold evaporating washes, and cold water, are best, when the wounded part is inflamed and hot, and the circulation is vigorous. Poisoned "Wounds. To the bites of various creatures man is exposed in most climates, and all seasons of the year. These may be divided into three classes. Bites of Miisquitoos and Spiders, and Stinn-s of Rees and Wasps. — For these, the best applications are a solution of common salt, or water of ammonia, or sugar of lead (239), or laudanum, or tincture of iodine. If none of these are at hand, at the moment, cover the part with wet earth. Tincture of arnica (240) is a good application. :|l,; I, Bites of Venomous Snakes. — Either instantly cut out a piece from the bitten part, or apply a dry cup, to prevent the abttorption of the poirton. Suction with the mouth will .sometimes answer the same purpose. After doing one of these things, touch the part with caustic potash. Internally, give Fowler's solution, twenty drops, in a little water, every two hours. Also purgative? injections, — stopping the arsenic when purging is well estal)lii*h('(l. For the bite of tli'e rattle-snake, tin; only known remedy is alcoholic drink, taken in large quantities, and itiiinediately. (iin and whiskey are believed to be the best. Fill tli(? system full. When \\\r. poison has begim to take ert'ect, onorriious (piantities will be borne, before in- toxication vMi\ bo induec^d. Kt^ep the whole person i^uturated until the symptoms decline. i«; Fractures. TnK existence of a fracture is to be known by tlic sjir'|)tom3. These are, pain, swelling, deformity from the liiiil) bending to one side, vsoiiictimes shortening of the limb, or loss of power i ) use it, and a crepitus or grating soinicl or sensation from tin; rnbl)l.!^ of tla- ends of the broken bone together. There are several kin«ls of fr;icturea. They an* The Traii.>»vei'se FriictuiT, which is directly across tin; Ijone. The Oblique Fnicture, which runs from side to side, In an oblique direction. Tlie Loiijcitudiuiil Fnicture, which runs lengthwise of the bone. A Simple Frueture is one in which the bone is broken simply, with- out any wound of the flesh with it. A Coniitound Fracture consists of a simple fracture, and of an ex- ternal wound in addition, caused by pushing the end of the broken bone through the flesh. A Cuuiplicated Fracture is one in which, beside the breaking of the bone, there is the dislocation of a joint, the wounding of an artery, th« extensive tearing of the soft [)arts, or the wounding of the bowels or some other internal organ. A Cuiiimiuuted Fracture is one in which the bone is broken into several pieces. Treatment of Fractures. — When a bone is broken, the first thing to be done is to get the injured person to his iiume, or to the nearest house. To do this in a rough or careless way, might add iimeh to his sufferings. If it be an arm which is broken, let it be placed in a 'road sling, extending from the elbow to the fingers. In this condition the pa- tient, if in tolerable health, and the distance is not great, will find it easier to walk home, than to bear the jolting of a carriage. illi li > 1' r 444 SURGICAL DISEASES. Fio. 14S. If 1h(! I('<,' or 1li(' llii]lsioil means taking hold of the lim!) below the fracture and pulling //7;w/ the body. Counter-Kvfoilsioil is pulling nlnrtr. the fracture foumrds the body. Thet'.e opposite puUings are done at the same; time to overcome the force of the muscles, which contract, and draw the ends of the bone by each other and shorten the limb. Sometimes no extension or counter-extension is necessary, the eiuls of the broken bone not being pulled out of their place. Wher. the pulling is necessary, it should be gentle and steady. (Sec p. 877.) COiiptilfioii means adjuslbi^ the ends of the bone to each other. The next thing is to provide for keeping the ends of the broken bone steadily in contact, so that nature may have a fair chance to unite them. To secure this object, mechanical contrivances are used, which arc simple, and may always be had without dilTiculty. They consist of liru'.n. ban/ioi^es, about the breadth of four fingers, and from four to ten yards long ; and pads, made of old woollen cloth or blankets lightly quilted together, or pillow-cases filled with tow, or chad", or cut stra\y, or even leaves ; and of splints, made of clapboards, i SURGICAL DISEASES. 445 or tliiclc shingles, four finT:crs wide, and in length con'esponding with th:it of the broken limb ; or wheat straw laid side by side, and quilted into a piece of cloth to prevent thoni moving about. A very useful splint may be made from the fresh bark of trees. The pads are to bo placed under the splints, to prevent injuries to the skin ; and the bandages to be bound over the whole. (Sco p. S78. ) For some hours after a linib is broken, the parts eontiiuie to swell ; and if bound up iinmcdiatch/ with the pads, splints, etc., nuich need- loss pain will be occasioned. It is best, therefore, not to put these on under two or three days, but merely to lay the limb in a natural •^o:iition, and perhaps lightly bind one sj)!'nt to it. Broken ribs and jollar bones are exceptions, and shoulu be bound up immediately. A broken arm lies easiest half bent, upon a pillow ; the thigh or leg, upon the outside, with the knee bent. When the apparatus is once adjusted, the less it is meddled with the better. In fractures of the shoulder or arm, a sling is a contrivance of groat importance. This, if well made and adjusted, keeps the broken bono in its place, and at tho same time, allows tho patient to tako some exercise by walking about. Fifl. 149. MdfiAso fract' re-boxes (Fig. 150), qx\ A fracture -era dies, — tho latter to keep tho bed-clothes lifted away from the painful limb. Fraoture- Beside tho above contrivances, there is the double inclined plane ; (Fig. 149) for giving the leg the advantage of a bent position. There FlO. ISO. l,i,! I r 446 SURGICAL DISEASES. beds are now brought to great perfection, and one ^^hou]d, if possible, be procured when the patient is likely to be confined a long time with a compound fracture. The fracture-box, represented by Fig. 150, may be made from thin boards, by any carpenter. It has a hinge at the knee to enable it to fulfil the double purpose of a double- inclined plane and a fracture-box. The Way in which Broken Bones Unite. The union of broken bones is much slower than that of severed flesh. The ends of the bone being kept steadily together, they »oon become surrounded by a swelling of the soft parts, which change to a sort of osseous substance, making a kind of bony hoop, to act as a splint or support, — nature not being willing to trust the surgeon to keep the fragments axactly in their place. This is called a provis- ional callus, because it only has a temporary use. This First Stag-e lasts about ten days. At the end of this time, t. spongy substance appears between the endi; of the bone. This sub- stance is not bone, but in the swelling around the fracture specks of bone begin to be deposited ; the fibrine here poursd out becoming first cartilage, and then receiving into itself phosphate of lime, it be- comes bone. A similar work is going on within, in the part called the medullary membrane. Tliis Second Sta^e lasts from the tenth to the twenty-fifth day. Then Begins the Tliird Stage, which goes to the end of the sixth or eighth week. During this period, the external swelling, and the internal medullary membrane, become completely ossified and firm ; though the ends of the bone are not yet grown together. The Fourth Stage goes to the end of the fifth or sixth month. During this time, the external swelling, or provisional callus, becomes covered with a periosteum, and the ends of the bones themselves are fastened together by a bony union. The Fiftli Stage extends from the fifth or sixth to the twelfth month. During this time, the ends of the bone become grown to- gether so strongly that the bony ring, or provisional callus, is no longer wanted, and it becomes absorbed, and disappears, — in other words, having no further use for it, nature takes off her splint. The place where the fracture was, is now as strong as any other part Union in Compound Fractures. The union of compound fractures takes place in a different way from that of the simple fracture, just described. In this case there is Buppuration, and the bones remain disunited several weeks, and there is no provisional callus formed. But after some weeks, the ends of the bone soften and granulate ; and when the production of pua de- clines, these granulations are gradually changed into bone. SUKGICAL DISEASES. 447 Time Required for Uniting Different Bones. Fractures of the arms unite sooner than those of the legs. The ribs and collar bone unite with tolerable firmness in about a month ; those of the arm in six weeks ; of the tnigh and leg in eight weeks. I only mean the firmness derived from the provisional callus. A broken bone will unite much sooner in a healthy pcrsoii than in an unhealthy one ; much sooner in a young than in an old person. As a general rule, the apparatus should be kept on thirty days in the case of children ; forty days in that of adults ; and much longer in that of aged persons. False Joint. The union of a broken bone is sometimes prevented by a frequent moving of the limb. The ends of the bone having failed to grow to- gether, will sometimes become rounded a nd smoothed, uniting only by a kind of ligament, and acquire the habit of sliding upon each other, and thus form what is called a false or artificial joint, — the limb being permanently capable of bending, to some extent, at the place of the fracture. Fractnres of the Skull. These are always dangerous in their nature, and the aid to be derived from surgery much less than in other fractures. If a fracture of the skull produce deep sleep, and snoring, and the patient does not show any symptoms of pain when pinched, etc., we are to infer that a piece of bone is pressed down upon or into the bro._ . In this case, if the position of the blow be known, a cut is to be made through the skin, two or three inches long, down to the bone. If arteries bleed, they must be taken hold of with a pair of forceps, and tied with a silk thread, the ends of which are to be cut off. The bone being well exposed by one or two incisions, the piece which is pressed down upon the brain is to be raised with a chisel, or some similar iuvstrument, to a level with the other bones. The surface must then be cleaned with a sponge, the hair around shaved off, the skin brought together, and the cut edges reunited by sticking plaster. When the inflammation appears, twenty-four hours after, it is to be kept down by doses of from five to ten drops of tincture of veratrum viiide, given every one or two hours. Fractures of the Bones of the Nose. Injuries of this kind may generally be rectified by passing a strong probe up the nostril, and pressing out the bones to their natural place, at the same time using the fingers on the outside to prevent their being pressed out too far. Inflammation must be kept down bj vloths wet in cold water and laid on, and by light diet. w ■li !l!i ,it- ^1 : ;:ii 111:'! I i 44tt SURGICAL DISEASES. Fracture of the Lower Jaw. This usually takes place near the chin. It may occur also near the aiii^les of the jaw. It may be .simple or compound, and is known by i\\i'. pain, the swelling, the inability to move the jaw, the indentation lilt by the finger, the irregularity of the teeth, and tlie grating sensa- tion felt while inoving the jaw with, the hand placed on liie back fVigment. TreatllU'llt. — Let one or both thumbs be introduced into the mouth. With u:>^9e, keep the back part of the jaw stationary, and pull for- ward tho fore part with the lingers on the fio.151. on t side. Tn this wuy the fracture can S003- be put i-ght. This done, shut the iiioutii "^irmly, ar^d place a of lint o/er the bioken part ; a piece ot pristeboara, ^^^etted so as to bend easily to tnt parts, ar»^ over this a stro'jg bandage oi muFlin, twt and a half inches wide, with a emdl ba^ to fit and hold the chin ; ail which is represented in hig. 151. For a fortnight, the patient must feed on gruel, broth, arrow-root, and milk, that the jaw may not be displaced by chewing. Fracture of the Collar Bone, or Clavicle. Tkis accident generaUy occurs about the middle of the bone, and is generally caused by falls on the arm and shoulder. le iracture can done, shut the y \ \ ' thick compress \\\ t ; over this put \\\ etted so as to \ N Fia.163 FiQ.158. Syniptoins. — Pain and tenderness at the place of the injury, arJ inability to lift the arm ; a small bunch or prominence at the point of m SURGICAL DISEASES. 449 the fracture ; the distance from the point of the shoulder to the breast- bone shorter than on the other side : and the dropping downwards, forwa'fils, and inwards of the shoulder. To moke the case sure, com- pare the two bones, and see whether they agree. Trentnient. — Place the knee between the shoulder-blades, and grasping the round ends of the shoulders with the two hands, draw them gently back till the ends of the bone come to their proper place; or, place the elbow of the patient close to the body, and a little for- ward, and then push it upward. To n^tain the shoulders in this upward and backward position for soino weeks, pass a flannel bandage, four inches wide, around the front of one shoulder, under the arm-pit, across the back, over the opposite shoulder, under the other arm-pit, and again across the back, ill the form of the figure oo. To prevent the bandage from cutting the skin, put pads under the arms. (Figs. 152 and 153.) Fracture of the Shoulder-Blade. When this accident happens, the body of the bone is generally broken across by some great direct violence. In a few instances, the end next to the collar-bone is broken. Symptoms. — Great pain in moving the shoulder, and the grating" sensation which may be felt by placing one hand on the upper end •f the bone, and moving the lower portion with the other. Treatment. — A bandage must be p. ssed round the chest, and a few turns be made around the upper arm, so as to fasten it to the side, and prevent all motion. Purging, low diet, and the tincture of veratrum viride will be requiiLvi to keep down inflammation. Fracture of the Acromion, or the end of the scapula which unites with the collar-bone, may be known by the flattening of the shoulder, — the broken part being drawn down by the action of the deltoid muscle. Treatment. — It must be supported by the same bandages as are used for a fracture of the collar-bone ; and the elbow must be well raised, so that the head of the upper-arm bone may be lifted against the upper p . :n of the scapula, and act as a prop to keep it in plaee. No pad should be put in the arm-pit, for this would push the broktfa part too much outward. ' , ' Fracture of the Upper-Arm Bone. The bone of the upper-arm is most frequently broken near the centre, though it may be fractured near the ends. It may be known by taking hold of the arm above and below the suspected fracture, and attempting to move the ends of the upper and lower fragments u|X)n each' other. If there be a fracture, the grating of the broke'n ends against each other will either be heard or felt The arm will 57 > m nil Ml m i :i:t 450 SURGICAL DISEASES. Fis. IM. also be bent and helpless ; and if the ends of the bone be slipped by each other, it will be shortened. Treatment. — Let a powerful man take hold of the arm and pull gently and gradually, but with considerable force, till the arm is brought to its natural length. — another man taking hold of the body of the patient, and pulling in an opposite direction. In the mean time, the surgeon is to adjust the ends of the bone to each other, and apply a bandage, but not very tightly, from the elbow to the shoulder, and over this, four splints, with |)ads vuider them ; one in front, reaching from the shoulder to the bend of the elbow, with a few turns of the bandage over it ; another behind, reaching from the shoulder to the point of the elbow, with a few turns of the bandage around it, also ; another on the inside, extending from the arm-pit to the inner projection of the bone at the elbow, also secured by a few turns of the bandage ; and the fourth one on the outside, reaching from the shoulder to the outside knob at the elbow. The whole is now to be se- cured either by a bandage or tape. (Fig. 154.) The arm is to be confined tx) the side, and the hand and fore-arm placed in a sling. In from seven to ten days, the dressing should be taken off to see if all is right. Fracture of the Elbow. This may be known by the pa+'ent being able to bend the arm, but not straighten it, and by the gratmg which may be heard or felt when the arm is moved back and forth by the operator, and also by the severe pain felt in the fractured parts Treatment. — First apply leeches and evaporating lotions to reduce the inflammation. When this is effected, straighten the limb, and ap- ply a bandage snugly from the fingers to the elbow. The broken end of the bone must now be brought to its place, and the bandage continued over it, and for a few inches above ir. Secure it heie, and bring it back, — carrying it above and below the elbow for several times ; and then extend it up to the shoulder. A splint must now be applied to the inner side of the arm to prevent its being bent, — ex- tending from the hand nearly to the shoulder, and another, of similar shape, to the outside. The joint should be kept quiet for four or five weeks, — during which time, the splints may be taken off three or four times, to see if there is any chafing of the skin, or any disturb- ance of the bones. Fractures Between the Elbow and Wrist. Thk part of the arm between the elbow and wrist, called the fore^ arm, has two bones, — one extending from the elbow on the inside to the wrist at the root of the little f iger, called the ulnOf and the other, SURGICAL DISEASES. 451 on the side next the thumb, a shorter and a smaller bone, and called the radius. When both these bones are broken at the same time, the fracture may be easily discovered ; when otily one, the sound bone keeps the other in place, and the injury i^ not so easily made out. Treatment. — Relax the nnisclcs by bending tlie elbow, and then, by extension and counttjr-extension, put the ends of the bones in proper place, and then place two splints thickly padded in the centre, one upon the front of the hand and fore-arm, and the other upon the back of the hand and fore-arm, — the palm of the hand being turned, not towards the chest, but downwards. They are to be covered with a bandage from the fingers to the elbow. The whole arm and hand should be placed in a sling, and remain in this position four or five weeks. Fractures of the Wrist, Hands, and Fingers. The setting of fractured bones in these parts is to be done by ex- tension and counter-extension, as in the case of other bones. If the wrist be broken, a splint should be applied in front and one behind, and a bandage bound tightly from the hand half way to the elbow. In fracture of the bones of the hand, a pad or compress must be put upon the palm of the hand, and a splint placed over this, with a bandage extending from the wrist to near thp ends of the fin- gers. If one finger only be broken, apply narrow paste-board splints on four sides, and cover them with a narrow bandage ; and then bandage the whole hand. In all these fractures, place the hand in a sling. About three weeks will be required for the bones to unite properly, and several weeks for the parts to acquire their natural usefulness. Fracture of the Ribs. This accident occurs either by blows, or by being crushed between two opposing forces. One, two, or more ribs may be broken at a time, according to circumstances. Symptoms. — A fixed, piercing pain, made worse by breathing, coughing, or any other motion, and also a grating sensation during the taking of a long breath, the hand being laid upon the injured part at the time. Treatment. — The ribs are to be held steadily in their place by pres- sure. To effect this, request the patient to draw in a long breath, and hold it. While the ribs are swelled out in this way, and the broken ends are thus brought to their proper place, pass a woollen bandage, five or six inches wide, several times tightly around the chest, from the arm-pits to the pit of the stomach. This will confine . 'I riii n 1 1- It Ijt 452 SURGICAL niSKA8ES. the muscles of the chest, and the breathing will have to be done with the muscles of the belly, and the ribs will thus be kept etill, and have a chance to grow together. If the pleura be wounded, and inflammation follow from this or other cause, the patient must be confined in bed, kept on a low diet, and his pulse be kept down by tincture of veratrum viride. The bowels should be emptied by recipes 18, or 20, or 27, or 41, both to liubdue inflammation, and to give the diaphragm a chance to drop down freely. Fracture of the Breast-Bone. Symptoms. — The injured part is frequently either sunk down or raised up ; there is difficult breathing, cough, spitting of blood, pain, inability to lie on the back, and a grating noise caused by breathing. Treatment. — The same as that for broken ribs. Should the broken part be pressed down upon the lung, so as to cause serious difficulty of breathing, an incision may be made, and the broken piece raisea up with a chisel, or stiff* case knife, or some similar instrument. Fracture of the Haunch Bones, or Pelvis. These fractures are dangerous, — being often connected with aome other injury, as tearing of the bladder, lower bowel, or great veins or arteries. Fortunately, however, they are only caused by some great violence, and do not often occur. Treatment. — Place the patient in the easiest possible position, and keep him entirely at rest. Generally a catheter should be kept in the bladder, that the water may pass off easily ; and the whole hips should be bo«ind round tightly with a flannel or calico bandage, and made as firm and fixed as possible, to keep the broken bones together. The most perfect rest must be ordered for six weeks or two months. If the extreme lower end of the sacrum^ the os coccygis (Figs. 8 — 3) be broken, the separated portion must be put in its place by introduc- ing the fi^iger into the rectum ; and the bowels must be kept loose by gentle physic, that the broken bone may not be pushed from ita place by the pressure against it of hard stools. Fracture of the Thigh-Bone. The points where this bone are broken are at its uppet poffion or neck and near its middle. The break at this latter place may be straight across, or oblique, — partially lengthwise. When oblique, the point of the bone may stick into one of the large muscles, and be made fast by it. Symptffinis. — The fracture in the middle of the bone, if it be trans* verse, may be known by some swelling or irregularity discovered by mnning the band along the thigh, and grasping it here and there; and if it be oblique, the enda of the bone will be drawn by each other, and the limb will be shortened. Treatment. — Place the patient on his back, and let two strong men use extension, — one taking hold near the hip, and the other grasping t.h(^ linib at the knee and pulling steadily and strongly till the limb is of (he proper length, and the ends of the bone are in their place. The man who takes hold of the upper end of th*.' limb jr»ay hold it more tirmly and with less fatigue by passing a folded sheet anmnd the groin. The extending force being still continued, the operator is now to apply the splints, which are to be four in number, — one in front, reaching from the knee-pan to the groin; out; behind; one on the inside, frotn the upper part of the thigh to the inside of the knee ; and a fourth one, about four inches wide, reaching from the arm-pit to a distance of two or three inches beyond the sole of the foot Cotton must be placed under these splints to prevent their injuring the skin, and they must be of a width to nearly, but not quite, touch each other. These being properly adjusted, and the extension stiil contiimed if the fracture is oblitjue, the bandage is now to be firmly applied from the foot to the upper part of the thigh, and then passed a few times around the body. This fracture is sometimes treated without eplints, as represented in Fig. 155. Fia. !£& Fio 166 Six or seven weeks will be required for the bones to grow together, during which time the patient will need to lie upon his back. But the dressing may now and then be taken off and put on again. I !' |,i I . Ijt " :■ ': 1 ■ !i i 454 SURGICAL DISEASES. SomctimcH only a single long splint is used ; sometimes no splint ; in still other (sascs, four splints, — the outside one being short, and the limb renting on a double inclined plain. Fructure at the Xeck of the Itoiie. — When the bone is broken at the neck, close to the hip joint, the injury is known by the knee and foot turning oulivanJ, and by the limb being an inch or two shorter than the other (Fig. 150). This is an accident to which old ptirsons are particuhirly liuL>le. When the bone is broken here, it seld >m grows together again. Tlie miion which is formed is generally by a ligiiment. Treiitnicnt. — This requires a very long splint, reaching from the armpit to Ix'yoiid the sole of the foot, and bound firmly with a band- age, as in rnutnn> in the middle of tin; thiii;h. The Ihul) should be ke|)t (^xtciuicd, and the injured one nuist be l)ound to the t)ther by a bandage, keeping both legs straight and innnovable. A i)road leather strap, lM)und lirinly round the hips and thighs, will hv. serviceable. Two or three months will be riupjired for *':,'. lUjuiy to become repaired, so that the liiul) may be used. The patient must get up cautiously, and be rarelnl not to use the limb much so long as pain is produced. (See p. 877.) • Fracture of the Knee-Pan. TiiR knee-|)an (patella) may be broken up and down, or across; — the latter fracture is the more common. It is a troublesome fracture, and is very apt to leave a stiff knee. Syiiiptoniii. — When the bone is brcrken across, the patient cannot stand upon the limb ; the leg may be flexed or crooked, but cannot be straightened ; the upper part of the knee-pan is drawn up away from the lower portion, leaving a wide gap, into which the fingers may be laid, — at the top and bottom of which the rough edges of the movable bones may be felt. TreiitiiiPiit. ^ — First, reduce the inflammation by tincture of arnica, leeches, etc. Then straighten the limb, and put a well-padded splint behind, to keep the knee motionless ; place the patient's body in a half-sitting posture, and raise the foot considerably above a level. Put a bandage over the splint, beginning half way up the thigh, and extending down to the knee-pan, and being made very tight just above the broken bone, so lliat it cannot easily slip under it. The broken bones must now i)e brought together, and the bandage be passed below and again above the knee several times in the form of a figure 8, to keep ihe bones from parting. The bandage, g(>uerally, may not be removed for a fortnight. After this i)eriod, if everything has gone on well, the limb may be carefully bent a little evciry day, to avoid a stifl' knee. SURGICAL DISEASES. 45o Fio. 157. Fracture of the Leg. The leg is that part of tlie limb between the knee and ankle. It has two bones ; the sinalior on the outside, called the fibula ; the larger on the inner and front side, called the tibia, or shin bone. One or both of these may be broken at the same time. If both are broken, it is impossible to walk upon the limb ; there ia a change in its shape ; it may be bent ; and the grating of the broken enda of bone may be felt or heard. Trentnieilt. — First, adjust the bones by means of extension and counter-extension, as in other fractures. Tiien apply two splints, one on the outside from the knee to the sole of the foot; the oilier upt)n the inside. Over these a bandage is to be firmly ap- plied, retieliinj^ from tli(! toes to llie knee Till! leg may rest upon the side or the back, as the eoinfort of the patient may reciuire. Upon the side is generally the; easiest position, with the knee a little bent (Fig. loT). The dressing may b(! nunoved in six or seven days, to see that the bones are in their propter phiee. Five or six weeks will be re(juired for recovery ; and at the end of this tiirie, the dressing may be laid aside. But the patient must use his leg very gradually. One of the simplest methods of treating a fractured leg is to place it in a fracture-box. A pillow is to be placed in this, and the leg, the bones being put in place, is to be placed in the box, and the foot to be secured to the foot-board by a bandage, aiid the sides of tl?e box, movable upon hinges, are to be brought close enough to the limb to keep the bones in place, — compresses, etc., being placed around the limb as required. Bran may be placed in the box in place of a pillow. Fractures of the Bones of the Foot. These are to be treated in the same manner with fractures of the hand. They are often attended with much other mischief, as lacera- tion of the llesh, ligaments, etc. Hence, cutting off the foot, or a part of it, is often necessary. Paste-board splints are frequently used in these fractures. If matter forms, it must be let out by opening the parts. Compound Fractures. "WdEN, in connection with a broken bone, there is a wound of the flesh, which leads to, and communicates with the space between th(^ broken enda of the bone, the whole injury is called a compourul frac- \i 456 SURGICAL DISEASES. )l!l ture. The wound in the flesh may be caused by the same force which breaks the bone, as a bullet from a gun, or a cart-wheel, or some machinery in which the limb is entangled. Quite often the flesh wound is caused by oik; of the ends of the bone being forced through the flesli and skin. But, however causiHJ, a coinjMMUjd fracture is of a much more serious nature than a simple one ; and it is particularly dangerous when a joint is involved. It is more serious above tlio kn<'e and elbow than below, and more to be dreaded in the lower limbs than in the upper. Treiltment. — An attempt should generally be made to preserve the limb ; it should not be cut otF, unless the compound fracture is of the worst kind. But if there be no hope of saving the limb, the amputation should be performed at once, while the constitution is tranquil, and before it has been shocked and injured by the sympa- thetic fever, suppuration, abscesses, and hectic, which are almost sure to follow such grave injuries. But, suppose it be determined not to cut the limb off", — as it gen- erally should be, — the first thing is, after the bone is set, to close the wound against all entrance of air, and to cause it to heal by the first intention, that is, without suppuration. To do this, one method is to cover the wound with lint dipped in blood ; but the more usual mode is, to bring the sides of the wound together, and secure them very carefully by strips of adhesive plaster, in the same way as in common cuts. The bandage should be kept wet with cold water, by squeez- ing a sponge over it, or by sprinkling cold water upon it as fast as it becomes dry. It will be necessary, in thia case, to keep the bed-clothes away from the limb while it is thus wet, which may be done by cutting a barrel hoop in two, and nailing it to two "pieces of lath. There t5houId be air circulating under the sheet, that the heat of the inflammation may not keep the limb in a steam-bath. Should the wound heal by the first intention, the danger will soon be over, and the treatment may be the same as for simple fracture. But this, unfortunately, does not often occur. It more often happens, that after three or four days, the patient i^rows restless, has very short and disturbed sleep, is hot and thirsty, has headache and shivering fits, is more ill towards evening, wanders in his mind, or becomes delirious, and perhaps dies in ten days or a fortnight from these constitutional disturbances. If the symptoms are a little less severe, the wound will at first discharge a small quan- tity of dirty, bloody matter, which, if everything goes well, will, by degrees, change to healthy matter, without smell, of a straw color, and about as thick as cream. The fever, and other bad symptoms, will now subside ; the sleep and appetite come back, and a new process begins that of healing by granulation^ or the formation of new flesh to hll up the gap made by the wound. For old persons, or those whose health has been broken, this stage ! ii SURGICAL DISEASES. 457 is full of danger, and is apt to result in death, if the lower limb be the injured part. If the constitution proves unable to bear up againat this stage of the injury, alternate heat and sweating set in, the face is (lushed with a pink color, the pulse becomes weak and (|uick, the body wastes, the appetite disappears, the tongue becomes dry and brown, restlessness, wanderinjj;, and delirium, follow in quick succession, and all are •pe»;dily terminated by death. With the setting in of the.-ie symp- toms, the wound stops discharging, or throws out only a thin, watery and stinking matter. Quite ol'tcn the skin and other parts mortify, and if there be strength enough to throw oil' the dead parts, the broken ends of the bone stick out, looking dead and white. When the constitutional symptoms begin, apply poultices, to set up, if possible, the formation of good matter; for if this can be brought about, the 8yn)ptonis may be regardi-cl as favorable. The poultice must be continued till the wound is tilled with new flesh nearly to the surface. In the First 8tag^e, the medical treatment must have reference to checking the inflammatory condition. Thin may be done by full doses of tincture of veratrum viride. Should the symptoms take a typhoid type, and the powers of life seem to sink, then quinine, and iron, and bitters will be needed. In the Second Stn^e, whatever inflammation there is depends on exhaustion, and everything fitted to prop and fortify the constitution, as brandy, wine, brot i, and easily digested, nourishing food, must b<« freely given. Dislocations.— Luxations. The surfaces where two bones meet and glide upon each other for the purposes of a joint, are called articular surfaces, and the union is said to be an articulation. These surface's are covered by a smooth cartilage, to render their play upon each other easy. The joints are held together by cartilaginous straps and ligaments, which serve as puUies ; by the aid of these, the joints turn back and forth, as a door opens and shuts upon its hinges. When by some external violence, or the weakening of these liga- ments, these surfaces are suddenly separated, or forced apart, there is said to be dislocation or luxation. Joints are divided into two kinds, the ball and socket (orbicular) which has a rotatory motion, as the shoulder, hip, thumb, — and the angular, or pump-handle (ginglymoid), as the elbow and knee. The ball and socket joints have a greater diversity of motion, and are more exposed to dislocation. They are likewise more easily put in their place. ' In a Primary Dislocation, the bone is thr vn at once into the place where the surgeon finds it. The Secondaiy Dislocation is one in which the muscles pull the i 458 SURGICAL DISEASES. head of the bone still further from its natural place than it was thrown by the first shock of violence. A Dislocation is Simple when there is no wound penetrating the synovial membrane. It is Compound when attended by such a wound. A Dislocation Ia Coniplet« when the articular surfaces are entirely separated. It is Incomplete when the separation is only partial. Recent Dislocations are rtictified with comparative ease. Old Dislocations are hard to be repaired, and sometimes cannot be ireduced at all. The Symptoms of Dislociition are, inability to use the joint; the head of the bone being felt in an unnatural |)lace ; llie limb shortened, lengthened, or distorted; a ehixnge in the shapes of llie joint, etc. Simple disloeulions are generally trivial. C'oinpomul dislocations often render amputation necessary, and are always perii»->'i8. Aged persons are less liable to disloc^ations than the young. When a dislocation and a fracture; occur at the same time, the dis- location is to receive attention first. A dislocation is to be reduced by a g-radiial and continuous extend- ing force. The reduction is kniwn by the limb recovering its natural length, shape and direction, and by its being able to perform certain n otions which are not possible while in a dislocated state. The pain is immediately reduced upon reduction taking place. In shoulder and hip dislocations, the head of the bone makes a loud noise when it slips into its place. i!! it, I i" ! Dislocation of the Lower Jaw. Gaping very wide is the usual cause of this. It has been known to result from a mere yawn. One or both sides may be disjointed. Symptoms. — If but or*^ '*ide is dislocated, the chin is twisted to one side, and immovable, and the jaws are partially open ; if both sides, the mouth is wide open, the chin projects, there is a hollow in front of each ear, great pain, inability to speak, and dribbling of spittle from the mouth. Treatment. — To effect a reduction, cover the thumbs with a towel or a piece of wash-leather to prevent their being injured by a sudden snapping tog^the- of the jaws, and then, staufling in front of the patient, introduce them into the mouth, press them upon the, crown of the back lower teeth, at the same time lifting the chin with the fingers. After the jaw is set, it should be kept bandaged for a few days, — the bandage being merely passed once or twice over the tt)p of the head, and under the chin. No solid food requiring chewing should H« taken for a short time. L- :■«* ^ SURGICAL DISEASES. 459 Dislocation of the Collar-Boue. This may take place by the end attached to the breast-bone slip- ping over or under that bone, or by the other end slipping ahove of beloiv the bone to which it is attached. When the first named end of the bone slips over the breast-bone, it is said to be a. forward dis- tocation ; when it slips under the breast-bone, it is back^vard. In this latter form of dislocation, the end of the collar-bone sometimes presses upon the gullet, and prevents swallowing, Sviiiptoiiis. — In the forivard dislocation of the iimer end of the bone, a hnncli may be felt by the hand at the top of the breast-bone; ill the biickivard disluca/ion, a depression or hollow. The upward dis- location of the onter end of the collar-bone, may be known by the flattened and sunken condition of the shoulder. TrentniPllf. — To put the bone in its place i i tlie first of these ac- cidents, draw the slionltlers back, by which means the collar-bone (clavicle) is drawn away from the breast bone (sternum), and easily slips into its place. To reduce the dislocation at the oilier (Mid of the bone, place the knee between the patient's shouhler-blades (seapuhe), and draw his shoulders backwards and vpwards. After the reduction, support the arm in a sling. Dislocation of the Shoulder-Joint. The head of the long bone of the arm (humerus) may be displaced in three diflferent directions, — downvmrd^ into the arm-pit (axilla); forward, under the muscrles of the breast ; and backward, upon the back of the shoulder-blade. Fio. 158. It is recognized by the shoulder losing its roundness, and becoming flat; by the lengthening of the arm ; by the head of the bone being felt in the arm-pit ; and by severe pain. :!l W: i !. ■ 'ill iijl .If: ifif I'll Hi liii 460 SURGICAL DISEASES. To effect the reduction in the first form of displacement, put the patient on a bed, or upon the floor. Put one heel in the arm-pit, against the head of the bone. Then, taking hold of the arm above the elbow, or at the wrist, pull steadily, and push with the heel. (Fig. 158.) The extension may be more steady and powerful by a double towel around the surgeon's nock. If the reduction cannot be eHectod, relax the muscles by a warm bath, or by naustjating doses of tartar emetic. After the reduction, a sling will be required, and three weeks' or a month's rest I Dislocations of the Elbow Joint. V Of these there are six varieties. In the first, both bones of the \ fore-arm (radius and ulna) are thrown backwards; in the second, both are drav/n backivards and inwards ; in the third, both are thrown backwards and outwards ; in the fourth, the ulna alone is forced back- wards ; in the fifth, the radius is forced forwards ; and in the sixth, the radius is thrown backwards. In general, these dislocations are all easily set. In the first four, the knee is to be placed at the bend of the elbow, and the fore-arm bent upon it, the surgeon grasping the upper arm with one hand, and the fore-arm with the other. In the dislocations oi the radius, the upper arm is to be put in a. Jixed condition, while the surgeon takes hold of the hand anc' pulls, at the satne time throwing the bone forward. If the luxation be backwards, there must be the same ex- tension and counter-extension, while the fore-arm is bent. Treatment. — The fore-arm must be placed in a half- 3nt position, and a splint should be band&ged upon the front of the whole limb, compresses being placed upon the head of the bones opposite the direction of the dislocation. This confinement must be continued three weeks. Dislocations of the Wrist. These are caused by falls upon the hand. Both the radius and nlna may be thrown backwards or forwards upon the wrist, caus- ing a projection either in front or behind. (Fig. 159.) The bones are to be set by pulling in opposite directions upon the hand and the fore- arm, and pressing later- ally, if the displacement be at the side of the wrist Fio. 150. Treatment — Put a straight splint on the front, and another on the back of the fore-arm and hand, with compresses on both sides of the wrist, and a bandage over the whole. Support the fore-arm in a sling, and keep down indammation by cold water, cooling lotions, etc a warm SURGICAL DISEASES. 46] Dislocation^ of the Bones of the Hand. Some one of the carpel bones may be pushed up out of its place, so as to form a projection on the back of the hand. To put it in its place, press upon it simply, and then put compres.ses on the front and back, with straight splints upon, these and a bandage over all. Put the hand in a sling. Dislocations of the finger joij)ts may generally be replaced by bend- ing the displaced phalanx over the head of the bone from which it has been disjoim^d. Sometimes a good deal of extension and counter- extension are required, for which purpose a piece of cord may be wound around the finger, — the skin being protected by ward. They are readily corrected by extension and counter-extension from the ankle and thigh, and pressure upon the head of the displaced bone. Treatment much the same as for displacement of the knee-pan. Dislocations of the Ankle. These may occur in a forward, backward, outward, and inward direction. (Figs. 164 and 165.) To rectify it, bend the limb, so as to relax the muscles on the back of the leg; then, while extension and counter-extension are made upon the foot and thigh, press firmly on the dislocated bone, and thus force it to ita place. Treatment. — Confine the foot and leg in splints made of thick Easte-board, soaked in hot water, and moulded to the shape of the mb| with a foot-piece at right angles. Keop the patient in bed five 464 SUl GICAL DISEASES. or six weeks, and when he begins to walk, snpport the ankle with a roller bandage, or a laced gaiter. Fie. 161. Vio.Ut. Hi I,. Gontasions.— Braises. When any blunt, hard substance comes in violent c<^ision with the soft parts of the body, without breaking the skin, the injury received is called a bruise. One of these accidents generally rup- tures a great number of the very smallest blood-vessels, which let out blood under the skin, producing " black and bluCy* or livid spots (ecchymosis). "What fis*,-jflffhiers call a black eye is an example. Treatnieilt. — Cold applications at fir^ to prevent the bkyod mn- ning oui of the small vessels' under the skin. After the iffflammatkm has subsided, stimulating applications, as vinegar and water, alcohf(i4, cara^^Wtfted liniment, ai«nmoikie» auid alcohol, equiu parts, and some- times bandages. Sprains. A SPRAIN is a forcible wrenching and twisting ot a joint to {Stich a degree as to stretch and more or less lacerate the ligaments of the part, and sometimes to break a tendon, but without entirely displac- ing a bone. Its symptoms are, violent pain, swelling, and discolora- tion of the parts from the blood running into the celk under the skin. In elderly persons, the effects of sprains are very tedious, disabling tbem for many weeks, or even months. Tk^afment — Elevate the limb, keep the joint perfectly qtiie^ and apply cold lotions, or fomentations. When the inflammation i» ail SURGICAL DISEASES. 46,5 past, ^pply »ti(nulating linimentsi, and bandages, or shower the part with cold water. Ruptures of Tendons. These accidents are known by a sudden snap, followed by pain, loss of motion in the part, and swelling and discoloration. Treutment. — Place the part in such a position as to relax the broken tendon, the ends of which must be brought together, and retained in contact till they grow together. Diseases of the Bones. The bones are supplied with blood-vesseis and nerves ; and as they live and grow like other parts of the body, so they become diseased and die in like manner. Ulceration of Bones. — Caries. Bones, like the soft parts, when attacked by violent inflammation, may ulcerate, discharge matter, and heal by granulation ; or, having lost a portion of their substance, may sink under entire disorganiza- tion and death. This disease passes in some parts of the country, under the name of " fever sore." Treatment. — Apply splints, and keep the part in a state of abso- lute rest Subdue the local inflammation by the usual means. If the disease arise from scrofula or syphilis, use the remedies for thoeo diseases. Death of the Bones. — Necrosis, This is like mortification of the soft parts. It occurs from injuries and inflammation of the periosteum. It is known by dull, deep-seated — sometimes acute — pain ; and is followed by increase of size, from the formation of new bone around the old, — the old being gradually broken into pieees, and discharged through external openings. Treatment — Poultices and quieting fomentations. « Unnatural Growth of Bones. — Exostosis. This disease coi- ists either of a tumor of a bony nature, growing upon and arising from a bone, or an enlargement of a bone. It springs from the periosteum, or from the surface of a bone, or from its spongy texture. The enlargement or the tumor may be white and hard, like ivory, or dark-colored and spongy, or a mixture of the twa fift 466 SUIIGICAL DISEASES. 'n| At first, a tumor of this kind is not attended with pain or incon* venicnce. It comes on slowly, and sometimes remains nearly sta- tionary for several years. Treatment — If the tumor be large and inconvenient, remove it with the knife. If not, use local pressure witii pads and bandages; also leech, blister, and restrict the patient to a spare diet. Diseases of the Joints. SoMK of these diseases begin in the cartilages, some in the svnovial membrane, and others in the heads of the bones. Disease of the Hip-Joint. — Cojcalgia. This generally consists in inflammation of the synovial membrane and capsular ligament of the hip-joint, ending frequently in ulceration and destruction of the head and neck of the thigh bone. The symptoms are fulness in the groin ; pain, which is increased by motion ; aggravated when the limb hangs without touching the ground; is more felt in the knee than in the hip itself; and shoots down along the inside of the leg, as far as the instep. The thigh inclines forward, and the limb has the appearance of being longer than the other, — though in the latter stages, it is really shorter. Treatment. — Before suppuration takes place, apply leeches and blisters, and enjoin perfect rest. After suppuration, keep the patient, npon his back, on a mattress, and mould to the parts thick paste- board splints, with pads, and give tonifjs. Keep the bowels open with senna and bicarbonate of potash, and rub the parts with iodide of potassium ointment, or with preparations (282) (283) (195). The disease being scrofulous, the iodide of potassium (140) may be taken with advantage internally. White Swelling.— Synovial Degenerations. There are several diseases of the knee-joint, characterized by swell- ing and white color from tension of the skin, which have passed under the common rame of white'SioeUin}>^. The diseases are not strictly the same, but as they all affect the knee, and have symptoms to some extent in common, it is well enough to group them under the same title, — especially as one treatment is adapted to all. One is a pulpy disease of the synovial membrane. It begins with a trifling stiffness, and a slight swelling. TVie swelling increases by degrees, and on touching the part, there is a sensation as if it con- tained fluid. By and by the cartilages ulcerate. The disease is in- curable, as the synovial membran" is finally converted into a pulpy I substance, and the limb has to be amputated. Another of these is inflammation of the synovial membrane, be- ginning with ulceration of the cartilages. It begins with pain in tiie I :;!J!;i SURGICAL DISEASKS. 467 i'oint, which is severe at one point, and attains its height in a week, n a day or two, the joint is swollcin from a collection of water. Trcatllient. — Splints and entire rest, as in all chronic diseases of the joints. Also a generous diet, and whatever is calculated to build up the health. Bunions. This is an inflammation, enlargement, and hardening on the inside of the ball of the great toe. It is frecniiMilIy connected wilh a distor- tion of the toe, which seems partially out of joint. The projection of the joint exposes it to great irritation from "tlu; shoe, and to re peated attacks of inflammation. It occasions great sufl'ering. Treiltllieilt. — Remove the pressure from the part, and when there is inflammation, keep the foot quiet antl cl(>vatcd upon a chair, apply- ing leeches, poultices, etc. Another method is to cover the bunion with soap plaster, spread on thick, soft leather, or, put the toe in a separate apartment of the stocking, like the finger of a glove. Then enclose it in a separate part of the shoe, which is contrived by fixing a piece of firm sole-leather in the bottom of the shoe, so as to make a separate compart- ment for the toe. By this means the pressure against the side is removc^d. Stick ing plaster may be spread on wash-leather, and a piece cut out the size of the bunion. This will take off a portion of the pressure of the shoe, and will hasten the cure. Fig. 166 represents a ganglion or tumor formed upon the synovial sheath of the tendon which bends the finger. Fia. 166. Whitlow.— Felon. — Paronychia. This is an abscess of the fingers, of which there are three kinds, — the first situated upon the surface of the skin, the second nnfler the skin, the third within the sheath which contains the tendons of the fingers, and sometimes involving the covering of the bone. The latter form of the disease is the most terrible, and begins with redness, swelling, and a deep-seated and throbbing pain, which grad- ually becomes so excruciating as to banish all sleep, and nearly drive the patient to distraction. Finally, matter forms and burrows in the deeper parts of the finger, and at length finds an opening, which brings relief. Treatment. — Carry the hand in a sling ; apply a leech or two, and use poultices. A poultice made of equal parts of powdered slippery- elm bark, poke root, ground flax-seed and lobelia seeds, mixed with hot ley, and changed twice a day, is an admirable application. 468 SUUGICAL DISEASES. When these methods fail to stop the progress of the abscess, the finger Hhould be laid open with the scalpel, cutting down to the bone. This will give vent to the matter, and the wound may be dressed with poultieos, until the inflammation is subdued, and the healing process is well established, when some simple salve may be applied. Pit Chilblains. This complaint should have been spoken of immediately after •• frost-bite," but it was forgotten. It is caused by exposure to cold, !ind atl'ects the fingers, toes, and particularly the heels, with a painful iuHammatory swelling, of a red, purple, or bluish color. The skin may be red in patches, and slightly swelled, with itching, tingling, pain, and lameness ; or there may be blisters, around which the skin is blue or purple ; or, worse yet, there may be ulceration and slough- "kng. Vreatiiieut. — Stimulating liniments are the remedies usually em- ployed for this complaint. One of the best consists oi' six parts of soap liniment, and one part of tincture of Spanish flies ; and another excellent one is prescription (307). If there is ulceration, use Turner's cerate, or the resin ointment Stiff Joint. — Anchylosis. This is of two kinds, complete and incomplete, — complete when the bones of the joint have become firmly united by bony matter, and incomplete when the motions of the joint are very much interrupted, but not entirely destroyed. The first is the result of ulcerations of the cartilages of the joints, and of the heads of the bon^s ; the latter, of fractures, sprains, bruises, thickening of the synovial membrane, and weakening of the muscles. Treatment. — No treatment is of much use in the first-named form of the disease. By sawing through the bone, and then daily moving the limb back and forth, a false joint may be made, but it is apt to grow together again, and finally defeat the purpose of the surgeon. When, however, stiffness arises from the weakening of the muscles, and some other causes involving the /igaments and tendons, something may be done by daily frictions with stimulating liniments, champooing, and warm fomentations ; and by gently bending the joint back and forth, several times every day, as much as can be done without pain. Tumors. A TUMOR is a swelling which consists of a new production, not constituting any portion of the original structure of the body. There are several kinds of tumors; but it is sufficient for my purpose to follow Mr. Ferguson, and divide them into the maligtiant and noft* malign,(mt. SURGICAL DISEASES. Cancer. This belongs to the class of malignant tumors. It has two stages. The first is that of induration or scirrhvs, — during which it has, under the finger, the feeling of stony hardness. The second stage is that of vlceratutn or open cancer. Cancer most often attacks the female breast, the skin, the muccu» membranes, the tongue, the stomach, the neck of the womb, the lips, etc. It rarely occurs in subjects under thirty years of age, and not often in persons under forty-five. Tlie Symptoms of Cancer, when it appears in the breast, arc, a puckered condition, and dull, leaden color of the skin ; a hard, knotty? and uneven feel ; and occasional sharp kio. m. pains. When it attacks the skin and mu- cous membranes, there is a hard, warty lump, which ulcerates, after a time, pro- ducing an open sore, with a hard base. (Fig. 167.) The sore of a cancer discharges an ^^ irritating, excoriating matter, which has vi^H|||f|^^fii^^" I a peculiarly fetid odor, so offensive and "i^^''*"'*^^*'"'^- so different from any other smell, that it is seldom forgotten. The bones of a cancerous person break with great ease. Unmarried females are much more liable to \\w dis<'ase than the mar- ried. The cancerous growth is composed, in part, of cells, rounded or caudate, containing, as seen under the microscope, nuclei, younger cells, and granules. (Fig. 168.) ■4^ FI0.1M. Fio. 109. na. 17& The difference between these cells and those of common pus gl'*f> oles may be seen by comparing Fig. 168 with 169, — the latter being pus corpuscles highly magnified by a powerful microscope. Fig. 170 represents pus globules not so much magnified. Treatment. — There are but two methods of treatment which prom- ise any success. The first is to extirpate the tumor by a surgical operation before the disease has so far invaded the constitution as to be sure of returning. The other is that adopted by Dr. J. W. Fell, 470 SURGICAL DISEASES. an American physician, who was permitted to try his remedies in one of the English hospitals, and who '} cw from the surgeons in charge of it a favorable report of the results, Dr. Fell's remedies are mainly blotKJ-root and chloride of zinc (336) made into a paste. The skin over the tumor is first destroyed, and this paste, spread u|)on strips of linen, is applied. This causes an eschar, into which incisions are made, half an inch apart, taking care to avoid the living tissue. The same paste spread in a like manner is then daily inserted into the fnrrows. By this means, which is orig- inal with l)r. Fell, the ert'ect of the caustic penetrates through all [)arts cf the tumor, causing the whole diseased mass to fall oil', and leave a liealthy, granulating surface. In incipient cancer, where the diseiise" has not made nuu-h progress, Dr. Fell uses the above, which he calls a l)r()\vn ointtiieiit (-WO), and in coruM'ction with it an oiiitinent of the iotiiile of lead (-W?), usini^ each twelve hours. Witli these, he claims that he cnrcs incipient cancers, with great readiness. He al^io employs, internally, half-grain doses of pulverized blood-root (1-4?J), witli ar^t-M' ^ and eieuta. Dr. Fell claims that with thesi; preparation.-*, Ik; has often cured tvpns, and has been very successful with them in treating indolent ulcers. Soft Cancer.— Bleeding Cancer. Medullary Cancer. — Enrephahiid Tumor. — Fung-ua Ilemalodes. This varies in size from a nutmeg to a ehild's head. Its color varies from white to deep red. At tirfies, it is soft and elastic at nrst ; at other times, it is firm and tense. The patient is wan and Eale from the beginning. The parts do not ulcerate, as in scirrhus; ut after the skin is broken, a spongy bleeding tumor protrudes. Treji liiiien^ Dr. Fell's method. Black Cancer. — Melanosis. This is an organic disease, in which the ti?.f ae of the disordered part is converted into a black, hard substance, which is converted into ulcerous caviti^'s. This often appears in the lungs, and is met with in the iiver and other |)art!;<. Ifs symptoms are, a sallow coiuplexioii, great debility, and dropsi cal swelling of the limbs before the termination. Treatnieilf. — When it appears externally, Dr. Fell's treatment is worth a'trial. When in the hmgs, the inhalation of tincture of blood- root and solution of chloride of soda (241) should be used. Two teaspoonfuls may be put in Warren's Vapor Inhaler, — the instru- ment being filled half full of hot water, — and inhaled ten minutes, three times a day ; the blood-root pills (143) being taken at the same time. I' ^ ' I! SURGICAL DISRA8RH. 471 Fatty Tumor. — Adipous Sarcoma. This is the most common of uU the forms of tumor. These bodies generally have a soft and doughy feel, or as if filled with wool. They are the least inclined to become malignant, and consequently the least dang(!rourt, of all the tumors. Whatever pain there is, is caused by their size, weight, and pressure. They are occasionally found a little below the point of the shoulder, in the deltoid muscle of females, and are caused by the unreasonable pressure of the dress at that point. Trc'UtllH'llt. — They should Ix; removed by an o|)eration, which is easily performed, as they separate very readily from surrounding parts. Polypus. Thk polypi constitute a class of tumors growing from mucous membranes. They are of two kinds, — the «>//, jeUy-Uke polypus, and the Jleshy or Jibrous polypus. TllC Soft Polypus, whicli grows from the nose, has not much feel- ing, and is not particularly di^posed to bleed. The Fleshy Polypus is firmer and harder than the preceding, and most generally connects itself with the womb. Trentiiient. — Both kinds of polypi are either twisted off with a pair of forceps, or strangled by putting a string, called a ligature, around their neck, which will cause them to fall oil' in a short time. Wens. — Encysted Tumors. The most common situation of these is under the skin of the head. A wen is simply a sac full of various matters, which, when examined with a microscope, are found to be oil globules, epithelial cells, and crystals of stearine. These contents are secreted by the internal surface of the sac. They sometimes look like curd or rice, sometime» like suet, and sometimes like honev. In other instances, they are mere water, and they have been known to consist of hair or horn. These tumors are round, elastic, and movable, and are without paio. They grow slowly, but steadily. Treatment. — The attempt to excite inflammation and consequently absorption, by punctures, seatons, or injections, are dangerous, and ought not to be resorted to. If the tumor is small, its opening, indi- cated by a small black spot, may be found, a probe be introduced into it, and the contents of the sac be squeezed out ; and this may be repeated as often as necessary. But the |)roper and only real remedy for these tumors is their removal by a surgical operation. 1 r 472 SURGICAL DISEASES Aneurisms. An aneuriam is a tumor formed by arterial blood, and commupl- cating with an artery. A true aneurism is formed by the coats of an artery getting weakened by some cause, and swelling out ^o as to form a pouch or sac. (Fig. 171.) There are other kinds of aneu- risms, which need not be descri bed. Fio. in. Symptoms. — An aneurism may be felt as a tumor somewhere along the course of an artery, and it beats under the finger like the pulse. The beating is caused by a fresh quantity of blood being pushed into this sac with every stroke of the heart. If it be small^ pressure on the artery above it will so far shut off the blood from it^ that it will feel flaccid or soft. The pat'ent will often say that the tumor began to appear after some violeit strain, when something appeared to give way. In the chest, "..lourism will produce an un- natural pulsation felt by the patient In the belly, it may generally be feH, as a tumor through the abdominal walls. Distinction. — Tumors which lie diiectly over arteries are lifted up every time the blood is driven along under them, and hence they pulsate like aneurisms ; but thej do not pulsate when smalt, whereas aneurisms do from the beginning of their growth. Aneurisms are so/l at/int, and hard afterwards ; whereas tumors are generally hard at first, and finally soft. Treatment. — In some few fortunate cases, aneurisms get well spon- ianeously. If the flow of blood through them can h<: stopped, that which is within them will coagulate, forming a hard tumor, which will (gradually waste away. To cure them, therefore, we must stop Vte circulation through them ; and this may be done, in some cases, by compression. The pressure upon che artery must of course be above the tumor, and should not be so great as to stop the blood altogether, but only very materially to diminish its flow. The pres- Rure is applied by an instrument having two pads, an arc of ($teel, a joint in the middle, and a screw by which the padded extremities are pressed together. (Fig. 172.) When this mode of treatment is not practicable, the artery must be tied between the aneurism and the heart The patient should b« placed in bed, witli the limb wrapped up to preserve its temperature^ Pla SURGICAL DISEASES. 473 and placed in an easy position. Nothing cold should be applied to it The force of the circulation should be reduced by the tincture cf veratrum. Fio.lTl. Fio. ITS. Bronchocele.— Derbyshire Neck. — Goitre. Bronchocele is what is called an endemic disease ; which n'leans, a disease which prevails in certain localities. This complaint is prev. a^uit in Nottingham and Derbyshire, England, among the Alps, and especially in the Tyrol and valley of the Rhone. It is thoiight to be produced by the use of melted snow, and water impregnated with lime and earthy matter. Symptoms. — A prominent, soft, elastic tumor, occupv'iig the front of the throat, in the situation of the thyroid ,^land, and like it in shapa It is not tender, and the skin is not discolored. In old cases, the tumor becomes hard. In Fig 173, the t-jmor is so large as to have pushed the gullet to one side. Treatment. — The ui.aal and perhaps the best remedy for this dis- ease is iodine. It may be given as iodide of potassium, with a bitter or Home other article (138) (145) (101). Ka iodine ointment may be applied to the tumor (185). The patient should move away f.om the infected district, and re- side, if possible, upon the sea coast Water in the Bcrotum. — Hydrocele. As the name shows, this is a collection cf water in the rcrotom or ba^' which holds the testicles. Ajrmptonil. — It presents a swelling, shaped like a pear, smooth oi 474 SURGICAL DISEASES. its surface. flnpt".atir:g if pressed, without pain, but causing a little uneasiness by its weight. On placing a lighted candle on one side of the scrotum, the 'ight may be seen through it. . Distinction. — This complaint may be distinguished from a solid enlargement of the testicle by its not being so heavy, solid, or painful, and by its fluctuating and being transparent; from rupture, by its forming slowly instead of suddenly, by the swelling beginning at the lower part of the scrotum instead of the upper, and by the enlarge- ment not bring increased by coughing as it is in rupture. Treatment. — In children, strong scattering washes (353) are some- times successful. But most commonly, a number of ^mnctures are made with a large needle, to cause the fluid to escape into the cell tissue of the scrotum, whence it is removed by absorption. To effect a radical cure in grown persons, the surgeon is to grasp the tumor behind, and introduce a trocar and canuhi into the sac, — being careful to point the instrument upwards, so as not to wound the testicle. The trocar is then withdrawn, — the eanula being at the same time pushed well into the sac, so that none of the fluid may get into the cell tissue outside the sac. The fluid runs oft" through the canula. When this has all escaped, some stimulating fluid, as common lime-water, or, still better, tincture of iodine, is to be injected through the canula into the emptied sac. After retaining this from two to five minutes, it is permitted to flow out. Inflammation fol- lows, which breaks up the secretion of water, and eftects a cure in two or three weeks. The amount of fluid thrown in, should be about one or two teaspoonfuls of a mixture of one part of tincture of iodine and two parts of water. If the first operation does not effect a com- plete cure, it may be repeated. Blood in the ScTotnm.— Hematocele. This is a collection of blood in the scrotum from some injury. Tresitinent. — If the quantity of blood effused be small, cold appli- cations may cause it to be absorbed. If it be large, make a puncture, and apply a poultice for the blood to ooze into. Acute Inflammation of Veins. — Phlebitis. The veins are subject to attacks of acute inflammation, which constitutes a very dangerous, and often fatal, diseas(>. • Symptoms. — Fits of shivering, or perhaps fainting, a rapid pulse, anxiety of counttMiance, lowness of sjjirits, cat,(;liing pains al)out the heart, and srrelliri^^i redness^ terulerness, and hardness ahni^ the course of the affected veins. Sometimes the tongue is furred brown or black, the skin is sallow, there is bilious vomiting, low delirium, and death. In cases less rapid, there are great swelling and redness over the cVnh :• ili't SURGICAL DISEASES. 476 eased veins, and abscesses form, which, when opened, reveal clots of blood, mixed with pus. Or, the patient, while remaining low, with a sallow countenance, and a yellow tongue, will complain suddenly of intense pain in some joint, as the knee or shoulder, — in which there will be a rapid formation of pus ; a similar suppuration will follow in other joints as well as in the lung^^, etc., until the patient sinks, and dies of exhaustion. Treatment. — Apply leeches freely over the inflamed veins, — also fomentations. Every abscess i^huiild be opened early. Keep the bowels moderately open with some propJiration of salts, and allay pain and restlessness by morphia. Hupport the strength by beef tea, etc.; and, if the puLe be feei)l(r, give wine or quinine. The suppuration may be checked, in this as in other complaints, by drliiking freely of chamomile teu. The power to control sup- puraton has recently been discovered as belonging io chamouiile flow'Ts. • ' Chronic Phlebitis. This is a far loss serious disease than the preceding. It generally affects the veiii . of the legs. Syiliptoilis. — Tenderness and hardness of the aflected vein, with swelling around it, and of the parts below; a giMieral puinfulness of the limb. After the inflamrr.ation has subsided, the vein feels hard, like a cord, because the inflammation causes the blood within to co- agulate, and harden, so that nothing can pass through the vessel. Treiltllieilt. — Leeches, fomentations, or cold lotions, as the patient may choose, purgatives, and rest, with the limb elevated. Subse* quently, when the inflammation seems completely subdued, friction with camphorate'i oil, and bandages. EiiT t^^^d or Varicose Veins. — Varix. TriE veins wl.- lie near the surface, especially tijosc of the legs, are iipt, by exfiau; i 4 labor i.|)on the fe(!t, and by strains, to get weakened, so that their valves 1 )se, the"- tone, and their sides stretch and give way in certain places, -lettir, ih^ blood bulge out, and form purple bunches. These bags of blood, . ..ig alotij; upon the surface of the liml), form knotty tumors, lookirig !'k(^ blood-boih. Tney oc- casion a kitid of distress, but no sharp pain. Persons of weak, soft, and relaxed muscles and blood vessels are particularly ' ible to this complaint. It often attacks women in the family wa- Treatment V/httie only a few veins are affected, it may be sufTicient, in bome cases, to c^pply firmly over them a few strips of leather, sprerd with soap plaster. But gerurrally it is better to sup- port fhc whol? limb with a good calico bandage, or with a laced stock- 476 SURGICAL DISEASES. ing, which should be applied in the morning before the patient is upi It is generally well, also, to use friction, with some liniment, or iodine ointment Lead water, or alum water, or an infusion of white oak bark, may be used with advantage. Burdock and plantain leaves, bound upon the skin, and removed before they are dry, are useful Showering with cold water strengthens the veins. I Rupture. — Hernia. Hernia signifies a protrusion of any internal organ from the cavity where it belongs ; but the term is generally restricted so as to mean no mora than a protrusion of the bovjet through the walls of the belly. When the abdominal walls are weak, from any cause, no mutter what, — lifting, straining, or making violent musculav exertion of any kind, will then often cause the bowel to force itself through at th-; most debilitated spot; a.' i^ushing the lining of the belly, the peri- toneum, along before it, .^ 'r sac is formed, in which the project- ing bowel is enclosed, formii.-. a external tumor. Divisions of Heniia. — Rupture may occur in several different places, and has accordingly received diiferent names. Umbilical Hernia is a protrusion of tno bowel at the umbilicus or navel. This is most common in children soon after birth ; and wonien who are often pregnant are liable to it- Ventral Ileniia is that which occurs at any part of the belly where other forms of rupture do not appear. Inguinal Heniia is that in which the bowel protrudes at the groins, or through the abdominal rings. Scrotal Hernia is that in which the bowel descends into the bag or scrotum. Femoral Hernia is the dropping down of the bowel behind what is called Poupart's ligament, and appearing as a tumor at the upper part of the thigh. Reducible Hernia. — Rupture is said to be reducible, when the bowel may be put back into the cavity from which it came. Irreducible Hernia. — Hernia is called irreducible when the pro* trading bowel cannot be returned into the belly. Stransfulated Hernia is that form of the complaint in which the bowel is so pressed upon at the point where it passes through the walls of the belly that it is strangled or constricted so that its contents cannot pass through, Symptoms of Hernia. — A soft tumor, which may be compressed, appears somewhere ab^ut the belly; and is increased in size when the patient stands up. It also swells when he coughs, cur makes any eiertion ; and grows smaller, or entirely disappears, when he Uei down ■i-! ^^i SURGICAL DISEASES. 477 Treatment. — In a case of reducible hernia, the first thing to be done is to put the bowel back in its place, which is accomplished by gently pressing and kneading the tumor, and swaying it back and forth, — being careful to use no violence, — until it can be pushed within the abdominal walls. It is then to be kept in its place by the use of a truss, made expressly to fit the case. This instrument should be constantly worn by day, and by night, too, if not too irksome ; but if worn by day only, it should always be applied before rising in the mornuig. Irreducible Hernia may be pnllialed by wearing a truss with a hol- tovf pud, which will so evenly and firmly embrace the tumor as neither to irritate it, nor permit any further protrusion or enlargement. Striiug:ulated Ilerniu. — If a person have worn a truss for some time, and, suddenly leaving it ofi, makes srrrie violent exertion, either the bowel or omentum is liable to be suddenly forced through a nar- row aperture, and to become strangled. In such case, the patient has flatulence, colicky pains, a sense of tightness across the belly, and a desire to go to stool, but no ability to pass anything. Then follows vomiting, first the contents of the stomach, then mucous and bile, and, lastly, the fecal matters from the bowels, which are not permitted to pass on to their natural outlet. The neck of the hernial sac now becomes swelled, tender, and painful, the countenance is anxious, and the pulse small, hard, and wiry ; and, after a time, the tumor begins to mortify, the patient expresses himself free from all pain, and soon after dies. In the treatment, the bowel is to bo returned if possible. To do this, the bladder should first be emptied with a catheter, and the patient should lie down with his shoulders raised, and both his thighs bent towards the belly, and placed close to each other, so as to relax all the ligaments and muscles of the belly. The surgeon me now work gently for half an hour, if necessary, trying to put the bowel back, but must be very careful not to excite inflammation by any violence. If he does not succeed, efforts are next to be made still further to relax the muscles, as well as to reduce the force of the heart's action, and to diminish the size of the tumor. With the tincture or fluid extract of veratrum viride, the heart's action and force of the c;iroula- tion may be reduced to any desirable extent. The muscles may be relaxed by injections of tobacco, made by steeping o\w. dram of to- bacco in one pint of water for ten minutes. This, however, is a somewhat dangerous remedy, and should give place to the compound lobelia injection. Two grains of tartrate of antimony in one pint of tepid water, make a suitable injection. To reduce the tumor, apply pounded ice in a bag, or a freezing mixture (354). If the pain be acute, give large doses of opium or morphia. If all these remedies fail, there is then no hope but in relieving the stricture by a surgical operation. General Directions. — Rupture is an exceedingly common affection, ^ i Ill" ' 1 i 1 V 1 1 1' : ( 478 SCTRGICAL DISEASES. Perhaps every third or fourth person suffers from it more or less. Females, from motives of delicacy, are apt to conceal the misfortune, and not seek advice. This exposes them to danger. Queen Caro- line, wife of Georn^f* II., lost her life by such concealment. A swelling coming on sudflenly in the groin or at the navel, after considerable exertion, may be taken to be a rupture without much fear of mistake. The complaint being discovered, the bowel should be put back in its place, and a truss be put on at once. In the case of young persons, a truss may frequently effect a cure, but, that it may do lliis, it should not be taken oH", night or day, (,'xcept to cleanse it, and then orily when the wearer is in bed. Those who can afford it, should have two trusses of the same size and strength, so that if one g(!t out of order, the other may take its place while it is being repaired ; for, an hour's absence of the truss might occasion a mischief which it would require months to repair. Persons having a rupture must be very careful to keep costivenesa at a distance ; for straining at stool is highly injurious. Varicocele.— Cirsocele. This is an enlargement or varicose state of the spermatic veins, and may be mistaken for hernia, inasmuch as standing and coughing increase it. But it feels like a bag of worms ; and by this peculiarity, may be distinguish(!d from rupture.. Treatment. — Wear a suspensary bandage. Deformities and Irritations of the Spine. Lateral Curvature. — There ^re several varieties of curvature of the spine; Some of them are caused by the destruction of some portion of the spinal column by disease. It will not be necessary for me to treat of these forms of curvature, as they can only be investigated and treated by the most skilful surgeons. Those who will use this book chiefly, would hardly think of meddling with them. The curvature which arises from debility of the bones, ligaments, and muscles, and which is very common among females, has the following Symptoms. — At first there is a projection of one collar-bone, or one side of the chest, or one shoulder is considerably elevated, and ir^ popularly thought to be ^^g-rowin^ out." On examination, the right shoulder and the right side of the chest will be found, generally, to be rounded and lifted up, while the other is sunk down and concave. At the same time, the left hip sticks out, and the loins on the right side have an inward curve. The spinal column will have a curve, as in Fig. 174. Causes. — This affection is caused by occupations which keep tho body in a laterally distorted position, and tax one side of the body SURGICAL DISEASES. 479 more than the other. lessons at school with one elbow resting on Ficj. 174. It is produced in children who study their a high desk. The muscles, too, get so weakened in many females of luxurious, sedentary, and indo- lent habits, that tlu^y cannot hold the bony frame of the body in an upright position, and the jointed cohunn of bones, ealled the spine, sags down to one side, and draws the whole skeleton of the trunk out of shape. Treiitriipuf. — The first thini? to be done is to learn what particular attitude of the body has occasioned tiie distortion. This discov(!red, every possible ('llort is to be made to break up the habit, whatever it may be. If it be standing on one foot, or sleepir)od for ten minutes in a gill of boiling watery and strained when co^d. Scrofulous Ophthalmia. Th's disease is chiefly confined to children undci w«^ht years of age. Symptoms. — Entire inability to bear light ; the lidv are spasmodi- cally closed, and the head constantly turn. '. away frori vhe light The blood vessels of the conjunctiva are not particulavly injected, with the exception of one or two large ones which run tf.warJa the cornea, and terminate in one or more small opaque pinvples. The cornea frequently ulcerates, and the complaint is very obstinate, — beiog Jiable often to recur. Tre^tmept — As in all scrofulous complaints^ tt is important in this to look after the general health. No more physic is required than to keep the bowels open ; and ':ven this, ir costiveness exist, had better be done by bread made from unbolted wheat flour, by injections of cool or tepid water, and by exercise. The health must be supported by iron, sarsaparilla, stillingia, and qumine. The eye is to be .strengthened by cold water applitd to the lids, the forehead, and the temples. The eyes may be bathed likewise with a warm decoction of poppies, or of chamomile flowers. But one of the best applications is a solution of nitrate of silver, one or two grains to the ounce of water, a few drops being put into SURGICAL DISEASES. 485 the eye once or twice a day. Occasionally a solution of sulphate of copper, of the same strength, may be used with decided advantage. Both eyes should be protected by a shade. Inflammation of the Cornea. — Comeitis, > Symptoiiix. — The corncii is rough, red, oprKiuc, and g<'nerally prom- inent. ThiTt! is soine p.iin and inability to bear light, but not great. The pulse is frequent, and the skin dry. TreiltllH'llt. — If the inflammation be acute, use leeches, emetics, purgatives, tincture of veratrum. Apply fomentations, and siiu-ai bclladornia ointment o\i the eyebrows. For the elironie form, give quinine and other bitters, and put blis- ters upon the nape of the neck, and behind the ears. The wine of opium, and the diluted nitrate of mercury ointment, must be applied to the lids. Inflammation of the Iris. — Intis. TuE iris is covered with a serous membrane, and is very liabl<- to adhesive inflammation, Syi ♦oilis. — In the first stage, the iris changes its color, and the puj) ontracted. In the next stage, lymph is poured out upon the surf . a thin layer, sometimes, which looks rusty, and sometimes ill larger quantities, filling the whole cavity of the acjuc'ous humor. CiUlses. — Injuries, or overworking the eye, but more frecpiently a taint of the system from gout or syphilis. Treutllieilt. — If there be considerable inflammation, apply leeches to the temples, and keep down the circulation by tim-ture of vera- trum. To relieve pain, if any, give Dover's powder, or morphia. The strength is generally to be supported by<|uinine; and in many instances, iodide of potassium is to be given as an alterativi-. A little solution of atropia, one grain to the ounce of water, is to be dropped into the eye once or twice a day, and a warm infusion of slippery eltn bark, or of marshmallow, to be used as a wash. The bowels to be kept open by gentle physic. Weakness of Sight. — Muscee VoUtantes. This is an affection to which persons of weakly constitution are liable, and those who write much, or examine very small objects. Syiiiptonis. — Dimness of sight; uneasiness on exposure to a strong light; and specks floating before the eyes, — often looking like flies. Treatment. — The complaint depends on debility, natural or ac- quired ; and tonics, as quinine and iron, and the shower or sponge bath, and out-:*loor exercise, are the proper remedies. :il! 486 SURGICAL DISEASES. Imperfect Vision. — Amaurosis. The complaint here referred +o if dependent on some change in the optic nerve or the brain, — most commonly the former. Sjmptoiiis. — In some cases the sight becomes suddenly dini, and i? perhaps soon lost altogether ; but more often it is impaired by slow degrr«;3, — being only defective at inter v^als, as when the stomach is out Oi order, or the eyes have been /atigued. At one time, it will begin with objects appearing dim ; at another, with their being double ; at still another, with the ability to see only one half of obj(!cts. In some instances, the complaint begins with a crooked, or disfigured, or discolored appearance of things looked at. Again it will begin as near-sightedness, or far-sightedness ; or the patient cannot measure distances, and will miss his aim in pouring water into a glass, or in putting a match to the wick of a lamp. The flame of a lamp will appear split. At times the eye does not bear light ; at other times it longs for it, and objects do not appear illuminated enough. Distinction. — Amaurosis may be distinguished from cataract by there being no opaque body to be seen behind the pupil ; and by the light of a candle appearing discolored, split, or lengthened, or iride- scent, whereas in cataract, vision is only clouded, and a lig'.ited candle looks as if surrounded with a m.ist. Chances of Cure. — These are generally not very favorable, unless the remedies employed very soon produce good effects. Treatment. — Electro-galvanism is one of the most promi^jing reme- dies. Bayberry root, dried and reduced to an impalpable power, and taken as a snuff, is occasionally useful. Cayenne, steeped in water, one grain to one ounce of water, and a little of it dropped into the eye, may stimulate the palsied nerve, and in some cases restore sight. Blisters may be applied behind the ears, or a seton may be tried upon the back of the neck, with some promise of .success. But probably nothing will do better than cold bathing, — a shower bath if it can be borne, — out-door exercise vigorously puisued, and an adherence for a lorig time, — perhaps a year, — to a strictly vege* table diet, — at the same time using nervine tonics, ecc. (3iC). Short and Long Sight. Short k^ij^iit, o.'dhxl mi/opia, depends on too 'j^rcal, a conrrxitij of the cornea, or crystaline lens, or vitreous liuinor, — one or all, — and the consetjiient format ion of the image of the object inspected a liltle in front of the optic nerve, or retina, — as at a, Fig. 173, instead of at b, where it should be formed. The rays of light are brought to a focus before they reach th(; retina. Children are either born with this defect, or it is brought on by too close study, or by long application of the eyes to minute objects. SURGICAL DISEASES. 487 It may be remedied frequently by exercising the eyes in looking at distant objects. Children afflicted in this way should have their studies abridged, and their exercise in the open air increased. "While atudyiiig they should have some apparatus applied to them which p'.iall keep the chin elevated, so that the head cannot be dropped too low, and the eyes brought too near the book. And the book should ( ach day be placed a very little further from the eyes. Fio. 173. Glasses worn by persons having this defect of vision should be concave, as a* c. liOn^ Sij?l>t, or prc.slf/opia, depends on the humors of the eye not being convex enon';!.. In this c;is(*, llic itnfige of the inspected object is formed beyond the optic ncnr, as nt ft. Fig. 174. This is one of the earliest signs of advancing ugc. Fio. 174. This defect is to be remedied by glasses which are convex, e. Per- sons in the early autumn of life, must not resort to glasses too hastily, or, indeed, until they are compelled to, nor should they change those first used too soon. Glasses should make objects look distinct and bright, but not larger than natural. Squinting. — Strabismus. In strabismus, the eyes are not parallel in their position an' I mo- tion- It is supposed tliat one eye may beeoiiie weaker than the other, or that the visual a.\is of the two may not be aadache, and dizziness, bleeding from the nose may be salu- tary, and necessary to ward oft' apoplexy, and should not be too s.id- denly stopped. When the bleeding is such as to require to have it arrested, plug the nostrils with the scraping from a fur hat, or with lint, dipped in a strong solution of alum, or tannin, or Monsel's persalt of iron, one part to ten parts of water. I, ; I ; Fio. ITS. Ingrowing Toe-Nail. To most persons, the above words will suggest some unpleasant associations, for there are few but have had some ])ainful experience with this aftection. It is generally, like corns and some other trouble- some things, the penaUy inflicted for wearing tight shoes. It gener- ally appears upon the great toe. The constant pressure of a narrow boot or shoe against the side of the toe, causes the edge of the nail to sink luto the flesh, and cause inflammation and pain, and finally ulceration. Nature, attempting to repair the mis- chief, sends out granulations, which, being perpet- ually irritated, shoot up into unhealthy growths, c&Weii jrraud Jiesh. Thenceforward, the suflferings of the patient become incessant; and he cannot now even compromise, as he would be glad to do, by putting on shoes of ample dimensions, but is obliged to negotiate a peace by putting away the shoe altogether, or by cutting a hole through it to take ofT the pressure. At the risk of giving the reader a few dismal twinges every time he looks upon this page, we place here, in Fig. 17G, a good representation oi this tormenting disorder, as a Buitable warning against, the folly of giving the toes narrow quarter* Treatment. — Make a lye by putting half a pint of hard-wood ashes into a quart of hot water; bathe the toe in this, wiiile warm, twenty minutes, every day. Innnudiately after ea(-h batliing apply a poultice, made of ground slippery elm and weak ly(>, changing the poultice twice a day. As fast as the innainmation is subdued by this, press a little fine lint gently under the edge of the nail. At each subsequent dressing, cut oft" as much of the nail as is raised out of the tcndcv^ tlesh, with the keen point of a penknife. Continue to do this till the whole offending portion is cut away. If the above treatment does not reduce ii.'\ inllammatioii and great r=iJ 492 SURGICAL DISEASES. tenderness, spread some extract of belladonna upon lint, — lay this upon the diseased part, and put a poultice over it. When the disorder begins to make its appearance, it is a good plan to scrape the nail very thin on top ; this will cause it to grow upon the upper surface, and to give way at the tender part, so as to obvi- ate, sometimes, the nettessity of any other treatment. The following is the best treatment. Wash the toe in warm watiT, and make the parts dry with cotton wool. Then gently press cotton wool in between the toe nail and the tt^nder projecting flesh, and ex- tend it along the groov«; back between the skin and nail. Next, wet the end of a piece of nitrate of silver, and rub it tlioroughiy upon tho nail, close to the cotton, not a''owing it to touch the tender flesh;! then put on a thin layer of cottt>n wool, and, in two or three hours, a poultice around the toe. In two days, the nail will be perfectly black, and, as far as the ni- trate was well applied, will be separated from the parts underneath, and may be taken ofl' without piiin. If the nail is verif thick, scrape ofl' the black and deadened part in two days, and apply the nitratt; again. This treatment is a vast im- provement on the old and cruel practice of tearing ofl' the live nail. Chafing and Excoriation. WnEN the neck, arm-pits, thighs, etc., of children, get chafed or excoriated, a remedy may be found by keeping the parts clean, and by dusting them with powdered slippc^ry elm, starch, or hair-powder. If this docs not effect a cure, apply Turner's cerate, or wash the parts with a solution of sulphate of zinc, or nitrate of silver, five grains to the ounce of soft water. Grown j>ersons may treat these troubles very much in the same way, or by wearing cotton between parts which rub together. Foreign Substances in the Nosa. Whkn any foreign substance gets lodged in the nose, close the mouth and the opposite nostril, and then blow forcibly through the obstructed side. Jf this is not successful, press the thumb against the nose above the obstructing body, and then make a hook of a piece of wire or knitting needle, and pressing it up over the ortending sub- stance, pull it down. • Foreign Substances in the Ear. If flies and other insects get into the ear, fill the ear with sweet oil, and then syringe it out with warm water. Sometimes it will be Buiitcient to hold the head down on one side, and have the ear filled with water, — remaining (juiet in this position for a short time, when the insect will rise to the surface. If any hard, substance be got into the ear, lie down quietly upon the affected side, and send for a phy- Ncian. Foreign Substances in the Gullet. If the substance have lot gone beyond the reach of the thumb and finger, thrust them down as far as possible, and try to pull it out ; or, a small curved pair of forceps will reach still lower than the fingers. Or, this failing, let some otic place one hand firmly on the chest of the choking person, and give him a smart blow or two between the shoulders with the other hand. If the substance be down some way in the gullet, it may be pushed along into the stomach by some smooth, blunt instrument. Foreign Bodies in the Windpipe. Sometimes foreign bodies will remain a long time in the windpipe, and will only create some inflammation and cough, but not any im- mediately dangerous symptoms. When the body has gone entirely below the epiglottis, but little can be done, except to give a oinch of enuff to cause sneezing, and to direct the patient to expel the air ex- plosively from the lungs by a few energetic and sudden coughs. Th«a may drive the oflfending body out. Bleeding from Wounds. If bleeding occur from any part where a bone lies near the surface, as Ihe head or face, it may generally be stopped by pressing firmly against the bone with a finger, or a piece of cork, or by binding on tightly a hard pad. If this does not succeed, lift up each edge of the wound, and examine carefully to see if any small stream of blood is spouting' out in jets. If so, an artery is wounded, and the point of Rmall forceps or tweezers must be dipped in where the jets come from ; the spouting mouth taken hold of and drawn out ; and a strong silk thread passed around it, and tied below the forceps. The white and gaping mouth of the vessel may then be seen. If the bleeding be profuse from an arm, the whole current c ?. blood to that limb must be cut oft', which may be done by some person pressing a thumb firmly into the neck behind the middle of the collar- bone. This will dam up the blood in the great artery of the arm, as it comes out of the chest. The handle of a door-key, wrapped in several folds of linen, may be pressed upon this j)lace for a long time until medical assistance can be had. Dangerous bleeding from the thigh or leg, may often be stopped by pressing the great artery just below the crease of the groin. If the bleeding be below the middle of the upp»^r arm, or middle of the thigh, pass a handkerchief once or twice around the limb, as far above the wound as possible, and tie it tightly. Slip a stifl' stick under this, and turn it round, like the handle of an auger, until the handkerchief becomes so tight as to stop the bleeding. This arrange- ment is called a stick-tourniquet, and is intended to answer the same purpose with the instrument represented by Fig. 146. (See p. 878.) i ITT 4M SURGICAL DISEASES. Apparent Death from Noxious Vapors. When persons become insensible from breathing foul air in a deep well or other place where it collects, let them be immediately exposed to the open air, and cold water be sprinkled upon the face and head, and strong vinegar be rubbed about the nostrils. As soon as there is ability to swallow, give some drinks, as lemonade, or a few drops of aromatic sulphuric acid, dropped into a tumblerful of water, and slightly sweetened. A stimulating injection (246) may be given. Apparent Death from Burning Charcoal. Some persons very thoughtlessly attempt to warm their sleeping or sitting rooms with a portable furnace, or open pan tilled with burning charcoal, or live coals from a wood fire. This is very wrong, as such coals while burning throw off large quantities of carbonic acid gas, a deadly poison. This being heavier than atmospheric air, falls tc the bottom of the room, and for a time may do no damage ; but, if there be no chimney-draught, or open door or window, it will rise above the heads of those in the room, and bring on asphyxia and death. Let such cases be treated the same as the preceding, with the addi- tional measure of attempting to excite breathing, as in the case of persons apparently dead from drowning. To Recover Persons Apparently Drowned. Drowning persons die by what is called asphyxia. The air being (shut off from the lungs, breathing stops, and the immediate accumu- lation of carbonic acid in the blood, paralyzes the nervous system, and insensibility immediately follows. The heart continues to beat, how- ever, from five to twenty minutes after the occurrence of insensibility and apparent death. Recovery may take place at any time before the heart ceases to beat, and has been brought about in some cases even after this organ has become still. It has taken place, in some few instances, as late as half an hour after being under water, but it can scarcely be expected, even under the best treatment, later than twenty minutes from tin- time of submersion ; and even as late as this, the chances are much against restoration. Treatment. — The best treatment is that recommended by Dr. Mar- shall Hall. Treat the patient instantly, on the spot, in the open air, and, except in severe weather, expose the face and chest to the breeze. Then, to Clear the Throat, place the patient gently on the face, with one wrist under the forehead. All the fluids, and the tongue now fall forward, leaving the passage to the windpipe free. If there be breathing, wait and watch. If there be no breathing, or, if there have been, and it has failed, l;; ii' + ■-» SURGICAL DISEASES. 495 Then, to Excite Breathing, turn the patient well and instantly on his side, and excite the nostrils with snuff, or the throat with a feather, and dash cold water on the face, previously rubbed warm. If there be no success, lose not a moment, but, instantly, Next, to Iiiiitiite Breathiii^, replace the patient on his face, raising and supporting the chest well on a folded coat or other article of dress. Now very gently turn the body on the side, and a little be- yond, and then quickly back upon the face, and repeat these turnings, ba(;k and forth, deliberately, cliiciently, and persevcriiigly, fifteen times ill a minute, occasionally varying the side. These motions will cause a kind of artificial breathing; for while the patient rests upon the breast, the weight of the body compresses this cavity, and expels the air, which is the same as the outgoing breath, or expiration ; when he is turned on the side, the pressure is removed, and the air rushes in as in natural inspiration, or the ingoing of the breath. When the patient is on the face, make even and efficient pressure along up the back of the chest, discontinuing it immediately before turning the body upon the side. This upward gliding pressure helps expel the air. Of course it must be stopped the moment the body is in a posi- tion upon the side to let it in. The result of these movements is breathing; and, if not too late, life. Then, to Induce Circulation and Warmth, mb the limbs upwards (and of course this should be done during the previous measures) with firm grasping pressure, and with energy, using handkerchiefs, and warm soft flannels if at hand. This pushes the blood along up towards the heart through the veins. In this way, too, the limbs are wanned and dried, and may be now clothed, — the bystanders sup- plying the garments. Avoid the continuous warm bath, and the position on or inclined to the back. Beside the above, pour into the nostrils a teaspoonful of aromatic spirit of ammonia, and thrust a feather into the nostrils, dipped in water of ammonia. Give also a .itimulatinff injection, composed of a pint of water with a tablespoon- ful of ground mustard, and a teaspoonful of pulverized cayenne, and put a mustard poultice upon the perineum and anus. Apparent Death from Lightning. A STROKE of lightning wiU frequently produce asphyxia by par- alyzing the muscles of resp. -ation. In such case, the same means for recovery should be used as in apparent death from drowning. Or, the apparently dead person may be placed in a current of fresh air, and cold water dashed upon the face, neck, and breast, and warm friction he applied if the body is cold. Apparent Death from Hanging. Persons found hanging, who have committed suicide, are to be cut down instantly, and the same means employed to reestablish breath- U* I' ^■^ il 496 SURGICAL DISEASES. ing as in cases of drowning. It may help to restore the breathing, to bathe the forehead and face with vinegar, or 1' cture of camphor, and to pass hartshorn frequently under the nostrils. Clothes Catching Fire. It is perhaps u.ireasonable to look for presence of mind when this frightful accident occurs, yet it is never more needed than at such r time. The instant a lady i erceives her clothes to be on fire, and in a blaze, she should seize the u^virest large rug, doakC, blanket, coverlet, or any ecjuivalcnt article, and, wrapping it tiffht around her, throw hersi-lf Hat upon the floor, taking care to keep the protecting covering close to her until the fire is completely smothered. If she does this with energy, and effectually, she will put out the fire instantly. If she continue on her feet, the blaze will rapidly ascend, and burn her vital parts. If she run to seek relief from others not present, the motion of the air will fan the (lame into a swifter work of destruc^ tion. If it be a child that is on fire, let any person present treat it as above. If it be badly burned before the fire is extinguished, put it instantly into a tub of cold water, or daj h cold water upon it, to prevent the burn from becoming deep. Accidents on the Water. If upset in a boat, or otherwise thrown into the water, and are not able to swim, draw the breath in< well, and keep the mouth shut tight Do not struggle and throw the arms up ; but yield quietly to the water, hold the head well up, and stretch out the hands only below the water. To throw the hands or the feet «/?, will pitch the head down, and cause the whole person to go immediately under water. Keep the head above, and everything else under water. Poisoning Accidents.— Antidotes of Poisons. Accidents from poisons are of such common occurrence, that every person should know the proper remedies, and not be obliged to wait the arrival of a physician before the proper corrective is applied. The most common remedies, with the methods of applying them, will be given under the proper heads below. The mineral poisons will be spoken of first. (Sec p. 880.) Poisoning by Ammonia. Water of ammonia, or hartshorn, if taken in an undiluted state, acts as a violent poison. When this accident happens, give vinegar instantly, mixed with a little water. Vinegar is an acid, and ammonia is an alkali \ and acids and alkalies neutralize each other. 'Hm SURGICAL DISEASES. 497 Poisoning by Antimony. Tartar emetic, and wine of antimony, are sometimes taken by accident in large doses, so as to act as poisons, and cause dangerous vomiting and prostration. Give a tea of slippery elm, flax-seed, marshmallow, etc.; also syrup of poppies, paragoric, or laudanum in twenty-drop (loses. To neu" trali/e the poison, give a strong solution of tannin, or an infusion of oak bark, or nutgalls. Poisoning by Arsenic. UsK the stomach pump instantly, if one is to be had; if not, give twenty grains of sulphate of zinc (white vitriol) in a little warm wuti'r; and promote the vomiting by filling the stomach with large dnuights of warm or cold milk, sweetened water, or flax-seed tea. Or, vomiting may be induced still mpre quickly, by giving a large tabiespoonful of strong ground-mustard, mixed with a teacupful of water. But thfe best antidote for arsenic is hydrated sesquioxide of iron. Mix a tivblespoonful of this with water, and give this amount every live or ten minutes, until half a dozen doses are taken. Treat the inflammation of the stomach which follows, by blisters, a bland liquid diet, mucilaginous drinks, etc. Poisoning by Verdigris, or Acetate of Copper. Cooking utensils made of copper never ought to be tolerated ; yet they are used ; and it is from the verdigris which forms upon them that most of the cases of poisoning by copper happen. Give an emetic instantly, and then two teaspoonfuls of carbonate of soda (bread soda) in a tumblerful of water, to be repeated in ten minutes. White of eggs, diffused in water, and mucilaginous drinks are proper. Poisoning by Corrosive Snblimate. This is the common bed-bug poison, and is often taken by mistake. Mix up quickly the whites of a dozen eggs, with two pints of cold water, and give a glassful of the mixture every two minutes till the stomach can contain no more. If there are not eggs enough at hand, take what there are, and make up the deficiency with milk. Wheat flour, mixed with water, is a good remedy. Use the stomach pump, if it is at hand. Treat the resulting inflammation with leeches and fomentations. 63 w 498 SURGICAL DISEASES. Poisoning by Sugar of Lead, or Aoetate of Lead. Give a ground-mustard, or a sulphate of zinc emetic; then, give diluted sulphuric acid, or, either epsuiu or gluuber's suits. Poisoning by Strong Lye. Strono lye Is sometiriK^s swallowed by children. The remedy ii vinegar, or oil. Vinegar will convert the lyt; into acetate of potash, and any of the oils* will unite with it, and form soap; and neither the acetate of potash, nor soap, will materially injure the stomach. Poisoning by Nitric, Muriatic, or Sulphuric Acid. When either one of i'' "se acids is swallowed, not a moment of time is to be lost. Fill thi; pitient full of calcined magnesia stirred up in water. This is the bent remedy ; but if it is not to be had, give half an ounce of soap in a pint of water. If neither are at hand, give chalk, or whiting, in water, or even pound fine some of the plastering of the room, and give it in water. 11 r. n Poisoning by Nitrate of Potash, called Nitre, or Saltpetre. Induce vomiting by luke-warm water, and by tickling the throat with a feather; but avoid irritating the stomach with the ordinary emetics. Poisoning by White Vitriol. Prcvok 3 vomiting by warm drinks, and by tickling the throat, and give freely carbonate of soda, in water. Poisoning by Oxalic Acid. This resenibles epsom salts, and is liable to be taken for salts by mistake. The two can always be distinguished by touching a little to the tongue. Epsom salts taste bitter ; oxalic acid, very sour. In cases of poison from oxalic acid, give magnesia in water as quickly as possible. When this is not at hand, give chalk, or liine^ or saleratus. Use the stomach pump, if it is to be had. ■■r/t. Vegetable Poisons. The vegetable poisons are quite numerous, and many of them quite as virulemt and rapid as any in the mineral kingdom. •*^^ .■^^. • !■ 8UU(UCAI- DISKASKS. 499 Poisoning by Acouite. GivK an ctnctic of f^ronnd-iiiustarcl or Miipliiitc of zinc, or use the !»toiiiiuli pump, instantly, and then give; stiinuhmts, a» brandy, gin, whiskey, rum, ete. Poisoning by Opium, Morphine, and Laudanum. UsK the stomach puinp, if at hand ; if not, a powerful emetic of sulph!ito --flrn warmth and moisture, soon generate an acid which corrodes the en- amel. The teeth, conseciuently, often begin to decay in parts where oiK^ presses upon an other, and in depressions, where food lodges and reiiiiiiiis. This shows Ihe necessity of cleansing the mouth and teeth often, — ])articniarly after meals. Wercary, when taken to the extent of salivation, — whether it be calomel, (•orn)sive snblimati', blue pill, or any other form of it, — causes indammation of the membranes about the teeth, and indi- rectly produces caries. Acidity of the stomach, the contact of decaying teeth and dead sliiiiijjs with sound ones, diseas«'d and ulcerated gums, and, abuv«' all, a filthy, uncU'an, and unwholesome condition of the moulh, are active causes of diseased teeth. Iiiipropcr Toutli Powders, as those containing gritty particles, are to be avoided. T«bn('('0, by deranging the general health, may be indirectly inju- rious to the teeth. Smoking blackens th(^ teeth ; and though ('hewing may be useful in deadening the sensibility of the uvrvv of a de.ayirig tooth, this alotic is not a sullicient reason for so imcieanly and disa- grceai)Ie a habit, wliile so many agents may be found to produce the name rlleet. T;irt.ir. — This is derived from the saliva, and is found, when ex- amined bv the microscope, to be cotii| )ose ol mvri.Kis yi nvmsr aniinals. When first ; bill, when not !)riished away, i( s«-on hardens, and elinnges from a yellow to a l)r(iwn, and sometinu's to a black color; ami ol'tcn i.i childicii, it becnuies a dark green. It deslniys the beauty oi' the Icftli, giving th(Mii a lillhy and revolting look; tin; setting of tim teeth ill iln'i<- so<'k''ty is weakened; their appearamre is elongafeil ; the p' rio>lenin or covering of the fang beeonics iiillaiiied and tender; and, if the proper rcnn'dy be not applied, tlu; ti'eth will become loos- ened, and linally fall from thi-ir soekels. It causes the gums to be- coiue inl!;mi"d, swollen, l"nd(>r, and id. (rated, ann allowed to collect, have it removed immedi- ately. The teeth should be (rarefully and thoroughly brushed daily with warm water, and th(i occasional use of a detifrice that is impal- pably tine, and that contains no acid. A Bnisll has no bad effect upon the teeth, as some suppose, for the parts of the teeth most exposed to the friction of a brush are never the first to begin to decay. 