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I ^\/ ] F MEDICINE NATIONAL LIBRARY OF MEDICINE N A T I 0 N A I L I B R A R 1 , TVNOUVN 3NI 3. C- 3 W JO A . V I. 9 IT TVNOUVN 3 N I 3 I 0 3 W J O A I V . I . T T V N O U V N 3NI3IQ ^3^ i^%>!<^#¥ 1^4 f\/ $ x/^ 3F MEDICINE NATIONAL LIBRARY OF MEDICINE N A T I O N A I I I B R A R Y O F M E D I C I N E NAIIO. i / v-->£ T TVNOUVN 1NI3IQ3W JO AHV.IIT TVNOUVN 3 N I 3 I Q 3 W J O A » V I 9 IT T V N O U V N 3NI3IQ r J&& - M^k\ > t V iV»^r^ - iwr^k X S / J CdOfv AMERICAN MODERN PRACTXEC; $ j , /'''is*? OR, A SIMPLE METHOD OF /' i,- V *~ THE LATEST IMPROVEMENTS AND DISCOVERIES* COMPRISING A PRACTICAL SYSTEM ADAPTED TO THE USE OF MEDICAL PRACTITIONERS OP THE UNITED STATES. TO WHICH IS ADDED, AN APPENDIX, CONTAINING AN ACCOUNT OF MANY DOMESTIC REMEDIES RECENTLY INTRODUCED INTO PRACTICE, AND SOME APPROVED FORMULA, APPLICABLE TO THE DISEASES OF OUR CLIMATE. A new Edition, improved. BY JAMES THACHER, M.D. A.A.S. \uthor of the American New Dispensatory, and Observations on Hydrophobia. " The young disease, which must subdue at tcB^tu^Zi}**\ Grows with our growth, and strengthens ^tfflrour strengfli^^JPopr?. BOSTON: \• " - t-> 4 PUBLISHED BY COTTONS & BARN'ARV- / John Cotton, printer. 1S26, .»9:, -~ District of 3Iassachusetts, to wit: DISTRICT CLERK'S OFFICE. BE IT REMEMBERED, that on the sixteenth day of September, A. D. 1826, and in the fifty-first year of the Independence of the United States of America, COTTONS & BARNARD, of the said District, have deposited in this office the title of a book, the right whereof they claim as proprietors, in the words following, to wit:— " American Modern Practice; or, a simple method of Prevention and Cure of Diseases, according to the latest improvements and discoveries, comprising a prac- tical system adapted to the use of medical practitioners of the United States. To which is added, an Appendix, containing an account of many domestic remedies re- cently introduced into practice, and some approved formula; applicable to the dis- eases of our climate. A new Edition, improved. By James Thacher, M.D. A.A.S. Author of The American New Dispensatory, and Observations on Hydrophobia. ' The young disease, which must subdue at length, Grows with our growth, and strengthens with our strength.'—Pope." In conformity to the Act of the Congress of the United States, entitled, " An Act for the Encouragement of Learning, by securing the Copies of Maps, Charts and Books, to the Authors and Proprietors of such Copies, during the times therein men- tioned :" and also to an Act, entitled, " An Act supplementary to an Act, entitled, An Act for the Encouragement of Learning, by securing the Copies of Maps, Charts and Books, to the Authors and Proprietors of such Copies during the times therein mentioned ; and extending the benefits thereof to the Arts of Designing, En- graving and Etching Historical, and other Prints." JOHN W. DAVIS, Clerk of the District of Massachusetts TO DAVID HOSACK, M.D. F.R.S. L. and E. Professor of the Theory and Practice of Physic and Clinical Medicine, in tho University of the State of New-York. DEAR SIR, It is by your eminent standing in medical literature and general science, and your ardent efforts, so auspicious to the dignity and prosperity of our profession, and the medical character of our coun- try, that I am induced to prefix your name to this work ; and I avail myself of this occasion to express my sense of obligation for the numerous testimonials of your friendship and regard, which, without a personal acquaintance, have been so liberally rendered by you ; for which I beg leave to proffer my grateful considera- tions, and to subscribe myself, with great respect, Your very humble servant, THE AUTHOR. Plymouth ; May 10, 1826. \ PREFACE. IT is confessedly a matter of regret, that a country, in which literature and science have been so honora- bly and successfully cultivated, should so long remain destitute of a systematic work on practical medicine. It may, however, be admitted in extenuation, that those most distinguished in the walks of science ; and who, by talent and experience, may be supposed best qualified for the important undertaking, are constantly subjected to urgent demands of professional duties, controlling the disposition of their time and inclinations. The position will undoubtedly be conceded, that the diseases peculiar to a country, are most judiciously treated by native physicians, who are particularly con- versant with their true characteristics. However am- ple the attainments of the practising physician, or prompt his sagacity in recogriizing diseases and their curative indications, every one must be aware of the aid to be derived from a practical system, when the energies of his mind are oppressed by a multiplicity of professional applications. To what source can such resort, with more confidence, than to the productions of those who have long laboured in the same field; whose whole lives have been devoted to similar pur- suits : who have successfully encountered the same em- barrassments, and sustained an equal weight of res- ponsibility ? VI PREFACE. Such has been the rapid progress of medical science, and such the essential improvements, effected by the zeal and talents of the professors and medical practi- tioners of the United States, within the last thirty years, that many periodical publications have been is- sued to record and promulgate important discoveries. These augment our materials for constituting a practi- cal work, embracing, in a methodical view and con- densed form, the principles of modern practice, every way adapted to the use of American physicians, and calculated for the meridian of the present day. Such is the object which the author has for years had in contemplation; and the fruits of persevering labour and research have now resulted in a compendium of the most modern and approved modes of treating the diseases of our country, and of the most judicious ap- plication of the medicinal productions of our own soil. The high responsibility which devolves on an author who undertakes to dispense instruction and rules of practice pertaining to health and life, cannot fail of prompting his solicitude to a conscientious discharge of duty : nor will his sense of the high obligations of hon- our and moral rectitude, permit aught to pass from his pen without the strongest conviction of its correctness and utility. Throughout the whole course of this com- pilation, the most substantial authorities have been con- sulted, such as no one, it is presumed, will be disposed to impeach, and under whose influence, even the wise and learned of the medical faculty will not disdain to prescribe. Dr. Thomas' Modern Practice has unques- tionably acquired in this country its merited popularity and repute; but in this compilation there is an evident redundancy on the one hand, and a deficiency on the other, as respects American practice. Should it there- fore be found that the present volume contains his ap- propriate practical precepts incorporated with our own improvements, it may with just propriety be re- commended as a substitute for that English produc- PREFACE. Vll tion. Disclaiming all pretensions to theoretical expla- nations, and rejecting hypothetical disquisition as falla- cious, I have directed my views simply to rules of practice. In preparing the present edition, I have con- sulted the most approved European authors, especially the very elaborate and erudite production of Dr. J. M. Good, and the valuable works of Drs. Parr, Armstrong, Abernethy, &c. But as respects the epidemic dis- eases with which our own country has recently been visited, precedence has been given to American au- thorities, as the surest guide to American practition- ers ; and those formidable epidemics which have just- ly excited the public interest and alarm, are portrayed in their true characters, with their medical treatment, according to the views of the most judicious and expe- rienced physicians. It is not without mature deliberation, that I have adopted the nosological arrangement of Professor Ho- sack in preference to others, as its pathological ar- rangement is well adapted to practical purposes, and it coincides with my views in making this work more completely American. The nosology of the learned Dr. John Mason Good so greatly abounds in new technical language, that many students, it is under- stood, have actually recoiled from the labour required to comprehend it as a practical system. In treating of the various subjects, I have been solicitous to adopt a concise and perspicuous style of language, divested as much as possible of technical terms, where others equally clear and expressive can be applied. However obnoxious this mode may be to the censure of the classical and scientific, it will not, it is presumed, appear objectionable to a majority of my readers, especially those who reflect, that what- ever relates to the health and life of man, cannot be exhibited in too plain a garb, or explained in too clear a lio-ht. Thus every class of readers may obtain a knowledge of those causes which produce, and those Vlll PREFACE* remedies which mitigate and relieve, the various dis- eases to which they are liable. The author cannot but indulge the hope that this work will be found calculated to assist those practition- ers whose retired residence may preclude them from the most ample sources of information, as well as the junior class who are about commencing their profes- sional career, as the pledge and hope of the rising gen- eration. To inculcate the high importance of a com- plete medical education, agreeably to the established rules of our universities and medical institutions, and to discountenance the attempt of the illiterate, who would thrust themselves into medical practice, are among the primary objects of this production. In the Appendix will be found a collection of formulas for the conve- nience of the young practitioner. In collating scattered materials from preceding wri- ters and loose notes, it was scarcely practicable, in eve- ry instance, to designate with the usual marks of quo- tation, and it is hoped that no censure will be incur/ed by the omission. If by indefatigable industry and laoo- rious research, the author has merited any share of praise or patronage, it only remains to solicit indul- gence in regard to imperfections and errors. INTRODUCTORY. HISTORICAL SKETCH OF MEDICAL SCIENCE, AND THE SOURCES AND MEANS OF MEDICAL INSTRUCTION IN THE UNITED STATES. AMONG the various sciences and literary pursuits of life, there is no one more pre-eminently important than that which is emphatically styled the healing art; that which brings health and joy to mankind. It is an inestimable blessing, bestowed in mercy, to counterpoise the frail condition of our nature, and to meliorate or remedy the miseries which result from the indulgence of our vicious propensities. It assuages the anguish of corporeal disease, and soothes that keen mental distress, which overwhelms the facul- ties of the soul. " Two thousand years ago, no fewer than three hundred dangerous diseases, besides their various species and degrees, were discovered by physicians ; and even now, new dis- eases are every day making their appearance." It would be a pleasant and useful speculation, to trace our art from its crude and embryo state, to its present condition of im- provement and maturity; but a cursory retrospect only will com- port with our present plan. When we contemplate the condition of the inhabitants of the earth in the primitive ages of the world, we are struck with the formidable embarrassments which they were doomed to encounter. Unacquainted with the means of fortifying themselves against the numerous evils of life, they were continually exposed to casual- ties and disease, and at the same time destitute of such assistance as would afford the desired relief. Ignorant of the structure of the human frame, and of the laws of the animal economy, no rational method of cure could be devised, and their medical knowledge 1 % HISTORICAL SKETCH OF eould consist only of an incongruous mixture of superstition and absurdities. The primitive inhabitants, however, were blessed with firm original stamina, robust and vigorous constitutions, and were pro- vided with plain and simple food for their subsistence; either the spontaneous productions of the soil, or the easy acquisitions ol agriculture. The climates, which they enjoyed, were probably of a mild and genial temperature, the air pure and serene, and the natural means of health and comfort, their peculiar patrimony. While, therefore, they observed the rules of sobriety and temper- ance in their living, according to the dictates of Aature and right reason, and adhered to the principles of morality and virtue, their diseases could be neither so numerous, nor so complicate and difficult, as to require profound skill for their removal. It is, nevertheless, presumable, that this happy condition of the human race was not of long continuance; but that a corruption of manners was gradually introduced, and the seeds of diseases sown either by irregularity or unavoidable incidents, and fostered by the baneful influence of effeminate and luxurious gratification. If, while in the salutary pursuits of pastoral life, men generally en- joyed an uninterrupted state of health; by a departure from the virtuous habits of such a life, and by yielding to temptations, and the corrupt propensities of nature, their constitutions became impaired, and the first principles of disease were engendered and nourished. In consequence of these powerful causes, and the influence of others of a physical nature, operating in conjunction, the system of individuals acquired a disposition to diseases, which could not fail of being disseminated among the people, and entailed, through their offspring, to succeeding generations. Although accustomed to the event of death by fatal accidents, or old age, the novel and affecting scenes exhibited, when diseases terminated in the ex- tinction of life, must have excited, among the early inhabitants of the earth, an uncommon degree of consternation and alarm; and being altogether ignorant of the true causes, which generated them, they would probably ascribe such extraordinary phenomena to some supernatural power. Prompted by a spark of that reason implanted in the breast of man for his preservation, as the first principle in nature, they endeavored to obtain from the most probable sources a remedy for their diseases; nor are we to be 5IEDICAL SCIENCE, &C s 'urprised that the human mind, influenced by superstition, and untaught by experience, should associate the idea of religion with medicine, and resort to charms and incantations, in full confidence of accomplishing their desired purpose of preventing and curing every malady. Such, in fact, was the melancholy predicament of our species during the early part of their history. Ignorant priests, magicians and astrologers were their only physicians, and the superstition of the times animated their hopes, while it gave a sanction to the grossest impositions. If, under infatuation and despair, consola- lation could have been derived from these sources of folly, fatal experience must soon have taught the sufferers that a cure of their maladies was to be effected by more potent remedies than those of sorcery and enchantment. In process of time, therefore,, an ex- pedient suited to their circumstances was put in practice for the attainment of medical knowledge. The sick were directed to be exposed in public places to the view of travellers and strangers, who were required to examine and compare their cases with such as might antecedently have fallen under their observation, and to recommend such remedies as had been known to produce ben- eficial effects in similar complaints. And when discoveries were thus made, the precious remedies were held in veneration, and the knowledge of them was conveyed by oral tradition, or recorded upon pillars in the most public places, or on the walls of the temples dedicated to the God of health: and afterwards registers of cures were kept in those consecrated places for the general good of mankind. Thus was the practice of physic commenced under no other advantages, than the simple principle of analogy ; and many ages elapsed before this abstruse and important science was placed upon a more solid foundation. The Egyptian medicine appears to have been little else than a collection of absurd superstitions. Among the Greeks, ./Esculapius was the most celebrated of those to whom they attributed the invention of physic. He was accounted the most eminent practitioner of his time, and his name continued to be revered after his death. He was even ranked among the Gods, and the principal knowledge of the medical art remained with his family till the days of Hippocrates, who reckoned himself the seventeenth in a lineal descent from jEsculapius. We are not furnished with a correct series of information relative to medical 4 HISTORICAL SKETCH OF history, until about four hundred and fifty years prior to the Chris- tian era, when, amidst a cloud of darkness and ignorance, the su- perior wisdom and brilliant talents of the great Hippocrates were displayed to the world. Under the auspices of this Prince of Physicians, the healing art first assumed the form of science, and was known and practised as a regular profession. In the treatment of diseases, he studied and copied nature, with the greatest care and assiduity, as the only sure basis of medical science; and so extensive was his knowledge, and so accurate his observations, that he has been constantly held in veneration through succeeding generations. His numerous writings on medical subjects remain a monument of his penetration and judgment, and are considered, by the learned, as replete with lessons of instruction, even at the present day. By his unparalleled industry and perseverance, this father of medicine acquired a character and fame, which united the applause of nations around him, and divine honors were con- secrated to his memory. A medical school was instituted at Alexandria in Egypt, which was conducted by the most learned professors of that early period. Dissections and the study of anatomy and surgery were practised and patronized, and the institution, which flourished near a thou- sand years, has been renowned in history as the earliest and most important seat of medical literature and science. It was here that Herophilus and Erasistratus were distinguished for the vast num- ber of human subjects, which they dissected, and for their impor- tant contributions to anatomical knowledge. But they were ac- cused of procuring access to the springs of life by the reproachful practice of employing the knife upon the living bodies of criminals. Galen, a man of signal talents and a disciple of the Alexandri- an school, whose life was devoted to the study and pursuit of medical science, was another celebrated name among the physi- cians of antiquity. He collected and arranged the rich treasures of medical knowledge, which the labours of preceding ages had acquired, and made considerable improvement on the original stock. He is said to have been the author of five hundred vol- umes on medical subjects, and, with the exception of Hippocrates was esteemed the greatest physician of antiquity. So surprising were some of the cures which he performed, that his skill was as- cribed to magic. Although he introduced a false and chimerical theory, and indulged in the most extravagant disputations respect? MEDICAL SCIENCE, &C 5 jng medical subjects, so high was the authority of his name, that, for about fourteen centuries, his systems and doctrines were most sacredly adhered to and reverenced by all descriptions of men. In the early part of the 16th century, the noted Paracelsus flourished, as a physician and chemist. He laid the foundation of a chemical system, directly opposed to that of Galen, which he resolved to subvert. The principal remedies which he employed, were mercury and opium, and the success of his practice extended his fame and celebrity, and inspired confidence in his system. He was an enthusiastic labourer in the cause of the alchymists, and boasted of being in possession of the philosophers' stone. He trav- elled through almost every country of Europe, consulting indiffer- ently physicians, barbers, old women, conjurers, and chemists. In the height of his prosperity he was appointed to deliver lectures in the town of Basle, in Switzerland, and was the first public pro- fessor of chemistry in Europe ; but he soon quarrelled with the magistrates about a medical fee, and left the city. He was ex- tremely dissolute and eccentric in his manners and character. While seated in his chair as professor, he burned with great so- lemnity the writings of Galen and Avicenna, and declared to his audience, that, if God would not impart the secrets of physic, it was perfectly justifiable to consult the Devil. He invented an elixirproprietatis, which he termed the elixir of life, for the pro- fessed purpose of procuring longevity, and pretended that, by the use of it, his life would be protracted to the age of Methuselah. Continuing to ramble about the country, he sunk into the deepest dissipation, being scarcely ever sober, and never changing his clothes, nor sleeping in a bed, neither the counsel of the Devil, nor his universal elixir conferred on him his boasted gift of im- mortality, and he died in a hospital in the 48th year of his age. The quacks and empirics of the present day may probably trace the origin of their craft, and vaunted nostrums, to the vagaries of their great master, Paracelsus. Notwithstanding the whole life of Paracelsus was a tissue of blunders and vice, it is acknowledged that his talents were great. and that his labours were not entirely useless. Having carried his speculations concerning the philosophers' stone and the universal remedy to the greatest height of absurdity, and having, in his own person, exemplified the ideal pursuit, he contributed more than any man to their disgrace, and subsequent banishment from the sci- 6 HISTORICAL SKETCH OF ence, and at the same time, gave a favourable impulse to the true principles of chemistry. Vesalius, professor of anatomy in the University of Padua, and Michael Servetus, a Spanish physician, were about this era, dis- tinguished for their medical abilities and erudition, especially for their attainments in anatomical knowledge. Boldly controverting the principles on which Galen had founded his system, and which were then deemed inviolable, these ingenious men soon developed and exposed the errors of their great predecessor, and during this investigation, Servetus actually discovered, in the year 1553, the course of the blood through the lungs, which is termed the lesser circulation. But, unfortunately for Servetus and the medical world, his love of controversy and ardour of temper involved him in a dispute with John Calvin, the celebrated religious reformer, which eventuated in a cruel sentence of death against him for heresy; and this valuable man, together with his writings, was, at the age of about 45 years, consigned to the flames. It is matter of wonder and astonishment, that, after the com- mencement of human dissections by Democritus, the cotemporary and friend of Hippocrates, two thousand years should elapse be- fore the very important discovery was made of the true circula- tion of the blood. But this luminous event was greatly retarded by a scrupulous adherence to the errors of Galen and his follow- ers, who attributed to the liver the office of preparing the blood and transmitting it through the veins to all parts of the body, con- ceiving that air was contained in the arteries, and that the veins were the only true channels of the blood. It was also the opin- ion of some, that the blood moved forward and backward like the ebbing and flowing of the tide. In the early part of the 17th century, Fabricius, a learned Ita- lian physician, announced his discovery, that the veins were fur- nished with valves, the mechanism of which precluded the possibi- lity of their performing the office which the ancient doctrine had assigned them ; the valves admitting the progress, but obstructing the regress, or return of the blood. This perplexing dilemma did not escape the observation of the sagacious Dr. William Harvey, an English physician, who had been a pupil of Fabricius. Unbiassed by the doctrines of the ancients, and inattentive to the errors of his immediate predecessors, this ingenious anatomist availed himself of established principles, and commenced his in- Medical science, &c. 7 vestigation of the structure and functions of the heart and arteries. Apprized of the fact that two ounces of blood is received into the heart and projected into the aorta, at every pulsation, his natural inquiry was, whence is this blood received, and how is it disposed of, unless by a regular course of circulation ? Having, therefore, tied an artery, the corresponding vein received no blood ; but, making a vein the subject of the same experiment, all its branches and the corresponding artery instantly became distended with that fluid. Animated by this successful experiment, he was induced to prosecute his inquiries with unremitting industry, for several years. His efforts were at last crowned with the attainment of their noble object, and it has been received as an invaluable acquisition to the science of medicine. In the year 1628, his new theory of the cir- culation of the blood became the subject of his lectures, and, by numerous experiments, he demonstrated the phenomena in a man- ner the most convincing and satisfactory. Such is the ignoble spirit of jealousy and envy, that it is not usually the fate of novel doctrines, however important, to be received without opposition ; accordingly we find that there were some, who, biassed by passion and interest, had the boldness to deny the facts so fairly proved, and to calumniate the name of the illustrious Harvey. Every argument against him was, however, completely refuted and si- lenced, and his new principles of circulation universally establish- ed before the termination of his honourable life. It is observed by a judicious writer, that " the books of Harvey present us with many indications of a great mind, acute discernment, unwearied application, original remark, bold inquiry, and a clear, forcible and manly reasoning." He was not less distinguished for his piety, than for his erudition, and, at the close of his useful life, he was consoled with the reflection, that the spirit of malevolence, so hos- tile to his merit and fame, became attempered to the grateful duty of enhancing and perpetuating the honour justly due to his charac- ter. Great and manifold are the advantages derived to mankind from the ingenious labours of the immortal Harvey. His splendid discovery, which had eluded the research of ages, subverted the fallacious doctrines of the ancients, and, at once, effected a total revolution in the theory and practice of medicine. Of all the transactions recorded in medical history, this is incomparably the most essential in its effects and consequences. Medical, like all other knowledge, is progressive, and the melancholy triumph of 8 HISTORICAL SKETCH of disease over its victims, and the numerous reproachful example;! of medical impotency, clearly evince that the combined stock of both ancient and modern learning is greatly insufficient to perfect our science. From the commencement of medical history, revolutions in the theories of physic have been extremely numerous and fleeting. Many of them were no other than visionary hypotheses, emanat- ing from perverted imaginations, unconnected with facts, and ut- terly repugnant to the plainest dictates of observation and expe- rience. An appropriate disquisition on the various systems and rotations of systems, which have prevailed, will not comport with the plan of this sketch. The reader may consult the writings of Boerhaave, Cullen, Rush, and the several Encyclopaedias, where the versatility of human systems is abundantly displayed. Every age has teemed with the controversies of the learned ; and while ambitious projectors imagined they had attained to perfection, their cotemporaries or immediate successors contested their prin- ciples, and triumphed over their errors; hence we see theories which scarce survive their authors, give place to others as tran- sient and unsubstantial as themselves. In consequence, however, of diligent and learned research, and of emulation among medical philosophers, new and important facts have been developed, and the restoring art has reached its present honourable and dignified rank among the sciences. Far indeed beneath the standard of perfection, it is still fraught with deficiencies, and altogether inad- equate to our desires. To what extent the frail condition of hu- man nature is capable of being meliorated, and existence protract- ed by the application of the principles of medicine, must be re- served to the wisdom and industry of future generations to deter- mine. It is nevertheless incumbent upon us to consecrate our talents to this noble science, duly to appreciate and exalt its me- rit, to cherish its dignity^ to study and improve its principles, and to cultivate a religious sense of the inestimable blessings which mankind derive from its influence.* While medical philosophers laboured with unceasing assiduity and zeal for the promotion of the science, its progress was imped- * So great, says the pious Dr. Rush, are the blessings which mankind derive from the healing art, that if every other argument failed to prove the administration of a Providence in human affairs', the profession of medicine would be fully suu> cient for that purpose. medical science, &c> 9 «d by the preposterous edicts of sovereigns and legislatures. In the l6th century the Emperor Charles 5th, although addicted to crimes of the blackest stain, ordered an assembly of divines to de- liberate whether it were lawful, in point of conscience, to dissect a dead body. During the same reign a violent controversy subsisted respecting the question whether, in a pleurisy, blood should be drawn from the arm of the affected syie, according to Hippocrates, or from the opposite side. The University of Salamanca, in Spain, decided by a decree, that no one should dare to let blood but from the contrary arm, alleging that the other method was of no less pernicious consequence to medicine, than Luther's heresy had been to religion. That eminent and indefatigable physiologist, Baron Haller, was obliged to flee the city of Paris, to avoid prosecution for dissecting dead bodies ; yet his ardour was not diminished, and he found means to dissect three hundred and fifty human subjects and a vast number of the brute creation, some of them while alive. The science of medicine is greatly indebted to the zeal and ability of this illustrious man. In some countries, laws have been enacted, obliging physicians to adopt, in all cases, the prescriptions which had been collected and approved by the physicians of former ages. During the pre- valence of a malignant fever in Barcelona, a few years since, the Court of Madrid, as is related, wrote the prescription, and, by the command of his Catholic Majesty, the physicians were ordered to adhere to it, • and forbidden to prescribe any thing else. Such bi- goted and illiberal procedure could not fail of suppressing the spirit of investigation, and of presenting insuperable obstacles to that pro- gressive improvement so ardently desired by every friend of medi- cal science. With respect to the medical history of our own coun- try we can only infer from a few scanty records and from tradition, that for many years after the settlement of the colonies the practice of medicine was with few exceptions united with the ordinary paro- chial duties of the ministers of religion, who were thus enabled in a double capacity to administer spiritual cousolation and soothe the bed of death. More exalted indeed were their avocations than that of the ancient priests of Egypt, of Greece and Rome; for it was deemed indispensable for clergymen to acquire a knowledge of practical medicine, that they might discharge the duties of piety and humanity to their suffering brethren ; and although not endow- 10 Historical sketch of ed with high attainments in medical science, they were neverthe- less qualified for great usefulness in their respective stations. Al- together unlike the ignorant empirics of later times, they were ac- tuated by the purest motives, and the highest considerations of be- nevolence. By their amiable manners, zealous attention, and pious converse they endeared themselves to their people, mutual attach- ments were formed and the fullest confidence reposed in their medical skill. The first settlers being exposed to extreme hard- ships and to famine, were frequently afflicted with alarming and fatal diseases, which at some periods threatened almost a total ex- tinction of their population. At different periods from 1678 to 1702, the small pox spread through the colonies, and from the injudicious method of treatment, its effects were like a mortal scourge wherever it appeared. We find on record the names of some respectable physicians who emigrated with, or soon followed the first adventurers to America. The first whose name we find on record, was Dr. Samuel Fuller, being a deacon of the Rev. John Robinson's Church, he formed one of the company who land- ed at Plymouth, December 22d, 1620. He is said to have been well qualified in his profession, and eminently useful as a surgeon and physician : extending his benevolent labours not only to the sick among his immediate friends at Plymouth, and the aborigines in the vicinity, but by the desire of Governor Endicot, twice visited the new settlement at Salem, where he manifested his skill and suc- cess in practice, among the numerous sufferers under the scurvy, and other diseases. Although Harvard College was founded' at Cambridge as early as 1638, many years elapsed before any con- siderable number of physicians could receive a complete medical education in the country, and for more than a century and a half after the first settlement, most of the more respectable medical cha- racters were either Europeans or gentlemen sent from hence to complete their education in foreign universities. We are not to be surprised, therefore, that few publications on medical subjects were known in America during that early period. The first of this description in Massachusetts was entitled " A Brief Guide in the Small Pox and Measles," published in 1677, by Thomas Thatcher, a clergyman and physician of Boston, who is spoken of as the best scholar ef his time. medical science &c. It The communication of the small-pox by inoculation was intro- duced in Boston in 1721, under the influence and patronage of Dr. Cotton Mather, a celebrated divine. The novelty of the subject and the strong prejudices then subsisting, occasioned much public agitation, and soon involved both clergymen and physicians in a spirited but illiberal controversy, relative to the propriety of thus experimenting with the lives and health of their fellow men. The clergy of Massachusetts were, for the most part, zealous supporters, while some of the medical faculty were violent opposers, of inocu- lation. Among the latter are mentioned Lawrence Dalhound, a Frenchman, William Douglas and Joseph Marrion. Dr. Zabdiel Boylston, a man of liberal views, and great literary acquirements, having obtained information by the transactions of the Royal So- ciety of London, of the successful practice of inoculation by Ti- monious of Constantinople, in 1713, and being warmly supported by Dr. Cotton Mather, resolved to surmount every obstacle, even at the risk of his popularity, and his life.* He selected as the subjects for his first experiment, three of his own family, an only son and two servants. In these cases he was completely success- ful which had the happy tendency not only to confirm in his own mind the safety and uiHUy of inoculation, but to quiet the fears of others. During the years 1721 and 1722, he inoculated 247 per- sons, and 39 were inoculated by others. Of this number only six died ; while of 5759, who in the same period took the disease the natural way, 844 died. Dr. Boylston visited London in 1725, where he was highly re- spected, and was honoured by being elected a fellow of the Royal Society. He published in 1726 an historical account of inoculat- ed small-pox in New-England, and lived to witness the extensive and very important effects of his intrepidity and perseverance in his professional duty. The practice extended, by degrees, through New-England to New-York and Philadelphia,and finally to Charles- ton, South-Carolina, where it was partially adopted in 1738. Dr. William Douglas,a native of Scotland, and a reputable practitioner of physic in Boston, wrote essays respecting the small-pox in 1722 * Dr. Boylston for his innovation in practice suffered the resentment of his professional brethren, and the greatest indignity from aa enraged popolace, being pelted with stones as he walked in the street, and his windows were broken by a mob in the night. 12 HISTORICAL SKETCH OF and 1730. Another publication on the same subject, by Dr. Na- thaniel Williams, a learned physician, a celebrated, chemist, and an useful preacher, appeared in 1742.* Among the earliest American publications, was an essay on the Iliac Passion, by Dr. Cadwallader, of Philadelphia, printed about the year 1740. Dr. Tennent, of Virginia, produced about the same time a work on pleurisy, in which he brought into view the virtues' of the Poly gala Senega or Seneca snake root, which was before unknown. This was followed by an ingenious essay on the causes of the different colours of people, in different climates, by Dr. John Mitchill, of Virginia, who also wrote on the yellow fever as it ap- peared in Virginia in 1742. This last was not published, but his valuable manuscripts were communicated to Dr. Rush through the hands of Dr. Franklin. Dr. Thomas Bond, an eminent physician of Philadelphia, was, about this time, author of some useful medi- cal memoirs/which were published in a periodical work in London. In 1743, Cadwallader Colden, Esq. Lieut. Governor of the Pro- vince of New-York, and a distinguished physician, communicated his thoughts on the most probable method of curing a malignant fever which occasioned great mortality in that city in 1741. He also published a treatise on the cure of cancer, and an essay on the virtues of the great water dock, which introduced the learned au- thor to the celebrated Linnaeus. The same author published in 1753 some observations on an epidemical sore throat, which ap- peared in Massachusetts, and had spread over a great part of North America. Dr. John Bard, eminently distinguished as a practition- er in New-York for more than fifty years, was the author of an in- teresting account of the malignant pleurisy, which prevailed at Long-Island in the year 1749, besides some other medical papers. About the year 1750, Dr. Benjamin Gale, of Connecticut, consider- ably distinguished for his skill and acquirements, published several of his productions; among which was a dissertation on the inocula- tion for the small-pox in America, in which he advocated the uti- lity of a course of mercury, as a preparative, affirming that, before that practice was adopted in the year 1745, one in a hundred of the inoculated died ; but of those who afterwards were the subjects * Much of this information has been obtained from Dr. J. Bartlett's Dissertation On the progress of Medieal Science, gee Med. Communication?. Mass. Med. Sop- MEDICAL SCIBNCE, &C: 13 of this new method of treatment, one only in eight hundred died. Another production on the same subject, and inculcating a similar mode of practice, appeared in 1760, by Dr. Thompson, of Pennsyl- vania. It appears that, in 1752, of five thousand five hundred and forty-four persons, who were the subjects of the small-pox in the town of Boston, the natural way, five hundred and fourteen died, and the whole number of inoculated persons was two thousand one hundred and thirteen, of whom thirty died. The first public hospitals for small-pox inoculation, of which we have any account, in New-England, were opened in the vicini- ty of Boston, 1764; one at Point Shirley, by Dr. William Barnet, from New-Jersey, and another at Castle William, by Dr. Samuel Geltson, of Nantucket. Mercury was, at this period, in the highest repute for its supposed specific powers, as an antidote to the variol- ous poison, and it constituted a part of the preparatory course of every experienced inoculator. About the year 1748, Dr. John Lining, of South-Carolina, pub- lished an accurate history of the American yellow fever, which was the first on this subject that issued from an American press. Dr. Lionel Chalmers, of the same place, in 1754 communicated to the Medical Society of London some useful remarks on Opis- thotonus and Tetanus, and the same gentleman published also an essay on fevers in 1767. Dr. Garden, a respectable physician of South-Carolina, presented to the public in 1764, an account of the medical properties of the Spigelia Marilandica, or Carolina Pinkroot, with a botanical description of the plant. About the same time, Dr. Ogden, of Long-Island, favoured the public with some valuable observations on the malignant sore throat. Dr. Peter Middleton, a man of great professional talents, and Dr. John Jones, a distinguished surgeon, both of the city of New- York, were authors, the former of a medical discourse or histor- ical inquiry into the ancient and present state of medicine, pub- lished in 1769, and the latter of an excellent work on wounds and fractures, designed chiefly for the use of the surgeons of the revo- lutionary army. In 1769, some observations were published by Dr. John Kearsley, jr. of Philadelphia, relative to Angina ma- ligna, or the putrid and ulcerated sore throat, which prevailed in 1746 and 1760. It extended, says the author, through the neigh- bouring Provinces, with mortal rage, in opposition to the united 14 HISTORICAL SKETCH OP endeavors of the faculty. It swept away all before it, baffling every attempt to stop its progress, and seemed, by its dire effects, to be more like the drawn sword of vengeance, to stop the growth of the colonies, than the natural progress of disease. Villages were almost depopulated, and numerous parents were left to bewail the loss of their tender offspring. In the years 1775 and 1776 the small-pox made its appearance in the form of an epidemic, and hospitals for the purpose of inoc- ulation were again established in various parts of Massachusetts, particularly at Cambridge and Brookline, by Drs. Isaac Rand, William Aspinwall, and Lemuel Hayward, by whom more than two thousand persons were inoculated in one year, and by whose successful mode of treatment, the practice of inoculation waa greatly encouraged, and its benefits extensively diffused. The high confidence which had long been reposed in the efficacy of a mercurial course, was now considerably diminished and practition- ers were daily strengthened in the opinion, that success depended principally on the cooling regimen, air, and antiphlogistic diet, with which it was accompanied. The small-pox again visited the town of Boston, it is hoped for the last time, as an epidemic, in 1792. The whole town was inoculated in three days, to appeasa the infatuated temper prevalent among the inhabitants, with res- pect to the danger of infection ; as the preposterous opinion had long been generally entertained that the small-pox infection is ca- pable of spreading far and wide, through the medium of the air, as a most deadly pestilence. The hurry and confusion in which inoculation was resorted to, on this occasion, precluded the possi- bility of affording, in every instance, the requisite attention, and of prescribing the most judicious and eligible mode of procedure, Nine thousand one hundred and fifty-two persons were the indis- criminate subjects of inoculation, and one hundred and sixty-five deaths were the consequence. These, however, were chiefly the children of poor families, many of whom were destitute of the comforts of life. Little reliance was now placed on the specific action Of mercury in this disease. In many instances it was en- tirely dispensed with, and shortly after altogether exploded. The hospitals and camps of our army afforded a new field and more ample scope for improvement in the knowledge of medicine and surgery than had ever before been exhibited in our country. MEDICAL SCIENCE, &C; lj Through the wisdom and prudence of the Commander in Chief, the immortal Washington, candidates for the offices of surgeon and mate were required to undergo an examination by a medical board, appointed for that purpose, at the commencement of the war in 1775. During the subsequent periods of that arduous struggle, the higher stations in the important department of medi- cine were occupied by men no less distinguished for public virtue and genuine patriotism, than for medical dignity and eminence.* Their united wisdom was happily directed to the melioration of the condition of our military medical establishments, and ultimate- ly, to the promotion of professional knowledge and the faithful discharge of duty among the surgeons of the army. Since the termination of our glorious struggle in the cause of liberty, the dark clouds, which, in our infant state enveloped the science of medicine, have been gradually dissipated, our imprisoned mental powers and faculties liberated, and progressively improved, and our medical character, like our national independence, has been honourably and advantageously established. It is ascertained by historical records, that the yellow fever made its appearance in the cities of Charleston and Philadelphia in 1699 and 1740, and that the same malady again visited Philadel- phia, New-York, and some other parts of North America, in the years 1744, 1747, 1760, and 1762. At the last mentioned period it was attended with such symptoms of malignancy, as baffled the skill of the most experienced physicians. The medical characters of those times, as well as the public, generally considered the disease to be contagious, and imported from the West-Indies. * The first Director General of the Hospitals was Dr. Benjamin Church, of Bos- ton, but being, soon after his appointment, charged with a treasonable correspond- ence with the British, was superseded by Dr. John Morgan, of Philadelphia. Af- ter his retirement, Dr. William Shippcn succeeded to the same office, and Dr. Ben- jamin Rush was appointed Physician General, which office he sustained only for a short period. The following gentlemen are personally recollected as holding the stations of Physician or Surgeon General, or Deputy Director of the different de- partments of the army, viz. Malachi Treat and John Cochran, of New-York, Jonathan Potts, of Pennsylvania, James Craig, of Virginia, and Isaac Foster, of Massachusetts. Andrew Craiggie, Esq. Apothecary General. Those who served as hospital or regimental surgeons, belonging to Massachusetts during the war, were Isaac Foster, Samuel Adams, John Warren, William Eustis, David Townsend, John Hart, Joseph Fiske3 Josiah Bartlett, John Thomas, Daniel Slwte, and James Thachcr. 16 HISTORICAL SKETCH OF The same fever was recognized.in our hospitals and camps, during some seasons of the revolutionary war. The dreadful visitation of the yellow fever in the city of Phil- adelphia in 1793, must be regarded as a memorable event in the history of the United States. Such was the magnitude of this awful calamity, as to excite in the breasts of all classes of people the keenest emotions of sympathy, and the most terrible sensations of consternation and dismay. No less than four thousand and forty-four persons fell victims to this destructive epidemic in that city, between the 1st August and 9th November. The same epi- demical fever has, at several subsequent periods, been permitted to ravage that city, New-York, and almost all the sea-port towns in the United States. It first made its appearance, as an epi- demic, in the town of Boston in 1798, where it exhibited every mark of great malignity. Although limited to a small section of the town, the deaths were about one hundred and forty-five. There were no evidences of its having been imported, nor any instance to justify the supposition of its being contagious. Boston was again visited by this fatal malady in 1802, with all the circum- stances of its former malignant and destructive nature, and about fifty persons died. The nature, causes, origin, and propagation of this formidable disease immediately became the topics of interesting inquiry and universal concern. The investigation was pursued by many of eur most distinguished medical philosophers with the utmost zeal and perseverance; but from the conflict of opinions on this ab- struse subject, a spirit of illiberality was, in too many instances, allowed to mingle with discussion, and to impede the progress and attainment of truth. Whether the yellow fever, as then prevalent, was of an inflammatory or typhoid character, was a question agi- tated with considerable warmth. The facts were also important to be decided, whether the disease was imported from a foreign country, and was of a contagious nature, or originated in some domestic and local cause, existing in our cities. The learned labourers in this ample field of controversy were designated by the names of contagionists and non-contagionists, or advocates for the importation, and such as favored the idea of the domestic origin of this awful source of mortality. Although the discordant opin- ions of the faculty were little calculated to satisfy and soothe the MEDICAL SCIENCE, &C. 17 distracted state of the public mind, they nevertheless effected a more rigid observance and assiduous application of the means of prevention than could have resulted, had either of those doctrines alone prevailed. A more complete system of quarantine laws were adopted, and more efficient regulations were introduced in the management of our police. It should be noticed in this sketch, that, for more than half a century, it has been the practice of some physicians of eminence, particularly in'New-England, to administer mercury as an effica- cious remedy in febrile diseases of every description. It was em- ployed, not so much for its evacuating power, as with the inten- tion of introducing it gradually into the system as an alterative. The writer has a distinct recollection, that, when a medical student in 1774, his respected instructer* reposed the fullest confidence in a moderate course of mercury, in pleurisies and peripneumonies, esteeming it the most efficacious attenuant and expectorant, which the Materia Medica afforded. Several other physicians of the same standing in Massachusetts were in the habit of pursuing a similar mode of practice.! But it was reserved to a more recent period to call into requisition this Sampson of the Materia Med- ica to combat those formidable destroyers of mankind, which have, of late, spread such havoc and terror in our country, the conta- gious and epidemical diseases. Dr. Rush, after having experienced the palpable inefficiency of all the known curative remedies in the yellow fever of 1793, was induced to adopt the depleting plan, and boldly resorted to the lancet and to mercurial purges, as his last hope; and at subsequent periods of its prevalence, the lancet was more cautiously employed, and mercury used as the sovereign remedy. It was given with the view of evacuating the alimentary canal, or in such form as would speedily induce a moderate sali- vation, in which event it proved eminently efficacious. Influenced probably by the opinion and example of Dr. Rush, most of the learned physicians of the United States have declared themselves advocates for the mercurial mode of treatment. Being thus sanctioned by the highest medical authority and by general assent, the mercurial practice is now received and adopted by most * Dr. Abner Hersey, of Barnstable. t See Dr. Holyoke's Letters. Med. Repo. Vol. I. p. 500. See also Dr Warren's excellent Treatise on Mercurial Practice. 18 HISTORICAL SKETCH OP of our practitioners as the safest and most successful method of cure, not only in the yellow fever, but also in typhus and other forms of malignant febrile affections. This plan of treatment was found to be coincident with the opinions and practice of some respectable medical men of the most extensive experience in the yellow fever of the West-Indies. Dr. Chisholm, indeed, is reputed to have been one of the earliest of those who resorted to mercury as an agent in controlling the violence of that fatal disease, in that climate, in the years 1789 and 1790; and he is worthy of being styled the champion and father of the mercurial practice ; having, in one instance, exhibited by the mouth, by inunction, and by clyster, no less than five thousand seven hundred and four grains of mercury in five days, and the result was the rapid recovery of his patient. It would seem scarcely credible, a priori, that the human constitution is capable of sustaining such an enormous quantity of this active metal, and it is to be presumed that the learned gentleman will long remain without a rival in this respect, in the United States. Among the epidemics which have visited our country, the Influenza, or Tussis Epidemica of Sydenham, deserves to be no- ticed in this sketch.* It has prevailed in America at nine or ten different periods, since the year 1733 ; but in the autumns of 1789 and 1807 it was more universally extensive and severe in its effects than at any preceding period of its visitation. It first appear- ed in New-York and Philadelphia, from which it was, iu a short time, diffused through every part of the continent. It was estimated, at the time, that three fourths of the inhabitants were, in a few days, affected with this singular epidemic, in a greater or less degree. The amazing rapidity with which it spread through the country, resembled more a storm agitating the atmos- phere, than the natural progress of a disease, from any contagious, source. Almost a whole city, town, or neighbourhood, became affected with its influence, in a few days, and as it did not incapa- citate people, in general, from pursuing their ordinary occupations, it was common to observe in every street and place of resort, such coughing, hawking, and wheezing, as to interrupt conversation, and, in public assemblies, little else was to be heard or at- tended to. Although all classes of people experienced the oper- * Termed by some writers catarrhus epidemica* MEDICAL SCIENCE, &C. 19 &tion of the influenza, it is remarkable that a small proportion, comparatively speaking, were so ill as to require medical attend- ance, and instances of its fatal termination were of rare occur- rence. The very brilliant and important discovery of the vaccine dis- ease by Dr. Edward Jenner, a celebrated English physician, and the fact, that it will render the human system unsusceptible of the small-pox, was announced in our news-papers, and in the Medical Repository of New-York in 1799. The first information relative to this novel and singular discovery, although from undoubted au- thority, did not receive universal credence. Hy some it was treat- ed as chimerical, while others resolved to suspend their opinion for the issue of future experiments. It appears that Dr George Pearson, of St. George Hospital, London, first called Dr. Jenner's attention to the application to be made of the facts familiarly known for years before, that the dairy maids were proof against the small-pox. This learned and distinguished physician first sug- gested to Dr. Jenner the use that might be made of those facts. In order that the vaccine disease might be substituted for the small- pox, Dr. Pearson transmitted in a letter to Dr. Hosack of New York a thread impregnated with the matter of the vaccine virus : and in a letter to Dr. II. towards the close of 1798, and which accom- panied a copy of his " Inquiry concerning the history of the cow- pox principally with a view to supercede and extinguish the small- pox" published in London, Nov. 1797, he says ; " I now send you my proof sheets of a new work on a subject which will much sur- prise you, and which promises to supersede that most loathsome disease the small-pox. I wish you to inquire whether such a dis- ease as the cow-pox exists in America, and give me advice of it. I send you this early information that you may avail yourself of it." Dr. Benjamin Waterhouse, however, then Professor of Medicine in the University at Cambridge, did not hesitate to proclaim his full confidence in the statements and facts, which he had received directly from England. In July, 1800, he procured matter from thence, by which he was enabled to test the experiment in the per- son of his own son, who thus became the first subject of vaccina- tion in the United States. From this source, matter was furnished lor the inoculation of several others, some of whom were tested by variolous infection, with the desired success, which afforded ad- ditional evidence of the prophylactic efficacy of the vaccine dis- 20 HISTORICAL SKETCH OF ease. In the year 1800, and at subsequent periods, Dr. Water- house presented to the public, historical and practical treatises on the cow-pox, and communicated, through the medium of news- papers, useful and discriminating directions and precautions rela- tive to the genuine disease. He was, for a season, exclusively in possession of vaccine matter, which he occasionally distributed to practitioners for the extension of its benefits to different sections of our country. In the following September, Dr. James Jackson, of Boston, returned from London, and having acquired experi- mental knowledge, by attending the practice of vaccination with Dr. Woodville, generously contributed to its propagation in Boston and the vicinity. In the same year Dr. Miller, of New-York, re- ceived matter from Dr. Pearson, of London, which failed, how- ever, to produce the genuine disease, nor was another supply, sent on from Boston, attended with better success. In fact, spurious matter, in some instances, and want of skill and experience in the operator, in others, occasioned numerous failures, during the first attempts, which had the effect of damping public confidence, and restricting the exertions of the friends of vaccination. The Massachusetts Medical Society, early in 1801, addressed an application to the vaccine institution in England, requesting a sup- ply of matter. Publications on this new subject were now con- tinually multiplying, and the most gratifying evidences in favour of vaccination issued from various quarters. In the year 1802, the Boston Board of Health, actuated by the most laudable views, directed nineteen persons to be vaccinated under their inspection, all of whom were afterwards tested by the small-pox infection in the most satisfactory manner and with the happiest result. In the following year, the junior physicians of Boston formed an association for the express purpose of bestowing gratuitously the benefits of vaccination upon the indigent, and of disseminating the matter among medical practitioners. The kine pock institution was established in New York in Jan. 1802, for the purpose of substituting the cow pock inoculation in the place of the small-pox ; more particularly among the poor, and for preserving a constant supply of genuine matter. The first phy- sician appointed to vaccinate for the Dispensary was Dr. Valentine Seaman. According to the annual report, dated Jan. 1806, no les* than 1,223 patients enjoyed the advantage of the City Dispen- sary, beside those who had received vaccine inoculation gratis.. MEDICAL SCIENCE, &C. 21 In the year 1808, the number of patients who enjoyed the advan- tage of the Dispensary was 1,340 : in 18) 1 the number was 1,446: the trustees also stated that in addition to these patients 1016 had been vaccinated at their office since the first of Jan. 1811, gratis, and that in every instance the kine pock has proved a perfect se- curity against the small-pox.—Med. and Phi. Register, Vol. 4th. In 1808, a committee was appointed by the counsellors of the Massachusetts Medical Society, for the purpose of collecting all the evidence which had transpired respecting the efficacy of the cow-pox, as preventive of small-pox, and to report the most eli- gible method of conducting the practice. A copious and interest- ing report was made and published in the communications of the society, accompanied with evidence sufficiently strong to remove every vestige of prejudice and uncertainty relative to-the prophy- lactic powers of vaccination. The fellows of the society, being also enjoined to inquire whether the native cow-pox had been dis- covered among the cows in this country, the result was a confir- mation of the fact in several instances. The town of Milton, having in 1809 made arrangements to ex- tend the benefits of vaccination to its inhabitants, Dr. Amos Hol- brook inoculated three hundred and thirty-seven persons, being more than a fourth part of their population ; twelve of whom were afterwards tested with small-pox, withbut receiving it. In imitation of this laudable example, the town of New-Bedford in the same year adopted a similar plan, and about fifteen hundred of its inhabitants were inoculated. The next attempt to dissemi- nate the advantages of vaccination will be found in the transac. tions of the legislature of Massachusetts, who, in 1810, authorized the several towns to appoint committees, and raise monies annually for this important purpose. The glorious triumph of vaccination over that most dreaded scourge of the human race, the small-pox, is now established by incontestible proofs, and has received the sanction and applause of the community, and of the wise and learned in the remotest re- gions of the earth. Wre can now congratulate the citizens of the United States, who, in common with the whole civilized world, are in possession of this heavenly blessing, a blessing which eradi- cates from the catalogue ©f human miseries the most odious and fatal disease, and which happily closes one of the most crowded avenues to the tomb. 22 HISTORICAL SKETCH OF The horrors occasioned by the ravages of the yellow fever in our cities had not ceased, when another epidemic equally formida- ble and malignant in its nature, and fatal in its consequences, com- menced its distressing career, and spread terror and desolation through the interior of the country. This malady, which has ob- tained the name of spotted or petechial fever, first appeared in the town ofMedfield, in Massachusetts, in 1806. Its ravages were afterwards experienced in Connecticut, and in 1810 it prevailed in the county of Worcester, with unexampled mortality, baffling the powers of medicine, and setting at defiance the best skill of phy- sicians. On this alarming occasion, the counsellors of the Massa- chusetts Medical Society appointed a committee with instructions to make all possible inquiry and investigation relative to the dis- ease in question. Their report, as to its causes, history and mode of treatment, was elaborate, honourable to themselves, and reputa- ble to the individuals who furnished its materials. This valuable document occupies a place in the Society's communications, lately published. The fact is well ascertained that the disease is not contagious, as was by some, at first apprehended. It is remarkable of this epidemic, that it is most rife in the cold seasons of winter and spring, and that it is more prevalent and o-enuine. in its character, in the interior, than in the vicinity of the sea board. But, wherever it waves its standard, the arrows of death cross its paths, and all classes and sexes become its indiscri- minate victims. In some situations and seasons, the proportion of deaths, in se- vere cases, is supposed to be greater than one half of the number seized. One instance occurred, at a considerable distance from the place where the disease was known to exist, of the death of seven adult persons out of eight, belonging to four or five contigu- ous families, before the fifth day, and the eighth survived but a few days longer. In other more favourable instances, and under a more improved and judicious mode of treatment, the number of deaths, it is said, has not exceeded one in sixty or eighty. In the autumn of 1812, a formidable epidemic made its appear- ance among the soldiers of the United States' armyat Greenbush, and other military stations, where its desolating effects were mark- ed with great severity. During the winter and spring of 1813, it was prevalent and extremely fatal among the inhabitants of Ver- mont, in the upper parts of the State of New-York, in several MEDICAL SCIENCE, &C. 23 tftwns in the interior of Massachusetts and the district of Maine, assuming a multitude of treacherous shapes, and triumphing over its victims with inexorable sway. The town of Boston and its vicinity werfr not altogether exempted from its attack, though its subjects were principally the newly enlisted soldiers quartered in that metropolis. According to its various symptoms and forms, this pestilence has been termed Bilious Peripneumonia, or Typhoid Peripneu- monia. In some of its appearances and forms it may be identified with the petechial fever above mentioned, but if it be a distinct disease, there is an obvious and close analogy in their nature and character. It has been remarked, that the petechial fever pro- duces a peculiar derangement of the functions of the brain, while the last epidemic directs its morbid powers to the pleura, lungs, heart and its membranes. The reader may consult Dr. N. Strong's Inaug. Diss., Dr. E. North, on spotted fever, Communic. Mass. Med. Soc. Vol. II., New-Eng. Med. Jour., Amer. Med. and Phil. Register, and Med. Repos. of New-York. To which may be add- ed, Gallup on Epidemics, Med. Sketches by James Mann, M. D., and Treatise on Typhus Syncopalis, by Thomas Miner, M. D. PROGRESS OF MEDICINE IN AMERICA. MEDICAL INSTITUTION OF PENNSYLVANIA. It will doubtless be deemed an extraordinary circumstance that on a retrospect of the early history of our country, it appears that more than a century and a half elapsed after its first settlement, before a single effort was made, either by public authority or by in- dividuals, for the establishment of institutions for the education of physicians or the regulation of the practice of medicine. But the science of medicine, even in Europe, had long continued at a low ebb, until the era of its revival commenced in 1719, when,by the splendid talents and enterprise of Dr. Monro, sen., the establishment of the celebrated medical school of Edinburgh was accomplished. This honorable achievement was succeeded by similar institutions • in various parts of Europe. The genius and industry of William and John Hunter, in London, of the great Boerhaave, in the Uni- versity at Leyden, and some kindred spirits in the medical schools in France, seemed to combine their efforts to elevate medical sci- 24 HISTORICAL SKETCH OF ence to a desirable state of improvement. In America the culti* vation of scientific knowledge had not been commensurate with our national progress in wealth and population, but it was reserved for some brilliant and philanthropic characters to follow in the laudable pursuit for the benefit of their native country. These were Dr. William Shippen, and Dr. John Morgan, both natives of Philadelphia. Having completed their preparatory education, and graduated, Dr. Morgan at the College of Philadelphia, and Dr. Shippen at the College of New-Jersey, they both commenced the study of medicine in their native city; the former with the justly celebrated Dr. Redman, and the latter with his father, then a re- spectable physician of Philadelphia. After the" usual course with their private instructers, they repaired to Europe to complete their medical studies in the public schools. Shippen first visited London, where he enjoyed the friendship of that eminent teacher, John Hunter, and also of Mr. Hewson, Sir John Pringle, and Dr. Fothergill; the latter of whom took a deep interest in the improve- ment of medical science in America, and lent him considerable assistance in founding the institution at Philadelphia. Shippen, after finishing his studies in London, repaired to Edinburgh, where he studied and graduated. He afterwards visited France, and re- turned to his native country in 1762, with the full determination of opening a school of anatomy. Morgan visited Europe, and at- tended the lectures of William Hunter, spent two years in Edin- burgh, and graduated at that university, and afterwards attended medical lectures at Paris. While Dr-s. Shippen and Morgan were in Europe, they concerted the plan of establishing a medical school in their native city. Accordingly, in 1762, Dr. Shippen commenc- ed a course of lectures on anatomy and midwifery, accompanied by dissections, to a class of ten students, and this was the first public Course of lectures upon anatomy ever delivered in America, if we except those delivered at Newport, in 1756, by a Dr. William Hunter. In 1765, Dr. Morgan returned from Europe, and was appointed professor of the institutes of medicine, and Shippen the professor of anatomy, and they were the only professors of this new institution until 1768, when Dr. Kuhn, who had studied under the celebrated Linnaeus, was appointed professor of botany and materia medica, and in the following year, Dr. B. Rush, who had just completed his studies and obtained medical honours in Eu- rope, was chosen professor of chemistry. These learned charac- MEDICAL SCIENCE, &Cs as- ters assisted by the venerable Dr. Thomas Bond, as lecturer on clinical medicine, zealously devoted their talents to the duties of the several departments of medical instruction ; thus laying the foundation for the first medical institution in the American colo- nies. This was soon after confirmed and established by the au- thority of the trustees of the college of Philadelphia, while the ve- nerable Dr. Franklin officiated as their president. The science of medicine was unfortunately deprived of the bene- fits and improvements expected from this very honourable asso- ciation, by various circumstances connected with the American revolutionary war. Since its close, however, the medical school of Philadelphia has been revived and re-organized under circum- stances propitious to medical improvement. An unfortunate com- petition and discord between the Medical College and an Opposi- tion school for a time marred their prospects, and impeded that progress which the friends of the institution and the public had confidently expected. But in 1791 some important changes took place, an harmonious union of the contending parties was effected, and Dr. Rush was appointed Professor of the Institutes and Prac- tice of Physic and of Clinical Medicine. From this period, the progress and improvement of the school has been honourable to the venerable founders, and beneficial to the community. The commanding talents and profound erudition of Professors Rush, Physick, Barton, Wistar, Chapman, and others, have given to the medical school of Philadelphia, a celebrity which will probably long remain unrivalled in the United States, and will enable it to vie with the most improved seminaries of the European world. It has become the resort of students from every section of the Union. More than four hundred in one season attended the vari- ous courses of lectures, and the inaugural dissertations of those who from time to time have received its honours, have extended the fame of the school from which they emanated. At the com- mencement in June, 1771, the degree of A. B. was conferred on seven, and the degree of M. D. on four students ; the latter were the first who received the degree of Doctor of Medicine in America. 4 26 HISTORICAL SKETCH OF MEDICAL PROFESSORS OF THE UNIVERSITY OF PENNSYLVANIA FOR THE YEAR 1825. Phillip Sing Physick, M. D. Professor of Anatomy. John Redman Coxe, M. D. Professor of Materia Medica and Pharmacy. Nathaniel Chapman, M. D. Professor of the Theory and Prac- tice of Medicine, and Clinical Practice. Thomas C. James, M. D. Professor of Midwifery. Robert Hare, M. D. Professor of Chemistry. William Gibson, M. D. Professor of Surgery. William E. Horner, M. D. Adjunct Professor of Anatomy. The public lectures commence the first Monday in November, and continue four months, and the commencement is about the first of April. To obtain a degree of Doctor of Medicine, the candidate must have attained the age of twenty-one years, and must have applied himself to the study of medicine three years, two of which, shall have been in this University ; and have attended the Pennsylva- nia hospital during one session, and have been the private pupil of some respectable practitioner. He shall have attended two complete courses of lectures, delivered in this University, on Ana- tomy, Institutes and Practic of Physic, and Clinical Medicine, Materia Medica, Chemistry, Surgery, and Midwifery. Excepting only such gentlemen, as have attended two courses of lectures on the same subjects, in some other respectable University, or school, and for such it shall be only necessary to attend one entire course in this University. The student must take a ticket on or before the third Monday of the session. Each candidate shall write a thesis, and undergo an examination upon it in presence of the faculty. The candidate shall be placed behind a screen, and the examination shall be so * The following are the names of those who have filled the respective chairs of the Philadelphia School and University, who are deceased :— Died Morgan, 1789 Hutchinson, 1793 Carsin, 1793 Griffiths, -- Shippen, 1808 Died Woodhouse, 1809 Rush, 1813 Barton, 1815 Wistar, 1818 Dorsey, 1818 MEDICAL SCIENCE, &C. 27 conducted, that no Professor, except the Dean of the faculty, shall know the candidate. The voting on this subject, shall be by pri- vate ballot. Two negative votes shall reject the candidate. The fees of graduation shall be paid to the Dean of the faculty, at the time of his examination. Each professor receives $20 for a course of lectures, but after two courses, admission is gratuitous. Each Professor, also, receives $5 for signing a diploma. The Pennsylvania Hospital, founded in 1752, and the Philadelphia alms- house, are connected with the school, to which the students are ad- mitted for clinical instruction. The number of medical students attending the course of lectures at the university in 1825, was 480. Such has been the prosperity of this first medical school founded in America. From the most accurate calculation that can be made, it is computed that not less than 7000 young men have receiv- ed instruction within the walls of this school since its first establish- ment. MEDICAL INSTITUTIONS OP NEW-YORK. The first human dissection in America, of which we have any record, was the body of Hermanus Carroll, who was executed for murder in the city of New-York in 1750. This dissection was con- ducted by two eminent physicians of that city, Drs. John Bard and Peter Middleton, by whom some arraugements were made about that time for the purpose of imparting medical knowledge to stu- dents. These attempts were, at length, followed by an establish- ment for medical education, in 1768, in which were united the learning and abilities of Drs. Clossey, Jones, Middleton, Smith, Tennant and Bard, by whom lectures on the several branches were delivered. The medical doctorate was conferred on Samuel Kis- sam, by King's College, as early as 1771.* The events of the re- volutionary war deranged, and wholly frustrated in its infancy the immediate design of this establishment. After the peace of 1783, ^ome exertions were made for the renovation of the medical school, and professorships erected for that purpose; but for the want of cordiality and agreement among the professors and others, the plan «as soon abandoned. Attempts were more successful in 1792, when the board of trustees formed a new medical establishment in * Inaugural dissertation on the anthelmintic qualities of Cow-itch, by Samuel Kissanh, was published in May 1771. Hosack's Sketch. 28 HISTORICAL SKETCH OF connection with Columbia College, formerly called King's College, and professors of distinguished talents and professional merit, were appointed to deliver lectures on the different branches of medicine, and the science was essentially promoted by their assiduous la- bours ; though, from various causes, the benefits arising from it were very limited,—-only thirty-four students since its creation to the year 1811, had completed their courses of study and received the medical honours of the institution. " Considerations of ex- pediency, however, affecting the interest of science, as well as other interests, arising from causes not implicating the distinguished gentlemen filling the different professorships in this medical school, determined the regents, on the 12th of March, 1807, to grant a charter, establishing the present college of physicians and surgeons of the city of New-York. The incorporation of this institution, under the patronage of the Regents, and its sanction by the legislature, gave verv general satisfaction,and the benefits which have resulted from it duringthe period of its existence, areto be seen in the annual re- ports to the Regents of the University. Its successful progress was however, for a short time, retarded by the feuds and discontent among the professional members of the institution and others, arising principally from competition and rivalry between medical schools in the same city, whose objects were the same. It was, theref-re, deemed advisable by the Regents, to whom representa- tions of these disorders had been made, to remodel the college of physicians, and this was accordingly done on the first of April, 1811, ingrafting alterations upon their charter, principally with a view to their union with the medical faculty of Columbia College. This union was finally and happily effected at the last session of the Re^onts, in 1814, and to the satisfaction of all concerned; and the united school now combines the most eminent medical talents in the state in one splendid seminary, under the general superintend- ence of the honourable the Regents, aided by the patronage and liberal endowments of the legislature."* In April 1816 the Re- gent made the following report to the legislature. " The college of physicians and surgeons, in the city of New- York, is advancing to that celebrity, which must soon place it at * The honourable legislature in 1808 made the liberal grant of 20,000 dollars, for the benefit of the college. MEDICAL SCIENCE &.C. 29 the head of similiar institutions in the United States. Perhaps no place can afford greater opportunities for giving medical instruc- tion to the best advantage, on all the variety of cases in which the human frame is liable to disease, and where more opportunities are daily offered to exhibit them to the inspection, and for the in- struction of students. It is, therefore, the decided opinion of the Regents, that this institution should receive the undivided support of the state : and that no other should be countenanced, which, by a spirit of rivalship or hostility, might, in any degree, succeed in re- pressing its justly deserved and increasing reputation as a medical school." The most sanguine expectations were entertained respecting the utility of the institution thus re-organized, and the result of a few years experience clearly evinced that the learned professors filled the important stations assigned them, with ability and success. The inaugural dissertations of the graduates, are indicative of great industry, and of acquirements which reflect honour on their au- thors, and which proclaim the medical advantages they have en- joyed at the institution. In 1811, medical degrees were conferred by the college of physicians and surgeons on eight persons ; and in 1812, the number was increased to twenty. In 1813, the number was reduced to five ; and in 1814, there were eleven graduates. The number of medical pupils in 1815, was one hundred and seventy-one, and the number of graduates was twenty-seven, great- ly exceeding the number attending at any prior session. The au- thor of an historical sketch of the present institution, concludes his observations in the following words. " When the advantages which New-York possesses for a great medical establishment are considered, advantages arising from its natural situation, its exten- sive population, now nearly equal to most of the capitals of Europe, its large and well endowed hospital, and other public charities, its botanical garden, its well organized medical college, and the exten- sive system of education which it embraces ; and when it is further considered, that these advantages are increased by the munificent patronage of the state, it is not too much to say, that, in the means of instruction, the college of physicians and surgeons is second to no similar institution in the United States." The college opens annually, on the first Monday in November, and the several courses begin, successively, that week, after the in- .30 HISTORICAL SKETCH OF troductory lecture of the respective professors. The session closes the last day of February. Professors for 1825 : Wright Post, M. D. Professor of Anatomy. David Hosack, M. D.F. R. S. Professor of the Theory and Prac- tice of Physic, and Clinical Medicine. William J. M'Nevin, M. D. Professor of Chemistry. Samuel L. Mitchell, M. D. F. R. S. Ed. Professor of Botany and Materia Medira. Valentine Mott, M. D. Professor of Surgery. John W. Francis, M. D. Professor of Obstetrics, and the Disease? of Women and Children. Frederic G. King, M. D. Demonstrator of Anatomy. David L. Rogers, M. D. Demonstrator of Surgery. Number of Students attending the lectures for 1825, was 196. expenses. Students are required to matriculate every session, and pay each time a matriculation fee of five dollars. There is to be paid to each professor a sum, not exceeding fifteen dollars, for each course of lectures. The expense of Graduation is twenty five dollars. No person shall be admitted as a candidate for the degree of Doctor of Medicine, unless he shall have regularly studied medicine for three years, with some respectable practitioner,shall have matricu- lated in this college, and shall have attended one complete course of the lectures delivered under the authority of the same, at not less than two winter sessions thereof; or unless he shall have previous- ly attended an entire course of lectures at some other respectable medical college or university, as well as a complete course of lec- tures delivered as aforesaid, in the said college of Physicians and Surgeons, at one winter session thereof. graduation. It is expected that a candidate for Graduation shall have at- tained the age of twenty-one years, and have attended the lectures of several Professors of the College, and the practice of the New- York Hospital, during one session at least. On or before the first of February, the candidate shall make known his name and intention to one of the Professors, by whom he will be informed of the time and place of examination. This MEDICAL SCIENCE, &C. 31 first examination is by the board of Professors only : it is private and confidential. A second examination is held before the board of Trustees, to whom, on this occasion, an appeal lies, and before whom there is offered an opportunity of redress, if a candidate think himself in any wise aggrieved. The names of those who have been approved by the Trustees are forwarded to the Regents of the University, who return an equal number of Diplomas, under the signature of the Chancellor. They are afterwards signed by the Professors. By the 20th of April, the candidate shall deliver to one of the Professors a dissertation on some medical subject. He is publicly examined on the same, in the College Hall, on the first Monday in May, and may publish or not, at his discretion. The Degrees are conferred the next day at a public Commence- ment. Good board, and comfortable accommodation, may be had for Students, at from four to five dollars per week. N. B. The Student of Medicine has abundant opportunities of prosecuting private dissections, under the immediate direc- tion of the Professors of Anatomy and Surgery, as the College enjoys the peculiar advantage of being able to procure subjects from the State Prison, under the sanction of an act of the Legis- lature. The New-York Hospital was founded in that city, in 1771. The Medical Society of the county of New-York was incorpor- ated by the Legislature in 1806, and by another act in 1813. The objects of this society are, to regulate and to improve the practice of physic and surgery. Of this respectable Society David Ho- sack, M. D. is the President, and his inaugural address was deliv- ered July, 1824. There existed in the city of New-York, prior to, and for sev- eral years cotemporary with, the college of physicians and surgeons, a faculty of physic connected with Columbia College; where lectures on the different branches of medicine have been annually delivered, and medical degrees conferred ; but, in order to annihi- late a source of mutual, jealousy, personal animosity, and perpet- ual collision and dissension, this., as already mentioned, has been *i>w HISTORICAL SKETCH OF amalgamated with the college of physicians, the officers of which are selected from both institutions. We find also a third respect- able medical institution in that populous city, but not recognized or sanctioned by authority. Being viewed as arranging themselves in opposition to the established institution, and aware of the evil Consequences arising from competition and rivalship, the honour- able legislature rejected their memorial and petition for an act of incorporation and pecuniary assistance. Students of this institu- tion who are found duly qualified, are invested with academic honours under the authority of the president and trustees of Queen's College, in the state of New-Jersey. MEDICAL INSTITUTIONS OF MASSACHUSETTS. The University at Cambridge, Mass. has also contributed to the interest and advancement of medical science, by an institu- tion founded on the generous benefactions of several enlightened and liberal individuals. Dr. Ezekiel Hersey, of Hingham, who died in 1770, bequeathed one thousand pounds, and his widow, at her decease, a like sum, to be applied to the support of a Professor of Anatomy and Surgery. His brother, Dr. Abner Hersey, of Barnstable, who died in 1786, and Dr. John Cum- mings, of Concord, were also donors to the amount of five hundred pounds each, for the same purpose, and William Erving, Esq. of Boston, left one thousand pounds towards the support of an addi- tional professor. In conformity with the views of the patrons and donors, professors of talents and character were, in 1782, appointed, by whom lectures on the several branches have been regularly de- livered, and students have received the honours of the institution. Previous to the American revolutionary war, the means of medical education in New-England were extremely limited and deficient; no medical school, public lectures, or public library for the resort of students; and unless educated in Europe, young physicians must commence their professional duties destitute of those scientific attainments which in later times have been deemed indispensable. But when the alarm of war pervaded our country, and an army was formed, a new and vigorous impulse was given to the investigation of subjects pertaining to medicine and surgery. Military hospitals were established under the auspices of the most MEDICAL SCIENCE, &C. 33 eminent professional characters, afford'ng a fund of practical knowledge, and no circumstance in our history could have been more efficient in accelerating improvements in the most important of all the sciences. It was not, however, till since the close of the war for Independence, that anything more than a tardy and silent progress could have been expected, as our present embarrassments and necessities required all our efforts. In 1780, Dr. John War- ren, while surgeon of a military hospital in Boston, commenced a course of anatomical lectures, ;md in the following year they were attended by the students of the University. This gentleman, at the instance of the lite President Willard, who was well apprized of his superior qualifications, furnished a plan for a medical school, which was adopted by the Corporation, and Dr. W. was appoint- ed the first Professor of Anatomy and Surgery, Dr. Benjamin Writer-house, Professor of the Theory and Practice of Physic, and Dr. Aaron Dexter, Professor of Chemistry and Materia Medica. Tins first medical school in New-England was thus organized, and its important objects have since been faithfully and ably pro- secuted. In consequence, however, of many inconveniences, both to professors and students, in the town of Cambridge, and of the superior advantages which might result from lectures delivered in a more populous situation, the Corporation and board of Over. seers of Harvard College deemed it expedient to establish a med- ical school in the town of Boston. The several courses of lec- tures were accordingly transferred, and commenced in that metro- polis in December, 1810. That the high expectations entertained of the superior advan- tages, which would be realized by the removal from Cambridge, were not imaginary, the immediate accession to the number of students, presents the most abundant and conclusive evidence. The number who attended the lectures while confined to Cam- bridge, rarely exceeded twenty, besides those of the first class of th.i University. The number of medical students who resorted to the Bus ion school in 1813, was nearly fifty, and the number of mi'dr.il graduates, twelve. At the Commencement in August, 1814, professional degrees were conferred on nine, and more than sixty medical students attended the lectures in Boston in Decem- ber'of the s,ime year. This flattering impulse towards the im- provement of the Boston school, and the honourable attestations 3 34 HISTORICAL SKETCH OP that their indefatigable services are justly appreciated, must afford the learned teachers the highest gratification. The Legislature of Massachusetts have granted the sum Of $20,000 to Harvard University, for the liberal purpose of improve- ment in the medical department. When the medical abilities and zealous efforts of the professors are considered, in connection with the numerous privileges an- nexed to this institution, it will be conceded, that the means and opportunities of acquiring medical knowledge, in our metropo- lis, are such as to justify the respect and full confidence of the community. The professors are in possession of a very valuable collection of anatomical preparations, presented by John Nichols, Esq., a counsellor at law, in England, with a number of natural prepara- tions, by his father. The University is also indebted to the liber- ality of Elias H. Derby, Esq. of Salem, for several valuable and curious imitations, in wax, of various parts of the human frame, from a nunnery in Italy. They are also furnished with an exten- sive chemical apparatus, which, by recent improvements and ad- ditions, is supposed to be the most complete of any to be found in the United States. In addition to the foregoing advantages, a very important one has been conferred by Ward Nicholas Boylston, Esq., a distin- guished and liberal citizen of this commonwealth. In 1800, he presented to Harvard University a valuable collection of more than 400 volumes of medical and anatomical works and engrav- ings, with permanent arrangements for future additions. The use of this collection is extended to the fellows of the medical society, residing within ten miles of Cambridge. In the year 1803, " with the beneficent and laudable view of improving the art of medicine, and to excite practitioners to bring those talents to light, which might otherwise be lost to the community," the same gentleman provided a fund, the proceeds of which are to be annually appropriated to the purpose of a compliment- ary premium to the authors of the best performances on such medical, anatomical, physiological or chemical subjects, as are proposed by a committee of the medical faculty, appointed by the corporation of Harvard University. Premiums have been annual- ly adjudged, agreeably to the design of the founder, for ingenious and approved dissertations, which sufficiently evince that this MEDICAL SCIENCE, &C. 35" generous establishment is well calculated to inspire the desired laudable emulation among professional men of the rising genera- tion, and to promote the interest of medical science in general.* Candidates for the degree of Doctor in medicine must attend two courses of the lectures of each of the medical professors in this University, and also their clinical practice in medicine and surgery, during the lectures. They must study two years under the direction of a regular practitioner of medicine, and allow a third to elapse before they can be examined. Provided, however, that, in extraordinary cases, the medical professors, with the consent of the president, may dispense with one course of lectures on such conditions as may be thought reasonable. Those who have not received a University education, shall satisfy the presi- dent and medical professors, of their knowledge in the Latin lan- guage, and in experimental philosophy. The examination of candidates will commence on the second Wednesday after the termination of the winter course of lectures, and the subjects of their examination will be Anatomy, Surgery, and Midwifery, the Theory and Practice of Medicine, Chemistry, Materia Medica and Clinical Medicine. Each of the candidates approved shall prepare an inaugural dissertation on some medical subject, which dissertation, having been submitted to the faculty of medicine, at least fourteen days before, shall be read and de- fended at a public examination, in the Philosophy chamber, at Cambridge, on the Friday preceding the last Wednesday in Au- gust, in presence of the Governors and Instructors of the Univer- sity, and such members of the Massachusetts Medical Society, and other individuals as may choose to attend. Each successful can- didate will be admitted to receive the degree of Doctor in medi- cine, at the ensuing Commencement. All those who have here- tofore obtained the degree of Bachelor in medicine at this Uni- versity, will receive the degree of Doctor in medicine. In the year 1809, John C. Warren, M. D. was associated with his father as adjunct Professor of Anatomy and Surgery, and John * The annual income of the Boylston fund amounts to one hundred dollars, which is divided into two premiums to be awarded as above mentioned. We rejoice that the valuable life of that distinguished philanthropist has been protracted to witness the great utility of his munificent donation ; and it should be gratefully acknowl- edged, that he has devoted his wealth and influence to the promotion of medical science, to a greateT extent than any other individual in America. 36 HISTORICAL SKETCH OP Gorham, M. D. adjunct Professor of Chemistry; and in 1812, James Jackson, M. D, superseded Dr. B. Waterhouse, as Profes- sor of the Theory and Practice of Physic. November 1st, 1815, John C. Warren, M. D. was inaugurated at the University Hall, Professor of Anatomy and Surgery in Harvard College, as successor to the late lamented Professor Warren, who held that station for many years, with great honor to himself, and advantage to the institution, and who was no less dis- tinguished for his talents and virtues, than zeal and success in per- forming the arduous duties of his profession. On the same occa- sion was announced the appointment of Jacob Bigelow, M. D. as lecturer in Materia Medica, and Walter Cbanning, M. D. as lec- turer in the Theory and Practice of Midwifery in the University. The legislature of Massachusetts, by a recent grant, have en- dowed the University with funds for the erection of a College of Medicine in Boston.* This large and handsome building is now completed, and the medical lectures of Harvard University begin in the lecture room annually, on the third Wednesday in Novem- ber, and continue three months. Fees. Anatomy and Surgery, by John C. Warren, M. D. $20 Chemistry, by John Gorham, M. D. 15 * The Massachusetts Medical College is situated in Mason-street, near the Boston Common and Mall. The building is of brick, 88 feet in length, and 43 in its greatest breadth. Its figure is oblong, with a pediment in front, and an octa- gonal centre rising above the roof, and also forming a three-sided projection in the rear of the building. This is surmounted by a dome, with a skylight and balus- trade, giving an appearance of elegance to the neatness and fit proportions of the building. The apartments on the first floor are a spacious Medical Lecture room, of a square form, with ascending semi-circular seats; a large Chemical Lecture room in the centre, of an octagonal form, with ascending seats ; a Chemical Laboratory, fitted up with furnaces and accommodations for the costly apparatus used in the lectures; and a room to be occupied by the Massachusetts Medical Society, which is filled by a Medical Library, already consisting of 3 or 4000 volumes. In the second story is the anatomical theatre, the most extensive room, occupying the whole central part of the building, covered with the dome and skylight; with semi- circular seats which are entered from above, and descend regularly toward the cen- tre. In this theatre are placed a beautiful statue of the Venus of Medici, and a noble cast of the Apollo of Belvidera, designed to illustrate the external forms of the human body. A large and a small room for practical anatomy, together with another for the museum, occupy, the extremities of the same story. MEDICAL SCIENCE, &C. 37 Midwifery and Medical Jurisprudence, by Walter Chan- nino, M. D. 10 Materia Medica, by Jacob Bigelow, M. D. jO Theory and Practice of Physic, by James Jackson, M. D. 15 For the degree of Doctor in medicine, 20 During the lectures, the students are supplied gratuitously with sets of osteological specimens for study, and can have the use of the dissecting room, on defraying the attendant expenses. They are admitted without any expense to the surgical operations and clinical practice of the Hospital. Medical students present, 1825? 130. Board in the city is obtained by a large portion of the class at $-3 per week. The faculty of medicine in Harvard University have founded, by their private donations, a library for the use of the students in medicine. The Boston medical library, consisting of nearly 2000 volumes, is now united with it, and deposited in the Medical College. The students of the Medical class will be admitted to both of these, as well as the valuable medical library presented by Ward N. Boylston, Esq. These highly valuable collections of medical books, will afford a supply amply sufficient for all the purposes of students in each of the principal departments of med- ical science. A hall in the new building is appropriated and fur- nished with every necessary aid and convenience for the study of anatomy. Students will have the aid of private demonstrations on any part they may prepare for the purpose, and every convenience will be furnished to assist them in making preparations for their own use. The number of subjects for demonstration is as great as could be wished. In future, the surgical lectures will be made to occupy nearly a third part of the course. Students will occa- sionally have access to the valuable and expensive collection of wax preparations lately purchased by the University, and when proper opportunities occur, they will be invited to attend surgical operations by the professor. The Massachusetts General Hospital, one of the most active and flourishing insitutions in the United States, has received, with- in a few years, more than $300,000 in private donations, in addi. tion to its previous very liberal endowment from the State Legis- lature. Some of the most splendid instances of public generosity 38 HISTORICAL SKETCH OP which the present age has witnessed, are to be found among the benefactions of the Massachusetts General Hospital. While this institution gives accommodation to the full extent of its means to the sick poor, it gives also admission, which was at first condition- al, but is now free, to the students of the medical class attending the lectures" of the physician and surgeon. Regular clinical lec- tures are now given, during the winter, by the professors of the theory and practice of physic, and students are admitted to the patients, to enable them to become practically conversant with the symptoms of diseases and the operation and influence of medicin- al agents. It is obvious that the privilege of gratuitous admission to so extensive a course of medical and surgical practice, is an advantage not usually attainable in medical schools, and one of the highest importance which can be offered during the period of pre- paration for the medical profession. The number of beds provid- ed for patients is at present one hundred, and the number of sur- gical operations of magnitude performed in this hospital within the last two years and nine months, amounts to one hundred and twenty. The cleanliness, punctuality, and order observed at the Hospital, the regular and daily attendance of the physician and surgeon, the care and attention in selecting suitable persons to serve as nurses and attendants on the sick, all combine to render this a most eligible and convenient asylum for those who may la- bor under chronic diseases requiring the assistance of the most skilful physician and surgeon. The practice of. the obstetric art was confined almost exclusive- ly to females, till within the last sixty years. The late Dr. James Lloyd, who finished his education in London, in the year 1753, was for many years an eminent physician in Boston, and he is said to have been the earliest systematic practitioner in midwifery in New-England. That branch is now taught in all our Univer- sities, and the practice has, in general, devolved on physicians. The establishment of a botanical garden at Cambridge, will doubtless prove, at a future period, an excellent auxiliary to the study of botany and pharmacy, and facilitate a knowledge of the indigenous plants of the country, and their introduction into the Materia Medica. Two townships of eastern land have been granted by our legislature, and a subscription of $30,000 has been obtained, for the purchase of land, and other expenses of this MEDICAL SCIENCE, &c. w valuable establishment. It is under the inspection of William D. Peck,* as professor of natural history, and a board of trustees, of which the president of the Medical Society is ex officio a member. The Massachusetts Medical Society was incorporated by an act of the legislature, in 1781, and in the following June was organiz- ed, and Edward A. Holyoke, M. D. appointed the first president. By several subsequent acts the constitution and by-laws have been so altered and reformed, as more effectually to promote the views and designs of the founders of this excellent institution. The number of fellows, originally limited to seventy, may now em- brace all the respectable practitioners of physic and surgery in the state, who, in the election of counsellors, may vote by proxy. In the act of incorporation, the honourable legislature have dis- closed their views of the high importance of medical regulations and establishments, formed on liberal principles, and fostered by the patronage of the government. They premise, that " it is clearly of importance that a just discrimination should be made between such as are duly educated and properly qualified for the duties of their profession, and those who may ignorantly and wickedly ad- minister medicine, whereby the health and lives of many valuable individuals may be endangered, or perhaps lost to the community." The society is therefore " authorized and required to appoint cen- sors or examiners of candidates, and license such as may be found qualified for practice; to devise and direct such systematic mode of medical instruction as might be deemed requisite for can- didates previous to examiuation, and to increase and diffuse med- ical knowledge." In order to subserve the views of the legislature, and to render the society extensively beneficial, it was desirable to unite and associate, as far as practicable, into one harmonious body of brothers, all the meritorious part of the medical practitioners in the commonwealth. For this purpose, great exertions have been made by the counsellors and fellows, since their organization, to select those gentlemen whose education and respectability as physicians or surgeons justly entitle them to the honours and privileges of the society. It is conceived that the object in view is in a great * Since the decease of Professor Peck, the botanic garden has been committed to the direction of Mr. Nattall. 40 HISTORICAL SKETCH OF degree accomplished, but if there remain some exceptions, the door is still open to persons of the proper description, and they will, when known, meet with a cordial reception. The society now con- sists of more than two hundred and sixty fellows, exclusive of hon- orary members. Their stated meeting is on the first Wednesday of June, annually, when a discourse on a subject connected with medical science is delivered by one of the fellows. Among other transactions at the annual meeting, a proper number of the fellows in the several counties of the state are elected by ballot to officiate as counsellors. This branch is authorized to elect fellows and honorary members, to appoint the officers of the corporation, to establish district societies, and, in general, to watch over and pro- mote the interests of the institution. The stated meetings of the council are on the day following the annual meeting of the society, and the first Wednesdays in October and February. The cen- sors meet for the examination of candidates for practice, on the Thursday next preceding the annual meeting of the society, on the days following the meetings of the council in October and February, and on special occasions, when the president by his writ- ten order may direct. The modes provided for the purpose of admission into this so- ciety, afford a facility which cannot fail of being satisfactory. Licentiates of the society and medical graduates at Harvard Uni- versity, who have been reputably engaged in the practice of medicine three years from the reception of the license or diploma, and have supported an honorable private character, may claim a right of admission. A candidate for admission by election must be nominated at a meeting of the counsellors by some one or more of the fellows of the society; and the person who has made the nomination, having satisfied the counsellors that the candidate is a respectable and honourable practitioner of medicine, he may be balloted for at any stated meeting of the counsellors after the expi- ration of three months. All Bachelors or licentiates in medicine, although not fellows, may claim the use of the society's library. It is the duty of the counsellors, once in three years, to publish a list of the most approved books, which should be read by medi- cal.students. The act of the legislature in 1813, authorizes the organization of district societies. Upon the application of any two members of the society, the counsellors may establish, within such districts and portions of the commonwealth as they shall MEDICAL SCIENCE, &C. 41 judge expedient, subordinate societies and meetings to consist of the fellows of the said corporation residing in such districts re- spectively, wherein the communication of cases and experiments may be made, and the diffusion of knowledge in medicine and surgery encouraged and promoted. (. The honourable legislature continue to extend their liberal patronage and encouragement to this society. In 1810, they grant- ed a township of land for its support, and they have exempted the fellows from serving in the militia, as a remuneration, in some degree, for their expense and exertions in promoting an institution of public interest and concern. The most salutary and beneficial effects have already resulted to the community from the association thus patronized by the go- vernment. By far the greater portion of respectable practitioners of medicine and surgery established in business in the common- wealth, are associated and cemented, into one learned body, whose efforts are continually directed to the extension and increase of medical knowledge. Their united and individual influence are exerted in favour of a regular system of medical education, and in discountenancing those who undertake the important employ- ment of the profession, without being qualified for the great and serious duties it imposes. They are, moreover, in some respects alert and vigilant guardians of the public health and welfare, re- garding with peculiar interest, as a public calamity, the occur- rence of every new epidemic or other disease, which assails the inhabitants of our country. The judicious measures adopted by the counsellors, relative to the cow-pox, in 1808, and the spotted fever, in 1810, have already been meutioned, and reference may be had to the society's communications for the detailed particulars of their valuable reports. At an early period of the institution (1790) the society pub- lished their first number of medical papers, containing a selection of important communications. A deficiency of funds for a time retarded the subsequent numbers, but two volumes are now com- pleted and distributed among the fellows of the society. In the last number will be found a brilliant and masterly dissertation on the mercurial practice in febrile diseases, by the president of the society, which is a valuable acquisition to the medical character of our metropolis, and of great utility to the physicians of the United 6 42 HISTORICAL SKETCH OF States. In 1808 a Pharmacopoeia conformable to the modern che- mical nomenclature, and designed to establish uniformity in the prescriptions of physicians, was published by the society as a stan- dard work. This valuable production was adopted as the basis of a compilation by the author of this work, entitled " The American New Dispensatory," which was approved by a committee of the society. A second edition has since been published, and, as co-operating with the society's Pharmacopoeia, and as an attempt to introduce many indigenous vegetables, as articles of our Materia Medica, it is hoped this Dispensatory may be found of some utility among the practitioners of our country.* The counsellors and fellows, having laboured with unwearied assiduity to establish this institution on a respectable foundation, and having imbibed a tenacious concern for its interest and dignity, it was not to be expected that persons of deficient education, or undeserving character would be admitted to a participation of its honours and privileges. Accordingly, proper means were adopted to exclude all such from a fellowship, as will appear by the follow- ing extracts from the bye-laws of the society. " Candidates and their qualifications. No person educated within the commonwealth shall be admitted to an examination by the censors of the society, or by those of any district society, un- less he have the following qualifications. 1st. He shall have such an acquaintance with the Greek and Latin languages as is neces- sary for a medical or surgical education, and with the principles of geometry and experimental philosophy. 2nd. He shall have attended two full courses of lectures, and studied three full years under the direction, and attended the practice of some one or more of the fellows or honorary members of the society ; during which time he shall have studied the most approved authors in Anatomy Chemistry, Materia Medica, Surgery, Midwifery and the The- ory and Practice of Medicine; or, at least, all those which the counsellors shall from time to time specify as constituting a proper course of medical or surgical education. No person educated out of this commonwealth shall be admitted to an examination either by the censors of the society, or those of any district society unless * A fourth edition of the American New Dispensatory has been published, and is nearly all disposed of. MEDICAL SCIENCE, &C. 43 he have the qualifications specified in the first of the articles above mentioned, and instead of those required in the second, shall have studied three full years under the direction, and attended the prac- tice, of some reputable physician or physicians, surgeon or surgeons, as the case may be. The censors of the society, and those of the several districts, before examining any candidate, shall demand and receive from him a satisfactory certificate of his being quali- fied in one or the other of the modes above mentioned. " Consultation. To promote the laudable design of the legis- lature in forming and incorporating this society, to prevent, as far as may be, all unqualified persons from practising medicine or sur- gery, and in order to discourage empiricism and quackery, it shall be deemed disreputable, and shall be unlawful for any fellow of this society, in the capacity of physician or surgeon, to advise or consult with any person, who, having been a fellow of the society, shall be expelled therefrom, or with any person whatever, who shall hereafter commence the practice of medicine or surgery within this commonwealth, until he shall have been duly examined, and approbated by the censors of the society, or by those of some district society ; or shall have received a degree of Bachelor or Doctor of Medicine at Harvard University ; or, (in case he shall have been educated in, or come from some other state or foreign country) shall have produced to the censors of the society, or those of the district wherein he resides, such evidence or testimonials of his qualifications for the practice of medicine or surgery, as they deem and certify to be sufficient to entitle him to the privileges of a physician or surgeon regularly introduced. And every fellow of the society who shall abet or assist any person not so qualified, by affording him assistance in the capacity of physician or sur- geon, shall, for such offence, be disqualified from giving his vote, at any meeting of the society, or of the district society whereof he is a member, for one year; shall be liable to the censure and re- primand of the counsellors, and, in aggrevated cases, to expulsion. " If any fellow of the society shall publicly advertise for sale any medicine, the composition of which he keeps a secret; or shall, in like manner, offer to cure any disease by any such secret medicine, he shall be liable to expulsion, or such other penalty as the society, vt their annual meeting, may think proper to inflict." 