1'liis beginning of decay takes place in their depressed surfaces, and where they touch each other. A soft brush is better for the teeth than a still" oik*, i)ecause the latter ia apt to fret the gums, and ciuisc^ Ihem to recede, which gives the teeth a lengthened appearanc(\ Teeth in a crowded condition should never be filed, unless they begin to decay. Toot!l-l*urks, made of quill, or wood, or ivory, should be used after mrals, and all particles of food lodged betwoen the teeth should bo renioved. In Si'ihness, the ndes for cleaidiness of the teeth should be mor(* rigiilly <'nr()rced than at any other tinu', as then they an; mon; ex- ptiscd to destructive agents, ind are liable to participate in the gen» oral d(!bility and disease of the system. Influence of Diseased Teeth upon the Health. The bad eflt'cta of a diseased and unclean nu*uth upon the general health, an; of more serious conseciuence than most people are aware. In twenty-four hours, we breathe twenty thousand time;* ; and what nnist be the cfiect upon the delicate structure of the lungs, wher), for days, months and years, the air we breathe is drawn through a di'pos- 004 SURGICAL DISEASES. itory of filth, and is poisoned by being mixed with effluvia arising from decayed and diseased matter in the mouth. The intermittent fevers of the West are caused by the effluvia aris- ing from the decaying matter of low grounds and marshes, which can hardly be more pernicious than the effluvia from the impurity and corruption generated in an unclean mouth, filled with decaying teeth. Dr. Hays says " no species of animal matter is so offensive to the health and vitality of the adjoining substance, whether nerve, or membrane, or any part or portion of the living body, as decaying bone." Fumigation of Infected Chambers and Other Places. Nitric Acid Fiimipition. — The efficiency of nitric acid in the form of gas, in arresting contagion, and in cleansing infected rooms, ships, and other olaces, .'s W^ell established. To obtain the gas, pour one cunce of sulphuric acid upon two ounces of nitrate of potash in a large tea cup, — the cup being placed in a basin containing hot water. Th'i gas or vapor will be»inmiediately disengaged. TJilo -^'uantity will thoroughly cleanse a small apartment, but if used in v. sick room, should be placed at some distance from the patient. In a large room, two cups will be required ; and if a whole houpj is to be fumigated, let several be placed in various apartments, and the doors and windows be closed for half an hour. Chloride of KillC. — A solution of the chloride; of zinc has great power in arresting contagion, and in cleansing infected places. A small {juantity of it will, in a few minutes, cleanse, the most offensive apartments. Chloride of Lime. — This is one of the most powerful disinfecting or cleansing agents known. To prepare it for use, add four gallons of water to a pound of the chloride of lime; stir the mixture well, and after allowing it to settle for a short time, pour oif the clear solution, and keep it in well-eorked bottles. Cliloride of Sodsi, — This, in disinfecting power, is about equal to the chloride of lime. In order that it may retain its properties, it must be ke|)t from the light, in a well-stopped glass bottle. When used, it rrust be mixed in the proportion of one ounce, or two large spoonfuls, to the pint of water. It is excellent for cleansing car- buncles, gangrenous sores, bad ulcers, ulcerated sore throat, and fetid discharges of every kind. A weak solution should be frequently ap- plied. Uses of Clilorides of Lime nnd Soda. — These articles almost in- stantly destroy every bad smell, and all effluvia arising from animal and vegetable decomposition, and entirely prevent their bad influ- ence. While infectious or contagious diseases prevail in large towns or aities, the rooms should be sprinkled^ morning and evening, with H some of H different H ticularly ^1 In hot H complair ^H rooms, a H should b ^H vessel or H Before H mersed, H washing ^1 be imme< H to dry wi H By poi ^1 water, in H as may b ^1 Meat > H molestati ^1 stant, an( H rendered i H To pui L^M to every c H The w; H it into all H A rooit H he sprinkl ^1 Stables, H which oil" ^1 mixtures. ^H J^ein^ li; of so .'re a ^^H In treat H to have ic H According ^1 TIk! sal H in them a H pulverized H a basin, or H inclosed in ^5 ohtain ext H 1)0 cooled H To five iH •Iram-i of IH water, in a H f'ca-water. ^1 niometer 1 1 degrees. ^1 SURGICAL DISEASES. 505 some of one of these solutions. Some of it should be placed in the dirterent rooms, in shallow dishes, — the small bed-rooms being par- ticularly remembered. In houses where there are typhoid and putrid fevers, and infectious complaints, it is highly proper to sprinkle the solution about the roomiji, and occasionally upon the bed-linen ; and the air of the room tshoiild be frequently renewed. A wincglassful added to the chamber- vessel or the bed-pan will prevent all smell. Before sending the bed and other linen to the wash, let it be im- mersed, five or six minutes, in one of these solutions, diluted, as mere washing will not always remove the infection. But the linen should bo immediately rinsed in pure water after the immersion ; to allow it to dry without such rinsing might injure it. By pouring a quart of one of these mixtures, added to a pailful of water, into drains, sewers, or cesspools, and repeating the application as may be required, will destroy all their offensive ellluvia. Meat will keep for some time, without any taint, and without the molestation of flies, if immersed in one of these solutions for an in- stant, and hung up ; and all tainted meat, fish, game, etc., will be rendered sweet by a little sprinkling of the same. To purify water in cisterns, and destroy the animalcules in it, add to every one hundred gallons, about a pint of one of the solutions. The washing of bedstciuls with one of the solutions, and putting it into all the crevices, will destroy bugs. A room just painted may be .sle|)t in safely, if one of the mixtures ho sprinkled about, and loft in shallow dishes. iStables, slaughter-lK)ns(>s, hog-styes, |)rivies, and nil places from which oilensive smells arise, may be tlioroiiglily purified by these mixtures. Being guardians of the public, jiealtli of such wide application, :uiU of so !T"eat utility, it is surj)rizing that they are not more used. Freezing Mixtures. In treating wounds, inflammations, etc., it is often quite important to have ice, which is not to be obtained without manufacturing it Accordingly, I give here a few dircctioiis for its immediate production. The salts used should be in a crystiilized state, with as much water in Ihcrn as po.-.nble without being damp. Tlu^y should be coarsely pulverized at the time of using, and put into the water contained in a basin, or other suitable vessel. The water to be frozen should be inclosed in a thin vessel, and immersed in the freezing mixture. To obtain extreme degrees of cold, the ingredients and the vessel should be cooled by one mixture, before being mixed for another. To five drams of pulverized hydroehlorate of ammonia, and five ilram-i of pulverized nitrate of potash (nitre), add two ounces of water, in a tin, stone-ware, or glass vessel, and you may freeze water, j'cii-watcr, milk, vinegar, or oil of turpentine. It will cause the ther- iiH)meter to sink from 50° above zero, to 10° above; that is, fort]f degrees. wi ITT: !!' .'-li* 506 SURGICAL DISEASES. A mixture of five drams of sulphate of soda, and four drams of diluted sulphuric acid, will sink the thermometer seven degrees lower than the above, namely, down to 3° above zero, or twenty-nine degrees below the freezing- point. If six dratns of sulphate of soda, four drams of hydrochlorate of ammonia, two drams of nitrate of potash, and four drams of dilutt^d nitric acid be put together, the n)ixture will lower the thermometer 60°; that is, to 10° below zero, or 4:2° below the freezing point. Beside the above, the following combinations may be used : Muriate of ammonia, live ounces; nitrate of not ash, five ounces; water, sixteen ounces. Mix. Nitrate of ammonia, four ounces ; crystalized carbonate of soda. four ounces ; water, four ounces. Mix. Nitrate of ammonia and water, equal parts. Mix. Nitrate of ammonia, and nitrate of ))otash, fi.ve parts each ; sul- phate of soda, eight parts; and water, sixteen parts. Mix. Phosphate of soda, nine parts ; liiluted nitric acid, four parts. Mix. Sulphate of soi'-», eight parts; muriatic acid, live [)urts. Mix. Sulphate of soda, six parts; nitrate of ammonia, live parts; di- luted nitric acid, four parts. Mix, Freezing Mixtures with let". — Snow or pounded ice, two parts; salt, one part. Mix. This will sink the thermometer to 5° below zero. Snow or pounded ice, four parts ; salt, two parts ; muriate of am- monia, one part. In this mixture the thermometer will go down to 12° below zero. Snow or pounded ice, twenty-four parts; common salt, ten parts; muriate of ammonia, five parts ; nitrate of potassa, five parts. Mix. Gives 18° below zero. Snow or pounded ice, twelve parts; common salt, five parts; nitrate of ammonia, five parts. Mix. Gives 2o° below zero. Snow, eight parts; muriatic acid, five parts. Mix. Gives 27° below zero. Snow, seven parts ; diluted nitric acid, four parts, below zero. Snow, four parts ; chloride of calcium, five parts, below zero. Snow, t hree parts ; potassa, four parts. Mix. zero, or b3° below the freezing point. Mix. Gives 30» Mix. Gives 40" Gives 51° below Dr. Ira Warren's Paracentesic Instrument. PuNcnjuiNG the chest for drawing ofi' water in extensive j)leuritic efi'usion, as practised of late, has proved one of the most valuable operations in modern surgt^ry. Like most new operations, however, it has been embarrassed by imperfect instruments. The annexed cut represents an improved instrument which I have just invented, by which this operation is made extremely simple and easy. At the right hand is the puncturing instrument, including the external canula, and the trochar inserted in it. At the letter i is a slid- ing guard whifh moves back and forth, and may be set at the point of desired depth to which it is desirable to puncture, and made fast by a screw. By this arrangement it may be driven home to the desired depth, without any fear of going too far, or of falling short of the mark. The guard also serves in u measure to keep the instrument steady during the operation, and to prevent indicting pain by having it oscillate about At b is a tubular attachment, opening into the canuia ; to this an India-rubber hose is attached, whi(^h coimects, at tht; other ly How, in a full stream, into the exhausted receiver, o. The working of the apparatus is ex- tremely beautiful. Five pints of water may be taken away with it in five minutes, — an amount which cannot be got with the old instru- ment in much less than half an hour. If the patient c-.iimot bear to have it drawn so rapidly, the stream may be wholly or partially ar- rested, at any moment, by entirely or partly closing the cock, a. The reader will see that the app;\ratus is so arranged that the ad- mission of air into +l^B 12. Bellado 1^1 tl3. Bismatl iH 14. Bryoniu :^H tl5. Calcarei i^^H 16. Calendi ^H 17. Ciiinpht ^B 18. Capsicu ^H 1!). Cantbai ^H 20. Caiinab ^H t21. Ciirbo n; ^H T'.'2. Carbo v ^H 23. Caiutici ^H 24. Cliamoii ^1 25. Cliiiia. S ^1 26. Chelidoi ^B 27. Cimicifu ^m 28. Cicuta V ^H 29. Cina. 3. ^^^H 30. Cucculu ^H 31. Co£Feac ^1 32. Colchioa ^H 33. Golooyn ^^B 34. Coniam ^H 35. Crooiut ■ 86. Coprnni 1 1. Aconite. ^H 2. Arnloft. ^H 3. Baptiaia. 1 4. Calenduli • The rerao ^H tl) on the docl ^^H r email powdei 1 tMipoonflilakc HOmSOPATHIC TREATMENT OF DISEASES. 509 employed in this treatise are of this character, and are comprised ia tlie following • LIST OF REMEDIES. 1. Aconite. 3. 37. DifflUlia. 3. 73. Nitram. 6. 2. Aloes. 6. t3R. nioscorea TllIoBa. 2. 74. Nitric aoid. 6. t3. Alamina. 6. 39. Droflera rotundifolia. 3. 75. Nnx vomica. 6. t4. Ammuniuni oarb. 6. 40. Dulcamara. 3. 76. Nux moscbata. 8. fS. Antimoniuincrad. 6. t41. Elaterium. .1. 77. Opium. 3. 6. Apia mellifioa. 6. 42. Eupborbium. 3. 78. Oleander. 3. 7. Arnica montanft. 8. 43. Euphrasia. 3. 79. Petroleum. 6. 8. Anenionm albom. 6. t44. Ferrum redact. 3. 80. rbospborus. 6. ti). Auriini metallicum. 6. 46. Oaniliogia. 3. 81. Pbospborlo acid. 6. 10. Anacardiam. 3. 46. Oelsemium. 1. t82. Platina. 6. 11. Baptisia. 1. t47. Graphites. 6. 83. Pbytolacca decandra. 1 l-j. neliodoDna. 3. 48. Gloniiinum. G. 84. Pulsatilla. 6. tl3. Bismath Bubnit. 8. 49, Helleborus nig. 6. 85. Podophyllum pelt 3. 14. Bryoniu alba. 3. tSO. Hepar Hulpb. 6. 86. Rhus tox. 3. tU. Calcarea carb. 6, 61. Hyoscyamus nig. 3. 87. Ruta graveolens. 3. 16. Calendnla. 1. 62. Hanmmelis. 1. 88. Sabina. 3. 17. Ciiinphora. 3. 63. Ignatia amara. 3. 89. Saiiibucus nig. 3. 18. Capsicum. 3. 64. lodium. 6. 00. Sanjuinaria. 3. 19. Cantbaris. 3. 66. Ipecacuaulia. 3. 91. Secale curnutum. 8. 20. Cannabis sat. 3. 60. Iris versicolor. 3. 92. SencRa. 3. t21. Carbo unlmalis. 6. tS7. Kali carb. 6. 93. Sepia ruccub. 6L T'.'2. Carbo veg. 6. tr>8. Kali bicbromioum. 3. t94. Silicca. 6. 23. Caiuticuin. 6. 69. Laobesis trig. G. 95. Spiitelia. 3. 24. Cliamoiiiilla. 3. tiO. I^dnm piilustre. 3. 96. Spongia. 3. 25. China. 3. 01. Laiirocer:iBUS. 3. t97. Stannuin. 6. 26. Chelidonium maj. 3. t(>2. Leptandria. 3. 98. Staphysagria. 3. 27. Cimicifuga raoeui. 1. t63. I.ycopodium clav. 6. 99. Stramonium. 3. 28. Cicuta Tirosa. 3. lA. Lobelia inflata. 3. tlOO, Sulpliur. 6. 29. Cina. 3. 6.5. Mercurius currosivus. 6. 101. Sulphuric acid. 8. 30i CocculuR indicus. i. t66. Mercurius vivus. 6. 102. Tartar eniet 6. 31. Cuffea crada. 6. t67. Mercurius iod. 3. 103. Uva ursi. 1. 32. Colchicam. 3. t6A. Mercurius biniod. 3. 104. Urtica urens. 3. 33. Golooyntbia. i. 60. Mercurioa aol. 6. 105. Veratrum album. & 34. Conlam mao. & 70. Mezerium. 3. 106. Veratram viride. L 35. Crooiu MtiTm. X 71. Mosofaua. 6. tlOS. Zinoum mat. & 86. Cnpnua aoet^ 6. 72. Natrum mariat. 6. TINCTURES FOR EXTERNAIi USB. 1. Aoonlta. 2. Arnica. 3. Baptiaia. 4. Calendula. 6. Gantharla. 6. Gonium. 7. Gaustioum. 8. Hypericum. 9. Ruta graveolana. 10. Staphyaagria. 11. Urtica urena. * The remcdie* marked f should be bought a* triturationt. Ask the pharmaclat to prepare thera til on the decimal scale, and so, also, the dilutioni. The trlturatlona may be given dry un the tongue, r email powder the size of a pea; or the Hamo amount or more dUitolved In half a tumblcrfUI of water, ■ UaipoonAil at one doa«k when It ia daalrable to repeat the medicine at siiort lnt4)rvala. rr-r RULES KOK TIIK AIlMINISTItATION OK KKMKDIKS. As specific directions will be found in the treatment of each disease treated of in this work, only a few general rules are ueces!sar\ . 1 . In acute cases, the elioscn remedy ma}' bo repeated every hour or two hours, until a change occurs ; then it is prudent to wait awiiile for the result. 2. If there is no favorable reaction within a few hours, or, in very acute pain, within half an hour, select another remedy according to the indica- tions; and, should no iavorublo reaction follow the administration of this. select another, and so on. 3. AVhen convalescence follows the administration of a remedy, it need not bo repeated uuU^ss the recuperation reaches a certain point and tliiu ceases ; in which event, select a remedy according to indications. 4. The same remedy may be repeated in case of continued convalescence becoming interrupted, provided there is no change other than amelioration of symptoms. 5. A change of remedies is admissible in obstinate cases, when one has been employed for some time without the desired effect. In chronic cases it is well to try the remedy at least a week before changing. 6. In chronic diseases, the remedies need not be repeated oftencr tha once or twice in twenty-four hours, and even at longer intervals. KORM3 OK MEDI0INK3 KOIl ADMINISTRATION. There are four forms in which honKcopathic medicines are prepared for use: 1 . Mother tinctures prepared from fresh plants ; 2. Triturations pre- pared from metals, salts, earths, and herbs-; • 3. Dilutions prepared from the tinctures ; and, 4. (ilobules medicated with the solutions. The last two are generally employed, and the first two occasionally, in household prac- tice. When water is employed as a medium for the administration of eitliir form, five drops of the tincture or dilution, or ten globules, or three or four grains of the trituration, may be thoroughly mixed in half a tumbler of water, and a dessertspoonful of this mixture will suffice for a dose. Tl.t tumbler containing the medicine should be carefully covered, and kc; ' away from the light and from any corrupting odor ; and all ottier medicines, teas, tonics, and stimulants are strictly prohibited during its administration : and all medicated po* 'tices, lotions, and the like, must be avoided, becausi; of their interference with the medicinal action of the remedy. RULES FOK PRESERVING THE PURITY OF MEDICINES. 1. The medicines should be kept in a small box or chest, exclusively for this use, carefully closed, and in a cool place. Examine the corks often tu see that they are perfectly tight. •DUutioni are noommeBdedto be prepared on the d$iUmal eeolfc 2. Be carcftll to keep the vials corked always with tlic .sanio cork, or one that has never been used for any otiier purpose ; and l»e particularly careful not to miaplaee the corks, or fail to rei)laee tlu; identical one each time when a vial is uncorked for uses .T. Never put inediciue into a vial that has been already used for one of ft dilferent kind, unless it be thoroughly washed and baked. ■1. Every vial should be; labelled, to prev' lit mistakes ; and «!very glass, spoon, or cup should be carefuily tlcumscd before usiiijj it in the prepuratioa of a remedy. 5. Never use the same spoon in giving medicines of a different kind to different {kirsons sick in the same house. ANTIDOTES TO MKUICINES. In some exceeding impressil)le conditions, the remedy chosen may pro- duce intense aggravation of suffering, which may be relieved by the admin- istration of a drop of the Spirits of camphor. If Belladonna should pro- voke an aggravation. Aconite will antidote its effect, anil so will Camphor f and tills latter is regarded the general antidote of homu'opathic reme- dies, two of which should seldcmi be given in alternation, because of the liability of their neutralizing the effects of eairli other. For the; same reason it will not do to change from one remedy to another suddenly. A period of from four to six hours should intervene in acute cases, except in emor- geucies of great pain, and from one to two days in chronic aii'ectiona. EXTERNAL APPLICATIONS. Compresses wet with cold water, coveri'd with a dry bandage, arc always a convenient and successful resort for bruises, sprains, and injuries in gen- eral. Tepid applications, or cold when agreeable, in the same way, may be applied to local iuflammatoiy affections. Warm poultices, to hot and inflamed surfaces, will often exert a salutary influence . The tinctures named for external use may at times be employed in full strength ; but lotions made of a teaspoonful of any one of them, to a cupful of cold water, is the usual form of applying them. Mustard poultices may be employed, either in full strength, or tempered by adding to the ground mustard a due proportion of meal. Simple cerate, cold cream, and healing salves may be employed when needed ; but any strongly medicated poultice, plaster, salvo, or ointment must not be used when taking homa'opathic remedies. BATHINO. Persons of debilitated constitutions should not bathe too frequently ; for those of robust constitutions, this luxury may be indulged in to almost any extent. Bathing in very cold water is not recommended. Tepid baths are the moat benefloial, aad shoold be takea regularly throughoat the year. tvi "(F-r Hot baths are weakening and relaxing. They may be employed for childrcQ in convulsions, and to overcome rigidity of the skin. Sulphur baths are sometimes recommended for rheumatism ; but they should be taken with caution ; and this remark is applicable to all vapor-baths. Sea-bathing u good for dyspepsia, and those inclined to biliary derangements. Consump- tives derive but little benefit ftom any kind of bathing aside from necessary ablutions. The addition of salt to the water is recommended in cases of debility. DIET AND REGIBTEN. But little need be said about diet here, as that which is appropriate U pointed out in the following pages, as a part of the treatment for each indi- vidual case. It may be romnrkcd simply that no medicinal condiment or food, no stimulant or other medicinal beverage, can be emplo3'cd when taking homoeopathic remedies ; and, further, all patients must be placed in the best possible condition for recovery. They must have clean and well- ventilated apartments, and plenty of fresh air. They must have clean and well-aired bedding. They must have proper clothes and food to correspond with the appetite and wants of the system. An experienced nurse is of great importance, especially in feven. DISEASES INVOLVING THE VARIOUS ORGANS. Simple Fever. TiiiB disease is a simple acceleration of the pulse, with flushes of heat ; and when brought on by fatigue, give four gh)l)ulc8 of Arnica; if from cold, Aconite; if from grief, Ignatia; if from indigostiou, Belladonna; if from dampness and chill, Gelsemium, or Rhus tox. Inflammatory Fever. In most cases this disease commences with pain in the head and full pulse, more or less thirst, loss of nppotito, constipation of the bowels, and dry, hot skin. One drop of the dilution, or four globules, o( Aconite may be given in the first stage, every hour, until the skin boromes moist, and the pulse somewhat reduced. Belladonna may follow Aconite, and be given in the same doses and intervals, until tlicro is a mitigation of the pain in the head ; or if the pationt becomes weak, and sulijeet to aggravation of suffering from the slightost mo- tion, give a drop, or four globules, of lin/onia, every hour, until there is a change ; with restlessness, and when fiom checked perspiration, Uhm tox.y same dose as Bryonia. In the case of urinary obstruction, give four globules of Cantharis; or of flatulent colic, four globulea of (Jhamomilla. The diet should bo farinaceous gruol or toast. Typhoid Fever. In general, the commencement of this disease is denoted by las- situde, headache, and considerable acceleration of the pulse. Then follow stupor or delirium, coldness of the surface, nnd great prostra- tion. Four globules, or one drop, of Aconite may be given at first, every two hours ; to reduce the pulse and moisten the skin (by many Baptisia, m drop doses, hourly, of the tincture is preferred to Aco- nite), Bryonia may be used after Aconite, a dose every three hours. If the patient becomes drowsy, give Rhus tox. ; cleanse the surface of the patient daily with a towel wet with topid water; and, if he will take any nourishment, give him beef-tea or mutton-broth ; milk is allowable, and rice gruel. When convalescent, allow some light wine throe times a day. For the diarrho?a of Typhoid, Arsenicumt four globules, after each discharge, is good. Bilious Remittent Fever. This disease is so named because it comes on by considerable gastric derangement, headache, and fever, which appears to be subject to eleva- tions and depressions, without any distinct intermissions. In the first m 514 DIHKASES INVOLVINO THK VA1UOU8 ORGANS. or infiumniatx>ry stage, give four j^lobulcs, or a drop, of the dilution of AcojiitPs and Ibllow it with a lik(; vlose of Ipecaaianlia, and repeat every hour, until the nausea and vomiting are better. If the bowels are consti- pated, give Niix vorniai ft night, — a single dose of four globules, if there is colic, give Coiocynth. If there is vomiting of greenish bilious xnatter. give limjonia or Pulaat<'la. Diet samt; as in intlannrmtory fever. Intermittent Fever. The 8ymf>tomf5 'oy wlucli this fever is sJi;:tinguishod are yawning, stretch- ing, shiiddi-niig. and cliiiliness, followed by beat, p.-iin in the back, limbs, thcad, rtc. ; and allerwards a copious porspiralion, and then an interim of coinpletc intcrniission. xirsenicioai wliere tlic ehilliuess and heat are eimultaiH'ous, and where, during the eold stage, there is intense tliirst for cold drinks; Araiat, wiiere there is s<)reness of the tlesh, as if bruised; JBtdlddonna, where headache and chilliness down tiie l)aek ; China., where there is ringiiv? in the ears ; Sulphur, in cases of long standing, where niiici) Qninim' has b<-c» given ; fin/onia, where tliere an; glairy voniitinjrs during the chill and fever, and where all the sulferingH are aggravated by motion. Apis, attacks ehronie, and jjreeeded by nettle-rash. — followed well by Nf.U. mur., either to lie given three timis daily. All the mediciuci) may be administered in drop doses of the dilutions, or four globules ; and repeated every two hours between the paroxysms. Yellow Fever, Common to the 'southern States during the warm season. Nearly all the symptoms of an ordinary bilious fever, in an aggravatecl form, char- acterize this dis«'ase ; and the victims become so sallow, and the surface so yello V, as to give rise to tlie name " Yellow Fever." When the stiige of febrile excitement exists, give Aconite. When tlie nose bleeds, give Bdladonna. When vomiting of blae buruir ., itching, and stinging; Croton tig. cures nearly nil cases, a favorite remedy with physicians. Doses an usual, and repeated eviiry hour or two hours until ndieved. Scarlet*.RttSh is Ihe roseola, or red eruption, and is nuich like the uettle-ras'-i. only less annoying. Bryonia, I^laatilla^ are the ordin; ry remedies ; and either may be given in doses of four globules every two hours ; Aeon . if waheful and restless. Scarlet-Pover usually begiina wi/(»ti of the eruption ; Jpi'inc, should it disappear too suddenly, with eonHe(|Uent inerease of eoinjh, or vomiting; I'/w'sphonm will obviate tlie iiillamuiatory efleet upon the hnigs : and Ifrosera will euro the entailed cough. Diet, simple ;iiid light. Erysipelas, either vesieular or phlegmonous, is denoted by a n'd, burning, and lieiy appeaianci' of the face, and sometimes l)y a Ihillar eruption, resemliling tly-l)listers. li/uis /d.i:., llc/htduuiid, and firyotiia^iiv prominent remedies. — Jiclldihniiui. when (lie head and fat" are most iinplieated ; Jilms ^u•., when theve is eruption on llie extremities, and ijreat weakness ; and Jirf/miia, when the suH\'ring seems greatly aggravated by motion ; Arsctiicuin, should there be great prostration, thirst, and rest- lesiiesH. — one of the best remedies in severe eases. Any of these remedies may be re[)eated every hour. Diet. — barley-gruel, rice-watisr, beef-tea, uiiiltou-broth, toast, and tea. rhicken-Po.\. — A pustular eruption, .attended with slight fever and giVi^ric (lerapgeinent. One or two doses of I'ldttatilla will generally remove !ill the sutleriug attendant on tliis disease. Varioloid is anotlier pustuhir disease, more severe, as it comes on with [min in th'- head and back, as if the latter would break ; and, being a near relation to Small- Pox, both may be considered under the sanm head. Siuall-Pox, of which varioloid is a modilieation, comes on with inttnise fever, spitting, pain in the heail and back and lower «'xtremities. All the suti'orings ai'c intense, Ni'.c voniiiu will removt^ the pain in the back ; lin/iinla will hasten the eruption : PnlxdillUi will aid in carrying it utT. As soon as the appetite returns, feed the patituit (piite gener- ously. In the small-pox delirium, you can give Strnmouuon ; and, to [)revent pitting, break the pustules, and cover theiu with Styptic Collodit/n. Bhenmatio Fevers. Inflammatory Rtieiiniatisni is accompanied by pain in the lir.ibs, in- flammation of the joint.s, swelling of the same, and great pain and dilH- cu'ty in moving about. Aconite reduces the fever ; Bryonia nilievcs the pain in mcving al)Out ; Pulsatilla, the intl.'imniation of the knee-joints; Colonjnth, that of the hi|)-joints ; Nxx ifmniai, the pain and rheumatism of the back; and iSiilphur and Rhus, the stiffne.sji that ensues during convalescence ; Ithus is indicat»'d if the cause be check of perapiration, or exposure to wet. Diet, — bread and butter, steak, and other meats. Ohroilic llheumatism is more confmed to the umscles than tlu; joints, ami is oft(!n the sequel of the acute form. Sniphur is one of the reme- dies much relied njion in curing this disease. Nitx vomica nniy hv. given after Sulpiinr, wh»'n there is pain in the back or sciatic rerve, and Ithua tox. when there is a general stiffness of the limbs. The medicines, in tho usual doses J may be repcaU^d every two hours. J 516 DISEASES INVOLVINQ THE VABIOUS OBOAHS. Lambngo is simply rheumatism of the back, in the lumber region, and su stiffens one that ite cannot stand erect. Sulphur^ four globules at night, and Pulsatilla, four globules in the morning, will generally cure this trouble. Cimicifuga is a very valuable remedy, given hourly, in water. Sciatica is simply neuriilgiu of the sciatic nerve, and may be cured in a short time by u galvanic battery. Rhus is often useful. Bel- ladonna, or its active principle, Atropine, is a valuable remedy to administer internally. The diet m all forms of rheumatism, whether acute or chronic, may be generous. Toothache. When caused by a cold, Niix vomica ; when from caries of the tooth, Merouriua viv.; at the menstrual period, Puhatllla; neuralgic, Bella- donna, or ChamomiUa; Aconite when there is heat in the gums. Dose as usual, repeated csvery hour. Diseases of the Alimentary Canal. lufliiminiitiun of the Tonsils is tlie result of a cold which affects this locality, and causes a swelling and sometimes a suppuration of these parts. When they first begin to inflame, give Aconite, and follow with Bella- donna : repeat every two hours. Mercuriav viv., Lacheiis, and Mercurim lodatus are also good remedies. <(uiiisy is the same as Tonsillitis, and requires the same treatment. IHltrid Sore Tliroat comes on by little vesicles making their appear- ance in the mouth and fauces, or throat, which soon, by reason of a low, constitutional fever, change color, run together, and constitute the offen- sive sore mouth which we denominate putrid. Araenicum, Mercunut vivus, Nitric acid, and Sulphur, or Stuph. acid, will generally cure. Dose and repetition as before. Canker of the Mouth. This troublesome disorder is caused by a disordered condition of the stomach, and requires Arsenicum when the breath is foul, the throat dry, and attended with much thirst ; Carbo vegetabilis, when the system is 'a a low condition, and there is much coldness on the surface of the body ; Dulcamara, when produced by a cold ; Hepar aulph., when the canker seems indolent, and slow in coming to a crisis ; Natrum muriaticum, when it assumes the chai'acter of Scurvy, or Mercurius rio. Dose and Adminixtration. — Dissolve from two to five dro[)s of the dilution in half a tumbler of water, and give a teaspoonful every two hours. Diet, — avoid salt provisions; use meat-broths, toast and tea. Inflammation of the Tongue. The first indications of this difficulty are soreness and difficulty in using the tongue in deglutition or eating. VVIicn caused by mochanjcal injury, or fr)m accidental biting with tlw teifth,j;ive J^rwtpa, jour glob- DISEASES INVOLVINO TBE VABIOUS ORGANS. 517 nles, and wwh the mouth with a dihition of ten drops of tincture of Arnica in half a tumbler of water. If from otiier causes, give Aconite or Belladonna in the same way. Wiien inflammation of the tongue takes the form of ulcers, give Arsenioum ; of biisti-rs, Mercurius or Laches Ig ; when the tongue inflames and crack'', give Nitric or Sulphuric acid. ! f' t ;:i& Pharyngeal Sore Throat. This isan inflaminatioti of the phaiyiix, or of the opening into the upper pnrlioii of tlie passage iVom the niciith into the stomach. It is sometimes qtiiie serious, and is usu;slly lermed " Quinsy Sore Throat." AaniKu iiiav he given at first, and this may l»e followed l»y Bii/lddouud, ami tliir* iv^iuw hy Mercurius vio. Should it become evident that ri'.ippurati(Ui must take place, give Hcpar salph. Whichever remedy is given, let it be repeated every hotir until anudi«)ration or ehiin^o. Baryta curb, is often tin- speeirte. Dyspepsia, Indigestion. Difiicult digestion, whatever form it assumes, is termed Dyspepsia, and must be treat'd in accordance with tlie symptoms, and the cause that lias produced tliem. Dyspepsia brougiit on by intemperance in drinking intoxicating iiipiors requn-i-s Nu.c voni. ; if from a cold, ami the patient is chilly and leverisli, y^c//(/(io/j«rt, or perhaps Brijonla ; if from eating iiit meat or "•ch food, Pulsatilla ; if from gi ief, Ignatia. Dose, «me drop, or foi • ules, repeated every three or six hours, according to the 'Icifrce of sulle. .^^\l. llniitlturii, or Waterhrash. — A burning at the pit of the stomach, aiiii ;i cDii^tiint ineliiiatim|>«thetie action of th. >iom:i( h i.lM.ii tiie h.v*. I, causing (niisiderable pain. Br>j»nia. Btllidonna, ('oc- culux. Nu^ r,nniat, and Ar.srnii-uni, roUKfitute the group ot remedu-s to jlivo relief or cm-e. When cold water, tak-n into the stom.icli. is ionnd IN) (lisaiiree with the stomach, , Palmtdld, or Vhhia wiAl aflord relief When any kiod of U»x^ disagrees with the » y k stomach, catising distress and lipadaehe. tfive either Ferrum. Cnup/ior, Chainomilla. Pulsatilla, or Sulphur, in the usual i\im' >4 one drop or lour nlobules. If caused by l)eer, Colocynth ; by nnlk, ^alcarm, Pulna- miii^'Nux vomien. When" animal food proves difficult of dijrv^iion, or lilt meat or gravi-^, drawn butter, Puhatdla, Jfmafi'^^ ^«** 9^mica, Coo- mhis, &c. Dy»]>n*«'a '•'' «" common a disease, and afflicts so great a va- riety of temp^raittwifi and habits, wc will U- exj/licit in pointing to specdie 1 518 DISEASES INVOLVING THE VABIOUS OBQANS. treatment. For hypochondriacal persons, Sulphur, Nux vomica, Ignatia, for liysterical persons, Sepia, Pulsatilla, Myoscyamus, and Lacht»i», for those of a sanguine temperament, Nhx vomica ; for the sympathetic, Puhatilla ; for the bihous, Mercurius viv. ; and for the niuhinchohc, Nitric and Phosphoric acid, Aurum metallicum, &c. When those of a D'jr- •VOU3 temperament are afflicted with Dyspepsia, we find Valerian, Hy^i' lyamus, Pulsatilla, Ignatia, and Mosohus good remedies ; ^hose of a 8crofuh)us habit require Oalcarca, Arsenicum, and Sulpfiur , students afflicted with Dyspepsia require Nax vomica, China, and JFerrum. Doyo and repetition as before. Sea-Sickness. There is no remedy that will prevent sea-sickness, and no condition ot neaith capable of always resisting it. But the effects of tiie sicknt'ss, which lUM often distressing, can be removed by Cocculus, Nux vomica, and Ignatia. If th.;re remains an inclination to retch after the sickness has passed, give Ipecac. Petroleum is often taken as a preventive with success. Mucous VomitiDg. This is simply sickness at the stomach, which may arise from its irrita- ble condition, and result in vomiting of slime, or mucus. The remedies that will obviate the difficulty are Ipecac, Itheum, Pulsatilla, and Vera- trum. Usual dose and repetition. Vomiting of Blood. This may bo caused by Jiiechanical injury of the stomach, and requires Arnica; if caused by pregnancy, Arsenicum; if from retained menses, PhoHph. or Pulsatilla; if from acrid humors, Arsenicum or Ipecac; if from suppressed eruption, Sulphur. Gastritisi or iDflammation of the Stomach. This is indicated by severe pain in the stoniiu'h, continuous vomiting, heat over the regi(m of the stomach, quick and feeble pulse, cold feet, and pain in the head. The remedies lor (lastritis are Aconite, Jiism. Huhnit., Arsenicum, lielladonna. Ipecac, Tart, emetic, Vera- trxim. Lobelia, and Cocculus, and somutimcs Nux vomica. Doso and repetition as usirl. GastfodyDia, or Cramps in the Stomach. A |);iin in the stDUiacli, with cnunp, is v»i y distn'Hsiiig, and i-annot 1 mistaken ; t'ur the t nnnp is ji sudden spasmodic action of the museles oi the st()in:ieli, which seems like takinij tlie breath out of one. Puhii- tilla, JVnx vomica, and Cnlorynth are the r»»medios. Any one o; thoni will bo likely to afford prompt relief. Dioscorea is usidul. Inflammation of the Bowaia. A severe pain in the bowels, with distention, and such sflflHBkto the touch that weight or pressure cannot be borne, betokens mmnm. m tion. Aconite may be given in the usual dose, every half-hour at first. If perspiration occurs, and the vomiting continues, give Bryonia in the same way. If there is tympanitis, or distention, so that percustuon upon the bowels causes them to sound like a drum, Terebinthe, Aritenicum, and Mercurias must be consulted. If the discliar be unable to bear the weight of bed-clothes. Aconite given in the usual doses every halt-hour, until the skin becomes moist, and then Jh^lUidonna, or Vcrat. viriUe. It there is thirst, Arsenicum; Pulmtilla, if in females. .Vux vornica^ if the bowels are constipated. If dropsy of the alxlonien follow, give Ilellehorns nif]., or Apia mellijica. Diet, — a very light gruel of corn-starch or farina. Diarrhoea. A looseness of the bowels, which may be watery, bilious, pappv, pain- less or with pain. A merely relaxed eoiitliti'>n ()f the bowels niny U* cured by a single dose of four globules o\ PuUatilhi ; or, it not arre^i«->J by tliir, give Jlcrcurius. A watt'iy iliarrlia-a may be arrested with ('ha'iioiuHhi, Nu.c vomica, or I'cratnim; a bilious diarrhiea. with A-»»'m''- cum and Mcntiniis ; a painless and invohnilary diarrhiva, with Pht'mi'horii ariil. I)ian-li(ea witii eolie recpiires ('hiiiw.inWa aiiM globules in half a tumbler of water, may be the mode of preparation. Tlio diet for persons suflering from diarrlmvi may be mutton-broth, beef-toa, boiled uiilk, or toast and tea, as the patient may elect. Dysentery. One of the moat formidable and prostrating diaoascs is Dysentery. It usually begins with a diurrhd'a. thoiigii ocuasionally with constipation, after a s«asou oflassitudc. and iiicrcasos until mucous discharges from the bowels follow. Tlie disease is diaiacteri/.cd liy nmch stniiiiiug wlien trying to evacuate tlie bowels. Tliis stiaiuing is involiuitaiy mid i)aiiilul. .lust be- fore tliere is an inclination for a slool, tluMc is usually a sharp pain in the lower portion of the abdomen . nyscnterie discharges are umcus mixed with blood, or pure blood, or no bloo stop the vomiting ; Ipecac, Tart, emetic, Podophylluvi are severally good remedies, and any one of tliem may com- plete the cure ; four globules may be given every iifteeu minutes until relief is obtained. Asiatic Oholera. More formidable than Choleia Morbus is Asiatic Cholera, as its attacks are insidious : first, by painless diarrluea, whuih seems to iiulicate that all the contents of the alim(aitary canal an' in a soluble condition. Floods of rice-water discharges pass fix)m the bowels, and tho same matter is vc)rr>it<'d profusely. Alter a time, the lowc^r extremities begin to cramp, and then the cramps come in the abdomen ; and, if the disease is not biSEASES INVOLVINO THE VARIOUS ORGANS. 521 Arrested, the patient soorv passes into collapse, and then to the grave. The treatment of this disease in the early stjige is very important. Very few cases need to prove fatal, if timely resort to the proper treatment is bad. As soon as the jtatient is attacked with diarrliocu, let him <;o to bed, and take Verati'um album. If lie has grt-at tiiirst, let liiin take Arseni- cum. If witliout puin, P/iosphorio acid. If with voinitinj; and pui'j;iti^, ;\nd ^reat prostration, 7m wr«/c'w/wr. Oflicr renu-dies, such as UlcUeruin, Secale cormdum, Catnphor. and Mercuriiis rir. may l)o consulted. Cuprum acet., if with vi(dent cramps. The inediciiios may l)o ad- ministei'cd every thirty minutes. In the collapse stage, givo Muri- atic acid, — ten drops in half u tuml)ler of water, a teaspoonful (!very twenty minutes. But little time can run to waste at any stage of tho disease ; every moment recjuires vigilance and attention. Should the disease pass over, and tho patient is left, he mast first have a stiuui- lutiiig diet, and then more and more geniu'ous, as he can bejir it. GonstipatioD, Costiveness. A confined condition of the bowels is scarcely a disease by itself, but a symptom that attends many maladies. In a torpid state of the livcr, it is generally manifest, and requires a treatment tending primarily to allect tills (U-gan, and thence tlie bowels. VVlii'ii tliere is a sense oi fulness in die rectum, Bryonia; when a teilious coiisti|iation, that indicates great ior|)idity of the bowels, Lycopodium ; a constipation following a diarrhoea re'.|uires Merairius viv. or iSulphiir ; a constipation resulting from a col- lection of hardened faiccs recpiircs Sulphur '.\\\<\ N'ux, vomica, or Sili~ cea. Two doses a day, of any of the remeclies, will be siilKeient. A diet for those addicted to habitual constipation is important: corn- lueal mush, brown bread or bran bread, prunes, apples, and other kinds of fruit are reconnnended. Invermination, Worms. This trouble is indicated by tlie cliiid iiickliig its nose, and by vora- cious ajmerite, restlessness at niglit, colic, and souu'times diarrlia-a and jiale exp.'ession of the face. Tlu.' reineclies for this ditliculty are iSantn- /(///, Ci/ia, Spiyclla, China, and Sulphur. Santuuln will suit bettei tor (111 long round worms, and Ciua, Calrana, and Nar. vomica for the pin- 'vorui3. Dose and administration as usual, three times a dav. Protrusion of the Intestine. Falling of the bowels, as tho [)rotrusion is usually termed, is caused by protracted diarrhoea, and straining at stool, while the intestine is weak and relaxed. Podophyllum, Mercurius viv., Tgnalia, and Aloes are reme- dies that will euro the difficulty. Either maybe given three times a day. Aoute and Ghronio Inflammation of the Liver. Denoted by ])ain in the right side, below tho ribs, sometimes se- vere and at others iluU. If there is fever, give Aconite or Verat. ■ viride, and follow with Nux vomica in Acute Hepatitis, and repeat every hour until relief or chan<;e. If much thirst, give Arsenicum. In the chronic form, a daily dose of Sulphur or Sepia, Mcrcuriua viv., Nux vomica, Pulsatilla, or Pudojihyllin, will do as much for the patient as auy treatment in the world. Jaundioe. When the gall-duct of the liver becomes obstructed, and the bile i.s prevented from passing off in the usual way, it sc-eks an escape throuj;b tlie skin, and gives it a yellow color. This is Jaundice. Podophyllin, Chelidonium, Mercuriua, Dulcamara, Leptandria, and ^ux vomica .ire competent to cure the severest cases. Carho regrtabilis, in a crude form, may bo given in massive doses wlien an offensive odor conies from tlic mouth or breath. The |):iti(>nt, having no appetite, must be supplied with some farina or rice, cooked in tiie most deli(;ate way. Inflammation of the Spleen. The spleen, being an associate purificatory organ with the liver, is liable to similar affections. When inflamed, it is manifest by pain in the left side, below tlic ribs. The same remedies tliat affect the liver will also affect the spleen. For congestion of the spleen caused by running, unmodeiate laughter, etc., China, a single ordinary dose, will answer. Painter's Golici The effects of lead upon the alimentary canal are sometimes disastrous ; and painters who work much in mixing the various preparations of white lead are liable to imbibe sufllclent of its poisonous quality to give them a most distressing colic: hence its name. The remedies employed inanti- doting the cffiicts of the load aie Opium and Alumina, or Colocynth. Should the first-named remedy fail to afford relief, try the next, and so on, in doses of three drops of the dilution in a spoonful of water. Olive oil, a wineglassftil every three hours, is good. Files, Hemorrhoids. There occurs in the rectum a class of small tumors, caused by conges- tion of the hemorrhoidal veins ; and these sometimes b;come so swollen as to protrude from the anus. Sometimes these protruding tumors are numerous, and resemble a bunch of grapes. They are exceedingly painful, and destnictive of comfort. To cure them is of the utmost importance. Constipation being often one of tlie proximate causes, such remedies as overcome this condition must be called into use. Nnx vomica, taken at night, has often proved salutary. Sulphur, when the tumors are painful, and sting and burn so as to be almost unbearable. For Hleeding Piles, IJamnmelis Virginica is particularly recommended. For excessively burn- ing piles, Arsenicum; and for those of a blue color, Conium, or Muriatu' acid. Each of these remedies may be employed in the liquid form, and three drops of the dilution may be taken in a spoonful of water every eight. The tincture of Podophyllum is also a valuable remedy, and may be administered as above ; and so also is Collinaonia. To designate l! lllt»KA^Eil OK IHK UKSt'lKAlUKY ORGANS. an appropriate diet for one afflicted with Piles requires a little care. Salt provisions must peneraliy be avoided. Tlie free use of stimulating drinks IS pernicious. Bran-bread and fruits are commendable. Meats, not iiijrlily seasoned, are allowable, and most kinds of vegetables. IfcllinK of the Anus, which sometimes is a concomitant of Piles and sometimes of worms, is cured in the fii-st instance with Sulphur^ and in the latter with Cina. The usual dose should be given night and morning. DISEASES OF THE KESl'IRATORY ORGANS. The organs of respiration embrace the nose, larynx, trachea, bronchia, lungs, pleura, heart, and their ay)pendages. We will therefore consider the diseases that affect them in their order. Ooryza, Gold in the Head. When, from exposure to cold, the nose becomes stopped, and there is an inclination to sneeze, and the eyes become more or less affected, the following remedies, as indicated, will prove useful : Nux vomica at night, should the Coryza be more apparent in the afternoon or evening, and particularly if it is attended with cold affecting the entin; system. Sti- biuin, or Tart. «/«., is a good remedy to lubricate the stoppage of the nasal passages; Hepar sulphur, also, when this stoppage is paiiiiully dis- agreeable ; .Irttenicum^ or Euphrasia, w]wu Ihere is a thin, acrid dis- charge from the nose. Fnlsatilla is best for children and ladies, when '•;)trering from Nasjil Catarrh. Coryza is synonymous with acute Ca- tarrh, as both affect the mucous membrane that lines the cavities of the nose. CliroiliC Catarrh is much like the Acute, only all the symptoms have become persistent. Acute Catarrh is often cured in a few days by Mer- (•urii(S, Nux vomica. Belladonna, Pidmtillu, Tart, cm., Hcpar aulphnr, : i\A if^ulphur ; Mercuriun, for stupciying iu'adaclK' with catarrli ; Nuxvoiu- ii.a, when the catarrh occasions nau.-ca ; JicUadonna, when thure aci-oui- |i;iiiies the difficulty pain over and in the eyes; Palmtilla, wiicn tlii-Te is lii'piossion ot" spirits; Tart, em., Jlrjxir Kulphnr, ixud Su//ihiir, to remove obstructions in tiie nasal ducts, and tosubihu' irritation aiidsoniifss of the fxternal orifices of the ducts. Doses as usual, repeated threi- times a day. Ill the treatment of Chronic (/atarrh, other remedies are called into requisition. Aurum metallicvnn, if there is a heavy yellow discharge from the nose, or crusts form at night; Mernirtus I'odatus, in scrofidous persons; Au7'um muriaticum, if there is any affection of the vomer, or partition of the nose ; Sulphur and IJepar sulphur mv, both vali;- ablo remedies, as are Arsenicum and Lachesis, when the peculiar symptoms are such as to indicate their affiliation. The remedies for the chronic form need not be repeated so often ; once in twenty-four hours, in the usual dose, is sufficient. 624 DISEASES OF THE RESPIRATORY OBGARS. Inflammation of the Larynx. The upper part of tlie windpipe, or trachea, is termed the " Larynx ;" and, wIk'ii iiifluincd, it is suid to be aiFected with Laryngitis: and this may 1)0 acute or chronic. Acufc liHryii'.' tiu'i is paint'nl soreness of the larynx, j^ive livUaduiina, Aconitf will rernevt tin? lever, and lidladonna the conj^estion of the capillary ve-.-i'|s of tin muc(»ii8 mombmnc, which ctuisos the hohmicss. Afcmn-hiM V7v. ofieti follows JJHladiniiHi well. If, aftortho ciiiploynient of lhes(! r(>m(Mli(>s, oxpectonition «>f mucus occurs from cou;^hiii[ irritatitui are constant, and the expectoration jfoan- tinies great. The disease hecoines chronica from the weakeniiii^of theori:an after one (»r more acute attacks of the disease. It sometimes miti^ati's in warm weather, and returns aa;ain in winter. Art/antuin mctallicim is a f^ooil ri'inedy for tin; chronic form, when characterised hy soreness (it the throat. Jirl/iulonna is always useful when the dillieulty is aggravated by a cold ; Ph'ispfwnis, when there is considerahle collection of nmcus. and Ui'par Kii/ftltiir when there are excessive dryni'ss and hoarseness. Caustifiiin is particularly useful when the inllaininatiou is persistent, ami the cough constantly excited, and when it resembles a croupy cough, ami comes i)n spasmodically or in |)aroxysms. When Chronic Laryngitis is iu)t kept in cheek or cured, it soon runs into that formidable disease known as Laryngeal Consumption, or becomes attended with hectic fever. In such a case, give St(inn>iin, or perhaps S id pi air ; but in no case uhmv than one dose a day. The patient should be warmly clothed, and slioulil always provide lor tempering ct)hl air before it is inhaled into the \\x\\^i. The diet must bo nutritious, and strictly non-inodicinal. Group. Croup is of two kinds, spasmodic and membranous. The spasmodic is the result of a cold ; and it comes on with a hoarse, rough cough, which is often spasmodic and suflocating. Tiie catarrhal or membranous conies on like a cold, and then supervenes a crowing cough and copious collec- tion of mucus ; and sometimes an exudation of a membranous charactir fills the larynx and upper portion of the trachea. For spasmodic croup, Tartar tmetia is undoubtedly the best remedy ; Aconite^ when there is fever: Belladonna, if tlio throat is sore ; Ipecac., if the brcatliing is asth- inutic. In membranous croup, u resort must be had to Aconite ut first, to induce perspiration ; if this fails, give Brtfonin, and then Spongia Iodine, Bromine, and Hepar nulph., in the order mentioned. The usual doses may be given every fifteen or twenty minutes wlien the symptoms are alrrming. Croui) goes under the teeluiical name of C'yuanciie TrachcaliB, because it implicates both tliu larynx and windpipe. • Inflammation of the Windpipe. — Tracheitis. There is some resemblunee of this disease to croup ; and yot it may occur, and not munifest tiuit peculiar character. It is denoted by cough, wtnu'tiines exceedingly tight, at others looser, gnjater or less obstruction of the breathing, and some pain and soreness of the throat above, und a tickling, raw feeling below, towards the bronithial tubes. Aconite is eHsciilial in tho treatment of this dilllcully, and also IieUadctoration. This disease is called Catarriial I'cver in its acuto form ; un ^> e and experience have brought a better adaptation of the temperature and continuance of the water appliances to the symptoms, constitution, and temperament of each patient. Formerly, weak, exhausted, and nervous persons, not less than the fuU-biooded and strong, were put into the wet-sheet pack, and reduced near to death's door ; and there is reason to believe that in some cases where the practice is in ignorant hands, this barbarity is not wholly discon- tinued. The practice, however, is now mainly in better hands ; and although I by no means admit its sufficiency as a system of remedial agencies, I am persuaded it is doing some good. Used in connectioiv with the ancient system of regular medicine, which is the joint pro- duct of time, science, and experience, the water treatment, moulded and modified to the circumstances and strength of the patient, is an auxiliary of no mean power. As such, I accept it As such, it is re- ceived by hundreds and thousands of regular practitioners throughout the world. Further than this, it never can or will be generally re- ceived. By pushing it beyond this, its rightful and honored sphere^ its friends only limit its progress, and injure its influence. The following is the substance of Dr. Shew's description of hydro- pathic appliance. The Wet-Sheet Pack. In this process a coarse linen or cotton sheet is used, long enough to reach from the patient's head to 'he soles of his feet, arid about two yards in width. The bed is stripped of all its covering, one or Via. 178. two pillows only being left for the head. One or two comforters are then spread upon it, and over these the same number of woollen blankets, which are less injured by wet than cotton comfortables. The sheet having been pretty well wrung out of cold water, — always pure and soft, if such can be had, — is then spread out smoothly upon the blanket. The patient, being undressed, lays himself upon the sheet, and, his arms being held up, an assistant laps one side of it over the body and lower limbs ; when, the arms being dropped at the sidp, the other part of the sheet is, in like manner, lapped over. The blankets are then, one by one, brought over the person in the same way, and tucked under from head to foot Comfortables may be added, if necessary. (Fig- 178.) It is always Oest i-o place a wet towel, covered with a dry one, on the patient's head while he is packed. If too much chill is not produced, the dry one may be left off. This is the ordinary way of taking a pack in chronic disease. 'J'he wet sheet is one of the most soothing and agreeable of all the water appliances. Hence it is that it is so often misused. It is so delightful, and tends so much to produce slumber, that the patient never feels ready 1o get out of it. But this slumber, — so profound and sweet as it often is, — he should remember, way be only an apoplectic stupor, which leaves him with a swimming head, attended with faint- ness, perhaps, and ending in a severe headache ; giving him, in short, a congestion of the brain. All this happens in consequence of robbing the skin too long of the air it should breathe. There has been a notion at some of the establishments that the wet sheet is to be used for sweating ; and to this end, the patient has been literally stewed hour after hour, in some cases, even fuur, five, and six hours in succession, with the view of sweating him. All such practice is hurtful. If the patient gets better under it, it is iii consequence of the good effects of water used in other ways, coupled with the ever-important adjuncts, air, exercise, and diet. In later times, Priessnitz never sweat patients at all, much less in wet sheets. If a man must sweat, leave off the wet sheet assuredly, as that only hinders the operation. Use the blanket pack, or the vapor bath. How Lony shall the Pack Continue ? — Here, too, tliere has been, and still is, much error in hydropathic practice. " Stay in the pack till you get warm," has been the old doctrine. But some get warm at first, and afterward get cold ; — so at least they feel. What is to be done ? One of Priessnitz's improvements was, to give short packs. " Re- main enveloped for fifteen or twenty minutes only," he saul. " If you are not able to bear the pack in that way, take the rubbing wet sheet and the lighter processes until you are." In some cases he gave two or three of these short packs in succession, the patient rising between rw 530 PROCESSES OF THE IIYDROPATTIIC TREATMENT. each to take an airing, a rubbing wet sheet, or other bath, and then returning to the pack. Thus far the wet sheet has been spoken of jis used in chronic dis- eases. In acute attacks it is managed differently, according to the case. If the object be to abstract caloric from the body, we cover the sheet but little, — with a single dry shec^t, or a blanket or two, or, per- haps, with noMi; of these. We know that if we keep a towel about a keg of water in a hot day, th(^ water will l)c made cooler by evaporation. In the same way, when a paticMit is hot and feverish, we keep one, or, still better, two \vr\ slieets around him, without oth(!r covering, and thus bring down the licivt and circulation to any desirable degree. We sprinkle watfer upon the sheets, or rewet them as often as is necessary, — in some extreme cases of fever continuing them a whole week or more. Ex- perience teaches that the continuous applicatio'i of the wet linen is, in such cases, a most serviceable application, and one that tends most powerfully to induce in the dermoid structure its natural and health- ful state. The Wet Sliect Acts by Absorption. — It draws morbific matter out of the body, as any one may see who applies the sheet for a short time, and then washes it. Observe, too, what an odor comes from the sheet when a diseased j)atient has been packed. At the same time, it absorbs the pure water into its finest tissues on a large scale, thus supplying that duid which of all substances the system, under such circumstances, most needs. This moist warmth of the sheet also acts as a most soothing poultice. The Wet Press. A MODIFICATIo^: of the wet sheet, and in some respects an improve ment, is the " wet dress,"so called. A coarse linen or coiton dress is made with large arms, so that one may take the application without help. The dress being wet and ap* plied, the patient lays himself upon blankets, in which he wraps himself just sufficiently to become comfortable. Or, he may have dry flannel dresses to put on over the wet one, and then lie in a common bed In this application, the air is not excluded from the surface to any thing like the same extent as in the common tight pack. Hence, i. patient may remain in it a half, or the whole of the night, if he chooses, — being careful to become neither too warm nor too cold Rewetting once or twice in the night will be of service. Often in a single night a bad cold may be thrown off" in this simple way. The Half Pack. Many patients have so little reactive energy, that while they can bear a half pack, so called, the entire sheet would abstract so much caloric from the body as to injure them. In such cases, the sheet is to be applied so as to extend only from the arm-pits, or at most, from rilOCKSSES OF THE HYnUOPATHIC TREATMENT. 5;n thn neck to the hips, leaving the lower extremities, as it \vi re, in the dry park. Sometimes the sheet is allowed to extend to the ankh's, not ineinding the feet. Packing the trunk of the body in wet towel:>. acts upon tlie same principle as the partial or half pack, and is, in many cases a valuable preliminary measure. It is well to take these preparatory steps when a patient who has sulll'red long from et, for enclosing the trunk from the armpits down. Two thicknesses of this are wet in cold water, to come niwt the body. This is a valuable applicati»)n in a host of ailments, as pleurisy, iridaimnation of tlu; lungs, inflammation of the bowels, colic, cholera, cholera morbus, rlunimatism, painful menstruation, after pains, etc. This remedy, which can be applied in live; minutes, will often soothe a patient (piietly to slee|), whose lot, without it, would be a night of agony. One advantage of this application is, that if a patient is loo ,weak to rise, the sheet may be opened in front, so that fresh water may, when needed, be sprinkled upon it, and wet towels may be added under it, upon the abdomen, if necessary. In all the methods of applying the wet sheet, there can be no pos- sible objection to using warm bricks, bottles, etc., for the feet when cold. Bath after the Pack. — It is the practice generally to take some form of the bath after the pack. If the patient is too feeble to rise, an ablution is performed while he is in bed. In other cases, a wet- sheet rubbing, shallow, plunge, towel, or other bath is resorted to, but not strictly of necessity. It is better, however, as a rule, to make the process a compound one, that is, to take some form of bath aftef the pack. This should also be followed by exercise in the open air, if it can possibly be taken. A pack, followed by a faithful turn at work, or by exercise in the open air, is always worth much more than when followed by rest within doors. The Rubbing Wet Sheet. The rubbing wet sheet, too little appreciated, and too seldom used, is one of the most valuable of all the hydropathic resources. There is probably no other single application of water, in all the multiform modes of hydropathic medication, that can be made, on the whole, as useful as this. It is a tonic, a stimulant, a sedative, an antispasmodic, a derivative, or a febrifuge, according to the circumstances under which it is applied. We take a coarse linen sheet, — although cotton answers a very good purpose, — large enough to throw around the body like an In- dian's blanket It is wrung more or less, according to the demands r)d2 I'UOCKSSES OF THE HYDROPATHIC TREATMENT. case. Thereupon, it is thrown quickly around the patient's who, if strong enougli, is in the standing posture ; and then, of tht body, both patient and assistant set vigorously to ^,^^ j.g •\vork, rubbing over the sheet, not vnlh it, as some do, three, four, or more minutes, until the surface becomes thoroughly warm (Fig. 179). It there is fever, less friction is required. After the wet sheet, comes a drt/ one, to be used in the same manner. Those who have sullicient reactive energy, — and most have, — may dry the body simply by fan- ning it with the dry sheet, the windows at the same time being open. This sort of air-bath exerts a highly pleasurable effect upon the skin. Instead of giving one a cold, it helps greatly to ward it off. This method of drying the body was one of Priessnitz's later improvements. The rubbing wet sheet, it should be remembered, is not a single application, capable of producing only one effect. It is used in three different gradations, and to produce very ditTerent results. It is well wrung, or only moderately wrung, or left quite wet and dripping. If a person is fatigued, or has a low degree of reactive energy, the first form is the one to adopt ; if there is not much fatigue, and good re- active energy, the second ; and if the patient is feverish, and the object is to abstract heat simply, we use the sheet quite wet and drip- ping ; and we repeat it as many times in succession as the case may need., One great advantage is, that we give it before or after a wet pack, when no bath is at hand ; we also give it in connection with an^ other bath ws may choose. See how admirable a remedy the rubbing wet sheet is, when pro v erly understood ! A patient, — a child, perhaps, — is so feeble in the reactive power, that almost any form of bath we can give it sends the biood from the surface, making the lips and nails pale or blue, and the extremities cold, showing congestion of the internal organs. When a bath produces such effects, it is very apt, to say the least, to do more harm than good. But we can apply the rubbing wet sheet in such a way as to cause none of these ill effects ; besides, it may be repeated many times in the day, so as to give the patient the ad- vantage of a strong treatment ; for a lig-ht treatment, which can be easily borne. Is made a strong" one by the frequency of its repetition, A wet sheet, well wrung, holds perhaps a pint of water; or, at most, a quart. Now, it must appear plain, that a pint or quart of cold water, spread over so large a surface as the whole skin, must be- come very easily warmed by the body's heat. Besides, if there is g'reat delicacy of constitution, we may wring the sheet out of water at seventy, eighty, or even ninety degrees, gradually lowering it as the patient can bear it. The domestic availabiliti/ of this application is also to be spoken of. Ti?. every dwelling, however humble, there is the coarse sheet, and the bucket of water. How useful, therefore, as a resort, in home prac- tice ! The rubbing wet sheet appears a trifling application, — one which is not capable of producing any great result. But when we rcmem- bor the myriads of nerves of aninjal life, spread over the skin, and (l(!riv('d from the brain and spinal cord, it need not. surpri/e us that its a|)plication should so invigorate the body, take otl' bodily and mental depression, remove languor and fntigue, expel flatus from the bowclt^, remove thirst, give appetite, and cause a feeling of calmness and relief which can be appreciated only by those who experience it. A minister, for example, j)reaches three times on a Sunday, nnd gets his brain so excited that he cannot sleep. A cold bath would be too powerful, and opiates would only act as stimulants, making the mat- ter worse. Two or three successful applications of the rubbing wet sheet, with powerful friction, bring the blood so much to the surface, that his brain becomes relieved, and he very .«ioon falls into a sound and refreshing sleep. So, too, when a man has been long wet and drenched on a rainy day, and comes home, with the surface and ex- tremities cold, and the blood pressing hard upon the brain and other internal organs, — the well-wrung rubbing sheet is applied, with plen- tiful friction, and at once the oppressed organs are set free. In using the rubbing wet sheet, as in all other forms of general bath, it is well to wash the hands and face in cold water, both before and after it. There is no need of throwing it over the head, as some have thought it necessary to do. A patient needs to breathe freely when he takes a bath. This a|)plication is not always the most pleasant cine. It does, in S'act, require a good degree of mor' ! courage to enable one to endure the first shock. The sensations produced by it are worse, if possible, than those from a plunge into cold water; 1 mean the first touch of the sheet to the body. Nervous ladies sometimes tell us they cannot take the rubbing wet sheet, when, at the same time, they take the cold plunge, which is far more powerful, and perhaps too powerful for their case. This unpleasant feeling does no harm, for it vanishes in a moment or two after the sheet touches the body. The Douche Bath. This is the most powerful, but not the most useful, of all the hydro pathic appliances. A common douche consists of a stream of watei from one to two inches in diameter, with a fall of ten, fifteen, or twenty feet. But douches may be arranged of any desirable size and height. (Fig. 180.) This remedy is useful in paralysis, stiff joints, gout, rheumatism, tumors, and old swellings of various kinds. Those who have weak lungs, stotnach, or other abdominal organs, should not resort to the douche without the best of medical advice. The Shower Bath. This is also one of tbo more powerful of the hydropat'iio appli- anccs, and needs judgment in its vise. It consists, in faet, of a vast number of small streams or douches, and hence is a powerful refrig- erant, as well as excitant, to the system. It is useful to commenco this bath, for a time at first, only upon the litnbs. The Cataract Bath. This also is one of the more powerful of tin; hydropathic processes, and is to be classed with the two preceding baths. Like them it may be said to be stimulant, toiiic, and ulleralive, while it is also highly sedative as far as animal heat is concerned. The Hose Bath. Tnitouon the modern improvements in India-rul)ber, gutta percha, leather, etc., it is easy, whenever there is a small fall or head of water, to arrange what is called a hose-bath. It is in |)rinciple a douche, with the additional advantage that it can be made to act upon any part of the body, and from whatever direction we (thoose. Rightly applied, the hose bath is a valuable remedy. (Fig- 181.) Fia. 180. Fia. 181. The Pail Douche. The process which passes under this name is taken thus : Tlie patient seats himself in an empty, shallow, or other bathing tub, and crosses his hands over his chest. As many pails of water as are or- dered are then dashed over him suddenly, one after another, before and behind alternately, — not poured, but thrown with some force, by first a backward and then a forward motion of the pail. A better method of using it is, for the patient to stand in an empty PROCESSES OF THE IlYDllOl'ATMlC TREATMENT. 5ar. bathing tub, while an assistant takes two pails of water, one ten de- grees warmer than the otiier, and empties th(^ warmer half upon the chest and half upon the back, and then bestows the colder pailful in the same manner ; then dries with friction. The Wave or Sluice Bath. This is taken at the sluice-way of an undershot mill-wheel, or in any similar place. The patient takes hold of a rope, or something by wliicli he can maintain his position, and th(Mi, iyini^ down, subjc^cts Ills body to tilt! action of the wafer. This is, on tlic whole, a pleasant and agreeabu; bath, and in its eflects somewhat- rcsenibles the douche, being, howeviT, milder and safer. The Half Bath. Tins bath may be used as one of the mildest of the water-cnre p^o'•.essf^, or as one of the most powerful. An ordinarv bathing tub is a very good apparatus for the purpose. A good sized washing tub will answer very well, if there is nothing else at hand. The water should generally be quite siiallow in this bath, — from three to six inches. Priessnitz's half-baths were made of wood, four or five feet long, about two and a half feet wide, and twenty inches deep. This simple contrivance is one of his most powerful remedial means, — that by which some of his highest triumphs are achieved. The water is generally used of moderate tem|)erature, at sixty to seventy degrees Fahr., and, when long continued, is changed, as it becomes warm from the heat of the body. This bath may be used, ■ First, as a means of cooling the mass of the circulation in the hot stages of fever, and in inllammatory attacks of every kind ; Set'Onilly, as a revulsive, or means of drawing blood in congestions or inflanunations of the nobler organs, the brain, lungs, stomach, liver, etc. Thirdly, as a means of resuscitation in the shock of s(!rious acci- dents, sun-stroke, and before, during, or after apoplectic and other lits In drunkenness and delirium tremens, the half bath is a sovereign remc^dy ; Fourthly, as a middle means, and preparatory to the general bath in weak constitutions.' In the latter of these indications, the bath is generally used but for a few minutes after the wet sheet, or at other times, as may be de- sired. In the former, much practical knowledge is necessary iii order to proceed always with safety, and to obtain the best results. Thus, six, or even nine hours may be required, with the greatest persever- ance, the patient being thoroughly rubbed over the whole surface, and ,thia to be kept up constantly by relays of assistants, the patient's head and shoulders, meanwhile, being supported. I: i; \m. "~ii 536 PROCESSES OF THE IlYDUOrATriTC T.IEATMENT. The Plunge Bath. In sea, rivor, and lake, as wrll as by artificial means, and as a matter of luxury, religious observance, purific^ation, and the preven- tion and cure of dirfcase, the phuige bath has, in all periods of time, and in ixll parts of the world, been a favorite resort. So elli(^acions, indeed, has this simph; means proved in healinij; the sicU, that not a little su|)erstition has been mir.gled with it. Springs and wells have often been supposed to possess soiik! mysterious |)ovver, and for that reason l)een named after some |)atron saint. \n this respect, the world has loved mystery and marvellousness rather than the pure and simple truth. In hydropathic practice, the plunge is much used ; but many pa- tients are not able to bear it. Those who are not suHieiently strong for it at first, should practise the rubbing wet sheet, the half-bath, drinking, exercise, etc., until the plunge can be borne. It is a favorite remedy at all the establishments, to be taken directly on coming from the wet sheet pack. . . The Head Bath. FnoM time immemorial, cooling applications to the head have been much depended upon in that violent and dangero'^s disease, inflam- mation of the brain. All other known r.ic^ans failing, certain obsti- nate affections of the heaa have been known to give way to affusion of cold water upon the part. In headache, drunkenness, delirium tremens, the delirium of fever, epilepsy, rheumatism of the head, dis- eases of the eye, earache, deafness, loss of smell and taste, and in nose-bleed, this highly energetic remedy is brought to bear. In taking it, the patient lies down, placing the back of his head in a shallow dish, filled only an inch or two with water. (Fig. 182.) Fio. 182. Fio. 188. The Leg Bath. This is usefal in cases of ulcers, swellings, eruptions, gout, rhea* matism, spriins, wounds, etc., of the leg or thigh. The relief and PR0CKS8ES OF THE HYDROPATHIC TREATMENT. 537 etrength obtained, oft( n by a single application of this remedy, is truly wonderful. A variety of apparatus may be contrived for auminiHter* ing the leg bath. A eomnion wooden tub, contrived for the purpose, like that represented in Fig. 183, answers a good purpose. In such a vessel, he covers the inflamed limb introduced, and cools the blood flowing to it. The Sitz-Bath. Convenient tubs, wooden or metallic, are constructed for this bathj but an ordinary wash-tub answers very well. The vessel should be Jiir^e enough to permit the motion of the arms in nibbing the abdo* men, sides, and hips, first witl< one hand, and then with the other Water enough should generally be used to pretty nearly cover the belly. The more movement and friction while in this bath, the better. It is more conveniently administered when the tub is elevated two or three inches from the floor. Some undress the patient completely, and place a blanket or sheet over the upper part of the body : bui oftener, only those parts are uncovered which are to be exposed ^ the water. (Fig. 184.) In a variety of ailments, this bath is highly valuable. It may be made one of the most powerful of all the hydropathic mode. Lik»: all other powerful applications, it should be taken only when diges- tion is nearly or quite ron vleted. As a tonic to ,the stomach, liver, bowels, womb, spine, etc., this bath is highly u "ful. In constipation, and other irregularities, it ia famous. Those of sedentary habits will find its use of rare service. For the tonic effect, ten, twenty, twenty-five, or thirty minutes. If continued for some length of time, the water is to be changed once or more, as it would otherwise become too warm. Fro. 184. Fio. 186. The Wash-Tnb Bath. Under a great variety of circumstances, the wash-tnb bath ia as invaluable remedy. For example, a patient is feverish ; by setting .,t.v :. 538 PROCESSES or THE HTBROI'ATIIIC TREATMENT. him in a wash-tub half filled with water, and, at the same time, if we choose, putting his feet in a pail of water, cold or warm, according to the case, we may give him any desirable amount of cooling. We cannot, indeed, too highiy prize this simple contrivance for using water, — a means which every family possesses. (Fig. 185.) The water, as a general rule, should be tepid, ranging from 72° to 90°, and may be prolonged from two to fifteen minutes, according to the strength of the patient. It should never be carriixi to the extent of producing bluencss of the nails. The patient should be dried with towels, or tlie dry rubbing sheet. This bath is useful in flie treatment of eruptive fevers, bilious k- mittents, the hot stage of intermittents, and in hectic and typlioid fevers. It is often used after the wet sheet paciv, in clironic alloc tions, and may then have a little coolor temperatun^ or else be fol- lowed by pouring a pail of cooler water over the shoulders, to tone up the skin. The Affusion. Thk patient stands in a wash-tub, bat'iing-tub, or other convenient place, when, by means of a pail, pitclKu-, or basin, the assistant pours water upon the head, neck, etc., either upon the whole of the body or only upon a part. The water is used in quantity and temperature according to the necessities of the case. The aHusion is one of the best of hydropathic modes. Fifty years ago. Dr. Currie, of England, performed great cures in fever by the afl'usion, sometimes tepid. others cold, according to the strength and heat of the patient. If there was great heat, the water was used cold ; if not, the reverse. In a variety of febrihi disea.se8, such as typ'ius fever, scarlet fever, small-pox, measles, tetanus, con- vulsions, etc., he used this remedy with remarkable success. Towel and Spong^e Bath. With one or two coarse towels and a quart or two of water we may take a very good bath almost anywhere, even in a carpeted room, at a hotel, or wherever we may be, without spilling a drop of the water. After a person becomes iutaistonied to this form of »l)lu" tion, none but the most indolent will be willing to do without it, unless they can have some other form of bath. A daily towel ablu- tion, thoroughly performed, is an excellent prevention against colds, helps the appetite and digestion, and is a good means of preventing constipation. Some are in the habit of sitting in a half-batli or a sitz-tub, and with a large sponge making the water pass freely upon the head, ucc.\i, shoulders, and other parts of the body. At the same time, the bather may pour water from a cup, basin, or pitcher, upon the head, neck, etc. This is a mild afi'usion, and stronger in eflect than the towel> bath. '^;'i'i|' i!'r.i!- ■' •. 'fi'''''W^3^ PROCESSES OF THE HYDllOPATIIIC TREATMENT. 539 Wpsh-Down. The process to which thiti name is given by Dr. Edward Johnsoiii is practised as follows : " The patiiMit stands in an empty sitting or wash tub, beside which stands a j)ail of cold water with two coarse towels souliing in it. The bath attendant, taking his place behind the patient, lifts one of the towels, all loaded with water, and lays it (luiolily on the paticMit's head. The |)atient itnmediately seizes it. removes it from his head, and rubs himself rapidly with it. — liis face, his throat, shoulders, arms, chest, stomach, bowels, thighs, and legs. Having gone rapidly ov(>r the whole body onee, he drops his Towel into the pail again, which the bath-man presses down to the bottom of the water, then lil'ts it out, and places it on his he;id Mgaiii. As Ix'fore, the patient seizes it, and goes all over the same ground once more, and then drops it into the water again, when the bath-man again lifts it and places it on the head to be a third time; removed by the patient, and applied as before, rapidly, aetivelv, and energetically, all over his [)0(ly in front. 'J'hi; bath-man is inilustriously occupied all the time bi^hind in the same mamier, from the back of the neck to the back of the legs, wetting his own towel as often as he wets that used by the patient, viz., three times. This is called a wash-down of three towels. The patient is then dried in a dry sheet. It is a more powerful bath than the common towel-bath, but not in all respects so convenient to take. The Cold Foot-Bath. Onr of the first things people who are troubled with cold feet do, is to plunge them into cold water. Nor is the assertion, put forth in some of the hydropathic works, that the cold foot-bath was prescribed by Priessnitz for the same purpose that the faculty order warm ones, correct. When the feet arc already cold, neither Priessnitz nor any one in his sober reason would prescribe cold water, which can only make the parts colder. To obtain th(! good elleet of tlu^ cold foot- bath, so far as the feet are concerned, they should be warm whenever it is tiiken. For a tendency to coldness of the \'vi;f, — a very common symptom in these days of so-called luxury and relinenKMH, and one that indicates a state of things in the system incomparably mon; to be dreaded than the mere eoldness of the feet, — this is l/ie remedy, It may be taken at any convenient tinu^ : just before the morning walk is a very suitable occasion, the parts being usually wi.rm early iti the day. At other times, if cold, thpy shonhl, if at all |)racticable, bo warmed by exercise and friction, before subjecting them to the action of cold water. But in cases of old i.ge, great debility, etc., the warm foot- bath, and other warm applications may be resorted to before the cold Thus with cold, exercise, and friction, accustoming the feet daily and frequently to cold water, will beget in them a habit of remaining Warm. In a grc it variety of ailments, such as toothache, rush of riia 540 PROCESSES OF THE HYDROPATHIC TREATMENT blood to the head, headache, earache, inflammation of the eyes, gout, rheumatism, hemorrhages, etc., the cold foot-bath is a valuable remedy. It is ordered deep or shallow, and of duration according to the nature of the case. Wading Foot-Baths. I HAVE often directed patients to wade in water in some convenient place, as a means of hardening the system and of giving tone to the nerves. Delicate ladies who were not able as they supposed, to v.n- dure cold water applied to the feet, have by degrees, wetting the feet but little at first, become so accustomed to the coldest watei , that in a few weeks they could bear as much as any one would desire. Caution and perseverance should be the rule. It is partly by sympathy and partly by the abstraction of heat, that foot-baths and wetting the feet act in so beneficial or deleterious a manner as we know them to do. The principle of sympathy is an old one in the medical art, but none the worst; for that. The Warm Foot-Bath. — Fediluvium. I AM aware that some wiio consider themselves genuinely hydro- pathic, object to the use of this remedy. Having truth for my object, however, 1 care not for such objections so far as myself am concerned, and without stopping here to argue the question, I simply remark that warmth under some circumritances is as natural au application for the living body, as cold under other circumstances. I have already re- marked, under the head of the cold foot-bath, that putting the feet into warm water is often a good preparat..ry process to that bath. It is good also, now and then, for soothing divers aches and pains, and also for warming the feet of old and weakly people, who cannot exercise sufficiently. The Nose-Bath. In a variety of nasal ailments, catarrh, colds in the head, inflamma- tion and ulceration of the nasal passages, nose-bleed, etc., the nose- bath is a salutary remedy. The water is used either tepid or cold, according to the case. It should be drawn back if possible, so that it is ejected by the mouth. Those who have injured the nasal cavities by much snuff-taking, will find advantage from sniffing water freely into the nostrils. If one is determined to leave off snuff, as every one addicted to it, if he regards either health or bodily comfort, ought, he will find it useful often to take cold water, instead of the abomina* ble weed. The Eye and Ear Bath. Various contrivance* may be brought to bear in applying water to the eye and ear. Light, ascending douches and showers are useful in PROCESSES OF THT5 HYDROPATHIC TREATMENT. 541 various diseases of the parts. There should not be much force tised in this way. Immersing them also in water is often useful. The water should not, in general, be very cold, tepid or warm being often the best Mouth, or Oral Bath. For inflammation of the gums, mouth, throat, and palate, in slimy secretions from the throat and stomach, in toothache, catarrh, colds, and chronic hoarseness, garglings and baths for the mouth are of great service. Pauley, a merchant of Vienna, has been thought singular for his zeal in recommending this bath. Clergymen and others who sutler hoarseness by much speaking, will find that holding very cold water in the mouth until it begins to grow warm, and then ejecting it, and by frequently repeating the process, much benefit will be obtained. Coughs and tightness of the chest may ofteil be essentially relieved by this bath. In mucous secretions from the throat and stomach, by ejecting the water a number of times, it will surprise those who have not witnessed the remedy to see the amount of slimy secretion thrown off- Division of Baths. On no one subject connected with hydropathy has there been more ."confusion of tongues," than concerning the temperature of baths. Botli ill books and in popular language, among physicians as well as laymen, have words been used, sometimes confusedly, and at other tiiiies without any meaning whatever. Orthodox medical works, as weil as the Mworthodox, come under the same category of error. A few simple explanations on this head, properly made, will be sufficient for all practical as well as scientific purposes. The simplest and most natural division of baths is into cold^ tepid^ warm, and hot. These are all terms of every-day life, and are fully sufficient to guide us in the selection of any and all the multiform uses of water which hydropathy teaches. I admit, however, that when we wish to be especially explicit, the actual thermometrical temperature should be mentioned. Hot baths, I maintain, have no proper place in hydropathic practice. He who resorts to them either does not at all understand the true principles of the Water-Cure, or is guided merely by the whims or caprices of those who employ him. But whatever words we use to designate the different baths, there is one objection, which is, that all such terms arc necessarily arbitrary in a greater or less degree. What appears to one person cold, may to another appear tepid, or warm, or even hot. Thus it is said that on a road over the Andes, at about half way between the foot and the summit, there is a cottage in which the ascending and descending travellers meet. The former, who have just quitted the sultry valleys at the base, are so relaxed, that the sudden diminution of temperature produces in them a feeling of intense cold ; while the latter, who left wr-f^ 542 PROCESSES OF THE HYDROPATHIC TREATMENT. the frozen summit pf the mountain, are overcome by distressing sen- sations of extreme heat. If on a cold winter's morning we go from a warm bed to a bath of sixty to seventy degrees Fahr., the water ap- pears cold. If we then plunge immediately into water which is at about the freezing point, and- then return again to the water at sixty to seventy degrees Fahr., it appears warm. "When the temperature of the atmosplicre is at til'ty-five degrees Fahr., in November or Octo- ber, in this latitude, and tlie body of a comfortable degree of warmth, and we take three basins of wyter at sixty, seventy, and eighty de- grees Fahr., placing one hand in the water at sixty degrees, the other in that at eighty degrees, letting them remain thirty seconds in each, and then immerse them both in the water at seventy degrees, it ap- pears to one cofd, to the other ivarvi. But we can arrive at rules which approximate so nearly to the ac- tual truth, that they will serve us, as before remarked, for guides in all practical and scientific purposes. Tlie Cold-Bntli. — "With a majority of persons, and at most seasons of the year, water at from seventy to eighty degrees Fahr. downward, gives, when immersed in it, a sensation of coldness. The spring water of all countries furnishes what may therefore be called a cold-bath, although there will be a range of many degrees variation in what we term cold. The Tepid-Bath. — The word tepid is from the Latin tepeo, to be warm. The true English meaning of the term however is, according to Mr. Webster, moderately warm, or lukeivarm ; in other words, water which, when a person is immersed ir' it, gives a kind of indefinable sensation, one which, coming properly under the neither cold nor warm, is said to be tepid. This temperature will be found to range at from eighty to ninety-two degrees Fahr. The Warm-Biith. — The term warm is generally well understood. It means that temperature of water which is peculiarly agreeable to the sensations. Fresh-drawn milk or blood we say 'e warm. The temperature of water which will cause this sensation, varies from ninety-two to ninety-eight degrees Fahr. The Vapor-Bath. — The temperature of the vapor of simple waiNr varies from about ninety degrees Fahr. upward, according to the heat of the water, and the space through which the vapor passes. The Hot-Bath. — The term hot is also expressive of its proper mean- ing. If the body is immersed in water above blood-heat, it causes an uncomfortable sensation, which we designate as hot. Hot water is a disturber of the vital functions, particularly if the whole body is im- mersed in it. Hot-baths, therefore, should be used, if ever, only in a most urgent necessity. Hot water, in no form whatever, entered into any part of Priessnitz's treatment Having thus explained the temperatures of the different divisions of the bath, it is proper to state them in a tabular form, the better to aid the memory. They are as follows : Cold-bath from freezing point, Tepid " . . . . Warm" . . . . Vapor " . . . . Hot " . . . . 32 to 85° F. 80 to 92° 92 to 98° 90° and upward, above 98° I now propose to explain somewhat minutely, and at the same time with a due regard to the needs of the non-professional reader, the physiological etlects of eaoii of the several kinds of bath, and I here r(!s|)ectfully premise that any one who attempts to practise the water treatment without having in his mind clear notions upon this subject is, to say the least, as much a " gro|)er in the dark" as he who attempts the practice of drugs of which he knows nothing, upon the living body of which he knows less. How can a itiari be trusted in water treat- ment if he cannot tell beforehand what effect a bath is to have ; and this he cannot, if he does not fully understand the meaning of the terms which I have here explained. Effects of the Cold-Butli. — The effects of the cold-bath are properly spoken of under two heads, the primarif and the secondary. The terms are sufficiently expressive of their meaning. The first are those which take place at the time of the immersion , the second, those that occur later, constituting what we understand by the term nadion. Immediately on immersion in cold water, the bather experiences some acceleration of respiration and the heart's action, although the pulse becomes at the same time smaller and weaker. Very soon, however, the panting; if I may so call it, passes off; the temperature of the body is found diminished, the surface paler than natural, the skin taking on that form of appearance known as " goose-flesh." The first effect of cold water applied to the body, generally, is to abstract a certain amount of heat from the surface, to constringe the capillary vessels, and to force the blood inward. Now, as the living body possesses the remarkable property of maintaining its tempera- ture at very nearly the same point, whether it is in a colder or hotter medium than itself, the vitals at once set to work in restoring the caloric abstracted by the contact of the water ; and as the functions of circulation and calorification go necessarily together, the vital power, acting through the heart and blood-vessels, attempts a return of the blood that had been forced inward by the coldness of the water. This is wha » call reaction. If the individual is sufficiently strong and well stocked with vitality, the blood is quickly returned to the surface and to the extremities (which are always most liable to become cold, being farthest from the heart), constituting what la termed good, or vigorous reaction. But if the surface and extremities continue to remain unwarmed by this return of the blood to them, as happens in the case of feeble persons, there is said to be poor^ or ir^ sujficient reaction. Effects of the Tepid-Bath. — The tepid-bath, which we have seen ranges from eighty to uinety-two degrees Fahr., produces effects anal- (^#1 544 PROCESSES OF THE HYDROPATHIC TREATMENT. ogous to those of the cold-bath, only not so lasting and permanent It Ik especially useful in the treatment of infants and children, and in all cases where the reactive energy is feeble. If in any case we are in doubt as to whether the cold bath is admissible, the tepid form will be a milder measure, and at the same time serve as a test in ventur- ing upon the cold. The tepid bath may be continued longer at a time, which in some cases will be found an advantage. Etfects of the Wunii-Buth. — There is among hydropathic physi. cians, if I am not mistaken, too great a fear of warm applications on the part of some, while others go to the opposite extreme. Mark, I speak of warm applications. Hoty as before remarked, have no proper place in hydropathy, — a rule to which the exceptions are few. The warm-bath, as before remarked, ranges from ninety-two to ninety-eight degrees Fahr. It is not the most useful of the hydro- pathic resources, but one of the most useful, as I shall endeavor here- after to show. Among the ancient Romans the warm-bath was not considered as a means of luxurious indulgence that tended to weaken the vital powers, but a means of refreshment for the wearied traveller, and of prepar- ing him for the repast and the enjoyment of other rites of hospitality. The effect of the warm-bath is not one of debility, as many suppose, but, on the contrary, it is a sedative, lowering the heart's action and the circulation, and tending to repose rather than excitement. Effects of the IIot-Bilth. — The hot-bath, before remarked, is one which is above the temperature of the blood, ninety-eight degrees Fahr. It was laid down ais a precept by Hippocrates, that a bath en- feebles when the heat exceeds that of the body immersed in it. The truth of this precept has often been verified in practice. I do not wish to be understood as affirming that hot applications can never be made with benefit to the body ; on the contrary, heat applied *o a part locally may be of service, although I am inclined to believe that even in those cases where heat acts in a beneficial way, 8ome other form of hydropathic appliance can be used more benefi- cially. I make, it will be remembered, a broad distinction between the terms hot and warm. Sea-Bathing. As regards temperature, sea-bathing comes under the gerieral head of cold-baths. Sea water, however, at those seasons of the year when sea-bathing is resorted to, is of but a moderate degree of coldness, varying in this latitude not much from seventy degrees Fahr. In order to appreciate fully the eftects of sea-bathing upon the sys- tem, a number of things are to be considered. Sea water differs in its effects from common water by its possessing greater density. This circumstance, however, is not of so great im- portance as that of the stimulating nature of the mineral it contains. The saline ingredient is a powerful stimulant and even irritant of the skin. On account of this property, it is found that an exposure to the PROCESSES OF THE HYDROPATHIC TREATMENT. 545 action o ' salt-water is not so liable to cause ill effects as that to fresh. The salt causing a degree of heat upon the surface somewhat higher than that of the natural state, the system is for the time shielded from the actitm of cold. It does not follow from this, however, that a person could live longer immersed in sea than in common water, any more than it follows that because alcohol for a time increases the ani- mal tnniporature, life can, under circumstances of great exposure to colli, bo the longer preserved. This it is now well known is not the case. An advantage of sea-bathing in the hot season is, that tne air at the sca-shoro is cooler than on land. That our climate in summer is too hot for the most favorable development of health is proved by tho great increase of mortality, not only in our cities, but in other parts, during the hot season. Tlifi European cities, with all their iiurabirs of inhabitants, dampness, narrow streets, intemperance, pauperism, etc., would naturally be expected to show a higher range of mortality than our American cities, but such is not tho fact. Even Now York, with all its natural advantages, is as sickly, probably, as any of tho British or European cities. This, it is agreed on all hands, must bo owing in great part to the great heat of our summer months. The manner of taking tho salt-water bath has some peculiarities which are favorable to health. It is, in tho first place, in tho open air, which, if the weather is favorable, that is, neither too hot nor cold, is always a great advantage. Other things being equal, a bath in tho open air is always attended with a better reactiuo and a greater (leirreo of iuvijroration than ono within doors. In the second place, sea-bathing is usually and almost necessarily connected with exercise both before and after the bath, circumstances which are alwa^'s highly favorable to the action of cold water. So beneficial, indeed, is exercise taken in this way, that it would be dif- ficult to determine which of tho two — the exercise or the bathing — is the more beneficial. In connection, the two act reciprocally upon each other, each rendering the other doubly beneficial. Injections. The term injection implies the act of throwing a fluid into some cavity of the body. In Water-Cure we inject water ,more frequently into the bowels than any other cavity. This kind of injection is also called enema, or clyster. Most people have so little confidence in simple water, that if a clyster is administered to them, they have no idea that it can operate ill so effectual a way as it usually does. Years ago, when the water treatment was much less known than at the present time, I have f^een suspected of having secretly put some cathartic sul)stance in tho water, " for," said the patients, " how is it possible for water to act in this way ? " A great variety of injection-i'^struments have been invented. Some _^ G9 WV.-3 m 546 FBOCESSES OF THE HYDROPATHIC TREATMENT. of these are very convenient and useful ; others are got up on mere speculation, and are but little worth. Every family, at least, ought to have a good force-pump injection-instrument, it they can obtain such a one. A lady's toilet is never complete without it. A good article is either manufactured or sold by most surgical-instrument makers, and druggists often have a good article. J^ut beware of im- position. It is better to got along with a common bladder and goose- quill, as wc may in an emergency, than to pay for a good-for-nothiug syringe. Modus Operandi of Water. It is often objected to hydropathy that water, being but one agent, cannot be made useftd in all diseases. • I propose here to make some remarks on Ihe modus operandi of water, in which I shall endeavor to explain, not only to the scientific scholar, but to the ordinary reader, that water is capable of being made available as a remedy, — and that powerfully too, — in a great variety of ways. It then acts : 1. By its Presence. — Water, as we have seen elsewhere, com- poses the larger part of the living body , and that without its pres- ence in a large proportion in the living system, the vital processes cannot for a moment go on. 2. By its Coldness. — Cold, within proper limits, preserves and augments life, while heat tends to debility and decay. In proportion as the animal heat is diminished in the different classes of animals, the less is the want of air felt. If in a puppy the eighth pair of nerves bo divided, producing a closure of the glottis so that no air can enter its lungs, the animal dies in half an hour, if kept at an or- dinary temperature. But if the animal is benumbed with cold it survives the operation ri)r a whole day. Frogs, in the summer, when the temperature of water is elevated, are obliged to come often to the surface for air. But in winter, when the water is colder, they live almost entirely under its surface. A cholera patient in collapse, a person who has been stifled by foul gases, one in the sinking stage of a fever, or fainting from loss of blood, or in any way asphyxiated, desires always coldness rather than heat. It may not be possible in the present state of science to explain these phenomena ; but unde- niably we have the facts. 3. By Endosmose and Exosmose. — Animal membranes have the power of absorbing liquids, — called endosmose, or imbibition, and of throwing them out, exosmose, or transudation. ? _,, If we take a portion of the intestine of a chicken, tie one end, nearly fill it with milk, then tie tne other end, and lastly immerse.it in a tumbler or other vessel of pure water, we find that in a short time the milk passes out of the intestine into the water, and the water inwardly mingling with the milk. This process goes on till the fluid within and without the intestine becomes one and the same. This is a familiar illustration of the principle in question. li 4. By Dilution. — Water is the greatest diluent in nature. There is no substance which is at all comparable t«) it for penetrating the myriads upon myriads of capillaries that exist in nil parts of the living structure. When the fluids become thick, viscid, and filled with impure matters, as is usually the case to a greater or less extent, iiidisease, it is an important olycct to dilute these matters. For this purpose water is the only available remedy. 5. By its Tonic Effect — Water is the greatest of all tonics, and possesses the valuable property, not of wearing out, but of increas- ing in its good effects. 6. By its Excittint or Electriciil Power. — A man feels dull aid stupid from excessive bodily or mental labor, from excessive alinien> lation, or spirit, or tea and coffee-drinking, with the blood all crowd- ing up into his head. We apply the well-wrung rubbing wet sheet one, two, or three times, to his surface, according as he may need, and he at once perceives a roost wonderful change for the better. Or- a man feels of a morning dull and stupid, with his muscles sore ; he has the rubbing wet sheet, the plunge, shower, or douche, and in- stantly his troubles banish. Or he may have a lumbar abscess, which has run him down so low that when he wakes in the morning he finds he cannot walk. Two or three gallons of cold water are poured over him, upon which ho walks readily. Now these effects of water, re- markable as they are, arise simply from its excitant or electrical power. 7. By its Temperature. — In acute disease, in all fevers and in- flammations, of whatever name or grade, the great power of water to filiate the temperature of the body is one of the most striking of all the phenomena cognizable by man. By the use of cold water wo can always vary the heat of the body and the velocity of the heart's action to any desirable extent. 8. By Pnrifyins the Blood. — Water accomplishes one thing which no drug, no other substance in nature can. It purifies the blood. It does this because it penetrates every laiw and alley of the system, however minute. No capillary is so delicate that it does not pene- trate its smallest possible part. It purifies the blood, because as long as the vital principle! lasts, the tendency of nature is to preserve the vital fluid in a healthy state ; and penetrating every tissue of the body as water does, it assists nature in the purifying process as no other substance can. 9. By A:i$:mentin]g^ the Vital Force, — No fact in science is better established than that water possesses the power of actually increas- ing the amount of vitality in the system. This is, in fact, the prime effect of water. It aids the system in throwing off disease in the eatne way that increasing a merchant's capital aids him in throwing off debt. The foregoing propositions are submitted as elucidating some of the leading principles concerned in the action of water upon the Ut- FT 548 PROCE8SE9 OF THE nTDHOPATinO TRBATMBNT. ing body. I do not claim, howv ver, thtit tho whole of the philoao- phy of tho cfTocts of water is yet uiidorstooc] by any one. Doubtless those who know most about it buve yet much to Icain. Rules for Using Water. The Time of Day. — In general, the more powerful applications should be made in the early part of the day. At this time the calor- ific powers and the circulation are more vitained, as this mode of opening windows is too gener- ally neglected in the construction of modern houses. No room, how- ever large, should be used as a sick-room, unless it has a chimney ; but neither the chimney-board nor the soot-board of tho apartment should bo put up, even in summer. No article of unnecessary furni- ture should be pei'mitted to remain in tho room ; and lliut which is left in it should be of a description fitted to administer to tho conven- ience of the invalid. Two tables are sufficient. One of them may bo small, to stand near the bed,- for tho immediate use of tho patient : namely, to hold his jug of barley-water, or toasc- water, or other beverage ; — a small tea-pot, or, what is preferal?le, a half-covered cup with a sjiout, to enable fluids to be administered without raising tho sufferer in bed ; — his medicines for tho day ; — and any other thing which ho may fre- quently require. The other table should be large, for tho accommodation of medi- cines not in immediate use, and also "or spare glasses, jugs, cups, * Thompson, On the Manageme ^ of the Sicl> fioom. 552 DOMESTIC MANAGEMENT OF THE SICK-ROOM. spoons, both large and small, and other necetrsary j.rticles. Thij table should have one drawer, at least, which ought to bo furnished with the following articles: broad and narrow tape; two or three half-worn ril)bc)ns ; a bundle of old, soft linen ; a sponge ; a few ounces of lint ; scissors, large and smaH ; a bone spatula for spreading oint- ment; a couple of rolls of nmslin, and the same quantity of flannel bandage two inches broad; a pin-cushion well supplied with pins; needles and thread ; and al)()ut half a yard of simple adhesive plaster. A Sofa or Reclininii: Chair, — A sofa, if th*^ apartment be suffi- ciently largo to admit of it, is a very important piece of furniture in the sick-room; the erect or the sitting posture being injurious in many diseases ; and, when the sick-bed requires to be made, a sofa affords the -means of removing the patient from the bed with as little inconvenience to him as possible. If there is not space for a sofa, there should be an invalid or re- clining chair; and, when circumstances will permit, it should be of that kind which is susceptible of a variety of changes, so as to vary, at pleasure, the position of the patient. There should not be more than two other chairs in the room. If there is a looking-glass in the apartment, in a situation which admits of the patient seeding himself in it as he lies in bed, its place should changed, or it sl.oulu be alto- gether removed from the room. A chest of drawers is ossential ; but none of the drawers should be appropriated for the reception of dirty linen, which ought never to bo allowed to remain a moment in the sick-room. One drawer should be specially allotted lor towels, of which an ample supply is, in evcvy case, necessary. The washing- stand will require two additional basins ; an additional water bottle and u tumbler ; and a largo, supernumerary water jug, under tue ta- ble, always full of water. IVo Cooking in Sick-room. — Thei-e should l)e no kettle, nor any implement of cooking, in the sick-room ; even in Avinter, and when a tiro is required. In general, a tire in the sick-room is only necessary for the comfort of the attendants ; but nurses too frequently take ad- vantage of it to bo;l the water for tiieir own tea, and to prepare the slops for the invalid ; a custom which cannot be t(»o severely repro- bated. Tlie lamp termed a Nighl-nurse, consisting of a water-bath placed over a lamp in a wiic-worUed cylinder; a small tin kettle which enters the top of the cylinder ; and a covered earlhen-waro vessel which fits it into the water-bath ; are useful for keeping fluids warm, and at the same time for preserving t* light in the room, when an unshadod lamp or a candle would bo hurtful. In continued fevers, the sense of hearing is often so morbidly acute, that ordinary sounds become causes of pain. In this case, if the floor of the sick-room bo lutt wholly carpeted, every precaiition to lessen the intensity of sound should be taken. One of the most effectual is to have a couple or more pairs of large list shoes outside the door, into which the feet, even of the doctors, may be advantageously thrust, when their shoes make a creaking nois), or when a visitor or nurse treads with a heavy foot. On the samo account, when more mmm DOMESTIC MANAGEMENT OP THE SICK-ROOM. 553 than one nurse or attendant is required to be in the room at the same time, no conversation, although it may be carried on in a whisper, should bo permitted. Whispering, indeed, is apt to excite delirium, and to augment it when it is already present. Beds and Ileddliig;. — The French beds, without curtains, are those best adapted for the sick-room. When four-posted bedsteads, i^v.r- roiuulcd by curtains, were more in use than at the present time, the mischief arising from excluding the free air, by dniwing the curtains close around the bed, was frequent and serious. In every case of disease, indeed, especially when it is attended by fever, the patient should bo kept cool, and the most perfect freedom bo given to the hrcathing; the mattress should bo placed over the feather bed, and the pillows be firm and elastic. The Marseilles coverlets, which are spread upon beds during the day, and often retained at night, are heavy, and calculated rather to increase than to subdue fever ; conse- quently they should be Avholly discarded from the sick-bed. Indeed, when the disease is fever, and when it is acc()n4)anied with great rest- lessness owing to the evening exacerbation, if the bed-room be suffi- ciently largo, two beds should be placed in it ; or if two adjoining bed-chambers can be obtained, a bed ought to be put in each, so that the patient can bo moved from one bed to the other every morning and evening. This both aids sleep, and it also tends greatly to insure the personal cleanliness of the patient. The bed-clothes of the bed from which the patie;it is moved, should, on his removal, bo iujinedi- atcly turned down and fully exposed to the air; a precaut. ^n which will set aside tho necessity of so frequent a change of lintMi, as wcdd ho, otherwise, required. When there is only one bed, and when (ho disease ia fever (unless the patient is too ill to permit his l)eing moved), the shoots which have been used iit niglit should be rephicod hy others in the morning, and hung up in tho free air during tho day, to bo again used at night. But, when it can conveniently be done, in every case of contiiiuod fever, especially of ar» infectious kind, tho sheets should bo changed once in twenty-four hours ; a practice which id likely to prevent tho fumes of infection from being communicated to the blankets or to any of the furniture of tho room. Ventiliition is always of primary importance; and that rieriod, happily, is gone by, in which air Avas carefully excluded from tho chambers of the sick, even when they were suffering imder febrile disease. Ventilation is ]3articidarly demanded in those fevers in which mil- iary eruptions d splay themselves ; uuder no circumstances is it so essential as in febrile diseases of an infectious kind. It may, how- ever, bo consolatory to those whose duty it is to attend such cases, to know that infoct.on, communicated through tho air, rarely extends above a few feet from the body of the patient ; and evtn in the most malignant diseases, with the exception of confluent small pox, and malignant scarlet fever of tho worst kind, its influence does not ex- ceed a few yards, if the room be well-ventilated. On tho contrary, if ventilation be neglected, the power of infection becomes greatly M mk-' 554 DOMESTIC MANAGEMENT OP THE SICK-ROOM. augmented from its concentration in confined and quiescent air ; it even settles upon the clothes of the attendants, and on the furniture of the room ; and these imbibe it most readily when their texture is wool, fur, or cotton, or any loose or downy substance capable of re- ceiving and readily retaining the air. Smooth and polished surfaces do not easily receive or retain infectious matter ; consequently the nurses and attendants, in cases of infectious diseases, should have glazed gowns, and aprons of oiled silk. In no infectious diseases are these rules more essentially necessary than in small pox and scarlet fever. It is well known that, if the bod- clothes of a patient laboring under either scarlet fever or small pox be closely folded up, they will retain tiie infectious matter, and com- municate the disease at a great distance of time ; but the influonco of free ventilation is so great, that medical practitioner.s who are attend- ing small pox patients, and who go from them into the open air, do not spread the disease. Indeed, all infection is weakened by dilution with air. The danger of infection is augmented, if, along with bad ventilation, the atmosphere of the room bo moist from any cause. It is further consolatory to know that tho infectious matter, even of the most virulent description, is not poisoiicms to every one who is placed within the sphere of its influence. A predisposition of the body to receive the infection must exist before it can be communi- cated ; a condition which i-s augmented by fatigue and watching, de- fective nourishment, mental depression, or anything which can lower the vital powers. The necessity, therefore, of maintahiing these powers by attention to rest, a sufficient quantity of good and gener- ous diet, and cheerfulness of mind, need not be insisted upon. In every case of infectious disease, the attendants, evei in tho best ventilated rooms, should stand on the windward, or on that side of the sick-bed from which the current of air comes ; as, by neglect of this rule, and by standing in the current which has passed over tho patient, the infectious exhalations are blown upon them in a direct stream from the body of the patient. The attendants should never lean over the sick, nor should they receive their breath. The health also of the nurses should always be supported by nutritious and gen- erous diet ; but not by brandy, nor any other ardent spirit. The terra infection, in its most extensive signification, implies some deleterious matter, originating from any source, and transmitted through the air, which is capable of causing diseases in tho human body. When this matter is emanated from the diseased bodies of men, the term is frequently regarded as synonymous vv^itli coniwjion; but, in strictness of ianguage, the latter refers only to the communi- cation of disease by contact. Whatever may bo the matter of infec- tion, it may enter the body through tho medium of the lungs, which is the most ready inlet, or by the saliva, or even through the surface, if the skin be abraded, or if any ulceration be present. Tho influ- ence of infectious matter is evidently exerted on tho nervous system, displaying itself by debility, inertness, dislike to motion, great sus- ceptibility of cold, irritability and despondency of mind, and by the production of a disease similar to that of the person from whom the II'- i- • DOMESTIC MANAGEMENT OF THE SICK-ROOM. 555 infectious matter has proceeded. The infectiou may be supposed to have taken effect, and to have produced the actual disease, when the person who has been exposed to its influence is attacked with giddi- ness, pain of the head, irreguhir heat and chills, nausea, and, if the infectious disease be small pox, convulsions. These symptoms are sufficient to denote the necessity for immediate medical advice. Tfiiiperature. — Next to ventilation nothiuf!^ is of more importance than the regulation of the temperature of the sick-room, avoiding both extremes of elevation or of depression ; but much depends on the nature of the disease. The best general temperature of a sick-room is 60° (Fahr. ) ; and it is preferable to regulate this rather by the thermometer tlian by the «ensations of the patient or the attendants. Uiulor soiro circum- stances, however, the feelings of the patient, and his susceptibility of impressions upon the skin, should not be overlooked. Thus if the temperature be a little above that of summer, and the pjitient, never- theless, feel chilly, it should bo raised five or six degrees. Thia chil- liness is very apt to be felt in a dyspeptic state of tlio habit, and more especially when it is accompanied with hyi)ochondriasis. It differs from that more severe but transient coldness which accompa- nies intermittent fevers, and some other periodical affections ; and it requires an elevated temperature of the air for its rer^>oval, whilst the cold stage of intermittent diseases is best relieved by the warm bath, either general or local. So important is the regulation of temperature, especially in fevers, \hat it often does more good than any other remedial measure. I have seen patients, laboring under high delirium in a close, ill-venti- lated room, become rapidly quite collected by merely lowering the heat of the apartment twelve or tifteen degrees. In convalescence, as the air of the sick-chamber should be fre- quently renewed, the temperature in spring and autumn ought to be maintained as near as possible at 55° to G0° (Fahr.) ; and it should be very gradually lowered as the invalid acquires strength, so aa to enable him to bear with impunity the varying tein[)erature of these seasons in the open air. Even thon, if the previous disease has been I ulmonary, the air admitted to the lungs should bo tempered by the use of tho Respirator, or a muslin hiindkcrchiof tied around the mouth. When the invalid first ventures out of doors, nothing, in- deed, is so essential, in a prophylactic point of view, as avoiding extremes and sudden transitions of temperature. Cleanliness. — Although deanlinens in the sick-room is essential, yet it may bo carried so far as to become an annoyance to tho inva- lid, and consequently to prove injurious. It is not requisite to sweep tho room daily, nor to dust and arrange tho furniture every morning, provided order be preserved in the room, and nothing but what is ifmmediately necessary for the comfort and convenience of the invalid be permitted to remain in it. It is truly distressing to observe the confusion which prevails in some sick-rooms ; everything being out of place, and to be searched for when it is wanted. n! 656 DOMESTIC MANAGEMENT OF THE SICK-ROOM. The period chosen for clpanin<5j and arranging the sick-room shouid be the morning ; us, after a night's rest, the patient h more ahle to hear the little noise and bustle which it always more or less occasions. !rhe carpet should bo sprinkled with moist tea-leaves, and liiihtly swept ; and during this operation the curtains of the bed, if there ho any, should be drawn. It is scarcely requisite to insist on the necessity of the utmost attention to the cleanliness of everything in the sick-room. The moment attc any vessel or implement is used by the invalid, it should be removed from the apartment, and returned as soon :is it u cleaned. Nothing in the form of a slop-basin or a slop-pail is admis- Bible ; they only administer to the laziness of nurses. The necessity of cleanliness in the vessels used for the food of in- valids is strikingly illustrated in the bad eflfects arising from the noeon undergone by the small portion which is always left in the gl;iss or cup, coinniiuiicatos^ the disposition to be decom- posed to that which may be noxt poured into the cup. An active medicine may be thus rendered inert; or one which is mild in its operation maybe so chsmgcd as to operate witii hazardous energy. The same precaution, as to cleanliness, is also requisite as to the minim measure, Avhen the medicines are directed to be administered in a form which requires its employment. Darkeiiiii ity. Health. — None of the quali^catious of a sick-nurse are of impor- tance more than health. An individual who herself requires atten- tion is ill-calculated to attend upon others. A woman who is asth- matic, or has any difficulty of breathing, or an habitual cough ; who is rheumatic or gouty, or haa any spasmodic affection ; who is af- flicted with palpitation ; or suffers from periodical headache, vertigo, or a tendency to paralysis ; or who is consumptive, or scrofulous ; or has defective sight or hearing ; or anything Avhich causes decrepitude, is disqualified for a sick-nurse. It is important, also, to ascertuiu there is no hypochondriacal nor hysterical tendency, nor predisposi- tion to mental depression. Temper and Disposition. — It is scarcely requisite to say that an attendant upon the sick should possess a happy, cheerful, equal flow of spirits ; a temper not easily ruffled ; and kind and sympathetic feelings ; but, at the same time, not such as to interfere with firm- | ness of character. The exf ression of the countenance should be open and winning, so as to attract the good-will and confidence of the invalid ; a pleasing and gei:tle manner being more likely to gain esteem, and insure obedience to the orders of the physician, than the most persuasive arguments which can be addressed to the under- stuniing of the patient. A collected, cheerful expression of the countenance, in the attend- ant on the sick, is likely to inspire hope, and to aid the efforts of the physician for the recovery of his patient. The general disposition of a sick-nurse should be obliging. Every little oflice, which the invalid may require to bo done, should be i)er- ' formed at once, and without the smallest apparent reluctance, even when the necessity for its immediate performance is not absolute- There is also an earnestness of manner, which should, if possible, be obtained or acquiesced m by the sick-nurse, as it impresses the idea that she feels deeply interested in the case ; a circumstance which is always highly appreciated by the patient. Finally, it is unnecessary to say that a nurse should bo honest, as no description of servant has so much in her power. But the honesty of the nurse is not to be measured by her respect for property ; she must be above imposing on the physician, with respect either to medicines or to diet. Her religion, also, should be sincere, but not Pharisaical ; and although she may occasionally persuade her charge ♦♦ to put his trust in God, the fountain of health," * yet she must rec- ollect that preaching is not her province ; and, when mistimed, even the best advice may prove not only profitless, but injurious ; and this is especially likely to be the result, when the doctrines which she professes are of a controversial kind. With respect to gossiping, it is a detestable habit under any cir- * Toller. DOMEPyriC MANAGEMENT OF TIIE SICK-ROOM. 559 ciirastances ; but, in a nurse, it may bo productive of the greatest danger, produce family feuds, and a tliousaiul oth'^i evils. In her Habits, a sicli-nurse should bo sober, active, orderly, and clean, and neat in her person. The first of those habits — namely, sobriety — is so essential a qualification in every attendant in the sick-room, that it requires no comment. Happily, the desire for ardent spirits is now less frequent than formerly, when women were seldom employed as nurses until they were nearly superannuated, and until their habits, good or bad, were too firmly rooted to be removed. The Activity essential for a good nurse docs not imply a bustling or fidgety manner, but a quiet, steady method of proceeding in the per- formance of her duties, equally devoid of fluster, turbulence, or noise. This activity is generally associated with orderly habits ; a most valua- l)le qualification, and without which the sick-room becomes a scene of confusion and disgust. Every medical man must have witnessed thb state of disorder with regret, when, on visiting his patient, he finds no chair to sit upon, until some article of bedding, or of clothing, bo re- moved from it, and the seat dusted with the apron of the nurse ; and when a former prescription, or anything else, is wanted, he must wait until the nurse rummages out half a dozen of drawt in search of it. Another quality, usually conjoined with activity and orderly habits in a nurse, is cleanliness in her own person, and in that of her charge, as well as that of the sick-room. The dress of a nurse should be simple and neat, without trimmings. Nothing is more out of place than a fine lady attempting to perform the duties of a nurse. Edacation. — It may appear a refinement to talk of the education of a nurse ; but there is not a greater difference between noon-day and midnight than between an educated and an ignorant nurse. The for- mer is often an aid to the physician, not only in carrying his orders into effect, but by observing and informing hira of symptoms of great importance which have occurred during his absence : whereas the lat- ter is a source of constant anxiety, and too often assumes the privi- lege of acting in direct contradiction to his orders, and according to her own opinion. XTnhired Attendants. Tee selection of a good nurse, however eminently qualified she may be for her duties, does not supersede the attendance of a rela- tive or a friend in the sick-room ; on the contrary, I can conceive no condition so deplorable as that of an invalid left altogether to the care and management of a hireling. It is, nevertheless, too true that few ladies, even those /vho are wives and mothers, have any acquaintance with the arrangements of the sick-room, and the management of the invalid ; they are, consequently, too often forced to be guided by, and to i;ely for instruction on, the nurse, instead of being able to superin- I ■'¥. J'" "'9 5G0 DOMESTIC MANAGEMENT OP THE SICK-ROOM. tend her conduct, to ascertain that she performs her cluty, and to cor- rect lier failings. Tlio degree oi intelligence which is demanded in a nurse is very diflcrent to that which is requisite for a wife or a relative in the sick- room. Tiie intelligence of the nurse is directed to supply the wants of the invalid, to administer to his comforts, and toohcy the instruc- tions of the physician ; that of the friend or relative involves tlio power of discriminating disposition and temper; of Avatching the progress of the disease, and judging of the propriety of not pursuing certain measures, which, although indicated by the symptoms at tlio time of prescribing, yet may require to bo altered, and consequently detailed to the physician, whoso presence may be requisite before his next intended visit. It is of the utmost importance, also, that rela- tives attending in the sicU-room should be able to control their feel- ings in the jiresence of the invalid. Nothing is more essential, in the domestic management of diseases, than a knowledge of the natural disposition and temper of the inva- lid. An irritable or a passionate man requires a very different man- agement from that which is pioper for a man of naturally mild and easy disposition. Disease awakens, in an augmented degree, the irri- tability of the former ; he becomes impatient of contradiction ; and every time his opinions are injudiciously opposed, the turbulent agi- tation of the nervous system which follows either increases the dis- ease or weakens the influence of the remedial agents. On the other hand, a mild and gentle disposition often leads to extreme sensitive- ness, when disease attacks the body : a word, a look, is sufficient to touch some sympathetic cord ; to unstring the whole nervous system ; and to augment the morbid susceptibility already present in the habit to a degree which is not always devoid .of danger. Much discretion and judgment, therefore, are requisite in both instances: in the one case, to prevent ebullitions of temper ; in the other, to refrain from ari3i;hing that might be construed by the invalid into harshness ; and yet, at the same time, in each case, to maintain that influence over the patient which the treatment of every disease demands in an at- tendant on the sick. Prejudice and Antipathies. — In those who are imperfectly or erro- neously educated, the judgment is apt to be biassed by prejudice and antipathies; and, under the influence of these, it is misdirected in a manner of which the individual is often wholly unconscious ; thence the necessity of freedom from prejudice in the attendants in the sick- room, and the farther importance of the friends or relatives of the sick being able to superintend the conduct and the management of hired nurses. On the other hand, the judgment, even in the well- educated, is apt to be misled by the affections^ the influence of which is as much opposed to the healthy exercise of discrimination as tlie prejudices of the ignorant. Self-control, therefore, is also an essen- tial qualification of the sick-room. It is only from knowing that tlic attendants of the sick are pos- sessed of intelligence and self-control, that a physician can rely upon DOMESTIC MANAGEMENT OF THE SICK-ROOM. 561 having hi9 orders correctly and duly executed : when those qualities ure absent, he has to dread, on the one hand, the presumption ofi ignorant projndiice ; and, on the other, the improper yielding of sen- sitive indulgence. To the invalid, also, it is important to know that tlie directions of his physician are fulfilled by an intelligent person ; for, even in the most severe diseases, as long as the mental faculties rcmiiin unaffected, a sick man is capable of detecting ignorance, or the effects of prejudice, in his attendants ; and, when he is convinced of the existence of either, nil the influence of the individual, whether nurse, or friend, or relative, is at an end. Were the business of the sick-room (independent of the wants and comforts of the invalid) confined to the mere observation and collec- tion of facts — namely, the noting of the symptoms of disease — and reporting them to tlie physician, it would be superfluous to urge the necessity of superior intelligence in its superintendent ; but many of its duties require not only a well-regulated understanding, but an cqiiiilly sound condition of the moral feelings and the benevolent affections, with a recognition of the authority of conscience in the whole operations of life. In the period of sickness, under the direc- tion of the judicious and discreet, an invalid may be led to the inves- tigation of his moral and religious condition, and to review his past conduct, with the determination of turning the result to his future welfare, should he happily recover and re-enter society. Surely such important duties as these cannot be intrusted to the unqualified, or the ignorant, or the hireling ; nor can more be required to demon- strate the importance of adding to the other branches of female edu- cation a knowledge of the various important duties of the sick-room, which females, whether as mothers or daughters, or wives or friends, arc likely to be called upon to fulfil. Prognostics. Ik every disease the medical attendant is naturally called upon to deliver his opinion of the degree of danger which hangs over the patient : hence, it is unnecessary to enter into any minute details on tho subject of prognostics. But, as in many diseases changes occur, in the absence of the practitioner, which ought instantly to bo examined into, in order that the danger likely to accrue from them may be averted, it is iniportant that the friends and ordinary attendants of tho sick should be aware of their presence, so as to obtain the imme- diate assistance of the medical attendant. Were this information, also, more generally diffused, many unnecessary visits would be saved to the physician, and much unfoinided suspicion of danger prevented from distressing and torturing the minds of the friends of the sick. In Fevers delirium ahme should excite no alarm, unless it be very high, or of tho low, muttering, incoherent kind. In jaundice, and in diseases of the chest, it is alarming; and in the latter stages of pulmonary consumption, its presence always indicates the approach of death. r^ 562 DOMESTIC MANAGEMENT OF THE SICK-ROOM. Great confusion of thought, loss of recollection of the most recent occurrence, a restless, wandering eye, and a correspondent vacancy or confusion of countenance, are always to be dreaded in fevers and in diseases of the brain. An expression of (/reat anxiety/ is equally alarming in all acute diseases ; and a presentiment of death is still more to bo dreaded. Hoarseness, with constant spitting, occurring at an early period in small-pox, is very unfavoruhlo. Squinting in ufTectionsofthehead ought to be particularly noticed, and mentioned to the attending practitioner ; and the same remark applies to a greatly contracted, or a dilated, or an immovable condi- tion of the pupil of tlie eye ; or the turning up of the pupils under the upper eyelids. Deafness is not an unfavorable occurrence in continued fever ; but a sudden attack of headache in pulmonary diseases ought instantly to be mentioned to the physician. The Sudden Disuppearnnce of Pain in inflammatory affections or the bowels is always to be dreaded ; but it does not in every instance portend the existence of mortification. Cong^h, depending on inflammation of the bronchial membrane, sud- denly supervening on a suppressed eruption, is always to be dreaded. In Croup, when the breathing is audible, or when there is a crow- ing sound in inspiration, or a cooing or croaking respiration, danger is present. In Hoopiuj^-Coujph, when the paroxysms suddenly increase in vio- lence, and the face becomes livid, and the thumbs are drawn across into the palms' of the hands, the appearance of convulsions may be anticipated : hence immediate notice of these symptoms should be communicated to the medical attendant. Rig;ors invariably excite alarm ; but they are only dangerous in chronic internal diseases, in which they often indicate the formation of pus, or the existence of suppuration. Pallidness of the countenance, with a slight degree of lividity, are symptoms of hazard in the inflammation of the lungs. The Position of the Patient as he lies in bed, especially in fevers, is of much importance. Constantly lying on his back, with a ten- dency to sink to the bottom of the bed ; a propensity to keep the arms and the feet out of bed, and to uncover the trunk ; or to pick the bed-clothes ; tremors ; twitching of the tendons ; grinding of the teeth, and sleeping with the eyelids half open, and the white of the eyes only seen ; are all justly regarded as symptoms of great danger. Fainting (Syncope) is to be considered alarming in diseases of the heart, or during profuse bleeding from the nose, or from any other ^ ipl'lf UOMKSTIO SIAXAOKMKNT OF TIIK 8ICK-UOOM. 56a part : deep Highiufj , also, under such circumstances, is most unfavora- ble, and often indicates rapid dissolution. Hiccup, in the advanced stages of cither acute or chronic diseases, is invariably alarming. Difficulty of Swalloulngp, also, in the advanced stages of fever, palsy, and aflections of the head, always indicates extreme danger ; vomiting, on the contrary, is not nntUvorable, unless it be very severe and protracted ; but, if the ejected matters be putrid, or fecu- lent, then the vomiting is always to be dreaded. Coma, or an irresistible propensity to sleep, following the sudden suppression of gout, or the cessation of periodical bleeding in piles, or the healing of old sores, is always alarming, and requires prompt medical assistance. Convulsions without fever or any affection of the head seldom prove dangerous ; but they are never free from danger when they are accompanied with stupor or coma. They are also dangerous when inflammatory fever is present. They are less dangerous in women than in men, in the young than in advanced ago. In infancy, convulsions are more to be dreaded in the robust than in the delicate and irritable child. Diarrhoea is, under every circumstance, an unfavorable event, when it occurs either iu fevers, or in the termination of chronic diseases ; and the passing of involuntary stools, when scarcely any diarrbcea exists, is equally to be dreaded. Retention of the Urine, as well as its involuntary discharge, is al- ways an unfavorable symptom. Purple Spots appearing on the skin, livid lips and cheeks, oozing of blood, sudden flushings followed by pallor, are unfavorable symp- toms ; and the appearance of oedematous swellings of the legs and skin in the last stage of chronic organic diseases always indicate ap- proaching death. When purple spots, also, appear in small-pox, with flattening of the pustules on the trunk of the body, and a white pasty aspect of the eruption in the face ; and if, at the same time, the extremities become cold, any hope of recovery can scarcely be enter- tained. Great and continued, or progressing emaciation in chronic diseases, and what is termed the Jades Hippocratica, are to be dreaded. Excoriations on the parts on which the body rests, — for example, the haunches, or the lower part of the back, — especially if these become livid and sloughy, always indicate extreme danger. Great Difficulty of Breathini?, even to a feeling of suffocation, is not necessarily hazardous iu asthma; for although few diseases are so little under control by the interference of the physician, yet asthma seldom proves fatal, unless it tends to the production of o^er diseasee. FT 564 DOMESTIO MANAORMENT OP THE SIGK-IiOOM. Ff'';. In Consumption, partial sweating, as of tho head, the chest, or the liml)!*, are always unfavorable symptoms. When pretjnancy occurs in a woman laboring under consumption, tho disease is arrested, until after delivery, as if Providence throw a shield over tho mother for tho safety of tho offspring. Tlie Sudden ilisappeaninee of Swelliujp of the Le8;s, in chronic or* guuic uisouses, is indicative of approaching death. When a child, instead of rallying after any ncuto disease, bocomes emaciated^ and tho belly is largo and tympanitic, there is always much daugor. • Ovarian Disease, or, as it is usually termed, ovarian dropsy , has hitherto proved incurable ; but it is relieved by tapping ; and, if tho powers of life be sustained by proper food, and carriage exercise iu the open air; and if all medicines be let alone, except such as are required to regulate tho bowels, life may bo sustained for many years. All diseases not involving organic changes are, with a few excep- tions, more or less under tho control of medicines, and are conse- quently curable. But some diseases, iu which no organic changes have been discovered, are nevertheless incurable. This is the case with spasmodic asthma, which has rarely been cured. It is true that functional disturbances are not unfrequently associ- ated with organic diseases ; but, under such circumstances, it is the province of tho attending physician to point out to the friends of the patient tho greater or the less degree of danger iu those complicutious. Diet, etc., in Disease and Convalescence. In numerous instances, much hazard often exists after disease has disappeared, and when the patient is declared convalescent : and as this period in the removal of diseases ia left to the management either of the patient himself or of his friends, some general remarks respect- ing it, and also in reference to particular diseases, are requisite. In every recovery from sickness, whether external or internal, be- fore tke salutary advantages obtained from the treatment be confirmed, the organ or part which has suffered must be either left at res^ or be used, according to tho nature of the case. Thus, if any part have suffered from inflammation, it must not be used 'or some time after the inflammation is subdued. If tho eyes have suffered, the person must neither read nor write, nor expose the .yes to the heat of tho fire, nor to a strong light, until some days after every trace of tho disease has disappeared. If tho arm has been affected it must bo kept at rest ; and if tho leg, not only should walking bo refrained from, but tho limb should bo placed rather higher than the trunk of the body. If tho previous disease has affected the brain, every men- tal exertion must bo avoided ; and so on, whatever may be tho organ which has especially suffered. Even when the exercise of tho organ is resumed, it should not be carried to fatigue, nor, on any accouut, should it be such as to produce excitement. At tho same time, it iH^^PWf IX)ME8TIC MANA(!EMKNT OP TIIK HICK-UOOM. 5(55 must not bo forgotten that, in tho treatmont of external injiirips, when it has been nocossary to Ivccp the limb long in a filing, in one position, — lis, for instance, in fractures, — tho muscles which hciu] the arm ncquiro from tho habit a contraction whic^h cannot l)e ovcrcotnn l>y tho antagonist mnscslcs, owing to tho length of time they have been oil tlio stretch weakening their contractile jxtwer. Tiie arm, there- fore, should bo frequently takcMi from the sliii'_', and, being retsted upon the elbow, a moderate weight should beheld in the hand, and friction with oil employed upon tho contractt'd muscles, k is true tiiiit sur- geons usually glvo directions for this o[)eration, before they quit the raaiiagement of tho case ; but surgeons, as W(dl as physicians, are sometimes dismissed before tlio convalescenco is complete ; on which account, arms and limbs have remained contracted for life, from a want of tiie knowledge necessary to counteract tho ovil at an early stage. I say nothing respecting the continuance of ren\edie3 during con- valescence from many diseases, ex(;cpt urging tho necessity of regu- lating the bowels. The most important part of the management of convalescence cer- tainly refers to air^ exercise, and diet. Tlie errors daily connnitted, in all those matters, oxcrt the most powerful influence in retarding complete restoration to health; and often, indeed, Induoo evils of a more formidable kind than the d'scases from which the jjationts have just emerged. 1. Air. In every convalescence, whatever may have been the nature of tho disease, if it has been so severe as to wear down the strength of tho invalid, country air is essontial. Tho benevolent Author of our existence has made medicinal tho hills, tho vales, the groves, and Jill tho harmonies of nature ; and in the reposo of these man finds a balm, not only for a wounded sprit, but for his stricken body. Ill selecting a country rcsideneo for a convalescent, care must be taken to ascertain whether any source of malaria exists in tlio neigh- borhood ; as, in that case, even if all other circumstances bo favorable, tho place is exceptionable. 2. Exercise. In convalescence, much caution is requisite in nppor- tioniiii; tho exi-rciso to the de£rreo of retiirnin;' streiiijih. When tho convalescent is still too feeble to take sufficient exercise on foot, the best substitute for it is riding horseback ; but, as soon as walking can bo borne, it should be preferred to either horse or carriage exercise. 3. Diet, In health, diet may be left, in a great degree, to the in- clination or the taste, as far as regards tho quality of the food ; and, although diseases occasionally originate from repletion, yc^t, in gen- eral, the appetite may be considered as the best regulator of quantity, when the food is simple, and tho a[)petito is not pampered by high seasoning and rich sauces. la disease, however, ii very opposite rule is to he observed ; the regulation of both tho quantity and the quality of the food is of the utmost importance. The taste is often so per- verted as to desire that which would prove injurious ; and were appe- tite to be the guide of quantity, diseases would frequently not only be increased in severity, but life itself would be brought into jeopardy. 566 DOMESTIC UtANAQEMENT'OF THE SICK-ROOM. As soon as solid animal food can be taken with impnnity, that which is most digestible should be selected. An opinion has ^oner- ally prevailed that gelatinous matters, and meats which readily yield jelly, — such; for example, as veal and lamb, — are the most easily digested, and at the same time, are also the most nutritive. This is a mistake ; for, with the exception of poultry, the flosh of young*ani- mals is stringy and of a lax fibre, and is oven loss easily digested than that of too old animals, wliich presents a great density of texture. The middle-aged animals afford the most digestible food. Nothing tends to lessen the density of the fibre of every kl.id of animal food so much as keeping it for a certnin time l)efore it is cooked. In this case, the tenderness is tlic result of incipient decom- position or putrefaction ; but the utmost caution is requisite to pre- vent this from advancing so Car as to present the slightest trace of taint, in the food of the convalescent. In the low stitc of vitality in convalescence, the change which commencing decouiposition (putre- faction) causes, renders anlmiil food, in that condition, a source likely to occasion either a relapse into the disease from which the patient bas recovered, or to form a now disease. In examining the relative vaklfi of other articles of d ict adapted for tho sick and convalescent, the firsOlWhich presents itself to our notice ia Hilk. — As milk is the food of almost all young animals, its diges- tibility appears at once evident ; and there can be little douI)t that it is very digestible, when it is drunk Immodiately after it is drawn from the udder of tho cow, or that of the a^s, or the goat, before its com- poneiits have time to separate. Wh^n this separation is eifcctcd, either spontaneously by time, or 1 y means of rennet or other agents, its properties are altered, and its digestibility is lessened. Cream, when intimately imited with t! \ 368 DOMESTIC MAXAGEMENT OF THE SICK-ROOM. nutritive, they Avould bo ill adapted for invalids. Rice in every case where the stomach is in an acescent state, is preferable to the cLher farinacefB, because it. ia i^^c. fnrr^iCuuible.. The fiiriuaoeoiis fond, which is ordered in the convalescence of children from acute diseases, is often made of bread so as to const'- tute^ap. No description of food h.is a greater tendency than this to become sour ; a quantity only sufficient for a single meal, therefore, should be made at a time; i'or what remains' is always sour bcforo the next meal ; and even if the quantity he .small, and it bo mixed with fresh pap, it communicates its faculty of becoming sour to the whole mass. Fluid Aliments. Water. — The best and the most unlv^ersal beverage for the sick is water: but the qualities of y.ater differ, according to the sources whence it is procured. The fewer foreign ingredients it holds in so- lution the greater are its diluent properties. Distilled water, or rain or river water filtered, and that of soft water springs which filtrate through silicious strata, are the only kinds proper for the use of the sick-room. Hard water, under whatever name it is found, whether as spring water, or pump water, or well water, should be excluded. The impurities of river and rain water are merely held in suspension ; consequently, they are readily removed by filtration. Water itself is aliment ; many individuals under certain circum- stances have lived for a considerable time upon it alone. Those who live chiefly on a'lhnal food require more drink than those who eat much vegetable Uiatter. The influence of water on the animal economy may be regarded in two points of view : As an article of diet. As a medicinal agent. As an article of diet^ in health, water is the bevferage provided by nature for all animals, man not excei)ted. The sensation of thirst is the natural call for fluids, cither to assist digestion, or to allay a dry, hot condition of the mouth and the gullet. The con.sequence of not satisf;yiiig this call is fever of a nervous kind ; and, if it be long re- sisted, inflammation of the air passages. On the other hand, too much fluid is injurious; foralthough the vital ))owers of the stomach counteract the tendency which it affords, by over-diluting the gastric fluid, to the fermentation of the aliment in the stomach, yet, when it is in excess, those vital powers languish ; hence spontaneous chemi- cal changes in the contents of the stomach take place, and induce dyspepsia. For all the purposes of dilution, in healthy water is ade- quate, and it is the only truly wholesome beverage. As a medicinal arfent, water is demanded in every disease in which a dry skin, and an elevation of the natural heat of the siu'face, consti- tuting fever, are present. In this case, the desire is for cold water, or DOHESTIO MANAGEMENT OP THE SICK-ROOM. 569 cooling fluids ; and it should always be indulged. The degree of temperature, however, must be regulated by the condition of the in- valid ; but the best medium temperature is between 50° and 60° Fahr ; although even 60° is too low, when the debility of the frame is consid- erable. The qualities of the various kinds of beverages proper, and gener- ally employed in the sick-room, should be known. Toast-water, when properl; prepared, which it seldom is, forms a useful beverage in the sick-room. It is slightly nutritive, owing to its containing a small portion of gluten, in conjunction with fecula and sugar. It is one of the oldesi'; and one of the best diluent demulcents ; diluting at the same time that it softens the acrimony of the secreted juices of the stomach, in febrile diseases. Gracl, whether made of groats or of oatmeal, is less mild and do- L^nlcent than barley water ; and it is more likely to undergo the ace- tous fermentation in the heat of the stomach ; a div^miistance which is greatly favored by the sugar and butter which is sometimes added to it. Unless gruel be very thin, it can scarcely be regarded as dilu- ;n> ■! when thick, it is too heating an aliment for patients laboring ;a It- ..orile symptoms. Tea, in the form in which it la usually taken, is too stimulant and astringent ij bo a good diluent; and, when it is strong, the narcotic pro[)crty whlcli it possesses renders it improper for most invalids, whatever may be the nature of tlioir diseases. As it is, nevertheless, agreeable to most palates, and very refreshing, it may bo taken in moderate quantity, provided it be not strong, with(iut any hazard. Sage, balm, and mii.it teas, are often s^ibstitutcd for common tea. Each of them undoubtedly allays the irritability of the stomach in sonic cases ; but, as general beverages in disease, they are less useful than toast-water. Ilaspberry vineyar, lemonade, tuTtid rind tea, apple tea, and simil;.:' compound diluents, siiould uever be admii:istered without the ^■ .>i..o.tu*; of the phj'sieian. If a patient be taking aix anti- nionial, t!i; y v \ :X(rite vomiting ; if a mercurial, griping; and they are o'luaJiv 'ui '<)..p .t,ible with many other medicines, and with many conditions ol . • siomach ir. disease. They are a description of beverage greatly f^.jmmended and largely distributed by (ho Lady liountifuls in the country, and hav frequently beei; prod ictivo of serious mischief. Coffee is more heating, and, consequently, less adm!«sil'lc chan tea ; it may, however, bo taken, if it be largely combined with milk. Cocoa j and chocolate are still more objectionable than either tea or coflee in I the sick-Torai. With 1* if. -tv/* the Kumberof Meals, and the periods best adapted for taking th. a, it /s scarcely requisite to remark, that, although in health, thre.' moderate meak, at proper intervals, are customary, and well adapted for the support of the frame, yet, under the changed T 570 DOMESTIC HANAOEHENT OF THE SICK-ROOM. condition of the system in disease, it would be improper to take any regular nuinber of meals, or to observe any stated periods for taking them : hem e no general rules can apply. As a gemral rule, in the decline of diseases, and on the approach of convaleso ';nce, when the desire of taking food returns, the best time for the principal meal, dinnar^ is about two hours after noon. If the breakfast be taken at nine o'clock, and the evening meal at seven, the hour of two is the middle period of the day ; so that, when dinner is taken at that time, the iiiteivais between breakfast and dinner, and between dinner and supper, are nut only equal, but neither is too short to limit the complete digestion of the previous meal ; nor too long to injure the powers of the weakened stomach by protracted fasting. All acute diseases require more or less abstinence, especially when the object of the treatment is to lower the system ; and in some chronic affections, abstinence is almost essential. If this be true, tbe necessity of the stride ' >bservance of the directions of the physic'an on this suliject must b us. It is one, however, which is not only neglected, but is oi ;ombated both by nurses and friends; and indulgences, which are supposed to be of too trivial a nature to cause any injury to the sick, have often been followed by fatal effects. But, although abstinence be requisite during the existence of an acute disease, yet it is injurious when it is too rigidly maintained after convalescence is actually established ; it often induces a new train of symptoms, not very unlike those for which it was properly prescribed and the removal of which it has aided : namely, accel- eration of the pulse, increased impetus of the heart, headache, and even delirium. . , General Diseases. Happily, in febrile affections, tiij appetite of the invalid is not ini a condition to desire food ; and no strouiirer demonstration can be required of the impropriety of forcing it upon him under such circum- stances. Simple fluids, such as diluents, are all that he desires, ali that the stomach can bear ; and such alone should be administered in fever, before that low condition of the system, which demands tbo use of wine or other stimulants, supervenes. In these cases, when the patient desires more nourishment than is usual, animal food oiiglit not to be given, unless by the direct recommendation of the physi- cian. Indeed, in general, the inclination of the invalid happily re- volts from animal food, as much as experience condemns its adminis- tration. While febrile symptoms are present, farinaceous matters, little nu- tritious, such as barley-water, gruel, arrow-i'oot mucilage, or sago, acidulated with lemon-juice, and sweetened to the taste of th(5 patient, are most suitable ; but even these should bo given in small quantity, and at considerable intervals. The beverage generally most agreeable, and also most salutary, to those suffering under fever, is cold water. ike any r taking pproach est time If the ven.tho liuneris ler, and r is too nor too 9 utracted ! 1 \y when H III some H true, the '<• B hysic'au !| | ti is not i 1 friends ; 1 nature by fatal ■ 36 of an intainod 9 a now jroperly r, accel- che, and i 1 .3 not in ( 1 : can he j 1 ci renin- !; ■ sires, all I stered in , I ' inds the ! ■ :>s. 'whcii ! B >donght|B ! i)hysi- i 1 1 jpily rc- adminis- ittle nU' or s>ago, patient, [imntity, jreeable, i water. ■ — i- DOMESTIC MANAGEMENT OP THE SICK-ROOM. 571 In the decline of fevers even, as I have already remarked, although the severity respecting diet should be relaxed, yet much danger may result from mistaken kindness and over-zeal, in urging animal and stimulant food at too early a period of the convalescence. Indeed, the necessity of caution at this time is greater than during the con- tinuance of the fever ; and the more acute the disease has been, the greater must be the caution in the convalescence, especially if the treatment has been of an evacuaiit and lowering description. The first change of diet, in the decline of fevers, should bo to an- other article of the same kind of food which wab allowed in the dis- ease; for example, from simplo arrow-rootmuciloyjieto arrow-root and milk, or to some other of the farinaceous compounds ; whilst, at the same time, aft-ses' milk may be given, in small quantity m\ the morn- ing Rice, one of the farinacete, is generally supposed to bo astrin- gent, but this is a mistake. It forms an excellent diet in all cases of early but decided convalescence. I>' ' ould be well-boiled, and mixed either with broth and beef-tea, or gravy which has been cooled, and the fat taken from it. In the transition to animal food, beef-tea, chicken-broth, and miMon-broth, and other liquid animal decoctions, should 1)0 first resorted to ; then ivhile-fish, simply cooked ; for, al- though fish is more digestible than animal food, yet it affords much less stimulant nourishment ; it is therefore better fitted for the early stage of convalescence. When convalescence is completed, a more generous diet is admissible. With respect to beverage, water, toaM-water or lemon- peel-water, is sufficient, until the medical attendant declares that a little wine is requisite. In convalescence fromyeuer, it is an error to permit the patient to get up too soon. He should not leave his bed until his strength be considerably advanced. No danger can result from too strict an observance of this rule ; whereas much risk may be incu' red by its fleglcct. If the head has been much affected, every mental exertion si. ould be refrained from during the convalescence ; and, according to the degree of suffering in any local organ, precautions must be taken to fTiiiird that part of the frame against a fresh attack of disease. Eruptive Fevers require more precaution in convalescence than gen- eral fevers, both as regards diet and exposure to sudden alternations of heat and cold. This is nioi'o especially essential after measles and scarlet fever. Measles are often followed by a distressing cough, and other symp- toms of pulmonary inflammation ; or by a harassing diaiThaa, which wears down the strength ; or by inflamed eyes, catarrh, or obstinate toothache. In infants, canker of the month occasionally makes its attack and proves fatal. All those affections, after measles, might generally be prevented by taking care not to allow too soon a return to the use of icnitnal food, or too early an exposure to cold or to night air. Even in summer, flannel should be worn next the skin for some vreeks after the disease has disappeared. wmu ':•?■■«: I 'mi 572 DOMESTIC MANAGEMENT OF THE SICK-ROOH. Scarlatina is frequeutly followed by dropsical symptoms ; which, however, might generally be avoided by the same attention to diet and regimen as after measles. Smnll-Pox, when severe, and especially when confluent, is very apt to awaken info iirtivity the dormant seeds of scrofula, if any heredi- tary taint exists in the constitution ; hence abscesses, ulcers, and swelled glands make their appearance. These demand the aid of the piiysician or the surgeon. But if the convalescent be pr()|)erly dieted, and recourse bo, had to a change of air as soon as his streuifUi will permit, these evils may be avoided. ' Erysipelas not unfrequently attacks convalescents from small-pox and other eruptive fevers. When it occurs, independent of any prior disease, the same attention to diet and regimen is requisite as in other eruptive fevers. Convulsions, it is well known, are not unfrequently the result of errors in diet, in individuals with an irritable condition of the stom- ach and bowels. Advice should always be demanded respecting the diet of those who are liable to, and who suffer from, convulsions ; but it must not be supposed that when they occur in children and have been subdued, a system of starvation is necessary to prevent their recurrence. As far as regards convalescence in such cases, it will bo proper to bear in recollection the following rules : 1. When the patient is oiskfull habit, has a short neck, and a ten- dency to discasos ot the head, the diet should bo spare. The use of animal food, indeed, in such a habit, should be loholh/ prohibited in childhood, and very sparingly employed l)y adults ; whilst vegetables, farinaceous matters, milk and weak broths, may bo allowed. 2. When tho habit of body is spare, and when languor and chilli- ness are present, the diet, although free from stimulus, yet should bo nourishing, and consist of the lighter kinds of animal food ; namely, poultry and fish, with a moderate share of vegetable matters. 3. Under ail circumstances, and at every period of life, fermented liquors and wine should be either wholly avoided, or very sparingly used, in almost all convulsive diseases connected with affections of the head. In convalescence from some varieties of convulsive diseases, tlio nature of tho diet must depend on circumstances which cannot be judged of by the attendants of tho sick-room ; hence it should be referred solely to the medical attendant. In St. Vitus's Dance (chorea), for example, although a tonic plan of treatment may have been successfully pursued, yet the diet may be required to be raild, and AvhoUy free from stimulus. Attention to diet in Hysteria is most important. When tho disease is connected with indigestion, the meals should be moderate ; and rest in the horizontal posture should be indulged for an hour afters wards, and then moderate exercise taken. Fluid food, such as broths and gruel, are improper; yet animal food should be eaten only onco a day. Tea and coffee should be very sparingly taken ; and the sim- DOMESTIC MANAGEMENT OF THE SICK-ROOM. 573 plest beverajjea, even water and toast-water, should be taken in groat moderation alter a meal, and should not bo diuiik dining dinner. In convalescence from hysteria, change of scene and air are abso- lutely requisite. The mind should bo directed to solid studies, and everything which can cherish morbid sensibility of the nervous system avoided. Dropsy. — An opinion was long maintained that fluids are to be withhold from dropsical patients. No opinion was i.ver founded ou more erroneous principles. Dropsical patients, indeed, should be allowed the free use of fluids. With respect to diet, it should, gen- erally speaking, be light and unstimulating : but much depends on the causes of dropsy. There is, however, less necessity for a rigid ad- herence to low diet in this than in other inflammatory aflections. In Palsy, abstinence from all stimulating food, solid or fluid, must be rigidly observed ; and the restriction should not be discontinued in convalescence. A.t the same time, change of air and of scene is al- ways of decided advantage. In every instance, an easy state of mind, and freedom from every source of irritation, as well as from the anxi* eties of business, aro indispensable. Gout ond Hiienmatism. — In no diseases affecting the general habit are abstinence and i'o|)oso moi'o essential during the attacks than in the two which head this paragraph, when they assume an a(!ute form. When they occur in weakened or in broken-down habits, it is too often supposed that the opposite plan of diet is to bo pursued, and thatstimulatingfood and a liberal supply of wine should be indulged; but nothing is more likely to prove injurious. When the paroxysm subsides, it is too customary In permit the in- valid to glide into his usual habits with respect to diet and regimen ; consequently the plethora which originated the disease gradually re- turns ; and the same plan being continued, paroxysm follows after paroxysm, at shortening intervals, until scarcely any interval occurs, aud life is sacrificed on the altar of self-indulgence. For some weeks after the paroxysm of gout has subsided, in a young or a middle-aged man, animal food should be sparingly taken, and fermented liquors altogether avoided. Chloror^", or Green Sickness, is a state of the habit which seems to depend on an impaired condition of the blcod itself. Its treatment is well understood, and recourse to medical advice should never be neglected ; otherwise it may terminate either in mcntiil derangement or in sudden death. In convalescence from it, the diet should be mild and light, but nutritious ; the exercise should be much within the lim- its of fatigue, and consist of both walking aud horse exercise, daily, in tho open air : the body, more especially the lower extremities^ should be warmly clothed ; the mind ought to bo amused ; all seden- tary occupations thrown aside ; and confidence placed in the honor of the physician, who should be made the repository of any mental auxioty, especially connected with the tender passion, which may be preying upon the vital energy of the body. 574 DOMESTIC MANAGEMENT OF THE SICK-ROOM. Affections of the Head. Whatevek roay be the cause of Apoplexy, no disease requires more prompt and energetic treatment : the alarming nature of the symp- toms is always sufficient to prevent any time from being lost by at- tempts to relieve the sufferer without medical assistance. Should the attack not prove fatal at the time, and should it not be followed by palsy, still the utmost caution is requisite to prevent a recurrence of the disease. It is scarcely necessary to insist on the strictest adhe- rence to temperance, both as to meat and to drink ; and the impoi- tance of daily exercise, when the attack is over; and indeed for the remainder of life. Prolonged study and intense thinking must bo given up ; the violent and exciting passions should be subdued ; and even the pleasurable moderated. Inflammation of the brain is one of those diseases which require, as observed respecting Apoplexy, the most energetic treatment. When convalescence has fortunately been established, the attention of the physician is still requisite, during several weeks, until complete re- covery be fully confirmed ; for the brain, after suffering from inflnm- mation, is very apt to relapse into the same state, from the excitement of too full a meal, or over-exercise, or even slight mental exertions or emotions. On this account, the convalescent must be kept per- fectly quiet, and completely free from the smallest excitement ; and the strictest regimen observed. His diet should not only be mild and unstimulating, but small in quantity. Inflammation of the eyes requires the same caution when convales- cence is secured as other inflammatory affections; namely, quiet, great moderation in diet, and avoiding exposure either to much light, heat, or cold, or whatever can stimulate the still highly excitable organ. Affections of the Chest. Inflammation of the Lon^s {Pneumonia). — In convalescence from this disease, the temperature of the room in Avhich the patient sits should not exceed 60° F. ; and it should be free from currents of air ; but, at the same time, it should not bo close. The necessity for con- tinuing the same elevated position of the shoulders when in bed, which is demanded during the existence of the disease, remains even when the convalescence is advauced. The patient should be pre- vented from talking, and from exerting any muscular motion that can accelerate the circulation. The diet should be of that desoi'iption which will support the strength without exciting or producing reple- tion. As the convalescence advances, and exercise is permitted by the medical attendant, it should be regular, but not hurried nor vio- lent ; and evening air should be sedulously avoided. Pleorisy. — Inflammation of the lining membrane of the chest re- <^; aires the same attention to diet and regimen during convalescence IX>ME811C MANAGEMENT OF THE 8I0K-ROOM. 575 fts the last-mentioned disease, except that a greater strictness with repird to abstemiousness in food is requisite ; the least deviation l»L'in<' likely to bring on a renewal of the inflammation. When tho (lisciiso assumosa chronic character, and when the object is to remove fluid effused into the cavity of the chest, and pressing upon the lungs so as to circumscribe their action, the same degree of strictness with lospoct to diet is not necessary ; but, as in this condition of the habit tho physician must continue bis attendance, the regulation of tho diet devolves upon him. An^inu. — In that condition of the habit which is connected with a predisposition to gout, but in which, instead of a regular paroxysm, tho heart and the pulmonary organs become affected, and the disease assumes that form which has been denominated diaphragmatic gout {Angina pectoris) , the regulation of diet is of vital impoi'tance ; and it should be of aa low a standard as the constitutional powers will admit. It should not bo of a description either to nourish much, or to augment or to cause fulness of habit : mild animal food, in mod- erate quantity, may be allowed ; but tho staple should be of a farina- ceous kind ; every stimulant, whether solid or fluid, should be avoided ; luid wine and malt liquors regarded as poisons. Tho invalid himself should be made aware, that whatever tends to excite or to hurry tho circulation is calculated to bring on a paroxysm ; nor is it sufficient that he avoids all stimulating viands and beverages ; he should also be instructed that the same deleterious effects are likely to follow a full meal, even of the most proper and mildest food. The same attention to diet, both as regards quantity and quality, is essential in palpitations depending on organic disease of the heart. Asthma. — In no affection of the chest is attention to diet so impor- tant as in asthma. Sir John Floyer, who himself suffered from the disease, recommends almost a degree of abstinence ; which is correct in reference to quantity ; but the diet, although of a light, yet should be of a solid, kind. This is especially necessary, when dyspepsia is present to aggravate and excite the disease of the lungs. In Hooping^-coa^h, the diet, whether tho patient be an adult or a child, should be of tho mildest description ; and, perhaps, no nutri- ment is so well adapted to support the tone of the body, without exciting it, as milk. In infancy, nothing but the breast should be given; the system of the nurse, at the same time, being kept as cool as possible by mild diet, and her mind in a tranquil state. If convul- sions occur, these sometimes depend on the nature of the milk ; in which case the nurse should be changed. It is still customary with non-professional persons to consider change of air essential in hooping- cough ; but it is only after the malady has run its course, and conva- lescence is progressing, when the cough remains as a habit, that change of air is really beneficial. It is unnecessary to combat tHe absurd opinion, that a chanj^e even to a worse air is salutary. piffi^Klf^f 576 DOMESTIC MANAGEMENT OF THE 8IOK-ROOM. n Affections of the Stomach and Bowels. Altuovoii acute injlammation off he stomach rarely occurs, yet there is a chronic form of thut disousc, in which, during its actual oxistcnco, nnd also in convalescence from it, much of tho safety of the invalid depends upon domestic manaj^ement. Every source of excitement should ho avoided ; the sicU-room should he airy, and its teinpcraturo that of summer. Tiie food should ho of the blaudcst kind, given cold, or iced, and in small quantity : even when the convalescence is established, tho diet should consist of fariniiceous matters, mixed with small quantities of heef-tea, or weak broths ; and this severe diet should bo persisted in for a considerablo time after recovery. Enteritis. — "When inflammatory action extends to, or exclusively exists in, the mucous lining of tho'bowcls, constituting this disease, the diet, during the early stage of it, should be confined to cold water, or iced almond-emulsion ; after which, milk and barley-water, or weak chicken or veal-tea, may bo given in small quantities ; namely, two or three tablcspoonfuls, at intervals of three or four hours. Nothing stronger should bo ventured upon, unless exj)ressly ordered by tho medical attendant. Atonic Dyspepsia, ov simple indigestion. — During tho attack, absti- nence, to a certain degree, is necessary ; but, if this is not essential, tho diet should bo somewhat stimulant, but simple; namely, a small cup of moderately strong coffee, with littlo sugar or milk ; or beef-tea, with a small quantity of dry toast; and, at? tho stomacli begins to retain its tone, a little animal food of easy digestion, such as mutton or poultry. During tho intervals of tho paroxysms of indigestion, attention to diet is of the first importance. As a general rule, tho patient should be confined to a spare animal diet, with a moderate share of well' boiled vegetables, and a considerablo restriction with respect to the use of fluids. Dysentery, which implies inflammation, acute or chronic, of the same membrane as in enteritis, but confined to the larger and lower bowels, requires the diet to consist of the mildest farinaceous matters, strictly avoiding all solid animal food. It should be given in small quantity at a time, and the whole allowance for the day should ho moderate. The farinaceous food should not be either solid, nor yet altogether fluid ; the former may prove injurious as a mechanical irri- tant ; tho latter is apt to excite griping, from the extrication of much flatus. Diarrhoea. — Much of tho domestic, as well as the medical manage- ment of diarrhoea depends on the nature of the attack, and its causes ; but too much attention cannot bo paid to the regulation of tho diet. It should bo both small in quantity, ond mild in quality. In tho early stage, and the acute form of the disease, barley-water, arrow-root, made with water, ricedr grit grael, and light broths, are proper. In DOMESTIC MANAGEMENT OF THE SICK-ROOM. s?: chronic diarrhcca, rice, properly boiled, and mixed with a small quan- tity of beef-tea, forms an excellent diet, as it nourishes moderately, and leaves scarcely any feculent matter behind it. Ill Cholera, convalescence is often tedious ; and nothing is so likely to cmse relapse as even slight irregularities of diet. For weeks after the leverish symptoms have disappeared, the diet should consist of a very moderate quantity of vegetable matter only. The feet should be kept especially warm, and the whole body clothed in flannel, to| prevent that irregular distribution of blood which so strongly charac- terizes the disease. After inflammation of the lining membrane of the cavity of the belly {peritonitis) has been subdued, the invalid should still observe the strictest diet and regimen. He should return very gradually to the use of animal food and wine. The bowels should be moderately and daily opened, the feet kept warm, and the skin maintained in a healthy condition by wearing flannel next to it, for a very considerable time after every trace of the disease has disappeared. Diseases of the Liver. — In all cases of recovery from these diseases,* whether inflammatory or otherwise, every precaution should be taken to guard against the deleterious influence of alternations of tempera- ture and also of damp, by clothing in flannel next the skin. Errors in diet should be avoided ; and fermented liquors and stimulating bever- age of every kind, refrained from. When pains of the side continue, after all the other symptoms of the disease have disappeared, the introduction of a seton, if prescribed, should not be objected to ; as th« greatest benefit has often followed that mode of countar irritation- 73 ' i] k .■' . ■-.> .s 1; 'IKfiiTr);; COOKERY FOR THE SICK-ROOM. It was said by the distinguished Dr. Rush, in his lectures before his class, that a physician ought to spend six months in a kitchen before beginning practice. A knowledge of dietetic preparations fitted for the sick, and for those recovering from disease, however apparently unimportant, adds much to a physician's power over his patient, and to his popularity ard usefulness. In giving nourishment to the sick, who are suffering from low dis. eases, it is an important rule which should never be forgotten, to give but little at a time, and to repent that often. In cases of great prostra- tion from disease, life may at times be endangered by a delay in giv- ing nourishment of even a few minutes beyond the proper time. Barley-Water. Pearl barley, two ounces ; boiling water, two quarts. Boil to one half, and strain. A little lemon juice and sugar may be added, if desirable. To be taken freely in inflammatory diseases. Rice-Water. Rice, two ounces ; water, two quarts. Boil an hour and a half, and add sugar and nutmeg. Rice, when boiled for a considerable time, becomes a kind of jelly, and, mixed with milk, is a very excellent diet for children. It has in some measure a constipating property, which may be increased by boiling the milk. Decoction of Bran. New wheat bran, one pint ; water, three quarts. Boil down one third, strain off the liquor, and add sugar, honey, or molasses, accord- ing to the taste of the patient. A bran tea may be made by using boiling water, and suffering the mixture to stand in a covered vessel for three or four hours. Sage Tea. Dried leaves of sage, half an ounce ; boiling water, one quart In* {nse for half an hour, and strain. Add sugar and lemon juice as COOKEUV von TlIK SICKUOOM. D79 required by the piitient. Balm and other teas are made in the samo manner. The above infusions form agreeable and useful drinks in fevers, and their diaphoretic powers may be increast^d by adding a little sweet spirits of nitre. Barley Coffee. Roast one pint of common barley in the same way in which coffee is roasted. Add two large spoonfuls of this to a quart of boiling water ; boil five miimtes. Add a little sugar. Lemon-Water. Put two slices of lemon, thinly pared, into a teapot, a little bit of the peel and a bit of sugar. Pour in a pint of boiling water, and cover it close two hours. A Refreshing Drink in Fevers. Put a little sage, two >"prigs of balm, and a little sorrel into a stone jug, having first washed and dried them. Peel thin a small lemon, slice it, and put a small piece of the peel in ; then pour in three pints of boiling water. Sweeten, and cover it close. Another. >iL an ounce and a half of tamarinds, three ounces of cran- berries, and two ounces of stoned raisins, in three pints of water, till the water is reduced to two pints. Strain, and add a bit of lemon S)eel, which must be removed in an hour, as it gives a bitter taste if eft too long. A Very Pleasant Drink. Put a teacupful of cranberries into a cup of water, and mash them. In the mean time, boil two quarts of water with one large spoonful of corn or oat meal and a bit of lemon peel ; then add the cranberries. As much fine sugar as shall leave a smart flavor of the fruit, and a wineglassful of sherry. Boil the whole gently for fifteen minntes, and strain. . Crust Coffee. Toast slowly one or two slices of brown or white bread, pour boil, ing wat tion takes place. Strain. Sweet Whey. Skimmed milk, two quarts ; a piece of prepared calf's rennet. Miji, and put in a warm place till coagulation takes plac** ; then strain. Whey with Tamarinds. Milk, boiling, one pint ; tamarinds, two ounces. Boil them to gether till coagulation takes place. , Wine Whey. Milk, two thirds of a pint; water, one third of a pint; Madeira, or other wine, one gill ; sugar, one dessert spoonful. Place the milk and water together in a deep pan on the fire, and at the moment when it begins to boil, pour in the wine and the sugar, stirr ig assidu- ously whilst it boils, for twelve or fifteen minutes. Lastly, strain through a sieve. This is excellent in all forms of fever, given in small quantities. It may be drunk either cold or tepid, a wineglassful at a time. Milk and Soda Water. Heat nearly to boiling, a teacupful of milk ; dissolve in it, a tea- spoonful of refined sugar; put this into a large tumbler, and fill with soda water. This is an excellent mode of taking milk when th3 stomach is charged with acid, and is oppressed by milk alone. Sippets. On an extremely hot plate, put two or thr< c slices of bread, and pour over them some of the juices of boiled btof, mutton, or veal, if there be no butter in the dish. Sprinkle over them a little salt. Restorative. Take two calf's feet, one quart of water, and one quart of new milk ; place all in a close-covered jar, and bake three hours and a half. When cold, remove the fat. Any desired flavor ma be given, by adding lemon-peel, cinnamon, or mace, while baking. Add sugar nfterwards. Coffee Milk. Boil a dessertspoonful of groiind coffee in nearly a pint of milk, for a qnarter of an hour, then put into it a shaving of isinglass, and clear it Let it boil a few minutes, and set it beside the lire to clarify. Sweeten with loaf sugar. Nutritive Fluid. Take two teaspoonfuL of lump magnesia, one teaspoonful of sal- eratuiJ, one teaspoonful of salt, two teaspoonfuls of flour, half a pint of milk, and one pint of water. Put the milk and water united over the fire, and rub up the flour with a little cold water to make a thiii paste. Just when the milk and water bogin to boil, stir in the paste. This will make a thin porridge, which should boil about five minutes. At the end of this time, remove from the fire, and pour into a pitcher. Now add the magnesia, pulverized, and mixed with the saleratus and salt. Sweeten to suit the taste. This may be drank freely, several times a day, so as to produce two evacuations of the bowels in twenty-four hours, in those cases of dys- pepsia attended by acidity of the stomach, and in many debilitated conditions of the system in which there is a tendency to loss of flesh. This is one of the leading fluids used by those who pursue what is called the " Nutritive System" of treating disease, and is really a val- uable preparation, having the effect often to increase the flesh, even while it acts as a cathartic. 1 'i ■i III vm m MEDICINES AND THEIR PREPARATIONS. Materia Medica. That department of medicine which treats of remedies, their doses, modes of using, and influences upon the constitution, is called materia medica. The agents employed in the treatment of disease are taken from three kingdoms of nature, — the vegetable, the animal, and the mineral. The largest portion of medicinal substances are taken from the vegetable world. They consist of leaves, flowers, seeds, barks, and roots. These lose much or all of their medicinal powers unless gath- ered at the right seasons of the year, and are properly cured. The different parts of a plant are to be gathered when their peculiar juices are most abundant in them. Tlie Roots of Annual Plants are best supplied with their juices be- fore they are in flower ; they should be gathered at this time. Tlie Roots of Biennial Plants should be gathered in the autumn, after their first year's growth. The Roots of Perennial Plants should be gathered in the spring, before vegetation has begun. • Before they are dried, the solid parts of these roots are to be cut in slices, after being washed, and the small fibres, urJess they are the parts used, are to be thrown away. Bulbous Roots are to be gathered at the time their leaves decay. Their outer covering being rejected, they must be sliced, strung upon threads, and hung in a warm, airy room to dry. After being dried, roots should be packed in barrels or boxes, and kept as free as possi- ble from moisture. Barks, whether of the roots, trunk, or branches, must be gathered in autumn, or early in the spring, when they peel off* most easily, and the dead outside and all rotten parts being separated, they must be dried in the same manner as roots. The most active barks are gen- erally from young trees. Leaves are to be gathered when they are full grown, and just before the fading of the flower. MEDICINES AND THEIR PREPARATIONS. 587 Those of biennial plants are not to be collected until the second year. For drying, they should be thinly spread on the floor of a room through which a current of air passes. For preservation, they should be packed in ves jels, and kept free from moisture, and insectu. Flowers must generally be collected about the time of their open- ing, — either a little before, or just after. They should be dried as rapidly as possible, but not in the sun, and may be packed away in the same manner as leaves. Fruits, Berries, etc., may be spread thinly upon the floor, or hung up ill bunches to dry. Articles to Accompany a Medicine Chest. As the author intends to prepare a Medicine Chest to accompany this volume, it is well to mention the following article's as necessary to be had with it : 1. A Spatula for mixing ointments and pills, and fo' spreading plasters. 2. A piece of smooth marble on which the above articles may be mixed, divided, and spread. 3. A glass funnel. 4. A domestic syringe for injections. 5. Adhesive or sticking plaster. 6. Lint. 7. Scales and weights. 8. A glass or wedgewood mortar and pestle. 9. A graduated wineglass for measuring teaspoonfuls and table- spoonfuls of liquids. 10. A minim graduated measure. 11. A two-ounce graduated measure. 1 9 Dnm. no. 186. Mtnlm*. S Onnc». FlO. 187. ^ DnM. HnnH xBAsuRa TWO-OUNGK MBA8UKIL The minim measure is represented by Fig. 186, and contains one fluid dram, or sixty minims, which is divided by twelve lines, — each line representing five minims. A minim is considered about equal to one and a half drops. "Mfl-fl 588 MEDICINES AND THEIR PREPARATIONS. The two ounce measure is represented by Fig. 187, and is divided off from half a dram upward. Doses, Weights, etc. Apothecary's weights, by which all medicinal preparations ought to be weighed, are divided into pounds, ounces, scruples, drams, and grains. The characters marked on weights and graduated measures, are explained as follows : gj one ounce, f gj one fluid ounce. gss half an ounce. 2j one dram. fSi one fluid dram> Sss half a dram, gj one scruple. ^ss half a scruplei The grain weights are stamped with punch marks. 20 grains. make one scruple. 3 scruples make one dram. 8 drams make one ounce. By apothecary's weight : lb The pound is equal to 12 ounces. g " ounce " 8 drams. By apothecary's measure : 3 B 60 drops make one fluii-dram. 8 drams make one fluid-ounce. 16 ounces make one pint. The dram is equal to 3 scruples. " scruple " 20 grains. The pint is equal to sixteen ounces. - 3 " dram " ninety 'drops, or sixty minims. The marks and words used by physicians and apothecaries may be a little more fully explained by the following table : R stands for recipe, and means take. aa stand for ana, and mean of each. • Q> stands for libra vel libra, and means a pound or pounds. g stands for uncia vel uncine, and means an ounce or ounces. 3 stands for drachma vel drachmcs, and means a dram or drams. ^ stands for scrupulus vel scnipuli, and means a scruple or scruples. O stands for octarius vel octarii, and means a pint or pints. f g stands for Jluiduncia vel Jluiduncice, and means a fluid ounce or fluid ounces. f 3 stands for fiuidrachma vel fluidrachrtUB, and means a fluid drachm or fluid drachms. m stands for minimum vel minima, and means a minim or minims. Chart, stands for chartula vel chariuke, end means a small paper or papers. Ooch. stands for cochlear vel cochlearia, and means a spoonful or spoonfub. CoUyr. stands for coUyrium, and means an eye-water. Cong, stands for conguit vel conguii, and means a gallon or gallons. Decoct, stands for decoctum, and means a decoction. J^. stands for Jiat, and means make. Garg. stands for gargarysma, and means a gargle. Gr. stands for granum vel grana, and means n grain or grains. Gtt. stands for gutta vel guttce, and means a drop or drops. ■ , JIaust, stands for haustus, and means a draught. Infus. stands for infusum, and means an infusion. M. stands for misce, and means mix. • Mass. stands for massa, and means a mass. Mist, stands for mistura, and means a mixture. Pit. stands for pilula vel pilulce, and means a pill or pills. Pulv. stands for pulves vel pulveres, and means a powder or powders. Q. S. stands for quantum sufficit, and means a sufficient quantity. S. stands for signa, and means write. Ss. stands for semis, and means a half. Domestic, or Approximate Nensiires.— A tablespoon contains about four drams ; a teaspoon, one dram ; a dessertspoon, three drams ; a wineglass, two ounces. Spoons vary so much in size, that they i should not be used as measures in giving powerful medicines. The Approximate Value of French Decimal Weights. One centigramme is equal to \ Two centigrammes " ' ^ One demi-decigramme " 1 One decigramme " 2 One gramme " 18 One gramme and three decigrammes is equal to 1 Two grammes " i Four grammes ** 1 One decagramme is equal to 2 drachms and 36 Three decagrammes and two grammes is equal to 1 Demi-kilogramme ^ 1 Kilogramme "2 grain. grain. grain. grains. grains. scruple. drachm. drachm. grains. ounce. pound. pounds. At Paris, the scruple is equal to 24 grains ; the drachm, to 72 grains. Everywhere else, the scruple is equal to 20 grains ; and the drachm, to 60 grains. The following table shows the relative doses for young people of different ages : The dose for a person of middle age being That of a person from 14 to 21 years will be " " 7 to 14 M M « U u u of « 4to7 4 3 2 1 « « M (( M 1 or 1 drachm. § or 2 scruples. ^ or J drachm. ^ or 1 scruple. J or 15 grains. ^ or 10 grains. I or 8 grains. T^ or 5 grains. In administering medicines, it is always well to begin with the smallest dose mentioned and gradually increase until the desired in- fluence is produced. wrwi m^ Tinotares. The preparations called tinctures are made by grinding or bruising the roots, leaves, or barks used, to a coarse powder, placing it in tlie proper amount of either alcohol or diluted alcohol, letting it stand from seven to fourteen days, — shaking each day, — and, finally, filter- ing through paper. A large proportion of tinctures are made by tak- ing one cmnce of the medicinal substance to one pint of the spirit ; and whenever tinctures are spoken of in this Materia Mcdica, and ip quantities are not named, the above proportions are to be prcsuiin-d. When a larger proportion of the medicine is to be used, I shall simply indicate the proportions in the fewest words, as under "Black Cohosh, — this tincture, four ounces to the pint of alcohol," meaning thereby, that the tincture is made by using four ounces of the root to the pint of alcohol. Tilden & Co.'s fluid extracts, which are the most reliable of any with which I am acquainted, have the same strength, ounce for ounce, with the roots, barks, leaves, etc., of which they are made. Tinctures may therefore be made with very little trouble, by substi- tuting, in each case, the same number of ounces of their fluid extracts to the pint of alcohol, which I name of the gross substance, or, when no quantity is named, one ounce to the pint. Infusions. Infusions are solutions of vegetable medicines, generally obtained by pouring boiling water upon the ^mbstance, and letting it stand till it coOls. When a more prolonged, application of heat is desired, the vessel may stand for a while by the fire^ but must not be permitted to boil. The vessel should usually be covered. As in the case of tinctures, I have uniformly, while writing this Materia Medica, briefly named the quantity to be used to the pint, whenever it varies from one otmce. Acetic Acid. — This is a clear liquid, without color, and has a strong, sour taste, and an agreeable smell. When held to the nose, its fine, pungent odor often relieves headache. A piece of cambric wetted with it and applied to the skin, excites heat and redness, and, very soon, a blister, — for which this acid may be substituted in inflamma- tory sore throat, and other cases requiring speedy action. Applied to corns and warts, with a camel's-hair brush, it destroys them. One part to seven of water, makes a good vinegar. Citric Acid. — This acid is extracted from lemon, or lime juice; it is also present in the cranberry, currant, strawberry, raspberry, tamarind, and is very abundant in the red elderberry. It is refrigerant, and anti- septic, and is chiefly employed as a substitute for lemonade. Nine and a half drams of the crystals, two drops of oil of lemon, and one pint of water, answers a good purpose, in place of lemon-juice. Dilated Nitric Acid. — This, in the undiluted state, passes under the ^p^^plwf MEDICINES AND THEIR PREPARATIONS. 591 name of aqua-fortis. It is tonic and antiseptic. Largely diluted with water, it forms a good drink in fevers, especially typhus. Taken in large doses, it is a powerful poison. One dram of this preparation, thirteen ounces of soft water, and one ounce of simple syrup, make a good drink in fevers, of which half a wineglass to a wineglassful is a dose. Excellent in cases of hooping-cough. Nltro-Murlatlc Aclll. — This acid, when properly diluted, has a tonic and stimulant influence. It is much used as a foot-bath in atl'ections of the liver, and in deficient secretions of the bile. Diluted Hydrochloric Acid. — This is known by the name of diluted muriatic acid. It is tonic, antiseptic, and diuretic, and is used in typhus, eruptions of the skin, and with other articles, as a gargle in inflammatory and putrid sore throats. Dose, from five to twenty drops, in a wineglassful of water. It is given in scarlet and typhoid fevers, about twenty drops being put into a bowl of barley-water or gruel. Diluted Hydrocyanic Acid. — This is commonly known by the name of prussic acid. It is sedative and antispasmodic, and is useful in spasmodic coughs, asthma, hooping cough, nervous affections, hic- cough, palpitation of the heart, irritable stomach, and dyspepsia. Dose, from two to five drops, in a glass of water or tea of Peruvian bark. Diluted Sulphuric Acid. — This acid, known by the name of diluted oil of vitriol, is tonic, antiseptic, refrigerant, and astringent. It is useful in dyspepsia, diabetes, menorrhagia, hsemoptysis, eruptions of the skin, hectic, and diarrhoea. It is often given with some bitter in- fusions, as cascarilla, columbo, peruvian bark, or quassia. The aro- matic sulphuric acid is often used in place of it, being sometimes considered more grateful to the taste. Dose of each, from five to fifteen drops. Tannic Acid. — This is an astringent preparation, and passes under the name of tannin. It is prepared from galls. It is used in diar- rhoea, dysentery, passive hemorrhages, and diabetes. Dose of the powder, from one to five grains. Tartaric Acid. — This is refrigerant and .antiseptic, and is used in inflammatory affections, fevers, and scurvy. It is much used in pre- pai'ing what is called lemon syrup, and forms an agreeable and health- ful drink. Alcohol. — Alcohol is the result of the fermentation of the juices of many vegetables. It is the intoxicating constituent in whiskey, rjm, brandy, gin, wines, porter, ale, beer, and cider. Its principal use in medicine is in the preparation of tinctures, essences, and extracts. One part of pure alcohol, to one part of water, forms the diluted alco- hol of the shops. Almonds. — The Amygdalus Communis, or almond tree, grows in the south of Europe and Asia, and yields the sweet and bitter almond. /392 MEDICINES AND THEIR PREPARATIONS. Tho oil of the sweet almond is used as a demulcent, in coughs, etc A dose is a teaspoonful. The oil of the bitter almond is poisonous, and is occasionally used as a valuable sedative. Its taste is like that of a peach kernel. Dose, from a quarter of a drop to a drop. It owes its poisonous properties to hydrocyanic acid. Cakes, etc., are sometimes llavorcd with an essence jncpared from it. Hues. — This is the hardened juice of the leaves.of several species of the aloe tree, in North and South Africa, in tlie south of P^urope, and in the island of Socotra. Aloes is purgative, acting chiefly upon the rectum, or lower bowel, in which it frequently produces irritation, and is a|)t to aggravate and induce piles. It is much used to excite the flow of the menses, and should never be given to women during pregnancy. It ^produces griping of the bowels, whifth may be dimin- ished by combining it with soap, or carbonate of potash. Aliiiii {Alumen). — The chemical name of this is sulphate of alu- mina and potassa. L» ordinary doses, alum is astringent and anti- spasmodic. In large do.:-?>< it is purgative and emetic, and is used both externally and internally. It is often used in solution as a gar- gle in sore throat, and falling down of the uvula, and as an injection in leueorrhoea. In doses of thirty or forty grains, it acts as a purga- tive, and used in this way, is useful in painter's colic. When exposed to heat in a vessel till it ceases to boil, it becomes dry, and is then called burnt alum, which, when pulverized, is applied with advantage to canker spots in the mouth, and to proud flesh. American Hellebore {Veratrum Viride). — This plant grows in many parts of the United States, usually in swamps, wet meadows, and on the banks of mountain streamlets. The root is the part used. It is slightly acrid, alterative in a marked degree, very decidedly and ac- tively expectorant and diaphoretic, and it is an excellent nervine, thoigti not narcotic. But its most marked and valuable quality — that in which it has no rival — is its sedative action upon the circula- tion. Li suitable doses, it can be relied upon to bring the pulse down from a hundred and fifty beats in a minute to forty, or even to thirty. In fevers, therefore, in some diseases of the heart, in acute rheuma- tism, and in many other conditions which involve an excited state of the circulation, it is an article of exceedingly great value, because it is always reliable. It has recently come into use ; and I doubt whether so valuable a contribution has been made to our list of medicines in a hundred years. Preparations. — Veratrum is used chiefly in the form of tincture, six ounces to the pint of diluted alcohol, or of fluid extract. The dose of each of these preparations, for a grown person, is three or four drops, every hour or two, in a little sweetened water, and gradu- ally increased, if necessary, till the pulse comes down to sixty or seventy. If taken in so large a dose as to produce vomiting, or too much depression, a full dose of morphine or laudanum, in a little brandy or ginger, is a complete antidote. Veratrin, the active principle of veratrum, is also used, in doses of one-half to one-third of a grain. MRDICINKS AND THEIU PREPAUATIONS. 593 Ameriean Ifutcmuanha {Euphorbia Ipecac). — This plant i« peren- nial, and growM in 8iindy Hoiis in the Middle and Boutliern HtateH. When cut or broken it gives out a milky juice. The root is the medicinal part. It is emetic, cathart.c, and diaphoretic. Dose, as a cathartic, ten or twelve grains ; as a iiaphoretic, three or four grains, every three or four hours. AiiierUniii Ivy {Ampelopsis QiiinquefoHa). - - T\m vine grows in all part.s of the United States. It is known by the names of faisf ^f<^P^ and tfnld woodbine. It is alterative, tonic, a.stringent, and expecto- rant. Used in scrofula and syphilis. ^Vatcr of Animoiiia {Liquor Ammonia). — This preparation, called hartshorn, o>* spirits of hartshorn, is formed by the union of water will) ainmonia gas. It has a powerful amtnoniacal odor, and an alkaline, caustic taste. Taken internally it is stinmlant, sudorific, and antacid, and applied externally, it is rubefacient. It stimulates par- ticularly the heart and arteries, without very much exciting the brain. It is an excellent remedy in heartburn, and for sick lus'idache, depend- oiir on sourness of the stomach. A dos(! is from ten to thirty drops, lari,'ely diluted with water. United with oils, or with alcohol in about eiiual proportions, and applied externally, it reddens the skin, and, if tiie cloth wet with it bo covered with oiled silk, or with flannel to pre- vent evaponition, it will sometimes quickly raise a blister. In cases of fainting, it is frequently applied to the nostrils, to excite the brain, and rouse the system. Cai'boiitite of Aiiiiiiiouia. — This is a white, moderately hard, crys- talline siiit, — having a pungent, ammoniacal smell, and a sharp, pen- etratihj^ 1 u/,e. When exposed to the air, it loses some of its ammo- nia, becomes a bicarbonate, and falls to powder. It is stimulant, diaphoretic, antispasmodic, powerfully antacid, and, in large Hoses, emetic, internally, it is more often used than water of ammc na, and for similar purposes. Coarsely bruised, and scented with oil of lavender, it constitutes the common smelling salts, so much used in fainting and hysterics. For internal use, the dose is from five to twenty grains, taken in the form of pills, every two, three, or four hours. Muriate of Ammonia {Sal Ammoniac). — This, also called hydro- chlorate of ammonia, is a white, translucent, tough, fibrous salt, in large cakes, about two inches thick, convex on one side, and concave on the other. It has a saline, pungent taste, but no smell, dissolves in one part of boiling water, and three parts of cold. Taken internally, it is stimulant and alterative. It is a valuable remedy in chronic bron- chitis, pleurisy, and inllammation of the serous and mucous mem- branes generally. But it must only be used after the first violence of these inflammations has abated. Pulverized, and placed over a spirit lamp in a tin cup, the fumes which arise when it sublimes, may be inhaled five or ten minutes once or twice a day, with great advantage in chronic bronchitis, and in chronic inflammations generally of the 75 u 594 MEDICINES AND THKIU rUKrAHATIONvS. air passages. A solution composed of one ounce of the salt dissolved in nine fluid ounces of water, and one of alcohol, may be us(;d as a wash, for bruises, indolent tumors, and ulcers. Solution of Aeet«t« of imiiioiiia {Liquor Amnionur Arrfatis). — Thi* is known by the common name of spirit of mindererus. The taste h saline, and is 'ike* that of a miAture of nitre and sugar. It is a valuable dia|)horetic, and is much employ<'d, alone o. mixed with Bweet spirit of nitre, two parts to one, m fevers and inflaimnatioiis It is a valuable external application in nuuups, applied hot upon a piece of flannel. One ounce mixed with seven ounces of rose-water, and two drams of laudanum, forms a valnal)le wash for the eyes iit chronic ophthalmia. The dose is from two dnuns t«» half a tluid ounce, juixi^d with sweetened water, every two or three hours. Aronititic Spirit of Aiiiiiioiiri (iS/nn'fus Anunoiuw Aroiiiafirus).-^ Taken internally, this answers the same purpose uf other prepara- tions of ammonia, and is much used on account of its agreeable taste and smell. It is valuable as an antacid in sick headache. Dose, from thirty drops lo a dram, sutliciently diluted with water. Anise (Pimpinrl/a Anisu/n). — This is a perennial plant, and grows in Egypt. Its fruit is caUed anise-seed. It is aromatic^ and cijrmina- tive. it is uuH'h used to allay naus<^a, flatulency, and colic, particu- larly in children. It is fre(piently added to other medicines to make them more agreeable, and to lessen the griping elfects of physic. The oil extracted from tlie seeds, dissolved in alcohol, an ounce of the former to a pint of the latter, forms what is called the essence of anise. Dose of the essence, from thirty drops to a dram in sweetened water. Anise forms a very valuable addition to cough preparations. Arnica {Arnica Montana). — This is a perennial ])lant, growing ii» mois', shady places in Siberia, etc. It is often call(>d lco})ard's bane. It .'s much used externaliy as a stimulating application to bruises- local inflannnation, etc. Preparations. — It is chiefly used in the form of tincture, or lluiii extract. Dose, ten to sixty drops. Half an ounc«! of tincture, livt and a half ounces of boiling vinegar, and two drams of carbonate et arr.monia, used warm, make in some cases a valuable fomentation It is one of the leading homoeopathic remedies. Arr«W-rw>t. — This is prepared from the Maranta AruruJinacen, a plant of the W«;3t Indies, It is chiefly used in forming dietetic pn*- parations, and belongs to the first or su:'charin«' group of (bod-art iclcs (see page (>6). Assafoptida. — This is the hardened juice from trie root of a Persian plant. It is stimulant, antispaarnodic, and expectorant, and is rmu'h used in nervous complaints. A dose of the, powder, is from live to ten grains, and of the tincture, made by macerating two ounces in a pint of diluted alcohol, from thirty to sixty drops. Balm {Melissa Officinalis). — Thii-; is a perenaml plant, growing in Euro|X' and this country. It is mo iKtrtht'rn |)arts of our country. A tincture made from the buds, in tlor'fs of from one to four lluid dianis, is useful in affections of the kidneys, in scurvy, and rheumatism. Hteeped in lard tijey form a use- ful ointment for souic purposes. Ridmoiiy {ClieJone Glabra). — This is a perennial |)lant, common tc the ( iiiicd States. It is tonii;, cathartic, and vermifuge. It is used in indigestion, debility, and d( rangetucnts of th(^ liver. A. dose of the powfiert'd leaves, is one dram; of the tincture, two lluid dnim, ; o\ the (Iccoctiou, t)tie or two (luid ounctes ; of the active prisicjple calleii chelonin, one to twt) grains. A decoction of balmony combined with tinetiire of assafm ten to thirty grains, in mucilage or syrup. Ifcirberry {Berberis Vnf^nris). — This shrub grows along the Atlan- tic coas'^, from Canada to Virginia. The parts used are the bark and b'Tries. It is tonic and laxative, and, in doses of a teaspoonful, pcfw- dered, is useful in jaundice, chronic diarrhcea, and chronic dysentery. A decoetijui of the berries forms an agreeable acid drink in fevers, cholera infai^tuin, etc., and as a gargle, it is useful for ulcers of the mouth, etc., as <:■ wash, fo? chronic inflammation of tin; eytjs, and as ao injection for leucvirrha;a. Betir-lwrry {(Jva ursi). — This plant, also called upland cmnberry hay a wide range, being found in the northern parts of Asia, Europe, and America, ft flowers from June to September, and ripens \i» herries in the winter. The leaves are the only medicinal parts. It is astringent and tonic, and acts particularly upon the urinary organs, for c(»tnplainther. !t is chiefly used for inhalation in chronic laryn- gitis and broiu'hif is. When used for this purptise, it may bv. added to boiling water, and the vapor be inhaled; or it may be burned upon coals, or a hot shovel, the fumes being inhaled. Benzoic Acill. — This is prepared by heating benzoin, and cauj^ng it to sublime, it consists of silky, feathery crystals, wliiuli arc white and soft. It has been found useful in the |>liospliatic variety of graviL A convenient way of giving it is to unite one part of it with four parts of phosphate of soda, the dose of which is from ten to thirty grains. ', w ■.M''y! MRDICrNKS AND THEIR PREPARATIONS. 597 Kl(3. ISHl. Betliroot {Trillium Penduhm). — A perennial plant, growing in rich Boils, in the Middle and Western States. The root is used, and is astringent, tonie, a«id antiseptie. It is useful in bleeding from the lungs and kidneys; also in exeessive menstruation, cougli, asthma, and (lillicult breathing. Boiled in milk, it is used, in the western country, in diarrlia-a and dysentery. Prepandiom. — Fluid extraet, dose, one to three drams ; Irilliin, do.'^e four to eight grains; infusion, dose, two to four ounees ; decoe- tioii, used as a loeal application to ulcers and sore mouth, and as an injection in lencorrlHea and gleet. A poultice made? from tlie root, is useful for carbiuiclcs, indolent tumors, buboes, foul uh-ers, and for iitinurs oi insects. Hitter •'•us plant, growing in rich soi's in the Uniicd States and Canada. The root is the part used, and is laxa- tive, tonic, diaphoretic, and alterative. It is em- ployed in chronic allections of tin; liver, syphilis, scrofula, intermittents, and tlu; low stage of tj- uhoid fevers. Forty to sixty strains will c iu»e vomiting without luuch nausea. Preparations. — Fluid extract, dose, as a tonie, ten to twenty drops; as a diaphoetic, lifteen to twenty-five drops; as an emetic, half a dram to a dram. Solid extract, dct^v^ two to eight grains; a|)ocynin, the active print-iple of the root, dose, half a grain to two grains; tincture, dose, BiTTKK-uooT. ^^^.^^ ^^ tluce dr'Mns; infusit)n, ilose, a wincglass- ful, three times a day. Risiiiiith, — The principal preparation of this mcta! used in m«'di- cinf, i.s the frisiiifni/c of liisiiiiff/i, also called ni/rufc, siihiiifrafr, and irliile o.'iili' oj hisintif/i. It is a white powiiiT, without smell or tsiste. U is used for various irritable iuid painful allections of the stomach, when there is no acute inlhunmation. It i.^ p irticnhirly useful in ciiroiiic diarrlKca, u'ore especially the diarrlwea of the latter sta^'cs of ciiiisiiMiptioii, — orcr i'^/iirh it lias tiiorr nuilrol tliuii uiiji olhrr kiuunn ■fvmalij. To sliow its b(st ellects in this foruj v)f diarrlio-a, it should be i;iven in large doses, not less than twenty to thir'y grains, iMinieiU atcly after each meal. The small doses usually givi-n are (oiiipara- tiv cathartic, alterative, sialagogue, and diuretic. It ai ts particularly on the glandular system ; in large doses, it evacuates and exhausts the system, acti,ig on the liver, and fuUiil- ing the ])urposes of mer(;ury. Prepara/iuns. — Fluid extract, dose, twenty to sixty drops; solid extract, one to four grains ; tincture, one to two drams. Iridin, the active and resinous principle, dose, half a grain to four grains. Fjquul parts of blue Hag, mandrake, and priekly-ash bark, mixed, and given in five to ten-grain doses, every two or three hours, will act as a pow- erful alterative, and cause free salivation, without making the breath oflensive or injuring the gums. 'J'hree grains of iridin, live grains d'' leptandrin, and twenty grains of bitartrate of potassa, lV)rm an excel- lent cathartic; in dropsy, producing free watery stot)ls. Blue V\\\ {ILfdrarii-f/ri PUiila). — This mercurial preparation, ij;en- erally known by llie eoiumon name of blue mass, or 0/iie pi/f, is made by rubbing mercury, confetrtionof roses, and pulverized li([uoric(vroot together until all the mercurial globides (llsa|)pear. Tlx; mass is di- vided into pills when wanteti. It is the mildest of all the mercurial preparations, and the least liable to produce salivation or irritation o{ the system. But even this should be usckI sparingly, and with caution. The blue mass is alterative and cathartic, and is considerably given to stimulate the action of the liver, and to produei! an alterative ciVect upon the digestive organs. The leptandra and the podophyllum have become its rivals, and will, I sincerely hope, finally take its place. Bonesct [Eupatorium Pc.rfoUatum). — An indigenous plant growing in most parts of the United States. The to|)s and leaves are medic- inal. It is tonic, diaphoretic, expectorant, and, in large doses, or when taken as a warm infusion, emetic, and aperient. Preparations. — Fluid extract, dose, one to two drams; solid extract, dose, five to twenty grains ; tincture, dose, one to two ounces ; infu- Kion, dose, one to three ounces. Eupatorin, dose, one to three grains. ' y""^ff MEDICINES AND THEIR PREPARATIONS. 601 Two scruples of eupatorin, one scruple of xanthoxylin, and one grain of strychnia, mixed, and made into twenty powders, is excellent for torpor of the liver, or kidneys, and for rheumatism ; one powder being taken three or four times a day. Fio. 195. Fio. 196. UUN'EMKT. liUCIItT. Bncliu {Baro.wia Crcnata). — It grows at the Cape of Good Hope. Tho leaves are the medicinal portion; they are stimulant, diuretic, antispasmodic, and tonic. Buchu is chieHy given in complaints of the urinary organs, attended with increased urie-aeid gravel, chronic inllanunation or morbid irritation of the bladder, urethra, and prostate, and retention, or incontinence of urine. Pre/Kinttions. — Fluid extract, dose, half a dram to two drams; tincture, dose, two to six drams ; infusion, one to six ounces. A com- bination of fluid extract of buciiu, half an ounce ; acetate of potash, two drams ; and water, cigiit ounces, taken in doses of four ounces, three or four times a day, is a valuable diuretic. This combination, however, may be improved by the addition of a little sweet spirits of nitre. Itiickliorn llrnke (Osmiinda Reg-fifis). — This is a fern growing in moist grounds in most parts of the United States. The root, which is the medicinal part, siiould be gatlu^red in the latter part of May, and in August, and very carefully dried, to prevent moulding. It is mucil- aginous and tonic, and is used in coughs, diarrhcca, and dysentery, and as a tonic while getting up from exhausting dis(!ase. One root infused ill a pint of hot water for half an hour will convert it into a thick jelly This mucilage may be sweetened with sugar, and freely taken. Buektliuni {RJiamnus Catfuirticus). — This plant grows in Europe, where it is much esteemed by practitioners. The berries and juice are actively medicinal. It is a powerful cathartic, producing large watery disciz^rges. It is seldom used alone on account of the severity of its action. Preparations. — Fluid extract, dose, one dram j >/rup of buckthorni made by uniting four ounces of fluid extras t with twelve ounces of simple syrup, dose, two drams. .I'lKrl . ■ I.J i« *::;.!■ «iii 602 MEDICINKS AND THEIR PREPARATIONS. Bui^leweed {Lycojnts Virginicus). — This grows in shady an places throughout a greater part of the United States. The and wet whole Iierb is used. It is a mild narcotic, sedative, sub-astringent, and styp^ tic. It is a valuable remedy in bleeding from the lungs, incipient consumption, and pneumonia. It quiets irritation, and allays cough, and nervous excitement. Preparations. — Fluid extract, dose, one to two drams ; infusion, dose, two to four ounces. Burdock {Lappa Minor). — A native of Europe, and growing in tht United States. The root is used, which is useful in scurvy, syphilia, scrofula, gout, leprosy, and disease of the kidneys. It needs to l« used for a long time. It is said to be useful for persons aniicted with boils, stye, etc. An ointment prepared from it is serviceable in some diseases of the skin, and obstinate ulcers. Preparuliuns. — Fluid extract, dose, one dram; solid extract, dose, five to twenty grains; tincture, dose, half an ounce to an ounce. Burgundy IMtcll. — This is the concrete juices of the Norway pine, abies ezcel.sa, growing in Europe and Northt-rn Asia, and of the silver fir tree of Europe, abies picca. It gently excites the skin, and is used chiefly in the form of plasters, either alone or mixed with other gums and resins. Bntternut {Juglans Cinerca). — This is a forest tree, growing in various parts of the continent, known also by the names of oilnut, and white walnut. The inner bark of the root is used, and is a mild cathartic, — being useful in cases of constipation. It is much employed by families, as a domestic remedy, in intermittent and remittent fevers. It evacuates the bowels without debilitating them. Preparations. — Fluid extract, dose,. one to two drams; solid ex- tract, dose, live to twenty grains; jnglandin, the active principle, dose, one to five grains. A very good pill is made by mixing one and a quarter drams of the solid extract of butternut, three c .larters of a dram of the solid extract of jalap, and ten grains of so p, and divid- ing the whole into sixteen i)ills. Froin two to live may be taken for a dose. Calcined Deer's Horn {Cornu Cervinrc Ustum). — The horns of the deer are said to be in velvet between August and December, and dur- ing this period, those which fall are collected, coarsely rasped, and placed in an iron vessel, which is tightly covered, and placed in an oven, or elscnvhere, and subjected to a heat of 200° F., which is con- tinued until the rasped horn becomes of the color of roasted collea When cooled, it is reduced to powder by trituration, and preserved in olosely stopped vials. It is a powerful styptic, taken in teaspoonful doses, every half hour ; or, a teaspoonful added to a gill of hot water, anH a tablespoonful of this taken every five or ten minutes. It has much efficacy in flocdings from the womb, and in excessive menstm- ation. Ciilonidl {Hydrargyri QUoridum Mile). — This is prepared from mercury, sulphuric acid, and common salt It is alterative, antisyphi' MEDICINES AND THEIU PUEl'AUATIONS. (yly3 Via lit: litic, and anthelmintic, and, in large doses, purafative. It is much used in venereal diseases, and chronic att'cctions of tlie liver, combined with opium ; in dropsies, combined with scpiill, foxglove, and elate- riutn ; and in rheumatism and leprosy, combined with antiiuonials, guaiacum, and other sudorifics. In tlie beginnini^ of ft.'vers and other c-(»iii|)laints, it is often combined with purgatives, as gamboge, scam- nioiiy, jalap, and rhubarb. (liven in small dos(?s, not large enough to purge, it gradually excites salivation. Dose, from one to ten grains. The tendency of this article to produce salivation, to iiijinn^ the giiiiis, loosen the teeth, etc., has given rise to much prejiulic*; ugainst it ill the public mind; and, indeed, it must be confessed that it has been used by many, from time immemorial, with great indiscretion. In the hands of sensible and prudent men, it is very serviceable in some cases; but the podophyllum and leptandra have so tine an action upoii tlie liver, ihat they arc fast taking tlii' plaee of calomel and other mercurials, and possibly may in time wholly supersede them. I have prescribed calomel but two or three times in this book, and am willing to see it banished from the materia medica, as soon as the careful investigations of science shall lind cause to decree its expulsion. Ciiiiiplior. — This is obtained from an ever- gree','. tree, growing in the East Indies, — the laurus caiiip/tora. It is a white, shiny, crystal- line substance, extrac^ted from the wood and roots of the above named tree, by boiling them, and is subsequently purified by sublimation. It has a penetrating, peculiar diftusible odor, and a pungent, cooling taste. It is moderately stimulant, diaphoretic, and antaphrodisiac. Dose, from one to ivn grains. Ciiiindii Biilsiiiii. — This is the fluid obtained from th'.; fir balsam, ahics balsamea, of Canada, Maine, etc. It is a stimulating diuretic, and, in large doses, cathartic. A dose is from ten to twenty drops, two or three times a day, in pills, or in emulsion. It forms a part of several ointments and plasters. It is used to mount objects in microscopic investigations. €iiUtula VhwhAW^ {]iJrii^eron Caniulrnse). — An annual plant, grow- ing in the Northern and Middle States. It is diuretic, tonic, and astringent, and has been found useful in dro|)sieal complaints, and tliarrhoja. The dose o( the |)owder is from thirty grains to a dram; of the infusion, from two to four fluid ounces ; of tin; solid extract, from five to ten grains ; to be repeated, in each case, every two or three hours. Canella {Canella Alba). — This is the bark of a South American tree, and is an aromatic stimulant, and a gentle tonic, and useful in debility of the stomach. Caraway (Carum Carui). — This biennial plant grows in Euro|)e. The seeds are the part used, and are aromatic and carminative ; they CAMI'HOlt TItBK. "II' are uh«(1 in wind colic, and to improve the flavor of other medicine. The dot»e \n from ten to sixty grains. The dose of the oil of caraway, extracted from the seeds, is from one to ten drops. Ciinlaiiioiii {Afpinia Cardamomum). — This plant grows on the mountains of Malabar. The seeds, which are the medicinal parts, are aromatic, and carminative, and are used to expel wind, and to (luvor medicines. Dose, from ten grains to two drams. The volatile oil obtained from them has similar properties. Ciistnirillil. — This medicine is the bark of the West India shrub croton efeuleria. It has an aromatic odor, and a warm, spicy tasic It is a pleasant aromatic and tonic, and is used in dyspepsia, dirouii diarrhfjea and dysentery, wind colic, and other debilities of the stoiii- ach and bowels. It counteracts the tendency of cinchona to product' nausea. Preparations. — Fluid extract, dose, twenty to thirty drops; tincture, dose, one dram; infusion, dose, one to three drams. An alkaline infu- sion, composed of Huid extract, three ounces ; carlx)nate of potassa, two drams; and water, ten ounces, is excellent in weak stomach, with acidity. Dose, one dram. Ciistor (Castoreum). — A peculiar substance obtained from the bea- ver. It is antispasmodic and emmenagogue. It is used in tv] lus, hysterics, epilepsy, retention of the menscis, and in many other kt- vous diseases. Dose, from ten to twenty grains. A medicine i no great value. Castor Oil {Oleum Ricini). — This is obtained by expression from the seeds of the castor oil bush, riciniis communis. WIkmi exposed to the air, it turns ranciil, and spoils. As a mild cathartic, this oil is extensively used, particularly among chiltlren. It is an exceedingly nauseous medicine, but may be ren- dered less ollensive by being mixed with a few drops of oil of wiiitei- green, peppermint, or cinnailion ; and its bad taste may be nearly destroyed by rubbing it up to a thick bat?ter with carbonate of mag- nesia. Or, It' boiled a few minutes with a little swet^t milk, sweetened with loaf sugar, and flavored with essence of cinnamon or peppcr- mint^ it may be easily taken. Dose, for an adult, one to tliree table- spoonfuls; Ibi ri child, one, two, or three teaspoonfuls, according tc its age. Ciitei'hu. — This is a solid extract, made from the wood of the acacia calechn, • tree growing in Asia. It is in dark, brown, and brittle pieces, and is soluble in alcohol. It is a powerful astringent, and is used in chronic diarrhoea, and chronic dyst-ntery. It makes a useful gargle in some forms of sore mouth, in elongated uvula, spongy gums, and sore nipples. The dose of the powder is from ten to thirty grains, and of the tincture, from one to two teaspoonfuls. Catnip ( Nepcta Calaria). — A native of Europe, and widely natural- ized in this country. The tops and leaves are the medicinal part, and are carminative and diaphoretic when drank as a warm infusion. It lHli:i!:'li'iT MEDICINES AND THEIR PUErARATlOXS. n05 is useful in fevers, in wind colic, nervous heada(;he, hysterics, and ner« vourt irritability. Preparations. — Fluid extract, dose, two to four drams; infusion, dof", two to four ounces. Fluid extract of catnip, tM'o ounces ; anc^ the lluid extract of sati'ron, one ounce and a half, united, make a popular remedy for colds, and the rashes of children. In nervoua toinplaints, a combination of fluid extract, of catiiij), six drams ; Huid extract of valerian, four v.rams ; and fluid extract of scuUcap, four drams, is a valuable remedy. Dose, one to three drams. riiyciiiie Pepper ( Capsicum Annuum). — This plant grows in hot fliiiiafc's, and is known by the common name of red pepper. The hcrry, which is the part used, has an intensely hot and pungent taste. It is a powerful, diti'usible stimulant, and is about the only stimulus which the stomach will bear in certain forms of dyspepsia. It is use- ful ill all cases of diminished vital action, and is frccjuently united with other medicines, either to promote their action, or to Icsseei the severity of their operation. It is much used in colds, hoarsetiess, etc., as it promotes a free discharge of mucus and phlegni. Taken in small doses, it has a fine cHect upon the mucous membrane of tin; stomach and bowels, lessening very nmch the severity of piles, and sometimes curing them. It may be sprinkled daily upon the foot taken in the form of eayeime lozenges ; it is frecjuently useful as n gurgle in sore throats, scarlet fever, etc. Dose of the powder from one to ten grains. Prcparalions. — Fluid extract, dose, five to fifteen drops; tincture, close, half a dram to a dram, used in low forms of fever, and gastric insensibility ; infusion, dose, one to three drams. A valuable gargle in scarlet fever may be made by combining fluid extract of cayenne, one ounce ; common salt, one dram ; boiling vinegar, one pint ; buil* ing water, one pint Celandine ( Ghelidonium Majus). — This plant is indigenous to Europe, and is extensively naturalized in the United States. It is a drastic purge, producing watery stools, and is equal to gamboge ; it is useful in anections of the liver, and particularly in those of the spleen. Ill the form of a poultice it is effective in scrofula, indolent ulcers, skin diseases, and piles. Preparations. — Fluid extract, dose, ten to twenty drops ; solid ex- tract, dose, five to ten grains ; tincture, dose, half a dram to a dram ; infusion, dose, two and a half to five drams. A very good hydra- gogue cathartic is made by compounding two and a half dnnus of fluid 3xtract of celandine, with half a dram of (hiid extract of hen- bane, one ounce of "sulphate of |K)tassa, one grain of tartar emetic, six ounces of elder water, and ounce of syrup of scjuill. Clidlk. — On account of its gritty particles, it is unfit for medicinal use until it has been levigated, after which it is called prepared chalk. This is the only form in which it is used in medicine. It is an excel- lent antacid, and is admirably adapted to diarrhoea, accompanied with acidity. The most convenient form of administering chi.. k is that of 60H) MKDICINKS AND TIIKIK rURI'AKATIONS. the chalk mixture, which conniHts of prepared chalk, half an ounce; HUgar and powdered gutn arable, two drams each ; cinnamon-water and water, four fluid ounces each, and rubbed tog«!ther in a mortar till tliey are thoroughly mixed. Dose, a tablespoonful frctjuently re» pcated. Fio 100. >*t;> ' *'"''; 'v ■ ■» - - i, ." - / / t '^ I CATENMK FKPPKB. CUAMUMILB. riDiiiioiiiilP (Anthrmis Nobilis). — This perennial plant grow? in Europt', and its flowers are considerably used in medicine, the whitest of which are best. They are gently tonic, and are generally used in cold infusion, in cases of weak stomach, dyspepsia, etc. In large doses, the warm infusion will act as an emetic. Preparations. — Fluid extract, dose, half a dram to a dram; solid extract, dose, four to twenty grains ; infusion, dose, half an ounce to an ounce. For dyspepsia, wind in the stomach, etc., thirty pills may be made, by combining one dram of solid extract of chamomile with five grains of the solid extract of rhubarb, and ton grains of assa- f(£tida, and taken, one pill at a time, two or three times a day, with advantage. Charcoal (Carbo Li^ni). — Prepared charcoal is antiseptic and ab- sorbent, and is employed with great advantage, in certain forms of dyspepsia, attended with bad breath, and putrid eructations ; it has a good effect in correcting the fetor of the stools in dysentery : it is con- siderably used, and with much advantage as an ingredient in poul- tices. I)ose, when taken internally, from one to four teaspoonfuls. Clilorofonn ( Chhroformum). — This is an anaesthetic, used to pro- duce insensibility during surgical operations. A teaspoonful or more is poured upon a handkerchief, which is held to the patient's nose, but not so closely as to prevent the admission of air. The numerous sudden deaths which have occurred from its use, prove it to be an unsafe agent, and it is now seldom employed by careful surgeons. Taken internally it is sedative and narcotic ; applied externally, com- bined with other articles, it is useful in painful affections, as nervous ■m^"p«(ll MEDICINES AND THEIR rUKI'AKATtONS 6o: headache, rheuniatinrn, iiuurulgia, t't(!. The iloho wru'a taken ir.ter. imlly, ii from ten to sixty drup^, ici (lax-seed tea. Ciniltliiion. — This is the hark of trees growing in Ceylon, Malabar, and Sumatra. It is a very grateful aromatic, being warm and cordial to the stotriaeh ; it is ai.so carminative and astringent. It is not often prescribed alone, but is cljieliy used as an aid to lesa pleasant medicines, and cnt<'rs into a great nimibcr of preparations, jt is peculiarly adapted to drirrhcra ; and in treating this ct>inplaint it is often joint'd with chalk and stringents. Dose of the bark, fr.