44 HISTORICAL SKETCH OP Officers of the Massachusetts Medical Society for 1825, James Jackson, M. D. President. Abraham Haskell, M. D. Vice President. John Dixwell, M. D. Corresponding Secretary. Johx Gorham, M. D. Recording Secretary. Jacob Bigelow, M. D. Treasurer. George Hayward, M. D. Librarian and Cabinet Keeper:" MEDICAL SCHOOL AT HANOVER, NEW HAMPSHIRE. The next medical school in course, is that of Dartmouth Col- lege, at Hanover, New-Hampshire, established in 1797. This school was founded by the ability and enterprise of Dr. Nathan Smith, who at that time had just returned from the University of Edinburgh, where he had spent some time for the completion of his studies. In 1798 he was appointed sole Professor of the school, and for 12 years gave lectures on the different branches of medicine, excepting two courses, in which he was assisted in the department of chemistry, and the institution has progressed to a respectable state of importance and usefulness. A considerable number of students have attended the annual courses of lectures, many of whom have been honored with professional degrees, by conforming to the university statutes, which are similar to those of Harvard University. Dr. Smith having relinquished his professorship in 1816, was succeeded by others, and the number of professors has been increased to three, as follows : Reuben D. Mussey, M. D. Professor of Anatomy, Surgery and Obstetrics. Daniel Oliver, M. D. Professor of the Theory and Practice of Physic, Physiology, and Materia Medica. J. Freeman Dana, M. D. Professor of Chemistry, Pharmacy, and Legal Medicine. The lectures commence in September, and continue fourteen weeks. There will be four lectures daily. Fee for the course, $50. For matriculation, $2. Boarding may be had at $1 25 * The following gentlemen have held the office of President of the Society from the period of its first organization. :— Edward A. Holyoke, M. D. 1782; William Kneeland, M. D. 1784; Edward A. Holyoke, M. D. 1786; Cotton Tufts, M. D. 1787; Samuel Danforth, M. D. 1795; Isaac Rand, M. D. 1798; John Warren, M. D. 1804; Joshua Fisher, M. D. 1815; John Brooks, M, D. 1823; James Jackson, M. D. 1825. MEDICAL SCIENCE &C. 45 per week. An infirmary has recently been established in connec- tion with the school, designed particularly for the instruction of the students, who will be admitted to operations upon infirmary patients. Graduations to take place at the close of the term and at the commencement. Many important additions have recently been made to their former valuable collection of anatomical and chemical preparations and apparatus. The number of students attending the lectures at this school in 1825, was eighty. MEDICAL COLLEGE OF MARYLAND. Tfie Fifth Medical School constituted in our country, is the Col- lege of Medicine at Maryland, established at Baltimore. Inl 804, Dr. B. Davidge commenced a course oflectures inBaltimore, on midwife- ry, to a class of six students. The year following, he lectured also on anatomy and surgery, to a class of seven students ; and in 180(3 to a class of nine students. In 1807, two eminent physicians, Dr. Cocke, of Virginia, and Dr. Shaw, of Maryland, united in the school, and lectures were given on the different branches of medicine. The same year a charter was granted by the legislature, and the school became regularly organized by the style of the College of Medicine, of Maryland. The medical department of this univer- sity, by the influence and zeal of its distinguished founder, and the labours of other eminent teachers, has been rapidly rising into im- portance, and at the present time is one of the most respectable institutions in the country. An infirmary has been recently erect- ed in connection with the school, for the purpose of clinical in- struction. There are seven professorships, and in 1824-5 the class was composed of 215 regular pupils. The present faculty :— John V. Davidge, M. D. Professor of the Principles and Practice of Surgery. Nathaniel Potter, M. D. Professor of the Theory and Practice of Medicine. Elisha De Butts, M. D. Professor of Chemistry and Mineralogy. Granville Sharp Pattison, Esq. Professor of Anatomy. Samuel Baker, M. D. Professor of Materia Medica. Richard W. Hall, M. D. Professor of Midwifery and the Diseases of Women and Children. Maxwell McDowell, M. D. Professor of the Institutes of Medicine. 46 historical sketch of MEDICAL INSTITUTION OF YALE COLLEGE. The Legislature of Connecticut, in October, 1810, devised a system of medical education admirably calculated to accomplish the important objects in view. It is to include a complete circle of medical science, and to consist of four professorships. Lec- tures were commenced in 1813, and have been continued annually. Students are required to study physic or surgery with some pro- fessor or practitioner of reputable standing, for two years, if graduated at some college, otherwise, three years, and to have arrived at the age of twenty-one years. They shall attend one course of each of the above systems of lectures at Yale College, or of some other medical institution, previous to being admitted to an examination for a license ; the said course of lectures being in- cluded within the term he is required to study. Candidates for the degree of Doctor of medicine are required to attend two courses of the above system of lectures at Yale College, or at some other public medical institution, where a similar course of public instruction is pursued. One meritorious and necessitous person from each county in the state, shall annually be allowed the privilege of attending one course of each of the systems of lectures gratis. For the benefit of the students, surgical opera- tions, and attendance during confinement, are given gratis by the professors, to all such poor patients as apply and submit to opera- tions in the presence of the class of medical students. Professors in 1825 :— ^neas Monson, M. D. Pofessor of the Institutes of Medicine. Nathan Smith, M. D. Professor of the Theory and Practice of Physic, Surgery, and Obstetrics. Benjamin Silliman, M. D. Professor of Chemistry, Pharmacy, Mineralogy, and Geology. Eli Ives, M. D. Professor of Materia Medica and Botany, and Lecturer on Diseases of Women and Children. Jonathan Knight, M. D. Professor of Anatomy and Physiol- ogy, and Lecturer on Obstetrics. Number of students in 1825, was 75. The lectures commence the last week in October, and terminate the last week in Feb- ruary. During the course, from 50 to 100 lectures are given by each professor. MEDICAL science, &C. 47 The students have access to the lectures on Natural Philoso- phy, on paying the fees of the course, and they may attend the lectures on Mineralogy and Geology, without charge. A distinct course is given on Obstetrics, by the professor of Anatomy, and another, on the elements of Botany, by the professor of that de- partment. The examination for licenses and degrees is held im- mediately after the close of the lectures. The Institution is furnished with a Library and Anatomical Museum. The students have access also to the Library of the College, and to the Cabinet of Minerals. The fees, which are paid in advance, are 12 dollars and 50 cents for each course. The Matriculation fee and contingent bill, are 7 dollars and 50 cents. The entire expense of a residence of four months, through the courses, including fees and all expenses, except clothing, is from 120 to 150 dollars. The medical students, during their residence in the Institution, are subject to the same moral and religious restraints, as those of the Academical College. COLLEGE OF PHYSICIANS AND SURGEONS OF THE WESTERN- DISTRICT OF THE STATE OF NEW-YORK. In June, 1812, a new medical school was incorporated by the Regents of the University of New-York, into a College of Phy- sicians and Surgeons. It was located in the town of Fairfield, Herkimer county, and encouraged by a liberal grant of $15,000 by the Legislature of that state. The year following, the school was organized by the trustees, and brought into operation with five professorships. In 1824-5, the medical class was composed of 120 students. Joseph White, M. D. President, and Professor of Surgery. Westel Willoughby, M. D. Vice President and Professor of Obstetrics. James Hadlev, M. D. Professor of Chemistry and Materia Medica. T. Romevn Beck, M. D. Professor of the Theory and Practice of Physic, and Medical Jurisprudence. James M'Naughton, M. D. Professor of Anatomy and Physiol- 48 historical sketch of MEDICAL COLLEGE OF OHIO. This institution was established at Cincinnati, in 1818, but has since undergone considerable changes, and for a time the lectures were suspended ; but its labors have recommenced under a new charter of the Legislature, and the first course of lectures deliver- ed after its reorganization, in 1824-5, was attended by 22 students. The present number of professorships is four. It has a hospital, to which the students are admitted for clinical instruction. Jedediah Cobb, M. D. Professor of the Institutes and Practice of Medicine. Elijah Slack, A. M. Professor of Chemistry and Pharmacy. John Moorhead, M. D. Professor of Materia Medica and Med- ical Obstetrics. Jesse Smith, M. D. Professor of Anatomy and Surgery. VERMONT ACADEMY OF MEDICINE. In 1818, the Vermont Academy of Medicine was established at Castleton, in that state, under the charter of Middlebury Col- lege. This school has five professorships. The medical students attending the last course of lectures were 124. Professors:— William Tully, M. D. Professor of the Theory and Practice of Physic, and Medical Jurisprudence. Theodore Woodward, M. D. Professor of the Principles and Practice of Surgery, Obstetrics, and the Diseases of Women and Children. William Anderson, M. D. Professor of Anatomy and Physi- ology. Amos Eaton, Esq. Professor of Chemistry and Natural Phi- losophy, and Lecturer on Natural History. Jonathan A. Allen, M. D. Professor of Materia Medica and Pharmacy. TRANSYLVANIA UNIVERSITY. The medical school of Transylvania University was instituted in 1818, at Lexington, Kentucky. At the time of the first organ- ization of the institution, five professorships were established, all of which have been filled. This school has experienced the most rapid growth of any in the United States. The first course of MEDICAL SCIENCE, &C. 49 lectures were delivered in 1819, to a class of 26 students. The medical class in 1824-^5 amounted to 235. An infirmary is con- nected with the school, which affords an opportunity for clinical instruction to the class. At their commencement, in 1824, 46 young gentlemen were admitted to the degree of M. D. July, 1825, the degree of M. D. was conferred on 57 students. Num- ber of the medical class, 272. Their anatomical museum com- prehends a very ample variety of wax preparations. Two pro- fessorships have been added. Benjamin W. Dudley, M. D. Professor of Anatomy and Sur* gery. Charles Caldwell, M. D. Professor of the Institutes and Clinical Medicine. Samuei. Brown, M. D. Professor of the Theory and Practice of Medicine. Daniel Drake, M. D. Professor of Materia Medica and Med- ical Botany. William H. Richardson, M. D. Professor of Obstetrics, and the Diseases of Women and Children. James Blythe, D. D. Professor of Chemistry. Robert Best, Adjunct Professor of Chemistry. MEDICAL SCHOOL OF MAINE. The Medical School of Maine was established at Brunswick, under the charter of Bowdoin College, in 1820. It has three professorships. Sixty students attended the course of lectures in 1824-5. The lectures commenced on the 20th day of February, 1826. Theory and Practice of Physic, by Henry H. Childs, M. D. Pro- fessor in the same department in the Berkshire Medical Insti- tution. A"dnny and Surgery, by J. D. Wells, M. D. Mkhrifry,by J. M'Kean, M. D. Chemistry and Mitcria Medica, by P. Cleaveland, M. D. The anatomical cabinet is very valuable and extensive, contain- ing all the preparations necessary for demonstrations, &c. The library alreidy embraces the most valuable modern works on medicine, and its collateral sciences; and is every year enriched by new works, both foreign and American. Surgical operations; 7 50 HISTORICAL SKETCH OF when any occur, are performed in the presence of the students. Boarding from $1,50 to $1,75 per week; or, including wash- ing, room-rent, fire-wood, and lights, $2,50. Fee for the lec- tures, $45. MEDICAL INSTITUTION OF RHODE-ISLAND. About the year 1756, a Dr. William Hunter, who had been ed- ucated at Edinburgh, gave, at Newport, the first anatomical and surgical lectures ever delivered in the American colonies. They were delivered two seasons in succession, and were then discontin- \^ ued. In 1815, some arrangements were made for medical instruc- j4 tion in connexion with Brown University, at Providence, and } several courses of lectures were given by William Ingalls, M. D. A as Professor of Anatomy and Surgery, and Solomon Drown, M. D. . v Professor of Materia Medica and Botany. At their commence- "Nrnent, in September, 1816, we find the names of nine graduates ■K rffeXti0116^ as having received the degree of M. D. after the usual 1 examinations, and having publicly read and defended medical dis- v sertations. In 1821, the medical department of Brown Univer- *-^ sity, at Providence, was organized with four professorships. Forty > students attended the last course of lectures, 1825. Levi Wheaton, M. D. Professor of the Theory and Practice of Physic and Obstetrics. John De Wolf, A. M, Professor of Chemistry and Pharmacy. Usher Parsons, M. D. Professor of Anatomy, Physiology, and Surgery. Solomon Drown, M. D. Professor of Materia Medica and Bo- tany. MEDICAL SCHOOL OF VERMONT. In 1822, the medical school of the University ef Vermont, was organized at Burlington, and four professorships instituted. The lectures commence at Burlington, on the second Wednesday in September, and continue twelve weeks. Professors under the new organization— Henry S. Waterhouse, M. D. Professor of Surgery and Ob- stetrics. George W. Benedict, A. M. Professor of Mathematics, Natu- ral Philosophy, and Chemistry. MEDICAL SCIENCE, &C. 51 John Bell, M. D. Professor of Anatomy and Physiology. William Sweetser, M. D. Professor of Theory and Practice of Physic, and Materia Medica. Fees for the whole course, $40, and $3 in addition, to be paid by each student on becoming matriculated. This school, it is be- lieved, offers to the student of medicine every advantage Which • can be obtained at any other medical institution of the same class- It has heretofore received a good share of public patronage, and the present professors pledge themselves to exert their best abili- ties, and to spare no expense which may come within their means, to increase its reputation and usefulness. It is situated in a popu- lous and delightful village, where board may be obtained near the lecture rooms, on very reasonable terms. The medical class of 1824—5, was composed of 42 students. BERKSHIRE MEDICAL INSTITUTION. This flourishing institution was founded in 1822, and located in Pittsfield, Mass. under the charter of Williams College, of that state. This school has six professorships, occupied as follows :— John P. Batchelder, M. D. Professor of Surgery and Physi- ology. Jerome V. C. Smith, M. D. Professor of General Anatomy and Physiology. Henry H. Childs, M. D. Professor of Theory and Practice of . Medicine. John De La Matter, M, D. Professor of Materia Medica, Pharmacy, and Obstetrics. Stephen W. Williams, M. D. Professor of Medical Jurispru- dence. Chester Dewey, A. A. S. Professor of Botany, Mineralogy, Chemistry, and Natural Philosophy, Ample provision has been made by the trustees, for the per- sonal accommodation and instruction of those who may resort to the institution. They have in possession an extensive collection of minerals, a valuable herbarium, and an anatomical museum, em- bracing a great variety of models and preparations. The annual lecture term commences on the second Wednesday in September, ind continues 15 weeks. Medical degrees are conferred at the ■ lose of the lectures, and at the annual commencement at Wil- 52 HISTORICAL SKETCH OP liams College, The requisites for an examination for a degree are, a good moral character, three years' study (including the time devoted to lectures) with a regularly practising physician, an ade- quate knowledge of the Latin language, and attendance on two full courses of lectures, one of which must have been in this in- stitution. The examination of candidates for degrees commences on Thursday preceding the close of the lecture term. Disserta- tions must be lodged with the Dean of the Faculty at least four weeks previous to commencement. Fees for the whole course, $40. Graduating fee, $12. Matriculating Ticket, $3. Tickets of admission for those who wish to attend the lectures on Botany, Mineralogy, Chemistry, and Natural Philosophy, $6. Board, including washing, lodging, and room-rent, $1,75 per week. In 1824-5 ninety-four students attended the course of lectures. In 1825-6, 112 students attended. MEDICAL COLLEGE OF SOUTH-CAROLINA. In 1824, the Medical College of South-Carolina was establish- ed at Charleston. In this school there are seven professorships. Fifty medical students attended the first course of lectures deliver- ed in 1824-5. The students have the privilege of attending the practice of the Marine Hospital. John Edwards Holbrook, M. D. Professor of Anatomy. S. Henry Dickson, M. D. Professor of the Institutes and Prac- tice of Physic. James Ramsay, M. D. Professor of Surgery. Thomas G. Prioleau, M. D. Professor of Obstetrics, and the Diseases of Women and Children. Henry Rutledge Frost, M. D. Professor of Materia Medica. Edmund Ravenel, M. D. Professor of Chemistry and Pharmacy. Stephen Elliot, LL. D. Professor of Botany and Natural History. The lectures commence on the second Monday in November, and continue five months. To entitle an individual to examina- tion for a degree, it is necessary he should have studied for two years with an established practitioner. Arrangements for private dissection are peculiarly attended to, and subjects are obtained in abundance, and with great facility. The college building contains a chemical laboratory, and the students have access, upon the MEDICAL SCIENCE, &C. 53 most liberal terms, to the select and extensive library of the med- ical society. The privilege of attending at the Marine Hospital and the Poor-House are obtained free of expense, and all opera- tions in surgery at those establishments may be witnessed by the whole class. MEDICAL SCHOOL OF JEFFERSON COLLEGE. The Medical School of Jefferson College, Pennsylvania, was established, and located at Philadelphia, in 1824. This school has six professorships; and, though fully organized, has not yet been brought into operation. An infirmary is connected with the school, to which the students will be admitted for clinical in- struction. John Eberle, M. D. Professor of the Theory and Practice and Clinical Medicine. George M'Lellan, M. D. Professor of Surgery. Jacob Green, A. M. Professor of Chemistry. B. Rush Rhees, M. D. Professor of Materia Medica. F. S. Beattie, M. D. Professor of the Institutes of Medicine, and Midwifery. Nathan R. Smith, M. D. Professor of Anatomy and Physiol- ogy- MEDICAL SCHOOL OF THE COLUMBIAN COLLEGE. The medical department of the Columbian College, in the dis- trict of Columbia, was instituted in the year 1824, under a charter of the Congress of the United States. The first course of lec- tures on the different branches of medicine was delivered in the spring of 1825, to a class of 22 students. The second course was commenced in November following, with a class of thirty students. An infirmary is connected with the school, to which the students are admitted for clinical practice and operative sur- gery, free of expense. The students are also permitted to attend, gratuitously, the lectures in the classical department of the college, on Natural and Experimental Philosophy, Astronomy, Botany, and Natural History. The peculiar advantages which this institu- tion derives from its location, being established at the seat of the national government, as well as from the situation of the surround- ing country, promises to become, under the zeal and enterprize of 54 HISTORICAL SKETCH OF its learned professors, one of the most important and useful med- ical schools of our country. The medical faculty are— Thomas Sewall, M. D. Professor of Anatomy and Physiology, James M. Stoughton, M. D. Professor of Surgery. Thomas Henderson, M. D. Professor of the Theory and Prac- tice of Medicine. N. W. Worthington, M. D. Professor of Materia Medica. Edward Cutbush, M. D. Professor of Chemistry. Frederick May, M. D. Professor of Obstetrics. In order to embrace all the benefits of a winter school, the lectures will annually commence on the first Monday in November, and continue to the last of February. During this period, lectures will be delivered daily, and full courses be given on the various branches of medicine. Such arrangements have been made as will furnish the professor of Anatomy with materials for demon- stration, and the class with ample opportunity for the cultivation of practical Anatomy. Provision has also been made for exhibiting to the class the clinical practice and operative surgery in the In- firmary of the Washington Asylum, free of expense. The exten- sive and complete apparatus of the professor of Chemistry will afford every facility for displaying the experimental parts of that science. Each student, before he can receive the ticket of any professor, shall pay five dollars to the Treasurer of the College. The fees for attendance on the lectures shall be $15 to each pro- fessor for the course. All students who shall have attended two full courses in this school, shall be entitled to attend succeeding courses free of expense. No student shall be admitted to exami- nation for a medical degree, till he shall have attended each pro- fessor during two full courses, or one full course in this College, and one in some other respectable medical institution, and shall have studied three years under the direction of some regular phy- sician. He shall have satisfied the medical professors of his classical attainments, if he be not a graduate in the arts. He shall have entered his name with the Dean of the medical department, as a candidate for graduation, and delivered to him an inaugural dissertation on some medical subject, thirty days at least before the close of the course. There shall be an annual commencement for conferring medical degrees, the time of which shall be as early *fter the close of the lectures as the examination of the candidates medical science, dec. JJ will admit. Before a candidate can receive the degree of Doctor of medicine, he must pay $30 for examination, and $5 for his diploma.* It may not be deemed improper to observe, that the introduc- tory lecture, by the professor of Anatomy and Physiology, in March, 1825, displays that talent and scientific intelligence which should characterize the professors of our medical schools, and which may be considered as a happy presage of the future success and prosperity of this establishment in the metropolis of our nation. A few detached paragraphs from this excellent production are introduced here, as follow :— " When we consider this as the place which has been selected by our country as the seat of its National Government; the residence of the chief magistrate of the Union, the heads of departments, the ministers of foreign courts; the place where our Senators, Representatives, and Supreme Judiciary, annually assemble to transact the affairs of the nation ; we cannot doubt but it is des- tined, ere long, to fulfil the expectations of its immortal founder, and become worthy to be the metropolis of this great Republic." Here is " that neutral ground on which the young men of Maine and of Georgia, of Pennsylvania and Missouri, of Florida and Michigan, may meet and mingle together ; read the same books; pursue the same studies; hear the same lectures; imbibe the same spirit; and form mutual and lasting attachments," &c. &c. This elegant production closes thus: " Who knows but some bold and fortunate genius, who shall have his zeal first enkindled in this school, may be destined,while climbing the Rocky Mountains, or exploring the vale of the Mississippi, to discover a plant or a mineral which shall prove a cure for hydrophobia, or a remedy for consumption 1—or find out on the shaking prairie of Louisiana, or at the mouth of the Mobile, the true nature of miasmata, and the mode of its operation on the human body ? Who knows but this school may be destined to produce a Sydenham, a Harvey, a Hun- ter, or a Bichat?—or to give to the world a Bard, a Rush, a War- ren, a Barton, or a Wistar V * Good board may be obtained for students, at from 3 to 5 dollars per week. 55 historical sketch or MEDICAL SCHOOL OF AUBURN, NEW-YORK. The medical school of Auburn was established in 1825, and has five professorships. James Douglass, M. D. Professor of Anatomy and Physiology. Pliny Hayes, M. D. Professor of the Principles and Practice of Surgery. . E. D. Tuttle, M. D. Professor of Theory and Practice of Physic. S. Mosher, M. D. Professor of Midwifery and Diseases of Woman and Children. Jedediah Smith, M. D. Professor of Chemistry and Materia Me- dica. MEDICAL SCHOOL OF THE VALLEY OF VIRGINIA. In 1826, the Medical School of the Valley of Virginia was es- tablished at Winchester, in that state, and has four Professorships. John G. Cooke, M. D. Professor of the Theory and Practice of Physic and Obstetrics. Phillip Smith, Professor of Materia Medica. H. H. Mc Guire, M. D. Professor of Anatomy and Physiology, A. F. Magill, M. D. Professor of Surgery and Chemistry. By the establishment of medical schools and societies through- out our country, within the last forty years, most important im- provements have been made in almost every branch of medicine, and it must gratify every patriot to know that our own country- men have acted a very conspicuous part in effecting an object, in which the interests of mankind are so deeply concerned. These circumstances will be hailed as propitious omens of the prosperity and literary fame which await our aspiring citizens. Important and auspicious effects are already visible in the character of our physicians. A thirst for the acquisition of knowledge, a laudable emulation, a taste for observation, inquiry and research, have been excited and the talents and efforts of medical men in various sec- tions of the Union have been combined. Within the last thirty years, medical publications have greatly multiplied in the United States, and many of them reflect hon- our both on their authors and on the national character. The numerous and valuable works of our late medical philosopher, Professor Rush, hold the first rank in the American catalogue. These, with the learned productions of Professors Barton, Mitchell, medical science, &c. 57 and Hosack, have been translated into various foreign languages, and received the meed of applause from some of the most cele- brated characters of the European continent. There are nume- rous other writers in the United States, who, by their labours, have honourably contributed to our domestic literature and sci- ence. Many handsome specimens of ability, industry and learn- ing, will be found among the various inaugural dissertations pub- lished by the students of our medical schools ; and the mest consi- derable portion of our journals and other periodical publications, in point of merit and utility, may vie with the long established vehicles and repositories of medical intelligence beyond the At- lantic. The first periodical publication, consecrated to medical science in the United States, was the Medical Repository, a valuable pro- duction, commenced in the year 1797, by the ingenious editors, Drs. Samuel L. Mitchell, Edward Miller, and Elihu H. Smith, of New-York. The fame of this work has extended not only through our own, but to different foreign countries, and its high character is universally acknowledged. Although Dr. Miller, one of the learned editors, has ceased from his labonrs, his active spirit still lives, to inspire his surviving associates in the work which he com- menced, and which has contributed so essentially to the growing fame of his country. The Medical Repository is not now our only medium of medi* cal intelligence. Many others of real merit have since been in- troduced ; among which are Dr. Barton's " Philadelphia Medical and Philesophical Journal," and " the Medical and Philosophical Register," a respectable work, by Dr. Hosack, of New-York ; Dr. Coxe's valuable " Medical Museum" is discontinued. The " New- England Journal of Medicine and Surgery" commenced in Bos- ton, with the year 1812. It is edited by gentlemen of profession- al eminence, and evinces the talents and ardour for medical im- provement which distinguish the faculty of Massachusetts. In addition to many valuable original essays, it exhibits to the Ame- rican student and physician the earliest information of whatever is new, ingenious, or useful, in foreign publications, connected with the science of medicine. The plans and means - of instruction in our establishments and seminaries, are continually meliorating and improving. The road to medical knowledge is laid open, and is fraught with allurements. 8 "u 58 HISTORICAL SKETCH OF Emulation and fashion are directing their votaries into its various avenues, and conducting them to the fountain of professional hon- ours, distinctions, and emoluments. Instead, therefore, of hum- bly reaping the fruits of European fields, let us assiduously culti- vate and diffuse the ample advantages to be found in our own. The opportunities of practical instruction, which our epidemic and endemic diseases of the hot season afford, are peculiarly interest- ing and important. They impart to young students a knowledge, which they cannot acquire in Europe, of the causes, symptoms, prevention and cure of the diseases of the country in which they are to practice. In duly appreciating our own institutions and advantages, we advance the interests and reputation of our coun- try, and prevent the necessity of students resorting to Europe, and subjecting themselves to heavy expenses to qualify them for the practice of medicine. With respect to theoretical systems, those of the celebrated Cullen and Rush, improved and modified according to the judg- ment of the respective professors, are in general adopted and taught in the various American Universities. In the art of surgery, the leading authorities are Pott, the Bells, Desault, the Coopers, Abernethy, Cline, Home, Latta and Hey, to which we may add our own countrymen, Dr. Physick, Dr. Gib- son, and the late Dr. Dorsey, of Philadelphia, Drs. Post and Mott, of New-York, and the late Dr. John Warren, and Dr. John C. Warren, of Boston, and others, whose names we may with pride associate with those who have adorned the annals of surgery, in either hemisphere, in ancient or modern times. In the depart- ments of chemistry and botany, the most modern European au- thors are consulted, together with the labours and improvements of our own enlightened professors. American botany is now cul- tivated with that ardour and solicitude, which the importance of the subject demands, and many indigenous medical plants have been introduced as new articles of our materia medica. We have now detailed, in the order of time of their respective establishments, no less than twenty medical schools and colleges in the United States, and there is the best reason to believe that they have been organized with great judgment, and are conducted with commendable zeal and ability. It will be perceived that a coarse of lectures is given in all the institutions on the various MEDICAL SCIENCE, &C, 59 ' branches of medical science, from three to five months annually. The subjects of anatomy and surgery are illustrated by dissections and operations on the dead subject, and by models, drawings, and dried preparations ; the subject of chemistry, by the exhibition of chemical experiments. Most of the schools are in possesion of valuable medical libraries, anatomical and mineralogical calrrnets, museums, &c, and, in almost all instances, hospitals or Infirmaries are established in connexion, affording the young student the best possible opportunities of improvement in practical medicine. Eve- ry school is invested with the power of conferring medical degrees on those who, on examination, are found to be entitled to such honours ; the manner and form are nearly similar in all the schools. Such is the unexampled progress in medical improvement, and the ample means of instruction at the present day, although "one hun- dred and fifty-eight years of our history elapsed, after the first settlement of America, before a single medical school existed in the country." No less than fifteen institutions for medical instruc- tion, have been established within the last seventy-three years. And though sixty years ago one only was established, and but ten pupils to attend its lectures, we may at the present time boast of twenty schools, occupying the combined talents of about ninety eminent Professors, imparting, at the sessions of the several schools in 1824-5, public instruction to more than two thousand young students, and at the lecture term the present season, the number has probably increased. Besides the numerous seminaries already noticed, medical societies for the regulation of the practice of phy- sic, and the suppression of quackery and empiricism, have been formed in most of the states in the union. The establishment of these institutions originated with the Legislature of Massachusetts, who in the year 1781, incorporated the first body of this descrip- tion, by the name of the Massachusettss Medical Society. The views and designs of the founders of this excellent institution, with the very important advantages which have resulted to the community by its operation, have already been detailed at page 39. "Similar societies," says Professor Sewall,* "have since been incorporated by the Legislatures of Maine, New-Hampshire, Vermont, Rhode Island, Connecticut, New-York, New-Jersey, • Scr Introductory Lecture at Columbian College, March SO.. 1825. 60 HISTORICAL SKETCH OF Delaware, Maryland, Virginia, South Carolina, Georgia, Mississip- pi, Alabama, Louisiana, Ohio, Indiana, and Illinois, besides one in the District of Columbia, constituted by an act of Congress. We have, therefore, at this time twenty State Medical Societies, most of which have subordinate branches in the different districts or counties ; besides numerous other associations, instituted for simi- lar purposes, in our principal towns and cities. In some of the states, where such societies exist, persons who are not licensed are permitted to practise, and are allowed the benefit of the law; and in some of the states, a severe penalty is inflicted for prescrib- ing medicine without a licence. The good effects of the latter re- gulation are strikingly exemplified in the exemption of Maryland and the District of Columbia from those quacks and impostors which are still found in some other parts of our country. These societies, wherever they have been established, have promoted a spirit of harmony among the members of the profession, and at the same time excited a degree of emulation, and a spirit of medi- cal inquiry, which have been highly beneficial, and, while they have given character and respectability to the practice of medi- cine, they have been signally useful in protecting the community against impositions and quackery." " Besides our medical schools and medical societies," says Professor Sewall, " dispensaries, hos- pitals, infirmaries, and asylums for the reception of the poor, the sick and insane, have been established in almost every part of the country. Several hundreds of these institutions, supported by public endowments or private charity, are found in the United States ; and while they afford means of protection and relief to a large portion of the helpless and suffering part of the community, they furnish ample opportunities to the medical student to investi- gate the causes and nature of diseases, and become acquainted with the operation of remedies ; thus uniting the objects of huma- nity and the advancement of medical science. This is not all that has been done in America for the interest of medicine. We have already produced some of the best works of the present day on anatomy, surgery, the theory and practice of physic, materia me- dica, pharmacy, chemistry, obstetrics, and medical jurisprudence ; works which have not only been adopted as the text books of our schools, but have been republished abroad, and received the high- est commendation of European professors. Our periodical jour- MEDICAL SCIENCE, &C 61 rials, of which we have no less than twelve, published quarterly, or at less intervals, besides hospital reports and the transactions of medical societies, abound with original papers, and many of them of great value. It must be gratifying to every American to know, that the medical literature of the United States is at this time sought for, and read with avidity in every part of the civiliz- ed world ; while much of it is translated into the French, the German, and Italian languages, and republished in the journals of those countries; the highest compliment that could be paid to the genius and industry of our physicians. Such has been the progress of medical science in the United States. If its advancement in the early periods of our country was slow and obscure, its im- provement in later times lias been rapid, beyond a parallel in the history of the world. What age, or nation, has produced in a little more than half a century, a system of medical education and of of medical police to be compared with that of our country 1 At what period, or in what nation can seventeen medical schools, twenty medical societies, more than two hundred hospitals, and other in- firmaries for the sick, twelve periodical journals,—to say nothing of other works on the various branches of medicine,—be found the product of sixty years ? Or where shall we find the salutary effects of medicalttducation so extensively diffused, or so striking- ly illustrated, as in the United States ? If we have produced no medical school which lias dictated to the world the doctrines that should be taught and believed, it is because freedom of inquiry, independence of thought, aud equality of condition, constitute the predominant features of our country, and enter into the genius of all our institutions. If we have produced no fortunate genius, whose discoveries have at once revolutionized the science, or established a new era in medicine; we have produced a host of able teachers, successful practitioners, and some of the best writers of the age." " If much has already been accomplished, much still remains to be done. Though our large towns and cities, and the more populous parts of our country are supplied with well ed- ucated physicians, a large portion of our territory, remote from the schools, is still without those who have enjoyed the benefits of public instruction. If we have ten thousand physicians, as computed by a late writer, we have more than fifteen thousand practitioners of medicine, many of whom have never heard a public lecture, 62- HISTORICAL SKETCH OF or seen a demonstration in anatomy. And, until medical schools be more extensively established through the country, many who enter the profession, must necessarily be deprived of the privileges of a regular education." " If, in sixty years, with the limited means we have possessed, and with all the difficulties we have had to encounter, we have produced the best system of medical educa- tion, the most perfect code of medical police that has been exhi- bited to the world ; if we have produced some of the best practi- cal and elementary books, and some of the most eminent physi- cians and surgeons of any age or country ; if we have done this iu the short period of sixty years that are passed, what will be our advance in sixty years" to come ? May I not with propriety, to use the language of a distinguished scholar of our country, say on this, as he said upon another occasion, ' He who shall stand where I stand sixty years hence, and look back on .the present condition of medical science from a distance equal to that from which we contemplate the founding of the first medical school in America, will sketch a contrast far more astonishing, and will speak of our times as the day of small things, in stronger and juster language than any in which we can depict the poverty of the science in the days of our fathers.' " The foregoing sentiments of Professor Sewall, as respects the multiplication of medical schools, and the increased facilities of acquiring professional knowledge, cannot but receive universal acquiescence, as a happy display of the prosperi- ty of our country, and auspicious to our national character. But it may be queried whether we have by our numerous establish- ments advanced to such a state of perfectability as to decide whe- ther our systems are to be considered as actual improvements on those of Europe, or is it problematical whether our twenty schools, and more than ninety Professors, act with more real efficiency than if the aggregate labours were concentrated into three or four institutions, advantageously located, with less than half the num- ber of Professors, and may it not be inquired, whether our two thousand students quit the institutions possessed of all those scien- tific attainments, which, in European schools, are deemed indis- pensable ? In some of our cities, instances have not been want- ing to prove that prosperity and successful progress depend less upon the number of schools, than the harmoniously combined ef- forts of a single institution. Nor is it to be supposed that all our MEDICAL SCIENCE &C; 6S Professors and teachers can have experienced snch advantages as to render them intrinsically qualified to discharge the duties which are imperiously incumbent upon them. Another point may also be questionable, whether a short session, as in some of our schools, and the daily lectures of six or seven Professors, is not calculated to confuse and overwhelm the mind of the student, without afford- ing a fair opportunity to treasure up and retain those lessons which are intended for his instruction ? It seems to be important that uniformity in discipline and bye-laws should prevail in all our medical schools,, that students may find no temptation to resort to a particular institution, with the view of obtaining a doctorate in medicine on terms more favourable and convenient. Collision and rivalry ought on every occasion to be reprobated, by all who have at heart the true interest and honour of the profession. But so multiplied and copious are now the fountains of medical hon- ours, that the streams flow into every one's soil, and the diploma waits to announce talent and acquirements with surprising facility. The following is a catalogue of periodical Journals on Medicine and Surgery, published in the United States. The New-York Medical Repository was the first, and was com- menced in that city in 1797, by the joint labors of Doctors Sam- uel L. Mitchell, Edward Miller, and Elihu H. Smith. Since the commencement of this work, a succession of periodical journals have been established, among which are— The Philadelphia Medical and Physical Journal, in 1804 Philadelphia Medical Museum, in 1805 Baltimore Medical and Physical Recorder, in 1808 New-York Medical and Bhilosophical Journal and Re- view, in 1809 American Medical and Philosophical Register, (at New- York), in 1810 The American Mineralogical Journal, (at New-York), in 1810 Eclectic Repertory, (at Philadelphia), in 1811 Baltimore Medical and Philosophical Lyceum, in 1811 New-England Journal of Medicine and Surgery, (at Bos- ton), in 1812 American Medical Recorder, (at Philadelphia), in 1818 Philadelphia Journal of Medical and Physical Sciences, in 1820 American Journal of Science and Arts, (New-Haven), in 1821 64 HISTORICAL SKETCH 01 New-York Medical and Physical Journal, in 1822 Western Medical Reporter, (at Cincinnati, Ohio), about 1822 Hartford Analectic Journal of Medicine and Surgery, in 1823 Boston Medical Intelligencer,* in 1823 Medical Review and Analectic Journal, (at Philadel- phia), in 1824 New-York Monthly Chronicle of Medicine and Sur- gery, in !824 Carolina Journal Of Medicine, Science, and Agriculture, (at Charleston), in 1825 " Several of the journals which have been established, are dis- continued, and -others have assumed a different title. Twelve only are published at the present time, though five more are soon to be added to this number." The Counsellors of the Massachusetts Medical Society have given notice, that candidates for examination before the Censors, shall give evidence of having read or studied the books whose titles are contained in the list which follows, viz. The Edinburgh System of Anatomy. Bell's System of Anatomy, or Wistar's Anatomy. Haller's First Lines of Physiology. Richerand's Elements of Physiology. Bichat on Life and Death. Bichat's General Anatomy, translated by Dr. Hayward. Beclard's Additions to Bichat's General System of Anatomy, translated by Dr. Hayward. Lavoisier's Elements of Chemistry. Gorham's do. do. Pharmacopeia of the United States. Bigelow's Sequel to the Pharmacopeia. Thacher's Dispensatory. Cooper's Surgery, or Dorsey's Surgery. Boyer's System of Surgery. Boyer on the Bones. Hunter's Treatise on the Blood, Inflammation, and Gun-sfiot Wounds. * This interesting production, is on the plan of a weekly newspaper of eight pages. It is conducted with intelligence and good judgment, and is entitled to the favourable notice of practitioners generally. MEDICAL SCIENCE, &C §5 Burns' Anatomy of the Gravid Uterus. Denman's System of Midwifery. Denman's Aphorisms. Good's Physiological System of Nosology. Good's Study of Medicine. G. Fordyce's Dissertations on Fever. Armstrong's Illustrations of Typhus, &e. Sydenham's Works. Heberderi's Commentaries on Diseases, Underwood on Diseases of Children. Hunter's Treatise on Lues Venerea. Baillie's Morbid Anatomy. Cook's Abridgment of Morgagni on the Seats and Causes of Diseases. " Although the books mentioned in the foregoing list are all that candidates are required to have read, yet the counsellors be- lieve that many more may be carefully read, during the period of pupilage, and they have therefore prepared another list of books, which they recommend for the perusal of students in medicine." The ample list just mentioned may be found in the New-England Journal of Medicine and Surgery, Vol. XV., page 215. 9 BOOK I. CHAPTER I. OF THE NONNATURALS.* PREVIOUS to entering on the principal subjects of this work, it will be proper to take a brief view of the several agents or causes which influence the human constitution, and, according to their nature or operation, conduce to health or disease. By the singular term nonnaturals, the ancients understood those' things which are natural in themselves, and necessary to our exist- ence ; such as affect mankind, without entering into his composi- tion, or constituting his nature. The term comprehends air, meat and drink, sleep and watching, motion and rest, retention and ex- cretion, and the affections of the mind :—the whole of which may be included in the term Dietetics. Of Air, or Atmosphere. Air is that invisible, transparent, compressible, and elastic fluid, which every where surrounds our globe ; and which generally re- ceives the name of atmosphere. It is the medium in which we breathe, and without which we cannot exist. It is now very gen- erally understood, that the atmospheric air, or that by which we are usually surrounded, is not a simple, but a compound body, consisting of at least four distinct substances, namely, oxygen, azote, carbonic acid, and aqueous vapour. The two former sub- * In treating of the Nonnaturals, I am assisted by Thompson's Family Physician; Dr. Willich, and other late writers. 68 AIR. BOOK I. stances, however, constitute almost the whole of the atmospheric air near the surface of the earth; the other two are variable in their proportion, and exist only in minute quantities, which it is difficult to appreciate. There are various methods known to chemists, by which these two airs may be separated from each other. Vital air, or ogygen, which constitutes about one fourth of the atmosphere, is necessary to respiration and combustion, and an animal immersed in it will live much longer than in the same quantity of common air. The remaining three fourths, called azote, or mephitic air, is totally incapable of supporting respiration. or combustion for an instant. If a candle be included in a given quantity of atmospheric air, it will burn only for a certain time, and then be extinguished, as the oxygen is all absorbed, and the azote which remains is incapable of supporting flame. If an ani- mal be immersed in a given quantity of common air, it will live only a cer ain time, at the end of which, the air will be found di- minished about one fourth, and the remainder will neither support flame nor life. It appears that three parts of azote, and one of oxygen, will form a compound similar to atmospheric air, and is that which is best suited to support the health of the body. Were the atmosphere to contain a much larger proportion of oxygen, by its powerful influence on the system, inflammatory diseases would be induced, and the excitability be sooner exhausted. If, on the other hand, a much less proportion of oxygen should prevail in the atmosphere, there would be a deficiency of stimulus, and the excitability of our systems would morbidly accumulate, and diseases of debility would be the consequence. The oxygen which is received into the lungs of animals, is supposed to communicate the red colour to their blood, and to impart heat and activity to the system. When animals die for want of vital air, their blood is always found black. There is a constant consumption of the oxygenous portion of atmospheric air, by the burning of combustible bodies; by the fer- mentation and putrefaction of vegetable and animal substances; and by the calcination of metals. A greater or less proportion, therefore, of the noxious ingredient, azote, in our atmosphere, undoubtedly arises from the innumerable processes of combustion putrefiction, and respiration of men and animals, particularly in populous cities, the atmosphere of which is almost constantly prejudicial to health. The atmospheric air is never absolutely BOOK 1. AIR. 69 pure and salubrious in any situation, but always mixed with heter- ogeneous particles, and the different states and changes produce very perceptible effects on the constitution. Warm air, if long continued, relaxes the solid parts of the body, quickens the circu- lation of the fluids, dissipates the watery part of the blood, ren- ders the bile acrimonious, and produces disorders in the bowels, and fevers of a malignant kind. A moist air, is universally the most productive of diseases, but when heat and moisture are com- bined, it is of all conditions of the air, the most destructive to the constitution, by impairing the elasticity of the solids, obstructing perspiration, and disposing to putrefactive diseases. A cold state of the air, if not excessive and long continued, is favorable to bodily vigour, especially in those who are accustomed to take ac- tive exercise ; but extreme cold air, by constringing the solids, and condensing the fluids, diminishes perspiration, and often occa- sions rheumatisms, catarrhs, and other affections of the lungs. The conjunction of dry and cool air, is attended with salubrious effects, but a pure dry air, moderately warm, is, of all, the most agreeable and salutary. All great and sudden changes from a warm to a cold air, and the reverse, produce in general a variety of complaints, and frequently, diseases of a fatal tendency. The surest mark of a salubrious and good air in any place, is the lon- gevity of the inhabitants. Winds, or currents of agitated air, likewise produce very sensi- ble effects on the human constitution. A wind blowing steadily from the north, purifies the atmosphere of noxious vapours, ren- ders the air serene and dry, by which the system is invigorated, and rendered active, though to persons of delicate habits it may prove severe and injurious. An easterly wind, is cold without bracing, and in our climate, is incomparably the most of all others uncomfortable, and the most prejudicial to health, especially to valetudinarians. To the asthmatic, and such as are disposed to intermitting fevers, it is particularly injurious. " The coldness of our easterly winds in the spring, is such as to occasion very un- comfortable sensations in the generality of persons exposed to their influence. It has been remarked, that the solvent power of an easterly wind upon the water is astonishingly great. After blowing over a large tract of the ocean, it contains much water, but is chemically combined with it, and consequently transparent; it is also observed to take up more vapour from the ponds and 70 AIR. BOOK L meadows over which it passes, than that which blows from any other quarter. The thermometer, of course, discovers the increase of cold consequent upon this evaporation."* It has been observed that long continued easterly wind, renders people who are natural- ly of a mild and placid temper, irritable and morose ; and that in- stances of suicide are more frequent in those countries and seasons where easterly winds are generally prevalent. The south wind is frequently accompanied with a latent humidity, which relaxes the body, and disposes to affections of the head and breast. The atmospheric air, as already observed, is incessantly cor- rupted by the respiration of men and animals, and by dissolution and putrefaction of innumerable substances. In populous cities, the air is constantly contaminated with sulphur, smoke, and a va- riety of other exhalations of a deleterious tendency, and from which asthmatic and consumptive persons, and likewise those of weak nerves, experience the most prejudicial effects. It is there- fore apparent, that persons of this description ought, as much as; possible, to avoid the corrupt air of large towns, or at least to change the air by frequently visiting other situations. In the open country there are few causes to contaminate the atmosphere, and the vegetable productions are continually tending to render it more pure. The winds which agitate the atmosphere, and con- stantly occasion its change of place, waft the pure country air to the inhabitants of cities, and dissipate that from which the oxygen has been in a great measure extracted. Were it not for this wise provision of the Author of nature, from the daily combustion of an immense quantity of fuel, the numerous substances constantly undergoing putrefaction, and the exhalations from a large number of people and animals, the air in populous towns must soon be- come unfit for the purposes of life. The numerous chimney-fires in cities serve also an excellent purpose by rarefying the atmos- phere, and thereby obviating the mischiefs which otherwise might ensue. The great importance of a pure air for the preservation of the lives of children, is placed in the clearest light by the fol- lowing instance. " In the lying-in hospital at Dublin, two thou- ' sand, nine hundred and forty-four infants, out of seven thousand, six hundred and fifty, died in the year 1782, within the first fort- * Warren on Mercurial Practice, BOOK I. AIR. 71 night after their birth, which is nearly every third child. They almost all died in convulsions; many of them foamed at the mouth, their thumbs were drawn into the palms of their hands, their jaws were locked, the face was swelled and looked blue, as if they were choked. Thi« last circumstance led the physicians to conclude that the rooms in the hospital were too close, and hence, that the infants had not a sufficient quantity of good air to breathe ; they therefore set about ventilating them better ; which was done very completely. The consequence is, that not one child dies now where three used to die." The air of any place, where a numerous body of people are collected together, especial- ly if, to the breath of the crowd, there be added the vapours of a great number of candles or lamps, is rendered extremely prejudi- cial, as it occasions great consumption of oxygen. The fact is well known, that when air has been long confined and stagnatedin mines, wells and cellars, it becomes so extremely poisonous, as to p;ove immediately fatal to those who imprudently attempt to enter such places. No person should descend into a well or cellarr which has been long closed, without first lowering down a lighted candle ; if it burn clear, there is no danger, but if it cease to burn, we may be sure that no one can enler without the utmost danger of immediate suffocation. It sometimes happens also, that, when air is suffered to stagnate in hospitals, jails, ships, &c. it partakes of the same unwholesome and pernicious nature, and is a source of disease. It is obvious, therefore, that in all confined or crowded places, the correcting of vitiated air by means of cleanliness, and frequent ventilation, is of the highest importance. The most effectu >\ preservative from foul air, and consequently from putrid disease^, is a rigid observance of the means of cleanliness in every particular; no accumulation of filth about houses, clothes, or in the public streets should, on any pretence, be suffered to continue, especially during the heat of summer. The pestilential effects which miy be the consequence of a neglect of this salutary prin- ciple are almost inconceivable. The air is often rendered impure by hot fires or stoves in small rooms not sufficiently ventilated ; this is peculiarly prejudicial to those who are subject to pulmonic complaints, and it ought to be cau- tiously guarded against. " The warm rooms, which are usually an appendage to the luxury of the capitals, and thin clothing abroad, lay the foundation for many of those complaints, which are the pre- 72 AIR. BOOK I. cursors of consumptions. It is thus that catarrh usually originates in this country ; and this always debilitates the lungs, and often ter- minates in consumption." It is a very injurious custom for several persons to sleep in a small apartment, and, if it be very close, and a fire be kept in it, the danger is increased ; and from this cause persons have sometimes been stifled in the night when asleep. It is deemed unsafe to leave the windows of a bed room open at night during the summer months, as perspiration might be checked by the cool night air, while the pores are relaxed by the heat of the day, and the warmth of the bed. The vapour of charcoal, when burnt in close apartments produces the most dangerous effects. Our houses, which are made close and almost air tight, should be ventilated daily, by admitting a free circulation of air to pass through opposite windows ; and even our beds ought to be frequently ex- posed to the influence of the open air. Churches, and other public buildings, if shut up for any length of time, and not properly venti- lated by fires of open windows, and, especially, if not kept clean, are found to contain a damp, musty and contaminated air, which proves extremely prejudicial to weak constitutions. Houses situat- ed in low marshy countries, or near lakes and ponds of stagnant water, are constantly exposed to the influence of putrid vapours, which exhale from such noxious sources. To obviate this evil, fires should be made during a sickly season, between the house and the place from which the putrid exhalations arise. But a very fertile and reprehensible source of poisonous vapours contaminat- ing the air, is that of church yards situated in the middle of popu- lous towns. The practice of depositing dead bodies in churches, is still more liable to censure, as this forms a constant source of pu- trid vapours however imperceptible, which cannot fail to prove greatly destructive to health. Among the most powerful means furnished by nature of correct- ing air, which has become unfit for respiration, is the growth and vegetation of plants. The generality of plants possess the property of correcting the most corrupt air within a few hours, when they are exposed to the light of the sun ; during the night, or in the shade, however, they destroy the purity of the air, which renders it a dangerous practice to allow plants to vegetate in apartments occupied for sleeping. In order to a more correct understanding of the qualities and effects of air, it is necessary to advert to that property of living bodies which renders them susceptible of exter- BOOK I. AIR. 73 nal influence, generally termed excitability. u There are, accord- ing to Dr. Garnett, three states in which living bodies exist: 1. A state of accumulated excitability. 2. A state of exhausted excita- bility. 3. When the excitability is in such state as to produce the strongest and most healthy actions, when acted upon by the exter- nal powers. These leading principles are of great importance, in many cases towards ascertaining more determinate rules of con- duct relative to the prevention and cure of diseases." When the system is in such a state as to be very susceptible of the action of external powers, the excitability is said to be abundant or accumu- lated ; in a contrary state of the system, the excitability is said to be deficient or exhausted. When the action of the exciting pow- ers ceases for some time, the excitability accumulates, or becomes more capable of receiving their action, and is more perfectly affect- ed by them. This proposition may be exemplified by the effect of heat upon our bodies. If heat be for some time abstracted, the ex- citability accumulates ; or, in other words, if the body be for some time exposed to cold, it is more liable to be affected by heat after- wards applied. For instance, if one hand be put into cold water, and then both be put into water which is considerably warm : the hand which has been in cold water will feel much warmer than the other. If one hand be plunged into snow, while the other is kept of the same heat as the body, and then both held near the fire, the heat will affect the cold hand infinitely more than the warm one. In like manner, when the body has been exposed to excessive cold for some time, the excitability will be so greatly accumulated that if the heat of a fire be suddenly applied, it will act with such vio- lence as to occasion a high degree of inflamation, and even morti- fication may be the consequence. Hence chilblains, and other in- flammatory affections, are common with those whose hands and feet are exposed to violent cold, or wet with snow, and receive the heat of a fire without being first put into cold water or rubbed with snow. The great changes in the temperature which the air undergoes, must have very considerable influence upon the constitution. In our climate the air varies from several degrees below the freezing point, to more than ninety-five degrees of heat. We then expe- rience the extremes of cold and of heat, by which our bodies are un- avoidably relaxed, and our constitutions exhausted. Heat possesses 10 74 AIR. BOOK t the property of stimulating, and acting upon the excitability, by which animal life is supported and continued, and without which we could not exist even for a few minutes. In a moderate temperature of air, the stimulus of heat acts upon the excitability without exhaust- ing it to such a degree as to occasion disease. But when the de- gree of heat in the atmosphere is much increased, and continues for a considerable time, an exhaustion of the excitability, and con- sequent relaxation and debility must be the result; as the com- mon stimulant powers on which life depends cannot produce a sufficient effect upon the excitability to impart to the body that tone which is compatible with health. When, on the other hand, the stimulus of heat is much diminished, or when cold is applied to the body, the excitability must accumulate, or become more sus- ceptible of the action of external powers. It'is not often, however, that ill consequences result from this condition of the system, un- less the exciting powers be improperly or too quickly applied : as we can bear a considerable diminution of heat with impunity, and the action of cold, unless it be excessive, never produces any bad effects upon people in health. It has been generally supposed that catarrh, or a cold, is con- tracted in consequence of exposure to cold air ; but it is now as- certained that the immediate cause of that inflammatory affection of the mucous membrane of the nose, fauces and bronchia?, which always attend a catarrh, is not to be ascribed to exposure to cold air after being heated, but precisely the reverse of this takes place. It is not until we approach a heated atmosphere after coming from a cold one, that we experience the symptoms of having taken cold. The cold air drawn into the lungs by every breath, dimi- nishes the heat of those parts, the excitability accumulates, and they become more liable to be affected by the succeeding heat. While we continue' in the cold air, we are not sensible of any ill effects, but on coming into a warm room we soon experience the operation of those symptoms which evince our having taken a cold, and the more we try to obviate these symptoms by the ap- plication of external heat, the more are they increased and aggra- vated.* Such is the effect of violent action of heat on the accu- mulated excitability. " After cold," says a late eminent physician, * This fact has so frequently been verified by my personal experience as to Jiave dissipated every doubt on the subject. BOOK I. AIR. 75 '" the sudden application of heat must produce the violent action which constitutes inflammation." " The symptoms are ascribed to the cold, and are the effects of an inflammation of ihe schneiderian membrane, which lines the nostrils, but it is the heat, which is the immediate cause. We do not feel that we have taken cold, till we are exposed to the action of heat; as when we come into a warm room, or in a warm bed, after exposure to a cold atmos- phere ; and similar consequences are known to follow the applica- tion of heat to frozen limbs, viz. inflammation and mortification of the parts."* It is a dangerous practice for persons when return- ing from an excessive cold atmosphere, to approach a fire without first waiting for the accumulated excitability to be gradually and moderately exhausted by the gentle action of heat; and to drink warm or strong liquors while the body is thus chilled with cold, is still more hazardous.t When persons have their hands and feet exposed to intense cold, by which the excitability of those parts is much accumulated, they will obtain the most effectual relief by putting them into cold water, or by rubbing them with snow until the morbid excitability be gradually exhausted. It is an erroneons idea, that people should cool themselves be- fore going from a warm room into the open air, they should, on the contrary, accumulate a large portion of heat, and then secure their bodies by warm clothing, and the use of active exercise, and being thus prepared they may pass through the most intense cold with perfect impunity. But after being exposed to cold air till the natural warmth begins to decline, they can never return into a warm room or near a fire, without a risk of dangerous conse- quences. Let it therefore be constantly observed as a rule, that when the body or limbs are affected with intense cold, the only safe method is to produce the natural feeling and warmth by means of gradual heat. The fact seems to be fully established, that in proportion to the increased degree of heat of the body, is the safety with which cold may be applied ; provided it be applied freely and before the heat begins to decline. Of this we have a sufficient proof in the * Warren on Mercurial Practice. t " The mistaken idea of the necessity of 'tatting something warm to keep the >:old out,' occasions more colds, perhaps, than all the other exciting causes of th6 omplaint united." 76 AIR. BOOK I. practice of the Russian inhabitants, who first bathe in water heat- ed to as high a degree as the body can bear, and immediately after roll themselves, in snow, and this with perfect impunity. Few of the refinements of modern luxury and fashion, are more prejudicial to health by rendering the body susceptible of cold, than the living in small close rooms heated to excess by fires or stoves. Another practice no less injurious, is to sleep in heated apartments upon soft beds artificially warmed, and under a load of bed clothes. It is far more salutary for the strong and healthy, to go into a cold bed, regarding it as a necessary rule however, to acquire a moderate degree of warmth immediately previous to retiring to rest, for if we get into bed cold and chilly we shall re- main so the greater part of the night. From the foregoing view of the subject, it is obvious that nothing so much contributes to enervate the powers of the human frame, as an excess of external heat, which debilitates by its perpetual stimulus, until the system becomes extremely sensible to the slight- est variation of temperature of the air. It is of primary impor- tance, therefore, that young persons be gradually habituated to bear the impressions of cold, and induce that enviable state ©f ha- rdiness that will enable them to brave with impunity the vicissi- tudes of the atmosphere of our climate. And in order to obviate. the most frequent causes of catarrh, which is so prevalent among us, we should accommodate our dress to the season and personal feeling ♦ and when changes from cold to heat, or the contrary, are unavoidable, carefully guard against the transition being sudden and immediate. CHAPTER II. EXERCISE, The position is universally established, that exercise should be ranked as among the most powerful agents which we can employ for the preservation of life and health. The ancients, as well as the moderns, have attributed great utility in pursuing a proper course of exercise, and even considered it the sole instrument in the cure of some diseases, especially those of the glandular and nervous systems. Galen was a zealous advocate for the various kinds of exercise, as a curative remedy, and the great Sydenham was so exceedingly sanguine in his opinion of its salutary effects, in the prevention and cure of numerous diseases, that he was led to give a latitude to it which can scarcely be admitted. Indeed, the beneficial effects to be derived from exercise properly performed, in all chronic diseases, are almost inconceivable. It strengthens the solid parts, and promotes the circulation of the fluids, be- yond any thing else within the compass of nature. It increases perspiration, and prevents many of those diseases which cannot be cured, and may remove others where medicine proves ineffectual. " A common source of consumption in our females," says the excellent writer quoted in the last chapter, " is want of exercise ; there is perhaps no place, in which the common habits of improved social life are adopted, in which this sex are less attentive to that most essential requisite for the preservation of health, than in this (Boston). " No exercise is equally salutary with that of walking. This gives action to the muscles of the limbs, whence the circulation, from the distance, of the vessels from the heart, is apt to be lan- guid. It throws the blood forcibly forward towards the lungs, and thereby affords an opportunity for the mass to be exposed in larger quantities to the action of the air, by which alone it is rendered fit for circulation. This oxygenation of the blood by air endues it with the property, by which it is enabled to excite its vessels into 78 EXERCISE. BOOK I. stronger action, and by that means to give strength and vigour to the whole system. " Who does not notice, that our sedentary females are put out of breath by the smallest degree of exertion, beyond what they have been accustomed to ? That the lungs have become so irrita- ble for want of the stimulus, which exercise exerts upon them, as to be thrown into a kind of convulsive cough from the most tri- fling acceleration of the blood in its passage through them. " Whereas, in the females of our country towns, who have con- stantly habituated themselves to walking, riding, and the greatest variety of domestic labours, may be noticed the large play of lungs in quick walking ; a deep and full respiration, with all the atten- dant advantages of a sufficiently complete oxygenation of the blood. " Nor are these observations inapplicable to the other sex. There is not one man in a hundred, that exercises sufficiently in mercantile cities; because not one in a hundred, from the nature of his occupation, is obliged to do it; and not one in two hundred will do it from principle."* The more active kinds of exercise, as walking, running, leaping, riding, swimming, fencing, &c. are the most suitable to youth and those of a middle age, and particu- larly to the corpulent. The passive kind, as riding in a carriage, sailing, swinging, &c. are best adapted to infants, to the aged, and to the delicate and weak. Walking gives the most general action to the muscles of the body and limbs, but for valetudinarians, and those who have weak bowels, or are consumptive, riding on horse- back is preferable. It is almost incredible how much the consti- tution may be strengthened by this exercise, when continued for a considerable time, especially when on long journies, a perpetual change of air, and of scenes and objects, combine their advantages. Invalids, who have recourse to this exercise, should be accompa- nied by a cheerful companion, and they should not commence a journey for health, until they have tried their strength in short rides; nor discontinue the exercise abruptly, but gradually. They should divest the mind of all deep reflection, and gratify the sight with the prospect of the various objects which present themselves to view. The unwholesome air of large towns, the damps of * Warren on Mercurial Practice. BOOK I. EXERCISE. 79 marshes, and the morning and evening dews, ought to be particu- larly avoided by invalids when travelling for health. It should be remarked, that exercise, immediately after eating, is frequently productive of hurtful consequences, particularly in those of ner- vous and irritable constitutions; and fatiguing exercise should ne- ver be practised till the process of digestion is completed, which generally requires three or four hours after eating. The exercise of riding in a carriage is conducive to health, bui the greater the motion allowed to the body of the carriage, the more beneficial will be its effects, provided too much fatigue be avoided. Dancing is a salutary exercise, especially in the winter, if not too violent or carried to excess; but when performed in the warm atmosphere of a crowded assembly, and especially, if at the same time, liquors of a heating nature be taken, or cooling drinks during a profuse perspiration, very serious consequences may be appre- hended from such excesses. The laborious kinds of exercise at- tending agricultural employments, as hoeing, digging, raking, chopping, should make the greater part of their diet consist of animal food. Milk is an article of food which cannot be too highly commended. It is intermediate between animal and vegetable substances, easy of digestion, and affording a mild and bland nutriment, calculated to obtund the acrimony of the fluids and purify the blood. In weak and consumptive habits, it is incomparably the most eligible of all nutritive substances, provided it does not disagree with the stomach. The age, constitution, and manner of life, are circumstances which merit attention in the choice of proper diet; and sedentary people should live more sparingly than those who are accustomed to much bodily labour. The diet best adapted under circumstan- ces of disease, will be an object of attention when treating of dis- eases particularly. The diet should not only be such as is best adapted to the par- ticular tendency of different constitutions, but it ought not to be too uniform, at least for any considerable time. When the stomach has been long habituated to the most delicate and tender kind of food, it becomes incapable of digesting any thing stronger, among the great variety which nature has provided for our support. Food ought to be taken at regular periods, for long fasting is injurious in every stage of life; it vitiates the fluids, and prevents the growth of thebody. Nature requires frequent supplies of fresh nourishment to BOOK I. OP FOOD AND DRINK. 85 obviate a constant tendency of the humours to become acrimonious. Loug fasting is apt also to occasion wind in the stomach and bow- els, and sometimes even giddiness and faintness, especially in those who are weak and delicate. It is proper here to caution against the practice of eating food while hot, as nothing can be more de- structive to the teeth, nor more injurious to the muscular tone of the stomach. The practice of eating heavy suppers just before going to rest, is exceedingly pernicious, as the digestive powers are in a degree diminished during sleep ; and in a horizontal posture the stomach presses upon a part of the intestines, and the blood is consequent- ly impelled to the head which may prove of dangerous tendency. The custom of taking a short sleep after dinner, may with proprie- ty be allowed to the aged and delicate ; the indulgence, however, should be confined to a repose of a few minutes in a reclining pos- ture. We come now to notice the articles of drink, which is an essen- tial part of our aliment, and of indispensable use to the digestion of our food. Among the great variety of liquids, water is the most universally employed, and when perfectly pure it is the most salu- tary and natural beverage of mankind. Its salubrity depends on the peculiar properties which it possesses. Some waters are strongly impregnated with animal, vegetable, or mineral particles, of a na- ture injurious to the constitution; and such impregnation may be known by the sensible qualities of the water. The best water is that which is pure, light, and without any particular colour, taste, or smell. Fermented liquors, if made very strong, and drunk in large quantities, inflame the blood, hurt digestion, and dispose to a variety of diseases. If too weak, they produce flatulence ; or if become stale, they turn sour on the stomach and injure digestion. Strong beer is very nourishing, and may be employed with advan- tage as a medicine in emaciated habits. Beer made of a great pro- portion of hops, and a small quantity of malt, is a good beverage, and well calculated to allay thirst. Cider, when of a proper age, and well refined and pure, may be considered as a pleasant and salutary beverage, and calculated to obviate a putrid tendency in the humours. Wine, moderately used, increases the circulation of the blood, promotes the secretions and excretions, and invigorates all the functions of the body. It is, however, only a stimulant, and not a permanently strengthening cordial; for most wine drinkers 86 OF FOOD AND DRINK. BOOK I. who indulge in excess, die of relaxation and debility. To the phlegmatic, to the aged, and to those who are disposed to flatu- lency, wine is highly beneficial, if used with prudence and modera- tion. Plethoric young men, and such as have weak stomachs and lungs, should not accustom themselves to the use of wine. It is believed that three or four glasses of wine, or one of spirits much diluted with water, daily, is as much as can be taken by most men without producing more or less injury to the system. No person, in the opinion of Dr. Trotter, if in good health, can need wine till he be forty. He may then begin with two glasses a day ; at fifty he may add two more ; and at sixty he may go to the length of six, but not to exceed that quantity, though he should live'to an hun- dred. It is to be remarked that we speak of pure wine in its un- adulterated state ; those once of genuine quality being too often' shamefully adulterated with poisonous ingredients, or changed in their nature by various mixtures. Ardent spirits are more stimulating, but less permanent in their effects than even wine ; instead of promoting digestion of food, they actually tend to retard it, and render strong food taken into the stomach still more indigestible. It is therefore evident, that neither wine nor ardent spirits are proper to be employed as drinks with our daily food. Vinegar is a vegetable production, possessing salubrious qualities; it is an excellent antiseptic, and, when diluted with water, and some ginger and molasses added, forms a wholesome and useful drink in most constitutions, in warm climates and seasons. All other vegetable acids, as the juice of oranges, lemons, &c. possess similar properties, and are both agreeable and useful. Our drink, of whatever nature, ought, as well as food, to be taken in a just and moderate quantity. Were we to be governed by the dictates of nature, we ought to drink only when solicited by thirst, and he who is accustomed to drink water only, will seldom be in danger of transgressing the proper measure, if he drinks as often as the calls of nature demand.* The following general account of the qualities of the different kinds of animal and vegetable food, is taken from Thompson's Family Physician. "Beef. Whenthis is the flesh of a bullock of middle age, it affords good and strong nourishment, and is peculiarly well adapt- * See chapter on Intemperance. POOR I. OP POOD AND DRINK. s; ed to those who labour, or take much exercise. It will often sit easy upon stomachs that can digest no other kind of food; and its fat is almost as easily digested as that of veal. " Veal is a proper food for persons recovering from an indispo- sition, and may even be given to febrile patients in a very weak state, but it affords less nourishment than the flesh of the same an- imal in a state of maturity. The fat of it is lighter than that of any other anim-d, and shows the^ least disposition to putrescency. Veal is a very suitable food in costive habits ; but of all meat it is the least calculated for removing an acid from the stomach. " Mutton, from the age of four to six years, and fed on dry pasture, is an excellent meat. It is of a middle kind, between the firmness of beef and the tenderness of veal. The lean part of mutton, however, is the most nourishing, and conducive to health ; the fit being hard of digestion. The head of the sheep, especial- ly when divested of the skin, is very tender; and the feet, on account of the jelly they contain, highly nutritive. " Lamb is not so nourishing as mutton ; but it is light, and ex- tremely suitable to delicate stomachs. " House-lamb, though much esteemed by many, possesses the bad qualities common to the flesh of all animals reared in an un- natural way. " Pork affords rich and substantial nourishment; and its juices are wholesome when properly fed, and when the ani- m-d enjoys pure air and exercise. But the flesh of hogs reared in towns, is both hard of digestion and unwholesome. Pork is particularly improper for those who are liable to any foulness of the skin. It is almost proverbial, that a dram is good for promot- ing its digestion ; but this is an erroneous notion : for, though a dram may give a momentary stimulus to the coats of the stomach, it tends to harden the flesh, and of course to make it more indi- gestible. " Smnked-hams are a strong kind of meat, and rather fit for a relish than for diet. It is the quality of all salted meat, that. the fibres become rigid, and therefore more difficult of diges- tion ; and when to this is added smoking, the heat of the chimney occasions the salt to concentrate, and the fat between the muscles to become rancid. " Bacon is also of an indigestible quality, and is apt to turn rancid on weak stomachs. 88 OF FOOD AND DRINK. BOOK r. " The flesh of Goats is hard and indigestible ; but that of kids is tender, as well as delicious, and affords good nourishment. " Venison, or the flesh of deer, and that of hares, is of a nour- ishing quality, but is liable to one inconvenience; which is, that though much disposed to putrescency of itself, it must be kept for a little time before it becomes tender. " The blood of animals is used as aliment by the common peo- ple ; but they could not long Subsist upon it unless mixed with oatmeal, &c. for it is not soluble alone by the digestive powers of the human stomach, and therefore cannot prove nourishing. " Milk is of very different consistence in different animals; but that of cows being the kind used in diet, is at present the object of our attention. Milk, where it agrees with the stomach, affords excellent nourishment for those who are weak, and cannot digest other aliments. Though an animal production, it does not readily become putrid, as, being possessed of the properties of vegeta- ble aliment; but it is apt to become sour on the stomach, and thence to produce flatulence, the heart-burn, or gripes, and in some constitutions, a looseness. The best milk is from a cow at three or four years of age, about two months after producing a calf. It is lighter, but more watery, than the milk of sheep and goats; while on the other hand, it is more thick and heavy than the milk of asses and mares, which are the next yi consistence to human milk. "On account of the acid which is generated after digestion, milk coagulates in all stomachs; but the caseous or cheesy part is again dissolved by the digestive juices, and rendered fit for the purpose of nutrition. It is, however, improper to eat acid sub- stances with milk, as these would tend to prevent the due diges- tion of it. " Cream is very nourishing, but, on account of its fatness, is difficult to be digested in weak stomachs. Violent exercise, after eating it, will in a little time convert it into butter. " Some writers inveigh against the use of Butter as universally pernicious; but they might with equal reason condemn all vegeta- ble oils, which form a considerable part of diet in the southern climates, and seem to have been beneficently intended by nature for that purpose. Butter, like every other oily substance, has doubtless a relaxing quality, and, if long retained in the stomach, is liable to become rancid ; but if eaten in moderation, it will not BOOK 1. OF FOOD AND DRINK. 89 produce those effects in any hurtful degree. It is, however, im- proper in bilious constitutions. The worst consequence produced by butter, when eaten with bread, is, that it obstructs the discharge of the saliva in the act of mastication or chewing; by which means the food is not so readily digested. To obviate this effect, it would be a commendable practice at breakfast, first to eat some dry bread, and chew it well, till the salivary glands were exhaust- ed, and afterwards to eat it with butter. By these means such a quantity of saliva might be carried into the stomach as would be sufficient for the purpose of digestion. " Cheese is likewise reprobated by many as extremely unwhole- some. It is doubtless not easy of digestion ; and when eaten in a great quantity, may load the stomach ; but if taken sparingly, its tenacity may be dissolved by the digestive juices, and it may yield a wholesome, though not very nourishing chyle. Toasted cheese is agreeable to most palates, but is rendered more indigestible by that process. " The flesh of Birds differs in quality according to the food on which they live. Such as feed upon grain and berries, afford, in general, good nourishment, if we except geese and ducks, which are hard of digestion. A young hen, or chicken, is tender and delicate food, and extremely well adapted where the digestive powers are weak. But of all tame fowls, the capon is the most nutricious. , " Turkeys, as well as Guinea or India fowls, afford a substantial aliment, but are not so easy of digestion as the common domestic fowls. In all birds, those parts are the most firm which are most exercised; in the small birds, therefore, the wings, and in the larger kinds, the legs, are commonly the most difficult of digestion. " The flesh of wild birds, in general, though more easily di- gested, is less nourishing than that of quadrupeds, as being more dry, on account of their almost constant exercise. Those birds are not wholesome which subsist upon worms, insects, and fishes. " Eggs- J" tne last class of terrestrial animal food, we may rank the eggs of birds, which are a simple and wholesome aliment. Those of the turkey are superior in all the qualifications of food. The white of eggs is dissolved in a warm temperature, but by much heat it is rendered tough and hard. The yolk contains much oil, and is highly nourishing, but has a strong tendency to putrefaction ; on which account eggs are improper for people of 90 OF FOOD AND DRINK. BOOK J. weak stomachs, especially when they are not quite fresh. Eggs, hard boiled or fried, are difficult of digestion, and are rendered still more indigestible by the addition of butter. All eggs re- quire a sufficient quantity of salt, to promote their solution in the stomach. " Fish, though some of them be light, and easy of digestion, afford less nourishment than vegetables or the flesh of quadrupeds, and are, of all the animal tribes, the most disposed to putrefaction. Salt water fish are, in general, the best; but, when salted, though less disposed to putrescency, they become more difficult of diges- tion. Whitings and flounders are the most easily digested. Acid sauces and pickles, by resisting putrefaction, are a proper addition to fish, both as they retard putrescency, and correct the relaxing tendency of butter, so generally used with this kind of aliment. " Oijsters are eaten both raw and dressed; but in the former state they are preferable : because heat dissipates considerably their nutritious parts, as well as the salt water, which promotes their digestion in the stomach : if not eaten very sparingly, they generally prove laxative. " Muscles are far inferior to oysters, both in point of digestion and nutriment. Sea muscles are by some supposed to be of a poisonous nature ; but though this opinion is not much counte- nanced by experience, the safest way is to eat them with vinegar, or some gther vegetable acid. " Bread. At the head of the vegetable class stands bread, that article of diet which, from general use, has received the name of the staff of life. Wheat is the grain chiefly used for the purpose in this country, and is among the most nutritive of all the farina- ceous kinds, as it contains a great deal of mucilage. Bread is very properly eaten with animal food, to correct the disposition to putrescency ; but is most expedient with such articles in diet as contain much nourishment in a small bulk, because it then serves to give the stomach a proper degree of expansion. But as it pro- duces a slimy chyle, and disposes to costiveness, it ought not to be eaten in a large quantity. To render bread easy of digestion, it ouffht to be well fermented and baked; and it never should be used till it has stood twenty-four hours after being taken out of the oven, otherwise it is apt to occasion various complaints in those who have weak bowels; such as flatulence, the heart-burn, watch- fulness, and the like. The custom of eating butter with bread hot from the oven, is compatible only with strong digestive powers. BOOK I. OF POOD AND DRINK. 91 « Pastry, especially when hot, has all the disadvantages of hot bread and butter ; and even buttered toast, though the bread be stale, is scarcely inferior in its effects on a weak stomach. Dry toast, with butter, is by far the most wholesome breakfast. Brown wheaten bread, in which there is a good deal of rye, though not so nourishing as that made of fine flour, is both palatable and wholesome, but apt to become sour on weak stomachs, and to produce all the effe&s of acidity. " Oats, when deprived of the husk, and particularly barley, when properly prepared, are each of them softening, and afford wholesome and cooling nourishment. Rice, likewise, contains a nutritious mucilage, and is less used in this country than it de- serves, both on account of its wholesomeness and economical utili- ty. The notion of its being hurtful to the sight, is a vulgar error. In some constitutions, it tends to make them costive ; but this seems to be owing chiefly to flatulence, and may be corrected by the addition of some spice, such as caraway, anise seed, and the like. " Potatoes are an agreeable and wholesome food, and yield as much nourishment as any of the roots used in diet. The farina- ceous or mealy kind is in general the most easy of digestion ; and they are much improved by being roasted. " Green pease, and Turkey beans, boiled in their fresh state, are both agreeable to the taste, and wholesome ; being neither near so flatulent, nor difficult of digestion, as in their ripe state ; in which they resemble the other leguminous vegetables. French beans possess much the same qualities ; but yield a more watery juice, and have a greater disposition to produce flatulence. The leguminous vegetables, in general, ought to be eaten with some spice. " Salads, being eaten raw, require good digestive powers, espe- cially those of the cooling kind ; and the addition of oil and vine- gar, though qualified with mustard, hardly renders the free use of them consistent with a weak stomach. i: Spit/age affords a soft lubricating aliment, but contains little nourishment. In weak stomachs, it is apt to produce acidity, and frequently a looseness. To obviate these effects, it ought always 'o be well beaten, and but little butter mixed with it. 92 OF FOOD AND DRINK. BOOK I. " Asparagus is a nourishing article in diet, and promotes urine ; but, in common with the vegetable class, disposes a little to flat- ulence. " Artichokes resemble asparagus in their qualities, but seem to be more nutritive, and less diuretic. " White Cabbage is one of the most conspicuous plants in the garden. It does not afford much nourishment, but is an agreeable addition to animal food, and not quite so flatulent as the common greens. It is likewise diuretic, and somewhat laxative. Cabbage has a stronger tendency to putrefaction than most other vegetable substances ; and, during its putrefying state, sends forth an offen- sive smell, much resembling that of putrefying animal bodies. So far, however, from promoting a putrid disposition in the human body, it is, on the contrary, a wholesome aliment in the true pu- triJ scurvy. " Turnips are a nutricious article of vegetable food, but not very easy of digestion, and are flatulent. This effect is in a great measure obviated by pressing the water out of them before they are eaten. " Carrots contain a considerable quantity of nutritious juice, but are among the most flatulent of vegetable productions. " Parsnips are more nourishing and less flatulent than carrots, which they also exceed in the sweetness of their mucilage. By bailing them in two different waters, they are rendered less flatu- lent, but their other qualities are thereby diminished in proportion. " Parsley is of a stimulating and aromatic nature, well calculat- ed to make agreeable sauces. It is also a gentle diuretic, but pre- ferable in all its qualities when boiled. " Celery affords a root both wholesome and fragrant, but is dif- ficult of digestion in its raw state. It gives an agreeable taste to Soups, as well as renders them diuretic. " Onions, garlic, and shallot, are all of a stimulating nature, by which they assist digestion, dissolve slimy humours, and expel fla- tulency. They are, however, most suitable to persons of a cold and phlegmatic constitution. " Radishes of all kinds, particularly the horse-radish, agree with the three preceding articles in powerfully dissolving slimy hu- mours. They excite the discharge of air lodged in the intestines; but this proceeds from the expulsion of the air contained in them- selves. BOOK I. OP POOD AND DRINK. 93 " Apples are a wholesome vegetable aliment, and in many cases medicinal, particularly in diseases of the breast, and complaints arising from phlegm. But, in general, they agree best with the stomach, when eaten either roasted or boiled. The more aroma- tic kinds of apples are the fittest for eating raw. " Pears resemble much in their effects the sweet kind of apples, but have more of a laxative quality, and a greater tendency to flatulence. " Cherries are, in general, a wholesome fruit, when they agree with the stomach, and they are beneficial in many diseases, espe- cially those of the putrid kind. " Plums are nourishing, and have, besides, an attenuating, as well as a laxative, quality ; but are apt to produce flatulence. If eaten fresh, and before they are quite ripe, especially in large quantities, they occasion colics and other complaints of the bowels. " Peaches are not of a very nourishing quality, but they abound in juice, and are serviceable in bilious complaints, " Apricots are more pulpy than peaches, but are apt to ferment, and produce acidities in weak stomachs. Where they do not dis- agree, they are cooling, and tend likewise to correct a disposition to putrescency. " Gooseberries, as well as currants, when ripe, are similar in their qualities to cherries, and, when used in a green state, they are agreeably cooling. " Strawberries are an agreeable, cooling aliment, and are ac- counted good against the gravel. " Cucumbers are cooling, and agreeable to the palate in hot weather; but to prevent them from proving hurtful to the sto- mach, the juice ought to be squeezed out after they are sliced, and vinegar, pepper, and salt, afterwards added. " Tea. By some, the use of this exotic is condemned in terms the most vehement and unqualified, while others have either as- serted its innocence, or gone so far as to ascribe to it salubrious, and even extraordinary virtues. The truth seems to lie between these extremes : there is, however, an essential difference in the effects of green tea and of black, or bohea ; the former of which is much more apt to affect the nerves of the stomach than the latter, especially when drunk without cream, and likewise without bread and butter. That when taken in a large quantity, or at a later hour than usual, it often produces watchfulness, is a point which 94 OF FOOD AND DRINK. BOOK I. cannot be denied; but if used in moderation, and accompanied with the addition just now mentioned, it does not sensibly discover any hurtful effects, but greatly relieves an oppression of the stomach, and abates a pain of the head. It ought always to be made of a moderate degree of strength; for if too weak, it certainly relaxes the stomach. As it has an astringent taste, which seems not very consistent with a relaxing power, there is ground for ascribing this effect, not so much to the herb itself, as to the hot water, which not being impregnated with a sufficient quantity of tea to correct its own emollient tendency, produces a relaxation unjustly imput- ed to some noxious quality of the plant. But tea, like every other commodity, is liable to damage, and when this happens, it may produce effects not necessarily connected with its original qualities. " Coffee. It is allowed that coffee promotes digestion, and exhi- larates the animal spirits ; besides which, various other qualities are ascribed to it, such as dispelling flatulency, removing dizziness of the head, attenuating viscid humours, increasing the circulation of the blood, and consequently perspiration; but if drunk too strong, it affects the nerves, occasions watchfulness, and tremor of the hands ; though in some phlegmatic constitutions, it is apt to produce sleep. Indeed, it is to persons of that habit that coffee is well accommodated : for to people of a thin and dry habit of body, it seems to be injurious. Turkey coffee is greatly preferable in flavour to that of the West-Indies. Drunk only in the quantity of one dish after dinner, to promote digestion, it answers best with- out either sugar or milk : but if taken at other times, it should have both, or in place of the latter, rather cream, which not only im- proves the beverage, but tends to mitigate the effect of coffee up- on the nerves. " Chocolate is a nutritive and wholesome composition, if taken in small quantity, and not repeated too often; but is generally hurtful to the stomach of those with whom a vegetable diet disa- grees. By the addition of vanilla and other ingredients, it is made too heating, and so much affects particular constitutions, as to ex- cite nervous symptoms, especially complaints of the head." CHAPTER IV. OF THE PASSIONS/ "Notwithstanding the universal condemnation of the pas- sions by the stoical sect of philosophers, they are a natural and necessary part of the human constitution, and were implanted in it by the great Creator for wise and useful purposes. Indeed, with- out them we could have no motive to action, the mind must be- come utterly torpid, and, there being no foundation for morality or religion, virtue and vice would be nothing more than indiscrimi- nate and unintelligible terms. The passions are only prejudicial when allowed to exceed their proper bounds; and to preserve them within those limits, we are furnished, not only with reason and the light of nature, but likewise that of revelation. " From the intimate, though mysterious, connection between the mind and body, they reciprocally affect each other, and thence the passions exert a powerful influence both in the production and cure of diseases. The two great sources of the passions respec- tively, are desire and aversion ; those of the former class tending in general to excite, and the others to depress, the powers of the animal system. The chief passions which arise from desire, are joy, hope, and love ; and the most eminent in the train of aversion are, fear, grief, and anger. "Joy is a passion in which the mind feels a sudden and extraor- dinary pleasure ; the eyes sparkle, a flood of animation over- spreads the countenance, the action of the heart and arteries is increased, and the circulation of the blood becomes vigorous. In- stances are not wanting where this passion, when unexpectedly excitod and violent, has produced immediate death ; but if mode- rate, and existing only in the form of cheerfulness, it has a benefi- cial effect in preserving health, as well as in the cure of diseases. "Of all the passions, hope is the mildest: and, though it ope- rates without any commotion of the mind or any visible symptom -* This chapter is taken verbatim from Thompson's Family Physician. 96" OF THE PASSIONS. BOOK I. of the body, it has a most powerful influence on the health of one, and the serenity of the other: it contributes, indeed, so much to the welfare of both, that if it were extinguished, we could neither enjoy any pleasure in this life, nor any prospect of happiness in the life to come; but, by the beneficent will of Providence, it is the last of the passions that forsakes us. " Love is one of the strongest passions with which the mind is affected, and has, at its commencement, a favourable influence on the functions of the body ; but, being often in its progress attended "with other passions, such as fear and jealousy, it is liable to be- come the source of infinite disquietude ; no passion undermines the constitution so insidiously as this; for, while the whole soul is occupied with the thoughts of a pleasing attachment, both the mind and body become languid from the continuance of vehement desire ; and should there arise any prospect, real or imaginary, of being frustrated in its pursuit, the person is agitated with all the horrors and pernicious effects of despair. Love, when violent, and unsuccessful, frequently produces a wasting of the flesh, called nervous consumption, which terminates in death. " Fear has its origin in the apprehension of danger or evil, and is placed as it were a sentinel, for the purpose of self-preservation; it retards the motion of the blood, obstructs respiration, and when in a moderate degree, relaxes the body; but if it rise to the height of terror, it puts all the springs of life into disordered action, and produces the most violent efforts in every muscle of the body. By weakening the energy of the heart, this passion disposes greatly to infection during the prevalence of contagious diseases ; in some instances it has produced palsy, loss of speech, epilepsy, and even madness. " There is no passion more destructive than grief when it sinks deep into the mind: by enfeebling the whole nervous system it depresses the motion of the heart, and retards the circulationof the blood with that of all the other fluids ; it commonly debilitates both the stomach and bowels, producing indigestion, obstructions, obstinate watchfulness, and disposing to every disease that may arise from extreme relaxation; it preys upon the mind as well as the body, and is nourished by indulgence, to the utmost degree of excess: during the violence of its earlier period, it spurns at all the \ BOOK 1. OP THE PASS10N8. 99 consolations either of philosophy or religion; but if life can sub- sist till the passion be alleviated by time, and submit to the cheer- ing influence of company, exercise, and amusement, there is a prospect of recovery ; though grief, long continued, often gives a shock to the constitution, in a manner that nothing can retrieve. " Anger is a passion suddenly excited, and which often no less suddenly subsides. Equally furious and ungovernable in its na- ture, it may justly be considered as a transient fit of madness. The face, for the most part, becomes red, the eyes sparkle with fury, an outrageous commotion is visible in the countenance, and pervades the whole body. The animal spirits flow with rapidity, the pulsation of the heart and arteries, and, with them, the motion of the blood, are sometimes so much increased as to occasion the bursting of vessels.* This passion being most frequent among persons of a choleric temperament, it is particularly hurtful to the liver and its ducts, which it seems to affect with spasmodic and irregular agitations, sometimes productive of the jaundice. But it operates likewise towards the production of fevers, inflamma- tions, spitting of blood, apoplexy, and other disorders. As anger is liable to be spent by its own violence, it is commonly of short duration ; but when existing in a more moderate degree, and com- bined with sadness or regret, it gives rise to fretting, which is extremely pernicious to the health. A person ought never to eat or drink immediately after a violent fit of anger ; and those who are constitutionally exposed to its influence should make every effort to restrain such an odious ebullition of the temper. Some have supposed, that in a violent fit of anger, the saliva possesses a slight- ly poisonous quality, but perhaps this opinion is founded more on analogy and conjecture than on real and accurate observation. " From the general view which has been taken of the principal passions, it appears that there are two of them which have a par- ticular claim to the attention of the medical faculty. These are hope and fear. By encouraging the former, and obviating the dis- position to the latter, the most important assistance may be given in the treatment of many diseases, not otherwise curable. In the * An instance of this nature occurred at Providence not many years since. A gentleman, in a violent fit of anger, fell, and instaatly expired, probably m conse- quence of bursting a blood-vesel of the heart. 13 98 OF THE PASSIONS. BOOK I whole compass of medicine, there is not a more enlivening and salutary cordial than the passion of hope, nor any which can be compared to it in point of permanent operation. " It is natural to persons, who have any dangerous complaint, to entertain fear and anxiety with respect to its termination. Such a state of mind never fails to aggravate any disorder; and the physician ought to exert himself all in his power to counteract tha effects of the passion ; for nothing can prove effectual for removing the disease, if baneful despondency support it. CHAPTER V. OF SLEEP. " Such is the general constitution of animal bodies, that, with all the aid of aliment, they cannot long subsist unless refreshed by the natural vissicitudes of waking and sleep. These periodical changes in the state of our existence are as necessary to health and life, as the alternate returns of day and night to the regularity of the solar system. In what proportion they ought to divide our time, is a question worthy of consideration ; and for this purpose it is proper to ascertain the end for which mankind was created. Both reason and scripture assure us that we are placed here in a state of probation, to exercise our natural faculties according to the laws of morality; and, by improving ourselves in habits of virtue, to be rendered fit for the enjoyment of a nobler and eternal state of ex- istence. " Such being the case, it follows, that the proper cultivation of the mind ought always to be our principal object: and, as this duty can be performed only when awake, we may justly conclude that the smallest portion of our time should be devoted to the repose of the bed. In this, however, we are left entirely to be guided by our own discretion : but it happens fortunately, that the dictates of reason coincide with the best physical rules for the preservation of health. In most constitutions, six hours will be found a sufficient time for the indulgence of sleep ; and, if protracted beyond eight, it proves rather injurious than beneficial; though with respect to children a greater latitude is allowed. "The proper time for the periodical return of sleep,is pointed out by nature herself, when the light of the day gives place to night, and when those who have laboured from the morning stand in need of repose. I would not, however, be understood to fix the com- mencement of sleep precisely to the approach of darkness, since in winter, unless for those who intend to rise early,such a practice would lead to the prolongation of sleep beyond the period which has been mentioned as the most salutary ; besides, that this would 100 OF SLEEP. BOOK I. interfere with the innocent gratifications of society, than which nothing is more agreeable, or more beneficial to health. " To secure sound sleep, the best expedient is to take sufficient exercise in the open air, to eat no heavy supper, and to lie down in bed in perfect,tranquillity of mind, and without the attention be- ing fixed on any subject connected with abstruse inquiry. It ought likewise to be observed, that a person should not go to bed till an hour and a half.after.'supper. " It is a general opinion that sleep is most refreshing in the fore part of the night: but perhaps this notion arose originally from a presumption, that the person who goes to bed at a moderate hour will of course rise sooner in the morning. It is certain, how- ever, that the hour of going to bed ought not to be so late as to protract the time of wakirt»*t;ilt the morning is far advanced : for the custom of early rising is extremely conducive to health. " To continue awake beyond a proper time, consumes the vital spirits, hurts the nerves, and causes many uneasy sensations. The fluids of the body become more acrid or sharp, the fat is consum- ed, and there comes on at length a tendency to giddiness, head-ache, and anxiety. Those who indulge themselves in much sleep are seldom liable to very strong passions. Excess of sleep, however, is prejudicial. The body sinks gradually into a complete state of inactivity, the solid parts become relaxed, the blood circulates slow- ly, and remains particularly long in the head. Perspiration is dis- ordered, the body increases in fat and thick humours, the memory is enfeebled, and the person falls into such a state that his sensibili- ty is, in a great measure, destroyed. It may be observed here, that old people, and those whose constitutions are not vigorous re- ceive great relief from a short nap after dinner, it allows the chief energies tobe exerted in the stomach almost the whole body else ■entirely being at rest." CHAPTER VI. OP INTEMPERANCE. There is not in the human character a more odious vice, nor one more truly degrading and destructive in its consequences, than that of habitual intemperance and drunkenness. It is to be considered as a gross offence against the law of nature, which directs us to preserve the use of our rational faculties. It is a palpable viola- tion of the moral law, which commands that man shall to the ut- most of his power preserve his own life. It is an unpardonable outrage against the laws of civil society, as it deprives the offend- er of the power with which the author of nature has endued him of contributing to the welfare and happiness of the common family of mankind. In every country and nation where ardent spirits have been in- troduced, thousands of the human race have fallen victims to a bru- tal indulgence in that detestable vice. As it respects our own coun- try, the following alarming facts are adduced for consideration. "It has been made to appear from substantial documents, that twenty- four million gallons of ardent spirits are distilled yearly in the United States—and that the importation of spirits had been, in for- mer years, but little short of eight millions of gallons per annum. So that more than thirty million gallons a year have been consum- ed in this country. " Now, supposing (and it is a very moderate computation) that, on an average, ten hogsheads, or a thousand gallons of those spirits, have occasioned the premature death of one person; then it will follow that the aforesaid thirty million gallons have brought oui fellow countrymen to an untimely grave, at the rate of thirty thou- sand persons a year. " Yes, it is not too much to say, that in these United States thirty thousand persons die yearly, by means of an immoderate use of brandy, rum, gin, and whiskey—not to mention a still greater nnmber of persons whom those intoxicating liquors render useless, and even a nuisance to society. Wrhat is the remedy for this dead- 102 0P INTEMPERANCE. BOOK fc ly evil ? What mounds can be erected to stop the progress of this devouring deluge, not of water, but of fire ?" It is a consolation to the friends of humanity that many respec- table and influential characters in our metropolis, and in various parts of New-England, are associating, and combining their efforts, to discourage and suppress the horrid practice of drunkenness and intemperance, and the most beneficial effects are anticipated from their very laudable endeavours. No man ever contemplated that species of human depravity with more acute sensibility than the late philanthropic Dr. B. Rush, and no one perhaps, ever exhibited the moral turpitude of that vice, with the long train of miseries, and deplorable disorders, which necessarily result from it, with more justness and precision, than will be found in the following valuable production from his pen; entitled, " An Inquiry into the effects of Ardent Spirits," 8gc. "Part I. By ardent spirits,I mean those liquors only which are obtained by distillation from fermented substances of any kind. To their effects upon the bodies and minds of men, the following inquiry shall be exclusively confined. Fermented liquors contain so little spirit, and that so intimately combined with other matters, that they can seldom be drunken in sufficient quantities to produce intoxication, and its subsequent effects, without exciting a disrelish to their taste, or pain, from their distending the stomach. They are, moreover, when taken in a moderate quantity, generally inno- cent, and often have a friendly influence upon health and life. " The effects of ardent spirits divide themselves into such as are of a prompt, and such as are of a chronic nature. The former discover themselves in drunkenness ; and the latter, in a numerous train of diseases and vices of the body and mind. " I. I shall begin by briefly describing their prompt, or imme- diate effects, in a fit of drunkenness. " This odious disease (for by that name it should be called) ap- pears with more or less of the following symptoms, and most com- monly in the order in which I shall enumerate them. " 1. Unusual garrulity. " 2. Unusual silence. :i3. Captiousness, and a disposition to quarrel; BOOK I. OP INTEMPERANCE. 103 "4. Uncommon good humour, and an insipid simpering, of laugh. " 5. Profane swearing, and cursing. " 6. A disclosure of their own, or other people's secrets. " 7- A rude disposition to tell those persons in company, whom they know, their faults. " 8. Certain immodest actions. I am sorry to say, this sign of the first stage of drunkenness, sometimes appears in women, who, when sober, are uniformly remarkable for chaste and decent manners. " 9. A clipping of words. " 10. Fighting ; a black eye, or a swelled nose, often mark this grade of drunkenness. "II. Certain extravagant acts which indicate a temporary fit of madness. " It belongs to the history of drunkenness to remark, that its paroxysms occur, like the paroxysms of many diseases, at certain periods, and after longer or shorter intervals. They often begin with annual, and gradually increase in their frequency, until they appear in quarterly, monthly, weekly, and quotidian or daily, pe- riods. Finally, they afford scarcely any marks of remission, eith- er during the day or the night. " It is further remaikable, that drunkenness resembles certain hereditary, family, and contagious diseases. I have once known it to descend from a father, to four out of five of his children. I have seen three, and once four, brothers, who were born of sober ancestors, affected by it, and I have heard of its spreading through a whole family composed of members not originally related to each other. These facts are important, and should not be overlooked by parents, in deciding upon the matrimonial connexions of their children. " Let us next attend to the chronic effects of ardent spirits upon the body and mind. In the body, they dispose to every form of acute disease ; they moreover excite fevers in persons predisposed to them, from other causes. This has been remarked in all the yellow fevers which have visited the cities of the United States. Hard drinkers seldom escape, and rarely recover from them. The following diseases are the usual consequences of the habitual use- of ardent spirits, viz. Punch, Toddy and Egg Rum, Grog—Brandy and Water, Flip and Shrub, Bitters infused in Spirits and Cor- dials, Drams of Gin, Brandy, and Rum in the Morning, i^jT The same Morning and Evening, The same during Day and Night, INTEMPERANCE. Vices. Idleness Gaming, Peevish- __ness, Quarrelling. Fighting, Horse Rac- ing* Lying and Swearing, Stealing and Swind- lingj Perjury, Burglary, Murder, Diseases. Sickness, Tremors of the hands in the morn- ing, puking, bloatedness, Inflamed eyes, red nose and face, Sore and swelled legs, jaundice, Pains in the hands, burning in the hands and feet, Dropsy, Epilepsy, Melancholy, Palsy, Apoplexy, Madness, Despair, Punishments. Debt. Jail. Black Eyes, and Rags. Hospital, or Poor- House. Bridewell. State Prison. do. for Life. Gallows t « A MORAL AND PHYSICAL THERMOMETER. A Scale of the Progress of Temperance and Intemperance.—Liquors, with Effects in their usual order. ~r^z Water, i Milk and Water, TEMPERANCE. Health and Wealth. Serenity of Mind, Reputation, Long Life, and Happiness. Y Cheerfulness, Strength, and Nourishment, when taken only in small quantities, and at meals. L06 OF INTEMPERANCE. BOOK I. " 1. A decay of appetite, sickness at stomach, and a puking of bile, or a discharge of a frothy and viscid phlegm, by hawking, in the morning. " 2. Obstructions of the liver. " 3. Jaundice, and dropsy of the belly and limbs, and finally of every cavity in the body. " 4. Hoarseness, and a husky cough, which often terminate in consumption, and sometimes in an acute and fatal disease of the lungs. " 5. Diabetes, that is, a frequent and weakening discharge of pale, or sweetish urine. " 6. Redness, and eruptions on different parts of the body. They generally begin on the nose, and after gradually extending all over the face, sometimes descend to the limbs, in the form of leprosy. They have been called { Rum-buds,' when they appear in the face. In persons who have occasionally survived these effects of ardent spirits on the skin, the face, after a while, be- comes bloated, and its redness is succeeded by a death-like paleness. " 7. A fetid breath, composed of every thing that is offensive in putrid animal matter. " 8. Frequent and disgusting belchings. Dr. Haller relates the case of a notorious drunkard having been suddenly destroyed, in consequence of the vapour discharged from his stomach by belch- ing, accidentally taking fire by coming in contact with the flame of a candle. " 9. Epilepsy. " 10. Gout, in all its various forms of swelled limbs, colic, pal- sy, and apoplexy. "Lastly, 11. Madness. The late, Dr. Waters, while he acted as house pupil and apothecary of the Pennsylvania Hospital, assur- ed me, that in one third of the patients confined by this terrible disease, it had been induced by ardent spirits. " Most of the diseases which have been enumerated, are of a mortal nature. They are more certainly induced, and terminate more speedily in death, when spirits are taken in such quantities, and at such times, as to produce frequent intoxication ; but it may serve to remove an error with which some intemperate people console themselves, to remark, that ardent spirits often bring on fatal diseases, without producing drunkenness. I have known BOOK I. OF INTEMPERANCE. 107 many persons destroyed by them, who were never completely in- toxicated during the whole course of their lives. The solitary in- stances of longevity which are now and then met with in hard drinkers, no more disprove the deadly effects of ardent spirits, than the solitary instances of recoveries from apparent death by drown- ing, prove that there is no danger to life from a human body lying an hour or two under water. " Not less destructive are the effects of ardent spirits upon the human mind. They impair the memory, debilitate the under- standing, and pervert the moral faculties. It was probably from observing these effects of intemperance in drinking, upon the mind, that a law was formerly passed in Spain, which excluded drunkards from being witnesses in a court of justice. But the de- moralizing effects of distilled spirits, do not stop here. They pro- duce not only falsehood, but fraud, theft, uncleanlincss, and mur- der. Like the demoniac mentioned in the New-Testament, their name is ' legion,' for they convey into the soul a host of vices and crimes. " A more affecting spectacle cannot be exhibited, than a person into whom this infernal spirit, generated by habits of intemperance, has entered. It is more or less affecting, according to the station the person fills in a family, or in society, who is possessed by it Is he a husband ? How deep the anguish which rends the bosom of his wife ! Is she a wife ? Who can measure the shame and aversion which she excites in her husband ? Is he the father, or is she the mother, of a family of children ? See their averted looks from their parent, and their blushing looks at each other ! Is he a magistrate ? or has he been chosen to fill a high and respectable station in the councils of his country ? What humiliating fears of corruption in the administration of the laws, and of the subversion of public order and happiness, appear in the countenances of all who see him ! Is he a minister of the gospel ?—Here language fails me.—If angels weep—it is at such a sight. " In pointing out the evils produced by ardent spirits, let us not pass by their effects upon the estates of the persons who are addict- ed to them. Are they inhabitants of cities ?—Behold ! their houses stripped gradually of their furniture, and pawned, or sold by a con- stable, to pay tavern debts. See ! their names upon record in the dockets of every court, and whole pages of newspapers filled with advertisements of their estates for public sale. Are they inhabi- 108 OP INTEMPERANCE. BOOK I. tants of country places? Behold! their houses with shattered windows,—their barns with leaky roofs,—their gardens overrun with weeds,—their fields with broken fences, their hogs without yokes, their sheep without weed,—their cattle and horses without fat,—and their children filthy and half clad, without manners, prin- ciples and morals. This picture of agricultural wretchedness is seldom of long duration. The farms and property thus neglected, and depreciated, are seized and sold for the benefit of a group of creditors. The children that were born with the prospect of in- heriting them, are bound out to service in the neighbourhood; while their parents, the unworthy authors of their misfortunes, ramble into new and distant settlements, alternately fed on their way by the hand of charity, or a little casual labour. " Thus we see poverty and misery, crimes and infamy, diseases and death, are all the natural and usual consequences of the in- temperate use of ardent spirits. " I have classed death among the consequences of hard drink- ing. But it is riot death from the immediate hand of the Deity, nor from any of the instruments of it which were created by him. It is death from suicide. Yes—thou poor degraded creature, who art daily lifting the poisoned bowl to thy lips—cease to avoid the unhallowed ground in which the self-murderer is interred, and won- der no longer that the sun should shine, and the rain fall, and the grass look green upon his grave. Thou art perpetrating gradual- ly, by the use of ardent spirits, what he has effected suddenly, by opium—or a halter. Considering how many circumstances from surprise, or derangement, may palliate his guilt, or that, (unlike yours) it was not preceded and accompanied by any other crime, it is probable his condemnation will be less than yours at the day of judgment. " I shall now take notice of the occasions and circumstances which are supposed to render the use of ardent spirits necessary and endeavour to shew that the arguments in favour of their use in such cases are founded in error, and that in each of them, ardent spirits, instead of affording strength to the body, increase the evils they are intended to relieve. " 1. They are said to be necessary in very cold weather. This is far from being true ; for the temporary warmth they produce, is always succeeded by a greater disposition in the body to be affect- ed by cold. Warm dresses, a plentiful meal just before exposure oook i. OP INTEMPERANCE. 109 to the cold, and eating occasionally a little gingerbread, or any other cordial food, is a much more durable method of preserving the heat of the body in cold weather. " 2. They are said to be necessary in very warm weather. Ex- perience proves that they increase, instead of lessening the effects of heat upon the body, and thereby dispose to diseases of all kinds. Even in the warm climate of the West-Indies, Dr. Bell asserts this to be true. " Rum (says this author) whether used habitually, moderately, or in excessive quanties in the West-Indies, always di- minishes the strength of the body, and renders men more suscep- ble of disease, and unfit for any service in which vigour or activity is required."* As well might we throw oil into a house, the roof of which was on fire, in order to prevent the flames from extend- ing to its inside, as pour ardent spirits into the stomach, to lessen the etfbcts of a hot sun upon the skin. " 3. Nor do ardent spirits lessen the effects of hard labour upon the body. Look at the horse ; with every muscle of his body swelled from morning till night in the plough, or a team, does he make signs for a draught of toddy, or a glass of spirits to enable him to cleave the ground, or to climb a hill ?—No—he requires nothing but cool water and substantial food. There is no nourish- ment in ardent spirits. The strength they produce in labour is of a transient nature, and is always followed by a sense of weakness and fatigue. " But are there no conditions of the human body in which ardent spirits may be given ? I answer—there are. 1st. When the body has been suddenly exhausted of its strength, and a disposition to faintness has been induced. Here a few spoonfuls, or a glass full of spirits, with or without water, may be administered with safety and advantage. In this case we comply strictly with the advice of Solomon, who restricts the use of " strong drink" only " to him who is ready to perish."—2dly. When the body has been exposed for a long time to wet weather, more especially, if it be combined with cold. Here a moderate quantity of spirits is not only safe, but highly proper to obviate debility, and to prevent a fever. They will more certainly have these salutary effects, if the feet are at the same time bathed with them, or a half a pint of them poured into * Inquiry into the causes which produce, and the means of preventing diseases among British officers, soldiers and others in^c West-Indies. 110 OF INTEMPERANCE. BOOK I. the shoes or boots. These I believe are the only two cases in which distilled spirits are useful or necessary to persons in health. " Part II. But it may be said, if we reject spirits from being a part of our drinks, what liquors shall we substitute in their room? I answer, in the first place, " 1. Simple Water. I have known many instances of persons who have followed the most laborious employments for many years, in the open air, and in warm and cold weather, who never drank any thing but water, and enjoyed uninterrupted good health. Dr, Mosely, who resided many years in the West Indies, confirms this remark. ' I aver, (says the Doctor) from my own knowledge and custom, as well as the custom and observations of many other people, that those that drink nothing but water, or make it their principal drink, are little affected by the climatej and can undergo the greatest fatigue without inconvenience, and are never subject to troublesome or dangerous diseases.' " Persons who are unable to relish this simple beverage of na- ture, may drink some one, or of all the following liquors, in prefer- ence to ardent spirits. " 2. Cioer. This excellent liquor contains a small quantity of spirit, but so diluted, and blunted by being combined with a large quantity of saccharine matter, and water, as to be perfectly whole- some. It sometimes disagrees with persons subject to the rheum- atism, but it may be made inoffensive to such people, by extinguish- ing a red hot iron in it, or by mixing it with water. " 3. Malt Liquors. The grain from which these liquors are obtained, is not liable, like the apple, to be affected by frost, and therefore they can be procured, at all times, and at a moderate price. They contain a good deal of nourishment; hence we find many of the poor people in Great Britain endure hard labour with no other food than a quart or three pints of beer, with a few pounds of bread in a day. As it will be difficult to prevent small beer from becoming sour in warm weather, an excellent substitute may be made for it by mixing bottled porter, ale, or strong beer with an equal quantity of water ; or a pleasant beer may be made by add- ing to a bottle of porter, ten quarts of water, and a pound of brown sugar or a pint of molasses. After they have been well mixed, pour the liquor into bottles and place them loosely corked in a cool cellar. In two or three days, it will be fit for use. A spoon- BOOK I. OF INTEMPERANCE. Ill ful of ginger added to the mixture, renders it more lively and agree- able to the taste. "4. Wines. These fermented liquors are composed of the same ingredients as cider, and are both cordial and nourishing. The peasants of France who drink them in large quantities, are a sober and healthy body of people. Unlike ardent spirits, which render the temper irritable, wines generally inspire cheerfulness and good humour. It is to be lamented that the grape has not as yet been cultivated in our country, to afford wine for our citizens ; but many sufficiently excellent substitutes may be made for it, from the native fruits of all the states. If two barrels of cider fresh from the press, are boiled into one, and afterwards fermented and kept for two or three years in a dry cellar, it affords a liquor which, according to the quality of the apple from which the cider is made, has the taste of Malaga, or Rhenish wine. It affords, when mixed with water, a most agreeable drink in summer. I have taken the liberty of call- ing it Pomona Wine. There is another method of making a pleasant wine from the apple, by adding four and twenty gallons of new cider to three gallons of syrup made from the expressed juice of sweet apples. When thoroughly fermented, and kept for a few years, it becomes fit for use. " 5. Molasses and Water, also Vinegar and Water sweetened with sugar or molasses, form an agreeable drink in warm weather. It is pleasant and cooling, and tends to keep up those gentle and uniform sweats on which health and life often depend. Vinegar and water constituted the only drink of the soldiers of the Roman republic, and it is well known they marched and fought in a warm climate, and beneath a load of arms which weighed sixty pounds. Boaz, a wealthy farmer in Palestine, we find, treated his reapers with nothing but bread dipped in vinegar. To such persons as object to the taste of Vinegar, sour milk, or butter milk, or sweet milk diluted with water, may be given in its stead. I have known the labour of the longest and hottest days in summer supported by means of these pleasant and wholesome drinks with great firmness, and ended with scarcely a complaint of fatigue. " 6. The Sugar Maple affords a thin juice, which has long been used by the farmers in Connecticut as a cool and refreshing drink in the time of harvest. " 7. Coffee possesses agreeable and exhilarating qualities, and might be used with great advantage to obviate the painful effects 112 OP INTEMPERANCE. BOOK I, of heat, cold and fatigue upon the body. I once knew a country physician who made it a practice to drink a pint of strong coffee previous to his taking a long or cold ride. It was more cordial to him than spirits, in any of the forms in which they are commonly used. " Let it not be said, ardent spirits have become necessary from habit in harvest, and in other seasons of uncommon and arduous labour. The habit is a bad one, and may be easily broken. Let but half a dozen farmers in a neighbourhood combine to allow higher wages to their labourers than are common, and a sufficient quantity of any of the pleasant and wholesome liquors I have re- commended, and they may soon, by their example, abolish the practice of giving them spirits. " In a little while they will be delighted with the good effects of their association. Their grain and hay will be gathered into their barns in less time, and in a better condition than formerly, and of course at a less expense, and an hundred disagreeable scenes from sickness, contention and accidents will be avoided, all of which follow, in a greater or less degree, the use of ardent spirits. " Valetudinarians, especially those who are afflicted with dis- eases of the stomach and bowels, are very apt to seek relief from ardent spirits. Let such people be cautious how they make use of this dangerous remedy. I have known many men and women, of excellent characters and principles, who have been betrayed by occasional doses of gin and brandy, into a love of those liquors, and have afterwards fallen sacrifices to their fatal effects. The different preparations of opium are much more safe and efficacious than dis- tilled cordials of any kind, in flatulent or spasmodic affections of the stomach and bowels. So great is the danger of contracting a love for distilled liquors by accustoming the stomach to their sti- mulus, that as few medicines as possible should be given in spiritu- ous vehicles, in chronic diseases. A physician of great eminence, and uncommon worth, who died towards the close of the last cen- tury, in London, in taking leave of a young physician of this city, who had finished his studies under his patronage, impressed this caution with peculiar force upon him, and lamented at the same time, in pathetic terms, that he had innocently made many sots by prescribing brandy and water in stomach somplaints. It is difficult to tell how many persons have been destroyed by those physicians who have adopted Dr. Brown's indiscriminate practice in the use DOOR I. OF intemperance. 113 of stimulating remedies ; the most popular of which is ardent spirits; but it is well known, several of them have died of intemperance in this city, since the year 1790. " Smoking and chewing tobacco, by rendering water and sim- ple liquors insipid to the taste, dispose very much to the stronger stimulus of ardent spirits. The practice of smoking cigars, has, in every part of our country, been more followed by a general use of brandy and water, as a common drink, more especially by that class of citizens who have not been in the habit of drinking wine, or malt liquors. The less, therefore, tobacco is used in the above ways, the better. " No man ever became suddenly a drunkard. It is by gradually accustoming the taste and stomach to ardent spirits, in the forms of grog, and toddy, that men have been led to love them in their destructive mixtures and in their simple state. Under theim pres- sion of this truth, were it possible for me to speak, with a voice so loud as to be heard from the river St. Croix, to the remotest shores of the Mississippi, which bound the territory of the United States, I would say,—Friends and Fellow Citizens ! avoid the ha- bitual use of those two seducing liquors, whether they be made with brandy, rum, gin, Jamaica spirits, whiskey, or what is called cherry bounce. It is true, some men, by limiting the strength of those drinks, by measuring the spirit and water, have drunken them for many years, and even during a long life, without acquiring habits of intemperance or intoxication ; but many more have been insensibly led, by drinking weak toddy, and grog, first at their meals, to take them for their constant drink, in the intervals of their meals; afterwards, to take them, of an increased strength, be- fore breakfast in the morning, and finally to destroy themselves by drinking undiluted spirits, during every hour of the day and night. I am not singular in this remark. ' The consequences of drinking rum and water, or grog as it is called, (says Dr. Mosely) is, that habit increases the desire of more spirit, and decreases its effects ; and there are very few grog-drinkers, who long survive the prac- tice of debauching with it, without acquiring the odious nuisance of a dram-drinker's breath, and downright stupidity and impotence.'* To enforce the caution against the use of those two apparently innocent and popular liquors still further, I shall select one in- ■ Treatise on Tropical Diseases 15 114 OF INTEMPERANCE. BOOK I. stance, from among many, to shew the ordinary manner in which they beguile and destroy their votaries. A citizen of Philadel- phia, once of a fair and sober character, drank toddy for many years, as his constant drink. From this he proceeded to drink grog. After a while, nothing would satisfy him, but slings made of equal parts of rum and water, with a little sugar. From slinks, he advanced to raw rum, and from common rum to Jamaica spirits. Here he rested for a few months, but at length finding even Jamai- ca spirits were not srrong enough to warm his stomach, he made it a constant practice to throw a table spoonful of ground pepper into each glass of his spirits, in order, to use his own words, ' to take off their coldness.' He soon afterwards died a martyr to his intemperance. "Ministers of the gospel, of every denomination in the United States !—aid me with all the weight you possess in society, from the dignity and usefulness of your sacred office, to save our fellow men from being destroyed by the great destroyer of their lives and souls. In order more successfully to effect this purpose, permit me to suggest to you, to employ the same wise modes of instruc- tion, which you use in your attempts to prevent their destruction by other vices. You expose the evils of covetousness, in order to prevent theft; you point out the sinfulness of impure desires, in order to prevent adultery ; and you dissuade from anger, and malice, in order to prevent murder. In like manner, denounce, by your preaching, conversation and example, the seducing influ- ence of toddy and grog, when yeu aim to prevent all the crimes and miseries which are the offspring of strong drink. " We have hitherto considered the effects of ardent spirits upon individuals, and the means of preventing them. I shall close this head of our inquiry, by a few remarks on their effects upon the' population and welfare of our country, and the means of obviating them. " It is highly probable, not less than four thousand people die annually, from the use of ardent spirits, in the United States. Should they continue to exert this deadly influence upon our population, where will their evils terminate ? This question may be answered by asking, where are all the Indian tribes, whose numbers and arms formerly* spread terror among their civilized neighbours? I answer in the words of the famous Mingo Chief, {the blood of many of them flows not in the veins of any human BOOK I. OP IN'TEMPERANCK. 115 creature.' They have perished, not by pestilence or war, but by a greater foe to human life than either of them,—Ardent Spirits. The loss of four thousand American citizens, by the yellow fever, in a single year, awakened general sympathy and terror, and called forth all the strength and ingenuity of laws, to prevent its recur- rence. Why is not the same zeal manifested in protecting our citizens from the more general and consuming ravages of distilled spirits?—Should the customs of civilized life preserve our nation from extinction, and even from an increase of mortality, by those liquors, they cannot prevent our country being governed by men, chosen by intemperate and corrupted voters. From such legisla- tors, the republic would soon be in danger. To avert this evil, —lot good men, of every class, unite and besiege the general and state governments, with petitions to limit the number of taverns— to impose heavy duties upon ardent spirits—to inflict a mark of disgrace, or a temporary abridgment of some civil right, upon eve- ry man, convicted of drunkenness; and finally, to secure the pro- perty of habitual drunkards, for the benefit of their families, by placing it in the hands of trustees, appointed for that purpose, by a court of justice. " To aid the operation of these laws, would it not be extremely useful for the rulers of the different denominations of Christian churches to unite, and render the sale and consumption of ardent spirits a subject of ecclesiastical jurisdiction?—The Methodists, and society of Friends, have, for some time past, viewed them as contraband articles, to the pure laws of the gospel, and have borne many public and private testimonies against making them the object of commerce. Their success in this benevolent enter- prize, affords ample encouragement for all other religious societies to follow their example. " Part III. We come now to the third part of this Inquiry; that is, to mention the remedies for the evils which are brought on by the excessive use of distilled spirits. These remedies divide themselves into two kinds. " T. Such as are proper to cure a fit of drunkenness ; and " II. Such as are proper to prevent its recurrence, and to de- stroy a desire for ardent spirits. "I. I am aware, that the efforts of science and humanity, in applying their resources to the cure of a disease induced by an act 116 OP INTEMPERANCE. BOOK I. of vice, will meet with a cold reception from many people. But let such people remember, the subjects of our remedies are their fellow creatures, and that the miseries brought upon human nature, by its crimes, are as much the object of divine compassion, (which we are bound to imitate,) as the distresses which are brought upon men by the crimes of other people, or which they bring upon them- selves, by ignorance or accidents. Let us not, then, pass by the prostrate sufferer from strong drink, but administer to him the same relief, we would afford to a fellow creature, in a similar state, from an accidental and innocent cause. " 1. The first thing to be done to cure a fit of drunkenness, is to open the collar, if in a man, and remove all tight ligatures from every other part of the body. The head and shoulders should at the same time be elevated, so as to favour a more feeble determi- nation of the blood to the brain. " 2. The contents of the stomach should be discharged, by thrusting a feather down the throat. It often restores the patient immediately to his senses and feet. Should it fail of exciting a puking, "3. A napkin should be wrapped round the head, and wetted an hour or two with cold water, or cold water should be poured in a stream upon the head. In the latter way I have sometimes seen it used, when a boy, in the city of Philadelphia. It was applied, by dragging the patient, when found drunk in the street, to a pump, and pumping water upon his head for ten or fifteen minutes. The patient generally rose and walked off, sober and sullen, after the use of this remedy. " Other remedies, less common, but not less effectual for a fit of drunkenness are, "4. Plunging the body into cold water. A number of gentle- men, who had drunken to intoxication, on board of a ship in the stream near Fell's point, at Baltimore, in consequence of their reeling jn a small boat, on their way to the shore, in the evening, overset it, and fell into the water. Several boats from the shore hurried to their relief. They were all picked up, and went home, perfectly sober to their families. " 5. Terror. A number of young merchants, who had drunk- en together, in a compting-house, on James river, above thirty years ago, until they were intoxicated, were carried away by a BOOK I. OF INTEMPERANCE. 117 sudden rise of the river, from an immense fall of rain. They floated several miles with the current, in their little cabin, half filled with water. An island in the river arrested it. When they reached the shore that saved their lives, they were all sober. It is probable terror assisted in the cure of the persons who fell into the water at Baltimore. " G. The excitement of a fit of anger. The late Dr. Wither- spoon used to tell a story of a man in Scotland, who was always cured of a fit of drunkenness, by being made angry. The mean chosen for that purpose, was a singular one. It was talking against religion. " 7. A severe whipping. This remedy acts by exciting a re- vulsion of the blood from the brain, to the external parts of the body.* " 8. Profuse sweats. By means of this evacuation, nature sometimes cures a fit of drunkenness. Their good effects are ob- vious in labourers, whom quarts of spitits taken in a day will sel- dom intoxicate, while they sweat freely. If the patient be unable to swallow warm drinks, in order to produce sweats, they may be excited by putting him in a warm bath, or wrapping his body in blankets, under which should be placed half a dozen hot bricks, or bottles filled with hot water. " 9. Bleeding. This remedy should always be used where the former ones have been prescribed to no purpose, or where there is reason to fear from the long duration of the disease, a material injury may be done to the brain. " It is hardly necessary to add, that each of the above reme- dies should be regulated by the grade of drunkenness, and the greater or less degree, in which the intellects are affected by it. " II. The remedies which are proper to prevent the recurrence of fits of drunkenness, and to destroy the desire for ardent spirits, are religious, metaphysical, and medical. I shall briefly mention them. " 1. Many hundred drunkards have been cured of their desire for ardent spirits, by a practical belief in the doctrines of the Christian religion. Examples of the divine efficacy of Christia- * I have been assured by a respectable physician, that many instances have oc- curred of persons found dead-drunk in the streets, who, on receiving a few stripes on the naked skin, have been instantly renovated so as to use their legs, and walk off as if nothing had happened, and he believes this application to be infallible. 118 OF INTEMPERANCE. BOOK I, nity for this purpose, have lately occcurred in many parts of the United States. " 2. A sudden sense of the guilt contracted by drunkenness, and of its punishment in a future world. It once cured a gentle- man in Philadelphia, who, in a fit of drunkenness, attempted to murder a wife whom he loved. Upon being told of it when he was sober, he was so struck with the enormity of the crime he had nearly committed, that he never tasted spirituous liquors af- terwards. " 3. A sudden sense of shame. Of the efficacy of this deep- seated principle in the human bosom, in curing drunkenness, I shall relate three remarkable instances. " A farmer in England, who had been many years in the prac- tice of coming home intoxicated, from a market town, one day observed appearances of rain, while he was in market. His hay was cut, and ready to be housed. - To save it, he returned in haste to his farm, before he had taken his customary dose of grog. Upon coming into his house, one of his children, a boy of six years old, ran to his mother, and cried out " O ! mother, father is come home, and he is not drunk." The father, who heard this exclamation, was so severely rebuked by it, that he suddenly be- came a sober man. " A noted drunkard was once followed by a favorite goat, to a tavern, into which he was invited by his master, and drenched with some of his liquor. The poor animal staggered home with his master, a good deal intoxicated. The next day he followed him to his accustomed tavern. When the goat came to the door, he paused: his master made signs to him to follow him into the house. The goat stood still. An attempt was made to thrust him into the tavern. He resisted, as if struck with the recollection of what he suffered from being intoxicated the night before. His masterwas so much affected by a sense of shame, in observing the conduct of his goat to be so much more rational than his own, that he ceased from that time to drink spirituous liquors. " A gentleman in one of the southern states, who had nearly destroyed himself by strong drink, was remarkable for exhibiting the grossest marks of folly in his fits of intoxication. One even- ing, sitting in his parlor, he heard an uncommon noise in his kitchen. He went to the door, and peeped through the key-hole,, BOOK 1. OP INTEMPERANCE. 119 from whence he saw one of his negroes diverting his fellow- servants, by mimicking his master's gestures and conversation when he was drunk.—The sight overwhelmed him with shame and distress, and instantly became the means of his reformation. " 4. The association of the idea of ardent spirits, with a pain- ful or disagreeable impression upon some part of the body, has sometimes cured the love of strong drink. I once tempted a negro man, who was habitually fond of ardent spirits, to drink some rum, (which I placed in his way) and in which I had put a few grains of tartar emetic.—The tartar sickened and puked him to such a degree, that he supposed himself to be poisoned. I was much gratified by observing he could not bear the sight nor smell of spirits for two years afterwards. " I have heard of a man who was cured of the love of spirits, bv working off a puke, by large draughts of brandy and water ; and I know a gentleman, who, in consequence of being affected with a rheumatism, immediately after drinking some toddy, when overcome with fatigue and exposure to the rain, has ever since loathed that liquor, only because it was accidentally associated in his memory with the recollection of the pain he suffered from his disease. " This appeal to that operation of the human mind, which obliges it to associate ideas, accidentally or otherwise combined, for the cure of vice, is very ancient. It was resorted to by Moses, when he compelled the children of Israel to drink the solution of the golden calf (which they had idolized) in water. This solution, if made, as it most probably was, by means of what is called hepar stdmuris, was extremely bitter and nauseous, and could never be recollec;ed afterwards, without bringing into equal detestation, the sin which subjected them to the necessity of drinking it. Our knowledge of this principle of association upon the minds and con- duct of men, should lead us to destroy, by means of other impres- sions, the influence of all those circumstances with which the re- collection and desire of spirits are combined. Some men drink only in the morning, some at noon, and some at night. Some men drink only on a market day, some at one tavern only, and some only in one kind of company. Now by finding a new and interosiing employment, or subject of conversation for drunkards at the usual times in which they have been accustomed to drink, and by restraining them by the same means from those places and 120 OF INTEMPERANCE. BOOK I, companions, which suggested to them the idea of ardent spirits, their habits of intemperance may be completely destroyed. In the same way the periodical returns of appetite, and a desire of sleep have been destroyed in a hundred instances. The desire for strong drink differs from each of them, in being of an artificial na- ture, and therefore not disposed to return, after being chased for a few weeks from the system. " 5. The love of ardent spirits has sometimes been subdued, by exciting a counter passion in the mind. A citizen of Philadel- phia, had made many unsuccessful attempts to cure his wife of drunkenness. At length, despairing of her reformation, he pur- chased a hogshead of rum, and, after tapping it, left the key in the door of the room in which it was placed, as if he had forgotten it. His design was to give his wife an opportunity of drinking herself to death. She suspected this to be his motive, in what he had done, and suddenly left off drinking. Resentment here be- came the antidote to intemperance. " 6. A diet consisting wholly of vegetables cured a physician in Maryland of drunkenness, probably by lessening that thirst, which is always more or less excited by animal food. " 7. Blisters to the ankles, which were followed by an unusual degree of inflammation, once suspended the love of ardent spirits, for one month, in a lady in this city. The degrees of her intem- perance may conceived of, when I add, that her grocer's accompt for brandy alone, amounted annually, to one hundred pounds, Pennsylvania currency, for several years. " 8. A violent attack of an acute disease has sometimes destroy- ed a habit of drinking distilled liquors. I attended a notorious drunkard, in the yellow fever, in the year 1798, who recovered, with the loss of his relish for spirits, which has, I believe, contin- ued ever since. " 9. A salivation has lately performed a cure of drunkenness in a person in Virginia. The new disease excited in the mouth and throat while it rendered the action of the smallest quantity of spirits upon them painful, was happily calculated to destroy the disease in the stomach which prompts to drinking, as well as to render the recollection of them disagreeable, by the laws of asso- ciation formerly mentioned. " 10. I have known an oath taken before a magistrate, to drink ro more spirits, produce a perfect cure of drunkenness. It *'s BOOK I. Or INTEMPERANCE. 121 sometimes cured in this way in Ireland. Persons who take oaths for this purpose, are called affidavit men. "11. An advantage wculd probably arise from frequent repre- sentations being made to drunkards, not only of the certamiy, but of the suddenness of death, from habits of intemperance. I have he'ird of two persons being cured of the love of ardent spirits, by seeing death suddenly induced by fits of intoxication ; in the one case, in a stranger, and in the other, in an intimate friend. " 12. It has been said, that the disuse of spirits should be gradual; but my observations authorize me to say, that persons who have been addicted to them, should abstain from them sud- denly and entirely. ' Taste not, handle not, touch not,' should be inscribed upon every vessel that contains spirits in the house of a man, who wishes to be cured of habits of intemperance. To obviate, for a while, the debility which arises from the sudden abstraction of the stimulus of spirits, laudanum, or bitters infused in water, should be taken, and perhaps a larger quantity of beer or wine, than is consistent with the strict rules of temperate living. By the temporary use of fliese substitutes for spirits, I have never known the transition to sober habits to be attended with any bad effects, but often with permanent health of body, and peace of mind." One disease, caused by the intemperate use of ardent spirits, should be added to the foregoing catalogue of Dr. Rush. It is that denominated delirium tremens, delirium vigilans, or brain fever of drunkards. This singular disease, I believe, in general commences some days after a sudden disuse of spirits, and some- times in subjects addicted to the use of spirits to excess, without becoming actually drunk. The delirium seems to differ from all other mental derangements. It comes on gradually, aud several days elapse before it arrives at the stage of its greatest violence. It is attended by tremors of the whole body, but particularly of the hands, with profuse sweating, and almost unsubduable watch- fulness. Several cases of this singular affection have, within a few years, come under my observation, and it has occurred several times in the same individual. This disease is always attended by febrile symptoms, and it is one of its peculiarities, that the mind. is continually haunted with the idea that they are infested by snakes and insects. I have frequently seen patients wearied in attempting to catch snakes, which they imagined were curMng 16 122 OF INTEMPERANCE. BOOK I. about them under their clothes. It should be our endeavour, in these cases, to procure calm and quiet sleep, as the result will be a speedy subsidence of the symptoms. The remedies usually re- sorted to, are bleeding, emetics, cathartics, and blisters, with low diet. The patient should be indulged with mild treatment, unless he is outrageous, when close confinement becomes necessary. The most essential and speedy relief is to be obtained by large and repeated doses of opium. I have administered opium, from 2 to 4 grains, every two hours, until 35 grains were taken, and about ten grains of digitalis, before sleep could be induced ; the result was an abatement of the delirium, and a speedy removal of the complaint. Stramonium may be advantageously combined with opium, and their effects upon the system continued until the desired result be obtained. CHAPTER V. OF EVACUATIONS. The three principal evacuations established by nature to free the body from the superabundance of fluids, are those by stool. urine, and insensible perspiration. Of the Evacuation by Stool. No one can enjoy uninterrupted health without a due regularity of the excretions from the intestines. If the faeces be expelled too soon, or if too long retained, the system must suffer inconvenience. Too copious evacuations of this kind, deprive the body of its nou- rishment, and of that strength which is necessary to support its ex- ertions. By a contrary state, the circulation of the blood in the intestinal vessels is retarded, and the retained faeces communicate a noxious quality to the fluids. Indeed, much depends on a proper regulation of (his evacuation, without which the most rigorous ob- servance of dietetic rules is insufficent for the preservation of our health. In healthy individuals, the evacuation by stool usually takes place once in a day ; but this is variable in different persons, and even in the same person at different times, according to any incidental deviation from regularity in diet, exercise and sleep. It is liable to be affected both by the quantity and quality of the food taken, and also by tlie particular habits of individuals. Lying late in bed is unfavourable to this discharge, not only by the warmth, which, increasing perspiration, diminishes all the other discharges, but likewise by the inactivity, and even posture of the body. Those are seldom subject to costiveness who rise early and use exercise in the open air, and, at the same time, solicit nature by going re- gularly to stool every morning, whether there is a call or not. This will in time induce a habit which will eventually become natural. With respect to medicine for obviating a costive disposition, the reader is referred to the chapter on costiveness; and to that on diarrhoea, for the proper remedies for that complaint. 124 OP EVACUATIONS. BOOK I. Of Urine. The discharge by urine is more frequent than that by stool, and is also more variable in quality and quantity ; on account of its be- ing greatly influenced by the nature of the aliments, the state of perspiration and the temperature of the air. The urine, being strongly impregnated with salts and oils, if it be retained too long in the bladder, becomes acrid and corrosive, and proves the cause of many disorders. According to the higher or paler colour of the urine, in an ordinary state of health, the body may be considered as being more or less vigorous. If, after long standing, no sediment be deposited in it, great weakness is supposed to be indicated. When it yields a sediment resembling brick dust, an impure state of the stomach is the inference. But all pretensions to discover thefuture affections of the body by inspection of the urine only, are too ab- surd and ridiculous to deserve consideration. As a free discharge of urine not only prevents, but actually cures, many diseases, it ought, by all means, to be promoted ; and every thing that tends to obstruct it should be carefully avoided. Food of a heating quality, and sleeping on beds that are too soft and wa^m, by increasing perspiration, will diminish this discharge. Persons who suffer from a deficiency of urine, ought to take mode- rate exercise, and to eat of such herbs and fruits as parsley, aspara- gus, celery, strawberries, &c. using at the same time thin drinks gently acidulated with the vegetable acids. The appropriate reme- dies in cases of too copious discharge of urine will be detailed when treating of Diabetes ; and other affections of the kidneys and bladder will be notified in their proper place. One caution, how- ever, ought to be suggested here; instances have occurred, where persons, by too long retaining their urine, from motives of false de- licacy, have lost the power of discharging it. The bladder being too much distended, has become paralytic ; and every effort to cure it has proved abortive. Such dreadful examples ought to serve as a warning against ever permitting a preposterous delicacy to oper- ate, when the consequence must be of such a serious nature. Of Insensible Perspiration. Among the natural evacuations on which the life and health of man so essentially depends, none is so important and extensive as BOOK I. OF EVACUATIONS. 125 that of insensible perspiration. According to the calculation of some, a person of middle stature, and in perfect health, perspires from three to four or five pounds weight during the twenty-four hours. It exceeds in quantity all the other evacuations, and, of course, every suppression of it must inevitably occasion a serious inter- ruption to health. This discharge from the system, varies in dif- ferent seasons, climates and constitutions, and is much influenced by the casual diversities in exercise, food, and exposure to heat or cold. It is, however, in general, more copious and uniform dur- ing the night, on account of the warmth of the bed and unifor- mity of the surrounding atmosphere. Insensible perspiration is weaker after a plentiful meal, which accounts for the chilliness often felt on that occasion. But as soon as the food is digested, this discharge returns with increased energy. The chyle, now changed into blood, imparts additional force to the vital powers, as well as to the circulation of the blood itself. The process of perspiration is supposed to be most forcibly affected, and sometimes totally suppressed by the following circumstances: 1. By violent pain, which in a remarkable degree consumes the fluids of the body, or propels them to other parts. 2. By ob- structions of the vessels of the skin, which are frequently occasion- ed by the use of salves, ointments, and cosmetics. 3. By severe colds, especially those contracted at night, and during sleep. 4. When nature is either weak, or endeavours to promote any other species of evacuation; or, as was before observed, during the time of concoction, particularly after using food that is difficult to be digested. Perspiration, on the contrary, is promoted by moderate exercise, the warm bath, and mild sudorific medicines; to which may be added friction, cleanliness, and the exhilarating passions, hope and joy. When perspiration is too profuse, indicating a weakness of the body, and laxity of the vessels of the skin, it is best removed by cold bathing. The variable state of the atmosphere, and the mutability of the weather, are among the most frequent causes of obsructed perspi- ration ; to counteract the influence of which, and fortify the body against them, nothing is so efficacious as being abroad whenever health will permit; for those who seclude themselves from the open air become extremely susceptible of its influence on every ex- posure. 126 OP EVACUATIONS. BOOK I, The evening air, especially when accompanied with dews, which fall most plentifully after the hottest day in summer, is a very fre- quent cause of obstructed perspiration ; this will suggest the pru- dent caution of avoiding as much as possible exposure to them. Those who inhabit marshy countries, where exhalations, fogs, and dews are more copious, are often seized with dangerous diseases, from an imprudent neglect of this caution. Another cause by which perspiration is liable to be greatly ob- structed, is wet clothes ; fevers, rheumatisms, and a multiplicity of diseases often originate from this source. Persons therefore im- mediately after getting wet should change their clothes, or keep constantly in motion till they become dry, but to sit or lie down in the fields with wet clothes, is an act of imprudence liable to pro- duce the most fatal effects. Perspiration is very frequently obstructed in consequence of wet feet, and this produces colics, inflamation of the bowels and other dangerous affections; nothing sooner induces a fit of the gout in people subject to that complaint. It is therefore of great import- ance that the feet be well guarded, by thick shoes, against wet grounds and morning dews. Damp houses, and rooms, rendered so by being newly plastered or painted, are extremely unwholesome, and a frequent source of consumptions and other diseases. The noxious smell of the mate- rials used in painting is well known to occasion pernicious effects. It has long been a received opinion that damp beds are a fruit- ful source of diseases, such as fevers, rheumatisms, consumptions, &c. Although Dr. Heberden, an eminent physician, maintains the opposite opinion, the respectable authority and universal .belief re- lative to the danger resulting from damp sheets, must deter all who have a regard for health from submitting to make a personal ex- periment on the subject. It is well understood that all sudden transitions from heat to cold have a remarkable effect in suppressing perspiration. Those who confine themselves in a warm room, and drink hot liquors till the pores become open, and immediately go into the cold air, may ex- pect to suffer the severest consequences; by such imprudent con- duct thousands have forfeited their lives. The same disagreeable effects are apt to ensue, when people while in a hot room, place themselves near an open window; for, the current of air being thus directed against one particular part of the body, it is scarcely pos-, BOOK I. OP EVACUATIONS. 127 sible to escape catching cold in such a situation : nor is it much less hazardous to sleep with open windows near the bed, even in the hottest season. It is likewise proper to caution people against the practice of drinking cold water, or other cold liquors, when the blood is hot and perspiration free. Numerous instances have occurred of persons having expired before leaving the pump from which they had taken the fatal draught. But the more favourable consequences result- ing from this practice are hoarseness, quinseys, and various febrile affections. When therefore, a man is afflicted with extreme thirst while hot, he ought not to drink a large quantity at once, but first rinse his mouth, which if frequently repeated has a powerful effect in abating thirst. If a spoonful of brandy or other spirits where it can be procured be taken into the mouth, or a bit of bread be eaten with a few mouthfuls of water, much less danger is to be appre- hended. But if, regardless of consequences, a man has imprudent- ly, when hot, drunk freely of cold liquor, his safety will require that he take active exercise till the liquor be thoroughly warmed upon his stomach; and this will counteract the hurtful effects of the chilliness which would otherwise ensue. The best remedy for cramp in conse- quence of drinking cold water when the body is hot, is laudanum; if the symptoms are very severe, a large spoonful every ten minutes, as the time is short. In less severe cases a teaspoonful as often. Camphorated Brandy also given liberally internally, and spirituous fomentations applied to the bowels, by which the patient will be re- lieved from the irritation and spasms : In some cases death hasbeen hurried on by blood letting. In instances of this kind the use of the lancet shou'd be severely reprobated. In bad cases, use the warmth bath immediately, and inject into the bowels a pint of spirits and water, one part of the former to two of the latter. It is a well known fact, that horses have frequently been destroy- ed in consequence of drinking freely of cold water, when their bodies were heated, and their exercise was soon after discontinued. Of the Saliva. The saliva is a fluid supplied from the glands of the mouth, for the purpose of mixing with the food in the act of mastication or chew- ing, and essentially contributes to the process of digestion. If this fluid be evacuated too copiously, for instance, by those who indulge in smoking tobacco, it is extremely detrimental, as it weakens the 128 OP EVACUATIONS. BOOK 1. organs of digestion, deprives the body of many useful fluids, and has a direct tendency to emaciation, particularly in young persons, and those of lean and dry fibres. Frequent smoking makes the teeth black; white clay pipes are apt to canker the enamel of the teeth to such a degree as to infect the breath, and produce ulcers in the gums. To persons of a middle age, or those of full growth, particularly the corpulent, the phlegmatic, and such as are subject to defluxions of the head and throat, it may occasionally be of ser- vice, if used with moderation, especially in damp, cold, and hazy weather. Such persons, however, ought never to smoke immedi- ately before or after a meal, as the saliva is essentially requisite to assist the digestion of the food. They ought to smoke slowly; frequently take small draughts of beer, tea, or other diluting liquors, but neither spirits nor wine. Lastly, they ought to use a clean pipe with a long tube; for the oil of tobacco, settling on the sides of the pipe, is one of the most acrimonious and hurtful substances, and would otherwise be absorbed, and mixed with the fluids of the body. Of Cleanliness. Among the means of extensive influence in the preservation of health, a strict attention to cleanliness is not to be considered as the least important. Uninterrupted perspiration is indispensable for the security of health ; but it cannot long be maintained, with- out an uniform attention to cleanliness. The vapours which con- tinually exhale through the pores, soon impregnate those parts of our apparel which come in contact with the skin, and this is a fre- quent cause of those cutaneous diseases which are often so trouble- some and difficult of cure. Besides, these^ putrid vapours, adher- ing to the skin, are apt to be absorbed into the blood, and thus be- come the source of malignant fevers, and other fatal diseases. Personal cleanliness is not only an amiable virtue, but a source of much comfort and satisfaction to all who pretend to the least de- gree of politeness and delicacy. With the laudible view of freeing the skin from impurities, the practice of washing the body in cold or tepid water is highly to be commended. The usefulness of this mean of cleanliness is scarcely to be conceived by those who have not experienced its advantages ; and those who have, would not be persuaded to relinquish the practice. Further observations re- lative to this subject will be found under the head of cold and warm bathing in the appendix to this work. CHAPTER VIII. OF CLOTHING. In a climate so variable as that of the United States, both the nature and the texture of the materials which compose our dress, merit more particular consideration than in general is bestowed upon them. Numerous diseases are to be ascribed to the want of attention in accommodating our dress to the temperature of the climate, and to the various seasons and vicissitudes of the weather. It ought to be varied in point of thickness and warmth, according to the sudden changes in the atmosphere, which occur at different seasons. It is, however, not intended to inculcate a scrupulous nicety in changing the dress with the daily fluctuations of the weather, but the general precept, not to dispense with the winter dress too early in the spring, nor retain that of the summer till the approach of the boisterous season of autumn, should be most strictly regarded. Those who have a just conception of the baneful influence of intense cold, when applied to the skin, will duly appreciate the precaution above suggested. The Dutch are so sensible of the importance of guarding the body against cold, that they wear more than double the quantity of clothing that is customary in this country, and it is said that catarrhs and consumptions are scarcely named in the catalogue of diseases among those people. The inhabitants of Canada are in the habit of wearing flannel next to their skins, and when ex- posed to the severity of the weather, they are wrapt in furs. Strangers who visit our country from abroad, have frequently ex- pressed their astonishment at our thin dress, so very ill adapted to withstand the inclemency of the weather in this cold and vari- able climate; and they were at no loss to account for the coughs, catarrhs, and consumptions, so prevalent among our inhabitants. The mode of dress among our leaders in fashionable life, can- not but appear strikingly inadequate to the salutary purposes for which it is intended. It is not uncommon to see young gentle- men coming from a warm, close room, and exposing themselves 17 130 OF CLOTHING. BOOK I. to the severity of cold easterly winds, storms, and night dews, with scarcely an additional garment. These votaries of courteous gallantry, it would seem, are more solicitous to display a hand- some form, than to adopt the means which Providence has put into their power for the preservation of life and health. Nor is the imprudent conduct among the other sex less reprehensible, In preparing for an evening visit, it is common for ladies to retire from a warm parlor to a cold dressing-room, and, having changed a comfortable warm gown, for one of thin muslin with short wide sleeves, leaving the arms naked almost to the shoulders, and the neck and breast bare, or covered with thin lace, they walk through the streets with thin shoes, by which their feet are unavoidably wet and cold, and as the rules of politeness forbid their drying them in presence of company, they sit a considerable time in a shivering condition. At length, tea being served about, and the fund of anecdote and conversation exhausted, they retire from a warm, crowded room, through the cold and damp night air, and soon go shivering to bed. Who will be surprised that the consequences of such imprudent exposure, are catarrhal affections of the chest and lungs, with cough and hoarseness, eventually terminating in fatal consumptions 1 " Motives of delicacy, as well as regard for heahb, have been repeatedly urged in vain to enforce the necessi- ty of relinquishing these destructive habits ; the arguments of the moralist, and of the physician having alike failed to convey con- viction ; hundreds, who would now have shone forth among the loveliest of the sex, have been dressed in shrouds, because, in an evil hour, they laid aside those parts of their apparel which health, as well as decency, forbade them to relinquish." In Scotland, colds were extremely rare, and consumptions seldom met with until the thick, warm, Scottish plaiding was relinquished for the thin English dress, when these disorders became extremely rife, and are now, perhaps even more frequent than in the other parts of the British Island. The feet and chest are the two parts of the body which are more especially liable to receive the ill impressions of cold, and communicate them to the rest, and these at least should be defended with the utmost care, by covering them with flannel or fleecy hosiery. There is another custom introduced among young females, which ought to be noticed here for the express purpose of bestow- ing on it the severest reprehension. It is that of wearing iron BOOK I. OP Ct.OTniN«. 131 or other hard substance, called corsets, against the breast bone, with the view of improving their shape. Could they be made sensible of the folly, and absolute danger of thus compressing the vital parts, they would readily relinquish all claim to genteel appearance, rather than incur the hazard which might attend the use of corsets. Some instances of fatal accidents, attributed to this cause, have been already announced. From a just consideration of these circumstances, the question may be readily solved, why consumptions have so greatly increased among our young people of late years. The perfection of dress considered merely as such, consists in its being accommodated to the form of the body, without pressing or binding any part, Tight bandages about the neck are ex- tremely detrimental. By impeding the circulation of the blood, they often produce head-ach, vertigo, and other more dangerous complaints, and when applied to the limbs, they prove injurious by hurting their growth, and occasioning lameness and many in- conveniences. The inquiry is often made, what is the covering most proper to be worn next the skin? The advantages and disadvantages of a flannel shirt, have received such ample consideration of late years, that little remains to be said on the subject, but to recommend the general employment of it, as one of the most useful articles of Wearing apparel. Experience has so fully evinced the utility of covering the skin with flannel, that no person who has been habit- uated to its use in our damp and variable climate, can be persuaded to dispense with it at any season of the year. It may not, perhaps, seem advisable to recommend the use of flannel shirts, indiscriminately, to infants, and young healthy persons, but to those who have passed the meridian of life, to persons of cold and phlegmatic habits, to such as are subject to gout, rheumatism, colds, and catarrhs, and, in short, to valetudinarians of every de- scription, this article of dress should be considered as an indispen- sable requisite. Linen shirts, when worn a few days, are not only liable to excite a sensation of coolness, but to obstruct perspiration, which effect it produces in proportion to the thickness of its texture. Flannel, on account of the gentle friction which it occasions on the skin, produces a moderate warmth, and promotes perspiration, at the same time, on account of the porous nature of its substance, the 132 OP CLOTHING. BOOK I, matter which it absorbs from the skin is easily evaporated. By its gentle stimulus on the skin, flannel has the beneficial effect of keeping the pores in a state the most favourable to a uniform per- spiration, and when, by brisk exercise, the body is covered with the matter perspired, it passes off through flannel into the air, and the skin remains dry and warm. But during a profuse perspira- tion in linen shirts, the perspired matter, instead of being dispers- ed into the atmosphere, is retained by the linen, and not only clogs the pores, but excites a very disagreeable sensation of chilli- ness, often followed by a violent cold, and sometimes even fatal effects. As flannel, from its open texture is not liable to retain the moisture discharged from the skin, people who wear it, are far more secure from taking cold, on going into the open air during profuse perspiration, than those who wear linen shirts. Prejudices have been excited against flannel, by some people imagining that it occasions weakness by too much increasing per- spiration, but when it is considered that perspiration can seldom be immoderate as long as the skin remains dry, and that flannel tends to preserve it in this state, the objection will not appear to be founded in truth. It is granted that flannel, when first used, excites an unpleasant sensation, and the skin is apt to become red and inflamed, but this inconvenience is of short duration, and will be deemed a trivial objection by those who know its many advan- tages. Instead of producing cutaneous eruptions, as some have asserted, a flannel shirt, by preserving the pores open, and increas- ing perspiration, tends greatly to remove the cause of such affec- tions. In short, there are no disadvantages attending the use of this valuable substance, except the wearer neglects to change it sufficiently often to prevent its becoming disagreeable by being soiled and dirty. The practice of wearing flannel during the night, says Dr. Barlow, is not only unnecessary, but injurious. The object of using a flannel dress next the skin is to preserve a uniformity of temperature on the surface of the body, and thereby keep the highly important but too much neglected functions of the skin in an active and healthy condition. The body requires no extraor- dinary warmth during sleep ; on the contrary, there is, at such times, even a tendency to an increase of the natural warmth. A flannel dress worn next the skin throughout the night, becomes so charged with perspiration, that its power of conducting heat is BOOK I. OP CLOTHING. 133 thereby greatly increased, and its preservative effects proportion- ably diminished. By substituting a coarse calico for a flannel during the night, the body is kept in that temperature which fits it for encountering the vicissitudes of the following day, and the flannel, when resumed in the morning, will be in a state which contributes both to comfort and protection. The gratification de- rived from resuming a dry, comfortable flannel in the morning, to- gether with the sensible increase of its utility during the day, will be found to compensate amply the slight unpleasantness attending the momentary exposure to cold while exchanging it the preceding night. Such are the beneficial effects to be derived from the use of flannel, that it may be strongly recommended as a preservative of health ; it is well suited to all seasons, and may often render a cumbrous upper dress unnecessary. As a remedy in diseases, a flannel shirt has been known to prove of great utility in gouty, and particularly in rheumatic habits, and in obstinate coughs, at- tended with symptoms of consumption. Upon the whole, this article of dress, considered both as a preservative and remedy of various diseases, merits a very general and extensive employ- ment.* It has become a fashion at the present day to wear a waistcoat of wash-leather over flannel; it is found to be an excellent pro- tection against cold, and a remedy against attacks of rheumatic affection. Cotton, is an intermediate substance between linen and wool; although it increases warmth and perspiration, it is far from being conducive to the preservation of health. A cotton shirt is very liable to imbibe and retain the matter of perspiration, and being accumulated in the form of a glutinous substance, obstructs the pores of the skin, and affords opportunity for the perspired hu- mours to be taken again into the blood, to the great injury of health. Cotton stockings, for the same reason, are improper, and both linen, and silk stockings, have nothing but taste and fashion to recommend them. In fact, stockings made of wool, are greatly to be preferred to all others, on account of warmth, and their quality of promoting an uniform perspiration. * " Those officers and soldiers who wore flannel waistcoats next to their skins not only escaped colds, but dysenteries, and other contagious disorders.while those that' wore none were soon carried off by the diseases so commonly fatal in camps." 134 OP CLOTHING, BOOK I. The old maxim of keeping the head cool, and the feet warm, is not to be regarded in its strict unqualified sense. The covering for the head like the other parts of the body, should be accommo- dated to the state of the weather. There can however be no dis- advantage in general, in keeping it lightly and thinly covered, and in many instances of young persons, the natural covering may of itself be a sufficient protection in moderate weather; and indeed, those who accustom themselves to wear thick warm caps in com- mon, render their heads unnaturally sensible to all changes of the atmosphere. There are, nevertheless, certain persons who suffer ex:i erne inconvenience from the want of some moderately warm covering for the head : deafness, head-ach, and many other com- plaints, are, on some occasions, to be attributed to this cause. The bes* gen ,;i rule therefore, is, to avoid the two extremes of great heat, or improper exposure to cold, and when experience evinces the necessity of it, some proper covering, as a cap or wig, ought to be adopted. In cold weather, it will be proper to cover the head at night with a cotton or flannel cap, in order to preserve that part in an uniform temperature with the rest of the body. It is a point of great importance during a hot season, to have the head properly guarded against the intense vertical rays of the sun, as inflammation of the brain, and even fatal consequences, have been known to ensue from an exposure to their influence.— The common black hats, with very narrow brims, which are sanc- tioned by the present fashion, are evidently ill calculated to shield the head from the solar rays. White, or light coloured hats, as they have greater power of reflecting the heat, ought in summer to be preferred to black, and the brims should be lined with green silk, and sufficiently wide to protect the eyes and face. The keeping the feet warm and dry, is to be considered as of the greatest importance, since numerous diseases owe their origin to a want of care and attention in this respect. In consequence of wet and cold feet, the blood is accumulated towards the head, a sensation of coldness over the whole body ensues, perspiration is obstructed, and not unfrequently a foundation is thus laid for incurable diseases. The feet, therefore, ought to be kept some- what warmer than the rest of the body. Having said thus much relative to the materials of our dress, it remains to be observed, that the quantity must be determined by personal experience, as no general rule can be prescribed that BOOK I. OP CLOTHING. 135 will apply to every individual. It will, however, be found a most salutary precaution on all occasions, so to increase, or diminish, the outer garments, that the body may, as nearly as possible, be preserved in a natural and uniform temperature in all seasons of the year. It may be useful to make one remark here in behalf of those who labour under the infirmities of old age. Warm clothing, more especially warm bed clothes, are indispensably necessary to preserve or increase the natural heat of old people. The late Dr. Chovct, of Philadelphia, who lived to be eighty-five, says Dr. Rush, slept in a baize night gown, under eight blankets, and a coverlet, in a stove room, many years before he died, CHAPTER IX. OF THE MEANS OF PRESERVING HEALTH, AND OF OBTAINING LONGEVITY. The human species are continually obnoxious to the shafts of death in various forms. Innumerable dangers hang as by a hair over the destinies of man. To the sure ravages of age are super- added pestilence, casualties and disease as auxiliaries, to baffle the efforts of human wisdom, and accelerate the great work of mortali. ty. Although tenacious of life and its enjoyments, man is acces- sory to his own premature dissolution. Unmindful of the laws of nature and morality, he yields himself a votary to licentiousness and vice, and plunges headlong down the precipice of destruction, To impress the mind forcibly with a sense of the infinite wis- dom of the great Author of our existence, we may contemplate the following among the various astonishing phenomena by which our being is pepertuated. The heart, in a healthy person, contracts above three thousand times in an hour, and at each contraction, expels into the aorta or great artery,two ounces of blood, which, according to Baron Haller, is thrown with a velocity equal to one hundred and forty-nine feet in a minute, and overcomes the resistance of all the arteries in the body. Thus the quantity of blood equal to the whole mass con- tained in the body, passes through the heart fourteen times in an hour, which is about once every four minutes. This wonderful machine never ceases its alternate motion of contraction and relax- ation, from the commencement to the termination of our existence. Its action is continued at the rate of one hundred thousand strokes every twenty-four hours, overcoming a great resistance at every stroke, and this without wear or derangement for eighty years to- gether ; nay, in some instances, the period is protracted to more than a century. And though the pulse become imperceptible and apparently extinguished, yet the heart still preserves its latent power, or susceptibility of motion, and needs only to be gently ex- BOOK 1. OF THE MEAN'S OP PRESERVING HEALTH, &C. 137 cited by suitable means to revive its action.* Such perpetual motion and friction as the heart sustains, would, in a short period, grind to atoms the hardest steel. No one, therefore, can be sur- prised that human life is as a shadow or a spider's web, and our continuance here extremely precarious. There is, nevertheless, implanted in the human breast, an unconquerable abhorrence of death, and a radical principle, by which we are attached to this mortal state, although we suffer pain, and sorrow, and all the infir- mities of extreme old age, and the numerous calamities which af- flict mankind. In a moral point of view, longevity must be esti- mated as an object of the utmost importance, as it carries man for- ward to a period when the violence of the most impetuous passions have subsided, and the temptations to irregular and dangerous in- clinations can have little influence on the heart; when the affec- tions of the soul are weaned from this transitory state, and a more favourable opportunity is afforded of preparing it for the enjoy- ment of the promised life everlasting. Since, by the constitution of our nature, we are solicitous of protracting the short span, it bee ;.nes both our duty and interest, to examine minutely into the V! :s means by which health and length of days may be obtained. :; is first to be remarked, that longevity, in most instances, is to be r. scribed to an hereditary disposition, or an innate principle, difficult to be explained, but which, like many family diseases, is propagated from one generation to another. Healthy, long lived vweuts, commonly transmit to their offspring the same inestimable inheritance, and it would be more frequently enjoyed, were it not for their own habitual irregularities, which so evidently tend to the abbreviation of human life. A svstem of rules most essentially necessary to be observed, in order to preserve health and life, may be found in the observations * It is recorded of Vesalius, a celebrated professor of anatomy, and physician ta Charles 5th, about the middle of the 16th century, that a Spanish nobleman who had boon his patient, was supposed to have expired. Dissections were at that time deemed unlawful and even impious. Vesalius, however, had the address to obtain leave to inspect the body, with the laudable view of ascertaining the nature of the disease. On opening the thorax, lie was astonished to perceive symptoms of life, and even to recognize the pulsatory motion of the heart. Vesalius was not only prosecuted for murder, but, that he might be punished with greater rigour, was ar- raigned before the Inquisition for the crime of impiety. The king, however, inter- posed, and saved his valuable life, on condition of his making » pilgrimage to the Holy Land. 18 138 OP THE MEAN'S OP PRESERVING HEALTH, BOOK I. contained in the preceding chapters, on the six nonnaturals, as they are termed, and these have been so amply examined and de- tailed, that little remains to be added, though it may be useful and proper to recapitulate a few particulars. It will be found, in many instances, altogether impracticable to conform rigidly to all the salutary rules above referred to, but it may be remarked, that a temperate climate, moderate exercise, pure country air, clothing adapted to the season and vicissitudes of weather, a strict regard to temperance, together with a prudent regulation of the passions, will prove the most efficacious in pro- tracting life to its utmost limits. All extremes should be avoided, as unfriendly to health and longevity. Excessive heat enervates the body ; extreme cold renders it torpid : indolence and inactivi- ty tend to clog the necessary movements of the machine, and in- cessant labour soon wears down the springs of life. Another es- sential circumstance to be regarded by those who are candidates for lortg life, is the choice of a particular situation for residence ; it should be elevated and dry, open to a free ventilation by the winds, at a proper distance from low swampy ground, or stagnant waters, and where a dry and salubrious air can be enjoyed, and if near the sea shore, the situation will probably be still more health- ful. The most efficacious means of preventing diseases, and prolong- ing life, are those most nearly connected with the moral virtues. A course of licentiousness, intemperance, and voluptuousness, has a direct tendency to undermine the constitution, to generate dis- eases, and to sborten the duration of life. The habitual indul- gence of a lascivious disposition, and a promiscuous sexual inter- course, especially in persons not arrived at the age of maturity, seldom fail to exhaust the vital energy, to enervate the system, and lay a foundation for imbecility, and numerous diseases. The absurd idea was in former times prevalent, that blood-let- ting, at certain seasons, is useful and necessary to the prolongation of human life. It wa. even supposed by many that the impurities of the blood may be drawn off, and the remainder of the mass thereby rendered more pure ; but this ridiculous fancy finds no countenance in modern times : on the contrary, it is a well-estab- lished principle, that blood-letting is never requisite, but often de- trimental, to those who are in health. Experience has long since determined the fact, that persons habituated to the loss of blood BOOK I. ANU OF OBTAINING LONGEVITY. 139 from the system at certain seasons, cannot relinquish the practice without incurring danger of the most serious consequences. The plain diet, and the employments of a country life, are high- ly conducive to health and longevity; while the luxury and refine- ments of large cities, are equally destructive to the human spe- cies. In proof of this assertion, let the comparison be made be- tween the sedentary, and delicate youths, of both sexes, in popu- lous seaport towns, and the athletic, robust labourers, who spend their days on farms in the country, and are constantly active in walking, riding, and other exercise so essentially necessary to ex- paud the chest, to strengthen the lungs, and invigorate the system. Much depends on wholesome diet for the preservation of health, and consequently for the attainment of long life. It is, however, not absolutely necessary to conform strictly to certain rules and forms in this article. A proper mixture of animal and vegetable food, appears to be the best calculated to subserve the purposes of nature, and in general the most congenial to the human constitu- tion. Such, however, is the diversity of constitutions, and such the influence of custom and habit, that the same mode of living, which in one individual, is happily adapted, would in another prove extremely detrimental. The nauseous and disgusting practice of chewing or smoking to- bacco, is in many constitutions productive of unfavourable conse- quences ; it is particularly prejudicial to persons of weak digestion, or delicate habits, and to those who are predisposed to consump- tive complaints. In every instance, where the use of tobacco pro- duces an uncommon discharge of saliva, (that fluid so necessary in the process of digestion,) its narcotic effects are more powerfully exerted, by which the tone of the stomach is weakened, and every kind of dyspeptic symptoms are produced. It appears, from observation founded on experience, that if we can pass a certain period of life in the fulness of health and vig- our, the probability is greatly in favour of living to a considerable age. This critical period is supposed to be in most constitutions, about the 63d year, and it is a just observation, that the human constitution begins at that time, if not sooner, to experience a rapid decay of strength and energy. The habit of early rising from bed, daily exercise, or moderate labour, are among the salutary means to be recommended for the ■ •reservation of health, and the prolonging of life. It has been as- 140 OF THE MEANS OP PRESERVING HEALTH, &C. BOOK I. serted, that in every instance of remarkable longevity, the person had been from his youth accustomed to early rising. Uniformity in the state of the atmosphere, particularly in regard to heat and cold, the avoidance of close hot rooms, the keeping the feet warm and dry, contribute in a considerable degree to the enjoyment of health, and the duration of life. These, with moderation in every thing that relates to both body and mind, a rigid adherence to the habits of virtue, and in every vicissitude to endeavour as much as possible to preserve a calm and tranquil state of mind, constitute the means of greatest efficacy for the attainment of that healthy condition which is the most favourable to a happy longevity. CHAPTER X. ON THE CHARACTER, QUALIFICATIONS, AND DUTIES OF A PHYSICIAN. THE duties and responsibility attached to the office of a med- ical practitioner, are in their nature peculiarly interesting and im- portant. A physician may be estimated as an invaluable blessing, or execrated as a curse to the community, as he alleviates, by his judgment and skill, the calamities of mankind, or by his ignorance and rashness, inflicts incalculable misery and sorrow. Having in his hands a weapon of immense power, it is incumbent on him to wield it with the utmost judgment and discretion ; as a single erroneous application may terminate the awful fate of the patient consigned to his charge. The man, therefore, who maintains this important station in society, should possess the strictest integrity of character. Disinterested benevolence and philanthropy should be interwoven in the constitution of his nature. He should possess that modesty, and humanity, which melts at every distress, extend- ing the hand of relief and comfort to the afflicted, especially to " the widow, to the fatherless, and to him that hath none to help him." He should devote no less attention to the bed of helpless, pinching penury, than to the sickly couch of wealth and luxury, and mingle a sympathizing tear with those, whether rich or poor, who are called to shed the tears of inconsolable sorrow. Whilst manifesting an ardent zeal and solicitude for the welfare of his patients, and devoting all the energy of his soul to their service and comfort, he is not to be actuated by the sordid motive of ac- quiring fame or emolument; but by the irresistible dictates of that tenderness and sympathy, which have their origin in the best feelings of the heart. To these meritorious qualities, should be a'dded, an acute, penetrating genius, a retentive memory, intui- tive discernment, and an intrepid and decided disposition of mind. The character here pourtrayed, it must be confessed, is of no ordinary cast, nor is it frequently exemplified; but such was the great Hippocrates ; such was the pious and sagacious Sydenham ; 142 OF THE CHARACTER, QUALIFICATIONS, BOOK I. such the illustrious and learned Boerhaave and Cullen; and no less deserving the applause of mankind, were those luminaries of American medicine, Rush, Miller, Warren, and Barton, the pride and ornaments of our own age and country. They have left be- hind them memorials which can never be forgotten; and such are the models which it becomes us, their followers, to study and to imitate. Every physician should be distinguished for his profes- sional knowledge and attainments, recollecting that literary dili- gence, when accompanied with original genius, is the parent of all that is great and valuable in science, and that even men of tol- erable capacities may, with proper application and industry, pro- duce valuable acquisitions, and render themselves conspicuously useful. To excel in the profession of medicine, and to practise with success and reputation, requires indefatigable industry, and a vast variety of liberal accomplishments, as well as an understand- ing improved by knowledge and experience. A minute detail of the various branches which comprise a regu- ler medical education at the present day, is not here requisite. The systems adopted at our several seminaries, are unquestionably the most judicious and eligible, and they will be found fully ade- quate to the purposes required. No one, in future, can have the smallest claim to confidence as a physician, unless he has availed himself of the advantages so amply provided, and so liberally proffered. But, having pursued the course prescribed, and obtain- ed the usual honours of a license, or a diploma at some university, he at once becomes a candidate of regular standing in the pale of medicine, and merits the respectful notice and confidence of the community. The first objects of attention are, Anatomy and Physiology, without a thorough knowledge of which, no person can be qualified for practice. Surgery, the Theory and Practice of Medicine, Chemistry, Pharmacy, and Clinical Medicine, are well known to be indispensable acquirements. Medical botany, and other branches of natural history, are also to be considered as valuable auxiliaries, and fraught with permanent utility in a pro- fessional view. Our country is provided with a rich abundance of medicinal plants, and medical men are invited to the pleasing task of investigating their properties and uses. We may anticipate, at no very distant period, when our Materia Medica will be copious- ly furnished in America, from the three kingdoms of nature. And tt should be considered disreputable for physicians to trample BOOK I. AND DUTIES OF A PHYSICIAN. 143 under foot, or pass unregarded, many of the most valuable productions of our soil, so bountifully bestowed by kind Provi- dence, as remedies for the diseases with which we are afflicted. The young physician should direct his particular attention to every circumstance, which relates to the causes, nature and cure of diseases. He should, especially, exert his endeavours to acquire an accurate knowledge of those, which are peculiar to the climate in which he resides, and of such as are usually prevalent at cer- tain seasons, as every climate has a tendency to produce particu- lar diseases, either from its excess of heat, or cold, or from other causes not perfectly comprehended. Contagious and epidemic diseases should occupy a large share of the physician's attention, and, when these are prevalent, it will be incumbent on him to ap- prize the people of their danger, and to adopt, or recommend the most effectual method to prevent a more extensive communication of the disease. Proper regulations respecting the articles of diet, air, cleanliness, and tranquillity of mind, should in all cases be enjoined, as of primary importance; without a due observance of which, the most judicious plans of medicine may be, and often are, frustrated. These means of comfort and safety are in the power of all, and the faculty are bound in duty to enforce that prompt attention to them, which their well known usefulness and importance demand. A physician, on the commencement of his functions, should not allow his mind to be enslaved by systems, nor to imbibe a bigoted attachment to great names, as there is no absolute perfection in systems, nor infallibility in the wisdom of man. He is not to be implicitly guided by the doctrines, nor the practice of others, however eminent, but establish a course of practice, the result of actual facts, founded on knowledge, and repeated experience and observation. In the exercise of practical duties, the young phy- sician will display a commendable candour and condescension, as- sociating the moral virtues with professional duties. He will avoid all appearance of vanity and ostentation, manifesting, how- ever, a modest confidence in his own merit, that he may "command the confidence of others; for nothing can be more irksome to a man of feeling than to discover a want of confidence in his judg- ment, and a ready acquiescence in his medical prescriptions. In these he will endeavour to combine simplicity with elegance, as far as may be consistent with the requirements of the particular 144 OF THE CHARACTER, QUALIFICATIONS, BOOK I. case ; rejecting the absurd idea, that a farrago, of thirty or forty simples in one prescription, may retain, and exert their separate virtues. He will confide in a few selected articles, judiciously adapted, that the indications may be answered by as few medicines as possible; studiously avoiding that pompous parade, so peculiar- ly characteristic of the quack, and so disgusting to every intelligent observer. It is requisite that a physician should have an absolute command over his patients; so far, at least, as to prevent any de- viation from his rules and prescriptions, which ought, however, in no instance, to be unnecessarily rigid and minute. Every measure of opposition tending to fetter the hands, or embarrass the mind of the attentive physician, would be almost unpardonable. It will often be justifiable, and even necessary, to conceal the name, and to reduce the medicine to a disguised form, as invincible preju- dices are frequently imbibed against certain remedies, which no reasoning can overcome, and a medicine covered with the veil of obscurity, is always more valued than one openly and clearly ex- plained. The frequency of the physician's visits should, in every case, be regulated by his own sense of duty ; his honour and deli- cacy being a sufficient pledge that they will not be unnecessarily multiplied and expensive. In the chamber of the sick, no possi- ble attention should be deemed superfluous; all the powers of his mind must be absorbed in the investigation of the case, nor should he permit the minutest circumstance to escape his observa- tion. A superficial, or cursory view of the patient, and a slight examination of the symptoms, will never satisfy the inquisitive and intelligent physician, nor inspire confidence in his skill and judg- ment. He should be systematic in his examination and inquiries, recollecting that external appearances are often fallacious, and that many diseases exhibit symptoms similar and common to other dis- eases of a different nature. The expressive countenance, the pulse, the tongue, respiration, perspiration, aud all the secretions and excretions, with numerous other particulars in connexion, must come into a critical review, in order to ascertain the charac- ter of the disease, and the indications of cure. It is of conse- quence to recollect that the presence of the physician seldom fails to excite a temporary perturbation, and, until this subside, and the mind recovers its calmness and tranquillity, no correct indication can be inferred from the state of the pulse ; a careful, and repeated ex- amination of which, will often be found of considerable importance. nooK i. AND DUTIES OP A PHYSICIAN. 143 Instances may occur to the young physician, in which a respecta- ble and valuable member of society, perhaps the head of a family, or the only child of doting parents, affected with a fatal disease, may be confided to his care. While life and death are poising on a delicate and acute point, all the energies of his mind will be called into exercise, and the keenest anxiety and solicitude will await him in the discharge of his official duty. Here is an opportunity to display that sympathy, and anxious attention, which engage the affections and confidence of the patient, and, in many instances, are of the utmost importance to his recovery. When a patient can enjoy the inexpressible comfort of recognizing, in his physi- cian; a kind and tender friend, his visits will be anticipated and welcomed, as those of a guardian angel ministering to his relief; while he who is callous to the sentiments of humanity and sympa- thy, unfeeling, rough and blustering in his manners, will appear to the patient, like the messenger who comes to pronounce his aw- ful doom. In the interesting exigency above suggested, the young physician will probably be disposed to acquit himself of a share of his responsibility, by having recourse to the counsel of some one of his more experienced professional brethren, in whose honour and integrity he can repose confidence. By this he will relieve h.s own mind, and increase the confidence and esteem of the pat'cnt and friends. He must not forsake the chamber of his patient, knowing that his presence is a constant source of consola- tion, and though he may be unable to cure, he may soothe, miti- gate, and relieve. He must not entrust the administration of medieine to unfaithful hands, but himself be the accurate observer of every effort of enfeebled nature, and the effect of every medi- cine prescribed. The balm of hope, which buoys the mind above despair, must never be abandoned or withheld, and the prognostic, when required, should be peculiarly cautious and guarded.* The signs of approaching death are often extremely fallacious, and when it is absolutely impracticable to ascertain the precise mo- ment of despair, the conscientious physician will not yield his hope, until life shall have spun out its last attenuated thread. In- * " As far as regards the feelings of friends, the prognosis is a point always de- serving of the most serious consideration on the part of the practitioner; and I may add that it is also of the utmost importance to himself, for I never knew a medical man retain his popularity long, who was unguarded in the delivery of his prognosis." Armstrong on Fevers 19 146 OF THE CHARACTER, QUALIFICATION*. BOOK I. stances have sometimes occurred of wonderful recoveries after the physician had discontinued his attendance, from the belief that the agonies of expiring nature had actually commenced. It has been alleged, that, in all cases of doubtful, of obviously hazardous event, the danger ought to be carefully concealed from the patient and friends, as the slightest mental exertion, during the state of disease and debility, might precipitate the fatal termination. Such indeed, is the incomprehensible union, and secret influence of the faculties of the soul, over those of the body, that a fatal prognostic might have a considerable share in its own fulfilment. Occasions may, nevertheless, occur, in which a cautious disclosure of the impend- ing event, will, both in a moral and religious point of view, be deemed highly expedient and proper. As the future peace and happiness of a family may depend on the arrangement of a pa- tient's worldly affairs, it may be necessary to suggest, in the most prudent manner, the real danger, that this important duty may not be neglected. To a man of sensibdity, this is one of the most painful duties which he can be called to perform, but it is of en indispensable, and requires great prudence, tenderness, and hu- manity. It is undoubtedly necessary, in certain cases, to intimate the real danger to the relations of the patient, that opportunity may be afforded for calling in further medical assistance if they should deem it proper; nor is it to be considered foreign to the office of a physician, to suggest to his patient the propriety of an interview with a pious clergyman, that he may administer the consolations of that religion so admirably calculated to compose the anguish of the mind, by encouraging a hope beyond the grave. Among the virtues peculiarly required in the character of a physician, are those of temperance, sobriety, and probity. Tem- perance is the only panacea known in medicine ; and the profes- sors of health should enforce their instructions of temperance, by the eloquence of example. Of all the disgustful objects ever ad- mitted into a sick chamber, a drunken physician is incomparably/ the most odious, and he who sustains this character, ought never to receive the least countenance in the line of his profession, but be treated with the utmost neglect and contempt. Consultations. Medical consultations are on many occasions, when judiciously and harmoniously conducted, extremely important both to the pa- BOOK I. AND DUTIES OF A PHYSICIAN. 147 tfient and the attending physician. In all cases of a doubtful or dangerous nature, where the physician cannot place sufficient de- pendence upon hi; own judgment, or where he finds that it would be a satisfaction to the patient or his friends, the counsel of one or more skilful physicians should be requested. A mutual agree- ment should always regulate the choice of the consulting physi- cians, who should in every instance be distinguished for sound judgment, great experience, and respectability of character. Let the patient or friends propose a certain number agreeable-to them, and from these the physician is to make his choice. In the inves- tigation of the patient's case, the consulting physician will exam- ine all the symptoms, and make the necessary inquiries of the at- tending physician, who should withhold no information which can tend in the smallest degree to facilitate a correct judgment of the disease in question. No questions should be asked excepting such as are absolutely necessary to explain the nature of the case to the consulting physician, and technical terms ought to be as much as possible avoided, as they may confuse the patient and lead him to suppose his case worse than it oftentimes is in reality. The con- sulting physician will be guarded in his answers to such questions as may be asked by the patient or friends, referring them to the attending physician. The examination being finished, the physi- cians will retire into a room by themselves. The attending phy- sician then describes in a clear and concise manner all the cir- cumstances relating to the case and his own method of treatment, and the opinion and prognosis which he has formed. The con- sulting physician next gives his opinion, and they decide upon the most proper manner of treatment to be pursued. In doing this, courtesy and due deference to each other's opinions must always be observed. If tlie plan hitherto pursued is deemed the most be- neficial, it is not to be changed, but if by long pursuance, or other- wise, it be considered inefficacious or inapplicable, a different me- thod must be agreed upon. Should there be a difference in opin- ion, if very essential, and but two physicians, a third should be called to decide as to the the most proper method to be pursued. The result of the consultation is to be communicated to the patient or friends by the attending physician, and if requested, another meeting is then to be appointed. In the consultations of physi- cians much propriety of conduct is requsite, no prejudice, jealou- sies, or other unworthy selfish views, should be permitted to influ- 148 OF THE CHARACTER, QUALIFICATIONS, BOOK. I. ence their minds ; but candour and mutual respect should preside over their deliberations, making it their" only solicitude, to devise such remedies as will most effectually contribute to the patient's recovery. Should debates or conflicting opinions exist, these should be strictly confidential, and not disclosed to the patient, to wrest from him the last ground of hope and consolation. Every endeavour should be practiced to inspire him with confidence in his physician, and the plan of treatment adopted. The attending physician should consider himself bound in duty and honour, ri- gidly to adhere to the mode of treatment agreed upon, that the patient may realize all the advantage which can be derived from their united skill and experience. It may be remarked that professional consultations are not on all occasions so conducted as to be productive of beneficial effects; and serious embarrassments too often attend an officious interfer- ence with the duties of the attending physician. It divides the weight of responsibility, and weakens a powerful motive of perse- verance and decisive exertion. It sometimes interrupts a syste- matic course judiciously adapted, and may result in a feeble, neu- tralized, inefficient practice, by no means adequate to the removal of the disease. From the discordant interview of physicians who are not in the habit of social and friendly intercourse, and where mutual confidence does not exist, no satisfactory, but very serious consequences may be expected. Motives of rivalship, and popu- larity may supersede all regard for the real welfare of the patient, and the contending physicians may expose themselves and the profession to contempt and ridicule. Surely no advantage can be derived to the patient, from the wranglings and disagreements of those who are rivals in interest and fame, and who are hostile to each other in their views and personal feelings. Such scenes can only serve to distract and confuse the mind of the patient, already debili- tated by sickness, and broken down by disease. Neither is it con- sistent with propriety, to associate a young inexperienced practi- tioner in consultation with one, who, from age and experience, must be acknowledged to possess superior advantages. It would be ab- surd, and unjust, to expect that the senior, tenacious of his own su- periority, will yield his mature judgment and opinion to one who ought to look up to him with deference and respect. Another point of exceptionable conduct which ought to be reprobated in strong terms, is that, when persons receive the advice of other physicians incidentally, in the absence, and without the knowledge of the at- BOOK I. AND DUTIES OP A PHYSICIAN. 149 tending one, and even conceal from him the medicine administered. It is difficult to convey an adequate sense of the impropriety and dangerous tendency of such irregular proceeding ; it is no less preposterous, than to require an artist to repair the machinery of a wat'h, while another is continually deranging its springs and movements. Beside, the diversity of opinion in such cases can only serve to embarrass and perplex the patient, and to generate animosities and jealousies among the gentlemen of the faculty. No one can wish to control the right which every person may claim to employ the physician of his choice, or any number he may think proper, but let it be remembered, that physicians too have their rights, and their peculiar sensibilities, arid there is on all occasions a suitable respect and delicacy of conduct to be ob- served in reference to the feelings cf the physician employed. Since all consultations have for their sole object, the advantage and welfare of the patient, it must be apparent that it is both his duty, and for his interest, to encourage such harmonious interviews only, as will most probably effectuate that result, and since* physi- cians themselves possess the best means of information respecting the skill, the honour and probity of their brethren, it is proper the attending physician should be gratified in the choice of a gentleman for consultation. He should never be required to con- sult with those who are personally enemies to him,—nor to de- mean his own character, or that of the profession, so much as to consult with quacks or empirics, with men not regularly educated in the profession, who constantly endeavour by all the little arts and pitiful meanness, to lessen the confidence of the patient in his physician.—With such, it would be derogatory to his character to consult; and if a fair understanding, and concurrence cannot be obtained, the proposed consultation had better be dispensed with. It is among the judicious regulations of the Mass. Med. Society, that no fellow thereof, shall advise or consult with any person, who shall hereafter commence the practice of medicine, without having been examined and approbated, or shall have received a medical degree, or otherwise shall have produced such testimoni- als of his qualifications for practice, as may be deemed sufficient to entitle him to the privileges of a physician regularly introduced.* The reciprocal duties, and civilities, due from individual members of the medical fraternity to each other, ought to be held in high * See page 42 150 OF THE CHARACTER, QUALIFICATIONS, BOOK I. respect, as a cement of friendly and harmonious intercourse. The principles of honour should be the invariable guide of their ac- tions, disclaiming all artifice and insinuations tending to produce jealousy, interference and collision, in professional pursuits. It is chiefly among those of ordinary education and deficient qualifica- tions for practice, that is found a dishonourable, and ungentlemanly conduct, which so often proves the source of animosities and con- tentions to the discredit of the medical profession. Conscious of their want of merit to entitle them to the respect and consideration of the community, they resort to artifice, and base insinuations, with the hope of procuring employment. The regular physician will scrupulously avoid, as inconsistent with the character of a gentleman, all interference with the patients of other, and every officious inquiry, or intimation tending in any degree to weaken the confidence in their medical attendant. If requested to visit the patient of another, he will, in honour, decline any examination or advice, (except in cases requiring immediate assistance,) until the gentleman previously attending can be called to act in concur- rence with him. And if requested to assume the charge of the patient of another, he will conduct with that commendable delicacy and candour, which, under similar circumstances, he would require and expect to receive from a professional brother. When we consider the great expense, and the time, requisite to acquire a complete medical education, and to form the character of a physician worthy the great trust reposed in him by all ranks of society; when we reflect on his high responsibility, and the painful solicitude of mind for the fate of his patients ; and lastly, the frequent exposure of his own health and life, while devoting himself to the services of others, it must be conceded, that no class of people can have a stronger claim to the respectful re- gards, and grateful remuneration of their employers. Every young practitioner, however, must calculate, in the line of his profes- sion, to be subjected to the severest trials, not only of his skill and abilities, but of his patience and constancy. He will, on some occasions, be called to encounter the whims and caprice of his patients and friends. Their wonted confidence will sometimes be withdrawn; and his best services requited with contumely and ingratitude. The caprice of the sick may receive indulgence, when no evil consequences can result from it; but his address and forbearance should be marked with that commendable inde- BOOK I. And duties of a physician. 151 pendence and firmness, which will neither sully his own charac- ter, nor wound the dignity of his profession. The employment of a skilful and faithful nurse is of more im- portance than is generally imagined. A nurse ought to possess the qualities of fidelity, patience, industry, sobriety, and cleanli- ness ; ready at all times to receive instruction from the physician, and strictly obedient to his directions relative to the administration of medicine. It should be required of the nurse to attend with par- ticular care to the symptoms of the patient, and to the effects pro- duced by the medicine, that the physician may daily receive the most correct information. On no pretence whatever, should the nurse be permitted to deviate from the prescribed rules ; or ad- minister other medicines than those directed by the attending phy- sician ; which has too often been practised, to the great detri- ment and danger of the sick. There is, in many places, a perni- cious custom of visitors crowding the houses and even the apart- ments of the sick. During the most afflictive scenes, when the mind is overwhelmed with anguish, and all concerned are affected with despair and sorrow, we have witnessed persons of all descrip- tions, intruding their unwelcome presence, although incapable, or not disposed to bestow the least share of sympathy or assistance. Nothing can tend more to derange the debilitated mind, and to inter- rupt the various duties to be performed. Physicians of delicacy have experienced the perplexities and embarrassments attending this in- decorous practice, and have been compelled to quit the chamber of the patient, without ascertaining some particular circumstances connected with the disease. The breath from every mouth con- tributes to the greater impurity of the air in a sick chamber, and frequently renders diseases more malignant and infectious. This absurd practice, so injurious to the sick, and hazardous to those in health, ought to meet the most pointed reprehension of physicians, and all concerned, until it be altogether abolished. Friendly and charitable visits may be admitted in a separate apartment; but intruders, from idle curiosity, should be most strictly prohibited, that the miserable sufferer in languishing despair, may enjoy at least the comforts of retirement, stillness, and composure. In cases of putrid and infectious diseases, no person, the necessary attend- ants excepted, should be permitted to sit in the room with the patient. 152 OP THE CHARACTER, QUALIFICATIONS, BOOK I. The young practitioner will derive much benefit from a metho- dical record of all important cases that occur in practice. If he describe with accuracy the disease, with the attending symptoms and mode of treatment, whether successful or otherwise, adverting with particular care to the operation of each medicine, and com- pare their effects- in different constitutions, and in the same indi- vidual, at different times, such record will furnish a document of much utility in facilitating his own improvement in practical know- ledge. The history of every case, which may be deemed of utility to the medical public, ought to be communicated through the me- dium of some society or periodical publication ; and all learned so- cieties and vehicles of medical facts, should receive the cordial en- couragement and support of every established physician ; that he may both contribute his share to the interest of medical science, and keep pace with the rapid improvements which new discoveries are constantly introducing into practice. Among the numerous subjects, which demand the particular at- tention of the junior physician, medical botany, and a thorough in- vestigation of our indigenous productions are not the least import- ant. Various articles of this description will be found to possess properties, surpassing in efficacy, many foreign drugs, that have received the sanction of ages. Were physicians to cultivate, as extensively as practicable, medical plants on their own soil, and preserve them with their own hands, they would know when to rely on the purity of the medicine they prescribe, and to econo- mize in the expenditure of foreign drugs. It is to be recommended as peculiarly important to medical practitioners to possess themselves of well chosen libraries. A so- cial medical library would prove a bond of union among physi- cians, and render the acquisition of knowledge cheap and easy to the proprietors. The modern works of real merit in the various branches of medicine, with the periodical publications of our coun- try, will be found of the greatest utility, as the only sources from which can be obtained a knowledge of the important discoveries and improvements which are so frequently made in the healing art. Among the objects worthy the attention of district associations, is that of regulating the professional fees ; that a uniformity in that respect may generally prevail, and that the pecuniary compensa- tion may be adequate to the services performed ; as it is both al- lowable and laudable to support our professional pretensions to BOOK I. AND DUTIES OF A PHYSICIAN. 153 honourable subsistence by honourable means. Every individual should pledge himself in honour to adhere to the rules that maybe adopted, and any deviation from, or evasion of the same, should be considered as meriting indignation and contempt. It is a prac- tice, sanctioned by custom, to discriminate between the wealthy citizen, and the more indigent class of people, in regard to the amount of compensation required ; nor is it to be considered as departing from strict justice, to demand of the rich, a more generous fee, while we extend to the poor a charitable beneficence. Every physician will, in the line of his professsion, frequently meet with indigent objects, requiring medical assistance, and no one of hu- mane and benevolent feelings will deny them relief and comfort to the extent of his power, believing with the great Dr. Boerhaave, that the poor are our best patients because God is their paymas- ter. The families of clergymen, and those of the medical pro- fession, are usually exempted from charges for medical attendance. Such of that character, however, who may be in wealthy circum- stances, will scarcely expect gratuitous attendance, when required for a considerable time, or when visits are made from a distance. It must appear reasonable that an extraordinary fee be demanded for the exposure of health, when called to travel in the night, or in storms and inclement weather. A more liberal compensation should be exacted for attendance in cases of malignant diseases, than in ordinary cases of fever. The skilful and acco mplished surgeon will no doubt require a more ample fee for a capital opera- tion, than a dentist for extracting a tooth, though both may be per- formed in an equal space of time. A physician is justly entitled to a reward for his advice when called in consultation, and the amount of his fee ought to be determined, by the greater or less import- ance of the occasion, and the station and condition in life of tlie patient. Practitioners of the obstetric art in the country, sel- dom realize an adequate remuneration for their arduous and un- pleasant services. From the liability to calls, at all seasons, and the great variety of untoward circumstances, which frequently at- teud that branch of practice, it must appear reasonable and pre* per, that a generous fee should be required, and varied according to particular cases that may occur, as, on some occ'asions, four times the amount of the customary fee would scarcely be deemed an adequate compensation. It remains to inculcate the importance of improving every opportunity of opening the bodies of the dead 20 154 OF THE CHARACTER, QUALIFICATIONS, BOOK 1. for examination. This is a source from which the most essential improvement, relative to the structure of our complicated machine, may be derived, and will, moreover, lead to a discovery of the na- ture and seat of such diseases as elude all other means of invest^ gation. Much is due to the medical faculry, and to the enlighten- ed inhabitants of our metropolis, that the practice of examining the bodies of victims to disease, has become familiar to every mind, and is no longer viewed as derogatory to that sense of sacred re- gard implanted in our nature for the relics of deceased relatives. The condition of physicians in society is conspicuous, honour- able and dignified, and their responsibility consists, not only in the faithful discharge of their immediate practical duties, but also in vie- ino-with each other in the promotion of social intercourse and pro- fessional urbanity; in directing all their efforts to give respectability and order to the practice of medicine, and to discountenance the vile practice of unprincipled and assuming pretenders ; in contri- buting all in their power, to perfect the healing art, and dissemi- nate its blessings to the community. It should be the pride and ambition of our young medical men, to maintain the respectability of their professional character. Let them reflect on their high re- sponsibility, and that they are answerable to a Supreme Power, for every capital error, resulting from ignorance, neglect, or inat- tion. Let them cultivate, with the greatest assiduity, the talents with which they are endowed, and a disposition to manifest their benevolence and sympathy, by consulting the comfort, interest and feelings of their afflicted patients, and administering with ten- der solicitude and a liberal hand, the healing balm of hope and con- solation. Thus the miseries of man may often be lessened, and the groans of suffering humanity happily allayed. It may appear improper to close this subject, illustrating the office and duties of a physician, without some observations relative to his character as a believer in the sublime and sacred system of Christianity. It is recorded for our imitation, that some of the most eminent physi- cians, both in Europe and America, were ornaments of the chris- tian profession, and distinguished for their zeal and piety. It would seem impossible to contemplate the mechanism exhibited in the formation of the human frame, without associating the most exalt- ed sentiments of piety. Our existence is indeed a continued mira- cle ; capable of being sustained only by the hand of that Omnipo- tent Being, whom we adore, as " the former of our bodies, and the BOOK I. AND DUTIES OP A PHYSICIAN. 