>m ten to twenty grains. The oil has properties similar to those of tho bark. CiiSMiii Hiuls. — This spice is a producrt of China. It consists of tho calyx surrounding the young germ of one or more species of cinna- mon. Cassia buds have some resemblance to cloves, and are com- pared to small nails with roimd heads. They may be used for the «iatne purposes as the cinnamon bark. CJleuvers ( Galium A/nirine). — An annual plant, common to this country and Europe, having an acid, astringent taste. The whole herb is used in infusion, as a cooling diuretic, in scalding of the urine, inllammation of the kidneys and bladder, in gravel, suppression of the urine, etc. It is also used in fevers, and all acute diseases. The infusion ia made by adding two ounces of the herb to a pint and a half of warm water. It should 'stand three or four hours, and be drank freely when told. Equal parts of elder-blows, cleavers, and maiden-hair, infused in warm water, make a refreshing drink iu scarlet fever, and other eraptive diseases. Cloves ( Caryophyllns Aromaticvs). — The flowers of this tree, a native of tropical climates, collected before they are fully develojMid, form cloves. They arc highly stimulant and aromatic, and are used to give tone to the digestive organs, particularly when flatulency exists, and to relieve nausea and vomiting. They are more generally employed to improve the taste and modify the action of other medi- cines. The dose in powder is from five to ten grains. The oil of cloves has similar properties ; dose, two to five drops. A little cotton moistened with the oil, and pressed into a decayed tooth, will fre- quently relieve the toothache. Cochineal ( Coccus Cacti). — An insect found in Mexico, inhabiting lifl'erent species of cactus. They are gathered for use by detaching them from the plant with a blunt knife, and dipping them, enclosed in a bag, into boiling water. Cochineal is anodyne, and has been used with advantage in hooping-cough and neuralgia. It is much used for coloring tinctures, and ointments, and the color called car- mine is prepared from it. A tincture is prepared by macerating two ounces of cochineal, in one pint of alcohol, for seven days, and filter- ing through paper. Dose, from twenty to thirty drops, twice a day. Cod Liver Oil {Oleum Morrhuae). — This oil is obtained from the 1 r 60H MEDICINES AND TIIEIU I'HEPAUATIONS. liverw of codlis-h, and is nutritive and altorativo. It is a popular rem- cdy ill consuinptioii and stTofula, and in those complaints gtMicruily in which thrre i.s impaired digestion, assiniilation, and nutrition. Done, a tahh'spor>iiful tiiroe tisnes a day. Inability to digest 'his oil, to eat lat ineatn, or to lake fats in any lorn), is an unfavorablv indication in eonsumption. rollodioil. — This is <.'nn-cofion dissolved in ether. It is applied with a i-ainerh-hair brush, to cuts, burns, wounds, h'ech-bites, vtc, over whicli it f,>rrus a thin peilieic or skin, protecting the injured part Jroin the atino^iphere. It .sjiouid be kept in well stopped bottles, to prevent its evaporating and becoming unfit for use. Colocyiltli {Cun/mis Cohxiintkis). — A native of northern Africa. The pari used in medicine i?; the; fruit, deprived of its rind. It is a |)owerfu'. drastic, hydragoguc cathartic; causing by it.s harsh action, griping, vomiting, and soiMctinies bloody discharges; from the severity of its operations, it is rarely used ahnu;. I'sefut in dropsy, derange- nicnts of tlx^ biaiii, and for overcoming torpid conditions of the diges- tive and l)iliary organs. Pn'/)an//if)ns. — Solid extract, dosi', two to thirty graina; compound extract, (h)se, two it) thiity grains. i'oloillho {('onui/i/s Palmaliia). — A perennial clim!)ing plant, grow- ing ill east Africa, and cultivated in the ]sle of l-^ance. It is a pure, bitter tonic, and is used in dyspepsia, bilious vomitings which att^'nd pregnancy, anti during recovery from exhausting diseases. Preparations. — Fluid extract, dose, twenty to sixty drops; solid extract, dose, four to ten grains; tincture,, dose, one to four dranin; infusion, dose, three drams to an ounce. A compouiui infusion made by uniting on«^ dniu of fluid extract, four drams of orange peel, and one ounct; of wafer, ia useful in a weak''ned state of the bt)wel.<, showing itself in ft diarrhos(, one dram every hour. CoUstout (Tussiiag-o Farfara). — A native of Europe, and natursd- izcd in this country, especially in the Northern States. It grows in wet places, aiui low meadows. The leaves are principai'y used. Tlicy are emollient, demulcent, and slightly tonic; usetl in congll^, a^thma, and hooping-c(iugh ; and externally in the form of poultice for scrofulous tumors. I'oiiifroy {Si/mp/ii/liiin Offirhmlc). — A perennial European plant, •ultivated in this country. The root is the part used it is den»ul- =J '^mw cent, and oliglitly astringent, and is serviceable In diseases of the mucous tisHiied, and in scrofulous habits ; also in diarrhcea, dysentery, coughs, bleeding from the lungs, whites, etc. It may be taken as an infusion, or as a syru|), one ounce to a pint of water; the dose being one to four fluid oun(!es, three to four tinfies a day. The fresh root bruised forms a valuable application to ulcers, bruises, fresh wounds, •ore breasts, and white swellings. Common Silk- Weed {Asdepias Syriaca). — This is a perennial plants coiiiiiKni thi()n«,'hont ihi-. United States. It gives out a milky juice upon ()eing woiuuied, and hence is often called milk-weed. The root is (liiiretie, alterative, emmenagoug exterminator. Cuttoii {(lossf/piuin Ilvrbaceum). — Cotton is cliieHy employed in cases of recent burns, and scalds, — :in iipplication of it, which sur- geons have learned from |)opular use. It (liiiiiiiishcs the inflarnina- tion, prevents blistering, and haste acted upon, it should be combined with rfwndrak4> ot Caiyt^'rijroot. The powdered ^"■* C'UA.Ntlrful nvulsive action is needed to call rgan with euTgy, without purgation. It is also useful in typhoid ffvrrs, and in dyspepsia, diarrhoea, and dysenU'ry. A powder * 612 MEDICINES AND THEIR PREPARATIONS. is made from it, containing itfl active principle, and called ieptandrin, which has u fine cH'cct in diarrhcca, cholera infantum, typhoid fever, some forms of dysjM'psia, and in all diseases connected with derange- ments of the liver. Preparations. — Fluid extract, dose, one third of a dram to a dram ; leptandrin, tiie active principle, dose, in acute cases, one fourth of a grain to one grain ; in chronic cases, one to two grains ; tincture, two ounces to a pint of iilcohpl, dose, one dram to one ounce. Daiidelioil [Taraxacum, Dens-Leonis). — This perennial herb is diu- retic, aperient, and tonic. It is generally tliouglit to act especially upon the liver. Used in dyspepsia, diseases of the liver and spleen, anOD Sleailly ^ijrlitsliiule (Atmpa BeWuitmna). — A {perennial pinnt, grow* ing in Kurope and iliis eomitry, and having a faint o«}or, nnd a suvet, nauseous taste. It is nar<-oti(!, diaphonntt-, and diuretic; is a V!*h*ablo remedy in eonvulsions, neuralgia, hm>pung-ci»u'i;h, rhemuatistn, «»vU, paralysis, and it:any diseases* having tin-jr seal in tlit nerv()u> j^-Hivin. It has been much praised as a preventive of scarlet fevcR. 'iKHiiiil it« powers for this purpose are doubtt'ul. Preparations. — Fluid (txtract, dose, five to ten dr»H«s ; soM extract, dose, one quarter to one grain ; tincture, two oum'«a> to a pini of ^mW' >'¥}, diluted alcohol, dose, from fifteen to thirty drops. The solid extract is used, mixed with lard or with other substances, as a local application for relieving pain, dilating the pupil of the eye, for removing stricture of the urethra, the anus, rigidity of the mouth of the womb, etc. Dopvood {C(nmus Florida). — This is a small tree growing most abundantly in the Middle States. The bark is used as a medicine. It is tonic, astringent, antiperiodic, and stimulant. It increases the frecjuency of the pulse, and elevates the temperature of the body. It lias been svibstitufed for peruvian bark in intermittent fevers. Dose of lh(! powdered bark, from ten to sixty grains. Vrcparalions. — Fluid extract, dose, lialf a dram to two drams: solid extract, dose, live to ten grains ; tincture, four ouik^cs to a pint of alcohol, dose, one to four drams; infusion, two ounces to a pint of water; dose, half an ounce to two ounces; cornin, the active principle, dose, one to ten grains. Hwiirf Elder {Aralla llispida). — A perennial under-shrnb, growing from New Kngland to Virginia. The bark of the root is diuretic and aherativc. An infus^ion made from it is used in gravel, suppression of urine, and dropsy ; to be taken in wineglassful doses, three or four times a day. Elder {Sambucus Canadensis], — The flowers, i)erries, and inner bark of the elder, are used in medicine. A warm infusion of the flowers is diaphoretic, and gently stitnulant. A cold infusion is diu- retic, alterative, and cooling; used in erysipelas, liver alVeciions of chil- dren, rheumatism, scrofula, and sornt! syphilitic diseases. The bark, |)ounded with lard, forms a useful ointment for burns and scald*", and some diseases of the skin. Elrcanipiilie (Inula Helcnium). — .This percmiial plant is \\ native of KnrojK! and .lapan, and is cultivated in this country. The riK>t is stirinilutit, tonic, diuretic, and (expectorant, and is used in chronic iifrections of the lungs and air passages. It is siiid a tit -oetioo from the root forms a good application for the iti h. and other *kui diseases. Dose of the powdiTcd root, from a scruple to a dram; of the iufusimi, «rie or two fluid ounces. Eleetro-Miiffiietism. — Within a few yetu-s, electro-magm'tisni has b. Tliat it is a valu.«t)l»" a^ent in th<* tn-atment of disease, few thinking physicians doubt ; y»'t, like um>t «ther new things in iiiedieitie, it has had its enthusiastic admirers, who hav(! claittied for it reuuHlial powers beyond what it really has, ttial who have applied it to purposes beyotjd its sphere of usefulnt^jw. Various instruments have been constructed for applying this retneaht. but no one has ap|M>aretl to m«' so well adapti>d to its purpose, as tiMii I manufactured by Messrs. Hinds & Williams, of this city. fcverfcvi [Pj/rclhium Parthenium). — In warui infusion, this herb is valuable in recent colds, Hatulency, worms, irregular menstruation, JU 614 MEDICINES AND THEIK rUEI'AUATlONS. hy»toricH, and suppression of the urine. The cold infuMiou la a tenia A poultice made of llie leaves, sootlicH and alleviates pain. Fi)(WOlt {Srrnphiifnria jS'otfosa). — The leave.s and root are diurelic, alterative, and anodyne, and in some places are used in liv<'r com- plaints, scrofula, dropsy, and diseases of the skin. Applied externally in the form oi'oinlmcnl, or fomentation, it is said to be useful in piliM, 1)ainful tumors, hruises, ringworm, and inilauuuatiou of the hreasts. )o»o. of the infusion, from two to four fluid omices, three* times a day. . FiilX'sn'tl {Liiium Usihitissimum). — This is demulcent ai^l luitri- tive, and is mncli used in coughs, bronchial diseases, inllanmiution of the urinary H- At 1 1 ^■-■•' ««^ 1 ' c<« ;i. 1.*^";; v' , i in)Xiii.iiVK Poiftlovj' (Diiiiliilis l*iir/tiin'a). — A biennial plant, i^rowing in tho lempeiale pJirl- nf Mmope. Tin' leaves, in proper doses, are sedativi; and diurelic, rcducidg the pulse, and increasing the flow of urine, hi large doses, they i're a narcotic poison. The medicine has been nmcli vised in inilaMunaturv diseases, palpitation of the heart, and in dropsy conn«'ct<'(l with disciised heart or kidneys. W'Imii taken for sonic time, it is liable to accumulate In the system, and suddenly to mani fest poisonous and ;ilarniing symptouis, a:i if a large dttse had been taken. The American hellelKMc is fast supplanting it as a remedy. Dose of the powderci! leaves of foxglove, from one to (hree grains; of the tincture, from eight to twelve drops. Fnistwn'd {Ilr/uuifhfiniim Canadcnst-). — This herb, also known by the name of rockr«>se, is tonic, astringent, and alterative, and has Immmi considerably used in scrofula; combined with turkey corn, and (pieen'i root, it is said to have eileeted cures in secondary .syphilis. A decoe- tiou forms a useful gargle in uh-erations of the mouth and throat in """'/■■' ^SWT^lT MKDICINKS AND THEIU PUEl'AUATIONs! G15 scarlet fever, and otiier diseases, and as a wash in scrofulous inflam- mation of the eyes. Dose of the fluid extract, one to two drams, three or four times a day. U\\\\s. — These are the unhealthy excrescences found growing on the young houghs of the dyer's oak, t/nerrus infcrtorin, growing in Asia. They are powerfully astringent. In the form of infusion, or decoction, tuade in ihe proportion of half an ounce to a pint of water, they are us«!ful as an astringent gargle, wash, or injection ; and fmely powdered galls, on(^ part to ••ight parts of lard, malic a valuahh; oint- njcnt for bleeding pih's. Dose of powdered galls, from ten to twenty grains. Caiilllhoico. — The hardened juic(! of trees growing in Siani and Cochin t'hina. This ginn-rcsin is a hynt external applica- tion in skin diseases, and also in place of lard in the preparation of ointments. , Gold. — The chief sort of gold used in medicine, is the chloride or muriate of gold and soda. It is diur<;tjc and alterative. It is used in scrofula, skin diseases, goitn?, scirrhous tumors, opthalmia, dropsy, and syphilis. The dose is from one thirtieth to one; twelfth of a grain, and is given dissolved in water, or made into pill with starch or gum arable. Golden Seal {IJi/drastis Canadensis). — A perennial plant, growing throughout the United States, particularly in the West. The root is the medicinal part. It is a tonic, having especial action upon diseased mucous tis- sues, and is partictularly beneficial during recovery from exhausting diseases. It is used in dyspepsia, chronic atlections of the nervous coats of the stomach, erysipelas, and remittent, intermittent, and typhoid fevers. United with geranium, it has a line cH'ect in chronic diarrhcea and dysentery. Preparations. — Fluid extract, dose, half a dram to two drams ; solid extract, dose, two to five grains; hydrastin (resinoid), dose, one half to five grains; hydrastin (neutral), dose, two to six grains ; hydrastina (alkaloid), dose, one to five grains; tincture, dose, three ounces to one pint of diluted alcohol, dose, half an ounce to an ounce and a half. For various forms of sore mouth and ulcerated sore throat, the following is a useful gargle : fluid extract of golden seal, half an ounce ; fluid extract of blue cohosh, half an ounce ; fluid extract of witch-ha/el, half an ounce; pulverized alum, one dram; honey, three drams ; water, one pint As a stimulant for a sluggish Fio. 205. OOI.DKM BBAL. n-v ' %'l MBDICINB8 AND THEIB PRKPARATI0M8. 617 dram; luggisb liver, and as a tonic in enfeebled mucous membrane in epidemic dys- entcry, and other complaints, the following powders arc valuable: hydrastiri, twenty grains ; leptandrin, twelve grains ; podophyllin, two grains ; pulverized cayenne, two grains ; sugar of milk, or pulverized loaf sugar, one dratn ; rubbed together thoroughly in a mortar, and divide into twenty powders ; give one every two hours. Ground Ivy (Nepeta Glechoma). — A perennial herb, common to the Uniti'd States and Europe ; in some places known as gill-over- the-{j;rii-Koil (So/idd'i'o Rii'if/d). — A pereiuiial plant, growing throughout the IJtiited States, especially on the western prairies. It is tonie, astringent, and styptic, and useful to arrest bh-cding from the nose, huigs, stomach, and bowels. The powder and infusion are used, both ('xternally and internally. HeUmias {Ilr/otiins Dioirn). — This herb is eonnnon in the United States, and is known by the name of ,Fafse Vniconi plant. The root, which is the part used, is tonic, diuretic, and vermifuge. In large doses, it is emetic, and when used fn'sh, sialagogue. In fiv«? or ten grain doses, three times a day, it relieves «lyspepsia, restores the appe- tite, expels worms, and relieves colic. It is a valuai)le wond) tonie, gradually removing debility of that organ, and curing whites, pain- ful menstruation, and a tendency to habitual abortion. Dose of the deeoction, from two to four fluid ounces. The detroetion is said to kill inse(rts, i)ugs, etc. Prepanifums. — Fluid extract, dose, one to three drains; heloiiiii, the aeliv«! principh;, dose half a grain to a grain. Ileilbiiiie (Ilyoscyamus Ni^er). — This plant grows abundantly in Great Britain, and on the continent of Europe, and is rare in this country. All the parts are active. It is narcotii', gently aceele'ratiiig the circulation, increasing the general warmth, occasioning a sense of heat in the throat, and after a time inducing sleep. It is often u.sed in the place of opium, because it does not bind the bowels. Used in rheumatism, gout, bronchitis, asthma, consumption, hooping-cough, hysterics, and spasmodic attections generally. Preparations. — Fluid extract, dose, ten to twenty drops; so'id ex- tract, dose, half a grain to a grain ; tincture, two ounces to one pint of diluted alcohol, dose, half a dram to a dram and a half ; hyoscya* IIAUDIIAUK. — mill, tin gia, rhe followin drains ; 1 one (Ira grnin pi : iiixii Mlils III MEDICINES AND TIIEIU I'UKPAKATIONS. 61U niin, tin" active principle, dose, oiio eighth to half a ^rain. In noural- cia, rhi'umatisiii, St. Vitn/s dance, painful menstruation, etc., the jollowinj^ may be found useful ; solid extract of hyoscyatmis, two (Iraiiis ; solid extract of valerian, two drams; solid extract of aconite, one dram ; sulphate of . -y k; ^Sciaices Corporation 23 WSST MAIN STREET WiBSTER.N.Y. 14580 (716) 872-4503 V v L1>^ >s\ ^v ^ 'e, and is cultivated in this country. The tops and leaves are the parts used. They are stimulant, aromatic, carminative, and tonic. The infusion has been much employed in chronic bronchitis of old people, and those of debilitated habits. It makes the raising of mucus more easy. The infusion may be combined with sage and alum, and sweetened with honey. The fresh leaves bruised, and applied exter- nally, relieve the pain, and. disperse the spots and marks caused by contusions. keliiiul Moss (Cetraria Islandica). — This plant is found in the northern latitudes, both of the oltl and new world, and is abundant on the mountains, and in the sandy plains of New England. It re- ceived its name from -its prevalence in Iceland, m which country, as well as in Lapland, it serves, in consequence of the gum and starch it contains, as food for the inhabitants. It is demulcent, tonic, and nutritious, and is well fitted to relieve afTections of the mucous mem- brane of the lungs and bowels, connected with debility of the digestive organs; it is given therefore in chronic bronchitis, and other afl'ections of the chest, attended with copious expectoration, especially when the matter discharged is purulent ; also in dyspepsia, chronic dys- entery, and diarrhoea. It is usually employed in the form of decoc- tion ; and is much used in the common article of diet, called blane mange. Ice IMtint {Monotropa Uniflora). — This perennial plant, found in various purts of the country, is snow white, resembling frozen jelly, and is juicy and vender, dissolving in the hands like ice. The flowers are in shape like a pipe; it is hence called the pipe plant The roOt is the medicinal part, and is tonic, nervine, and antispasmodic. It has also been considered sedative and diaphoretic ; and the powder has been sometimes used in the place of opium. It is said to be valuable in epilepsy, chorea, and other spasmodic affections. Dose of the powdered root, from thirty to sixty grains, two to three times a day. Indian Hemp {Apocynum Cannabinum). — This perennial plant re- sembles bitter-root, and grows in similar situations. The root is powerfully emetic, and in decoction, diuretic, and diaphoretic. It diminishes the frequency of the pulse, and produces drowsiness. It has great efficacy in dropsy. Preparations. — Fluid extract, dose, as a tonic, five to fifteen drops, as an emetic, twenty to sixty drojis ; solid extract, dose, one to five grains ; tincture, dose, one to two drams, as a tonic, half an ounce to an ounce, as an emetic ; infusion, half an ounce to a pint of water, dose, half an ounce to two ounces. Indian Turnip {Arum Triphyllum). — This is a perennial plant, growing in damp places in North and South America, and known by the name of dragon root. The root when chewed, is excessively acrid, producing a bitmg sensation which may be somewhat relieved by '^ milk. The fresh root is acrid, expectorant, and diaphoretic, and has been used in asthma, hooping-cough, chronic bronchitis, chronic rheu- matism, and colic, and externally, in scrofulous tumors, scald head, and other skin disorders. Dose of the grated root, in syrup or mucil- age, ten grains, three or four times a day. Iodine {Ibdinum). — This is prepared from the ashes of kelp, or sea- weed, and is in small bluish-black, shining scales. It is alti'rativc, tonic, and somewhat diuretic. It has been chiefly employed in dis- eases of the absorbent and glandular system, particularly scrofula, goitre, and glandular tumors generally. Dose, in substance, half a grain, two or three times a day, in form of pill ; in form of tincture, five to ten drops. Iodide of Potiissium {Poiassii lodidum). — This is one of the pre- parations of iodine, and is sometimes improperly called hydriodate of potassa. It is formed by decomposing the iodide of iron, by carbon- ate of potassa. It is used for the same purposes as iodine, but chiefly as an alterative in tertiary syphilis, for which it is a specific ; also in some forms of chronic rheumatism, and in leprosy. Dose of the salt, from two to twenty grains. It is much combined with bitter tinc- tures, and particularly wuth the compound preparations of sarsapa- rilla, yellow dock, and queen's root. The acids and metallic salts are incompatible with it. Ipecacuanlin. — This is a small perennial plant, growing in moist woods, in several countries of South America. The root is the jjart used. It is a very valuable emetic, in large doses ; in smaller doses, it is sudorific and expectorant. Used to produce vomiting in the commencement of fevers, inflammatory diseases, swelled testicles, and before the paroxysms of ague ; and to excite nausea in dysentery, asthma, hooping-cough, varior.s hemorrhages, and inflammation of the lungs; and, combined with opium, to produce diaphoresis in rheu- matism, gout, and febrile complaints. Dose, as an emetic, from fifteen to thirty grains ; to excite nausea, from one to three grains ; and to produce diaphoresis, two to six grains, with one grain of opium. Preparations. — Fluid extract, dose, as an expectorant, five to ten drops ; as an emetic, half a dram to a dram ; tincture, half an ounce to an ounce and a half; wine of ipecac, three ounces to one pint o! sherry wine, dose, a quarter to half a dram, as an expectorant ; two and a half to five drams as an emetic. The following is a useful ex- pectorant for young children : fluid extract of ipecac, two drams ; syrup of tolu, five drams ; mucilage of gum arable, one ounce ; sherry wine, three drams, — mix. Dose, one dram. Iron (Ferrum). — As this is the most abundant, so it is the most useful of all the metals. It is widely diffused through the mineral, the vegetable, anc. the animal kingdoms. It is an essential constitu- ent in the blood < f man, and as a medicine it has great value, being a powerful tonic. In most cases where the blood is thin and reduced, iron is our best remedy ; it raises the pulse, promotes the secretions, and gives color, body, and nutritive qualities to the blood. It is mucli ^f^^^yl used, in some one of its prepared forms, in chronic aneemia, chlorosis, hysterics, whites, rickets, chorea, dyspepsia, neuralgia, and particularly consumption. The following are most of. the chemical preparations of iron used in medicine. Ammoiiio-Citrrtte of Iron {Ferri Ammonio-Citras). — This is in the form of thin scales, of a beautiful, garnet-red color, and has a slightly acid taste. It is very soluble in water. Its great solubility gives it lome advantages over the citrate. The dose is five grains, three timea a day, in solution. Black Oxide of Iron {Ferri Oxiduni Nigrum). — This is a dark, grayish-black powder, unchangeable in the air, and having magnetic properties. It is a valuable chalybeate, and may be given in five to fifteen-grain doses. Citrate of Iron (Ferri Citras). — This is a valuable preparation of iron. It is soluble in water. Usually given in the form of pill, in two to five grain doses, three times a day. Citrate of Iron and Quinia (Ferri et Quinm Citras). — In the form of shining scales, garnet-colored, and soluble in water. An excellent antiperiodic and tonic. Given in intermittents, when the blood is low, etc. Dose, five to ten grains, two or three times a day. Citrate of Iron and Strychnia. — Dr. James R. Nichols & Co., of this city, were the first to introduce this combination of strychnia with iron, to American physicians. It is a valuable preparation, and is constantly winning the favor of the profession. It combines the properties of iron and strychnia, and has proved an efficacious remedy in atonic dyspepsia, absence of tlie menses, St. Vitus's dance,, green- sickness, hysterics, etc. It is a beautiful salt, looking like citrate of iron, except that it is a little darker. Three grains of the iron are com- bined with one sixteenth of a grain of strychnia. Hydratcd Oxide of Iron (Ferri Oxidmn HydrcUum). — This is in a reddish-brown, moist mass, not much used in medicine, except as an antidote to the poison of arsenic, for which it is very valuable. It should be given in tablespoonful doses, often repeated. Iodide of Iron (Ferri lodidum). — The iodide of iron is a crystalline lubstance, of a greenish-black color, and styptic taste. It has tonic, alterative, diuretic, and emmenagogue properties. It is employed chiefly in scrofulous complaints, swelling of the glands of the nee!:, chlorosis, absence of the menses, and leucorrhoea. In obstinate syph- ilitic ulcers, and in secondary syphilis, occurring in scrofulous and debilitated subjects, it has been used with success. Dose, three grains, gradually increased to eight. It should never be givep in the form of pill. Lactate of Iron (Ferri Lactas). — This has the general medicinal propv-rties of the ferruginous preparations. It increases the appetite in a marked degree, and has been used with decided benefit in chlo- rosis. Dose, one to three grains, three times a day. The dose may be gradually increased. Given in the form of solution, pill, or lozenge. 634 MEDICINES AND THEIR PREPARATIONS. Phmphate of Iron (Ferri Phosphas). — This is a slate-colored pow< cler, insoluble in water. It is a ^raluable remedy in consumption, cancer, and nervous diseases, accompanied by a low state of the blood. Dose, one or two grains, three times a day. Per 8alt of Iron {Mansers Styptic). — This is a most valuable styp. tic, and is used with success in restraining violent bleedings. It pro- duces no irritant effects upon the tissues, and may be used with safety both in slight and extensive surgical operations. Physicians should have it by them, and will find it very serviceable in sudden emergen- cies of bleeding. It is prepared in solution and in the form of dry salt, by Dr. James R. Nichols & Co., of this city. The solution is the most convenient and eligible form, and may lie applied as prepared. Powder of Iron {Ferri Pulvis). — This is whet is often called iron by hydrogen, or Qudvenne's iron. It is an irapalpaple powder, and of an iron-gray color. If black, it is worthless. It \s used in anaemia, and in all those conditions characterized by deficiency of coloring matter in the blood. The best metallic iron for medicinal use. Dose, from two to six grains, several times a day ; to be given in the form of pill. Precipitated Carbonate of Iron {Ferri Subcarbonas). — This is a reddish powder, insoluble in water. It is tonic, alterative, and em- menagogue, and is used in neuralgia, chorea, chlorosis, anemia, epi- lepsy, scrofula, etc. Dose, five to thirty grains, three times a day, to be taken in a little water. Protoxide of Iron {Ferri Protoxidum). — This is of a dark blue color, and has a tendency to absorb oxygen from the air, which con- verts it into the sesquioxide. It is a valuable preparation of iron. Dose, from two to six grains, three times a day. Solntion of Protoxide of Iron. — The protoxide of iron being more readily absorbed and assimilated, and agreeing better with the stom- ach, than any other preparation of this metal, has led to a general desire for this salt in some eligible form, protected from the chemical changes to which it is so liable. This desire has been met by Dr. James R. Nichols & Co. of this city, who, by a new method of chemical ma- nipulation, have prepared an unchangeable solution of it, in the form of an elegant syrup, which is permanent in form, pleasant to the taste, and free from the inky flavor peculiar to iron preparations. Dr. Nich- ols, one of the most reliable practical chemists in the country, has conferred a benefit upon the profession by preparing this syrup. 1 have had the pleasure of Tsing it, with peculiar satisfaction. Dose, from one to two teaspoonfuL , three times a day. Solntion Protoxide Iron, with Rlinbarb and Colunibo. — This is a composition of protoxide of iron with vegetable tonics ; a combina- tion long desired, but just now, for the first time effected, by Dr. James R. Nichols & Co. of this city. As a remedy in many forma of dyspepsia, it must prove of great value. Solution Protoxide Iron, witli (Quinine. — This has become a remedy MEDICINES AND THEIR PREPARATIONS. 625 of established reputation. Quinine combined with iron, particularly with the protoxide, must have great advantages as a chalybeate tonic. This is one of the reliable preparations of Dr. Nichols. Each table* spoonful contains half a grain of quinine. Solation Protoxide Iron, with Iodide of Potassa. — In this prepara- tion, the valuable alterative properties of iodide of potassium, are connected with iron. It is therefore alterative and tonic, and may be Ui«ed in scrofulous and other weakened conditions of the system, ft ia a remedy of decided merit. Three grains of the iodide of potas- sium are contained in each tablespoonful. This is also prepared by Dr. James R. Nichols & Ca Sulphate of Iron {Ferri Sulphas). — This is in the form of transpa- rent crystals, of a pale, bluish-green color, and efflorescent in the air. It has a styptic taste, and is soluble in about twice its weight of cold water, but insoluble in alcohol. It is astringent and tonic. In large doses, it produces nausea and griping of the bowels. Useful in scrofula, and as an astringent, in passive hemorrhages, sweats, dia- betes, chronic mucous catarrh, leucorrhoea, and gleet. As a tonic, it 18 useful in dyspepsia. Syrap of Iodide of Iron ( Syrupus lodidi Ferri). — This is an ele- gant preparation of iodine and iron, and is given in all debilitated conditions of the system, when there is a taint of scrofula. Dose, from twenty to fifty drops, well diluted, at the moment of taking, with water. Syrup of Iodide Iron and Hangfauese. — This is of a light straw color, prepared from protosulphate of iron, protosulphate of manga- nese, and iodide of potassium. It is a remedy of unsurpassed effi- cacy in aneernic, scrofulous, syphilitic, and cancerous affections. It is considered superior to the syrup of iodide of iron. This is another of Dr. J. R. Nichols & Co.'s valuable preparations. Dose, from ten to sixty drops. Tartrate of Iron and Potassa {Ferri et Potasses Tartras). — This is in the form of beautiful shining scales, of a dark ruby color, of a slight'y chalybeate taste, and very soluble in water. It is one of the milcl- est of the salts of iron, and is considerably use^ in scrofula, weak- ness of the bowels, general debility, etc. It is much used of late, as a remedy for syphilis, both externally and internally. The dose is ten to thirty grains in solution. Tincture of Muriate of Iron ( Tinctura Ferri Chhridi). — This has a reddish-brown, yellowish color, a sour and very styptic taste, and an odor like muriatic ether. It '\9 one of the most active and certain pre- parations of iron, generally agreeing with the stomach, and much employed for purposes for which iron is used. It is useful in scrofula, gleet, and leucorrhoea ; also in hemorrhages from the womb, kidneys, and bladder, of a passive character. Dose, from ten to thirty drops, gradually increased to one or two drams, two or three times a day. It should be given diluted with water. ^ 79 mmm Talerianatd of Iron.. — .This salt is in the forrn of a dark-red pow. der, having a faint odor, and a taste of valerianic acid. It is soluble in. alcohol, and .insoluble in water. Given in hysterical affections, complicated with chlorosis. Dose, one grain, several times a day. Isinglass {Ichthyocolla). — A gelatinous substance, prepared from the bladder of iishes. It is soluble in alkaline solutions, and diluted acids. In boiling, it (dissolves, and forms a jelly upon cooling, in which form it is chiefly used as a nutritive diet for the sick. Jalap {Ipomcea Jalapa). — This is a Mexican plant. Its root is an active cathartic, producing liquid stools, more or less griping. United with cream of tartar, it becomes a hydragogue, and is useful in dropsy. The dose is from fifteen to thirty grains. Preparations. — Fluid extract, dose, a quarter to one dram ; solid extract, dose, three to eight grains ; tincture, two ounces to the pint diluted alcohol, dose, one to two and a half drams ; jalapin, the active principle, dose, one to two grains. Juniper (Juniperis Communis). — This evergreen shrub is a native of Europe, and is naturalized in some parts of this country. The berries, which are the part used, are wrinkled, of a dark-purple color, about the size of a pea. They are gently stimulant and diuretic, and have been used in scurvy, and inflammation of the bladder, chiefly in connection with more active diuretics. The oil of juniper obtained from the berries is used for similar purposes. Five minims of the oil, mixed with one fluid dram of sweet spirits of nitre, and given three times a day, is valuable in dropsy. Dose of the berries, from one to two drams ; of the oil, from five to fifteen drops. Kino. — This is the hardened juice- of an Ea,'t Indian tree, P^cro- carpus Marsupivm. There are several varieties of it. It is a power- ful and « aluable astringent, and is much used in diarrhcea, not atten- ded with inflammation. Opium is often united with it, and it is a favorite addition to chalk mixture. It is also used in chronic dysen- tery, leucorrhcea and diabetes. It may be used in the form of powder, infusion, or tincture. Dose of the powder, ten to thirty grains ; of the tincture, one or two fluid drams ; the infusion is useful as an injection, in leucorrhcea and gonorrhoea. The powder is sometimes sprinkled with advantage on indolent and flabby ulcers. Ladles' Slipper ( Oypripedium Pubescens). — The fibrous roots are the parts used of this plant. It is tonic, nervine, and antispasmodic, and is employed in nervous headache, and other nervous afl'ections, a? excitability, hysterics, neuralgia, etc. Preparations. — Fluid extract, dose, half a dram to a dram ; solid extract, dose, five to fifteen grains ; tincture, two ounces to a pint of diluted alcohol, dose, half an ounce to an ounce ; cypripedin, the active principle, dose, two to four grains. The following is a useful preparation for producing sleep, in wakeful and excited conditions: fluid extract ladies' slipper, one ounce ; fluid extract pleurisy root, «ne ounce; fluid extract skunk cabbage, one ounce; fluid extract scullcap, or)e ounce ; mix ; dose, half a dram to a dram, three times a (lay. For sick and nervous headache, dependent on an acid stomach, the following is useful : fluid extract ladies' slipper, half an ounce ; fluid extract catnip, half an ounce; fluid extract scuUcap, half an ounce; water, one pint ; mix ; dose, one and a half to three drams. Lead {Plumbum). — Lead acts u|X)n the system as a sedative and astringent. Internally, it is used for the purpose of reducing the force of the circulation, and for restraining improper bleeding, and other excessive discharge -j. Externally, it is employed to subtiue inflamrna- tion. It should not be excessively used ; for, if taken internally for a long time, it injures the nervous system, and brings on apoplexy, palsy, and particularly lead colic. Nature generally gives notice when H is doing mischief, by drawing a blue line around the edge of the gum. The preparation of lead chiefly used in medicine is the following: Acetate of Lead (Plumbi Acetas). — This is known by the name of sugar of lead, and is a white salt, crystallized in brilliant needles. It has first a sweetish, and then an astringent taste. In medicinal doses, it is a powerful sedative and astringent ; in large ones, an irri- tant poison. It is principally used, internally, for bleeding from the hings, bowels, and womb. The dose is generally two grains, united to half a grain to a grain of opium, in the form of pill. Externally, ft is employed in form of solution, and applied to inflamed surfaces mih cloths. Four grains of sugar of lead, and four of pulverized opium to the pint of water, makes a good lotion for various purposes. Lemon {Citrus Limonum). — This is a well-known tropical fruit, the juice of which has a grateful acid taste, which is much used in fevers and inflammatory complaints, to form the agreeable drink called lemonade. The oil of lemon, obtained from the fresh rind of the fruit, is chiefly used in perfumery, and to render the taste of medicines more agreeable. Lettuce (Lactu^a Sativa). — The medicinal properties of this gar- den plant are contained in the milk. It is given when opium disa- grees with the patient, to allay cough and irritability. Preparations. — Fluid extract, dose, half a dram to two drams ; BoKd extract, dose, two to five grains. The following is a usi:ful com- pound syrup : fluid extract lettuce, two ounces ; fluid extract poppy, four ounces ; simple syrup, ten ounces ; mix ; dose, half a dram to a dram. Life Root ( Senecio Aureus). — This is a perennial plant, growing on the banks of marshy creeks, in the Northern and Western States, and sometimes called Ragwort. Both the root and herb are diuretic, pectoral, diaphoretic, and tonic, considerably valued as a remedy in gravel, and other urinary affections, particularly strangury. It is use* ml for promoting menstrual discharges. Preparations. — Fluid extract, dose, half a dram to a dram ; infa- ■ioi\ dose, one to four ounces ; senecin, the active principle, dose, Kr 628 MEDICINES AND THEIR PRBPABATIONS. three to five grains. For chlorosis, accompanied by absence of the menses, the following is a useful preparation : senecin, aletrin, and sulphate of iron, four grains each. Mix, «..:d divide into two grain powders. Six grains each of senecin and geraniin, inixed, and taken in doses of two to four grains, has a good effect in restraining an immoderate flow of the menses. In painful menstruation the follow* ing is a good pill : senecin, two grains ; quinino, six grains ; solid extract belladonna, three grains ; make into ten pills, and take one every three hours, till the pain is subdued. Lime (Calx). — This is one of the alkaline earths, and is an abnn< dant natural production. It is used in several forms in medicine, of which the following are the chief. Chloride of Lime ( Calx Chlorinata). — This is a moidt, grayish* white substance, having the odor of chlorine, and possessing powerful bleaching properties. Externally used, it is disinfectant, and, dis* solved in water, is applied with advantage to ill-conditioned ulcers, burns, chilblains, and eruptions of the skin, also as a gargle in putrid sore throat, and as a wash for ulcerated gums, and to purify the breath. It has been used with advantage in dysentery, both by month and injection, to correct the fetor of the stools. Lime Water (Aqua Calcis). — This is made by dissolving four ounces of lime in a gallon of water, and letting the solution stand in a covered vessel, and pouring off the clear liquor when it is w^anted for use. It is antacid, antilithic, tonic, and astringent, valuable in all complaints attended with acidity of the stomach. United with milk, and used as the sole diet, it is sometimes the only remedy for chronic diarrhoea of long standing. Dose ,of lime water, half an ounce to two ounces. Liquorice (Glycyrrhiza Glabra). — This grows in the south of Europe and Asia. The root is the part used. It is demulcent and expectorant, and is useful in cough, chronic bronchitis, and irritations of the mucous surfaces generally. The pulverized root, united with an equal amount of sulphur, and a little molasses, is a valuable pre- paration for coughs. The black extract may be used for the same purposes as the root. Liverwort {Hepatica Americana). — An indigenous plant, growing in woods, upon the sides of hills and mountains. The leaves with- stand the cold of winter, and the flowers appear early in the spring. The whole plant is medicinal. It is a mild demulcent tonic and as- tringent, and has been ui«ed in fevers, liver complaints, bleeding from the lungs, and coughs. Preparations. — Fluid extract, dose, two to three drams; infusion, four ounces to the pint of water, to be taken freely. Lobelia {Lobelia Inflata). — This weed grows throughout the United States ; both its seeds and leaves are used in medicine. The plant is emetic, expectorant, sedative, and antispasmodic. As an emetic, it is generally used in combination with other articles for that purpose. MEDICINES AMD THEIR PREPARATIONS. 629' I of the in, and o grain d taken nine an ! follow- 13 ; solid ake one in abnn* iicine, of grayish" powerful and, dis- id ulcers, in putrid urify the by mouth ving four ion stand is wanted ible in all vith milk, ar chronic ounce to south of cent and irritations nited with uable pre- the same ;, growing aves with- the spring, ic and aa- iding from the United he plant is raetic, it is it purpose. It is of great advantage in spasmodic asthma, as well as in bronchitis, cronp, hooping-cough, and other throat and chest aflections. When> ever relaxation is required to subdue spasm, or for other purposes, lobelia will be found useful. Preparations. — Fluid extract, dose, as an expectorant, ten to sixty drops ; as an emetic, one fourth of a dram to a dram ; tincture, two ounces to a pint of diluted alcohol, dose, as an expectorant, one to three drams, as an emetic, half an ounce ; infusion, dose, an ounce every half hour till vomiting ensues ; lobelin, the active principle, dose, half a grain to a grain and a half. The following mixture will be found excellent, as an expectorant and sudorific, in spasmodic croup, hooping-cough, and asthma, and for subduing mucous inflammation about the throat and air passages : tincture of lobelia, half an ounce; tincture of bloodroot, two ounces ; oil of spearmint, half a dram ; empyreumatic syrup, five ounces ; dose, half a dram every two hours. A poultice made of lobelia, elm bark, and weak lye, relieves sprains, bruises, rheumatic pains, erysipelatous inflammations, and poison from ivy or dogwood. FiQ. aoo. Kio. 210. LADIES' BLIPFBB. LOBSUA. Lo^ood {Haniatoxylon Campechianum). — This tree is a native of tropical America. The wood is used in medicine. It is tonic and astringent, and is used with advantage in diarrhoea, dysentery, and in the relaxed state of the bowels after cholera infantum. Used freely with other treatment, it also benefits constitutions broken down by disease or dissipation. Preparations. ^ — Fluid extract, dose,, half a dram to a dram ; solid extract, dose, five to thirty grains ; infusion, half an ounce to a pint of water, dose, four drams every three or four hours, in diarrhoea. Magnesia {Magnesia Usta). — Calcined magnesia is obtained from carbonate of magnesia, by exposure to a strong h THEIR PREPARATIONS. leaves of tlie East Indian tree cajuputi. It is diaphoretic and anti< spasmodic, and a powerful diffusive stimulant Given in cramps d' the stomach and bowels, colic, flatulency, hysterics, and chronic rheu* matism. It is considerably used as an ingredient in liniments, to be applied externally in rheumatism, and neuralgia. Dose, from one to five drops, on sugar. OH of Turpentine ( Oleum TerebirUhina). — This is generally called spirits of turpentine, and is obtained by distilling turpentine. As f>. medicine, it is stimulant, cathartic, diuretic, anthelmintic, and astrin> gent. In large doses, it causes strangury, and other unpleasant symp' toms. The dose is from five to thirty drops, repeated every two oi three hours. Fifteen drops, taken every fifteen minutes or half houi powerfully restrains bleeding from the lungs, and is, perhaps, the bes^ remedy we have for this frightful accident. It is also very efficacious in checking other hemorrhages. Exter- nally, it is used considerably as an ingredient in liniments and rube" facients, in rheumatism, paralysis, etc. Combined with linseed oil, it is much used for burns and scalds. Olive on ( Oleum Oliva). — This oil, often called sweet oil, is ex- pressed from the fruit of the olive tree, Olea Europece. It is nutrient and emollient, and in doses of one to two fluid ounces, laxative. It is much employed as a constituent of cerates, liniments, and plasters. Onion (Allium Cepa). — The medicinal properties of the onion are much like those of garlic. The juice, mixed with sugar, is used to some extent as -x remedy for the coughs and colds of infants. Roasted onions, applied as a poultice, hasten the suppuration of boils, tumors, etc. They are also useful, in some cases, applied as drafts to the feet Opinni. — This is the hardened juice of the unripe seed of the poppy, Papaver Somniferum. It is a stimulant narcotic A moderate dose increases the fulness and frequency of the pulse, augments the warmth of the skin, invigorates the mu ;ular system, quickens the senses, ani- mates the spirits, and gives energy to the mental faculties. Its opera- tion is directed with special force to the brain, which it sometimes excites to intoxication and delirium, which excitement subsides in a short time, and is followed by a delightful calmness, and placidity of mind, all care and anxiety being banished, and the thoughts yielded to the control of pleasing fancies. At the end of an hour or more, this reverie is succeeded by sleep, which, at the end of eight or ten hours, passes ofl*, and is followed by headache, nauseia, tremors, and other nervous disturbances. Large doses are followed by shorter periods of exhilaration and excitement, and by more protracted sleep^ Opium is used in medicine to produce gentle perspiration, relieve pain, and lessen nervous excitability in all febrile and inflammatory diseases ; also as an antispasmodic in hysterics, colic, convulsions, coughs, etc. It should not be used in cases of constipation of the bowels. A solution, composed of two grains of opium to one ounce of water, is sometimes a valuable injection in gonorrhoea and spas- modic stricture. Dose, as a stimulant, one quarter U> one half a grain.' and anti- ramps d' >nic rheu* nts, to bft )m one to illy called lie. As f. id astrin' mt syrnp' ry two 01 lalf houi the bes' Exter md rube- eed oil, it oil, is ex- 3 nutrient ative. It plasters. onion are s used to Roasted 8, tumors, the feet he poppy, rate dose e warmth tnses, ani- Its opera- ometimes sides in a acidity of a yielded or more, ht or ten mors, and y shorter ted sleep. »n, relieve .mmatory ivulsions, )n of the me ounce ind spas- fa grain: MEDICINES AND THEIR PREPABATIONS. - 687 , as a narcotic, one to two grains ; in some spasmodic affections, it ii given in very large doses. ■orphia, generally called morphine, is one of the alkaloid principles of opium. It is used under the various forms of sulphate, murtate, acetate, and valerianate of morphia, — all having the general properties of opium, and are given for similar purposes, in doses of one eighth to one quarter of a grain. One sixth of a grain is equal to one grain of opium. Strong coffee is an excellent antidote to the poisonous eff'ecvs, both of opium and morphia. A solution of morphia may be made by adding ten grains of the salt to one fluid ounce and a half of distilled water, and half an ounce of diluted alcohol, and then adding two drops of sulphuric acid, if it be the sulphate of morphia, or two drops of acetic acid, if it be the acetate of morphia, or two drops of muri« atic acid, if it be the muriate of morphia. The eflects of morphia may be obtained by sprinkling some of it on a blistered surface. Orang^e Peel (Aurantii Cortex). — The orange is the fruit of a tree belonging to the tropical climates. Orange juice is a pleasant refrig- erant, useful in fevers, and particularly in scurvy. Sick persons suck- ing the juiee of the orange, should be careful not to swallow any of jthe skinny portion, or the peel. The peel of the orange is chiefly employed to give a pleasant flavor to other medicines, and to prevent their nauseating properties. It is a mild tonic, carminative, and stom- achic, and improves the bitter infusions and decoctions of gentian, quai«sia, columbo, and peruvian bark. Orange peel should never be given in substance. Preparations. — Fluid extract, dose, half a dram to two drams ; tincture, one ounce and three quarters to a pint of diluted alcohol, chiefly used as an addition to infusions, etc. ; syrup, two ounces fluid extract or tincture to a pint of simple syrup, used with water as an agreeable drink. Ori^num ( Origanum Vulgare). — A perennial herb growing in Europe and this country. The warm infusion of it causes perspira- tion, and promotes the menstrual discharge, when interrupted by a cold. The oil of origanum is a very useful ingredient, in several stimulant and rubefacient liniments. Parsley {Petroselinum Sativum). — The root of this biennial plant is aperient and diuretic, and is used in dropsy, scarlet fever, and dis- eases of the kidneys ; also in retention of the urine, gonorrhoea, and strangury. The dose of the infusion is from two to four fluid ounces, two or three times a day. The bruised leaves are applied with advantage to contusions, swelled breasts, and enlarged glands. Partridg^e Berry {Mitchella Repens). — This perennial, evergreen, creeping herb, grows in dry woods and swampy places throughout the United St-ates, and has white, fragrant flowers in June and July. It is parturient, diuretic, and astringent, and is used in dropsy, sup« !i ' ' i "■■ 'M -:j?f^;| ■!_ AiiM 638 MEDICINES AND THEIR PREPARATIONS. pression of urine, and diarrhoea. It acts as a tonic npon the repro- ductive organs, giving tone and vigor to the womb, and making labor less tedious. Dose of the decoction, from two to four fluid ounces, two or three times a day. Peach (Amygdalus Persica). — The leaves of the peach are sedative and slightly laxative, and are used in inflammations of the stomach and bowels ; likewise in irritable bladder, hooping-cough, sickness at the stomach, and dysentery. They are used in the form of cold infu- sion, a tablespoonful being a dose, to be taken every hour or two. A good tonic is made by adding four ounces of the bruised kernels to a quart of honey. Pennyroyal (Hedeoma Pulegioides). — Pennyroyal is a gently stim- ulant aromatic ; it relieves wind colic and sick stomach, and qualifies the action of other medicines. Like most aromatic herbs, it has the property, when given as a warm infusion, of promoting perspiration, and of exciting the menses, when the system is already disposed to the effort. In cases of recent suppression, it may be given at bed- time as a warm tea, aft«r bathing the feet in warm water. The oil of pennyroyal has the properties of the herb. Fio. 216. Fi8. 217. rBXRTBOTAL. PKBnvIAN BABK. Peppennint (Mentha Piperita) — The peppermint is a native of England, where it is largely cultivated, as it is to some extent in this country, for the sake of its essential oil. It is a valuable herb, having a strong aromatic smell, and a pungent, warming taste. It may be used in the form of tea, which, when largely drank, imparts warmth to the system. It is valuable in colds, flatulent colic, hysterics, spasms, cramps in the stomach, nausea, and vomiting, and to disguise unpleas- ant medicines. The peppermint furnishes an essential oil, which, dissolved in alco- hol, forms the essence of peppermint The dose of this is fifteen to thirty drops, on a lump of sugar, or in sweetened water, warm or cold. ^^w? Persimmoil (Diospyros Virginiana). — This is a tree growing in the Southern and Middle States. The bark and unripe fruit, are used in medicine, — being astringent and tonic. Persimmon has been found useful in chronic diarrhoea, chronic dysentery, hemorrhage from the womb, and fever and ague. It is used in the form of infusion and 2.yrup, in doses of a tablespoonful, every two or three hours. The infusion is also used as a wash and gargle in sore mouth and throat, and as an injection in whites. Peruvian Bark ( Cinchona). — This valuable bark is derived from several species of the cinchona tree, on the western coast qf South America. The remedy is said to have been first introduced into Europe in 1640, by the Countess of Cinchon, wife of the Viceroy of Peru, on her return to Spain. There are three varieties of this bark : the pale, the red, and the yellow. The pale bark is least liable to offend the stomach, and is perhaps the best as a general tonic ; but for the treatment of fever and ague, the red and the yellow are both preferable to the pale, and the red is considered better than the yellow. Cinchona is tonic and antiperiodic, and is much used, and with ( great 8ucc^s8, in all periodical diseases, as fever and ague, remittent fever, neuralgia, and epidemic diseases ; also in chronic diseases at- tended with debility, as scrofula, dropsy, and affections of the skin. Dose of the powdered bark, as a tonic, from ten to sixty grains ; as an antiperiodic, from twenty to a hundred grains. Preparations. — Fluid extract, dose, half a dram to a dram ; com- pound fluid extract, dose, half a dram to a dram ; tincture, four ounces to one pint diluted alcohol, dose, one to four drams ; infusion, dose, one to two ounces. A good compound infusion of cinchona is made by combining one ounce fluid extract with half an ounce of fluid extract of snake-root, two drams of fluid extract of orange peel, one dram of fluid extract of cloves, one dram of carbonate of potassa, and one pint of water. Dose, one to one and a half ounces. The follow- ing is a good nervine and tonic for persons of nervous temperaments : fluid extract of cinchona, one ounce ; fluid extract of valerian, one ounce ; essence of cardamom, two drams ; dose, one dram every three hours. Cinchonia is a white crystalline substance obtained from the pern- vian bark. It is sometimes used as a substitute for quinia, in doses of from one to four grains, three times a day. Sulphate of Quinia is snow white, and in satin-like crystals, having an exceedingly bitter taste. It is completely soluble in water, or alco- hol, by adding a few drops of sulphuric acid. It is the chief active principle of cinchona, and has similar properties, namely, febrifuge, tonic, and antiperiodic ; it is, however, less apt to nauseate and op- press the stomach. In the treatment of intermittent fevers, it has almost entirely superseded the use of the bark. Valerianate of Quinia* — This is a combination of quinia and vale- rianic acid. It is tonic febrifuge and sedative. It is used for head- pR'Iflil, T'* ?i-'-:^'l ache of a periodic character, and for nervous irritability, wakefulness, restlessness, etc. Dose, from half a grain to two grains. Petrolium. — This is a blackish liquid bitumen, flowing spontane- ously from the earth in Italy, France, West India Islands, etc. As a medicine, it is stimulating, antispasmodic, and sudorific. It is occa- sionally administered in affections of the chest, when not attended with inflammation. Externally, it is employed in chilblaini), chronic rheumatism, paralysis, diseases of the joints, and affections of ths skin. It is an ingredient in the well-known remedy called Britiah oil. The petrolium found in the State of New York, and called Seneca oil, is extensively used in domestic practice. The dose of petrolium is from thirty drops to a dram. Phosphorus. — This is a semi-transparent solid, and is flexible, and has a waxy lustre. It is extracted from bones by sulphuric acid. As a medicine in small doses, it acts as a powerful general stimulant ; in large doses, as a violent, irritant poison. When taken in substance it causes irritation of the stomach, and should, therefore, always be administered in solution ; and even in this form it is objectionable; it ok is better to resort to the phosphates, and the hypophosphites. Phos- W phorus, being an element in the composition of the brain, has been given, and with advantage, in the various forms of nervous debility, as consumption, typhus fever, amaurosis, paralysis, and the general breakdown of the vital powers. Phosphorus burns when exposed to the air, and should therefore be kept covered with water. Fia. 218. Fio. 319. FIKK SOOT. PIPBI88KWA. Pink Root (Spig-efia Marilandica). — This perennial herb grows in rich soils in the Middle and Southern States. The root is the roadici- nal part. It is a powerful anthelmintic, and is but little used, except for expelling worms. Preparations. — Fluid extract, dose, half a dram to a dram and a half ; compound fluid extract, dose, half a dram to two drams ; fluid ^^ MEDICINES AND THEIR PREPARATIONS. 641 extract of pink root and i^enna, dose, half a dram to a dram ; infusion, half an ounce to a pint of water, dose, two to six. ounces. Pipsissewa (Chimaphila Umhellata). — This is a small evergreen plant, growing in the United States, and in Northern Europe and Asia. It is known by the name oi princes' pine. The whole plant is tonic, diuretic, and astringent, and has proved itself useful in dropsy, general debility, rheumatism, chronic disorders of the kidneys, blad- der, urethra, etc. Preparations. — Fluid extract, dose, one dram ; solid extract, dose, ten to twenty grains \ infusion, dose, two ounces. Plantain {Plantago Major). — This perennial herb grows both in Europe and America. A strong decoction of the tops and the roots is highly spoken of for syphilis and scrofula ; the dose being from two to four fluid ounces, two or three times a day. But the bruised leaves are most useful, when applied to wounds, ulcers, bites of poisonous insects, erysipelas, etc. Plenrisy Boot (-4sc?^ea« Tubero&a.) — This perennial plant is abundant in the Southern States. The root, which is the part used, is oarniinative, tonic, and diuretic ; used in pleurisy, bronchitis, inflannnation of the lungs, acute rheumatism, and dysentery. The warm infusion promotes diaphoresis, without raising the temperature of the body. United with the warm infusion of wild yam root, it is excellent for flatulency and wind colic. Preparations. — Fluid extract, dose, half a ^ Prickly Abo. and excite the system, when in a languid state, and for derangements of the liver, rheumatism, and chronic syphilis. It stimulates and strengthens mucous mem- branes, and is a valuable tonic in low typhoid fever. Applied externally, it im» voves indolent and malig- nant ulcers. Dose of the powdered bark, from ten to thirty grains, three times a day. Preparations. — Fluid extract, dose, fifteen to forty- five drops ; tincture, four oimees to a pint of diluted alcohol, dose, half a dram to a dram and a half; infu- sion, half an ounce to a pint of water, dose, half an ounce to two ounces ; xanthoxylin, the active princi- ple, dose, two to six grains. For chronic rheumatism, the following is a good preparation : xanthoxylin, one dram ; cimicifugin, one dram ; apocynin, one dram ; diluted alcohol, one pint ; dose, four drams, three times a day. Prickly Ash Berries are carminative, antispasmodic, and stinuilant, and have a special direction to mucous membranes. The tincture is excellent in nervous diseases, spasms of the bowels, flatulency, and diarrhcea ; and combined with the tincture of poke berries, is very serviceable in chronic rheumatism and syphilis. It is said to have l)cen used with great success, in the West, in Asiatic cholera. Dose of the tincture, from ten drops to a fluid dmm, in sweetened water. Dose of the oil of prickly asa berries, from two to ten drops, on sugar. Prickly Elder (Aralia Spinosa). — ^This is a tree which grows in the Southern and Western States, and is called southern prickly ash, tvnA toothache tree. The bark is stimulant, alterative, and diaphoretic. The fresh bark, emc Mc and cathartic. The tincture is serviceable in skin diseases, syphi. -, and chronic rheumatism. Dr. John King re- ports, that in the ch'' era of 1849, it was found very serviceable, where cathartics were required, in the following combination : compound I If powder of jalap, one dram; powdered prickly elder l)ark, one drum ; compound powder of rhubarb, two drams. These Avere mixed, and given in half-teaspoonful doses, every half hour, or hour, until they operated. The bark is sialagogue, and, in small doses, powdered, is said to relieve the dry and parched condition of the throat, in many diseases. Pumpkin Seeds. — The infusion of pumpkin seeds, made l)y placing them in water without bruising them, are mucilaginous and diuretic, and are used in inflammation of the stomach and bowels, scalding of the urine, strangury, etc. But this infusion is more pirticularly valu- able for its power of expelling the tape-worm. It may be drank freely. The oil of pui.^iikin seeds, obtained by expression, has simi- lar properties, and may be taken in doses of six to twelve drops, several times a day. (Quassia (Picroena Excelsa). — This is the wood of a tall tree grow- ing in Surinam and some of the West India Islands. It is an in- tensely ))itter tonic, feljrifuge, and anthelmintic, possessing in the highest degree the properties of the simple bitters. It invigorates the digestive organs, without produclnfif much excitement of the cir- culation. It is Avell adapted to dyspepsia and the del)ility of the stomach which succeeds acute disease, and indeed ail complaints where simple bitter is required. Its generic title perpetuates the name of the negro Quassi, of Surinam, who first discovered its medicinal virtues, about the middle of the last century, and who became famous for treating malignant fevers with it, as a secret remedy. Preparations. — Fluid extract, dose, hs'lf a dram to a dram ; solid extract, dose, three to five grains ; tincture, dose, four to eight drams ; infusion, tv^o drams to a pint of water, dose, two to four ounces. Queen of the Meadow {Eupatorium Purpureum). — This perennial herb grows in low, swampy places, in many parts of the country. It is called trumpet weed, and, from its fine medicinal effects in com- plaints of the urinary organs, ^mue? root. It is an excellent diuretic, tonic, and stimulant. Used in gout, rheumatism, hematuria, chronic diseases of the urinary organs, strangury, gravel, and dropsical affec- tions. The decoction is the form in which it is most used ; the dose being two to four ounces, two or three times a day. A preparation called etipuipurin is also extracted from it, which, in three-grain doses, is a powerful diuretic, occasioning, in some cases, it is said, an enormous flow of urine. Queen's Root {StilUngia Sylvatica). — This pereunial herb grows in sandy soils in the Southern States. The root is medicinal, being in large doses, emetic and cathartic ; in small doses, an alterative of considerable value in skin diseases, rheumatism, syphilis, and scrofula, and in such other complaints as require alteratives. Preparations. — Fluid extract, dose, five to fifteen drops ; compound fluid extract, dose, half a dram to a dram ; tincture, two ounces to a pint of diluted alcohol, dose, one to three drams ; infusion, dose, one to two ounces. In chronic bronchitis, and similar complaints, the following syrup is well recommended : fluid extract of stillingia, two ounces -, fluid extract of bloodroot, two ounces ; fluid extract of cherry l)ark, two ounces ; balsam of tolu, one ounce and a half; syrup, two and a half pints. Dose, one to two drams. RedChickweed (Anagallis Arvensis) . — An annual plant, common in Europe and this country. It has small scarlet flowers in June and July. It has been used in nervous diseases, as mania, delirium, epilepsy, and particularly hydrophobia. Old and ilUcouditioned ulcers are improved by its use, in the form of poultice. Red Foot ( Ceanolhus Americanus) . — This shrubby plant has the names of Nieio Jersey tea and icild snow-ball, and is found in all parts of the United States. The bark is antispasmodic, sedative, astringent, and expectorant, and tastes and smells like the peach leaf. A decoction is useful in dysentery, diarrhwa, liooping-cough, and chronic Inonchitis, in doses of a tablespoonful, three times a day. It makes, likewise, a very good injection in leucorrhcea and gleet, and gargle for ulcerations of the mouth and throat. Red Clover {Trifolium Pratense). — The blossoms of this very common biennial plant are mr licinal, and are highly recommended in deep, ragged, and cancerous ulcers, as well as in badly-condi- tioned burns. They are soothing and detergent, and promote heal^- ful granulation. Preparation. — Solid extract, to be used as an external application, chiefly in the form of ointment, ma:^^ by uniting four ounces of it with half a pound of lard. Red Rose ( tlosa Gallica) . — The petals of the rose are slightly tonic and astringent, and are considerably employed in chronic inflam- mations of the eye. Rose water, distilled from the petals, is used for similar purposes. Red 8aunders (Pterocaiyyus Santalinus) . — This is a large tree growing in Ceylon, the wood of which imparts a red color to alco- hol, ether, and alkaline solutions, but not to water. It is almost solely used for imparting color to tinctures, etc., having little or no medicinal i)roperties. Rosin. — This is the solid resinous matter which remains after the distillation of turpentine. It is much used as an ingredient in oint- ments and ])lasters, but is never taken internally. The vapor which arises from heating it upon some hot surface is sometimes inhaled with great advantage in chronic bronchitis, and other chronic aflec- tions of the air tubes. Rhatany {Krameria Triandra). — This is a native of Peru, grow- ing in dry, sandy places. It is a powerful astringent, and a gentle tonic. It is given with advantage in excessive menstruation, vomiting of blood, chronic diarrhcea, leucorrhcea, and inability to retain the urine ; likewise, as a local application .in falling of the bowel. It is valuable also for nose-bleed, and bleeding gums. Dose of the powder, for internal use, from ten to thirtv grains. riiiiWliMMiM^ iiil i 5 <>« > 1 1, H'i 648 MEDICINES AND THEIR PREPARATIONS. Preparations. — Fluid extract, dose, half a dram to a dram ; solid extract, dose, five to twenty groins ; tincture, three ounces to a pint of diluted alcohol, dose, three to six drams ; infusion, two ounces to a pint of water, dose, half an ounce to an ounce. Bhabarb {Rheum Palmatum). — This root is derived from several species of rheum, and passes under the various names of European, Russian^ Chinese, East India, and Turkey rhubarb. The variety called Russian, or Turkey rhubarb (for they are the same) , is con- sidered the best. Rhubarb is cathartic, astringent, and tonic. It is much used in mild cases of diarrhoea and cholera infantum ; likewise, as a stomachic and gentle tonic in dyspepsia, accompanied with a de- bilitated state of the digestive organs. It is a valuable remedy in the complaints of children, and is deservedly much used in treating them. It acts upon the muscular coat of the bowels, producing thick rather than watery stools. It is therefore not adapted to the treatment of d/opsical complaints. Its astringency may be increased by roasting it, or diminished, by combination with soap, or an alkali. Preparations. — Fluid extract, dose, half a dram to a dram ; aro- matic fluid extract, dose, half a dram to a dram ; fluid extract of rhu- barb and senna, dose, half a dram to a dram ; solid extract, dose, two to ten grains ; tincture, an ounce and a half of fluid extract, and half an ounce of essence of cardamom, to a pint of diluted alcohol, dose, half an ounce to an ounce and a half; infusion, one ounce fluid ex- tract and vWO ounces spirit of cinnamon to a pint of water, dose, one to three ouLces ; syrup, three ounces of fluid extract to fourteen of syrup, dose, two to five drams. Rosemary {Rosmarinus OJlcinali). — This evergreen shrub grows on thts borders of the Mediterranean, and is cultivated in Europe and this country. It is stimulant, antispasmodic, and emmenagogue. It is not used, in this country, however, except to perfume ointments, tinctures, and syrups. Round-Leaved Pyrola {Pyrola RotundifoUa) . — This perennial shrub grows in various parts of our country, and bears white flowers in June. It is called canker lettuce, pear-leaf winter green, etc. Its medicinal properties are those of a tonic, astringent, antispasmodic, und diuretic. Used in decoction for epilepsy and other nervous dis- orders ; also for gravel, and other diseases of the bladder and kidneys. The decoction may be used, too, as a wash for ulcerations of the mouth, indolent ulcers, and chronic ophthalmia. The decoction may likewise be used in making poultices for painful swellings, boils, and carbun- cles. It may be taken in doses of from one to six ounces. Rue {Ruta Oraveolena). — Rue has the medicinal virtues of the antispasmodics, anthelmintics, and emmenagogues. In large doses, it is poisonous. It is useful in wind colic, worms, hysterics, epilepsy, etc. Dose of the leaves, from ten to twenty grains ; of the infusion, from one to four ounces. Saflh)n ( Crocus Sativus) . — This is a native of Greece and Asia Minor ; it is also cultivated in France, England^ and America, as well "•^fwiflifpll h ; .!l as in other countries. It has been thought to be stimulant and anti- spiismodic, in small doses, relieving pain, and producing sleep ; in large tlases, giving rise to headache, and producing stupor. In the general judgment of the profession, it is now considered, however, as having very. little activity. It is accordingly not much used, except in do- mestic practice, where it has some reputation among nui'ses for its jwwer to bring out measles, and other eruptions. It is also thought to be beneficial in amenorrhoea, dysmenorrhcea, chlorosis, and hysteria. It is chiefly used at present to impart flavor and color to tinctures. Pr^arations. — Fluid exti*act, dose, twenty to sixty drops ; tinc- ture, dose, half a dram to a dram ; infusion, one dram to a pint of water, dose, two to three ounces. Sage (Salvia Officinalis) . — The tops and leaves of this well-known garden plant are aromatic, astringent, diaphoretic, and slightly tonic. The infusion is useful in debilitated conditions of the stomach, at- tended with flatulence ; it frequently relieves nausea ; the cold inf'- • sion cheeks and sometimes entirely removes the night-sweats of hectic. The infusion is useful as a gargle in inflammation of the throat, particularly, if united with a little honey and alum. Dose of the infusion, from one to three fluid ounces. Sarsaparilla {Smilax Officinalis). — Grows in swamps and hedges in the Middle and Southern States, The root has long been held in esteem as an alterative, diuretic, and demulcent, beinjr used in scrof- ula, chronic rheumatism, and affections of the skin ; but its most extensive and useful application has been found to be in the treat- ment of secondary and tertiary syphilis ; and especially in the broken condition of the system which follows the use of mercury in these affections. Preparations. — Fluid extract, dose, one dram; fluid extract of sarsaparilla and dandelion, dose, one dram ; solid extract, dose, five to twenty grains ; infusion, dose, two to four ounces. Sassafras (Laurus Sassafras). — This tree is common in the United States. The bark of the root, which is the medicinal part, is altera- tive, diuretic, diaphoretic, and a warm aromatic stimulant. It is mainly used to improve the flavor of other medicines, and also, as a constituent of those compounds, which are recommended in chronic rheumatism, sjrphiloid affections, eruptions of the skin, and scurvy. Preparations. — Fluid extract, dose, one to two drams ; tincture, six ounces to a pint of alcohol, dose, half an ounce to an ounce ; in- fusion, two ounces to a pint of water, to be drank as desired. ^Ay\n (Juniperus Sabina). — An evergreen shrub, growing in Europe and North America. The tops and leaves are diuretic, dia- phoretic, emmenagogue, and anthelmintic. The warm infusion pro- motes menstruation, and destroys worms. Cai'e should be taken never to administer this medicine during pregnancy, its effects being violent and dangerous. Preparations. — Fluid extract, dose, ten to thirty drops ; solid ex- tract, dose, one to five gitiins : tincture, four ounces to a pint of m w tr 650 MEDICINES AND THEIR PREPARATIONS. Fio. 224. diluted alcohol, dose, half a dram to a dram and a half; Infusion, haJ.f an ounce to a pint of water, dose, half an ounce to an ounce. The following mixture is useful in amenori'hoea : fluid extract of savin, half a dram; fluid extract of ginger, one dram; sulphate of potassa, two drams. Mix. Dose, half a dram, twice a day. The oil of savin has properties similar to those of the leaves. Dose, from two to live drops, on sugar. Scaminony ( Convolvulus Scammonia) . — This plant is a native of Syria, and the neighboring countries. The medicinal part is the hardened juice of the fresh root. It is an energetic cathartic, pro- ducing griping, and sometimes operating with decided harshness, on which account it is generally combined with other medicines which lessen the severity of its action. The dose is from tivc to twenty grains. ScuUcap {Scutellaria Lateriflora). — An indigenous plant, flowering in July and August. Tiie whole herl) is used. It is a valuable ner- vine, tonic, and antispasmodic ; while it gives support to the nerves, therefore, it imparts both quietness and strength to the whole system, and does not, like other nervines, leave the patient excited and Irritable. It finds its use in the treat- ment of neuralgia, chorea, convulsions, lockjaw, and most other diseases of the nervous system. Preparations. — Fluid extract, dose, half a dram to a dram ; compound fluid extract, dose, half a dram to a dram ; tincture, four ounces to a pint of diluted alcohol, dose, one to two ' in moist places throughout the United States ; sometimes called mmdow cabbage. The root is stimulant, expectorant, antispasmodic, iuul slightly narcotic. It is given for pulmonary and In'onchial affec- tions, epilepsy, hysterics, asthma, hooping-cough, and irritable nerves. Preparations. — Fluid extract, dose, twenty to eighty drops ; tinc- ture, three ounces to a pint of alcohol, dose, half a drain to a dram ; intiwion. dose, one to two ounces ; syrup, two ounces of fluid extract to eight ounces of simple syrup, dose, two to three drams. For nsthnm and cough, and to promote expectoration, and remove tight- ness across the chest, the followiug is a very good compound prepa- ration : one ounce each of the fluid extract of skunk cabbage, lolielia, bloodroot, pleurisy root, and ginger, one pint of water, and three pints of alcohol. Dose, two to four drams. Slippery Elm (Ulmus Fitlva). — The inner bark of this well- known tree is nutritive, demulcent, emollient, and slightly expecto- rant and diuretic. It is valuable as a demulcent drink in inflamma- tions of the lungs, stomach, bowels, bladder, and kidneys ; also, for coughs, strangury, dysentery, and the -summer complaint of infants. It makes a valuable poultice for vai'ious purposes. Small Spikenard (Aralia NudicauUs) . — This plant gi-ows througli- out the United States, from Canada to the Carolinas, in rocky woods. It is called false aarsaparilla and wild aaraaparilla. The root is a gentle stimulant, diaphoretic, and alterative. It is used in domestic practice, and by some physicians, in rheumatism, syphilis, and cuta- neous diseases. The American spikenard, aralia racetnoaa, resem- bles the small spikenard in medical properties. Either of these roots is valuable in chronic affections of the lungs and air tubes. Soap (»5a/)o). — Soap is laxative, antacid, and antilithic, and is much used in coml)ination with cathartics, to lessen the severity of their action. In mesenteric fever, advantage is derived from rub- bing the tumid belly of children with a strong lather of soap, morn- ing and evening; and few things are moi*e effectual in removing hardened feces from the rectum in cases of obstinate costiveness than an injection of soap-suds. Sodinm. — This is a soft white metal. United with oxygen in the proportion of one equivalent each, it forms the alkali, soda. The following are the principal preparations of soda used in medicine : Bicarbonate of Sodf^ (Sodce Bicarbonas). — This is a white, inodor- ous powder, generally called super carbonate of soda. It is antacid, antilithic, and slightly diuretic. It is chiefly used in preparing what are called soda powders, and in various preparations of medicine, when an antacid is required. It is also taken simply dissolved in water, for acidity of the stomach. The yeast powders ^ now so much used, are said to be composed of about two and a half parts of cream of tartar, and one part each of corn starch and bicarbonate of soda. Housewives may as well make the combination for themselves. Borate of Soda {Sodas Boras). — This is everywhere known by the name of borax. It exists naturally formed in several parts of the world, and is likewise manufactured. It is a mild refrigerant and diuretic ; also emmenagogue, promoting menstruation, facilitating parturition, and favoring the expulsion of the after-birth, by its spe- cific influence upon the womb. It has considerable reputation in the treatment of urinary diseases, particularly those connected with an excess of uric acid. The dose is from twenty to forty grains in solu- tion. Combined with rose-water, honey, and various other things, according to circumstances, l)orax makes a valuable wash for inflam- matory affections of the mouth and throat, skin diseases, etc. 3, lol)elia, ind three ;his well- expecto- intlamtna- also, for >f infants. s through- ty woods. B root is a I domestic and cuta- la, resem- hese roots ic, and is everity of from rub- lap, morn- removing eness thai» 'gen in tlie oda. The idicine : ite, inodor- is antacid, aring what medicine, issolved in w so mucli ts of cream te of soda. Ives. lown by tlie arts of the igerant and facilitating by its spe- ition in the ed with an ins in solu- her things, for intlara- etc. Chloride of Sodium (Sodii Chloridum) . — This is the chemical name of muriate of soda, or common salt. In small doses, it is tonic, alterative, and anthelmintic. It checks bleeding from the lungs, when taken in teaspoonful doses. The dose as an alterative is from ten to sixty giains. As moderately used in food by most civilized people, it promotes digestion and improves the general health. Sulphate of Soda (Sodce Sulphas). — This has a very pretty name, but it will not sound half as well to thousands of young per- sons, when they are told that it is the well-known glauber's salts. From half an ounce to an ounce of it, dissolved in half a tunil)lerful of water, acts as a cathartic ; a smaller dose, as a laxative and diu- retic. Its nauseous and bitter taste may be somewhat concealed by a little cream of tai-tar, or lemon juice, or a few drops of sulphuric acid. Snlphite of Soda (/Sodce Sulphis). — This preparation is in the form of transparent crystals, and is very soluble in water. In doses of sixty grains, this is said to have been used with success in frothy vomitings ; it is also well spoken of as a remedy in acute rheuma- tism, and as a wash in thrush, and some diseases of the skin. Tartrate of Potassa and Sc' (Soda: et Potassce Tartras). — Tliis is one of the mildest, and mosi cooling purgatives among the salts. It is known as rochelle salt, and generally agrees well with irrital)le and delicate stomachs. Dose, from two drams to an ounce, in a tuin- l)l(Mful of water. The gentle physic called seidlitz powders is com- posed of two drams of rochelle salt and two scruples of bicarbonate of soda in a blue pajjcr, and thirty-live grains of tartaric acid in a while paper. The contents of each paper is dissolved in half a tum- bler of water by itself; one solution is then poured into the other, and the whole is drank during the effervescence. Solonion's Seal ( Convalaria Multiflora) . — This is one of our own perennial plants, and is found in various parts of the country. The root is tonic, mucilaginous, and astringent. It acts especially upon mucous tissues, and has therefore found its use in chronic dysentery, and piles, and in chronic inflammation of the stomach and bowels. Dose of the decoction, or infusion, from one to four fluid ounces, three or four times a day. Large doses purge and vomit. The decoction, applied locally, relieves the inflammation caused by the poison vine. Solution of Arsenite of Potassa {Liquor Potassce Arsenitis). — This is known under the names of arsenical solution and Fowler's so- lution. It is a transparent liquid, having the color, taste, and smell of spirits of lavender. It has the general action upon the human body of the arsenical i)reparations. It is the preparation generally resorted to where arsenic is given internally, and is used with con- siderable success in intermittent fever, leprosy, and several other skin diseases, St. Vitus's dance, periodical headache, and some other com- l)hiints. The dose is from three to ten drops, three times a day, given in water ; generally, it is better not to go beyond five dro'ps. Some- times it disturbs the stomach, and binds the bowels, producing head- '•w\ 654 MEDICINES AND lilEIR PREPAllATIONS. ache, dizziness, and confusion of mind. When such effects follow its use, it must be hiid aside, and a purgative given. After an inter- val of two weeks, it may l)e resumed in smaller doses. It often requires to be used for several months. Spanish Flies (Cantharis Vesicatoria) . — These insects are of a beautiful, shining, golden-green color. They attach themselves to such trees, in France, Spain, and Italy, as the white poplar, cldiM', privet, and lilach, upon the leaves of which they feed. They niiikc their appearance in swarms upon these trees, in May and June, and ai*e shaken off in the morning while torpid with the cold. Internally administered, they are a powerful stimulant, exercising a peculiar in- fluence over the urinary and genital organs. In large doses, thiy excite violent inflammation of the alimentary canal and urinary or- gans, strangury, irrittition of the sexual organs, headache, delirium, and convulsions ; also painful priapism, vomiting, bloody stools, sali- vation, fetid breath, hurried breathing, and difficulty of swallowing. They are given intei'nally for chronic gonorrhoea, leucorrhcea, semi- nal weakness, and paralysis of the bladder. Dose of the powder, from half a grain to two grains ; of the tincture, fiom twenty to sixty drops. Solution of potassa, given every hour, in thirty-droj) doses, is a remedy for strangury produced by cantharides. Spiinish flies are used externally, in the form of blistering plaster ; also in the form of tincture, mixed with various solutions, to produce irritation and redness of the skin. Spearmint (Mentha Viridis). — This has carminative, diuretic, and antispasmodic virtues. The Avarm infusion of it is much employed in domestic practice, to produce perspiration, after taking cold, and while suffering from feverish symptoms, from various causes. The oil of spearmint has similar properties with the herh, and may be taken in five to ten drop doses, on sugar. One ounce of the oil of spearmint, dissolved in a pint of alcohol, constitutes the essence of spearmint. Spermaceti (Cetaceum). — This is a white crystalline substance, obtained from the head of the spermaceti whale. In household j^rac- tice, it is considerably used for the coughs and colds of children, being generally simmered with molasses or loaf sugar. It forms a p:.rt of several cerates and ointments. Spider's Web (Tela Aranece) . — The web of the black or brown spider, gathered in barns, cellars, etc., is sometimes given in five or six grain doses, in pill form, and it is said with good effect, in peri- odical headache, hysterics, St. Vitus's dance, asthma, and fever and ague. It is likewise applied externally to check bleeding. Spirit of Nitric Etlier fSpiritmuEtherismtrici). — The gencvi\\ reader will know this article better under the name of sweet spiritx of nitre. It is aiuretic, diaphoretic, antispasmodic, and stimulant, and in large doses, a narcotic poison. It is much used in diseases of the urinary organs, either alone or combined with sedatives, and other vfm diuretics. Dose, from twenty drops to two fluid drains, to be taken in water, three or four times a day. Sponge (Spongia). — When burned, this is used as an alterative in stitttula, scrofulous tumors, goitre, and obstinate diseases of the skin. It is much employed by homoeopathic physicians, though it has much less remedial power than iodine. Dose, one to three drams, mixed with honey or syrup. Spurred Bye (Secale Cornutum). — This is a diseased product of rye, known by the name of ergot. This article has a peculiar eti'cct upon the womb, causing it to contract with great energy, Avhen given in full doses. It should never l)e given, however, continuously, for a great length of time, as it has been known, when so used, to produce (hy gangrene, typhus fever, and nervous disorders connected with convulsions. Such were its ett'ects in certain provinces of France, in consequence of the use of rye bread contaminated with it. It is use- ful in excessive uterine hemorrhage, which it arrests by causing the womb to contract, and thus to condense its tissue, and close up its bleeding vessels. It has also been successful in bleeding from the lungs. Preparations. — Fluid extract, dose, half a dram to a dram ; tinc- ture, four ounces to a pint of diluted alcohol, dose, two and a half to tive drams ; infusion, dose, one to two ounces ; wine, five ounces of Huid extract to a pint of sherry wine, dose, two to four drams, in cases of labor ; for other purposes, one to two drams. Squill {Scilla Maritimd) . — A perennial plant gi'owing in countries on the Mediterranean. In large doses, it is emetic and purgative ; in small doses, expectorant and diuretic. It is used in pulmonary aft'ec- tions to increase expectoration, and in dropsical complaints to aug- ment the secretions of the kidneys. Dose of the dried root, one to five grains, generally to be united with nitre or ipecac. Preparations. — Fluid extract, dose, as an expectorant and diuretic, two to six drops ; as an emetic, twelve to twenty-four drops ; com- pound fluid extract, dose, ten to twenty drops ; tincture, two ounces to a pint of diluted alcohol, dose, twenty to forty drops ; syrup, dose, a <]uarter to half a dram. Star Grass {AletrisFarinosa). — This plant is found in dry soils throughout most parts of the United States, and called iinicoi'n root, ague root, and crow corn. The root is an intensely bitter tonic, and is used to improve the tone of the stomach, and for flatulent colic and hysterics. It is said also to give tone io the female generative organs, affording a protection against miscarriage. The Eclectics call it one of their best agents in chlorosis, suppressed menstruation, engorge- ment and falling of the womb, and painful menstruation. Dose of the powdered root, from five to ten grains, three times a day. Preparations. — Fluid extract, dose, ten to thirty drops ; tincture, two ounces to a pint of diluted alcohol, dose, half a dram to a dram ; infusion, two drams to a pint of water, dose, one or two ounces ; m }.\. i '» ii 656 MEDICINES AND THEIR PREPARATIONS. syrup, dose, one to two drams ; aletridin, the active principle, dose, one to three grains. 8t. Ignatios's Bean (Faba Sancti Ignatii) . — The seeds are the part used, and are the product of the Ignatia Amara, — a tree of middle size, growing in the Philippine Islands, and is a species o{ the atrich- no8. These seeds possess a large amount of strychnine, and conse- quently, in medicinal doses, are a powerful nervine tonic, and are used for improving the digestive functions, and for rousing and strength- ening the whole system when prostrated by nervous complaints. Preparations. — Fluid extract, dose, five to ten drops ; solid extract, dose, half a grain to a grain and a half. Storax (Stt/rax Officinale). — This is the hardened juice of the storax, a native of the countries along the Mediterranean. It is a stimulant and expectorant, and is used for chronic bronchitis, laryn- gitis, and cough. The liquid storax is sometimes employed instead of copaiva in gonorrhoea and gleet. The dose is from ten to twenty grains. Storax is a constituent in the compound tincture of benzoin. Fig. 227. Flo. 228. STAR ORASa. STRAMONIUM. Stramonium {Datura /Stramonium) . — This annual plant is most known in this country by the name oi Jamestown %oeed; in England by that of thornapple. The leaves and seeds are medicinal. Stramo- nium is a powerful narcotic ; it is also antispasmodic, anodyne, and sedative. It is used in various nervous affections, as chorea, epilepsy, palsy, tetanus, and mania. It is much used for relieving acute pains, etc. Taken in large doses, it is a powerful poison. Preparations. — Fluid extract, dose, five to twenty drops ; solid extract, dose, half a grain to a grain ; tincture, two ounces to a pint of alcohol, dose, half a dram to a dram and a half, and to be gradu- ally increased. Sulphur. — This is considerably used in medicine, being laxative, diaphoretic, and resolvent. It is chiefly used for piles, chronic iheu- matism, gout, asthma, and those affections of the breathing organs ' ■': 'ill not Attended with ucute inflammation. Externally and internally* it is much employed in .skin diseases, particularly the itch, for which it is a specific. In these affections, it is frequently applied in the form of suljjhur baths. The dose of sulphur is from one to three drams, mixed with syrup, molasses, or milk. When sul>limcd, this article imMcdJfowei's of sulphur, which is the form in which it is chiefly used in medicine. Sumach {Rhus Glabrum). — Found in almost nil parts of the United Stiitcs, in old neglected fields, and by the side of fences. The bark aiul berries are astringent, tonic, antiseptic, and diuretic, and are used ill (liarrlioken of, also, for dyspepsia, diarrhoea, malig- nant fevers, and as an external api>lication to foul and ill-conditioned ulcers. Dose of the [wwdered bark, from twenty to sixty grains ; of the infusion, from two to four fluid ounces. Swamp Milkweed (Asclepias Incamata) . — This is a native of the United States, and l^ears red flowers from June to August. It has the name of white Indian hemp. The root is emetic, cathartic, and diuretic, and is useful in asthma, bronchitis, rheumatism, syphilis, and worms. Preparations. — Fluid extract, dose, twenty to forty drops ; solid extract, dose, three to five grains ; tincture, two ounces to a pint of diluted alcohol, dose, one and a half to three drams ; infusion, dose, three to six drams ; syrup, four ounces fluid extract to twelve ounces simple syrup, dose, half a dram to a dram and a half. Sweet Fern (Comptonia Aspleni/olia) . —This shrub, growing in stony pastures in New England and Virginia, is tonic, astringent, alterative, and aromatic, and is used in diarrhoea, dysentery, cholera infantum, rheumatism, and debility after fevers. Dose of the decoc- tion, from one to four fluid ounces, three or four times a day. 83 ,:i ' ■ I 658 MEDICINES AND THEIR PREPARATIONS. Sweet Flag {Acorun Calamm). — Found in damp plaeos, in most parts of the world. The root is Htimulant, tonic, and aromatic: us<'. ful in wind colic, weakened conditions of tlie stomach, and dysjiepsia. Dom of the root, from twenty to sixty grains ; of the infusion, from two to four rtuid ounces. Sweet Gum {Liqnidamher Styraciflna). — This tree grows in the Middle and Southern States. Being wounded, it yields a yellowish- white, honey-like balsam, which hardens into a gum. This, melted with ecjual parts of lard or tallow, forms an ointment which is used in some parts of the country for piles, ringworm of the scalp, fever isorcs, and other complaints. Used internally, it has very nearly the same oflects with storax. Tag Alder {Alnus Rubra). — This shrub grows in swamps and other damp places, in northern United States. The bark is altera- tive, emetic, and astringent. It is used in scrofula, secondary syphilis, herpes, impetigo, and other skin diseases. Preparations. — Fluid extract, dose, one to two drams ; infusion, two ounces to a pint of water, dose, one to two ounces ; ulnuin, the active principle, dose, one to three grains. Tansy ( Tanacetum Vulgare) . — Tansy is a perennial herb, having tonic, emmenagogue, and diaphoretic properties ; the cold infusion l)eing tonic, and useful in dyspepsia, wind in the stomach, jaundice, and worms ; the warm infusion, diaphoretic and emmenagogue. D6se of the infusion, from one to four fluid ounces, two or three times a day. Tar {Fix Liquida) . — The medicinal qualities of tar are like those of turpentine, and it is sometimes used in old chronic coughs and bron- chitis. The vapor of boiling tar was once thought to be very service- able in bronchial diseases, when inhaled. Doubtless it is useful in some cases, but its virtues have been extolled aliove their merits. In the form of ointment, it has real efficacy in scald head and tetter. Thimbleweed (Rudbeckia Laciniala). — The whole of this herb is balsamic, diuretic, and tonic, and in the form of decoction, used freely, is said to ha^'e Ijcen found useful in some urinary complaints, as Bright's disease, strangury, etc. Tobacco {Nicotiana Tabacttm). — The leaves of tobacco are acrid, narcotic, and poisonous, and are chiefly used in the form of ointment, in skin diseases, etc. Its poisonous qualities, however, render it dangerous when much used, even externally. Trailing Arbntns {Epigma Repena). — This grows in sandy woods and rocky soils, its flowers appearing in early spring, and exhaling a spicy fragrance. The leaves are diuretic and astringent, and are very useful in gravel, and most diseases of the urinary organs, being regarded in some cases superior to Uva ursi and buchu. Preparations. — Fluid exti'oct, dose, one to two drams ; infusion, dose, two to four ounces. ■~"flSi MEDICINES AND THEIR IMIEPARATIONS. 6:) 9 Tapioca {Janipha Manthot). — This pliint y at the South. The root is antispasmodic, and is successfully Uct' ; ; bilous colic. It is said to bring relief in the mo.st violent ^^asey this complaint. It allays nausea and spasms during pregnancy. It i.s given in the form of decoction, two or three t5ii'^ ounces every th.rty ^1 MEDICINES AND THEIR PREPARATIONS, 663 or forty minutes. Dose of die tincture, from a quarter of a dram to a dram ; of dioscorein, the active principle, o..e to four grains. Willow (Silex Alba). — The willow is common in Euroi)e and America. Its bark is tonic and astringent ; and is used, occasionally, as a substitute for peruvinn bark, in intermittent fever. It is also employed in the treatment of chronic diarrha?a and dysentery. Dose of the powdered bark, one dram; of the decoction, one to two fluid ounces. Siilicin, the active principle, is given, sometimes, in place of quinine ; dose, from two to ten grains. Wint*;rgreeii ( Gaultheria Procumbens) . — This evergreen grows in mounbiinous, barren regions, throughout our country. The leaves are an agreeable stimulant, aromatic, and astringent. Used for chrop.ic diarrhoea, and as an emmenagogue. The oil and essence are useful in flatulent colic ; dose of the oil, from Ave lo ten drops, on sugar; of the essence, thirty to forty Jrops. Much used to flavor other medicines. Witch Hazel (Ilamamelis Virginica). — This derives its name from its having fruit and flowers together on the same tiee. It is found in most parts of our country. The bark and leaves are toni(!, astringent, and sedative. It is used in bleeding from the lungs and stomach, and in diarriia'a, dysentery, and excessive nmcous discharges. It is also used in incipient consumption, and for sore mouth, etc. Preporalions. — Fluid extract, dose, one to two drams; infusion, dose, four drams ; syru[), four ounces of fluid extract to twelve ounces of simple syrup, dose, one to two drams. Fig. 234. Fia. 235. WOLFBBAKiC. WOBIIWOOD. Wolfebane {Aconitum Napellua) . — This has already l>een described, under its other common name, which is Monkshood; but as the ctit we h>«:l prepared to accompany it was omitted, we give it a place here, referring the reader to monkshood for its description. ,i ll- Wi ,..rl^:l ' ':*'::vi"a :,:!.;;;|_ 'lii*?i*il 664 MEDICINES AND THEIR PREPARATIONS. Wormseed (Chenopodhim Anthelminticum) . — This perennial is called Jerusalem oak, and is found in waste places all over the United States. An oil is extracted from the seeds, which, in doses of fiom four to eight di-ops, niorning and evening, for a child, destroys worms. A stiong infusion of tin; tops has a similar ctfect. Tl.e romody should be used four or tive days, and he followed hy a purge. Wormwood (Artemisio Ahf<-int/tinm) . — The tops and hiavosof Ihis perennial are tonic and anthelmintic ; used in intermittent fever, jaun- dice, and worms. It restores the appetite in a wtiakeniid state of tho digestive organs, and is also useful in amenorrhtt'a. It is excelleiil applied as a tincture, or in the form of fomentation, to bruises, sprains, and local inllanunations. Prejxiritfions. — Fluid extract, dose, one third to two thirds of a dram ; solid extract, dose, three to five grains ; tincture, two ounces to fou'icen ounces of diluted alcohol, dose, two to *bur drams ; syrup, two oi. '! id extract to six ounces of simple s>yri>p, dose, one to two dran Yarrow ^^Lchillea Millefolium). — A perennial herb, common to the Old AVorld and New, and growing in old fields and along fences. It is tonic, astringent, and alterative, and has been used in inter- mittent fever, bleeding from the lungs, excessive menstruation, wind colic, and chronic dysenteiy. Dose of the infusion, a wine- glassful, three or four times a day. Yeast {Cercvlsla'. Fermenlum). — Yeast \s slightly tonic and stim- ulating, and has been used with advantage in ty|)hoid fever ; also in scarlet fever, and in all diseases where there is a disposition to jjutrid- ity. The dose is from one to two fiuid ounces, every two or three hours. It makes an excellent antiseptic poultice, for unhealthy and fetid ulcers, especially if combined with powdered slii)pery elm bark, and charcoal. Yellow Dock {Rumex Crispus). — The root of this ^"'- ^'^■ perenniel i)lant is alterative, tonic, diuretic, and deter- gent, and is regarded as very valuable in the treatment of scrofula syphilis, leprowy, scurvy, and other skin diseases. Preparations. — Fluid extract, dose, one to two dnuns ; solid extract, dose, four to eight grains ; syrup, four ounces of fluid extract to twelve ounces of simplfe syrup, dose, half an ounce to an ounce ; rumin, the active principle, dose, two to four grains. Yellow Jessamine ( Geheminum Sempervirens) . — '.his abounds in the Southern States, where it is culti- vated as an ornamental vine. The root is a powerful febrifuge, narcotic, and relaxant, controlling and 8ul>- duing ifever, quieting nervous irritability and excitement, equalizing the circulation, promoting pei-spirution, and rectifying the secretions. It is much used by the Eclectics of the Western States, but the general TBIXOW DOCK. It-. ' ; ^ i^'l ■■i DOCE. MEDICINES AND THEIR PREPARATIONS. 665 judgment of the i)rofession is, that it is too |)owerful a remedy to be siife. My own opinion is, that the American hellebore is equally trt'cc'tive with the yellow jessamine, and that its general use involves far loss danger. Preparations. — Fluid extract, dose, two to twenty drops ; tincture, four ounces to a pint of alcohol, dose, fifteen to sixty drops, and in- crease ; gelserainin, the active princii)le, dose, half a grain to a grain iiiul a half. Yellow Ladies' Slipper (CypripediumPubescens). — This perennial l)laut is called American valerian, nerve root, etc. The HI)rous roots iiie tonic, nervine, antispasmodic. Mid diai)horetic, and are used in ncivous headache, nervous excitability, hysterics, neuralgia, and St. Vitus's dance. Dose of the powder, ironi ten to thirty grains. Preparations -Fluid extract, dose, half a dram to a dram ; solid extract, dose, five to fifteen grains ; tincture, two ounces to a pint of diluted alcohol, dose, half an ounce to an ounce ; syrup, four ounces of iluid extract to fourteen ounces of simple syrup, dose, two to four drams; cypripcdin, the active principle, dose, two to four grains. Yellow Parilla {Meninpermum Ganadense). — This is a perennial jiiant, growing in woods, and near stream^s, througluMit the country. The root has the properties of a tonic, laxative, alterative, and diu- retic. It is valued in the treatment of scrofula, syphilis, skin diseases, •font, rheumatism, dyspei)sia, general del)ility, and chronic iniianuna- rion of the stonmch and bowels. Dose of the decoction, from two to four fluid ouiicv s, three times a day ; of the solid extract, from two to four grains. Zinc. — Several preparations of this metal are used in medicine, as follows: . Acetate of Zino. — This is used as an external remedy only, gener- ally as an astringent Avash for inflammations of the eye, and as an nijection in gonorrhoea, but only after the acute stage of these diseases has past. The strength of these solutions generally should be one or two grains to a fluid ounce of soft water. Chloride of Zinc (Zmct Chloridum), — This is a powerful escharo- tic, and is employed as an external application to cancers and obsti- nate ulcers. A weak solution of it is occasionally em[)loyed in old chronic gleet, also in whites, and puruleat discharge from the neck of the womb. Iodide of Zinc ( Zinci lodidum) . — This is in the form of white needles, and is tonic and astringent. It is not much used, except externally, being applied in a solution of twenty grains to a fluid ounce of water, to enlarged tonsils, by means, of a camel's-hair pencil, or a piece of s]ionge tied to the end of a stick. Oxide of Zinc (Zinci Oxidum). — Thi£< is an inodorous, white pow- der, insoluble in water and alcohol. It is tonic and antispasmodic, and is given in chorea, epilepsy, hooping-cough, and other similar 1 Jll-il ' i tip C66 MBDICINKS AND THEIR PREPARATIONS. diseases ; but it is more especially employed to an-est the night- sweats of consumi)tion, for which purpose, we have at present no other article of equal efficacy. It is sprinkled externally ujion ex- coriated surfaces, and is used in ointments. Dose from two to eight grains, in the form of pill. • Precipitated Carbonate of Zinc ( Zinci Carbonas Prcecipitatas) . — This is emi)loyed for the same purpose as prepared calamine, being adapted only to external use. Prepared Calamine (Culamina Proeparata). —This is in theforiu of a pinkish or flesh-colored powder, of an earth}' appearance. It is employed only as an external application, being dusted on excoria- tions and Hupei-ficial ulcerations, as a mild astringent. It should be a very fine powder. Snlpliate of Zinc {Zinci Sulphas). — This is a colorless, transpar- ent salt, crystallizing usually in small, four-sided prisms. It is tonic and astringent, and in large doses, a prompt emetic. Used "s atonic incases of debility attended with irritation. In obstinate intermit- tents, it is sometimes conjoined with sulj/hate of quinia ; it is chiefly employed, however, in such spasmodic diseases as ei)ilepsy, chorea, and hooping-cough. As an astringent, it is used externally, being applied in solution to bleeding surfaces, as a wash In ophthalmia, and as an injection in whites and chronic gonorrhoea. Valerianate of Zinc ( Zinci Valerianas). — This is in v/hite, pearly scales, with a faint odor of valerianic acid. It is tonic and antispas- modic, and is used in the various nervous affections which accompany chlorosis. Dose, one or two grains, several times a day, in the form of pill. Preparations. Pharmacy. The preparation of medicines for use, constitutes the art of phar- macy. It is the peculiar business of the apothecary. It will not he necessary in these psiges to describe his art, in all particulars, but merely as many of the preparations which it is his duty to prepare as are really needed in the treatment of disease. In doing this, I shall classify the preparations alphabetically, and begin with Cerates. These substances have a degree of hardness midway between oint- ments and plasters. They may be spread upon leather or linen, with- out the use of heat, and they do not melt and run when applied to the skin. They are made of wax, or spermaceti, combined with lard or oil. The articles are melted together by a very gentle heat, and dur- ing the process of cooling, the whole should be Avell stirred. Calamine Cerate. — Prepared calamine and yellow wax, each three ounces ; lard, one pound. Melt the lard and wax together. When the mixture begins to thicken, on cooling, gradually stir in the cala- mine. Il 'IIIIW'^I'I' MEDICINES AND THEIR PREPARATIONS. 