155 father of our spirits." From the striking proofs of divine wisdom, and benevolence, displayed in the animal structure, may be deriv- ed arguments, not only the most numerous, but the most clear and decisive, and the best calculated to confirm the sentiments of ra- tional piety, and to induce habits of active religion and virtue. Hence, even "atheistical persons, obdurate to every other evidence of the existence of a God, who created the universe, have, on wit- nessing a dissection, been instantly convinced of their mistake, and have acknowledged with equal astonishment, and shame, that notli- ing less than a Being of infinite wisdom, and power, could have contrived, and executed, such a wonderful piece of mechanism, as that of the human body." In more than one sense, the judicious poet is correct when he asserts, that, " The proper etudy of mankind is man." Those, however, of cultivated understandings, and minds enlarged by the cxalied principles of religion, will not readily yield them- selves bigots to any particular sect, or religious system ; but exer- cise christian charity, piety, brotherly love and universal goodness, without wishing to offend others, who may differ from them. '; The study of medicine," says the amiable Dr. Gregory, " of all others, should be the least suspected of leading to impiety. An intimate acquaintance with the works of nature, raises the mind to the most sublime conceptions of the Supreme Being, and at the same time, dilates the heart with the most pleasing views of Provi- dence. There are besides, some peculiar circumstances in the pro- fession of a physician, which should naturally dispose him to look beyond tlie present scene of things ; and engage his heart on the side of religion. He has many opportunities of seeing people once the gay and the happ}-, sunk in deep distress ; sometimes devoted to a painful and lingering death ; and sometimes struggling with the tortures of a distracted mind. Such afflictive scenes, one would imagine, might soften any heart, not dead to every feeling of hu- manity, and make it reverence that religion which alone can sup- port the soul in the most complicated distress; that religion which teaches to enjoy life with cheerfulness, and to resign it with dig- nity." The noble and disinterested sentiments of the venerable Syden- ham, as expressed in the following language, are worthy of being adopted by every physician. " Upon deliberate reflection, I find it better to assist mankind than to be commended by them, and J56 OF THE CHARACTER, QUALIFICATIONS, &C BOOK. 1, more highly conducive to tranquillity of mind ; popular applause being lighter than a feather, or a bubble, and less substantial than a dream. I have always thought it a greater happiness to discover a certain method of curing even the slightest diseases, than to accu- mulate the largest fortune. For can a person give a stronger proof Of his benevolence and wisdom, than by endeavouring always to promote the public good, rather than his private interest, as he makes so small a part of the whole ? I am determined to give my- self little concern for the failings of others, being convinced that all that is incumbent on me is, to act like an honest man, and dis- charge the office of a good physician to the best of my abilities." It may be recommended to young gentlemen, who are about to commence the practice of medicine, to peruse the excellent apho- ris.tical instructions of the late professor Rush, in the first volume of his Medical Observations. It is by such authorities as those just recited, that dignity and excellence, are imparted to a profes- sion, to which in all ages honour has been paid, and to which, when religiously and conscientiously exercised, universal favour and gra- titude arc dye. CHAPTER XI. OF EMPIRICISM, QUACKERY, AND PATENT MEDICINES. Having designated the character and qualifications of the scien- tific physician, I am now to examine the pretensions of those igno- rant and unprincipled empirics, who set at defiance all learning and every virtuous pursuit; practice the vilest arts and deceptions, and sport with the health and lives of their fellow mortals with im- punity. Every country and age, is infected with these insidious foes to the science of medicine, who attempt to despoil it of its dignity and usefulness, and prostrate its character in the dust. They endeavour to make themselves conspicuous by the shameless audacity with which they slander, and seek to disparage the merit, and services of those who sustain the fairest reputation, and arc entitled to confidence and respect; proclaiming at the same time their own pretended worth and superiority. Impostors of this de- scription, too frequently receive attention, and encouragement from the heedless multitude, who delight in the marvellous, and willingly yield themselves slaves and dupes to the grossest folly and absurdities. Hence we hear of new prophets, and mystical fanatics, who suddenly appear, announce their pretended divine mission, and feed their credulous patients with bubbles and magi- cal drugs.* Hence too the herd of young men, who without learning their alphabet in medicine, are expeditiously " popped into the world" after a few months study, assuming the character of full grown doctors, and courting the attention due to men of the most * A few years since, a man in the state of Vermont, proclaimed himself a prophet, and pretended to cure all diseases by prayer to Heaven, requiring no other informa- tion relative to the patient, than a few lines from his hand. So great was the cre- dulity, and so strong the faith of the multitude, that letters, and messengers were de- spatched to him from the sick, the blind, and the crippled, from the distance of several hundreds of miles, until thousands had accumulated on his hands which he could not find time to read. No cures however, were performed, a d the deluded people, we trust, were at length led to reflect that the prayers of the wicled ;ire an abomination, and were induced to prefer their own petitions, offered in sincerity of heart. 158 OF EMPIRICISM, QUACKERY, BOOK I. finished erudition. It is notorious, that the contemptible ignora- mus, the foreign renegado, and mechanic labourer, have been rais- ed by the voice of popularity, above the level of the learned and experienced physician. Although addicted to habitual intemper- ance and base falsehood, and devoid of every principle of honour, and moral rectitude, yet they find means to pursue their destruc- tive ccurse, and escape that condign punishment which their crimes so justly merit. It is astonishing to conceive, with what avidity many ignorant, and credulous persons, receive and propa- gate unfounded rumours in support of these deceptious wretches. It is among their ingenious tricks to blazon forth exaggerated ac- counts, of the most trivial circumstances, in their favour, as examples of skill exceeding that of all regular practitioners. If people die in their hands, they audaciously assert, that they were called in too late, and through the erroneous practice of the physician who had previously attended, the case was rendered irremediable. Thus the delusion is continued, and all attempts of the medical faculty, to expose the conduct of these vile impostors, and caution the peo- ple against their stratagems and frauds, are attributed to the sordid views of self interest, and therefore contemptuously rejected. It is not to be alleged, that the ignorant and illiterate are the only dupes with whom those vagrant jugglers display their medical frauds ; even the more enlightened class, on some occasions, have so far suppressed the suggestions of reason and propriety, as to be- come the ludicrous subjects of such base impositions, whilst the faithful services of the honest physician are requited with ingra- titude. Those who maintain the ridiculous idea, that men may be en- dowed with intuitive knowledge, or supernatural gifts, and become skilful physicians without education or study, betray a pitiful and contemptible credulity. It is a proof of great ignorance and fol- ly, only equalled by the conceits of those, who believe in the ap- pearance of ghosts and spectres, haunting the dwellings of the dead. These puerile, and superstitious notions will be rejected with con- tempt, by all men of cultivated understandings, as the offspring of pure ignorance and delusion of mind. If it be inquired how the unintelligent class of people may dis- tinguish between the medical impostor and the regular bredp hysi- eian, it may be replied, that the dictates of common sense will pre- clude from confidence all such, however popular, as do not BOOK I. AND PATENT MEDICINES. 159 sustain a character irreproachable for moral rectitude, and who cannot produce sufficient testimonials that they have received a regular medical education, and are qualified for practice. He that is thus duly qualified, being admitted into full confidence, and as- sociated as the medical friend of a family, soon acquires a compe- tent knowledge of their constitutions, and the diseases to which they are most liable. But if he continue to make his regular vis- its for weeks or months in succession, displaying a pompous pa- rade of medicine, and boasting of his experience, and success, and yet his patient remains in statu quo, and if he be incapable of a satisfactory explanation relative to the nature, and probable event of the case, it then becomes a question whether his medical abili- ties and skill are adequate to his pretensions. And when a man sets himself up in opposition to all other physicians, and at the same time endeavours to conceal his ignorance, by insinuating that he is peculiarly favoured with some instinctive knowledge or super- natural gift; some infallible catholicon, or secret remedy,unknown to regular bred physicians ; andrif he give assurance that he will cure such as honest physicians have pronounced incurable ; and profess to set bones where others can detect neither dislocation nor fracture; then beware of a contemptible impostor, who ought to be avoided as a shameless interloper, and pest to society. —Few persons perhaps, who presumptuously assume the exercise of the medical functions, inflict greater misery, in proportion to the number of unhappy people who entrust their lives to their care, than that description of quacks, who style themselves " Cancer Doctors." Totally ignorant of the nature of the disease which they profess to cure, many harmless, indolent tumours, are declar- ed to be cancers, for which they alone possess a secret and infalli- ble remedy. The roots resembling the claws of a crab, as they affirm, must be " drawn out," by the application of plasters, which they have invented for that purpose. These plasters consist, it is well known, of the most virulent poisons, or caustic materials, the principle of which is arsenic. It is erroneous to suppose, that reg- ular physicians are unacquainted with these pretended remedies ; but they wisely, and conscientiously disclaim the employment of them. When applied to the living substance, instead of drawing. they operate by corroding or burning, in a manner similar to a hot iron. The pain attending their process is exquisite, far exceeding 1500K I. OF EMPIRICISM, QUACKERY, fGO that of the knife, and is of long continuance. These applications frequently produce extensive and ill-conditioned ulcers, difficult to heal; or by irritating the tumour, it is rendered infinitely more inveterate, and the unhappy sufferer is doomed to linger out a miserable life of pain and torment. Besides those terrible conse- quences, arsenic, when applied to ulcerated parts, seldom fails to insinuate its poisonous qualities into the general system, where it produces the most dreadful effects. A melancholy example of this description occurred to my observation not long since. The timid patient, in order to avoid the operation of the knife, confided in a man who had been in the habit of trifling with the health and lives of his fellow creatures, and the most awful and fatal conse- quences were the result (see chap, on Cancer). From a similar empirical source proceed a vast redundancy of quack or Patent medicine, which, through the medium of newspapers, are im- prudently palmed upon the public attention. It would seem as though a host of quacks and impostors, have leagued in hostility against the profession of medicine, inundating the world with nos- trums, and usurping the power not only to remedy all the diseases of mankind, but actually to fortify the human constitution, and ren- der it invulnerable. Wre can scarcely peruse a newspaper, without being disgusted with an ostentatious and nauseous display of the pretended virtues of their Balm of Gilead, vegetable syrups, tooth- ach drops, cornp lasters, and pile ointments, lotions and lozenges, tinctures and elixirs, cordials, balsams and pills. And, to add to the absurdity, a single article is often extolled as being adequate to the prevention and cure of a whole catalogue of diseases, how- ever opposite or discordant in their nature. Thus are we kindly invited to expend a few dollars to purchase of those self "dubbed doctors," that health and longevity, which even the judicious hand of science is too often unable to bestow. While in the use of nos- trums under the firm persuasion of their infallibility, the precious moment, the only favourable opportunity of a cure, is often lost, and the disease gaining ground, becomes inveterate in its nature, and baffles all medical skill. Can it be imagined that a single medicine, however efficacious, can be equally applicable to all the various forms and stages of the complaint; if in one state of the disease, it appears well adapted, in another, it must of necessity prove highly injurious. If it be affirmed, that attestations can be adduced of the successful employment of quacks and patent medi- BOOK I. AND PATENT MEDICINES. 161 cines, so may it be asserted, that a random shot has by chance ef- fected the desired execution ; yet what man in his right senses, can be found willing to trust his life to such fortuitous incident? But it is to be remarked, that most frequently their testimonials are de- rived from exceptionable sources, being from ignorant or perhaps interested persons, liable to be deceived, if not to be bribed and corrupted. If it be said that physicians themselves have, in some instances, given countenance and support to popular nostrums, it need only be replied, that whatever may have been their motives, they claim our indulgence for their indiscretion, rather than any commendation for their sagacity and judgment.* Let it, however, be granted, that among the numerous powerful quack medicines, some instances of beneficial effects can be produced. Who, on the other hand, shall reveal the melancholy reverse 1 Who dis- close the sorrowful tale of injured constitutions and of premature deaths, justly ascribable to hazardous and unwarrantable experi- ments ? These observations, however, are to be received with some exceptions, and not as implying an unqualified censure on all medicines not in the hands of the scientific physician. It is that promiscuous empirical practice, without distinction of circum- stances, constitutions, or forms of disease, that is here intended to be reprobated. It is not to be denied, that many of our most valuable remedies were at first discovered and introduced by those who could have little or no claim to medical knowledge ; and there is no reason to doubt, but some quack medicines now em- ployed, and others to be discovered, will be found to possess great efficacy ; but if useful even in ignorant hands, how much more valuable and important must they prove, when judiciously con- verted to their appropriate purposes 1" The pertinent observations of Dr. Willich, relative to patent medicines, are worthy of remark. " Although," says this sensible writer, " there is but one state of perfect health, yet the deviations from it, and the genera and species of diseases, are almost infinite. It will hence, without difficulty, be understood, that in the classes of medical remedies there must likewise be a great variety, and * A by-law of the Mass. Med. Society provides, that " whenever any fellow of the society shall publicly advertise for sale any medicine, the composition of which he keeps a secret; or shall, in like manner, offer to cure any disease by any such. secret medicine, he shall be liable to expulsion, or such othor penalty as the society. at their annual meeting, may think proper to inflict." 21 162 OP EMPIRICISM, QUACKERY, BOOK I. that some of them are even of opposite tendencies. It is there- fore evident, that an universal remedy, or one that possesses heal- ing powers for the cure of all diseases, is, in fact, a nonentity, the existence of which is physically impossible, as the mere idea of it involves a direct contradiction. The belief in an universal reme- dy has long since been exploded in those classes of society, which are not influenced by prejudice, or tinctured with fanaticism. But the lower and less enlightened classes of the community are still imposed upon by a set of privileged impostors, who frequently puzzle the intelligent reader to decide whether the boldness or the industry with which they endeavour to establish the reputation of their respective poisons, be the most prominent feature in their character. Having acquired their ill merited reputation by mere chance, and being supported by the most refined artifices, in order to delude the unwary, we are unable to come at the evidence of perhaps nine tenths of those who have experienced their fatal effects, and who are now no longer in a situation to complain." After having reprobated the idea of Panaceas or universal remedies, Dr. W. introduces the subject of Nostrums or Specifics, such, for instance, as are made to cure the same disease in every patient, with which, also, impositions of a dangerous tendency are often practised. In those diseases, which, in every instance, de- pend upon the same cause, as in agues, the small-pox, measles, and many other contagious distempers, the possibility of specifics, in a limited sense, may, he thinks, be rationally, though hypotheU ically, admitted. " But in other maladies, the causes of which depend upon a variety of concurrent circumstances, and the cure of which, in different individuals, frequently requires very oppo- site remedies, as in the dropsy, the various species of colic, the almost infinite variety of consumptions, &,c. &c. a specific remedy is an impudent burlesque upon the common sense of mankind." So much depends upon ascertaining with precision the seat and cause of the affection, before any medicine can be prescribed with advantage or safety, that even life and death are too often decided by the first steps of him, who offers to intrude his advice upon a suffering friend. Dr. W. next adduces several striking instances, to illustrate the danger attending the precipitate application of the same medicine in similar disorders; the recital of which cannot but excite the most painful sensations. He adds that cases of this BOOK I. AND PATENT MEDICINES. 163 nature happen so frequenily, that it would be easy to extend the account of them, by a long catalogue of interesting, but fatal acci- dents. From what has been premised, it will not be difficult to conceive, that when a patient resorts to the remedy which is re- ported to have been successful in similar circumstances, if his case does not exactly correspond with the other, any chance remedy may be extremely dangerous, and even fatal. The absurd idea, therefore, of an universal medicine can only obtain credit with the weak, the credulous, and the ignorant. In closing his remarks on this subject, Dr. W. quotes the fol- lowing from Dr. Buchan. " As matters stand at present, it is easier to cheat a man out of his life than out of a shilling; and almost impossible either to detect or punish the offender. Not- withstanding this, people still shut their eyes, and take every thing upon trust, that is adminstered by any pretender to medicine, without daring to ask him a reason for any part of his conduct. Implicit faith, every where else the object of ridicule, is still sa- cred here." In Parkinson's Medical Admonitions, we have the following observations. " It would undoubtedly be rendering a great benefit to society, if some medical man were to convince the ignorant of the pernicious consequences of their reliance on ad- vertised nostrums: but, unfortunately, the situation in which med- ical men stand is such, that their best inientioned, and most disin- terested exertions, for this purpose, would not only be but little regarded, but frequently would be even imputed to base and in- vidious motives. Those to whom they have to address their ad- monitions, are, unhappily, those on whom reason has least influ- ence. " Prithee, Doctor," said an old acquaintance to a celebrat- ed empiric, who was standing at his door, " how is it, that you, whose origin I so well know, should have been able to obtain more patients, than almost all the regular bred physicians V— "Pray," says the quack, "how many persons have passed us whilst you put your question 1"—" About twenty."—" And pray- how many of those "do you suppose possessed a competent share of common sense?"—" Perhaps one out of the twenty."—"Just so," says the Doctor, " and that one applies to the regular physi- cian ; whilst I and my brethren pick up the other nineteen." The whole system of quackery, and the arcana of charlatans, cannot be too severely reprobated by every friend to humanity; and by every advocate for the honour aivl respectability .d our 164 OP EMPIRICISM, QUACKERY, &C. BOOK I. national character. The evil is of such magnitude as to require the attention of legislative authority. The great object of our legislators in instituting and encouraging medical schools and col- leges, for the improvement of literature and science, is but par- tially achieved, whilst their sons, after having expended much time and money for medical instruction by the most able preceptors, and studying for years with unremitting labour, are degraded to the level, and liable to be supplanted by the most illiterate and audacious impostor, who is totally unacquainted even with the ro* diments of physic. CHAPTER XII. OF CONTAGIOUS AND EPIDEMIC DISEASES. There is not, perhaps, in medical science, a subject which has, of late years, furnished a more fertile field for discussion and con- troversy, than that of febrile contagion, and the character of in- fectious and epidemic diseases in general. Many of the most em- inent physicians of the United States have prosecuted their inves- tigations and inquiries, relative to these abstruse topics, with much ardour and zealous perseverance. By their well directed labours, and comprehensive observation of facts, since the visitation of the yellow fever in the year 1793, much light has been elicited ; but the interesting controversy seems not yet to have terminated. The sentiments and opinions of medical men, relative to the origin, and real nature of contagious and epidemic diseases, continue to be singularly discordant and diversified. It would require volumes to examine and illustrate the various points in controversy, but these will be left for contagionists and nontontagionists to decide. The object* of this sketch, is merely to recite established facts, and to impart such practical observations, as the occasion may- suggest. Without attempting, therefore, to investigate or decide, respecting the merit or utility of the schemes and distinctions of the learned authors of the present day, I propose to adhere to the former technical terms, contagion and infection, as generally re- ceived and understood, being adequate to convey practical truths respecting those deleterious principles or invisible agencies, by which the functions and actions of our bodies are so often derang- ed and interrupted. The terms contagion and infection, have often been employed synonymously; but contagion is now defined to be an animal poison of a specific nature, generated in persons in a diseased state, and capable of communicating the particular dis- ease from one person to another, either by contact, or by ap- proaching within its sphere. According to the late Dr. John Warren, " contagious diseases are understood to be such as arise from the vitiated product of vascular action, capable of exciting in 166 Or CONTAGIOUS AND EPIDEMIC DISEASES. BOOK I. a healthy person a disease like that by which itself was produced; and infections, such as, though they may propagate disease, do not necessarily do so, nor invariably produce the like disease." And in another place he says, " those fevers which arc the effect of chemical operation on marsh miasmata, were supposed to be inca- pable of propagation by any changes to which they were subjected in the human body; and therefore always to cease in the individu- als on whom their generating causes had acted ; and these should be denominated infectious diseases."* Dr. W. also coincides with Dr. Rush in the opinion, that diseases arising from foul exhala- tions, will, under certain circumstances, be contagious, especially those of the typhoid kind. Dr. Clark is decidedly of opinion that marsh miasmata may produce contagious fever. " A contagious disease," says Dr. Mil- ler, " is distinguished from all others by the property of generating or secreting a matter, which applied by contact, or inhaled with the air, by near approach to the sick, or inanimate substances charged with their effluvia, successively reproduces the same dis- ease ;" and he supposes the matter of contagion to be invariably the production of animal, and miasmata of chemical action on matter emanating from dead animal and vegetable substances. The word contagion is by Dr. Wilson and some others, consider- ed as expressing the morbid poison, or the means of transferring the disease : and infection, as expressing the operation of the poi- son, or the act of communicating the disease. Dr. Shecut, an ingenious physician of Charleston, South Car- olina, has published a valuable essay on contagions and infections, in which is presented the following SYLLABUS. DISTINGUISHING CHARACTERS OF CONTAGIONS AND OF INFECTIONS. Contagions are to be distinguished I Infections are to be distinguished from from Infections, J Contagions, 1. In being the product of living an- $ 1. In being the product of dead or- imal bodies. i ganized bodies, animal or vegetable, or J both combined. 2. By being a secreted fluid, or other i 2. By being terial fluids, or gates, matter, capable of reproducing the same J evolved or disengaged from the foregoing specific disease. J during their decomposition. * See Mercurial Practice. BOOK t. OP CONTAGIOUS AND EPIDEMIC DISEASES. 107 3. In being communicable only by i 3. And are, in general, only commu- contact, or by the close approach of per- J nicable through the medium of an impure sons; and by the absorption of the mat- s atmosphere; i. e. the atmosphere which ter, or fomites of contagion. 5 supports them. 4. And that under all circumstances i 4. Or they are the product of an in- of the weather, whether a pure or im- 5 flammatory constitution of the atmos- pure atmosphere, wet or dry, hot or 't phere, and thence universal. cold, &c. \ In the opinion of Dr. D. Hosack, of New-York, the distinction of some late writers between contagion and infection is unneces- sary and fallacious. This learned physician divides all diseases which are contagious, infectious, or communicable from one per- son to another, into three different classes, according to the several laws which appear to govern their communication. The first class embraces those diseases which are communicated exclusively by contact. Second, those which are communicated both by con- tact and by the atmosphere. Third, includes those which are only in general communicable through the medium of an impure atmos- phere. Epidemic diseases arise from a peculiar state of the atmosphere, and when they occasion great mortality among the inhabitants of cities and countries, they are termed pestilential. Diseases of this character have scourged the human race from the earliest ages, and at various periods spread over, and often depopulated, exten- sive regions of the world. Those included in this class are principally the acute or febrile diseases, as the plague, yellow fever, typhus, or jail fever, inter- mittent and remittent fevers, scarlatina, small-pox, measles, dysen- tery, influenza, spotted fever, typhoid pneumonia, ophthalmia, hooping cough, &c. Typhus, or jail fever, which is propagated by a poison produced in the clothing, bedding, furniture, . In furtciionibus vitalibus. 140 Sternalgia. 142 Asthma. 141 Pleuralgia. BOOK I. SYSTEM OF NOSOLOGY. c. In functionibus naturalibus. 143 Colica. 146 Hysteria. 144 Nephralgia. 147 Hydrophobia. 145 Hysteralgia. Ord. IV. VESANIA. 148 Amentia. 150 Melancholia. 149 Oneirodynia. 151 Mania. Class VII.—CACHEXLE. Ord. I. MARCORES. 152 Marasmus. Ord. II. INTUMESCENTIA. a. Sanguinece, b. Adiposa;, 153 Plethora 154 Polysarcia, c. Flatuosce. 155 Emphysema. 157 Physometia. 156 Tympanites. d. Aquosoc. 158 Hydrops celluraris. 163 Hydrops uteri. 159 Hydrops cerebri. 164 Hydrops ovarii. 160 Hydrops spina?. 165 Hydrops testis. 161 Hydrops thoracis. 166 Hydrops articuli 162 Hydrops abdominis. e. Solidce, lG7 Physconia. Ord. III. VITIA, 168 Rachitis. 172 Scrophula. 169 Fragilitas ossium. 173 Syphilis. 170 Mollities ossium. 174 Scorbutus. 171 Lithiasis. 175 Plica, Class VIII.—LOCALES. Ord. I. TUMORES. a. Haymatici, 176 Fungus Haematodes. 179 Ecchymoma. 177 Aneurisma. ISO Haematocele. 178 Yarix. fc. b. Adenosi. 181 Scirrhus. I82 Carcinoma. 194 183 Polypus, 184 Ganglion. 186 Sarcoma. 188 Exostosis. 189 Hernia. 190 Prolapsus. 192 Vulnus. 193 Laceratio. 196 Enthesis. 197 Venenatio. FEVERS IN GENERAL. c. Gelatinosi. 185 Hydatis. d. Adiposi, 187 Encystis, e. Osteosi. Ord. II- ECTOPIA. 191 Luxatio. Ord. Ill, DIALYSES. 194 Fractura. 195 Ulcus. Ord. IV. TYCHICA. 198 Verminatio Ord. V. DEFORMITATES OF FEVERS IN GENERAL The term fever has always been used with great latitude, as well by medical writers, as by mankind in general; and it is remark- able that the definitions which different authors have given of it, are exceedingly various. That of the celebrated Cullen, with the others, appears to be vague, imperfect, and fallacious. The late learned Professor Rush, declined the attempt to give any definition, alleging that the disease appears in so many different forms, that a just view of it can only be given in a minute detail of all its symp- toms and states. According to Dr. George Fordyce, a fever is a disease of the whole body, affecting the circulating, the absorbent, and the nervous systems, the skin, muscular fibres, membranes, and also the mind. It does not, however, affect the various parts of the general system uniformly and equally; but, on the contrary, sometimes one part is more severely affected than another. An ingenious and sensible writer in the New England Medical Jour- nal, proposes the following definition, in which the new disease termed petechial or spotted fever, is intended to be included. " An extensive morbid affection in the blood vessels, or else in their contents ; which sometimes discovers itself solely at intervals; and which commonly deranges one or more of the greater func- tions, as well of the body as of the mind in a manifest manner." The term fever includes a numerous and diversified class of dis- eases common to both sexes, to every period of life, and to all cli- mates and countries. In the most extensive signification of the term, it is the most general of all the morbid states to which the human constitution is liable. It constitutes in its various forms, ac- cording to Sydenham, two thirds of the diseases of mankind. That memorable author calculated, that as large a proportion as eight out of nine of all the victims to disease, are cut off by those denominat- ed febrile diseases. This calculation will not perhaps appear extra- vagant, if we include fevers of every description both primary and symptomatic. It must appear obvious, that for the practical pur- poses of the physician, the general application of the term fever, is too vague and indefinite ; and as the disease originates from causes essentially different^ authors have distinguished fevers into two great classes. Those arising from general causes operating on the body at larije, have been denominated primary, or idiopafhic 190 FEVERS IN GENERAL. BOOK t, fevers ; while those which depend on inflammation or other local'af- fections of a particular organ, are termed secondary or symptoms tic fevers. In the accurate medical language of the day, the term fever is applied solely to the idiopathic fevers, as in the other class of febrile diseases the state of fever is but a symptom, a conse- quence of some morbid change of a particular part of the body, which constitutes the primary disease; when this is removed, the fever ceases. But in idiopathic fever, the symptoms are probably independent of any previous organic affection, and are not regulat- ed in their course or termination by the progress or removal of any other disease. Idiopathic fever occurs under the form of ephemera, (consisting of one paroxysm only/) intermittent fevers, or agues, remittent, and continued fevers : the last of which appear under a variety of types, exemplified in plague, typhus or low nervous fever, yellow fever, &c. " The division which is now generally adopted, is into the three orders of intermitting, remitting, and continued fevers; which are again distinguished by their leading symptoms." The inflammatory is new known by the title of Synocha, and the nerv- ous by that of Typhus. A combination of these two, constitutes the simple continual fever, or Synochus of modern authors. Un- der the denomination of Typhus, several varieties are comprehend- ed, as Typhus petechialis ; Typhus mitior, or the nervous fever; Typhus gravior, the putrid fever j Typhus icterodes, the yellow fever. The new epidemics which have recently visited different parts of our country, termed spotted fever, and.typhoid pneumonia, have received a variety of specific appellations. Where in addi- tion to the usual febrile symptoms, there is a redundant secretion, and vitiated state of the bile, occassioning frequent evacuations by vomit or stool, the fever is denominated Bilious; but this most commonly, is in the form of a remittent, and in warm climates, or in the hot season of temperate ones, the Billious remittent is often a malignant and fatal form of fever. Hectic fever is not consider- ed as an idiopathic disease, but is symptomatic of other diseases, particularly of phthisis pulmonalis, and is a frequent attendant on surgical disorders from the sympathy of the whole constitution, with the disturbed state of a part. The Brain fever is that which arises from an habitual use of ardent spirits, or frequent and excessive in- toxication. The term malignant, is applied to such fevers as appear in their most aggravated forms ; Dr. Tissot terms those fevers malignant BOOK I. FEVERS IN GENERAL. 19/ in which the danger is more than the symptoms would make us ap- prehend, and he compares such fever to <; a dog that bites with- out barking."* * The following definition of malignancy, is extracted from a letter to the author, by Thomas Miner, M. D. " What is a malignant state of disease 1 Has the term malignancy any definite meaning in medicine 1 A great deficiency of muscular strength, an increase, or even a degree of muscular strength which is disproportioned to the other symptoms, excessive pain or spasms, faintncss, and gastric sinking, mor- bid clearness of intellect, great delirium, coma, palpitation, interrupted respiration, calor mordax, coldness, numbness, insusceptibility to the action of ordinary rube- facients and epispastics, suffusion of the capillaries, great contraction or dilatation of the pupils, double vision, extreme irritability, or extreme torpor of the alimentary canal and other' passages which are lined with the mucous membrane, and also the same irritability or torpor of all, or of either of the organs of sense, excessive ex- haustion after ordinary depletion, or evacuations, passive hemorrhages, melsenic discharges from the stomach oi bowels, all the excretions very fetid, or much less so than in health, very frequent, very slow, very weak and intermittent pulse, sphace- lation, petechia, ecchymosis, vibiccs, pestilential carbuncles, buboes, and other eruptions. The early appearance of either of these symptoms, when sufficiently severe, or a combination of two or three of them, makes it apparent to the most su- perficial observer, that a fever, whether of the nervous or putrid type, is malignant, and highly dangerous. When either of the first two stages* of a fever is wanting, when any essential is symptom is absent, or when it is present in an improp- er stage, when subsultus, visible pulsations of the carotids, hippocratic face, and other signs of urgency occur unusually early, when any violent or accidental symp- tom suddenly appears, or when all the stages follow each other in such a rapid suc- cession, that a strong criticial effort supervenes within half the usual time from the attack, the malignancy is equally apparent. But, there ia another set of malignant diseases, that are very apparent to the accurate and exeperienced observer, which it is extremely difficult to describe in words, so that they can be easily recognized by the inexperienced or inattentive practitioner. I refer to the insidious cases, in which the symptoms cause so little distress to the patient, that neither he nor the bystanders are willingly to allow, that any danger exists. Such cases, improperly managed, (on the fifth or seventh day, or sometimes as late as the fourteenth, or even the twenty-first,) are ever liable to sink suddenly, and by the time the danger is dis- covered, the patient is at the gates of death. Perhaps three fourths of the deaths, which occur during the prevalence of a malignant epidemic, are among cases of this description, and the unwary are taken by surprise. Nearly all the symptoms, which are mentioned as attending the sudden and violent cases, and which in them arc such prominent signs of a want of vitality, occasionally appear in a very mode- rate degree; and though neither one of them seems to be in the least urgent, yet there is something in the tout ensemble, which can leave no doubt on the mind of the attentive observer, that there is something latent, that there is a hidden ambush, that extreme danger is lurking behind; and more especially this is the fact, when sudden malignant cases are common, when a peculiar diathesis prevails at thesametime. It is * Every regular fever, that runs its whole course has three stages—The forming stage, the stage of reaction, and the stage of exhaustion ; besides, there is often * etagc of predisposition, and a Mage ofconvalscrncr 198 FEVERS IN GENERAL. BOOK I, Notwithstanding the great prevalence of fever in all ages and climates, and the universal attention which it has excited among" medical observers ever since the days of Hippocrates, the disease still remains the subject of much discussion ; and its essential na- ture, or the proximate cause of its symptoms, is still a problem in medical science. We may suppress our surprise at this circum- stance ,however, when we consider the almost endless varieties un- der which fever occurs: so various are its modifications, that of those fevers which are nominally the same, scarcely any two in- stances accurately resemble each other; and of all the symptoms which constitute those varieties, not one can be found which is in- variably present in every case, not one, therefore, which can be considered as pathognomonic or characteristic of the disease. Causes of Fever. The causes most generally productive of fever, are those agents or incidents, which induce debility or suppression of strength in the system; the principal of which may be contagion, this if ap- plied in a certain degree, is of itself capable of inducing fever in any constitution. Contagion may originate from marsh miasmata, or human effluvia eliminated from diseased bodies, or even from those in health, if confined in warm, close, and uncleanly apart- ments ; and contagion from this source may spread rapidly through whole families and neighbourhoods. Dr. G. Fordyce relates an instance where seven out of nine, who approached near a person affected with fever, were seized with the same disease in the space of three weeks afterwards. Dr. Haygarth from the result of ex- periment asserts, that not one in twenty-three, or even one in this variety that Tissot compares to " a dog that bites without barking." There seems from the very access of the disease, to exist a state analogous to that of apoplexy or palsy, or to the factitious diseases produced by excessive quantities of narcotics, essential oils, lead, or mephitic gases—an almost total extinction of the vital principle —the patient appears to be but half alive from the very onset—there is a derangement sui generis of the powers of life, attended with a difficulty of changing the morbid condition by common means, and an insusceptibility to the action of ordinary exist. ing and supporting remedies, in ordinary doses or quantities." Dr. Miner expresses in strong languge his opinion that a distinction between the malignant and the non malignant in acute diseases, is of great importance in practice, especially during the prevalence of severe epidemics. He sums up the whole in a few words—" A malig- nant disease, is one in which there is a peculiar deficiency of vitality, attended with an insusceptibility to the curative action of ordinary exciting and supporting reme- dies, in ordinary doses and quantities." BOOK I. FEVERS IN GENERAL. 199 thirty-three, escapes infection, when exposed for a sufficient length of time, and that as many persons are liable to receive typhus as the variolous contagion. We find an instance recorded in New- Ensr. Med. Journal, Vol. I. p. 228, from Dr. J, A. Allen, State of Vermont, of three persons having died in one house of Ty- phus gravior. The weather being unusually warm, the corpses of the two last suddenly run into the putrefactive process, and not being deposited in coffins sufficiently close, the effluvia evolved was very offensive to the people who attended the funeral ceremo- nies. Nearly all who were exposed to those septic gases had an attack of the disease ; and from the sick, it was communicated to their attendants through the season, and thus it became epidemical. The interim of time from exposure to an attack, was from ten to twenty-one days. Other causes are depressing passions of the mind ; fatigue from long continued exertion ; immoderate study, or other close applica- tion of the mind, especially if encroaching on the hours of sleep; damp and night air ; indigestible food, or other substances affect- ing the intestinal canal; exposure to extreme heat and cold ; ex- cess or sudden suppression of usual evacuations, and intemperance in the use of spirituous liquors. One or more of these causes must be applied under certain conditions of the body in order to produce fever. But it frequently happens that febrile diseases supervene without any of the foregoing circumstances having been known to precede them; and, on the contrary, persons may be exposed to many of the causes, and yet escape the consequent fever. Symptoms,—There is no one symptom invariably characteristic of fever. Neither chilliness nor heat uniformly precede its acces- sion, and we can therefore obtain a knowledge of its existence and nature only by an attentive observation of the concourse and suc- cession of the symptoms. " The pulse is exceedingly various, it may be small, weak, slow, contracted and unequal, or it may bo strong, quick, full, and regular; hard or soft, according as the fever is at the commencement, increase, height, or in the remission and termination ; or as the genus and nature of the fever may chance to differ. So also the heat may be equally diffused, or confined to particular parts: sometimes the external parts are cold, with a sense of internal heat, at others, there is general heat or cold over the. body : and sometimes the heat is not greater than 200 FEVERS IN GENERAL. BOOK I. what is natural. Sometimes the face is pale, and at others it is red or swelled ; now it has the natural look, and now the reverse of this. The eyes are heavy languid, and sad ; or red, and impa- tient of light; they are prominent, distorted, or wild; shining, dull, or ghastly; sometimes bedewed with tears, and deprived of their usual lustre. The tongue is generally dry, chapped, scabrous, red, white, or variegated; often covered with mucus, but notun- frequently moist and natural, without any thirst. The breathing is frequent, hot, unequal, or impeded ; the breath often offensive, The appetite is usually extinct, but in a few instances some desire for food remains. Sometimes the urine is crude and watery ; at others red and thin ; or often thick, soon becoming turbid, and depositing a sediment; sometimes it is of a natural appearance, To these symptoms are added, pains in different parts of the body; depression of strength, and watchfulness, or on the other hand, heaviness, stupor, or imbecility of mind ; delirium ; diarrhsea, or constipation ; vomiting ; tension of the hypochondria ; subsultus tendinum ; emaciation, and other affections, arising with the fever itself, or gradually supervening to it. Besides the ordinary febrile symptoms of hot skin, irritated circulation, foulness of the tongue, thirst, and deficient or irregular secretions, preceded by lassitude, heaviness, listlessness, and rigours, there are pains in the head, generally of the throbbing kind, and extending along the continual tion of that portion of the brain which is lodged in the channel of the spine ; increased heat of the head, even though the extremities be cold ; unusual throbbing of the arteries in the temples and neck; suffusion of the eyes, and an altered expression of features, easily observed, but difficult to be described, together with disturb- ance of all the functions immediately belonging to the brain. If to these be added irregularity in regard to sleep and watching, which, though common to many diseases, belongs in a peculiar manner to the one under our investigation, we shall have charac^ ters always sufficient to enable us to detect the presence of fever in the system, and affording at the same time the clearest indica^ tions of its nature. It is only from a diligent examination of these appearances conjoined together, that we are enabled to judge of the presence or absence of fever; not from any of them taken singly. By making a general assemblage of the symptoms, we may venture to call it a disease which affects every part of the body, and in which there usually prevails a difficulty of perform-- jng some of the vital and animal functions." BOOK 1. FEVERS IN GENERAL* 201 Cure.—A fever begins gradually, and progresses to a certain point, and continues in that degree for a certain period of time, after which, unless it terminates fatally, or by a perfect crisis, it gradually diminishes, and goes off without any cause which has yet been explained. The critical days observable in continued fevers, as supposed by authors, are the third, fifth, seventh, ninth, eleventh, fourteenth, seventeenth, and twentieth. " The symptoms point- ing out the approach of a crisis, are, the pulse becomes soft, mod- erate, and near its natural speed ; the tongue losing its fur and be- coming clean, with an abatement of thirst, the skin being covered with a gentle moisture, and feeling soft to the touch ; the secretory organs performing their several offices, and the urine depositing flaky crystals of a dirty red colour, and becoming turbid on being allowed to stand any time." The first object in the cure is to su- persede or arrest the febrile affection, if possible, in its very com- mencement, by exciting another commotion in the system. The two most efficacious remedies for this purpose are emetics, and the affusion of cold water over the body. If an active emetic be ad- ministered during the continuance of the chills, and free vomiting be excited, the cold fit is often speedily terminated, and a general glow, accompanied with a degree of perspiration, is produced. Or if the emetic be delayed until the hot fit have commenced, its oper- ation is frequently followed by a relief to all the symptoms, the fever is prevented from proceeding, and the patient is left with a slight degree of weakness only, from which he recovers in two or three days. Affusion of Cold Water. Affusing the body with cold water as a remedy in fevers, is a practice for which we are indebted to Drs. Wright, Currie, and Jackson. Dr. Currie instituted numerous experiments, by which he ascertained, in the most satisfactory manner, the species and forms of fever, and particular circumstances in which the remedy can be employed with safety and success. He extended his trials to almost the whole class of febrile diseases, and established his principles. In typhus mitior, and typhus gravior, as well as other low contagious fevers, we have the authorities, not only of the geutlemen above mentioned, and Dr. Thomas, but many of the most eminent physicians of the United Snttos. to assert, that relri 26 202 FEVERS IN GENERAL. BOOK I. water applied to the body under certain restrictions, is a safe and very efficacious remedy. It is capable of making a strong and general impression on the system, by which the progress of fever is often arrested, if employed early, or during the first stage; but proper evacuations from the stomach and intestines, and by the lancet, if required, should always be premised. Dr. Currie pre- fers the afternoon or evening, during the paroxysm, or exacerba- tion, for the application of the remedy, thinking it most safe, as well as most useful, at the height of the fit, or immediately after it has begun to decline. But, he says, the remedy may be safely used, when there is no sense of chilliness present, when the heat of the surface is steadily above what is natural, and when there is no general or profuse perspiration ; which, he observes, are par- ticulars of the utmost importance. Under circumstances the re- verse of these in any one respect, the application of external or internal cold, is inadmissible and actually unsafe. During the cold stage of the fever, cold water nearly suspends the respiration, greatly disturbs the pulse, increases the chill, and seems to bring on the struggles of death; and really would do so, if repeated. It should be an established rule in every case, that the cold affu- sion is not to be resorted to until the hot stage of fever is com- pletely formed, until the heat has become steady and equal over the surface and extremities, and exposure to slight cold no longer excites shivering, or renews the sensation of chilliness. When this stage is established, the greater degree of cutaneous heat and dry skin, the safer and more beneficial the application of cold water. Perspiration, diminution of heat, of head-ach, of thirst, and of frequency of pulse, and a disposition to sleep, are the gen- eral results of this operation at any period while the dry heat continues ; but before the end of the third day these results are frequently final. "On the first and second days, the disease often in- stantly vanishes with one aspersion ; and sometimes on the thirdday; but on the fourth day this is rare. Each aspersion, however, instant- ly removes the symptoms; and a few repetitions of it on the suc- cessive returns of the paroxysms, in two or three days happily ter- minate the disease, with none or trifling aid from medicine." Where, in the advanced stage, the heat of the body is reduced, and the debility considerable, some cordial, such as wine warmed with the addition of spice, or an infusion of snake-root with a little brandy, should be given immediately after the affusion. The BOOK I. FEVERS IN GENERAL. 203 mode of applying cold water, varies according to particular cir- cumstances. In the early stage, before much debility is induced, the whole body is sometimes immersed in the water, or the water is thrown forcibly from a pail, or falls from a height over the head and body in the manner of the shower bath. When employed in the advanced stage, aspersion, or ablution with a sponge is deemed more safe and eligible. On some occasions, the patient is wrap- ped in a blanket or sheet thoroughly wet with cold water, and ©fen renewed. In each of these modes, the application is grate- ful and refreshing, and seldom fails to reduce the febrile heat, and materially to meliorate the patient's condition. But the advan- tages of affusion over those of simple ablution, are supposed to be in general very considerable. The application of this remedy must he repeated three or four times in the twenty-four hours, ac- cording to its effect and the recurrence of the hot fit; the patient being exposed to the cold air, and afterwards wiped dry, and re- placed in bed. But in every case, the operation should be so carefully conducted, as to occasion the patient as little fatigue as possible. In the advanced stage of fever, either the cold affusion may be employed, or the surface of the body washed by means of a sponge, with cold or tepid water, or tepid water may be used by affusion, observing all the precautionary rules already stated in regard to the application of cold water. The tepid affusion, the water being lukewarm, or from 87° to 97° of Fahrenheit, pro- duces a cooling effect equal to that of cold affusion, partly in con- sequence of a more speedy evaporation, and partly because so great a glow, or re-action, does not succeed. The important ob- ject of diminishing heat, therefore, may be obtained with great certainty by the ropcated employment of the tepid affusion, suffer- ing the surface of the body to be exposed in the interval to the external air. A diminished frequency of the pulse and respira- tion, and a tendency to repose and sleep, immediately ensue, though its effects are not so permanent as those of the cold affusion. It must be remarked, in those cases of fever where the lungs are oppressed, and the respiration laborious, the sudden stimulus of the cold affusion might be dangerous; in such case, considerable benefit may be derived from the tepid allusion, or by sponging the surface with warm water, or vinegar and water. Besides typhus mitior and typhus gravior, this energetic remedy has been found applicable to intermittent and remittent fevers, for abstracting ex- 204 FEVERS IN GENERAL. BOOK I, cess of heat, where no catarrhal symptoms, or inflammatory affec- tion of the lungs are present; in yellow fever, eruptive fever of small-pox, and in scarlatina. A mercurial course, or even a sali- vation, or eruptions on the surface of the body, are said to be no obstacles to the cold affusion. The effects of the two active agents just mentioned, emetics and the cold affusion, in interrupting the train of febrile action in its commencement, are generally aided by diluents, diaphoretics, and cathartics. The perspiration should be encouraged only by the exhibition of small doses of some preparation of antimony, or the neutral salts, and by the free use of tepid aqueous liquids. The con- finement of animal heat around the body by heaping a load of bed- covering over the patient, is a pernicious practice, under these cir- cumstances, tending directly to counteract the effect of the remedies. If the means already mentioned have not been employed within the first three days, or at the utmost until the fourth day of fever, or if they have failed to arrest the progress of the disease, it will then proceed through an indefinite course, which medicine has not often the power to interrupt. In the progress of continued fever, the vital actions are produc- tive of danger chiefly, from exceeding their ordinary degree of rapidity or strength, on the one hand, or from falling short of it, on the other. " The two leading indications of cure, therefore, are, 1st. To diminish those actions and changes which are in ex- cess; and, 2nd. To increase those which are defective." The first indication is to be effected by withdrawing or diminishing those iritations, or stimuli, which are constantly applied to the body in one degree or other, and actually excite the actions of life, or which are more particularly the consequences of the febrile state. The avoiding these as much as possible, or of moderating their force when that is impracticable, constitutes what has been called the antiphlogistic regimen, which it is requisite to pursue in almost every continued fever. It is proper to exclude the light, and noises of every kind, and to adapt the bed to the ease and comfort of the patient, carefully, however, guarding against the impression of external heat and confined air. The. impulse of nature inclihes to stillness, to darkness, to a cool, well ventilated chamber, and the constant use of cooling and acidulated drinks. The observance of these particulars is so obvious and natural a method of affording relief to those who suffer from heat, that deep- BOOK I. FEVERS IN GENERAL. '205 rooted prejudice alone could have prevented their being univer- sally adopted. Another error, both unpleasant and prejudicial to the sick, is that of permitting the apartment to be encumbered with a crowd of idle visitors. We have seen flushing of the face, tremors, and twitchings of the tendons, delirium, and the whole train of symptoms greatly aggravated, by the presence of a few in- dividuals. The respiration too, of a crowd of people, heats and vitiates the air, by which fevers are rendered more malignant and infectious. It is from this cause that febrile diseases are frequently communicated, and whole families in succession involved in the same calamitous situation. The state and condition of the skin, or external surface is to be regarded as of primary importance, and ought to receive more attention, than in general, practitioners have been accustomed to bestow. When morbid heat super- abounds, it should be counteracted by the application of cold, that great sedative agent, as already detailed, and by the judicious ad- ministration of diaphoretic medicines, and diluting drinks, avoid- ing, at the same time, external heat, and every thing of a stimulat- ing nature. If on the other hand, the cutaneous vessels are in a state of collapse or torpor, and the heat of the body below the natural temperature, every attempt should be made to equalize the excitement throughout all the vessels of the system, by means of artificial heat repeatedly applied to the surface, and by the in- ternal administration of suitable cordial diaphoretics. The celebrated Dr. G. Fordyce, whose good judgment, and ex- tensive practical knowledge entitle him to the highest confidence, after having premised an emetic, constantly employed a solution of tartarized antimony, with the view of arresting the course of con- tinued fevers in their early stage ; and he asserts, that in one half, or certainly in one third of the cases, he has seen symptoms of a crisis arise in less than five hours after the exhibition of the medi- cine, and in less than twelve hours, the fever has often ceased altogether. The sensation of thirst frequently occasions considerable irrita- tion in fevers, and in this instance as in that of extreme heat, ihe instinctive feelings of the patient direct him to the source of relief; to simple diluent drink in the one case, as to exposure to cool air, or immersion in water in the other. The safety and advan- tage of indulging these instinctive propensities of the constitution, js fortunately corroborated by observation and experience. The 206 FEVERS IN GENERAL. BOOK.'I. safety and utility, however, of cold drink in fevers, are dependent on the same principles, and its administration is to be regulated by the same rules, as the external application of cold ; namely, that when there is a steady heat of the surface, without any sense of chilliness, or a general perspiration, it is safe and salutary, and at- tended by similar effects though generally less in degree, than those of the cold washing. Another irritation which it is requisite to avoid in fevers is motion, especially that which requires the exercise of the muscles, and it must be observed, every motion of the body is more stimulant and exhausting, in proportion as the body is weaker. Hence, that posture is to be chosen which employs the fewest muscles, and which keeps none of them long in a state of contraction. The exercise of the mind, also, adds much to the excitement of the body, more especially when there is considerable debility, as in fever, and when, therefore, the exercise of the mental powers requires more exertions on the part of the patient. Hence, as soon as a febrile attack has come on, every circumstance that can lead to thought, and especially to anxiety about his disease, or to ex- cite passion, or emotion, should be carefully avoided ; and all unnecessary attendants or visitors should be excluded from his presence. A very important part of the antiphlogistic regimen, relates to the nature and qualities of the food and drink, to be given to per- sons labouring under fever, particularly in the early periods of it. The presence of recent aliment in the stomach, always proves stimulant to the system, and the irritation ought to be moderated as much as possible, consistently with the safety of the patient. Total abstinence from food, for the first few days of continued fever, was much practised by the ancients, and in many instances very successfully, by the best modern physicians. No solid animal food ought to be given during the existence of continued fever however slight. The effect of such food is to increase the heat, the frequency of the pulse, and respiration; to excite great rest- lessness, and a sense of uneasiness, and to augment the depression of strength during the time that it remains in the stomach and in- testines. In short, it totally deranges the fever, and often pro- duces the appearance of a fresh paroxysm. It brings on delirium, and in every way aggravates the danger of the disease. Even after the' disease has been terminated by a crisis, animal food in a HOOK I. KEVERS IN GENERAL. 207 solid form, should be rejected, there being no cause which has pro- duced relapses so frequently as using solid animal food too soon. The most proper nourishment in fever, consists of light fluid ve- getable matters: such as the decoctions of barley, the seeds of oats or other farinaceous grain ; the various forms of vegetable starch, which are prepared under the names of sago, tapioca, arrow • root, &c. answer the same purpose of furnishing aliment, which gives the least disturbance to the organs of digestion. In regard to the nature and quality of the drink, which is proper to be given to persons labouring under fever, the principle of avoiding irrita- tion or excitement of the arterial action, is to be constantly kept in view, at least in the ^ar'y stages of fever. When there is con- sid"rable heat of the body, water from the spring is generally most grateful to the palate of the patient; and is not perhaps to be excelled in wholesome qualities by any combination of art. If more agreeable to the patient, toasted bread, sage, or balm, may be infused into it; but the vegetable acids of every description will prove both pleasant and useful. All fermented and spirituous liquors, as directiy stimulant to the system, should be interdicted during the early and middle stages of continued fever, of whatso- ever denomination. The absurd practice of resorting to the use of vinous liquors, on the supposition that fever is a disease of mere debility, and that stimulants are requisite at the first occur- rence of fever, is often attended with fatal effects. A collection of crude and in ligested food in the stomach, and of feces in the intestines, aro causes of irritation, and require to be removed in all cases of fevers. Of Venesection.—With the view of fulfilling the first indication of diminishing excessive action in the system, we must have recourse to evacuations of the circulating fluids directly, or of the secretions from them, through their respective emunctories. The first, and most important to be considered, is blood-letting, as a diminution of the quantity of the fluids must be the most direct means of di- minishing the activity of the sanguiferous system. But a cautious and deliberate consideration of innumerous and variant circum- stances, is requisite in determining on the propriety of abstracting blood from the general system in fevers, since the diminution of that fbiid which is the immediate pabulum of life, cannot be a mat- ter of indifference to the constitution : if 14be the m^st powerful means of influencing the vital actions, so it is the most dangerous. 208 FEVERS IN GENERAL. BOOK I, when improperly employed ; if the most effectual in diminishing excitement, it is consequently the most apt to exhaust the vital energy. We have no infallible index to direct us, it is impossible, from the state of the circulation in fever, to point to any certain criterion for the employment of the lancet; the state of the pulse is often ambiguous and deceptive. Even in the most malignant feversrthe pulse is frequently so little affected as to afford no in- • formation relative to the propriety of venesection. It may be such as to contra indicate bleeding, at the moment when from local con- gestion of some vital organ, the existence of the patient depeuds on the evacuation. The pulse in the early stage of fever is often small, low, feeble, and irregular, or laborious and oppressed, until relieved by evacuations ; when re-action takes place, the pulse rises and becomes fuller and more equal. It may be strong and forcible in the heart and large arteries, yet feeble and languid in the extremities. These circumstances require the nicest discrimi- nation, as the result is often very different in cases seemingly ana- logous. A precipitate decision is fraught with danger, and a mis- take may be certain death. In pure inflammatory fever, or syno- cha, blood-letting may in general be resorted to with great advan- tage,,but in typhus, which is the fever most prevalent in our cli- mate, under all its modifications and forms, is attended with great gener.il debility, and as exhaustion of vital energy soon ensues, it is obvious that to diminish the quantity of the vital fluid, must be to increase that dangerous state of the system which accelerates the fatal termination. Various, therefore, are the circumstances to be taken into view, and great is the diversity of opinion to be examined, in order to a right decision of this difficult point in practice. Much of the beneficial effects which the lancet is capa- ble of affording, depends on the correct ascertainment when it is most proper to employ it. In general, venesection should be re- sorted to within the first twenty-four or forty-eight hours of the at- tack, and repeated at short intervals until the symptoms abate. If, in the early stage, there be increased heat, and the pulse hard, full, tense, or corded, and above one hundred in a minute, firm, and equal, blood-letting will certainly be proper, and, if at the same time the heat and inflammatory action be violent, with laborious res- piration, and signs of considerable local congestion, the evacuation becomes of indispensable importance. But whatever may be the opinion of the cautious and discerning practitioner, relative to the BOOK I. FEVERS INT GENERAL. 209 abstraction of blood from the general system, it will be admitted that local blood-letting by means of leeches or cupping, is often of great advantage in certain conditions of fever, more especially in relieving local congestion of blood in the head, and the symptoms thence resulting. Thus, when there is much head-ach, or deliri- um, accompanied by flushing of the countenance, and redness of the eyes, the application of a few leeches to the temples, or the scarificator and cupping-glasses to the same part, or to the nape of the neck, has often diminished the symptoms ; sometimes carried them off entirely, and arrested the progress of the fever. Sweat- ing is another mode of diminishing vascular action in fevers. The natural effects of sweating are a general increase of all the secre- tions, the tongue becomes moist, spasm is relaxed, excessive heat is allayed, and the skin is softened. But it is in the forming state only that artificial sweats are useful in fevers. After they are com- pletely formed, sweats are generally hurtful, and when excited by stimulating medicines, a load of bedclothes, and a heated atmos- phere, their beneficial effects do not occur; but the heat, thirsty and general excitement are increased, as well as the head-ach, anxiety, and difficulty of breathing; and the very reverse of the indication of removing irritation, and diminishing excessive action, is the consequence. In general, the most advantageous perspiration is produced by the opposite plan, viz. by cooling the body, and diminishing ex- citement, in which case it approaches more to the spontaneous sweating which accompanies the natural solution of fever. The principal medicines now employed for the purpose of exciting perspiration, are, the alkaline salts with the vegetable acids, and the preparations of antimony with diluent drinks. But although antimonial preparations are more certain in their operation on the skin, they are chiefly useful in those cases where the vital energy is not diminished ; for when considerable debility is present, they frequently fail of the desired effect, and occasion a dangerous diar* rluea.* * There is an eligible mode of exciting a sweat, and of applying artificial heat to the surface, as follows : Take a quantity of hemlock or pine twigs and leaves, moist- en them a little, but not so much as to damp the bed linen; heat a stone or brick quite hot, and surround this with the twigs wrapped in a cloth. Apply these to the feet, the sides, or armpits, while the patient is moderately covered, and confine the steam or vapours by the bed clothes until the desired purpose be effected) Sro a description of Jennings' Steam Bath, in this work. 27 210 FEVERS IN GENERAL. BOOK I, Purging, so far as to empty the bowels of indigested aliment, or feculent matters remaining in consequence of the weakened peristaltic motion, we have already said, is useful, by removing a troublesome source of irritation.. The removal of the dark and offensive matter which in many instances is accumulated and cor- rupted in the alimentary canal, is a most important point in the cure of fevers. Head-ach and delirium have often been removed by a moderate cathartic, and in some instances in which the fever had been preceded by considerable constipation, a brisk cathartic or two have appeared to remove the symptoms altogether. It is, however, to be recollected by the young practitioner, that an ac- tive purgative during a state of extreme debility, may be produc- tive of great mischief, and in the last stages of contagious typhus, even the mildest cathartic operation has occasionally produced a dangerous sinking of the vital powers. Blisters and rubefacients to the skin have been resorted to as a remedy in fevers, and by a majority of the profession the practice is conceived to be of no in- considerable advantage. Blisters are decidedly beneficial in re- lieving local pains and congestions ; and every practitioner has ex- perienced their utility, when the brain, stomach, lungs, &c. have been thus affected. In fevers attended with coma, or delirium, they are often em- ployed with advantage, being applied over the shaven scalp, for the nearer they are applied to the part affected, they are the more powerful in giving relief, like all other local remedies. The second indication is, " to increase the actions that are de- fective." The symptoms which occur in the latter stages of the disease, are principally the result of a general failure of the vital power, or nervous energy; and such a failure is the necessary re- sult of the previous over-excitment, and the privation of the ordi- nary means of support, from aliment, sleep, &c. Henee the means of preventing this failure of life, consists partly in fulfilling the first indication, or diminishing the over-excitement, and partly in using those remedies which tend to support and increase the vital actions, when the symptoms of their failure appear. It must be obvious, therefore, that the early employment of stimulants, cordials, and tonics, with the view to obviate debility, must be ex- tremely pernicious. Some who practice by rote, on the first on- set of fever, exhibit in liberal quantities, wine, Peruvian bark, and various cordials, regardless of the period and circumstances of the BOOK I. FEVERS IN GENERAL. 211 di-ease, and thus accelerate that debility, the consequences of which they are most anxious to avoid. This mode of treatment cannot be too strongly reprobated, more especially when there are symptoms of considerable local congestion in the head or other parts. When, however, the symptoms of exhaustion and defective ac- tion begin to appear, it becomes requisite to administer those reme- dies wbicli possess a stimulant power over the actions of the arterial and nervous systems. ' rl hose medicines which are known to possess .strong sensible qualities, and excite an obvious and immediate action, as wine, or alcohol, spirits, volatile alkali, and ether, are denominated stimu- lants. A great variety of these have been employed for the pur- pose of obviating debility in the late periods of continued fever; wine is the most grateful and efficacious, but this, according to Dr. Gregory, has been given in too large quantities, sometimes to the amount of two or three bottles in the day. Although the strength may be speedily roused by powerful stimtdi in large quantities, the new excrement is immediately followed by a fatal inflammatory condition of the brain. Perhaps a pint of wine in a day should not in general be exceeded, unless some cases of violent putrid fever be excepted. Tonic medicines, are those which slowly, and by repeated exhibi- tion increase the power and force of the actions of the animal body, or the tone of tl»e moving parts. They are cinchona, cascarilla, thoroughwort, and other vegetable bitters, the metalic salts, and preparations of iron. The principal tonic medicine that has been employed in continued fever, is cinchona, or Peruvian bark: but experience has evinced that this remedy is too often detriment- al, especially when the tongue remains foul, the pulse frequent, and the skin not yet become soft, cool, and moist. But according to Dr. Fordyce, the relaxations which began to take place in the dis- ease, have been much diminished, the pulse has become more fre- quent in the morning, the head-ach and confusion more consider- able, the skin drier, the tongue more furred, the oppression upon the pivecordia, and the difficulty of breathing increased, by a few doses of cinchona untimely administered. Where there are marks pf congestion in the head, lungs, or other viscera, the administra- tion of bark is at all times to be deprecated ; it is in fact seldom beneficial in continued fevers, unless in those cases where there is 212 FEVERS IN GENERAL. BOOK 1. I an obvious remission and exacerbation, when it may be employed with safety and advantage. But it is most useful in restoring the strength in the convalescent state, when the symptoms of fever have altogether disappeared. Musk and castor, have been frequently given in the last stage of fever, but Dr. Gregory considers them as no further active, than by tbeir strong impression on the senses, and much less efficacious as antispasmodics, than wine and opium. The serpentaria, or Virginia snake-root, carbonate of ammonia, and other cordial and aromatic substances, are often administered in low fevers with advantage. The prevention of putrefaction in the last stages of infectious fevers, is principally effected by the means already enumerated. The putrefactive tendency is chiefly the result of extreme prostra- tion of strength, and as the presence of the excretions of the pa-' tient, and all other filth augment the depression of the vital powers, the utmost attention to cleanliness is of great importance ; and a constant ventilation to free the air of the chamber, from the noxious exhalations, contributes much to the support and comfort of the patient, and is conducive to the preservation of the attendants. The putrid sordes which accumulates in the stomach and bowels, should be frequently evacuated by such gentle means as will not occasion a further exhaustion of the patient's strength. With a view to correct or obviate putrescency, the mineral acids are com- monly directed, and as tending to quench thirst, to settle and com- fort the stomach, and as being grateful to the patient, these should be liberally administered in all cases of fever. According to the opinion of Dr. Reich, a Prussian physician, and the late Sir William Fordyce, corroborated by the observa- tions of Dr. Thomas, author of modern Practice, the muriatic acid in particular, in all febrile diseases of a malignant nature, has prov- ed eminently efficacious, and merits the preference of all other acids. Of Mercury. A few brief observations relative to the utility and efficacy of mercury, as a curative remedy in febrile diseases, have been reserv- ed for this place. The employment of this metal has become not only familiar in the hands of every practitioner, but received the sanction of the BOOK I. FEVERS IN" GENERAL. ^13 highest medical authorities in our country ; nay, some have even dignified it with the appellation of specific, in fevers of a conta- gious character. For more than half a century, mercury has been a favourite agent with a certain class of reputable physicians in New-England, for the cure of fevers of almost every description. The ravages of the yellow fever, and other malignant febrile af- fections in our cities and seaports, of late years, naturally arrested the attention of our most able and intelligent physicians, who zeal- ously exerted their talents to the object of devising a remedy ade- quate to the formidable foe. In this investigation, the late Dr. Rush was a distinguished champion ; he commenced and prosecut- ed his inquiries with a solicitude, and sense of duty, worthy of his benevolent and exalted character. Surrounded by innumerable suffering objects, affected with the new epidemic in 1793, his situa- tion was peculiarly propitious to a correct investigation of its na- ture and character. Having experienced the palpable inefficiency of all the known curative remedies, he was induced to adopt the depleting plan, and boldly resorted to the lancet, and to mercury. This medicine he atfirst employed with the intention of evacuating the intestinal canal of its irritating contents, and the result was the fullest conviction of the correctness of his judgment. When at subsequent visitations of the epidemic, the liberal employment of the lancet was deemed inexpedient, mercury was resorted to as the sovereign remedy, and its powers have since been tested in the most extensive manner. The plan adopted by professor Rush, was found to accord with the opinions and practice of Dr. Chisholm and other respectable physicians of the most extensive experience in the yellow fever of the West Indies. (See page 18.) The utili- ty of the mercurial practice, as applicable to the various forms of fever, being abundantly substantiated, it has been received and adopted, by the generality of our medical professors and practition- ers, as the most successful method of treatment. The forms of administration are various; on some occasions calomel is combined with jalap or rhubarb, as an active purgative, but it is considered in general, essentially important that its action should be extended to the system at large, and affect in a greater or less degree the salivary glands. With this view, from one to three grains of cal- omel are directed every four or six hours, and the course persist- ed in until its effects on the system become evident, by a moderate ptyalism, and the more speedily this is produced, the greater is the 214 FEVERS IN GENERAL. BOOK I. certainty of a cure. Opium is frequently combined with calomel, in order to prevent its irritating effects on the stomach and bowels. Mercury has been given at the commencement, and in all stages of fevers, but the discerning physician will be particularly attentive to its operation, when in the advanced stage of typhus, the strength is greatly prostrated, and the vital powers much exhausted, lest it be productive of fatal consequences. The action of mercury, ac- cording to the theory of the late Dr. John Warren, is to be ascrib- ed to its stimulant power, by imparting oxygen to the system, and by changing the existent diseased action. Such is the diversity of cir- cumstances in different examples of fever, and so great is the uncer- tainty of the effects of mercury on the system, that no precise rules for its administration can be given or regarded. In some instances, a few small doses will effect a solution of the fever, while in others, no quantity within the limits of common prudence will either pro- duce a salivation, or in any manner induce the desired salutary consequences. It is obviously important, therefore, that none but experienced and judicious practitioners, should be permitted to conduct a mercurial course in fevers. When from an irritable state of the stomach, or other cause, mercury cannot be introduced into the stomach to such extent as to answer the immediate inten- tions, it has been applied to the surface of the body by inunction, and injected into the intestines byway of clyster, in either of which forms, salivation may be produced, if required, but in fevers this should always be avoided. The utility and efficacy of the affusion of cold water, the muriatic acid, and of mercury, is corroborated by the experience of the late p'< fessor Warren, in some instances of typhus fever in Boston which he related to me, and which are recorded in his very lucid and ex- cellent performance on Mecurial Practice. In this will be found a rich fund of information, and such substantial facts relative to the subject on which he treats, as must enforce conviction on every canclid mind. The author of an interesting performance, entitled, Sketches of tiie Epidemic Diseases of Vermont, objects to the employment of mercurv as an alterative in fevers, on account of its stimulant effect, though he admits that as a purgative, calomel may often be given with advantage. "The mercurial mania," he observes, " has spread like a pestilential influence, and we should be happy if it could be said with much less malignity." With the be9t intentions, Dp BOOK I. FEVERS IN GENERAL. '2 I ."> Gallup, from an excess of zeal may have descanted on the worst side of the question only, by attributing to mercury many dangerous qualities which in fact are owing to a great diversity of circumstan- ces. He may not have been conversant with that malignant form of fever which has so frequently baffled the skill of the most ex- perienced physicians in our cities, resisting the influence of every other power, save the supremacy of a mercurial course. It may not have fallen under the immediate observation of this gentleman, that yellow fever and all diseases accompanied with visceral in- flammation, especially when the liver is the organ affected, yield with more facility to preparations of mercury than to any other remedy. This fact has been so clearly substantiated as scarcely to require additional demonstration. Had this gentleman expe- rienced the liberal use of mercury as practised by his learned bretlnen in our cities, he might have perceived with Dr. Risb, th :t, "on salivation taking place in typhus fever, the pulse be- comes full and slow, with evident relief." Nor is it believed that in his serious itimuk :its, he would have referred his readers to the " tragi-comedy called the mer-itrLtd, for a burlesque" on one of the most invaluable remedies in the Meieria Medica. See his work, p. 222. Mercury, it is universally conceded, operates by its stimulant powers, but from its successful employment in judicious hands, we are warranted in the inference, either that stimulants often produce salutary effects in fever, or that mercury imparts to the system some other property by which the secretions are opened, the ac- tion of the absorbent vessels increased, and the equilibrium of the circulations restored. That along continued use of mercury tends to induce prostration and debility, the most zealous advocates for the practice will not deny ; nor that the indiscriminate employ- ment of it, especially in the last stage of typhus fever, is to be con- sidered as an abuse of the medicine and altogether inadmissible. This subject will now be dismissed by quoting the concluding paragraph of Dr. Warren's excellent treatise. " No instance, I believe, has ever been afforded within the whole compass of medical experience, of a medicine of equal activity, having been so thoroughly tested in different countries, and in all forms and degrees, as mercury. It so destructive to the constitu- tion as some hive represented, it would long since have been con- demned by the experience of physicians in those countries in which 2lG FEVERS IN GENERAL. BOOK. I. it has been most exhibited. That salivation increases the irritabi- lity of the system, and may sometimes have laid ihe foundation of chronic disease, may be admitted ; though a suspicion of it ought not to prohibit the use of it as an excellent remedy in some of the above diseases in the hands of the skilful. But this circumstance should be improved to enforce caution in practice." Consistently with his views of discarding stimulants in fevers, Dr. Gallup has condemned in strong terms the employment of opium in any form. Although the stimulant powers of opium are well known to every practitioner, the administration of it has been sanctioned by the highest authorities; and Dr. Rush, that very accurate observer, emphatically said, " that those physicians en- joy but little pleasure in practising physic, who know not how much of the pain and anguish of fevers of a certain kind may be lessened by the judicious use of opium." However improper the stimulant effects of this drug may appear, under circumstances of high inflammatory action, ft will not readily be dispensed with in fevers of a low type, by those who have experienced its many ad- vantages in mitigating pain and anguish, inducing repose, allaying irritation, and restraining evacuations. As there are distinct kinds of fever, each requiring a different mode of treatment, and as much depends on the ability of the phy- sician to discriminate between them, without which such errors may be committed at an early period, as to render all subsequent attention and skill unsuccessful, we shall proceed to discourse id the ensuing chapters, on the different species, and to point out the appropriate method of treatment. Class I.—FEBRES OR FEVERS. Order I.—INTERMITTENT FEVERS OR AGUES. This fever, in its most regular form, consists of repeated parox- ysms, the patient during the intermediate period enjoying appar- ently a state of good health. From the shivering which com- mences the fit,the disease has been called ague, and when it recurs every day, it is termed a quotidian, when every alternate day, or once in three days, forty-eight hours intervening, a tertian, and when on the fourth day,with an interval of seventy-two hours, it is called a quartan. The common people denominate the quartan a third day ague, and the tertian, a second day ague, but as physi- cians reckon the day on which a disease commences the first, and the third day after, the fourth of the disease, the above terms are Correctly applied. When these fevers arise in the spring of the year, they are known by the name of vernal, and when in autumn, they are called autumnal. They often prove obstinate, and are of long duration in warm climates ; frequently resisting every mode of cure, they degenerate into other chronical diseases, particularly dropsical swellings and enlargements of the liver or spleen. From a peculiar susceptibility induced in the system by this fever, the patient is liable to repeated renewals of it during a long period when expos- ed to the influence of the original exciting causes. Vernal agues most readily yield to medicines, and the tertian is the most com- mon and easily cured. The miasmata or effluvia arising from putrid stagnant water, or marshy ground, when acted upon by heat, occasioning putrefactive decomposition, is generally acknowledged to be the most frequent cause of this fever. This is evident from its prevalence in rainy seasons, and in those countries which abound in stagnant ponds, and in low swampy and marshy situations. Intermitting fevers may also be occasioned by whatever relaxes the solids, diminishes the perspiration, or obstructs the circulation in the capillary vessels \ such as a watery poor diet, great fatigue, long watching, grief and anxiety, exposure to a moist or cold damp atmosphere, lying upon damp ground, especially during evening dews, the suppression *4 ^customed evacuations, and the repulsion of eruption*". 28 218 FEBRES. CLASS I, Each paroxysm consists of three parts, denominated the cold, the hot, and the sweating stages. The cold stage commences with languor, a sense of debility and sluggishness in motion, frequent yawning and stretching, and an aversion to food; sometimes a vomiting, with pain in the head, back and limbs. The face and extremities become pale, the features shrink, the bulk of every ex- ternal part is diminished, and the skin over the whole body ap- pears constricted, as if cold had been applied to it. At length the patient feels very cold, and universal rigours come on, together with increased pains in the head, back, loins, and joints, nausea, and vomiting of bilious matter ; the respiration is small, frequent, and anxious ; the urine is pale ; sensibility is greatly impaired; the thoughts are somewhat confused; and the pulse is small, frequent, and often irregular. These symptoms abating after a short time, the second stage commences with an increase of heat over the whole body, redness of the face, dryness of the skin, thirst, pain in the head, throbbing in the temples, anxiety and restlessness ; the respiration is fuller and more free, but still frequent; the tongue is furred, and the pulse has become regular, hard and full. If the attack has been very severe, delirium will often ensue. When these symptoms have continued for some time, a moisture breaks out on the forehead, and by degrees becomes a sweat, and this, at length, extends over the whole body. As this sweat con- tinues to flow, the heat of the body abates, the thirst ceases, the urine deposits a sediment, respiration is free and full, and most of the functions are restored to their ordinary state: the patient is, however, left in a weak and wearied condition. After a specific interval, according to the species of intermitting fever, the paroxysm again returns, commencing as above described. When the paroxysms are of short duration, regular in their re- currence, and leave the intervals quite free, we expect a speedy re- covery ; but when they are long, violent, and attended with much anxiety and delirium, the event may be doubtful. The employment of medicine is seldom requisite during the cold fit of an ague, but warm drinks should be freely used for the pur- pose of promoting sweat, which is the natural crisis of the disease. These may consist of water-gruel, camomile, or thoroughwort tea, and wine whey acidulated with the juice of lemons or oranges. During the intervals of the fits, the patient's food ought to be nou- rishing, but light and easy of digestion ; such as broths made of OROER I, INTERMITTENT FEVERS, OR A0UES. 219 the tender meats, especially beef-tea, sago, arrow root, and light puddings. He may likewise drink frequently of infusions of bitter herbs, as wormwood and thoroughwort. If we can increase the strength, and support the natural heat dur- ing the intermission, we prevent the return of the cold fit and all the subsequent train of symptoms. In this view, exercise is of in- dispensable necessity ; however strong the disposition to indolence, it should on no pretence be indulged. If riding in the open air cannot be accomplished, walking through the house as much as the strength will permit, ought to be constantly encouraged. It is an opinion among some persons, that an ague proves salu- tary to the constitution, and in expectation of such event, the dis- ease is allowed to take its course for a considerable time without the application of medicine. It must be confessed that persons of a bad habit of body, and whose natural streigth has been impaired by a long continuance of some chronic complaint, have experienced a favourable change in the constitution by repeated shocks of an intermittent fever. But such complaints are probably susceptible of cure by means fax less severe, and not injurious to the constitution. When the ague is propeny formed, and the patient has under- gone several fits of shaking and sweating, the curative remedies should be immediately adopted. Dr. Trotter, of the British navy, has found by his experience, that a proper dose of opium taken at the approach of an attack, will effectually prevent the cold fit. His method is to give thirty drops of tincture of opium (liquid laudanum,) to an adult, and if it do not bring on some warmth in the space of ten or fifteen minutes, from twelve to twenty drops more are given. He never had oc- casion to go beyond sixty drops, for in no case did the remedy fail to give relief in the space of an hour. As soon as any symptoms indicated another paroxysm, thettincture of opium was repeated in the same manner as in the former fit, and always with equal suc- cess ; so that the patient seldom experienced much shaking or trembling. Another novel remedy is that of compression of the circulation in the extremities, by means of a tourniquet or ligature. Mr. G, Killie, surgeon in the British navy, relates the curious fact, that in several instances he applied a tourniquet on one thigh and one arm of opposite sides, at the same time, and jn {wo minutes after 220 FEBRES. CLASS I. the application of the tourniquets, the shaking and other symptoms of the cold stage entirely ceased, and a mild hot stage was imme- diately induced, and the patient found himself quite relieved. Af- ter suffering the ligatures to remain on for about fifteen minutes, they were removed, and the cold symptoms did not return. When the tincture of opium or the torniquet have been omitted, or in the event of their failure when employed, the patient must resort to the usual course of remedies. Bleeding is improper in intermitting fevers, unlessexcessive heat, delirium, and other symp- toms of inflammation appear at the beginning, and it is rarely ne- cessary to repeat the operation. Essential advantages, however, are to be derived from the early employment of emetics in the cure of this disease; nature herself points out the propriety of eva- cuations from the stomach and bowels, large quantities of bile and viscid phlegm being usually thrown off by vomiting. A dose of about thirty grains of Ipecacuanha will answer the purpose for an adult, and the operation should be promoted by drinking freely of warm camomile tea or water-gruel. The vomit ought to be taken two or three hours before a return of the fit is expected, and it may be repeated in two or three days if necessary. Emetics not only cleanse the stomach, but increase the perspiration, and all the secretions, and sometimes cure intermitting fevers without the assistance of any other medicine. After the operation of an eme- tic, some suitable cathartic medicine should be administered dur- ing the intermission, that its operation may be finished before the next return of the fit. Either rhubarb, jalap, extract of butternut, or Glauber's salt, will be found to answer the desired purpose, and it may be useful to give a grain of opium, or thirty drops of lauda- num, after the operation of both the emetic and cathartic. The stomach and bowels having been properly cleansed, and the perspiration and other secretions rendered free, the patient should commence taking the cinchona, or Peruvian bark, as the most efficacious remedy with which we are acquainted. It is to be observed that the benefits arising from this medicine, depend chiefly upon a large quantity being administered in a short time. Several ounces of bark given in a few days, will do more than as many pounds taken in the course of some weeks. Let it be a rule to throw in the medicine in such doses, and as often as the sto- mach will receive it. This valuable medicine is to be given in the simple form of powder, in preference to any of its preparations. ORDER I. INTERMITTENT FEVERS, OR AGUES. 221 It may be taken in a glass of Port wine, or mixed in a cup of milk, as may be most agreeable to the palate and stomach. About one ounce of good powdered bark will, in general, be found sufficient to prevent the return of the ague and fever, when taken in the in- terval. From forty to sixty grains may be taken at a time, and in a quotidian, or every day ague, a dose ought to be taken every hour ; in a tertian, every two hours ; and in a quartan, every three hours during the intermission. If the patient find it difficult to take the medicine in such quantity, he may diminish the dose and take it more frequently. For younger persons and children, the dose must be proportioned to their age. Although by the use of the bark another fit of the ague has been prevented, the employ- ment of the medicine is by no means to be immediately discontin- ued, but it must be taken in smaller quantities for several days or weeks after the disease appears to be cured, in order to secure against a relapse which so frequently occurs. Those who have once been troubled with ague, are peculiarly liable to a return of it during cold moist weather, and easterly winds, when the air is most favourable to its production ; such persons ought at those seasons, to take the bark, or a preparation of it combined with aro- matic bitters, as follows ; one ounce of bark, one drachm of Vir- ginia snake-root, two drachms of the outer rind of Seville oranges, and half an ounce of calamus aromaticus, or sweet flag root. Or, take one ounce of the leaves and flowers of thoroughwort, half an ounce of calamus aromaticus, and of quassia and orange peel, two drachms each. Let these ingredients be infused in a quart of brandy, or pure old cider, for three or four days, and af erwards filter the tincture, through paper; about half a wine glass full of this tincture may be taken twice iu a day. Tire use of this medi- cine will also render the bark more efficacious in the cure of agues if taken at the same time. The bark may be administered in de- coction or infusion, when it cannot be swallowed in substance. When the stomach cannot bear the bark in any form, it may be given by way of clyster, which often proves successful; about a drachm of the extract of bark, dissolved in a sufficient quantity of water, with the addition of a few drops of laudanum, shouiri be in- jected every four hours. Children have been cured of agues by means of a waistcoat with powdered bark quilted between its fcids, as they likewise have by being bathed frequently in a decoction of the bark. Bathing and rubbing along the spine of children with strong spirits, or anodyne balsam, has often proved beneficial, 222 FEBRES. CLASS I. When the hot fit of an intermittent is accompanied with symp- toms which indicate considerable inflammation, whether in adults or children, much benefit has been received from the use of the saline julep, prepared as follows : take of salt of tartar, or carbon- ate of potassa, one drachm ;' fresh juice of lemons, or sharp vine- gar, three table-spoonfuls : in less than a minute after they are mix- ed, or as soon as the effervescence ceases, add of mint water and common water, each two table-spoonfuls, with a bit of loaf sugar, or a little common syrup. To a child four or five years old, three tea-spoonfuls of this julep may be given every two hours. When the bark has a tendency to pass off through the bowels, a few drops of laudanum may be added to each dose, and if costive- ness be produced, a few grains of rhubarb may be conjoined to the bark occasionally. In case of much inflammatory diathesis, and especially if cough and pain in the side attend, nitre, or carbonate of potassa, should be conjoined, and the application of blisters will be proper. Dr. Rush affirms, that in all cases of autumnal inter- mittents in which bark did not succeed after three or four trials, the application of blisters to the wrists seldom failed of rendering that remedy efficacious ; but if blisters had been neglected, or ap- plied without effect, and the disease had been protracted into the winter months, he generally cured it by means of one or two mod- erate bleedings. It was the practice of Dr. Lind to give opiates in the hot fit of intermittents. It generally gives sensible relief to the head, abates the burning heat of the fever, and occasions a profuse sweat. And he has found that opium is the best preparative for the bark, occa- sioning such a salutary and copious evacuation by sweat, as gene- rally to render a much less quantity of bark requisite. Adult persons may take fifteen or twenty drops of laudanum, half an hour after the hot fit has begun, and for a young child, two or three tea-spoonfuls of the syrup of white poppies will answer the purpose. Of the various species of bark now to be met with, a decided preference is given to the yellow, as possessing virtues far superi- or to the red, or any other species yet introduced into practice. The numerous other barks which have been introduced as substi- tutes for the Peruvian, are augustura, quassia wood, swietenia feb- rifuga, St. Lucia bark, and the bark of the willows, particularly the broad leafed willow. These are recommended with much ORDER I. INTERMITTENT FEVERS, OR AGUES. 223 confidence by those Europeans who have experienced their effica- cy, but in the United States they are not much employed. The cold bath between the fits has sometimes been successful in the sure of obstinate agues. The sulphate of zinc (white vitriol), is said to have been administered in agues with success, and the sul- phate of copper (blue vitriol), in doses of a quarter or half a grain every four or six hours, has proved very efficacious in some cases of intermittents of the most obstinate nature. But of all the me- dicines introduced of late years, no one is more highly extolled than Dr. Fowler's solution of white arsenic. It is undoubtedly a very powerful medicine, and intermittents of the most obstinate character have in numerous instances yielded to it. The peculiar activity of the arsenical solution, however, is such as to require much caution and very precise rules in its administration, in order to obtain its beneficial effects with safety. The most proper man- ner is to begin with four drops for an adult, and add one or two to every morning and evening dose, until the patient experience a peculiar sensation about the eyes or skin of the face, somewhat similar to that excited.by a cobweb adhering to the skin. This sensation being the criterion, it should be continued by doses either diminished or increased, according to its effects on the system. The number of drops will seldom exceed twelve or fifteen, and sight days administration of the medicine, will, it is said, generally be found sufficient for the radical cure of an intermittent. We have among our own productions numerous articles possess- ing in a greater or less degree, the tonic and astringent properties of Peruvian bark, and several of these have been successfully em- ployed in the cure of intermittents. The one which first demands our attention, as being in the highest repute, is the Eupatorium perfoliatum, or common thoroughwort. It appears, by an inau- gural dissertation by Dr Andrew Anderson, of New-York, that the leaves and flowers of this plant, possess properties exactly similar to the Peruvian bark, and in addition to his own, he adduces the authority of many very respectable practitioners, particularly Drs. Barton and Hosack, in proof of its superior efficacy as a remedy in intermitting and remitting fevers. The author relates six cases of intermittent fever, in which after a single evacuant, the thorough- wort effected radical cures, and adds, that the same remedy was administered in almost all the instances of intermittents that occur- red in the New-York almshouse in the year 1812, to the exclusion 224 FEBRES. CLASS 1. of the Peruvian bark, and with uniform success. It was given either in decoction or in powder, from twenty to thirty grains eve- ry second hour during the intermisssion. See American New Dispensatory. It happens not unfrequently when intermittents have continued a long time, whether much bark has been taken or not, that tu- mours are formed in some of the abdominal viscera, as the liver or spleen, vulgarly denominated ague cakes ; these in general prove difficult of cure, but will finally yield to a course of mercury if ju- diciously conducted. Dropsical complaints are also sometimes occasioned by the long continuance of intermittents, but may be removed by the use of the bark, combined with stomachic bitters, diuretics, and chalybeates. It is deemed altogether unnecessary to mention the numerous empirical and whimsical remedies which have been handed down by popular tradition, or proclaimed by persons of the present day, for the cure of intermittent fevers ; since, amidst the great abun- dance of remedies of unquestionable efficacy, no rational person can be so regardless of health and life, as ever to trust for a cure to nostrums, or to any thing of a doubtful or insignificant nature. The inhabitants of our southern states, and of the low swampy situations on the Delaware river, &c. are peculiarly liable to the attacks of intermitting fevers, but those affected with it who resort to the salubrious air of New-England, experience a speedy cure, and that frequently without the aid of medicine. To prevent the attacks of agues, or their recurrence when once cured, care should be taken to avoid the influence of the hot sun, and the damp air of morning and evening ; a flannel shirt should be constantly worn next the skin, and regularly changed once a week. The tincture prepared as directed in this chapter, will prove a valuable pre- ventive if taken twice or thrice in a day. If fires are kept burning in the sitting rooms, mornings and eve- nings, during the damp seasons, they will be found useful by de- priving the air of its unhealthy mbisture, and keeping the walls dry. " By this practice," says Dr. Mease, " I have known the health of a family in the swamps of Delaware, preserved during a whole summer while the neighbours were all afflicted by agues." Dr. Rush recommended that fires should not only be kept in the house during the sickly months, but that large fires be made every evening, of brush, near the house, between it and the spots from CLASS I. INTERMITTENT FEVERS OR AGUES. 225 whence the exhalations are derived. This practice, he observed, should be continued till the appearance of two or three frosts; for frosts, as well as heavy rains in the autumnal months, never fail to put a stop to the progress of intermittents. Since this chapter was completed, it has been announced in the New-England Journal of Med. and Surgery, Vol. IV. page 105, by Dr. Makesy of the British forces stationed at Castine, that common charcoal powder properly prepared, has been found by European physicians to be an efficacious remedy in intermittent and remittent fevers. The author mentions that in a village in Sicily, one hundred and five cases were speedily cured by this new remedy, two or three doses of which being often found sufficient to interrupt the expected paroxysm, and cut short the disease. From half a drachm to two drachms given three or four times during the intermission, or immediately before the expected par- oxysm, will in most cases prove sufficient. I must not omit to mention that cures of ague have been per- formed by simple cobweb, in doses of two or three grains every few hours until the fits are subdued. See appendix to this volume. The sulphate of quinine has obtained very considerable reputa- tion as a remedy in Intermittents. Several physicians in different parts of the United States have given their testimony in favour of its efficacy. It has been employed in the New York hospital greatly to the satisfaction of the Professors. " In some cases, it was given in the form of the sulphate, and in others that of the super-sulphate, prepared as follows : R Sulphat Quinin - - - - 3j. Elixir Vitriol ----- 3ss, Syrup Zingib.....3ij- Of this mixture, a tea-spoonful was given every hour, and in every case with the most perfect success, in preventing the return of the paroxysm. This formula containing the superaddition of the sul- phuric acid, possesses much greater efficacy than the sulphate, as it is ordinarily exhibited." The prusiate of iron was also tried in the New York hospital, as reeommended by Dr. Zollickoffer, but with little success. ?o 226 FEBRES. GLASS t, Order II.—REMITTENT FEVER This fever receives its name from the appearances which it pre- serves through its progress, having affinity with both intermittent and continued fever, but seems more nearly allied to the former, and differs from the latter, by being attended with a remission or abatement of the febrile symptoms at irregular periods, and of un- certain duration. The more closely, however, the fever resem- bles a regular intermittent, the less is the danger of a fatal ter- mination. This fever may in general be ascribed to similar causes with those of intermittents. It prevails most in low marshy situations, abounding with wood and stagnant waters. Where great heat and moisture are combined, remittents often have a malignant and putrid tendency, and prove very fatal. They are most frequent when close and sultry weather quickly succeeds heavy rains, or great inundations. No age, sex, or constitution is exempted from the attack; bufit chiefly seizes those of a relaxed habit, who live in low dirty habitations, breathe an impure, stagnating air, and use a poor unwholesome diet. Remitting fevers, in general, commence suddenly with weak- ness, lowness of spirits, yawning and stretching, pain and giddiness in the head, with alternate fits of heat and cold. Sometimes the patient is affected with a delirium at the first attack. There is a pain, and sometimes a swelling, about the region of the stomach, the tongue is white, the eyes and skin frequently appear yellow, and the patient is often afflicted with bilious vomitings. The pulse is small and quick, but seldom full, and the blood when let, rarely shews any signs of inflammation. In some patients there is a troublesome looseness, in others, the opposite extreme. At length, about the sixth or eighth day, a moisture appears over the surface of the body, when a remission of the febrile action ensues. It is impossible to describe all the symptoms of this disease, as they vary according to the situation of the year, and the constitution of the patient. They may likewise be greatly changed by the method of treatment, and by many other circumstances, too te- dious to mention. Sometimes the bilious symptoms predominate, sometimes the nervous, and at other times the putrid. Nor is it ORDER II. INTERMITTENT FEVER. 