667 This is called Turner's cerate, and is useful for burns, excoria- tions, superficial ulcers, and sores. Goulard's Cerate. — Take of solution of subacetate of lead, two Huid ounces and a half; white wax, four ounces ; olive oil, nine fluid ounces ; cauiiihor, half a dram. Mix the wax, ju'eviously melted j with eight fluid ounces of tiic oi! ; remove from the fire, and when the mixture Ix5gins to thicken, gradually pour in the solution of subacetate of lead, stirring constantly, with si wooden spatula, till it becomes cool. Then add the camphor, dissolved in the remainder of the oil. This is the cerate of subacetate of lead, and is used for excoriations, inrtamed burns, scidds, and chilblains, and for eru^jtions of the skin. Excellent for blistered surfaces, indisposed to heal. Half an ounce of this preparation united vrA\\ half an ounce of fiiini)lo cerate, atid one dram each of calomel and powdered opium, makes a very valuable I'emedy for various eruptions of the skm, of a local nature. . '' ,•' Resin Cerate. — Take of resin, five ounces ; lard," eight ounces ; yellow wax, two ounces. Melt together with a gentle heat, and stir till cool. This IS known as basilicon ointment, and is used as a gentle stimu- lant to blistered surfaces, indolent ulcers, burns, scalds, and chilblains. Compouiid Resin Cerate — Take of resin, suet, and yellow wax, each a poujjd ; turpentine, half a pound; flax-seed oil, half a pint. Melt togetlier, strain through linen, and stir till cool. This, under the name of Deshler's salve, is i)opularly used for sim- ilar t)urposes with the resin cerate. Sayine Cerate. — Take powdered savine, two ounces; resin ce- rate, a pound. Mix the savine with the cerate, previously softened. Used as a dressing for perpetual blisters. Simple Cerate. — Lard, eight ounces ; white wax, four ounces. Melt together, and stir till cool. Used for dressing blisters, wounds, etc., where it is desirable sim- ply to preserve the moisture o£ the part, and to exclude the air. Spanish Flies Cerate, known as blistering plaster. Take finely powdered Spanish flies, a pound ; yellow wax and resin, each seven ounces ; lard, ten ounces. To the wax, resin, and lard, previously melted together and strained, add the Spanish flies, and, by means of the most gentle heat, keep the mixture in a fluid state for half an hour, stiiTing occasionally, then remove the heat, and stir till cool. This can be easily spread without the aid of heat, and is used for the pur^iose of drawing blisters. It is now, however, superceued in a great degree by various preparations, composed for the most jMirt of mntharidin, either dissolved in oil, and applied to the skin by means of a piece of paper saturated with it, or incorporated with wax, and sj)read in a very thin layer upon fine waxed cloth, s;ilk, or paper, con- »etter than extracts or decoctions, because not so often injured by heat in their pi*eparation, and not requiring to be taken in large doses. Great skill is required in their preparation, and they should alwaj's be obtained from those who have the reputation of making reliable articles. None that I am acquainted with, better deserve confidence than those of Tilden & Co. Fomentations. Fomentation is a sort of partial or local hot bath, and consists either in the application of cloths dipped in hot water, or some hot medicated decoction, and applied to the affected part, or, of bitter or anodyne herbs steeped in vinegar or water, and then, while hot, en- closed in a muslin bag, and laid upon the diseased place. In either case, whether the cloths wet in a decoction of the herbs, or the herbs themselves, slightly steeped, be applied in a bag, the application should if!:!"" ■| •■>.,| in 'li 4? ,11 670 MEDICINES AND THEIR PKEPAUATI©N8. 1m} as hot as can be home, and not so moist as to wet the bed or (;lothes of the patient. Fomentations act by their warmth and moisture chiefly ; and slightly, in some cases, by their medicinal virtues. Their object is to lessen pain and inflammation, l)y relaxing the parts, and relieving tension and spasm. They may be prepared from equal parts of hops tansy, and wormwood, or from equal parts of hops, lobelia, and stra- monium, etc., etc. Infusions. For a description of simple infusions, see page 588. Those made of one article only are sufficiently referred to in previous pages. It will only be necessary here to insert such compound infusions as are deemed important. Componnd Inflision of Catecha. — Take of powdered catechu, half an ounce , bruised cinnamon, a dram ; boiling water, a pint ; macer- ate for an hour in a covered vessel, and strain. An elegant mode of administering catechu. Dose, from one to three fluid ounces, three or four times a day. . Compound Infusion of Gentian. — Take of bruised gentian, half an ounce ; dried orange peel and coriander seeds, bruised, each a dram ; diluted alcohol, four fluid ounces ; cold water, twelve fluid ounces. First, pour on the diluted alcohol, then, three hours afterward, the water. Let the whole stand twelve hours, and strain. An excellent form for using gentian. Dose, one fluid ounce, three or four times u day. Compound Inftision of Geranium.- — Take of geranium root, sweet bugle loaves, golden seal root, witch-hazel bark, each, in coarse powder, one ounce ; boiling water, four pints. Mix, and allow all to stand in a covered vessel, two hours, applying a gentle heat ; then strain. Two drams of alum may or may not be added. Used in chronic diarrhoea and dysentery, in one or two tablespoon- ful doses, every two or three hours ; also as an injection in gleet, whites, falling of the bowel, etc. ; and as a gargle in ulcerations of the mouth and throat. Componnd Inftision of Parsley. — Take of parsley roots and seeds, and subcarbonate of iron, each, two ounces ; horseradish root, one ounce ; squill, juniper berries, white mustard seed, mandrake root, and queen of the meadow root, each, half an ounce ; coarsely bruise these articles, and place them in boiling cider, and exjiose them, for twenty-four hours, to a very gentle heat, in a covered earthen vessel. The cider should be sparkling and tart. Let the articles stand in the cider. Useful in dropsy. Dose, one or two fluid ounces, three or four times a dUy. Compound Inftision of Senna. — Take of senna and manna, each, one ounce ; jalap, cream of tartar, and caraway seeds, bruised, each, ^W|"P! two drums ; boiling water, one pint. Add all the ingredients to the water, in a covered vesHcl, and let them stand twelve hours. Then udd four ounces of elixir sulutis. This is a vahuible, and not disagreeable, gentle i)hysic for various j)uri)()ses. Dose, from one to four ounces. Compoond Inftasion of Trailing Arbutus. — Take of queen of the laoadow root, dwarf elder bark, marshniallow root, and trailing arbu- tus, each, coarsely bruised, half an ounce ; add to them, one {)int of boiling wat6r, and one i)int of Holland gin, and steep by the tire four hours, in a closely covered vessel. Strain, and sweeten with honey. Excellent for gravel, suppression of urine, scalding of urine, and various other disorders of the urinary organs. Dose, from an ounce to a wineglassful, with more or less frequency, according to the ur- gency of the case. Injeotions. — Clysters. These are preparations to be introduced into the lower bowel by means of a syringe. A sufficient number of them are given among the recipes at the end of the book. It is not necessary to repeat them here. Liniments. These are liquid preparations, generally a little thicker than water, and thinner than oils, intended only to be applied to inflamed, pain- ful, or swelled parts. They are designed to soothe, or quiet, or stim- ulate, or make red the part to which they are applied ; and are rubbed on with the hand, or a piece of flannel or cotton, and frequently in connection with heat, by sitting or standing before a fire. A large number of liniments are given under the head of recipes at the end of the book. To those, I add a fe v valuable ones here. Camphor Liniment. — Take six drp.ms of camphor, and dissolve it in one fluid ounce of chloroform, and add to this one fluid ounce of olive oil. For sprains, neuralgia, rheumatism, etc. Compound Camplior Liniment. — Take two ounc ^ nad a half of camphor, a fluid dram of oil of lavender, seventeen iiuid ounces of alcohol, and three fluid ounces of strong solution of ammonia. Dis- solve the camphor and the oil in the alcohol ; then add the ammonia, and shake till they are mixed. To be used as a rubefacient and anodyne for local pains, particu- larly rheumatism. Compound Liniment of Ammonia. — Take five fluid ounces of strong water of ammonia, two fluid ounces of tincture of camphor, and one fluid ounce of spirit of rosemary. Mix them well together. JfM l67.,„^: This is Hitnilar to Dr. Granville* a counter-irritant lotion; and is used ns II |)r(>ini)t nnd powerful rubefacient, or even vesicatory, in neural- gin, rheiimatiKni, gout, .spasms, and inflammations. Croton Oil Liniment. — Take one fluid ounce of croton oil, and seven fluid ounces of oil of turpentine. Mix, and shake them well together. A good rubefacient and pustulating preparation to apply to the chest and other parts. Liniment of Opium. — Take six ounces of castilc soap, an ounce and a half of opium, three ounces of camphor, six fluid drams of oil of rosemary, and two pints of alcohol. Macerate the soap and o|)iuiu in the spirit for three days ; then filter, and add the oil and cam|)hor, and shake briskly. This is a useful anodyne and rubefacient liniment for bruises, sprains and i)ains of a rheumatic and gouty nature. Liniment of Spanish Flies. — Take an ounce of powdered Spanish flies, and half a pint of oil of turpentine. Mix, and apply gentle heat to them, in a covered vessel, for three hours. Then strain. Employed with advantage, externally, in the sinking stage of ty- phoid fevers. If so powerful as to be in danger of causing blistering, it may be weakened by adding flax-seed or olive oil. Liniment of Turpentine. — Take half a pint of oil of 'nrpentine, and, a pound of resin cerate. Melt the cerate, and adi' oil to it, mixing them well. This is a valuable remedy for scalds and burns, and should be applied soon after the accident, and be discontinued when the inflam- mation excited by the fire is removed. The burned or scalded surface should be covered with lint wet with the liniment. Opodeldoc. — Take three ounces of white bar soap, sliced, an ounce of camphor, a fluid dram each of oil of rosemary and oil of origa- num, and a pint of alcohol. Digest the soap in the alcohol by means of a gentle heat, until it is dissolved ; then add the camphor and oils, and when they are dissolved, pour the whole into broad-mouthed vials. This is the camphorated soap liniment^ and is used as an anodyne application to sprains, bruises, and painful tumors, etc. Medicated Waters. Those preparations consisting of water impregnated with some medicinal substance are called medicated waters. They are prepared from volatile oils by triturating in a mortar a dram of the oil, more or less, with a small quantity of carbonate of magnesia, and then very gradually pouring on one quart of water, while the trituration is con- tinued. At last, the pre^iaration is filtered through paper. The quan- tity of oil, magnesia, and water, used for each preparation, is as fol- lows : MEDICINES AND THEIR PREPARATIONS. 673 Oil of bitter almonds, sixteen minims; carbonate of magnesia, a drani ; wuter, one quarts Oil of cinnamon, half a fluid dram ; carbonate of magnesia, a dram; water, one quart. Twenty minims of oil of roses, a dram of carbonate of magnesia, bnd one quart of water. Oil of fennel, half a fluid dram ; carbonate of magnesia, a dram; water, a quart. Peppermint Water, Spearmint Water, and Pennyroyal Water, are all prtipared from the same quantities of their several oils, as Cinna* moil Water. The dose of these waters is half a fluid ounce to two fluid ounces, except the bitter almond water, which is one or two fluid drams. Caiiiplior Water, — Take two drams of camphor, forty minims of alcohol, four drums of carbonate of magnesia, and one quart of water. Rub the camphor first with the alcohol, afterwards with the carbonate of magnesia, and lastly, with the water, gradually added. Then filter through paper. Medicated Wines. Wines are used in making certain preparations, because the alco- hol they contain will extract from plants, etc., some medicinal proper- ties which water will not, and at the same time is less stimulating thuii the tincture^*, etc., made from alcoholic spirits. C'oiiiponiid Wine of Coiiifrey {Restorative Wine Bitters). — Take one ounce, each, bruised, of comfrey, Solomon's seal, and spikenard; and half an ounce, each, bruised, of chamomile flowers, Colombo, and gentian. Cover these with boiling water, and let them stand twenty- four hours, in a covered vessel. Then add two quarts of sherry wine. Macerate fourteen days, express and strain. Valuable in leucorrhoea and other female complaints. Dose, from half a fluid ounce to two fluid ounces, three or four times a day. Coinpound Wine of Golden Seal. — Take one dram, each, bruised, of golden seal root, tulip tree bark, and bitter root, half a dram of pulverized cayenne, and two quarts of sherry wine. Macerate for fourteen days, with occasional shaking ; then expre'^s and stmin. This is a pleasant bitter tonic in dyspepsia, etc. Dose, from half a fluid ounce to two fluid ounces, three times a day. , Wine of Ipecacuanha. — Take two ounces of bruised ipecac, and one quart of sherry wine. Macerate fourteen days, with occasional shaking. Then express and filter through paper. This is a valuable emetic preparation, — especially for children. Dose, as an emetic, for an adult, one fluid ounce ; as an expectorant, from ten to thirty minims ; for a child two years old, as an emetic, one fluid dram, repeated every fifteee minutes till it operates. 85 { I ftif mil. Mixtures These are prcjjarations in which medicinal substances which can» not be dissolved in water are suspended in it by means of some viscid matter, like sugar, or gum arabic. Their object is to conceal the taste, prevent the sickening effect, and make it more easy to take disagreea- ble medicines. To make a perfect mixture requires skill. Ge»>*»rally, tlie medicine to be suspended should be triturated in a mortar with the sugar, gum ; rabic, etc., before the water is added. kiiiioud Ml\tiir'e. — Take half an ounce of sweet almonds, half a chain of powdered gum arabic, two drams of sugar, and eight fluid ounces of water. Soak the almonds in the water, and having removed their external coat, beat them with the gum arabic and sugar in a mortar, till they are thoroughly mixed ; then rub tne mixture, gradu> ally adding the water, and lastly, strain. This is an agreeable, nutritive demulcent, in bronchial, dysenteric, and urinary affections. It must be used freely, the dose being from two to eight fluid ounces. Chalk Nixturet — Take half an ounce of prepard chalk, two drams each of refined sugar and powdered gum arabic, and four fluid ounces each of cinnamon-water and water. Rub them together till they are thoroughly mixed. This is much used in looseness of the bowels, accompanied with acidity, particularly among children. If an increase of its astringency be required, add laudanum, or kino, or catechu. Compo';apo- ration, if necessary, until, when added to the tincture first obtaint'd, it will make a gallon and a half, tWen mix the two solutions together. This is a useful preparation for diarrhoea, dysentery, cholera morbus, summer complaints of children, acidity of the stomach, heartburn, etc Dose, one fluid dram. Mettauer's Aperient. — Take one ounce and a half of pulverized aloes, four ounces of bicarbonate of soda, two fluid ounces of com- pound spirits of lavender, and two quarts of water. Place the whole in a jar, or jug, and let them stand fourteen days, shaking well once a day. Then pour off from the flregs. It improves by age. This preparation was made by Professor Mettauer, and was held in so high ec ceem by him, that when he sent it to the London Lancet, he requested that he might have the credit of compounding it Tc is one of the best known aperients for costiveness, — particulatly 'A'hen connected with bilious dyspepsia. For that class of bilious persons who overeat, and hav*^ acid stomachs, it has great value. In bilious cases, the nitro-muriatic acid, taken before meals (the aperient after meals) may be usefully associi'^^ed with it. In the constipation of hysteria and hypochondriariis, the fluid extract of valerian may be added to it. Dose, from two drams to two ounces. Saline Mixture ( White Liquid Physic). — Take half a pound of sulphate of soda, and one and a half pints of water. Mix, and dis- solve the soda ; then add two fluid ounces of nitro-muriatic acid, and one dram and eight grains of powdered alum. Used to allay nausea and vomiting, and as a cooling purgative; also for colic, diseases of the liver, diarrhoea, dysentery, intermittent fevers, etc. This is one of the remedies of the Eclectic school of physicians, and is held by them in high esteem. Dose, a tablespoonful in a gill of water, to be repeated eveiy hour or two, until it causes one or two •vacuations from the bowels. Ointments. Ointments are composed of fatty substances, about the consistence 01 butter, impregnated with medicine. All gritty matter should be excluded from them. To prevent the rancidity to which they are liable, a little glycerin is now frequently added. Ointment of Acetate of Lead. — Take two ounces of white wax, and four ounces of lard ; melt them together, and add two and a half irams of finely powdered acetate of lead; stir constantly till cold. Thtd is useftil for burns scalds, ulcers, and excoriations. ii 't ^. V 676 MEDICINES AND THEIR PREPARATIONS. Ointment of Bayberry. — Take half a pound each of tallow, white turpentine, and bayberry, and four ounces of olive oil ; melt together and strain. Good for scrofulous and indolent ulcers. Ointment of Belladonna. — Take a dram of extract of belladonna- and 'an ounce of lard ; mix them. A useful anodyne application for painful tumors, neuralgia, etc. Ointment of Creosote. — Take half a fluid dram of creosote, and an ounce of lard ; mix them. A useful application for syphilitic, scrofulous, and cancerous ulcers. Compound Ointment of Galls. — Take six drams of finely powdered galls, six ounces of lard, and a dram and a half of pu.'verized opium; rub them together. A valuable preparation in irritable piles. Ointment of Red Iodide of Herciiry. — Take one dran of red iodide of mercury, and seven drams of ointment of white wix: incorporate them thoroughly together by trituration in a mortar. Used as a dressing for indolent scrofulous ulcers. Ointment of Nitrate of Mercury. — Take one ounce of mercury, eleven fluid ounces of nitric acid, nine fluid ounces of fresh neats-foot oil, three ounces of lard. Dissolve the mercury in the acid, then heat the oil and lard together in an earthen vessel to 200° F. ; then add the mercurial solution, and stir with a wooden spatula, constantly, as long as efliervesccnce continues, and afterward occasionally till the ointment stiffens. milder Ointment of Nitrate of Mercury. — Take an ounce of oint- ment of nitrate of mercury, and seven ounces of lard ; rub them to- gether. The first of the above two preparations is the citrine ointment, and is much and advantageously employed as an external application in porrigo, impetigo, psoriasis, and pityriasis. It is nearly a specific for mflammation of the eyelids connected with the formation of scaly matter about the lashes. The second of these two preparations is merely a dilution of the first. Ointment of Oxide of Zinc. — Take half an ounce of oxide of zinc, and three ounces of lard ; rub them together. This is a mild astringent application in chronic opthalmia, erup- tions of the skin, sore nipples, and other excoriations. Ointment of Poison Hemlock. — Take one dram of extract of poison hemlock (Tilden & Co.'s preparation), and one ounce of lard; rub them together. An anodyne application for painful swellings, ulcers, and piles. Ointment of Poke. — Take a dram of the extract of poke, and one ounce of lard ; mix them. For malignant ulcers, scald head, itch. etc. Ointment of Stinmoninm. — Take one dram of the extract of stra- monium leaves, and one ounce of lard ; rub the extract ^ith a little water till it is uniformly soft, and then with the lard. Used as an external application in irritable ulcers, painful piles, and skin eruptions. Simple Ointment — Take a pound of white wax, and four pounds of lard ; melt them together with a gentle heat, and stir constantly till cold. Ointment of Rose Water. — Take a fluid ounce of rose water, two fluid ounces of oil of almonds, half an ounce of bpermaceti, one dram of white wax ; melt together, by means of a w?ater-bath, the oil, sper- maceti, and wax ; then add the rose water, and stir the mixtuie con- stantly till cold. This is the well known preparation called cold cream, and is used with much ^^Hvantage for chapped lips and hands, excoriations, etc. Spermaceti Ointment — Take five ounces of spermaceti, fourteen of white wax, and a pint of olive oil ; melt them together over a slow fire, and stir constantly till cold. A mild dressing for blisters, wounds, and excoriated surfaces. Tiir Ointment — Take a pound each of tar and suet ; melt the Buet with a gentle heat, and add the tar to it ; then stir constantly till they are cold. A useful stimulating application to various scaly and scabby erup- tions, particularly leprosy and scald head. Ointment of Wliite llellel»ore. — Take on*- ounce of powdered white hellebore root, four ounces of lard, and twelve drops of oil of lemons; rub them thoroughly together. A useful ointment for the cure of Ointment of Wild Indi<^. — Take o.ie pound of powdered wild indigo root, moisten it thoroughly with al(oh> !, and let it starid twenty-four hours; then put it in a percolator, and add alcohol as long as the liquid which passes contains the taste oi tlu- root. Distil the alcohol from this filtered tincture until half a gallon of tinetur*- is obtained. Melt one pound of fresh butter, without salt, add me above tincture, and carefully evaporate the rest of the alroliol , stir constantly till cold, after the alcohol has nearly passed t)fl. This is one of the preparations of the Eclectics, and is a cleansing, detergent, antiseptic, and discutient ointment^ useful in scrofi 'ous, erysipelatous, and malignant ulcers, eruptions of the skin, etc. Pile Ointment. — Take three handfuls each of witch nu/ul bark, white oak bark, and sweet appletree bark ; bruise or grind them, and add to them three pints of water; boil down to one pint, and strain ; add to this liquid half a pound of lard, and simmer till the water all disappears, stirring continually both before and after removing from the fire till it cools. • This forms a brick-colored anodyne, astringent ointment, admira* bly adapted to the cure of pile tumors. ■'i'> m ') t ii: '.f . ). +i-- .0, _iJ' Compound Lead Ointment — Take two and a half pounds of olive oil, four ounces each of beeswax and unsalted butter, and half a pound of white turpentine ; melt them together, strain, and then heat to nearly the boiling point ; then gradually add one pound of red lead, stirring constantly till the mixture becomes black or brown; then remove from the fire, and when it is partly cool, add to it a mixture of twelve ounces of honey, and half a pound of powdered camphor. This is a very healing ointment, and is much used for ulcers, burns, wounds, and skin diseases. Compoiind Snlphur Ointment. — Take one ounce of sulphur, one dram each of ariunoiiidted mercury and benzoic acid, one fluid dram each of sulphuric acid and oil of bergarnot, two drams of nitrate of potassa, and half a pound of lard. First, melt the lard with a gentle heat, then add the other ingredients, stirring constantly till they are cold. A sovereign remedy for itch. Pills. Pills are small masses of medicinal substances, in globular shape, and of a size convenient for swallowing. Each pill generally weighs from three to five grains. Those medicines which cannot be dissolved in water, and are particularly unpleasant to the taste, are usually given in the form of pill. Sugar-toated, as now very extensively prepared by Tildcn & Co., from every important medicine, and in a great variety of ' ii I PHP Lili li t I 'i , ' I f 682 MEDICINES AND THEIR PREPARATIONS. Aromatic Powder. — Take two ounces each of cinnamon and gin- ger, and an ounce each of cardamom deprived of the capsules, and grated nutmeg. Rub them together int«) a very fine powder, and keep in well-stopped bottles. The powder is stimulant and carminative, and in cases of weak- ened digestion, may be given in ten to thirty-grain doses. Compound Powder of Aloes and Canella. — Take a pound of aloes, and three ounces of canella. Rub them separately to a fine powder, and mix them. This is the preparation known as hiera piera, or simply picra. It may be used for amenorrhoea, or generally as a bitter to correct co8< tiveness, and improve the appetite. Compound Powder of Catechu. — Take two ounces each of catechu and kino, and half an ounce each of cinnamon and nutmeg. Reduce all to a fine powder, mix, and pass them through a tine sieve. For chronic diarrhoea, dysentery, etc. Dose, from fifteen to thirty grains. Compound Powder of Chalk. — Take half a pound of prepared chalk, four ounces of cinnamon, three ounces each of tormentil and gum arable, and half an ounce of long pepper. Rub them separately into a very fine powder, and mix. This powder is warm, stimulant, astringent, and antacid, and is well fitted for diarrhoea, not connected with inflammation. Compound Powder of Chalk with Opium. — Take six ounces and a half of compound powder of chalk, and four scruples of powdered opium. Mix them. The opium in this preparation increases the efficacy of the com- pound powder of chalk in diarrhoea. Dose for an adult, ten to twenty grains, and repeated after each discharge. Compound Powder of (iolden Seal. — Take two drams each of powdered golden seal, blue cohosh, and helonias, and mix them. Useful in dyspepsia, and chronic inflammation of the mucous mem- brane of the stomach, etc. Dose, half a teaspoonful to a teaspoonful, three or four times a day. Compound Powder of Hydrastin. — Take half a dram each, in powder, of hydrastin, leptandrin, rhubarb, and myricin. Mix tho- roughly, and divide into thirty-two powders. This is tonic and laxative, and is useful in dyspepsia, jaundice^ chronic inflammation of the bowels, and during recovery from ex- hausting complaints. One powder may be taken often enough to produce one movement of the bowels a day. Inhaliuf Powder. — Take one dram of crystals of nitrate of silver, and two and a half drams of lycopodium. Work the lycopodium into a very stiff" paste, with a little warm water, in which the nitrate 18 dissolved. Spread this thin in a shallow dish, cover it so as to shut out the light, and set it where it wili dry; when thoroughly -dry, pul- verize. ==J ^~™^^^p^ >^l:!^ I have used this powder with great advantage in many caues of bronchitis, by directing three or four grains of it to be inhaldd once a day, in an instrument I had constructed for that purpose. This is the only really valuable catarrh snvff ever used. A pinch of it taken once a day (never oftener) for nasal catarrh, will often do excellent service. Compound Powder of Ipecacnniilia. — Take a dratn each of pow- dered ipecacuanha and opium, and one ounce of sulphate of potassa. Rub them together into a fine powder. This is the well known Dove/s powder. It is an admiral^Ie ano- dyne and diaphoretic, and is much used in inflammatory complaints, particularly rheumatism and pneumonia, complicated with low, ty- phoid symptoms. Dose, from five to fifteen grains. Compound Powder of Jaliip. — Take half an ounce of pulverized jalap and senna, one ounce bf pulverized bitartrate of potassa, half a dram of pulverized ginger, and ten grains of pulverized cayenne. Mix thoroughly. This is a valuable purgative medicine, and may be used in most cases where a simple cathartic is required. Dose, half a teaspoonful to a tablespoon fui. Com|Miund Powder of Kino. — Take fifteen drams of kino, half an ounce of cinnamon, and a dram of dried opium. Rub them sepa- rately to a very fine powder, and mix them. This is anodyne and astringent, and is useful in diarrhoea, etc. Compound Powder of Rhubarb. — Take four ounces of powdered rhubarb, one pound of magnesia, and two ounces of finely powdered ginger. Mix thoroughly, and preserve in well-stopped bottles. An excellent laxative and antacid, and well adapted to the bowel complaints of children. Compound Powder of Rhubarb and Potassa {Neutralizing Pawder). ~-Take half an ounce each of powdered rhubarb, bicarbonate of potassa, and peppermint leaves. Mix thoroughly. Valuable in diarrhoea, cholera morbus, dysentery, summer com* plaint of children, sour stomach, heartburn, etc. Worm Powder. — Take one ounce each of powdered white Indian hemp root {asclepias incamata), mandrake, pink root, and bitter root; two ounces of powdered balmony, and four scruples of powdered aloes. Mix thoroughly. A very good remedy for all kiads of worms. A teaspoonful of the powder may be mixed with a gill of molasses, and a teaspoonful of this given to a child every hour or two till it operates. After this, give a teaspoonful three times a day, for a few days. Syrnps. A 8TR0N0 solution of sugar and water is a simple syrup. When the water is first charg«d with some medicinal substance, and sugar ^l"v?*if 'Si.f! k 684 MEDICINES AND THEIR PREPARATIONS. IB added to this, we have a medicated syrup. Refined sugar should always be preferred, in preparing medicated syrups. Simple Syrup. — Take two and a half pounds of refined sugar, and a pint of water ; dissolve the sugar in the water by heat, remove any Bcum that may arise, and strain while hot. Syrnp of Almonds. — Take a pound of sweet almonds, four ounces of bitter almonds, three pint« of water, and six pounds of refined sugar. Blanch the almonds, then rub their, in a mortar to very fine paste, and add, during the trituration, three fluid ounces of the water, and one pound of the sugar. Mix the paste thoroughly with the remainder of the water. Strain with strong expression, add the re. mainder of the sugar to the strained liquor, and dissolve by a gentle heat. Strain through fine linen, and after it is cool, put it into bottles, thoroughly stopped, and keep in a cool place. This is demulcent, nutritive, and sedative, and is sometimes added to cough mixtures, etc. Synip of Citric Acid. — Take two drams of powdered citric acid, four minims of oil of lemons, and two pints of syrup. With one fluid ounce of the syrup, rub the citric acid and oil of lemons, then add the remainder of the syrup, and dissolve by a gentle heat. This is much employed as an agreeable and cooling addition to drinks, especially to carbonic acid water. Tartaric acid, being cheaper than citric acid, is often substituted for it, and the preparation thus made is much sold under the name of lemon syrup. SyiUp of Giirlic. — Take six ounces of fresh garlic, sliced and bruised, one pint of diluted acetic acid, and two pounds of refined sugar. Macerate the garlic in ten- fluid ounces of the diluted acetic acid, in a glass vessel, four days, and express the liquor. Then mix the rest with what remains of the acid, and again express, till suffi- cient has passed to make the whole when filtered measure a pint Then pour the filtered liquor on the sugar in a bottle, and shake till it is dissolved. Excellent in the bronchial affections of children. Dose, a teaspoon* fnl, for a child a year old. Symp of fiiin^er. — Add two fluid ounces of tincture of ginger to a quart of simple syrup; evaporate the alcohol by a gentle heat This is carminative and stimulant, and gives tone to the debilitated stomach, removing wind, etc. It is added to other medicines to im- prove their flavor. Compoand Syrup of Hypopliospliites. — Take 256 grains of hypo- phosphite of lime, 192 grains of hypophosphite of soda 128 grains of hypophosphite of potassa, 96 grains of recently precipitated hypo- phosphite of iron, 240 grains of hypophosphorous acid solution, 12 ounces of white sugar, half an ounce of extract of vanilla, and a sufficient quantity of water. Dissolve the salts of lime, soda, and potassa, in six ounces of water ; put the iron salt into a mortar, and gradually add solution of hypophosphorous acid till it is dissolved; les to im« MEDICINES AND THEIR PREPARATIONS. 68ft to thia add the solution of the other nalts, after it has been rendered ilightly acidulous with the same acid, and then water, till the whole measures nine fluid ounces. Dissolve this in sugar, with heat, and flavor with the vanilla. Without Havorins, this syrup is not unpleas- ant, being slightly valine, and not at all ferruginous. Any other flavoring may bo used, as orange peel, orange Howcr, or ginger. It is also suggested to physicians that glycerine may be used, wholly or partially, in place of sugar, when indicated, six ounces and a half of ^{lycerine being substituted for twelve ounces of sugar. This syrup has been much used of late as a new remedy for con- <(umption, on the authority of Dr. Churchill. It is elegantly manu- factured by Dr. James R. Nichols & Co., of this city. Dose, a tea- Bpoonful, three times a day before meals. Syrup of Ipecacuanha. — Take one ounce of ipecacuanha, in coarse powder, one pint of diluted alcohol, two pounds and a half of sugar, and one pint of water. Macerate the ipecacuanha in the alcohol fourteen days, and filter; evaporate the filtered liquor to six fluid ounces, filter again, and add water to make the liquor measure a pint ; then add the sugar, and proceed as directed for syrup. This is chiefly used in complaints of children. Dose, as an emetic, for an adult, two fluid ounces ; for a child a year or two old, one or two fluid drams. As an expectorant, for an adult, two fluid drams ; for a child, five to twonty minims. Syrup of Lemons. — Take a pint of strained lemon juice, two pounds and a half of refined sugar, and two and a half fluid ounces of rectified spirit; boil the juice ten minutes, and strain; then add the sugar, and dissolve. After the syrup has cooled, mix the spirit with it, A cooling and grateful addition to drinks in fevers, and serves to cover the taste of salts and other purgatives. Aromatic Syrup of Rhubarb. — Take two ounces and a half of bruised rhubarb, half an ounce each of bruised cloves and cinnamon, two drams of bruised nutmeg, two pints of diluted alcohol, and six pints of syrup. Macerate the rhubarb and aromatics in the alcohol for fourteen days, and strain ; then, by a gentle heat, evaporate the liquor to a pint, and, while hot, mix it with the syrup previously heated. This is a warm cordial laxative, admirably fitted for the bowel complaints of infants. Dose, a fluid dram, repeated every two hours till it operates. Syrnp of Seneka. — Take four ounces of fluid extract of seneka, and one pint of wat.er ; mix, and dissolve in the liquid one pound of refined sugar, and proceed as directed for syrup. This is a stimulating expectorant, used in colds, coughs, etc., after inflammatory symptoms have subsided. Dose, for an adult, one or two teaspoonfuls, as often as necessary. Syrup of Squill. — To one pint of vinegar of squiU, add two pounds of refined sugar, and proceed as directed for syrup. 6H6 MEDICINES AND THEIR PREPARATIONS. It is a useful expectorant for coughs and bronchial affectiund of infants and children. Dose, half a dram to a drain. Syrup of Tolu. — Take two fluid ounces of tincture of tolu, and one pint of simple syrup; mix, and gently heat the mixture to evapo- rate the alcohol. This is chiefly used to flavor other preparations. Syrup of Wlld-Clierry Bark. — Place two pounds and a half of coarsely powdered wild-cherry bark in a percolator, and pass through it one gallon of water. Strain this, and dissolve in it by heat sixteen pounds of refined sugar. This makes an elegant tonic and sedative preparation, and is mixed vath various other articles in prescribing for dyspepsia, consumption, etc. t'Omiiound Syrup of Partridge Berry. — Take half a pound of par- tridge-berry, and two ounces each of helonias, blue cohosh, and hi^h cranberry bark ; add to them one quart of brandy, antl macerate luur days. Press out the brandy ; and place the herbs in three quarts of boiling water, and boil down to .two and a half pints. Strain, add one pound of sugar, and evaporate to two and a half pints. Remove from the fire, and when nearly cold, add the brandy previously pressed out. This is considerably used by the Eclectic physicians, under the name of motlier^s cordial; and may be usefully employed by all pliy- sicians in suppression of the menses, painful menstruation, profuse menstruation, and habitual abortions. Dose from one to two ounct"!. two or three times a day. Compound Syrup of Phosphates (Chemical Food). — Take ten drama of protosulphate of iron, twelve drams of phosphate of soda, twelve drams of phosphate of lime, twenty drams of phosphoric acid (glacial). two scruples of carbonate of soda, one dram of carbonate of potustsa, sufficient quantity of muriatic acid, sufficient quantity of water of ammonia, two drams of powdered cochineal, sufficient water to make twenty fluid ounces, three pounds of sugar, and fifteen drops of oil of orange. Dissolve the sulphate of iron in two fluid ounces of boil- ing water, and the phosphate of soda in four fluid ounces of boiling water. Mix the solutions, and wash the precipitated phosphate ol iron till the washings are tasteless. Dissolve the phosphate of lime in four fluid ounces of boiling water, with sufficient muriatic acid to make a clear solution, precipitate it with water of ammonia, and wash the precipitate. To the freshly precipitated phosphates, as thus prepared, add the phosphoric acid, previously dissolved in the water. When clear, add the carbonates of soda and potassa, and afterwards sufficient muriatic acid to dissolve the precipitate. Now add the cochineal mixed with the sugar, apply heat, and when the syrup is formed, strain and flavor it This is an elegant syrup, agreeable both to the eye and taste, and has been extensively sold and used as a nutritive tonic, in chronic de- bility, in cases of broken down constitution, wasting of the flesh, etc. o ounce''. Compoond-Syrnp of Rhubarb and Potassa {Neutralizinfi^ Cordial). — Take half a pouivl e&uh of powdered rhubarb and bicurbonatc po- tassa, and four ounocs each of cinnamon and golden Heal ; niueerute for four days in one gallon of best fourth proof brandy. Express ihe tincture with utrong pre»«surc, and add to it two fluid drains of oil of peppermint, previously dissolved in a little alcohol. Break up the cake from the press, place it in a percolator, and gradually puss through it warm water till the strength id 'Exhausted. Evaporate this tiolution to four quarts, and w)iile the liquor is still hot, dissolve in it 8ix pounds of refined sugar. Continue the evaporation, if necessary, till the addition of the tincture first obtained will make three gallons. Then add the tincture. A valuable antacid and laxative in diarrhoea, dysentery, cholera morbus, and summer complaint of children. Dose, for an adult, a tablespoon ful, to be taken as circumstances require. Compound Syrup of Sarsaparilla. — Take a pound each of sarsa- parilla, yellow parilla, and pipsissewa ; an ounce and a half of guaia- cum ; one ounce each of red roses, senna, and liquorice root ; and three minims each of oil of sassafras, anise, and partridge-berry ; di- luted alcohol, five pints, and four pounds of refined sugar. Grind and mix the sarsaparilla, yellow parilla, pipsissewa, guaiacum, roses, senna, and liquorice, and add to them the alcohol. Let the whole stand fourteen days ; then express and filter. Evaporate by a water bath to one quart, and add the sugar. Lastly, rub the oils in a mor- tar with a little of the syrup, and thoroughly mix with the remainder. This is a valuable alterative syrup, and is used for syphilis, scrofula, diseases of the skin, etc. It is much improved by adding half an ounce of the iodide of potassium to each pint of the syrup. Dose, a tablespoonfuL Compound Aromatic Syrup of Senna. — Take four ounces of senna, one ounce and a half of jalap root, half an ounce of rhubarb, one dram of cinnamon, one dram of cloves, and half a dram of nutmeg^ Reduce these articles to a coarse powder ; add one quart of diluted alcohol. Let the whole stand two days, and percolate. Filter, dis- solve in it one pound of refined sugar, and add one dram of oil of lemons. An excellent cordial physic. Compound Syrup of Stillinfia. — Take a pound each of queen's root and turkey corn ; half a pound each of^ pipsissewa leaves and tlder flowers ; and four ounces each of prickly ash berries and carda- mom seeds. Grind all the articles, mix, and place them in a jar, and moisten them well with alcohol. Let them stand two days ; then place them in a percolator, and gradually add hot water till two pints are obtained, which must be strained and set aside. Then continue the percolation so long as there is a sensible taste of the spirit Re- serve this also. Then continue the percolation till what is obtained is almost tasteless. Boil down this last till the addition of the two reserved tinctures will make two gallons of the whole. Now add twelve pounds of refined sugar, and make a syrup. i m I :'^ji 688 MEDICINES AND THEIR PF,EI»A RATIONS. This ia one of the Eclectic medicines ; and is quite an effective alterative for syphilis, scrofula, etc. Improved by adding iodide of potassium. Dose, from a teaspoonful to a tablespoonful. Comi^ound Syrap of Yellow Dock. — Take two pounds of yellow dock root, one pound of the bark of the root of false bittersweet, and half a pound each of American ivy and figwort Make a syrup ac* cording to the directions for compound syrup of stiilingia, using six- teen pounds of sugar, and making two gallons of syrup. A valuable preparation for scrofula. Improved by iodide of pota.n- nium. Dose, a tablespoonful, three or four times a day. Tinctures. Foa a description of the method of making tinctures, see page 588, I will siiiiply add here, that an ethereal tincture is one which is made with tther as the solvent instead of alcohol, and an ammoniated tinc- ture, cne made with water of ammonia as the solvent. Simple tinctures, in which only one medicinal article is used, are made thus : Tincture of Aconite. — Take eight ounces of powdered aconite root, and one pint of alcohol. Mix, and let them stand for two weeks, fre- quently stirring. Then express, and filter through paper. Given in fevers and inflammatory diseases. Dose, three drops every hour or two in a little water. In the above maimer all simple tinctures are made. Some mwii- cines recjuire alcohol to extract their active principle ; some only diluted alcohol. One Ounce to the Pint of Alcohol In preparing simple tincturest from the following articles, alcohol ia used, and one ounce only of the mediciup is employed to the pint, namely: Castor, SaftVon, Lcptandria. One Ounce to the Pint of Dilated Alcohol. — In making tinctures from the following articles, one oun»^ is used to the pint of dilated alcohol : Iodine, Quassia. . Two Ounces to a Pint of Alcohol : Asisafietida, Camphor, Oil of Peppermint, Oil of Spearmint, Ben- zoin, Colchicum seeds, Lupulin. Tivo Ounces to a Pint of Diluted '/icohol : Cardamom, Cotton Bark, Cochineal, Colombo, Coichicum, Ergot. GaIIh, Hemlock, Cubebs*, Foxglove, Black Hellebc ./e, Henbane, Laciu- earium, Ijobelia, Pok«\ Shrubby Trefoil, Bloodroot, Squill, Valerian, Bitter:nvor,t, Belladonna. Three Onnces to a Pint of VAlateA Alcohol : Peruvian Bark, Rhatany, Poison Hemlock, Sheep Laurel, Stramo- nium, White Hellebore, Yarrow, Prickly Elder, Jalap. Fonr Ounces to a Pint of Alcohol : Nux Vomica, Ginger, Guaiacum, Black Cohosh Four Ounces to a Pint of Diluted Alcoliol : Yellow Jessamine, Prickly^ash Berries, Ergot, Matico. The following tinctures embrace those which vary from the above proportions among the simple tinctures, and also the compound tino> tures : Tincture of Oranjpe feel. — Take three and a half ounces of dried orange \)rie\^ and one quart of diluted alcohol. Macerate for seven days, express and filter. Tincture of Bucliu. — Take five ounces of buchu, and one quart of diluted alcohol. Digest seven days ; pour off the clear liquor, and ulter. Tincture of Indian Hemp. — Take of extract of Indian Hemp (Cannabis Indica) one ounce, and one pint of alcohol. Dissolve th^ extract in the spirit Dose, from twenty to forty drops. Tincture of Cantharides. — Take ai ounce of bruised Spanish flies, and two pints of diluted alcohol. Macerate for fourteen days, express arut filter through paper. Dose, from twenty drops to a dram, three or four times a day. Tincture of €t)ycunc Pepper. — Take an ounce of pulverized cay- enne, and two pijits of diluted alcohol. Macerate fourteen days, and filter throngh paper. TInctKfC of Cdteciiu. — Take an ounce and a half of catechu, an ounce of bruised cinnamon, and one pint of diluted alcohol. Let them stand together two weeks, frequently shaking; then express and filter. Dose, from thirty drops to a tablespooisful. Tincture of Cinnamon. — Take an ounce and a half of powdered cinnamon, and one pint of diluted alcohol. Let them stand together for two weeks ; express and filter. Dose, from one to four teaspoonfuls in sweetened water. F'iiir Vitriol. — Take half a pint of alcohol ; drop into it seven fluid drams of sulphuric acid, and let the mixture stand three days ui a close vessel; then add two drams *:.' powdered ginger, and three drams of pcwdered cinnatnon. Macerate seven days, and filter. Useful in diarrlitEU, dysentery, etc. Dose, from five to twenty drops, To avoid injury to the teeth- it should be taken through a quill, or else the mouth should be rinsed immediately after swallowing it Tincture of Loltclia. — Take four ounces of lobelia, and one pint each of distilled vinegar and alcohol. Macerate two weeks, express and fdter. Dose, as a nauseant or expectorant, from thirty to sixty drops. Tincture of Opium {Laudanum). — Take two and a half ounces of 87 II 'V.Vr'i^ » ■ I ill II Pi ': 69U MEDICINES AND THEIR PREPARATIONS. opium, and two pints of diluted alcohol. Macerate fourteen days, express, and filt^-r through paper. Dose, from ten to twenty-five drops. Tincture of Tolu. — Dissolve one ounce of Balsam of tolu in one pint of alcohol, and tilter. Tincture of Rliuhiirb. — Take three ounces of bruised rhubarb, half an ounce of bruised cardamom, and a quart of diluted alcohol. Mac- erate two weeks, exj>ress, and filter through paper. Tincture of Tii^inia Sniilie Root. — Take three ounces of bruised Virginia snake root, and one quart of diluted alcohol. Macerate two weeks, express, and filter through paper. This is advantageously added to the infusion of Peruvian bark, in low states of the system. Dose, one to two fluid drams. Compound Tincture of Aloes. — Take three ounces of powdered aloes, one ounce of safl'ron, and two pints of tincture of myrrh. Mac- erate fourteen days, and filter. This is the well known elixir proprietatis, or, more commonly, elixtr pro. It is considerably used in female disorders, connected with sup- pressed, retained, or deficient menstruation. Dose, one to two fluid drams. Compouiul Tincture of AssafcBtlda. — Take half an ounce each of lupulin, assafoetida, in small pieces, bruised stramonium seeds, pow- dered valerian root, and one pint and a half of alcohol ; macerate two weeks, shaking frequently, then express and filter. This is anodyne and antispasmodic, and is used in epilepsy, St Vitus's dance, and hysterics. Do.se, a teaspoonful. Compound Tincture of Benzoin. — Take three ounces of benzoin, two ounces of purified storax, one ounce of balsam of tolu, half an ounce of powdered aloes, and two pints of alcohol. Macerate two weeks, and filter. This is used in chronic diseases of the air passages. Dose, from thirty to sixty drops. Compound Tincture of Cardamom. — Take «ix drams of bruised cardamom, two ounces of bruised caraway, five dratns of bruised cinnamon, five ounces of seeded raisins, one dram of bruised cochi- neal, and two pints and a half of diluted alcohol. Macerate two weeks, and filter. This is a very agreeable aromatic ; used as a carminative, and to improve other preparations. Dose, one or two fluid drams. Compound Tincture of Catechu. — Take three ounces of catechu, two ounces of bruised cinnamon, and two pints of diluted alcohol Macerate fourtc^en days, express and filter. This is frequently added to chalk preparations for diarrhoea, etc. Dose, from one to three fluid drams. Compound Tincture of Cinnamon. — Take one ounce of bruised cin- namon, half an ounce of bruised cardamom seeds, three drams of I in one bruised ginger, and two pints of proof spirits. Macerate fourteen days, express, and filter. This is a warm, aromatic tincture, useful in spasms, and debility of the stomach. Dose, one to two fluid drams. Conipoiiiid Tincture of Black €olio.sli. — Take one fluid ounce of tincture of black cohosh, half a Huid ounce of tincture of bloodruot, and two fluid drams of tincture of poke root. Mix. This is used in diseases of the lungs, liver, and stomach. Dose, from twenty to sixty dro|)s, three or lour times a day. Compound Tincture of Blue Cohosh. — Take one ounce of powdered blue cohosh root, half an ounce each of bruised water pepper and ergot, two fluid drams of oil of savin, and twelve fluid ounces of alcohol ; mix, macerate for a fortnight, and filter. A uterine tonic, used for suppressed and painful menstruation, etc. Dose, a teaspoon ful, two or three times a day. Compound Tinctiu'e of Colchlcuni. — Mix one fluid ounce each of tincture of black cohosh and tincture of colchicum seed. Used for inflammatory rheumatism and gout Dose, ten to sixty drops. Compound Tincture of Gentian. — Take two ounces of bruised gentian, one ounce of cange peel, half an ounce of bruised carda- mom seeds, and two pints of diluted alcohol. Macerate fourteen days, express, and filter. An elegant bitter, much used in dyspepsia, and as an addition to tonic mixtures for a weakened state of the stomach. Dose, one or two fluid drams. Compound Tincture of Golden Seal. — Take one ounce each of powdered lobelia seed and golden seal, and one pint of diluted alco- hol. Macerate two weeks, express, and filter. This is used as a local application to diseased mucous membranes, in leucorrhoea, gleet, etc. Ammoniated Tincture of Gnaiac. — Take four ounces of powdered guaiac, and a pint and a half of aromatic spirits of ammonia. Mac- erate for two weeks, and filter. This tincture has considerable reputation in the treatment of chronic rheumatism. Dose, one or two fluid drams. Compound Tincture of Hemlock ( Golden Tincture). — Take one ounce each of powdered balsam of tolu, guaiacum, gum hemlock, and gum myrrh, one ounce and a half of oil of hemlock, one ounce of oil of winter green, and four pints of alcohol. Mix, let them stand fourteen days, shaking frequently, then filter. This is used by the Eclectics for rheumatism, wind colic, water brash, soreness of the chest, etc. Dose, a teaspoonful in a wineglass- fu) of water. Compound Tincture of Hii^h Cranberry. — Take one ounce of high cranberry bark, powdered, half an ounce each of powdered lob«?fia Becd and bruised skunk cabbage seed, two drams each of bruisod f ^ifr*-40^ * 692 BiEDICINES AND THEIR PREPARATIONS. \ -. * s itramonium seed, powdered bloodroot, and capsicum, and two pints of alcohol. Macerate two weeks, express, and filter. This is an Eclectic remedy, and is useful in nervous and spasmodic complaints, particularly hysterics, etc. Dose, from twenty drops to a teaspoonful. Compound Tincture of Lavender. — Take , three fluid drams of oil of lavender, one dram and a half of oil of anise, one ounce of pow- dered cloves, three drams of mace, one ounce of raisins, two ounces of red Saunders, and one gallon of Jamaica rum. Mix, and macerate fourteen days ; then express and filter. This is often used for flatulence, hysterics, and faintness. Dose, from one to three teaspoonfuls, in water. Compound Tincture of Lobelia (Dr. J. King's Expectorant Tincture). — Take one ounce each of coarsely powdered lobelia, bloodroot, skunk cabbage, wild ginger, and pleurisy root. Place them in a vessel, and pour over them one pint of boiling water or vinegar, and cover tightly. When cold, add three pints of alcohol. Macerate two weeks, then express and filter. A valuable emetic for infants and children, in croup, hooping-cough, bronchitis, and convulsions. Used also as an expectorant, in coughs, pleurisy, etc. Dose, as an emetic for a child, half a teaspoonful and upwards. Com^t>jund Tincture of Lobelia and Capsicum. — Take one ounce each of powdered lobelia, capsicum, and skunk cabbage, and one pint of diluted alcohol. Mix, macerate fourteen days, and filter. A prompt antispasmodic in cramps, spasms, lock-jaw, etc. Dose, half a dram to a dram. Compound Tincture of Myrrh {Hot Drops). — Take four ounces of bruised myrrh, two ounces of capsicum, and four pint.* of alcohol Mix, macerate a fortnight, and filter. Applied externally, and occasionally given internally for distress oi stomach, flatulence, etc. Camphorated Tincture of Opium. — Take one dram each of pow dered opium and benzoic acid, one fluid dram of oil of anise, tw» ounces of clarified honey, two scruples of camphor, and two pints of diluted alcohol. Macerate fourteen days, and filter. This is known to all the world as paregoric elixir. It is an agree* able anodyne and antispasmodic, and a good deal used among chil- dren to allay cough, and to relieve pains, diarrhoea, etc. Compound Tincture of Peruvian Bark. — Take two ou.nces of red bark, powdered, one ounce and a half of bruised oiange peel, three drams of bruised Virginia snake-root, one drain each of saffron, cut, and red saunders, rasped, and twenty fluid ounces of diluted alcohol. Macerate two weeks, express, and filter. This is Huxhani's tincture. It is an excellent stomach cordia', and is used with advantage in low forms of fever, etc. Dose, from oue to four fluid drams. ;wo pints Rasmodic ops to a ma of oil B of povr- ro ounce* i macerate 9S. Dose, Tincture). oot, skunk vessel, and vrer tightly, recks, then )ing-cough, in coughs, oonful and one ounce id one pint r. etc. Dose, r ounces which a specific action upon the diphtheritic mucous membrane is attributed, either disin- fectant or parasiticidtil. The parusiticidal action is based upon the undemonstrated parasitic nature of the disease ; the disinfectant action is, in most instances, chiefly a deodorizing one, though a cleansing one also, which is of the greatest importance for the com- foit of the patient and for the greater safety of his attendants. These substances are employed in the dry or liquid form, by insuf- flation or by inhalation, — in the latter instance several times a day. The remedy to be especially commended is common sublimed sul- phur, to be used every four to six hours, by being blowiji through a long quill upon the affected parts, and allowed to remain for at least a half-hour, without being disturbed by food, drink, or gargles. This use of sulphur has many warm advocates ; it is harmless, and cannot interfere with the action of most other remedies likely to be employed. Gargles are often used with great advantage. The following is excellent: Chlorinated soda, one ounce; muriatic tincture of iron, half an ounce; water, six ounces; use every half hour or hour. The following is also a good gargle: Chlorate of potash, half an ounce; strong hydrochloric acid, eighty drops ; water, one pint. One prac- titioner speaks of obtaining great success by the use of the tincture of black cohosh, mixed with an equal quantity of water, and cm- ployed, every few minutes, in two teaspoonful doses, as a gargle. Its use should begin at a very early stage of the disease. The internal tredtment should consist mainly of antiseptics and tonics. The muriatic tincture of iron is highly praised in this disease, as well for internal use as for external Prescription 73 is a suitable 88 • (1 If! I S ' If { 11 11 ■ 698 DIPHTHERIA. form in which to take it. If ro8e-watcr is not at hand, soft water may be sabstitutcd. If there hv offensive breath, and a tendency to rotting of the tonsils, a little chlorinated soda, or chlorate of potu»|), may be added to the above : one or the other of these two last-nanitd articles may sometimes be taken alone. The following is a good recipe : Pulv. guaiacutn, two drams; pulv. gum arabic, one-half drum ; pulv. white sugar, one dram; water, six ounces: mix, and then add chlorate of potash onit-half dram. Let two great spoonfuls of thm be taken once in two hours. The same do}*e may be taken, with similar frequency, of the following: Chlorate of potash, one dram; diluted hydrochloric acid, two drams; muriatic tincture of iron, three drams; water, twelve ounces; mix. This mixture may al.'io be used as a gargle. Should there be great depression and sinking, — as there often is, — carbonate of ammotiia may be taken, or muriate of am- monia (13-1), or aromatic spirit of ammonia, presfri[)tion 135, leaving out the laudanum. Brandy and wines are often used with advan- tage. In cases of great depression, if" there be a lendenoy to the formation of purple spots upon the flesh, add ten to fifteen drops of hydrochloric acid to each dose of prescription 73. The following pre- scription is likewise a useful one : Quinine, diluted hydrochloric acid, and muriated tincture of iron, each two <1 ams; cinnamon water, twelve ounces; mix. Dose, two great spo ifuls three times a day Or the following: Muriated tincture of ■. on, one ounce; diluted hydrochloric acid, two drams ; cinnamon water, twelve ounces. Mix, and takp two table-spoonfuls every four hours. The diet should generally consist of that which is nourishing and easily digested, — as beef-tea, chicken-broth, eggs, with wine, new milk, arrowroot, cream, etc. As recovery advances, beefsteak, lamb, chicken, etc., may be taken. Many patients die of pure debility. Let the diet, therefore, be such as to guard against such a termination of the complaint. Let all drinks be given warm, as cold drinks tend to aggravate the complaint.. When recovery begins to take place, use all possible precautions against a relapse. Let exercise taken at this time be gentle, and not pushed to the extent of great fatigue. The blood is gen«'rally reduced so low, that sudden death may result from overdoing. Especially, let all cases of this complaint receive early attention. Throat ails, generally, while diphtheria is abroad, should have prompt and careful treatment, and if possible, be removed, for their preseuca invites an attacL '^"i|«ii.|!l m OLD AGE, AND ITS DISEASES. LtFF., like the natural day, has its morning, its noon, and its even* ing. Each period has its sunshine and its clouds ; its light and its darkness; its fuir weather and its storms; its joys and its sorrows. The old do not feel the exhilarating brightnet»s of the morning of life, nor the fervid strength of its noon ; but they often experience what is better: a calm, quiet stillness, and peaceful repose, in its evetting. There is, perhaps, no one thing — certaii. iiot many things — which impress the reflective mind and tender heart with more sad- ness, tlian to see an old man, bending low with years, with little or no self-restraint; the passions all untamed, except so far as age has quenched their tires; fretful, peevish, jealous, complaining ; distrustful of the ways of Providence ; doubting the integrity of any human being; surrounded by clouds and darkness ; and stepping down grad- ually and reluctantly! amid a cold, drizly, sleety, t loral rain, into a dark, nncheered, and unillumined grave. On the other hand, how unspeakably pleasant it is to see the silver- haired pilgrim, in the evening time of life, cheerful, happy*, trnsttul in God and hopeful of men ; the winds and storms of life bringing little or no disturbance of his peace ; bareing the head reverently and bow- ing it meekly in the presence of great afflictions, and lifting it up rejoicingly when blessings fall upon it ; converting, by the soft, sub- dued, and beautiful sunshine which he spreads around him, the very nnpromising elements of the latest autumn into the finest Indian summer of life ; and finally sinking down peacefully to his rest amid the golden evening sunlight, and leaving the sky, long after, tinted with colorings more beautiful than artists ever conceived. " Why weep ye, then, for him who, having won 1 he hound of man's appointed yenrs, at last, — Life'8 hlessings all enjoyed, life's labors done, — Serenely to his final rest has passed : While the soft memory of his virtues yet Lingers, like twilight hues when the bright san ii setl " Beside these general reflections, it is proper in this chapter to con- template the old from several points of view. They are Experienced Persons, and we may learn much from them. To be sure, they have, in most cases, lost the acuteness of their ..1 M R I \i , ' . M. [?m 'S;; 'f ^!;'^^ !*■.:'/'; i-iSfeS^-; i-^:- f i ' (7 ■■>!■ 11 15^ senses. They do not hear, or see, or taste as sharply as the young, or even always think as quickly ; yet their Judgments are foundpd on a large experience ; their decisions, though not as prompt, or emphatic, or brilliant as those of younger persons, are more safe and reliable. They are worthy, therefore, of our respectful confidence. We may seek their council and advice, and in most cases follow it with safety. True, they are apt to be conservative, and to distrust new things and ideas ; but these new things and ideas are matters in which they Imve had no experience — matters which belong to an age subi^eqnciit to their time — matters, therefore, which lie outside the sweep of their active life, and respecting which they should not be expected to jiidm'. It is no diHparageinent to them to say that they are not fitted to judge of those new thoughts and discoveries which have swarmed upon the world since the sun of their life has been sinking low in the wi'stcrii sky. But in all those staple maxims and ideas which underlie human duties, in all ages, the old may safely be taken as our counsellors. Depositories of Family History. — They are the frail depositories and keepers of a vast deal of valuable family history, anecdote, and reminiscences of events fast fading from human recollection. Few errors of my own early life have been so much regretted by me as the neglect to learn from my aged relatives, when I liad the opportunity, some of the more important points in the history of my family. My grandfather, Col. Gideon "Warren, — a first cousin of Gen. Joseph Warren, and a personal friend of Ethan Allen, — lived in some of the towns of southern Vermont, and finally spent his last days, and died, in Hampton, N. Y. There stands his tombstone to this day, with the following beautiful words from Young's Night Thoughts engraved upon it: " An angel's arm can't snatch me from the f^ve ; Legions of angels can't contine me there. " < These few facts are about the substance of what I know of his his- tory. In what town his father settled, who was one of three brothers who immigrated to this country, or who were his brothers and sistfrs, or what became of them, I have not been informed, simply becau.te I did not obtain the information, now so much desired by me, as 1 might easily have done, between thirty and forty years ago, while spending a year in Hampton fitting for college. An uncle of mini', Caleb Warren, was then living in Hampton, an old man. He had learned from my grandfather the full histxiry of the family ; and from him I might have derived knowledge which I should now value above price — knowledge which 1 intend yet to acquire, if the pressure of professional business shall ever be so lifted from me that I can com- mand time for the investigation. But I shall never cease to remember the fact, or to lament my misimprovement of it, that from this vener- able relative I might have learned facts and put them on record in one hour, which it will cost roe weeks and months of correspondence, travel, and the searching of records to acquire. I say to all young persons, value very highly the knowledge of your family history, which joa may easily learn from your parents, grandparents, uncles and lants, et4^, and esteem those very highly who are able to impart it to you. Soon these living records will be suddenly blotted by the hand of death ; and then no regret for past negligence will enable you to repair your loss, if you have misimproved your opportunity. The Fathers of oor Race anil the Founders of our Institutions.— The aged people who yet linger among us are our fathers. We have our existence, through God, from them, and from others who have preceded them to the silent land. They educated the present race. All that is valuable in the moral principle and mental culture of the men and women of this generation, has been derived from them. Much of their lives was spent in training us, mentally and morally, and fitting us for usefulness. Not only the fine moral and intellectual characters which are found everywhere, acting like salt and leaven in human society, are the work of their hands, but society, and government itself, have been handed down to us by them, with much valuable instruction as to the means of their preservation. We can scarcely conceive the amount of obli- gation our fathers have laid upon us in giving us these vast blessing!*. The men who have been the means of bringing us into life ; who have educated and trained us ; who have preserved our governm«uit and passed it into our hands unbroken ; who have built and enlarged our colleges, established and improved our unequalled common schools ; hivi; founded and endowed our charitable institutions, and thus made our land famous throughout the world, are certainly worthy — those of them who are yet among us — of our constant regard and ven- eration. Loneliness of the An^ed. — The old are left, in some sense, alone in the world. The age in which they had their active being has gone by. The world has slid frotn under them ; and they stand far out, as it were, on a narrow neck of land between this world and the next, from which they hear strange sounds coming to them from the moving mass of beings of whom they are soon to take leave. Most of the companions with whom they started in the journey of life have, one by one, dropped away from their side, and the younger and stirring multitude who have come after them, are moved by new, and to them strange, thoughts and aspirations. The throng of younger men is driven forward by impulses which they never felt, and in paths which they never trod. Manners, speech, dress, modes of doing business — all have changed. The old-fashioned fire-place, the stage-coach, the spinning-wheel, the hand-loom, the polite yes sir, and no madam, the boy's bow and the girl's courtesy to strangers in the street, — these all — some of them useful and some of no further value — have dis- appeared, never more to be enjoyed by those who so much prized them in their day. What wonder if at times a sense of loneliness and desolation «hould steal into the minds of the aged ? It is not without cause m . i n 11' l.fr ( ■I i that they often yiold to melancholy rcHections. The young have their companions, and their sports. The companions of the old have mostly gone; an'scnf, they are thrown upon the pasi, and too often look gloomily \o the future. They should he sympathized with and encouraged. We «1:< nid sit l)y their side, and talk with them of the manners and events of ()th<*r days. Their conversation is often instructive i'.s well as amusing. Would we engage in it 'vith right feelings towards ilic old, it would be to us a sourc«! both of profit and pleasure. To ;i right-minded person, few things are more pleasurable than to sit by ijiteiligcnt aged persons, co/ily seated in a large armed-chair, luid listen to their tales of personal adventure and experience. 'I'licy enter upon such narratives with so much animation, and live over the past with such (evident satisfaction, that the benevolent peison would find pica.sure in engaging thern in that conversation for this reason altnje. llelpIfHS l»4'}H^iidt'iK'i> «f the Atred. — No one thing »houId tend more to excite our |»ity, compassion, and kindly feelings for old people, tiian their helplessness and dependence. It is one of the best indications of humanity to deal gently with the weak. The old are in their Hccond childhood. In their day, they have been strong and vigorous — laboring, many of them, in season and out of sc.ison, to support their families and gain a eotnpetence. They have felled the primitive forests, and brought the soil under the dominion of the plough and hoe; they have constructed turnpikes and built bridges; made .■iliip.H and sail«>d them over stormy seas , whitened every harbor with the emblems of commerce ; tilled every city with the beautiful creations of art, aiul the useful productions of mv!chanical handicraft; created syatems of education and philanthropy ; framed strong governments and worked them, — in a word, have carried the world upon tluir ahoulders, without bending or giving tokens of exhaustion. But a multitude of years have robbed th(!m of the strength which did all these thiiigs. They now totter like a young child. The brain which conceived and the arm which executed, are alike feeble. How proper that nmch which is kindly should now be done for those who have done so much for us and for the world I Oh, let the old have a warm place in the aft'eotions! Supply, as far as jwssible, all their want-. Go with them, in spirit, into the shadows of evening, w?thin whic h they are retiring, and there liold them up. Be a staff' to thern in their weakness ; and, .1 it be possible, Avhen the shades deepen around them, lift the curtains of the future, and le' in upon thern, though it be nev«!r so few. some rays of light from the heavenly world. From these general remarks, I pass to consider — xi mil The Changes (}ccnrring in Advanced Life. fjno'.VTr?, maturity, and decline are the three periods which divide and measure human life. have their ve mostly le pr.'siMit, lily to llie i^fd. We iiid events J" well as wnrds 1 lu- re. To ;i I to sit by rhiiir, and V.V. They live over int person >ii for thi.s tend more ;ople, tlian ndicatioiis re in their d vigorous to support ; primitive lough and nade .per who have re a warm •ir want". lin whii li them ill en uroiHul M, though irld. lich divide if= OLD AGE, AND ITS DISEASES. 703 During growth, the deposit of new matter takes place more rap- idly than the decay or waste which i« also going on. During healthy maturity, waste and increase are exactly equal, the one taking place just as rapidly as the other. The decline of old age reverses the order of growth, and waste outstrips addition. The newly deposited matter comesj but not so ra}>idly as tlu^ old is east away. l>i'('lilliiis( Ajfe may be said to extend from fifty to sixty. Incipient Old \%e. from sixty to seventy. Kipe Old Age from seventy to eighty. Decrepitude or Second Infancy from eighty to the end of life. During all these periods, particularly during the latter, important strueturpl and other changes 'e oc(!urring in the human system. Files, apoplexy, paralysis, disea^< s of the liver, kidneys, and bladder, with organic changes af the heart, dropsy, chronic aflections of the breathing organs, gt)ut, etc., frequently appear. No fear of Death. — It is a wise and merciful provision of Provi dence, that as old age advances, and the natural end of life draws near, the dread of death diminishes. As the aged gradually lose their hold upon life, they do so with less and less reluctance, until finally they let go willingly, and part from it even with joy. Persons passing from life at the age of iMghty or upwards, generally look forward to death with more of pleasure than of fear. It is one good reason why it is desirable to live to* great age, that life may come to a close without those harrassing fears which so many dread. Preservation of Old People's Health. It is proper here to speak of the hygiene of old age, or the means of preserving aged people's health. It is natural to desire a continuance of life ; and except in the case of the cxtren»ely old, there is a generai wish for its prolongation. I Those who are born of parents who have lived long, are more likely to attain length of days than those who have descended from short- lived ancestors; yet the inlluence of correct habits may add quite as umny years to their lives. Re^nilar llabita. — The old feel ' . ^v or less completely effected in boiling according to the amount of water used, and the length of time employed in the process. In making soup, we have no objection to a separation between thf hard and juicy parts of the meat, because the latter passes into the water and helps form the soup. Hence the proper way is to put the meat into cold water when it is put over the fire, and let it come to the boiling point very gradually ; during which time the ju«'y part has a chance to dissolve out, and, uniting with the water, make rjch soup. But when the meat is to be boiled simply, and eat as boiled meat, we should aim to retain the juice within it, that we may retain the whole of it. To do this, we must put the meat into water which i> briskly boiling over the fire. The juice of the meat contains a larg< quantity of albumen, a substance just like the white of egg; and putting the meat suddenly into boiling water almost instantly hardens this albumen all around the surface, just as boiling water kardeii^ white of egg, and this prevents all the juice of the inner pt»ni«»nol the meat from running out into the water and being lost. Kt'ep the meat in the briskly-boiling water a few minutes, then pour in » little cold wat»T to reduee the temperaturt^ slightly, and keep it in thi»« !*ome- wliat reduced temperature until it is done through. Broiling and roasting are pretty generally understood, bikI ai^ done well enough wluire persons are disposed to take pains. Krvin. is an abomination : and should be banished from all civilized huut^** holds. OLD AGE, AND ITS DISEASES. 705 Milk is an cxeullcnturticlo of diet for old persons. Except in sonio few cases where it disajjrecs with the stomach, it is nnion^ the veiy best. Sometiuies, when it disaj^rees with a weak stomach, a little liine- Wiitcr added to it will make all rijrht. Artificial ass' milk, which will •fciicrally set we!! on afu! ; i)ut sliould be eaten Ml meal time, not between meal.-;. Among thes«s ripi' apples, peais, pciu ln's, plums, strawberries, currants, and grapes are luxuries in wliieh not even the old.st persons need fear to indulge to a reason- alile extent. IMalii Puddings and t^les are not entirely obj«'etionable ; but all rich iiiiil liigli-seasoued arlii'lcs ofpjistry should be strictly rejected by the old, as they shoidd, in fact, by all classes. Wine, etc. — If any persons in the world may indulge in a little wiin! for their stomach's .sake, it is the old. Ihit tnen they, if they li:i\c not lieeu accuslouud U) its use, often get along very well without il ; and wlu'u they vM\ do so it is better, for vaiioiis n^asons, espet'ially tiiiit their ex.imple may liave a good inthience w ith others. \N'hcn the fVi'lilc vitality of tl\«' aged seems to rcMjuiro it, especially if th«!y have Im'ci) ill I lie habit of leaning upon it, they should be encouraged to use it. And if tlu^y chance to lie poor, and cannot procure it them- >M"lvcs, for tri«Mi «ry thoroughly SaH<*eptibllit> to Cold. — Aged people suffer very much from cold lumdsMiKl feet, uiid, indeed, from languid circulation and low tom- IM'iiutir" genendiy. The heart, like all their other muscles, has \»<(,fne feeldc. and .sends the blcMxl very lazily along the arteries. Tlio clothing of the ohl shoidd Ikj thicker ttn (o support the vital • nergics "J age ; uud ^/iiie writers have recommended that the vital wurmth •» JSSSSZ luwa ru6 OLD AGE, AND ITS DISEASES. of the old should be kept up by lettinji the young" of our own spcci«'s sleep with them. The humanity of this suggestion is very question- able. The aged would doubtless be bcuetitod by sueh a [)roceejv it indulged by the old. ('arriage exercise i> very suitjible tor old npo{»le, but the more activf exercise of hoivbmk riding, walking, imm even working in the gar- t omitted — VKMtriiig always in mii'd that great fatigue is injurious. Hleep. — Ageack's Alemoirs, who always woke Ciirly in the morning, and turning his head where his feet had lu'cn, invariably fell into a sound slumber, which was mons refreshing than that of tlu! night. When h<^ chanced to omit this, he felt ill all day. Observing that the head of his bed was directed to the south, Itei«;h- I'uliack persuaded him to tiun it to the north ; and ever alter he blc>j)t M)undly till the jn'oper time to rise in the morning. Without pronouncing upon the correctness of this theory, I \ ill -imply say that in my winter residence in town, the head of my i)ed IS to the south. I sleep /oZeraWy well; but not as well as at my »uniin(!r residence a little out of town, where the head of my bed is Inwards iho north. How nuuh tlui stillness of the country, and the LMvater purity of its atmos[)herc may contribute to this difference, I will not pretend to decide. Ilf\- '■'"" ■t Medical Treatment of the Old. In prescrihin*; medicine for old people, we should bear in mind the difference between the sexes. W'onicki in advanced life are less ex- citable, and enjoy better health, fre«|uently, than in early life. Old men, on the contrary, are more nervous, in their latter years, and conse(iuently more easily affected. The physician cannot rely on the reaction of the system in old age. Wiy must do more by his remedies, and depend less upon nature to help him out of straits. The small jiower of rallying in the systems of the old, puts nil blood-letting, severe i)urging, etc., entirely out of the (luestion. the man is near enough to insanity who, except in some very rate case, bleeds the young, lie who takes a drop of lilood from the old, should be put in a straight-jacket and sent to the insane hospital. Larger Doses. — The tor[)id condition of the system in old age, fre- quently recjuires larger doses of medicine to nuike an impression. Fluid Medicines. — Pills and i)owders sometimes pass through the stomach and bowels in the same state in which they entered. Fluids are more readily appropriated — especially when the more active me- dicinal ingredient is mixed with wine, or some stinmlating tincture, or aromatic water. These things rouse up the torpid stomach aud bowels, and cause the medicine to take effect. Medicine by Rectum. — When the disease is situated in the imme- diate neighborhood of the lower bowel, as the bladder, etc., it is sometimes better to administer the medicine by injection into the rectum. Suitable Medicines for the Old. — The acids, the alkalies, and the neutnil salts are unsuitable to be administered much to old people. All metallic medicines must be given sparingly, and with caution. Iodine and iodide of potassium are not very well borne. Narcotics must sometimes be used to some extent. Marsh and drastic purga- tives are out of the question, except in some few instances in which they may be given sparingly in connection with compound tincture of gentian, or some other stinudating tonic. Sulphur is a valuable remedy for aged i)eof)le. So are the stimulant tonics, bitters, astrin- gents, gum-resins, balsams, etc., together with the various carmina- tives, as anise, coriander, fennel, casearilla, ginger, etc. Surgical Operations. — Some of the smaller operations in surgery need not Iw forbidden in llje ca.s») of the old ; but great operations arc There is not lecupcrative power enough to Diseases of tLe Old. Most of the diseases which afHict aged people are of course much the same with those which come upon people at all periods of life. not to Ik> thought of. bear them. mmitm Wt ii'miiiai IMiiliillii ;nri3' ■•'■■■ iftll These having all l)cen treated of in the previous pages of this Imok, do not require to ho gone over particularly again. There are a few complaints, however, which are peculiar to the old, of which I must briefly speak. Bronchial Fluz. — Bronchorrhcea. A MORE than usual amount of nuicous expectoration, accompanied with cough, is very common with old i)eople — so common that in many cases they think very little of it, even when the expectoration becomes very profuse. This discharge, however, from the mucous surface of the lironchial tubes, is very apt to be attended by shortness of breath on making even very slight exertion ; and the whole trouble is aggravated in dam|) weather, and by constipation, and the stoppage of leucorrlio'a in females, or the interruption of in8en8il>le persi)iration through the skin. Slow progress. — This complaint makes very slow progress, as a general rule, often continuing many years without doing any great mischief. It is apt, however, to degenerate into a mischievous con- dition in the end ; and should, therefore, as a general thing, receive 8ome attention. Treatment. — Attend carefully to the skin. Keep it in as healthy a condition as possible, by regular and faithful bathing and friction. This isof i)rinie importance. C^are nuist be had not to suppress the discharge too suddenly. It mny lie necessary, at times, to use some expectorant (see (;xpeetorant8 among the prescriptions) to make the raising easier. Hut when it is thoroughly loosened up, we should begin to supj)ress it by astringent inhalations. For this purpose Inhalant No. 4 is excellent. It might be well, however, to begin with the Inhalant N(». '>, which is slightly styptic. If idcers on the h^gs have recently healed, they should be o[)ened, or lilisters applied in their vicinity. Removal to a dri/ climate is a valuable remedy , provifJ«-d tl*»» cli- mate is n(>t too hot, and is healthfid in every other re.s|>ect. Other Diseases. — The other diseases with which old persons are nttlicted are so connnon to all ages, that I do little more than nanje them, adding a few general remarks. Asthma. — The asthma, en- intermittent ditliculty of breathing of tile old, is connected with various other troubles, as chronic inflatnina- tion of the bronchial tubes. !iir in the lung tissue, swelling of the lungs, enlargement and dilatation of the heart, and diseases of its valves, etc. It is also dependent on impurities of the blood, and is t'omu'cted witn torpid action of the kidneys. It is impossible, some- limes, to say which of these conditions it is dependent upon. As far as may be, however, the cause must be searched out ; and then, while l*#i.^i.'f' 710 OLD AGE, AND ITS DISEASES. i' ill tho goncml remedies for usthina nmnt ho employed, the particular thiii«i^ with which it i» connected must ulso receive attention, especially if it 1)0 connected with derun<;ement of tho kidneys. Asthmatic old |)eoplo aro almost always dyspeptics. Tho stomach and howels, therefore, re(|uiro particular attention. Tho warm pur- <;ativos, combined withalkalies, are generally useful : as rhulmrhand soda, equal parts, or Mettauer's Aperient, with a little tincture of ginger or tincture of cayenne in it. A very valuable preparation is compound tincture of gentian and tincture of columbo, two ounces each, ono half ounce of tincture of ginger, and half an ounce of bi- carbonate of soda. Mi.x, and take a teaspoonful as occasion may require. Apoplexy and Paralysis. — The nervous system biiiug weakened in aged people, the way is opened for greater frerjuency of attack from apoplexy and paralysis. The exciting cause may be hypenvniia, too much blood ; or ana>mia, too little blood. It may be general debility, or gout, or a poisoned state of the blood. The treatment is to be conducted mu(;h on the same principles us when these diseases occur in younger subjects. 1 pass over numerous ccMuplaints which may be said to be soujewlmt more conunon in advanced life than at earlier j)eriods. They are so fully treater. Lfwi»^8 New Gymnastics " A few of these notices may l>e given. " We look upon Dr. Lewis as one of the bcnefhctors of his race." — Grarp Grerniennd. " Success to Dr. Lewis's Oymna.siuni. No better Institution exists." — The Knick- erbocker. " It was my privilege to welcome Dr. Lewis fit his very first arrival here, and everything since then tins only confirmed my confidence In his ability to superintend tills system. '* — Sev. Dr. Kirk. " We shall look for great results in the physical development of the nation, if this admirable system should be generally adopted." — Boston Traveller. " Every muscle of the body is brought Into motion without straining or unpleas- ant eiTort. Many of the attitudes are graceful and striking. In a word, it is poetry in motion, and motion set to music." — iV. Y. Tribune. " We are glad to hear that this simple apparatus and Ingenious series of exercises arc being introduced into many of the best schools of the State." — Boston Courier. "TheBo.ston (Jymnusium has sent a graduate to our city who is teaching large classes, composed of our gravest divines, physicians, and others. Ladies mingle in the happy crowd." — iV. 1'. Times. " This .system avoids the objections of other systems. I have witnessed Its effects in several .■*cliools, and can say they are all good without exception " — President Felton, in an address at Dr. Lewis's Oymnasium, of which he was the presiding officer up to the time of his death. He has recently i.ssued a handsome volume, known as " T/ie New Gyinnastics for Men, Women, and Children,'' through TicUnor & Fields — .1 beautiful volume, full of illustrative cuts. The inwk has been so generally noticed by the j)ress of the country that all have learned of its features. A single notice or two may be given. "Dr. Lewi.s's book is the most practical, sensible work on this subject, extant In any language." — Continental Monthly. " Dr. Lewis has given us far the best and most practical of all publications on the siihject of physical culture." — N. Y. Independent. This vigorous worker in the field of physical education has recently cHtablished in Boston a Normal Institute for physical education, in which he is preparing teachers of the New Gymnastics. About seventy persons of either se.\ have already been fitted, and have gone out to teach N>arly every' progi'cssive school in the Northern States has men or », s of the New Gymnastics in its daily drill. And so far as teachen, <;}.n be obtained, the schools have adcled a gynmast to their <'orp9 -4' tfiichers. There is room for a thousand or ten thou.sand lalMMcrs in the new profession. Persons of cither sex may find in this callii g heullh, usefulness, and large profit. In addition to the New Gymnastics, the graduates go out prepared 3«jj f'm IMAGE EVALUATION TEST TARGET (MT-S) fe // :/ A 1.0 I.I 1.25 ■klUU M 2.2 6" 20 1.8 LLl IIIIM p^^ <^^ > A ^^ '^^ ;> v Photographic Sciences Corporation \ <^^ #v ^^ O If- o^ V 3 WEST MAIN STREET VVESSTER.N.Y. 1 380 \r,b) •i'''".-4S«3 ? > e compared with the New Gymnastic ring, the dumb-bell deserves its great popularity. Among the Greeks it had a peculiar shape, and in this respect has undergone many changes, of which something will be said hereafter. Its present shape is well known. A practical suggestion upon this point may not be amiss. The handle should be at least half an inch longer than the width of the hand, of such size as can be easily grasped, with a slight swell in the middle. The manufacturer must not forget there is a wide di^ierence between the hand of a little girl and that of a large man. Heretofore dumb-bells have been made of metals, The weight in this country has usually been considerable. The general policy at present is to employ those as heavy as the health-seeker can put up. This is wrong. In the great German gymnastic institutes, dumb- bells were formerly employed weighing from fifty to one hundred pounds, but now Schreber and other distinguished authors con- demn such weights, and advocate those weighmg from two to five pounds. I think those weighing two pounds are heavy enough for PHYSICAL CULTURE. 715 I all lijjht. any man : and as it is important that they ho of considerahle size, I introduced, some years ago, those made of wood. Every year my faith grows stronger in their superiority. In my early experience as a teacher of Gymnastics, I ndvoeated iicavy dumh-bells, prescribing for those who couUl j)ut uj) one hun- dred pounds, a bell of that weight. \s my success had always been with heavy weights, i)ridc led me to continue their use long after 1 (l(ml)1(!d the wisdom of such a course. For some years I liave em- ployed only those made of wood. I know it will be said that dunih-bolis of two pounds weight will do for women and children, but cannot answer the rcniuirenients of stiong men. The weight of the dumb-bell turns entirely on the maimer in which il is used. If only lifted over the head, one or two pounds woukl be iilisurdly light; Itut if used as we employ them, then one weighing ten j)ounds is bey a hotel, devours with them a dozen monstrous eonii)ounds, with the keenest appetite, and without a subsecjuent pang. I amcontident that the loyal jjoople of this country havi; eaten and digested, since Koanoke and Donelson, as they had not before since Sumter. Could we have an unbroken succession of good news, we should all have good digestion without a gymnasium. But in a world of vexa- tion and disappointment, we are driven to the necessity of nmsclcj <'ulture, and other hygienic expedients, to give the nervous system that sui)port atul vitality which our Htfnl surroundings deny. If we would make our muscle-training contriJ)utive in tlie highest degree to the healthful elasticity of our nerves, the exercise nmst 1)0 siuh as will bring into varied combinations and play all our nmsdes and nerves. Those exercises which require great accuracy, skill, and dash are just those which secure this happy and complete intermar- riage of nerve and muscle. If any one doubts that boxing and small sword will do more to give elastitity and tone to the nervous system than lifting kegs of nails, then I will give him over to the heavy lifters. Another point I take the liberty to urge. Without accuracy in the performance of the feats, the interest must be. transient. This prin- ciple is strikingly exemplified in military training. Those who have studied our infantry drill have been struck with its simplicity, and have wondered tlmt men could go through with its details every day for years without disgust. If the drill-master permits carelessness, then authority alone can force the men through the evolutions ; but if he enforce the greatest precision, they return to their task every morning for twenty years with fresh and increasing interest. What precision, permit me to ask, is possi!)le in "putting up" a heavy dumb-bell? But in the new dund>-bell exercises there is opportunity and necessity for all the accuracy and skill which are found in the most elaborate military drills. I have been a teacher of boxing ami fencing, and I say with con- fidence that, in neither nor both is there such a tield for fine posturing, wide, graceful action, and studied accuracy, as is to be found in the new series of dumb-bell exercises. But, it is said, if you use bells weighing only two pounds, you FP wm I ■ ' '^9 j , 1 ''„^ ■■ .;. \ 9 5 i m m 1 718 PHYSICAL CULTUKE. must work an hour to reach the excn-cise which the heavy ones would furnish in five minutes. I need not inform those who have practised the new series with the li<^ht bells, that this objection is made in ignorance. If you simply "put up" the liuht l)cll, it is true ; but it you use it as herein described and illustrated, it is not true. On \\v^ contrary, in less than tive minutes legs, hips, back, arms, shoulders, neck, lungs, and heart will each and all make the most emi)li;itie remonstrance against even a quarter of an hour's practice of siu;h feats. At this point it may be urged that those exercises which hasten the action of the thoracic viscera to any considerable degree are simply exhaustive. ' 'his is another blunder of the " big-muscle " men. Thcv seem to think j'ou can determine every man's constitution and health by the tape-line ; and that all exercises whose results are not diitor- minable by measurement are worthless. I need scarcely say, there are certain conditions of brain muscle, and of every other tissue, far more important than size ; but what 1 desire to urge more particularly in this connection, is the importance, the great ph;siological advantages, of just those exercises in which the lungs and heart are brought into active play. These organs are no exce[)tions to the law that exercise is the principal condition of development. Their vigorous training adds more to the stock of vitality than that of other organs. A man may stand still and lift kegs of nails and heavy dumb-bells until his shoulders and arms niv. Sampsonian ; he will contribute far less to his health and longevity than by a daily run of a mile or two. Speaking in a general way, those exercises in which the lungs and heart are made to go at a vigorous rate, are to be ranked among the most useful. The "double-quick " of the soldier contributes more in five miimtes to his digestion and endurancs, than the ordinary drill in two hours. I have said an elastic tone of the nervous system is the physiological purpose of all physical training. If one may be allowed such an analy- sis, I would add that we exercise our muscles to invigorate the thoracic and abdominal viscera. These in their turn support and invigonilc the nervous system. All exercises which operate more directly up>>ii these internal organs, as, for example, laughing, deep breathing, and running, contribute most effectly to the stamina of the brain and nerves. It h: only this mania for monstrous arms and shoulders that could have misled the intelligent gymnast on this point. But, finally, it is said you certainly cannot deny that rapid motions, with great sweep, exhaust more than slow motions through limited spaces. A great lifter said to me the other day, "Do you pretend to deny that a locomotive with a light train, flying at the rate of forty miles an hour, consumes mare fuel than one with a heavy train mov- ing at the rate of five miles ?" I did not attempt to deny it. " Well. then," he added, with an air of triumph, "what have you to saji now about these great sweeping feats with your light dumb-bells, as coni- mr |i;iiod with the slow })utting up of heavy ones ?" I replied hy askin<^ liiiii another (luestion. "Do you pretend to deny that when you drive your horse ten miles within an hour, l)etbre a lijjht carriafre, Ik; is more exhausted than by drawing a load two milcis anhour? " "That's my doetrine, exactly," said he. "Then," I asked, "why don't you always drive two miles an hour?" "But my patients would all die," replied my friend. I did not say aloud what was parsing in my mind, — that the danger to his patients might he less tliiiu he imagined, — hut 1 suggested that nearly every man, as well ;is (ivery horse, had duties in this life which involved the neressity of rapid and vigorous motions; that were this slow movement iienerally adopted, every phase of human life would be stripped of jirogress, success, and glory. As our artificial training is designed to fit us for the more suc(;t^ss- ful performanve of the Imsiness of life, I suggest that the training should be, in character, somewhat preparatory for those duties. If you would train a horse for the carriage, you would not do it by driving at a slow pace before a heavy load. If you did, the first fast drive would go hard with him. Just so with a man. If he is to lift hogsheads of sugar, or kegs of nails, as a business, he may be trained by heavy lifting ; but if h'ts l)usiness requires the average velocity and free motions of human occupations, then upon the basis of his heavy slow training, he will iind himself, in actual life, in the condition of the dray horse, who is jjushtcl before the light carriage at a high speed. Perhaps it is not improper to add, that, to me, all this talk al)out expenditure of vitality, is full of sophistry. Teachers and writers speak of our stock of vitality, as if it was a vault of gold, upon which you cannot draw without lessening the quantity, whereas, it is rather like the mind or heart enlarged by action, inci'eased by expenditure. When Daniel Boone was living alone in Kentucky, his intellectual exercises were, doubtless, of the quiet, slow, heavy character. Other white men joined him. Under the social stimulus, his thinking became more sprightly. Suppose that in time he had come to write vigorously, and to speak in the most eloquent, brilliant manner, does uiiy one imagine that he would have lost in mental vigor and dash hy the process? AVould not the brain, which had only slo.v exercise in his isolated life, become bold, brilliant, and dashing, by bold, brilliant, and dashing efforts? A farm boy has slow-, heavy muscles. He has been accustomed to heavy exercises. He is transferred to the circus, and performs, altera few years' training, a hundred beautiful, splendid feats. He at length reaches the matchless Zampillaerstation of Wm. Hinlon. Does any one think that his body has lost power in this brilliant education ? Is it true that in either intellectual or physical training, bold, brilliant efforts, under proper conditions and limitations, exhaust the powers of life? On the contrary, is it not true that we find in vig- fWWW^ Hi' Ivi i.i^-ilv&^'!S 720 PHYSICAL CULTURE. oroiis, l)o1d, dashing^, In'illiant efforts the only source of vigorous, hold, dashing, and brilliant powers? In this discussion I have not considered the (roatnient of invalids. The principles presented are applicable t.o the training of children and adults of average vitality. In a work upon which I am now engaged, devoted to the " Move- ment Cure," to bo published early in ItiO.'J, I shall advocate, and for n'Msons which will appear in the work, an entirely ditlerent policy. In the nu'an time, 1 will rest upon the general statement, that all persons of both sexes, and of every age, who are possessed of avciji-ic vitality, shoidd, in the dei)artm(Mit of })hysical education, employ liiiht apparatus, and execute a great variety of feats, which re(iuire skill, accuracy, courage, dash, presence of mind, quick eye and hand, — in Itrief, which demands a vigorous and c()mi)lc!te exercise of all the ])o\vers and faculties with which the Creator has endowed us ; whiio deformed and diseased persons should be treated in consonance with the philosophy of the Siredish Movement Cure, in which the movc- nuMits are slow and limited. It is but justice to the following scries of exercises with dumb-bolls, as well as to myself, to state that not only are they, with two or three exce}itions, \\\\ own invention, but the wisdom of the precise urrangcjuent given, as well as the l)alance of exercise in all the nius- I'lcs of the body and limbs, have been well proved by an extensive use for several years. It must not be forgotten that, in all the dumb-bell exercises the pupil should, as a beginning jjosition, stand with his heels together, the toes separated so as to make l)etween the feet a right angle, and the arms hanging by the sides, with the dumb-bells horizontal and parallel to each other. Not only in all the exercises, but in all the changes from one exer- cise to another, the pupil must keep time to the music. In the al)sence of other musical instruments, a drum may be employed to mark the time ; and even without this it may be kept by counting one, two ; one, two ; one, two. It nuist 1)6 remembered that in no case should the pupil bend the legs at the knee, or his arms at the elbow, unless it is so directed. No rule in the dundwbell exercises is so important as this. If it be for- gotten, exercises with dumb-bells will lose more than half their value. No. 1. The position is shown in /^/r/. 1. Tbuml)s outward. Bells exactly horizontal. Turn the thumb ends of t\ e l)ells to the hips, and then back again to the i)osition shown in tliNf figure. Repeat ten times. Let the change be made with the grea» \st accuracy. AVhcii it is well done, no matter which end is at the li p, a straight rod run through one dujub-bell, lengthwise, would rv \he same time run through the centre of the other. In this and all subsequent duml>-bell exercises, the pupil must he careful not to bend the elbows. When exceptiorvj to this rule occur, they will be plainly indicated. . PHYSICAL CULTURE. 721 a one exer- No. 2. Position seen Fig. 2. Keep the elbows pressed against the sides, and twist the hells so the ends are exactly reversed. Be 8ure they are exactly in line with each other, and the forearms par- allel. Repeat ten times. Figure 1. Figure 2. No. 3. In passing from No. 2 to No. 3, bring the bells to the chest, and on the next beat to the position in Fig. 3. The palms of the hands are upward. Bells exactly horizontal and parallel to each other. Turn the hands over, knuckles upward. Bells now exactly in the same position as br^ore. Repeat ten times. Fitfiire i. FIgiiri; 4. No. 4. In passing from No. 3 to No. 4, bring the bells to the chest, and on the next beat to the position in Fig. 4. The palms forward. 91 ] ^P^a^^ I '! • ■''•MmWm I,- '•^■' ^^i~i Sj'i'^WKH^M 'rill: 11 722 PHYSICAL CULTUUE. Twist the bolls so the knuckles are forwiird. Repeat ten times. Arms to be kept parallel from first to last. No. f). rosition as in Fig. ii. In passini; fron' No. 4 to No. 5, bring the ])ells to the chest. Twist the arms so that the l)clls are exactly reversed. It will l)e seen in the figure, the j)alnis are upward. W'len the l»ells are revc^rsed, th the arms •ge out on aight, that PHYSICAL CULTURE. 729 No. 27. As in nearly all other exercises, begin with the heels Figure 26. Figure 27. together, body erect, chest forward, shoulders back, arms hanging, dumb-bells horizontal and parallel to each other. Step diagonally I, I i Figure 28. Figure 29. backward with the right foot, as seen in Fig. 26, and repeat the exercises in No. 26. Same with the left foot. 92 > 730 PHYSICAL CULTURE. In this exercise the forward leg is kept straight, that behind is l)ent as much as possible. No. 28. Bells on the chest. Carry the right arm out at the side, thrusting it as far back as possible ; suddenly bring it back to the chest in a circle as if grasping a large body standing in front. Repeat five times. Left hand, same. Alternately and sinudtancously, saiuc In this exercise the arms should he kept in the horizontal plane, and should in the performance of the exorcise enclose as large an armful of the imaginary objects as possible. No. 2D. Standing erect, arms liiiiiiiinjr at the side, suddenly turning the body to one side as far as you can twist it Avitli- out moving the feet, carry the arms to the position seen in Flf/. '21 . Bring thorn back to the sides, Avhile at the same tnue you bring the body to tlie first position. Swing the arms up on the other side, and so continue, alternating twenty times. No. 30. Standing erect, arms hanging, bring the bells to the chest, then to the floor, as shown in the dotted line in Fig. 28 ; then rising, bring the dumb-bells again to the chest, and on the next beat thrust them as far upw^ard as possible, rising on Figure 30. the toes ; then back to the chest. Repeat twenty times. ' Figure 81. No. 31. Standing erect, dumb-bells on the shoulders (rat on the PHYSICAL CULTURE. 731 chest) , thrust the right arm out at the side as seen in Fig. 29, ten times. Left, the same. Altcrn-itely nnd simultaneously, the same. No. 32. Standing erect, arms hanging, nuuy the arms to the hori- zontnl in front ; then to the position over the head seen in Fig. 30 ; now down to tlie horizontal again, and then to the floor as seen in the dotted lino. Repeat ten times. In this exercise there must be no bending at the knees or elbows. No. 33. Standing erect, arms hanging, charge out with the right Figure 32. ^ foot, and sweep the left arm as shown in Fig. 31 ; on the next beat return to the first possition. Repeat five times. Same on the left side. Alternately, five times. No, 34. Standing erect, arms hanging, without moving the body carry the right foot out sideways, lifting it from the floor, and bring- ing it back to the other foot, without bending the knee, five times ; then charge into the position seen in Fig. 32, and return to the firet position, five times. The arm which is brought over the head nuist be canned in a direct line from the side to the position over the head, and not brought toward the front of the body in ita passage up or down. ^ BagEzercises. The use of small hags filled with beajis, for gymnastic exercises, was suggested to my mind six years since, while attempting to devise a series of games willi large rubber balls. Throwing and catching objects in certain ways, requiring skill and i)resence of mind, affords not only good exercise of the muscles of the arms and u[)iK'r half of the ])ody, but cultivates a quickness of eye and coolr.css of nerve very desirable. Appreciating this, I employed large niblHi balls, but was constantly annoyed at the irregularities resulting froi:; the diflScuIty in catching them. When the balls were but ijartinlly inflated, it was observed the hand could better seize them. This nt length suggested the bean bags. Six years' use of these bags lias resulted in the adoption of the following, as the best size and sliaiw. The material is a strong bed-ticking. Bags for young children should be, before sewing seven inches square : forhulies, nine inches; for ladies and gentlemen exercising together, ten inches ; for gentle- men alone, twelve inches. Sew them with strong linen or silk thread, doul>led, nearly three quarters of an inch from the edge, leaving a small opening at one corner to pour in the beans. Fill the bags three quartei-s full, and they are ready for use. Jf used daily, once in two weeks they should be em^jtied and washed. To allow them to be i)layed with after they are soiled, is })retty sure to furnish much dust for the lungs of the plnyers, beside soiling the hands and clothes. There cannot be too much ca^e exercisvjd in regard to this point of cleanliness. Before the beans are used the first lime, they should be ri)ised with water until it runs from them quite clean, when they nuist be dried ; and every month or two afterwards this cleans- ing should be repeated. The dirty carelessness with which these bag exercises are gener- ally managed, makes them a positive nuisance. Premising this indispensal)le preparation and care of the bags, 1 shall now proceed to give those exercises which I have found best adapted to schools and gynmasiums. Fig. 1 represents a series of hoops lashed between two stroiiT ropes and stretched across !!.;• room, the ropes fastened on tlio side of the room into staples, and on the other rumiing throuiih pulleys. By these means the ropes may be drawn very taut. It is well to fasten the staples and pulleys into slides, that the hoops may be altered for persons of difl'erent ages. Nearly all the exercises with bags are greatly improved by throw- ing them through the hoops. It will be ol)served the cut srepresent the player as throwing the bags quite high. This has reference to the hoops. But the bags may be thrown between the players without the hoops. (XXXX) Figure 1. PHYSICAL CULTURE. 783 ;se baj^s has ; for gcntlo- s are gener- No. 1. Arrange yourself in two classes. Classes face each other, six feet apart. Members of one class will each have a bag. The other class will have no bags. Each person will play with the one standing exactly opposite. Hold the bags under your chins Figure 2. Figures. {Fig. 2). When one gives the work, each couple is to throw its bag backwards and forward ten times, counting both ways. At the be- ginning of this and the following exercises, the leader will announce how many times the bag is to be thrown. Figure 4. Figure 5. Fisure 6. Each coui)le will play as rapidly as possible, and as estth finishes, the two players will hold up their hands, and cry out the number in a loud voice. Now ready ! One, two, thuee ! ! The bag is always to ho thrown fi-om the chest, never to be thrown from the lap. No. 2. Same as the last, except the bag is thrown and caught with the right hand. The position is well shown in Fig. 3. ''ii 734 PHYSICAL CULTURE. No. 3. Same as the last, but with the left hand. When the rif'ht hand throws, the partner's right hand must catch, and so with the loft. No. 4. In this one, the bag is thrown with both hands, from the position seen in Fig 4. Figure 7. Figure 8. Figure 9. No. 5. Same as the last, except the bag is thrown with the right hand, as shown in Fig. 5. The unoccupied hand in this and all other single-handed bag exercises is to be held on the corresponding side, with the arm akimbo. No. 6. Same as the last, except with the left hand. No. 7. The bag is to be thrown over the head from the position seen in F/'q. 6. Figure II. Figure 12. Figure 10. No. 8. To be thrown from the position seen in Fig. 7, with the right hand. The one who catches must receive it, while the left hand grasps the arm in the same way. No. 9. Same as the last, only using the left hand. No. 10. Standing with your right side toward your partner, hold PHYSICAL CULTURE. 