227 at all uncommon to find a succession of each of these, or even a complication of them at the same time, in the same person. In remitting fevers the patient is always to be considered in considerable danger, particularly in warm climates, where it usu- ally goes through its course in the space of five or six days; but in colder ones, it is frequently protracted to twelve or fourteen days. The principal object in the cure, is to bring it to a regular remission, which greatly facilitates a favourable termination. In cold climates, and in a very early stage of the disease, when the patient is of a full plethoric habit, the pulse full and hard, the heat intense, the breathing difficult, or the head much affected with stu- por, or delirium, it will be necessary to have recourse to bleeding; but in warm climates, when few or none of these symptoms are pre- sent, this evacuation may be dispensed with, as it may prove injuri- ous, or weaken the patient, and prolong the disease. It will, howev- er, in all cases, be requisite to cleanse the stomach, by giving an emetic of about twenty grains of Ipecacuanha and two of tartar emetic, which may be repeated at proper intervals if the sickness or nausea continue. After the operation of this, the body must be kept open by mild laxative medicines, as an infusion of sen- na and manna, with tamarinds, prunes, cream of tartar, or Glau- ber's salts, which may be taken in small doses every hour till a stool is procured. If the following mixture be taken every few hours, it will be found a valuable laxative in this fever. Take good powdered rhubarb, twenty grains, salt of tartar, qr of worm- wood, ten grains, lemon juice, or sharp vinegar, two table-spoon- fuls. Let this be given in the act of effervescence, or the powder may be taken in water-gruel and the acid swallowed immediately after. In order to reduce the feverish heat, or to bring on regu- lar intermissions, the saline julep, mentioned in the cure of the in- termittent fever, should be given with tlie addition of one eighth, or one quarter of a grain of tartar emetic in each dose. As soon as a distinct remission is perceived, the Peruvian bark must be immediately given, in the quantity of half a drachm or up- wards, and repeated every two hours; by which the usual increase of the fever may be prevented, and the disease entirely subdued. In domestic practice, the powder of thoroughwort may be sub- stituted for the Peruvian bark, with a fair prospect of success. Fowler's arsenical solution, in doses regulated as in intermittents, 228 FEBRES. CLASS I. is by many practitioners considered as a valuable remedy in this fever. In warm climates, calomel is considered a valuable remedy in this species of fever to deterge and evacuate feculent matter from the bowels; where there is much nausea or vomiting, it may be retained on the stomach when all other purgatives might be reject- ed. Where frequent vomiting prevails, antimonials must be omit- ted, but the saline mixture mentioned in the last chapter, should be frequently administered in a state of effervescence, adding to each dose ten drops of laudanum ; flannel cloths, wrung out from a decoction of camomile flowers, or mullein, and bruised poppy heads, with some spirits, should be constantly applied over the region of the stomach, and if the vomiting still continue, a large blister ought to be applied to the same part. The patient, during the continuance of the vomiting, should swallow as little drink as possible, and only moisten the mouth and throat; for whatever is received into the stomach will be rejected with considerable violence, by which the disease is strengthened and the patient exhausted. The cold affusion when applied agreeably to the rules prescrib- ed in page 182, has been found productive of the most decided good effects in remittent fevers. This should be employed at the height of the paroxysm, when the sensations of heat are violent, the head-ach severe, and the skin dry. The effects to be observed from the cold affusion, are an alleviation of the violent symptoms, a tendency to quiet sleep is soon induced, the skin becomes moist, and a distinct remission follows. Where from great debility of the patient, or other cause, it may not be deemed prudent to resort to the cold affusion, tepid water may be employed in a similar manner, or the sponging the body over with cold water and vinegar, will be found to induce grateful sensations, and afford essential relief. The diet of the patient must be suited to the degree and symp- toms of the disease. If considerable inflammatory action appears, e\ery thing of a heating quality both in food and drink must be avt ided ; but when nervous or putrid symptoms occur, the patient must Le supported with such diet and cordial liquors as are usu- ally directed in those fevers. Wine, given with the bark, has often excellent effects after distinct remissions have become manifest OROER II. REMITTENT FEVER. 229 It is of great importance that the patient be kept clean, cool, and perfectly quiet. Fresh air ought to be frequently admitted into the apartments by the windows and doors, and the floors should be sprinkled with vinegar. Both linen and bed clothes should be frequently changed, and the excrements immediately re- moved ; for too much attention cannot be given towards keeping the air of the chamber pure and untainted. Bilious Remitting Fever. When a continual remitting or intermitting fever is accompanied with a frequent and copious evacuation of bile, either by vomit or stool, the fever is denominated bilious. A fever of this character frequently exists in the United States, and from the season in which it is most prevalent, it has been termed autumnal fever. According to Dr. Rush, it prevailed in Philadelphia in the autumn of 1780. It came on with rigour, giddiness in the head, and faintness. The fever was accompanied with acute pains in the head, eye-balls, back, and limbs, sometimes affecting the neck and arms with unusual soreness of the flesh resembling rheumatism. So exquisitely severe were the pains and soreness in every part of the body, that the patient could not lie in bed, and from these cir- cumstances the disorder obtained the name of the Break-bone fever. A nausea, and sometimes a vomiting, attended ; the pulse was quick and full, but seldom bard. The tongue and skin were generally moist, and the former was tinctured of a yellowish colour. Remissions, or at least, exacerbations were observed, morning and evening. A rash often appeared on the third and fourth day, which proved favourable. When the fever did not terminate before the fourteenth or twentieth day, it assumed in its progress the usual symptoms of the typhus gravior, or niitior, of Dr. Cullen. Dr. Rush treated this fever by giving a gentle vomit of tartar emetic, and if given while the fever was in its forming state, it frequently effected an immediate cure. If a nausea, or ineffectual attempt to vomit, continued after the exhibition of the tartar emetic, he gave a second dose of it with the happiest effects. He next gave gentle doses of Glauber's salts and cream of tartar,* or of the butternut pill, so as to procure two or three * Dr. R. observes, cream of tartar renders the purging salts less disagreeable ta the taste and stomach; but that lemon juice and loaf sugar, added to a solution of salts, form a mixture that is nearly as pleasant as strong beverage. 280 EEBRES. V.LASS I. plentiful stools. In every instance the patients found relief by these evacuations, especially from the pains in the head and limbs. Small doses of salts and tartar emetic were afterwards administer- ed, to promote perspiration, and to evacuate the bile as fast as ac- cumulated. He recommended the use of pediluvia every night, and for drinks, sage and balm teas, apple and tamarind water, weak punch, lemonade, and wine whey. On the third or fourth day, the severity of the symptoms abated, with a sweat, which was diffused over the whole body, and distinct remissions occurred. Though the pulse remained quick, a few doses of the bark taken in the interval, seldom failed to prevent a return of the fever. After the necessary evacuations had been made, opium was found to produce the best effects in relieving pain, procuring sweat, and re- mission of the fever. If the fever continued beyond the third or fourth day without an intermission, Dr. R. had recourse to blisters, which produced the most immediate good effects. Where the fever did not yield to blisters, and assumed the form of typhus, the medicines usually employed in that species of fever were given. The convalescence from this disease, was marked, says Dr. R. by a number of extraordinary symptoms, which rendered pa- tients the subjects of medical attention for many days after the pulse became perfectly regular, and after the crisis of the disease. A bitter taste in the mouth, accompanied by a yellow colour on the tongue, continued for near a week. Most of those who re- covered, complained of nausea, and a total want of appetite. A faintness, especially upon setting up in bed, or in a chair, followed this fever, and a weakness in the knees was universal. These •complaints were removed by the tincture of bark, and elixir of vitriol, with nourishing diet, and gentle exercise in the open air. Dr. Norcom, an experienced and observing physician of Eden- ton, North Carolina, has communicated to Dr. Hosack some very important observations on the subject of remittent fever, in the two forms in which the disease appears annually in that climate. The following abstract is taken from the Med. and Phil. Register, and Medical Essays by Dr. Hosack. The annual remitting fever of Edenton, and the country in its vicinity, usually begins with the month of August, and the most ORDER II. REMITTENT FEVEK. 231 malignant cases always occur in this month, or during the hot weather in September. According to Dr. N.'s observations, the remitting fever is most fatal in seasons tending to dryness, and accompanied with unusual heat. In its character and symptoms it is as various as the circumstances of climate and season under which it exists. Sometimes persons are seized violently without any prev'ous indisposition, with a chill, or mixed sensations of heat and chilliness, that last for an hour or two, and are succeeded by a severe fever, with pains in the head and back, and full, hard, quick, and bounding pulse, great thirst, a hot and dry skin, hurried respiration, with redness or a muddy suffusion of the eyes, and a disposition to delirium. The stomach, in this form of the fe- ver, does not seem to be affected with much sickness or nausea ; yet vomiting is a frequent occurrence, and it is with difficulty that a patient can retain the least particle of food whatever. A sense of heat or burning is generally complained of, which is very dis- tressing, and occasions every thing to be thrown up that is swal- lowed, if it contain stimulus, or be in any way substantial. The exacerbations of the fever are oftenest quotidian, returning gener- ally in the afternoon, and the intervals short, with an imperfect re- mission, without sweating, or any considerable abatement of pain. The most successful mode of treating this inflammatory or malig- nant remitting fever, is by bleeding, purging, emetics, diaphoretics, and diluents, adapted, in quantity and continuance, to the circum- stances of the case. In this inflammatory form of remitting fever, attended with burning heat and oppressive anxiety about the pre- cordia, neither spontaneous nor artificial vomiting appears to do good : on the contrary, emetics have often increased the affection of the stomach, and exasperated the symptoms of the disease. The bark is a medicine which here does little or no service; on the contrary, it does much harm by increasing the troublesome affec- tion of the stomach, which never fails to aggravate the most leni- ent form of the disease. Bark is given in this fever to remove debility and exhaustion, which are its consequences, but seldom with a view of stopping or curing the disease. Mercury is advantageousby employed, especially in the decline of the fever, after plentiful evacuations. Another form of remitting fever, which is the true bilious remittent of that climate, comes on with a distinct chilly fit, of greater or less duration, and is succeeded by the ordinary symptoms of fever, with a frequent, full and soft pulse, such sr* 232 FEBRES. CLASS 1. may almost always be felt in the paroxysms of an intermittent. It is not accompanied with much acute pain, but great aching and restlessness, nausea or vomiting, with ejection of bile, or matter exhibiting a bilious appearance. The type of this fever is gener- ally that of a double tertian, having an exacerbation one day in the afternoon, the next in the evening. Its remissions are more distinct than those of the inflammatory remittent; it sejdom re- quires bleeding; and, after the exhibition of the proper intestinal evacuants, invariably yields to the bark. It is rarely fatal, and when it is, seldom terminates in less than from ten to sixteen or seventeen days, Towards its close it sometimes puts on the garb of typhus, and does not end in death or recovery in less than from twenty to thirty days. The fever last described is that which af- fects the greatest number of persons at a time, and is the least mortal of any of our continued fevers. Neither the inflammatory nor the bilious remittent, is very fatal; the former, however, is much the more so, in the proportion of at least three to one. It either ends fatally in from four to eight or nine days, or favourably, somewhere between the eighth and thirteenth, but is not unfre- quently protracted to a later period ; the fatal issue generally oc- curs early in the disease, The tongue, in the bilious remittent, is commonly furred and yellow; the skin, likewise, exhibits a yellow hue, which increases as the fever progresses; whereas, in the in- flammatory remittent, the tongue exhibits the common febrile fur, in most cases without yellowness, and the skin is hardly ever discol- oured,until about the close of the complaint. In two or three instan- ces, the surface of the body turned yellow soon after death from the in- flammatory remittent, when not the smallest discoloration had been observed before. In the inflammatory remittent, the vomit- ing occurs with little nausea or sickness; is seldom attended with bilious discharges ; affords scarce any relief, and is always increas- ed by bark and stimulants. In the bilious form of this fever, it is preceded by great nausea, attended with large discharges of bile, gives the patient relief, and is very often to be removed altogether with bark, aromatics, and cordial drinks. Emetics are of the ut- most importance in this form of the fever, and if had recourse to in the beginning, never fail to do great service. From the bilious remittent of Carolina, no age, sex, or constitution, no condition, is exempt. To the inflammatory remittent, the young, the robust, the plethoric, and strangers, are peculiarly subject; and these last ORDER III. INFLAMMATORY FEVER, OR SYNOOHA. 233 are oftenest the victims of the disease. In most of the fatal cases of inflammatory remitting fever, the heat of the skin has continued intense until a short time before dissolution, and the patient has expired in a paroxysm or exacerbation of fever. The bilious re- mittent, when about to prove mortal, in a majority of instances, puts on the garb of typhus, and terminates with the symptoms common in the last stage of that disease. Order III—CONTINUED FEVERS. The doctrine of critical days in continued fevers, has, from the time of Hippocrates, had its advocates and its opposers among the learned of the medical faculty. This point of doctrine, however, ought to be regarded as of some importance in a practical view, since it is almost universally admitted, that there is, in the nature of all acute diseases, except those of a putrid kind, a certain dura- tion of continuance. When, therefore, the termination is to be favourable, the salutary change, unless the course of nature is in- terrupted by improper treatment, or some accidental occurrence, is generally manifested at certain periods, denominated critical days. These are the third, fifth, seventh, ninth, eleventh, four- teenth, seventeenth, and twentieth. All continued fevers, there- fore, unless from the causes already mentioned, almost constantly terminate by a regular crisis, or the morbid cause falls on some particular organ or parts, producing inflammation, suppuration, &c. ; or otherwise, the fatal termination occurs about the same periods. Inflammatory Fever, or Synocha. The ardent or inflammatory fever, is attended with symptoms denoting general inflammation in the system, by which it may be distinguished from either the nervous or putrid fever. It makes its attack at all seasons of the year, but is most frequent in the spring and beginning of summer, and it seizes persons of all ages and habits, but more particularly those in the prime of life, with strong, elastic fibres, and of plethoric constitution. This acute fever may be occasioned by sudden transition from heat to cold, swallowing cold liquors when the body is heated by 30 234 FEBRES. CLASS I. exercise, too free use of spirituous liquors, violent passions, expo- sure to the heat of the sun, the suppression of habitual evacua- tions, and the sudden repulsion of eruptions. It commences with chilliness and a sense of lassitude and inactivity, succeeded by ver- tigo, and pains over the whole body, particularly in the head and back, redness of the face, great restlessness, intense heat and un- quenchable thirst, difficult breathing, nausea and sickness, a foul tongue, and loss of appetite. The skin is dry and parched, the eyes appear inflamed, and are incapable of bearing the light, the urine is high coloured, and the pulse is full, hard, and quick, beating from ninety to one hundred and thirty in a minute. In some instances, after the symptoms have continued for some days, they assume those of typhus, so that the disease obtains the form of Synochus. The blood, when drawn, exhibits a yellowish or buffy crust on its surface. If the fever runs very high, or continues many days, with delirium, subsultus tendinum, picking at the bed-clothes, labori- ous respiration, hiccoughs, cold clammy sweats, and involuntary discharges by stool and urine, the event will certainly be fatal. From the danger with which this fever is attended, it will ap- pear advisable to procure the best medical assistance as soon as possible, that the proper evacuations, and other remedies may be applied before the strength of the patient be too much exhausted. If the physician fincfthe pulse frequent, full, and hard, and the pa- tient young and plethoric, he will not hesitate to draw about eighteen ounces of blood from a large orifice, remembering that one large bleeding at the beginning, will be more beneficial than repeated small ones afterwards. He will judge of the propriety of another bleeding in a small quantity, from the appearance of the blood, and the abatement of the inflammatory symptoms. Should the patient be too much reduced to bear a considerable loss of blood, and the head be much affected with severe pain, or delirium, topical bleeding, by the application of three or four leeches to the the temples, will be found beneficial. A powder, or pill, consisting of calomel, four parts, opium, one part, given in doses of about three grains every six hours, will tend greatly to open the secretions and to induce a solution of the fever. If nausea or sickness prevail, the stomach should be relieved by exciting a gentle vomiting, by the use of a solution of emetic tar- ORDER III. INFLAMMATORY FEVER, OR SYNOCHA. 23fi tar, in small doses, every quarter of an hour, assisted by chamo- mile, or thoroughwort tea. In this fever, cathartics will be found peculiarly useful. A few grains of calomel, made into pills with the extract of butternut, or a solution of Glauber's salts and man- na, will effect the desired purpose, without increasing tho heat and irritation. Costiveness may afterwards be obviated by a repetition of mild laxatives, or by laxative clysters. The antiphlogistic regimen should be strictly observed, through the whole course of this fever. The patient's food should be light and easy of digestion, as preparations of barley, oatmeal, sago, and arrow root, roasted apples, &,c. His drink should be barley water, linseed tea, toast and water, apple tea, whey, thin gruel, and lem- onade. If, from the dictates of nature, the patient should mani- fest a longing, or strong desire for some particular kind of food or drink, he may be indulged in moderation, though it may Seem in a degree improper. Bathing the legs and feet in warm water, is among the means to be frequently employed, and cleanliness, and a free circulation of air, ought never to be neglected. Acids of all kinds, when suffi- ciently diluted, are refrigerant remedies of particular utility in all continued fevers. Besides the mineral acids, those from the vegetable class, as tamarinds, oranges, lemons, currants, apples; lVc. may be mixed with various fluids, and will form a grateful and refreshing beverage. Cream of tartar dissolved in hot water, will be of use as a cooling laxative, and fifteen grains of sal nitre, or six- ty or eighty drops of sweet spirits of nitre, added occasionally to some of the drinks, will be found well adapted for the purpose of moderating the heat, and quenching thirst in this fever. It is a point of considerable importance, to determine the circulation to the surface of the body, and to excite a general perspiration. This is generally effected by the use of the neutral salts, and the preparations of antimony, either separately, or combined as fol- lows : take of salt of tartar or wormwood, two drachms, juice of lemons or strong vinegar, four table spoonfuls, mint water, a gill, loaf sugar, half an ounce, mix them, and give three table spoon- fuls with twenty-five drops of the wine of antimony every four or live hours. Ten grains of sal nitre may be added to each dose, when the heat and thirst are great, and the diaphoretic effect of these medicines, should be increased, by taking frequently small draughts of w 'in liquids, and by warm fomentations to the lower 236 FEBRES. CLASS I. extremities. All attempts to excite sweatng in fevers, by the common method of stimulant, keatin,; nd inf.ammatory medicines, will prove decidedly more injurious than beneficial. A partial sweating, confined to the upper parts of the body, instead of re- lieving, is almost sure to aggravate and prove hurtful. The pa- tient should be kept quiet in bed, and not covered with more bed- clothes than is usual while in health. Should great oppression in breathing, or violent pains in the head, stupor, or delirium ensue, the application of a blister near the part affected, will in general afford essential relief. Where there is any unusual coldness of the extremities, with a sinking pulse, trembling of the nerves, &c. blisters must be applied to the ancles, inside of the legs, or thighs, and stimulating poultices, of mus- tard and vinegar, or of roasted coakum root, to the soles of the feet. The strength of the patient must now be supported, by a free use of cordials, as strong wine whey, sago, or arrow root gruel with wine, and the efforts of nature should be further assisted, by camphor, the volatile salts of ammonia, ether, compound spirits of lavender, &c. Should the patient be troubled with vomiting, the saline draught ought to be taken in the act of effervescence, with the addition of eight or ten drops of the tincture of opium, and a few drops of the essence of peppermint to each dose. In case of great restlessness and want of sleep, where opjum is deemed improper on account of much pain of the head or stupor, a pillow filled with hops, and laid under the patient's head, or a strong infusion or tinc- ture, drawn from the flowers and leaves of that herb, will probably have the desired effect, of procuring refreshing sleep. If about the tenth or twelfth day, the pulse becomes more soft, tongue more moist, and the urine begins to let fall a reddish sediment, there is reason to expect a favourable issue to the disease. Under these en- couraging circumstances, or when the febrile symptoms are con- tinued and kept up solely by debility, it will be requisite to admin- ister some of the vegetable tonics, as the Peruvian bark, cascarilla, quassia, thoroughwort, &c. But these should be given at first in the form of decoction or infusion, and acidulated with the elixir vitriol. In the state of convalescence, the recovery of the patient is to be completed, by a perseverance in a restorative and generous diet, with a moderate use of wine, a change of air, and the employment of daily exercise, carefully avoiding all fatigue of body or mind. It has already been observed, that modern physicians, are much in the practice of employing the affusion of cold water over the ORDER III. NERVOUS FEVER, OR TYPHUS MITIOR. 2o7 body of the patient, for the purpose of moderating or abstracting the morbid heat in fevers. It is not to be expected that this pow- erful agent will be resorted to in all cases indiscriminately, nor is it to be recommended without first consulting a judicious physician. In almost every fever, however, where no catarrhal symptoms, or inflammatory affection of the lungs are present, it will be perfectly safe and proper during the hot season of summer, to wash and sponge the surface of the body with cold water, in the height of the paroxysms of heat. See directions for the application of this remedy, in the chapter on fevers in general, the remittent fever, and the two following chapters. TYPHUS, VEL SYNOCHUS. Nervous Fever, or Typhus Mitior. The slow nervous fever is distinguished by its effects on the ner- vous system ; but it does not affect the habit so universally as the one last described. It principally attacks those of weak lax fibres ; who lead a sedentary life ; study much ; and who indulge freely in enervating liquors. This fever may be occasioned by whatever depresses the spirits, or impoverishes the blood ; as grief, fear, anxiety, want of sleep, intense thought, living on poor watery diet, and unripe fruits ; and likewise by damp, confined, or unwholesome air. It is often gene- rated, and it proves most fatal in jails, hospitals, transport and pri- son ships, crowded baracks, work-houses, and the ill ventilated apartments of the poor. (See page 19S.) Whatever debilitates the system, obstructs perspiration, or in- duces spasmodic stricture of the solids, contributes to the causes which produce nervous fevers. The autumn is the season in which this fever is usually the most prevalent. " But the most general cause of typhus mitior is contagion, communicated through the me- dium of an impure or vitiated atmosphere, by concentrated effluvia arising from the body of a person labouring under the specific dis- ease ; but whatever debilitates the system or depresses the mind, may induce a state of predisposition more readily to be influenced by the operation thereof.''* * Sec observations on contagious and epidemic diseases in this volume 238 FEBRES. ^ASS I. "The nervous fever makes its first appearance with slight chills and shudderings, uncertain flushes of heat, and a sensation of weari- ness over the whole body, resembling that which is felt after great fatigue. It is commonly attended .with a dejection of mind, and more or less of a sense of weight, pain, or giddiness of the head. A great numbness, or dull pain and coldness, affects the hinder part of the head frequently; and likewise along the middle from the forehead to the back part. A sickness of the stomach and a loathing of food soon follow, without any considerable thirst, but often with an inclination to vomit, which, if it happens, brings up little else than insipid phlegm. These symptoms are commonly succeeded by some degree of delirium. " In this condition the patient often continues for five or six days, with a heavy, pale, sunk countenance ; seemingly not very sick, and yet far,from being well; restless, anxious, and commonly deprived of sleep, though sometimes very drowsy and heavy ; ap- pearing to those about him actually to sleep, but is himself so insen- sible of it, that he does not acknowledge that he has slept at all. " The pulse during all this time is quick, weak, and unequal; sometimes fluttering, and sometimes for a few moments slow, per- haps even intermitting; and then, with a sudden flush in the face, immediately very quick ; soon after which, it may again be surpris- ingly calm and equal. " The heats and chills are equally variable with the pulse; some- times a sudden glow arises in the cheeks, while the tip of the nose and ears are cold, and the forehead at the same time in a cold dewy sweat. It is even common for high colour and heat to appear in the face whe;: the extremities are quite cold. The urine in this fever is commonly pale ; frequently of a sherry or natural colour, containing either no sediment, or a kind of loose matter like bran, scattered up and down in it. The tongue at the beginning is sel- dom or never dry or discoloured, but sometimes covered with a thin whitish slime, but towards the crisis of the disease it often be- comes dry,red, and chapped,or is, with the teeth, incrusted with a dark brown fur, though the patient scarcely ever complains of thirst. About the seventh or eighth day, the giddiness, pain, or hea- viness of the head increases, with a constant noise in it, which is very disturbing to the sick, and frequently precedes a delirium." It frequently happens, that the fourth or fifth day, the fever dimi- nishes in its violence, and presents flattering appearances, but soon ORDER III. NERVOUS FEVER, OR TYPHUS MITIOR. 239 increases again, and assumes a more formidable aspect. "There is an irregularity in the exacerbations, which instead of the evening, sometimes appear in the morning. Profuse sweats frequently break forth all at once about the tenth or twelfth day, commonly coldish, and clammy on the extremities; often also very thin stools are discharged, and the patient's strength is depressed, even to faintness, whenever he attempts to sit up. " The whole nervous system is much affected with tremours and twitchings ; involuntary motions of the muscles and tendons arise, the patient picks at the bed-clothes almost incessantly, and either mutters to himself, or talks incoherently, and there is a dilatation of the pupils of the eyes. In most instances, the patient grows deaf and stupid towards the end of this disease. It is not uncommon for them to languish eighteen or twenty days in this fever, but often it exceeds a month in duration, and there is no other evident crisis than the urine becoming turbid, and depositing a sediment. " When about the fourteenth day the pulse becomes fuller and more slow, the tongue more moist, and respiration free, a gentle moisture appears on the skin, or a suppuration happens in one or both ears, and large pustules break out about the lips aud nose, a favourable termination of the disease may be expected. But if profuse evacuations by sweating or purging ensue, if the tongue, when put out, trembles excessively, and there is a sinking of the pulse, great incoherency of ideas, muttering, picking at the bed- clothes, involuntary discharges by urine and stool, starting of the tendon^, and hiccough, with almost a total loss of sight and hear- ing, deaih will soon close the scene." In some instances the access of this fever is so mild and slowly progressive, that medical attention is dispensed with for many days, and the patient is scarcely apprehensive of approaching seri- ous indisposition. But when the fever is completely formed, it will in general pursue its course in despite of all our endeavours. The degree of violence, the duration, and the final issue, are great- ly influenced by the different modes of medical treatment. It has been the practice almost invariably among former writers, to con- demn the use of the lancet, as altogether inadmissible in this modi- fication of typhus fever, but practitioners are daily becoming less tenacious of the vital fluid ; and it has been asserted that typhus fever has of en been marked with symptoms of inflammatory ex- citement to a device justifying depleting remedies, and that expe- ^4U FEBRES. CLASS I. rience has evinced their utility. In the early stage, therefore, if inflammation and excitability greatly prevail, such quantity of blood may be cautiously drawn as will be fairly proportionate to the strength of the patient and urgency of the symptoms. When the use of the lancet is deemed improper, and it is desirable to relieve particular symptoms, such as topical inflammation of the thoracic viscera, or congestions, with considerable determination of blood to any part, the application of leeches may be recommended for the purpose. After this evacuation, it is indispensably necessary to clear the first passages of their crude and acrid contents, byahe early exhibition of an emetic, which, by the concussion it gives to the whole system, dissolves the morbid catenation, and frequent- ly terminates the disease ; and in every stage of this fever, mild emetics may be exhibited as often as indicated with beneficial ef- fects. Cathartics of calomel and jalap, or neutral salts and manna, are next to be directed, and throughout the whole course of the dis- ease, costiveness must be obviated, either by mild laxatives or emollient injections. At bed time it will be proper to direct an opiate, and its effects will be promoted if combined with camphor, or with Ipecacuanha, as in the form of Dover's powder. These evacuating remedies having been applied, it is a general and very efficacious mode of practice next to administer tartar emetic in so- lution, and calomel and opium in small doses. Let about one and a half grain of the former, and one quarter of a grain of the latter, be given every sixth hour, and if a very moderate degree of ptya- lism be induced, it will tend greatly to open the secretions, hasten a restoration of the balance of excitement, and shorten the dura- tion of the fever. If the head should be considerably affected, it will be proper to apply a blister to the back of the neck or tem- ples, and blisters should be applied to different parts, as circum- stances may require. On some occasions when stupor, coma, or delirium prevail, bathing the feet in warm water, with frequent washings of the temples and whole head, when properly shaved, with cold water and vinegar, or applying either to these parts, may be advantageously substituted for blisters. Shaving the head, and washing it frequently with vinegar and water, and keeping it thinly covered, are refreshing, and often afford considerable relief. As a diaphoretic medicine, the neutral mixture, or spirit of Mindere- rus, to each dose of which, one quarter of a grain of tartarized an- timony may be added, will be found beneficial if given a table- ORDER III. NERVOUS FEVER, OR TYPHUS MITIOR. 241 spoonful for a dose, once in two or three hours. If nausea prove troublesome, omit the tartarized antimony, and add a few drops of laudanum and of the essence of peppermint to each dose. Should great irritability of the stomach, and frequent- vomiting attend, there is not, perhaps, a more effectual remedy, than a large blister applied over the region of the stomach, and sometimes it becomes requisite to apply one on the inside of each thigh, from which es- sential benefit will be derived. When there is a torpid state of the vessels of the skin, and the external heat is below the natural standard, it becomes a point of considerable importance to have recourse to artificial heat, so applied as to effect an equable de- gree of excitement, and to relieve the internal viscera from oppres- sion. For this purpose, the warm bath is frequently employed, but it is now supposed that dry heat possesses many advantages over that of moisture. The most eligible mode of applying heat to the surface of the body, is by means of the spirituous vapour bah, invented by Dr. Jennings. Another process for the purpose of imparting dry heat, described in note, page 209 of this volume, m iy be employed with much advantage. But there are frequent occasions for adopting a practice the re- verse of that just described. In those cases where there is amor- bid increase; of external heat, the affusion of cold water over the naked body is the most powerful remedy. The human body, like all oilier bodies, when prcternaturally heated, may be reduced to its natural temperature by the application of cold water over its surface, and when judiciously conducted, this remedy has proved one of the most powerful and efficacious means which can be em- ployed in typhus fevers. If adopted in the forming stage of the disease, this remedy will frequently arrest and cut short its pro- gress, or if delayed till after the fourth day, when the fever is completely formed, the patient will experience the most essential relief from the heat and other distressing febrile symptoms. But there are particular circumstances, and precise rules, to be regard- ed bv the physician in the application of this remedy. The safest. and most advantageous time for using cold water, is when the ex- acerbation is at its height, which is marked by increased flushing, thirsi, and restlessness : when there is no sensible chilliness pres- ent ; 'when the beat is steadily above what is natural, and when there is no general or profuse perspiration. In the advanced stage of typhus fever, or in fact, at any period of the disease when the 31 242 rEBRES. GLASS I. heat is already reduced, and the debility great, some cordial, such as wine warmed with the addition of spice, or even brandy, should be given immediately after the employment of the cold af- fusion. The mode of applying the cold water, is by dashing it from a pail or allowing it to fall from a height in considerable quantity from a watering pot, or when the patient is extremely weak, it may be applied by wrapping him in a blanket well wet with cold water. If in the advanced stage of fever the cold affusion should appear objectionable, the aspersion, or ablu- tion of the body, by means of a sponge, may be substituted, or the tepid bath may perhaps be more eligible. See page 203. When a slow feeble pulse, with diminished external heat, indi- cates a torpid state of the extreme vessels, the following cordial powder will produce the happiest effects, by invigorating the vital energy, inducing the desirable perspiration, and diffusing a more uniform warmth over the surface. Take powdered camphor and carbonate of ammonia, of each six grains: Ipecacuanha two grains, mix for a dose, and repeat it every three hours. The spirit of hartshorn, or of sal ammoniac, in doses of thirty or forty drops in a cup of mustard whey, or infusion of Virginia snake-root, often repeated, is a useful auxiliary for the same purpose. If a diar- rhoea attend, and threaten to debilitate the patient, a mild cathartic should be administered, after which it may be restrained by a free use of the chalk mixture, or the compound powder of chalk with qpium. When restlessness or other symptoms arise for the want of sleep, opiates combined with diaphoretics, either in the form of Dover's powder, or laudanum in proper doses, should be directed; it has been observed that opiates are almost constantly found ben- eficial in typhus fever. When the patient is much affected with subsultus tendinum, it has been usual to administer musk, castor, camphor, and by some sal succini; each of these may in some in- stances prove useful, and when given to the extent of twenty grains, musk often has a powerful effect as an antispasmodic. But I should repose equal confidence in the virtues of the root of a domestic plant, pothos fcetida, or skunk cabbage, as an antispas- modic, destitute of heating properties, and well calculated to di- minish nervous irrittiaons and subsultus tendinum. If in the progress of typhus mitior, symptoms of putridity should arise, two table spoonfuls of yeast, if given every three hours, will be found of great utility. It frequently happens that miliary WRDER III. NERVOUS FEVER, OR TYPHUS MITIOR. 243 eruptions appear about the ninth or tenth day of the disease ; they must by no means be checked by any kind of evacuation, as they may prove to be an effort of nature to throw off the fever; nor should the patient be kept too warm, as sometimes happens, in order to force out such eruptions. When the mouth becomes af- fected with apthous ulcers, a gargle, composed of borax and honey, should be frequently applied to those parts. The sophora tincto- ria, or Indigo weed, has of late been found to produce the most speedy good effects of any application yet employed, the infusion of the root being used as a gargle. See American New Dispen- satory, and Appendix to this volume. Cold water, if taken internally in the cold stage of the parox- ysm of fever, increases the chilliness and torpor of the surface and extremities, and produces a sense of coldness in the stomach, aug- ments the oppression on the prsecordia, and renders the pulse more frequent and more feeble, according to Dr. Currie. When the hot stage is fairly formed, and the surface is dry and burning, cold water may be drunk with the utmost freedom, as at this period it is highly grateful, and tends to diminish the heat of the surface, and lessen the frequency of the pulse, and often brings the paroxysm to a speedier issue. During the whole course of this fever, the patient must be supported by light nutriment, such as oat meal gruel, ;sago, panado, arrow root, jellies, chicken broth, and beef tea. For ordinary drink, wine whey, or negus, prepared by mixing one part of Port wine with two parts of water and sweetened, and also mustard whey, acidulated with the juice of oranges or lemons, will be useful in this fever ; and the mineral acids, especially the muriatic, must not be omitted. The chamber of the patient should be well ventilated and the floor frequently sprinkled with vinegar, the bed and body linen must be kept constantly clean, and the excrements immediately removed from the room. The impressions made by noise, light, external heat, and thirst, should be avoided as prejudicial in this and all other fevers. Every experienced physician must be sensible, that the treat- ment in tvphus fever, requires to be varied after the inflammatory symptoms of the first stage have been vanquished by the evacua- tion of blood and other depleting means. It would be exceedingly improper to continue the exhibition of mercury and antimony in flic last stage of typhus. As soon therefore, as distinct interims- 244 FEBRES. CLASS. |. sions, or remissions of the fever become manifest, the Peruvian bark or some of its substitutes, should be prescribed in the ab- sence of the paroxysms. Haifa drachm of the cinchona in pow- der may be given in a glass of wine every two hours. The bark of cascarilla and the Virginia snake-root will sometimes be found useful, when the cinchona is inadmissible, or when combined with it. The eupatorium perfoliatum, or thoroughwort, has of late been substituted for the cinchona, with decided advantage, and 1 have known it to succeed more effectually than cinchona, and without producing any unpleasant effect. The cordial qualities of wine are well calculated to exhilirate and to invigorate the vital powers, when much exhausted in the latter stage of typhus fever. The wines to be preferred are Madeira, Port, or Claret, and if pure and sound, one bottle or more may be used in twenty-four hours, pro- vided no ill effects result from it. If the least degree of intoxica- tion arise, wine should be discontinued. The mineral acids, es- pecially the muriatic, if liberally employed, will prove useful aux- iliaries in the cure of this disease, as also pure old bottled cider. When, in the last stage of typhus, the usual stimulant remedies fail in rousing the powers of life, the most singular advantages have been derived from the use of the arsenical solution. From trials in the hands of Drs. Ferrier and Thomas, successful results may be confidently expected from its use in similar circumstances. When the patient has been happily brought to a state of conval- escence, it is important that he enjoy a pure air, take moderate ex- ercise daily, and use a nourishing diet, recollecting however, that over-eating is a more frequent cause of relapse than any other. Peruvian bark, and wine, with stomachic bitters, should be em- ployed to complete the restoration to health. As typhus fevers are of an infectious nature, every endeavour should be exerted for suppressing its further propagation as recommended under the head of contagious diseases. To sum up the treatment of this form of fever, it is to be ob- served, that the active and inflammatory symptoms, so soon as they arise, are to be subdued and removed by bleeding, emetics, cathar- tics and sudorifics. One, or more, or ail these remedies are to be used, and more or less fully, according to the circumstances of particular cases. After the administration of these remedies, if the heat should con- tinue, at times, to be injuriously great, the best mode of reducing ORDER III. NERVOUS FEVER, OR TYPHUS MITIOR. 24:> it is by external means, so far as these shall be found sufficient. These are, cool or cold air, cleanliness, the affusion of cold water, or spenging the surface of the body with cold or lukewarm vinegar and witer,with the internd use of cool or cold water. So long as the skin is hot and dry, and thirst is present, and cold water produces no sense of weight or coldness in the stomach. and no local disease exists, so long the patient may drink it just as freely as he pleases, and this not only with safety, but with great comfort, satisfaction and advantage. This rule I have adopted for fifteen years, and have not seen cause to regret it in one single instance. Under these conditions, what cau be more grateful or beneficial to the sick than this indulgence, so strictly prohibited in former times ? This permission, with the proper external use of cold water, and the warm and vapour baths, coustitute one of the greatest im- provements in the late and present treatment of febrile complaints, This management shortens the duration, lessens the sufferings, and prevents the fatal tendency of this numerous class of maladies, beyond the conception of any who have not witnessed the difl'er- ent effects between this and the oldfashioned, opposite practice. The following are the outlines of Dr. Miner's treatment of INer- vous Fever, extracted and abridged from his Essay on the Resolu- tion and Treatment of Fevers :— When called to a patient who has the precursory symptoms of fever, or even if be has advanced two or three days into the pre- paratory stage, after we have investigated the nature of the case, the first inquiry is, whether there be a rational prospect of break- ing up, or procuring a resolution of the disease ; if there is, to make the attempt is of immense importance. The means should be such as can be most conveniently employed, be kible to the fewest accidents in their execution, and though they might happen to fail of breaking it up, they should be such as wdl best moderate its violence, shorten its duration, and at the same time, put the pa- tient in the least danger of sinking at a critical period, and also, best prepare him fur the subsequent appropriate remedies. \\ hen the fever has a typhoid character, slow and moderate purging with calomel, answers the indications just mentioned, berer than any other method. It is the only one, of all the common devices for breakmg up fevers at their access, which in my prac- tice, has been attended with any degree of certainty. Tiie cdo 246 FEBRES. CLASS I. mel, mixed with any mild syrup, but not in the form of pill, should be administered in small doses—from two to five grains, every two or three hours, according to the circumstances of the patient, till sufficient catharsis is produced. If possible, the calomel should be given in such doses, and at such intervals of time, as to be retain- ed in the stomach and bowels twelve hours, before it produces its operative effect. But if catharsis does not take place in eighteen hours at farthest, it must be assisted by castor-oil, or some other mild vegetable purgative. At the same time, it is proper to pursue a moderate, diaphoretic regimen ; such as pediluvian, tepid aroma- tic and diaphoretic drinks, fomentations and sinapisms, or epispas- tics, as the local symptoms require. When the pain in the head is violent, a blister to the forehead will not only be of essential service in relieving this particular symptom, but will very much as- sist the effort at breaking up tbe disease, by superinducing an ad- ditional new action. Warm bathing is also an excellent adjurant in the severer cases. In putrid-fever, when the heat is above the natural standard, and the skin dry, we may also resort to cold affu- sion, with a cooler regimen, there being nothing in the calomel practice to interfere with its use, in truly hot cases. Cold affusion is, however, with us, rarely indicated; as in the majority of our fevers, which are decidedly of the nervous type, the heat scarcely exceeds the temperature of health, and is ,and the fort id stools which are discharged. In addition to these symptoms, the peculiar biting heat of the skin, the perpetual writhing of tlie body, which has been termed a mortal iuquietude, the more floiid colour, and the violence of the symptoms at the commencement, will afford a sufficient diagnosis between this and typhus mitior. The general source from which putrid fevers originate, is conta- gion, (seepage 198) communicated either immediately from the body of a person affected with it, or by clothes or other articles 254 FEBRES. 1 CLASS I. having been in contact with the sick. It is sometimes generated by a hot and moist constitution of the air : and in low marshy countries, by the effluvia arising from animal and vegetable sub- stances, in a state of putrefaction, especially when intense sultry heat quickly succeeds a wet and rainy season. But typhus fever is supposed to originate in general, from exhalations arising from hu- man excretion, when closely confined, and acted upon by animal heat. Hence no situations are more liable to this fever, than close and confined rooms, such as crowded hospitals, gaols, camps, and on board of ships, when the strictest attention is not paid to a free ventilation, and other proper means of cleanliness. It is also oc- casioned by eating flesh or fish, that have been too long kept, and by living too much upon salted animal food, without a suitable quantity of vegetables ; whence seamen on long voyages are much exposed to its influence. Damaged corn, and water that has be- come putrid by stagnation, may likewise produce putrid fever. The poor inhabitants of large towns, who breathe a confined un- wholesome air, and such mechanics and manufacturers as are em- ployed about dirty substances, and are constantly confined within close and crowded rooms, are peculiarly liable to putrid fevers. Persons of lax fibres, and who have been weakened by any pre- vious debilitating cause, such as poor diet, long fasting, hard labour, continued want of sleep, &c, are most commonly the subjects of this disease. The symptoms of this fever in the beginning are not unlike those of the nervous fever, but the attack in general is more sudden and violent, and the progress more rapid and alarming. There is usu- ally considerable chilliness attended with, and gradually ending in acrid and often burning heat with little remission ; great prostra- tion of strength ; general anguish of body, and depression of spirits. The breathing is short and anxious ; and a nausea and vomiting of bilious matter sometimes ensue ; the pulse is quick, small, and often hard, with distressing head-ach, noise in the ears, and a vio- lent throbbing of ihe temporal arteries. The eyes are sunk, dull, listless, with a dusky, sallow, dejected countenance, or red, full, and rolling with restlessness and fierce delirium; the tongue is generally foul, often brown or black, with blackness of the lips and foetid sordes about the teeth ; and there is sometimes considerable thirst. The urine is scanty, and at first but little changed, but pro- gressively becomes high coloured, sometimes greenish or sooty, ORDER III. PUTRID AND MALIGNANT FEVER, OR TYPHUS GRAVIOR. 25 ') and generally of a strong smell. The fever continuing to increase, the speech becomes inarticulate and scarcely intelligible ; the pa- tient mutters to himself, and delirium attends. At length symp- toms of putrefaction appear, the stools are dark coloured, offensive, and pass off insensibly, haemorrhages issue from the gums, nostrils, and intestines; or more frequently, extravasations of blood from the cutaneous vessels produce red, livid, or purple spots, or petechias, or larger marks, like bruises, on the neck, breast, arms, and other parts of the body, shewing the great malignity and danger of the disease. The pulse now intermits and sinks, the extremities grow cold ; hiccoughs ensue, and death soon closes the tragic scene. The duration of the putrid fever is extremely uncertain ; some timos finishing its course between the seventh and fourteenth day, and at other times continuing for several weeks. When ^fter the fourth or fifth day, a gentle universal warm perspiration, with di- minished frequency, and increased fulness of the pulse, a moist and cleaner tongue, scabby eruptions about the mouth, and moderate- ly loose stools occur, a favourable termination may be expected; while partial clammy sweats, weaker and irregular, or tremulous pulse, dry, black, and chopped tongue, swelling and tension of the abdomen, involuntary discharges by urine and stool, subsultus ten- dinum, picking the bed-clothes, high delirium, constant vomitings, coldness of the feet and hands, and trembling motion of the tongue, laboured respiration, and difficulty of swallowing, denote a fatal event ; and if the patient can lie on his back only, and draws up his knees, and makes frequent attempts to get out of bed without assigning any reason, and passes frequent stools of a very offensive smell involuntarily, the hour of dissolution is near at hand. In the treatment of this fever, one of the principal objects is to counteract as far as possible the putrid tendency of the fluids ; to support the patient's strength and spirits, and to assist nature in resisting the cause of the disease. No part of the treatment is more important than a rigid attention to the means of personal cleanliness, a free circulation of pure air, and the exclusion of noise and light from the patient's chamber. As the breath and perspiration of a person whose whole mass of fluids is in a state of putrefaction, will soon contaminate the air of an apartment, and as the least noise or fatigue of body or mind in such debilitated state, will occasion faintness. and aggravate the other symptoms, it is obvious, that the avoidance of all these causes 256 FEBRES. CLASS L ought to be strictly enforced during the whole course of the fever, Not only should the chamber be constantly ventilated, but the floor should be sprinkled with vinegar, and its fumes diffused through the house by burning or boiling it. The juice of oranges or lemons, or other vegetable acids, should be freely used by the patient, and the skins of those fruits, together with strong scented herbs, as rue, tansy, and wormwood, may be distributed about the bed and apartment, as means of rendering the air more agreeable, and of preventing the spread of the disease. The vegetable acids are peculiarly useful in this fever, and they should be mixed with all the patient's food and drinks, which may consist of barley water, orange, mustard, lemon, or vinegar whey, camomile or tho- roughwort tea, and occasionally with a proper addition of Port or Madeira wine. The food must be light and easy, as panado, oat- meal gruel sharpened with acids, or the jelly of currants, &c. and the patient may eat freely of ripe fruits, jellies, and preserves, of almost every description. Thoroughwort tea, will be found very serviceable in this disease, and it may be acidulated by adding to every cup ten or fifteen drops of the elixir of vitriol. When the body is bound, a teaspoonful of cream of tartar may be dissolved in a cup of the patient's drink occasionally, or a decoction of tama- rinds, will tend to quench thirst and promote a discharge by stool. The patient ought to swallow a little food or drink very frequently, as it will tend to support his strength and spirits. If delirium pre- vails, the hands and feet should be frequently fomented in a strong decoction of thoroughwort, which both relieves the head and as- sists in counteracting the putrid tendency. In regard to the curative treatment, blood-letting was formerly deemed inadmissible in typhus and putrid fevers ; nothing but the clearest evidence of high inflammatory affection could, it was im- agined, justify the practice, even at the first onset of the disease; but more recent improvements have changed the sentiments of physicians in this respect, and venesection is now resorted to by some with the same freedom and confidence as in other acute dis- eases, limiting the extent by the effects produced on the pulse and system; but this requires much caution. Emetics given at the beginning, and repeated occasionally during the course of the fe- ver, never fail of rendering very essential service, and when ad- ministered before the forming state, it often arrests its progress. \fter the stomach has been sufficiently cleansed, an adequate dose ORDER III. PUTRID AND MALIGNANT FEVER, OR TYPHUS GRAVIOR. 257 of calomel and jalap should be exhibited, to evacuate* from the intestines that accumulation of putrid matter which tends to in- crease the fever, and aggravate all the symptoms. The bowels during the progress of fever, should be kept constantly at com- mand by means of calomel, or some mild laxative medicine, and occasional injections. When delirium, local pains,- or symptoms of congestion, are present, or when diminished excitement on the surface or extremities, demand the use of blisters,these should be extensivtdy employed. Applied to the head and inside of the legs and thighs, they are productive of the most important good effects. Stimulating sinapisms of mustard seed, rye meal, and vinegar, or the coakum root, should be applied to the soles of the feet, and warm frictions and rubefacients to different parts of the body, where torpor and coldness prevail.- These may sometimes super- sede the use of blisters, and are less apt to occasion gangrene. Calomel and opium, as advised in typhus mitior, have usually been exhibited in the early stage of typhus gravior, with much confi- dence, and generally with great success ; a fatal termination rarely occurring where a mild affection of the salivary glands has been induced. The celebrate^ Dr. 6r. Fordyce relies chiefly upon a weak solution of tartarized antimony, administered in such manner as to induce a slight nausea, and repeating it every third hour, un- til either vomiting, purging, or free perspiration be excited, taking care not to push it so far as to weaken the patient by profuse sweats or other evacuations. By the use of this medicine in the early stage of typhus, he asserts that in one third or one half of the cases, he has seen symptoms of a crisis arise in less than five hours after the exhibition of it, and in less than twelve hours the fever has often ceased altogether. Every practitioner, how- ever, must be aware that a constant nausea is a Very unpleasant and distressing sensation, and also that both mercury and antimony have so powerful a tendency to exhaust the vital energy, as to render their use exceedingly objectionable after the first stage of typhus fevers. But tonic and antiseptic medicines and nourish- ment are mostly to be depended on for the cure, after the necessa- rv evacuations have been made. In the advanced stage, all debil- itating causes must be avoided, and the patient should be support- ed by cordials and stimulants adapted to the peculiar circumstances of the case. Such are volatile alkali, ether, porter, yeast, Vir- ginia snake-root, and cascarilla : but good sound wine, an Port. 33 258 . FEBRES. CLASS I. Claret, or* Madeira, is incomparably the most efficacious. Nu- merous extraordinary cures have been effected, when patients were reduced to the last extremity of danger, by the administra- tion of wine to the extent of a quart or more in twenty-four hours. But nothing can exceed the beneficial effects to be obtained from a free use of a wine made from the officinal black currant. We are not acquainted with a better cordial and antiseptic remedy in all putrid diseases.* Another useful article in this species of fever is pure bottlod cider, which may be given with much freedom. In the most dangerous form of the fever, when purple or black spots appear, two table-spoonfuls of yeast should be administered every two or three hours, and no time should be lost in resorting to the cinchona, joined with the mineral aeids. The most efficacious form of administering the bark "is certainly in substance. One ounce of the powder may be mixed in half a pint of water, and the same quantity of red wine, and sharpened with the elixir vit- riol, which will make it sit easier on the stomaeh, and render it more beneficial. A little loaf sugar may be added, and the pa- tient should take two table-spoonfuls every two hours. If in this form the bark should offend the stomachy it may be tried in decoc- tion or infusion, conjoined with Virginia snake-root, to which some of the compound spirit of lavender may be added. The muriatic acid has obtained considerable repute for its efficacy in typhus and malignant fevers. In his Modern Practice, Dr. Thomas vouches, in strong terms, for its great utility, as experienced in his own practice for several years. Having premised the usual evacua- tions, and subjected the patient to the cold affusion where that is deemed proper, he prescribes for adults, ten or twelve drops of the muriatic acid, guarded with five drops of laudanum, and mix- ed in about an ounce and a half of an infusion of cascarilla or columbo. This he directs to be repeated every four hours, grad- ually increasing the quantity of the acid to eighteen or twenty drops or more. The effects of the muriatic acid in all febrile dis- eases of a malignant nature, says Dr. Thomas, are truly great: and from using it in all such cases, his practice has been attended with the most decided success. In the hands of other practition- ers, likewise, the muriatic acid has been productive of favourable effects in both typhus mitior and gravior. In one case of the * It is much to be desired that our horticulturists would pay more particular at- tention to the cultivation of that very valuable fruit, the officinal black currant. ORDER III. PUTRID AND MALIGNANT FEVER, OR TYPHUS GRAVIOR. 259 latter species, attended with extreme danger, I administered this medicine in a strong infusion of thoroughwort, with a few drops of laudanum; when it had been taken freely for about twelve hours, a profuse sweat ensued of a yellowish colour, and nauseous smell; a favourable change immediately appeared, and the recov- ery was rapid. The patient's linen was corroded and entirely destroyed, by what exuded through the pores. As a mild tonic and antiseptic, the thoroughwort, in the form of infusion, acidulat- ed with the mineral acids, will prove beneficial in all the stages of this fever. Opiates are indispensably necessary, and afford great relief in this disease, a suitable dose of which may be given every night with some diaphoretic medicine or drink, more especially if a troublesome looseness attend. And to obviate this threatening symptom, recourse must be had to internal astringents, such as the compound powder of chalk, catechu, the root of tormentilla, and, in obstinate cases, the acetite of lead, one grain, opium, half a grain, every two hours, till the desired effect be produced. For the healing of those foul ulcers so troublesome about the mouth and tongne, antiseptic gargles should be freely employed, among which, no one is to be preferred to an infusion of sophora tinctoria, (sec Appendix.) When from extreme irritability of the stomach, a troublesome and obstinate vomiting attends, the neutral mixture ought to be so administered that the effervescence may take place in the stomach, and a few drops of laudanum occasionally added ; or eight or ten grains of salt of tartar, or sal seratus dissolved in a wine glass full of lime water, with a few drops of essence of peppermint, should be given every three or four hours. A large blister should be applied over the region of the stomach, and blisters to the thighs and legs will also be very beneficial. Spirituous fomenta- tions with laudanum to the stomach, and the latter injected into the intestines, will often afford great relief. The internal exhibition of carbonic acid gas is supposed to be highly useful in taking off that peculiar debility of the stomach which is often so distressing in putrid diseases. This gas may be conveniently administered by means of aerated water, prepared as in the Appendix, or by the neutral mixture, as above mentioned. In the act of effervescence the gas is extricated, and exerts its effects directly on the stomach. 11 is on the principle of its affording fixed air, that yeast has obtained such high repute in putrid diseases. The discovery originated with the Kev. Mr. E. Cartwright, an English clergyman, and the rem- 260 FEBRES. CLASS r. edy has been found by experience to merit the highest attention. Whilst visiting a boy ill with putrid fever to such a degree as to preclude all hope of recovery, he recollected an experiment of a piece of meat being made sweet, by being suspended over a tub of wort in the act of fermentation. The idea occurred that yeast might correct the putrid nature of this disease, and he immediate- ly gave the boy two large spoonfuls, and directed it to be repeated every three hours. The good effect was immediately visible, and the recovery was remarkably rapid. This benevolent clergyman repeated his trials with astonishing success, and he affirms that he has since administered the yeast to above fifty persons, labouring under putrid fevers; and what is singular, all of them recovered. In some instances the relief was so speedy, that from a state of drowsy insensibility, with a black tongue, and pulse scarcely per- ceptible, the patients were in a few hours able to leave their beds and walk. It is given in doses of two table-spoonfuls in a cup of water, or an infusion of malt, or mild porter, every two or three hours, and bark and wine are given at proper intervals at the same time. A decoction of the root of sophora tinctoria, from its antiseptic properties, has been administered in a few cases of putrid fever with effects so decidedly beneficial, as to excite sanguine expecta- tions of its efficacy; and as it may be given without interfering with other remedies, it is recommended for further trial. Since the introduction of the practice of affusing the body with cold water, that remedy has been resorted to in cases of putrid malignant fever, and the proofs are now irresistible, that, when judiciously employed, it is productive of the most important ad- vantages. Mr. Marshall, surgeon, reported to Dr. Currie, that in sixty cases, out of sixty-four, in which this remedy was employed at an early period, the disease was arrested by having recourse to it three or four times; and in the other four, which were advanced in their progress, although ihe disease was not stopped from going through its natural course, still all the patients recovered. The circumstances and restrictions under which alone this powerful agent may be used, have been fully described in the chapter on fevers in general, and on typhus mitior, to which the reader is referred. In all instances of contagious fever, the utmost care should be taken to prevent its being communicated to other persons, The ORDER III. PUTRID AND MALIGNANT FEVER, OR TYPHUS GRAVIOR. 26l sick should be as much separated from the rest of the family as possible ; the bed linen, and every thing about the patient, ought to be changed every day ; all discharges and filth of every kind immediately removed, and cleanliness, in the strictest sense of the word, most rigidly and constantly enjoined. The chamber or apartment must be properly ventilated, by allowing a free admis- sion of fresh air into it during both day and night, securing the patient, however, from a current of cold or damp air. The fumes of warm vinegar in which some aromatic herbs have been infused, should be diffused through the room. No person, but the neces- sary attendant, should have any communication with the sick, and these should avoid sitting down on the patient's bed; or inhaling the breath or vapour arising immediately from his body. It may be proper for those who are necessarily exposed, to keep a sponge, or handkerchief, moistened with camphorated spirits or vinegar, to the nose and mouth,* and the various means recom- mended in the chapter on contagious diseases, ought to be adopt- ed, and a steady perseverance enjoined. The author having described in detail the most approved modes of treatment in tyhhus fever, it remains to caution the inexperienc- ed physician against an error in practice, of which he may not be aware. It is that of doing too much, and expecting more from our art than can be realized. Typhus is a subject not so easy of con- trol as some may imagine ; it will in general run its course, and it is even doubtful, whether in the aggregate, more lives are saved by what is termed bold, vigorous, efficient practice, than by the most simple mode of treatment, and more reliance placed on the efforts of nature, carefully regarding her dictates, and judiciously fulfilling her indications. * " When the contagion of a putrid fever is taken by the saliva into the stomach and bowels, which is its constant road, if the patient, the moment he finds himself attacked with a sense of chilliness, loss of appetite, and an unpleasant taste in his mouth, has recourse to two emetics at proper intervals, and after the operation of the first emetic takes a cathartic, he has certainly got rid of the infection." Totonsend's Guide to Health, Vol. II. p. 53 262 FEBRES. OLASS. I. DYSENTER1A, OR DYSENTERY. This disease is characterized by violent griping, tenesmus and straining at stool, attended with frequent scanty and mucous or bloody discharges from the intestines, while the proper foeculent matter is for the most part retained. The dysentery is often oc- casioned by much moisture succeeding quickly to intense heat, or great drought, whereby the perspiration is suddenly checked, and a determination made to the, intestines. It is likewise produced by the use of unwholesome and putrid food, and by noxious exha- lations and vapours, hence it is frequent in camps and ships, and other places where a number of people are assembled under cir- cumstances favourable for its production. It is most prevalent in autumn, and is frequently of a contagious nature, and in some par- ticular conditions of the atmosphere it prevails epidemically. This disease is most commonly preceded by costiveness, unusual flatuleuce, acid eructations, and wandering pains in the bowels; in most cases, however, from the commencement, griping pains are felt in the lower part of the abdomen, which often arise to a considerable degree of severity; the bowels are irritated to fre- quent evacuation, in indulging which, but little is voided, and the rectum often becomes exquisitely painful and tender ; the matter evacuated is often very foetid, and the stools are frequently com- posed of mucus, pus, blood, membranous films, and white lumps of a sebaceous nature ; the mucus is generally mixed with a watery fluid, and is often frothy : tenesmus in a greater or less degree ge- nerally accompanies the evacuation of the bowels, and it very rarely happens, that natural foeces appear during the whole course of the disease, and when they do, they are in the form of scybala, that is, small separate balls, which appear to have lain long in the cells of the colon ; when these are voided either by the efforts of nature, or are solicited by medjcine, they procure a remission of all the symptoms, more especially of the frequent stools, griping, and tenesmus ; with these symptoms there is loss of appetite, great anxiety about the praecordia, frequent sickness, nausea, vomiting, and the matter ejected is frequently bilious, watchfulness, and prostration of strength; there is always some degree of sympto- matic fever, which is sometimes of the remittent or intermittent type ; sometimes it assumes the synocbous, and very frequently ORDER ill. DYSENTERY. •2&J the typhous type : the tongue is white, and covered with tough mucus, or rough, dry, and sometimes black ; the patient complains of a bitter taste in the mouth, and in the advanced stage of the the disease there is hiccough and aphthae, When the fever attending the dysentery is of a violent inflamma- tory kind, and especially when it is of a highly putrid nature, the disease often terminates fatally in a few days by a gangrene, or mortification of some part of the bowels ; but when the attendant fever is moderate, or entirely disappears, the disease is often pro- tracted for weeks, and even months. If vomiting, hiccough, greenish or black stools, with an extreme putrid smell occur in this disease, the danger is great; and when the pulse becomes weak, and the extremities cold, with difficulty of swallowing, and convulsions, death will soon close the scene. In' the curative treatment, particular regard should be paid to the prominent symptoms,'carefully discriminating between those which attend the early stage, and those which succeed at a later period, that the remedies may be properly appropriated to the different stages and circumstances. If the disease is attended with acute pains, and a tenderness of the abdomen, indicating inflamma- tion of the coats of the intestines, venesection is obviously indispen-, sable, and the necessity of a repetition must be determined by the continuance of inflammatory symptoms, whether the pulse be full and tense, or small, frequent, and more or less hard. In warm cli- mates, however, this practice must be pursued with a degree of cau- tion, as the employment of powerful antiphlogistic measures is often succeeded by a sudden and dangerous debility, and tbe fever which attends, is very apt to assume a typhoid type. We may, however, always begin with emetics, which are not only useful in emptying the stomach and bowels, but they also determine to the surface. The most efficacious emetic is Ipecacuanha and tartarized antimo- ny combined, and after the operation of the first full dose, smaller doses of the same may be advantageously employed. The morbid and noxious contents of the intestines, the pernicious source of the irritation, must be expelled by cathartics, and calomel is one ot the most efficacious, but it should always be combined with some antimonial preparation, as the tartrite, or cerated glass of antimo- ny ; from six to ten grains of this last, with an equal quantity of calomel, is greatly extolled by many practitioners as an excellent cathartic in the early stage of dysentery ; but in general it will 264 FEBRES. OLASSI be more advisable to begin with small doses, increasing according to the effect produced. Other purgatives well adapted in dysentery, are castor oil, with or without an equal quantity of the oil of tur- pentine^ xtract of butter nut, sulphate of magnesia and manna, in a solution of which, a few grains of tartarized antimony should be dissolved. These form an ample variety for the choice of the prescribes The spirit of Mindereus in doses of a table-spoonful, with six or eight drops of laudanum, given every two hours, has been found very useful in determining to the surface and relaxing the skin. During the intervals Of the operation of the cathartics small doses of calomel and opium, as directed in fevers, will be productive of excellent effects, by opening the secretions, deterg- ing the intestines, and abating distressing pain. Nauseating doses of Ipecacuanha, as two or three grains three times «a day, will prove useful by impelling the fluids towards the surface hf the hody ; and this is, in fact, one of the most important curative indi- cations. There is almost constantly a diminished action in the extreme vessels, and a coldness and dryness of the skin ; nothing can be more important than to restore and equalize the circulation, and thereby induce a salutary diaphoresis. With this view, the most efficacious diaphoretics accompanied by friction, and the nieans of external beat, must be diligently and perseveringly ap- plied. Perhaps no diaphoretic is to be prcferited to Dover's pow- der, with the addition of a few grains of camphor to eash dose; this should be administered in such a manner as to excite some nausea, and repeat it every few hours, until free sweating be induced, and this continued for several hours, the patient being properly secured from the access of cold air. For the purpose of impart- ing external warmth, Dr. Jennings' steam bath, heated billets of wood, bladders or jngs of water, or heated bricks frequently renewed, may be employed. It has recently been anounced by Dr. T. Clark, an English physician, that a decoction of the root of Ipecacuanha has been administered as injections in dysentery with surprising success, and the practice has been successfully adopted by others. He directs for an adult, three drachms of the bruised root to be boiled in a quart of water down to a pint, strainecl and given all at once by way of enema, and re- peated if necessary. The following preparation, has, by common report, gained some reputation as a remedy in this disease. Add to lemon juice, or stroDg vinegar, as much xommon salt as the BRDER 1U. DYSENTERY. 265 acid will dissolve. Give a large spoonful of this in a cup of mint tea, or hot water, sweetened, every two or three hours. After the proper evacuations have been made, opiates become indispensable to allay irritation; the extract of hyoscyamus, by its anodyne and gently laxative qualities, is also well,adapted to this disease. Where languor and coldness of the surface and extremities have supervened, the repeated application of blisters and warm frictions to the extremities are auxiliaries of peculiar importance. The warm bath, or semicupium, or the partial fomentation of the abdo- men, is often used with much advantage, and should in general be advised, especially where the abdomen is hard, tense, and painful to the touch, and the gripings are frequent and severe ; campho- rated spirits should be added to the fomentation, and if these fail to afford relief, a large blister must be applied to the region of the abdomen. Should an obstinate vomiting attend, it will be highly important to bathe the region or the stomach with tincture of opium, and camphorated spirits, and to inject into the intestines, proper quantities of opium, until relief is obtained. There is in dysentery, a spasmodic constriction of the intestines, interrupting their natural peristaltic motion. Upon this principle, some re- spectable and experienced physicians are in the practice of ad- ministering full and repeated doses of opium in the first iiistance9 keeping the patient under its influence for some time, and when the constriction is removed, if evacuations do not follow, the mild- est laxatives produce their speedy effect. With the view of abat- ing the tenesmus, or continual straining, and desire of going to stool, which is one of the most distressing symptoms of this disease, clysters, made of half an ounce of powdered starch, dissolved in half a pint of barley water, or the same quantity of fat mutton broth, without the starch, with forty drops of laudanum, should bo given twice every day. The pain attending the tenesmus may also be allayed by fomenting the anus with a decoction of chamo- mile flowers, with some tincture of opium sprinkled on the cloths which are applied. If strangury should occur, it will be effectu- ally relieved by fomenting the pubes and perinseum. During the whole course of this distressing disorder, mucilaginous demulcent liquids must be given in the most liberal manner, for the purpose of defending the intestines against the acrimony of their contents, and alleviating the violent gripings which often prevail. For this intention, one ounce of gum arabic dissolved in a pint of bar- 3-1 266 FEBRES. CLASS I, ley water, or half a drachm of spermaceti, mixed with the mucilage of gum arabic may be advantageously employed, as also mucilage of slippery elm bark, or linseed tea. But nothing can exceed the good qualities of melted fresh but- ter free from salt. " It is," says professor Chapman, of Philadelphia, " better than anything I know." If given freely internally, and in injection half a pint thrown up every hour or two, its good effects will soon be manifest. It relieves griping and tenesmus like a charm. In the early stage of dysentery, I should, from my own ex- perience of its efficacy, place much reliance upon it to abate the dis- tressing symptoms if not to effect a cure." We have seen the fol- lowing preparation recommended in dysentery. Saturated solution of sulphate of soda in water six ounces, spirits of turpentine two ounces, ipecacuanha one scruple, sometimes three grains of opium is added. Half an ounce to once ounce is to be administered after every dysenteric stool, or it may be used in clyster. In the ad- vanced and chronic stage of the disease, as acidity of the stomach chiefly prevails at that period, absorbents will be useful, as the chalk mixture, lime water, or the compound powder of chalk com- bined with opiates ; astringents will also at this period of the disease be proper, as the kino, logwood, alum and catechu ; when there exists a remarkable degree of debility, with a frequent discharge of stools without pain, small doses of white vitriol with opium, is well adapted to remove the complaint. Dr. Mosely, of Jamaica, asserts that in chronic dysentery, unattended with fever, there is not a more efficacious remedy than the following solution taken every morning, and an opiate at bed time. Take sulphate of zinc, three drachms, alum, two drachms, spirits of lavender, half an ounce, boiling water, one pint. Dose for an adult, frohi four to six drachms on an empty stomach without diluting it; in severe cases to be re- peated every six hours. When evacuations are required, the quan- tity of alum may be diminished, or entirely omitted ; and when astringency is required, the alum increased, and the sulphate of zinc diminished. I have been informed from a source deserving of credit, that in some parts of the state of New-York, the root of the common blue flag is employed as a successful domestic remedy in dysentery; and one case has been reoorted to me by Dr. E. Sergeant of Lee, in which the discharges *ere bloody, acrid, and attended with severe ORDER III. DYSENTERY. 267 gripes ; the patient without advice took a table spoonful of the powdered root of blue flag, the effect of which was immediately favourable, the pain was relieved, the stools were changed in appearance, and the next day he was in a state of convalescence, and he sooure covered. In the last stage of the dysentery, we must endeavour to restore the lost tone of the bowels, by administering astringents and tonics, as simarouba, cinchona angustura, logwood, oak-bark, and the bark of the root of wild cherry tree, accompanied with Port wine, or the wine of black currants, to which a little cinnamon should be added; the bowels at the same time kept in a soluble state by the occa- sional use of rhubarb and magnesia. In this chronic form of the disease, should putrid symptoms prevail in any stage, yeast, as recommended in typhus gravior, will be useful, and the patient's drink should be sharpened with the vegetable acids, and ripe fruits, jellies, &c. may be freely used. Opium combined with the nitric acid, according to Dr. Thomas, has on various trials been found to have been attended with the best effects in the advanced stage of dysentery, when all other remedies have proved ineffectual, and even in cases where death seemed almost inevitable. It is admin- istered in the following form: take nitric acid, two drachms, opium, two grains, pure water, three otmces, mix, and give a table spoon- ful three times in a day. If this disease should be complicated with an intermittent fever, and protracted chiefly from that circumstance, the euro must be performed by the Peruvian bark. The diet in the first stage should consist of milk, sago, panado, arrow root, jellies, veal or chicken broth, rice, gruel, &c. During the whole course of this disease the patient should wear a flannel roller round the body, as recommended by Mr. Dewar. In tbe ap- plication of this excellent contrivance four or five folds of flannel are first to be laid over the abdomen, and then a flannel bandage moderately tight should extend from the groin to the arm-pit. The advantages of this application are supposed by some to super- sede the use of the warm bath, fomentations, and all other external remedies. In the chronic form of dysentery particularly, no ap- plication has ever been found of equal utility. It effectually obvi- ates the impression of cold, imparts new vigour and energy to the torpid and lanpuid vessels, and affords a mechanical support to the 268 FEBRES. ULASS 1. intestinal canal. The drink at the commencement should be either barley or rice water, boiling water poured upon toasted bread, whey, or the decoction of hartshorn ; in the advanced stage of the disease, Port wine, or Madeira, or a moderate quantity of spirits di- luted with water will be proper; chamomile or thoroughwort tea if not offensive to the stomach, will often be useful. It yet remains to be observed, that as dysentery is often of a very eontagious nature, every precaution should be taken to prevent its spreading ; both the patient and his apartment should be kept as clean as possible. Every thing about him should be frequently changed ; his excrements as soon as voided, ought to be carried off and buried under ground; a free ventilation should be kept up in his chamber by means of the door and windows: and the floor ought frequently to be sprinkled with vinegar, and its vapour diffus- ed through the room, PESTIS TROPICUS, OR YELLOW FEVER. The yellow fever was known to exist in Charleston (South Car- olina), and in Philadelphia, so early as the year 1699, and in 1748 Dr. Lining, of Charleston, published an accurate history of it, and pronounced it an imported disease, and contagious. During our revolutionary war, it was recognized in our camps and hospitals. In 1793, it visited the city of Philadelphia, where it spread uni- versal terror and desolation; and at divers subsequent periods and seasons, it has prevailed in most of our seaport towns, and in its fatality, equalled, if not exceeded, the plague itself, to which mala- dy it bears a strong similarity, in many of its symptoms. The prevalence of this dreadful epidemic could not fail to occasion the greatest consternation and alarm, while at the same time it afford- ed opportunity for the display of talent and industry, in the inves- tigation of its nature and origin. On a subject so recondite in its nature, a difference of opinion among the learned faculty is natu- rally to be expected. There were some who supposed that the yellow fever being of a contagious nature, was imported by ships from the West-Indies, while in opposition to this doctrine, Drs. Rush, Miller, and other learned investigators, firmly supported the opinion, that this malady originated from local causes, and is not Ln its nature contagious. They allege that the primary and essen« ORDER III. PESTIS TROPICUS, OR YELLOW PEVKR. 269 tial cause of yellow fever, is a miasma or pernicious exhedation floating in Vie atmosphere. This miasma is emitted from accu- mulated masses of dead animal and vegetable substances, under- going decomposition by means of solar heat combined with mois- ture. Besides the high authorities above introduced, we have that of the learned and experienced Dr. Ramsay, and Dr. Tucker Harris, both of the city of Charleston, where the disease has often been prevalent, in favour of its local origin and non-contagious nature. Dr. Ramsay, in a letter to the late Dr. Miller, of New-York, says, " There is but one opinion among the physicians and inhabitants, and that is, the disease was neither imported nor contagious. This was the unanimous sentiment of the medical society, who, in pur- suance of it, gave their opinion to the government, that the rigid enforcement of the quarantine laws was by no means necessary on account of the yellow fever." The fact is corroborated by their undoubted testimonies, that in no one instance has the yellow fe- ver been communicated from one individual to another, even when a constant exposure had been unavoidable.* f This fever is commonly ushered in with alternate slight chills and heats. Dr. Rush says the disease appeared with different symptoms in different people, and that the premonitory signs of it were costiveness, a dull pain in the right side, defect of appe- tite, flatulency, perverted taste, heat in the stomach, giddiness, or pain in the head, a dull, watery, brilliant yellow or red eye, dim and imperfect vision, a hoarseness or slight sore throat, low spirits, a disposition to sweat at night, or after moderate exercise, or a sudden suppression of night sweats. More or less of these symp- toms frequently continued for two or three days before the patients were confined, and in some tliey continued during the whole time of the prevalence of the fever in the city, without producing the disease. Many went to bed in good health, and awoke in the night with a chilly fit; many rose in the morning after natural and regular sleep, and were seized at their work, or after a walk, with i* Sic Dr. Hosack's opinion in chapter on Contagion. f " Nor have I seen an instance, during nearly twenty years constant practice in this disease, in which it appeared to me to be communicated from one person to an- other, or of its having originated from any exposure whatever, excepting in places peculiarly circumstanced."— Litter on the Yellow Fever of the ll'est-Indies, by P. Osgood, M. D. Practitioner of Medicine in the city of Havana. 270 FEBRES. CLASS I. a sudden and unexpected attack. He observes, that it frequently came on with a weak pulse, and often without any preternatural frequency or quickness ; and that, in some instances, it was so low as not to be perceived without pressing hard on the artery ; in some cases, the pulse intermitted, and these intermissions occur- red in several persons who were infected, but who were not con- fined by fever ; in others, there was a more than ordinary slowness of the pulse, which was now and then accompanied with a dilated pupil of the eye. Haemorrhages happened at the commencement of the disorder, chiefly of the nose and uterus ; and as it advanced, the discharge of blood became more universal, and then issued from the gums, ears, stomach, bowels, and urinary passage. Many complained of a dull pain in the region of the liver, but few felt any soreness to the touch, or pain at the pit of the sto- mach ; in some, a determination of blood took place to the lungs, but the brain was chiefly affected with morbid congestion, which was indicated by the suffusion of blood in the face, redness of the eyes, dilatation of the pupils, pain in the head, haemorrhages from the nose and ears, by sickness or vomiting, and by an almost uni- versal costive state of the bowels. With respect to the secretions and excretions, there appeared to be a preternatural secretion of bile, which was discharged from the stomach and bowels in large quantities, and of different quali- ties and colours, being in some cases yellow, and in others black. The urine was often plentiful and of a high colour; sometim e pale, and at others small in quantity and turbid ; accompanied with sweats of a yellow colour, and highly offensive. On the first and second day, the tongue was invariably moist and white ; but as the disease advanced, it became red, and put on a smooth, shining ap- pearance ; towards the close, a dry black streak appeared in its middle, which gradually extended to every part of it. The effects produced on the nervous system were different, ac- cording as the fever affected the brain, the muscles, the nerves, or tho mind. In a few instances, apoplexy was induced, which usu- ally proved fatal; tremours of the limbs and twitchings of the ten- dons were common ; delirium was a frequent symptom, but many passed through the disease without the least derangement of ideas : in some cases, the pain in the head was acute and distressing, and the stomach, towards the close, was affected with a burning or spasmodic pain of the most severe nature. Deafness and dimness ORDER III. PESTIS TROPICUS, OR YELLOW FEVER. 271 of si<_dit sometimes took place. Thirst and want of appetite were present, as in most other fevers. In some cases the skin was pre- ternaturally warm ; in others it was cooler than in health. The yellow colour was by no means universal ; when it did take place, it was seldom to be observed before the third day, but more fre- quently about the fifth or seventh from the first attack. The eyes seldom escaped a yellow tinge. There were eruptions of various kinds on the skin, and in the latter stage petechia? were common ; carbuncles also took place in some. The disease ended in death in various ways. In some, it was sudden ; in others, it came on gradually. The last hours of some were rojirked with great pain and strong convulsions ; but in many, death seemed to insinuate itself into the system with all the gentle- ness of natural sleep. It is to be remarked the symptoms in this fever are extremely variable in different subjects. Dr. Rush observed the disease in some instances continued for fifteen, twenty, or thirty days. Per- sons in the prime of life were most liable to it, and men more sub- ject to its attack than women. The symptoms that may be regarded as favourable, are, a settled state of the stomach, lessened head-ach, eyes lively, appearance of an eruption on the skin, free perspiration, copious and high colour- ed urine, bilious flux, and sound sleep. No disease, however, ex- hibits a greater variety of symptoms, and often less to be depend- ed upon, than this; for sometimes it goes on with favourable ap- pearances, then suddenly changes to the worst, and sometimes pa- tients apparently almost in a state of convalescence expire in a few hours. Youth and a plethoric state, are invariably circumstances of danger. A sudden oppression of all the functions at once ; great debility; weak irregular pulse; sighing; severe vomiting of dark coloured matter ; t rem ours of the body when moved, with a ten- dency to faint on the slightest exertion ; pensive sadness in the countenance ; and a dilatation of the pupils of the eyes, with coma ; are signs of great danger. Black and foetid discharges by urine and stool, the breath being highly offensive ; and the appearance of petechia1, portend almost certain death. Willi regard to the most approved and successful mode of treat- ment in yellow fever, this has been a subject of no inconsiderable degree of contention among our most distinguished practitioners. It 2f'2 FEBRES. CLASS h seems, however, to be generally agreed, that in our climate, this most fatal disease, in its early stage, is marked by symptoms of in- flammatory diethesis, and that it tends rapidly to a state of univer- sal putrefaction. The antiphlogistic course as pursued by Dr. Rush, has been almost universally adopted in the first stage, and the ear- lier this was commenced, the more successful has been the result, In this as in all fevers, the patient should abstain from animal food, and confine himself to gruel, panado, sago, arrow root, chick- en broth, and other spoon meats; he should use cool diluting drinks, such as barley water, toast and water, lemonade, apple tea, tama- rind water, hop tea, thoroughwort tea, and also ripe fruits, which tend to keep the bowels soluble. The chamber of the sick^should be spacious and airy, and frequently ventilated, vinegar impregnat- ed with aromatic herbs, should be frequently sprinkled, and diffused over the rooms, bed-clothes, &c. The passions ©f the mind ought to be calmed and composed. The excrements and every offen- sive thing, out to be immediately removed. These directions should be considered of great importance both to the sick, and to those whose duty it is to frequent their apartments. The first indication in this fever is to subdue the inflammatory diathesis by the most speedy means in our power. The second is to arrest, or obviate as much as possible, its progress to a putrid state, and at the same time to support the strength of the patient. Bleed- ing and purgatives are the means most suited to accomplish the first intention. Bleeding ought, however, to be performed as soon as possible after the attack, within the first twenty-four hours, or at most within thirty-six. The operation may be repeated with a view of alleviating the violent pains of the head, eyes, &c. provid- ed it be performed within the time prescribed. In order to moderate the violent determination to the head, the feet should be bathed in warm water, and an opening clyster occa- sionally administered. As obstinate costiveness generally prevails, and the stomach is seldom capable of retaining those purgatives which are in common use, no one can be better adapted to circum- stances than calomel and jalap combined; four grains of the for- mer, with eight or ten of the latter, may be given either in powder or pills every four hours, until a proper effect is produced ; and either by this medicine, or more lenient purges, as castor oil, soluble tar- tar or Epsom salts, four and five evacuations every day should be procured. Mercury when given so as to excite a degree of saliva- ORDER IH. PKSTIS TROPICUS, OR YELLOW FEVER. 273 tion has been found a more successful remedy in yellow fever than any other which has been employed. To insure its success, it should however, be exhibited at the very commencement of the disease, and be so conducted as to affect the mouth before the dan- gerous symptoms of the second stage of the fever make their ap- pearance ; after the second stage has come on, but more especially when si^ns of putrescency are present, mercury aggravates and in- crease:; the danger, if not accelerates the fatal event. When in- cessant vomiting prevents the use of calomel in sufficient doses to effect a speedy salivation, mercurial frictions have been successful* ly substituted. In this form mercury may be employed at any period of the disease, so long as the extremities continue warm, and the absorbents preserve their power. From half a drachm to one drachm of the strongest mercurial ointment should be rubbed into the thighs, hams, legs, and arms, every four hours, and calomel either by itself or combined with opium, may be exhibited inter- nally at the same time. When a gentle ptyalism takes place, these remedies ought to be immediately discontinued, and only nourish- ment and wine be given, as all danger is then supposed to be over, and the recovery of the patient to be almost certain, In cases of great irritability of the stomach, where excessive vo- miting prevails, the early application of a blister immediately over the part will often be attended with the happiest effects. The vomiting has sometimes been known to cease upon the application of a large poultice of mustard flour to the stomach and feet, which occasioned a very extensive and painful inflammation of the skin. The saline mixture, administered so that the effervescence may take place in the stomach, with an addition of ten or twelve drops of tincture of opium to each dose, will frequently have the effect of checking obstinate vomiting. When symptoms of putrefaction have occurred, the Peruvian bark must be given in as large doses as the stomach will bear, either in substance, decoction, or infusion, and also by way of clyster. The mineral acids, especially the muriatic, would undoubtedly be very serviceable in this fever, and they ought on no account to be omitted. The affusion of cold water over the body, or aspersion, or spong- ing the body with vinegar and water on the first onset of yellow fever, agreeable to the rules advised by Dr. Currrie, have proved eminently serviceable, and effected cures in a variety of instance* 274 PEBRES. CLASS I. The proper directions for the use of this remedy will be found in the foregoing chapters. In a state of convalescence, tbe patient should avoid every thing which may tend to bring on a relapse; such as a too early expo- sure to improper exercise, food, and drink. He should eat but little at a time, and that little should be easy of digestion. Morn- ing and evening air should be avoided at all events. Bark should be continued in moderate doses, until the debilitated system is in- vigorated, the digestive faculty repaired and strengthened, and the patient returns to his usual mode of living. During the prevalence of yellow fever in Philadelphia, in 1793, it is well known that Dr. Rush adopted the method of copious bleeding and mercurial purges, and with such success, that " in his joyful state of mind, he entered in his note-book, dated the 10th of September, ' Thank God ! out of one hundred patients, whom I have visited or prescribed for this day, I have lost none.' " " It is probable," says Dr. Ramsay, in his eulogy on Dr. Rush, " that not less than six thousand of the inhabitants of Philadelphia were saved from death, by purging and bleeding, during the au- tumn of 1793." Dr. Ramsay further observes, " The objections that have been made by some to Dr. Rush's principles and prac- tice, as leading to an indiscriminate use of the lancet, mercurial purges, and consequent salivation, in the treatment of yellow fever and other dangerous diseases, arc without foundation. His system reprobates all prescriptions, but those that are founded on their suitableness to the present circumstances of the patient. His treatment of the yellow fever in twelve successive years, is dis- tinctly laid down in his works, and is not precisely the same in any two years." In a letter to Dr. Ramsay, dated October 15th, 1803, Dr. Rush observes, " our epidemic has been more tractable than in some former years. I have bled sparingly, purged freely, blistered early (sometimes on the first day), sweated profusely, with almost universal success. The last remedy was suggested to me by the moisture which I found upon touching the wrists in my first visits to my patients. I have not found it necessary to sali- vate in a single case. The violent pain and inflammation excited on the arms by the blisters, was a substitute for a sore mouth, and happily saved the stomach and brain by a new and revulsive ac- tion on the fourth and fifth days." To those who charged Dr. Rush with using strong mercurial medicines for ordinary com- ORDER III. PESTIS TROPICUS, OR YELLOW FEVER. 275 plaints, he replied, " that he was not in the habit of destroying mosquitoes with cannon bullets."* " The yellow fever differs from typhus gravior in the following circumstances, viz. it usually prevails only during, or immediately after very hot seasons, in which typhus is soon extinguished ; and it is, in its turn, completely annihilated upon the accession of cold weather, in which typhus is commonly most prevalent, particularly if accompanied with humidity of the atmosphere. It attacks most readily and violently the young and robust, over whom typhus is allowed to have the least power ; it begins with much greater ex- ertions of the living power than typhus, is attended with many symptoms of a different nature, and it frequently changes into a regular remittent, and sometimes even to an intermittent fever, which true typhus is never observed to do." The author has been highly favoured by receiving from Dr. J. L. E. W. Shecut, of Charleston, Dr. W. R. Waring, of Savannah, and Dr, D. Osgood, of Havana, their respective publications on the subject of yellow fever. Each of them having resided many years in cities where the devastations of this disease, in all its forms, have been almost unparalleled—in regions where death draws the tragic picture of his ravages in the strongest colours ; such authori- ties, therefore, must be held in the highest estimation, and I avail mvself of their sentiments and views, as respects the causes, patho- logy, and cure of epidemic yellow fever. " 1st. The predisposing cause is a peculiar derangement of the atmospheric air, by being deprived of a due proportion of the elec- trical fluid, either from excessive hot and dry, or hot and moist summers ; in consequence of which its vital influence is either in greater or less degree diminished, and a specific gaseous poison is generated therein ; which, being inhaled by persons peculiarly pre- disposed, produces, according to the degree of predisposition, either a common bilious remittent fever, or that more violent and deadlv form, yellow fever. 2d. A peculiar state or diathesis in the animal economy, particularly predisposing it to disease, and which is speedily called into action by the morbid effects of the noxious existing power, or gaseous poison of the atmospheric air, thus deranged." '*' The same identical powers which restore the electrical equilibrium in the atmosphere, are the same powers * Ramsay's Eulogy. 276 FEBRES. CLASS I. which put a stop to the further ravages of this fever, and these are thunder, lightning, and frost.*" Marsh miasmata, in its simple un- combined state, or combined with animal putrefaction, generates in the air a specific gaseous poison, capable of producing, not only intermittents, but the highest grades of fever, according to the abundance of moisture, solar heat, local circumstances, and suscep- tibility of the subject of it. Whenever there is superadded to this peculiar combination, a cause productive of malignancy, it then becomes infectious or contagious, according to circumstances, and it is according to the degree or the diminished or accumulated powers which produce our epidemics, that they assume such vari- ous types in different seasons. The gaseous poison produces in the stomach effects very analo- gous to those of arsenic when received into that organ. The symptoms and effects will be nearly or altogether similar in both cases. The closing scene of both are the same, or so nearly the same, as has been proved by dissection, as to admit the belief that their effects on the animal economy differ only in proportion to the quantity of the mineral producing more speedy and more fatal effects in less time than that produced by the specific gaseous poi- son of yellow fever. The epidemic yellow fever prevailed in Sa- vannah, in 1820, with unprecedented mortality. At one period, the deaths, as estimated, were in the astonishing proportion of one to five of the population. That most formidable and mortal symp- tom, which is considered as almost characteristic of the disease, black vomit, was unusually frequent. It consists of a quantity of blackish matter, resembling coffee-grounds, intermixed with flaky substances that float among the discharges. This is neither cor- rupt blood from the stomach, nor a secretion from the liver, as has been suggested by some. During the epidemic at Savannah, the stomach seemed to be the constant, and perhaps universal seat of the disease. Not only the external appearances, but almost every instance of dissection, evinced this fact; the same kind of blackish matter as that which constitutes the black vomit, was found in the stomach, and marks of inflammation, or erythema, were evident. The inflammation, or the morbid effect, was generally confined to the internal coat in the latter stage of the disease. In the begin- ning, the muscular coat felt its influence, in some degree, as ap- * Shecut on Yellow Fever. ORDER III. PESTIS TROPICUS, OR YELLOW FEVER. 277 peared by the more frequent vomiting : this was the case in the in- cipient stage, or stage of irritation, before the establishment of in- flammation. As the soreness of the epigastrium increased to the touch, that is, as the inflammation of the inner coat was augmented and confirmed, the affection of the muscular coat, or disposition to vomit, diminished. The stomach was often found in the highest state of inflammation, and sometimes filled with the matter of black vomit, when there had been very little vomiting, or none at all. Irritation appears to dispose much more to this effect than actual inflammation. The inner coat of the stomach was inflamed in dif- ferent degrees, over its whole extent. In some instances, in ro- bust and strong subjects, the blood-vessels of the stomach were so rapidly distended as to burst, and the cavity was filled with pure blood. The yellow fever seizes more readily those who are strangers to the climate in which it prevails, and the robust, athletic and plethoric, are the subjects of its greatest violence and mortality. In a disease so extremely diversified in its forms and stages, no one mode of treatment, or particular remedy, can apply universal- ly, nor is it possible to prescribe a uniformity in the rules of prac- • tice ; much will depend upon a judicious discrimination between the various subjects. Both principle and experience dictate the antiphlogistic course of curative treatment. Inflammation must be subdued in the earliest period of attack; morbid excitement must be diminished. In the robust and plethoric, the lancet is to be the first resort, but guarded with circumspection. Whether one large full bleeding, or smaller quantities taken at short intervals, must be decided by its effects, and the urgency of circumstances. The next essential point, or the first where venesection is im- proper, is to evacuate the intestinal canal, by calomel alone, or conjoined with jalap, according to the practice of Dr. Rush. This is to be regarded as a very essential part of the cure, as evacuating the retained offending matter from the first passages, and favour- ing all the intestinal functions, and also relieving the diseased ful- ness of the blood-vessels of those parts. A mercurial course to the point of ptyalism, and the whole treatment of Dr. Rush, as detail- ed in the preceding pages, together with the cold affusion or spong- ing of Dr. Currie, were generally adopted by Drs. Waring and Osgood. In addition to the above, in a few instances, trial was made of oil of turpentine, the utility of which, as a remedy, re- 278 FEBRES. CLASS I. mains doubtful. Sugar of lead proved injurious. Equal parts of milk and lime water, to the quantity of twelve ounces in twenty- four hours, exclusively of any other food or drink, often suppress- ed the vomiting, even af cr black vomit had ensued. Two table- spoonfuls of fresh yeast, in a cup of warm water, every hour or two, was of much service, and an infusion of hops and good old porter was useful. When inflammatory symptoms had subsided, and the irritability of the stomach continued, the black vomit has been cured by the administration, every three or four hours, of three grains of capsicum, made into pills with dough, so as to pre- vent a burning effect on the throat. Antimonials we're rejected as pernicious. External stimulating applications were employed with considerable advantage, and blisters to the inside of the upper arms, and kept open, afforded great relief to the stomach when in a painful state of irritation. But it must be observed, that in numerous instances at Savan- nah, all the skill and efforts of the most attentive medical attendant, having at command the whole powers of our materia medica, were set at defiance, and the faithful physician could only witness the triumph of death over its devoted victim.* When we consider that the yellow fever is a disease of warm climates and hot seasons, and consider also that in some of its * In order that nothing may be omitted that can tend to improve our knowledge of remedies for the yellow fever, I am induced to introduce the following singular piece of intelligence. In a letter upon yellow fever, dated Madrid, Nov. 11, 1819, from Dr. M. Lagasea, to L. Dufour, M. D. we find stated the case of a captain of a regiment, twenty-five years of age, who was seized with the fever, and whose symptoms are detailed. " Twenty-four hours after the attack (says the Dr.), I judg- ed that the unfortunate man would fail, whatever method of treatment might be adopted, (for as yet he had taken nothing.) At first I attempted to inspire him with an exaggerated confidence, and then I made him take half an ounce of cinchona at a dose, recommending to the nurse to give him the same quantity an hour after. This nurse, who had been treated and cured by Lafnente's method, thought it a duty to surpass my directions, and made him swallow an ounce and a half at once. Half an hour after this imprudent dose, I found the patient extremely uneasy, the face inflamed, the pulse much raised, a very sharp heat, and inexpressible restlessness, all which left me very little hope. But after the nurse had informed me of the cause of these unexpected symptoms, I was easy upon the subject, and in an hour and a half afterwards, I gave him two drachms of cinchona. The pulse soon became large, full and strong, the skin assumed a breathing suppleness, and finally a copious sweat appeared. In the space of twenty-six hours, he took sixteen ounces of cin- chona, in powder. Fifty-six hours from the first attack of the disease, he earnestly requested food. Soup and wine were allowed him. The following day, I met him walking in full convalescence. A perfect cure soon followed." CLASS II. PHLOGOSIS, OR PHLEGMON. 279 forms and symptoms it bears a strong analogy to the malignant autumnal bilious remittents ; is there not ground to conjecture, that cinchona may be a remedy of specific efficacy, if given in large doses before the fever has completely formed its inflammato- ry stage. Will the supposition be deemed more preposterous, than would have been, a few years ago, the practice of abstracting from the human system more than one hundred ounces of blood in a few days, or administering, as a remedy, near twelve ounces of mercury to an individual, in five days. See page 18, of this volume. « The proper means of prevention of yellow fever, are inserted and particularly recommended in the chapter on contagious dis- eases. Class II.—PHLEGMASIA, OR INFLAMMATION. PHLOGOSIS, OR PHLEGMON. This is defined, " Inflammatory Fever, with redness, heat, and painful tension of an external part." Almost every part of the body is liable to inflammation, and when confined to one particular point, it is called local or topical; but when the whole system be- comes affected, it receives the appellation of general inflammation. Numerous hypotheses or opinions respecting the true nature and cause of inflammation, have for ages been advanced, and for a time sustained ; but even at the present day, the various doctrines ap- pear to be considered altogether problematical. In every inflam- mation there is increased impetus and accumulation of blood in the vessels affected, accompanied with a sense of tension and heat; the sensibility and irritability of the part are increased, its vessels distended beyond their natural tone, and the circulation of blood through them rendered more rapid. Whether the cause of inflam- mation be ascribed to a spasmodic stricture of the blood vessels, a Ientor, or viscidity of the circulating fluid, or to an error loci, it is certain that this affection in general depends upon a phlogistic diathesis in the system of the individual. Authors have divided inflammation into two kinds. That circumscribed affection of the skin and cellular membrane, with a swelling of a bright red colour. attended with a throbbing pain and distention, which terminates in 280 PHLEGMASIA. CLASS H. the formation of pus, is called Phlegmonous inflammation. When the affection is confined principally to the skin, when seated out- wardly, and to the mucous membrane, when internally, and ap- pearing of a mixed red colour, readily disappearing upon pressure, but quickly returning again, it is denominated Erysipelatous in- flammation, or, as it is sometimes termed, Erythematic inflam- mation. Phlegmonic inflammation, in its usual course, terminates either by resolution, suppuration, effusion and adhesion, or gangrene, or, on some occasions, when seated in glandular parts, this species of inflammation terminates in scirrhus and cancer. Phlegmon most generally arises from some external injury, as by wounds, bruising, burning, overstraining any part ; or by some extraneous substance, lodged in the integuments, muscles, or cellular membrane, produ- cing irritation, or by the application of cold by which perspiration is obstructed. It appears in the form of a circumscribed tumour, assuming a florid colour, attended with itching, dryness, tension, and increased heat, and soon after, a shooting and throbbing pain ensues. The symptomatic inflammation is frequently so consider- able as to affect the general system, the pulse becoming full, hard, and quick, the skin dry and hot, with great thirst, &c. For the removal of this complaint, it should be our first object to effect a resolution of the tumour, if practicable, and to obviate the phlogis- tic diathesis either of the whole system, or of the particular part which is affected. If any extraneous substance should be the ex- citing cause, this, without a moment's delay, should be removed, dilating the external wound, if necessary. Should the general in- flammation run high, it will be seen that bleeding from the system, and the use of saline cathartics, will be requisite; but in cases of local inflammation only, the common antiphlogistic applications may be relied on for the purpose. A proper quantity of blood, however, may be drawn from the neighbourhood of the part affect- ed, by means of cupping glasses, or a number of leeches, which is preferable, increasing the flow of blood by linen cloths dipped in warm water, often repeated. The discutient remedies best adapt- ed to disperse an incipient phlegmon, are, a poultice of rye meal or crumbs of bread, moistened with a weak solution of the acetate of lead, which should be applied cold, and renewed twice or three times in a day ; or if a poultice, from its weight on the tender part, is found inconvenient to the patient, cloths wet with the Class ir. piilogosis, or phlegmon. 281 water of acetate of ammonia, with an equal qumtity of alcohol, or a solution of the muriate of ammonia in vinegar and water, may be employed as convenient and useful substitutes. These should be renewed as often as they become warm to the part, and if steadily persevered in for several days, in many instances the in- flammatory symptoms will be subdued, and a suppuration prevent- ed. If, however, the tumour should continue to increase in size, and show the usual signs of a suppurative process, a different course of remedies must be adopted. The progress of suppura- tion must be accelerated by the application of warm emollient cataplasms, frequently renewed. Poultices composed of the fol- lowing materials will be found far preferable to any others. Lin- seed, a little bruised, or the roots or leaves of marsh mallows, or the inner bark of slippery (dm, boiled in milk and water, with the ad- dition of a little crumb of bread. Before the application of each poultice, it will be useful to foment the part with flannels wrung out of a warm decoction of emollient herbs, such as chamomile flowers, the leaves of marsh mallows, or poppy heads, When by the use of these means the suppurative process is completed, and a maturated abscess is formed, manifesting itself by the tumour becoming more prominent, the skin at the apex becoming thin and while, and an increased redness at its base, with a fluctuation of m-i'ter near the surface, perceived by a pressure of the finger, we need not hesitate to make an opening in the most depending part, for the discharge of its contents. Instances will occur, in which the usual emollient applications will not effect our purpose, without the addition of more stimulant ingredients, in which cases, roasted onions may be employed, and sometimes warm plasters of Galba- num, or Burgundy pitch, will be useful instead of the poultice. The inexperienced practitioner will occasionally meet with em- barrassing cases, where the matter is deeply seated, and the inte- guments exhibit very little of the usual inflammatory appearances. I have not unfrequently been called to witness swellings of the extremities, ascribed to rheumatic affection, and treated according- ly, greatly to the disadvantage of the patient, and discredit of the medical attendant. There are few occasions on which more skill and correct judgment are manifested, than in detecting a collection of matter, when deeply seated in the interstices of the muscles, A patient, in a hot day, the last summer, in consequence of wet- ting his feet and legs in a cold stream, while in free perspiration, 3f» 282 PHLEGMASIA. CLASSIh was affected with a tumefaction of the whole thigh. This was for some time injudiciously treated by blistering and the usual embro- cations for rheumatism, without relief, until, at length, a different course was directed, and a deep incision being made, about four pounds of purulent matter was evacuated, and the discharge con- tinued for many months, during which, no less than eight abscesses occurred in succession, in various parts of the body, not one of which was attended with pain or sensible inflammation, not even a discoloration of the skin, but when opened, purulent matter was discharged, and as no means eould produce a healing disposition, the patient died from exhaustion occasioned by the immense discharge. In all cases of phlegmon, it will be proper to keep the bowels in a soluble state; and to moderate the febrile heat, a few grains of the nitrate of potass ought to be given several times in a day. The powder of calomel and opium used in fevers, will tend much to promote a suppuration, and to quiet irritation. At the close of the complaint, the cinchona, in large doses, will be indispensable. The food, at the same time, must consist of articles of a cooling, but nutritive nature, easy of digestion. For the most proper method of obviating a tendency to gangrene or scirrhus, and the mode of treatment in those affections, the reader is referred to books on surgery. Anthrmx, or Carbuncle, is a hard Circumscribed tumour, seated in the skin, and of a purple hue, early exhibiting a tendency to sphacelus ; occurring for the most part in advanced life, and in a vitiated habit of body. Dr. Hosack's mode of treatment is, to support the strength of the patient by a nutritious and stimulant diet, and a free use of bark and wine; at the same time preserving the tone and action of the part itself, by frequently washing the tumour with spirits or brandy, and by the constant application of a poultice composed of bark and yeast; and the result has in all instances been successful. ERYSIPELAS, OR ST. ANTHONY'S FIRE. The erysipelas consists of an inflammation of the skin, accom- panied with an inflammatory fever ; and when the inflammation is '•LASS II. ERYSIPELAS, OR ST. ANTHONY?S FIRE. 2S3 confined to the skin, and is unattended by any affection of the gene- ral system, or when the affection of the system is only symptomatic of the external inflammation, the disease is termed erythema. When the whole system is affected, and the external inflammation is only symptomatic, the disease is termed erysipelas. It most frequently appears in autumn, or when hot weather is succeeded by cold and wet; and is very apt to return, and sometimes periodically, in those who have once been afflicted with it; sometimes it is a primary disease, and at other times only a symptom of some other disorder. Any part of the body is liable to its attack, but it most commonly seizes the face and legs, especially the former. The erysipelas is generally preceded by cold and shivering, after which come on heat, thirst, restlessness, and other feverish symp- toms. When the face is the part affected, it swells suddenly with great pain, and a shining redness, inclining to yellow, on which ap- pears a number of small pimples, containing a thin colourless fluid. One or both eyes are sometimes so much affected as to be closed up. The inflammation sometimes terminates in seven days ; but at others it will continue for ten or twelve, and at last goes off by a plentiful sweat. In the worst cases, the brain is affected with the complaint, and a delirium or coma ensues. When the disorder seizes the breast, the part swells, and becomes hard with great pain, which sometimes ends in an abscess or ulcer. V violent pain is felt in the arm-pit of the side affected, and there also the same event frequently ensues. Whatever part be affected, when the swelling falls, the heat and pain abate, the redness which before prevailed, becomes yellow. and the skin falls off in scales. Such is the progress of the disorder, in its milder state ; but when the swelling is large, deep, and affects a sensible part of the body, there is no small ground for apprehension. If the red colour changes into a livid or black, a mortification is near at hand; and the same fatal event is apt to'take place when the swelling instead of being discussed, which is the only favourable termination, pro- ceeds to suppuration. When this disorder proves mortal, the pa- tient commonly dies on the seventh or eighth day, being carried off by the fever, which is attended with difficulty of breathing, and of- ten with delirium and great drowsiness. This disease is brought on by the several causes which are apt to excite inflammation : such as injuries of all kinds, the externa! 284 PHLEGMASIA!. CLASS II. application of stimulants, &c. and by violent passions or affections of the mind. It may be occasioned by a stoppage of natural or ar- tificial discharges, such as the piles, issues, setons, or the like. It is frequently produced by drinking or bathing in water that is too cold ; and exposure of the body to the cold air immediately after it has been heated to a great degree, giving a sudden check to pers- piration. In the treatment of erysipelas the patient must neither be kept too hot nor cold, as either of these extremes will tend to make it retreat, which is always to be guarded against. When the disease is mild, it will be sufficient to keep the patient within doors, without confining him to his bed, and to promote the perspiration by dilut- ing liquors, &c. ; the diet ought to be slender and easy of digestion, and rather of a cooling nature^ avoidinganimal food, spices, pickles, and all other things that may heat and inflame the blood : the drink should be barley water, toast and water, infusions of sage, and eld- er flowers, common whey, &c. ; a little wine may be added, in case the pulse become low and the spirits are sunk. Some diversity of opinion has prevailed concerning the propriety of external applica- tions in erysipelas. It has been supposed that the mildest soften- ing fomentations, equally with cold astringent lotions, were attend- ed with considerable danger, but in the opinion of Dr. Thomas, cool- ing lotions are productive of real advantage. He employs cloths wetted with equal parts of the liquor ammon acetatis, or muriated ammonia dissolved in water, with the addition of a little vinegar and camphorated spirits, as affording much benefit and relief to the feelings of the patient. Flour, or powdered starch, sprinkled over the inflamed skin, is considered to be one of the best remedies. When the patient is of a plethoric habit, and the signs of con- siderable inflammation are present, bleeding will undoubtedly be justifiable and proper. If the patient has been accustomed to the use of spirituous liquors, and the head be much affected with the disease, the loss of some blood will be highly necessary; the quan- tity must be regulated by circumstances, and a repetition of the operation is to be determined by the symptoms. But in the mild- er cases, it will be sufficient to employ gentle purges, such as crys- tals of tartar, or Glauber's salts and manna. If the swelling and inflammation attack the face or brain, the feet and legs ought to be frequently bathed in warm water, strong purges given ; blisters CLASS II. ERYSIPELAS, OR ST. ANTHONY'S FIRE. 285 should be applied to the neck or behind the ears, and animonial diaphoretics must be administered, Erysipelts may be combined with phlegmon, and a collection of matter formed under the skin, which is denominated erysipelas phlegmonides. When the inflammation cannot be discussed, and there appears a tendency to produce matter, this ought to be promoted by warm fomentations made of chamomile flowers, and the roots of the marsh-mallow ; and with poultices of bread and milk, or of lin- seed, than which nothing can answer better for this purpose. When, on the contrary, there appears a tendency to mortification, which may be known from the black or livid colour of the part, cloths dipped in warm camphorated spirits should be immediately applied, and renewed often, at the same time that the part be fre- quently fomented with a strong decoction of the Peruvian bark. In this dangerous case the bark must likewise be given internally, in as large doses as the stomach will bear, even to the extent of a drachm every two hours, with ten or fifteen drops of elixir vitriol in each dose. The use of nitre has been much recommended in this disease, and it is one of the best medicines, when the fever and inflammation run high, if given in doses of ten or fifteen grains every three or four hours. If the swelling should suddenly sink, and the sharp humour ap- pear to strike in, and to be followed by oppression and anxiety, with a weak pulse, a free use of wine will be proper, together with the volatile spirits and the compound spirits of lavender. In what is called the scorbutic erysipelas, which continues for a considerable time, it will only be necessary to give gentle laxa- tives, and such things as purify the blood and promote perspira- tion. There is another species of erysipelatous inflammation, which most usually attacks the trunk of the body, and is that which is known by the name of shingles. It surrounds the middle of the body like a belt, in the form of little pimples of a yellowish colour, but more frequently blackish, and both in appearance and their corrosive quality resemble a tetter. The fever which attends this eruption is commonly slight; but if the pimples should be driven back, the event might prove of dangerous consequence. Those who are subject to frequent returns of the erysipelas, might to be sparing in the use of fat meats and strong drink, and ' 286 PHLEGMASIA. CLASS U. confine themselves chiefly to a vegetable diet. They should guard against Costiveness, and avoid the extremes of heat and cold. Moderate daily exercise is equally advantageous to health and the prevention of the complaint ; and to wear a flannel waistcoat next to the skin has by many been found highly service- able. PHRENITIS, OR INFLAMMATION OF THE BRAIN An inflammation of the brain is sometimes an original disease, but more frequently symptomatic, arising during the progress of general fever, or in consequence of a translation of rheumatism, gout, erysipelas, &c. It may affect either the membranes of the brain, or the brain itself. The causes of this disease are violent fits of anger, long want of sleep, concussion or other mechanical injury of the head, intox- ication, long exposure of the head to the intense heat of the sun, and the stoppage of either natural or artificial evacuations, such as the bleeding piles, menstrual evacuation in women, drying up of issues, setons, or any old ulcers. The symptoms are, intense pain and sense of fulness, or stric- ture within the head, redness and turgescence of the eyes and face, the eyes very irritable and extremely impatient of light, continued watchfulness, and fierce delirium, accompanied with violent fever. When the brain itself is inflamed, the pulse is always soft and slow ; but when the membranes only are affected, it is hard- er and quicker. There is usually a great throbbing of the ar- teries of the neck and temples, a costiveness, and dryness of the skin, a retention of urine, and a black and dry tongue, but without thirst.. A phrensy, whether idiopathic or symptomatic, may always be regarded as a dangerous and alarming complaint; it often proves fatal between the third and seventh day ; and if long protracted, is apt to terminate in mania, or great prostration of strength: it often terminates in stupor and insensibility. Grinding of the teeth, white or ash coloured faeces, suppression of urine, startings of the tendons, with convulsions, cold sweats, a fluttering pulse, and coma supervening on delirium, denote a fatal termination : on CLASS 11. PHRENITIS, OR INFLAMMATION OF THE BRAIN. 2S7 the contrary, when there is a copious haemorrhage from the nose, mouth, or lungs, or even from the urinary passages, or haemor- rhoidal vessels, or when diarrhoea ensues, when the delirium is re- lieved by sleep, the perspiration is free and general, the pulse less frequent, but fuller and soft, and the febrile symptoms become milder, there are hopes of a recovery. For the cure of this disease, large and repeated bleedings must be considered as of primary importance, proportioning the quan- tity to the age and constitution of the patient, and the severity of the symptoms. Opening the jugular vein or temporal artery, may perhaps be preferable to drawing blood from the arm, and taking a considerable quantity at once is better than repeated small bleed- ings. After this operation, leeches, or cupping-glasses, should be applied to each of the temples ; and endeavours should next be made to solicit the motion of the blood towards the lower extrem- ities, by bathing the feet in warm water, and by applying to them poultices or sinapisms. It is important that the head be shaved, and frequently washed with warm water and vinegar, or with ether. Linen cloths wet with these, and often renewed, are particularly serviceable in in- flammatory affections of the brain ; while all cold applications di- minish the discharge by perspiration, so essentially necessary for the removal of inflammatory action. Blisters, too, when applied to the head, have a direct tendency to aggravate the excitement of the brain by increasing the determination of the blood to the head ; whereas, if applied between the shoulders or to the extremities, they will, by creating a new irritation, divert the current from the primary seat of the disease. With the view of diverting the blood still more from the head, cathartics of jalap and calomel, or other strong purgatives, should be given, and repeated every second day until the desired effect be produced. A copious discharge from the intestines has been found by experience highly beneficial in diminishing the determi- nation of the blood to the head. If there be reason to suppose that the disease proceeds from the stoppage of any particular discharge, it ought to be restored as soon as possible, or some other substituted in its place. During the course of the disorder, the patient ought to be kept quiet and composed, and should be indulged and gratified in every thing as far as his safety will allow. His chamber ought to h° 288 PHLEGMASIA. CLASS H. kept in a moderate degree of temperature, and the light so far ex- cluded as may be agreeable to his mind and feelings. He should lie with his head considerably raised. The patient's food should consist of water gruel, panado, arrow root, and other mild substances, and his drink may be barley water, lemonade, or other cooling things, which may suit his inch* nation, and ten or fifteen grains of nitre should be given every two or three hours. Where the brain has suffered much injury by a long distention of the vessels, it sometimes happens that the patient's senses never perfectly.return, but there remains a degree of imbecility or weak- ness of mind during life. OPHTHALMIA, OR INFLAMMATION OF THE EYES. The eye is a complex and delicate organ, and greatly suscepti- ble of inflammation, sometimes in consequence of other affections of the eye and adjacent parts, but frequently ophthalmia is itself the primary disease. In general, the inflammation of the eye may be distinguished into two kinds ; one of which is seated in the membranes, or coats of the ball of the eye, and the other in the edges of the eye-lids. But though either of these may at first exist separately, yet as one may excite the other by sympathy, they are frequently connect- ed together in the progress of the complaint. The causes producing ophthalmia, are external injuries of the head, as blows, contusions, and wounds ; extraneous bodies of an irritating nature introduced under the eye-lids ; exposure to bleak winds and cold ; too free a use of spirituous liquors; the suppres- sion of accustomed discharges, as the healing of old ulcers, drying up of issues, &c. It may be occasioned by a long application of a strong light, or exposing the eyes to the vivid rays of the sun, by night watching, especially reading, or writing by candle light, and in smoky rooms. A prevailing acrimony in the mass of blood, will also produce ophthalmia, and it is often symptomatic of other diseases, such as measles, small-pox, scurvy, scrofula, and syphilis. The inflammation of the membranes affects commonly the white if the eye; in which it excites a redness attended with more or CLASS II. OPHTHALMIA, OR INFLAMMATION OF THE EYES. 2§9 less pain and generally an affusion of tears. There is also an un- natural sensation of heat in the eyes, with itching, and an uneasi- ness, seeming as if it arose from particles of sand in the eyes. The patient cannot bear the light, and in irritable habits, the pulse will be quick and hard, the skin dry> and some degree of fever will ensue. Where one eye only has been affected, it is often succeeded by an inflammation in the other, particularly in a scrofulous habit. The mild acute ophthalmia, may be easily cured by means of low diet, gentle purging with Glauber's salts, and removing any extraneous body that may have insinuated itself beneath the eye- lid ; after which, the eye should be repeatedly washed with a de- coction of marsh-mallow flowers, or leaves, boiled in new milk, and then covered with a soft emollient poultice, made of the mu- cilage of slippery elm bark and crumbs of bread, or of linseed alone, included in small bags of fine muslin. The inflammatory stage, by the above treatment, will cease in four or five days, when an astringent collyrium of sulphate of zinc -(white Vitriol,) Will soon complete the cure. In the severe acute ophthalmia, all the symptoms are greatly aggravated, and the patient, when the pain in the head is violent, and continues long, is in danger of losing his sight. A very close attention, and rigid application of remedies become indispensably necessary; the antiphlogistic treatment must be observed in its full extent. The diet can scarcely be too spare, especially in the begining, the patient must abstain from every thing of a heating nature, and confine himself chiefly to mild vegetables, weak broths, and gruels, and his drinks should also be of a cooling nature. Both general and topical blood-letting should be spedily adopted, and repeated in such quantities as the violence of the symptoms, and other circumstances may appear to justify and require. It will perhaps be more beneficial if blood is drawn from the jugular vein or temporal artery. Leeches should be applied to the temples, and to the vicinity of the eye-lids, the wounds must be suffered to bleed for several hours, and the discharge promoted by the appli- cation of cloths dipped in warm water.* Purgatives of jalap and * " I have known in one case, seventy bleedings required for the cure of an ob* Ktinate acute ophthalmia, the quantity of blood lost at each operation was generally sii or eight ounces. In the Pennsylvania hospital, I havr cenerallv directed *br 37 290 PHLEGMASIA. ORASS II. calomel, or the neutral salts, are in this stage of the disease rem- edies of importance, and ought to be frequently administered. Blisters should be applied to the nape of the neck, and to the tem- ples, or behind the ears, and if applied directly over the orifices made by the leeches, they will be still more efficacious. The pa- tients feet ought to be bathed in warm water, and all applications to inflamed eye*, should be made warm. Cold water, applied to the head or eyes is constantly injurious. The patient should be directed to observe perfect quietude, and to lie with his head in an elevated position, and his eyes secluded from the light. Topical emollient applications to the inflamed eye, are of great utility, and should never be neglected. The most eligible are the decoction of marsh mallows, and the emollient poultices mentioned above, which ought to be renewed every two hours. All liquid remedies are best applied by means of an eye-cup, or glass, and held in such a manner, that the eye-lids may be opened and shut, while immersed in the liquor. When the inflammation runs high, the vessels of the white of the eye and of the whole inside of the eye-lids, become extremely nu- merous, enlarged, and turgid with blood. In this case, great bene- fit has been experienced from scarifying the turgid vessels daily with a lancet, which, by a steady hand, may be done with per- fect safety. In such instances of violent inflammation, and swelling of the eye, Mr. Ware, a celebrated English oceulist, has experienced the most essential relief from the application of aether. A few drops are to be poured into the palm of the hand, and diffused over it by pressing the other hand against it. The hand is then to be applied to the eye, and kept so close to it, that the spirit as it evaporates, may insinuate itself into the part affected. Mr. Ware, has also found the vinous tincture of thebaic, eminently servicea- ble when evacuations and other proper means have diminished the inflammatory action, and excessive irritation. Two or three drops of the tincture may be insinuated between the eye and eye- lids, and made to glide gradually over the eye. When first appli- patients afflicted with acute ophthalmia, to be bled every other day, and on the intermediate day to be purged; to live upon a very abstemious, diet and to remain constantly in a dark room. These are, in almost every recent case, very speedily successful, and active measures ought surely to be preferred to tampering with serious diseases." Dorsey's Surgery, Vol. I. p. 298 CLASS II. OPHTHALMIA, OR INFLAMMATION OF THE EYES. 29.1 ed it causes a sharp pain, accompanied with a copious flow of tears, which continues a few minutes, and gradually abates, after which, a greater degree of ease generally succeeds. In order to prevent the eye-lids from being glued together during sleep, a little sperma- ceti ointment, or that more delicate one, called cold cream, men- tioned in the Appendix, may be applied between the eye-lids at night, and to procure sleep and ease, thirty drops of laudanum may be taken internally. When ophthalmia is attended with a discharge of purulent mat- ter, it will be useful to apply the alum curd, noticed in the Appen- dix, and also astringent collyriums of white vitriol, and sugar of lead, injected with a syringe every two hours, or applied by means of an eye-cup. Whenever the violence of inflammatory action has subsided, and the patient can bear a moderate degree of light, all coverings should be removed from the eyes except a shade of green or black silk. A brighter light should be gradually admitted every day into his chamber, so that he may become ha- bituated as soon as possible to the open day light. Nothing has a greater tendency to keep up and increase the morbid irritability of the eyes, than keeping them unnecessarily long in a dark situa- tion, or covered with compresses and bandages. Those persons who are often afflicted with returns of ophthal- mia of the chronic kind, will find extraordinary good effects from a seton in the neck, or between the shoulders, it should be placed lengthwise with the spine, instead of being put across the neck, as this soon wears out, and is both more painful and troublesome than between the shoulder blades. The scrofulous ophthalmia often proves obstinate, but may be cured by a course of cinchona with a nourishing diet. In obstinate inflammation of the edges of the eye-lids, red nitra- ted quicksilver, finely levigated, and made into an ointment, with the addition of a little opium, is a very efficacious remedy, it should be carefully applied to the parts affected, with a camel-hair pencil, keeping the eyes fast shut after it. In some obstinate cases of this complaint, considerable benefit has beeu received from the use of stimulating snuff, which excites sneezing and a discharge from the nose ; and washing the eyes with sea water has been found useful. If ophthalmia arise from mere weakness of the vessels of the eye, it will be of advantage to bathe the eyes night and morning, either with cold water alone, 292 PHLEGMASIA. CLASS II. or with the addition of a little vinegar, or a sixth part brandy. This application tends to strengthen the eye, and restore the elas- ticity of the vessels. The watery eye may be cured by the same application, or by astringent collyriums. See Appendix. Inflammations are sometimes followed by specks on the eye. which obstruct the sight, these may be removed by blowing into the eye, by means of a tube or quill, a little of the powder of tutty, or'white vitriol mixed with an equal quantity of loaf sugar finely powdered, and daily repeated. For the same purpose, solutions of vitriolated zinc, or acetate of lead, may be frequently dropped into the eye. The purulent ophthalmia peculiar to young children, may be cured by a weak solution of the sulphate of copper, with a little camphor carefully mixed together, and injected into the eye with a small syringe. That dreadful malady, the Egyptian ophthalmia, is not yet num- bered among the diseases of the United States, and may kind Heaven ever preserve the eyes of our citizens from being blind- ed by that contagious pestilence. OTITIS, OR INFLAMMATION OF THE EAR. The internal parts of the ear, like all other parts of the body, are subject to inflammation, and as those membranes are well furnished with nerves, they are endowed with great sensibility. When affect- ed with inflammation, therefore, the pain is very acute and severe, attended with more or less fever, and on some occasions delirium ensues. This disease is produced by the same causes with other inflammations, but by none more readily than a partial exposure to cold, as when a current of air is driven forcibly into the ear through narrow crevices in doors and windows. Ear-ach may continue many days without any evident signs of inflammation, and is easily cured by filling the ear with laudanum or ether, or warm oil and water. But if occasioned by a living in- sect having crept into the ear as sometimes happens, the smoke of tobacco or a few drops of common spirits will be the most proper remedy, In genuine otitis, attended with considerable inflammation and severe pain, bleeding and purging may be necessary, accompanied CLASS II. ODONTITIS, OR TOOTH ACH. 293 with a slender diet as in other inflammations, and a blister behind the ear will be useful. If the pain be violent a few drops of the tincture of opium mixed with warm oil should be introduced into the ear, and a proper dose of tincture of opium taken internally. If the pain does not abate, but a throbbing still continues to in- crease, a suppuration will ensue ; and this must be promoted by the external application of warm poultices of bread and milk or flax- seed. When the abscess hn-. burst, the ear should be syringed with warm water and soap, or with barley water in which is dissolved a little honey, to each gill of which a table spoonful of tincture of myrrh should be added. This injection will tend to promote the discharire of matter and keep the ulcerated parts clean, and it should be continued till the ulcer is healed, though it may be pro- tracted to several weeks. Another injection extremely well adapt- ed in this complaint is a deCoction of sophora tinctoria, this may with much confidence be recommended for trial. ODONTITIS, OR TOOTH ACH The term tooth-ach applies only to a particular symptom of some disease with which the tooth is affected. It is in general a symp- tom of a caries of the tooth, or of such diseased state of it, as will, if not cured, terminate in caries. When the tooth is in this condi- tion, it is liable to be acted upon by various irritating causes, such as the application of cold about the head, or by cold and wet feet, which repel the blood towards the head. The tooth-ach may pro- ceed from any of the causes of inflammation, and is often owing chiefly to an acrimony in the fluids, either of a rheumatic or ascori butic kind, when the whole side of the face will be affected. When a tooth becomes carious, or rotten, it is not only trouble-. some from the severe pain which it occasions, but it frequently af- fects the neighbouring teeth, and unless timely checked, or remov- ed, it may extend its influence even to the jaw bone, producing tedious caries and ulcerations. In most Instances, the caries ap- pears first upon the external surface, or enamel of the teeth, but in some, it commences in the internal surface, or bony part, and the caries spreading and corroding deeper, at length penetrates the sub- Stance of the tooth, and giving access to tbe external air, and other 294 PHLEGMASIA. CLASS n, matters, these, by irritating the nerve, excite the painful sensation of tooth ach. Extraction of the diseased tooth is undoubtedly the only effectual method of curing the disorder, but there will be cases in which this operation will appear inadmissible, and it will often be strongly ob- jected to by the patient. It would, indeed, be absurd to attempt this operation, when the gums and contiguous parts are greatly in- flamed and tumefied ; but when this is not the case, and when the tooth-ach is evidently owing to an external cause, or open caries, there is reason to believe, that the affected tooth will prove a mar- tyr to the disease, and it ought to be extracted before it becomes so carious as to render the operation ineffectual. In attempting to cure the tooth-ach, our first object is, to divert the flux of humours from the part affected, by the usual means of mild purgatives, and bathing the feet in warm water. The per- spiration should also be promoted, by drinking freely of wine whey or other diluting liquors, and if much heat prevail, ten grains of sal nitre may be given two or three times a day. If the gums and cheeks are much inflamed and tumefied, a roasted fig should be ap- plied to the tumour in the mouth, while poultices of linseed, or elm bark, with a little meal added, are applied externally, and these ought to be renewed until the complaint entirely ceases, or a suppu- ration takes place. There is, however, no application of superior efficacy to blisters, they should be large enough to extend from be- hind the ear over the greater part of the lower jaw of the side affected. When the carious tooth is hollow, the pain may be removed, by introducing into the cavity some caustic substance, to destroy the sensibility of the nerve. For this purpose, a little lint or cotton, impregnated with some of the essential oils, are usually employed, as the oil of cloves, nutmeg, and savine ; but the cajeput oil, when it can be procured genuine, is preferred to any other. The mine- ral acids, properly diluted, are also recommended. A small pill of opium and camphor, with two drops of some essential oil, or equal parts of laudanum, and tincture of myrrh, or a few drops of aether, put into the hollow of the tooth, will seldom fail of procuring tem- porary relief, and to prevent a return of pain, the hole ought to be stopped up with wax, or lead, so as to exclude the external air. It is asserted by Dr. Conyer, that a teaspoonful of aither applied io the affected jaw, and covered closely with the hand, that it may tLASS It. PAROTITIS, OR Ml'MPS. 293 not too soon evaporate, and repeated till the pain cease, is a never failing remedy for the tooth-ach. Dr. Buchan says that a piece of sticking plaster with a bit of opium in the middle of it, laid on the temporal artery, will relieve the pain. Promoting an increased flow of saliva by means of chewing some pungent vegetables, as horse-radish, ginger, mustard, and tobacco, frequently alleviates the severity of tooth-ach. When this complaint proceeds from a foulness of the stomach, as it often does, an emetic is the only proper remedy. I have known the application of cotton wet with the oil of tur- pentine to the hollow of carious teeth, afford instantaneous and per- manent relief, and in those rheumatic pains which affect the whole jaw and face, the same application may be adopted with beneficial effects. Washing the teeth every morning with a soft brush or piece of sponge dipped in water, in which powdered charcoal prepared as directed in the appendix, has been diffused, immediately takes away the bad smell from decayed teeth, and preserves the gums. When in scorbutic habits the gums becomes soft and spongy, a mix- ture of tincture of Peruvian bark, two ounces, and tincture of myrrh, half an ounce, may be employed with advantage. Those who wish to preserve their teeth from decay, should avoid hot food "*i drink as well as those that are extremely cold. PAROTITIS, OR MUMPS. Tins is a contagious disease,affecting chiqfly children and young people, and is often epidemic. It is known by an external move- able swelling that arises on one side of the neck, but more com- monly on both, and frequently attains to so considerable size as greatly to impede the powers of respiration and deglutition, giving rise thereby to symptoms of fever. These tumours occupy the paro- tid glands ; are large and hard, and somewhat painful, continuing to increase till the fourth day; when thev, with the attending fever" 5 decline and soon disappear. After these symptoms have subsided, it is remarkable, that the contents of the scrotum in males, and the breasts in females, become affected with a large, hard, and often painful swelling, which generallv subsides in a few day*. Som<»- 296' PHLEGMASIA. CLASS H. times, however, the tumour in the fauces is suddenly suppressed and not attended with the last mentioned symptom • in which case the fever increases rapidly, and is often succeeded by delirium, and has sometimes proved fatal. The mumps commonly terminates without danger and seldom requires the assistance of medicine. The principal requisite is, to keep the head and feet warm, to avoid taking cold, &c. to regulate the bowels by the mildest cooling lax- atives. But should the tumour in the neck suddenly vanish, and the inflammatory fever increase so as to induce an apprehension that the brain will be affected, it will be advisable to promote and reproduce the swelling, by warm fomentations, and to obviate the fttal consequence that may result from its sudden repression, by emetics, bleeding or blisters, according to the nature of the case. When the testicles, or the female breast, become affected, and are much swelled, every endeavour should be exerted to prevent sup- puration from ensuing, by having recourse to bleeding, carthartics, cooling and discutient applications, such as solutions of saccharum saturni, and crude sal ammonia?, and directing a suspensory bag for the swelled testicle. MASTITIS. " An enlargement of the glands of the mammae, attended with the syptoms of phlogosis, and terminating by resolution, abscess^ scirrhus, chronic ulceration or cancer." For the mode of treat- ment see diseases of women. CATARRHUS, OR COLD AND COUGH. However trivial, in the view of many persons, complaints of this description may appear, they are, in reality, to be regarded as of a serious nature, and as frequently leading to the most fatal consequences. A cold, when aggravated, or rendered extrcriiely frequent in its return, by neglect or imprudence, eventually be- comes a malady sufficiently formidable to combat and defeat the skill of the most experienced physician f and this is the rock upon which the health and lives of thousands have been wrecked, CLASS II. CATARRH, OR COLD AND COUGH. 297 Some interesting observations respecting the manner in which colds are contracted, will be found in the chapter on air and at- mosphere, in the first part of this volume, to which the reader's particular attention is requested* A catarrh or cold is always occasioned by a suppression of per- spiration, by exposure to cold and damp air, or to alternate changes from heat to cold, and vice versa ; and the degree of severity depends on the violence of the cause, or the constitution of the patient. If we could always enjoy a uniform degree of tempera- ture, we should never be affected with a catarrh, but such is the Variableness of our climate, that our constitutions are perpetually subjected to diseases in consequence of obstructed perspiration. The symptoms of a catarrh, or cold, are so generally known, as scarcely to need description. They are most commonly lassi- tude or weariness; a sense of chilliness alternating with glows of heat upon the skin; stuffing of the nose; more or less obtuse pain of the head ; frequent sneezing; a disagreeable dryness and huskiness of the nostrils; the eyes are watery, red, and sore ; a cough, with hoarseness and sore throat, difficulty of breathing, and a slight degree of fever. At length a copious excretion of mucous fluid from the nostrils and throat, proves a solution of the com- plaint. Sometimes, however, the cough and other symptoms are more severe, and tbe affection being extended to the bronchial system, the breathing becomes laborious and wheezing, the fever is often considerable, and the disorder assumes its most severe forms. A cold, in general, is not difficult of cure, if early atten- tion be given to the application of proper remedies, but if long neglected, or frequently renewed, it may prove both obstinate and dangerous. For the removal of catarrh, we should endeavour to restore obstructed perspiration, and obviate the occurrence of inflammatory symptoms. The patient must be kept in a moderate temperature, avoiding the extremes of heat or cold. Those who adopt the old adage, of " feeding a cold," with the view of a cure, will be con- vinced of their error, when too late to retrieve their dangerous condition ; and he who will practice upon the opinion, that colds are soonest cured by a debauch in wine, or drinking hot punch, or other heating liquors, hazards an experiment which will often dis- appoint his expectations, and may convert a slight complaint into some dangerous inflammatory affection. 38 298 PHLEGMASIA. CLASS If. Immediately on the approach of symptoms of catarrh, the pa- tient ought to diminish the usual quantity of solid food, and ab- stain from all kinds of spirituous liquors, and other stimulating drinks. The food should consist of broths, light puddings, rice, sago, arrow root, fruits and vegetables. A free use of cooling mucilaginous drinks should be directed, such as barley water, infu- sions of licorice, flax-seed, quince-seeds, slippery elm bark, mul- lein, or water gruel sweetened with honey. The drinks should be taken cold, and pure cold water is by some late writers held in preference to all other liquids, repeated draughts of which they recommend as the best mean of promoting perspiration. By the use of these means, and bathing the feet and legs in warm water at bed time, perspiration will be induced in the course of the night, and by a due perseverance in this method, a common cold may often be speedily cured, which, if neglected, might be attended with the most pernicious consequences. In severe cases of catarrh, when the symptoms are urgent, the most soothing and immediate relief may be obtained by inhaling into the throat and lungs the warm vapours from the infusions of emollient herbs, such as the flowers of marsh-mallows, mullein, or Of elder. The receiving these vapours into the lungs by inhala- tion, is esteemed as a remedy which ought never to be neglected in cases of catarrh, or other pulmonic affections. The inhaler in- vented by Dr. Mudge, is admirably calculated for rendering the process convenient for children, as well as others. When, how- ever, this apparatus cannot be obtained, a coffee-pot, or an invert- ed funnel may be substituted. The operation should be continued about twenty minutes each time, and repeated morning and even- ing, especial care being taken to exclude the external cold air from having access to the throat and lungs. If inflammatory symptoms prevail, with a hard quick pulse, and pain of the hVad and breast, and a hot dry skin, it will be necessary to take blood from the arm in proportion to the urgency of the symptoms and other circum- stances of the patient, but not to such extent as to reduce the pulse and heat below the natural standard. An emetic of Ipeca- cuanha will next be highly useful, and the bowels must also be moved by a proper dose of jalap and calomel, or by the following saline mixture. Take of Glauber's salts, one ounce, fresh lemon juice, one ounce, boiling water, half a pint, loaf sugar, two ounces, two table-spoonfuls every hour, for an adult, until it prove laxa- CLASS U. CATARRH, OR COLD AND COUGH. 299 tive. If the skin be hot and dry, the warm bath should be used, after which the patient should go into a warm bed, and during the continuance of the febrile symptoms, it will be advisable to admin- ister either the neutral mixture with a small quantity of tartarized antimony and laudanum, or the following mixture in doses of one table-spoonful every hour, with the view of diminishing the heat and promoting perspiration. Take sal nitre, half an ounce, water, half a pint, lemon juice, half an ounce. Should the fever still prevail, small doses of calomel and opium may be given morning and evening, and at bed time, 20 or 30 drops of spirits of sal am- moniac in a cup of wine whey. For appeasing the cough, a simple domestic medicine may be t prepared, by mixing lemon juice, honey, and sugar candy in equal parts, of which a table-spoonful may be taken at pleasure. In the absence of fever, two tea-spoonfuls of elixir paragoric, or a suit- able dose of syrup of white poppies, should be taken at night. The syrup of marsh-mallows is very useful in cough from irrita- tion. Common Cough. It must be obvious to every observer, that a long protracted obstinate cough, especially if improperly treated, too often lays the foundation for a fatal consumption of the lungs. When, there- fore, a cough, produced by a cold, has not yielded to the method of treatment above recommended, or if that has not been adopted. the condition of the patient ought to excite alarm, and receive the most prompt attention. If the cough appears to proceed from a defluxion of thin acri- monious humours irritating the membranes of tlie lungs and other parts, the most proper remedies are those which tend to thicken and sheathe the sharp humours, such as mucilages, oils, and gentle opiates, as the following preparation. Take of barley water, six ounces, white sugar and gum arabic, of each three drachms, incor- porate the two last articles in a mortar, with a small quantity of the water, and gradually mix one ounce of the oil of almonds, or of olives, and then by little at a time, add the rest of the barley- water, and it will form a soft white emulsion, well adapted to the complaint; or if preferred, spermaceti may be used instead of tbe pil. Two table-spoonfuls of this excellent sheathing emulsion. 30p PHLEGMASIA. CLASS If. may be taken every two or three hours. Another emulsion, equally useful, may be prepared as follows. Take blanched al- monds, or white poppy seeds, two ounces, beat them in a marble mortar with the same quantity of sugar, adding a small quantity of water to facilitate their mixture, and then add a quart of barley water to the ingredients, and strain the liquor through a fine cloth for use. If it is required to be more mucilaginous, one ounce of gum arabic may be dissolved in it while warm. Half a pint of this mixture, taken frequently, serves an excellent purpose in ob« tunding and sheathing the sharp mucus, and in diluting the acri- monious juices in the lungs, or in the first passages. These remedies must be assisted by the use of opiates, which are often requisite to appease urgent coughs, and to procure a respite from the violent action on the chest and lungs which they occasion; with this view, two or three tea-spoonfuls of the paragoric elixir, thirty drops of antimonial wine, may be given in a cup of the mucilaginous drinks or emulsions above mentioned, at bed time, and repeated as occasion may require. Purgatives are commonly necessary to keep the bowels soluble during the continuance of the cough, Glauber's salts, manna, castor oil, or cream of tartar, afford a choice for the purpose. Emetics may also be given in every stage of the complaint, with much advantage. Should the cough continue obstinate, and be attended by symp- toms of an approaching pulmonic consumption, a change of air, with proper exercise, and a milk diet, should be recommended, and promptly adopted. In the appendix to this work will be found a variety of compositions, in the form both of pills and mixtures, admirably adapted to this complaint. When the lungs appear to be loaded with tough viscid mucus, not easily expectorated, and if no fever be present, the medicines to be relied on are those of a pectoral and attenuating kind, as gum ammoniac and squills. Half a drachm of gum ammoniac, made into pills with twenty drops of laudanum, and taken at bed time, is said to have an excellent effect, in almost uniformly pro- ducing an expectoration, and abating the distressing fatigue of the cough. If a liquid form be preferred, dissolve two drachms of the gum in half a pint of mint water, and let the patient take two table-spoonfuls three times in a day. The oxymel, or syrup of squills, may be mixed with an equal quantity of simple cinnamon water, and taken in the quantity of a table-spoonful two or three CI ASS II, CATARRH, OR COLD AND COUGH. 301 times in a day, if they do not disagree with the stomach ; or some of the preparations in the Appendix. In obstinate coughs, occasioned by a flux of humours on the lungs, blisters are highly expedient and useful; they should be applied between the shoulders, or about the chest, and kept open a considerable time by the savin ointment; or when one has heal- ed, a new one should be applied. If blisters are not employed, a plaster of Burgundy pitch should on no account be neglected. This ought to be worn between the shoulders, and renewed once every week so long as the cough continues, which, by its stimulat- ing effect, will afford considerable relief to the lungs. Issues and setons, near the chest, will also be beneficial by diverting from the lungs that flux of humours, which irritates that tender organ, and excites the action of coughing. Those persons who are of a con- sumptive disposition, should be particularly careful to avoid taking cold, as it may bring on a spitting of blood, or if tubercles are about forming in the lungs, they may thence be excited to a speedy and fatal suppuration. Persons advanced in life, often experience the most serious consequences from taking cold, such as inflammation of the lungs, or chronic catarrh, from which they seldom recover. Aged persons when affected with a tedious cough unattended with inflanimation, often receive essential relief by the use of bal- sam of Peru, balsam of Copaiva, or the balsam of sulphur, with half the quantity of the oil of aniseed mixed ; a common tea- spoonful of this last taken two or three times in a day, sometimes prove more efficacious than any other remedy. It is not to be recommended that persons for every slight cold, confine themselves to close warm rooms, and drink too freely of warm liquors, as these tend to relax the system, and protract the complaint; but if no fever attend, the patient should take some exercise in the open air whenever the weather will permit. Coughs sometimes have their origin in the stomach, affecting the lungs by sympathy, in which case the cure depends chiefly on cleansing and strengthening the organ primarily affected. After giving an emetic or two, a cure may be effected by a stomachic tincture composed of Peruvian bark and bitters, either in wine or brandy, assisted by proper exercise, particularly riding on horseback. When a cough proceeds entirely from an affection of the nerves, the proper indications are, to strengthen the body by mean': of 302 PHLEGMASIA. CLASS II. tonics, as the Peruvian bark, thoroughwort, and preparations of iron, with a light nourishing diet, tranquillity of mind, and daily exercise on horseback. In this complaint, however, much relief may be obtained by the occasional use of asafcetida, one drachm of which may be dissolv- ed in two ounces of cinnamon water, and a table-spoonful taken three times in a day. But the root of pothos fcetida, or skunk cabbage, will, in most instances of this description, prove a more pleasant, as well as a more efficacious remedy. This root may be taken either in powder to the extent of half a drachm three times a day, or in the form of infusion, as most agreeable to the patient. In children, we frequently meet with a cough occasioned by teething, and often by worms; in both which cases, it 'is to be cured by such remedies as are adapted to those complaints. When women in the last months of pregnancy, are affected with a troublesome cough, the complaint is greatly mitigated by small bleedings, and keeping the bowels soluble by gentle laxatives, avoiding at the same time all food of a flatulent nature. When the intimate connexion between the lungs and the surface of the body is considered, and that by preserving the perspiration uninterrupted, the lungs are in a manner secured from injuries which otherwise they are so apt to suffer, the utility and necessity of wearing a flannel shirt next the skin, cannot but be duly appre- ciated. The caution too, of guarding against wet feet, cannot be too often repeated to those who are habitually disposed to com- plaints of the breast. With regard to both of these particulars, I speak experimentally from the fullest conviction of their great im- portance. From the particular interest which I take in the welfare of our meritorious clergymen, I am induced to observe here, that in- stances too frequently occur, in which they hazard their future health, and even their lives, by the great fatigue and exertion in speaking in public assemblies, while labouring under complaints of the lungs and breast. Influenza, or Epidemical Catarrh. This species of catarrh has been known from the days of Hip- pocrates, and it has been mentioned as prevailing frequently in CLASS II. INFLUENZA. 303 England during the last century. In America, it has appeared at nine or ten different periods since the year 1733, but at no period so universally extensive, and with such severity, as-in the autumns of 1789 and 1807. It commenced first at New-York and Phila- delphia, from which it soon pervaded every part of the continent.* According to estimation, three fourths of the inhabitants were in a few weeks affected with the disease, in a greater or less degree. It spread with such amazing rapidity, as to resemble more a storm agitating the atmosphere, than the natural progress of a disease from any contagious source ; almost a whole city, town, or neigh- bourhood, becoming affected in a few days. Although all classes of people experienced the operation of this singular epidemic, it is remarkable that a small proportion, comparatively speaking, were so ill as to require medical attendance, and instances of its fatal termination were of rare occurrence. The few cases of mortality were confined chiefly to the aged and those who were previously affected with pulmonic complaints. But it was not uncommon for persons from intemperance, or ex- posure to cold and wet, to suffer relapses, which proved severe and lingering, and in a few instances led to fatal consequences. The symptoms which characterized the disease, were very sim- ilar to those that attend a common catarrh or cold in its severest forms. It was in general ushered in with chilliness and shiverings, succeeded by some degree of heat, a hoarseness, soreness, and rawness of the throat, lungs, and stomach, accompanied with an incessant tickling cough or hawking, with expectoration of thin sharp mucus. Pains in the head, chest, back, or limbs, with a lassitude, restlessness, and great prostration of strength, almost universally attended. The pain in the head was often severe, accompanied, in a few instances, with vertigo and slight delirium. The pain and oppression in the breast, resembled that of perip- neumonia notha, and those in the back and limbs were often simi- lar to the pains accompanying the accession of typhus fever. The respiration and cough, in some instances, exhibited that pe- culiar croaking noise which takes place in croup. Sometimes a diarrluea, at others a nausea, but more frequently a constipation * The source of this disease is a peculiar or vitiated state of the atmosphere, " the air alone being the medium of its communication, and that under all circum- stances, whether pure or impure, summer or winter, and wet or dry." " It is verv properly termod an terial or travelling infection.'''—Sheeut on Contagions. &-r. 3.04 PHLEGMASIA. CLASS Hi of the bowels, with thirst, a furred tongue, quick pulse, but not very full, high coloured urine, and more or less fever, accompani- ed the complaint. Some have the full symptoms of pulmonic inflammation, as stiches in some part of the chest, tinged expecto- ration, and a pertinacious cough. When perspiration was free, and the bowels lax in the early stage, the fever usually declined about the fifth or sixth day, but the cough continued for some time longer, with a free expectoration of mucus, and some old and in- firm people died, apparently from an accumulation of phlegm which they were unable to expectorate. Such in general was the form of the influenza, but its modifications were extremely nu- merous. With respect to the medical treatment of this disease, the plan varied in the hands of different practitioners. A large proportion of those affected were subjects only of simple domes- tic remedies usual in cases of common colds. Blood-letting was practised in a few instances, but in general this evacuation was considered as inadmissible. Emetics, when nausea indicated their use, blisters, to relieve the pain about the chest, diaphoretics and mild laxatives, were more universally employed. The inhalation of warm vapours, the liberal use of emollient drinks, and the mucilaginous emulsions already directed, are to be considered as the most appropriate remedies in the influenza, and as all those means, with directions for their use, have been mentioned in the preceding pages, a more particular recital here would be super- fluous. I must not omit to mention that an unpleasant, and not unfre- quent sequel of both catarrh and influenza, is a partial or complete loss of voice, depending upon a state of the muscles subservient to speech approaching to palsy. This is sometimes only of a very temporary nature; at others, it has been known to continue for several months after the disappearance of the other symptoms. It is in general easily to be restored by the use of stimulating gargles, composed of mustard seed and horse radish, but still more effectually by a decoction of seneka snake-root, with the addition of a little honey, a table-spoonful of which for an adult every two hours, and gargle with the same. The lobelia inflata is another efficacious medicine in this affection, which may be used as a gar- gle in the form of tincture or infusion. Electricity has also been known speedily to remove this complaint. CLASS II. LARYNGITIS. 305 In the influenza, as prevailing this season, a troublesome sore throat has been one of the attendant symptoms, in which a de- coction of the wild indigo root, (see Appendix,) proved a valuable remedy when used as a gargle. When the cough was severe, and continued for some time, the compound syrup of sanguinaria cana- densis, to be found in the Appendix, greatly alleviated, and event- ually proved an effectual remedy. In those cases attended with a severe pain over the eyes and head, the application of leeches to the temples seldom failed to relieve, and was found greatly preferable to blistering. LARYNGITIS, OR CYNANCHE LARlNGiEA. This is an inflammation of the larynx, attended with great hoarseness, a frequent convulsive cough, and difficult respiration ; oftentimes ending in ulcer and hectic fever. " It is only of late," says Dr. Thomas, " that this fatal variety of sore throat has at- tracted the notice of practitioners, having commonly been con- founded with croup. In many cases, there may, indeed, arise some difficulty of forming a just diagnosis ; but the following pecu- liarities will greatly assist us. " In cynanche laryngaea, the symptoms are, an uneasy sensation in the larynx, difficult and painful deglutition, partial swelling of the fauces, a supervening and perpetually increasing difficulty of breathing, nearly amounting to a sense of suffocation, the voice being extremely hoarse, or reduced to a scarcely audible whisper, attended by inflammatory fever. In cynanche trachealis, there is a difficulty of respiration, without any swelling of the fauces, or painful deglutition; the expirations, especially in coughing, are very shrill, but the fever in this is also inflammatory. " The usual cause of cynanche laryngaea is exposure to cold, which excites an inflammatory determination to the membrane in- . esting ihe larynx. " It comes on with chilliness, succeeded by heat and fever, which are soon followed with a hoarseness and indistinctness of voice, laborious respiration and pain, or, as it were, a stricture in the throat, threatening suffocation ; the pulse is quick and feeble, the eyes are suffused with blood, and somewhat protruding, the coun- tenance has a livid or swollen appearance, the tongue is- furred, 300 PHLEGMASIA. CRASS II. the tonsils, uvula, and pharynx, presenting a dark red appearance on inspection, and any attempt to swallow is succeeded by excru- ciating pain and difficulty. If the symptoms are not properly at- tended to, and subdued by an immediate adoption of active and proper means, the patient is destroyed by suffocation. " The morbid appearances to be observed on dissection of those who die of cynanche laryngaea, are as follow:—The mucous mem- brane investing the epiglottis and margin of the glottis, is inflamed, serum is infused under it, or coagulable lymjjji on its external sur- face, by which the rima glottidis is narrowed, or actually closed. Sometimes there has been perceived an accumulation of mucus in the cells of the lungs, with a slight effusion of serum into their re- ticular texture. In some instances, the pleura has been found par- tially adhered, with more fluid in the cavities than is natural. " To control and manage the disease with success, a timely and active employment of an appropriate treatment is obviously neces- sary, and this must be directed to the subduing the local inflamma- tion as quickly as possible. In the first stage of the inflammation, (or first four and twenty or thirty hours of its commencement), when the patient feels uneasiness in the larynx, with difficult and painful deglutition, we should have recourse to copious blood-let- ting from the arm in a free stream, (such as from sixteen to twen- ty ounces, if an adult,) repeating the operation on the same day, and nearly to the amount of the same quantity, should the breath- ing and deglutition not be very considerably relieved. In children of an early age, it will be better to draw blood from the external jug- ular vein than from the arm ; but in adults and other, blood-letting from the arm is to be promptly and boldly employed, repeating the operation as circumstances may require. After bleeding, some active purgative, such as the sub-muriate of mercury, joined with jalap, or the compound extract of colocynth, ought promptly to be administered ; and should it not act quickly and satisfactorily, a ca- thartic clyster may be injected. The bleeding, as also the purga- tive, may be repeated the succeeding day, if judged necessary; between the doses of which, we may prescribe small and frequent- ly repeated nauseating doses of some antimonial preparation, such as the pulvis antimonialis, or solution of the antimonium tartariza- tum, wdiich may be given in combination with a saline mixture and nitrate of potass. Antimonials are valuable medicines in cynanche laryngaea and acute bronchitis, for they not only lessen febrile ex- CLASS II, TRACHITIS, OR CROUP. 307 citement, by exciting nausea and opening the pores of the skin, but, by their action on the exhalant vessels of the lungs, they pro- mote expectoration, and thus lessen the inflammation of the mu- cous membrane. " Should the inflammatory action in the parts not be subdued by venesection and purging, we may advise the application of sev- eral leeches to the throat, and a large blister to be put on the chest, immediately under the throat. In addition to these means, the frequent use of an inhaler, filled with warm water and vinegar, may afford some relief, as may also gargling. As an auxiliary, we may likewise recommend the semicupium. " Now and then, suppuration takes place, and a copious dis- charge of matter is thrown up by a violent fit of coughing, produc- ed by an effort at deglutition. Where suppuration exists, it might be advisable to excite vomiting, that the abscess may be ruptured, and the matter discharged by the mouth as expeditiously as possi- ble, and thereby prevent suffocation. " Where the disease resists our best endeavours, laryngotomy affords the only chance of escape from suffocation, by enabling the patient to breathe, till the inflammation, narrowing the aperture of the glottis, may have time to subside ; but this operation should not be delayed too long, as, at a late period, it may afford but little re- lief; whereas, when performed in an early stage of the complaint, the benefit to be derived from it will be of high importance. " Mr. Bell has lately endeavoured to simplify and improve the operation of laryngotomy. He recommends the incision to be made with a small scalpel, through the membranous space betwixt the thyroid and crycoid cartilages, then to introduce the handle of the knife, and turn it so as to open the slit. This will be suffi- cient, if the occasion be temporary; but if a more permanent gap be required, the four corners left by the incisions may besnipt off." TRACHITIS, OR CROUP. There has prevailed a great diversity of opinions among practi- cal writers, respecting the peculiar nature and treatment of this disease. Nosologists have described it under the various appella- tions of cynanche trachcalis, cynanche laryngaea, angina stridula, \c. ; and in every country it has also obtained a vulgar name by 308 phlegmasia;. class n. which it is generally known, as choke, or stuffing ; rising of the lights, hives, and quinsy. This disease has been by some writers divided into two species, inflammatory and spasmodic, but there is no practical utility in such distinction, as it is probable that in the greatest number of cases, these two states are combined in a cer- tain degree, and happily those means which are acknowledged the most effectual in counteracting inflammation, are such remedies as possess powerful antispasmodic virtues. The only distinction of species, which we shall admit as proper, is the idiopathic and the symptomatic. The disease is known by the latter appellation, when it succeeds to the malignant sore throat, scarlatina, measles, small-pox, putrid thrush, a common catarrhal affection, pneumonic inflammation, or the acute rheumatism. But it is only in its idio- pathic form, that Ave are to consider it in this place, when the dis- ease is primarily and exclusively local, and confined to the mucous membrane of the trachea, bronchiae, and surface of the lungs. It often commences suddenly, without any premonitory symp- toms ; or the previous indisposition is so short and inconsiderable, as scarcely to attract observation. Under whatever circumstances it may occur, it is an inflammatory affection of the mucous mem- brane of the trachea and larynx, often extending throughout the whole of the windpipe, and a considerable part of the surface of the lungs, producing a lymphatic incrustation,* which is sometimes vomited or coughed up in detached portions. Whether the attack be sudden or more gradual, it is accompa- nied with the common febrile symptoms, which, in infants incapa- ble of communicating their feelings, may be discovered by the heat of the skin, thirst, reslessness, and nausea. In many cases, for several days previous to its invasion, the child will appear drow- sy and inactive, the eyes watery, inflamed, and heavy, the pulse frequent, the breathing shorter and quicker than natural, and at- tended with a hissing noise. This peculiarity in the sound of the respiration is more observable when the child first awakes, at which time it will be seized with an unusual hoarse, shrill, dry cough. The disease is frequently epidemic, but never, as has been sup- posed by many physicians, contagious. It most commonly occurs * Dr, J. Jackson, of Boston, has communicated several cases of dissection, in which <( the peculiar sound of Croup was exceedingly evident," where this preterna* tural membrane of coagulable lymph was not present in the larynx. See New. England Journal of Med., &c. Vol. I. p. 383. CLASS II. TRACHITIS, OR CROUP. 309 during the variable weather of autumn and spring, but more rarely in the severe cold of winter, or the mild and genial warmth of sum- mer. But solitary cases have been witnessed in every season, if at the time there prevailed much dampness, with an atmosphere al.ornately warm and cold. From these facts it may be inferred, that the application of cold is the general cause which produces the disease. It has likewise been observed to be peculiar to cer- tain families;—that children under six months are not so liable to this complaint, as they are after that period to the age of eight or ten years;—that it most frequently seizes the ruddy and robust;— and that those who have once suffered an attack, are peculiarly lia- ble to repeated returns of the disease. Adult persons are not al- together exempt from an attack of the croup ; several instances are on record, besides that memorable one which deprived our country and the world of the illustrious Washington. In his case, the disease was the effect of a cold, by getting wet about the neck. Dr. Mitchell, the learned professor of natural history in the uni- versity of New-York, has also been the subject of a very alarming attack of this disease. The duration of a fit of croup is various; in a few instances it proves fatal within twenty-four or thirty hours after the attack ; in other cases its fatal termination has been prolonged to a week. The unfavourable symptoms are, violent fever, a permanent dys- pnoea, great anxiety, frequent cough, without expectoration, and the voice becoming more shrill and sonorous. When it proves fatal, it is generally by suffocation, induced either by a spasm of the muscles of the glottis, interrupting the passage of the air, or a preternatural membrane, obstructing the windpipe. Notwithstand- ing it is an inflammatory affection, it very seldom ends in suppura- tion or gangrene. Practical authors have differed widely in their opinions with re- gard to the mode of treatment which is to be pursued in the cure of the croup. Some physicians have relied entirely upon antispas- modic medicines ; while others have rejected them as useless, and have given calomel in doses almost incredible to be believed.* A few practitoners have had recourse to blood-letting, which they ad- * Dr. Stearns, of Albany, prescribed to a child of a year old, 20 grs. of calomel, with 8 grs. of the cerated glass of antimony ; and to a child of two years of age, he gave 25 or 30 grs. of calomel for a dose, with a proportionate increase of antimony. »o Coxc's Med. Museum, Vol. V. p. 19"> 310 phlegmasia;. CLASS II. vise to be carried to that degree of profuseness, which will pro- duce deliquium. This practice has been opposed by those who dread the debilitating effects which succeed to bleeding children freely. Venesection, emetics, and the warm bath, have been em- ployed by English physicians in the first attack of this disease, with a view to obviate the inflammation, and they recommend the use of antispasmodics during the remainder of the cure. With- out attempting to refute, or to reconcile these discordant opinions, we shall divide the disorder into three stages, agreeably to the plan of Dr. D. Hosack, of New-York,* and propose such reme- dies as are best adapted to each of them. The first may be de- nominated the forming stage, in which is manifest the premoni- tory symptoms above described, when the affection is merely local. Perhaps the only marks of indisposition at this time will be, a difli- eultv breathing, which is generally attended with a wheezing nf tc; a peculiar hoarse, hollow, shrill, cough ; and a slight degree '21 restlessness. Children have frequently been relieved in this stage by the exhibition of common family prescriptions. But more generally the disease is only momentarily arrested in its pro- gress by these nostrums, and much valuable time is lost. We are not to infer that there is no hazard, because we find the skin cool and moist, the pulse not accelerated, and the system unaffected. Even in this stage, the disease requires the most active remedies, to prevent the irritation being extended to the system generally, and to restore the suppressed secretions of the trachea and surface of the lungs. This is the only situation, while the disease is con- fined to the parts primarily affected, that the physician can pre- scribe with confidence or success. To effectuate the most important object in the cure, the turpeth mineral alone, or calomel and antimony combined, constitute by far the most efficacious remedy ever devised. The precise dose must be determined by trial, and attentive observation as to the effect. Of calomel, two parts, tartarized or cerated antimony, one part, a child under two years, may take ten or twelve grains at Dr. Burns assures us that 50 or 60 grs. of calomel are often given, and occasion- ally above 100, to children in this disease, without producing salivation. Vide Prin. Mid. * Vide Observations on Croup, or Hives; addressed in a letter to A. R. Delile, M. D., of Paris; by David Hosack, M. D. Professor of the Theory and Practice of Physic and Clinical Medicine, in the University of the State of New-York, first published in the Amer. Med. and Philo. Register, Vol. II. No. 1. eLASS II. TRACHITIS, OR CROL'P. 311 first, and a smaller dose every half hour, until a severe vomiting is induced, and the alarming symptoms have subsided. The pur- gative effect of the medicine may, if necessary, be assisted by an injection. Dr. J. Fisher relies chiefly, if not entirely, on the tur- peth mineral as an emetic in croup. He administers one or two grains, according to the age of the child, and repeats, if necessary • which method, this excellent physician assures me, has succeeded in every instance of his extensive practice. In the second, or febrile stage, the irritation is extended to the whole system ; the pulse is frequent, the skin hot, and dry, the re- spiration difficult, hurried, and stredulous, the cough frequent, shrill, and of a very particular sound, the face flushed and swelled, and the eyes protuberant, and sometimes watery, attended with great thirst and restlessness. In this stage of the disease, it is necessary to lessen the general febrile excitement of the system, and pre- vent the determination of the circulating fluids to the affected part, by employing blood-letting, either at the arm, or jugular vein, in proportion to the age and constitutional powers of the child. Dr. Hosack, never, even in the youngest children, experienced any difficulty in opening a vein upon the back of the- hand, and of drawing a sufficient quantity of blood from that part which he pre- fers to the jugular vein, first immersing the hand in warm water. He takes from a child under two years, from two to four ounces ; from two to six years, from four to six or eight ounces, and to be repeated as the urgency of the symptoms may require. The prac- tice recommended by some physicians, of bleeding the patient until faintness be induced, Dr. Hosack believes to be improper. After the use of the lancet, it will be advisable to administer the antimonial or the mercurial emetic, notwithstanding the bleeding should appear to have produced an entire relief. But should not the disease yield to these means, a blister must be applied to the throat, and a carthartic of calomel given, whose operation should be assisted by injections. Should we not succeed in subduing the febrile symptoms, and diverting the irritation from the lungs and trachea, the third stage of the disease will ensue, which is denomi- nated the membranous or purulent stage. In this third stage, in which the membranous effusion occurs. lining the trachea and bronchia, we observe the same laborious res- piration as in the preceding stages, the cough violent, and unat- tended with any expectoration ; but if any thing is spit up. it ha? 312 phlegmasia. CLASS M, either a purulent appearance, or consists of films resembling por- tions of a membrane. The countenance is of a bluish livid colour the face and lips tumid, and the patient is threatened with imme- diate suffocation. In this advanced period of the croup, we must have recourse to stimulant remedies, neither of which, excepting calomel, would be proper in the two first stages. Here, we ou°ht to exhibit repeated doses of calomel, together with squills, and asa- foetida, and the seneka snake-root. This last medicine must be given in the form of infusion, of such strength, as to act sensibly on the mouth and throat, in exciting coughing, &c, as in this disease, those parts in a manner, lose their natural sensibility. Half an ounce of the bruised root, simmered in a close vessel, in half a pint of water, until reduced to four ounces, will, probably, in most Cases, be sufficiently strong. A tea-spoonful of this is to be given every hour, or half hour, so as to keep up a sensible action of the medicine in the mouth and throat, until it act as an emetic or cathartic, or the patient is otherwise relieved, and then continued in smaller doses. We are indebted to Dr. Archer, of Maryland, for the introduction of Polygala Seneka, as a remedy in croup, and the experience of many years has confirmed its utility. The powder of seneka, Dr. A. observes, has been used in doses of four or five grains mixed in a little water, with effects equally pleasing with the decoction. The syrup of onions is frequently administer- ed in the last stage of croup, with beneficial effects, but Dr. Ho- sack urges the importance of varying the remedies according to the different stages of the disease. Such powerful stimulants as syrup of onions and seneka, cannot be given with safety in the forming, or in the febrile stage, when blood-letting and other means of reducing the increased excitement of the system are indicated: and the relaxing and debilitating remedies which were indicated during the two first stages, ought in this to be prohibited ; for, in this debilitated state of the system, they not only diminish the power of secretion, but of ejecting the matter secreted. Cases have occurred when in the last stage of croup, emetics of sulphate of copper, or sulphate of zinc, have been found preferable to other emetics. Professor Francis, of New-York, has, in three apparently desperate cases, succeeded beyond expectation, by administering x solution of white vitriol composed of a drachm of the zinc to an ounce of water; three tea-spoonfuls were given at intervals of ten minutes. Tn twenty minutes after the last dose was taken, the e-LASS if. TRACHITIS, OR CROUP. Slti ■ -fleets of vomiting were renewed, and the patient completely reliev- ed, hi this, as in the other two cases, bleeding, vomiting, calo- mel, the antimonial solution, and the warm bath had been era* ployed. As the last resource, Dr. Hosack recommends the ope- ration of Tracheotomy as the only means of preserving life.* Professor Smith, of New Haven, has had many opportunities of witnessing the beneficial effects of blood-root in diseases of the lungs, and in croup, in which last disease, he deems it a sovereign remedy. The case of a woman labouring under croup, was so violent, that the professor found the attending physician prepared for the operation of opening the trachea. He gave a strong infu- sion of blood-root, in table-spoonful doses, repeated once in 20 minutes, and in two hours, the disease was cured so far, that she breathed with perfect ease. He has witnessed the effects in seve- ral cases where it was equally and as speedily beneficial. Pro- fessor Ives, of New Haven, also states, that if given in large doses, sufficient to produce full vomiting, it often removes the croup, if given in the first stage. It has been given, he remarks, for many years, in the country, some physicians relying wholly on this re- medy for the cure of croup. If given early in cynanche tra- chealis, says Dr. W. Tully, it may be considered as almost a spe- cific. About one scruple of the powdered root may be infused in half a gill of hot water, and to a child two years old, a small tea-spoonful may be given every half hour, in urgent cases, until relief is obtained. It appears from an extract from the Edin. Med. Journal, April 1825, in the New England Med. Journal, vol. 14, that W. Mackenzie, Professor of Anatomy, and Surgery at Glasgow, has discovered a fact, which appears to be of much im- portance. That in croup, the exhudation of fibrin, very frequently commences on the surface of the tonsils, thence spreads along the arches of the palate, and the uvula, and at length covers the internal surface of the pharynx and oesophagus, the larynx and tra- chea. The remedy which this gentlemen has found effectual, even in severe cases, is a solution of nitrate of silver ; one scruple of the nitrate is dissolved in an ounce of distilled water. By means of * The operation of opening the trachea for the removal of foreign bodies acci- dentally received in that tubo, has been several times successfuly performed in the United States ; in Pennsylvania, by Dr. Charles Mc Lane, in Hartford, Connecti- cut, by Dr. Cogswell., and by Dr. Mott, ihe Professor of Surgery in th«? univercitv r»f New York 40 U4 PHLEGMASIA CLASS II. a large camel hair pencil, this solution is to be applied freely, once or twice a day, according to the severity of the symptoms, to the whole lining membranes of the fauces. The surface of the ton- sils, or wherever else the fibrinous crust is actually in view, will of course be particularly attended to; the pencil may with safe- ty be pushed to the lower part of the pharynx. This application produces no irritation, and uniformly alleviates the distressing symptoms of croup, by throwing off the false membrane by which the parts are covered. PERIPNEUMONIA NOTHA, OR TYPHOID PNEUMONIA The epidemic now to be considered has a strong affinity to that described in the preceding pages. Both are probably dependent on the same predisponent and exciting causes, and equally desti- tute of the contagious character. Confederate accomplices in the great work of mortality, they are no less humbling to the pride of medical science, than fatal scourges to the human race. In 1812— 13, this formidable epidemic prevailed among the soldiers of our army on the frontiers of Canada,and extended to the inhabitants in those vicinities, with the most alarming mortality. It has since continued to display the arrows of death, and to spread consterna- tion and dismay through various sections of the United States. Its greatest prevalence has been during the cold weather of winter and spring, and generally remote from the seaboard. According to its supposed existent forms, it has received the different appella- tions of peripneumonia notha, pneumonia typhoides, bilious pneu- monia, and malignant pleurisy.* The analogy between this epidemic and spotted fever, seems to be evinced by the violence and suddenness of attack, variety of forms, sudden prostration of the vital principle, and rapid progress to a fatal termination ; and on some occasions by the appearance of both at the same epidemical season. The analogy of the two diseases is also manifest by nearly the same appearances on dissec- tion, and that on general principles they require a similar mode of * The vulgar term " cold plague" or " cold skin fever," given it in the southern states, is not inaptly applied, considering the remarkable coldness of the surface and extremities, and also its dreadful fatality in some particular places and seasons. PERIPNEUMONIA NOTHA, OR TYPHOID PNEUMONIA. 315 curative treatment. The two diseases, however, are not to be con- founded either in theory or practice, In the petechial fever, the principal morbid affection discovered on dissection was on the parts within the cranium ; in the present disease it is generally found in some of the thoracic viscera, as the heart and lungs with their mem- branes ; yet in some instances, all those different parts participat- ed in a greater or less degree in the diseased affection. The peri- pneumonia notha is far from being a new disease, we find it men- tioned by the great Sydenham about the year 1680, under the de- nomination of bastard peripneumony, which he says " arises every year towards the beginning, but more frequently at the close of winter. It chiefly attacks such as are of a gross habit of body, and middle aged persons, but oftener those who are more advanced in years and too much addicted to spirituous liquors, especially brandy." The very accurate description given of peripneumonia notha, by that excellent practical author, Dr. John Huxham, in the year 1759, so exactly corresponds with the epidemic which has recent- ly visited our country, that no one can doubt of their real identity. I shall give a concise abstract of his description, " Though the load at the breast is very great, breathing difficult, and the cough very importunate and sometimes violent, yet the fever and heat are small, many times scarce perceptible, the pulse cither quick, weak, and small, or sluggish and oppressed, never hard and tense. So that as this distemper hath very different, and almost quite con- trary symptoms to those of a true peripneumony in several re- spects, it is reasonable to suppose it arises from very different causes, and requires a very different method of cure.—And in fact we see, that bastard peripneumonies commonly seize the old and phlegmatic, the weak and lax, the fat and unwieldy, and are most rife in wet, fogiry weather and winter seasons ; whereas the true in- flammatory peripneumony generally attacks the robust, vigorous, and active, and is most frequent in cold, dry weather, during north- east winds and high stations of the barometer.—These two diseases, then, seem to differ almost as much as ardent and slow nervous fevers; or as much as an inflammatory quinsy doth from one that is purely humoral, or arising merely from a serious deduction. The fre- quent chills and flushes of heat, however, the quickness and irregu- larity of the pulse, anxiety and weight at breast, pain and giddiness of the head, foulness of the tongue, lVt, sufficiently indicate a fi> 31G PHLEGMASIA. CLASS If. verish habit." " A perpetuaL laborious wheezing, great anxiety and constant oppression on the praecordia, comatose symptoms cold extremities, and dark lead coloured nails and visfige, are marks of great and immediate danger." The following observations to be found in Mr. J. Bell's Anatomy will further confirm the close resemblance of this epidemic with the European disease. ** In peripneumonia notha, there is not merely an inflammation of the pleura, as the name expresses, but of the lungs themselves ; and it is not from inflammation, pain, fever, or acute suffering, that they die, but because the lungs are entirely crammed; the heart can no longer move; they are not sensible of their dangerous state, but are suffocated in a moment, and die without a groan." " When this disease comes upon a place, it comes with all the frequency and destruction of an epidemic disease; and the sudden and unexpected deaths are terrible." " The pulse is weak; the cough slight; the difficulty of breath- ing more anxious than painful; the face sunk in the features, and flushed, or rather of a livid colour, except when it is cadaverous, pale, and sallow. The suffocation is sudden ; the lungs have, as Morgagni expresses it, a liver-like, solid consistence ; they have no longer the cellular appearance of lungs, for their bronchiae ara crammed with blood ; their common cellular texture is also full of exuded blood ; they are dense,solid, and very heavy and black, and they sink in water like the lungs of a foetus. The heart is so curbed in its actions, that it gives but a small, feeble, and trembling pulse," &c. It may be deemed somewhat singular, that having the character- istics so accurately portrayed by the first European authorities, we should not be prepared to recognize the disease immediately on its appearance in our country. The shades of dissimilarity, may, it is presumed, be explained by referring to the difference in climate, and the constitutions and habits of the people. The disease has in general commenced with acute pain in the side or breast, stric- ture across the thorax, and difficulty of breathing, short distressing cougb, sometimes attended with a mucous expectoration tinged with blood ; numbness in the muscles, excruciating pains in the limbs and about the region of the heart, chills and great prostra- tion of strength, together with palpitation, irregularity, depression, PERIPNEUMONIA NOTHA, OR TYPHOID PNEUMONIA. 31? and annihilation of the pulse, syncope and cold sweats; but in a few cases, the pulse was very rapid and not depressed. In some instances the patient was seized with a violent pain in the bead, soon became delirious and died in a few hours, (sec spot- ted, or petechial fever.) This most violent and fatal malady is to be combated wit^ promptitude and decision, little time is afforded for deliberation. Remedies should be applied within the first few hours of attack. As Dr. Huxham observes, " the timid, low, insipid practice of some is almost as dangerous, as the bold unwarranted empiricism of others; time and opportunity, never to be regained, are often lost by the former ; whilst the latter, by a bold push, sends you off the stage in a moment." The remarkable mutability of the disease, and the discordance of opinion among practitioners, bring the fullest conviction that no precise or uniform rules can be adopted, all must be regulated by the particular state and condition of the patient. Relative to a few points, however, there exists no contention among judicious practi- tioners. Blood-letting is not to be resorted to indiscriminately, and the stimulant plan by the use of ardent spirits has in general been denounced as highly injurious, while some individuals having ex- perienced their salutary effects, extol the remedy as being singu- larly efficacious, even when exhibited to such extent as in a state of health would appear a dangerous experiment, and it is sometimes found difficult to control the popular bias in favour of their adminis- tration. But let it be observed as a general position, that the in- tended effects of ardent spirits and other cordials, are to warm the stomach, and to increase the force and frequency of the heart and large vessels, when these are almost arrested in consequence of pressure on the brain ; but by the liberal and indiscriminate exhi- bition of such stimulants, while those organs are in a gorged state. there is much hazard of so increasing the local congestion of blood, as to lessen the power of the vessels to contract, and to produce sudden death. Ardent spirits seldom fail also of interrupting the natural evacuation from the lungs by expectoration. That excel- lent physician, Dr. Huxham, was an advocate for bleeding at the commencement of peripneumonia notha, provided great load and oppression at the breast with difficult breathing, full, or tense and hard pulse, and other urgent symptoms, indicated the necessity of it; but in contrary circumstances he advises to proceed with gre;>t 318 BHLEGMA&I.E,; CLASS U. caution ; and when the blood drawn appears loose, thin, and florid or more commonly of a darkish livid hue, and without that thick viscid buff as in common inflammations of the lungs, a repetition of the operation is inadniissable, as the patient soon sinks, and the powers of life fail in consequence of the evacuation. But the fact jp to be remarked, that in this, as in all other epidemics, no invari- able rules can apply to particular seasons, constitutions and other individual circumstances ; very much must depend on the vigilant attention and happy discernment of the attending physician. Dur- ing the epidemic, the present year, (1816,) in this state, blood-let- ting had in general a remarkable tendency to a fatal termination, inasmuch that it became an established opinion among the most ju- dicious, that in not more than one in ten instances could the lancet be employed with safety. Local blood-letting by leeches or cup- ping, may often prove beneficial, when the general evacuation is to be avoided. Cases may, and have undoubtedly occurred, however, where the lungs are so gorged with blood, that the heart and arte- ries are dangerously impeded in the performance of their action, while at the extremities and surface of the body, torpidity and cold- ness prevail. This condition of the patient is often accompanied also with most laborious and suffocating respiration, arising from the bronchia? being loaded with bloody mucus. Here the stimulus of ardent spirits internally must be carefully avoided, but the most effectual means of external warmth should be immediately and as- siduously employed. It is in these circumstances that the use.of the lancet is not to be guided by the state of the pulse ; although a full evacuation may be improper, small bleedings of four or six ounces, and repeated every six or eight hours, attentively watching the effect, will afford opportunity for the gorged vessels to relieve themselves from the oppressive load, and may be the means of per- manent advantage. And when a general warmth and uniformity of action, and excitement are restored to the surface and extremi- ties, a more copious evacuation may in some instances be requi- site ; or the appropriate auxiliary remedies may now be diligently applied with the fairest prospect of success. One of the most effec- tual applications is a large poultice of onions, either raw or roasted, and sprinkled with vinegar, and so large as to cover the whole re- gion of the lungs. A very extensive application of epispastics to the parts most affected, as advised in spotted fever, should be re- garded as among the principal remedies to be relied on; these, when PERIPNEUMONIA NOTHA, OR TYPHOID PNEUMONIA. 310 ipplied to the legs and thighs, says Dr. Huxham, are often found to relieve the head and breast when other methods fail. But the limbs when cold and torpid, should be well rubbed before the blis- ters are applied, and then wrapped in flannel, and other stimulants and rubefacients should also be applied as recommended in spotted fever. Our attention should next be directed to the morbid con- tents of the stomach, and to induce a discharge from the lungs by expectoration. For this purpose an emetic of ipecacuanha, with three or four grains of turpeth mineral, should be administered. Kxperience has decidedly evinced the importance of inducing a mercurial action to counteract the diseased action existing in the system, in which event a fatal termination rarely occurs. Mercu- rials in general are excellently adapted to promote expectoration, and turpeth mineral is, it is believed, the preparation to be prefer- red. This, if given in doses of two grains every fourth or sixth hour, may supersede the use of the lancet, produce the desired copious expectoration, and effect all that can be attained by any medicine. When this preparation is not employed, recourse will undoubtedly be had to calomel, either by itself or conjoined with tartarized anti- mony, and opium will be occasionally added, as in the following form. R. Calomel gr. ten, opium, gr. five, tartrite antimony gr. one, m. two or three grains every four, six, or eight hours. An early introduction of mercury into the system is with few exceptions considered by experienced physicians as tbe most efficacious me- thod of combating this formidable disease. Antimonial preparations are also of great utility, and Dr. Huxham extols the antimonial wine as an admirable attenuant, deobstruent, and diaphoretic, safe and efficacious, and in this disease great advantage has been derived from it, when combined with elixir paragoric, in appeasing cough, and promoting expectoration. Other pectoral medicines, as gum ammoniacum, squills, decoction of figs, liquorice, and elecampane, are usually employed, and will afford essential relief. As a free and regular perspiration is of the first importance in the curative plan, much of our attention should be directed to the class of dia- phoretic medicines, among the most useful of which are Dover** powder, alkaline salts and camphor; and in cases of low state of circulation with torpor and cold extremities, where stimulants are required to invigorate the stomach and system, the indications may be advantageously fulfilled by the use of volatile tincture of gum guaiacum, volatile tincture of valerian, decoction of thoroughwort 320 BHLEtiMASL*;. CLASS 11, infusion of Virginian snake-root, saffron, and vinegar or mustard whey. But the seneka-root is probably one of the best diaphore- tics which can be employed. It is mentioned by Dr. Gallup, in terms of high commendation in his sketches of epidemic diseases having experienced its superior virtues in his own case and many others. The proper dose is about six grains of the powder every three hours until the desired effect be accomplished. The course above detailed should be accompanied with some or all the means of communicating external heat, as the warm bath, or enclosing the patient in blankets wet with warm water, billets of wood after being boiled, bladders filled with warm water, «fec. The method discovered by Dr. Jennings, of imparting dry warmth, by means of a spirituous vapour bath, is said to be preferable to all others, for the purpose of removing torpor of the surface, and equalizing the excitement. When the lungs are much oppressed with mucus and phlegm, with little expectoration, the inhalation of steam from hot vinegar and water, if properly employed, will produce benefi- cial effects ; and this may be considerably assisted by repeated po- tations of pure bottled cider a little warmed. In those cases which require internal stimulants to revive the exhausted energy of the system, a mixture of equal parts of ether and laudanum, will be found happily adapted to the indication, the quantity to be ad- ministered will depend on existing circumstances. The aqua am- monia?, or volatile alkali, may sometimes be advantageously exhi- bited alternately with the above mixture. Cathartics of calomel and jalap, at the beginning, and afterwards appropriate laxatives to keep the intestines free of all irritating substances during the course of this disease, comprise an indispensable part of the curative plan. Opium will sometimes be resorted to by the experienced physician with the view of assuaging the severity of distress, and abating irri- tation, or with the hope of mitigating the tortures of despair. The food and drinks should consist of nutritive properties, and the patient may indulge more freely than in other fevers in the use of animal broths, soups, and jellies ; increasing in more substan- tial articles in a state of convalescence. In that sinking condition of the disease, when great debility occurs, and the vital powers are at a low ebb, the patient will require a free use of mustard whey, warm wine, and suitable doses of cinchona and brandy, together with friction, and external warmth. See the mode of treatment of spotted or petechial fever. But let it be constantly recol- <;LASS II. PERIPNEUMONIA NOTHA, OR TYPHOID PNEUMONIA. 321 lected that the features of these two epidemics, however close theii affinity in some instances, are often so infinitely modified, that no delineation can apply to all their varieties. Hence it will be found, that the most discriminating and experienced practitioner, having established a judicious system in one season or situation, will be reduced to the alternative on other occasions, either of varying his mode of treatment, or suffering himself to be foiled and baffled in all his efforts to afford relief. The following observations on Peripneumonia Typhodes is copi- ed from the appendix to Dr. Thomas's Modern Practice, by Pro- fessor Hosack. This diseaseis not a " new calamity," an " unknown epidemic,"" as it has been represented by some writers: on the contrary, it has been well described by Sauvages*, Huxham, and others: by the former, under the very appropriate appellation of" Peripneu- monia typhodes." Nor is this a new disease in the United States : in the first volume of the medical and Philosophical Register, the late Dr. John Bard of this city, lias given an account of a disorder which prevailed on Long Island, in the winter of 1749, aud which, in its essential symptoms, corresponds with the epidemic lately prevalent in this state. Dr. Bard has termed the com- plaint the " Malignant pleurisy." In the second volume of the Medical Repository (first series), the same disease is noticed by Dr. Hugh Williamson, as it pre- vailed in North Carolina, in the year 1792. In the southern states, it is commonly called, " Pleurisy in the Head," in consequence of the violent pain in the head, which frequently attends the disease in that climate. Malignant Pleurisy, or rather Typhus Peripneumony well ex- presses the mixed character of this disease ; for at the same time that it is attended with inflammation of the lungs, and in some in- stances with inflammation of the brain, the general affection of the whole system is certainly that of typhus fever. That inflammation of the lungs frequently constitutes a part of the disease, is manifest, not only from the presence of those symp- toms usually attendant upon pneumonic inflammation, viz. cough. pain in the chest, especially upon taking a full inspiration, expec- ■'■ Sec his Nosologia Methodica, vol. I. For other synonyms, sec also Cullun's Nosology, under the head of " Peripneumoniae idiopathicse complicate j'ol»r.-."' vol II.]». 101. 4) 322 PHLEGMASIA. tLASS ii toration tinged with blood, in the early stage of the complaint; but it is also evident from the phenomena presented upon an ex- amination of the body after death: the overloaded state of the lungs, the large effusion of serum, and sometimes purulent natter, the adhesions found between the membranes covering the lungs, and those lining the chest, all clearly show, that the patient has been destroyed by such inflammation.* In like manner, in some cases, the whole force of the disease is vented upon the brain, pro- ducing similar phenomena in that organ. On the other hand, the usual symptoms of a putrescent state of body, the petechia?, blotches, haemorrhages, in the latter stage,of the disease, the offensive state, of the excretions in general, and great prostration of the powers of life, which rapidly ensues, no less declare the enfeebled and vitiated state of the whole habit. There are, therefore, two oppo- site conditions of body to contend with ; local inflammation on the one hand, a typhus state of the whole system, on the other. The causes of the disease are no less compounded, than the disease itself. The local inflammatory affections are probably oc- casioned by the sensible changes of the atmosphere, while the typhoid character of the disease is derived from an epidemic con- stitution of the air, the same which has given rise to the typhus petechialis, or spotted fever, which has prevailed for some time past in our northern and eastern states, and which is doubtless a similar disease, with the exception, that the present epidemic is complicated with the symptoms of local inflammation of the chest, brain, throat, &c, the effect of the present cold season of the year. With this view of the mixed nature of the disease, and of the combined causes which have produced it, we are prepared to ex- pect the various and opposite opinions, and modes of practice, which have been adopted by different physicians. We accordingly find some prescribing the strict antiphlogistic treatment by large and repeated blood-lettinjj, active cathartics, and other depleting remedies, treating the disease, as purely inflammatory. On the other hand, we find another class of practitioners, pur- suiug the opposite course of exciting the system by the most pow- erful and diffusible stimuli, to counteract the putrescent state of body ; alleging, that it is exclusively a putrid disease, and only to be controled by antiseptics and the avoidance of all those * See Report of the Mass. Med. Society, and Dr. Hudson's letter on the pre vailing epidemic. CLASS II.. PERIPNEUMONIA NOTHA, OR TYPHOID PNEUMONIA. 323 means which are calculated to debilitate the system. As far as J have seen the disease, they are both wrong : the indiscriminate use of the lancet, recommended by some, is, in my opinion, an addi- tional source of the mortality of the disease. On the other hand, the practice of administering brandy, and Other ardent Spirits in the quantity they have been lately prescribed, is truly adding fire to the flame that is already consuming the patient, and cannot be justi lied either by principle or practice. But the prudent physician will avoid both these extremes : In the young and athletic, he will pre- vent the brain from being inundated with blood, by the early and judicious use of the lancet, blisters, and other means usually pro- scribed foi diminishing inflammation ; keeping in view the age, strength, constitution of his patient, and the general symptoms in- dicating a putrescent state of the system. On the contrary, in fee- ble old age, in the habit debilitated by disease, 01' intemperance, in which those inflammatory symptoms are less violent, and the tendency to putrefaction is most predominant, he will depend chiefly on those means usually resorted to for the purpose of pro* moting the perspiration and other excretions^ at the same time, that, by suitable antiseptic drinks and nourishment, he will guard against that debility which so rapidly ensues in this condition of the system He will in such cases, of course, carefully abstain from the use of blood-letting and other depleting remedies. But he will certainly not effect the fi'st purpose by the excessive use of brandy, and ardent spirits. So far from promoting the excretions of the system, they actually restrain those very evacuations which it should be our object to promote, and by which alone we are en- abled to counteract the typhoid state ofbody in this or any other febrile disease. As a substitute, therefore, for this stimulant mode of treatment in those cases where this typhoid tendency prevails, we are forbidden the use of the lancet, and other depleting remedies, or where the symptoms of local inflammation are so mild that they are not indi- cated, let me recommend, after emptying the bowels by an enema, or mild purgative, to make free use of the warm bath, fomenta- tions of vinegar and water to the extremeties, the liberal use of the infusion of snake-root, the eupatoriiou, ainl wine who,, in very- debilitated habits, or where the powers of 1'fe are much reduced, \v order thereby to procure a plentiful pe epilation. By tlm evacua- tion, we not only counteract the general vitiated state of the fluids. 32'4 PHLEGMASIA. LlLASS n. but we at the same time diminish, and in some cases, totally re- move, the local irritation which affects the lungs, ©r other organs. involved in the disease. For further information on the subject of the pneumonia ty- phodes,see the luminous Report of the Massachusetts Med. Society, an abstract of which may be found in the American Medical and Philosophical Register, Vol. I.; Dr. Low's account of the epidemic in Vol. IV. of the same work, and the report of the Saratoga Coun- ty Medical Society. PERTUSSIS, OR HOOPING COUGH. This is a convulsive cough, attended with a peculiar, sonorous, spasmodic inspiration, or hooping, from whence it has derived its name. It generally commences like a common cold, with slight febrile symptoms, a hoarse cough, and difficult expectoration, which sometimes last many weeks before the disease appears to be actu- ally formed, or the hooping comes on. It depends on a specific contagion, which can-affect children but once in their life. The immediate cause appears to be a viscid phlegm lodged upon the bronchia?, trachea, and fauces, which adheres so firmly as to be ex- pectorated with great difficulty. The cough generally comes on very abruptly, and the paroxysm consists of a number of short ex- pirations, in quick succession, which are followed by a full, violent, and noisy inspiration, the coughing is again renewed, and conti- nues in the same manner until a quantity of phlegm is coughed up or vomited, alone, or with the contents of the stomach, and this terminates the paroxysm. During the fits, the extremities become cold, the face turgid and purple, and the whole frame very much agitated. The forehead is covered with sweat, and in severe cases blood gushes from the nose or other parts. Hooping cough often proves tedious, and is very dangerous for very young infants. It has been known to terminate in apoplexy, suffocation, peripneumony, anasarea, and convulsions ; and in the predisposed, it lays the foundation for asthma, scrofula, and pul- monary consumption. In many instances, hooping cough appears to affect the patient in so mild a form, that a few domestic reme- dies, and avoiding exposure to cold, will suffice to obviate any se- i:LASS Hi PERTUSSIS, OR HOOPING COUGH. 32j rious consequences, but when in the first stage inflammatory or febrile action are considerable, our first step should be to deplete the vessels, by abstracting a suitable quantity of blood from the system, say from four to six ounces from a child under two years old ; and so important should this evacuation be considered, that the physician may, on many occasions, feel justified in repeating the operation. Should general bleeding in any case appear inad- missible, a sufficient number of leeches ought to be applied to the neck or chest, and the antiphlogistic course should be freely adopt- ed. For the relief of the cough, nothing is so beneficial as eme- tics, and they ought never to be neglected. At the commence- ment of the disease, the emetic should be given every morning, or every other morning, according to circumstances, and occasionally repeated during the whole course of the disease, in order to dis- burden the lungs and bronchial vessels of the viscid phlegm with which they are constantly oppressed. The wine of ipecacuanha, either alone or with the addition of syrup of squills, will be found to answer the purpose. The tincture of lobelia inflata is well adapted to the same purpose, it excites a speedy vomiting, without that straining and violent effort which tend to weary and debilitate the patient. In smaller doses, the same tincture promotes the ex- pectoration, and relieves the breathing, independent of the opera- tion of vomiting. If there is much difficulty of breathing, the ap- plication of a blister to the chest will be highly proper. The sto- mach, thorax, or spine, should be frequently rubbed with stimulat- ing substances, such as a combination of camphor and oil of tur- pentine or oil of amber, and juice of garlic, or the following em- brocation :—one scruple of emetic tartar, half an ounce of tincture of cantharides, mixed with two ounces of water ; after the applica- tion, cover the part with flannel. Similar applications, or a poul- tice of garlic, to the soles of the feet, and bathing them frequently in warm water, arc too useful to be omitted. A large plaster of Burgundy pitch, with the addition of oil of amber, should be worn constantly between the shoulders. The ilyosciamus, in the fol- lowing form, has been found extremely beneficial in the hands of an experienced physician. Dissolve ten grains of extract of Hy- osciamus in one ounce of vini antimony—dose from twelve to twenty drops for a child two years old, two or three times in a day. The Prussic acid, when skilfully and cautiously adminis- tered, allays the spasmodic violence of the cough, ami affords es-« 326 PHLEGMASIA. CLASS II. sential relief, but it must not be entrusted to unprofessional per- sons, or inexperienced practitioners. Let it be reiriembered, that some preparations of this active medicine are stronger than others, and that it should be given in small doses at first, and its effects carefully observed; before it will be safe to increase the dose, but never to exceed from four to six drops in twenty-four hours. Professor Ives, of New-Haven, thinks highly of the efficacy of blood-root in hooping cough, and Dr; William Tully, of Connecti- cut, coincides in the same opinion, and adds* if vigorously adminis- tered and faithfully persevered in, it is one of the best remedies. It should be combined with opium. The form most proper for children, is equal parts of camphorated tincture of opium and wine of sanguinaria, made in the proportion of one ounce of the bruised root to half a pound of wine. This mixture, beginning with about fifteen drops for a child two years old, may be increased to twenty- five or thirty, three times in a day, according to its effect. The preparation of hyosciamus must not be given at the same time. During the progress of tlie disease, some children become very weak, are much emaciated, and are threatened with hectic ; in such cases, nothing will contribute so much to their restoration, as country air, a milk diet* and keeping the bowels open. Blisters should be applied to the breast, if there be fixed pain, or laborious breathing. If there occur anasarcous swellings, much benefit will be derived from cathartics, and the tincture of digitalis conjoined with cordials. If the patient is seized with convulsions, it will be advisable to shave the head and apply a blister, and also the warm bath, to open the bowels, and administer the infusion of skunk cab- bage, as recommended in convulsions, and to change the air with- out delay; The cough is liable to return with violence on any fresh expo- sure to cold, after it has gone off for a time, inwhich case, a gentle emetic is the best remedy. During the continuance of the dis- ease, the patient, if weak, must be supported with a light but nour- ishing diet; and towards the decline of the disease^ the Peruvian bark and other tonics will be highly necessary; In addition to these means, we would recommend the frequent use of mucilaginous diluent drinks, and that young children sleep with their head and shoulders raised. In all cases, it will be ad- visable, upon a recurrence of a paroxysm of coughing, to hold the child up, so as to stand upon its feet, with the body bending a litte; CLASS II. PERTUSSIS, OR HOOPING COUGH. 