735 llio bag on the point of the elbow, l)eiiig sure to keep the foreunn vertical {Fig. 8); throw from this posilioii the number of times an- nounced by the leader. To bo caught in the hands. No. 1 1. Same as the last, except the left side is turned, and the \n>Z is thrown from the left elbow. NO. 12. Hold the bag as represented in Fig. 9, and toss to your parliu-r. He will of course return in the same manner to you, and thus it will 1)0 tossed backward and forward the number of times in- (liciited by the leader. As in all the other exercises thus far given, (lull coui)le ui)ou reaching the indicated number, will hold up their hands and cry out that number in a 1 jud voice. No. 13. Turning your right side to your partner, throw from the Figure 13. Figure 14. FiRure 15. position represented in Fig. 10. Your partner catches the bag, stand- ing in the same attitude. No. 14. Same as the last, except you turn your left side to your partner, and throw with the left hand, either without bending the knees, as seen in Fig. 11, or bending them, as seen in Fig. 10. No. 15. Again turn your right side to your partner, and throw the hag from the position seen in Fig. 12. No. 16. Same as the last, except turning the left side, you throw with the left hand. No. 17. Turn your back to your partner, and bend backwards, so that you can see him. He bends back, so that he may see you, and then you throw the bag to him as represented in Fig. 13. Always cry ready! that he may not be kept waiting too long in a.i uncom- fortable position. No. 18. Face your partner, and throw from the position repre- sented in Fig, 14, holaing the bag on the back of the hand. No. 19. Same as the last, except the left hand is employed. No. 20. Face your partner, and throw the bag around the back and over the opposite shoulder, as shown in Fig. 15. No. 21. Same as the last, except you see the other hand. 736 PHYSICAL CULTUUE. No. 22. Each couple having ten bags, you throw to your part- ner, and he catches as many aa he can hold, folding his arms. (Fig. 10.) This one will not ordinarily be played in class, as the number of bags will scarcely be sufficient. No. 23. The two classes will stand as represented in Fitf. 17. Place ten bags on a chair or box at the feet of the first player of eacli 'S claws. The leader gives the word, one, two, three/ and the two claflsc compete in passing the bags over their heads backwards, to the foot of the class, when they whirl round and immediately pass them bacU. The class which has the entire ten on the chair or box at its hoaci, tirst, counts one in the game. It is usual to make the jamei three, live, or ten. Figure IS. Figure 17. No. 24. Let the two classes face each other again, and pass the bags as in the last, except that they are carried along in front and as high as the chest, being careful not to stoop forward. No. 25. Let the bags he all placed at the head of one of the classes. We will call this class No. 1 ; the other, class No. 2. The tirst player in class No. 1 throws a bag to the first player in class No. 2, who throws it back to the second player in class No. 1, who throw.s it back to the second player in class No. 2, who in turn, throws it to the third player in class No. 1, and so oti, working it down to the foot of the class. But one bag is not allowed to make the trip alone ; all follow, one after another, in rapid succession. In this game, the bags are all thrown from the chest with both hands, as represented some pages back, in No. 1 of the bag exercises. No. 26. The whole company may now be divided into trios, eacli trio playing with three bags, as represented in Fiff. 18. Each one throws the bag to the player at his right hand, and at the same time catches the bag thrown from the player at his left. PHYSICAL CULTURE. 737 To secure the proper distance between the players for this game, they should take each other by the hands, and pull- ing hard, they will have the right position. Eiich player must look constantly at the one from whom he receives the bags, and never for a moment at the one to whom he throws. If they forget this rule, the bags will soon fall to the floor. No. 27. Same as the last, except the bags are passed the opposite way. No. 28. The company is again divi- ded into couples, and each couple plays with two, three, four, or more bags. A throws a bag with his right hand to B, who catches it with his left hand, and immediately changing it to his right, throws it back to A, who catches it with his left, and who, changing it to his right, throws it back agaia to B (^Fig. 19). Two, three, four, or five bags can be made to per- form this circle between two players at the same time. Figure 18. ! ';l' \^ Figure. 19. The bags, in this as in all the other bag exercises, except one, should be thrown, and not tossed. No. 29. Same as the last, except the bags are thrown with the left, and caught with the right hand. No. 30. Now the players will stand in two classes again, the classes to be six feet apart, and the players in each party to be six feet from each other. Place six bags on a chair at the head of each class. Upon the word one, two^ three! the first player in each class seizes a bag and runs with it to the second player, who carries it to the third, who in turn rushes to the fourth, and so on to the foot of the class. But one bag is not allowed to make the journey alone. One at a time, the 93 ' ! I '•^1- ' i ^i 738 PHYSICAL CULTURE. whole six arc hurried onward. Instantlvt and without any signal, they are sent bueit to the head of the class in the same order. The class which has its six bags on the chair at the head of the class first, counts one in the game. Exercises with Rings. This series of exercises is entirely new, and beyond all comparison, the best ever devised. Physiologists and gymnasts have everywhere bestowed upon it the most unqualified commendation. Indeed it is difficult to conceive any other possible series so complete in a physio- logical point of view, and so happily adapted to family, school, and general use. If a man were as strong as Sampson, he would find in the use of Figure 1. Figure 2. these rings, with another man of equal strength, the fullest opportu- nity to exert his utmost strength ; while the frailest child, engaged with one of equal strength, would never be injured. There is not a muscle in the entire body which may not be brought into direct play through the medium of the rings. And if one partic- ular muscle, or set of muscles is especially deficient or weak, the ex- ercises may be concentrated upon that muscle or set of muscles. Wherever these rings are introduced, they will obtaia the highest favor and awaken the most earnest enthusiasm. The ring is generally turned from cherry wood, and when finished measures six inches in diameter, while the body is one inch thick. It should be highly polished, especially on the inner part Fig: 1. gives a good idea of the ring. No. 1. Standing in the position represented in Fig. 2, the end of the right toe against the right toe of your partner, the toes meeting on niYSICAL CULTURE. 739 a stmight line drfivvn through tho entire hull, on which nil the pinyers stiuul, unci phu'inj; the left ibot sit right angles with the right foot, as seen in tlie figure, pull hard and twist the right arm hard from right to left and left to right ten times, keeping time to the nmsie. Be careful in this, as in all other exercises with the ring, to draw the shoulders well back and keep the head erect. No. 2. Same as the last, but using the loft hand, with the left fool forward. Figure S. Figure 4. No. 3. Join both hands vrith two rings, and plr e the right toe against your partner's right toe, as in No. 1, being sure to keep the foot which is behind at right angles with the one in front (which I Figure 6. Figure 6. may say here, is to be looked after with much care through this whole series, whenever it is possible), then pull hard, ten times, and twist the arms, keeping time to the music. No. 4. Exactly the same as the last, but with the left foot forward. No. 5. Without letting go tb ' rings, turn back to back, place the ^ 1 740 PHYSICAL CULTURE. outside of your left foot against the same of your partner, in the same way you would push against the wall of the room, and pulling hard in the position represented in Fig. 3, twist hard ten times, keeping time to the music. No. 6. Same as the last, but with the right foot behind. No. 7. Turn face to face, raise the hand:* us high as you can over the head, and, standing about two feet and a iialf apart, bring the rings down to the floor without bending the knees, as represented in Fig. 4, ten times, and all the following e:«.ercises ten times. In the perform- ance of this you must not bend the elbows, which you can avoid doing Figure 7. Figure 8, by carrying the rings outward at each side. (In the ring exercises, when your pupils, standing their faces toward each other, turn their backs, see that they do not let go the rings). No. 8. Standing as in the last exercise, but only two feet apart, place the rings in the position seen in Fig. 5. Now as the arms on one side rise, the arms on the other side fall, keeping time to the music. Be careful not to bend the arms at the elbows, which of course can be prevented in this as in many other exercises, by carrying the hands outward at the side. In this exercise a great deal of force should be used, so that when the ring is carried up on one side, it goes far be- yond the perpendicular line, the bodies of the players bending freely. No. 9. Same as the last, except the two rings go up and dowa simultaneously. No. 10. Standing as in the last two exercises, the hcirds hanging down as low as may be, and keeping them in the same relation to each other, swing them from side to side as far as you can. No. 11, Same as the last, except that instead of swinging the hands from side to side, they make a complete circle, being carried over the head, as well as down between the bodies of the players. No. 12. Same as the last, except the circle is made the opposite way. in the same yuUing hard les, keeping i. roa can over ing the rings ed iu Fig. 4, the perform- 1 avoid doing ing exercises, ler, turn their ro feet apart, s the arms on to the music, of course can ing the hands rce should be goes far be- nding freely. ip and dowa apds hanging le relation to an. swinging the being carried e players, the opposite No. 13. Back to back, as seen in Fig". 6, thrust the rings up with great force, each player keeping his two arms exactly parallel. No. 14. From the same position seen in Fig-. 6, thrust the rings out sidewise, as in all the other exercises, ten times. No. 15. Same as the last, except the rings are thrust downward by the hips. No. 16. The last three, consecutively, ten times. No. 17. Take the position seen in Fig. 7 ; your partner the same. The inside of your left foot to the inside of his left. Draw your left hand as far back past your left side as possible, dragging your partner's right hand after it. At the same time he has done the same thing with his left. Do the same with your right hands. And so continue to alternate. Do this strongly, pushing your hand past your partner's side as far as possible, at the same time pulling his hand as far past yours as possible. No. 18. Same as the last, except the right foot is forward. Be sure in this, as in all others, that your two feet ar-e at right angles. No. 19. Same as the last two, except the feet go with the hands. When you thrust your right hand forward, the right foot goes forward too. When the left hand goes forward, the left foot goes with it. If this be well done, the feet and hands making long sweeps to the Figure 9. Figure 10. music, it not only presents a 6ne, animated appearance to the specta- tors, but brings all the muscles of the body and limbs into fine play. No. 20. Back to back, touching each other's heels. Each lunge out vv'ith tht! right foot in the direction the toe points, the feet being at right angles, and raise the hands over the head so they touch, thus reacliing the position seen in Fig: 8. Now back, heels together, arms at the side, lunge out with the loft feet in the same way, and thus alternate, keeping time to the music. No. 21. Standing as represented in Fig. 9, your partner the same, with the inside of his left foot to the inside of your left foot, and hold- ing the 'rings as shown in the figure, push them vigorously toward I" ^^, i .. ' .1 A ■f ■" ' 742 PHYSICAL CULTURE. your partner, simultaneously thrusting them past his body as far as possible. He pushes them back in the same manner, and so on. No. 22. Same as the last, except the right foot is pushed forward, instead of the left. No. 23. Stand back to back, heels all together ; both step out side- wise in the same direction as far as you can reach, and at the same instant raise the' hands on the same side as high as you can, then re- turning to the upright position, hands by your sides, charge out at the other side in a similar manner. When this has been done both ways, as in every other exercise, ten times ; the leader cries " alternately," and you continue to change sideways as before, only in opposite directions as represented in Fig: 10 Figure U. Figure 12. No. 24. Standing face to face, two feet apart, charge sideways as in the last exercise, and as seen in Fig: 11. In alternation with this, charge the opposite way. After the regular number of times, the teacher cries " alternately," and you charge out sideways with your right foot in opposite ways, as seen in Fig. 12 ; alternate with the left foot. No. 2o. Standing back to back, charge, your faces both in one di- rection, with bodies fronting the same, as shown in Fig. 13. When the teacher cries ^'■change I " you must change sides with each other, still facing in the same direction. Keep time to the music with your feet, when changing sides, and as soon as you make the change, go on with the charging, using, of course, the other hands and feet. No. 26. Joining only with your right hands, and standing apart far enough to make the arms st.aight and horizontal between you, charge as seen in Fig. 14 ; the left hand and foot the same. No. 27. Joining with both hands, charge right and left alternately, each time, as represented in Fig. 14. No. 28. Stand, each with his own heels together, as seen in Fig. 15, and perform the exercise ejcliibited in the figure. As the hands PHYSICAL CULTURE. 743 on one side go up, the hands on the other go down. So alternate the regular number of times, when you will do the same simultaneously, the hands on both sides rising and falling together. Figure 13. Figure 14. No. 29. Standing as seen in Fig: 16, except that the inside of the right foot should be exhibited as pressing against the inaide of your partner's right foot, you draw back from each other as far as you can, Figure 15. Figure 16. and then come up, touching each other's chesits, all without bending the elbows. No. 30. Same, with the left foot forward. If ,1 744 PHYSICAL CULTURE. No. 31. Standing as seen in F^. 17, draw far away from cacn other, keeping the arms precisely horizontal. In:mediately approach- ing each other again, touch the shoulders as in the figure, and so con- tinue ten times, keeping time to the music. No. 32. Same as the last, with the feet changed. Figure 17. Figure 18. No. 33. Standing face to face, raise the hands on one side as in Fig: 18. As these hands are brought down to the side, raise those on the other side in like manner, and so alternate ten times. No. 34. Back to back, and raise the arms on one side as in Fig. 18, but carry the hands completely over the heads and down on the other side of the body. Alternate with the arms on the other side, ten times. Figure 1». Figure 20. No. 35. Carry the hands all over together, as seen in Fig. 19. Change thus from side to side, twenty times, always keeping time to the music. No. 36. Turn face to face, and now back to back, and again face ,. ", ■I *■ ll •'ft',' '■\''^{r, rom cacn approach- id so con* e side as in lise those on s in Fig. 18, on the other ler side, ten n in Fiff. 19- leping time to ud again face PHYSICAL CULTURE. 74t to ftt«!e, and so continue to change, alternating the sides toward which yon^ turn. No. 37. Perform the exercise seen in Fig. 20, being sure that you draw the arm of your partner directly into your axilla or armpit After alternating twenty times, then draw the arms back and forth simultaneously, ten times. No. 38. Join right hands with your partner with one ring, and stand apart so that your arras are straight and horizontal. Advance your right foot two feet, keeping the two feet at a right angle. Now puKh you; chests as near together as you can, without bending your knees or elbows, as seen in Fig. 21. Now drawing the arms back to the horizontal on the next beat of the music, carry the hands down as low as possible without bending knees or elbows on the next beat. Now back to the horizontal, and then up as high as possible, and so continue ten times. No. 89. Same with the left hands, the left foot being pushed for- ward. Figure 21. Figure 22. No. 40. Join the right hands again, holding them in the horizontal position. Now push them sidewise as far as possible without bend- ing knees or elbows. On the next beat bring the arms back to the straight line between you, and now carry them sidewise the other way, and so continue ten times. No. 41. Left hands the same. No. 42. Join right hands again. Instead of thrusting the hands directly upward, or sidewise, carry them obliquely upward, and after bringing them back to the straight, horizontal line, carry obliquely downward, and so continue ten times, being careful not to bend kn-^es or elbows. No. 43. Still use the right hands, and carry them obliquely upward the other way, and downward the other way. Nos. 44 and 45. Same with the left hands. ^ :!■ '-k-F 'f '",1 746 PHYSICAL CULTURE. No. 46. Back to lack, and plice the outside of the left foot against the outside of yoir partner's left foot. Right foot well forward. Now raise the hands over the. head as seen in Fig: 22 (I see the artist has not placed the outsides of the left feet against each other, as he should have done), and draw away ^rom each other, bending the knee Figure 23. Figure 24. of the leg which is. pushed forward, and thus sink down somewhat. As you come back, touch your shoulders against tliose of your part- ner, and thus repeat ten times. No. 47. Same, with a change of feet. In the last two exercises, as you draw away, you must not pull on the rings a single ounce. If this be forgotten, your backs may be hurt. No. 48. Face to face, join the right hands, and place the tips of the right toes against each other, and the left feet at right angles two feet behind. Whirl the right hands, making as large a circle as possible without bending the elbows or knees. After whirling ten times one way, then whirl ten times the other way. No. 49. Same with left hands. No. 50. Back to back, two feet apart, each with his own heels together. Raise the hands as high as possible over the head, and bring them down as seen in Fig: 23, five times. No. 51. Join the right hands, and turn your right side toward your partner, iieepiiig the right arms straight between you. Both must now step straight forward with the right Figure 25. foot as far as you can reach, while the right arms are kept horizontal, as seen in Fig. 24. No. 52. Face the opposite way, and use the left arms and feet in the same manner. i and feet in PHYSICAL CULTURE. 747 No. 53. Stand as shown in Fig. 25. Pull your arms directly for- ward, which of course will draw your partner's arms directly back- wards. Then he draws yours backwards in like manner, and so continue ten times. No. 54. Back to back, your shoulders touching your partner. Arms perpendicular, over the head. Dnivv your right arm directly forward. Siinuhaneously with this your partner does the same thing. Now the left arms the same; and so continue to altcrnule, ten times. And last, draw both of your arms forward ; immediately your partner does the same, and so continue to alternate, ten times. These are not a quarter of tlie possible exercises with the rings; but, after a long* use of them, with much study and irmurnerable experiments, I believe this series gives the best variety, and is suffi- ciently extended. Besides, this series is admirably eaU^ulated to de- velop those particular muscles which are almost universally deiicient in the people of the United States. ' Exercises with Wands. A STRAIGHT, smooth stick, one inch in diameter and four feet long (three feet for children), with round ends, is known in this gymnasium as a " Wand," and is highly prized. It is used to cultivate flexibility, and is ecpially useful to persons of all ages and degrees of strength. As a stiff, inflexible condition of the ligaments and muscles con- nected with the shoulders is the principal obstacle in the way of beginners, and as the wand is the best known means to remove this stillness, it should be made prominent during the first few weeks or monthiiof training. It is perhaps umiecessary to say that the symmetrical development of the upper half of the body turns entirely upon the freedom with which one can use the shoulder joint. This is sufficiently obvious when we reflect that exercise of the body above the waist depends upon the arms, and of course upon the degree of freedom with which we can use the arms. While it cannot be denied that certain muscles about the shoulders and chest may be developed to any degree, and the shoulders remain dmoping and stiff, it is quite as undeniable that general and symmet- rical development of that part of the body (which is almost univer- sally distorted and deficient among Americans), can be achieved only by complete liberty about the shoulder joint, through which as a ful- crum or centre, all considerable training of the upper part of the body is derived. I h"d pursued the study of Gymnastic Culture but a short time, before I saw the great importance of the wand, in a system of training adapted to the American people. i j ..fi' 1 to ■;:,':■•;■))".■■...■ '.■>,:? r*?^ 748 PHYSICAL CULTURE. I have invented a very extended series Oi these exercises, some of which are here described and illustrated. No. 1. Divide the wand into three equal parts with the hands, and hold it as represented in Fiff. 1. Thrust it downward close by the legs with much force, and again bring it up by the chin, holding the eibows high, as seen in the figure, and so continue twenty times. Figure 1. Figure 2. No. 2. From the position seen in Fig. 1, carry the wand directly upward as high as you can reach, and back to the chin, ten times. No. 3. From the highest position of No. 2, bring the wand down to the knees and back again, twenty times, without bending the elbows. Figure 8. Figure 4. No. 4. Holding the wand high over the head, bring it down on the back of the neck, ten times, as seen in jp^. 2. No. 6. Same as thi last, except every second time the wand i» PHYSICAL CULTURE 749 brought down to the chin, being careful that every time that the wand is carried upward, it is carried as high as pos- sible, and with much force. No. 6. Hands over the head, but this time at the ends of the wand, as seen in Fig. 3, and now bring it down behind as seen in Fig. 4, twenty times, being very careful not to bend the elbows. No. 7. Same as last, (.xc»?pt that every second time the wand is brought down to the knees in front. No. 8. Hold the wand directly overhead, hands grasping the ends, and carry it from side to side (Fig. 5), being very careful not to bend the elbows, and yet the wand must come to the perpendicular on either side. No. 9. Hold the wand directly in front, and per- pendicular, with the hands in the middle of it, six inches apart, and the arms as nearly horizontal as pos- sible. Keeping the arms stiff, whirl the wand from side to side as far as you can. No. 10. Standing erect, heels together, put the wand out with your right hand midway between two lines, one of which runs directly forward, and the other at right angles with this, at your side ; which dire(!tion we shall call diagonally forward. Let the wand rest on the door, at a point removed as far from your feet as possible, keeping Figure 6. Figure 6. Figure 7. your body and the wand perpendicular, and the arm horizontal. The. elbow must not be bent. Step out as seen in Fig. 6, the foot passing' behind the wand, as seen in the figure. In doing this you must not bend the elbow, nor must you move the wand. It will be seen that the shoulders scarcely move, the motion being confined to the legs and lower part of the body. Charge thus ten times. No. 11. Same as the last, but with left hand and foot. No. 12. Stand erect. Carry the wand out with the left hand di- agonally forward, as far as you can reach. Step out to the wand ■'■,■-. t ' 750 PHYSICAL CULTURE. with the left foot. Let the foot remain there. Now the body \» to rise and fall as far as possible. {Fig"' 7). Don't bend the knee of the right leg. Keep the shoulders and head well back. No. 13, Same as the last, on the right side. No. 14. Stand as seen in Fig. 8. Thrust the arms straight for- ward, and back again to the chest, ten times, keeping the wand all the time perpendicular. No. 15. At the conclusion of the last exercise, when the arms are thrust forward, bring the wand into the position seen in Fig. 9. Then carry it right back to the position seen in front, with the arms straight and horizontal. Now bring it down on the left side, and so continue ten times to each side. ; No. 16. In concluding the last, when the arms are extended in Figure 8. Fignre 10. Figure 9. front, bring the hands and wand to the position seen in Fig. 8. Carry it diagonally forward and upward on the left side, as seen in Fig. 10. Bring it back to the chest again, and thrust it out on the right aidv. Alternate twenty times. No. 17. As you thrust out the wand on the right side, step out the foot in the same direction. Be sure it is neither forward nor at thf side, but diagonally forward. {Fig. 11). Alternate between the right and left side twenty times. No. 18. Same as the last, except that the wand goes to the right a.s the left foot charges to the left, and the left arm and wand to the left, while the right foot charges to the right. No. 19. Same as the last, except when the right foot charges di- agonally forward, the wand is made to point diagonally backwards over the left shoulder, and vice versa. No. 20. Same as the last, except when the right foot charges PHYSICAL CULTURE. 751 extended in diagonally forward, the wand is made to point diagonally backward over the right shoulder, and when the left foot charges diagonally for- ward, the wand is made to point diagonally backward, over the left shoulder. No. 21. Same as the last, except the feet charge diagonally back- ward. As the left foot charges thus, the wand is made; to point diag- onally forward, on the right side, and vice versa. {Fif^. 12). No. 22. Same as the last, excejjt when the left foot charges diag- onally backward, the wand is made to point diagonally forward on the left side, and when the right foot charges diagonally backward, the wand points diagonally forwartl, on the right side. No. 23. Same as the last, except when the left foot charges diag- onally backward, the wand points diagonally backward on the sam^ Figure IL Figure 12. side. And when the right foot charges diagonally backward, the wand points diagonally backward, on the same side. No. 24. Same as the last, except when the left foot charges diag- onally backward, on its own side, the wand points diagonally back- ward on the right side, and vice versa. It must not be forgotten that in all these compound exercises, in- volving the action of the arms and legs, the wand is always held at an angle of forty-five degrees above the horizontal ; and that in every case in passing from one charge to another, the wand is brought to the position represented in Fig: 8. Without this it would be im- possible to keep time to the music. Let the steps be as long as possible. No. 25. Wand horizontal over the head, as seen in Fig-. 3. As in almost all the wand exercises, be careful not to bend the elbows. Turn the wand round so that the right hand comes exactly in front, and the left hand exactly behind. Bring the left in frc*nt and the right behind ; so change twenty times. No. 26. Hold the wand horizontal over the head, with the right 752 PHYSICAL CULTURE. hand in front and the left one behind. Make, by the side of the body, the motion seen in paddling a canoe. Each time carry the wand so far back that it shall be perpendicular. Do this ten tnnes on the right aide; then ten times on the left; then alternately ten times. Each time, as the wand is brought over the head, it must be made horizontal, with one hand exactly in front, and the other behind, ttiul as it is brought behind the body, it must be made perpendicular. No. 27. Charge diagonally forward with the right foot ; wand in the same direction. Left foot diagonally forward ; wand tbo same. Left foot diagonally backward ; wand the same. Right foc-t dia^'- onally backward ; wund the name. Having thus gone all aroue^d, be- gin again with the left foot and go round the other way in like manner. No. 28. With both hands take hold at the end of the wand. Hold it horizontal in front. Carry it di- rectly backward without, bending the arms, as seen in Fig. 13. (I see the artist has tipped the figure so far that the centre of gravity is lost). No. 29. Heels together. Wand directly in front, resting on the floor, ami perpendicular. Arm straight. Step the right foot forward to *he wand, and back to the other foot, five times. Left foot the samr, No. 30. Step the right foot backward as far as you can reach (Fiff. 14), and bring it back to the other foot, ten times. Same with the left foot. No. 31. Carry the right foot forward to the wand. Returning, do Figure 13. Figure 14. Figure 16. not stop by the other foot, but carry it backward as far as you can reach. Now forward to the wand again. Make this long sweep ten times. Left foot the same. No. 32. Seizing the upper end of the wand with both hands, as seen in Fig. 15, carry the right foot forward to the wand, and the left PIIT8ICAL nULTURR. 753 foot back as far as you can reach. Change them at a single jump, and HO continue ten times. No. 33. Hold the wand in the position seen in Fig: 9, on the right Hide, with the right hand at the lower end, and the left hand at the u|)|)er. Change it to the left side, with the left hand at the lower end, iiiid the right hand at the upper; so change from aide to side, ten tiliH'rt. Nu. 34. Begin the same as in the last, except the wand is held on the back of the right shoulder instead of the front. Carry it now to the back of the left, and so alternate ten times. No. 35. Beginning at the front of the right shoulder, as in No. 32, ciirry it to the front of the left shoulder. Then to the back of the left .shoulder, and now to the back of the right shoulder. Go thus around the body five timey. No. 3G. Begin at the front of the left shoulder, and go around the body the other way five times. Figure 16. Figure 17. No. 37. Hold the wand on the front of the right shoulder. Carry it to the back of the left shoulder. Back again to the front of the right shoulder. Repeat ten times. No. 38. Begin at the front of the left shoulder, and alternate with the back of the right shoulder. No. 39. Again putting the wand in front, on the floor, perpendicu- lar, with the right hand seizing the upper extremity, and the arm straight, step the right foot forward to the wand. Bring it back to the other foot. Now step sideways to the right as far as you can reach. Bring it back to the other foot again; now step backward a^; far as you ean reach. Bring it back to the other foot. Still using the right foot, step sideways to the left as far as you can reach, passing it by the left leg behind (Fig' 16), now back to the other foot again. Pass it to the left again, in front of the left leg (i%. 17), and bring it back to the other foot. Continue this round five times. 95 '^iii i 754 PHYSICAL CULTURE. No. 40. Same with the left arm and leg, five times. In all this the wand must not lose its perpendicularity. No 41. Stand upright, with the the heels together, seize the wand at its middle, with the right hand, and hold the arm horizontal in front — wand perpendicular. Keeping the arm in the horizontal place, whirl it round the body, making a'complete circle, but do not stir the feet. Same with the left hand, ten times. No. 42. Grasp the middle of the wand with both hands, and whirl as in the last, as far as you can, ten times. No. 43. Same as the last, except the wand is held horizontal, in- stead of perpendicular. No. 44. Seizing the wand as seen in Fig. 18, step backward and forward over it with the right and left foot, ten times. Figure 18. Figure 19. No. 45. Stand upright, heels together, grasp the wand at the ex- treme ends and i.old it behind the body, keeping the arms straight. The right hand high up, and the left hand low down. Now swine the left hand high up, and the right low down, and so continue tr change the relative positions of the end of the wand, without bendins; the elbow, ten times. No. 46. Charge the right foot diagonally forward, as seen in Fig, 19, five times. Now the left foot with the left hand raised high, five times. Alternate five times. No. 47. Same as the last, except that when charging with the right foot, you raise the left hand high, and vice versa. The wand exercises from this point are performed in couples, and while marching. No. 48. Marching as represented in Fig. 20, leap sideways as far fis possible, first one foot, and then the other, without losing your relation to each other. No. 49. Putting the two wands together, and holding them as rep- resented in Fig. 21, leap sideways as before, being sure to keep the ind at the ex- [arms straight. Now swine JO continue tr ithout bendini PHYSICAL CULTURE. 755 shoulders back, and so leaping together, that the two will move as one person. Be sure to keep the arms quite perpendicular over the si.oulders. Figure 20. Figure 21. No. 50. One person walking directly behind the other, take hold of the extreme ends of the wands, and then allow the hands to rest on the shoulders. Marching in this way, at the word of command, " Up," Figure 23. Figure 22. ' I raise the wands as high as you can, and as the right foot goes forward ; thrust the right hand as far forward as possible, the left one at the same 1 time being pushed as far back as possible {Fiff. 22), and as the left foot comes forwcd, reverse the hands. 756 PHTSICAL CULTUBE. No. 51. Same as t.hft \»nt. PVAPnf +he right hand goes forward with the left foot, and the left hand with the right loot. In all these you must not bend the elbows, except when you are told to bend them. No. 52. Still keeping your arms perpendicular, carry both of your hands forward as far as you can reach with your right foot, and as you step your left foot forward, carry both hands as far back as you can reach, and thus continue for ten steps. No. 53. Same as the last, except that the hands go forward with the left foot, and backward when the right foot goes forward. Figure 24. Figure 26. No. 54. Bring the hands to the shoulders, and as the right foot steps forward, raise the right hands as high as you can reach. When the left foot goes forward raise the left hands, and bring down the right hands, and so continue to altern«ite ten times. No. 55. Same as the last, except the right hands go up as the left feet go forward, and the left hands with the right feet. No. 56. The two hands go up simultaneously with the stepping forward of the right feet, and come down as the left feet go forward. No. 57. Same as the last, except the hands go up as the left feet go forward, and down as the right feet go forward. Be sure in the last four exercises that the arras go up and down quite vertically. No. 58. Put the two wands together, and take hold of them with one hand, as represented in Fig: 23, and marching side by side, leap sideways right and left, keeping the wand as high as you can reach. No. 59. Partners change sides and repeat the same. No. 60. Carrying the wand as in Fig: 23, as you step forward with the right foot, bring the wand down so as to strike your right leg with the hand, and then as your left foot goes forward, carry the wand back to its vertical position, and so continue ten times. No. 61. Change sides with your partner, and do the same again, only bringing your wand down as the left foot goes forward, and rais- ing it as the right foot goes forward. No. 62. Cross the hands on the two wands placed side by side, but instead of holding them over the head, as in Fig. 21, let them hang down in front, and carrying them thus, leap from side to side. No. 63. Walking one in front of the other, and extending the arms horizontally, being careful not to bend the elbows, carry the rij^ht for- ward as far as possible with the right foot, as represented in Fig. 24, and simultaneously with this, carry the left foot backward as far as possible. When the left foot comes forward, let the left hand come forward too, and thus alternate. No. 64. Same as the last, except that the right hand comes for- ward with the left foot, and vice versa. No. 6o. The same, simultaneously with the right foot and with the left foot. Be careful in the performance of the last four, that you keep the arms exactly horizontal from first to last. No. 66. Walking one in front of the other, with the wands hang- ing in the hands on either side, carry one up as high as you can reach, as in. Fig. 25, and then as the other foot goes forward, carry up the other while the first is brought down. No. 67. Same as last, except the right arms goes up as the left foot goes forward, and vice versa. No. 68. Simultaneously up, with the right foot forward, ten times, and the same with the left foot. It is perhaps unnecessary to repeat that every motion with the wands is to be done to music. In making the changes from one exercise to another, this rule must not be forgotten. It must not be forgotten that the feet, iu every exercise, are to be kept at right angles with each other. Gymnastic "rown. T'; «ii.,%si burthens on the head results in an erect spine and an elas- tic g,, Observiii,'^ persons who have visited Switzerland, Italy, or the Gull States, have observed a thousand verifications of thi^ physiological law. Cognizant of the value » *' t! is feature of gymnaftic training, I have employed, for this purpose, -.vithin the last twelve years, various sorts of weights, but have recently invented an iron crown, which I think completely satisfactory. The accompanying cut gives a good idea of its general form. I have them made to weigh from three to one hun- '■'id pounds. The crown is so padded within, it rests pleasantly on ■ e.tire top of the head, and yet so arranged that it requires skill 'linue it. It is beautifully painted, and otherwise ornamented. « 758 PHYSICAL CULTURE. The following suggestions are important in wearing the crown : Wear it five to fifteen minutes, morning and evening Hold the body erect, hips and shoulders thrown far back, and the crown rather on the front of the head, as shown in the cut. Walking up and down stairs while wearing the crown is good, if the low- er extremities are not too much fa- tigued by it. When walking through the hall or parlors, turn the toes, first, inward us far as possible ; second, out- ward ; third, walk on the tips of the toes ; fourth, on the heels ; fifth on the right heel and left toe ; sixth, on the loft heel and right toe ; seventh, walk with- out bending the knees; eighth, bend the knees, so that you are nearly sit- ting on the heels while walking ; ninth, walk with the right leg bent at the knee, rising at each step on the straight left leg ; tenth, walk with the left leg bent, rising at each step on the straight right leg. With these ten diflferent modes of walking, the various muscles of the back will receive the most invigorating exercise. All persons, of both sexes and of every age, who have round should- ers or weak backs, are rapidly improved by the use of the gymnastic crown. The Pangfymnastikon. The Germanic natioi.:.lity has been redeemed from political and social degredation by gymnastics. I coifld mention a score of emi- nent German writers and patriots who freely admit that the physical invigoration of the German people, through the universal practice of gymnastics, was the foundation of the subsequent moral revolution. The soul is so interwoven with and dependent upon the body, that when the body is sick the soul must suffer with it. If the foun- dation give way, the superstruction must soon fall ; and while the ex- istence of a good foundation does not necessitate a superstruction, the latter cannot exist without the former. Gluttony, drunkenness, licentiousness, and other vices so under- mined the German constitution, that adventurers and tyrants found Germa y an easy prey. Gutsmuth, Jahn, Eiselen, Opiess, and their fellow-workers turned back the tide of physical degeneration and death. Inspired with the noblest patriotic instincts, they gave their lives to the introduction of gymnastics as an integral part of the na* us muscles of PHYSICAL CULTURE. 759 tional education. They clearly saw in a physical redemption, the foundation of a political redemption. The great German heart turns to-day toward these great gymnastic reformers as the falvation of their noble nationality. It may be justly claimed that among all the great and good patriots who have devoted themselves to this momentous task, the great Schre- ber of Leipsic was the most eminent. He was a voluminous author, and the most remarkable of his productions was the Ptuig-i/ntnastikotL He was in the habit of speaking of this invention and tlie book describ- ing it as the most important of his contributions to the cause of physical culture. That work I have translated, and reproduced the 108 cuts complete. The entire work with the cuts is published in my work known as the " New C4ymnasrics," published by Ticknor &c Fields, Boston. I will here say, that whoever desires to put up, for home use, a Pjingymnastikon, after Scb'-'- ber's design (and without doubt it is the best means for home trauiing ever devised), can obtain detailed de- scriptions of this apparatus, by sending a request to that ertect to Dr. Dio Lewis, Box 12, Boston, with a stamp to pay the return postage. With a complete illustrative cut, and •'ull descriptions in text, there will be no difficulty in understanding the invention. School-Desks and Seats. A RADICAL change m school furniture is needed. The seats and desks now used compel an attitude which results in a stooping form. Kiffure 1. Figure 2. The other day I stood an hour in the street and saw more than five hundred persons pass, not one of which was erect. Bending over the 760 PHYSICAL CULTURE. desks in otir schools would make us crooked if we were made of spring-steel. ^ The desk tops should be so arranged that it can be raised nearly to the perpendicular before the face of the pupil, and the book h<^'d in such a position which compels him to sit with head and shoulders well drawn back. Fig. 1 exhibits a fruitful source of stooping shoulders. Fig. 2 shows a better desk and the improved position of the pupiL Fig. 3 is a model desk. The top can be raised to any desired Figure 3. Figure 4. height, or let down to nearly the horizontal for writing exercises. On the desk top will be seen a bar which supports the book. This can be moved at pleasure and has a pair of fingers which will hold the book in any position. Fig. 4 shows two support-bars, an arrangement which must prove most convenient to students of the languages, and to those who have occasion to consult a dictionary while reading. The seat is easily ad- justed to any desiied height. The new Book-holder, patented Dec. 9, 1862, is destined to play an important part in the prevention of the round-shoulder deformity, and its certainty to produce erect forms will be seen upon an examination of the cut It may be used upon the ordinary desk, and is made to hold one, two or three books in a much better position than by the desk. It is exceedingly light and pretty. The inclination can easily be altered by raising the hook attached to the strap. The fingers, im- perfectly shown, keep the book open, and thus dispenses with the use of the hands. There is no chance in its use to sit stooping without bringing the face in direct contact with the book. When we remem- ber how many years children are engaged over their books, the great importance of this invention will be appreciated. It is cheap, and not liable to get out of order. Those wishing to procure such a holder can send to Dr. Warren, Bostoa mum PHYSICAL CULTURE. 761 e made of b it can be pil, and the h head and f the pupil any desired ereises. On k. This can will hold the I must prove 3se who have t is easily ad- ed to play an eforrnity, and I examination id is made to 1 than by the ion can easily le fingers, im- 3 with the use oping without ;n we remem- oks, the great sheap, and not such a holder History of gymnastics in the United States. I DO not purpose a general history of the Physical Culture Move- ment in this country. I shall speak of only one feature. I refer to the efforts to introduce physical education into young ladies' semi- naries. A consciousness of its need was deeply felt. Thoughtful ed- ucators know that education meant a preparation for the duties of life ; and they saw the graduates of these institutions, pass from the school into hopeless invalidism, not in rare instances, but as a rule. As the phrase goes, their ^^ education was finished," but the// too were finished. Their spines were unable to support their learned heads. Anxious fathers and mothers besought school manag(!rs to give their daughters' bodies a chance for life. Willing to respond, they announced, " Physical culture receives, in our institution, careful at- tention," etc. Generally they had no conception of what was meant by physical culture, and of course accomplished nothing. The girls under their charge who needed two or three hours of daily unre- strained, romping, laughing, and vigorous muscle training, were made to walk in solemn procession through the school grounds under a picket g^zhrd of maiden ladies, on proper days, and once or twice a week they were conducted through a series of dull calisthenic arm-motions, under corsets and long dresses. No wonder they " got through" with pale faces, drooping shoulders, and ruined health. I hazzard nothing in saying that the physical training given in ninety- nine hundredths of the female seminaries in the country has no value. How much benefit would be derived from musical training in these same schools if they employed a person who had no comprehen- sion of harmony ; or of mathematics, who had never learned the multiplication table ; or of reading and spelling, who did not know the alphabet? Physical education must be placed on the same basis as moral and intellectual training, and competent teachers employed ; otherwise it will as certainly fail as would the efforts to introduce pianno music, without a teacher who knew how the touch the keys so as to bring forth harmonious sounds. Parents and teachers are beginning to understand this. Patrons of schools now loudly demand tliat a three years course they give their daughters shall improve, shall educate, instead of spoil their bodies. A true change has begun. The graduates of the Normal Institute for Physical Education are in eager demand. Only two years ago, the principal of one of the most celebrated ladies' seminaries in the country wrote me a letter, of which the follow- ing is an extract: " I wish you would indicate the day on which yoa can give me an hour or two with the least inconvenience to youiselt I am determined to introduce your entire system, and as I know noth- ing of it, you must give me a good lesson." He thought it was a science which could be learned in two hours. Two years have passed away, and the same institution employs a lady teacher, thor- 96 762 PHYSICAL CULTURE. oughly trained, from my school, at an expense of $650 per year. Un. der her management all the young ladies of the institution devote more than an hour daily to thorough bodily training. What is now wanted is Ten thousand teachers. Young men and women can enter no pro- fession more favorable, useful, and profitable. Those who would pro- pare for this important work, should come to Boston, either on the second of January or the fifth of July, and enter the Normal Institute from which they can, with average capacity, graduate in ten weck.s, prepared to enter a noble and remunerative profession. I cannot close this brief consideration of the history of our efforts to introduce gymnastics into ladies' seminaries, without alluding to one or two successful attempts. Rev. George Gannett, Pemberton Square, Boston, has a first-class seminary for young ladies. He has recently added a largo hall to his already extensive establishment, with almost sole reference to physi- cal training; and he is pushing the work with commendable zeal. During more than two years I have had charge of this important de- partment in Mr. Gannett's institution, and can say that his earnest- ness is constantly increasing. The Maplewood Institute at Pittsfield, Mass., under the charge of Rev. Mr. Spear, is carrying on the same work with energy. The fine private school located at West Newton, Mass., under the management of N. T. Allen, Esq., is thoroughly alive in this vital de- partment. During more than two years I have had supervision of physical education in Mr. Allen's school. Graduates of the Normal School for physical education are en- gaged in many of the first young ladies' seminary in the country. The friends of a true education have occasion to rejoice and take courage. PRESCRIPTIONS. -RECIPES. TriESE prescriptions are numbered, and referred to by corresponding numbers in the treatment of the various diseases. This arrangement saves the troul)le of writing out each prescription every time it is wanted under the several disorders. When there are sev(!rai recipes, each of which is suitable in a certain stage of a comphiint, this plan affords the means of referring to them all in a little space, by simply giving their numbers. The doses named are always for groivn per- sons, unless it is otherwise stated. Great pains have been taken in preparing these prescriptions. A considerable portion of them are the favorite recipes of the most dis- tinguisli(d pliysicians, the world over. The classification of these recipes under separate heads, is necessa- rily very imperfect, and has been attempted only to jnake it more easy for me to refer to them while writing the book. The classifica- tion could only be applied to a part of them, however ; the rest are indiscriminately mixed. , » Pukes. Emetics. 1. Pulverized Ipecac, 1 scruple ; pulverized cayenne, 10 grains ; water, 2 ounces. Mix. To be taken at a draught. 2. Pulverized Lobelia, 1 oz. ; pulv. blood root, ^ oz. ; pulv. seneka, 1 scru- ple ; pulv. ipecac, 6 drams ; pulv. cayenne, 4 scruples. Mix. An excellent emetic in all cases where one is required. Dose. — One-half teaspoonful ia warm water, and repeat every fifteen minutes three or four times. 3. Wi7ie of Antimony, 1 dram ; wine of ipecac, 1 oz. Mix. 4. Tartar Emetic, 1 grain ; pulverized ipecac, 1 scruple. Mix. To be taken in a wine-glassful of swe(!tened water. Purges. Cathartics. 5. Precipitated Sulphur, 15 grains; magnesia, 1 scruple. Mix. To be taken each night at bedtime, for costiveness and bleeding piles. 6. Confection of Senna, 2 ozs. ; cream of tartar, 1 oz. ; sulphur, 1 oz. j iyrup of ginger enough to make a stiff paste. Mix. A piece as large as a nutmeg is to be taken as often as necessary to keep the bowels open. One of the very beat remedies for piles. nil 3- ^ , > *> 'Ui 764 PRESCRIPTIONS. — RECIPES. 7. Jiocheik Saltt, 2 drams ; bi-carbonate of soda, 2 scruples ; water, ^ pint. Mix. To this mixture add 3d grains of tartaric acid, and take the whole fotw.nng. This is the recipe for Seidlitz powders. 8. Calcined Magnesia, 1 dram; water, 2 ozs. Mix. To be taken at a draught. 9. Sulphate of Magnesia, (epsom salts), 2 drams ; freshly roasted coffee in coarse powder, 2 scruples ; hot water, 4 ozs. Mix and boil for three minute:), and strain. This may be sweetened, and taken every morning for habitual cos- tiveness, or repeated once in three hours, if an immediate effect is desired. 10. Castor Oil, 1 oz. ; the yolk of one egg ; put together, and add, simplti syrup, ^ oz. ; peppermint water, 2 ozs. Mix. To be taken at a draught, after being well stirred or shaken. 11. Sulphur, 1 dram; cream of tartar, 2 drams. Mix. To be taken in syrup or molasses. 12. Rhubarb, 10 grains ; calcined magnesia, ^ dram. Mix. To be taken in syrup or molasses. 13. Powdered Senna, ^ dram ; powdered jalap, 10 grains ; powdered cloves, 10 grains ; Mix. To be taken in sweetened water. 14. Powdered Jalap, 10 grains; cream of tartar, 2 drams. Mix. To be taken in syrup or molitsses. 15. Fluid Extract of Senna and Jalap, 2 drums; infusion of cloves, 2 ozs. Mix. To be taken at a draught. 16. Castor Oil, 1 dessert spoonful ; oil of turpentine, 1 dessert spocnful. Mix. 17. Castor Oil, 1 dessert spoonful : magnesia, 1 dessert spoonful. Rub together into a paste. By this combination, the taste of the oil is almost en- tirely concealed, and children will take it without opposition. 18. Sulphate of Magnesia, 1 oz. ; cream of tartar, 1 oz. ; pure water, 1 pint. .Mix. A wine-glo^ssful occasionally. 19. Compound Extract of Colocgnth, ^ dram ; blue pill, 8 grains. Mix, and divide into 8 }nlls. 20. Epsom Salts, 2 ozs. ; tartar emetic, 1 gvain ; spearmint water, 1 pint. Mix. 21. Senna, 3 drams ; salts, | dram ; manna, j^ dram ; fennel seed, 1 dram ; boiling water, ^ pint. Macerate for one hour in a covered vessel, and strain. Take a teacupful once in four hours, till it operates. 22. Aloes, 2 scruples ; carbonate of pota^sa, 15 grains ; decoction of barley, \ pint. Mix, and rub together. 23. Mix. Mix. One dessert spoonful, Sulphur, 1 teaspoonful ; cream of tartar, 10 grains ; saltpetre, 5 grains. To be taken at a dose. 24. Manna, 2 drams ; fennel water, 1 oz as a cathartic for an infant. 25. Compound Infusion of Senna, 4 ozs. ; caraway water, 2 ozs. ; tartrate of potassa, 2 drams ; manna, 1 dram. Mix. A tablespoonful for a child, to relieve costiveness. 26. Calcined Magnesia, 1 scruple ; pulverized rhubarb, 1 scruple ; pulver- ized ipecac, 1 grain. Mix. Give one-fourth of this daily. >e taken at a ) be taken ir To be taken ssert spocnt'ul. 27. Epnotn Salts, 2 drams ; dissolve in pure water, 1 oz. Then add sweet gpirits of nitre, 2 dramti ; laudanum, 10 drops. Dose.— -A teaspountul, to be repeated according to circumstances. 28. Pulverized Rhubarb, 1 scruple ; leptandrin, 10 grs. ; calcined magnesia, 2 scruples ; pulverized cinnamon, 10 grains. Mix. Three or four grains ever/ tliird hour, to a child of six months. 2!>. Compound Ertract of Cofocynth, ^ dram ; extract of jalap, 15 grains. Mix. Make 12 pills. Two or three pills will produce active operation of tlia bowels. 30. Pulverized Senna, 2 drams ; bicarbonate of potassa, 2 ozs. ; pulver* {zed cayenne, 10 grains ; pulverized jalap, 1 dram. Mix. Divide into 18 parts. One part for an adult every four hours till it operates. 31. Pulverized Cfamboge, 12 grs. ; pulv. scammony, 12gra. ; claterium, 2 grs. ; croton oil, 8 drops; ext. of stramonium, 3 grs. Mix. Make 12 pills. One pill is a dose, repeated every hour until it operates. 32. Pulverized Scammony, 1 2 grs. ; pulv. gamboge, 1 2 grs. ; pulv. colocynth, 8 grs. ; castile soap, 4 grs. ; oil of anise, 5 drops. Mix. Make 12 pills. One pill, repeated every three hours till it operates. 33. Pulverized Scammony, 6 grs. ; croton oil, 4 drops ; pulv. loaf sugar, 1 S teaapoonfuls. Rub well together in a mortar. Give one teaspoonful every hour or two, to a child 7 years old, till it operates. 34. Leptandrin, 1 dram ; jiodophyllin, 1 scruple ; scutillarine, 2 drams ; pulv. cayenne, 1 scruple ; pulv. loaf sugar, 4 ozs. Rub together for some time in a mortar. Dose for an adult, -^ of the above. 3 "). Pulverized Rhubarb, 2 scruples ; bicarbonate of potassa, 1 scruple ; ext. of nux vomica, 5 grs. Mix. Make 20 pills. One pill twice a day. 36. Leptandrin, 1 dram ; podophyllin, 1 scruple ; apocynin, 1 scruple ; ext. nux vomica, G grs. ; castile soap, I dram. Make 30 pills. One pill every night. 37. Sweet Tinct. of Rhubarb, 4 ozs. ; bicarbonate of soda, 2 drams. Mix- From a teaspoonful to a tablespoonful, as occasion may require. 38. Pulverized Rhubarb, 2 ozs. ; bicarbonate of potassa, 1 oz. Mix. Of this take enough to produce one movement of the bowels per day. 39. Leptandrin, 30 grs.; podophyllin, 10 grs.; pi.lv. cayenne, 10 grs.; ext. nux vomica, 6 grs.; quinine, 12 grs. Mix. Make 24 pills. One, two, or three times a day. 40. Podophyllin, 15 grs. ; leptandrin, 2 scruples ; cream of tartar, 5 scru' pies. Mix. Divide into 10 powders. One is a dose. 41. Comp. Powder of Jalap, 1 oz.; cream of tartar, 1 oz. Mix. Ono te* spoonful is a dose, to be taken in sweetened water. 42. Pulverized Charcoal, \\ drams; pulverized rhubarb, 2 scruples; pul- verized ipecac, 6 grains ; extract of hyoscyaraus, 12 grs. Mix. Divide into 12 portions. Give one every three or four hours, 43. Pulverized Blood-root, 1 dram ; pulv. rhubarb, 1 dram ; castile soap, 2 scruples. Mix, and divide into 32 pills. Take one morning and night. Ex- cellent for costiveness. 766 rHESCRIPTlONS - UKC'Il'ES. 44. Jiorhelle, 14 drams; nuif^nesia, 11 ilrams ; jiowdcred charcoal, 8 (Irums. Mix, Dose. — A heaping teaspooniul in dyspepsia and costivencsu, with foul breath, etc. 45. Pulverized Mlinkirb, 8 prs. ; pulv. guaiacnm, 8 grs. ; galbanuni, 2 gra. ; pulv. ipecjic, 2 grs. Mix. Maiic 8 ])ills. Take one to two pills night and morning. For a weak Htomach, and u biliouH condition. Tonic and Cathartic. 46. Podophi/llin, 4 grs.; loptandrin, 8 grs,; quinine, 8 gra. ; ext. nux vom- ica, 2 gra. Mix. Make 10 i)ills. One, two, or three pills, at bed time, accord ing to the requirements of the cjise. 47. Sulphate of Iron, 1 8cru})le ; pulverized aloes, 2 scruples. Mix, and make into 20 pills. One pill twice a day. An excellent remedy, in chlorosis, when the bowels are confined. 48. Carbonate of Iron, 1 dram ; pulverized rhubarb, ^ dram ; pulver- ized aloes, ^ dram ; extract of hops, ^ dram. Mix. Make 30 pills. One pill three times a day. 49. Fluid Extract of Senna, 1 dram ; compound fluid extract of gentian, ^ dram ; fluid extract of ginger, ^ dram ; aromatic spirits of ammonia, I dram. Mix. To be taken in a wine-glassful of sweetened water. 50o Aromatic Syrup of H/mbarb, 1 oz. ; tincture of Colombo, 1 oz. Mix. Dose. — Two teaspoonfuls three times a day. 51. Compound Infusion of Gentian, 6 ozs. ; epsom salts, 4 drams ; diluted sulphuric acid, 16 drops. Mix. A table spoonful every six hours. 52. Blue Pill, 10 grs.; pulv. gum arable, 5 grs.; magnesia, 1 dram white sugar, 5 grs. ; comp. infusion of gentian, 1 ^ ozs. ; water, 1 ^ ozs. ; tiiict, of ginger, 1 J ozs. Mix. From a teaspoonful to a tablespoonful to be taken night and morning. 53. Pulverized Peruvian Dark, 1 oz. ; pulv. rhubarb, J dram ; p''lv. muri- ate of ammonia, 1 dram. Mix. Divide into eight powders. Take one three times a day. 54. Oxide of Zinc, 2 drams; magnes., ^ oz. ; quinine, 1 scruple. Mix. Divide into 32 powders. Take one four times a day, 65. Aloes, 1 oz. ; gentian, 1 oz. ; orange peel, 1 oz. ; juniper berries, 1 oz, ; aniseed, bruised, 1 oz, ; gin, 1 pint. Mix. Macerate two weeks, and strain. Dote. — A tablespoonful. Good for bilious habits. Oarminative Physic. 66. Manna, 1 oz. ; aniseed, bruised, 1 dram ; boiling water, J pint. Mix- Let the mixture stand for half an hour, then strain, and add three drams of carbonate of magnesia so as to make a perfect mixture. Take a wine-glass fiiU every two or three hours, till it operates. For the drum-head state of the bowels. 57. Thoroughwort, 2 ozs. ; ginger and cloves, each, \ oz. ; ext, dandelion, 4 ozs.; water, 1^ pints. Boil to one-third, and add sugar, 1^ pounds, and brandy, J pint. An excellent cordial cathartic to act upon the liver. ruKscim'TioNs. — kkcipks. 767 Tonics. !')H. Chatnnmile Flowers, \ oz. ; cold wattT, I pint. Macorat*! for one hour uiid Htrain. A wiiic-gliussfiil to Xw. taken sovt.'ral tiint's a diiy. AO. Sulphate of Qiitnine, lo grains ; dilutctl ^siilpliuric acid, lo drops ; cotiipound tinctui't' of uirdani., 3 drain.s ; linctiirc of hops, li drams ; compound, infusion of rosos, ('» ozs. Mix. A tcaspoouful two or tlin-c timcsi u day, ia calorosis. fiO. Diluted Sulphuric Acid, 2 di'ams ; syruj) of orungn peel, 2 ozs. ; c>inn»« mon water, 1 o/.. Mix. A teaspounful or two in a wiiiehate of morphia, 1 gr. ; ext. of nux vomica, 5 grs. Mix. Make 24 pills. For an adult, one pill three times a day. 81. Ext. of Scullcap, 2 drams ; ext. of chamomile, 2 drams ; ext. of boneset, 1 dram ; quinine, 1 dram ; pulv. cayenne, 1 scruj^'e ; oil of valerian, ^ dram. Beat well together and make i)0 pills. For an adult, one pill every two or three hours. 82. White Vitrio\ 1 dram ; ext. of nux vomica, 8 grs. Mix. Make 32 pills. One pill three times a day. 8?. Strychnia, 2 grs. ; ext. of aconite, 16 grs. ; ext. of hyoscyamus, 16 grs.; quinine, ^ dram. Mix. Make 32 pills. One pill three times a day. 84. Citrate of Iron, 1 dram ; trisnitrate of bismuth, 1 dram ; sulphate of quinia, 1 scruple : ext. of nux vomica, 6 grs. Mix. Make 32 pills. Take one pill three times a day. Nerve Tonics and Antispasmodics. 85. Strychnine, 2 grs. ; ext. belladonna, 5 grs. ; alcoholic extract of hlacl cohosh, 2 scruples. Mix. Make 40 pills. One pill four times a day. 86. Strychnine, 2 grs. ; diluted phosphoric acid, 1 oz. ; pcnpermint water, 8 pints. Dissolve the strychn le in the acid ; then add the peppermint whIh'. A taijiospoonful to be taken three times a d'ly, in palsy, dyspepsia, ncuralgiii, and in most states of the nervous system rt';*i!" of lemon, 12 4 oza. Mix. insanity. ; ext. of mix . infusioa of drop. Mix. sd. Irams ; syrup il in a wine B I dram; ext ill, every one, 1 ext. of nux B times a day. St. of boneset, irian, ^ dram, i every two or X. Make 32 imus, 16 grs.; lay. ; sulphate of piUs. Take tract of Nad day. lermint water, )ennint water, sia, nouralgiii, » in fever and oz. ; scullcnp, tlioe to a i>int I i;si)Oonrul lour >onato of am- of valerian, 2 PRESCRIPTIONS. — RECIPES. 769 89. Ext. of Valerian, 12 grs.; ext of hyoscyamus, 12 gr?. ; oxide of sine, 21 grs. Mix. Make 12 pills. One pill twice a day. 90. Sulphate of Morphia, 2 grs. ; cyanide of potassium, 4 grs. ; ext. of valerian, 4 grs. Make 24 pills. One pill three times a day. 91. JSxt. of Hyoscyamus, ^ dram; sulphate of morphia, 3 grs.; strych- nine, 2 grs. ; pulv. cayenne, ^ dram ; sulphate of zinc, 15 grs. Make 30 pills. Take one four times a day. Excellent in neuralgia. 92. Eri. of Hyoscyamus, ^ dram ; valerianate of zinc, 1 scruple. Mix. Make 30 pills. Take one, two or three times a dry, for neuralgia of the face. 93. Ext. of Hyoscyamus, J dram ; valerianate of iron, 1 dram. Mix. Make 30 pills. Give from one to three a day. F >r neuralgia, in its various forms. 94. Tin:', of Black Cohosh, 2 ozs.; tinct. of skullcap, 2 ozs. Mix. One tea^poonful from two to five times a day. 95. Alcoholic Ext. of St. Ignatius's Bean, 30 grs. ; pulv. gum arable, 10 grs. Make into 40 pills. Take one pill three limes a day. 96. Simple Syrup, 1 oz. ; prussic acid, 1 drop. Mix. A teaspoonful morn- ing and evening. If no dizziness or sickness is produced within forty-eight hours, repeat the dose three times a day. This is tor a child six months old ; a** ; one drop more of the acid for each additional year of the child's age. 97. Comp. Pill of Galbnnum, 1 dram ; comp. pill of valerian, 1 dram. Mix. Divide into 40 pills. One oi two pilis three times a day. 98. Sulphate of Zinc, 1 dram ; cyinp. gulbanum pill, J dram ; ext. of fycscyamus, 1 scruple. Mix. Make 32 pilL. One pill three times a day. For St. Vitus's dunce. 99. D oscorein, 12 grs.; pulv. camphor, 4 grs.; pulv. cayenne, 12 grs.; white sugai, 1 scruple. Mix. Divide into four powders. Give one every 15 minutes. 100. Ext. of High Cranberry Bark, 1 scruple; cypripedin, 1 scruple; aletridin, 1 scruple ; pulv. cayenne, 1 scruple. Mix. Make 20 pills. Take one pill an how after each meal. Alteratives and Tonics. 101. Iodide of Potassium, 1 oz. ; cojnpound infusion of gentian, or infusion of quassia^ 6 ozs. Dose. — A tables|KX)nful, for secondary and tertiary syphi- lis, and oth'jr complaints. A teaspoonful tor a child. 102. Iodide of Iron, A dram ; compound tincture of nlombo, 1 oz. ; pure water, 7 oz:<. Mix. A tiiblespoonful three times a day. '03. Syrup of Iodide of Iron, 1 oz. Thirty drops three times a day, in water. An excellpnt remedy in chlorosis, and all other low states of the blood connected with .scrofula. Expectorants and Cough Preparations. 104. Tartar Emetic, 1 grain ; boiling water, 10 drams. Mix. Take one tcaspoonfu' every two hours. . 97 =L) ill ,'t:' 770 PRESCRIPTIONS — RECIPES 105. Infusion of Senega, 4 ozs. ; syrup of ipecac, 1 dram ; syrup of squills, 3 drams ; tartar emetic, 1^ grains. Mix. A tea^spoonful every ten minutes. 106. Tincture of IjobeUa, J oz. ; syrup of squills, .V oz. Mix. Twenty droi)s four or five times a day for a child two years old. 107. Peppermint Water, G ozs. ; epsom salts, 1 oz. ; tartar emetic, 1 grain, Mix. Two tables{)oonfuls every four hours. 108. Hydrocyanic Acid, 25 drops ; wine of ipecac, 2 drams ; syrup of tolii, 1 oz. ; soft water, ;} ozs. Mix. A teaspooiiful four or live times a da,y. An excellent remedy in hooping cough. 109. Tinct. Blood-root, 1 oz. ; laudanum, 2 drams ; wine of ipecac, 4 drams ; syrup of tolu, 2 ozs. Mix Dose from 30 to 60 dro])s four times a day. 110. Tinct. Blood-root, 1 oz. ; sulphate of morpliia, \\ grains; tinct. digi- talis, \ oz. ; wine of antimony, i oz. ; oil of wintergreen, 10 drops. Mix. Dose from 20 to 40 drops twice or three times a day. J^xcellent for a hard, dry cough. 111. Tinct. of Lobelia, ^ oz. ; tinct. of blood-root, 2 ozs. -, oil of spearmint, }j dram ; molasses, 5 ozs. Take one-half a teaspoonful as often as needed. 112. Syrup of Tolu, 1 oz. ; syrup of squills, ^ oz. ; wine of ipecac, 2 f.rs.; paragoric, 3 drs. ; mucilage of gum arabic, Ij- ozs. Mix. Take a teaspoonful ^occasionally. 1 13. Tinct. Blood Root, 2 drams ; syrup of tolu, 1 oz. ; mucilage of gum arabic, 3 ozs. ; diluted hydrocyanic acid, 40 drops ; sulphate of morphia, 2 grs. Mix. Dose, from one to two teaspoonfuls. GarminartiTes. 114. Bruised Cloves, 2 drams ; boiling water, 1 pint. Macerate for two hours in a covered vessel, and strain. A wine-glassful to be taken occasion- ally. 115. Comp. Tinct. of Gardamonij 2 ozs.; comp. tinct. of lavender, 2 ozs.; comp. tinct. of gentian, 2 ozs. Mix. One teaspoonful at a time, as occasion may require. ^ Narcotics and Anodynes. 116. Extract of Jfyoscyamus, 1 scruple ; gum camphor, 1 scruple ; Dover'si powder, 1 scruple. Mix, and make into 20 pills. Dose. — One twice a day, for painful menstruation. 117. Powdered Camphor, 12 grains; powdered castile soap, 12 grains; powdered opium, 12 grains ; syrup, 2 scruples. Mix. Make into 12 pills. Take one every hour till the effects of opium are experienced. 118. Laudanum, ^ oz. ; wine of ipecac, J oz. ; spirits of nitric aether, J oz. Mix. One teaspoonful every hour, till narcotic effects are observed. 119. Camphor, 2 drams ; chloroform, 1 dram ; the yolk of an egg. Mix, and rub together ; and tiien add, tinclure of opium, 1 oz. ; aromatic spirits of ammonia, 1 oz. Mix well. Take one teaspoonful every hour until it proves anodyne. 120. Camph ' ^ dram ; extract of opium, 6 grains ; muc>lage of gum arabic^ 2 scruples. Make 10 pills. 121. Chloroform, 2 ounces; compound sulphuric ether, 2 ozs. ; Inudanum, 2 ozs. ; tinct. cayenne, H ozs. ; hydrocyanic acid, diluted, ^ oz. Mix. Dose. — Haifa teaspoonlul every three hours till anodyne effects are experienced. 122. JUxt. of Belladonna, 10 grs. ; hydrocyanii^ acid, 40 drops; tinct, coiombo, 1 oz. ; simple syrup, 1 oz. ; soft water, 2 ozs. Mix. One teaspoonful three or four times a day. Excellent in gastralgia .and irritable dyspepsia. Also in iisthma. 123. £!xt. of Belladonna, 6 grs. ; ])ulv. ipijcac, 10 grs. ; confection of roses, 2 grs. Mix. Make (i(> pills. Take 1 pill twice a day. Diaphoretics and Sedatives. 124. Tinct. of American Hellebore, 1 dram ; tinct. of black cohosh, 2 ozs. * Mix. Take one teaspoonful from three to six times a day. I^xcellent for Neuralgia. 12.*). Pulverized Gum Arabic, 1 scinple ; soft water, 2 ozs. ; sweet spiints of nitre, ^ oz. ; tinct. of verati-um viride, 20 drops. Mix. Give half a teaspoon- ful every half hour. 126. Piilv. Blood-root, 2 dnuns ; pulv. golden seal, 2 drams ; pulv. sumach berries, 2 drams ; pulv. b.ayberry bark, 2 drams. Mix. Make an infusion in a pint of hot water, and give a t^iblespoonful every half hour. To produce perspiration. 127. Pulverized Camphor, 2 grs., pitlv. nitrate of potash, 2 grs.; pulv. opium, 1 gr. Mix. Make two powders. Take one on going to bed, in rheumatism. Diuretics. 128. Tincture of Digitalis, 1 oz. ; syrup of squills,! oz. Mix. Ten drops for a child 7 years old every four hours. 129. Nitrate of Potassa, 2 scruples ; water, 1 4^. suit Mix. Flavor to 130. Infusion of Digitalis,^ ozs.; acetate of potash, 2 di uus ; sweet spirits of nitre, 2 drams; cinnamon water, 1^ ozs. Mix. A tables !>oonful every four or five hours. 131. Spirits of Mindererus, 2 ozs.; sweet spirits of nitre, 1 oz. Mix. Take one teaspoonful every three hours. Refrigerants. 132. dream of Tcrrtar, 2 scruples ; water, 1 quart. Mix. Flavor to suit. 133. Bicarbonate of Soda, 30 grain-s; water, 6 ozs. Mix. To this mix- tore add 25 grains of tartaric acid, and tiike the whole foaming. Stimulants. 134. Muriate of Ammonia, 1 oz. ; soft water, 9 ozs. Mix. Take one table spoonful three or four times a day. if i IM 772 PRESCRIPTIONS. — RECIPBS. 135. Aromatic Spirits of Ammonia, 2 drams; ether, 1 dram; laudaaum, 20 drops ; spirits of camphor, 1 dram. Mix. Half a teaspoonfiil as often m required. Alteratives. 136. ProtO'iodide of Mercury, 10 grains ; extract of opium, 5 grains. Mix. Make 20 pills. Take one pill night and morning. 137. Biniodide, of Mercury, 5 grains ; extract of conium, 2 scruples. Mix. Make 20 pills. Take one pill night and morning. 1 38. Compound Infusion of Sarsaparifla, 1 pint ; iodide of potassium, ]f oz. Mix. Take a teaspoonful after each meal. 139. Compound Infusion of Sarsaparilla, 1 pint ; corrosive sublimate, 4 grains. Mix. Take a teaspoonful four times a day. 140. Compound Infusion of Gentian, 4 ozs. ; iodide of potassium, \ at. Mix. One teasi)oonful after each meal. 141. Iodide of Arsenic, 5 grains ; soft water, 1 pint. Mix. One tea- spoonful three times a day. 142. Blue Pill, 12 grains; pulverized ipecac, 3 grainij ; extract of hyos- cyamus, 4 grains. Mix. Divide into 12 parts, one to be given every three hours. 143. Pulverized Blood Root, 1 scruple ; iodide of arsenic, 2 grs. ; ex- tract of cicuta, 2 scruples. Mix. Make 40 pills. One pill three times a day. 144. Iodide of Potassium, 1 dram ; water, ^ oz. Mix. Thirty drops to a child 7 years old, every hour. 145. Comp. Syrup of StiUingia, 1 pint; iodide of potasi^ium, 1 oz. Mix. A tablespoonful after each nical. 146. Fluid Ext. of Sarsaparilla, 4 ozs.; fluid ext. of pipsissewa, 1 or,; water, 1 quart ; iodide of potassium, 2 ozs. Mix. Take a tablespoonful three times a day. 1 47. Bicarbonate of Potassa, 3 drams ; water, 4 ozs. Mix. Add a table- spoonful of the solution to the same quantity of lemon juice, previously mixed with a tablespoonful of water. To be taken foaming, several ilmes a da^ . 148. Blue Pill, ^ dram; extract of henbane, 1 scruple. Make 10 pills. One pill at night. 149. Mercury with Chalk, \ dram ; extract of conium, 1 scruple. Make into 8 pills. Take one pill night and inurning. 150. Corrosive Sublimate, 4 grains ; extract opium, 5 grains. Mix, and make into 20 pills. Take one pill night and morning. 151. Iodide of Potassium, 1 dram ; syrup of sarsaparilla, 4 ozs. Mix. Take two teaspoonfuls three times a day. Astringents. 152. Sugar of Lead, 2 scruples; opium, 1 scni, le; conserve of red roses, 1 scruple. Beat into a mass, which is to be divided into 30 pills. Take one every hour, until narcotic effects are observed. n; laudaBum, nl as often m grains. Mix. sruples. Mix. of potassium, live sublioiate, jtassiam, { or. [ix. One tea- xtract of hyo8- en every thr^e ic, 2 gre. ; ex- 1 three times a Tliirty drops im, 1 oz. Mix. )9i8sewa, 1 o?.; espoonful three Add a table- reviously mixed nes a day. Make 10 pilk scruple. Make rins. Mix, and 4 0Z8. Mix. ve of red roses, ilia. Take one PRESCRIPTIONS. — RECIPES. 773 n 153. Dover's Powder, ^ dram ; prepared chalk, 1 scruple. Mix, and divide into 12 equal powders. 154. Chalk Mixture, 4 ozs. ; tinct. of catechu, ^ oz. ; laudanum, 1 dram. Mix. Dose, in diarrhcea, Lvro to four teaspoonfuls three times a day. 155. Oil of Turpentine, 1 dram ; mucilage of gum arabic, 1 dram ; simple syrup, ^ oz. ; cinnamon water, 2 ozs. Mix. To be taken at a draught. 156. Sugar of Lead, 16 grains; prepared chalk, 1 dram; pulverized ipecac, 4 grains ; pulverized opium, 2 grains. Mix. Divide into 16 portions, one to be given every three or four hours. . 1 57. Sugar of Lead, 8 grains ; vinegar, 8 drops ; white sugar, 1 dram j Boft water, 1 oz. Mix. A teiispouaful tliree or four times a day, until thv-? dis- ' charges are abatc«l. 158. Prepared Chalk, ^ dram ; pulverized ipecac, 3 grains. Mix. Make 12 powders. Give one, two or three times a day. 159. Pulverized Catechu, 2 drams ; bruised cinnamon, ^ dram ; boiling water, 5 ozs. Steep in a covered vessel for one hour, and strain. A teaspoonful every two, three, or four hours, according to age, nature of tlie case, etc. 160. Soft Water, 1 oz. ; sugar of load, 5 grains; vinegar, 6 drops; loaf sugar, 3 drams. Mix. A teai»poonful every hour or two. 161. Tinct. of Catechu, ^ oz.; laudanum, 2 drs. ; spirits of camphor, 2 drs.; tincU of niyrrhae, 2 drs. ; tinct. of cayenne, 2 drs. Mix. Dose, from half a teaspoonful to a teaspoonful, for diarrhoea. 162. oyrup of Orange Peel, 1 oz. ; acetate of morphia, 2 grs. ; tinct of cinnamon, 6 drs. ; tinct. cardamom, 2 drs. Mix. Dose. — A teaspoonful. A valuable remedy in diarrhoea. ■^ Counter-irritants. 1 63. Tincture of Spanish Flies, 1 oz. ; olive oil, 2 ozs. ; alcohol, ^ pint. Mix. To be applied externally, watching the effect, so as not to produce a blister. 164. Water of Ammonia, 1 dram; olive oil, 1 oz. Mix. Apply to the skin. 165. Mustard Poivder, 1 tablespoonful. Mix with a little water to mike a thick paste. Then spread upon a piece of brown papt;r or cotton cU th, and cover its surface witli a piece of thin muslin to prevent the mustard from sticking to the flesh. Place it upon the sort or riainful part, and keep it on fifteen or twenty minutes, or till a good degree of r less is produced. 166. Vinegar of Spanish Flies, 1 oz. ; spirits of camphor, 1 oz. Mix. To be rubbed gently upon the skin. If applied freely, and rubbed thoroughly in, it may protluce a blister. 167. Yellow Wax, Rosin, Lard, each, 6 drams. Melt over a slow fire, and then stir in slowly, when at a very moderate degree of warmth, 1 ^ drams of pulv. Spanish flies, to make an ointment. 168. Water of Ammonia, strong, 1 oz. ; alcohol, 1 oz. Mix. Wet a piece of cotton cloth, and lay it upon the painful part, and cover it with flannel to prevent evaporation. \¥M ,1 -^^ii ,.'i'vv : ^,' ..(.6 ., , . f '^m/ff^,^ 774 PRESCRIPTIONS. —RECIPES. Ointments. 169. Mercurial Ointment, 1 oz. ; extract of belladonna, 1 oz. ; extract of henbane, 1 oz. ; camphor, 10 grains. Mix. For external use. 170. Extritct of Belladonna, J dram ; lard, ^ oz. Mix. To be rubbed )n the neck of the womb in painful menstruation. 171. Prussic Acid, 2 drams ; sugar of lead, 1 dram ; cocoa-nut oil, I oz.j lard, 1 oz. Make an ointment. 172. Neapolitan Ointment, 2 drams ; extract of belladonna, 1 dram. Mix. 173. Extract of Pelludouna, 15 grains; lard, 1 oz. Mix. 174. Sulphurct of Lime, 1 dram; camphor, in powder, 1.0 grains; lard, 1 oz. Make an ointir.ent. 175. Elder-Flower Ointment, 1 oz. ; oxide of zinc, 1 dram. Make an ointment. 176. Oxide of Zinc, 1 dram ; spermaceti ointment, 1 oz. Mix. 177 Napthaline, 2 scruples ; lard, 1 oz. Make an ointment. To be epread upon linen, and applied to the diseased skin night and morning. 178. Mild Nitrate of Meroiry Ointment, 3 drams ; sugar of lead, 16 grains; rose-water ointment, 1 oz. 179. Laudanum, \ dram ; sulphur, \ dram ; oxide of zinc, 1 dram ; oil of almonds, 1 oz. ; lard, 3 ozs. Make an ointment. 180. on re Oil, 4 ozs.; white wax, 2 drams. Melt these together, and then add honey, 2 drams ; croton oil, 20 drops. 181. Elder-Mower Ointment, 1 oz. •, pulverized blue vitriol, 1 scruple. Make an ointment. 182. Purified Beeves^ Marrow, or lard, 6 drams ; oil of sweet almonds, 2 drams ; pulverized Peruvian bark, 1 dram. Mix. 183. Pulverized Sulphate of Copper, 10 grs ; extract of Spanish flies, 5 grs. ; lard, 1 oz. Mix. Rub into the scalp. 184. Iodide of Lead, 1 dram ; lard, 2 ozs. Mix. To be rubbed on the surface. 185. Iodide of Potassium, 1 dram ; lard, 2 ozs. Mix. 186. Basilicon Ointment, 1 oz. ; red precipitate, 1 dram. Mix. 187. Iodide of Potassium, ^ dram ; lard, 1 oz. Mix. 188. Veratria, 4 grs. ; lard, 5 drams. Mix. 189. Tobacco Leaves (fresh and sliced), 10 ozs.; diluted acetic acid, 4 pintaj basilicon ointment, 13 ozs. Boil the tobacco in the acid, strain, and evaponite the decoction to six ounces. Add this to the basilicon ointment, heated, and stir till cold. For gathered breasts. Liniments. 190. Sweet Oil, 1 oz. ; strong water of ammonia, 1 o«. Mix. To be rubbed on with a piece of flannel. PRESCR' PTIONS. — RECIPES. 775 191. Lime Water, 2 ozs. ; flax seed oil, 2 ozs. Mix. Apply outwardly. 192. Olive Oil, 1 oz. ; solution of potassa, 2 drams ; strong mercurial ointment, 1 dra"n. Mix. 193. Oliv; Oil, 4 ozs. ; oil of amber, 2 drams ; oil of rosemary, 2 drama. Mix. 194. Spirits of Turpentine, 1 oz. ; linseed oil, 1 oz. ; lime water, 1 oz. Mix. For ext(,'rrial uium liniment, J oz. Mix. For neu ralgia, etc. Apply a tea-spoonfnl to the painful part. 198. White Sonp, 12 o7s. ; camphor, G ozs. ; oil of rosemary, 1^ ozs. ; alco- hol, 4 pints ; opium, 3 ozs. Mix and filter. An excellent liniment, acting at times like a charm in the removal of local pains. 199. Sulphuric Acid, 1 dram ; spirits of turpentine, 1 dram ; olive oil, 3 drams. Mix the oil and spirits of turpentine flrsi, then gradually add the ■sulphuric acid. A valuable liniment for chilblains. To be rubbed on two or three times a day. Washes. Lotions, Gargles, etc. 200 Bruised White Oak Bark, 1 oz. ; water, 1 \ \ym\s. Boil down to a pint, and strain. To be used as a wash. 201. Borat" \>f Soda or Borax, 2 drams ; water, 4 ozs. Mix. To be used as a lotion. 202. Alum, 2 drams ; water, 4 ozs. Mix. To be used as a lotion. 203. Tannin, 1 scruple ; water, 4 ozs. Mix. For external use. 204. Bihorate of Soda, \ oz. ; rose 'vater, 6 ozs. ; sulphate of morphia, 6 grains. Mix. To be used as a wash in itching of the female privities. 205. - ply to the hair. 265. Nitrate of Silver, 1 dram ; nitric acid, 1 dram ; soft water, 1 pint ; sap green, 3 drams ; pulverized gum arable, 1 dram. Mix. Keep well corked. 266. Hydrosulphuret of Ammonia, 1 oz. ; liquor potassa, 3 drams ; soft water, 1 oz. Mix. Apply this with a tooth brush 15 or 20 minutes. Then brush the hair over with the following : — nitrate of silver, I dram ; soft water, 2 ozs. ; using a clean comb to separate the hair. Miscellaneous. Wine of Spurred Rye, 2 ozs. Dose. — One teaspoonful three times For profuse menstruation from a relaxed state of the womb. 267. a day. 268. Sulphate of Iron, 1 dram; sub-carbonate of potash, 1 dram. Mix, and make into 38 pills. One pill twice a day, and gradually increasing to four a day, in chlorosis. 269. Sulphate of Iron, 1 dram ; extract of hops, 15 grains ; extract of poppies, 15 grains ; oil of cinnamon, 15 drops. Mix, and make into 24 pills. One pill two or three times a day. 270. Oxide of Zinc, 2 drams ; ezt of cicuta, 2 scruples. Mix. Make 48 pills. PRESCRIPTIONS. — RECIPES. 779 Mix. Make 271. Pulverized Savin, 1 scruple; sulpliate of copper, 1 scruple. To bo sprinkled on veiiereul lumps or tumors, called condylomutu, on the i'emule geni' tills, or elsewhere. 272. lialsam of Copaiva, 1 oz. ; oil of cubebs, 2 drams ; laudanum, 1 dram ; mucilaj^e of gum arable, 2 ozs, ; swet;t spirits of nitre, \ oz. ; compound spirits of lavender, .'{ drams ; camphor water, 4 ozs. ; white sujjiir, 2 drams ; oil of partridge-berry, a drops. .Slix. Take a table-spoonful tliree or four timiis a day. For gonorrlui-a. 27.'3. liahttin of Cnpaira, 1 oz. ; pidverized onbebs, 2 ozs. ; essence of pefv permitit, •'{() drops. Make a thick paste, like doiigli. 27 1. Pulverized Borax, 1 oz. ; pulverized white sugar, 1 oz. Mix. A little to be dissolved on the tongue. 27.>. Pulverized Borax, J o?,. ; honey, 4 ozs. Mix. 276. Ifi/ilrochloric Arid, 1 drain ; honey, 1 oz. Mix. For touching large curdy palciies in -oie mouth of ciiildren. 277. Pulverized Ipecac, 3 grains ; precipitated sulphur, 2 scruples ; extract of hyo/cyainus, (> grains. Mix. Drvide into 12 parts. One to be taken every three or four hours. 278. Pulverized Belladonna-root, 5 grains , compound ipecac, jiowder, 10 grains ; precipitated sulphur, J, dram ; white sugar, 2 scruples. Mix. Make 20 i)owd«M's. One every three hours to a child two years old. 279. Pulverized Alum, 2.5 grains ; extract of cicuta, 1 2 grains ; syrup of red poppies, 2 drams ; spearmint water, 3 ozs. Mix. A dessert-s[»oonful every six hours for a child two or three years old. 280. Camphor, 1 dram ; sulphuric ether, 1 oz. IMix. Ten drops every half hour. 281. Pulverized Rhubarb, 1 scruple ; mercury with chalk, 10 grains ; aromatic powder, 5 grains. Mix. Divide into 10 powders. One every four or five hours. 282. Pulv. Blood-root, i to 1 oz, ; chloride of zinc, J to 2 ozs. ; water, 2 ozs. Add enough wheat Hour to make a paste as thick as molasses. 283. Sal. Volatile, ^ dram ; camphor water, 1 oz. Mix. 284. Tinct. of Nux Vomica, \ oz. ; tinct. aconite, 2 drams ; volatile tinct. of guaiacum, 2 drams. Mix. Thirty drops every three hours. 285. Tinct. af Black Cohosh, 2 ozs, ; tinct. of digitalis, 2 drams. Mix. One teaspoonful from two to five times a day. 28fi. Barberry Bark, 1 oz. ; pipsissewa herb, 2 ozs. ; wild cherry bark, 1 oz. ; bitter-root, 1 oz. Mix. Infuse for sevci'al liours in 4 pints of water One tablespoonful three or four times a day. 287. Horse Radish Root, 1 oz. ; bayberry bark, 1 oz- ; barberry bark, 1 oz. ; wild cherry bark, 1 oz. ; prickly ash bark, 1 oz. Reduce tl\e whole to a coarse p»-wder, and infuse for several hours in 4 pints of cider. A. tablespoon' ful three or four times a day. 288. Mercury, 95 parts; balsam of storax, 48 parts ; diacalon plaster, 312 parts; wax, rosin, turpentine, each, 16 parts; ammonia, bdellium, eac>>., 5 parts; olibanam and myrrh, each, 5 parta ; saffiron, 3 parts ; spirits of kvender, 2 parts. Mix, and spread. 780 PRESClilPTIONS. — RECIPES. m ■% 289. Populin, 20 grs. ; sanguinarin, 10 grs. ; pulv. white sugar, 80 gra. Rub well together, and divide into 16 powders. Take one four times a daj. At the same time use prescription 73. 290. Ptelein, 24 grs. ; hydrastin, 24 grs. ; ext. of belladonna, 3 grs. ; ext. of nux vomica, 2 grs. Mix. Make 24 pills. Take one three times a day. 291. Strychnia, 2 grti. ; ptilv. cantharides, 4 grs.; pulv. arnica leaves, 1 dram. Mix. Divide into 32 powders. One to be taken three times a day. 292. Wine of Colchicum Seeds, 1 oz. ; fluid ext. of dandelion, 1 oz. Mix One tcaspoonful three times a day. 293. Willow Bark, 1 oz. ; boiling water, 1 pint. Boil for ten minutes, and strain. Dose. — A wine-glass full once in three hours. 294. Canada Balsam, 1 dram ; Hlaked lime, 1 dram. Mix, to form a paste. An excellent remedy for tooth ache, when pressed into ilm cavity. 295. Ttn?t. Black Cohosh, 1 oz. ; iodide of potassium. 2 drams; syrup of ipecac, 1 oz. ; spring v/ater, 2 ozs. Mix. A tcaspoonful tiiree or four times a day, in rheumt^tism and cell-dropsy. 296. Tinct. jJinfk Cohosh, 1 oz. ; tinct. myrrh, 6 drams ; laudanum, 1 dram ; tinct. cayeiuie, 1 dram. Mix. Take 30 or 40 drops lour times a day, for dropsy. 297. Solution Chloride of Soda, 6 drops ; water, 2 ozs. Mix. To be taken at a draught. A sure remedy for offensive breath from deranged stom- ach. 298. Cream of Tartar, ^ o*. ; fresh lemon peel, bruised, 4 ozs. ; Loaf sugar, 4 ozs. ; boiling water, 3 pints. Mix, and, after standing a while, strain. 299. Citric Acid, ^ dram ; bi-carbonate of potassa, ^ dram ; lemon syrup, 1 oz. ; soft water, 6 ozs. ; epsom salts, 1 oz. Mix. Two table spoonfuls, to be repeated every four hours, if necessary. 300. Hard Wood Ashes, 1 quart"; common soot, ^ gill ; water, 6 pint's. Digest, settle, and lilter. Take one tablespoonful three times a day, in acidity of stomach. 301. Peppermint Water, 1^ ozs;; wine of colchicum-root, ^ oz. ; sulphate o>' morphia, 1 gr. ; magnesia, 1 scruple. Dose. — One tcaspoonful three or four times a day. Excellent for rheumatism. 302. Cream of Tartar, 1^ ozs. ; sulphate potassa, J oz. ; pulv. squills, 2 drs. ; tartar emetic, 2 grs. A tcaspoonful of this mixture to be taken four or five times a day, in dro])sy. 303. Pulv. Alum, ^ dram ; white precipitate, 1 grain. Rub these well to- gether, and place the powder in a bottle ; then add 1 ^ drams of glycerine. Shake the bottle until the mixture is of the consistence of cream, and repeat the shaking whenever it is about to be applied to the skin. For external use in erysipelas. 804. Copaiva, 5 drams ; yolk of one egg ; gum of extract of opium, one grain ; water 7 ounces. Mix. To be used as an injection several times a day in gonorrhoea. 305. Tannin, 3 grains ; ext. belladonna, | grain ; ext coniura, 2 V grains ; infusion of senna, 3 ozs. ; fennel water and syrup of marshmallow, each 1 }j oz». liix. A tablespoonful to be taken every two hours, in chronic bronchitis, and otiier complaints. I minutes, nnd PRR8CRIPTI0NS.— RRCIPR8. 781 306. Glycerine, 1 drain ; tannin, 1 dram. Dissolve the tannin in the f^ly- cerine. Excellent for sore nipples, and for chaps and excoriations generally. 307. Collodion, 1 oz. ; Venice turpentine, ^ oz. ; castor oil, 2 drams. Mix. To be applied outwardly, for chilblains and chaps. For cancer, manganic acid. Not as painful as other caustics. 308. Sulphate of Coftper, 2 grains; wine of opium, 1 dram; soft water 2 drams. Mix. Apply freely with a soft camel hair brush, three times a day, for purulent ophthalmia. 309. Pure Acetic Acid, 2 drnms ; soft water 3 ozs. ; simple syrup, 3 drams. Mix. A tcaspoonful is to be taken every three hours, in scarlet fever, at the !ers<>iis. 32.'». Carlxmafe of Soda, 10 prs. ; aromatic spirit of ammonia, \ dram ; tinc- ture ol" ornnjre peel, 1 driuu ; syrup of'oranfj*' peel, 1 dram ; <'onipound infusion of geiilian, JO drams. Mix. To be taken at a draught twice a day. s : comp. infu- sion of orange peel, (> dr ins. Mix. The whole to be taken to relieve head- ache, after intoxication. 326. Matfiicsiiu J;") grains; solution of potassn», 1/) drops ; comp. tincture of senna, 1 dram : »'on.p. infusion of senrui, (! drams ; syrup of ginger, 1 dram ; comp. iniiision of orange peel, \ ounce. Mix. TaJien at a draught, tus an aperient, in sick and billions headaches, 327. Aromatic Spiri'f of Ammomn, 1 dram ; tincture of columbo, 1 dram ; infusion of columbo, 10 drams ; syrup of poppies, 1 dram. Mix. To be tak("i> ttt n draught, three times a day. 328. Diluted Snlphima Acid, 15 drops ; diluted hydrochloric aciu, 10 dropn , tincture of orange i)ei'K 1 dram; ccmip. infusion of gentian, (5 drams; syrup ot poppies, 1 dram. To be taken at u draught, thi-ee times h day, half an hour before meids. 329. Diluted Nitric Acid, 12 drops ; diluted hydrochloric acid, 8 drops; in- fusion of cascarl:a, 11 drams; i?yrup of poppies, 1 dram. Mix. To be taken at a dniught, twice a day. 330. Jilue Pill, 4 gr,s. ; comp. pill of rhubarb, 4 grs. ; ext. hyo.scyamus, 2 grs. Mix. Make two pills ; one pill to be taken at night. 331. Ext. //y'Mcyrr/rt?(,i(, 2 ^ grs, ; pulv. camphor, 2)^ grs. Mix. Make tv.-'> piilfi ; one to be taken when the pain is most severe, in nervous headache, 332. Comp. Trafjacanth Pmvder, 8 grs. ; oil of lemon, 3 drops ; camphor water, 11 drams; (>omp. tinct. cirU*duniom, J dram ; tinct. hyoscyamus, .J dranr chloroform, \h dramH ; uxtravi. of cunium, 6 dranu. Mix, and make an ointment. PRESCRIPTIONS —UKCIPES. 783 S37. Iodide uf Lead, \ scrupli; ; glycerine, 1 drain; spermaceti ointment, 2 ozr.. Make an ointment. ;{.'iS. Rh^dmrb Pidr., ^ oz. ; spcarinint hcih, piilv. \ oz. ; nulv, eascarilla, \ (I/..; piilv. liiviiilionale of polassa. .^ oz. ; piilv. wild clicrry lia "a, .', oz. ; .Mix, iiiid pour on out" qiiurl of iiol water. Let liiis stand till told, and add half a pint of bi-andy. Dose lialf a wineglassful. .'5311. Ext. licllddonua, f> {.'rains ; pulv. iperac. 10 ;^rains ; confection of roses, 2 jrrain*. JMix. Make .'JO pills, one pill to Ix- taken twice a day. .'MO. JJioscorcin, 1 2 {xrains ; ])ulv. ca:n|)hor, i <2;rains ; pnl v. cayenne, 1 2 prain.s ; white sugar, 1 scniitle. Mix. Divide into tour powders. Ciive one every fifteen minutes. .'iH. Leptandriiu 12 ^'rains ; geranium, 12 grains ; mj.icin, 12 grains. Mix. Divide into twelve powders, of wliich one may be given three or four times a (lay. 312. Quinine, }, dram; pulv. catechu, 1 dram ; pulv, opium, 15 grains. Mix. Make 32 pills. Give one pill three times u day. 343. Compound Syrup of Rhulxirb and Potassa, 4 ozs. ; tincture of prickly a. Be(h Hoot, 1 oz. ; geranium, I oz. ; blackberry root, 1 oz. ; wild cherry bark, 1 oz. ; cinnamon, 1 oz, Powder the whole, and add to them 1 i pints brandy, and 1 ^ pints water. Let them stand s veral dayS; stirring frequently. Add sweetening if preferred. Dose. One or two teaspoonfuls t"very two or three hours. 347. Rnspbernf Leaves, 1 oz. ; geranium, 1 oz. ; blackberry rw.j, 1 oz. ; lep- taiulra root, I oz. Mix, and nuike three pints of strong decoction. Dose. A ♦eii.«poonful every hour. Suitable for a gargle. 348. Su(/ar of Ljcad, 24 grains ; vinegar. 1 dram ; syrup of poppies, 1 oz. ; rosM water, 3 ozs. ; soft water, 4 ozs. Mix. Dose, one or two table- !=|Hxmfuls 349. Pjaasio-tnrtrate of iron, ^ oz. ; syrup of orange peel, 1 oz. ; water, t oz, Mix. Take two teaspoonfuls three times a day. 350. Geranium, golden seal, marshmallow, wilil indigo root, rosemary, each half an ounce. Mix, and make mie pint of strong infusion. After straining, will two drams powdered borax, and one gill of honey. An excellent astringent gargle. 351. Dover's Powder, \5 grains: leptandrin, 5 grains. Mix. Divide into ten powders. One every three hours, for a child. 784 PBESCKIPTIONS— Ri:CII'ES. 35^. Dover's Pmoder, 15 grains , calomel, 5 grains. Mix. Divide into ten powders. Give one every three hours to a child in croup. 353. Hydrochlorntf. of ammonia, \ oz. ; diluted acetic acid, \ oz, : alcohol, \ oz. ; camphorated mixture, 15 oz.«. Mix. A good scattering wash for hydro- cele, etc. 351. Chloride of soda, nitrate of potash, and hydrochlorate of ammonia, equal parts, and water enough to dissolv* *^esu. Mix. An excellsnt freeaing mixture. Divide into ten CONCLUSION OF HOMCEOPATHIC REMEDIES. ORGANS OF CIRCULATION. Thb heart, its appendages and valves; the pericaidium, or membrane tliat covers the heart ; the nerves that are distributed to the organ, as well as tlie arteries and veins, lion. are embraced in the organs of circula- L Inflammation of the Heart. — Endocarditis. When a sharp pain is sometimes felt in the region of the fifth rib, with quick pulse, Hushed face, and hurried respiration, there are indications of Endocarditis. Aconite in the usual dose niiiy he given every hour until the frequency of the pulse is diininished ; Vend, vin'de, if Aconite fails to reduce the ])ul.so in twcntv-four hours. If (ho disease has boon brought on I)v .i shock oi injiny, Anii'ra; if from excessive griof, T'jnnlui ; if from cold, Ai'scnicuta; if it is the se(|Uol of in- llauunutory rh(!umalism, Pulsatilla; if the disoaso terminates in dropsy of the pericardium or chest. Apis mellijica. Let the diet be simple, and easy of digestion. Inflammation of the Pericardium. — Pericarditis. Acute Inflammation of tlio pericardium is denoted by symptoms much the same as those attendant on Endocarditis, and may be brought on by a cold, a sudden check ol' perspiniiion, or simultaneously with a sudden attack of inflammatory rheumatism. Aconite repeated every hour. Pnhatilla or Dryoma may follow in the usual dose, and be repeated every hour until a change occurs. Tim jjoricardium, l)ciug a serous nieiid)rano, is liable to u profuse collection of scrum alxxit the heart. Apis mellijica in the usual dose every two hours will bo likely to give relief; Anncijnuin and Ilellehnrus nig. are also reuuMlics that maybe cm|)loyed in curing this troul)le. If the heart i)alpitates severely, give Pulsatilla or i)ifjifalis. Diet simple and nutritious, and free tVom any exciting stimulants. Chronic Inflninniniioii of the Perlcardiinn has similar symptoms, but not so severe. It often attends Uw. gout, and is treated with the same remedies. Colchicum \:i a valuable remetly, and may be given throe times a day, in usual doses. Sulphuv is often useful. Chronic Pericarditis may sometimes be cured by Calcarea or Lycoj^o- dium. Aurum muriaticum and ISpigelia are called into re(][utsition when . 786 >€ I' \i ility to evacuate the bladder. Doso and udmlnistration, four globules every hour. 787 if, 788 DISEASES OF THE URINABT OBOiWSr '■(> ■■ ,•■■. ili 1 -fi T'>*j:^i|v'" Stone. When one is voiding urine, and some obstacle to its passage suddenly interferes, and the stream is cut short, we ma}' infer that a stone lias inter* posed at the orifice of the bladder. The symptoms are like those of strangury. Oftentimes there is pain in passing urine, inclination to pass it often, and straining to keep tlie stream flowing. Against the ill effects of stone in the bladder, Cantharis or Cannabis are among the prominent remedies. Lycopodiuniy Cakarea, and Phosphorus are also good remedies. The two remedies first named niuy be given in drop doses every hour, and the three lost only tliree times u day. The patient should driuk soil water, and live upon a moderate non-mcdi 'final diet, avoiding malt and distilled liquors as a beverage. This is indicated by violent, cutting, intermittent pains in the region of one or the other hip and kidney, extending down the ureter to the groin cc down the thigh, frequent but scanty urine, fever, and nausea. The most iseful remedies, in tlm order of their importance, are Uva ursi, Belladonna, Chamomilla, and NUrum, repeated often. Retention of Urine. This difHculty results from fever or some local irritation, and consists simply in disinclinatiun to evacuate the bladder, not from inability on ac- count of inflammation, or some obstruction, but because tliere is an irre- sistibly pronencss to retain the urinary secretion, either from nervous weakness or spasm of tiie neck of tlie l)lad(ler. The remedies found most nseAil are Cina, iSpif/clia, Jl;/osc,i^amus, Belladonna, and Rhus tax. Kitlier of these may be given and repeated until the patient is relieved. Ihfoscy" amus and Gina are preferable. With old people, Arsenicum or Secale. Suppression of Urine. In some fevers the kidneys do not perform tiieir ofliee, and tlie urinar}' secretion is suppressed and tlirown back upon the system ; and, as a conse- quence, the blood fails of being defecated, and the result, in a sliort time, must prove quite disastrous. A dose of Sulphur may sometimes overcome tliis ditliculty, and set tlie organs of secretion at work. Baptisia, Nitrum, PulnaJilla, Bryonia, Rhus, Cautharin, and any of the remedies that act spedtically upon the renal region, will be lilcely to afford relief. Tlie n'nu'dies may be repeated every two hours, and the diet should be muci- iuginous drinks. Incontinence of Urine. Some persons cannot help urinating at once as soon as the ])ladder fills. Their incontinence becomes uianifeHt when no opportunity oilers for im- mediate resort to the water-closet, and in many instances l)econie.s painfully mortifjang. and rendi'rs the victim an olyect of 8\ inpatliy. Munmrius vious may be given in tha usual r a trial of a few (lays, the patient is not improved, give Opium, China, Calcarea, Causticum, and Svdphur in the same way. Wettinfif tlie Bed. — Nocturnal Enuresis. Childrcin addicted to this habit from some diseased condition maj' be cured by plicable to the one will serve for the other. Arsenicum may, however, be added to the remedies, particularly if there is any burning at the neck of the bladder and tenesmus. Inflammation of the Sidneys. When there is pain in the back, and increased flow of urine, and a desire to urinate frequently, and sometimes severe pain in the hip and side, nausea, vomiting, and fever, there is undoubtedly inflammation of Ibc kidneys. In the treatment of this painful ditliculty, we find ^' 'ica the best remedy if the inflammation has been j)roduccd by a mechan- ical injury. If from a cold, Jihns tax. or JV^ux vomica. If there is much fever. Aconite; chilliness down the spine, JMhidoitua. When there is obstinate vomiting. Bismuth. The patient should lie in bed, and not try to exercise much till the inflammation passes off. The medicine should be given every hour or two hours, according to the Hcverity of the inflammation. ' >ffl >r'-, i ' 6^ ' ** J. s. M DISEASES OF THE ORGANS OF GENERATIOIT. Tm? organs of generation in the male are the penis, testes, and tlioir Appendages. Those of the female are the vulva, vagina, womb, ovaries, and their appendages. Inflammation of the Urethra. The urethra is the common passage through which the urine passes from the bladder, and the semen from tlie testes. AVhen it becomes intiaraed from cold, or as the sequel of some acute disease, Pulsatilla, Cannabis, Mercurius viv.,or Sulphur may cure the dillioulty by being given every two or three hours. One remedy only must be given ; if this fails, try another; but if the disease is the result of impure connection, and is the ( Jonorrhrea (or Clap), give Cantharia, and afterwards Catuiahitt. If there is painful smarting, give these remedies every hour in alternation until the disciiargo ceases. Give Pulsatilla, also, every hour, if the other remedies fail, aud use a solution of Ilamamdis in water as an injection. Syphilis. Nearly allied to (lonorrhoca is Syphilis ; only tl- . latter is a more formi- dable result of impure connection, wliich inoculat the blood, it becomes manifest in discliarge from tlie urethra, chancres, uboes, etc. When there is a purulent discharge from tlie uretlira, Mercurius viv. may bo given per- sistently for several days, and this may arrest the further progr<>ss of the disease ; but sliould it not, and ciiaiicrcs make their appearance on the prepuce or foresliiii, or on the glans, burn them witli Nitric acid, full strength of the stores, aud tlinn give Mercurius corrosivua every six hours for several days; dressing tiie sores with lint wet with cold water ami Cah'uihda. If the cliancrcs heal, it is well and good • if th»!y do not. give Mercurius indalus tlirce times a day. Let the patient avoid drinking uiiy intoxicating beverage whatever, and abstain from all niediciual articles of diet. Inflammation of the Testicles. Sometimes a suppression of Gonorrhoja will cause inflammation and swelling of the testicles. Both may bo implicated, and become exceedingly painful and enormously swollen. For the first stage before the swelling, 790 DISEASES OF THE ORGANS OF GENERATION. 791 Aconite may be given erary two hours to reduce tlie general febrile condi- tion of the system. Afterwards Arnica may be given to remove the sore- ness, and Pulsatilla to remove the swelling. Either of these remedies may be given every day, three times, until the object for which they are given is accomplisiied. Let the patient lie in bed, and apply warm com- presses to tht part. Let Him subsist upon a spare diet, and drink no exciting drinks. Let him wait with patience for a subsidence of the swelling and inflammation. Dropsy of the Scrotum. — Hydrocele. Sometimes inflammation of the testes will result in Hydrocele, and the scrotum will become tilled with water, ffelleboriis nifj., Apia mel., and Arsenicum are remcdips that have been employed to cure the difficulty ; but sometimes remedies prove unavailin<2;, and tijo water has to bo drawn off by a trochar, in which event consult an experienced surifeon. But try the remedies first, and give each named in succession (provided the first or second does not prove effectual), every three hours during the day. Inflammation of the Yulva. This may occur from acrid Leucorrhoeu, or cold, or from Gonor- rhoea ; and, from whatever cause, it recpiircs the application of warm water and compresses, and a dose of Aconite or Belladonna every hour until relieved. Inflammation of the Vagina. The vagina is lined by a mucous membrane, which sometimes becomes inflamed ; and when from a cold, producing an ordinary catarrh, give Nux vomica or Sulphur, night and morning, until better. If from chronic irritation of the membrane tiiere is a Leuchorrhoeal discharge from the vagina, give Sepia night and morning. If this fails, give Calci- rea carb. ; and, if this fiiils, give Sulphur in the same way. Leucorrlioea may be occasioned by falling of tlie womb, which irritates the mucous membrane of the vagina, in which event Sepia or Nux may be given every night, with full prospect of a cure. Inflammation of the Wombi This painful malady is often the result of protracted labor, and is known by great thirst, pain over the region of the womb, and great ten- derness of the touch. Arsenicum, given every three hours at first, and followed by Belladonna, generally j)roves successful ; but Bryonia and Rhus tax. or Verat. viride may be resorted to, and repeated every three hours, if found necessary. Inflaniiuation of the womb is a painful difficulty and u dangerous one, and should bo treated with great care. Warm bran poultices, if the patient can bear them, may l)e applied while giving the remedies. Et' 'h:u If w J.-, ■1 792 DMIA8I8 or THB OBOAMS Ut OOESATIOM. Falling of the Womb. The womb is said to rail, when from debility, or a relaxed condition of its ligaments, it sinks down into the vagina ; and this is indicated by pain in the back, and a dragging sensation over the hips, and bearing-down pains. These are often attended with headaches and other derangements, which must be considered. Nux vomica, every night, is one of the most valuable remedies for prolapsus uteri. Sulphur sometimes does well. Sepia every morning has often cured and relieved the headache, nausea, and other concomitant symptoms. Calcarea has relieved when the pain is most j)rominent about the hips ; Ljnatia, when the difficulty has been brought on by grief. Patients of this description should not drink coflee or strong green tea. Blaok tea, cocoa, and milk may be allowed, with a moderately generous diet. Inflammation of the Ovarieto This difficulty is denoted by sharp pains, eitlior in the right or lell side, or both, just fnint of the upper edge of the hip-bone. It sometimes is very painful, and requires rest and the best treatment and nursing to subdue it. Conium, in daily doses, has relieved some ; so has Pulsatilla, Belladonna, and Ignatia. Some remedies relieve for a time, such as Bryonia and lihut tox. Belladonna will cure when the inflammation is attencK 1 with head- ache and considerable neuralgic pain in the region of tl i2;lands ; if much fever attends the aflfection, give Aconite three or four iiines a day. Now, as all these affections disturb the nervous system, and give rise to various forms of nervous complaints, such remedies as Pulsatilla, Igna- tia^ Hyoscyamus, Nux vomica, Moschus, and Caulophyllin will be con- stintl}' needed, and stimulants need to bo taken with great cuution. Cold comnre.sses in acute attacks. Ulceration of the Womb. Any thing that irritates the mouth of the womb may occasion, first, in- flammation of the OS tincae, and then ulceration. Frequent miscarriages will so weaken the organ, and especially its ligaments, as to admit of its being easily misplaced, or turned backwards or forwai-ds. These misplace- nents are often the cause of ulcerations, and almost always the source of weakening Leucorrhoea. The medical treatment of this difficulty is of the first importance. Sulphur every night may commence the treatment. If, after ;8ing the Sulphur for a week, the purulent discharge becomes less, and there is less pain and soreness in the region, and still considerable pain remaining in the back, give Nux vomica every night for a week. If these two remedies fail of bringing about a cure, then drop twenty drops of the tincture of Calendula (Marygold flowers) in half a tumbler of water, and inject it into the vagina every day, and at the same time take a dose of Sepia every morning. Continue this treatment as long as useful. Calct^ rea, taken every night, sometimes has a good effect. Local applications tc thn ulcers are sometimes made, but this is the business of the sur^on. LenoorrhcBE. — Whitea, When the mucous membrane lining the womb and vagina becomes in> tated or inflamed, it undergoes solution, and there is a white discharge. This is of frequent occurrence, and in some instances is sucii n diain upon the system as to weaken the function and tone of the nutritive organs. Any treatmer*' that will strengthen the wholo system will generally euro the derangement. China, Ferrum, and Aurum are i-onii'diea that may be employed, either of which, in daily doses, will prove suflfirient. In tliP mean time, let the patient refrain from over-exertion. A more aggra- vated form of Leucorrhoea attends falling of the wonih, and tliis perhaps is the cause of the difficulty. The remedies which will best meet this rliffi- culty are S^ia and Calcarea carh. ; the former may be given every morn- ing, and the latter every evening ; or perhaps Nux vomica may be given in the evening, and Calcarea in the morning. If there is sick headache attending this form of Leucorrhasa, Sepia is still the remedy. If other biliary derangements, Nux vomica is equally applicable. Ladies afllicted with any of tliese uterine difficulties must not drink strong tea or cotfee ; but mild black tea, cocoa, and milk should be the chief beverages, and, if the appetite permit, a moderately generous, but non-medicinal diet may be iddea. 100 If t{,^ •s'.. I J 'i' ; r: I .k i] u 1: ' Mi .'i DISEASES OF THE SKIN. Boils. — Furunculi Thesb are smallv circumscribed, and painful tumors, which begin in the form of a pimple, and then grow until they acquire tlie size of acorns. They are several days in coming to maturity ; and sometimes their pain- fulness excites fever and chilliness, loss of appetite, and other dcrango- ments. When suppurating, the pain in them is intense and pulsating just before the crisis. As soon as they break, the pain diminishes, and very soon the injury is repaired. Aconite may be given two or three times a day to subdue any fever that may be present. Belladonna also will re- move the pain of congestion ; and this may be given several times during the day. Arnica tincture may be applied externally to remove the sore- ness, and with great advantage it may be taken internally ; and in the same way Hamamelia Virginica may be employed. Wet a compress, and apply directly over the boils, and renew several times a day, and the pair, will be very greatly diminished. Poultices, in case of very large boils, may prove of service, — bread and milk, or flaxseed ; and, when employed, give at the same time Ilcpar aulph., four globules, and repeat twice a day. Arsenicum often prevents their recurrence. Oarbiinole. — Antfirax. The difference between a boil and a carbuncle is this : a boil is circum- scribed, but a carbuncle travels, or moves along the subcutaneous tissue ; and, when it breaks, it seems to have several openings instead of one as in the case of the boil. Anthrax is a troublesome disorder : sometimes it is attended with active inflammatory fever, and sometimes with low fever. It is far more common among old than young people, and sometimes very difficult of cure. A carbuncle upon the back of the neck, accom- panied by fever, requires Aconite during the time of its development, and afterwards Hepar sulphur. The effect of this latter remedy is to hasten suppuration. Phospliorus is also employed to promote the same end. Bread and milk poultices may be employed ; and a dressing of adhesive plaster, with apertures for the pus to discharge, mav be applied after the poultice. The sore should be dressed every day ; and, if very painful, com- presses wet with HamamelU voaj be resorted to. To remove great sore- 794 DISEASES OF THK SKIN. 796 ness, Arnica may be used in the same way. Sometimes in aged people a carbuncle becomes gangrenous ; and then Araenioum should be employed, a dose every three hours. When the discaso, or carbuncle, comes on the hack, either to the right or lefl of the spine, it is liable to mike its way downwards ; and, in order to prevent its doinj; so to any extent, compresses bound tightly beneath may ke(3p them wlioro tlioy bi'sin. In all cases when there is active fever acconipanyiiiji carbuncle. Aconite may be iKiCessary ; for, so long as there is great arterial exc;iteiniMit, it will tend to- wards the carbuncle and greatly auj^inent itn severity, if low fever, or a lassitude and stupor, attends the discrasia, give ^ryo/i/a, and repeat every three hours ; or perhaps Jihua tox. ; Arsenicum, if' the pus is of an olfen- sive smell. Carbuncles are supposed to orJL^inatu from low conditions of the ciiculation, and therefore a generous tliet is su'j:;:('ste(l. Avoid medicinal food and condiments, except salt. Animal food is most com- mended for a diet. Abscesses. Abscesses generally form in the subcutaneous tissue, but manifest tliem- selves through the skin. Generally there is some protuberance or swelling upon the surface; sometimes there is none. Frecjuently there will be some redness, to indicate that an inHammatory process is going on ; and, at other times, there will be no indication of tlie kind. An abscess, then, is simply a circumscribed collection of pus, formed from broken-down tissues or blood corpuscles. They are subject to medical treatment. OulcareUy tor abscesses in scrofulous persons, may bo given every day, and espe- cially in cases of ficrofulou:? children. Abscesses uj)on the arms or hands may be cured by .t.ie use of Puhatilla or Nux. Abscesses on the face require Bryonia and Calcarea ; abscesses from the bone require Silicea. Abscesses should be relieved of their p'ls by the lancet as soon as suffi- ciently ripe. They may be washed with Calendula tincture. Persons prone to suffer from abscesses should subsist upon a spare diet, and should avoid rich gravies or great quantities of butter. Bread, potatoes, beana and peas, beef and mutton, may constitute about the range of diet ; and oof}(3e, ale, cider, and distilled spirits must not be touched. Corns. The feet appear to be the only locality affected by corns ; and they occur, frequently upon the toes. Acorn is simply hardened cuticle or skin, rendered so by some pressure or irritation upon the surface, such as a tight boot or shoe. Those who subject the I'eet to such treatment must suffer the consequences. The best treatment for a sore corn is to shave off' the hard skin, and apply the tincture of Arnica, or perhaps the tmcturo of CausticAun. It is said, however, thiit Graphites, Silicea, /Sulphur, and Antimonium crud. are remedies that may bo taken internally to cure corns. Either of the remedies may be taken in daily doses. A corn-salve is sometimes applied, made of pine pitch or diachylon. Any plaster that will protect the tender and irritated spot from the pressure of the boot will be found useful. Uloerst Ulcers »re included among skin-afFections, because they break the continuii5 of tlie skin, and manifest themselves upon the surface. An ulcer is form i r;enera!ly by the disorganizing influence of itiHammation, which atteots tiio membranes and skin. Ulcerati(m of the soft, puns, jiml ulceration of the stomach and intestines, are of frequent occnrrenci.' ; and an ulcer is slow to heal, and constantly discharges j)ns. Ulcers ^^\' the legs, toes, feet, hand,^,, and arms, are met with extensively. Liict'is of tlie lo\v<;r extremities, or legs and feet, can be cured by a ilaily doiiV! of S'dicea or of Salphti'. Uk^ers of the upi»er extremities, or the arms and iiand.s, can be cured by daily doses of Calcarai and GrnpluUH. Ulcers of the soft parts require Phoispluinm or China. Ulceration itt the stomach requires (Joniiun or Pkmph'tras. Ulceration of the bowchi recjuiros ^lr.st'?u'(nt/rt. Each of these remedies may be given in daily doses, and continued as long as observation teaches their utility. Ulcerations are supposed to result from lou- states of the blood ; and, therefore, stimulants nmst be em|''-.>yed to tone up th<> system. A generous jlict is generally to be commended. There is no use in trying to heal over the surface of an ulcer ; {it\\ in so doing, it may work out deeper mischief in the economy. The only sate way is 'o build up the most healthy state of the system, and let tiie ulcer dischaige itself, and heal from the I ottoin. l*ers()ii.s Mibjcct to ulcers are evidtnitiy scrofulous, or the victims of Homo otln'r (aint. If jscrrofnlous, Arsenwuni, Silicea, or Calcarea may benefit (he coixlition. Ulcers arise also frotn hen-edit ary syph- ilitic taint. MercnriuH vio., Me./r,nrii(s ioddfiis, and Jlercuriut. corr. aro compolt^nt to cradic-atc this taint from the constitution; so is llepar fudph. or Nitric acid. If llic ulcers arise from this taint, alcoliolic stimulants must be avf)idc(l, and the most generous meat dit^t ?uust t:il\e their plac<*. Whatever be the predisposirig cause of ulceration known in a family, it should l>e carefnllv watched. Chilblains. Frosted feet, as this complain^ is termed, occurs niostiv in cold weatlx r. find most frequently in persons susceptible from .some constitutional taint. It has been observed that chilblains will iissnme the character of painte! fores in those known to be of o ■croiulous habit. The teet being very susceptible to cold, become cl^ihcd, and afterwards the !ieels, and some- times the toes, becomes painfully tcndcu', Cruton liy. - pnralinu and a cure. Rhus or Lachesh, if the system is in a low condition. Either remedy may be administered twice in twenty- four hours. Itch. — ScabiQS. This cutaneous eruption consists of small pimples, or pustules, wiiicli make their appearance in clusters upon the skin, and itcli and burn con- tinually. Tliey are believed to result from the acarus, or itch-mite, cm- betldeu in the cuticle. These |)iinples usually break out between the lingers, on the liamls and wrists, ami over the lioilv. Sulphur has uver bocu found a salutaiv reuuMly, taken intornally, and applied !is an ointnuMit daily. In many <'ascs, (Ja/carea, Jlepar Hnlph., Jlercnriits, and JUiiis have been lound useful. For what is lenncd the Prairie licli, which is veiy stubborn, Mercuriun viv., taken internally, and an ointment of the red oxide o/merruri/, used with care, externally, has proved ellectual. Sidphnr ointment has been in freiuu'al use, and is of great service if used sparingly and with caution. Itching of the Skin. — Prurigo. Sometimes there will be intense itchiui^of the skin, without any appar* ent eruption. Scratchini^ or rubbinj^ does not relieve ; every attempt to relieve in this way aggravates the difficulty. There is no disease of the skin ap[)arently uu)re superficial, nor yet mure annoying. As there is i.o prominent symptom but itching, we would naturally snppose that some single remedy would antidote it. But not so. In bilious temperaments, Mcrcuvius is the best remedy. In sanguine temperanu'nts, Nux VDinioa, /nni(i or //x'nif.. an in the inflammatory stage, aw^l Hepar Bulph. after: when ulceration takt > place, Arsenicum and Carbo vegetabilis may be called into use. A do.^ every day will hasten a cure. Felons. Felons commence at the bone, beneath the periosteum, or membrane that surrounds it. They are very painful, and most commonly make their appearance on the fingers or thumbs ; at first a prickling sensation is ex})erienced, as from a splinter, and then a sensation of heat attend3 contracted by using bad soap upon the face, when shaving or washing the beard. A dull razor, that p' ills and irritates the skin, may form the nucleus of the difficulty. In lal)oring people, exposed to dust, especially of tobacco, and where there is not particular pnins in watiliing out the dust frequently, the disease is likely to bo generated. The disease resembles, in some degree, the herpes of the lips, makes its first appear- ance on the chin in small clusters of red pimples, or tubercles, each of which is perforated with a hair. These pimples increase in size and dis- gusting appearance, though not painful, until arrested bv some remedial means. OraphiteSj in daily doses, has often cured. Citric acid^ also, twice a day, has proved efficient. Aurum muriaticum,, alone, will cure cases in those having psoric or syphilitic taint. Silicea^ Carbo animalia, Ht/oaeuamua tincture (externally), are also good remedies. Nitric acid may be applied m n diluted form, externally, and also Sulphur ointment, A solution of Iodide of Potass., two grains to an ounce of water, applied several times daily, cures stubborn caaee. 101 1 '.. I , DISEASES OF THE HEAD. Headaohei — Cephalagia. This affection is usually attendant on other diiHcultics, and must be treated with reference to the cause. If from cold, affecting the entire sys- tem, and accompanied by pains in the back, give Nux vomica. If from heat, or determination of blood to the head. Belladonna. If from chilli< ness, Ar%enicum. For rheumatic Headache in cold, damp weallier, Bry- onia. For that produced by constipation, Nux vomica. Bilious, Merc. viv. Sick-houdaclu', Iria versicolor, Sepia, VnUotiUa, or Sulphur. Nervous hcadacho, Co/f'ea. For headache caused by suppressed eruption, Calcarea or Sulphur. From su[)prcssion of the menses, Pulsatilla. From a fall, or fatij^uo, Ai'nira. From simple cold in the head, Aconite. A dose of four <;lol)ules, of any remedy se- lected, may bo ro})eated ovtsry four hours until relieved. Vertigo, Swimming of the Head. This uncomfortable feeling consists in a sensation of the head whirling around, causing one to stagger, and sometimes to fall. If I'rom a de- ranged stomach, iVwx vomica. If from a cold, Geheminum or Arsenicum. From (h-rancement of tiie biliary sy atem, Aconite, Pulsatilla, or Bri/onia. Vertigo picnlueed by rush of blood to the head, Aconite or Belladonna. The remedy indicated may bo repeated in the usual dose every two liours. For vertigo from riding in a carriaj'o, Cocculus. From a shock or fall Amion. Dose and administration as above. Bingworm of the Scalp. This is a pustular eruption, that begins at oue or more points upon tht» hairy scalp, and spreads sometimes so as to invclve much of the surfhce. When there are a number, they spread until tliey coalesce and form a continuous eruption, from which exudes a greenish or sanious matter, that mats the hair, and renders the \yholo appearance of the head disgusting. Great care is required to keep the surfiice clean ; and, for this purpose, no soaj) should be used. Water, softened by the white of a raw egg, is a better wash. Culcarea may bo administered in the usual doso -4L m every morning and evening. If thin remedy does not prove effi- cient, give Sulphur in the same wsiy, iind also Jfepar aulph., or Lycopodinm. The head may be, at Ihe same time, washed once or twice a day with a h)ti()n made of twenty drops of the tincture of Sulphur in a half-tmnbler of water. Scald-headi — Tinea Capitis. This is also an eruption \ipon the scalp, tliat may ho dry or hnmid. For the dry Scald-licad, Natrum muriaticum or Sulphur may ho administered twice or three times a day. For the humid Scald- head, Lycopodium, Arsenicum, Conium, or Graphites may he given twice a day. The same restriction as to the use of soap must be observed, and the satno measiu'es for cleansing may bo recommended, as in the case of pustular liingvvorm of the scalp. Uloers of the Scalp. In scrofulous children, these ulcers sometimes occur in the form of small furunculi, or boils, exceedingly sore and painful. The best remedies are Ai'senician, Ilepar sulphur, Citric acid, and Siltcea. They may be given as required in daily doses of four globules. The ulcers may be wet with Uamamelis Virginica, after having been pricked with the lancet. Baldness. When the hair falls from the head by reason of debility, the remedies to be given are China and Ferrum; when in consequence of piu'spnation, Mercurius; from the use of quinine. Belladonna, or Pulsatilla; if from the abuse of mercury, Carbo veneta.; if from gnef or trouble, Phos. acid. If Baldness occurs after pro- tnicted mflammatory diseases, and nervous and typhoid fevers, give Calcarea in daily doses or Heparmlph. and Silicea. For Dandruff, give Lycopodium, I^M '. 1 I ' .Hi I 1- DISEASES OF THE BRAIN AND NERVES. Brain Fever. This disease comes on with more or less pain in the head, attended with heat and delirium ; the eyes also exhibit a red or fiery appear- ance: and this pain, heat, and delirium are sometimes followed by drowsi- ness, and inclination to vomit. The pulse is usually rapid and feeble. In Brain Fever, there is loss of appetite, great restlessness, short, comatose naps, and frequent inclination to cry out with pain. Aconite is useful to commence with, and this may be ibilowed with Belladonna. If respi- ration is hurried and labored, give Araenicum. If Brain Fever is brought on by a full, or a blow upon the head, give Arnica; and if no relief follows in twenty-four hours, Glonoine. If from trouble or grief, Ignmtia. If from intoxicating drinks. Nux vom. If at the men- strual poriod, Pulsatilla. If Irom intense study, or close application to business, Sulphur and Nux vomica. Biuh of Blood to the Head. The signs of this occurrence are intense headache or vertigo at first, which is followed by fainting, and oflen with loss of consciousness ; at times there will be twitching and spasms. The difficulty may occur from various causes, and is common with females and those of nervous temper- ament. Aconite, in solution, may be put in the mouth of the patient, and also the head may be wet with cold water. The head should be laid a little lower than the body ; the lower extremities should be rubbed, and friction should be applied to the arms and hands. Belladonna may be given after Aconite, or, in grave cases, Glonoine. If the rush of blood has been caused by running and getting heated, give Arnica, and bathe the temples with a solution of twenty or thirty drops in Haifa tumbler of water. If at tho menstrual period, give PulaaliUa. In plethoric persons, oxp(Ks, and fiiUs i:i'(.'n>il)!i.' to the jL'rouiid or IIkop, with convulsive met ion of tlu; limh-^, di-^toiiioii ol't!i'> mii'^clcs of tiio lace, fiotli- inff at the uioiitli ; and sonit'tiines the month, lips, and jaws arc spasinod- ieally closed, the hands clinched, and a LTcncral i'i:;i(lity of the uniscles of th'j entire body. Alter a time, the riiiidity pulses oil", and ail tin' niii.'v cles become relaxed ; tlie patient then ap])ears to he in a (lce|) sluinl)ei', and remains so lor a lonjfer or shorter period, ;ind then awnkes to co?i- sciousness, teelinv; weaned, but totally unawnre of any lliini: unn>ual hav- ing occurred. Confirmed Epilepsy is rarely, if ever, cured. When the iliftcase is not conjxenital, the nuripiont stai>i", with i- deep sluniher, w;ik('s to con- iiiiiisual iiav- l. When the )o :>vorc()me. I siiins of the donna, Ilyos- inf(Mnpciiince, 1(1 the sooner l)stinonce the [KiticMits when the incipient may bo given leep sleep and ory following ', Chimin Fer- !ure ; the only ndition for the m the attacks, lus, and spare feletis. 18 of the spine, suffering of the 1 is iinpHcated, ick part of the Fected as to pro- on. Aconite i* lie inflammation is may he used . viride is con- dorsal portion i of the spinal cord is beset with inflammation, there is shortness of breath, dyspnoea, or fainting, and a sense of suffocation. There is, at the same time, pain in the back and chest, a rapid action of the heart. Tlie spinal accessory nerves, that supply ti»e intercostal muscles, partaking of the difficulty, renders the function of lungs, (lia[)hrai:in, ami heart, severally, impaired. Aconite, lor the inflammation in this locality, may he given at first, and repeated every hour; and a lotion ol' twenty drops of the tincture? in half a tumbler of water may he Jipplied to tlie spine. JJrl/adonna may be given when there is intense pain between tlie ,slM)iili|(i--IiIa(lis. liri/o- nia is quite essential when every motion of the piitient a;:iiravates the Buffering; Conium, when tht; ])ain is not so niarki'd, but the respiration is difficult ; Cocculus, also, when the pain in the back iiiUcts th • .-'tjuiach, producing nausea and |)r(tstration ; l*uUat'dla, wlu'ii this occuis iii v.>ung women or children, or in those of lyinphatic teinperaiiieiits. 'JMio patient should take but little exercise, if any. It" only the lowi-r portion of the spinal cord is alfccted, tliere will be paiit in the small of the back. The secretion of the kidneys may be diiniiiisjied oi- increased; the bladder, also, may be implicated. Tiie woiub may be .subject to neural;j,ic pains; the nerves accessory may imi)licate the abdomen, and cause severe pains. Nux vomica, when the ]»ain is the most prominent in the small of the back, and when there is pain in the bowels, and constipation. When the bladder is im[>licated, or spasmodically closed, UijoscyaniUH is the remedy. When there is too great secretion of the urine, Nux voiu. and Sulphur will tAy- viate the difficulty. When this portion of the spinal cord is all'ectecl, the womb may become subject to neuralgic pains. JJclhtdunnn, t'Icula, Jy- natia, and Ifux vom. are all valuable remedies. Conium, to remove the inflammation of the cord, may be given every three hours, until the pain ceases. If spasms attend the difficulty, give IIifOHcijainus every two hours, as long as tiiey last, or else Ljnalia or lielladonua. If the inflam- mation is brought on by a fall, or shock upon the nerves, give Hi/peri- cum every two hours, and bathe the back witii a lotion of the tincture, -forty drops in half a tumbler of water. Bryonia is also good for inflam- mation of the cord in the lumbar region, and especially when motion augments the suffering. The diet for all persons having the nervous centres implicated must be simple and nutritious. Paralysis, Palsy. When the whole nitisctilar system becomes so feeble and trembling as to bo no longer controlled by the will, it is a ease of Palsy ; and tliin is brought on by some trouble in the nervous centres. It attends Apoplexy, Epilepsy, and other atfcctions incident to the nervous centres. Intlamniation of the ISpinai Cord will often produce the affection. The palsy may affect only one hand or one cheek ; or it may be more general, and all the muscles may bo smitten with paralytic weakness. Belladonna is often indicated for right-sided paral- ysis, and is, perl-ini-.. She best remed}', in the majority of caies. Pulsatilla is one of the bes' raiv lies for this disortler : give a dose of it three times a day. If this tovj t.tt cure, give Cocctdus, in the same waj', or Ifux vomica, China, .>r Iijiatia. For palsy of the tongue, give Galcarea; for palsy of the fac;, luihotilla ; for palsy of the arms and legs, give MercuriuM IMAGE EVALUATION TEST TARGET (MT-3) // S' .^ ^ /a 1.0 I.I m iiM I ^ IS I. . IL25 i 1.4 IM 1.6 Hiotographic Sciences Corporation 23 WEST MAIN STREET WERSTFR.H.Y. 14580 r ; : c ) S7a-4503 i\ a? iV <^"- -<^J^ -^X '^\ "•i t/j Q^ ^ b' V 1 ill DIPHTHERIA. AN exudative inflammation of tlie throat, during the progress of which a dirty, grayish membrane is exuded upon the tonsils, aud often upon the phar- ynx and posterior nares. The disease is commonly usliercd in by the follow- ing symptoms: chilliness, headache, pains in the back and limbs, excessive prostration, fever, some difficulty iu swallowing, though not always, and ofteu- sive breath. Later appear acrid running from the nostrils, or bleeding, as rather an unfavorable indication ; swelling of the external throat; and some- times, in very severe cases, vomiting or hoarseness, and other indications that the disease is invading the larynx or trachea. This disease is now almost univei'sally considered in some degree contagious, and for this reason the patient should be, so far as possible, isolated from tlioso who are not in charge of the case. All his excreta should be disinfected willi a strong solution of Sulphate of Iron at onre. The room sliould be well aired constantly. The throat should l)e gargled, to prevent decomposition, wiih glycerine and water mixed, one part of glycerine to seven of water, to be used every two hours, or oftener in severe cases. Small pieces cf ice allowed to dissolve in the mouth have a favorable influence. The patient's strength should be sustained by nourishing liquid food, such as broth of beef, lamb, mutton, or fowl; milk, or milk and raw egg; oatmeal gruel; oysters, iu cold weather, are allowable. Stimulants are not recommended, except as a gargle, as much as formerly; though in severe cases, with alarming sinking of vital- ity, brandy in small doses may do good, when repeated often. Dangerous symptoms have resulted from the patient being allowed to sit up too soon. Tlic membrane should begin to disappear on or before the fifth day, else grave symptoms may be apprehended, such as delirium, epistaxis, vomit- ing, croup, or paralysis of the heart. The urine should be watched carefulh , as albuminuria is generally present in a mild form, and sometimes complicates convalcscev'^e, inducing dropsical swellings, etc. In severe cases the patient should exercise care against a relapse for at least three months. Be sure that your house is properly drained. Local filth is the most common exciting cause of this dreaded and fatal disease. For the benefit of those who cannot secure the advice of a competent physi- cian in this grave disease, the following brief but trustwortliy indications for its treatment are given : -^ For the premonitory symptoms, such as chilliness, flushed face, headache, backache, and fever, OelsemiHtn, ten drops in half a tumblerful of water, a teaspoonful every half-hour until the fever subsides. Should there be no im- provement in twelve hours, give Gimidfuga in the same way. This remedy has proved of great service in the ha^ ds of physicians of both schools. For the throat symptoms, the most frequently indicated remedies are the several preparations of Mercurius, the Mercurius biniod. taking preference, in water, and repeated hourly. This, or the Mercurius cyanuretum, may be altf mated with Cimicifufja, or Oelsemium, or, later, iu obstinate continuance of the mem- branous exudate, with Phytolacca decandra. When the breath is very putrid early in the attack, and the membrane offansive, with fever, darkly flushed face, delirium, Baptisia is better than Oelsemium, or any other remedy. Should the tonsils swell rapidly, and the throat and external face have a puffy appear- ance, Apts mel. is indicated, in place of the mercurial preparation... It should be given in water, hourly. Should croupous symptoms begin, indicated by ie foi- at least Qost common hoarseness, whistling breathing, dusky complexion, or doughy pallor, croupy cough, Sponyia or lodium will be the main reliance, together with the inhala- tions of the vapor of boiling water. Lachcsis has saved cases of a grave type, which have resisted the before-mentioned remedies. When bleeding from the nose becomes troublesome and alarming, the best remedy Is Carho Veg.y to- gether with a free local use of ice. The remedies should not be changed oftener than once in twelve hours, as it is a disease slow to show improvement Homoeopathic Treatment of Diphtheria. Two views have been taken with regard to the intimate nature and cause of diphtheria. Most physicians regard it as an essential fever, and are of the opin- ion that the local alfections of tiic throat and air passages arc secondary, and are but local manifestations of llic special condition of' the system, and that they have the; same relation that the local affection of the skin and mucous membranes hav(! to the eruptive fevers. Tlie}', however, admit that the general disorder is increased ami inten-iiied by tlie absorption of tlie sentic matters of the local disorder, Ihcreb}' producing the blood poisoning of ^eptictemia. The othei vio-.v is what is called the genu theory. According to tiiis view, the disease; is caused by a vegetable organization, which naturalists call sphero- bactcria or micrococci, which, finding access to the throat through the nostrils and the mouth, fasten upon the mucous membranes of the tonsils and fauces, and produce an intlammation which is characterized by the effusion of a fibri- nous exudation called diplitherile. This is no. all: under the conditions favor- able for their life and growth tliey possess an enormous power of reproduction. From this centre of infection these germs find their way into the different tis- sues of the body, and acting as ferments, give rise to deleterious chemical prod- ucts which destroy life. These vegetable parasites, according to this theory, are as inseparable from the diphtheritic process as the bacteria of decompo- sition are from putrefaction and decay. Without bacteria there can be no diph- theria. In grave cases, these pa.-asites are found everywhere, in the smallest patches of membrane, and in immense numbers in the different tissues of the body. They are the cause of embolism, of metastatic abscess, and the inten- sity of the disease increases with their number. These are the theories of diphtheria. The duration of the disease depends upon its severit}\ The period of incu- bation occupies from two to eight days. In mild cases the membrane com- mences to be shed on the fourth day ; in severe cases not before the tenth or twelth day, and it may take four or more days to finish it. The membrane is detached in the same way as any slough or necrotic tissue, by the process of suppuration. Whatever theory is adopted, the local treatment is of primary and equal importance ; for the mucous membrane of the throat, if it is the avenue through which germs find entrance to the body, is also the generator of those irritant poisons, the absorption of which con- taminates the system and destroys life. No specific has as yet been discovered for this disease The object of the treatment is, first, to put a stop to the spread of the disease, and to bring about a retrogression of the inflammatory process, with the removal of the membrane ; secondly, by the most perfect dis- infection and antiseptic cleansing of the mouu\ and throat, to prevent the absorption of injurious products of decomposition from the surfaces of the diseased tissues. In order to accomplish the above results, the local treatment by the applica- tion of disinfectant and antiseptic remedies is now in vogue. 812 MISCELLANEOUS DISEASES. 1-^. i.Ui' . y: Cauterizing substances are considered hurtful, and but seldom used. The most common remedies now resorted to are carbolic acid, salicylic acid, per. maugauate of potash, choral hydrate, sulphite of soda, benzoate of soda, and chlorate of potash. These various substances have been applied in solu- tion by means of a sponge or a brush, in the form of spray, and in the form of a powder, taken dry into the mouth combined with sugar, I think that the best way to treat the throat is by the frequent inhalation of a hot steam, applied in hourly sittings of about fifteen minutes' duration. Thest* may be medicated with chloride of sodium, or ihe chloi^te of potash, about twerty grains to the ounce. Such fluids, steadily flowing over the surfaces of the mucous membranes, wash away masses of mucus, remnants of food, and other products of decomposition. They assist nature's work of promoting sup- puration, which is the legitimate way in which these pseudo-membranes are shed; and by combining this treatment with the use of strong gargles, com- posed of the solution of any of the above disinfecting substances, we more com- pletely prevent septic absorption than by any other treatment ever used. The steam may be generated in any ordinary kettle, and conducted to the patient's mouth through any suitable tube. The general treatment of the patient ie, as in every other infectious disease, to be 8u.staining. Tonics, such as sulphate of quinine and the tincture of the muriate of iron, are also always indicated. It has been claimed that alcohol conjoined with quinine, given freely from the first, is an effective curative agent. Alimentation is an essential part of the treatment. The diet should be highly nutritious; milk and animal broths are of this class. Patients affected with this disease should be at once isolated. Thorough disinfection of the dejections, and of all articles which have been in contact fith patients, and of the apartments which they have occupied, is to be recom- mended, and all defects of drainage must be remedied. Belapsing Fever. A fever has lately made its apptnrance in some of our large cities, having all the characteristics of a common '.yphoid, that apparently passes through all its stages, and then reproduces itself, and the same round occurs again. Each siege lasts about seven days. Several of. these in succession make the condi - tion of the patient precarious, and the prognosis unfavorable. The treatment is with stimulants, and the usual remedies for low fevers, such as Ars., Carbo vegetabilis, Bryonia, and Bhus tox. Doses as usual, and repetition of the rem- edy selected every three hours. A stimulating diet always required. Black Tongue. In warm climates and in a low country, there are biliary derangements, ac- companied with low fever, and a black coating upon the tongue. This is what ki termed the Black Tongue. Carbo veg. has been given freely, even the crude powder, a teaspoonful at a dose. Blftok Vomit. Tliis is another bilious disease, that results trom superabundance of carbon in the blood, and a wretched derangement of the liver and stomach, which iriate of iron, s Ars., Carlo causes copious vomitings of black bile. Araenicum, given every hour, has I'cmedied this difficulty. After the vomiting is arrested by the use of Arneni- cum, give Oarbo veg., China, Shua, or Bryonia. Whichever remedy is selected by the indications should be repeated every hour or two hours, until complete recovery takes place. As soon as the patient can take nourishment, give beef- tea and other nourishing soups, and then more solid aliments. Nightmare. — Incuhus. The characteristic symptoms of this distressing condition are semi-con- sciousness, and a sense of inability to extricate one's self from some imaginary weight or seizure. It may be caused by some defect, in the circulation, or indigestion. The sufferer is generally supposed to bo asleep; but in some cases, ho knows when persons are about him, and yet, unless he is spoken to or moved, or by effort himself can voluntarily move his foot or hand, he is liable to remain spell-bound, under a sense of weight or oppression. To relieve one when thus affected, turn or shako him. The remedies that may be employed to prevent Nightmare are .drr^ute, when there is a feverish condi- tion of the system; Nux vomica, when there is indigestion; and also PuUatiUa and ISulphur. Hysteria. This is a name applied to a great variety of nervous derangements, that for the most part are dependent upon nervous debility. It may manifest itself in an irresistible inclination to weep or laugh; sometimes in fainting and spasms, shortness of breath, screeching, and a sensation of choking. Aconite will sometimes quiet the nerves; Ignatia, if there is an inclination to weep; Ilyos- cyumua, if inclined to laugh; PuUatillay if connected with the menstrual period. For hysteric mania, Hyoacyamna, Stramonium, or Belladonna. Either of the remedies may be given in the usual dose, and repeated every two or three hours until relief is obtained; and it is also recommended that auoh persons ride out in the open air, and seek change of scene. Hydrophobia. — Babies. The bite of rabid dogs is productive of this disease. The poison commum- cated by the bite may remain in the system for an indefinite period ; and then all at once, the sight of water or some polished metal will throw the vic- tim into indescribable distress and madness, which are apt to increase and ter- minate in death. A dread of water is an unmistakable sign of the disease. When one is bitten by a rabid animal, the effect may bo extinguished by an immediate resort to cauterization. A heated poker brought as near to the wound as possible without contact is believed to be effectual in destroying the poison ; or the application of Nitrate of Silver immediately may also have the same effect. Hydrophobia has been cured by the persistent use of Belladonna in the usual dose, repeated every hour or two houra for several days ; ITyoscyor mus may also be employed in the same way; Cantharis has been recommended as an antidote to Rabies. Lnchesis, and even copious draughts of whiskey, have been found useful, Nothing, however, has been found more salutary as an immediate resort than dry or radiating heat. DISEASES OF THE EYE AND LIDS. "Hi i'l ikW Stye. This is a small tumor on the lid, about the size of a pea, which is quite painful. Aconite will often cure in a day ; Pulfiatilla, also, affords speedy relief ; Belladonna , Avhen the inflammation of the stye causes redress of the eyeballs; Stajph. prevents their recur- rence, taken once daily awhile. Inflammation of the Eyelids. When the . entire lids become involved in acute inflammation, A.conite, in the usual dose, may be given every two hours until relieved ; Puis., the same way, when there is burning, with flow of tears. If the lids become congested, red, and swollen, give Bella- donna. If the inflammation is chronic, give Calcarea once a day, or else Srdphur or Ilepar sulphur. If dependent upon gastric or bilious derangement, give Nux vomica or Mercurius every two hours until relieved, the latter especially when there are cutting pains, worse nights. Iritis, Inflammation of the Iris. The little circle in the front of the eyeball, which we call the Iris, is subject to inflammation. It may result from a cold, or from injury, or from some impurity of the blood. When from a cold. Aconite speedily affords relief. If very painful, Belladonna. If from injury. Arnica or Aconite. The patient must be kept in a dark To eighth room until the inflammation passes off. resort has been had to Morphine, in one repeated every four hours if necessary. external applications in Iritis ever prove used, none are better than water in which six grains of Opium to a ffill has been boiled. relieve acute pain, of grain doses. It is doubtful if any beneficial. If any arc «f< Scrofulous Sore Eyes. In persons of a strumous constitution, a cold, or any undue exposure of the eyes, may cause them to be the seat of scrofulous inflammation ; in which event, there will be a redness of the eyeballs, and swelling and ulceration of the lids, and a greater or less accumulation of matter be- neath the lids. This disease is often very painful, and destructive to the ?oats of the eye ; and, what is worse, it becomes the fruitful source of 814 DISEASES OF THE EYE AND LIDS. 816 I cataract and blindness. When the eyes first becomf, inflamed and burn- ing, Araenicwm may be given ; when the lids are implicated, give Calca rea ; when the inflammation passes otf, leaving white spots on the cornea, give Sulphur^ Hepar sulphury or Uonium. Daily doses of the remedy selected will be sufficient. Syphilitio Sore Eyes. Sometimes syphilis will affect the eyes, and threaten the destruction of sight. The lids will inflame ; tlie cornea will be congested, and of a bluish red : the conjunctiva will become the seat of inflammation, and sometimes of ulceration. MercurluB iod. may be given first, while the patient is kept in a quiet and darkly illuminated room, two doses daily, if the patient has already been treated with Mercurius, give NitriG acid or Hepar sulph. If considerable matter exudes from under the lids, give Aurum once a day ; and if the eyes itch continually, give Sulphur. Oataraot. This film, that obstructs the sight of the eye, is undoubtedly the sequel of scrofulous inflammation, or injury of the crystalline lens. It is simply an abnormal growth of a film over the pupil of tiie eye, partially if not wholly obstructing the sight. Conium mac.^ given twice a day. Merc, iod. is also a good remedy ; Phosphorus, Causiicum, or /Sulphur may be indicated. Either may be repeated twice a day when selected. Eheumatio Sore Eyesi Rheumatism of an inflammatory character may fall with great force upon the eyes, and produce severe pain and temporary blindness. Nux vom.^ Belladonna, Bryonia^ and Aconite, are remedies that may be con- sulted. Bryonia may be given three times a day, when every effort to open the eyes is attended with pain ; Belladonna, when the pain is such as to give the sensation of the eyeball being too large for the socket ; and also when there is a feeling as if the eyeball would burst. Sulphur, for dull pain in the eyeballs, and the sight impaired. Rhus whea the eyes are pink, and lame on moving them. Gonorrhoeal Sore Eyes. When the eyes become inoculated with gonorrhoeal matter, there will be smarting, and then inflammation and swelling of the lids, and such serious infiltration as to close the eyes ; and, in a very brief period, a per- fect disorganization of the texture of the eye will take place. As soon as the character of the inflammation becomes known, it is well to make some compresses of linen a half-inch thick, and bind them tightly over the eyes, and then give Canno^is every three hours for two or three days ; afterwards, give Oantharia in the same way ; and, after the smarting pain begins to cease, carefully remove the compress, keep the patient in a dark room, and Sulphur^ in daily doses, may complete the cure. W'K-V] ^ nf •■ ' ■xn\ S16 DISEASES OF THE ETE AHD UM. Speoks on the Oornea. Little opaque spots on the cornea may be left after scrofulous inflam* mation has passea away. These may be removed by daily doses of Sul- phur or Euphrana. Watery Eyes. When the eyes are watery, or prone to become so, from slight exposvre to wind or cold, the diiEculty may be obviated with daily doses of Pulach iillaf Mercurius vivus, or Lachesis. Blood-shot eyes will bo re- lieved by dftily dosea of Euphrasia. Squinting, Strabismus. What is termed crosa-eyed in persons is usually the sequel of some cerebral disturbances, that have deranged the normal action of the little muscles that regulate the position of the eyeballs, and give them an ab- normal or squinting appearance. Sometimes daily doses of Hyoacyamm or Belladonna will entirely remedy the difficulty. SHORT-siOHTEDNRSf may be remedied by daily doses of Sulphur^ Lycopodittnit or Pxd aatilla. DISEASES OF THE EAR. Inflammation of tlie Ean When there is inflammation and swelling of the external ear, and it has a red and fiery appearance, Pulsatilla may be administered twice a day. If the swelling and inflammation extend within, so as to close the external orifice, give Belladonna twice a day until the difficulty passes aw.'iy. If suppuration threaten, Ilepar sulj)h. Earache. This may result from cold, or from gathei-inf^s within the ear; or it may i)ossil)ly ho neuralgia, or proceed from decayed teeth ; or, in children, from teething. When from cold, give Chamomilla or Dulcamara three times a day ; if from injury, Hypericum or Ar^ nica; if from gatherings, Ilepar sulph. or Qalcarea; if from decayed teeth, Mercurius viv.; if in teething children, Pi/^.sa/e/^a, two doses a day; if the pain is neuralgic, give aVax vomica or Uelladoima. Running of the Ears.— OWorr^cea. Ottorrhoea may be occasioned by a cold, when there are no sores. For this, give Pulsatilla; when from sores in tiie ears, Oalcarea. If thia should fail of cure, try, in succession, Sulphur ^ Mercurius utw., and Silicea. ^ Deafness, Hardness of Hearing. To remedy this difficulty when produced by a cold, give N^ux vomica every night until relieved. For that which occurs ai'ter scarlet fever, Oalcarea, and for that after measles, give Pulsatilla; from hardened wax, Sulphur; if from rush of blood to the nead, or congestion, AoonUe or Belladonna; Causticum, if these fail. The remedies may be repeated every four hours until relieved. Nervous Deafness. When the nerves of the ear lose their vitality, and Deafness results as the consequence, Phosphoric acid may be given, in drop doses, twice a day ; or Sulphur may be given every night, or Nux vomica, or Causti- oum, in like manner. When Deafness occurs from Rheumatism, Pulsa- tilla may be given three times a day. Arsenicum, Nitric acid, Calcarea^ and Mercurius viv. may likewise be consulted. If Deafness occurs from suppressed eruption, the remedies are Sulphur, Oalcarea, Graphites, or Causticum, in daily doses. If Deafness is the sequel of malarious fevers. Phosphorus or Phosphoric acid, in daily doses ; if from sudden check of nose-bleed, or discharges from the nose or ears, Hepar sulphur, or Lache- sis; if from enlargement of the tonsils. Nitric acid, Mercurius^ oi Aurvm. 8i7 103 T DISORDERS OF THE NOSE. Nose-bleed. —^a8toa»>. This trouble arises from various causes, and must be treated accord- ingly. When it arises from arterial excitement, Aconite; from an injury, Arnica ; from rush of blood to the head, Belladonna ; if from inflamm'a« tion of the lungs, Bryonia ; in typhoid fever, Bhii tox. ; if caused by worms, Gina or Spigelia ; if from weakness or debility, China^ or Carbo veg. ; if from cold, or coryza, Nux vomica. Dose, three times a day. Obstruction of the Nose.— Ozoena. Ozoena is an entire obstruction of the nasal ducts, from thickening of the mucous membrane, or other causes. If from accumulation of the mu- cus, Pidsatilla; if from suppressed eruption. Sulphur, Lt/copodium^ and Galcarea; if from scorbutic tendency, Bryonia; if with dry crusts, Aurum, The usual dose, three times a day. Polypus of the Nose. Not unfrequently, a morbid growth attached to the mucous membrane of the nose will fill the entire nostril. This is termed a Polypus, and is perfectly curable. Calcarea^ when the disease appears in scrofulous sub- jects; Sanguinaria, when a cold has been the exciting cause; Sepia, when there is pain in the head and nausea ; and Staphy%agria, when it is the sequel of other disorders. The medicines may oe given in the usual dose, and repeated every four hours. 818 DROPSIES, HYDROPS. A OENEAAL swelling of the whole exterior surface of the body, and a sen- Bation of weakness, is termed General Dropsy, because the water infiltrates into the cellular or subcutaneous tissue all over the body. Local dropsies may affect the chest, abdomen, head, womb, and testes. Qeneral Dropsy, Anasarca. This is caused by Cellulitis and infiltration of water into the areolar tissue, causing one to swell all over the body. There is {;;enerally some thirst and fever that ushers in General Dropsy. Arsenioum in the usual dose may cure the disease when it seems to arise from a low state of the system. When it is the sequel of Scarlatina or Erysipelas, give Helleborm nig. tlirco tim(!s :i day. If after a Hilioiis Fever, give Mercurius viv. Following Scarlet Fever, Apis, or Terebinth. ' Dropsy of the Bellj, — Ascites. When inflammation of the peritoneum terminates in Dropsy of the Abdomen, Apia melifica may be given, every three or four hours, for sev- eral days. If it fails of effecting a cure, Apoeynum may be given, in the same way, and in like manner, Bryonia, Ilelleborus nig., and Ar- senicum. Tapping is somttimes necessary, when the ijeritoneal sack is filled with water, and dees not yield to rcniodios. Dropsy of the Ohest, or Hydrothoraz. The cause of this affection is inflammation of the pleura, causing an accumulation of serum in the pleural cavity. Apis melifica in the usual doses, repeated at intervals of three or four hours, will often effect a rad- ical cure, and so will Apocynum. If these fail, use Sulphur, Dropsy of the Heart. This is an accumulation of water around the heart, in the cavity of the pericardium. Spigelia ov Apis mellifica will generally cure. Sulphur is efficient in many cases. Bryonia, if from pericarditis or rheumatism. I ftv- 820 D&OPSIES, HTDBOPS Dropsy of the BTa.m. — ffydrocepIialua. Inflammation of the brain may terminate in an eft'usion of serum in the arachnoid cavity, and is often fatal. Hyoioyamua in the usual dose, re- reated four or five times a day, may prove beneficial. Af>i8 melifica has >ocn om[>l()y(M] in tho siinic way, also Ildleborus. Dropsy of the Womb. — Hydro metra. In^aramation of the womb often terminates in this affection. Bella donna, Apia melifica, Araenicum^ and Helleborus nig. have been employe* J against it. Dropsy of the ^OTotvim, — Hydrocele. This consists in the scrotum becoming filled with serum or water, after inflammation and swelling of the testes. It may be caused by Gonorrhoea, or it may be the sequel of Scarlet Fever. The same remedies employed in other local dropsies may be employed ; or, these failing, tho water may bo drawn off, and a weak solution of iodine may be injected into tho sack by a surgeon. Ovarian Dropsyi Inflammation of the ovaries is the cause of this difficulty. Artenioum will generally have a good effect, and so will Conium, and also Apii melifica and Puls given first; Pulsatilla may be given after Aconite, to remove the pains in the abdomen, and to promote menstruation. If there is much pain, and the function is tardy in making its appearance, give Galcarea or Sulphur, and then follow with Pulsatilla every four or six hours until the period commences. In case of considerable leucorrhcea, give Sepia, or perhaps (rJ'a- phives. When the periods become establi'^hed, they should last from three to five days. If scanty at first, give Ferrum, and follow with Pulsatilla; if there is intense headache, give Belladonna', if there is hysteria, and much agitation and suffering, give Hyoscyamus; and, during the interim, let the young lady take strengthening food until signs of the recurrence of another period. If it comes on normally, it is well ; but if tardy or painful, resort again to Pul- satilla, Hyoscyamus, Belladonna, and Graphites, as they may be indicated ; and continue this treatment from time to time until regularity is established. If tardy, with pains in the back, Kali carb. Interrapted Menstruation. This may be caused by cold, fright, fevers, diarrhoea, and dysentery, and by pregnancy. When by cold, or getting the feet wet, Aconite, at first, to remove any febrile excitement or headache, and then PvisatiUa. 92* DISEASES OF WOMEN. 8iT If this fail to remove the obstruction, give Galcarea, and follow with Niix moachata ; should this fail, try tiulphur. When menstruation is interrupted by fright, and there is intense headache, give Aconite, and follow with Belladonna or Ignatta, and fin.ally with Pulsatilla. When fevers weaken and depress the sj'stem, so as to interrupt thai function, first reduce the fever, and then, V,y properly nourishing the patient, the period may return. The same rule may be observed in treating the interruption caused l)y Diarrhoea or Dysentery. These diseases should be treated and cured by appropriate remedies, and the period will be likely to return spontaneously. If otherwise, i-esort may be had to Pulsatilla, Belladonna, Sepia, Galcarea, and other remedies, according to indications. Excessive Menstruation. When the flow is excessive or weakening, Ipecac, and China may bo employed, — the first to regulate, the last to strengthen the system ; and this treatment will be found necessary at ciicii pciiiMl, until duly regu lated. Calcarea should be given once daily between the periods. Menorrhagia, ar Profuse Bleeding from the Womb. This indicates a want of tone in the uterus, if not a state of disease, and is usually attended with fainting, pain in the back, nausea, and hys- teria. When from a want of tone, or debility, China or Ferrum may arrest the difficulty ; if from disease or inflammation, Belladonna or Ar- unicum ; when there is fainting and nausea, Ipecac. ; pain in the back, JSfux vomica, JVux moschala, or Ignatia, especially if the flow is dark O!' almost black, with fainting and drowsiness ; for hysteria, give Hyoscyamns. The patient should lie in bed until relieved, and should begin sitting up with great caution. A generous diet, easy of digestion, shcmld be supplied patients of this description. When the strength will permit, this class of patients should seek fresh air, and should avoid warm baths. Bathing with tepid water is far better. Painful Menstruation. — Dysmenorrhcea. Some ladies suffer intensely at every menstrual period. They have ohills, headache, fever, colic, and most excruciating pains in the womb. Aconite must be given for the fever, Belladontia for the chills and head ache, ^ locyntfi for the colic, and, for the pains in the uterus, Hyos- cyar/ius, Pulsatilla, Oimicifuga, or Rhus. Ailments attending Change of Life. Thb occurs about the forty-fifth year of life, and is denoted by irregu- larities, — profuse menstrual periods, great irregularities, pam m the hwd, melancholy, mania, loss of memory, and great nervous depression. For profuse menstruation at this period, give Arnica or Lachem; tor head- ache. Belladonna or Sepia; for intense pains in the womb, Arsenicum and Conium: for Melancholy, Lachesis, or perhaps Petroleum; tor mania StramMiium : for loss of memory. Sulphur, China, or Calcarea. Ailments daring Fregnanoji Some ladies are t'^mbled much with morning sickness in the early stage of pregnancy, and this is often cured with Cocculus or Nux vomica ; if with heartburn, Cimicifuga or Mercurius viv. ; if with water-brash of a hot or acrid nature, Arsenicum. Sometimes theee derangements are so stubborn that no remedies seem to relieve. Simple sirup y by the wineglassful, has been taken by some, Champagne wine by others, hard Cider by others. The simple resort will sometimes relieve ; and, at others, nothing seems to afford relief. Discharge of blood from the uterus may be cured with China. Leucorrhcea, Tery profuse and debilitating, requires Sepia twice a day ; corroding discharges, Calcarea twice a day ; for rheumatic pains, Caulophyl- lum; for painful breasts, bathe with Phytolacca; for threatened mis- carriage, Ipecac, Sabina, China, Arsenicum, and Belladonna; for sleeplessness, Nux vomica or Ars., and a light diet at night; for iK)se-bleed, Carho veg.. Aconite, Belladonna, JJachesis, and Mer' eurius, a dose of any one of them twice a day. LABOR, PARTURITION. False Fains. There ia a kind of pain that afflicts parturient women, that simply aggravates and unsettles tho nerves. (Jimicifuga or Caulophyllum will usually control this. When true labor pains commence, they may be regarded as normal if they come at regular intervals, and increase in force and [Vequency as the labor progresses. No medi- cine is needed ; and waiting, with patient labor, will accomplish the object. After the child is l)orn, a dose of Pulsatilla will aid in ex- pelling the placenta. If there is hemorrhage, elevate the hips and depress the head, and give a dose of Secale comutum; if anything more complicated occurs, call on an experienced midwife. Milk Fever. About the third day after labor, there is a struggle in the system to fill the breasts with milk, attended with fever. Give Bryonia or /*uZ^ satilla; if the milk is tardy in coming, give Calcarea. Difficult Urination. After labor, there may be difficulty in passing urine, which Ar- senicum or Hyoscyamus will usually relieve, if aided with cloths wrung out of warm water applied to the region of the bladder ; or else Aconite may be used instead of Hyoscyamus^ and sometimes Pulsatilla, or Canlharis. Soreness after Delivery. A painful soreness of the muscles after delivery may be relieved by the internal administration of drop doses of Arnica in a spoonful of water, while at the same time a towel wet with Arnica tincture may be applied to the abdomen. If there is soreness of the vagina, fc ty drops of the tincture of Calendula^ in half a pint of tepid water, may be used as an injection. AVt9 830 LABOR, PARTUBITION. OoDstipation of the Bowels. This condition after labor may be removed by one or two doses of Nuat vomica^ or perhaps by the same of Lycopodium ; if they fail, the bowels should be moved by an enema of warm salt water. Excoriated Nipples. Soon after the breasts fill with milk, and the child begins to nurse, the nipples are apt to become sensitive, and sometimes exceedingly sore. For \ fittle sensitiveness, or slight irritation, bathing the breasts with a solu- tion of Arnica will help them ; or perhaps a solution of powdered Boraz will do as well. If the soreness amounts to a decided inflammation, and tlie exterior of the nipples crack and bleed, a more careful and efficient treatment is needed. When putting the child to the breast excites great pain in the gland, and severe after-pains at the same time, the internal administration of Belladonna is necessary, — two or three doses during twonty-four hours ; and, at the same time, wet a compress with Arnica tincture, and apply to the nipple. Arnica also may be given internally. Wlien Belladonna fails, Bryonia, when the pains are worse in damp, cold weather. As an external application, a decoction of Oak bark has been found useful, and also the same of the Apple-tree root. A solution of Alum, Tannin, or Sulphate of zinc, has been employed ; but if the skin is cracked, and blood oozes out every time the child nurses, it is of little service. A weak solution of Citric acid is better, two drops to an ounve of Avater, The host external application for healing the cracks is the Glyceroh of aloes, which is made by dissolving one ounce Aloes in four ounces of Glycerine. This is the best prepara- tion known to heal an inflamed and cracked surface on any part of the body. At the same time, Sulphur, llepar sulphur, Calcarea, and Nitric acid may be administered internally. It is hardly neces- sary to add, that whatever lotion is used extemalty must be carefully washed off" with warm milk and water before the child is allowed to nurse. Suppression of the Milk. After the breasts have once filled with milk, and it disappears, a return may be promoted by the internal use of Calcarea carbonica, followed with Pulsatilla, or Phytolacca, while the patient is required to drink chocolate, or table beers. , . Induration of the Breasts. When the breasts cake, or portions of them seem hard, like a potato, rub them well with lard, and give internally Carbo animalis. In a ma- jority of instances, these hard cakes will disappear if carefully attended to. When lard fiiils to soften, try dry rubbing with the hand. If tlif breasts ache, give Belladonna; if there is fever, Aconite, or Phytolojcca. If inflammation sets in, and cannot be scattered, give Hepar sulphur to hasten it to a crisis. Poultices of flaxseed meal may also be applied to hasten suppu LABOR, PARTURITION. 831 ration. If it is found necessary to lance the abscess, lut it be done with an opening in the direction of the milk-ducts, and not across them ; for, when once severed, the parts never unite perfectly again. After the matter has discharged, some emollient salve spread on chamois skin may be applied, for the double purpose of protecting the breasts and healing the sore. Suppression of the Loohia. The flowing after delivery is termed " Lochia," and should continue foi ten days or two weeks. If, through any unfavorable influences, the flow is suppressed, the whole system will be more or less disturbed. If simply arrested, Pulsatilla may be given every two hours, for at least a day ; and, if there is no return, give Secale comutum. If still the suppression seems stubborn, and the head begins to feel liglit, and the nerves become unstrung, give Hyoscyamua, and i-eneat every three hours until better, or there is indication tor a change. Sulphur will sometimes remove the difficulty. If the light-lieadedness be very marked and maniacal, and there is no inclination to sleep, a decided advantage may be found in the use of Belladonna. If the lochia should finally return, and be of offen- sive odor, give Mhus tox.; if much thirst and dryness of the throat, Arsen- icum; in case of diarrhoea, Arsenicum and Mercurius viv., repeated every two hours. The application of tepid cloths to the abdomen is rec- ommended, until the lochia returns. Should the lochia continue too lonof, — that is, beyond the seventeenth day, — Rhus, Child-bed Fever. A low form of fever frequently sets m about the fourth or fiflh day after confinement, sometimes severe enough to prostrate the patient for weeks. Every day, she will suffer from pain in the head and copious perspiration ; the hair falls out. This fever sometimes continues imtil a diarrhoea sets in, and the patient sinks into a typhus and expires. Therefore, at the first manifestation of this fever, Bryonia should be given eveiy three hours ; and this may be followed with Rhus tox., in the same manner. In case of diarrhoea and prostration, give Arsenicum or Veratrum alhum. If there is sallowness of the complexion, give Mer- curius viv. A very light mutton-broth may be given for nourishment. Should there be a general pain, and aching of the whole body, give PhosphoriM two or three times, and especially if the diarrhoea should be lark and watery. If the fever should be subdued, and convalescenr established, allow the patient a little wine and water, beef-tea, and a grad- ual approach to more substantial aliments. Should the above reme- dies fail, any typhoid symptoms present themselves, Baptisia, hourly. LencorrhoBa after Confinement. A flux of this kind may result from general debility, and requires for its removal a good nourishing diet. China may be given three or four times a day at first, and afterwards Sqtia or Caiearea. fe; 832 LABOR, ..BTUBrnOM. Falling of the Womb. In some cases, after child-birth, there will be falling of the womb. This may be the result of a weakened condition of the muscles that retain the womb in its place. When this trouble is of an aggravated form, and is attended with copious Leucorrhoea, Nux vomica may be given every evening. The patient should allow herself to be as little upon the feet as possible, — rest being one of the essential conditions for gaining strength and for obviating the difficulty. Hemorrhoids, or Piles. For the piles consequent upon a tedious labor, Arnica may be given every morning and evening, or perhaps Hamamelis^ if they are inchned to bleed ; also Nux vomica and Sulphur^ when there is severe constipa- tion and hemorrhage at every stool. Sulphur in the morning, and Nuz vomica in the evening. Stewed prunes, Graham toast, and chicken loup, may enter into the diet. DISEASES OF INFANTS. Crying. When a young infant is inclined to cry continually, and sleeps but little, give it one or two globules of Coffea^ and repeat every four hours. Golio. For infantile colic, which may be caused by flatulence, give Cham- omilla; put one or two globules upon its tongue. If this does not relieve, give a globule of Nux; if restless, and throws up its food, after the Nux, give a globule of Coffea. Verat. album is an excellent remedy for infantile colic, and Dioscorea has a great reputation. Infantile Diarrhoea. There will generally be a diarrhoea after an infant has nursed the first-fruits of the breast. If excessive, give one or two globules of Pulsatilla; if attended with colic, give the same of Chamomilla; if the diarrhoea is acrid or scalding, give Arsenicum, one or two globules ; if with excessive vomiting, give Ipecac. Infantile Dysentery. When young infants are observed to strain, and have frequent itool., and sometimes pass mucus and blood, give Ipecac., one globule, or elto MermnaaL If they cry out after each stool, and the intestine protrudes, give one or two globules of Ignatia. If they refuse the breast, give Aconite. In case of heat in the head, give Belladonna, Inability to take the Breast. Some infants are congenitally opposed to nursing the breast ; and all the coaxing and trying which a patient perseverance can supply avails but little. Such infants require to be fed ; and to devise for them a good and wholesome nouiisliment is sometimes difficult. The nursini)vi!itod. When J/i/osci/armis fulls, give a globule or two of Pulaalilla or Aconite, Teething, Dentition. When an infant has attained the age of four or six months, the pciiod of teething commences. The child begins to drool, and is restleus and unt^asy, and frequently cries out with pain. At times the cheeks will be red, and tlie head will be hot ; or else there will be diarrhoea, and the food will pass the bowels undigested. The child is generally fretful and un- easy. The most effectual remedy for the restlessness and irritative fever is Ghamomilla. Two or three globules may be given three times a day. When the head is hot, and the child thrusts its fingers into its mouth, give two globules of Belladonna ; when the food passes undigested, give two globules of Pulsatilla. Wiien there is a general heat of the body, a'ld deranged condition of the stomach, give two globules of Aconite; if this fails to relieve in twenty-four hours, give Gimicifuga every hour. Summer Oomplaint, Cholera Infantum. ^ During the heat of summer, toothing children are prone to be affected with a pi strating diarrha^a, jsonietiuics watery, at others dysenteric, when the stools are tinged with blood. In the first stage, when there is considerable fever and watery discharges from the bowels, two or three globules of Aconite may arrest tho difficulty, followed by Tartar emetic; if the discharges are profuse and fre- quent, Veratrum album ; if there is much thirst, Arsenicum. For discharge of mucus, give Mercurins; when tinged with blood, give Ipecac. The dose of either is two globules. When there is cold- ness of the face and extremities, give Carho ver/. If, in spite of these remedial measiu-es, the disease continues, let tho child be taken into the open air, or into the country. A trip upon tho water in a steamboat has frequently resulted in a favorable change in the condition of the child. The diet, aside from nursing, should be mutton-broth and beef-tea, or perhaps arrowroot or farina gruel. MarasmuSi ETtreme Emaciation. From the combined effects of teething and interrupted nutrition and also from diarrhoea, the child will lose its flesh in a remarkable degree, and nearly all the adipose or fatty tissues will seem to disappear. Th6 bones of the face will become prominent ; the eyes will sink back Into theur sockets ; the skin will be shrivelled and oose over the entire body, and very marked upon the upper and lower exti nities. The most prominent feature of the disease is interrupted nutriti .1 ; and often the child's stom- ach rq'ects the simplest kind of food. When there is continual retching. ^^^1 s 836 DISEASES OF INFANTS. give Ipecae.j to allay the irritable condition of the stomach ; and then give Call area; or if, at first, there is no nausea, but thirst, give Arsemcum. Sulphur is a valuable remedy, and also Ferrum. When either beef- tea, or barley-gruel, or any other kind of light soup or giael, fails of being retained upon the stomach, a grUel made of the flour of the yelk of a hard-boiled a^^ has supplied the want of rourishmont, and promoted the recovery of marasmus patients. When ihe child is old enough to feed himself, the yelk, boiled hard, may be broken in a saucer, and seasoned with a little salt ; and the child will pick it up a little at a time and eat it. But if otherwise, to a pint of Doilin^ water add a half-pint of fresh milk and the flour of one yelk, seasoned with salt, and sweetened. This makes a gruel that will flow through a nursing-tube. This food contains the b'^st preparation of iron for tne infantile system, and in many instances '.las been effectual in curing marasmus. Hiccough. — Singultus. This annoying difficulty results from the irritation of the diaphragm and the oesophagus, or passage from the mouth to the stomach. Nux vomica^ Ipecac.^ Pulsatilla, and SanAucus, have been euin^oyed as reme- dies. A single dose of two globules of either may be administered when infants are so affected. GonvnlsioDS, Fits. There may be various causes of these convulsions in infants. A fever, an irritable stomach, teething, or cold, may produce them ; when from fever, give two globules of Aconite, and in two hours follow :nt\i a dose of two globules of Belladonna. When from an ill-conditioned stomach, give Chamomtlla, Ipecac, or Ignatia; when irova: coXdi, Nux vomica or Sulphur. When the convulsion comes on with vomiting. Ipecac. ; when from colic, Pulsatilla or Colocynth ; when with inclination to sleep, Opvum^ or perhaps Stramonium ; when from the sudden disappearance of any rash or eruption, Cuprum, EzooriationSi The tender and delicate skin of infants is liable to become excoriated from the slightest causes. To relieve the pain and suffering attendant ipon it, give two globules of Chamom'ila, Mercurius viv., or PulaatiUa internally, and wash them with a weak solution of Arnica or Hama* melis externally. Should this condition persist, give Sulph. daily. Soreness behind the Ears. When a child is teething, and there is considerable of the fever of dentition, an eruption is liable to show itself behind the ears ; and, although this eruption is believed to be effectual in preventing more serious disease of the head, it is, nevertheless, an unnecessary disease. Graphites may be given to remedy the lifficulty, a single dose in twenty-four hours ; and, in uke manner, Arsenicum, Catcarea^ and Baryta Carh.^ may be employed. Piiokly Heat During intensely hot weather, children are liable to break oat with prickly neat. The stomach at first seems slightly deranged, and the eruption apon the surface appears to be an elimination of some internal disorder. There is sometimes much fever and headache : for this, give two globules of Aconite. If the child is teething, give ChamomiUa. If the surface becomes red and inflamed, give Rhus tox. If burning and Mnarting, give Aneiiicwm. In case of severe itching, give Sulphur. When children are taken out by their nurses on a hot day, they must not be exposed to the heat of the sun : shade should be sought for them, where, if any air is stirring, they can get the benefit of it. I Milk-0ru8t. — Porngro. This is a scabious eruption upon the scalp cf nursing infants, which at first appears to be a humid scurf. It collects as a slight humor, and begins to enlarge, involving more and more of the surface, until that of the scalp is entirely covered. It is a source of annoyance to mothers and nurses. There appears to be great difficulty in keeping the affected surface clean, and consequently a hasty resort to some drying wash ha? wrought disastrous effects. When Milk-Crust is suppressed, the irritation is apt to fall upon internal organs, and produce worse affections. The tar and sulphur ointments, which have been too frequent - resort, have had the effect, in some measure, to dissipate the eruption ; but the usual sequel to this are convulsions, or fatal brain diseases. It is, therefore, recommended as the most prudent course, to depend upon the internal administration of remedies such as eliminate the hutnor, and keep it upon the surface. The purer the blood can be kept, the sooner will the disease disa|)pear. If no attention is paid to the use of external agents, the entire difficulty will bo eliminated and dissipated in the course of a few months. Two globules v>i Aconite may be jjiven when there is fever, and this may be t'ollowed for a while with daily doses of Rhus tox. and liryania. In scrofulous children, jfive Oalcarea, Arsenicum, or Sulphur. In debilitated constitutions, jnfivc! Graphites, Ferrum, Hepar sulphur, anci Of"'na. Lycopodium, throe limes daily, has cured most obstinate cases. All oily food should be withheld. Butter is not allowable. After children have been weaned, and still the Milk-Crust remains, a farinaceous food is best. Sourf of the Head. This is an accumulation upon the scalp, of an oily and dirty appearance, which, in mary cases, is the result of not being particular in washing and wiping the head dry. Soap should never be used upon the scalp. and strong alkaline solutions are injurious. Water softened with corn or rye meal will answer all the purposes for cleanliness. As the difficulty does not penetrate below the external skin, Rhv* tox.y Pulsatilla^ OcUaa- rea^ and Silicea are remedies, either of which, in daily doses, will be all that u required. i\ I'M if; Sorofhloiu Swelling of the Saliyoiy Glands. This is a disease somewhat common to children tf scrofulous parents ; and it is of the utmost importance to understand well its character and treatment. When these children take cold, the glands are apt to become excited, an i there is a perpetual flow of saliva from the mouth ; at the same time there will be soreness of the throat, stiffness of the neck, and swelling of the glands externally. Sometimes children will carry their heads to the right or left shouWer, when laboring under the difficulty ; and, in spite of the best efforts to relieve them of suffering, they will con- tinue indisposed a long time. Two or three globules of Aconite will subdue the initial fever. Mercurius viiK may then be given two or three times a day. If tliis fail to ai'i'cst tlie salivation, give Nitric acid for a day, at intervals of six hours. Belladonna also may be given to remove any congestion of the throat. Silicea may be given afterwards to aid in softening the glands. Also, Nux vomica and Sulphur may prove to be useful remedies. The children should be kept in a room of moderate temperature, and not be allowed at any time to be exposed to extremes of heat and cold until they have fully recovered. Sleeplessness of Infants. Infants are sometimes smitten with inability to sleep, as well as adults. The cause is not always kii^iwu. It is believed, however, to be the result of some disorder acting upon their delicate nerves ; such as indigestion, excoriation, or overloading their stomachs. If from an irritable stomach, give them Ohamomilla or Coffea every night. If from any excoriated surface, that burns and smar.s; give two globules oi Arse icum^ and then apply to the excoriated surface a little rye flour, or Lycopodium pow- der, and soothe them to sleep in a quiet and noiseless room. If the sleeplessness is produced by retention of urine, give Hyoicyamus ; if by worms, Cina. If the head is hot, give Belladonna. If the sleepless- new is from feeding the child too much, give two globules of PulsatiUa, If from constipation of the bowels, give Nux vomica or Lycopodium at night. If these remedies fail, a tepid bath will often consummate the iesired result. DISEASES OF VARIOUS ORGANS AND REGIONS. Passage of Gall-Stones. The passage of gall-stones is attended by severe pain in the region of the stomach, obliging one to writhe in agony, and roll from side to side. The strongest men become subdued when suffering from the pas- sage of these concretions. The pain resembles an intense colic ; and sometimes the agony produced by biliary calculi goes under the name of Bilious Colic. In addition to the pain occasioned by the concretions, there may be vomiting, headache, cold extremities, and sallow com> plekion. To reUeve the suffering, resort has been had to Morphine and Opium ; but those sedatives only prolong the difficulty. Tney afford only temporary relief from pain, and the use of them must be discour- aged. Cathartics, on the whole, have failed of accomplishing the pur- pose, and only weaken the patient. Homoeopathic remedies have some* times afforded prompt relief; but, as a general thing, the success attend- ing the most perfect affiliations of indicated remedies has not been great. The most modern treatment for biliary calculi is to administer to the patient from two to four ounces of pure Olive oil,, the laxative effect of which has gently moved the bowels, and brought from the gall-duct large numbers of the concretions, sometimes a dozen or more ; afler which, the blackness of the countenance will begin to disappear, the indurations found in the region of the liver become lessened, the appe- tite returns. When attacks of Bilious Colic occur, it is not always certain that the gall-duct is obstructed with stones. Therefore, (Jolocynth^ in the usual dose, may afford prompt relief; even when gall-stones have been present, and the suffering and agony are indescribably great, Puha- tilla has cured. When there is severe pain and induration in the region df the liver, a dark, sallow countenance, and black circles around the eyes, much relief has been obtained by the use of Ar%enicum. When there remain black spots or discolorations upon the face. Sepia. When there is much vomiting during an attack. Ipecac. External applications sometimes prove useful. Emollient poultices applied to the region of the pain have proved beneficial. The pain attending the passage of biliary concretions has sometimes been mistaken for chronic Inflamma- tion of the Stomach ; and, on this account, the remedies have failed to 839 ;^ PI I 840 DISEASES OF VARIUUS ORGANS AMD REGIONS. control the suffering. Very many perspns suffering from chronic Liver Complaint become victim? to the suffering produced by gall-stones, and should restrict themselves to a simple but nutritious diet. After an attack, the olive oil should be taken for at least six jnonths, a table- spoonfiil on retiring, each night. Cancer of the Liver. — ^cAiitms. In the event of a constant suffering in the right side, with apparent hard protuberances, while, at the same time, there are dark circles around the orbits of the eyes, and when there are shooting or lancinat- ing pains darting from the i;idurated protuberances, a cancer may be suspected. If not too far advanced, it may be cured by the* administi-a- tion of Arsenicum^ when there is much thirst and dryness of the mouth, a white coating upon the tongue, and considerable prostration. Conium maetUatum may be given three times a day when there is pain in the right side, as if constricted by a band, or tearing and stretching in the region of the liver, and colicky, abdominal spasms. f^wt Oanoer of the Stomacli. This formidable disease often comes on insidiously, and the victim supposes himself to be a sufferer from an aggravated form of Dyspepsia. Severe anxiety and trouble are supposed to have a serious influence in the production of the disease. A constant irritation -of the mucous lining of the stomach may tenninate in the difficulty. The chief symptoms denoting the presence of Cancer in the Stomach are great depression of spirits, a downcast countenance, a pinched appearance of the nose, with the comers of the mouth drawn down, and also a constant inclination to retch and vomit dark matter, somewhat resembling coffee-grounds, and also severe cutting or shooting pains in the stomach, with intense thirst. Ntix vomica has sometimes cured Cancer of the Stomach. The indica- tions for its ube are intensely bitter eructations, and spitting up of dark matter; and also when the eructations are followed by vomiting of sanious or bloody matter. When the patient has suflfered greatly from anxiety and Dyspepsia, Ignatia may be given, instead of Nux vomica. When the tumor can be diagnosed or discovered by external manipu- lation, Arsenicum, and also Conium, may be given twice a day. Coccur lus also may be given when the nausea and vomiting are similar to that produced by riding in a carriage, or sea-sickness. When one has sui^^ fered many years from Dyspepsia, and then begins to emaciate and spit up this dark matter. Nine vomica given persistently is most likely to be of service. The patient should subsist upon broths, beef-tea, and the most delicate farinaceous diet. Oanoer of the Intestines. The symptoms which denote the presence of Cancer of the Intestines are constant pain in the bowels, and acrid discharges of blackish stools, a very black or dark appearance of the countenance, downcast expre»> lion, a constant inclination to relieve the pain by pressure of the handf ■m DISEASES OF VABIOUS 0BGAM8 AND BEQI0N8. 841 and arms. This affection generally terminates &tally,— the result being perforation of the bowels. When aatopsy, or post-mortem examination, reveals the fact, it is then called to mind that tite victim has worn the expression and complained for a long time in a way that might have excited suspicion of the trouble. To note these symptoms when they first occur may suggest a treatment that possibly might avert a fatal tei> ,mination. Ar»enunim may be given when the patient has thirst, burn* ing pain in the bowels, and hot, acrid stools ; Comum^ when the pain* appear to be of a neuralgic character, and persistent ; Belladonna^ when there is a painful distention of the abdomen. The diet should be th» Miae as that directed for Cancer of the Stomach. Ganoer of the Skin. When inflammation of the skin, or any persistent irritation, terminates in Cancer, there is a rough, hard tumor of a bluish appearance, at first about the size of a common wart. It sometimes grows into the shape of a tumor, and is the seat of sharp, shooting pains. The remedy that has apparently cured this affection is Silicea, in daily doses. It is particu- larly indicated when there is painful soreness or sensitiveness of the skin, and an itching of the whole body ; and also when there is stinging in the sore. To prevent cutaneous ulcers of the skin from becoming can- cerous, the same remedy may be used. To prevent horny excrescences from assuming a cancerous character, Conium or Causticum may be given in daily doses. Almost any persistent irritation may assume the cliarac ter of a cancer. Ichorous ulcers, fetid sores, malignant boils or ulcers, should be carefully treated and cured, or otherwise they may take on a settled or constitutional schirrous character. The skin should be kept clean ; a flesh-brush should be frequently used, and exercise in the open air is commended. Diet free from condiments, but nutritious. Fig-Warts, These are excrescences upon the skin in the shape of a fig, and hence their name. Nitric add and Thuja are remedies for these excrescences. Thvja is more particularly indicated when they bleed ; Nitric acid^ when they are flat ; Nvix vomica, when they are dry. When they sup- purate, or are humid. Thuja; wiien they split or crack, Nitric add. Of the remedy selected, give a dose every day. For Common Warts, Thuja is also the chief remedy, and should be given every two or three days. , Gangrene. When one has been so long sick as to acquire bed sores, and these become black and fetid and deathlike, they are said to be gangrenous. They indicate a low condition of the system, and generally indicate the employment of Arsenicum in daily doses, or else Lachem. For Dry Gangrene, give ArMenioum, For that which \% humid, ^ve China, ^ B' 842 DUEASES 0FVA7.I0US OBGAMS AND REGIONS. i^^' For that which emits an offensive odor, give SeoaU eomutum. Thii last remedy may be given for gangrenous blisters. The patient. If he take it, should have a generous cuet. Zona, or Shingles. In some cases, there is a zone or belt of vesicles, four or six inches iu width, that extends half round the body, on the right side, over the region of the liver. These vesicles appear to be filled with lymph, rnd are prone to burn and itch to almost an unbearable extent. It is believed to be a concomitant of chronic Liver Compb.int, and indicates an exceedingly lov? rendition of the blood. Mhiis tox.^ in daily doses, will generally cire the disease. Graphites may be given after lihua tox. When there is pain in the right side and a sallow complexion, give Mercurius. Bryo- nia will eliminate the eruption, and aid materially in the invigoration of the system. If there is much headache, give Belladonna. If the patient is scrofulous, give Arsenicum or Calcarea. The diet of the patient, if his appetite will permit, shoul J be quite generous. A little wine every day is recommended. Beef or mutton without condiments, and the usual vegetables, are allowed. * ^ Nasal Polypus. This fungous growth in one or both nostrils sometimes proves a serious obstruction to respiration through the nose, and can be cured, in most instances, with well-chosen remedies. When both nostrils are affected. give a dose of Calcarea every twenty-four hours. When the Polypus is in the right nostril, give Pulsatilla ; when in the left, give Sanguir naria. If the nostril seems plugged, give 8epia or SUicea, Warts on the Nose. Warts on the nose aie sometime-s quite annoying, as they not only are inconvenient, but oflen painful. It is difficult to let one of these excrescences alone ; and, by constant irritation, it may become cancerous: therefore, prompt treatment when they make their appearance is requisite. Camtieum^ given at first, will soon relieve the nose of this appendage. Warts on the Hands. When warts on the hands are prone to grow thick and large, and appear to be seedy. Thuja in the form of lotion may be applied extern nally, while the usual dose of the same may be taken internally. Chir prum asceticum also may be taken internally, and a wash of Ckiprum ndph., one dram to half a pint of water, may be applied externally. Inflammation of Glands under the Arms. A sore upon the back of the thumbs, and sometimes an irritable sore upon the bftcks of the fingers and hands, may cause soreness and inflam- tv J DISEASES OF VABIOUS ORGANS AMD BEOIONB. 843 mation of the elands in the arm-pits ; that is, the inflammation may be transferred to this locality from the thumb, fingers, or liands. At first, a slight soreness is felt under the shoulder in the arm-pit, and the glands will swell and become sore to the touch ; more cr less fever will manifest itself at the time : and not unfrcquently pain, throbbing, and suppuration supervenes upon the inflammation. Aconite may be given to subdue the fever and inflammation ; Hepar nulphur may be given to promote sup puration; Belladonna or Bryonia to prevent it. Phytolacca, also, is a most useful specific, given every three hours until relieved. Inflammation of the Oroin, Inguinal Glands. The inguinal glands are situated in tlie groin ; and sometimes sores «/f an irritable character upon the toes may operate so as to transfer these influences to this region, causing swelling and suppuration. If takf n in time, this soreness may amount to nothing more than an uncomfortable lameness, rendering it difficult to walk. If not arrested, tiie inflamma- tion will pass into suppuration. Sores or chancres upon the integuments of the penis may also cause inflammation, swelling, and even suppura- tion, of the inguinal glands. When caused by sores on the toes, poul- tices of bread and milk may be applied to ther- to draw the inflamma- tion from the groin ; and Nux vomica may be ^.v^en internally, to aid in curing the difficulty. When this inflammation occurs in scrofulous per- sons, Ar»eni(mm may be given twice a day. When the inflammation proceeds from a chancre, give Merc. iod. three times a day ; when from suppressed Gonorrhoea, give Sulphur. Mercurial ointment may be a|»- plied to the sores, when of syphilitic origin. If tkey occur from Syphilis, Mere. iod. may be given internally three times a day. cancerous: Milk Leg. — Phlegmasia Dolens. This affection frequently occurs one week afler delivery. It consists in a swelled condition of the thigh and leg of either the right or lefl side. The skin becomes tense, sore to the touch, adematous or dropsical, and very sensitive. It rarely affects both limbs at the same time, although in some instances such is the case. It may sometimes be arrested in the incipient stage by a single dose of Aconite. In a more advanced stage, Belladonna will have a curative action ; and, where there is great sen- sitiveness of the skin, Rhus tax. When the victims of Milk Leg have been afflicted with dropsy before confinement, Arsenicum may be given. In cases where women are suffering from rheumatic pains in the knees, or where there is suppressed lochia, Pulsatilla. When the bowels are constipated, Lywpodium may be given, and not repeated for several days.. Stone Bruise. By a Stone Bruise is understood an injury upon the plantar, or under surface of the foot, which becomes inflamed, painful, and suppurative. It mostly occurs with boys and girb who run barefooted through tne warm J A •n Ic fcy^- ^r^ I 844 DISIASE8 OF VABIOUS ORQANS AMD BBQION& weather ; and it is believed to be the result of stepping forcibly upon pebbles or other hard substances. Amiea given cmce or twice internally, and a lotion of the same applied externally, will often remove the pam speedily ; but, after suppuration has taken place, the sooner the matter it let out with a lancet tne better. Bonioiis. These protuberances upon the joint of the great toe, or upon the side of the foot immediately back of the little toe, frequently grow so large as to interfere with the wearing of a shoe or a boot, and so painful as to interfere with the comfort of the patient. In order to derive any benefit from treat ment, all mechanical interference must be removed, the boot or shoe must be shaped to favor the tumor, and then wet the tumor a number of times during the day with Arnica. Antimonium crud. may be given internally, or else Calcarea, Sepia^ or Sulphur. Give but a single dose of each remedy ; after which, wait with patience. If the bunion is very painful, give Oalcarea ; and, after two days, give Nitric acid. If the pains are stinging, Lycopodium^ Silicea, or Sulphur. Give a single dose of either remedy, and wait forty-eight hours. A weak solution of Nitric acid will often moderate the severe pain of a bunion in dry weather ; Bryonia will do the same in cold, damp weather. Silicea or Rhux tox. will afford great relief when every change of' weather aggravates the pain and suffering. In case of the bunions becoming the seat of neuralgic Eain, Belladonna may be given ; and when they are made sore by chil- lains, as in scrofulous persons, Arsenicum must be given. The patient must not walk much, but keep the feet dressed and warm until the sore- ness disappears. A poultice of bread and milk will soflen and mollify the aching during a storm. Heotio Fever. The importance of this fever is so great, that, instead of elaborating upon it under the head of'* Fevers," it is introduced here, because it should not be confounded with other febrile diseases. There is a common im- pression that Hectic Fever and Consumption are one and the same thing ; but this impression will be corrected when we consider briefly ths origin of this fever. |t is sometimes intermittent, and sometimes remittent. Often a slight chilliness is felt some time during the day ; and this is followed by a febrile re-action, more or less severe, and of a pros- trating character. Extf-eme debility may cause a fever of this kind to spring into existence ; and, under such circumstances, it may take the form of a low nervous fever, very slow, and wearing upon the nutritive system. But Hectic Fevers show themselves where there are local cnronic inflammations and suppurations, as in the case of abscesses, car- buncles, &c. They are sometimes caused by grief, or emotions of any kind. They are caused by the loss of animal fluids ; or they may supervene upon any prostrated condition brought on by acute disease. They result also from Scrofula and Syph'Us, and from the poisonous influ- ences of Quinia or mercurial medicines. It is probable, therefore, that Hectic Fever; taken in time, is curable, provided the organic lesions i on which it depends are not of a fatal or incurable kind. That which usually accompanies pulmonary tubercles can only be overcome by curing the Tuberculosis of the lungs. We will proceed to specify the treatment according to particular indications. Those springing from debility, and of a slow nervous fever, require the use of China and Arsenicum. Give the China every time the fever remits or intermits, — a single dose. Give Arsenicum in ti>e same way wlien there is extreme prostration and thirst. Give Phosphoric add when tliere is diarrhoea. Wlien the fever attends local inflammation, Arsenicum may be given, when there is great ema- ciation and debility, with palpitation of the heart, hot, dry skin, and night- sweats ; Calcarea, when there is constant heat and little thirst, frequent fluslies of heat, especially in the evening, with red cheeks. Calcarea is also indicated when there is loss of appetite, great debility and ema- ciation, and also paroxysms of anguish. China is indicated when there is great paleness, sunken cheeks and eyes, great listlessness, dry and flaccid skin, great hunger, or else loss of appetite, and a tendency to Diarrhoia. For Hectic Fever brought on by emotions or grief, give Phos- phoric acid, followed by Capsicum wiion there is painless diarrhoea, sad, op- pressed mood, febrile heat in the evening, smd sweat towards morning Give Ignatia when the patient weeps during the fever, and hus much heat in the palms of the hands. Give Graphites when the patient is pale, and the heart is prone to palpitate. If the fever is produced by debilitating losses, give China when from hemorrhage; give N'ux vomica when from sexual excesses ; Phosphoric acid when from diarriioeu, and there is accelerated pulse, anguish, and sweats in the morning. When the fever comes on after Dysentery or Typhus Fever or Cholera, give Arseti- ieum, if there are dysenteric discharges, and if the patient is greatly emaciated, and has laborious breathing, with debility and palpitation and thirst, obliging one to drink frequently. Give Cocculus wheii Hectic Fever sets in after Typhus, when there is great debility, and trembling after the least exertion, blue margins around the eyes, dry mouth, and loss of appetite, oppression of the chest, and with great sadness and anguish. Give Veratrum album when hectic comes on after Cholera, if there is great weakness, or cramps, or pain in the back of the head during the fever. When Syphilis is attended with Hectic Fever, and if the patient has taken much Mercury, give Aurum mur. or Slannum, when there is great emaciation, and pains in the bones, and loss of appetite. Nitrio add may be given when the hectic fever has been brought on by mercurial medicines, and when there is great dryness of the tliroat, and varices of the tongue. In many cases of Hectic Fever springing up like those named above, a careful selection of the remedy, and corresponding adaptation of diet and regimen, will bring about a large proportion of cures. Persons suffering from any form of Hectic Fever should be kept in an atmosphere of uniform temperature, — from 68° to 70° Farenheit , and should be supplied with generous food when the appetite will take it, and in some cases the best of grape win?. Night-Sweats. If night-sweats break out in particular diseases, they do not require any special consideration, unless it happens to be one of the most promi- 1 '■fq 846 DISEASES OF VARIOUS ORGANS AND REGIONS. .1^ I "I" if t -if m: i.i nent symptoms ; in which case, it ma^ constitute an important indica- tion for the selection of a remedy. A profuse perspiration of this kind which affords no relief indicates Mercurius or China. Exhausting nij^ht- sweats in the case of persons that hiive become weakened by disease or other causes, point to Carho. vegetahflis. Vcratrum album. Sulphur. I5ut tliorc are indivi(hials, who iippear to be w*;!! euough otherwise, who per- spire copiously every ni}>ht, and sometimes so proruseiy as U> wet the bed- clothin:;. It would seem that sleep induced some kind of labor that wrought the system up to this pitch of perspiration. It is said to be most common with corpulent persons. Such cases as only exhibit the one symptom of sweating for consideration, must be treated as follows : When one begins to sweat as soon as he lies down to i*est at night, Arsenicum may be administered. When he fails to sweat so long as he keeps awake, give Hepar., if he is corpulent ; or Calcarea if he finds the sweats to iminish his strength. If exercise of mind sets him to perspiring after getting into bed, give Nux vomicoy if there is a sanguine temperament. If the person is a good feeder, and eats heartily, and has these prostrat- ing sweats at night, let him eat less, and take Pulsatilla. Exhausting night-sweats that occur after fatigue require Arnica and China. If after severe mental labor, give Cocculus or Nua; vomica. If from no cause that can be determined, Carbo. animalis. When no fever precedes one of these exhausting sweats, and there is great debility after, China, Fer- rum, and Qraphitea are appropriate remedies. For the exhausting night- sweats that occur after masturbation, China is also the remedy. If there is uncomfortable feeling about the head, — a dull feeling, — give Phos- phoric add. Those night-sweats that occur after excessive sexual indul- gence require China, Arsenicum, and Qraphites. For morbid sweats in general, Arsenicum, Arnica, Bryonia, China, Ferrum, Qraphites, Helle- borus nig., ffyoscyamiis, Ignatia, Mereuriv*, Nux vomica, and Sulphur may be consulted. . • . Polnionary Oonsamption. There is reason for a distinct monograph upon this disease. Much that can be done to ward off the disease by domestic treatment should be done ; and, therefore, to point out a plain description and treatment of the incip- ient stage is at least desirable. The cause of Consumption may be hered- itary taint or overpowering influences that break down the strongest constitutions. When hereditary, it frequently exists as a predisponent in the system until aroused by some exciting cause. It is therefore of the first importance to become familiar with the means of protecting one thus disposed from surrounding influences that may develop the hereditary taint. When a child of consumptive parents appears to thrive well and grow, betraying no signs of disease, it is well to keep him surrounded by such atmosphere, food, and clothing, as contribute to his healthy develop- ment, until the age of puberty. It is at this period that changes occur, more or less fraught with danger. With the male, there is danger ol' arousing any latent tendency to pulmonary tubercles ; with the female, there is danger of the menstrual function becoming so feebly developed, that it acts as an excitant upon any latent discrasia of the blood. Treat DISEASES OP VARIOUS OUQANS AND REGIONS. 847 mt'iit is therefore required at this period, not only to obviate any derange- ment consequent upon its occurrence, but to aid a burthened system in ])rinnfinf; uhout this physiolonfical change, so as to answer all the do- niiuuls upon it. Scpiirato beds shouhl bo insisted upon. For males at the age of puberty, children of scrof'uloufl parents, give a dose of Calo. carb. twice a wr^ek, and restrict tliein to a strictly nutri- tious diet, free from fat or gravy. In case of their being children t>f parents who had tubercular disease of the lungs, give them Lyoopudimn twice a week, or perhaps Graphites, and direct for them a good dii't of animal and vegetable food ; let them avoid ex|)()sure to extremes of teui- petature ; let them sleep in well-ventilated apartments : and any hered- itary tendency to Consum})tion can be overcome. Should a cough ensue upon the period of pubescence, give Lyoopodium or Oalcarea ; if a short, hacking cough, give Phosphorus ; if a tidcling cough, give Pulsatilla or Sepia. By thus watching the first development of cough, and by giving the appropriate remedy at once, the same can be cured. In females, when there is great debility of the chest, and sometimes a slight bleeding occasioned by a trifling cough, give Sauro cerasus. Thus, by noting the slightest development of cough at this period, and by being prompt in selecting the appropriate remedy, this incipient form of Consumption can be cured, and sound health be established, and will remain until some other revolution occurs to unsettle the system. Any excesses on the part of the male must be avoided. Whatever weakens or deteriorates any of the functions may prove an exciting cause, so long as there is any predisposing influence in the system. On the part of females, there is danger at the period of the first pregnancy. This revolution will either make further improvements in the direction of sound health, or it will arouse unfavorable influences that depress and ruin it. Thus it may seem plain that Consumption may be successfully treated in its incipient stage, whether it shows itself early or late in life. If there is indication of its approach after a fever, give China ; if after excessive fatigue, give Lyco- podium or Stannwn. If excessive venery causes a development of con- sumptive symptoms, give Arsenicum or China; if the shock of labor produces depressing effects, give Arnica, China, and Arsenicum ; and if cough ensues, give Bryonia or Phosphorus, and a well-regulated diet. It is believed, that, in a majority of instances. Hereditary Consumption can be erased from the family record by carefully Waging a warfare upon the first approach of the enemy. But a different aspect presents itself in that form of Consumption which comes on by reason of a good constitution having been over- taxed and worn out. A cold, badly treated, may leave behind a perma- nent irritation even upon the most naturally healthy constitutions. A !ough from a cold is not to be trifled with ; therefore, attend to the slight- est cough. Nux vomica may remove a cough brought on by a cold, if given at once ; a dry, hollow, or hoarse cough may be cured with Hepar sulph. ; a cough with heat of the chest and soreness of the lu.igs may be cured with Bryonia. Long exposure to cold that chills the whole sys- tem .may be followed by a violent fever that fixes itself u|)on the lungs, producing violent inflammation ; and this, if improperly treated, ma)r end in Consumption. Almost any acute disease, badlj treated, may terminate ^m >l •4 Pel f 848 riSEASBS 07 VARIOUS ORGANS AMD RB0I0M8. In fatal Consumption ; therefore, when any interruption occurs in the function of respiration, it is more or less dangerous. The slighter the interruption the better, and the more easily can it be removed. But it must not be neglected. An exceedingly slight capillary congestion, if neglected, may become chronic, and end m Tuberculous Consumption ; a slight bronchial disturbance, not properly treated, may terminate in Bron- chial Consumption : in short, any of the ailments of a trivial character, which can be made worse by neglect, may demand the most careful treat- ment, or otherwise they may terminate in Consumption. fuflueuza) or Grippe, comes on like a cold, ^vith sneezing or snivelling, puin in the chest, and a general appearance of Catarrh. Too frequently it liaa been neglected in the first stage, and it has run into the chronic form of Bronchitis, and thence into Consumption. Such being the known ten- dency, it is well to seek the best of treatment for this disease at once. Arsenicum, in the incipient stage, will relieve some of the symptoms: it will relieve tl»e thin discharge from the noae and eyes, the pain in the limbs, and general acliing in the bones. Euphrasia relieves many casea in the be- ginning which resemble Arsenicum. Marciiriua vio. is also a fine remedy for the stoppage of the nose, eyes, and general restlessnos of the whole system. Influenza has been reckoned among the causes of Consumption, because, in many instances, it has been the means of calling into action certain latent tendencies that have ever b(!on dormant until set upon by this exciting cause. . Influenza is but an acute form of Hronchitis, and as such it must be treated. Aconite may be given if there is a quick, full pulse. After Aconite has softened the pulse, and produced moisture upon the skin, if the head continues to ache, give Belladonna ; if there is soreness of the throat, give Merc, viv.; if much thirst, Arsenicum; if pains in the back and loins, Nux vomica In females, Pulsatilla may remedy many of the derangements which influenza produces. If a sudden check of menstruation supervenes upon an attack of this disease, give Aconite, and follow with Pulsatilla; and, finally, if influeu/:i shows itself in an epidemic form, and almost every man, woman and child become victims. Aconite, Belladonna, Mercuriua, and Nux vom., or else Arsenicum, Apia md., Bryonia, Calcarea carh.. Phosphorus, and Sulphur, may constitute the group from which is to be selected a remedy, according to symptoms. It is an old saying, with regard to diet, '^ to starve a fever, and stutFa cold ;/* but all proverbs are not true. There is, in every cold, some degree of fever that must be heeded, because a too generous diet would be likely to do harm. A moderate diet of black tea, rice, barley, toast, and fruit, is best. Thus, by judicious medication and an appropriate diet, there need be no sequel that causes the patient to sink r£r,'idly into the grave. If otherwise, it will arouse some constitutional di'-.chesis, and this will render the joint action formidable in the extreme. As in Tubercular Consump- tion, or, rather, in that which is hereditary, a constant vigilance is re- auired to put in action certain antagonistic influences to overpower the isease, so in Bronchial Consumption, or that which is generated by a succession of ailments that implicate, in a less or greater degree, the mu- cous membrane that lines the bronchial tubes, an effort must be made to bring any and every assault upon the bronchia to a successful termina- tion, — whether a common cold, a trivial cough, a slight soreness upon the air-passages, or even Pneumonia : let each be treated persistently, accord- an in the lighter the d. But it igestion, if itnption; a te in Bron- character, reful treat- snivellintj, requently it ironic form known ten- se at once, mptoms: it in the limbs, OS in tl>o be- remedy for hole system. , because, in ortain latent :citin}» cause, it be treated. ! has softened inuestoache, no.; if much In females, iza produces. ' this disease, :i shows itself iomG victims, nicum^ Apis ay constitute o symptoms, tutfacold;** le degree of be likely to and fruit, is there need a grave. If s will render ir Consutop- ance is re- erpower the aerated by a ree, the mu^ t be made to i'ul termina- ess upon the ntly, accord' uig to svmptoms, until perfectly cured, so as to leave no entailment in the form cf a sequel, to prey upon the constitution. Hygienic treatment must correspond with the auministration of remedies. Well-ventilated apartments, sufficient clothing, and good, nourishing food, cannot fail of putting the system in a favorable condition for recovery. Regular sleep, regular meals, and a well-regulated temperature, are things indispensable Weakness of the Sight. — Amblyopia. The term Amblyopia signifies a weakness or morbid alteration ci flight ; and there is every grade, from mere dimness of vision to complete blindness. 'A sense so important as that of sight is entitled to a distinct consideration, inasmuch as a variety of causes may operate to impair it. riio difficulty may be attended with many morbid conditions of the organism, and a variety of remedies may be required to treat the affiiction. We will therefore point out the treatment for tiie various grades, in order. For Simple Weakness of Sight in plethoric persons, give Belladonna ; for scrofulous individuals, Cnlcarea ; for weak or debilitated individuals, China; for nervous persons, Hyoicyamua. For those whose sight is im- paired from biliary derangement, Sepia or Sulphur. For Incipient Amaurosis, Aurum, Sepia^ S 'iphur. For Complete Amaurosis, not incurable, give Belladonna to persons of full habit ; Calcarea to persons who have a scrofulous tendency ; Mercuriua, for those suffering from hepatic derangement ; Phosphorus, for those suffering from catarrhal atfections ; and for those subject to sick headache. Sepia. For Torpid Weakness ok Sight, Phosphoric acid. For weakness of sight brought on by fine work, give Belladonna or liuta. For that which occurs fiom old age, give Baryta carb.. Opium, or Secale comutum. Where weak- ness of vision occurs after suppression of the menses, or hemorrhoids, give Pulsatilla or Lycopodium. For that occasioned by suppression of Measles, Causticum, Stramonium, or Sulphur. For that supervening upon Rheumatism, give Belladonna, Pulsatilla, or Rhus tox. For that attendant on Gout, give Nux vom. or Colehicum. For that caused by the abuse of mercury, give Nitric acid. For that caused by worms, give Cina. For that occasioned by Diarrhoea, give Merc. viv. For that brought on by loss of blood, China. For that produced by Scrofula, give Arsenicum, Calcarea, or Nitric acid. When produced by cold in the eyes. Dulcamara or Nux vomica. That produced by blows or con- cussions requires Arnica, Ruta, Euphrasia. The remedies chosen must not be repeated oftener than once a day. When weakness of sight is attended with nervous headache, give Aurmn, Belladonna, Bryonia^ Sepia, or Sulphur. If by congestion of blood to the head, give Bella- donna, China, and Phosphorus. For that attendant on deafness, or noises, give Cicuta, Nitric acid, or Pulsatilla. The remedies need not be repeated more frequently than once or twice in twenty-four hours. If weakness of vision is attended by gastric or abdominal ailments, give Cocculus^ Nux vom., Jynatia, or Pulsatilla. If attended by derangements of the womb, give Calcarea or Sepia. If by pulmonary complaints, give PhosplioruSy Lycopodium^ Calcarea^ and Svlphur, If by disease of the 107 ; 850 DISEASES OF VARIOUS ORGANS AND REGIONS. l!..-1''!t ■ I- heart, Lache»i», Phosphorus^ Pulsatilla^ Sepia, and Spigelia. If by Epi- lepsy, Spasm, or Hysteria, Hyoscyamm, Opium, Stramonium, or S Iphur. The remedy may be repeated, if necessary, every twenty-four hours. The particular indications for several of the remedies may be stated •IS follows : Aurum.. for bL^.ck spots or scintillations, or halt-sightedness, or tensive pain in the eyes, or in case of sudden attack after Scarlet Fever, or during confinement after duliven . Belladonna for dilated pupils, or insensible pupils, spasmodic twitch.ng of tliu lids, or mist before the eyes, aching and distensive pains :n the orbits and forehead, and red face, Oalearea, for mistiness of sight, as if gauze were before the eyes, espe- r ially when reading; for dilated pupils, and for pressure or leeiing of ', oldncss in the eyes. Oavsticum, for sudden and frequent loss of sight, with sensatio!^ as if sometl .lUg \^er3 stretched over the eyes," or for dim- sightedness, as if looking through a veil or mist. China, for weak sight: the patient only sees the outlines of things near him ; letters look pale, and appear to be surrounded by white borders ; dilated and not very sensible pupils ; dimness of the cornea, as if the eyes were filled with smoke, or black motes. The eyes feci better after sleeping. Oicutay is indicated when the sight frequently vanishes, and when there is vertigo or absent-mindedness, or aching pains in the orbits. Cina, for dimness of sight improved by wiping the eyes, and for pressure in the eyes when reading, as if sand had got in. Oimicifuga, when there is aching pain ia the centre of both eyeballs, and black specks before tlie eyes. Drosera, for frequent vanishing of sight, or when the eyes are dazzled with the glare of light or of fire. Qelseminum, when there is a thirst for light after Apoplexy, or Congestion of the Brain Hyoscyamus, for squinting, illu- sory sight, and stupefying pains over the eyes. Mercurius, for parox- ysms of momentary blindness, se-.siriveness of the eyes to light or the glare of fire. Nux vomica, for red face and sensitiveness of the eyes to light only in the morning. Pho'splwrus, for paroxysms of sensations as if things are covered with a gray veil. Pulsatilla, for paleness of the face, and disposition to vomit, and a sensation as if dimness of sight could be removed by wiping ; for frequent and copious flow of tears, and con- traction of the pupils. liuta, for mistiness of sight, and boring pains in the orbits, and the filling of the eyes with water in the open air. Sepia, for dimness cf sight when at work, stripes befoie the cy(?s and aching pains in the eyeballs, vith sick headache. Silicea, paroxysms of sudden obscuration of sight, as if a colored veil were before the eyes. Sulphur, iov general mistiness of sight, as if lookin;: through featiier- dust or black gauze ; great dryness of the eyes. Veratrnm album, for profuse shedding of tears, or the copious filling of the eyes with water. Vera- trum viride, when walking brings on blindness, with fainting vertigo and dilated pupils. When any one of the remedies is indicated, let the dose be repeated only once in twenty-four hours. In all affections of the sight, the paiient should avoid hearty meals or excessive overloading of the stomrich ; he should be regular in his habits, and free as possible from mental anxiety ; and, above all, his habits should be strictly temper- ate, and late hours should be avoided. In most cases of defective sight, the eyes require '-est. Ai; attempt to exercise them in readiiig in any defective light is pernicious ; and so is prolonged reading iu any light. n Paralysis of the BjeMs. — Blepharoplegia. This affection sometimes occurs in chililien, but very rarely in adults, aiul requires remedial treatment. The best remedies are Belhdonna, Spigelia, Sepia, and Stramonium. Belladonna, if there is redness of the face ; Spigelia, if there is any sifTu of spasms ; Sepia, if it follows severe headache, and sickness of the stomach ; Stramonium, if there is pale face, and inclination to sleep. Oausticutn for chronic cases. Whooping-Oough. — Tusi>is Spaamodica. Among the diseases of children, we find this malady quite common. The cause is only conjectured. As it is a disease much dreaded by parents, we shall not oidy be particular in describin;^ the disease, but also in pointin*^ out the remedies for the various sta(:;es and complications. The cough begins in the form of an ordinary catarrh arising from a cold. The child has coryza, and coughs ; the mother or nurse may be aware that the disease commences in this way, and their fears may be that it will turn out Whooping-Cough. The catarrhal stage may last ten days or two weeks, and then a different and characteristic cough sets in. This cough comes on in paroxysms, in which a number of rapid expirations follow each other, as in the act of coughing, and with much violence, and without any intervening inspiration, till the patient turns black in the face, and seems on the point of being suffocated ; then one long- draw n act of inspiration takes place, attended with that peculiar rough crowing noise, which is denoaiinated a whoop, and gives the disease its name, immediately after this long-drawn inspiration, a s;ories of short expiratory coughs, repeated till tiiy breath is almost exhausted ; and then a second whoop, until a white glary mucus is thrown up, unci this ends the paroxysm. After a lap?o of some little time, the paroxysm will be re- peated. During the urgency of some of these paroxysms, the face becomes red and swollen, the nose bleeds, the eyes start from the sockets, the little suffertr stamps with impatience, and clings to some object near him ; and this frenzy continues till vomiting or expectoration ends the paroxysm. The victim pants a little v/bile, and appears quite well again, and begins to have a craving foi; food. The number of paroxysms that occur every twenty-four hours varies in different subjects. Children are very suscepLih.'e to the disease, and it spreads by contagion. The ordinary duration of the disease is from six weeks to three months ; but it may run its course in three weeks, atiu sometimes not for four or five months. As long as this disease is ur complicated, — unmixed with inflamma- tion, and therefore without fever, or with that flight inflammatory con- dition proper to a mild catarrii, — it is not a dangerous disease. In all probability, it will run its course under the most favorable ^ircum* uiinces. How much it can be abridged by appropriate remedies is yet a question , but the violence of the disease mi'.y be moderated, its sequel may be guarded against, and its complications may be tempei-ed, by the rigiit use of remedies. The most favorable season for the disease to rage is in the 852 DISEASES OF VABIOUS OBGANS AHD BEGI0M8. ■ spring, when the weather ia hflpnnitng wortT«er The most uiuayor* able is late in the fall, when the weather is augmenting in coldness. Cold or damp weather is thought to protract the disease, and warm weather to abridge it. We have thus been somewhat particular in ie- Hcrihing this malady, in order to facilitate its treatment by mothers aad nurses. We will now proceed to direct the use of appropriate remedie.