327 forward. In order to appease the violence of the cough, a proper dose of elixir paragoric ought to be repeated occasionally. Tiie duration of the disease varies fiom one to three months ; and if taken in the winter, it seldom terminates until the return of warm weather. But in every instance, both the duration and vio- lence of the disease may be diminished by a removal into the country air, or at some distance from the place where it was con- tracted. A solution of the alkaline salts is a remedy of considera- ble efficacy. The following formula has been on some occasions recommend- ed to public notice, as a remedy in hooping cough; although we have no experimental knowledge of the medicine, it ma}' be de- serving of trial. Dissolve twenty grains of salt of tartar in a gill of water, add to it ten grains of cochineal, finely powdered, sweet- en this with fine sugar, and give an infant a tea-spoonful four times a day. To a child of two or three years old, two tea-spoofuls ; from four years and upwards, a table-spoonful or more may be taken. In every case it is necessary that the bowels be kept loose by the use of mild laxatives. It is often found necessary to administer opiates to alleviate the urgent symptoms in hooping cough, but it is best to combine opium with ipecacuanha and carbonate of soda, as recommended by Dr. Pearson. After the accumulated phlegm has been thrown off by antimonial emetics, he directs for a child between one and two years old, one drop of laudanum, five drops of wine of ipeca- cuanha, and two grains of the carbonate of soda, made up into a draught with syrup and water, and to be repeated every four hour& for several days, obviating costiveness by calomel and rhubarb. Dr. Thomas recommends laudanum, with a few drops of ether ap- plied as an embrocation to the breast and stomach, three or four times in a day. As an antispasmodic in pertussis, artificial musk* has been given with considerable success. The dose for children is ten or twelve drops, graduated to the age and circumstance-s. Both natural and artificial musk may be very conveniently exhi- bited in the form of julap, with gurn arabic and sugar.f Among the remedies in pertussis, hemlock and digitalis have their advo- cates, and when combined with opium, they have appeared to af- * Artificial musk is made by pouring three and a half drachms of nitric acid on one drachm of oil of amber, and washing the product. t Sec the American New Dispensatory 328 PHLEGMASIA. CLASS H. ford relief. Belladona has been much employed in Europe, and it is said with signal, success. The dose is a quarter of a grain of the powdered root, with a few grains of sugar, morning and night, to children under one year, to those from two to three years, half a grain, twice in the twenty-four hours; and to those from four to six years of age, a grain and a half in the same time. The dose may be enlarged every two or three days, until the increase equals half of the first dose. The arsenical solution of Dr. Fowler has a high reputation with many practitioners who have been in the habit of employing it in pertussis ; it moderates the symptoms in a few days, and sometimes cures the disease in a short time : dose, from two years old to four, two drops, or three to five; from five to seven, five to seven drops ; from eight to twelve, seven to ten drops ; from thirteen to eighteen, ten to twelve drops. These doses may be repeated once in eight or twelve hours, diluted with gruel or barley water. The compound syrup of sanguinaria cana- densis, to be found in the appendix, appears to be well adapted in this complaint. It remains to mention that the feeble patient in the advanced stage of this disease, will require all the aid to be obtained from tonic medicines and a restorative diet. Cinchona bitters, the bark of wild cherry-tree, with preparations of steel and :zinc, may be recommended. PNEUMONIA,—PLEURITIS OR PLEURISY. A pleurisy is an inflammation of the pleura, or membrane which lines the thorax and envelopes the lungs. It may be occa- sioned by exposure to cold, and by all the causes to which other inflammatory diseases are usually ascribed. It prevails chiefly in the spring, and attacks most frequently those of robust constitu- tion and of a plethoric habit. This disease generally begins like most acuta fevers"with a sense of cold and shivering, followed by heat, thirst, flushing of the face, and other febrile symptoms. The pulse is puick, hard, and strong; and an acute pain is felt in one of the sides, most commonly the right, which increases upon every inspiration, and attended with a difficulty of lying on the side affected. A difficulty of breathing succeeds, accompanied with short cough, at first dry, but afterwards 'LASS II. PLEURISY. 32^ moist, with some expectoration of phlegm, either streaked with blood or of a yellowish colour. The efforts of nature in this disease indicate relief by expecto- ration from the lungs, with which the pleura is intimately connect- ed, and our utmost endeavours should be directed to the promotion of that salutary discharge. The patient should be kept quiet, cool, and easy; his diet must be of the most slender kind, and his drinks should be mucilaginous and cooling, as barley water, gruel, infusions of figs and raisins marsh-mallows, liquorice, flaxseed, and mullein. These should be taken moderately warm, and often sipped, in order to moisten and relax the throat and adjacent parts, and they have an excellent effect in sheathing the acrimony of the humours, which irritate and excite fits of coughing. His feet and hands ought to be bathed in warm water several times in a day, and the steams of the decoc- tion of emollient herbs, or of warm water and vinegar, should be frequently inhaled into the lungs by means of Mudge's inhaler, or an inverted funnel. Drastic cathartics are improper in this disease, but the bowels must be kept moderately loose by small doses of Glauber's salts or aperient clysters. Pleurisy is one of those diseases in which every physician knows the importance of copious bleeding from the system, as early as possible, after the complaint is formed. It is immaterial from which side blood is drawn, but very essential that it be from a large orifice. Dr. George Fordyce is particularly solicitous to inculcate this practice, and it accords with the sentiments of our most experienced practitioners. The quantity drawn, ought to be to the full extent of the strength, and the violence of the symp- toms of the patient. If after the first bleeding the pulse re- mains full, hard, and obstructed, the pain in the side acute, the breathing difficult, and the blood exhibit a sizy crust on its sur- face, it will be necessary to repeat the operation at the distance of some hours, and even a third or a fourth time, should there be no mitigation of the symptoms ; recollecting, however, that after a free expectoration has commenced, bleeding will be injuri- ous. Topical bleeding, either by leeches, or by cupping glasses, and scarification, applied immmediately over the pained part, is of considerable advantage. Emollient fomentations made of camomile flowers, elder flowers, or marsh-mallows, should be applied to the sides as warm as the patient can bear, and soorj 42 3S0 PHLEGMASIA. QLASS A. as the cloths cool they ought to be changed, and care taken to prevent catching cold. Blisters are of great utility in pleurisy, but in every case of acute inflammation, their use should be pre- ceded by copious bleeding, as they seldom produce so good an effect until the inflammatory action of the system has been in a considerable degree subdued. After proper bleeding has been premised, a blister of eight or ten inches square should be applied immediately over the part affected, and when one is healed another ought to succeed it, and be continued open for several days, or till the pain is removed. Or a large poultice of onions, either raw, or roasted, and sprinkled with vinegar, will sometimes afford more speedy relief than blisters, where the lungs are greatly oppressed without expectoration. With the view of assisting nature as much as possible in throwing off the offending matter from the lungs by expectoration, various means have been employed and recommended; among the first, and certainly the most efficacious, are mercurials. Very beneficial effects may be derived from the use of turpeth mineral in doses of one or two grains every four or six hours ; or a powder Composed of about two grains of calomel and half a grain of opium, or this proportion, varied as the case may require, should be repeated every six or seven hours, and a liberal quantity of barley water ought to be directed during its use. This remedy has received encomiums from various respectable sources as an excellent expectorant, and the course should be commenced immediately after blood-letting has been premised. The pleurisy root as directed in the Ameri- can New Dispensatory, will be found a valuable remedy. Antimonials, in nauseating doses, are also considered as highly useful in promoting both expectoration and cutaneous perspiration". A solution of tartarized antimony, is the preparation most general- ly prescribed for this purpose, and the doses should be such as to excite a slight nausea without vomiting. If four grains of emetic tartar be dissolved in six ounces of water, with one ounce of spirits of lavender, and a little sugar, a table-spoonful of the mixture may be taken every four hours. As a powerful refrigerant, sal nitre is much commended in this disease, in doses of ten or fifteen grains every three or four hours; it may be added to the mixture just mentioned, or to the mercurial powder, to avoid multiplying the medicines. When the chest is much oppressed with tenacious phlegm not easily expectorated, the following mixture will be found ULASS II. PERTPNEUM9NY, OE INFLAMMATION OP THE LUNOS. 331 well adapted to afford relief. Take of the milk of gum ammoni- acum, four ounces, of oxymel or syrup of squills, one ounce, a table-spoonful every four or five hours. Where the action of the lungs requires to be excited by a moderate stimulus, a decoction of the seneka root has been used with satisfactory success. It may be directed in the quantity of two or three table-spoonfuls, as the patient's strength will permit, three or four times in a day. The class of mucilaginous and oily medicines should in no case of this disease be omitted, as they serve to sheathe the acrimonious humours, to abate irritation, and appease fits of coughing. For this purpose the common emulsions, and the syrup of marsh-mal- lows, are admirably adapted. As opiates evidently tend to give a check to expectoration, they should be prohibited in the first stage, but when they become abso- lutely necessary to procure sleep, and to appease the distressing cough, at a more advanced period, two tea-spoonfuls of camphor- ated tincture of opium, (paragoric elixir,) with the same quantity of spiritus nitri dulcis, may be directed at night with much safety and advantage. After the fever and pain have subsided, and the patient is in a state of convalescence, a few doses of gentle physic should be advised, and his body ought to be replenished with healthy juices, by means of a light diet of easy digestion. As persons who have once been affected with pleurisy are particularly liable to its at- tacks, they ought prudently to avoid every cause which can have a tendency to reproduce the disease. PERIPNEUMONY, OR INFLAMMATION OP THE LUNGS. This disease is sometimes complicated with pleurisy, and there is such analogy in their nature and character, that instances occur in which physicians are unable to define the line of distinction. In pneumonia, there is a variation in the symptoms accordingly as the inflammation affects more especially the substance of the lungs, and their proper covering, or the contiguous membranes, and com- bined with each other in various degrees. The peripneumony is commonly divided into the spurious, which is occasioned by a vis- cid pituitous matter obstructing the vessels of the lungs, and the 332 PHLEGMASIA. CLASS II. true, or catarrhal, when it arises from a thin acrid defluxion on those organs. Pulmonary inflammation, by some called lung fever, may proceed from the same causes as the pleurisy, especially the application of cold and wet to the body which gives a check to per- spiration, and determines an unusual flow of blood to the lungs; severe exercise, a free indulgence in the use of ardent spirits, repell- ed eruptions, and external injuries. It attacks principally those of a robust constitution, and plethoric habit, and occurs most fre- quently in the winter and spring. The symptoms which characterize pneumonia, are great op- pression at the breast, with difficulty of breathing, an obtuse dull pain in some part of the chest, with inability to lie on the side when that is affected, together with a cough, dryness of the skin, heat, anxiety, flushing of the face, sometimes it is swelled, and appears of a purplish hue. The pulse is usually full, strong, hard, and frequent; but in the advanced stage, it is commonly weak, soft, and often irregular. In the beginning, the cough is frequently dry, but in some cases it is moist even from the first, and the matter spit up is various both in colour and consistence, being often streak- ed with blood. When pulmonic fevers terminate favourably, the change com- monly takes place from the fourth to the seventh day, though in some cases it is extended to the fourteenth. The curative treatment of pneumonia, both in diet and medicine, is in general, the same as in pleurisy. The cooling antiphlogistic plan of regimen, should be strictly enjoined through the whole course of the disease ; the patient must be supported with food of a light nutritive nature. Blood-letting is of essential importance, and it ought to be drawn from a large orifice, and the quantity proportioned to the strength and vigour of the patient, and the urgency of the symptoms. One copious bleeding is always more beneficial than repeated smaller ones; though in cases of high inflammation, and imminent danger, a repetition of the operation will be indispensable, until an abate- ment of the inflammatory diathesis takes place. In many instances of slight pneumonia, the pectoral remedies usually directed in catarrh, will effect a cure without bleeding, and in aged persons the loss of blood is often inadmissible, so that much depends on the judgment of the attending physician in this dangerous com- plaint. The next mean, best adapted to afford relief from the CLASS II. PERIPNEUMONY, OR INFLAMMATION OF THE LUKGS. 333 distressing symptoms, is the repeated application of strong blisters, eight or ten inches square, to the parts affected ; practitioners of experience need not to be reminded that vesicating the parts about the thorax, is of the greatest utility in cases of pulmonic inflamma- tion, not only from the discharge which they occasion, but from their effect in removing spasm, and promoting the discharge from the lungs. Warm fomentations, and a poultice of roasted or mash- ed onions applied to the chest, will be found highly beneficial. The safety of the patient, however, greatly depends on a free and easy expectoration within the first three or four days of this dis- order. Those most powerful expectorants, the mercurial powder, and the solution of tartarized antimony, in small nauseating doses, as directed in pleurisy, may in this disease be administered with full confidence, as experience has amply confirmed their superior efficacy. The two preparations may be given alternately, and when the mouth becomes slightly affected by the calomel, the fe- brile symptoms will soon subside, and should the antimony induce evacuations from the stomach or bowels, it must be discontinued, or the doses diminished, lest it produce too great debility of the system. The turpeth mineral will be found of signal advantage as an emetic and expectorant. Moderate purgative medicines will occasionally be proper, but these must neither be heating or dras- tic ; eight or ten grains of calomel, followed by an ounce of Glau- ber's salts, will be a suitable carthartic for an adult. Instances will occur in this disease, in which emetics will be strongly indicated; when the stomach appears to be overloaded, and the lungs greatly oppressed with phlegm, moderate doses of Ipecacuanha, combined with tartarized antimony, or squills, will afford more effectual re^ lief than any pectoral medicine. In cases of young children, who are frequently affected with this disease, there is not a more ef- fectual mode of procuring relief, than by repeated vomiting by means of Ipecacuanha or antimonial wine. It not unfrequently hap- pens, that emetics in their ordinary doses, or even when increased, fail to produce the desired operation. I have in such cases of late years, administered the lobelia inflata, or Indian tobacco, with much success. It will often induce vomiting in a very speedy and effectual manner, and frequently relieves the laborious breathing, without its emetic effect. A table-spoonful of the tincture, for an adult, and a tea-spoonful for a young child of three or four years, may be a proper dose, and repeated if necessary according to its effect. 334 EHLEGMASLE* CLASS II. Mucilaginous and demulcent medicines are among the most use- ful means of affording relief from the fatiguing cough. These have been often detailed in the chapter on catarrh, and on pleurisy. But the inhalation of the steams of warm water, impregnated with vinegar, or demulcent herbs, is a remedy so peculiarly useful in all pulmonic complaints, and at the same time so seldom put in prac- tice, that the employment of it in the most copious manner may be again recommended. The gum ammoniacum, squills, and the extract of liquorice, pos- sess pectoral qualities which may be advantageously applied in some varieties of pneumonia, and in aged persons, much benefit may be derived from the use of a decoction of seneka snake-root. When the inflammatory symptoms have subsided, and the patient is much exhausted by a distressing cough, two or three tea-spoon- fuls of paragoric elixir, in some pectoral drink, will effect the de- sired respite and relief. It may be proper to observe, that a large proportion of cases of inflammation of the lungs, have an unfavourable termination, and in the asthmatic, especially those advanced in life, it generally proves fatal. When on recovery, the patient should carefully guard against exposure to wet and cold, or any irregularity which might occasion a relapse, as it may lay the foundation for a fatal consumption. When tonic medicines become necessary, the cascarilla, quassia, thoroughwort, and the wild cherry tree bark, should be advised, as the cinchona bark will seldom be proper. When the inflammation of the lungs does not yield to bleeding, and the other remedies prescribed, it usually terminates in suppu- ration, and a vomica or empyema is the consequence. The former is an abscess or collection of matter formed in the substance of the lungs, and the matter in this case may be discharged by expectora- tion ; the latter, being a fluid floating in the cavity of the breast, between the pleura and the lungs, can only be discharged by an incision made between the ribs, and without this operation the event will be fatal. Diaphragmitis, inflammation of the diaphragm, Carditis, in- flammation of the heart, and Pericarditis, inflammation of the pericardium, are on most occasions scarcely to be distinguished from pneumonia, and probably are usually combined with it. c' Happily the treatment which has been recommended in pneu- eLASS It. SPOTTED OR PETECHIAL FEVER. 335 monia is equally suited to these inflammations, with this difference, however, that as the parts affected are immediately necessary to life, the means of cure must be employed with promptness and diligence." Since it is the opinion of some American writers that the disease now to be con- sidered should be distinguished in its pathological character from peripneumonia typhodes, I shall feel myself justified on the present occasion in adopting that appel- lation which has been assigned to it by general consent. SPOTTED OR PETECHIAL FEVER. This very formidable disease made its first appearance in our country in the town of Medfield, Massachusetts, in the year 1806. Subsequent to that period, it has occasionally been recognized as an epidemic in various parts of the New-England states, in the state of New-York, and on the borders of Canada. In 1810 it prevailed with mortal rage in the county of Worcester, and other parts of this state, and in the autumn of 1812, and winter of 1813, the same or a distinct epidemic visited the army of the United States, at Greenbush, and at various other situations, where its destroying power has scarcely been exceeded by military slaughter. It was prevalent also in Connecticut and Vermont, and a consid- erable number of fatal cases occurred likewise in Boston, both among the inhabitants, and the soldiers quartered in that metropo- lis. It has usually occurred during the cold weather of winter and spring, and its continuance has been protracted in some seasons to May and June, chiefly in the interior of the country. In some instances, death has ensued within a few hours in a manner similar to the plague, but in others, the disease has been very mild in its attack, and short in its duration. This epidemic exhibits a re- markable variety of character, often counterfeiting other disorders; and is so insidious in its approach, that the physician is not un- frequently surprised by the event of death, even before danger wa^ suspected. The name " spotted fever,'" as designating the present disease, has been deemed exceptionable by most medical men, as a very small proportion of cases were marked with petechia3, spots, or eruptions ; nay, some have asserted that spots are wanting in five- 33C PHLLGMASLE. CLA-SS II. cases out of six. A judicious writer in the New-England Journal of Medicine and Surgery, Vol. I. p. 240, prefers the name malig- nant nervous fever, as being more appropriate. The predisposing cause of this terrific malady, seems to have eluded investigation. That it is not contagious, is universally agreed. The suggestions that ergot, (spurred rye,) or any other foul grain, has been influen- tial in its production, is not corroborated by a single shade of evi- dence. The true cause of its prevalence undoubtedly is, like that of all other epidemics, dependent on a peculiar state of the atmos- phere, and the predisposition of our bodies being favourable to its operation. The exciting causes are precisely those which are known to operate in all cases during the prevalence of epidemics which are not contagious. These are errors in diet, intemperance, exposure to cold or damp air, fatigue, anxiety of mind, and assidu- ous attention to the sick. All ages and classes are liable to its attacks, and to become its victims. Persons have often been at- tacked a second time, and relapses have frequently occurred with the same symptoms as in the original attacks, and these cases often terminate fatally. The most fatal consequences have been known to result from tlie influence of fear and horror. The terrific name of spotted fever, or cold plague, its well known fatality, the tolling of bells, ♦lie frightful visage, the weeds of mourning, and the tears of sor- row, wonderfully conspire to induce a morbid state of the system, favourable to the reception of the disease, and tend more immedi- ately, perhaps, than any other causes, to multiply the instances of mortality. The humane and prudent physician, therefore, will, to the utmost of his power, divest the disease of its terrific name, and obviate all the circumstances and causes which occasion alarm. In March, 1810, the counsellors of the Massachusetts Medical Society, solicitous for the public welfare, appointed a committee to investigate the nature, history, and mode of treatment of this alarm- ing epidemic ; and of their very able and judicious report, I avail myself on the present occasion.* The invasion of the disease is generally sudden and violent. The patient is seized in the midst of his usual labours, and often- times is struck down suddenly almost as by a stroke of lightning. * The committee consisted of Thomas Walsh, M. D.; James Jackson, M. D.; and John C Warren, M. D. el.ASS II. SPOTTED OR PETECHIAL FEVER. 337 The first symptoms are exceeding various, scarcely two cases re- sembling each other, and the diversity of symptoms are not to be comprised in any enumeration. The disease often commences with shifting pains, sometimes beginning in one joint, or one limb, in the side, back, neck, or head, either a sensation like a stinging of a bee, or most excruciating pain moving from place to place, with great violence, and is often confined to one side of the body. The pain in the head is often so intolerably severe, that it is com- pared to the beating of hammers upon the part. Partial loss of sensibility, numbness and paralysis of the limbs, deafness, dimness of sight, or total blindness ; delirium, either mild or furious, stupor and coma, convulsions and spasms occasionally attend the access, or occur in its later stages. Some have been affected with that species of spasm termed opisthotonos, when the head and heels have been violently drawn almost in.ccmtact. There is a remark- able prostration of strength, and sometimes accompanied or fol- lowed by severe chills ; the skin dry and pale, eyes dull and glassy, pupils contracted, and again suddenly dilated ; the tongue white at first, and assumes a reddish colour; the face sublivid, with paleness around the mouth, and the countenance expressive of the utmost anxiety and distress. The whole body becomes cold, respiration very laborious, pulse small, feeble, and irregular, slow at the begin- ning, but afterwards greatly accelerated. There is great oppres- sion and faintness, with indescribable distress about the praecordia ; eructations, nausea, and vomiting ensue, occasionally becoming incessant, embarrassing, and obstinate. With more or fewer of these symptoms of the first stage, some have died in twenty- four hours. In the second stage, about the third day the pulse becomes more full and regular, the skin warmer, countenance flushed, respiration short and very difficult; eye-lids swollen, and eyes staring, with a throbbing pain in the head, great restlessness, anxiety and delirium ensue. In a large proportion of cases, these symptoms have all subsided, and the disease has ter- minated within three days, often in one, the patient suffering pnly a slight debility. The following singular appearances have been observed among the various forms of this disease, especially with female patients. " Universal deadly coldness; skin white as polished marble and smooth ; countenance perfectly placid ; not one distorted muscle ; pulse in the wrist imperceptible ; motion of the heart scarcely to be felt; respiration visible only by gasping. 43 338 PHLEGMASIA. CLASS 11. and that not frequent; and as it were only a step between this imperfect state of life, and death." Even from this forlorn and hopeless condition, recoveries have been known to result. The intestines appeared in general to be exempted from the ef- fects of the disease, as constipation or diarrhoea rarely occurred, though in a few instances bilious matter was evacuated from the stomach and bowels. The urine is scanty and high coloured, and the patient is often afflicted with strangury. When sweating took place, the matter discharged imparted a peculiar mawkish smell. A small proportion of the sick, greater in some districts than others,, die in ten or twelve hours, others in twenty-four, thirty-six, or forty-eight hours from the first symptoms of the disorder. On some occasions the threatening symptoms seem to subside, when in a few hours another paroxysm dissevers the slender thread of life. When the fatal termination happens within two days, besides many of the symptoms already enumerated, the countenance is fallen, the solids flaccid, petechial spots of dark colour, violet, or livid, suddenly appear on the superior extremities, and immediately over the whole body. At length confusion of mind, with constant drowsiness, inability to swallow, respiration more frequent and more laborious, with fluttering pulse, bespeak the speedy dissolu- tion of the sufferer. The spots on the skin occur in all stages of the disease. The blotches are florid, or red and fiery. Vesicles and pustules re- sembling measles, vaccine and variolous eruptions, attended with itching, and followed by scabs of a* brown colour, have in a few cases been observed. After death, the skin assumes a formidable livid colour, either generally diffused over the body, or in spots on the face, neck, and shoulders, and gradually extending to the back 'part of the trunk. The parts that had been blistered become quite dark coloured and bloody. On dissection, it almost constantly appeared that the brain with its meninges and blood vessels were in a diseased state, and in most instances there was an effusion of serous fluid, and of coagu- lated lymph within the ventricles. In the thorax, the heart and pericardium have in general exhibited some appearance of diseas- ed affection, and the lungs and pleura have often been found in a morbid condition. It has been remarked that this, like all other epidemics, is sub- ject to great mutability of character, seldom retaining the same' CLASS II. SPOTTED OR PETECHIAL FEVER. 3<39 form and degree of malignancy in different seasons, and in remote parts of the country. In that form which it assumed in 1812—13, though manifestly the identical disease, the peculiar symptoms were, extreme pain in the side or breast, with great oppression and difficulty of respiration, short distressing cough, chills, and great prostration of strength, the pulse a little accelerated, rather full, not very hard, but easily compressible. The tongue at first yellow, then brown and dark coloured, the countenance peculiarly livid, and the patient slightly delirious. Afterwards the cough increases, and expectoration sometimes occurs. The heat of the body is not proportional to the violence of the pain, and never ap- proaches that of common inflammations. In the worst cases, the pain in the side or head is inexpressibly severe, and the general sensation about the praecordia is indescribably distressing; the pa- tient becomes delirious, and dies in two or three days. In some instances tho disorder resembled a common pleurisy, except that the pulse was not so hard, the cough nor the heat so great, nor the progress so regular. Dissections in these cases demonstrated a morbid state of the heart and lungs, with their contiguous mem- branes. With respect to the mode of medical treatment in this awful disease, it is obvious that it must be varied with the vacillating symptoms which are present. In a large majority of instances, no pressing danger will occasion solicitude, or embarrassment on the part of the physician, and little attention will be requisite to dis- criminate between those of the mildest grade, and violent cases, which demand the most prompt and decisive applications to obviate the speedy destruction of the patient's life. Because experience has sanctioned the practice of evacuating from the system at the beginning of acute diseases in general, it would be absurd indiscriminately to adhere to this rule in diseases of a malignant and debilitating tendency. The most important of all evacuations is that which abstracts the vital fluid from the gen- eral system ; this may, in the present case, prove highly beneficial, or irreparably injurious. Such is the infinite diversity of forms and symptoms, that no measure can be adopted with a prospect of success, without a cautious discrimination of existing circum- stances. The constitution, former habits, season and particular character of the epidemic, must be critically reviewed. Instances have must undoubtedly occurred in practice, in which blood-letting 340 PHLEGMASIA. CLASS II. to considerable extent has been the mean of " turning death into life, and despair into confidence ;" whilst on the other hand, there have been some, who, while their condition was not apparently very dissimilar, became the victims of the same operation. It should probably be established as an invariable rule in this disease, never to open a vein when the blood has receded from the surface and extremities, and left those parts in a state of coldness and torpor. But first moderately stimulate the heart and arteries by mild cordials, as warm wine, ether and laudanum, accompanied by the application of external heat; and when by these means external action and warmth are restored, and the pulse perceived to rise and become hard, blood may be drawn, but if the pulse again sink during the operation, the evacuation must be stopped and cordials administered. It has been remarked, that in the epidemic of 1810, evacuations were scarcely admissible, whilst in that of 1813, evacuations of some kind were almost constantly necessary, and blood-letting in particular was in most severe cases indispensable. When there is phlegmonous inflammation affecting the brain and its membranes, or when that organ is suffering pressure from the fulness of its ves- sels, manifested by coma or convulsions, respiration extremely distressing, and if the pressure is so violent that the face swells and becomes almost black, like a person who is strangulated, no prudent physician can hesitate to draw blood from the jugular vein, or the arm by a large orifice, that the relief may be as im- mediate as possible. If the head be unusually hot, the application of cold water to the head and face during the operation will be proper, and some mild cordial stimulant, as aqua ammoniee with spirit of lavender, and essence of peppermint, should be given to prevent a dangerous faintness. In cases of inflammation, or local congestion on the heart, lungs, or their membranes, venesection will become equally indispensable ; and if in either case much re- lief be obtained, if the pulse become more full, soft and slow, and especially if considerable inflammatory buff appear on the blood, the operation may probably be advantageously repeated. But in circumstances the reverse of those just detailed, the use of the lancet must be prohibited. Should there be evidence of a foul state of the stomach, and a dry skin, an emetic of fifteen grains of ipecacuanha, and eight or ten of sulphate of copper should be exhibited. The intestinal <"LASS II. SPOTTED OR PETECHIAL FEVER. 34L canal must be kept in a soluble state by small doses of calomel or some mild laxative and injections during the continuance of the disease. The next remedies to be mentioned as among the most impor- tant, are epispastics ; these should be applied early in the disease, and as near the part most affected as possible; and in order to obtain their speedy good effects, the skin should first be excited by friction with strong tincture of cantharides. When the blisters are applied, care should be taken that they adhere properly to the skin until it be thoroughly vesicated. So highly beneficial are their effects, that blisters ought to be applied in succession to the head and chest, until the most effectual relief be obtained. In every case of considerable violence, the head should be immedi- ately shaved, and cold water and vinegar applied, while the back of the neck and temples are vesicated. Sinapisms to the feet, and sometimes to the wrists, may be useful. In most instances of this disorder, sudorifics will be found essentially beneficial; for this purpose ipecacuanha and opium, in the form of Dover's powder, with camphor, is one of the most eligible preparations, in doses of fifteen or twenty grains, often repeated, until the desired diapho- resis be effected. The sweating should in no case be carried to excess, but a moderate diaphoresis ought to be continued a consid- erable length of time, to derive from it all the benefit it is capable of affording. Such is the compound character of this disease in different sea- sons that instances will occur in which the pulmonary affection will yield only to large and repeated bleedings, in connexion with the other antiphlogistic means. In others, the general prostration of the system will be such, from the commencement, that the lancet must be rejected, and resort had to an alterative course of calomel and opium, in the efficacy of which great reliance may be placed to effect a change in the diseased action of the system. \V hen the patient is tormented with intolerable pain, recourse must be had to opium as the only solace, and in fact, instances have been reported in which this medicine has rendered perma- nent advantage. Where besides excruciating pain, the pa- tient suffers from faintness, depressed state of circulation, and torpor of the extreme vessels, the following cordial preparations may be expected to produce the happiest effects, though I have not ascertained that it has been employed in this disease: Take 342 PHLEGMASIA. &LASS 11, of volatile tincture of gum guaiacum and anodyne balsam, equal parts, about two drachms every two hours, until relief be obtained. This will produce warmth in the stomach, and over the whole body, excite increased action of the heart and arteries, relieve pain, and promote a diaphoresis. The oppression on the lungs attended with cough without ex- pectoration, is to be relieved by blisters and pectoral medicines. Of this class none is to be preferred to turpeth mineral; if the patient is not too much debilitated, about two grains given every fourth or sixth hour soon exerts its effect by exciting a free expec- toration. This may be assisted, if necessary, by squills and sene- ka root, the latter of which in doses of a table-spoonful of the decoction, or about six grains in powder, three or four times in a day, has been found highly useful as an expectorant and diapho- retic. Antimonials are not, in any form, it is supposed, advisable in this complaint. We must however except some reported cases) where antimonial wine and laudanum combined, was advantageous- ly employed. A whey prepared from mustard seed, as in the Ap- pendix, has been employed with good effects, and is recommended as a useful warm stimulant and expectorant. As assisting the oper- ation of diaphoretic medicines, a warm decoction of thoroughwort is by some held in much estimation. Here it is proper to advert to the hazardous practice, so absurd- ly adopted in many places, of administering, without the advice of a physician, large quantities of brandy and other internal stimu- lants, tending to increase the excitement in the large internal ves- sels, without being capable of inducing reaction, and equalizing the circulation in the extreme vessels of the skin. The fullest at- testations derived from ample experience, prove the dangerous tendency of these measures when indiscriminately or incautiously employed, as they aggravate all the symptoms, and occasion a ra- pid progress of the fever into its most malignant state, which sud- denly and unexpectedly terminates in death. These means, how- ever, are not in every instance to be prohibited, for oftentimes a cautious use of stimulants may be indispensably necessary. The excitement of the system should on all occasions be supported nearly as possible to the natural standard, but never raised by ar- tificial means above that of health. With this object in view, the stomach must be invigorated by the lighter kind of stimuli, as warm aromatic tea drinks, and such medicines as will commuui- CLASS II. SPOTTED, OR PETECHIAL FEVER. 343 cate congenial warmth, without irritating by their stimulus the heart and arteries. Among these are, saffron, sage, pennyroyal, orange peel, seneka root, Virginian snake-root, cinnamon, camphor, spirit of lavender with essence of peppermint, ether and wine, to which may be added pure cider, coffee, mustard whey, and animal broths. Whilst some of these are given in moderation, the appli- cation of artificial heat to the surface is by no means to be neglect- ed, provided there is a deficiency of natural warmth and excite- ment in the extreme parts of the body. When a torpid state of the cutaneous vessels, and consequent coldness of the skin prevails, and perhaps the internal organs are at the same time labouring under a dangerous congestion, the application of external warmth becomes a point of primary importance in the early stage of the disease, in order to excite action on the surface, and divert from the internal viscera. The warm bath is well suited to answer the desired purpose, but on many accounts it may be more conveni- ent, and not less useful, to enclose the body of the patient in blan- kets dipt in warm water, renewing them often as they become cool, after which the skin should be wiped dry, and the patient's body kept moderately warm between blankets, that the renewed action on the surface may be properly supported. Billets of wood* having been well heated in boiling water, may also be applied to different parts of the body, where required. The small limbs, or twigs of hemlock, or pine, after being a little moistened, and then thoroughly heated by enclosing them in a cloth with a hot stone, will impart to the body a dry heat, well calculated to fulfil the in- dications. But the method invented by Dr. Jennings, of commu- nicating heat by means of a spirituous vapour bath, is supposed to be preferable to all other means hitherto employed for restoring warmth and heat to the surface and extremities of the body. What- ever method be adopted, should be so regulated that the heat of the surface be not increased beyond the natural healthy standard. One circumstance, not generally adverted to, is to be regarded as peculiarly important; the patient should never be permitted to sleep longer than one hour without being roused and desired to swallow some drink or medicine, otherwise a fatal torpor or coma may ensue and close in death. In regard to the use of tonic re- medies in the last stage of this disease, Huxham's tincture of Pe- ruvian bark, decoction of cascarilla, stomachic bitters, and the 344 PHLEGMASIA. CLASS II. mineral acids, with thoroughwort, are those which may be most advantageously employed. Fowler's solution of arsenic has acquired considerable repute and practitioners in general of most experience in this disease, have agreed in their expressions of confidence in its superior effi- cacy. This remedy, however, is not often to be advised at the onset, but reserved to an after period, when proper evacuations have been made, and a subsidence of violent symptoms has taken place. The proper dose is from three to six drops, every four or six hours, until its effects-on the system become evident by a pe- culiar sensation about the eyes and face. The diet during this disorder may be more liberal than that al- lowed in acute diseases in general, as the appetite and powers of digestion are not much impaired. It may consist of the usual fa- rinaceous substances, and animal broths and soups, with some ve- getables. The following valuable statement has been presented for this work by Dr. Benjamin Page, of Hallowell. The extensive expe- rience of Dr. Page renders his communication particularly accept- able, and from the accurate and judicious manner in which he de- tails his method of treatment, it may well be considered as an ac- quisition meriting the confidence of the public. • Dr. Page's practice, in the spotted fever, was in Hallowell and other adjacent towns, in the state of Maine, and for a short period at Wiscasset, and comprising a period (chiefly in the winter) from the commencement of 1810 to the summer of 1816, but the dis" ease prevailed more generally, and with its greatest violence, in 1814. " The symptoms of this fever? on its first attack, were extremely various. It frequently appeared in disguise, and often counterfeit- ed other diseases; but its characteristic features were so prominent, as seldom, if ever, to mislead the attentive practitioner. It com- monly commenced with chilliness, or violent rigors, and the sys- tem was usually so torpid, that the patient, though shivering, wa3 never sensible of being cold. Great heat followed, but there was little thirst. Violent pain was felt in the head, commonly across the forehead or through the temples. Sometimes severe pain oc- curred in the stomach, accompanied with nausea and vomiting ; at others, stiffness and pain in the muscles of the back of the neck. Some were seized with pain in one of the eyes, ears, teeth, or in 'AASS II. SPOTTED OR PETECHIAL FEVER. 345 a single joint; which would often change its situation with the ra- pidity of an electric shock, to other parts of the body. Many were seized with numbness of the extremities, which sometimes pervaded the whole surface of the body. Slight soreness of the throat usual- ly occurred. There was commonly great prostration of strengths with dejection of spirits, an anxiety about the region of the stom- ach, and palpitation of the heart. Many persons, without any premonitory symptoms, fell, as it were, lifeless, and required im- mediate exertion to restore the partially suspended action of the powers of life. The pulse was frequent or feeble, and often une- qual and intermitting, but sometimes free from all irregularity. Spots of different sizes and colour, appeared on different parts of the body, at different periods of the disease. "The bodies of those in whom the disease proved fatal, common- ly exhibited a livid discoloration of the skin immediately after death. Hemorrhages sometimes occurred, but were not always an unfavourable symptom. The brain and nervous system were much affected. Coma and delirium sometimes occurred, especial- ly with aged persons, on the commencement, though more general- ly in the progress of the disease. The hearing was deranged, and in many cases the eye sight impaired. The pupils were dilated, and the eyes suffused with blood. Biles and carbuncles often af- flicted the patients, especially in the convalescent state ; and some- times the parotid axillary and inguinal glands were enlarged from the commencement of the disease. " From these various affections we may conclude, that the first and principal indication of cure is to increase the excitement, and support the sinking powers of life. This may be effected by sti- mulants, especially of the cordial and diaphoretic class, and tonics. The stimulants should be external and internal. The former may be obtained by putting the feet into warm water, placing the pa- tient in bed between blankets, and applying to different parts of the body, billets of wood boiled in water, hot bricks, or brands of fire quenched in vinegar or water, and bladders of hot water or flan- nels wrung out of the same. In severe eases, frictions of the whole body with sweet oil were sometimes used. Blisters and rubefa- cients to the head, neck, chest, stomach, or limbs, were often high- ly important; as also sinapisms to the feet. Internally, may be given hot teas of pennyroyal, sage, peppermint, or dwarf yew, (commonly known in these northern parts by the name of groom} 44 346 PHLEGMASIA. CLASS II. hemlock ;) either alone, or combined with brandy or other good spirit; also the warm essential oils ; (those most used were pep- permint, lavender, rosemary, origanum, cinnamon, spirits of tur- pentine, &c. as circumstances required;) also hot punch, wine whey, &c. When the stomach is much disordered, a gentle eme- tic of ipecacuanha and sulphate of copper may be given; always directing after its operation a draught of hot brandy and water, with the essence of peppermint or compound tincture of lavender, or any other suitable cordial. A powder of camphor, ipecacuan- ha, and opium, with sometimes half a grain, or a grain of calomel, was given every two, four, six, or eight hours ; its frequency de- pending on the necessity of exciting perspiration. A general cir- culation and warmth should be procured, and perspiration support- ed by the cordial drinks, &c, above mentioned, together with hot strong broth, highly seasoned. No purgatives were given until after the first three days; and then those only of the mildest kind ; (such as castor oil, rhubarb, carbonate of potass, and tartrite of potass and manna, &c.) Injections of milk, sugar, and salt, by way of clyster, were always safe, and often recommended. The contents of the bowels were generally in a natural and healthy state, and therefore needed no rash evacuants; especially in the low and depressed situation in which the patient was often found. Some were known to die while under the operation of a dose of calomel and jalap, in places where the disease made its first ap- pearance. The lancet was found to be equally unsuccessful. " The above treatment was continued for twelve, twenty-four, thirty-six, or forty-eight hours, or indeed until the pains abated.— The patient was then taken up, and had all his cloths changed. He was again placed in bed, but between sheets ; and kept in only a gentle perspiration. The following preparation from Dr. North was uniformly pleasant and useful to the sick: R Cort. Cinchonse Officin. 3 j. ( boiled in 3 lbs. water 10 or 15 Cort. Citri Aurant. )--_... { min.; strained; and a gill of mo- Rad. Serp. Virg. ] a a J" ' lasses and a Siu of ym%i adcled- After standing six or eight hours to ferment, a wine glass of it may be given every three or four hours ; and sometimes with the addi- tion of two, three, or four drops of Fowler's mineral solution, or from six to ten drops of the tincture of opium, or from four to eight or ten drops of the essential oils.—When this beer was not given in the first stage of the complaint, yeast and the muriatic acid were substituted. CLASS II. SPOTTED OR PETECHIAL FEVER. 347 " This course was pursued till the violence of the disease abat- ed, which was commonly about the third day; when Huxham's tincture of cinchona, and aromatic sulphuric acid, were employed. In cases of delirium, camphor and opium, with wine and brandy, were freely given, and cold applications used for the head. In cases of coma, (which may be considered as the dying state of the disease,) injections of yeast, brandy, and laudanum, were given with the best effect; and some lives have been saved by this prac- tice.— In one case, where the patient became comatose, in conse- quence of the nurse neglecting to give the necessary stimulants for several hours, we succeeded in getting down five hundred drops of laudanum in six hours, with a quart of wine, and nearly as much brandy ; and though the stimulants were continued through the day, so that he took about two ounces in all, of the laudanum, yet he soon recovered. He had been motionless and senseless ; had ster- torous breathing ; was incapable for a time of swallowing ; and had rattling in his throat.—A young married lady was attacked with this fever after her first lying-in, and had mild delirium which soon rose to a most violent fit of distraction, with supervening coma. In one hour, forty grains of camphor, and one hundred and eighty drops of laudanum, were given to her; and in the following three hours, she took four hundred drops more, a bottle of Madeira wine, and some brandy ; immediately after which, she began to mend, and gradually recovered, contrary to the expectation of all her friends. Ice was applied to the head in both cases. " One patient, in profound coma, was saved by shaving and blistering the head, &c. Various similar cases might be mentioned. " In order to give a more clear and concise view of the method pursued by the writer in the management of this perplexing dis- ease, its usual varieties will be classed under the four following species, or descriptions, and some practical remarks made on each : for it seized, 1° the head ; 2° the chest; 3° the viscera of the ab- domen ; 4» the extremities ; though this last species was usually complicated with each of the others.—But in this division of the disease into certain prevailing forms, it must be remembered, that one and the same disease exists under each of them ; and that therefore the general nature of it should always be kept in view: the necessity of which will soon be seen in practice, as the pe- culiarities of the species commonly disappear after a time, leaving nothing but the simple disease to be treated by its general rem- "dies. 348 PHLEGMASIA. CLASS n. " 1». When the attack is upon the brain, and there is increased heat of the head, and throbbing of the carotid and temporal arte- ries, attended with mild delirium, cold vinegar and water may be applied to the forehead and temples ; but in severe cases with a tendency to coma, apply a bladder partly filled with powdered ice ; place a blister on the back of the neck, temples, or forehead; give large doses of camphor and opium ; inject yeast, brandy, and lau- danum, by way of clyster; apply sinapisms and heat to the feet and legs ; and employ any of the general remedies before men- tioned, which shall best suit the case. The patient should not be allowed to sleep more than twenty or thirty minutes at any one time, without taking medicine or nourishment, which indeed should be a general rule in all severe cases of the disease. " 2°. The spurious peripneumonic form of the disease has gen- erally prevailed during the spring months. The primary symp- toms were generally, moderate alternate chills and heats ; but in some there was, a death-like coldness, which pervaded the whole body; yet neither the heat nor the thirst was considerable ; pains (sometimes obscure) occurred about the chest, with great oppres- sion and cough, difficult breathing, and expectoration of viscid dirty brown matter; and in some of the most malignant cases, blood (sometimes very florid) was expectorated completely dissolved; and there were sometimes nausea and vomiting. " To relieve the oppression and pain of the chest, a bladder of hot water, or any one of the heated substances before mentioned, was first applied to the pained part; after which, if there was much nausea, a gentle emetic of ipecacuanha and sulphate of cop- per was given and frequently repeated. A powder composed of camphor, compound powder of contrayerva, carbonate of ammo- nia, and spermaceti, was directed every two, four, or six hours, to promote warmth and perspiration, &c. A decoction of seneka snake-root, elecampane, liquorice, and aniseed, sweetened with honey, was also given, farther to encourage warmth, perspiration, and expectoration. The patient should frequently inhale the va- pour of water and vinegar, as rising from a heated shovel, or from a vessel. In mild cases, after using warm external applications as above mentioned, the chest was anointed with sweet oil, and cov- ered with warm flannel; or rubbed with an infusion of cantharides in vinegar, till vesication was produced; but in deep seated affec- tions, large vesicating plasters should be applied. Internally should '•LASS II. SPOTTED OR PETECHIAL FEVER. 349 also be given, in malignant cases, warm stimulating cordials, such as some of the essential oils, old Geneva and water, hot punch, wine, wine whey, mustard whey, and bottled cider. When the beer before mentioned was prescribed, (and it was usually given after a few days to the worst of the sick) seneka was substituted for the Virginian snake-root. The bowels were kept open by in- jections, or mild laxatives. Camphorated tincture of opium may be taken in the evening in wine whey. When dysuria occurred, linseed tea and gum arabic were given ; and warm stimulants ap- plied to the hypogastric region. A decoction of barley with rai- sins or figs, and broth, were also taken for nourishment. * " 3°. When the violence of the disease was directed to the stomach and bowels, and produced vomiting, cholera morbus, or colic ; in addition to the common remedies, a solution of the car- bonate of potass and yeast may be given by the mouth ; and the same, with tincture of opium, by injection. A bladder of hot water, or a flannel bag with bitter aromatic herbs, (such as hops, tansy, or wormwood,) infused in heated spirits, may be applied to the stomach and bowels: or a rag may be dipped in the heated in- fusion, and this application to the part be repeatedly renewed. The compound powder of contrayerva should be given with the common powder of ipecacuanha, camphor, and opium, first men- tioned ; and also an infusion of Virginian snake-root, camomile flowers, and cinnamon or ginger. Sometimes carbon, in the shape of powdered charcoal, was employed in the injections; and often, when there was purging, this carbon was taken by the mouth. Every thing must be taken here warm ; and if there be nausea, it must also be in very small quantities at a time, even by tea-spoon- fuls. The bark beer may be give here, and brandy, and warm soup also, highly spiced, should not be forgotten. A cordial com- posed of essence of peppermint, compound tincture of lavender, and laudanum or paragoric, should be taken several times daily ; particularly when the strength or spirits at any time begin to fail. Frequent rinsing the mouth with cold water was very grateful to the patient; but when swallowed, it chilled the stomach and occa- sioned vomiting; as did all insipid drinks. In some cases, the taste was so much depraved, that the patient would drink clear high proof brandy with as much facility as pure water; scarcely perceiving the difference. 350 PHLEGMASIA. CLASS H. " 4o. When the extremities were affected by coldness, pain, or numbness ; then stimulants in the way of friction were employed, (such as a decoction of pepper or mustard in spirit, tincture of cantharides, or an infusion of cantharides in vinegar.) The warm internal stimulants, &c. spoken of in the general treatment, will also be here applicable, " Biles and carbuncles should be treated with stimulant applica- tions. A poultice of onions may be applied, or a plaster of flour and honey, and a little powdered myrrh, till the parts suppurate and discharge. Afterwards they may be daily washed with weak ley, and dressed with digestive ointment, or flour and honey. Zinc ointment also often succeeds, even better than the rhubarb and colomba root of Sir Everard Home. " Bark may now be given in substance. But the writer has found no medicine superior to Griffith's myrrh pills for convales- cents. The following is the form taken from Dr. North, who has a little varied the prescription of Dr. Griffith. R Pulv. Myrrhae 3ij. Sulph. Ferri 3j. Carb. Potassa? 3ss. Gum. Camph. grs. xvi. Syrup, q. s. " Three of these pills may be taken three times a day, drinking after each dose, a decoction of the cinchona, eleutheria, or angus- tura barks ; or the colomba or quassia roots. " The rooms of the sick should be kept uniformly warm, but freely ventilated; and the bed and body linen changed as often as every other day. " No disease requires more careful nursing, and perhaps none is more liable to relapses. These happen not so much from indulging the appetite in eating; for a convalescent patient has seldom been known to be injured by taking beef or mutton steak, chicken, neat's tongue, ham, small fresh fish, &c. in due moderation ; but from too early an exposure to cold or to fatigue. Severe relapses, when they do occur, are frequently dangerous, and often fatal ; but are to be treated as new cases. " More than two thousand cases of this disease have been man- aged according to the method herein described; and after making every allowance for delay in calling for advice ; improper remedies previously used; bad nursing; uncomfortable situations; the want make a mass, to be divided into 36 pills. CLASS II. SPOTTED OR PETECHIAL FEVER. 351 of necessary supplies, and imprudence on the part of the patient, often occasioning relapse; the average number of deaths has not exceeded two and a half in a hundred.—The fever has generally run its course by the fourteenth day.—Many violently attacked were cured by the third day ; particularly because in such cases there was no delay in calling for immediate advice, or neglect in following it.—Since the present year (1816) commenced, few or none but pneumonic cases have appeared ; and those generally have been milder than heretofore. Since February last, the writer has attended upwards of two hundred aud twenty patients in this form of the disease, of whom one only has died; and to him he was not called till after he got a relapse, from fatigue in walking out and taking cold. One only of this number, a man of robust and full habit, was once bled to the amount of eight or ten ounces; and this bleeding might have been safely omitted. " Before closing this paper, it may be remarked, however, as a general fact, that the disease as here described and treated, was once only observed by the writer on the sea-coast; his residence as a practitioner confining him to the interior parts of the country, where both the situation and winds are dry and healthy." Hallowell, September 16, 1816. In a late publication by Thomas Miner, M. D. the author has substituted for spotted fever the name Typhus Syncopalis, Sink- ing Typhus. The following is an extract from that production, and it is hoped 1 hat its intrinsic merit will apologize for its length. " Typhus Syncopalis may be defined, a nervous fever in which the stage of reaction is wanting, the torpid or forming stage and the stage of exhaustion being blended together, attended with pain in the head and vertigo, and paroxysms of gastric sinking; and for the most part, with a cool skin and a slow pulse, and an absence of all febrile smell. Petechia?, eruptions, ecchymoses, general suffu- sion of the capillaries, coma, delirium, palpitation, interrupted re- spiration, numbness and insusceptibility to the action of ordinary rubefacients and epispastics, and sinking after evacuations, arc much more common than in any other febrile disease. By attend-* ing to these symptoms, it may be more easily distinguished than any other continued fever. Coma or delirium may sometimes be so se- vere or so protracted, as to overwhelm or disguise every other 352 PHLEGMASIA. CLASS II, symptom ; or the attack may be so violent as to destroy life in a few hours ; and in these circumstances, in sporadic cases, there may be with the inexperienced, some hesitation as to the nature and name of the complaint; but on the whole, there is less liabi- lity to mistake, than in the diagnostics of any other acute fever with which we are in the habit of meeting in the ordinary course of practice. Dysentery, cholera, cynanche, catarrh, cough, pneu- monia, measles, rheumatism, gout, and even common typhus, are often complicated with it; yet there is always some prominent symptom by which it may be determined, when the general affec- tion of the system is that of typhus syncopalis." Dr. Miner states that between the last of March and the last of December, 1823, two physicians had the care of more than one hundred and seventy-seven cases of this disease, in Middletown. Connecticut, which went through their course, and required close and vigilant attendance. They also had the charge of more tha n one hundred and eighty other cases, which either from original mildnes«, or prompt treatment, proved to be comparatively slight. Out of these cases, being in the whole about three hundred and sixty, twelve died; viz. six adults and six children. Persons of all ages, from one year old to seventy, and of both sexes, were the sub- jects of this disease. The condition of the brain in this disease was usually very similar to that state which is produced by expo- sure to carbonic acid gas, or which is occasioned by excessive doses of some preparations of lead, or of certain essential oils, or of ac- tive and pure narcotics. In many cases it resembled concussion, or apoplexy, or palsy. In all the severe, and in a majority of the mild cases, there was from the very access, before a particle of medicine had been taken, a peculiar deficiency of vital energy inth brain, and the whole nervous system; so that raising the patient" in- to an erect posture, would generally produce the same sort of ver- tigo, anxiety at the stomach, acceleration of the pulse, nausea and even faintness, which result from a similar position after'a great loss of blood ; but in one instance the patient could not lie down with- out feeling as if his feet were in the air, and his body hanging from them with the head downwards. He was very speedily re- lieved by blistering the head. Nearly every case of delirium, al- ternated with coma, but every case of coma was not attended with delirium. In some cases the delirium resembled intoxication; in many, hysteria; and in others it was of the low muttering kind, such > 'LASS II. SPOTTED FEVLK. 35 3 as is common in ordinary low fevers. In many of the severe cases, the patient on going to sleep would fall into a state resembling in- cubus, with difficult or partially suspended respiration, which would require his being awaked as often as every five minutesj nnd some would awake spontaneously in the most excruciating fright and distress, and greatly exhausted. Every variety of pulse occurred except the strong and hard, and this often in the same pa- tient. In many of the mild cases, and in most of the others till the period of fatal sinking, it was rarely so frequent as in health ; but towards the close of life in several of the fatal cases, it was one hundred and twenty or thirty, and occasionally one hundred and sixty in a minute. In less than twelve hours it would sometimes vary in frequency from forty to one hundred and thirty. In one instance it was slow as twenty-seven, and in six or eight hours varied to one hundred and thirty* This patient recovered rapidly. In some instances even in the dying, the ptdse would give a delusive feel of fulness and force that often deceived the very best judges respecting the danger, unless attention was particularly directed to other symptoms. In most of the worst cases the circulation Was daily so languid by turns, that the extremities had a livid ap- pearance and were often nearly pulseless. One patient at least re- covered that was without pulse at the wrist for several hours. A very prominent symptom consisted of paroxysms of subsidentia, or a death like sinking sensation in the epigastrium, that was de- "icribed sometimes as a painful sense of vacuity and faintness, some- times as trembling or fluttering, sometimes as real pain and an- guish, and at others was declared to be utterly indescribable. Some- times these paroxysms of sinking were attended with palpitation, and often with spasms ; tremors and subsultus were not uncommon in every stage. In many of those cases which were neglected, or treated with evacuants, a peculiar and somewhat different, and usually irreparable sinking and exhaustion occurred after a critical effort, or in lieu of a crisis, on the third, fifth, or more commonly on the seventh day. Under such circumstances, in addition to the sinking in common with other cases, the respiration was interrupted and peculiar, the inspiration occurring only at intervals of several seconds and being usually long and full; while the expirations were so short that the breath was parted with instantaneously. The critical sinking in combination with morbid respiration, was often the first warningof danger in the insidious cases, and it was almost invarin* 354 PHLEGMASIA. CLASS II. bly irremediable. In other fatal cases the disease terminated in a deadly coma. Paroxysms of coma were periodical in some instances, as were those of sinking in others. The stomach on the one hand,was usually as torpid and inactive as a leathern bag,s<«j^ in many instances, the patient would choose scalding hot liquids^oB on the other, it was irritable in the extreme. The change from one to the other of these extremes was generally sudden, and occasion- ed by slight causes, or took place without any assignable cause. In some instances the irritablity would be so extreme, that without the nicest and most careful nrahagement vomiting or retching would be incessant. The matter ejected generally consisted of little more than the drink or secreted mucus. In a few instances it was greenish, in a very few dark coloured, seldom any bile evacuated. The vomiting seemed to be entirely symptomatic of an affection of the brain, or was obviously the effect of an emetic or carthartic. This was evinced by its being excited by raising or moving the head, or by an erect posture, and relieved by a recumbeut posi- tion ; and especially by blisters to the forehead, temples, &c. The author has seen carbuncles two or three inches in diameter, in the last stages of this disease, and also has known the carbun- cle to be the earliest symptom that was noticed ; swelling of the parotid glands, phlyctaenae, vibices, petecchiae, ecchymosis, &c. oc- casionally occurred. In the treatment of typhus syncopalis, it should be observed as a rule to avoid every thing that might tend to waste the vital pow- ers. Evacuations, if copious, invariably rendered the mild cases severe, and the severe ones fatal. Probably more than three quarters of the fatal cases were the consequence, of spontaneous or factitious purging or vomiting. In some few cases under pecu- liar circumstances, where torpor prevailed, emetics of zinc and ipecacuanha in skilful hands have successfully roused the symp- tom ; but then it often requires a drachm of each to operate. Small doses are worse than useless. In sudden and violent cases, emetics and carthartics at first are utterly inadmissible. The mild- est emetic would almost inevitably produce incessant vomiting, which if not controled by very large doses of opium, or laudanum, by enema, would end in exhaustion and death. More than three quarters of all the cases were at first very slightly purged with Calomel, so guarded as not to operate before twelve or eighteen hours. It was necessary to manage laxatives with the greatest CLASS II. SPOTTED FEVER. 355 caution, and very generally toconjoin^them with opium. Several patients who of their own accord attempted to purge themselves even with castor oil, provided it operated more than once or twice, 'und.was not instantly checked by opium, obviously sunk down and ^ died in consequence of it; one patient sunk irretrievably by a single operation of an enema. The proper time for evacuating the bowels in the lowest cases, was indicated by tenderness of the abdomen, uneasiness, or slight pain, which showed^hat the torpor of the in- testines had ceased. The' hest^ wa$OT evacuating the bowels ap- peared to be by giving daily about a drachm-of maenesia, and if ne- cessary assisting it by an enema. Bleeding need not be mention- ed but to warn against its fatal tendency. That a number of cases sunk from bleeding, when the disease first appeared and was mis- taken for active phrenitis, is universally notorious. In every severe case free bleeding, as also free vomiting and purging, is almost cer- tain death. Opium, was the most important remedy in the severe form of this disease, and was in such cases regidarly administered from the very first visit. A few cases imperiously required half an ounce of the tincture in an hour, or half a drachm in substance, in the course of twelve hours, before the urgent symptoms could be controled; and even some cases required a drachm in the same time. All those patients whose symptoms promptly met with opium invariably recovered. Opium in sufficient quantities, assisted by external application, would command every peculiar symptom with certainty except the extreme sinking ; and even in this forlorn state it mitigated much of the anxiety and distress and prolonged life. Alcohol was beneficial in some cases, but less so than opium. Lytta and capsicum internally were very serviceable in the torpid cases; but increased the irritability of those who were previously ir- ritable. Arsenic, in the form of Fowler's solution, was very effica- cious when the head was much affected, and the stomach at the same time torpid. Tincture of stramonium, combined with tincture of opium, occasionally relieved delirium. Camphor, ammonia and ether, were useful during the sinking paroxysms. The same was the fact with the essential oils. Enemas of one drachm of oil tur- pentine, and two of laudanum, every four or six hours, will prove useful in coma. The early use of the hot bath, the water being as hot as can be borne without danger of scalding, proved very serviceable. Bottles M' hot water, heated bricks, or wood, hot spirits, mustard, liquor 356 PHLEGMASIA. CLASS n. of ammonia, capsicum, and oil of turpentine, were resorted to as strong and quick rubefacients, and these greatly assisted the oper- ation of epispastics which were very extensively and advantageous- ly employed. Oil of turpentine, warmed and confined to prevent evaporation, was the speediest epispastic, and was of much benefit in coma. But after all, in the severest forms of the disease opium, alcohol, arsenic, aromatics, tincture of cinchona and ex- ternal applications with no other medication, might be depended upon. In a state of convajesaence the sulphate of quinine was administered in preference to any other preparation of cinchona. To conclude, in the words of Dr. Miner, " Typhus-syncopalis or the spotted fever, when neglected or injudiciously managed, is among the most deadly maladies which a mysterious Providence permits to scourge the human race. When taken in season, and treated with decision and judgment, fe\v diseases yield with so much certainty to a proper course of medication." " No foreign author, it is confidently believed, has described this disease. We occa- sionally see the typhus petechialis of nosologists; it differs essen- tially from the spotted fever of New-England." The following singular case of sinking typhus was communicat- ed in a letter from Dr. Miner. A female about sixty years old, naturally robust, in the winter of 1826, after labouring under the disease for a week or two was seized with a delirium resembling that of mania a potu, though she continued to be so weak as to be unable to get off her bed. In this condition she took two drachms of strong laudanum every hour, and one drachm tincture of stramo- nium, every two hours for four or five days. She recovered en- tirely. This, s^ys Dr. M. is a case of the heaviest practice I ever knew, but not too much to meet and control the symptoms. What a strange disease must that be which could even tolerate such practice for half a day! much more so four or five days ! PHTHISIS, OR PULMONARY CONSUMPTION It is a melancholy truth verified in numerous families, that pul- monary consumption constitutes a large proportion of our bills of mortality, and forms one of the most crowded avenues to the tomb. It is supposed that about one seventh of all the deaths in Massa- chusetts, are to be attributed to this fatal disease. It is calculated* CLASS II. PHTHISIS, OR PULMONARY CONSUMPTION. 35/ by Dr. Young, an eminent English physician, that one fourth part of the inhabitants of Europe are swept away by consumption, and he estimates the fatal instances in Great Britain alone to amount to no less than 55000 annually. This disease has been observed to make the most deplorable ravages among our youth of both sexes, between the ages of 17 and 27. When hereditary predis- position is derived from parents, instances frequently occur of whole families one after another becoming victims to it in the ear- ly periods of life. It seems to be a received opinion that phthisis possesses a contagious nature in a slight degree. There is indeed much reason to apprehend that by sleeping in the same bed with a consumptive patient in the last or ulcerative stage, with foetid expectoration, night sweats, and offensive breath, or by being much confined in a close room and imbibing the effluvia from the lungs, the disease may by these moans be actually communicated to those in health, but more especially to those who have a similarity of constitution and hereditary predisposition. The immediate cause, in the largest proportion of instances, of consumption, is supposed to be tubercles, or small tumours, which finally suppurate and form ulcers in the substance of the lungs, and this is considered as the most dangerous kind. These tubercles, although they may continue for an indefinite period in an indolent state, at length become inflamed, and are changed into little absces- ses, or vomicae, which burst and pour their contents into the bron- chia? from which a purulent expectoration ensues. This is termed the strumous or tuberculous phthisis, there being an obvious con- nexion between scrofula and pulmonary consumption, as the tumors in each case exhibit similar appearances and are equally intracti- cable in their ulcerated state. These vomicae are apparently con- globate glands, similar to scrofulous, and are excited into a state of inflammation from accidental colds or from irregularities of diet, and when numerous vomicae have suppurated, the lungs are loaded with pus and a whole lobe is sometimes destroyed a considerable time before death closes the scene. The generality of consump- tions in the United States, are the consequence of colds and coughs, which have been neglected, or injudiciously treated in their early stage. Persons who are most subject to become consumptive, are those of a delicate make, fair complexion, and florid countenance, soft skin, long neck, narrow chest, prominent shoulders, with hol- low temples, thick upper lips, a weak voice, great sensibility, and 358 PHLEGMASIA. CLASS II. clear white teeth. This description of persons have constitution- ally weak and tender lungs, and need nothing but colds and coughs to excite inflammation, which end in suppuration, hectic fever, ulcers, and consumption. This disease is also often hereditary, and those most subject to spitting of blood, are likewise most liable to its attacks. There are some occupations in life which dispose persons to consumptions, such as require artificers to sit in one position, or constantly to lean forward and press upon the stomach and breast, as cutlers, tailors, and shoe-makers ; it has been also observed that the small particles of stone, wood, metals, and other hard substances inspired into the lungs by the workmen, have pro- duced this disease in the artists who work in those substances. Phthisis pulmonalis often takes place in consequence of certain diseases, such as catarrh, pneumonia, inflammation, ulcerated ton- sils, haemoptoe, syphilis, scrofula, influenza, small-pox and measles; and also from violent passions of the mind, as grief, disappoint- ment, anxiety, and close application to study, without proper exer- cise ; playing on wind instruments, dissipation, and intemperance ; over exertion of the vocal organs by public speaking, singing, &c. Those clergymen who spend their strength unsparingly in the pul- pit are peculiarly liable to phthisis. Excessive evacuations of vari- ous kinds, and a sudden suppression of cutaneous eruptions, and of those evacuations to which the system has been long accustomed, are also to be reckoned among the causes which give rise to this disease. Among the operative causes in the female constitution, is a too long continuance of nursing children at the breast. The excessive drain from the system, the fatigue of carrying the child, and the interruption to sleep at night, have an inevitable tendency to exhaust and debilitate the system, and to act as the exciting cause of this fatal disease. Women of delicate and feeble habit should not carry this duty beyond nine or ten months at one period. The sudden changes of temperature to which our climate is sub- ject, is undoubtedly a principle cause of the frequency and preva- lence of consumptions, and many other diseases in our country, Confined air in hot close rooms, is well known to be extremely prejudicial to health. What can be more pernicious and destruc- tive to the human constitution, especially to tender lungs, than the sudden changes from heat to cold, and from cold to heat, as prac- tised by many young gentlemen who spend the day in an office or counting room, heated to a great degree by a stove, and in the CLASS II. PHTHISIS, OR PULMONARY CONSUMPTION. 359 evening exposed to the dews, damp air, and cold easterly winds, unprovided with covering sufficient to protect the body from their noxious influence ? nor is this remark inapplicable to the other sex; our fashionable young females, accustomed to a warm apart- ment during the day, often brave the elements in the evening, and resort to the theatre or ball-room with uncovered breast and neck, naked arms to the shoulders, and thin shoes ; by such impru- dent exposure, who is surprised that colds are contracted, and that so many young persons are consigned to the grave in the bloom of life? Another source of great injury to the constitutions of young per- sons, is a habit of indolence, or a want of bodily exercise, which nature requires to expand the chest and strengthen the lungs, to preserve vigor and energy in the system, and that due or- der and regularity in the animal functions, on which a healthy state so essentially depends. For practical purposes, Dr. Thomas observes, it may be suf- ficient to distinguish carefully between pulmonary consumption which occurs in persons of the strumous temperament, and that which attacks constitutions of a different description from acciden- tal causes, such as an exposure to cold, or as the consequence of other diseases. Dr. Hosack, however, prefers as the best distinc- tion that can be made, to divide the disease into two stages, the. acute and the chronic. These terms convey a correct idea of the nature of the inflammation attending upon the first stage of phthisis, and of the termination of such inflammation in the last stage, in which ulceration or an excessive excretion of pus takes place. For this reason, too, Dr. II. has thought proper to give it a place among the phlegmasia?, instead of considering it as one of the hemorrhagies in which order it is arranged by Dr. Cullen. The first symptoms of phthisis pulmonalis, usually vary with the cause of the disease ; when tubercles are the immediate cause, it begins with a short dry cough, without much expectoration for some time, except a frothy mucus, that seems to proceed from the throat, and mostly in the morning, sometimes exciting vomiting. The patient feels an uneasiness about the chest, or a sense of pain on lying down oo one or both sides, or under the breast bone ; the breathing is also oppressed by the least quickened motion, and particularly so in hot rooms, or in moist weather ; his spirits are very irregular, being either very lively, or much dejected, with- 360 PHLEGMASIA. CLASS I J. out any known reason, and the body gradually emaciates. A par- ticular quickness and cautious manner of speaking is observable, as well as an unnatural peevishness, though before of the most amiable disposition. These symptoms may be observed perb/u^ many months before the patient thinks of complaining, or will ac- knowledge that he is so ill as to require attention ; when indeed this is a most critical moment, and perhaps the only one, when by proper care and judicious management, he may be rescued from his impending fate. The patient under these circumstances, is more easily affected than usual by slight colds ; the cough grows more troublesome and severe, particularly at night, and the expec- toration is more free and copious, of a greenish colour, and on some occasions streaked with blood. The laborious breathing, the emaciation and weakness, go on increasing, the pain becomes severe, and the patient is unable to lie ort the side affected, or to make a full inspiration without exciting a fit of coughing. The pulse at the beginning is often natural, or perhaps is soft, small, and a little accelerated ; but at length becomes full, hard, small, and frequent, even to one hundred and twenty or upwards in a minute: a red flush now appears on one or both cheeks, particu- larly after meals, with a dryness and heat in the pa!msofthe hands and soles of the feet, the evening exacerbations of fever be- come obvious, and the patient is now affected with the whole train of symptoms which usually accompany a confirmed hectic fever. " This species of fever is evidently of the remittent kind, and has two exacerbations every twenty-four hours. The first occurs usually about noon, and a slight remission ensues about five in the afternoon. This last is, however, soon succeeded by another ex- acerbation, which increases gradually until after midnight; but about two o'clock in the morning, a remission takes place, and this becomes more apparent as the morning advances. The patient is very sensible to any coolness of the air, and often complains of a sense of cold, when his skin is at the same time preternaturally warm." The evening exacerbation in hectic fever is by far the most considerable, and on some occasions, particularly in cases of heemoptoe, the hectic symptoms advance with more rapid strides. In general the urine is high coloured, and deposits a copious bran- ny red sediment. The appetite is not greatly impaired, the tongue appears clean, the mouth is usually moist, and the thirst is incon- siderable ; at length, aphthous ulcers appear in the mouth, and the TLASS II. PHTHISIS, OR PULMONARY CONSUMPTION. 36l ted vessels of the coats of the eye assume a pearly whiteness, a florid i ncumscribed redness appears on each cheek during the exacer- bations, but at other times the face is pale and the countenance mink and dejected. The tongue appears clean, and with the fauces is of a bright red colour, and generally sore and tender. The pulse is frequent, full, and tense, or small and quick ; the palms of his hands and his feet are hot and dry ; his nails are of a livid colour, and are bent over the ends of his fingers ; his breath offen- sive, quick, and laborious. A colliquative diarrhoea and night sweats ensue, and induce great debility and emaciation, the eyes lose their lustre and brilliancy, the cheeks appear prominent, the nose sharp, the temples depressed, and the strength rapidly declines. The miserable patient now exhibits the appearance of a walking skeleton bewailing the loss of its corporeal substance. His voice becomes hoarse and feeble, his hair falls off, and his feet and legs are affected with oedematous swellings, and a glossy appearance of the skin. At this period the substance of the lungs Is almost con- sumed, and their feeble remains are loaded with purulent matter, large quantities of which are constantly expectorated ; the labour- ed breathing now, like the expiring taper, grows more and more feeble, faintness often occurs, the heart ceases to perform its office, the voice falters, and the melancholy, long protracted scene is brought to a close. Thus thousands are consigned to a premature tomb. It is a characteristic trait in this disease, that the patient is seldom alarmed with his approaching fate, but retains his hope to the last and still flatters himself with a speedy recovery.* In fe- male cases the menstrual evacuation is sometimes profuse, at others altogether suppressed. When women are affected with consump- tive complaints previous to a state of pregnancy, the symptoms are generally suspended, or so disguised during that period, that both the patient and friends are unconscious of any impending danger; but shortly after parturition, the disease resumes a more rapid pro- * Even physicians themselves have been known while just expiring with this com- plaint, to be unconscious that they were consumptive. '; A late eminent teacher of Anatomy, in his very last lecture, (at a time when the symptoms of confirmed de- cline were too obvious to be mistaken by the youngest of his pupils,) speaking of this circumstance whilst describing the structure of the lungs, observed : " This de- ceitful persuasion is not to be wondered at in those who have not studied physic : but that any man to whom frequent observations must have made every fatal symp- tom so familiar, can be blind to his own situation, is truly wonderful.' He himseU died of phthisis within the fortnight 46 362 PHLEGMASIA. CLASS II, gress, and soon terminates in death. In some instances, however, by several successive pregnancies the phthisical diathesis has been altogether eradicated and a healthy condition established. When it is desired to ascertain whether the matter expectorated be pus or mucus, the following experiment, discovered by the late Mr. Charles Darwin, will afford a decisive discrimination. Let the expectorated matter be dissolved in sulphuric acid and in caustic alkaline lixivium, and then add pure water to both solutions ; and if there is a fair precipitation in each, it is a certain sign that some pus is present: if in neither a precipitate occurs, it is a certain test that the material is entirely mucus. Another method has been in- vented by Dr. T. Young, physician to St. George's Hospital, more eonvenient and not less satisfactory. He found by experiment that a luminous body, when viewed through a transparent liquid holding in suspension minute particles of nearly equal dimensions, " is surrounded by rings of colours somewhat resembling the rain- bow, but differently arranged and often beautifully brilliant. Blood, a little diluted, always exhibits them in great perfection, and they afford a very accurate criterion for the distinction between pus and mucus. Mucus, containing no globules, affords no colours, while those which are exhibited by pus exactly resemble the appearance produced by the blood, the rings being usually of the same dimen- sions. A minute quantity of the fluid to be examined in this man- ner, may be put between two small pieces of plate-glass, and if we hold the glass close to the eye, and look through it at a distant candle, with a dark object behind it, the appearance, if the glob- ules are present, will be so conspicuous as to leave no doubt respect- ing their existence." Pus is of the consistence of cream, of a whitish .colour, and has a mawkish taste ; it is inodorous when cold, and when warm, it has a peculiar smell. It should here be remark- ed, that instances sometimes occur in which there is neither much cough nor expectoration till within a short period before the pa- tient expires ; nay, further, a hectic fever has been known to prove fatal after a long continuance, without any purulent expectoration, or any very considerable discharge of mucus ; and it often has the appearance of a slight cold. There are likewise many instances on record, of the lungs on dissection being found perfectly sound, no traces of tubercles or ulcers being discovered ; all the terrible symptoms of confirmed consumption in these cases, arising from extensive inflammation of the membrane lining the bronchia. Pus, CLASS H. PHTHISIS, OR PULMONARY CONSUMPTION. 363 it has been ascertained, may be formed from the vessels of a mem- brane where there is no ulceration, and the debility and emaciation consequent to a copious discharge of purulent matter, will readily account for all the symptoms which supervene. Confirmed phthisis may be considered among the diseases most difficult to be controlled by the medical art, yet Dr. Parr asserts that in six distinct well defined instances,'he has seen recoveries perfected by nature; and Dr. Good has seen one instance of re- covery when reduced to such a condition as to expectorate a pint and half of pus or purulent mucus daily, attended by exhausting night sweats and anasarca. Whether this cure was to be attribut- ed to the means employed or to the efforts of nature, Dr. G. does not decide. The plans of treatment in phthisis pulmonalis, vary with the supposed cause, and according to the views of the* different prac- titioners by whom they are prescibed. There is, however, little or no diversity of opinion relative to the great utility of a rigid ad- herence to a well adapted regimen, and a careful avoidance of all the exciting causes by which the disease has been produced. From the fullest conviction, derived from experience, as well as the ob-* servations of others, 1 can assert, that more confidence is to be reposed in this plan, than in all the drugs and medicine that can be prescribed by the most skilful physician. Of all the articles of diet, I consider milk as incomparably the best adapted to the cir- cumstances of consumptive patients. It constitutes a sort of medi- um between animal and vegetable food ; it is of a mild bland bal- samic nature, easy to be digested, and admirably calculated to furnish the blood with sweet, wholesome, nutritious chyle, and to sheath the acrimony of the humours. But in order to derive all the advantages of a milk diet, it is not to be taken sparingly once or twice in a day, it must constitute the principal sustenance of the patient, combined with a little toasted bread, or some light agree- able vegetables. Asses' milk has been held in the greatest estima- tion in this disease, but in this country it cannot be procured in sufficient quantity for the purpose of diet. That milk should be preferred which comes from young, sound, and healthy cows ; aud it should be taken while warm from the animal if convenient, at least four times in twenty-four hours. Dr. Buchan says, that milk alone is of more value than all the medicines in the Materia Medi- ca. But 1 am aware of the objection that milk doe.? not agree with 364 PHLEGMASIA. CLASS II, all constitutions ; it may be admitted that in some stomachs, when first introduced, it is apt to produce unfavorable effects, but by proper management, it may in almost every instance be rendered agreeable and salutary. If the milk be too rich, or there be an acid in the stomach, by which the milk is coagulated into cheese curds, let one third the quantity of lime water be added ; if it pro- duce a diarrhoea, a spoonful of good conserve of roses, or a drachm of prepared chalk will correct it; if costiveness be induced, a little rhubarb and manna, or cream of tartar, may betaken occasionally. There are several articles possessing mild nutritious properties, which ought to be combined with milk ; apples baked or roasted are admirably adapted to this purpose ; consumptive patients have been cured, It is said, by this simple diet alone. There is a vab uable domestic article but little known, produced plentifully in our low meadows, which may be esteemed as not inferior to any thing of the kind with which we are acquainted. It is the root of the Osmund Royal, by some called meadow Buck's horn.* There is not perhaps a vegetable which produces a soft bland mucilage in so great abundance. The roots fresh from the ground, should be cleaned, and then boiled in milk, or with the addition of a little water, until it thicken to the consistence of common starch for use; it imparts no unpleasant taste to the milk, and the patient may eat of it to any quantity he pleases, and with a certainty of beneficial effects, it having in some-instances contributed, it is said, very great- ly to the cure of consumption in its early stages. Besides milk, the preparations made from it,as whey and butter-milk, may be used by consumptive patients with great advantage. The whey may be made from new milk, by adding to it a little rennet, cider, orange juice, or cream of tartar, and the patient should habituate himself to the drinking a tumbler full of it several times in a day. Butter- milk, while new and sweet, may be taken in the same manner, and with salutary effects, beginning with small quantities, and increas- ing as the stomach can bear. Other articles possessing nutritive qualities, proper in consumptive cases, are beef tea, meat broths, calf's feet jellies, eggs, and shell-fish ; oysters taken with their juices in a raw state, are perhaps, preferable to every kind of an- imal food, on account of the nutritive and salutary properties which they afford. Mi11 i 11 ■ i i * Flowering Fern. • LASS II. PHTHISIS, OR PULMONARY CONSUMPTION. 365 Oysters have been represented as peculiarly calculated to coun- teract a tendency to consumption ; they may be eaten either raw or moderately warm with a little pepper, and they form a mild balsamic and cooling article of diet well adapted in cases of warm flushings in the face, and other feverish symptoms, and nervous irritations. When made a principal part of a meal, half a pint of hot milk should always be taken immediately after, which will pre- vent any coldness or heaviness being produced on the stomach. In the vegetable class may be enumerated rice, sago, arrow root, asparagus, barley, light puddings, turnips, and potatoes. To these may be added conserve of roses, jellies, and preserves made from ripe fruits, and also subacid fruits of every description, in their proper season. The acid juices of oranges, lemons, grapes, cuis rants, strawberries, gooseberries, plums, and cherries, all tend to quench thirst, and cool the blood, and should be taken in a liberal manner, even though the thirst should not bo very urgent. If, not- withstanding this plentiful resource, the strength and spirits of the patient should decline, and something more solid should be requir- ed, he may be allowed strong broths, and once a day a little animal food. Such is my conviction of the salutary effects derivable from this course of diet, that I am irresistibly impelled to recommend a regular persistance in it for many months, or even years, if circnni- stances should render it necessary. It is proper, however, to observe, that patients are not to depart from a full animal diet all at once ; the change should be gradually introduced ; and be the kind of food what it may, it ought to be taken in small quantities at a time, and the stomach must not on any account be overloaded. All fer- mented liquors, particularly spirituous ones, must be carefully avoided. The next points of importance in the cure of consumptions, art a pure uncontaminated air, and a proper degree of exercise on horseback, or in an open carriage. At an early period of con- sumptive complaints, arrangements should be made, if circumstances permit, for journeying through the country at a proper season of the year, avoiding the unwholesome air of large towns, and if prac- ticable, the patient should spend the winter season in a warm cli- mate. In along journey, the advantage of a continual change of air, is joined to that of the mind being constantly entertained with new objects, and agreeable scenes. During his exercise, he should most carefully guard against any exposure to cold, which nevei 366 PHLEGMASIA. CLASS lj. fails to determine an undue quantity of blood to the lungs. He should not omit to wear flannel, or fleecy hosiery next his skin and stockings of cotton, or worsted, in preference to linen or silk. In some instances of consumption, a sea voyage has been produc- tive of considerable advantage, by the constant exercise, the change of air, and the vomiting, which it sometimes occasions. " Wholesome air, proper exercise, and a diet consisting chiefly of milk and vegetables, is the only course," says a popular writer, "that can be'depended on in a beginning consumption. If the patient has strength and sufficient resolution to persist in this course, he will seldom be disappointed of a cure. I have frequent- ly seen consumptive patients, who had been sent to the country with orders to ride and live upon milk and vegetables, return in a few months, quite plump, and free from any complaint. This, in- deed, was not always the case, especially when the disease was hereditary, or far advanced : but it was the only method in which success could be expected : where it failed, I never knew medicine succeed." Sydenham affirms that he has frequently cured both tabes and phthisis by horse exercise and long journies, when all medicines had been given in vain, and this not merely in the inci- pient stages, but when night sweats and diarrhoea, usually the con- cluding symptoms, had appeared. But when great arterial excite- ment is present, it may seem doubtful whether exercise should be deemed a well adapted remedy. Those who cannot have the benefit of travelling at a distance, GUght to make use of as much exercise by short rides, or other- wise, as their strength will permit without much fatigue. Swinging is a kind of exercise which may be useful, and severe friction with a coarse cloth, may tend to increase the action of the vessels in the extremities, and to preserve a uniformity in the circulations. In the advanced stage of consumption, exercise can be of little ser- vice, and much fatigue may prove detrimental by increasing debi- lity. Dr. Rush has recommended, in the early stage, severe exer- cise by bodily labour, and even exposure tp the hardships of a sea voyage, as having in some instances proved successful. When a young person of phthisical habit, or whose connexions have died of phthisis, is attacked with haemoptysis, or affected with symptoms of incipient consumption, even in a slight degree, the alarm should be taken, and the patient advised, without delay, to adopt the most, effectual means of arresting the progress of tiie dis- < LASS II. PHTHISIS, OR PULMONARY CONSUMPTION. 367 oase ; if the proper course be persisted in until the patient have reached the thirtieth year of his age, there will be much reason to hope that the consumptive disposition is eradicated, and a healthy condition of the system established. The course to be recom- mended as most likely to prove successful, is a strict pursuance of the antiphlogistic plan, abstracting blood from the system occasion- ally, particular attention to diet and regimen, and above all a re- moval to a warm climate, for several succeeding seasons, to avoid die severity of cold winters. But in whatever climate, he should be particularly enjoined to rise early in the morning, as nothing tends more to weaken the body than perspiration in bed. He may, if necessary, repose on the bed in the course of the day. The diet and repimen being thus properly accommodated to the disease, the next object should be to apply the most salutary food to the patient's mind ; this should consist of amusements, cheerful company, and the most soothing reflections, which exhilarate and keep the mind in the same active state that exercise does the body. The consolations of religion are excellently adapted to compose the mind, when prudently suggested. But all melancho- ly and gloomy ideas ought, if possible, to be dissipated. We come now to-notice the various medical remedies which are held in the highest repute for the cure of phthisis pul- monalis. The first point which demands attention, is the very im- portant one relative to the propriety of abstracting blood from the general system. The former practice of repeated small bleedings having been carried, probably, to an unwarrantable extent, and without a successful result, has fallen very much into disrepute, and physicians are now supposed, in consequence, to have vibrated to the opposite extreme. It is rational to suppose, that in all cases of tubercles, or of inflammatory affection of the lungs, bronchial vessels, or their investing membranes, it ought to be the primary object to diminish the inflammatory diathesis, and to produce a resolution of inflammation, and thereby obviate a tendency to the process of suppuration. So long, therefore, as the circumstances of the case will justify a hope of effectuating this important object, we may use the lancet with a degree of confidence, as being the best adapted agent to fulfil the indication. The evacuation must in all cases be in proportion to the arterial action, and the system may be subjected to a repetition of bleeding, until it be reduced below the point of morbid irritability : if this can be done with- 368 PHLEGMASIA.. CLASS II, out increasing the debility. Instances have been reported in which recourse was had to the lancet every few days, for several weeks or months, with the happiest result. This procedure, how- ever, is to be decided in each case by the physician of discernment, precise observation and experience. He will be guided by the more or less fulness and tension of the pulse, pain about the chest. and irritability of the system, and the quantity of blood should be judiciously proportioned to the strength and other circumstances of the patient. The inflammatory character of the forming stage of pulmonary consumption, says Dr. Hosack, cannot be too constantly kept in view, and the treatment indicated for the removal of other inflam- matory affections of the chest, will be found to be most successful in this more insidious disease. We have in many instances em- ployed blood-letting, with the most happy effects, in many cases of incipient phthisis, even where strong hereditary predisposition ex- isted. Indeed, we are induced, from late observations on this sub- ject, to express the opinion that in the commencement of phthisis, as in peripneumony, blood-letting is not sufficiently employed, but is too frequently neglected until the inflammation has proceeded so far that suppuration becomes inevitable. Nor do physicians in general appear to have been sufficiently attentive in describing the symptoms characteristic of the first or inflammatory stage of phthi- sis, and consequently have been regardless of the active antiphlo- gistic treatment, which alone can prevent the tuberculous or sup- purative stage. Inasmuch as suppuration, or a purulent secretion from the lungs, necessarily implies preceding inflammation, wc conceive too early attention cannot be given to the premonitory symptoms which announce the inflammatory stage, but which are frequently so inconsiderable, being seated in the less sensible, the cellular portion of the lungs, that both physician and patient are alike regardless of the present symptoms, and of the consequences to which they lead. Instead, therefore, of trusting to syrups, ano- dynes, pectorals, ptisans, or the Iceland moss, to allay the hack- ing cough and pains in the chest which indicate the first approach of the disease, we earnestly recommend the same active treatment by blood-letting, blisters, and other means of diminishing excite- ment, as are employed in the treatment of a pleurisy, or any other acute inflammation, and we could add, in confirmation of this view of the subject, many recent cases in which the practice here re- LASS II. PHTHISIS, OR PULMONARY CONSUMPTION. 369 commended has been attended with the most beneficial results. In one case a young lady was attacked with all the symptoms of the approach of this disease, viz. pain in the chest, frequent cough, the expectoration of matter manifestly purulent, the regularly formed hectic, returning at midday and at night, the circumscribed flush of the cheek, &c. &c. Having lost ten sisters with consumption, she indulged very little hope of relief. Her mother, in the full expectation of losing her only daughter, whose whose attack she considered, in all respects, similar to those that had gone before her, almost hesitated to apply for medical aid ; but she at length yielded to the advice of her friends. In this case, as the habit of the patient was naturally full, and her strength not much impaired, the lancet was freely and repeatedly employ- ed. By this alone, her cough, pain of the chest, and expectoration were all sensibly diminished. A large blister was then laid upon the chest, and afterwards occasionally renewed ; saline cathartics were prescribed, and an expectorant mixture of the mucilage of gum arabic and tartarized antimony, was administered in divided doses, so as to produce a degree of nausea, and to relax the sur- face. Its effects were promoted by tepid drinks, consisting of barley water, toast water, &c. Her diet consisted of those articles which are least calculated to add to the excitement of the system. In a word, the case was treated as pure pneumonia, and the result justified the view I have taken of the disease. For, by the remedies prescribed, all affection of the chest had totally disappeared, and the patient is restored to perfect health. This is not a solitary instance of recovery in this disease from the alarming symptoms which have been related. Several others of a similar nature, and followed with the same favourable result, might be added in justi- fication of the practice recommended. Local blood-letting, by the application of cupping glasses, or a number of leeches to the chest, may in many instances be employed as an advantageous substitute for drawing blood from the system at large. But in the last stage of ulcerated lungs, with pu- rulent expectoration, night sweats and debility, no beneficial effects can possibly be expected from the loss of blood. In every in- stance of this complaint attended with a fixed pain and straitness about the thorax, blisters are of indispensable necessity, and they' should be applied to the parts affected in constant succession, so 47 370 PHLEGMASIA. CLASS II. as to keep up a perpetual discharge. Vesicating plasters are sel- dom made sufficiently large; they should be eight by ten, or ten by twelve inches. A plaster of Burgundy pitch, of six or eight inches in length, ought to be worn between the shoulder blades and renewed once a week. A seton, or issues between the shoul- ders, or ribs, are advisable, and in many cases of incipient phthisis, they have undoubtedly produced very beneficial effects. When expectoration requires to be promoted, strong decoctions of pecto- ral medicines may be directed, such as liquorice root, with figs and raisins, marsh-mallows, colts-foot, and mullein sweetened with honey. Where there is much feverish heat, particularly in the evening, the patient should take a tea-spoonful of spiritus nitri dulcis, every third hour, in a cup of warm tea of mullein flowers sweetened with honey, and if the cough is very severe and trouble- some, two tea-spoonfuls of elixir paragoric may be taken in the same drink at bed time. During the absence of the febrile symp- toms, the cascarilla bark, and the bitter pectoral herbs, will be found useful, and less apt to bind the chest than the cinchona bark. Among these are thoroughwort, elecampane, horehound, ground ivy, and Roman wormwood. Both the mineral and vegetable acids, of every description, should be freely used in the patient's drinks; as they serve to cool and abate fever, quench thirst, and check night sweats. For this last purpose, the elixir vitriol should be freely employed in every stage of the disease. The lac am- moniacum, or milk of gum ammoniac, is a medicine of considerable efficacy in promoting expectoration ; though the following mixture is equally well adapted to answer the same indication: take of mucilage of gum arabic, or of quince seeds, six ounces, oxymel of squills, two ounces, powder of ipecacuanha, thirty grains, liquid laudanum, thirty drops. A table-spoonful of this mixture may be taken every few hours. If it excite vomiting, lessen the dose, or if vomiting be desired to relieve the lungs from tough phlegm, it may be increased accordingly. It often happens that a little exertion by puking will unload the lungs more expeditiously, and indeed it is more safe and pleasant than continual coughing. The digitalis purpurea, or fox-glove, has been introduced of late years as a valuable remedy in pulmonary consumption. European physicians of the first eminence, have resorted to the use of it with high expectations, and many of them have made the most flattering CLASS II. PHTHISIS, OR PULMONARY CONSUMPTION. 371 reports respecting its superior efficacy.* It is administered with the view of its peculiar properties in exciting the action of the absorb- ent vessels, and its singular power in retarding the circulation of the blood, and diminishing the frequency of the pulse. Among our own physicians of high reputation, we are indebted to Dr. Isaac Rand, of Boston, for his valuable observations on digitalis, read before the Massachusetts Medical Society, in June, 1804. In this production he details two cases treated successfully by the use of fox-glove, and closes his address in these words. " I must acknowledge and with pleasure assert, that I have cured more by this, than by all and every other medicine conjoined." Notwithstanding, however, the high encomiums bestowed on fox-glove, it has not in general answered the valuable purposes which its sanguine advocates have encouraged us to expect. It is by no means to be regarded as a specific, though we have undoubt- ed evidence of its having, in many instances, produced beneficial effects. It should therefore be employed, after venesection, as an auxiliary in the incipient stage, and in the more advanced period, as a valuable palliative remedy, to quiet and soothe the distressing symptoms, and to soften the pillow of death. The form in which fox-glove is commonly advised in phthisis, is the saturated tincture, to be found in the Am. New Dispensatory, and in the Appendix to this volume ; beginning with from ten to fif- teen drops three times a day, increasing two drops every second day, until its influence upon the system becomes evident, after which the dose may be increased or diminished, according to the desired effect. On some occasions it is found useful to combine with the tincture one quarter or one third part laudanum; or if the form of pill be more agreeable, take digitalis in powder, eighteen grains, opium in powder, six grains, for twenty-four pills. Give one pill three or four times in a day. Should occasion require, the system may be kept under the influence of fox-glove for weeks or even months, carefully attending to its effects. The prescriber must be aware, that this powerful medicine exerts a wonderful con- trol over the heart and arteries, reducing the pulse from one hun- dred and twenty, and even one hundred and forty, to fifty in a ♦^Dr. Thomas cites the following eminent European physicians, as zealous advo- cates for the use of fox-glove in phthisis : Drs. Fowler, Drake, Mossman, Beddop* M, Lean. 372 PHLEGMASIA. CLA8S li. minute, allaying at the same time, in a most extraordinary manner the cough and irritation of the lungs and general system. There is a singular fact to be regarded in the administration of fox-glove; that its action is considerably influenced by the different positions of the patient's body, whether erect or recumbent. In one case of phthisis, after taking this medicine, the pulse was not lessened in frequency when the patient stood erect, being upwards of an hun- dred. When he sat down it fell considerably, and when lying on his back it fell much more. When sitting, it was reduced to seven- ty-five, and when lying, to forty. The experiment was repeated many times, and always with the same effect.* The next remedy to be noticed is sanguinaria canadensis. This, in the hands of several respectable practitioners, has been found, in its effects, a valuable substitute for digitalis, and has obtained some confidence for its usefulness in coughs and consumption. We have the authority of Professors Smith and Ives, of New-Haven, and Dr. W. Tully, of Connecticut, to assert, that blood-root is of considerable utility in the incipient stage of pulmonary consump- tion, and even in confirmed phthisis. Dr. T. affirms that it palli- ates the symptoms, and renders essential service to the patient. The saturated tincture may be taken in doses of from thirty to sixty drops twice in a day, either by itself or combined with a little laudanum. The compound syrup of sanguinaria, mentioned in the appendix, is a preparation in which the virtues of blood-root are conjoined with another plant possessing, it is supposed, consid- erable efficacy in pulmonic complaints, and which is probably de- serving of some attention.! When the cough and other symptoms are very urgent, resort must be had to opium in some form for relief, but not to such extent as to suppress expectoration and in- crease the dyspnoea. According to Dr. Duncan, sen. who has published an excellent treatise on phthisis, a valuable substitute for opium may be found in the inspissated juice of the common garden lettuce. From his own experience, he considers this production far superior to the Turkey opium in any form. He avers that of all the medicines which he has employed for allaying cough in phthisis pulmonaris, * Vide Edin. Med. Jour., Dr. Hamilton on Digitalis, and Thomas's Modern Practice. * Lycopus Europaus. Water-horehound, Bugle-weed. CLASS II. PHTHISIS, OR PULMONARY CONSUMPTION. o73 next to opium he has found no article so beneficial as his lactu- carium or lettuce opium. It does not, like Turkey opium, occasion confusion of head, vertigo, irritation of the skin, sickness, vomiting, &c. nor does it induce a state of constipation. The dose may be about the same as common opium.