^. In the catarrhal stage, give Aconite. If there is fulness of the nose, and headache, give Belladonna. In case of asthmatic breathing, give Ipecac. Aconite is the remedy for a dry, v/heezing cough, with fever or burning pain in the larynx, or windpipe. Belladonna is the remedy for severe paroxysms, witfi congestion of blood to the head, expectoration of blood, and bleeding from the nose, the eyes appear congested, involuntary stool and urine, and also when the paroxysm is announced with crying, which arises from pain in the stomach, but not accompanied by vomiting. Also, in the first stage, Oarbo veg. may be given when the cough is con- vulsi\'e, especially in the evening, and when there is great exhaustion after each coughing-spell. Dulcamara is a good remedy when the cough is moist from the commencement. Ipecac, for the incipient stage, when tlie child has coughing-spells so rapid as not to be able to get his breath, and when the open air is requisite to relieve him. Pulsatilla is useful when the cough is loose from the beginning, and worse towards evening. In the second stage, after whooping sets in, with vomiting, and bleeding from the nose and mouth, give Caulophyllum. If without bleeding at the nose, give Drosera. If thu children suddenly become rigid, give Cina. This remedy is specific when children are affected with the usup-i worm symptoms, and the paroxysm is followed by a gui-gling noise from the abdomen. Corallia rubrum is believed to be a sure remedy for violent spasmodic cough ; short, barking cough alt Jay, and towards evening becoming violent and spasmodic. Oaprum in indicated when every paroxysm is attended with cataleptic fits, so that in must every paroxysm the child appears as dead. Verairum is very suitable after Cuprum. Drosera is the remedy when the paroxysigs come on at midnight, and cease before noou, and are very severe and suffocat- ing. Vcratrum album, is indicated, after Drosera and Cuprum have been employed, when the patient is very feeble, quick pulse, and with a sort of hectic fever, and cold sweat upon the forehead, and great thirst ; and also when the coughing causes an emission of urine, and pain in the chest and loins, and when the patient, between the paroxysms, is in a comatose state, and cares not either to move or converse ; and also when there is excessive weakness of the neck, so that the victim is scarcely able to keep the head erect ; and also when there is rash over the body, or face and hands. For the most severe or convulsive stage of whoop- ing-cough, give Belladonna, when there is pain in the head, or convul- sions ; give Bryonia when the child coughs immediately after eating or drinking, and vomits what he has eaten, and returns immediately to finish his meal, and then coughs and vomits again ; giro ChamomiUa when the cough and vomiting are more frequent during a meal, fretful disposition, p-nd worse at night; give Cauiticvm when the cough is better, and when it is dry and hollow; give Hyoscr/amut when the patient is worse lying down, and better on sitting up ; give Arnica DISEASES OF VARIOUS ORGANS AND REGIONS. 853 when the patient feels sore from coughinf;. After the cough subsides, and there is any sequel left beliind, give whatever remedy is indicated ; Bs Aconite for fever, ^ux vom. for constipation, Phosphorus for catarrh, China for extreme weakness, &c. If there is no loss of appetite, allow a substantial diet in all the stages of the disease. Change of air j? very beneficial, even if but a short journey from home, especially to the sea- shore. ■irr ^J '-: AFFECTIONS OF THE MIND. It is well known to physiologists, that soundness of mind, as well as entire soundness of body, indicates a condition of perfect health. The two are so intimately ble y-d, that one can hardly exist without thn other, and vice vend. An a \ condition of the physical system is often attended with manifest u. ndness of mind. It is not intended to include the mental phenomena frequently attendant on acute fevers, as in Nervous, Scarlet, and other fevers, but such only as appear to exist as the chief symptom of disturbance in the entire system ; and we will begin with simple Mental Derangementi What is understood by mental derangement is a disordered mind^ which may have been occasioned by one or more of a variety of cau:ie3 It is indicated by irrational expressions of illusory notions, incohereiit ideas, strange fancies, and not unfrequently by vicious inclinati':r3. There is, nevertlieless, some specific cause for every case of ment'J alienation that occurs ; and the treatment has to be adapted with refer- ence to the cause, when there is a cha n of circumstances that indicateu it. Nevertheless, the cause is not always apparent, and therefore par- ticular symptoms must be our guide in affiliating remedies. When insanity takes the form of rage, and the patient appears to be governed by angry and revengeful feelings, and is inclined to utter imprecations and threats towards his best friends, give Acovite in daily doses. If his face appears flushed, and his eyes suffused, and exhibit a fiery red ap- pearance, give Belladonna. If in a scrofulous subject, give Oalearea. If strange fancies seem to beset the patient, or complaints are made of illusory sights, give MyoscyamvA. If the patient is inclined to run away from home, or hide in some secret place, give a dose of Sulphur^ and follow with a few doses of Stramonium every three or four liours. If the patient seer. ) depressed, and sighs frequently, give LaolAnii. If much distress is evinced, and there is defective nutrition, give Nux vomica. For violent rage, followed by soporific sleep, give Opir um. If the patient laugh* and talks continually, give Myoacyamus , or if given to crying, sobbing, or constant weeping, give Jgnat;**, If ■^■P AFFECTIONS OF THE MIND. 855 the patient is subject to cold sweats, give Veratrum. If thirsty, give Aramicitm. If there is great weakness and prostration, give Chiva, If, during paroxysms of rage, there is intense perspiration, give Mercu- riu8. Disposition to suicide, Aurtim. None of the medicines need be re- peated oft(!ner than twice a day. Great care should be +aken to keep the stomach of'tiie patient at ease, by furnishing for it light but nutritious food. Mania Produced by Depression of Spirits. Protracted Grief* — Extreme mortification or chagrin, or intense an- ijer, may end in mental derangement. When grief wears out the mind, And strange fancies begin to show themselves, give Ignatia. When Sfrea t mortification on account of some exposure to censure, or on account «>f some humbling of family pride, give Phos. acid. When disappoint- men t unsettles the mind, and chagrin gives rise to insane imaginings, give Pulsatilla; or, if there is a ^ .^nifest inclination to hide away from I i-i ends, give Sulphur, and follow, in four or six hours, with a dose of Hyoscyamiis. If the face is red, and the temples beat and throb, give Belladonna. When excessive anger and general moroseness of spirit •^nsue, with general antipathy towards every one, give Sulphur, and, in aix hours, follow with a few doses of Nux vomica. Mania from Excited Emotions. The mind is often beset with emotions of one kind or another, that often tend to unsettle and derange it. An<;uish or forebodinj; often has this disastrous effect, and one o'' the principal remedies is Aconite. If there is an attending inclination to weep, give Ignatia. If there is dul- ness or stupor, give Opium, or if in females, give Pulsatilla. If mania is produced by fright, give Aconite, Coffea, or Nux vain. W^hen fear un- settles the mind, give Lachesis, Hyoscyanius, GeUenm n. Opium, or Pulsatilla. When exces.sive joy produces derangcmenc of the mental faculties, and gives rise to strange fancies, give Coffea, Opiums or Pulsatilla. When homesickness unsettles the mind, give PJics. acid. When fancied neglect of friends distracts the imagination, give Caus- ticum or Capsicum. For unhappy love, and the derangement of mind consequent thereon, give Uyoscyamus, Ignatia, or Phosphoric acid^ or perhaps Coffea, or JVux vom. If disappointed affection, or any cause, produces the mania oi' suicide, give Aurum. If excessive jealousy ends in mania, give Hyoscffamus. If rage ensues upon insults, gi^e Veratrum alb., Belladonna, or Chamomilla, if upon contradiction, give Aconite, and afterwards Ljnatia or ^*/a; vom. For the concomitant symptoms of insanity from excited emotions, give Aconite when there is headache, feverish heat, or tendency of blood to the head. Give Belladonna when there is loss of consciousness, or constant anx- iety, with fear, weeping, howling, and malice (m children), and also when Aconite and Opium had proved insufficient for the consequences of fright. Give Bryonia when there is chilliness and shuddering over the whole body, great tendency to vehement anger, loss of appetite, nausea, vomiting, and bilious state in consequence of anger. Give Cap It. l._D 856 AFF&TnONS 01 THE MOID. tieum for sleeplessness caused by homesickness, with heat and redness of the cheeks. Give Chamomilla when anger produces bitter taste of th» mouth, nausea, disposition to start, and vomiting of bilious matter. Give Coffea when there is much nervous excitement after great joy. Give Cohcynth when chagrin or mortification produces Spasmodic Colic» or cramps. Should this condition persist, give Causticum. Give Hyoscjf' amuH wlxen fear produces stupefaction or convulsions, iffvoluntary laughter during sleep, or a ilesire to run .iway. (Jive Ignatia for grief, disappoint- me't, or unhappj' love, when there is deep, gnawing, irresistible grief, vomit- ing, headache, vertigo, pale face, convulsions, or epilepsy, and in children when they occur from the shock of fright or fear. When homesickness, fright, or mortification is attended with great anguish, restlessness, and trembling, or sudden starting from wleep, or accelerated circulation on the least exer- tion, sleeplessness, and inability to bear the warmth of the bed. great ner- vousness, a disposition to be quarrelsome, and to complain of everybody a» being hateful, and the patient takes a dislike to his own family, and wishes to leave them, and also when there is sliivering and ni^rht sweats, give Mer- curius. Give Niix vomica^ when, alter an angry lit, there is chilliness without heat. Give Opium wlien diarrhoea follows excessive joy or fear, or when a sudden start or fright produces sudden and involuntary diar> rhcea, with heaviness of the abdomen. For chronic diarrhoea from fright, Oelsemium. Give Phosphoric acid in all cases after deep grief, homesick- ness, or unhappy love, when the patient is taciturn, dull, or listless, and has a constant desire to sleep, and has night-sweats towards morning, after hectic fever in the evening. Give Pulsatilla when fear produces cold hands and feet. Give Veratrum album when any emotional excitement produces diarrhtca or involuntary evacuations from the bowels, with coldness of the whole abdomen. Morbid Emotions. ' A celebrated writer on insanity considers all morbid emotions und(!r this head, and for this reason : that all morbid states of the mind may become so augmented as to result in complete Mania or Monomania. It is, therefore, well to understand the best method of bringing remedial action to bear upoii the first departure from sound health of any faculty or emotion of mind. For anguish or anxiety, no remedy seems better adapted than Arsenicum, to be given morning and evening, or, perhaps, Pulsatilla for females at the menstrual period, or Veratrum album for veiy weak and exhausted persons. For apprehension or fear, give Aconite morning and evening, especially if the suftbrer is a plethoric, full-blooded person. Give Belladonna to one who suffers much from headache, or rush of blood to the head ; or Bryonia if thei-e is anxiety, with heat of the chest and difficult respiration ; or HyoscyamuB for anxiety about oneV safety, or religious anxiety ; or Opium for a kind of anguish and depres- sion of spirits that confuses one's ideas, and is attended by a stupidity and headache. When one is constantly vexed" and irritable, it may be in- ferred that a corresponding physical condition requires Arsenicum once or twice a day, or perhaps Nux vomica. Ignatia is suitable when there is a tendency to be vexed, and to weep on account of trifles. For one AFFECnONS OF THE MJKD. 857 dness of e of th* matter, eat joy. iic Colic, ' Hyoscy* laughter 4appoint- ;f, vojnit- children IS, fright, ■embling, ast exer- ;reat ner- ybody a» «is md,, Bell., Graphites f Merc, Conium, and Sulphur, £68 so pOW" r, that a quelled, e Malig- count by 1, pinches lie subtle nd disor- it runs a ifore any Pimples inviting ig fire to I in the round, soon as and then :e for the as soon lid there Arsent- i for the the face ery half I. After alignaut emedies. ,ry delay he brain ilication. aubt^dly ., Bell., INSIDIOUS DISEASES. 863 Spotted Fever. — Fehris Petechialis. This fever usually begins wit!i great lassitude ; the patient feeli fatigued, and unable to be about ; aiul then a headache ensues, without much fever ; the j)ulao is not much accelerated, the tongue is coated with a (lark or brown coating, nutrition becomes interru[)ted, and rapid einacia- lion takes place. After a while, the patient begins to suffer from intense pain in the back and limbs ; a cold chill comes over him, and a febrilo re-action, that is characterized usually by great thirst, entire loss of a|)petite, and inclination to vomit. During the febrile excitement, the skin becomoi discolored, and red or purple spots appear in great numbers upon the sur* face of the body. This is believed to be the crisis, and afibrds an indi- cation of the malignant character of the disease. B'or the most part, the patient lies in stupor, or perhaps at times evinces a low, muttering deli- rium, and inclination to pick the bed-clothes. The cause of this fever is supposed to be some malarious poison acting upon the blood. The prog- iKisis, or prospect of the result, is by no means favorable ; yet many such cases recover under proper treatment. In the first stage, when the patient is complaining of great weariness and lassitude, give Arnica every three hours. When the head begins to ache, give Belladonna, and especially if there is any twitching of the muscles, or redness of the eyesi. If there is any derangement of the kidneys, following checked perspiration, give Rhus tox. For the intense puin in the l)a<'k, give Belladonna^ and follow with Vorat. viride. When the cold chill ensues, and the countenance looks pallid and sunken, give Carho egetabilis. When the lever appears, and there is thirst, and incli- tion to vomit, give Arsenicum, or perhaps Veratrnm album, and repeat the renaedy every three hours. When the low, muttering delirium shows itself, give Stramonium. Let the surface of the body be rubbed gently with a crash or Turkish towel, and wet with tepid water. If the patient becomes quiet, and the spots gradually begin to disappear, and the coating upon the tongue begins to break up, and a normal secretion upon the tongue begins to show itself, — these are signs of convalescence ; and then it is well to give China, and supply the patient with beef-tea or broth in moderate quantities, and then with something more substantial, as he can bear it. Cold Fever. In some parts of the country, there has prevailed endemically a kind of fever which at first makes its appearance with general prostration and coldness of the surface of the entire body. The face appears as cold as marble, the nose pinched, the eyes sunken in their sockets, the tongue covered with a thick white coating, no appetite, but intense thirst. This cold stage lasts for a longer or shorter period ; and then it is followed by a febrile re-action, and the entire body becomes intensely heated, the pulse becomes quick and feeble, the head and back become the seat of pain for a while ; and then all these symptoms disappear, and another cold, sunken condition of the system ensues, and sometimes the body is covered with a cold perspiration, which lasts for an indefinite period ; and then a 864 INSIDIOUS DISEASES. M^- *6j' Ms more fierce febrile re-action comes on again, and elevates the pulse and temperature of the skin, ifiving a flushed appearance of the countenance, redness of the eyes, and heat of the head ; when a warm perspirr-'on ter- minates the febrile heat, and tl)en there gradually appears the ci^idness of the surface again. These alternations of the extremes of temperature upon thu surface go on until a crisis occurs that terminates the life of the patient, or the disease begins to wane. But, to mitigate the severity of the disease by treatment, in the co!d stage, give Carlo, veg. ei'ery four liours until the re-action commences, and tlien give Bryonia or Khu9 ; and these remedies may moderate the re-action. If, in the cold stage, the patieni la stupid, give Belladonna ; zfJii" Carlo veg., and for the cold pei> spiration, give Carlo animalis. At ths recurrence of the fever upon the surface, give Arsenicum and Bri/ynia. If the patient has much heat in the head, and is delirious, give ^eZ/acfonna / and, until theco}»ting upon the tongue begins to disappeai', do not thrust any food other than light gruel upon the patient, but as soon as the natural secretion of sahva appears upon the tongue, give beef-tea, or good mutton-soup, a little wine, and other nutritious stimulants ; avid, as tlie appetite returns, increase the strength of the diet. The same process of rubbing must be employed aa in the Spotted Fever. If the urine is turbid, give JVux vom. If the feet swell during the convalescence, give Araonicum, Apia mel.y or Hellebore. Putrid Fever. This fever, as its name implies, emits an unpleasant or fetid odor. It comes on much like those just described, only the breath appears to be tainted with sonr.ething of a putrid character, and very often there are pu- trid discharges from the bowels. The urine lias a putrid odor ; and, when there is any perspiration upon the surface, it has the same smell. The disease comes on unobserved, and is attended with lassitude and inappe- tency. There is seldom any noticeable cold stage, and yet there is very little if any heat upon the surface. The tongue becomes coated with a dark-brown coating, and sordes collects upon the teeth in large quantities. The pulse is feeble and quick.; the skin, for the most part, is dry and of low vitality. There is often more or less pain in the bowels, and a dis- tension of the abdomen. The urine is thick and high colored, and of an offensive odor. The patient rejects all kinds of food and drink, except water; and this uniformly has to him a disagreeable taste. His nose is dry and sore, and his lips become dry and cracked ; and sometimes M black or dark-colored saliva runs out of the corners of his mouth, which discolors them, and gives to his pale and sunken countenance a distressing appearance. The progress of this feier is slow and low, and often terminates in ulceration of ti^e boweh. There is from the fii-st a labored respiration and a putrid breath. For the commencing stage, give Arnica; if this fails to relieve ino symptoms in twent^'-four hours, give Baptisia; when the mouth becomes dry and the lips cracked, and the Bordes collects upon the teeth, give NUrie acid, and follow with Arseni- cum; when the patient complains of pain in the bowels, and there are putrescent discharges f>om them, give Phosphorus; if there is involun- tarv and oainless diarrhoea, give Phosplwric add; in case of great pros- mSIDIOUS DISEASES. 865 iilse and itenance, r^'on ter- idness of iperature le life of 5 severity eery fouf hiis ; and stage, the cold pei^ iver upon las much lie costing ther than n of sahva ittle wine, crease the aployed as vom. If Vpia mel.i tration, give Arsenicunit followed in twelve hours, if no relief, by Muriatic acid. Putrid fevers aro often fatal, and especially where a putrid diarrhoea is kept up by the fever. For distension of the abdomen, give Nux; for the thick and offensive urine, Sulphur ^ Carbo veg.y or Arsenicum; should the putrid stage pass off, leaving the patient prostrate, give Chinay wine, egg-nog, and even a little orundy, to keep up the vitality of the system. The sooner any one r«' SPECIFIC INDICATIONS FOR REMEDIES IN FEVERS. In giving specific indications for the selection of remedies in Fevers, a large gruund. is covered, inasmuch as nearly all the diseases to which flesh is heir are attended by some specifically characterized fever, which calls for the proper remedy. It is therefore deemed important to state, in connection with the names of the important remedies, the particular characteristic symptoms that they represent. Aconite is indicated for violent heat and chill, heat about the head and face ; and red cheeks, palpitation of the heart, pleuritic stitches, anguish, sadness or ill-humor, despondency, and dread of death, bodily rest- lessness. Autimoniam is indicated when there is little thirst, yellow coating upon the tongue, bitter taste in the mouth, eructations, nausea, loathing, vomit ing, and other gastric derangements ; constipation or diarrhoea. Arnica is indicated when there is thirst before the chill, and when the chill comes on in the evening after considerable aching of the bones ; and also when there is constant desire to change one's position during the fever ; for apathy, and pains in the stomach ; for want of appetite, and aversion to meat when the fever has gone off. It is particularly indicated when there is weariness, listlessness, yellow color of the skin, and bitter taste, and following a blow or concussion. Arsenlcam album is called for when the chill and heat set in simulta- neously, or when they rapidly alternate with each other, or when then* is internal chilliness and external heat, and viee versa; also for burning heat, as if boiling water was flowing through the veins ; no sweat until the commencement of sleep, oppression of the chest, anguish and uueasinestt, Pressure in the head, vertigo, pains in the liver and spleen, great debility, urning pain in the stomach, and disposition to vomit, great uneasiness and anguish in the region of the heart, violent pains and lameness of the extremities, and tendency to dropsy. BcUadouna, when the fever comes on with violent headache with stu pefaction, marked chilliness and slight heat or the opposite; redness of the face, with heat and throbbing of the temporal arteries and carotids ; entire absence of thirst or the reverse ; and also when the patient is irritak!« «nd in a whining mood. 86ft BS. Feven, ft to which er, which t to state, particular head and I, anguish, (lily rest- ting upon ng, vomit when the ones; and uring the letite, and indicated skin, and In simuUa- jhen tlieiv |r burning it until the measiriesH, it debility, I uneasiness less of tne with stu Iness of the lids ; entire itabU «nd SPECIFIC INDICATIONS FOR REMEDIES IN FEVERS. 867 Bryonia, for coldness, chill with red cheeks, heat about the head, and yawning ; or when the heat prevails with subsequent chilUness, heat of the chest with slight pains indicating pleurisy ; or when there is a coated tongue, or headache and vertigo during the heat, nausea and f aintness on sitting up. Calcarea carbonica, for heat in the face, then chills ; or with cold hands, heaviness of the head and limbs, pains in tlio small of tlie back, and rest- lessness ; cold, HOur-smelling sweat on the head. Capsicam, when there is thirst during the chill and fever, and much mucus in the mouth, throat, and stomach ; also when there is diarrhoea with sliiny and burning evacuations ; and when the patient ir> irritable, anxious, and oppressed during the chill, and when the chill begins in the back. €arbo veg., when the chill occurs in the evening or at niglit ; thirst during tiie clsiil only, which is followed with fever and copious sweat and chilliness ; afterwards rheumatic pains in the teeth and limbs before or during the fever; and when there is vertigo, nausea, and red face during the heat. Chamomilla, when tliere is pressure in tlie pit of the stomach, hot sweat on the forehead, despair, tossing about or bilious vomiting, diarHui^a and colic, — the thirst, heat, and swe.it prevailing, frecpient urination. China is indicated when there is nausea, canine hunger, headache, an- guish, palpitation of the heart, or other ailment previous to the paroxysm ; when there is thirst generally before or after the chill and heat, or during the sweat ; when there is no thirst, but tendency of blood to the head, headache, red face, uneasy sleep, and yellow complexion. China is also indicated when there is drowsiness, pains in the liver and spleen, bilious or dropsical symptoms, or enlargement of the liver and spleen. Cina, for vomiting and canine hunger, both before and • the parox- ysm of fever ; the face is pale during the fever, and a tendency to emacia- tion exists, and dilated pupils. Femun is indicated when the fever comes on with chill and thirst, headache, and tendency to congestion of various organs ; swelling of the external veins, swelling of the face, especially around the eyes ; great debility, vomiting of the food when partially digested, and laborious breathing. , Ig^atia, when there is thirst only during the chill, and when this is moderated by external heat, or when there is external heat with partial internal shuddering; nausea and vomiting, pale color of the skin, and {)ains in the back during the chill ; and also when there is no thirst, with leadache, vertigo, and delirium, and particularly when there is paleness of the face, or else alternately pale and red, or only one cheek red during the heat ; great languor, deep sleep, with snoring ; after or during the fever, eruption on the lips and in the corners of the mouth. This rem-, edy is also indicated for the fever attending Nettle Rash and other erup- tions of the skin. Ipecacuanha is indicated for a fever of much chilliness and little heat, or vice versa, and when the chill is increased by external heat, or when t 't'i h «'( 868 SPECIFIC INDICATIONS FOB REMEDIES U; FKVEBS. fir. there is little or no thirst during the chill, and great thirst during the heat ; and also when there is nausea and vomiting, and other gastric symptoms, previous to, or during and between, the paroxysms of fever ; and when there is a coated tongue and an oppression of the chest. Lachesis is particularly indicated when chills occur afler a meal in w^e latter part of tlie day, with violent pains in tiie limbs, and pleuritic stitches, oppression of the chest, and convulsive motions ; and when there is violent headache during the heat; delirium, burning thirst, red face, restlessness, internal shudderings during the licat, livid complexion, debility, prostra- tion between the paroxysms, heat especially at night, sweat after the heat, and when the fever is easily excited by eating lemons o» other sour things. Hercurius is indicated when heat and sweat appear together, and when there is violent thirst, pains in the right side, acid stomach, and regurgi- tation of sour or bilious matter from the stomach ; and when there are pains in the bones, and an aching of the limbs. Nux Yoniica is suitable for a fever that comes on with great debility, then chill and heat ; constant desire to be covered, even during the heat and sweat ; and when, during the chill, the skin, hands, feet, and face arc blue ; and when there are pains in the chest and abdomen, back, and par- ticularly in the small of the back, or drawing in the limbs ; and when there is headache, buzzing in the ears, distress in the chest, heat about the face, red cheeks and thirst during the chill and heat ; and also when there are gastric or bilious symptoms, vertigo, anguish, and ccstipation. Opium is called for when there is sleep during the heat, and even dur- ing the chill, with snoring respiration with the mouth open ; convulsive twitchings, warm sweat, suppression of the secretions. Tt:is remedy is (suitable for old people and children. l*uL$atiliii is wanted when there is no thirst during the fever, or thirst only during the heat, and when there is an aggravation in the afternoon or evening, with headache, anguish, and oppression during the entire period of the fever ; and when there is a red and bloated face, sweat in the face, and shuddering as soon as the patient recovers himself; and also wlion there are gastric or bilious symptoms, bitter taste in the mouth, bilioos, slimy, or sour vomitings, or diarrhoea, alternating with constipation, ')p]>ression of the chest, moist cough, or headache. PtUsatilla is fre- quently suitable after LacheaiSj or when the fever comes on again after overloading^ the stomach in any way. Often beneficial after the abuse of Quinine. Rhus tox is suitable for an evening or night fever, when the chilliness and heat both make their appearance simultaneously, and a copious sweat comes on after midnight or towards morning ; and when, during the chill, tliere are pains in the limbs, headache, vertigo, or toothache ; or when, between the paroxysms, there are convulsive twitchings of the limbs, net- tle-rash, colic, diarrhoea, and gastric derangement ; or when there is jaun- dice, sleeplessness, and tossing about, thirst at night, palpitation of the heart, with anguish and pressure in the pit of the stomach. Teratmiil, when there are external chill and cold sweat, or internal heat, with dark-red urine, delirium, and flushed &ce ; or when there is m SPKCIFIO INDICATIONS FOR REMEDIES IN FEVEB8. 869 chill, with nausea, vertigo, pains in the small of che back and back ; or when there is chill alternating with heat, constipation, or vomiting with diarrlioea ; and when there is tbir.«t during the chill and heat. With the above remedies, or any of them, the following remedies may be employed ; as Cantharis, when the urinary passages are involved ; or C'occulua, when the patient is nervous and threatened with spasms, cardi- algia, and constipation. When the fever for which any of the remedies are indicated is in sensitive persons, made restless by great nervousness, give Coffea ; and especially wiien there is sweat with tliirst, soft stools, or diarrhoea. Give Droseru^ when there is violent chilliness with cold face, icy cold hands and feet, nausea and bilious vomiting, headache and spas- modic cough during the heat, and gastric symptoms between the parox* ysms. Give Hepar, when the patient has coryza, cough, or distress in the chest, or chill and thirst, preceded by bitter taste, followed by heat and sleep. Give Hyoscyamus^ when the fever is attended by cough at night, or even epileptic attacks. Mercurius, sour and fetid sweat, with palpita- tion of the heart. Sulphur^ when the fever is from suppressed Itch, with chills every evening, heat and sweat towards morning, fever with palpi- tation of the heart, and violent tliirst even before the chill. In case of any fever occurring with symptoms described as being par- ticular indications for the employment of any one remedy, always select that remedy*; and, in all probability, but few doses will be required to effect a cure, provided the patient is placed in the most favorable condi- tion Tor recovery : for this is as essential as the employment of remedies. In many instances, only a single symptom may present itself, while in other respects the jjatient may be well. A brief consideration of some of these may be useful ; as, — Aversion to Food, — Anorexia. When this exists as a mere symptom, or dislike for food, give Tart, emetic. If after gastric affections, give Cldna. For aversion to food, accompanied with hunger, give Bryonia or Rhus tox., or else Ignatia or ifttx vomica. For complete loathing of food, give Ipecac- or Pulsatilla. Loss of Smell. — Anosmia. Thia symptom may show itself independently, and c. sists in a mere insujceptibiiiij' of the olfactory nerves, which may be quickened by one or two doses of Belladonna^ Calcarea, or Sanguinaria. If from paralysis of the olfactory nerves, give Nux vomica or Sepia. If from catarrh, give Calcarea^ HepaVy tSilioea, or Sulphur. Loss of Taste. — Aguatia. For the absence of this sense, independently of other affections, give Natrum mur. and Silicea. For loss of taste from purely nervous causes, such as paralysis of the gustatory nerves, g'-^e Hyotcyamua^ Nux vom., or 870 SPECIFIC INDICATIONS FOR REMEDIES IN FEVERS. I it iSIema. For the same attended with catarrh, coryza, and other effects of cold, give Pulmtilla or Sulphur, or else ffepar or Sepia. Give the usual dose, and repeat twice a day as long as is necessary. For alterations of taste, viewed as mere symptoms, the following remo- dies mav be employed : Aconite, Arsenicum, Belladonna, Bryonia, Mer* curiua, jRhus, PuUatilla, &c. For bitter taste, give Aconite, Bryonia, Mercurius, or iVkc vomica. For the taste of blood, give Ipecac, or Sul- phur. For the taste of pus, Pulsatilla. For clayey taste, China, Hepar, PuUatilla. For flat, watery taste, or iirsinid, give Bryonia or China. For the taste of bad eggs, cheese, «fec., give Arnica, llhus, or Sulphur. For greasy taste, Caiistioum. For metallic taste, give Calc, Lachenis, Nux vomica, or Rhu^. For clah.ir;v or slimy taste, Arnica or Belladonna. For rancid taste, give Bryonia or Ipecac. For salt taste, Arsenicum, Carlo veg., or Sulphur. For sour taste, give Calc, China, J\'ux vomica, .ir Sulphur. For other forms of illusory or bad taste in goiieral, give Nux, Pulsatilla, or Sepia. For sweetisii taste, give Belladonna, Bryonia, China, Merc, or Pulsatilla. When food tastes bitter, give Coloeynth. For bitter taste after eating and drinking, Bryonia, China, Pulsatilla. When food has a salty taste, give Carbo veg. When it tastes sour, give Calc or China. When there is a sour taste after eating, Nux vom. or Pulsatilla. Sour taste after drinking. Sulphur. P" after drinking milk, Nux vomica. When bread tastes sweet, give Mercurius. When those who use tobacco imagine that it has an acid taste, Staphysagria. When there is an illusory taste of sweetness of beer, Pulsatilla. For nauseous taste. Ipecac. A single dose of the remedy indicated for illusions of taste will generally correct the disorder. Nearly all these departures from the normal condi* tion of the sense may be indicative of some peculiar derangement of the animal or organic functions, that the chosen remedy may avert or correct. The value of these isolated symptoms in pointing to remedies that may be used as timely preventives of more serious derangements can hardly tie appreciated. As, for instance, a bitter taste may forebode a serious biliary derangement, that Aconite may prevent. And so with all the other varie- ties of illusory taste : what might follow, if neglected, no one can tell. It is better to prevent than to cure a malady ; and when the sentinels of taste and smell stand ready to guard against the approach of diseases, it is always best to give heei to their admonitioua. r p effects of the usual wing reme- tonia, Mef' e, Bryonia, •ac. or Sul- ina, Hepar, Vdna. For p]mr. Foi- chesis, Nux. belladonna. Arsenicum, hix vomica, J Moral, give rt, Bryonia, yeynth. For Ilia. When ive Calc. or Pulsatilla, Vux vomica. use tobacco 1 an illusory Ipecac. A 11 generally )rmal condi' ment of tlie t or correct. s that may n hardly va rious biliary other varie- :an tell. It sentinels of : diseases, it POISONS, AND THEIR ANTIDOTES. SunsTANCES which derange the vital functions, and produce death by an action not mechanical, are denominated poisons ; and diLtinguished writ- ers have noted three classes of tliese substances, which may be noted as follows : — Ist. Irritant Poisons, or those which produce irritation or inflamma- tion, as mineral acids. Arsenic, Copper, ^e. 2d. Narcotic Poisons, or those which produce stupor or deliniim, and other affections of the brain and nervous system, as Opium, Pruatio acid, ^c. 3d. Narcotic-acrid Poisons, or those which sometimes produce irrita^ tion, and sometimes narcotism ; sometimes both together. The.«c are all derived from the vegetable kingdom ; as Strychnia, Nux vomica, ^c. As most everybody is obliged to be so situated, that, through mistake or accident, poison of one or another of these classes may be taken into the system, it seems desirable to be well instructed in the use of antidotes, and the treatment of the supervening irritation or inflammation. If, through mistake or accident, either sulphuric, nitric, or hydrochla- rio acid is taken into the stomach in poisonous doses, give Chalk or Mag- nesia; or, if this is not at hand, beat down the plaster from the wall, and make into a thin paste with water, and give this. Soap-suds is another antidote. Drink freely of any mild fluid, or milk, both bef e and after the antidote is administered. For the supervening inflammation, such remedies may be employed as in Gastritis from any other cause : Aconite, in case of much fever ; Bryonia, if glairy vomitings ; Nux vomica, if th«»re is sense of weight, &c. In case of Oxalic acid being taktin into the stomach by mistake, as this may occur from its resemblance to Epsom salts, it will be necessary to excite vomiting at once by tickling the throat with a feather, or b^ ^u emetic ; and, after, to administer ChaVe or Magnesia in large doses sus- pended in water. These not being at hand, break off the plaster, and make a paste as before. Alkalies will not answer, as they would only form neutral salts. For the after-symptoms, give Aconite dissolved in water, — a tablespoonful after every paroxysm of vomiting, until they cease ; and give the victim at the same time, freely, mucilaginous drinks, •nd also Coffta and Opium as antidotes. S71 872 POISONS, AND THEIB AIITIDOTB& Forfommxng vfith Artenicy the first thing necessaiy is to thoroaghW evacuate the stomach ; and, for this purpose, give an emetic, and then fol- low with iron-nuty or the Sesqui-oxid of Iron, largely diffused in water ; and let the patient drink freely of mucilaginous, rarinaceous, or albuminous drinks, and milk. The subsequent inflammation must be treated with Aconite, — a dose every two hours until the nausea entirely disappears ; Nuxvomica, also, for the inflammation and soreness of the gas- tric region ; Brt/onia, if the slightest motion produces pain ; and PnUatilla or iV^«.? V tm., if the most delicate kinds of food aggravate tlie suffering. For Poisoning with Mercury, and Corrosive mblimate. — This is the usual form of Mercury employed for committing suicide ; and, as it is used for bed-bug poison, it is liable to be taken through carelessness or mistake. It is therefore requisite to point out some antidote the nearest at hand. Give whites of eggs in abundance, or Gluten if eggs cannot be had ; or else milk. The most usual form of the supervening irritation is Saliva- tion or Mercurial Fever. For these, give Nitric acid, Hepar sulphur, and obtain for the patient fresh air and a nourishing diet as s>on as possible. For Poisoning with Copper. — The blue vitriol, or Sulphate of Copper, and Verdigris, are the forms in which this poison is most common ; and, when taken into the system, the most ready antidote is the white of eggs. Great care should be taken to exclude vinegar, for this acid would add virulence to the poison. To allay or cure the remaining irritation, give Sulphur twice a day. Poisoning with Antimony, or Tart, emetic, is liable to occur, as this oubstance is sometimes used in medicine as an emetic. When given to excess, it produces vomiting, attended with burning pain at the pit of the stomach, followed by purging and colic, stricture of the throat, and cramps. As an antidote, give large draughts of warm water, and tickle the throat with a feather to induce vomiting ; also the decoction of any bark containing tannin, as oak, hemlock, or cherry-tree bark. For the subsequent ailments, give Sulphur, Cldna, Nux vomica, or Opium. For poisoning with Zinc, or white vitriol, which is denoted by violent vomiting, sunken eyes, and pale face, cold extremities, and fluttering pulse, give the infusion of any of the substances containing tannin, and I'eed the ])atient with cream, butter, and chalk quite freely. For poisoning with Lead. — Red lead and white lead, as well as sugar of lead, are liable to be taken by mistake ; and their poisonous effects are denoted by obstinate colic, spasms of tlie muscles, and some- times apoplexy. As an antidote, give water of ammonia, or liartshorn, or pearlash-water, or any of the earthy sulphates, as lime, etc. For Lead Pa- ralysis, give Sulphur, and afterwards ^ux vomica. For colic, Opium. For poisoning with Cantharides, which is denoted by intense burning in the pit of the stomach, and pain in the lower abdomen, feeble voice, laborious breathing, strangury, and tenesmus of the bladder, headache, and delirium. To remove the Cantharis from the stomach, excite vomiting in the quickest and most speedy way, — by tickling the throat with a feather, or drinking a strong mustard-tea, or by taking snuff upon the tongue. Give Aconite to allay the fever ; give Nux vomica and Pulsa- tilla to allay the irritability of the stomach, and Arnica to relieve the 'A iron£ :hen used in ieous, or nost be entirely the gas- ^idmtilla ring. is is the it is used mistake, at hand, had; or 3 Saliva- mlphur, s>on as ' Coppery }n ; and, white of •id would irritation^ r, as ihia 1 given to he pit of roat, and md tickle )n of any For the tm. 3y violent flattering nnin, and well as poisonous nd some- tshorn, or Lead Pa- burning ;ble voice, ache, and vomiting >at with a upon the id Pulsa- 3lieve the POISONS, AND THEIB ANTIDOTES. 873 tenenntUy or straining; or else spirits of Camphor. This is believed to be the best antidote. For poisoning with Morphine^ which is denoted by giddiness and stupor, the person becomes motionless, and insensible to external impressions, breathes slowly, and lies quite still, with the eyes shut and the pupils con- tracted, the whole expression of the countenance being that of perfect repose. As the poison advances, the features become ghastly, the pulse feeble and imperceptible, the muscles excessively relaxed ; and, unless assistance is speedily called, death soon ensues. The first thing neces- sary is to remove the poison from the stomach, which is by inducing vomiting. If soon after taking the morphine, give mustard-water freely, or inject in the stomach some sulphate of zinc, if the patient is too insen- sible to take it otherwise. After vomiting is induced, arouse the victim, make him walk up and down the room for hours, until the inclination to sleep is superseded bv nausea, headache, and vomiting, and then give him strong coffee ; and afterwards, to remove the entailed symptoms, give Nux vomica. For poisoning with Prussic Add, when not fatal, resort to cold shower- hath, and inhalation of diluted water-of-ammonia vapor ; give, also, solu- tion of carbonate of potass. For poisoning with Charcoal Gas, as from the fumes of burning char- coal in a close room, resort to cold affusion, and give Aconite, in drop doses, in a spoonful of water. The same treatment may be resorted to in case of poisoning with any of the poisonous gases, as sulphureted hy- drogen and carbonic acid. Poisoning by Strychnia, or Nitx vomica, is denoted by convulsions, with much anxiety and agitation during the fits. The whole body is stiffened or straightened ; the legs pushed out and forced wide apart ; no pulse or breathing can be perceived ; the face and hands livid, and the muscles violently convulsed. Nux vomica, or Strychnia, in poisonous doses, gen- erally proves fatal, in spite of treatment. If emetics are given, and the Stomach is made to disgorge its contents sufficiently early, and the patient is not attacked with convulsions in two hours, he will generally be safe. In treating any case of poisoning, two things are required : 1st, re- moval of the exciting cause ; 2d, treatment of tli« effects that remain. The removal of the poison should be done, if possible, with little violence, and by the simplest and most innocent method, either with the linger, or in case the poison has been a long time swallowed, excite vomiting oi stool by the simplest means. Copious administration of tepid water, irri- tating the fauces by means of a fi-'ather or something similar, or by salt, mustard, and snuff, or injections of tobacco-smoke ; and neutralize the poisons by means of albumen, vinegar, lemon-Juice, coffee, camphor, milk, oil, soap, mucilaginous drinks, tea, wine, sugar, or, as it has Ibeen seen, with ammoniacal gas, iron-rust, cliarcoal, kitchen salt, Epsom salt, potash, and starch. It is well to be familiar with these antidotes of poisons, and to bear in mini] the particular indications, or poisonous substances that call for themt, as follows : — AUmmen, or whites of eggs, antidotes such metallic substances as quick- silver, corrosive sublimate, verdigris, tin, lead, and Sulphuric acid, when 110 =r«* ■'ill I r 874 F0I80NS, AMD THEIR ANTIDOTES. the victim complains of violent pains in the stomach, with tenesmas, or diarrhoea, and pains at the anus. Vinegar antidotes alkaline poisons, and obviates the ill effects of acon- ite, opium, poisonous mushrooms, belladonna, &c. Coffee. — Strong black coffee, made of the berry lightly roasted, and drank hot, is an antidote to opium, nux vomica, belladonna, narcotica, mushrooms, poisonous sumac, bitter almonds, and all those substances containing prussic acid. It must be borne in mind, however, that the eause must be removed, if possible, first. Camphor antidotes the ill effects of poisonous insects, and especial'_y nntharis, whether administered internally or externally. Camphor also antidotes the toxical effects of phosphorus, apigelia, and sqntonin. It ia also useful for the after-effects of acids, salts, metals, &c., after the poi- sonous substance itself has been removed from the stomach by means of vomiting, &c. Milk is frequently alluded to as an antidote for poisons ; but it has no real merit. Mucilaginous substances are better, and much to be pre- ferred. Olive Oil ranks with milk, and is much less useful than is believed. It is useless in metallic poisons, and even hurtful in poisoning with arsenic. It is of some service, however, in case of poisoning either with Nitric^ Sulphuric, or Phosphoric acid. Olive oil and vinegar, administered in alternation, has proved serviceable in cases of poisoning with alkalies. Soap. — Castile soap., dissolved in four times its bulk of hot water, and drank, will antidote many cases of poisoning with Corrosive sublimate and also with arsenic, or with any of the numerous forms of lead. Soap' suds is likewise a valuable antidote for poisoning with Sulphuric and Ni- tric acid. Soap is hurtful in cases of poisoning with alkalies. Sugar., or sugar-water, is quite as good as any of the antidotes, and much to be preferred in cases of poisoning with paint, verdigris, copper, sulphate of copper, alum, &c. In cases of corrosive sublimate, in solu- tion, being taken into the stomach by mistake, as it has been, sugar-water may be given before the white of an egg. Sugar is also an excellent an- tidote in cases of poisoning with arsenic. The other antidotes are, — Ammoniacal gas, or the volatile odor of spirits of hartshorn, for poi- soning with alcohol, bitter almonds, or prussic acid. Iron-rusty or the sesqui-oxide of iron, for poisoning with arsenic, freshly prepared. Epsom salt, for the various alkaime poisons. charcoal, for poisoning with putrid fish, meat, or mushrooms, or nmssels. Kdchen salt, for poisoning with nitrate of silver, and poisonous wounds. Magnesia, for poisoning with any of the mineral acids. Potash and Sweet Almond oil are also good antidotes for acids. Starch, in solution, is the best antidote for poisoning with iodine. Strong tea is a good antidote for poisoning with honey ; and so is Wine, for noxious vapors and poisonous mushrooms. And here it may be repeated, that the first thing we have to do, in treating cases of poisoning, is to remove the poison bv vomiting, and then to administer the suitable antidotes. In case we should not be able to ascertain what kind of poison has been swallowed, we should first admin- esmns, ot I of acon- isted, and narcotica, lubstancea , that the especial.^ nphor also lin. It is p the poi- means of it has no to be pre- ilieved. It bh arsenic, ith Nitric^ listered in Ikalies. water, and ! aublimate d. Soap- io and Ni- idotes, and is, copper, te, in sola- agar-water cellent an- aro, — n, for poi- ;h arsenic, or niusnels. poisonous ds. dine, so is 'e to do, in , and then be able to irst admin- POISONS, AND THEIR ANTIDOIES. 875 ister the white of egg ; and in case there should be stupor, give coffee, quite strong, made of the lightly-roasted kernel. But if we should know the poison to be mineral or metallic, the first resort may be to white of egg, sugar-water, soap-water, or soup-suds, and for the remain- ing effects give Sulphur, which has bci'ii ascertained to be a real antidote to the effects of metallic poisons. If it should be known that ackls or corrosive substiuices have been taken, give castilo soap mixed with four times its bulk in warm water, or magnesia dissolved in water, or powdered chalk stirred up in water, or a solution of saleratus, pearlash, or supi-r-car- bonate of soda, in spoonful doses, after each paroxysm of vomiting, as long as it continues; and afterwards give mucilaginous drinks, and, alternately, coffee and opium, in the form of homoeopatliic remedies ; and for the remaining aihnents, give PubatUla. After the antidotes have bi'on ad- ministered, give PuhatUla for suli)huri(: acid, Iiri/07iia for muriatic acid, and Aconite for other acids, and especially for CTab-a|)ple vinegar. In case it should be known that alkaline substances have been swallowed in poisonous quantities, vinegar and water may be given in large quantities, and also lemon-juice or cranberry-sauce, without sugar, or sour 7nUk ; and for the secondary effects of poisoning with potash, give Coffea or Carlo veg. If the poisoning is known to be the effects of spirits of hartshorn, give Hepar sulph. ; if it should be known the patient had been inhaling noxious vapors, bathe the patient freely with vinegar and water, and let him inhale the vapor of a solution of hydrochloric acid ; and, after a return to full consciousness, give a strong decoction of partially-charred coffee, or a few doses of Opium or Belladonna. The vapors of coal, when having a poisonous effect, may be antidoted by copious draughts of vinegar and water ; and for poisoning by an}' sub- stance not mentioned, first follow the rule of removing the poison from the stomach by vomiting, and, for the irritation or inflammation left bo- hind, affiliate any homojopathic remedy that may meet the case. If there is much fever or arterial excitement, give Aconite every hour ; if severe burning at the stomach, and thirst, gwe Arsenicum or Mereurius ; if there is great soreness of the muscles, give Arnica, and let the patient be bathed with a lotion of the same ; if it is known that any of the animal poison* have been taken into the stomach, give a teaspoonful of powdered chai> coal in half a tumbler of water at a dose, and repeat after each vomiting until the stomach becomes quiet ; and if a poison of this kind has come in contact with the eyes, give Aconite; and, finally, to guard against the infection of poisonous wounds, when touched with the fingers or hand, let them bo held in strong heat, as strong as it can be borne, for ten or fifteen minutes, and afterwards wash them with soap. t i^ In REVISED TREATMENT. Pleurisy. — Pleuritia. {Treatment continued from page 240.) Nothing gives so much and sucli iimnediatc relief to pain as n Bubcutancous injection of morphine. Aconite also is a valuable sedative in this stage. It may be given in half or whole-drop doses every fifteen minutes for two hours ; then afterwards a drop, to be repeated hourly till sone impression is made upon the heart's action. Smtdler doses are to be given if the pulse becomes feeble. In the second stage, if tiio acute symi)tonis have yielded to treat- ment as they usually do, the t)bject of treatment is to promote the absorption of the fluid. This is done by the judicious use of saline cathai*tics and by dure tics, for the bowels and the kidneys are the natural pumt)s of the system. The application of counter-irritants is also of use for this purpose, such as the tincture of iodine, and small blisters, which are to be allowed to remain on till vesication, and then the blister is to be dried up and a now one is then appli(!d. If at any time during this stiige the effusion is rapid and excessive, so as to endanger life, it is to be drawn oft' by puncturing the ch(!st between the fifth and sixth ribs on the side with a small trocar, and the fluid is to be drawn ort' by suction. Convalescence commences when the liquid begins to be absorbed ; and active medication should then cease, and that course should be pursued whi-'h will lead to the restoration of the general health. This is done by tonics, a nutritious diet, and other hygienic means. If the effusion ceases to l>o absorbed or the process takes place very slowly, then that state of things exists which is called chronic j)leu- risy. Then the main o1)jects of treatment are to ert'ect the removal of the fluid, and to develop and sustain the powers of the system. Under these circumst^uices, it is better to discontinue remedies which act upon the bowels and the kidneys, at least for a time, and try gen- eral treatment. This consists of tonics, stimulants, and gentle exer- cise in the open air, and with this the surgical removal of the fluids from the cavity of the chest. The operation is now so much improved, and is so safe and simple and attended with so little pain, that it has become an every-day practice, and an operation which was only resorted to as an extreme measure to save life, is now admissible whenever the pleural cavity remains filled with liquid, after only a brief trial of the remedies designed to promote absorption. 876 pain as a , valuable rop doses rop, to be t's action. i to treat- omote the 3 of saline ^8 are the s purpose, are to be o be dried this stage it is to be cth ribs on wn ott' by absorbed ; should be •al health, nic means. )laco very mic pleu- 10 removal 10 system, dies which id try gon- entle exer- the fluids and simple every-day n extreme ural cavity B remedies BBVISED TREATMENT. 877 Fracture of the Bone. — Treatment, (Continued J)rom page iM.) In the treatment of fractures of the shafts of the bones of the lower extremities, three indications shoulO be fulfilled : First, coap- Uition and fixation of the fragments ; second, moderate extension ; third, gentle compression and support. Provided these reciuirc- mcnts are carried out, it matters little what a]>f)aratus may be em- ployed ; but that which can be applied with the least disturbance of the fractui'ed bone, and is most comfoitable to the feeling of the patient, should be preferred. The best mode of extension and counter-extension now in use is by raising the foot of the bedstead about eight inches, by a block of wood placed under each fore leg. This makes an inclined plane, and the b;>Hy consequently tends to incline towards the head of the bod ; this is the counter-extension. Then extension is made as follows : A strong piece of adhesive plaster, about two and one half inches wide and about three feet long, is applied to the sides of the leg, extending from a little below the knee, leaving a loop under the foot four or five inches long. This is secured firmly in place by a bandage to the whole length of the log. A piece of cord is fastened to the loop and passed over a pulley, which is fixed to the foot-l)oard of the bed. To the other end of this cord i attached, a weight. This need not exceed ten or twelve poui ^« In this way we get our counter-extension and extension : the body is drawing one way and the weight is pulling the other all the time. This is a simple and comfortable way of treating fractures of the shafts of the bones of the lower extremities which require extension. It may bo applied to the different fractures of the neck of the thigh bone, to fractures of the shaft, and also to fractures in the shafts of the bones of the leg. It is the best and most effectual way of preventing undue short- ening that we have in use, and what is of as great importance to the patient, a most comfortable way of keeping the painfiil limb in the proper shape. (See page 454.) Fractures. — Connter-exteyision. Modern surgery has developed two simple mechanical means of making extension and counter-extension for the purpose of overcom- ing muscular spasm, which rarely fail. One is by the use of elastic rubber bands, and the other by the attachment to the limb of a cord running over a pulley at the foot of the bed and sustaining a suitable weight. The method of employing these will be given in detail in connection with special fractures. (See page 444.) '!,» Fractures. — Coaptation, A great point is to have the splints accurately adapted in each cai?e, and the ability to aft'ect this is an Iiuportant element of success in this branch of surgery. W )od may be generally cut into suitable shape, but it is porha})s easier to use moulded splints of leather, felt, gutta- percha, or shellac clot.i. The stjirched or })laster bandage or guuuned paper mi'-y be effectively used ; and with a proper pair of she:irs, sheets of tin or zinc may be cut into splints, which will answer admirably. Woven iron wire splints are highly recommended. (See page 445.) . . « Bleeding from Wounds. . One of the best methods now in use of arresting hemorrhage in cases of accidenUil injuries of the large arteries of the extremities, is by suiTounding the limb above with two turns of a piece of rubber tubing, al>out three fourths of an inch in diameter, and tying it tight. This safely and ettectually controls all bleeding. Advantage is taken of this elastic property of rubber in controlling hemorrhage, in ijerforming what is called ))loodless operations of surgery. It is called Esmarch's metliod, from the name of the origi- nator. It may be resorted to in all operations on the extremities, whether of ani})utations, the removal of tumors, or in the minor operations of nduoving needles, and whenever the bleeding intert'eres with the perforinance of the operation,, It is applied as follows : T!ie limb should first be tightly bandaged with an elastic rubber bandage about three inches wide, from below upwards, 4ind then surrounded at the highest point with a band or tube of rul)ber in the place of a tourni(iuet. The bandage is then to be removed, when the operation ra; y be perfonned in t. the presence of organic germe floating in ^he almos- !i :ii: phcre. Carbolic acid is used on account of its known destructive effects upon low forms of organic life. These low forms of vegetable organisms, which float in tht air in great abundance as constitutints of the dust, are called by naturalists biicteria, of which there are map.y varieties. Whenever they tinle it to become uniformly moistened when dip{)ed into a watery solution of tin acid, is applied directly over the wound, the ends of the drainage tube protruding abcnit an inch from each extremity of the incision. The wound is then covered with a layi^r oi antiseptic gauze dip{)ed into 'i solution of one to forty of the iKv'xd. There are then Hu])erimi)('sed six other layers of dry gauze; then the mackin- tosh or a piece of lubber cloth ; then an eighth layer of gauze large enough to cover in all the remainder, and finally a bandage of the game. When the dressings are renewed, it is to be done under the spray, trreiit cfire being taken not to admit any nun-carbolized air. 880 BEVIdED TKEATMEirr. 1] The dressings are not to be changed until the discharge has begun to soak through and appear below the edge of the rubber cloth. The antiseptic gauze is made by impregnating cotton cloth of open texture with a mixture of carbolic acid one part, resin five parts, paraffine seven parts. The resin acts as a vehicle for the acid, while the paraffine is added to prevent inconvenient adhesiveness. (See page 440.) Poisoning Aocidents. Poisons >nay be classified under two heads; viz., mineral and vegetable. In the treatment, three objects are to be kept in view : first, to get rid of the poison ; second, to stop its action ; and third, to avert its tendency to death. The first indication is accomplished by the administration of emetics to cause vomiting, or by the use of a stomach pump. The simplest way to provoke vomiting is to give large draughts of luke- warm water, and to thrust a finger down the throat. A teaspoonfnl or two of mustard in warm M^atcr is oftentimes an eflectual emetic. Some of the emetics are ipecacuanha, tartar emetic, sulphate of zinc, and sulphate of copper. Sulphate of zinc in twenty-grain doses is about the best. The second indication is to use an antidote. The third indication is ful- filled by palliating the symptoms, and neutralizing the after efiects on the constitution. Aftor copious vomiting, soothing liquids should be given, such as oil, milk, bcaten-up raw eggs. These are useful when the poison has been of an irritating character. If the patient be much depressed in body or mind, the hands and feet cold, the lips blue, the face pale, a cold perspiration on the fore- head and about the mouth, some stimulant may be administered. Strong, hot tea is the best, because it is a chemical antidote to many poisons. Strong coflee is a good stimulant. Brandy and other spirits are sometimes necessary. Sometimes when the powers of life are much depressed, artificial heat also is necessary. (See page 496.) Acute Rheumatism. Since 1875 two new remedies for rheumatism have come into use ; viz., salicylic acid and its salts, and salicin, the active principle of the willow bark. When given at the commencement of an attack, it oftentimes arrests the course of the malady as effectually as quinine arrests the intermittent fever, or as opium and ipecacuanha arrest dysentery. It exerts such a beneficial influence that it is recognized by the profes- and IS and le fore- Istered. many other of life le page [iiple of sntimes 38ts the lontery. 1 profes- sion as u specific. From ten to fifteen grains of salicylic acid or the salicylate of soda should he given every two hours until relief is ob- tained. Thi.s usually takes place in from twelve to thirty-six hours. In n)ost cases liui fever and swelling will abate within the above time. If not entirely arrested, the disease is xci'y much shortened. W' hen the spc(!ifi(! etle^'- Diminution below the normal .stnndaid i« comparatively rare ; yet it sometimes occurs and is of some importance. In the course of typhoid fever, a sudden decrease may indicate intestinal hemorrhage. Scmietinies the temperature falls, without hn- provcment in the otlua* symptoms. This is an unfav()ral)le symptom. The value of thermometric changes dei)ends in no small measure upon the symptoms Avith which they are associated. Fysemia. This frightful afTection has been called the banc of surgery. It is I'.iused by a peculiar poison, resulting from the fermentation and dis- integration of the tissues of a wound, which" is taken into the system either by the veins or absorbents, and is usually accompanied by the ix)rnuition of collections of pus in the various tissues and organs of the body. It follows very tritling as well as severe injuries, and it is a frecijuent sequela of surgical operations, oftentimes of a very slight character. The only tenable theory which can explain the different phenomena of this dfsease is, that the pyromic condition is caused by the absorption of septic material, sometimes in a fluid, sometimes in a gaseous state, which unfits the blood for the processes of healthy nutrition, induces capillary stagnation and its consequences, low forms of inflammation in difl'erent parts of the body, as in the joints and serous cavities, and may finally produce those secondary deposits of pus, in any or all parts or organs of the body, called metastatic abcesses. When an internal organ is involved, the result is generally fatal. When suppuration attacks the integuments ov the extremities, there is a fair chance of recover3\ Thence the disease has been divided into two classes : the intenial or acute, the external or chronic pytemia. When jwieniia involves the internal organs, the course is usually rapid and fatal. A\'hen it attacks the external j)arts, it is slow in its course and may he recovered from. Duration of the DiseaNO. — Sometimes its course is so rapid that the patient may die in two or three days after the appearance of tin; symptoms. As a rule, however, bad cases terminate during the second week. Some go on for six or seven weeks. In cases which recover, the patient goes through a long illness and may be left per- manently crippled l)y secondary affections of the joints. As a rule, the longer a patient lives the better the hopes of a successful ending. Pyicmic symptoms generally make their appearance after the fourth day. The first symptom is a chill ; this is repeated at iiTegular intervals, and is followed by profuse aud exhausting sweats. The hot stage which characterizes the malarial paroxysms of inter- mittent fever is usually absent or but slightly marked. During the ■•-J B ; yet idicute lut im- iptom. casure . It is nd dis- system . by the s of the 1 it is a f slight ifFerent used by iinics in healthy es, low e joints leposits tastatic y fatal. s, there nteniiil nvolvos iVheii it may bo |)i^ ,rv- Tho bowels if constipated are to be opened by a gentle laxative, and the different secretory organs restored to a healthy action as far as possible. The vital energies of the patient are to be maintained or stimu- lated, and everything that tends to lower them must be warded off. (^uiqine is the most val(ial>le remedy we have for the treatment of pyicmla. Some surgeons give it in largo doses and speak highly of its effects. It is valuable in doses of four or five grains every three (ji- four hours. It may be combined with iron advantageously in some cases. The best combination is with the citrate of iron. Four gniius of each arc to be given four or five time a day. Stimulants are also of great importance to maintain the powers of life. In some cases it isinecessary to employ them freely to keep up the waning strength. The diet should be as nutritious as the patient's assimilative powers will bear. Milk and tho animal broths arc tho best. When the stomach rejects nourishment it must be given by the rectum, enema of beef tea and milk with b>andy being administered every four hours. When tho nervous system is disturbed by pain and want of rest and sleep, some of the forms of opiates or anodynes are to be given, small doses frequently repeated being better than large. Should diarrhoea exist it is to be kept under control. It should not be chocked suddenly, as it appears to have an eliminative ten- dency in cases of blood poison. Carbonate of ammonia in ten-grain doses five or six times a da} is a valuable remedy when other tonics cannot be tolerated. When secondary abscesses form, they should be opened and kept cleansed by some disinfectant fluid, such as carbolic acid or the solu- tion of the chloiiuate of soda, in their proper strength. laxative, \n aa far ir stimu- rded otF. itmcnt of hij^lily of ery three jously in u. Four towers of > keep up re powers 3n by the ainistered it of rest » be given, It should ative ten- les a da} and kept the solu- MARRIED LADIES' PERPETUAL CALENDAR. Tbb otility of these tables, as serving for a faithful and confidential friend in matters of nrarat interest, cannot fail uf being perceived. Tbo young and newly-marricd mi^ht bo spareii an nnpleosaiit amount of eraburr.issmont by consulting tlie Calendar as to the timo of coiitiiiement, wliich, in reckouiM{^ the full period of gestation 280 days from conception, niiiy be very nearly approximated; or, m ttie event of the time of conception being uncertain, from the period of quickening, which she con usually note, she may reckon 140 days. It will bo perceived that the Calendar hus three columns of figures, denoting the days of the months noted ut the head of each. TLe first column gives the date of conception; the second, that of the period of quickening; and the third, that of delivery. Thus, if a lady dates the period of conception .Ian. 1, 1870, quickening will occur May 20, and confinement about the 8th ot October followuig; or, if she is ignorant of the time of conception, bv consulting the middle cohunn as to the time of quickening, if it occurs May 20, she may expect her confinement to occur about the 8th of October following;, or 140 days after the period of quickening. The date in the first column is that of conception ; the correspond- lr.g date in the second column is that of quickening; and the corresponding date of the third col- omo, that of confinement. Janaary. ClMMp'ii. Qmclcen'g. Deliv'n. Ian. I 2 8 4 6 « 7 8 9 10 11 12 18 14 16 16 17 18 19 20 21 aa 38 24 25 26 27 28 29 80 81 May 20 21 22 23 24 25 26 27 28 29 30 81 June 1 2 8 4 6 6 7 8 9 10 11 ^-K 18 14 16 16 17 18 19 Oct. 8 9 10 11 12 13 14 15 16 17 IS 19 20 21 22 23 24 25 26 27 28 20 80 81 Nov. 1 2 8 4 6 « r JFettmary. Blarch. April. Omeep'it, Qukken'g. Deliv'ii. Feb. 1 2 8 4 6 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 28 28 24 26 26 27 28 June 20 21 22 23 24 25 26 27 28 29 30 July 1 2 8 4 6 6 7 8 9 ,10 11 12 18 14 16 16 17 Nov. 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 26 26 27 28 29 80 Deo 1 a 8 4 i Omeep'n. Qaicken'g. Deliv'i/. March 1 2 8 4 6 6 7 8 9 10 11 12 13 14 16 16 17 18 19 20 21 22 23 24 26 36 . 27 28 89 80 ai July 18 19 20 21 22 23 24 25 26 27 28 29 80 31 Aug 1 2 8 4 6 6 7 8 9 10 11 la 18 1' u 6 ..'.7 Dec. 6 7 8 9 10 11 12 13 14 15 10 17 18 19 20 21 22 23 24 25 26 27 i( 29 80 81 Jarj. t a 8 4 6 Ctmetp'H. Quiektn'g. /Jklivy April 1 2 3 4 5 6 7 8 9 10 11 12 13 14 16 16 17 18 19 20 21 22 28 24 26 36 27 38 39 80 Aug. 18 19 20 21 22 23 24 25 20 27 28 2U 30 31 Sepu 1 2 8 4 6 « 7 8 9 10 11 13 18 14 16 U Jan. 6 7 8 9 10 11 13 13 14 16 16 17 18 19 20 21 2Si 23 24 25 20 27 28 29 30 81 Fek 1 a s 4 h I "^ n t'tii !■■■ ? J 886 IfABBIED LADIES' fERPETUAL CALENDAR. May. Jane. July. AuKvat 1 CtawW gMfefanV. iM<«V. OMMvtk Quidim'i. DMxft Cbiwqiti. QhMmii'v. DtUi^t. Otmeip'n. Quiektn'g DM^ Kay Sept Feb. 17 6 June Oct March July Nov. April Aug. Dec. Ma, 1 1 18 8 1 17 7 1 18 8 3 18 6 2 19 3 18 8 3 19 8 10 7 8 30 10 8 19 9 8 20 10 4 30 8 4 31 11 4 30 10 4 21 11 6 31 6 33 13 6 31 11 6 22 12 6 33 10 38 18 6 23 13 S3 18 T 38 11 7 34 14 7 23 13 7 24 14 8 34 13 8 36 16 8 24 14 8 25 16 B 36 18 30 16 9 25 16 20 16 10 30 14 10 37 17 10 20 10 10 27 17 i; 37 16 11 38 18 11 27 17 11 28 18 13 38 10 13 39 10 12 28 16 13 20 19 18 30 17 18 80 20 13 29 19 13 30 30 14 80 18 14 81 31 14 30 20 14 31 31 Oct Not. Dec. Jan. 16 1 19 16 1 22 15 1 21 15 1 32 16 3 30 10 3 33 10 2 22 10 2 28 IT 8 31 17 8 24 17 3 23 17 8 34 18 4 33 18 4 26 18 4 24 18 4 36 10 6 33 10 6 36 19 6 25 19 6 36 30 34 30 27 20 20 20 6 27 31 7 36 31 7 28 31 7 27 21 7 38 33 8 30 33 8 30 22 8 28 22 8 39 38 37 38 80 28 9 20 23 30 24 10 38 34 10 81 24 10 80 24 10 81 March April May June 36 11 1 36 11 1 26 11 1 35 11 1 36 13 2 30 13 2 36 13 3 26 13 3 37 18 8 27 18 8 37 13 8 27 13 8 38 14 4 28 14 4 28 14 4 28 14 4 30 16 6 30 16 6 29 15 5 29 15 6 80 16 80 16 6 80 10 80 10 81 17 7 81 17 7 81 17 7 Septonbflr. ■ October. November. December. OMQi'a. Qwletm't. JWJW. Omnp'n. QiOAaCg. Dtliv'f. CiMKapV QalektH'g. JMUv^f. Omap-n. QuidtaiV iMi*>. Sept. Jan. Jbho 18 8 Oct Feb. July 1 17 8 Not. March Aug. 1 20 -8 Dec. 1 April 19 Sept 3 10 2 18 3 31 9 2 20 8 8 30 10 8 10 10 8 33 10 8 31 4 31 11 4 20 11 4 38 11 4 39 10 6 33 13 6 21 13 6 24 13 6 2 11 • 38 18 33 18 6 25 18 i 13 7 34 14 7 38 14 7 26 14 7 3> IS 8 36 16 8 24 16 8 27 15 8 30 14 30 10 36 10 9 28 10 9 27 16 10 27 17 10 30 17 10 29 17 10 28 10 11 38 18 11 37 18 11 80 18 11 29 17 13 39 10 13 38 10 13 ;)l 19 12 80 18 18 80 20 March April May 14 81 31 18 1 30 18 1 20 18 10 Fob 14 3 21 14 3 21 14 3 30 16 1 33 16 8 22 15 8 23 15 8 31 16 2 28 10 4 23 10 4 38 10 4 32 17 8 24 17 6 34 17 6 34 17 6 28 18 4 26 18 36 18 36 18 24 10 6 20 10 7 20 19 7 26 19 7 26 30 27 30 8 37 20 8 , 37 30 9 26 31 7 28 21 38 31 9 38 31 27 33 8 20 33 10 39 22 10 29 33 10 28 38 4 80 38 11 80 23 11 80 28 11 20 July 34 13 81 34 13 81 24 la 80 34 10 i • Aug. 36 18 1 Sept Oct 26 11 2 3S 18 1 26 18 36 12 8 30 14 3 30 14 3 20 14 37 IS 4 37 16 8 37 16 8 27 16 38 14 6 36 10 4 38 16 4 28 10 30 16 6 39 17 30 17 6 29 IT W 16 7 SO 18 « SO IS 6 SO IS 1 SI 18 7 •1 It PRONOUNCING DICTIONARY. . . . GLOSSARY. AB-no'MEW. The belly, A-ck-tah' ii-lum. The Rockot for the hcnd of tlio thi)!li hone; an anciout vesoel for hold- init vinegar. Ah-dom'j-nal c'av'i-ty. The cavity of the hclly. Ad-diic'tor. a Tntiscle whioh draws one part of the tKxiy towards aiiottiur. Ab-8Ur'iiunth. Ulaiuls and vcshcIs which absorb or Ruok up suhstances from within, or without; also, niudicincs which, tboui;h nearly or quite inactive themselves, alMorb, or combine with acid matter m the Btomach o; bowels. A-€ko'mi-on. That part of the scapuin, or shoulder-blade, which unites with the coilar- bone. Ai^nii-oiN'B-A. The white of the eye. A1/TKU-A-TIVE8. Medicines which ^nudu- ually reestablish health, without sensibly in- crcasinK the circulation, or aupneiiting the perspirat'on, urine, or other excretions. Al'vecvlak. Kelatiut; to the sockets of the teeth. Al'vine (Al'trin), Relatins to the Intes- tines, as alvine ditcharyts, — discharges from the bowels. A-MOK'PHOim. Havlnp; no reKnlarform. Ah-ni-ot'ic LiQ^uin. The fluid surround- ing the fetus in the womb. An-^8-tiik'i4ia. Suspended sensibility. An-as'to-mosb. The unitint; ot arteries and veins bv Joining their mouths. AN-CHir-Lo'»iH. A stiff or useless joint. AN-i-MAi/oi'-L,f;. Animals so small that tliey can only Ihj seen with a microscope. An-18'i-ac8. Medicines supposed to excite and promote the sexual appetite. A-pon-eu-ro'8I8. The mentbranoiw ex- pansion of tendons and muscles. A-re-o'la, a colored circle, as tins circle around the nipple. Ar-o-mat'ic8. Medicines which have a gntteful, spicy smell, and un agreeable, pun- gent taste. A8-piiyx':-a Suspended animation ; b|>- parent death. Ab-then'ic. Relating to debility; or to disease marked by debility. AB-TRiN'GENTti. Meilicincs which have tho power to eonstringe or pucker up the tissues of the IkkIv. and thereby check discharges. At^RO-piiy. a wasted condition; leanness. Ax-ii^'la. The arn>-pit. AtrsHiUL-TA'TioN. The art of detecting disease by listening to the sounds of the lungs, heart, etc. Aii-Top'sY. Personal inspection, — used in the sense of a post-mortem examination. Azote'. Nitrogen; one of the constitu- ents of the ntmo-sphere. Bron'chi-a. The pipes which convey the air through tho luni;8. Bitr's* Mu-co'sa. Small sacs, situated under tendons, ai)out the joints, containing a Htiekv fluid. Cai/cii-uts. a solid, unoi-ganized Ixxly formed in the kidneys, or bliulder, and called a stone. The plural is calculi. CAp'ii.-i.A-nv. Small; resembling a hair. Cap'sui.e. a membraneous bag, enclos- ing a part. Car'ti-laoe. Gristle attached to the ends of the l)ones. Car-.min'a-tiver. Medicines which expel wind from the stomach and bowels, and allay tho pain caused by it. Ca-tiiar'tic8. Medicines which purge tho t)OWClH* Oer'Vix. Tlienock. Cer^vix U'ter-i. Th« neck of the womb. Car'i>i-ao. Kelating to the heart. /■ / 888 GLOSSARY. m If]'- Car'pal. Relating to the wrist. Cat-a-me'ni-a. Tlio nuntlily flow of fe- males. Ca-tiiak'bih. PurKini;. Catii'k-tkr. a tuliu for drawing ofl* tlie urine. Cel-i.u'lar. Rcluting to ccIIh. Ckr'k-iikal. Kelnting to tlie briiin. CiiA-i.Yii'K-ATK. roiittiininK iron or Htecl. CiiK-M»)'8i8. A KWi.'lliii;{ of the t'vc, in wliicli till! oje proji'i'tH, with u depresKJon In the centre. Ciio'i.A-noouK. A ineh'tki:.m. The lirst secretion of milk. Co'MA. rrol'onnil stupor, or sleep. CoN'uri.K (kon'dil). A knob; applied to certain projections of boties at joints. Con'klu-ent. Not disdnet; running to- gether. Con-oen'i-tal. Kxisting at the time of birth. Con-oks'tion. Distention of parts Uy an aecumululion of blood in them. Con-iMinc'ti-va. The membrane which covers the eye and lines the eye-lid. Con'tra-Is'i)i-ca-teu. Not indicated; the opposite implied. t.'ouii'iAi.s. Medicines which have a grate- ful, wanning, and exhilarating effect upon the stomach. Cohn'tku-Iu'ri-tants. Articles which by iiTltatIng one part, withdraw l)lood from, and relieve another. Ciii'sis. The tunnng point of a dlsoasc. Cu'Tr-CLK. The epidennis;' the scarf-skin. I)k-<;ii)'ii-a. a thin, exicrnul membrane, within tire womb, thrown olf after ehild-bear- in;r. I)e-i.iq'iii-um. Fainting. I)K-Miii,'cKNT». Medicines of a softening nature, which correct acrid conditions, and, by their bland effects, soothe inflamed and irri- tated parts. Dk-im-e'tion. Diminishing the ftdness of a part or parts, as by purgatives, or bleeding. De-sqi;a-.ma'tion. Separation of the skin in scales; scaling off. De-tek'uknts. Medicines which cleanse. Di-A(j-No'si9. The art of determining the nature of diseases. Di-a-i'iio-ret'ic'8. Medicines which pro- mote gw<;utlng. Di-ATir'E-8is. Any particular disposition, itate, or habit of iwdy. Di-u-i>k'si8. Copious flow of urine. Dit.'ii-ENTS. Watery drinks •vhlch increase tho fluidity of the blooem'|(} Dih-eah'eh. Discuses prevail' ing in certain Uicalitles or districts. Ki'-i-oem'io Dih-kah'kh. Diseases extend' Ing over a large extent of country. Ei'-i-iiUiT'ris. The cartilage, which, in the act of swallowing, slint'4 down upon the tup of the wluil-pipe, and prevents food from gt)iiig Into the breath-passage. Kr-is-i'As'TK's. Siili'.tances which inflame the skin, and raise the cuticle, and cause what is called a blister. Kk-cha-uot'ich. Articles which burn, cor- rode, disorganize, and destroy the aidmal tiS'' sues, causing wlint is called an eschar, or slough, which is dead mattt;r, and falls off. Kx-i'Ec'ro-UANTH. Articles which act upon the system, so us to make the discharge of mucus and other substances from the uir-tubes more easy. Kr'kiunks. Substances which cause sneez- ing, and a discharge of mucus from the nose when simfU'd. Ks'ciiAK. Tho dead part, killed by caustic, or m<>rtificatk>u, which falls off; a slough. Kx-ko-li-a'tion. a scaling off, as u piece of dead bone. Fau'ces. The back part of the mouth. Fe'huii.e. Uelonging to fever. Fe'ces. The matter discharged from the bowels. FKii'Ki-Fd-cES. Medicines which assuage or remove fevers. Fi.a'ti!8. Wind, or rather, gas, in the stoin- udi or bowels. F<)i-'i,i-<;i.E. A little hag or sac. F<»-iia'.mi;n. a hole, or opening. Foit-M i-<;a'tiun. a sensation like the cieep* ing of ants. Fi;u-fi-ua'ceoU9. Dranny, or scaly. (i vN(i'i-i-ON. An enlargement In the coarse of a nerve. (iAN'cKEXE. Mortilication; partial death. (iAS'Titic. Delonging to the stomach. Ges-ta'tion. The period of jiregnaney. Gi.dt'tis. The opening Into the wind-pipe, covered by the epiglottis, UitAN'u-LAK. Like small grains. Gkan'u-la-ted. Covered with grannla- tions. Gran-u-la'tion. The filling np or cover- ing of a wound, or ulcer, with small, red eleva. tions, looking like grains. lI.t:-Mui''TY-8i». liaising blood fix>m the lungs. IIe-mi-cra'm-a. head. lIi1':M'OR-RIIAGG. IIa^m-or-riia'gic bleed. IIe-pat'ic. Uelonging to the liver. Hy-per-ca-thar'818. Exccssive purging. Hy-i*er'tro-i'IIY. An unnatural enlarge- ment of an organ, without change of structura H YP-NOT'iC8. Medicines which cause sleep. Icii'oR {Ikior). A thin, watery, and acrid discharge. In-tkr-cos'tal. Between the ribs. Lar'ynx. The top of the wind-pipe; the cavity which contains tbn vocal ligaments. Pain on one side of th» A flow of blood. Having a tendency to iCToep- I coarse ( ovcr- eleva. lency to arfring. enlar;:©- ructum sc Bleep, id acrid ipe; th« enU. 0LOS8ART. 889 Lax'a-tiveb. Medicines which render the tiowelH a little more relaxed than natural, but do not purge. Liu'ate. To Meciire with a li((ature. Lio'A-TURK. A cord, or thread. Lo'ciii-A. The hluody discliurKe fVom the woml) lor some time after child-ltlrth. I/>'ciii-AL. KuliitiiiK to the lochia. LvMi'ii. A whitish Huid contained by the lyniplmtic vcuscis. LYM-riiAT'it8. The vessels which carry lympli. Mac-eu-a'tiox. The act of Rottcninp; ^r soakln;; a tliin;^ by Icttintj; it stiind in water. Mac'ij-i,a;. Colored spots; hleniishcs. Ma-i.a'ui-a. Noxiou.s giwes from decom- posed matter. Mam'.ma. The female breast. Man-ui»'im,au. Kclatinj; to the Jaw. Ma«-ti-«'a'tion. The net of cliewin);. Mas-tuu-iia'tion. The nit of exciting the genital organs with the hands. Mi;n'»tkii-1!.m. Any solvent, or vehicle. Mi;t-a-caii'i'iis. The hand between the wrist and the lingers. Mk-ta8'ta-ri». The changing of a disease IVom one place to another. Mkt-a-tak'8ii9. That part of the foot Ihs- tween tlie ankle and the toes. Mi-A»-MAT'ic. Partaking of the nature of miasm. Mu'co-pu'Ri-FOKM. ConiiMiscd of both mucus and pus. Mu'co-sK'no-i.ENT. Composed of both mucus and serum. Nau-cot'ics. Medicines which relieve puin and produce sleep. N AU'SE-ANTH. Medicines which cau.se sick- ness at the stomach, or a disposition to vomit. They are often used as expectorants. No8-ol'o-ojst (Aose-ol'o-yitt). One who explains and classitlcs diseases. Nu'ci.K iJ9. A central spot. Nu-CLE-o'i.ii9. A spot within a nucleus. Ok-tiioi'-nik'a. Great difHculty of breathing. 08 U'tkk-i. The mouth of the womb. 08 8i-fi-<;a'tion. The formation of bone. O'vuM. An eg^. O'va. Kggs. Pa-1'1l'la. a red, elevated point upon the tongue, or elsewhere. Certain diseases maiio these points more prominent, Pau-a-cbn-tk'818. The operation of punc- turing the chest, or the al>domen, for the pur- pose of drawing off water. I'ak-a-i'iii.k'oi-a. I'aralysis of the lower half of the body. Pau'ox-ys.m." a fit of disease taking place periodically. Pak TU'Hi-ENT. Urlnging forth, or giving birth. Par-tu'ri-ent8. Medicines which promote child-bed labor, by causing contractions of the womb. Par-tu-ri'tion. Child-birth. Pec'td-rai^s. Medicines intended to cure or relievo diseases of the chest. Pel'vis. The bony cavity, or basin, at the lower part of the body, containing the womb, abdomen, rectum, etc. Pkr-i-ne'um. The part, or space, between the anus and testicles. Per-i-os'te-uu. a thin, hard membrane, covering the bones. Per-i-os-ti'ti8. Inflammation of the peri- osteum. FBR-i-To-NK'nM. A serous membrane lln> Ing the cavity of the belly, and folded over most of the organs contained in It. PKT-E'ciii-ii:. Purule s)xjis which appear upon the skin in low levers, looking like ttea- bites ; called aUo ecchymoses. Piia-«k-i>en'ic. Corroding, eating, — ap- plied to ulcers. PiiA-LAN'uES, The bones of the Angers and tOi'S. Piiar'ynx. The npiwr part of the thmnt. Piii.K(i-.M(>'N(HiH 1n-fi,a.m-.ma'tion. Inllani- mation marked by redness, heat, and pain, and a tendency to form matter. PRoc of the propcnies of pus aitd blood t>i-.i)'A-TivE9. Medicines which diminish the action of the lieart and nerves, and which are used when wo wish to allay any excited action in the system. Sk'hoi.s. Watery. ScKo'TtM. Tho bag which contains tho testicles. ,S(;y»'a-i,a. Hard, round lumps in tho feces. Si'A-i,A-(i(>(iUK8. Medicines wliich inci-eiLso the flow of saliva. Si.oi;oii {Sliiff) Any part of tho body killed by niortilicHtion,or caustic, and cast off. Si'kr-mat'ic C<>ki»8. Two cords, composed of nerves, veins, and arteries, descending, one on each side, from the abdomen into the scro- tum, and suspending the testicles. Kyi'A'Mourt. Scaly; having scales. Sok'dks. The dark matter deposited upon the lips and teeth, in low fevers. SrKu'Nti.M. The breast-bone. ■Stek'toh. Noisy breathing, as in apo picxy. iSnorlng. Steu'tor-oi;s. Snoring and noisy, as ap- plied to breathing. Stim'u-i.ants. Medicines which increase the activity of the system. Sto-macii'ic8. Meilicines which support and renovate tho stomach, making its action healthy. Stru'ma. Scrofula. Styi-'tics. Substances which, when ap- plied externally, have the power to constringe or pucker up bleeding vessels, and stop the loss of blood. 8uu-cu-ta'ne-ou8. Under the skin. Suu-MAX'iL-LA-RY. Under the lower jaw. Suu-8ul'tu8 Ten'di-num. Slight twitch, ings of tho tendons, which occur in low forma of fever. Mr I: If' 1. si It .\, W Sii-DO-RiK'irs. Modicincii which vnmo a flow «f nurHninition, rather inuro frco than (hut proiliiocd liv iliHphureticH, Sri'-i'uit'i-TO-KiKH. Solid medicinal 8ub- ■tancen, of a conical or cylindrical Hhupo, which are placed In th« roctiini for the pur- pose of rolicvinK constipation and thu pilcA, and for romovInK Htrlcturc. Syn'oo-i'E. Fainting; xwoonitiK- Te-nes'mu8. a painful l>enrlii>j down in the lowur bowel, and a dlHtreHMiiiK dcHiro to |{o to stool. Ton'ics. Medicines which gradually pivo tone and strcn^^th to weakened organs, or to the whole system. Some act upon the ncr- voua system.' und some upon the other tissues, by condensini;, bordenintf, and invigorathiK tbem. Tor'mi-na. OrlplnRpaln. U-re'tkhr. Thu tubei* whicli ronTfljr the urine from the kidneys to the bladder. U-hk'tiira. The canal which conveys the urine fh)m the bladder out of the iMMly. U'ter-U8. The womb. Vao'i-na ( V(idi-na). The passoRo tmm the external ^t^nilal organs to the womb. Va'ri-«;o8E Vkinh. Veins which are mor- bidly enlarged, an(V present aiouK their course Hoi'tj knotty, purplish tumors. Vkh'ti-wo. Dizziness; Kll'no8a. VE-Ki-t'A'riON. ItlisierinK. Vi'rub. I'oison; contagion. Vis'ciis. A liver, stomach, kldnoj, ueart, or any organ within one of the cavities of the body. It is believed that the hai^ words introduced into thiii book, and not contained i« the above GlosBary, are nearly or (juite all explained at the places where they ara Mcd. Ill I uyi the r. i;o from lb. ire inor- r courM y , ueart, a» of the unod !» they are • • I 2sr 1) h; x. • *« PAoa Abdominal Cavitri DImims oi; AbicR rnnailvnRlH, " KxcclsB, " rioea, Abortion, Abacetmen, Abnuiici' or Monnex, Absorbent VpsmcIh, Acacia Catvoliii, AcuiilentH on Water, " bv I'oiMoning, Acetate of Ooiiper, poiHoning AU, 282 017 6()2 fi02 3HI) 429 avt 6(M 498 496 4»7 " Leaa,|)oii Acutum, fXtO Achillea Miliefulium, 664 Acid, Acetic. r>90 " Citric, hW) " Diluted Hydrochloric, 591 " " Hydrocyanic, 591 " Nitric, 590 ■• " Sulphuric, 591 " Nitro Muriatic, 591 " Tannic. 591 " Tartaric, 691 Aconite, 632 " PoiHoninfT by, 4iW " Tine t. of, 688 Aconitum NupelluK, OWi AcoruR Calamus, ■ 6.58 Adipous .^iircoma, 471 Atfectionn of Chent, 574 '• " Head. 674 " " Stomach and Howela, 670 AmiKlon.The, r^Vi Age, Influence of, 1'>1 Axue Koot, 655 " Fever and, 413 Air CellH or VegfcleR, 35 ■' " Hnlargement of, 231 '• in Cbeit, 236 " SwellinK*. 283 " and Veutilation, 108 Albumen, 15 Albuminuria, 299 Alcohol, 691 Alder, TaK, 658 Aletrii Farinoaa, 655 Alimentu, Fluid, 668 Allium Cepa, 636 Sativum, 615 Almonds, 591 Syrup of, 684 Almond Mixture, 674 Aluus Uubra, 658 Aloes, 692 " Comp Tinot. of, 690 '* and Canella, Compound Powder of, 682 Alpinia Cardamomum, 604 Althca Offlolnalia, 681 Alum, 693 PAoa Alumen, 692 Amaurosis, 4*46 Amenorrhira, .354 American Hellebore, 592 " liMicaouanha, 603 " Ivy, 593 " Valerian, tW) Ammonia, Aromutio Spirit of, 594 '• CurboiiHte of, 593 " Muriute of, 593 " rol!' Head, 636 " Hose, 634 •' l^g, 686 " Mouth or Orai, l'41 " Nose, 640 " Plunge, 586 " Shower, 684 " Sitz, 587 " Towel and Sponge, 538 " Wading Koot, 640 " M'arm Koot, 640 " Wash-Tub. 637 " Wave or Sluice, 538 " Cold. 542 " " F,fl"ects of, 648 " Hot, 642 " " Efleotsof, 644 " Tepid, 642 " " FJTectsof, 648 " Vapor, 642 " Warm, 542 " " RffiMStsof, 6*4 Baths of the AncienU. 108 " Cold. 106 » Division of, 641 " Names of, 104 " Negleot of; IM 892 INliEX. nntlui, Bc^ction after, " 8hi>«a. " Oiiifmcnt, " )'l»»itlT, ri)i»oiiiiiK by, Hensiiii! Aciil, livil.'.nlli, I'lUiip. Tioct. of, ISKibvris ViilgHrlc, 1 '.('til mot, ilili; ill .siomnch, r>iiiui'y ('iiifiili, KilioUN ( olit:, Kt-iiiitteut Fever, UiHiiiiitli, " NltratiMif, " Xubiiili!il« of, " 1 rihiiitiiili' of. " White Oxido of, IJItllT Itoo!, Illllt'lSWlK'l, llliii;k Aider, " l'olit>»h, #40* W7 Bruit!, AbfierM of, 109! • 11)5 1 KM) I Km I ""' i 644 tiTrtI (i6«i 70-V8i ft:'6i /yiril 6ta ;'.> fi7>!| ()7i> TAO* ]56 15H 16»> m Hrvytfy ol, Kiilarfjvnicnt of, lOxertfliw.' of, I'Vvi.T, lU/nltli of, liiituratiitn of, ' iiIlHinniulioii nf, .ml Nvrvi.'M. tiidCttsesof, 162 1 (JajiKin Aciilifoiia Carunt Cami. C»rtitaK<:, Arytenoid, " < rvcoid, " 'lliyroid, l,''i^!>Caryop)iillii!< Arumulicua, f>7 '('aMisiiilla, ir)ij|Cai>(!iti<', IMi CuM'K 'I'reatcd. 96 " (Jill IVopleH, " Overworitinff, " Sliriitki)«K of, .SnlW'iiiiii; ol, " 'J iiinois of, Uraii. lii'Ooctioii ol. Kritiiily Mi.vtint-, Itifiiil iiikI SV liter I'oultice, ilrt'ii^t Hull!'. Kriicliirf of, r.rolicii, liiHuiiiinqtioii of, W) Bn-atliiiiK, OI/jfciH of, fiiXi '■ riiiloMipliy of. f('t'- UrijihlV I>iM;ii' UroiicliiuS I'lilicfi, 61)7; •• riniHiiniption, (14 I'.roiicliitii<, Ai-ulc, 2iiH '■ t'liniiuo, 2HJ liroi-ftiocele, 411 ItriiiKufi, f)!'7 lliilio, fill7 J'lucliii, r,!l7i •• finct. of. fi!i7 Hih'kliiini ISi'skf, f)it7' rilH'kllKHIi. Wi7 Itiifkwlit'iil, f.'.t7 l',ii»!;l(:\vt'i;(l, .MIS iliiiiioiii', i'.lH llKiiliick, tiWi 4^,2 lilH Conip. Tinct. of, (i'.il ISiirnmnly fitch, " Hoot, (!(•;> lluriM. " Williiw, m> ItiitK.'iiitit, llhuiitlxjrry, TillK BhidiliT. ;M CiiiiOufjc, " Acute liiltitnitnatiun of, 2Ui " .Skiiiik, " <'1ii(iiiii; •• " 1!!)H t'aluniiiie t'eiute, HleediiiK I. :>m KiiiiievB, aiZ •■ I'lepured, " " N'lvc, " 4UI f'al.iniiiie I'lii-parula, " " Wounds, 878, 4il3 ialoiiit'd fkcu.'B Horn, IlJetiorrliiiKia, 311 < uk.iiliis, Hiiflecin^ I'luhler, (1117 (aitV hf.'t .Jully, Illuud ill Scrotum, 474 ( ah'o Hutlt, ItloddriKit, fi'.Hi Citlomol, JJIoolv Khix, Z)'J (':il.\, Uluo t ohOKli, fitmi " Chlorliiat*, '■ " Comp. Tinct. of. 01)1 Caiiiplior, •• |)iMca«c, ' 408 " Liniment, " KIUK. Oliol " Wiit.r, " I'ill, llody, ^itrl^clur^• of the, •' riieiui'Mtl I'nrMTtlesof, riiysieal 61M '• Uudi 5i> I Castor, iriij - Oil, l.''>4; Castoreiim, ITi/i: (.'atiilcjuiy, 57H| OatiipliiHiiiR, »;;t t uiuracl bath, C'aturrli, t'Htiinliul Opthalmia, t'ateuliu, " Tliict. ol. " t'oiiip. riiiet. of, " ('oiiip. Towder of, 2'.Wi Catnip. 44('| ('uuli>pliylluii) ilialii^troides, '■■ • Cuuiopliyliiii, < ayeiiiie I'epiier, Tiiict. of, )'i-aiiolliu)> AraericauuH, ( eluiidyiie, (JerateM, Cerebellum, Cerelinini. Centvisue I'cruientmn, Cefaiitiiiii ol Mt'iiueJ, Celiiccuin, C<-li',iiia Isluiidica, Cliuliii^f, Cliulk, ■• Mixture •' Coiiip Powder of, " Coiup. I'owder ul, with Dpuim, Cloimiiiuile, ' Clii;ii,'iial, Clieliiioiiiiiiii MajuH, (.'lieloiie (liiitoa, C'lii'iiiical Kood, lujurieo. (1(12 Oiei.opodiiHii Aulhciniinti- 815' , cum, 6W4 821-321' liOl (iOI tiUI 7i» W> 4(;7 6irj ijifi 435 mi 70 (i61 »>)(i m-, TAOt «0{ 4! 41 41 tKI7 (ill4 i<; 2t.;j (i60 titl7 (im. 004 (IU4 KM m> 484 604 lifrt) m) mi (174 tiUl OK)' ramphorated Soup Liniment, (172 Cliild-Hid I'ecer, 14; Caiialiiik liidiva. fiiict. of, IIH!i Cliildren,Cuie«ii({ " Vital Boiled t'loiir, lioilri, Uor.en, Anatomy of, " IUkcbrck of, " Death ol, ■' of [lead. '' " Trunk, " " lJp|K!r Kxlremtiiea, " " Lower •' " 1 ime re>K< " t'lniawrAl (irowth OS*, " ulce'atlou of, " Use', of, 'Soncnet, Itorax, )4' Caunda i'lati^iitn Kii " KleiiliBiie. m\ " HuukelEoQt, N<2 Cancer, 4:i3| " of Mouth, 18 Caiicnjni Oris, 4(i&|Cunii!Ia, 4U5! " Alba. 2()iC«nkcr lA'ltiuie, 21 : Canthaiis S I'lsieatoriiL, ZiV'aiitharidi'H, I'iiict. of, 24; CfiplllurieH. itjHpi'iouin Aniiuum, 447] " I'lHHter, C 4(i5 Caput ilbiitipuin, 405, Caraway, ■,<6!CarbuLi)(ni, (iOO ; Carbuncle, aia. Cardialida, 4.7 out ^m C'4 2H(! 2(1) a;i7 'J47 4t)8 3^7 il)liteiUici9of,3'JI 0():) •• Niii>iiiK Sick, KM <^J;Chlrnapliil>. Uinbellula, oil 4'!'i)i Ch!oriitoi-.u, 'ii"! Hii Chloioloiniuin, • i>"l 4(K) Chloriwis. am e.l3 Choloe ol Hfek-Koom, 6ol 6('' ■holcra, Vxiatic, 2Vi) f , " nfunlum, <>>1 064 " MorbuH, HX tm Ciunca, jtU) 37 " Chronic, li'i) 6<)5 Choroid Coal, 49 (17!) Cliyle, C-1 480 Cliyriie. (14 (Kk't ciliary rrocetwcH, 41) WK! Cirnieifuna Kaceinonn, PUS 434 CiniieifiiKin, 5I)D 270 Cinv'lioiia, 031' M.H I iiielionia, liTfJ (!t<() ( iiiiiainon, 61'* arD' '• Tinct. of, 089 891 ! '• Coinp. Wnot. of, OHO 401 rirculnflon, Organi'of, 3« 4(i6-4i(l (;irtocele. 47S 79 Citric Acid. Syrup of, 984 w. of, er of, ;t. of, nan 0nt 41 4) 41 (K»T (!l)4 M 2i:t Wi OUT ti04. 004 (114 liM 5114 IW 4H4 C04 (»«» (HJl f.ity fitir, r>s;l Ml m't Oiti 4» u (iri tiVl Gill r of, ;r of, with ftiminti- ti«i fVitl hi I.) Will 4»>-'j iWl (itil t,'4 211) •i;n ,'KJ •ill )laeiu?ci8of, ifJl ick, ina, I. 1 Iviot. of, I' of, of, :>i.2 (>U 'iin! (.11! HHP twl HVi) ^J4 iUO jCiO 1.1) 4U &t <>4 4^ WIS (Kf'.* euu 3« 4;s 084 INDEX. CitniB Limonum, Map. ( IciinitiRtlioTt^th, ( k-aiiliiiL'Mi, ('l»'«Vt'|-tl, Clergy men '« Sore Throat, riimiitf, C'loitii'H Culcliing Kire, Clotliiii);, " Color of, " Cotton, " Uiiir UH, " J.iii<'n, " i'oroiitt, •« .Silk, " Ti«lit, " Woollen, Kol, PACII 62-1 asii 100, fA5 mil 1!>1 '' 4iHl i«! ItXIl Hit; !W 100 no, 111 !l't •I ("lover, CloMV, rioviis, < h»ti'l>, ( IWCIIH ('HCti, ( oi't^iilii-^ I'almnlua, ( oCllilK'lll, ( oclik'urlu Armomcia (■(Ml l.ivi'rOII, lofli'i', Bwrley, ( " CrHiit, I " Milk, I " Coiiip. Tiuct. of, ! Cold, KiToets of. I " Foot Itutli, |i Cold!', ' Colic, •' Biliouii, II -' l'aiiitvr'8, •• Win.', (diiuii rici'iimm, I iiilli". I iiloi;.\ iidi, I i>liiili'>ii, I iilollll'O, ('dloll', I (ilC'loot, [jlollV Joot, Ciiriifruy, •' Corop. Wine of. Common (Siik Weed, I (iin|)loiiiu AH|,tenifoUn, Coiup. Kiactures, 44(J— 456 " lufudiuu of Catecliii, fiTO " " " (<<'iitiiiii, " " " (leraiiium " " " I'arHley, " " " .Senna, Comn. InfURion of I'ruiling .\rmituK, ConipreiKw, luuleotioiiK, Aiomalic, " ol (uteului, Comp , " of .Senna, fi)nffe.«tivi' Kever, (Aiiiiiiin Muciilulitin, I'oihOiiiiiK by, dini'erv,'!!, I oiiHtipHiion, CoUHtitutlon, " Idliwvvicmoy of, rnnMitiitional OidTercncei", CimiiUinptioii, A d'ciieriil DlccaHe, Uroiiclinil, ( u>)M'» of, 2ir>- (147 (iOT I4r> (in, (107 1 (i08 007 cao (107 84 r.79 679 f>86 (i;!2 (>!•! I 4;ifi 6.3SI 20.-) 41 '6 a-i 28.1 2S2 •JS.'. (KH (lOH lill'( (KiS (i« •m 073 (5r,7 PAOI Com, Indinn, 78 Cornea, 49 " Inflammation of, 486 Coriu'itis, 485 ('oriiN, 145 Coniii Cervina: L'Htum, 602 Coniii.s Kloridu, 013 " .Sirviceii, ()67! Coriowiie .Siililimute, 609 " roiBoningb/,4y7 Cov> jliiii^ i'oinioKa, (169 Co»ii» tiic^<, 28(J Cotton. (ilOl CoU|Mie .Soliel, l(i2{ Cow I'ox, IJUi, Coxiiluiii 466 ( iiiinp liHik, flIOl Cnini|iM. 171 { iani'>l)ill, (ilOj Cruniil Nerve*, 4.1 Crii«ley, tilO Creiiin of Tartar, (iCi t;reonote, till " Ointment, i>7ti Crcosoluni, tUll Crocu^ .S:itivi8, (MSl Croton. I'.lMtyria, (!04! " Oil, (111 " " Liniment, n7-.' " TlKliuin, c,li Cnitip. 401 Crow Con:, liiVi Cruiul I'hli'bitis, .'W7 Cril.«t CoH'ee. 679 ( I n^lni letter, 142 Culi-li.r, (ill Ciihi'hs, (ill ( II. ufiiljer, Willi, 002 ( iiciiiniH (OloeyntlilK 008 CtilverV lioot, till ( iipri SiibiiOi'liiH, (i09 ( ii|iri SulpliaM, 609 Ciipiinn, 609 Cjiiiiovirt, 408 CyiiiiiH'ilin. (iiki ( \ liiijii'iliiiin rubewceiiH, 620, (iii.1 Cvytiiie OepositH in Urine, .')lt Cvdlirrliuju, 2'J8 CjstitiB, 297 Didlocations of Hip Joint, M '• " Knee Pan UiKtnrbed .Sleep, \\.-i l>i//in('>s. Ul Doek. Vellow. tfii Uoj<»OII(l, t: Doniest ie >l ii iiuf^ement of tbt .Sick-liooin, ri6t DoM!*. IW! I>oiiclie Itiilli, .\n I'lijl, ';H Dover'K I'ovvder, " Inllammation <enlery, «»K Cbronic, •.S.fi I Dysnienorrlitca, ^t^i D}I<|M'|I~JU, U " Can?e8 of, '/".V. I'reatinent ^>f, !iT4 " Tnbrn'iilar, [''oMtiiKeii Wo'indit, |< ontusioiiK, ICunvolvuiiiK Kcaniiiionia, ICookery fur Sick lf«M»iii, |f opiiitera Ofllcinuli'i, |lOji]M'r, " Siibacetnte of, " .Sniphate of. ICoraltorhiz* <>loutorhiz*, (170 (170 070 ti70 671 549 (Vi8 008 412 641 499 (i08 28(i I -JO 121 217 ai'.i 'J'.'O 217 -218 212 411 v;\ I'M r,7s r.or, I10!> (iO!t (109 610 UHiioini;, 92 Duiideiron, ei'J Datura .Stramonium, 660 Deadly NiKltt^liadv, 612 1 UeMfneiw, 4!>0 Dealli of UoneH, 4(i6 Decoction of Bran, .178 Dieoctions, 008 UeformitieH of iSpilM, 478 DeliHler'n Cerate, O07 Delivery. .Wl Deliriuin Tremena, 1.1.1 Dementia, 176 )>ens Leoniii, (>I2 DerbvHhii'H Neok, 47.'J DialH>fi'M, 301 Dlarrbu-a, 289-4(W " Chronic, 2Ht Dictionary, 717 Diet, 228, 604 " in Di^ense and ConvaleH- eenee, .Kil Diincnlt ieetlkCuttinx, 401 l)ii(e.-hyKemH, KneepbalitiH. F.iieeplialoid Tumor, I'jieyMed, " F-iidoeanlilin, Kninigi d Veini*, F.noiM mux Atrupiir.iuivt Klllelilix, F.neiircsis. I''.pi).'ii'a BepeiiH I'ltinlodix, " I' ilammatinu Kpile|ii>v, F.iiile|)tle Fits, KpihtuXiM, Frfot. Ki iKeron ( anadenae, KriiptionK, .Scaly, Kr> xi|M>lai<, F.rytbeiini, Fr'ttbennitic .Stomatitis, h^wneeH, Fwenoe of B««f, (>-■ Urinary Uepo«ttaW. itTS ! I , M ■■■ — -^ -— ,'«^ y «" M i >l ,.yr «» .>^ j.^ ~:rjss^iC.-f..:r'''TT ■siftV m r j^^^*^- /■ . V •ZU^&,^,:-J«. - f-u. riflt ■ 1 tluliu, 601 Flaxseed, 614 Gclsemlnin, 6;4 " I'lirpureun^ 646 682 Uengivltis. m Vu^ .'inrbiu Ipc'Oac, bm Fluid Alinieutg, 668 General Disease*. " System, Discaies of; 571 J :i'iirpiiriii, KuKmcliiuii Tube, Mi " Extract*, 669 4o9 61 " Nutritive, 686 Gentian. tJ15 l{X'.:oriHtiuii, 402 FIiiorAlbiM, 86S,800 " Conip. Tlnot. ot, i;>)l *\ rciw;, 8S Folded V/et Sheet, 681 Gentianu l.utea. «I5 " Activo and PHSslve, 8&-93 Folllcloa, 40 Geranium .Maculatum, ')|i| " KxccKsivti, 80 Follicular Inflammation of Gill-over-the-grouud, «I7 '• Iii-iloor. 03 Mouth, 800 Uinger. Gir> " Mciitul CoUperatlon In. ill FomentotionM, 069, •• Wild. WJ " Out-door, W— 'i2f) Food. (>1 " Syrup u^ m *' l'luu.«uriible., , 80—94 '• Albnminon^, 74 Ginseng. m " KvkuIhi', 89 " Amount of. 80 Glands. 40 " for SludenlH, 90 " Animal and Vegetable, 81 I4ichrymal, »< " WIhmi to take, 80-05 " Articliaof. 76 " Oil. 4a •' for Youuj{ Women, 01 " Azotized and Non-azo* " I'arotid. 31 • halaiiU, 40 tlzod. 67 " .Submaxillary, 31 ! . Off osiH, 4- " Fatty, 76 Ghwwiry. Glottis, Spasm ot. Glycerin. 721 tawu, c:4 " Heat-^'eneratlng. 68 4112 Kyi'brows, «» '• Mature and DeKiination f.lii Kyrf;anic, 66 Golden Seal, r,|.; " and Kar Hatli, fi40 " Ktaruli and Snijur a». 76 •' " Comp. I'owder ot, nf^'i " Koi I'ijrii Itodleg in, 480 " Tables of Viilui- of. ' 70 " " Tinct. of. 'Ill " (ililic ol. 48 " in YoiitliHiid Manhood , 78 " " " Wiueol. li-..l " lliiuiorH of. 49 Foot Hiilli. Coid. ^Sn:(;olden Tincture. ■: 1 •' Warm. 640l (ioiiorrhoea, 4o.')i (Ku'Hyplum llerbaeeum, *'! Kaba Saocti Ii,'DatU, (BO " Fracfiiiesof. Bin KalntiuK. 181 Fore Arm, Fra>,!"re« ot, 4r>0 (iout. 417 FnlliiiK uf llowel. 4()r> Foreign Itodien in Kye, 480| Uranulation, 17)3 (Irasa, iStar. Ui " Womb, 3'i8 Fouler'H Solution. rr,-' ■ " over of Womb, 8G8 Foxglove, 614 travel" am; KoIhc drape. 6(« Fnicturc-B. 87R,87" -442 •' Root. iVI'i " Joints, 447 1 *• ComjMHiud, l.'tf " of Hones of Foot, 4f.A " Urio Acid, m '• iloanlos. 4 (in-en Sieknecs, ^ it " !San>aiinrilIa, (Va " " " " Nose, 417 tirimthn M)rih Mlxtxit^ " Unicorn, 618 '• " Brtant Hone, 462: Ground Ivy, i.i; Fat. 1(1 " " Collar Hone or i " Hice Milk, w Fatly Tumor, 471 : C'luvlcl«, 448 Grubs or Worun), u» FavuK. 151 •• .'<■ F.lbow 4W Gruel. Arrow Uoot. r-i Kul boTinurii, COtli " " Fore Arm, 4W " KIce, m JVIon, 407 ■■ '• " Uund and Flii- , " SaK<), VI Female Dlgenaes, mt 1 vera. 461 i " Water, ^«i Feri>. «r>7 " " Ilauncli Boue« (Mialac, Animouiatftd Tiuct. F«rM Ammonio Citraa, 6'.';t or IVIvia, 4.V2 of. njii " t'ltriis. 613 " » Kuecl'au, 4.^4 GuaiH,uum. « " Thigh none. 4.')2 Gnnsbot Wounds. 44. " rroto\uiuin, 824 •' " UppcrArmBono.440 Ciyninaatios, i,. " l'Hlv;g, 624 " " WrlBl, 451 " et (^uiiiic Citrma, 623 Freezing Mixtures, French Decimal Weights. 606 Ha'maptasla, 'ii" " 8iibriirbon»8, 624 680 lln'inattM-ele, 4') •-■<^ SMildlMS, (i26 •• Mlllc I'orrldge, ' 682 iiaiiiatoxylon Campechla- ■> SvripuB lodldl, •' Tiuc ura Chlorldi, 025 Froat Bite, 436; iium, ('■-' 626 Froat^veud, 614iHicniaturla, Fernini, 62'i l''umIf{Htion of infected places 604' Ilalr. Disorders of, u KurunouluB, 483 F'uiiirus Hematoidea, 470'liair< aiiMoM, i\n FeviT, 4()1» 1 Hairitatli. :,:v '* and Ak le, 413 KiallMinum Plaater, Comp., 670 ilammainelis Virglnlca. ■■-> " milou- 1 mittent, 411 Ualinm Apariue, 4 12, GsU Bladder, 007 Hand. DUIotution of Uouun " (■ongP''tb , 88' Of. ■I'i' " Iiitfrmitlei •, 413! " Moi>«a, 268 " Fractures of; 1 1 " UlDj!, i'40 Galla. 6T5 Hardlia.'k. '1- " I'eniicious Ini rniiil<'i,t,H8! " romp, Ointment of. 676 llardlcaft.ol.'erRod. i;i- " HefreeldnK Urintioii 41(rGWl^-#e of Ucuiiit 615 iiauiicli Itoiies, Tracturcs of I': " Tyijbold, " ^' LunK, 4fH) Hazel, Witch. I't'.^ 242 (iarHt, •M'.! Heariacliesi, \^' Feverfew, «I8 (iarlkJ, •llo Head. AtfretionH of. ;j ' Fibrlnc, 5 " Syrtip of, (iastrlo FeviT of liifl(D«y ';<'4 •• IJatli, "l Fliiworf, FiriiiR IVeth. 6l4 HW " Water 111. li'i 602 " Juk*, rgaii>' o>> KlnirerH, FmctnrM of. 4ni (iaotrltiK. •Mi llvarl. ;) I ' t'lotbes ( aMiing, 4«fl ".aKtl-odvuia. 0-. ' ! ■ . ..^ ' ..y,. ■.-.-•">» J >(*. fiout«t» • ■ >/#. ,;/',<,».. ,-f- .("■'•is.nw.J'^' - -ffi^^'.. --.. -jss;^;:.,..^ ..::^ .'^■. FAflt m mpervlreiw, M it f"^ ■ bincaaea of, ^lO Tlnot. ot, tai J Olo ulslum, ';|'i ruuud, '; i ot, jinal, id, axillary, I. t». noC ilabra, Oomp. I'ovrder ot, <^. >• Wiue o^ <>;'< ture. ^,{ lerbaceuBi, B'^.' Aeld, ) ri h MlxtMr», .' MilV, w Uoot, ,monJ«t»d Unct. >ij{n Bodle* In, (ii'R. irumatlon of| 'ouiid«. 514 firt! <',K 4:1: >r. 44'. le lim Campaclilft- rdem of, JlldVirftlnlcf. locution of llont* 4'H l.'ii| cttires ofi '.ol.'ep Bod. oiR'n. i'lftctur*" "'• 'I Itch. s, fe«:ttonii of. ^^ . ■ter 111. Orxau'O'i INDEX. 8y;"» FAnil Heart, Atrophy of, 2W " Hone mill v'BrtilnRO in. 2.VJ ■' Uilatuliiiu o.'' Vciitrick'H of, aw " DI-'pliici'mciitH of. " Ni'iiniljsia of, 'Jint " l'14 llcliantliii'< Annuus, <■." llcll,l)(ir.', Wliite, iv;i llflonias, (lis Dioioa, lilH llrmicrHnia. 172 lli'niiplili-);ia. Iii2 llcinlocU, Comp. Tlncl. of, tWl (iiiin, lilT llomorrhoidH, 287 li.Mi) ' UIH llri 645 III'). ' ' .lerioaua, fUH lliTiiiii. 47t! iict|if», i:e) Hicronifli, ISil llisili ('ranbi-rrv, «Ut 41' Hi CompTinctof.nttl loint, DiHcuHc of, 4i'i». •' " dislocation of, 4'il lli|ipiiric Acid in lJrin<% .Il'l lli«|MnK (Jough, 40.*^ Itoin, 6I» Hordeolum, 4H1 llorelioci il. 419 Water, •« lli)i'H)>mint, fiO lioriMTadich, W) ■ Ion. Itath, A9t Mot rtrnpn, WJ lions. .~-k, ti20 ll'iiiMrt TfUor. r^ IlnmiiliiH l.iipulu!<, niO lliixliiinrK I'incture, • llvdHtliln rtrrine, '.' llyilntiiKKU. 1)2*1 AliorpKCenc. (520 llyd'WKyri Cliloridum Mite, 602 i'ilhilir. (VK) Hvdriwtin, Comu I'owdi r of, flS2 HvdraMtiH (^BnaiirnidR, filt; llvH'^iodatu I'otaioa. l<<>)«»'hv, 61 Hyilroy«thic Treatment. 1)281 t(\dr<>p<>ricardiuin, 269 llvdrcv.hobia, 1(V) llydr'K-.t'ptialun, Acute, 157 " ChroDio, l5Hi llydrotlinras, 287 1 llyaii'iM'. -" KyoACyamtw Tfixer, ''' " PoTdoning by, 4'r. Ilviior'ropliy »r Jjunitii, 2361 Hyp<«hoiMb«» 1781 IIy(>ophu<», U'('lan!ia, Ictenis. Idiocy, li;niiliii /iinara, llcnni, y lnii>'. Ms.'o. Inciwil H'oundt, inciiliiiK, ludiuii t'orn, '• Hemp, " '• Tinct of, " Turnip, Indi|2eKtioii. Indigo, Wild, lnfane\ of lteln|{. Intanli. linHtric Fever of, '■ .Milk lor. " Snminer Cotnplaliitx of, Iiitlaiii'niitlon, Inlhiiiimiilory ItluKh, Inilnen/a, li\t'usiiin of Malt, liifnsions, WKi, InhalaiitN, Ob.lectH of, IiilnilHtion. .\tiniisiiheriv. Iiiliiiler, .Mi'dieiitcMl Vapor, llilialiii;.' I'owder, InjectionH, .>l"i, " t'hemical, " Mi'chanlcal, In!drated <»xld«" of, " f/f'.de of. " l.,tir';iti. of " F.r I'l t J'ou lit f i»r, rrecipilatud Ci of, rroloxido of 8'>luiioni of frotoxid* •.f. ilphate of. .;,, rup of Iodide of. Hyfup of Iodide of, and lUogoiiece, flS4 t;2i >ai ■■m am 821 d21 G2n 2H7 17(t 6M 82 142 4:is 182 78 1121 G8il lai 271 (i(i2 r,2 40<> r,wi 41 ^ 425 liW 20') .'■.7'.> •170 221 22.1 227 '*2.1 r^'i (171 4.3> 437 17.1 177 17.-> 2(>2 2J.2 67 41.3 »2 5 tU.3 (r.'2 tt22 622 fi22 (18.3 685 673 62(1 tKKt 4!) 48.'i BOO 681 485 623 623 (12.3 (rii Rt! •ELI '•m4 628 62.3 623 624 624 It* 8»l Iron, Tartruteof, ami I'otaNia " Tinetiire of Muriate of, " Valerianate of, iKchiiria K"iiuli.'<, IbinKla.-H, " .lellv, llc'.i, " Ilnrlier!"'. " .lackMoirx, Itchin;f. I " of Ivxtemal Tarts, Ivy, American, " HiK. " ( I round, " I'oisonitiK bv, I .Tackxon's Itch, Jalap, I " Comp I'owder of, .lamestown Weed, •lani|.>i.i .Mi.niliot, •laiimllee. Jaw, Fractures of Lower, " nislocation of " •lejiiiiiim. J.OIv, Culfs Feet,' " Irish Moss, " lKinf!liL«», " Tapioca, Jerusalem Oak, .lessamine. Yellow, i.lointH, ! " l)isea!>uH of, I " False, iJiielandin, Inplans (iiierca, liini|ier. Iiiiiilieris Conimunln, iluniperus Sa'iiiia, TAnn . 62/i 112(1 .•!'>.3 (iu; rm l:«» Ui> 149 lid .370 .'/.•;! (1.33 (il7 490 14« (120 (!«3 (>56 6.->9 267 448 463 32 683 681 f)81 6«1 664 604 46r> 447 2 602 (12(1 649 Kalniia .Xnuuxtifolia, (133 l.atifolia, KVi Kidneys, .34 " Acute Inflammation of, ^.n " Chronic Intlarama- tion of, 296 " nieediiiK from, .302 " Uriglit's Diseast of, Zr.) Kin);'). F.vil, 419 Kinu, t!26 " Comp. Powder of, r.8.3 Kneu Joint, Dislocatian ot. i'''8 •' Pan, " ■' 4<>.. " ■' Fractures of, 454 Krameria Triandra, 647 Ubor, 381 r.abyrinth, 51 I.aciTatiil Wounds, 441 Laehryn al Canals, 60 " (ilands, &• " Sac, Inflammation of, 482 r.acteal<« .32 Lactuea .Saliva, 627 I.adie« Slippi'r, Kii\, (I'm Lappa Minor, fUfi l.aryiiKeal .Shower .Syringe. 1% LarygismiiK StridulUH, 402 LarviiKiiis, Follicular, I'.i'i Larynx. 40 Inflammation of, 19:^ liaudaniim. 689 " Poisoning by, 49lt T4tur<'l, Narrow l.ea^ (J.3.3 •' Sheep, d."*? f.aiirus .SassafrBR. ('.19 Mveiider, Come Tinct of, 692 l-ead, tr-T " Aeetate of, '•27 " >Mnlmcnt, Comp., i>78 " falsv, 164 ' PI|)C8. 87 ' I'laatcr, RW " " Comp., «7» .^5 israt:tsctliif ■>^fm I i i.'iv INDEX. r rAoi iMidff^. e^oiiaenrative! 11 £|J| Wtlh, M6 " f CActurca of, 4fi6 ' Svrup, ti85 'f« Watur, 679 {jtfttl'ttiarie, 680 .i^'tiirivo Klcctuarv, 608 l^iruiiuriis Cardiaca, 682 lAHtt'urJ'H Itnuc, CM U:\'n, 143 > i«9Mra>y, 14^ ^|,nnin.)lraVirginioa, 611 Jettiio', 627 ' t,i!Ui' trrliaia, 863 , U'b.iauty, 10 l.«tri|Mi, 144 Ltfc, 62 ♦• Itoot, 627 ' Ul;), White Pond, 601 I.fitet, 62H ' iljilorido of, e-iS '• 'iVali-r, 628 ■ I. nVunits, 6;l Masturbation, Matei-ia Mediea, Matico, Hattory Piinplea, Headow Caboafi*, '■ Saffron, UeaHlea, " Falae, MeaHuniH, . '* Doine«tio, MeatK, McntuR Aiulitorus, " Inflammation of, Mvoliaiiical Injuries, MuUioated Waters, Wines, Medicine, I'ro);rei*s of, " Cliest, Articles for, Sleillclnes, MuduMa Oblongata, Melunclioly, Mi^lnnaoJH, Melifumcinall^ MuniKp4>rmum Canadeusc, LiUJItsu tit of Ammonia, Corop. 671 Monorrlmula, '♦•' l'iiiu|ilior, 671 JlenBos, Absence of, Caro|)liorat«d Soap, 672 { " Cessation of. Comi). Camphor, ' 671 ' '» <'rofont>il, 67? ,■■''* ofOpium. 672 MlAHi ^liitutlH^imllm, 614 i.icinM«nibcr 8tyruciflua, 668 U^Mur AmmouiO!, '' " Acutatlo, ,■ lorioe, t. ' iaIi idron Tuliplfbra, tlenstrualion, " I'ninfui, " I'roiuse, Mentha IMperlta, " Viridfs, 66!) 83 '3ute Intiammation of, 2(>t " Clironio H ,t Sulphur, t»ff*i> Inflata, Tiuct. of, Comp. Tinot. of. and Capsicum, Comp. Tinot. on Vinegar pt; ^,ti'.»t I'alsy, l.*5«t«i| Jaw, '.(Vfoi-d, i.(^M(«n>-M of Bowela, jUiintttiTlMexua, ^Jbfti^ t'«>ver, *%"«•• »• Urpertrophy of, ^ Hwelling of; I.ftpiAia,, Itonna, LyMJMx Virginicus, Lyt% ruisonfiig b/, ty«M'»{lc«, liaaai)", Cnrbmate of, ' Sulphate of, " Uiita, Itntm'lx Carbonas, » Sulphas, WaJa '■'•■ni, ktif mint Pustule, ■*ait, ]*ri^ii>ion of, -MiJ8 654 40' 8T 675 &->8 377 74 585 r)80 387 681 278 584 657 178 5!H 380 604 i-87 257 674 640 Muaeles. Shape of. Mustard, " Volatile Oil Of Myriea Cerifera, Myrlcin, Myristica Mosohatu, i Myrospernuui Toluiferft" Myrrh, i •' Comp. Tine* of, i Naptha, 'i Mupthaline. Nait Sweet Spirit i', aSI NitrJo Acid, PoiK 'ng by, " Kther, 8pir jf, V.oxo Bath, •' Bleeding fron.. • " Foreign SubsltfMiyi la, " Fractures of. Nurse, " Activity of, " Age of, " Education of, " Habits of, " Health of. " Strength ot, " Tem|ier. etc., of, Nursing Sore Mout i, Nutmeg, Nutrition Table, Nutritive Fluid, Nux Vomica, «»9 Oak, White, *»i Oil ('iland*, Dixordeioa, 686! " ofCajeput. 146' " of Turpentine, 632 OttttmentP, 1)33 Oka Kunii;*, 541 Olfiim ( iijiipati, • aun - MtirrhuK, " tHivis, Mft " Kkiiii, «» " 1 «rebintbin V. Xk " TiglH, 6S Olive CHI, iST Omentum, 9SS Onanism, 4t* One l'H:aMe». 485<>iiiOi'. 27 1 Ophthaliu.* CatitrvtviiK 89 " Kg^\f<"*»k, m\ *u slrjstttxras: M *1 ■aln nitA. $ ^ *f. lud, W t ^^™