* Some advantage has been experienced by inhaling the vapour of sulphuric aether, in which the dried leaves of conium maculatum has been macerated ; this is recommended by Dr. Duncan in his publication. Hemlock and hyoscyamus have been employed for their narcotic properties, but opium and lactucarium are to be preferred. The muriate of barytes has not on trial gained much confidence in phthisis. The Prussic acid, so highly extolled by many judicious and experienced practitioners, has in the general course of practice disappointed the expectations that had been formed, more failures than actual cures having been the result. This medicine, however, is known to pos- sess in a remarkable degree the properties of a direct sedative, more capable even than digitalis of prostrating the vital powers, and in an over dose, of arresting in a moment the action of the heart and arteries. As, however, we are fully authorized to affirm that some radical cures and many instances of relief have resulted from its use, it is entitled to our regard in the treatment of phthisis .pulmonaris. When it is deemed advisable to administer the Prussic acid, it should be recollected that the strength of the par- ticular preparation must be ascertained, as there is a variation in the strength of different preparations. In the administration of this acid, distilled water should be employed in the preparation, as common water will inevitably decompose and destroy its efficacy. Of a formula consisting of 6 or 8 ounces of distilled rose water, and 8 or 10 drops of the acid, a table-spoonful may be given every two or three hours, or two drops of the acid in a spoonful of dis- tilled water, or almond emulsion, every two or three hours during the day, increasing the quantity 2 or 3 drops on the whole portion taken in the 24 hours every day until relief be obtained. Prussic acid may be combined with tonics with real advantage, as with the infusion of cinchona, colomba, cascarilla, or in incipient pul- * As this article is undoubtedly of some importance in medicine, the reader is re- ferred to the American Now Dispensatory, 4th edition, for directions for its prepar- ation. It is but fair, however, to observe, that in the hands of other practitioners, hctucarium has disappointed expectations. 374 PHLEGMASIA. CLASS II, monary conplaints, in a strong decoction of lichen Islandicus.* The late Dr. Beddoes, and other medical men of high standing, have introduced a plan for supplying the lungs with factitious airs and gases, as remedies in the early stage of consumption, and they were reported to have contributed essentially to the relief and benefit of the patients, but the day of their reputation seems to have passed by without a prospect of a revival. There is, how- ever, some reason to believe, that the inhalation of carbonic acid gas, in some cases of incipient consumption, has been the means of mitigating the urgent symptoms and of protracting the fatal period. The lichen Islandicus is very universally employed as a remedy in the early stage of phthisis, and from its mucilaginous and nutri- tive properties has been held in much estimation. In those in- stances which have been preceded or accompanied by haemoptysis, or when from relaxation there is an accumulation of mucus upon the bronchia, occasioning a constant expectoration, this medicine has been found so beneficial that actual cures have been attributed to its efficacy, and in most cases it is a valuable auxiliary. This lichen is usually prepared by first boiling in water to a strong de- coction, then, by adding a proper quantity of sugar it is formed into a thick syrup, or jelly, and eaten very freely with milk. It is not improbable that this article has lost some credit by reason of its not being taken in sufficient quantity. Cooling neutral salts, through the whole course of this disease, are always useful, partic- ularly sal nitre, ten grains of which should be given frequently, or half a drachm to a pint of milk of almonds or mucilage of gum arabic, with a little laudanum, may be taken in spoonful doses occasionally. In the first stage of consumption, a frequent repeti- tion of emetics has been recommended, which is known to be pro- ductive of the happiest effects. The sulphate of copper is held in preference to any other of the class of emetics. When given by itself, the dose is about ten or twelve grains dissolved in two or three ounces of water. The vomiting is speedily excited, and the patient may drink freely of warm water. With due regard to the strength of the patient, the same mode of evacuating the sto- mach, and relieving the lungs, may with much advantage be resorted to in the second stage of this disease. The method which * In the American New Dispensatory, 4th edition, will be found the most ampl* information respecting the properties and character of the Prussic acid. CLASS II. PHTHISIS, OR PULMONARY CONSUMPTION. 375 originated with Dr. Marryat and other English physicians, and was adopted by the late Dr. Senter, of Newport, consists in the exhi- bition of an emetic, composed of from seven to ten grains of sul- phate of copper, and the same quantity of Ipecacuanha, made into pills, to be taken in the morning, fasting, without drinking any thing for some time afterwards. This, which is termed the dry vomit, is to be exhibited every second or third day; it excites vomiting without relaxing the stomach, irritating the intestines, or greatly fatiguing the patient. Dr. Senter assures us that he has restored more persons labouring under hectic fever, from glandu- lar suppuration, by vomiting in this manner, and giving in the intervals as much as the stomach would bear, of Dr. Griffith's myrrh and steel mixture, than by all other medicines he ever read of or tried. " To the good effects of the mode of treatment pur- sued by Dr. Senter, I can bear," says Dr. Thomas, " ample testi- mony, having adopted it in many cases of incipient phthisis with infinite advantage." Among the detergent remedies, the Balsam of Copaiva stands conspicuous; it is a favorite with some physi- cians, and greatly praised for its virtues in chronic inffammation of the bronchia and other pulmonic affections. According to Dr. Armstrong, " this balsam exerts in many cases a specific influence over the mucous membrane of the trachea and its branches, it in- creases the flow of urine, it not unfrequently keeps the bowels regularly open, and sometimes acts upon the skin, causing itching or eruption. Upon the single or combined influence of one or other of these effects its main efficacy probably depends." The dose in which Dr. A. administers it, is unusually large, being from 30 or 40 drops three times a day, and gradually increased until 60 or 80, or even more drops be taken at each time ; but where it obviously and shortly lessons expectoration, the cough and irri- tation, it will seldom be requisite to increase it to the last mention- ed dose. Care should be taken that the balsam be pure, neither adulterated nor injured by age. The following is perhaps the best formula for the administration of it. R Bal. Copaiva, 3j. Spt. lavend. comp. spt. nit. dul. aa 3ij. Laudanum, 3j. Gum arab. gij. Water 3 iv. m. Dose, a table-spoonful morning, noon, and night. Sulphur corr bined with balsam copaiva has been said to be useful. 376 PHLEGMASIA. CLASS II. The next remedy to be noticed, and probably more deserving of praise, is myrrh. This has long been employed with a good share of success in those cases of hectic fever, which are unattend- ed with any great degree of heat, or thirst, and which do not shew manifest signs of inflammation, myrrh combined with steel, as re- commended by Dr. Moses Griffith, has been found a valuable re- medy. When administered in the early stage, and duly persisted in,'it has demonstrated its superior efficacy, and evinced its tonic and invigorating powers in the most satisfactory manner. Dr. Thomas views this preparation of myrrh as preferable to all other forms, and says it is best to begin with small doses, and it may gradually be increased, the myrrh to 17 or 18 grains, the subcar- bonate of potass to ten, and the sulphate of iron to four, for one dose given in the morning, in the afternoon, and at bed time. Dr. T. proposes this myrrh and steel mixture, with a proper dose of tincture of digitalis to each draught, and vomiting twice a week with the sulphate of copper, as the plan which he has adopted in several cases with much seeming advantage. But if preferred, the myrrh and other ingredients may be formed into pills, and the tinc- ture of digitalis given in an ounce of the infusion of quassia or cascarilla.* The cinchona bark is sometimes recommended in the ulcerative stage of phthisis, but unless the remissions of the fever are very distinctly marked, more injury than benefit will attend its use. But in hectic fever, arising from absorption of purulent matter from abcesses in other parts, and without the presence of inflam- mation of the lungs, cinchona and the mineral acids must be our chief dependence. The diarrhoea attending hectic fever should be restrained by astringents and opium, or a small dose of calomel and opium may be occasionally interposed. The powerful aid of mer- cury has not been overlooked as a remedy in pulmonary consump- tion. This, in a few instances, in the skilful hands of the late Dr. Rush, proved decidedly successful. But a mercurial course has not received the sanction of other experienced practitioners, and ex- cept in that variety of the disease connected with obstructions in the abdominal viscera, or a venereal taint, this active medicine will be more likely to aggravate than to remove the affection. The warm bath in every stage of phthisis is undoubtedly useful; its di- * See his Modern Practice. CLASS II. PHTHISIS, OR PULMONARY CONSUMPTION. 377 rect tendency is to excite the cutaneous vessels, to bring a flow of blood to the surface which relieves the oppression on the lungs, and contributes to allay feverish heat and irritation. Whenever the warm or tepid bath is resorted to, it should be accompanied with friction of the body most assiduously employed, and from their combined operation the most favourable effects are to be expected. There is so close a connection between the skin and lungs, that nothing is more important than a uniform temperature of the atmosphere, and the patient who is unavoidably exposed to the inclement win- ter of a cold climate, should be advised to confine himself in a warm close room, or rather several rooms, the atmosphere of which is regulated by the thermometer. The air should be kept from 62 to 65 degrees. The clothing of the patient should be such at all times as to shield the skin from the action of cold air, so long as he shall remain in a cold or changeful atmosphere. Flannel, fleecy hosiery, and calico are the articles most proper to be worn next the skin, and these should be frequently changed. The inhalation of the fumes from boiling tar or pitch, has recently been introduc- ed into practice, by Sir Alexander Chrichton, and as favourable re- ports have been made of its salutary effects, it is desirable that it should have a fair and full trial. Dr. Hosack observes that the most decided benefit was obtained from the tonic treatment, parti- cularly from the bitter infusion in combination with the sulphuric acid, and by the use of the fumes of boiling tar. In one case of a most unpromising nature, the latter remedy, in conjunction with the free use of tar water taken from a pint to a quart daily, effected a cure. The patient came into the house greatly exhausted, ex- pectorating at least half a pint of the most offensive purulent mat- ter in the 24 hours. By the use of the last mentioned remedies, this excessive drain was gradually lessened, and in six weeks from the time the patient commenced the use of tar water and the tar fumigation, he was discharged from the hospital perfectly cured. Other trials of the tar fumigation afford less encouragement, and it has in a few instances excited an attack of acute inflammation of the windpipe, and produced a distressing irritation of that part. When the fumigation is employed, the patient must not hastily expose himself to cold air. The method advised by Dr. Thomas for fill- ing a room with the vapour of tar is, to place the vessel contain- ing it over a spirit lamp, let it boil slowly, but not burn, and the fumigation should be repeated every three hours. IS 378 PHLEGMASIA. CLASS II. The Seltzer water is known to possess a peculiar power of allay- ing feverish irritation, and has done much service in slow hectic fevers, attended with flushings and profuse night sweats. It checks the violence of perspiration as well as the discharge from the lungs, composes the patient at night, and improves the appetite. It mixes well with milk, and is thus used with advantage by hectic patients, or it may be taken with sugar and wine. The acetate of lead joined with opium, has a favourable tendency in restraining the morning perspiration, and also a spitting of blood. Having taken a view of the numerous remedies which from time to time have been recommended for the cure of pulmonary con- sumption, I close with the remark, that it is in the incipient stage only that a cure of this most cruel disease can ever be expected; in the last stage, the healing art is incompetent to any further assist- ance than to palliate the distressing symptoms, to sooth the pa- tient's mind, and to smooth the path of death. It has in too many instances happened that in a confined phthisis, when the body is emaciated, the mind debilitated, and the spirits desponding, the miserable patient is advised to a change of climate ; all the com- forts of home and the cheering attentions of friends are abandoned, a long journey or a sea voyage is encountered, and the patient is introduced to the society of strangers; the consequence almost constantly is, that the scene is either closed abroad, or he returns worn down with fatigue and disappointment, under a rapid increase of the fatal malady. If a change of climate cannot be accomplish- ed during the incipient stage, it should on no account be recom- mended at an after period. It is a painful consideration that nu- merous instances occur of young females labouring for months under a severe cough and other complaints, in consequence per- haps of a cold, contracted at a critical period, unconscious of any impending danger, while the insidious disease is making impercepti- ble approaches, and fastening its hold on the constitution. No medical advice is requested, the unfortunate patient being flattered and deluded with the vain hope, that a few trivial medicines, without any regard to a proper regimen of diet, may be the means of restoring the desired state of health ; until at length a severe pain and oppression about the chest, with a more distress- ing coufh and a copious expectoration of purulent matter, attend- ed by hectic fever and night sweats, excite alarm, and arouse the unhappy patient or friends to a sense of danger. A physician is "LASS II. GLOSSITIS, OR INFLAMMATION OF THE TONGUE. 379 now consulted, but the disease has advanced to that stage, when, alas ! it is deemed irremediable. Thousands have in this manner trifled away their lives, which by early care and attention, might have been preserved as ornaments to society, and blessings to their friends. The admonition of the poet, therefore, cannot be too fre- quently repeated, that ---------------" For want of timely care Millions have died of medicable wounds." GLOSSITIS. Inflammation of the tongue is certainly a disease of rare occui rence, and not often noticed by authors; but Dr. Hosack has seen it in two instances to occur as an idiopathic disease, and he has been induced to give it a gcueric place in his nosological arrange- ment, and to detail the ciivumstances of those cases which have fallen under his notice. The first case was that of Mr. J. Hamil- ton, a respectable citizen of New-York. This gentleman, on a jour- ney in July, 1817, exposed to a hot sun, was very much fatigued as well as heated. At night he imprudently washed himself in cold water, and lodged in a room exposed to an open window; he awoke in the night much oppressed with a considerable degree of sore- ness about the throat. His complaints gradually increased, on the third day his tongue began to swell, and in a little time so much enlarged in all directions that it pressed against the roof of his mouth, and was even protruded beyond the teeth ; he was unable to close his mouth or to articulate ; his swallowing was attended with much difficulty and distress. Not only the tongue, but the sublingual glands and those at the root of the tongue, with those of the neck and jaw, all became very much enlarged ; his whole neck from the jaw to the clavicles became very much distended, hard, and almost unyielding to pressure. His attending physiciau, Dr. Cooper, urged the necessity of immediate blood-letting. This was unfortunately resisted by Mr. Hamilton, upon the ground that lie had been subject to gout: had he submitted to the first advice of his physician, he probably would have been immediately relieved. Vn active purge was given, a blister was applied to his neck, and a proper e of such drinks as were best 380 PHLEGMASIA. CLASS II. calculated to allay the existing inflammation. His symptoms all increased in violence, his oppression was now so great that he was unable to lie down. On careful examination a tumor was discover- ed under the tongue, indicating suppuration ; a lancet being passed into it, a small discharge of a very offensive purulent matter fol- lowed, which afforded some relief. Not long after, a slight delirium ensued. His face became of a dark red colour, the blood being evi- dently retarded in its return from the head by the distention of the neck and neighbouring parts ; his pulse was frequent and full, his respiration more hurried than natural and somewhat labored, occa- sionally attended with effort to throw off the matter excreted about the throat; his skin was moist; the discharges from the mouth were very offensive, and chiefly consisted of a dark coloured slimy matter, with some slight appearances of pus ; now and then he be- came exceedingly restless, rose from his seat, walked for a few minutes, and returned to repose. Although eight days had elapsed since his attack, it was advised in consultation to take from him twelve or fourteen ounces of blood, fot the purpose of lessening the pressure upon the brain, and a saline carthartic was directed, As his heat of skin was increased, his face and limbs were also di- rected to be frequently sponged with tepid vinegar and water. By the operation of his medicine and the loss of blood, he was in some degree relieved ; but upon the approach of evening all his symptoms were sensibly renewed with increased violence. A few grains of ipecacuanha being administered, hevomited two or three times, and was followed by a discharge of phlegm and mucus from the fauces and lungs. The tongue became much cleaner and was much diminished in size; insomuch that he could now bring the teeth of the two jaws together—he passed a more comfortable night, being enabled to get some sleep in a horizontal posture, which he had not done during his illness. The next day the circumstances just mentioned and the suppuration that appeared, gave some en- couragement of a favourable issue ; but the tumour was still hard and unyielding, his breathing remained very much oppressed, his circulation was yet active, more or less of coma and aberration of mind occasionally appeared. A large blister was now applied to the throat and neck, and a gargle consisting of yeast, borax and honey, directed to be made use of every hour. His drinks were continu- ed as before, with an occasional cup of panada, and chicken soup, prepared with a large proportion of vegetables: his blister drew (LASS II. TONSILLITIS, OR INFLAMMATORY SORE THROAT. 381 well, and he passed the early part of the day with more comfort than usual: in the afternoon his symptoms were sensibly ap;"Tavat- ed ; he was exceedingly restless, frequently walking about his room, ids pulse increased in frequency, his breathing more difficult, with some tendency to diarrhoea. His bowels were readily composed by an anodyne ; his nourishment was rendered stimulant by the addition of wine, and a decoction of bark and snake-root was ad- ministered ; his restlessness increased in a very great degree ; he continued to walk from one chamber to another, and from thence through the hall the whole evening and night, his muscular powers remaining unimpaired, until within a very few minutes of his disso- lution ; analogous to those remarkable cases of yellow fever in which the patient may be almost said literally to walk to his grave, belaid down and breathed his last a few minutes before one. The second case of glossitis which fell under the observation of Dr. Hosack, occurrcH in the New-York hospital, in the summer of the year 1822. The symptoms were very similar to those just de- tailed in the case of Mr. Hamilton. By means of copious bleeding, deep scarifications in his tongue, and blister to his throat, and anti- monials with a saline carthartic, the disease was entirely removed in a short time, and by the continuance for a few days of the anti- phlogistic treatment, the tongue was reduced to its previous size. TONSILLITIS, OR INFLAMMATORY SORE THROAT, OR QUINSY This is an inflammation affecting one or both tonsils, and often extending through the whole of the mucous membrane of the mouth and throat, so as to interrupt the speech, and the power of deglutition or swallowing, and of respiration. This disease is most frequently occasioned by exposure to cold, either from sudden vicissitudes of weather, sitting in wet rooms, having wet feet, drinking cold water when the body is over heated, or otherwise giving a sudden check to perspiration. The suppres- sion of accustomed evacuations will also produce this disease; and persons having experienced a few attacks are peculiarly liable to returns of it. The spring and autumn are the seasons in which it most frequently takes place, and it i* most incidental to persons of a full and plethoric habit. 382 PHLEGMASIA. >UASS II. The inflammatory sore throat, or quinsy, is manifest from the redness, tumour, and heat of the tonsils, rendering deglutition pain- ful, respiration difficult, with dryness of the throat, difficult excre- tion of mucus, and a quick, hard pulse, and other symptoms of fever. It may be distinguished from the malignant ulcerous sore throat, by the strength of the pulse, the greater difficulty of deglutition, the absence of ulcers in the throat, and the accompanying fever being inflammatory, and it differs from that also in not being con- tagious. The inflammation begins, for the most part in one tonsil, and soon extends to the other, and to the uvula and parts adjacent. If both sides of the fauces or throat be affected, the pain and dif- ficulty of swallowing become extreme; and if the inflammation extend itself to the muscles about the top of the windpipe, and the parts are much tumefied, the patient will be in some danger of suffocation. When tbe external parts of the throat are puffed up, it is considered as a favourable sign. The singular fact that more pain is experienced in swallowing liquids than solids, is accounted for by a greater portion of mus- cular fibres being employed in the former than the latter. In the treatment of this disease, the same method which is proper in other inflammatory affections of a local nature must be adopted. Both food and drink should be of the lightest and most simple kind. The patient ought to be kept quiet, and avoid speaking as much as possible ; his head should be raised while in bed, and a moderate perspiration should be encouraged. His feet and legs must be often bathed in warm water, and his bowels gen- tly deterged with Glauber's salts when required. It is important that the neck be kept warm, and a double flannel, well moistened with the volatile liniment, if often repeated, in conjunction with the means above mentioned, will frequently remove slight affec- tions of the throat, and render further expedients unnecessary; or a blistor may be applied to the part with advantage. An emetic given in the early stage has been found highly efficacious. The steam of warm water, or of the infusion of hops, received through Mudge's inhaler, or from a coramon funnel, is extremely useful. A poultice of hops, prepared with the addition of vinegar, and inclosed in a thin cambric cloth, applied to the throat, is also of great use in any stage of an inflamed throat, whether incipient, or proceeding to suppuration. All irritating gargles, in the first stage, have a tendency to aggravate the inflammation ; but when eLASS II. TONSILLITIS, OR INFLAMMATORY SORE THROAT. 383 the mouth is dry and parched, and the tonsils much inflamed, con- siderable relief may be obtained by dissolving in tbe mouth a few grains of nitrate of potass, and allowing it to lodge on the parts affected, or leisurely swallowing it. After the inflammation has subsided, the use of gargles is attended with the most beneficial effects, by attenuating the viscid mucus which clogs»the mouth and throat, and rendering it more easily removed. An infusion of red rose leaves sweetened with honey, and acidulated with the sul- phuric acid, of such strength as the patient can easily bear, will answer the desired purpose. Another preparation of this kind may be made of sage tea, with a little vinegar and honey ; and it may be improved by the addition of the jelly of black or red cur- rants. With some such preparation the mouth should be frequent- ly cleansed, and if necessary, it may be injected by means of a syringe. When astringent gargles are required, nothing can be more useful than an infusion of marsh-rosemary root. The ap- plication of cold water to the throat, both externally and internal- ly, has sometimes been found beneficial. In some instances, the inflammation and fever will run to such height at the beginning, as to require bleeding from the arm or jugular vein, the quantity and repetition of which must be deter- mined by the urgency of symptoms, and strength of the patient. After this evacuation, leeches ought to be applied to the throat. The volatile liniment ought also to be employed as mentioned. above, and should it not prove effectual, a blister must be applied round the throat in its stead. By a diligent employment of the means above recommended, the inflammation will, in most cases, be dissipated, and a suppuration prevented. If, however, the in- flammation cannot be resolved, and the formation of an abscess is indicated, we ought to hasten the suppuration by the frequent ap- plication of warm fomentations, and emollient poultices to the throat, and directing the patient to inhale the vapour from warm miik and water, through an inverted funnel, several times in a day. When the abscess has progressed to a ripened state, if it break not spontaneously, nor by the efforts of the patient, it must be opened with a lancet. If in any instance the tumour becomes so large as to obstruct the passage of food into the stomach, it only remains to afford the patient sustenance by nourishing clysters. made of broth, thin jellies, gruel, and milk, by which means he may be supported until by the breaking of the abscess, the passage 384 phlegmasia;. class II. for food is restored. The size and pressure of the tumour may be so increased as to obstruct the passage of the lungs, and endan- ger the life of the patient by suffocation, in which case bronchoto- my, or making an incision into the windpipe, must be performed, if an experienced surgeon can be procured; but fortunately there occur very feA* instances in practice where recourse to this opera- tion is necessary. There is sometimes an obstruction and enlargement of the glands of the throat, which occasion a difficulty of swallowing, unattended with inflammation, which may be soon removed by the application of the soap liniment or opodeldoc, and keeping the neck warm- Persons who are subject to inflammation in the throat, should Carefully observe regularity and temperance in living, and should occasionally carry off the superabundance of humours, by purging and other evacuations. They ought likewise to guard well against cold, and avoid whatever is of a stimulating nature in diet. Drinking cold liquor immediately after violent exercise, is very prejudicial; as is likewise a sudden exposure to cold air, after any great exertion of the throat by speaking or singing. The glands of the throat sometimes continue swelled after an inflammation, and acquire a degree of hardness which is difficult to be removed. No attempt should ever be made to resolve these tumours by any stimulating application. The throat should be kept warm, and the fauces gargled twice in a day with a decoction of figs or barley, sharpened with vinegar, leaving the swellings to dissipate by time. PHARYNGITIS. This is an inflammation of the pharynx, accompanied with painful and difficult deglutition ; respiration not materially affected. It is of the same nature as tonsillitis, is produced by the same causes, and requires a similar treatment. CLASS II. INFLAMMATION OF THE PERITONEUM. 385 OESOPHAGITIS. " Inflammation of the oesophagus, attended with a sense of heat and burning; painful and difficult deglutition, food frequently rejected, and with violence." The pain is fixed behind the ster- num in swallowing only, and the breath is not affected. The complaint is so uncommon, and so seldom attended with danger, that it is not often noticed by authors. The cure is easily effected by swallowing slowly nitrous and mucilaginous medicines. PERITONITIS, OR INFLAMMATION OF THE PERITONEUM. This affection occurs as a symptom in puerperal fever, and is so closely connected with it that an attempt to draw the line of distinction between them might be more embarrassing than useful in practice. But males are not un frequently the subjects of it, be- ing produced by cold when the body has been heated by severe exercise. According to Dr. Cullen, peritonitis is not only an in- flammation affecting the peritonium lining the cavity of the abdo- men, but also affecting the extensions of this membrane in the omentum and mesentery. This disease is known by a pain in the abdomen, increased by pressure or exertion of the body. It is to be distinguished from enteritis by the pain being much more super- ficial in the former than in the latter case, and generally not ac- companied with sickness or disturbance of the intestinal canal. Dr. Armstrong, is a warm advocate for copious bleeding, followed by large doses of opium for the purpose of subduing inflammation of the abdominal viscera. He carries the point to a greater extent than has been heretofore practised. In acute inflammation of the peritoneal coat of the stomach or bowels, and of acute peritonitis, and hysteritis, as soon as called in the first stage, Dr. A. directs bleeding to complete relaxation to approaching syncope, whatever may be the quantity of blood necessary to produce that effect, for it is to the effect, and not to the quantity which we look for relief in such formidable cases. Immediately after the patient recovers from the faintness, three grains at least of good opium in a soft pill are given. The effects of the opium, thus given, are to pre- vent a subsequent increase in the force or frequency of the heart's action, and a return of the abdominal pain, while it induces a ten- dency to quiet sleep and copious perspiration. If in three or fw 49 386 PHLEGMASIA. CLASS II, hours after the administration of opium, there be pain or pressure in any part of the abdomen, with a hot skin, and quick jerky pulse the patient is again bled in the same prompt and decisive manner as before, and carried to complete relaxation ; and two grains of opium, with three or four grains of calomel are exhibited in the form of a pill, as the faintness disappears. The patient is left to repose in quietness, and a free perspiration most frequently suc- ceeds. A third venesection is rarely requisite, but after the ex- piration of five or six hours, if pain and fever still exist, the opera- tion should again be performed as before, and one grain of opium with two or three of calomel given almost immediately afterwards ; while half a grain of the former with two grains of the latter, may be repeated every four hours till sleep and general perspiration be induced. After this active mode of proceeding, the mildest laxa- tives with simple injections of warm water, frequently repeated, will, in general, subserve all the desired purposes. Dr. Armstrong does not advise the use of opium when the tongue is in an unnat- ural state of dryness ; it is only in case of a moist tongue that it should be administered. It is an erroneous idea that opium con- stipates the bowels in cases of abdominal inflammation ; it produces a contrary effect, by relaxing the spasmodic constriction, it actual- ly tends to promote the discharges from the bowels. With the view of removing any remains of topical inflammation, leeches may be applied, and also large folds of flannel, wrung out of a decoction of chamomile flowers and bruised poppy heads, should be applied to the umbilical region, and confined there with a roller until the heat is expended. GASTRITIS, OR INFLAMMATION OF THE STOMACH, An inflammation of the stomach is an acute disease which is attended with great danger. It may be produced by drinking too freely of cold liquors when the body is very hot, from acrid or poisonous substances taken into the stomach, as arsenic, corrosive sublimate, the mineral acids, and sal nitre, in a large dose, as some- times happens by mistake. One fatal instance occurred to me in practice, in a young woman, which was occasioned by eating a large quantity of unripe damsons and apples. It may proceed from drinking too much ardent spirits, from a surfeit, a stoppage of pers- piration, repulsion of the gout, and violent passions. CLASS 11. GASTRITIS, OR INFLAMMATION OF THE STOMACH. > Among the most powerful causes of this disease is a sudden transition from cold to heat, as passing from a cold atmosphere into a warm room. Gastritis is divided by Dr. Cullen, and follow- ed by other authorities, into two species ; the phlegmonous, and erysipelatous. Phlegmonous gastritis is known by a violent burn- ing pain in the region of the stomach, with extreme anxiety, rest- lessness and tossing about of the body ; excessive heat and a con- tinued painful vomiting of every thing swallowed, a great soreness, tension and fulness of the stomach with flatulency and most dis- tressing thirst. The pulse is quick, hard and contracted. Great loss of strength, faintness, short and interrupted respiration, cold clammy sweats, hiccoughs, coldness of the extremities, and an inter- mitting pulse are the sure harbingers of death. I have known a temporary mania and hydrophobia attended in one instance, in a delicate lady, who recovered. A disease so fraught with danger re- quires the most prompt exertion in our power, as a very few days will decide the point between life and death. Hence we are told that, " the cure of gastritis is to be attempted by copious and repeated bleedings, employed at an early period of the disease, not regarding, or being intimidated by the smallness of the pulse, as it usually becomes softer and fuller after the operation ; nor by ex- treme debility, syncope, or convulsions, for all these are the effects of the disease. Draw off blood, therefore, every four or six hours, in such a quantity each time as the action of the heart will bear, and continue the practice as long as the characteristic symptoms of inflammatory disease remain. After venesection, topical bleed- ing, by means of several leeches over the stomach, or scarifying and cupping, may also be immediately adopted, if necessary."* But with deference to superior judgment, may we not hesitate be- fore we adopt extremes in practice without discriminating between the feeble and delicate and the robust aud vigorous constitution. In the former, the milder remedies will sometimes suffice, but in tbe latter when the disease appears in its acutest form, a more vig- orous discipline becomes requisite, nor will it be denied that cases of gastritis have been presented in which the boldest practice could not bo deemed justifiable or expedient. A large blister shou'd be applied to the region of the stomach, and continued without inter- mission for a length of time. The feet and legs should likewise * Thomas's Modern Practice. 388 PHLEGMASIA. CLASS U. be frequently bathed in luke warm water, and the whole body im- mersed in the bath. Clysters of infusion of chamomile flowers and linseed, or mallows, with the addition of two drachms of sal nitre to each, ought also to be often administered ; they ought also to be large in quantity, that they may act not only as laxatives, but as fomentations to the bowels and stomach. In regard to pur- gatives, we conceive that calomel, in the form of pills and followed by a solution of Epsom salts, either alone or with manna, are to be considered as by far the most eligible and the best adapted to the state of the stomach. Castor oil is probably the next article best calculated to answer the desired purpose. From the great propensity of the stomach to reject every thing taken down, very little can be expected from internal remedies, and every heating and irritating substance must be most carefully avoided. The food taken should be of the most mild diluent nature, such as bar- ley water, beef tea, and chicken broth in small quantities at a time. Demulcent and diluting drinks, moderately warm, may, however, be tried ; as may likewise small doses of nitre with spermaceti, or some mncilage of gum arabic, or of the slippery elm bark, to which may occasionally be added a few drops of laudanum. But opiates may be given in clysters when the vomiting has a little abated, with great advantage ; a drachm or two of the tincture of opium, in half a pint of barley water, should be often injected ; and with the view of affording the patient some nourishment, a gill of warm milk ad- ded to the clyster will be highly useful. If the disease cannot be resolved by the means above mentioned, mortification and death must ensue, and this fatal tendency may be known by the sudden cessation of the pain ; by the pulse continuing its frequency, but becoming weaker, and by delirium, hiccoughs and other marks of increasing debility. ENTERITIS, OR INFLAMMATION OF THE INTESTINES. This acute and very hazardous disease may be occasioned by the same causes which were recited when treating of inflammation of the stomach. It may arise, also, from obstinate costiveness, cold, fever, worms, hard indigestible aliments, drinking stale and windy malt liquors, sour wine, cider, &c. Very high seasoned and stimulating food sometimes gives rise to it, and it is often pro* CLASS II. ENTERITIS, OR INFLAMMATION OF THE INTESTINES. 389 duced by wet feet, wet clothes, and whatever obstructs perspira- tion. Another cause of this complaint, is what is termed an in- trosusception, or running in of one part of a bowel into the other, and there confined by some stricture or adhesion. It may like- wise be occasioned by a rupture, and by scirrhous tumours of the intestines. An inflammation of the intestines is accompanied with nearly the same symptoms as inflammation of the stomach. It com- mences with slight wandering pains in various parts of the abdo- men, which soon becomes fixed about the region of the navel, and is excessively violent, with a burning sensation of heat; the belly- being swelled, tense, and extremely tender to the touch ; the fever is acute, the tongue is parched, and of a dark brown colour, and the thirst is unquenchable. There are frequent evacuations, and urgings to vomit, and the efforts are sometimes so violent, that the motion of the bowels is inverted, and even the excrements are discharged by the mouth. When this last symptom occurs, it is called iliac passion. The urine is discharged in small quantity, and with pain and difficulty ; and the costiveness is often so obsti- nate, as not to yield to the greatest efforts. The pulse is small, hard, and quick, frequently becoming at last irregular and intermit- tent ; and the prostration of strength, as in gastritis, is in propor- tion to the violence of the symptoms. If efficacious remedies are not early employed, or do not succeed, the disease sometimes ends fatally in ten or twelve hours, and almost always before the third day; so that there is seldom any suppuration. If the pain soon changes its situation, and becomes less violent; if the vomitings lessen, and stools are produced, and the heat abates, it may be expected that a resolution is about taking place. But if the pain increases, and keeps constantly on one point, and the belly be- comes more tense and tender; if no stools are obtained, and the vomiting continues, and fcecal matter with the clysters is thrown up, it is too evident, that littlaground for hope remains; and when a sudden cessation of pain, hiccoughs, clammy sweats, fallen coun- tenance, convulsions, and coldness of the extremities occur, the fatal termination is near at hand, by a mortification of the intes- tines. In the cure of this dangerous complaint, nothing is more impor- tant than copious bleeding, and this should be repeated according to the urgency of the symptoms, until the pulse- becomes soft. As 390 PHLEGMASIA. CLASS LI. to the bold and energetic practice of Dr. Armstrong in acute in- flammation of the abdominal viscera, already noticed under the head of peritonitis, page 385, it must be submitted to the serious con- sideration of the attending physician, whose judgment and skill will be called into exercise on similar occasions. I can only observe for the encouragement of the timid and inexperienced practitioner that tbe process of Dr. A. appears to be extremely well adapted to the indications of cure, and has received the cordial approbation of many judicious medical men. Topical bleeding, either by cup- ping glasses, or leeches, may also prove advantageous, provided the patient can bear their application; and blisters over the abdo- men are of essential importance, and ought, on no account to be omitted. The patient should be placed up to his breast in luke- warm water, or emollient fomentations must be most thoroughly applied. His feet and legs should be often bathed, and mild sof- tening clysters, consisting of milk and water, barley water or gruel, as they serve the purpose of internal fomentation, ought to be fre- quently injected. Having thus far attempted to reduce the inflam- mation, the next point is, to endeavour to procure an evacuation of the contents of the bowels, by the use of purgatives of the gentlest kind; among which, no one, perhaps, is to 'be preferred to castor oil, provided it can be retained on the stomach; it may be rendered less unpleasant, by combining it with mucilage or yolk of egg. Another mild, but very useful laxative, may be formed by dissolving one ounce of Glauber's or Epsom salts with an ounce of manna in a pint of water, a tea-cup full of which may be taken every half hour, till the desired effect is produced. It may be proper to give small doses of laudanum occasionally, to appease the vomiting during the employment of the solution. If liquid purgatives cannot be retained, or should fail of producing the desired evacuation, we must resort to those of the solid kind, of which calomel unquestionably is the most eligible, and when conjoined with opium, the compound fulfils the double effect of an antispasmodic and aperient. A pill of ten grains of calomel and two grains of opium, repeated at proper intervals, say every three or four hours, will seldom fail to effectuate the object in view. Should the vomiting still continue to distress the patient, blisters must be repeated over the abdomen, or applied to the upper part of each thigh ; yeast, or the saline draught in the act of efferves- cence, with a few drops of laudanum, will be likely to mitigate the CLASS H. ENTERITIS, OR INFLAMMATION OF THE INTESTINES. 3Ql complaint. Fomentations, with decoctions of chamomile flowers, wormwood, and peppermint, to the stomach and bowels, are always useful; and the irritable state of the stomach may be ap- peased by equal parts of new milk and limewater, given in spoon- ful doses. In some instances, when the inflammatory excitement has subsided, an emetic of ipecacuanha and tartarized antimony has been known to produce the most substantial benefit. The fumes of tobacco injected into the rectum, act with a favorable ten- dency, by relaxing the spasmodic stricture, and thereby promoting the alvine evacuation. A very erroneous supposition sometimes prevails, that the con- stipation in this disease should be the first and chief symptom to be attended to, giving it the vulgar name of stoppage ; they imme- diately have recourse to active purgatives, and persevere in their use, to the great hazard of the patient. Another error is some- times committed, by mistaking this disorder for colicky pains, when spirituous and other heating liquors are administered, which greatly tend to increase the inflammation and the real danger. The fever, with quick and hard pulse, and great tenderness of the abdomen, will sufficiently distinguish this disorder from colic. In regard to food in this disease, it is obvious that, very little can be taken, and nothing but the most bland and mildest liquids should be swallow- ed. After the acute stage of this disease is over, we not unfre- quently meet with a swelling or induration between the crest of the right ilium and the umbilicus, which seems to be the seat of the pain, is tender to the the touch, and produces great uneasiness when the contents of the alimentary canal pass through this part. The difficulty undoubtedly proceeds from coagulable lymph effused among the intestines, and from inflammation in a subacute degree. The cure is effected by cupping, or applying leeches to the part, or by frequently bathing it with some cold liquid, as dilut- ed alcohol, camphorated spirit, foe. Perhaps the following may be preferable to any thing else. Take of the water of acetite of ammonia and of pure water, each four ounces, brandy, one ounce, mix and place them in a cool situation. Keep flannels wet in this preparation constantly applied to the part, and renew as often as they get warm. Experience has proved both the efficacy and safety of this course. The danger of attempting to produce sup- puration will appear obvious to every one who reflects on the nature of the parts concerned. If. however, suppuration should 3S2 PHLEGMASIA. CLASS II, take place, contrary to all our wishes, a's soon as the circumstances will admit, we must proceed to make an opening for the passage of the matter. From the consideration of the obstinacy of this dreadful disease, and its frequently fatal termination, it must be obvious, that people cannot guard with too much caution against the various causes by which it is produced ; among these are long continued costiveness, sour unripe fruit, and sour or very stale liquors. The danger of wet clothes should be particularly avoided, and especially wet feet, which, of all the various ways of catching cold is the most perni- cious to the bowels. Such is the imminent and pressing danger attending these acute diseases affecting the vital organs, that the physician should feel it as a duty to be present with his patient during the most critical period, to watch the effects of the remedial applications, and the various changes in the disease, recollecting that the operation of all medicines is powerfully modified by the condition of the system at the time of their administration, and that the slightest error may decide the point of life or death. In our circle of practice we become familiar with cases of obsti- nate constipation of the bowels, unattended with active inflamma- tion at the onset. This complaint probably originates in a torpid state of the liver, or a deranged condition of the biliary organs, or by some indigestible article of food. I have met with one very obstinate case occasioned by eating freely of tamarinds and swal- lowing the stones ; it was about eighteen days before the stones were evacuated. In the course of the disease, a degree of inflammation and of spasmodic constriction are induced; the digestive organs are deranged, the abdomen becomes tumefied and painful, loose and watery stools are on some occasions discharged, and a troublesome vomiting ensues. But such is the unyielding intestinal obstruction as to require a persever- ance in the use of the ordinary cathartics for fifteen or twenty days, for its removal. The general course of treatment is, when the arterial action is considerably excited, to abstract the requisite quantity of blood by one or two operations, to employ the usual topical applications, and to administer calomel to the point of sali- vation. When calomel produces ptyalism, it is shortly after fol- lowed with alvine evacuations. To abate the spasm, opium is to be interposed, and calomel is aided by other purgative CLASS II. HEPATITIS, OR INFLAMMATION OF THE LIVER. 393 medicines and enemata of various compositions. Tobacco smoke injected into the rectum, and dashing cold water upon the lower extremities, are also among the remedies recommended. This course was regularly arid faithfully pursued with a patient in the hands of Dr. Hosack, without success, until, on the 20th day from the commencement of the course, when the patient had taken four hundred and eighty grains of calomel, in doses of from ten to twenty grains, he complained of a soreness of his gums, and a rumbling in his bowels, with an inclination to go to stool. The next day the evacuations became frequent, and were extremely foetid. No further use of purgatives were necessary, and health was soon restored. Dr. H. has since improved upon the method of treatment in this species of constipation, in which he is confirm- ed by the soundest experience. After venesection, when that operation appears requisite, his chief dependence is upon emetics of ipecacuanha and tartarized antimony. If the dose is promptly effectual, in its operation, he repeats the administration until the curative indications are accomplished. In his detail of numerous examples of this successful method, we are furnished with the most unequivocal evidence of the superior efficacy of emetics over all other means of cure. Physicians in general, therefore, will, it is presumed, adopt this successful plan of treatment of this dis- ease. HEPATITIS, OR INFLAMMATION OF THE LIVER Inflammation of the liver is more frequently met with in warm climates, than in cold or temperate ones. It commences in general with a rigour, or shivering, which is succeeded by febrile heat with pain, either acute or dull, under the short ribs of the right side, inj creased by pressure upon the part, and frequently extending to the Collar bone and shoulder. There is a difficulty of laying on the left side, shortness of breath, a dry cough, and sometimes vomiting of bilous matter attended with hiccoughs. The symptoms vary in this disease according to the degree of inflammation and the par- ticular part of the liver which happens to be affected. Sometimes the pain is so inconsiderable, that the disease progresses to a dan- gerous state before it is even suspected. There is a loss of appe- tite, great thirst, and costiveness ; the urine is of a deep saffron ">0 394 PHLEGMASIA. CLASS II. colour, and small in quantity ; the pulse strong, hard, and frequent« the skin is hot and dry ; the tongue covered with a white oryellow- .ish fur, and in some, it is attended with yellowness of the eyes. This disease maybe distinguished from pneumonia, or pleurisv fu- tile pain being less violent, and extending up to the shoulder, the pulse not so hard, by the sallowness of the countenance, by the cotifdi being unaccompanied by expectoration, and commencing at a later stage of the disea'se, and a less degree of labour in breathing. The causes which may produce this disease, besides those which give rise to other inflammations, are certain passions of the mind, violent exercise, any thing that suddenly cools the liver after it has been much heated. Too free use of hot spicy aliment, and strong wines ; but more especially spirituous liquors. Gall stones ob- structing the passage of the bile may sometimes produce this disease. Inflammation of the liver, like that of other parts, may terminate by resolution, suppuration, gangrene, or scirrhus ; but in this climate, a suppuration or gangrene, is not a frequent occurrence. A resolution is often effected by some spontaneous evacuation, as a bleeding at the nose, or the bleeding piles. Sometimes it is ac- companied by a bilious looseness, a profuse sweating, or a dis- charge of urine depositing a copious sediment. When the disease ends in suppuration, the matter of the abscess may be discharged by the biliary ducts, or if that part of the liver most contiguous to the abscess, has formed adhesions with some neighbouring part, the matter may be discharged by the different outlets with which this part is connected, thus, it may be coughed or vomited up, or the matter may work its way outwardly by bursting through the integ- uments, or a passage be made for it by incision. But if the abscess should burst into the cavity of the abdomen at large, death will be the consequence. It frequently happens, that the inflammatory symptoms at the beginning of this disease, are not sufficiently alarming to arrest the attention ; but as soon as the existence of the disorder is ascertain- ed, no time should be lost in drawing from the arm a proper quan- tity of blood, and though the pulse should not be remarkably hard, a repetition of the operation must be determined by the degree of pain and fever, with which the patient is attended. After general bleeding in acute hepatitis, leeches may be employed, fomentations. softening clysters, bathing the feet, and the whole antiphlogistic 'LASS II. HEPATITIS, OR INFLAMMATION OF THE LIVER. 395 plan should be rigorously pursued as directed in other inflamma- tions. A large blister should next be applied over the region of the liver, and mild laxatives of Glauber's salts and manna, preced- ed by a few grains of calomel, administered. As diuretic medi- cines have been found useful in this complaint, about twenty grains of sal nitre, or a tea-spoonful of the spiritus nitri dulcis, may be given in a cup of tea drink every three or four hours. A tenden- cy to sweat may be encouraged, by drinking plentifully of warm diluting liquors, and repeated doses of the saline mixture, with tartarized antimony. Should a looseness occur, it ought not to be checked, unless the evacuations be so considerable as to weaken the patient, as loose stools often prove critical, and carry off the disease. Whon all our endeavours to subdue the inflammation, fail, and an abscess is about forming in the liver, which is marked by the pulse becoming softer, frequent shiverings, abatement of pain, and a sensation of weight about the part affected, we must endeavour as much as possible to promote the suppuration. For this purpose, the usual application of poultices, and emollient fomentations must be immediately made, and duly persisted in, un- til the contents of the abscess can be discharged by an incision, through the external teguments by some skilful operator. The opening should be made in the most depending part of the tumour, where a fluctuation is perceived. Having with a scalpel, cut through the external teguments, and reached the abscess, it may be pierced with a trocar and the matter gradually evacuated. It the liver has formed such adhesion to the peritoiueum, as to pre- vent the pus from falling into the cavity of the abdomen, the life of the patient may be preserved. The Peruvian bark, in doses of half a drachm in powder, should be given four or five times a day, during tho formation of the abscess, and after it is opened, in order to support the strength, and to guard against the effects of absorp- tion of the purulent matter. The patient is to be supported with light nourishing food and cooling diluting drinks, carefully avoid- ing all heating substances as in other inflammations. If" the pain and swelling do not yield to the antiphlogistic plan, which has been advised, and the inflammation should terminate in induration, and scirrhus, the patient may survive for many years, provided he pay proper attention to his diet and mode of living. He oucht in this case, to use less of animal than vegetable food : avoiding high seasoned meat and strong liquors. 396 PHLEGMASIA. CLASS II. There is likewise a chronic inflammation of the liver, in whicli the symptoms are more moderate, and the disease is slow in its progress, often continuing for many months, and at last terminating in a very considerable suppuration. The patient complains rath- er of a sense of weight than of pain, and the fever occurs in pa- roxysms or fits, somewhat resembling the attacks of an intermit- tent, and the liver on examination externally, will often be found to be considerably enlarged. In both chronic inflammation and scirrhous affections of the liver, a moderate course of mercury will be found of singular efficacy. Mercury may be introduced into the system, by rubbing in about one drachm of the ointment in the neighborhood of the part affect- ed, or in the groins every night, until some very obvious effect is produced on the constitution ; or till the swelling and hardness are dispersed. If an internal course should be preferred, about two grains of calomel and half a grain of opium, every night, will probably ef- fect the desired purpose without carrying it to the extent of com- plete salivation. When it is desired to combine antimony with mercury, the Plummer's pills may be considered as the best form. During the course, it will be advisable to exhibit a mild laxative of neutral salts, every third or fourth day. It will in some instances, perhaps, be necessary to continue this course for five or six weeks, observing at the same time a proper regulation of diet, consisting chiefly of light puddings, of rice or arrow-root, with milk and ve- getables, meat broth, and farinaceous substances. Salted meat, greasy substances, and all spirituous liquors, must be particularly avoided. Recently, the nitric acid has been used in chronic affec- tions of the liver, and has received much commendation as an aux- iliary remedy, during the employment of mercury. It is even by some made a substitute for that medicine, especially in scorbutic habits. The method of giving the acid at first, is to mix one drachm with a pint of water, sweetened with simple syrup. This quantity is to be taken at different times in the course of twenty- four hours, through a glass tube or quill, to prevent the teeth from being injured. If no inconvenience is felt, the quantity of the acid may be increased to two, and even in certain cases to three drachms. By some modern writers, dandelion is highly extolled in the treatment of chronic inflammation of the liver, or incipient scir- CLASS II. INFLAMMATION OF THE SPLEEN. 397 rhus of that organ, in a dose of half a drachm of the extract twice a day. Either a strong decoction, or the fresh expressed juice, in doses of from two ounces to four, two or three times within the twentv-four hours, will, however, be found more active prepara- tions. A course of stomachic bitters, with cinchona and colomba, ought to be adopted during the convalescent state. SPLENITIS, OR INFLAMMATION OF THE SPLEEN. This disease comes on with a shivering, succeeded by great heat, thirst, and other febrile symptoms ; anxiety about the prae- cordia, difficult respiration, and dry cough. An obtuse pain is felt under the short ribs of the left side, extending over the whole abdomen, and shooting through the diaphragm into the left shoul- der. The fever generally increases every fourth da}', the feet and knees grow red, the nose and ears sometimes pale. The pulse on the left side is sometimes partially suppressed, intermittent and weak. There is lassitude and debility, watchfulness, and some- times delirium. Indigestion ensues, with anorexia, vomiting of green bilious matter, faintings, and bleeding from the nostrils. The swelling on the left side, which accompanies this disease, re- presents pretty nearly the form of the spleen. Splenitis is ac- companied with less danger than hepatitis, and a vomiting of black grumous matter, which in other acute diseases is reckoned a fatal symptom, is said to prove sometimes critical and salutary in this. Splenitis, like other inflammatory affections, may terminate either in resolution, suppuration, or scirrhus, though it is sometimes car- ried off by the haemorrhoids. An abscess of the spleen will some- times be formed without much previous distress or disorder, wbicli bursting suddenly, pours its contents amongst the viscera of the abdomen, and in a few days destroys the patient. That enlarge- ment of the spleen, the consequence of long continued intermit- tents, is called ague-cake. A simple enlargement of the spleen mav continue for many years, without much injury to the general health. For the cure of splenitis, the antiphlogistic system must be put in practice, by general and topical bleedings, mercurial purgatives, blisters and fomentations, as in hepatitis. In chronic enlargements or indurated state of the spleen, recourse must be had to mercury in an early period, both as a purgative and a do- obstruent. 398 PHLEGMASIA. CLASS H, PANCREATITIS, OR INFLAMMATION OF THE PANCREAS. A morbid conditioner the pancreas has seldom been made the subject of investigation by pathologists, or admitted into nosologi- cal arrangements. The pancreas being an organ of glandular structure, is liable to be affected with inflammation, ulceration and scirrhus. For the following statement I am indebted to an inge. nious inaugural dissertation on the functions and diseases of the pancreas, by Thomas Sewall, M. D.* Our author, after citing two instances of diseased pancreas from Morgagni, proceeds to de- tail the particular circumstances attending two examples of it whicli fell under his own observation, together with the appearauces ion dissection. Both these subjects were young persons, of studious and sedentary habits. The prominent symptoms in the first case, were, an obtuse pain, deep seated," and fixed in the region of the epigastrium, with an incurvation of the body forward, and an ina- bility to sit or stand erect without greatly increasing its severity, In a few months these symptoms were accompanied with dyspep- sia, great acidity of the stomach, and an occasional vomiting. His appetite was generally good, but nothing could be retained long enough by the stomach to undergo digestion, except milk, which constituted the greatest part of his diet, ever after the attack, till his death. This case finally terminated fatally, by a pulmonary consumption. In the second case, the patient was first affected with a tumefaction of the parotid and submaxillary glands, also of some of the lymphatic glands of the neck. This suddenly subsid- ed, and soon after a considerable tumour made its appearance in the epigastrium, accompanied with severe deep seated pain, and an almost constant vomiting, There was, as in the preceding case, an incurved position of the body, and inability to sit or stand erect without greatly increasing the severity of the pain. Nothing could be retained by the stomach but liquid food, and that only when taken in small quantities and at short intervals. The bowels were usually costive, and could only be kept free by the use of ca- thartics and enemas. These, with blistering over the stomach, Opium, and lime water, were the most effectual remedies in allevi- ating these distressing symptoms. But their effect was only pallia- * This gentleman js now Professor of Anatomy and Physiology, in the Columbia Medical School, at Washington, and is an ornament to his profession, and distin "uished for his indefatigable pursuit of medical knowledge and improvement. ' LVSS II. NEPHRITIS, OR INFLAMMATION OF THE KIDNEYS. S[)[) tive ; meat emaciation and debility ensued, which finallv terminat- ed in death. On examination of the first subject, the pancreas was the only one of the abdominal viscera, in which there was any mark of disease. This was enlarged to about twice its natural size, and scirrhous, particularly its right extremity, which embraced the duodenum, and pressed so firmly on the pylorus, that its orifice would scarcely admit of the introduction of a common sized cathe- ter. On examining the second subject, the pancreas was found enlarged to nearly three times its natural size, with its left extremi- ty extending into the left lumbar region, and its right pressing firm- ly on the duodenum and small extremity of the stomach, and there- by nearly obliterating its pyloric orifice. Its surface was univer- sally irregular, hard and unyielding, and in many places exhibited in its appearance the scirrhous structure. From the foregoing cases, says Dr. Sewall, pain in the epigastrium, vomiting, and aci- dity of the stomach, appear to constitute the most remarkable in- dications of an enlarged and scirrhous affection of the pancreas. Vomiting is another symptom which strongly indicates an affec- tion of the pancreas. This was a leading feature of the disease in each of the above cases; it is also mentioned by Morgagni and Bonnetus, as constituting the principal indication of an affection of the pancreas, in all those cases which they examined after death. The incurvatod state of the body appears also worthy of notice. This is probably chosen from its relaxing the abdominal muscles. enlarging the cavity of the abdomen, and thereby taking off from the diseased pancreas the pressure of the neighbouring viscera. The treatment of scirrhous affection of the pancreas, it is evi- dent can be only palliative. The principal indications are to alle- viate the pain, restrain the vomiting, and correct the acidity of thr -tomach. NEPHRITIS, OR INFLAMMATION OF THE KIDNEYS The patient, in this complaint, is seized with the usual symptoni> of inflammation, and is attended with heat and a sharp pain about the region of the kidneys, and a stupor, or dull pain in the thigh of the affected side. The urine is at first clear, and afterwards ot a reddish colour, voided frequently, and in small quantities at * time 400 PHLEGMASIA^. CLASS II, There is a vomitings and often a costiveness and difficulty in breathing, with cold extremities. There is a painful uneasiness when sitting upright or standing, the most easy position bein" that of lying down on the side affected. This disease may be dis- tinguished from the colic, by the pain being seated further back than in colic ; and from lumbago, by the patient being able to move the trunk of his body without occasioning that severe pain •^shooting along the course of the ureters, and by the difficulty of passing his urine. This disorder may proceed from any thing of an acrid nature stimulating the kidneys, as strong diuretic medicines, spirits of tur- pentine, tincture of cantharides, &c. It may also be occasioned by suppressed evacuations, external contusions, calculous concre- tions, strains of the muscles of the back, violent or long continu- ed riding on horseback, or shaking in a carriage. At the first onset of this complaint, bleeding must be employed, and if the quantity of blood taken should prove insufficient to af- ford considerable relief, the operation ought to be repeated, ac- cording to the urgency of the symptoms, within twenty-four hours, especially if the patient be of a full habit. Fomentations and the warm bath are among the most important means to be employed; but blisters, on account of the irritation which might be excited by the cantharides, are not to be advised in this complaint. A mild laxative, consisting of an infusion of senna, Glauber's salts, and manna, will be highly proper, and soft emollient clysters of milk and water, or mallows and milk with some linseed oil, must be frequently injected. The mucilage of gum arabic, with barley water, or an infusion of linseed or marsh-mallow root, sweetened with honey, may be drank occasionally with much advantage. In case of violent pain, twenty drops of laudanum every six or eight hours, will afford essential relief, but if combined with a tea-spoonful of spiritus nitri dulcis, the effects will be still more beneficial. Considerable relief may sometimes be obtained by mixing a tea-spoonful of laudanum with the clyster. Besides bleeding from the system at large, topical bleeding, by the application of leeches to the haemor- rhoidal veins, has in some instances afforded relief. A decoction of the dried leaves of the peach tree, says Dr. Thomas, drank in the quantity of a pint a day, has been found a very useful remedy in many cases of nephritis. CLAsS II. INFLAMMATION OP THE BLADDER. 401 Should this affection of the kidneys terminate in suppuration, which may be known by the abatement of the pain, a remaining sense of weight in the loins, with frequent shiverings, succeeded by heat, and the appearance of purulent matter in the urine, balsamic and detergent medicines, with chalybeates and the Peru- vian bark, must be directed. But the uva ursi, or the wild cran- berry of our woods, when gi\en in doses of half a drachm or more three times a day, has been productive of the happiest effects. Where an inflammation of the kidneys has proceeded from the stimulus of a stone or gravel, the same course is to be followed, with the additional means recommended under those particular heads. Should a venal haemorrhage occur, alum as an astringent, and the acetate of lead and digitalis as sedatives, may be relied upon as remedies. In all these complaints, the patient should abstain from every thing which by its acrid or heating qualities may prove a stimulus to the kidneys. His diet ought to consist chiefly of milk and vegetables, with animal broth and rice, or barley. His drink should be whey and butter-milk ; the latter, used while fresh, is said to be a valuable remedy in ulcers of the kidneys. CYSTITIS, OR INFLAMMATION OF THE BLADDER. In this complaint, the patient experiences a violent pain in the region of the bladder, sometimes attended with an external redness in that part. There is a frequent desire and a great difficulty in discharging urine, often a total suppression, with frequent efforts to expel the faeces, occasioned by the perpetual irritation affecting those parts. These symptoms are accompanied with febrile heat, sickness, and vomiting, great anxiety and restlessness, and some- times delirium and coldness of the extremities ensue. The cure of this disease is to be effected consistently with the plan which has been prescribed in the preceding local inflamma- tions ; but the case will require the most prompt attention and ap- plication of remedies. Bleeding, fomentations, and the warm bath, followed with gentle laxative medicines, are chiefly t» be 51 402 PHLEGMASIA. CLASS U. relied on. Ten or fifteen grains of sal nitre, or a tea-spoonful of the spiritus nitri dulcis, may be given in the patient's drink occa- sionally, which should consist of barley water or linseed tea. If the urine be retained from a stricture in the neck of the bladder and all other means fail to relieve, the catheter must be employed to evacuate the urine, but this must be done with the caution of an experienced hand. But no disease requires or bears more copious bleeding than an inflammation of the bladder, and it should be repeated so long as the symptoms continue to be violent. Hysferitis, being an affection peculiar to females, and succeed- ing to child-birth, will be noticed under the head of Diseases of Women. Urethritis and Orchitis will receive attention under the head of Gonorrhoea and Venereal Disease. PHLEGMASIA DOLENS, OR LYMPHATIC SWELLING OF THE LOWER EXTREMITIES OF PUERPERAL WOMEN. This singular complaint, to which lying-in women are subject, is not of very frequent occurrence, and is more formidable and distressing in its circumstances than dangerous in its nature and consequences. Numerous conjectural theories have been advanced, with the view of explaining the nature and causes, and accounting for the phenomena of this perplexing disease; but the result, so far from being satisfactory, seems to evince that the subject has hitherto eluded investigation, and re- mains involved in obscurity. It is, however, the opinion of most modern writers that phlegmasia dolens is a lymphatic disease of a local nature, confined to the lymphatics of the pelvis, and the limb actually affected, and dependent on causes peculiarly connect- ed with the puerperal state. The usual period of its attack is from fifteen to twenty days after parturition, and frequently when the woman is in the most favourable circumstances of recovery, and not having been exposed to any error or untoward accident either at the time or subsequent to delivery. It commences sud- denly with a sense of weight, stiffness, and pain about the back, upper part of the thigh, groin, and labia pudendi of one side; CLASS II. PHLEGMASIA DOLENS. 403 sometimes preceded by rigors and accompanied with a degree of febrile heat. In some instances the pain is first felt in the calf of the leg or knee, darting down to the heel; the limb soon begins to swell, and becomes very tense, with heat but without redness? tlie skin being pale, and of a peculiar shining aspect. The swell- ing sometimes proceeds from the groin downwards, and in other cases begins at the calf of the leg and proceeds upwards, but in every instance the pain and swelling continue to increase and extend un- til the whole limb, from the hip to the toes, arrives in about twenty- four or thirty-six hours to twice or thrice its natural size. The skin is now of a pale glossy white colour, rather warmer than natural, ex- cessively tense and elastic, leaving no impression of the finger; exquisitely painful and tender, the patient being utterly incapable of moving her body or leg from the spot which it occupies; some abatement of pain takes place when the swelling has arrived at its greatest extent. The pulse is seldom below one hundred and twenty, often one hundred and forty in a minute ; the tongue is white and moist, and there is thirst and loss of appetite. The countenance exhibits a pale chlorotic appearance, the bowels are sometimes bound, but oftener loose with foetid stools, and some- times attended with a vomiting of dark coloured bile. The lochia! discharge and lacteal secretion are in some instances suppressed, in others these continue free during the progress of the disease. The inside of the pelvis and the inguinal glands are tumefied, painful, and tender. Within six or eight days, or sooner, after the attack, the inflammatory or febrile symptoms generally subside, and the swelling, tension, and pain of the limb begin gradually to di- minish, from the groin downwards, and in this state of the com- plaint, some indentation may be made with the finger, but the patient is debilitated, and the limb remains stiff, weak, and often motionless, for some weeks, or even months. It sometimes hap- pens that before the complaint has completed its course in the leg and thigh of one side, the other becomes in the same manner af- fected, and this has no influence on the progress of the first; and in fact the extremities may be a second time attacked with the same affection. If in any stage of the disease the skin be punc- tured, very little serum is discharged, as in anasarca, nor is the swelling increased by placing the limb in,a depending position. In the curative treatment of phlegmasia dolens, regard must be paid to the s ate of the limb, and to tli.it of the general svstem. 404 PHLEGMASIA. CLAss ir. Cases may present of robust, plethoric habits, in which such de- gree of inflammation may prevail as to indicate the use of the lancet and the antiphlogistic regimen for its removal. The bowels should be moderately excited by a solution of the neutral salts and cream of tartar, or other laxatives, and the saline mixture, with tartarized antimony, should be administered to promote a regular determination to the surface : but if much nausea or vomiting at- tend, a gentle emetic will undoubtedly be proper. Where consid- erable irritability of the system and restlessness prevail, the com- pound powder of ipecacuanha may be given in a proper dose at bed time. We are not, however, to promise ourselves much per- manent advantage from the feeble means above mentioned in this obstinate complaint. A remedy of superior efficacy and in which we may confide for a cure, is to be. found in the sub-muriate of mercury; a moderate course of calomel, either by itself or com- bined with opium, will in most cases of this description rectify the diseased action of the lymphatic system, and speedily reduce the swelling of the affected limb. About two grains of calomel given every six or eight hours for a short time, has in several instances effected permanent cures; the pain, tumefaction, and other symp- toms, yielding very readily to a slight affection of the salivary glands. Opium is a medicine of much importance in these cases, and must be administered to such extent as pain, irritation, and restlessness may require. In those instances where the patient is of a lax habit, or is much debilitated by previous evacuations or other cause, the antiphlogistic regimen must be rejected, and means re- sorted to for the purpose of restoring the proper tone and energy of the constitution. The medicines best adapted for this intention, are cinchona bark, bitters, chalybeates with wine, a nutricious diet, exercise, and cold bathing. The tonic medicines may on some occasions be combined with diuretics, as crystals of tartar and squills, with advantage. With respect to topical applications, these have not in general produced the beneficial effects which were de- sired and expected. All attempts to induce a discharge of lymph from the diseased limb by punctures or blisters, have proved use- less, or of mischievous tendency. More beneficial effects have been derived from the application of a strong solution of sal am- moniac and acetate of lead in vinegar. In one instance I have known a soft poultice of boiled turnips to afford more relief than any other application which was tried. From the known efficacy CLASS II. PHLEGMASIA DOLENS. 405 of mercury, internally administered, it may be proper to suggest the trial of the inunction of the mercurial unguent, to which may be added a due proportion of camphor, and attentively observing its effects. Flannel cloths wrung out in hot vinegar, and renewed as often as they become cold, have, according to Dr. Thomas, been practised with invariable success in the lying-in hospitals in Lon- don ; and much relief, he observes, has been received by surround- ing the limb with a soft poultice, composed of bran and olive oil, with the addition of half an ounce of tincture of opium, and a sufficient quantity of warm water to give it a proper consistence, renewing it morning and night. A flannel roller should be con- stantly worn round the limb, being applied uniformly smooth and moderately tight from the foot upwards. When in a state of con- valescence, the restorative and tonic plan ought to be pursued as respects medicine, diet, and exercise. Professor Hosack has dis- played much intelligence in discussing the doctrine advanced by Dr. Davis, that the proximate cause of phlegmasia dolens is a vio- lent inflammation of one or more of the principal veins within and in the immediate neighbourhood of the pelvis. The learned pro- fessor thinks that from taking a general view of the disease, it may be traced to an inflammation of the limb, involving all its parts, muscles, cellular membrane, cutis, lymphatics, glands, nerves, and blood vessels. The success, too, which has generally followed the antiphlogistic treatment, where it has been vigorously pursued in the first stage of the disease, is certainly favorable to this view of the pathology of phlegmasia dolens. Professor II. is very decid- ed in the opinion that phlegmasia dolens is an inflammatory dis- ease, not only affecting the limb, but the whole system. Of course, in the treatment of phlegmasia dolens, regard must be had to the stage of the disease. During the inflammatory or first stage, those means should be employed whicli are calculated for the re- moval of general and local excitement, viz. blood-letting, saline cathartics, nauseating doses of antimony or ipecacuanha, and the use of tepid vinegar and water as a fomentation to the limb : in some cases blisters to the parts most affected have been found ser- viceable. In the second stage of the disease, when the febrile and inflammatory symptoms have subsided, great advantage has been obtained from small doses of calomel and squills, while stimulating liniments, friction, and the flannel roller, are among the most ben- eficial applications to be made to the part. In the first stage of 406 PHLEGMASIA. CLASS II. the disoase, the diet should be strictly antiphlogistic—in the last, the moderate use of wine and the more stimulating nourishments may be administered, proportioned to the degree of debility in- duced. RHEUMATISMUS. Of this disease there are two species, the acute in which both fever and inflammation exist in a high degree, and chronic, when neither of these are present, but severe pains of long continuance are the principal symptoms. It attacks persons of all ages, and the spring and autumn are the seasons in which it is most pre- valent. The rheumatism is frequently the consequence of obstructed perspiration, sudden changes of tbe weather, wet feet, wet clothes, lying in damp linen, or on the damp ground when the body is hot, and all quick transitions from heat to cold : it may also be occa- sioned by the stoppage of the customary discharges, or by exces- sive evacuations, which debilitate the system ; it is often the effect of chronic diseases, which vitiate the humours ; as the scurvy, sy- phylis, and obstinate autumnal agues. Acute rheumatism generally commences with the usual symp- toms of fever, preceded or succeeded by acute and pungent pains in the joints, increased by the action of the muscles belonging to the joints, and attended with heat on the part; the pain is not, however, confined to the joints, but it frequently shoots along the muscles from one joint to another ; the parts most commonly af- fected, are the hips, knees, shoulders, and elbows, more rarely the ankles and wrists ; the pain is much increased by the slightest mo- tion, or even by the heat of the bed ; there is some degree of swelling and redness in the parts most affected, which are painful to the touch ; the pulse is frequent, full and hard ; the bowejb are generally costive, the urine at the commencement of the disease is high coloured, and generally without sediment; but on the remis- sion of the symptoms, it deposits a lateritious one, and there is a tendency to sweating in the course of the disease, which rarely brings relief: an exacerbation of the febrile symptoms takes place every evening, and a remission towards morning, and the pains are most sovere and most apt to shift their place in the nighttime. VLASS II. RHEUMATISM. 4U7 The pain shooting along the course of the muscles, its being in- creased Ui>on the slightest motion of the affected muscles, at the same time not having been preceded by dyspeptic symptoms, and its attacking the patient in the day time or evening, will distin- guish acute rheumatism from the gout, which commonly makes its attack about two or three»o'clock in the morning. The curative treatment in acute rheumatism is nearly the same as that of an inflammatory fever, the morbid excitement must be reduced by a strict adherence to the antiphlogistic regimen by blood-letting, which must be repeated in proportion to the degree of strength and hardness of the pulse, and violence of the symp- toms ; but still with some caution, as very profuse general bleediug not only retards the recovery of the patient, but frequently induces an obstinate chronic state of the disease ; topical evacuations by means of leeches, may, after general blood-letting, be advantageous- ly employed : when the pain becomes fixed in the joints, attended with redness and swelling, six or eight leeches may be employed at a time, and the same number again the next day if the pain be still very severe. A course of purgative medicines should next be administered, such as calomel and neutral salts, and a proper dia- phoresis is of great advantage in this disease ; one of the most ef- fectual medicines for this purpose is Dover's powder, ten grains of which may be taken every hour or two, till the desired effect is produced. The spiritus Mindereri is another valuable medicine in this disease, a table-spoonful of which, with one quarter of a grain of emetic tartar and six or eight drops of laudanum, given every two hours, will be admirably adapted to the purpose of ex- citing a diaphoresis, and mitigating the febrile symptoms. But for the purpose of opening the secretions and subduing the inflamma- tory diathesis, there is not, perhaps, a more effectual medicine than calomel and opium conjoined, from one to two grains of the former, and from a quarter of a grain to one grain of the latter, may be administered three times in a day with the happiest effects ; the patient should in the mean time take freely of warm barley water, gruel, or mustard whey, with cream of tartar. When the morbid excitement is considerably reduced, and the pain confined to one part, blisters will prove useful; and when the extremities are much swollen after the employment of leeches, the following cataplasm may be applied to the tumefied parts with great benefit ; take of rye meal, one pound, old yeast, four ounces. 40f> PHLEGMASIA. CLASS 11 common salt, two ounces, warm water, a sufficient quantity • let the whole be wrought into a paste, and wrapped round the pan affected as warm as can be; renewing it morning and evening. Warm fomentations, as they tend to aggravate the pain, should never be employed in acute rheumatism. The digitalis or fox- glove, is a remedy of considerable efficacy in this disease; when given in tincture, from ten to twenty drops every four or six hours it has, in the hands of many practitioners, answered the most san- guine expectations, and often superseded the necessity of blood- letting. Another plant of similar powers, and adapted to the cure of this disease, is the blood-root; this is to be administered in tinc- ture, from forty to sixty or eighty drops, three times in a day. carefully watching its effects, and diminishing or increasing the dose as may be deemed necessary ; for although it is not so dele- terious in its operation as fox-glove, it is sometimes apt to produce gxeat prostration of the vital powers. The eau medicinale, as directed in the chapter on gout, has of late obtained a just reputation for the essential relief which it has frequently afforded during the distressing pains which attend both acute and chronic rheumatism ; further trials of it ought to be re- commended. After evacuations have been premised, it is not uncommon for acute rheumatism to assume more or less the form of an intermit- tent, and the pain to be attended with distinct intermissions ; in these circumstances the cinchona is the remedy to be relied on, and will in general effectuate a cure, but it is supposed to be more efficacious when eight or ten grains of sal nitre are added to each dose. The chronic rheumatism is most common to people in the de- cline of life ; the pains, which are more or less of a wandering na- ture, are felt in the large joints or muscles, particularly upon mo- tion, which are much relieved by artificial warmth ; the parts af- fected are pale and rigid, and a sensation of coldness is felt in them, even when the other parts of the body are in a state of pers- piration ; there is at the same time no fever, and in general but little or no tumour. In this species of rheumatism, a different mode of treatment must be adopted: bleeding from the system will in general appear inadmissible, but it will be necessary to rub the parts affected seve- ral times in a day, with the volatile liniment or the anodyne bal- CLASS II. RHEUMATISM. 40$ sam, and then wrap them in flannel; and in some instances, elec* tricity or galvanism may prove beneficial. Camphor, dissolved in aether, has been applied externally in painful affections of the joints, with the greatest utility. In long continued and obstinate rheumatic affections of the liga- ments and membranes of joints, local bleeding by means of a num- ber of leeches, or the operation of scarifying and cupping, will probably afford more permanent relief than any other remedy; after the employment of which, a drain by the aid of issues should be continued for a length of time. The general or partial warm bath is a remedy of some efficacy in these complaints, but the diligent application of the steam or vapour from warm water, to the particular parts, or Dr. Jennings' spirituous "vapour bath, is reported to be still preferable. Some advantages have been realized from the repeated applications of blisters near to the diseased joints, so as to keep up a perpetual discharge, as in cases of white swelling. By some, sea bathing or other cold bath is recommended, while others have but little con- fidence in the remedy. The mercurial compound liniment, to be found in the Appendix, is undoubtedly particularly well calculated for lessening the stiffness and chronic thickening of the ligaments of joints, so often the effects of this obstinate disease. The employment of the external remedies just detailed, must be accompanied with such internal medicines as are best adapted to stimulate and warm the system, to promote a diaphoresis, and to alleviate the painful symptoms. The gum guaiacum and the vola- tile alkaline salts are among the most powerful of this description, the former of which, when taken in as large doses as the stomach can bear, has often produced the desired effect. " The following preparation is calculated to afford much relief: take ammoniated tincture of guaiacum, one ounce, anodyne balsam, half an ounce ; mix and give two tea-spoonfuls twice in a day in a cup of infusion of guaiacum wood, or of burdock roots. In some instances, consi- derable benefit may be expected from the'use of calomel combined with Dover's powder, in palliating the symptoms and allaying irri- tation. There are several of our domestic plants which are entitled to the confidence of physicians as remedies in both acute and chronic rheumatism ; the root of skunk cabbage has been known in several slight cases to remove every svmptom of the disease, and it is uu- ,V2 410 PHLEGMASIA. class n, doubtedly worthy of trial in every case, however severe or obsti- nate. The phytolacca decandra, or garget, has acquired consider- able reputation in the southern states as a successful remedy in rheumatism. Both of these plants may be prescribed according to the directions in the Appendix, and a perseverance in their use enjoined till their efficacy is satisfactorily ascertained ; and in many instances it is highly probable that no medicine will be more likely to succeed. In those cases of chronic rheumatism where there is great red- ness of the surface of the body and extremities, often covered with clammy sweat, and attended with pain, tumefaction and rigidity of the joints, Dr. Chapman of Philadelphia, is in the habit of prescribing the juniperus sabina, or savin. The result of his extensive experi- ence is such that he strongly recommends it as a warm, powerful and diffusible stimulus, which seldom fails to produce the most bene- ficial effects. He directs the powdered leaves in doses of twelve or fifteen grains three times a day, to be continued until relief be obtained, or for several weeks. When the chronic rheumatism affects the back and loins with severe pains, so that the patient cannot stand upright nor enjoy ease in bed, the complaint is called lumbago ; and when it fixes in the hip joint it has the name of sciatica, or hip-gout. Both of these complaints are to be treated nearly in the same manner as chronic rheumatism affecting any other parts; issues should be made in the leg or thigh, and the following will be found a very efficacious application : take of camphor, two drachms ; dissolve it in an equal quantity of oil of turpentine, and add of basilicon, an ounce, com- mon black soap, half an ounce, and volatile sal ammoniac, half a drachm; let the mixture be spread upon leather and applied to the part. The most efficacious remedy for the cure of sciatica is the oil of turpentine. This should be applied to the part and rubbed into the skin twice in a day, for a week or two, and it will seldom fail to remove the complaint. It may be well to dissolve a little camphor in the oil. In the chronic rheumatism the patient may continue his ordinary mode of living, unless inflammatory symptoms occur; his diet should be nutritive and somewhat stimulant; mustard and horse-radish taken in their natural state will be salutary; wine or mustard whey, or barley water with cream of tartar dissolved in it, will be the most proper drink, and the patient should wear flannel next his <.XASS II. RHEUMATISM. 411 skin, and carefully guard against exposure to cold, night air, wet clothes, and wet feet, which are particularly prejudicial. " Dr. Balfour of Edinburgh, has published in the Edinburgh Medical and Surgical Journal for April, 1815, a long paper on the good effects of tight bandages in chronic rheumatism." He ap- plies a flannel roller to the affected limb, with a degree of tight- ness which the patient can conveniently bear. In some instances he directs the bandages to be removed daily, and diligent friction to be employed for some time, when tbe bandage is to be replaced as before. If high and inflammatory symptoms be present, he di- rects venesection to the necessary extent and laxatives to be ad- ministered. By the assistance of bandages the patient is immedi- ately enabled to walk in the open air, by which a universal glow and moisture of the skin is more successfully promoted than by the most powerful sudorifics. Several cases are detailed in which cures were speedily effected by the above treatment. See New England Medical Journal, Vol. IV., page 393. Dr. Hosack has observed the most decided benefit from the use of the flannel roller, but he has lately had recourse to the antimonial ointment, qickeued by the addition of the tincture of cantharides, or of blistering ointment, with more effect than from any local application he has tried in this disease. His formula is as follows : R. tart, antimon. 3iij» adip. suill. 3j. tincture Lyttae, gtt. xxx. vel. ung. vesicat. 3j. M. The limb or part affected, is directed to be rubbed three times a day with this ointment, an eruption of pustules soon succeeds, which very rarely fails to afford relief. In some instances, in which the rheumatic affection was attended with an enlargement or unusual laxity of the joint, great advantage was obtained from the celebrat- ed Hungarian plaster. This consists of the gum ammoniac, dissolv- ed to saturation in the vinegar of squills ; a flannel cloth dipped in this liquid, and closely applied to the affected joint, not only pro- duced an excitement and eruption similar to the antimonial oint- ment, but when dried and contracted around the joint, afforded the additional advantage of a mechanical support to the relaxed parts, in aid of the excitement derived from the stimulating ingredients composing the plaster. It is proper to add that the medicated steam bath has been found extremely well adapted to the cure of rheumatism in all its forms. 412 PHLEGMASIA. CLASS H ARTHRITIS, OR GOUT. The most common subjects of this tormenting disease, are those who are indolent and inactive, who use a full diet of animal food and indulge freely in the use of tartarous wines, and other ferment- ed liquors. It more frequently attacks corpulent robust men than women, and unless hereditary, it seldom appears before the age of thirty-five. Besides a hereditary disposition, this disease may be produced by a deficiency of the customary evacuations, intemper- ance, or a free use of acidulated liquors, strong tea or coffee, severe application of mind, grief, vexation, night watching,excess invene- ry, exposure to cold, and whatever tends to induce debility. The gout will be distinguished from rheumatism by the pain generally attacking the joints of the extremities; it is at the same time less inclined to shift, and is not so much increased upon the slightest motion of the affected muscles, and when it does shift it generally attacks the corresponding limb, or some of the viscera; the parts affected are generally more red and swollen, and the dys- peptic symptoms, which rarely precede rheumatism, are present in a considerable degree for some days preceding the attack of the fit. A paroxysm of regular gout sometimes makes its attack without any previous warning ; in general, however, it is preceded by indi- gestion, belching of wind, and slight head-ach and drowsiness, The appetite is irregularly increased or impaired ; there is in some a coldness, numbness, and sense of prickling in the feet and legs, accompanied with cramps of the muscles of the lower extremities. These symptoms having continued for several days, the attack com- mences sometimes in the evening, but more frequently on going to bed, the patient enjoys his usual natural sleep until two or three o'clock in the morning, when he is awakened by a very acute pain, most commonly in the first joint of the great toe, but sometimes in other parts of the foot; the pain resembles that of a dislocated bone, and is attended with a sensation of cold water poured over the part; and more or less of a cold shivering, which abates as the pain increases in violence, and is succeeded by a hot fit; the pain continuing to grow more violent, is sometimes so exquisite as" to be compared to a dog gnawing the part; the pain and fever continue, and are attended with great restlessness of the whole body till the midnight following, after which it gradually declines; and a gentle CLASS II. GOUT. 41S sweat coming on, the patient falls into a sleep. In the morning he finds the part affected with some redness and swelling, which after continuing some days, gradually abate : for some time the pain and fever return in the evening, but with a less degree of violence, and a remission takes place towards morning ; and after these symptoms have continued for about ten or fourteen days, gradually becoming less severe, they generally cease altogether. When the fit is going off, an intolerable itching seizes the part affected, a desquamation of the cuticle ensues, and some trifling degree of lameness remains; the patient, however, enjoys more perfect health and spirits than he had for a long time previously experienced. The first attacks of the gout are generally at long intervals, for the most part three or four years,but after repeated attacks, the intervals become shorter, and at length the attacks occur annually, afterwards twice a year, and at lasi several times in the course of the autumn, winter and spring, so that the patient is scarcely ever free from it except for two or three months in the summer. In the progress of the dis- ease, different parts become affected ; at first it is commonly con- fined to only one foot, but in the subsequent fits, both feet in suc- cession ; and frequently removes from one foot into the other. In many instances, after the disease has frequently recurred, concre- tions of a chalky nature are formed upon the outside of the joints, and for the most part immediately under the skin ; where it seems to be deposited at first in a fluid state, but afterwards becomes dry and firm; which contributes with other circumstances to destroy the motion of the joint ; and the same kind of concretions art sometimes deposited in the kidneys, occasioning nephritic com- plaints, which alternate with the gouty paroxysms. Instances sometimes occur where the inflammatory affection of the joints does not take place, and the pain is only slight and wandering; there is loss of appetite, indigestion, flatulence, nausea, vomiting, acid eructations, and severe pains in the region of the stomach; there are often pains and spasms in the trunk and upper extremi- ties ; the bowels are commonly costive, sometimes, however, a diar- rhoea with griping and colicy pains attend, and when the viscera of the thorax are the seat of the disease, palpitations, faintings, asthr ma and other affections of the lungs are the consequence. In other cases, the head is affected with pains, vertigo, palsy and ten- dency to apoplexy. These symptoms constitute what is called atonic gout. 414 PHLEGMASIA. CLASS H. When the inflammation attacks the joints in the usual manner, but the pain neither attains its usual degree of violence, remains the accustomed time, nor recedes in a gradual manner, but ceases on a sudden, and some internal part becomes affected ; if the stom- ach is the seat of the disease, nausea, vomiting, anxiety, and vio- lent pain in the region of the stomach, with the sensation of cold- ness, ensue ; if the heart is attacked, syncope is the consequence ; if it fall on the lungs it produces an affection resembling asthma, or pneumonia; and if the head be affected, apoplexy or palsy may arise. To these occurrences the term of retrocedent gout is appli- ed. Another variety of irregular gout, is that which is called the misplaced, where instead of the inflammatory affection of the joints and extremities, the gouty diathesis produces inflammation of some internal part, and which appears with the same symptoms that at- tend inflammations of those parts from other causes. Dr. Rush has greatly improved the treatment of the gout, by recommending bleeding in cases of gout where there is great mor- bid action in the blood vessels and viscera. The advantages of bleeding in gout, he says, are, it removes or lessens pain ; it prevents those congestions and effusions which produce apoplexy, palsy, pneumonia notha, calculi in the kidneys and bladder, and chalk stones in the hands and feet. It shortens the duration of a fit of gout by throwing it not into the feet, but out of the system. Dr. Hosack advances the opinion that gout is exclusively an in- flammatory disease of the whole system as well as of the part af- fected. That its associate or vicarious diseases, apoplexy, palsy, asthma, habitual catarrh, eruptions on the skin, obstructed viscera, and dropsy, arise from the same habit of body and from the same causes. That the predisposing causes of gout are the excessive use of wine, ardent spirits, animal food, the condiments of the ta- ble, and the neglect of the exercise necessary to counteract their effects upon the constitution. While the check of the excretions by the cold of autumn and winter, or the sudden impetus given to the circulations by the returning spring, prove the most usual ex- citing causes of this disease. That the most effectual means of removing the inflammatory action attendant upon the first stage of the paroxysm of gout consist in depletion by the lancet, cathartics, and such remedies as operate by restoring the excretions from the surface of the body, the physician paying due regard in the use of these means to the constitution of the patient, his time of life, and CLASS II. «out. 415 season of the year. That in correspondence with the use of these remedies, both the diet and the regimen of the patient should be simple, and strictly antiphlogistic. Dr. Hosack further observes that the treatment recommended has not only been pursued in his own private practice with the most salutary effects, but that the use of blood-letting in particular, which it is his object to recommend in the treatment of gout, has long since been sanctioned by the truly respectable names of Sydenham, Huxham, Cullen, Musgrave, Mac- bride, Hamilton, of Lynn, and our late distinguished countryman, Dr. Rush. The antiphlogistic and depleting practice by bleeding and purgative medicines, has long been pursued by the learned Dr. Mason Good, but he enjoins a nice discrimination of cases and cir- cumstances. That mischief has resulted from the practice he readily admits, but that great and essential good, and an easy and rapid cure have been also, in hundreds of instances effected, must be admitted as readily. It is in sound and vigorous constitutions, the robust and healthy, in whom the depleting and refrigerant plan is particularly applicable. In weakly habits, or idiosyncrasies, or incidental debilities of particular organs, a metastasis is a frequent result and peculiarly marks the character of gouty inflammation ; and here, indeed, refrigerants, violent purgatives, and venesection, ought to be most assiduously abstained from, and not unfrequently the best practice we can adopt, is that of committing the " person to patience and flannel alone." But in one particular, Dr. Good is rather singular in his practice ; it is in the use of cold water ex- ternally applied. He speaks from a trial of several years upon his own person, and is anxious that others should participate in what has proved so decisive a comfort to himself. In the heighth of a paroxysm of pain he stripped off the flannel and boldly plunged his foot into cold water for four or five times in succession. The ap- plication was peculiarly refreshing ; the fiery heat and pain, and all the inflammatory symptoms diminished instandy ; he repeated the cold bathing two hours afterwards, and continued to do so through the whole of the day ; the complaint gradually diminishing upon every repetition, and in twenty-four hours the fit completely dis- appeared, and he was capable of resuming his accustomed exercise of walking. For five or six years afterwards in his annual attacks, he always had immediate recourse to cold immersion or affusion. Where the stomach is dyspeptic, the lungs asthmatic, the heart subject to palpitation, the head to nervous pains or drowsiness: u6 PHLEGMASIA. CLASS 11. or where there is any known disability in any other important or- gan, the antiphlogistic course must be avoided. Dr. Sendamore agrees with some of our best modern practitioners, that when the inflammatory diathesis is considerable and is permanent, bleeding is the proper remedy, and its early employment is a point of much importance. The quantity to be abstracted and the repetition of venesection, must be regulated by the degree of the general inflam- matory action and the effect produced, regarding the powers of the individual rather than his age. But on the choice and free employ- ment of cathartics and diuretics to remove redundant matter from the alimentary canal, and by the secreting functions of the kidneys, the successful treatment of the paroxysm chiefly depends. He prescribes calomel conjoined with cathartic pills, and where a com- bined and continued action upon the bowels and kidneys is requir- ed, he gives magnesia and sulphate of magnesia conjoined with acetum colchicum at intervals, so as to procure from four to six stools in twenty-four hours,until the fceces and urine acquire healthy characters, and the tongue becomes clean and moist. The prepar- ation of colchicum with vinegar joined with direct purgatives, has never disappointed him in its effects, either to assist the other in- gredients in the production of watery evacuations from the bowels, or to increase the urine abundantly, or both; but colchicum in the form of powder or tincture, has failed in his hands of the desired effect. Mercury in small doses combined with antimonials, or in a full dose with purgatives, produces excellent effects; but when ex- hibited so as to produce mercurial fever or irritation, it proves ex- tremely injurious. As a local application, Dr. SendamOre prefers camphorated alcohol to all others. This should be applied by means of a linen compress, consisting of several folds ; the liquid must be about luke warm, for if it be either hot or cold, the inten- tion of the remedy is frustrated, and the slightest and coolest cov- ering will be sufficient. External warmth he deems of pernicious tendency. In regard to retrocedent gout, our author ascribes the exciting cause to sudden cold applied to the body generally, or locally to the affected part. He is entirely opposed to the usual stimulating mode of treatment of this form of the disease ; instead of which, if the stomach be oppressed with indigestible food, first to clear the alimentary canal by vomiting and purging, immediately after which to administer from forty to eighty drops of laudanum. If the dis- CLASS II. eouT. 417 ease attack the bowels and induce enteritis, or the brain, as in apo- plexy, we are advised to abstract sixteen or twenty, or even thirty ounces of blood from the arm, and to divert the diseased action again to the extremities by sinapisms, warmth and other topical stimulants. Professor Chapman, of Philadelphia, seems to be decided in his opinion that gout, " if not originating in, has a most intimate con- nexion with certain states of the alimentary canal." Disregarding the authority of Sydenham, the Professor has, for several years, habitually employed purgatives in the paroxysms of gout, and with unequivocal advantage. Not content with simply opening the bowels, he completely evacuates by active purging, the entire ali- mentary canal, administering every day or every other day a very large dose of rhubarb and magnesia, to produce a greater or lesser number of operations, according to the strength of the patient and the violence of the case. During this course, all the distressing sensations of the stomach are removed, the pain and inflammation of the limb gradually subside,and the paroxysm thus broken speed- ily passes away. Every species of irregular gout is attended with considerable danger, and are to be guarded against with the utmost care. During the paroxysms of gout, if the patient be young and strong, both his diet and drinks should be light, thin and cooling ; but if the constitution be slender, and the patient accustomed to high living, it will not be prudent to deviate essentially from his usual diet; a generous glass of wine should be allowed, and in order to promote perspiration, wine or mustard whey may be directed for his ordinary drink, and it will be rendered more efficacious by mixing with it twice a day a tea-spoonful of the spirit of hartshorn, or of the volatile tincture of gum guaiacum, unless inflammatory symptoms should chiefly prevail. During the continuance of the paroxysm, the leg and foot should be wrapped in flannel, fleecy hosiery, or new combed wool. After the excitement has abated, we are advised by that enlightened physician, the late Dr. Rush, to apply blisters to the legs and wrist, and cabbage leaf to the part affected. When the violence of the symptoms is abated and the pain returns only during the night, and prevents sleep, opiates may be taken at bed time wiih safety and advantage ; especially in the case of persons advanced in life, and who have often been affected with the disease. When after the cessation of the fit, some swell* 41 § PHLEGMASIA. CLASS II. ing and stiffness remain in the joints, recourse should be had to the diligent use ofyhe flesh brush, and a dose or two of the bitter tincture of rhubarb or wine of aloes may be taken with advantage, and the Peruvian bark, with stomach bitters, assisted by a light but nourishing diet, ought to be employed. The body must be kept gently open by means of diet, or very mild laxatives; it is very important that the patient be constantly kept as quiet and still as possible, and his mind soothed and calmed during his painful situa- tion. It should be enjoined on the patient to use gentle exercise on horseback or in a carriage, and although it may be painful to use the joint affected during the decline of the fit, it will be found in the end to be productive of beneficial effects. In the atonic gout, or that which does not fix itself in the feet and hands, we must attempt the cure by carefully avoiding all de- bilitating causes, and by employing at the same time the means of strengthening the system in general, and the stomach in particular, for which purposes moderate exercise both of the body and mind should be directed, and cold bathing may be employed with safety and advantage, if the extremities are not threatened with pain, and the patient feels a glow of heat upon coming out of the bath, and his appetite and spirits are rendered better: the moderate use of animal food and wine will be proper; as old Madeira and sherry wines are least disposed to turn sour on the stomach, they should be preferred ; if, however, wine disagrees with the stomach, weak spirit and water may be substituted. For strengthening the stom- ach and the system in general, bitters and the angustura, or Peru- vian bark, must be employed, as also some of the preparations of iron, and the chalybeate waters if to be procured fresh from the spring. To these means may occasionally be added cordial and other gently stimulating medicines, as the volatile tincture of gum guaiacum, ginger, mustard, and sassafras tea. If the dyspeptic symptoms are very troublesome, gentle emetics should be admin- istered, which not only clear the first passages, but often cause the gout to' appear in the extremities ; costiveness must be obviated, cold particularly guarded against, and issues in the extremities are often found serviceable ; blisters on the lower extremities are some- times of great utility, but they must on no account be applied when any pains have been felt in the joints. It should be recommend- ed to persons liable to atonic gout, to repair to a warm climate during winter, and in all cases to wear fleecy hosiery or flannel CLASS II. GOUT. 4iy next the skin. The retrocedent gout happens when the moving powers are so weakened as not to be able to throw the offending matter to the extremities, or when there deposited, to keep it in that rituation. When this species of gout makes its attack upon the stomach, and immediate danger is threatened, w-'j must have recourse to large quantities of strong old wines, joined with spices, and given warm ; or a tea-spoonful of" aether, or the spirits of sal ammoniac, may be given ; but the most powerful remedy probably is a large dose of laudanum, and the same may be given in smaller doses, conjoined with aromatics, or hot brandy and water, at short inter- vals ; frictions with brandy are useful, and bladders filled with hot water must also be applied to the stomach ; hot bricks wrapped in flannel must also be put to the feet, and blisters and mustard cata- plasms should be applied to the lower extremities If the stomach is in a vecy irritable state, and will not retain the necessary reme- dies, the epigastric region must be fomented with hot brandy and the tincture of opium ; a flannel moistened with brandy, or a blis- ter, or an anodyne plaster may be tried, and hot brandy and water with laudanum should be frequently injected into the intestines. In moderate cases, the asafcetida and opiates combined with aro- matics, or with camphor and volatile alkali, will generally answer; but musk in large doses has been much commended in this form of gout: when the affection of the stomach is attended with vomiting, it should be encouraged by drinking chamomile tea mixed with wine, after which thirty drops of laudanum with a tea-spoonful of the compound spirits of lavender should be given. If there is a diarrhoea, it will be necessary to promote it by taking plentifully of weak broth; and after the bowels are thus cleansed, the irrita- tion may be allayed by a dose of laudanum and lavender, as above mentioned. Should the lungs be the seat of the disease, and the gouty asthma be produced, we must order opiates, antispasmodics, and blisters to the thorax, and between the shoulders, and the calves of the leg-;, and stimulating poultices of" mustard and bread crumbs applied to the soles of the feet. If the disease makes its attacks on the head, and causes head-ache, vertigo, coma, apo- plexy, or palsy, the external applications already mentioned may be employed, and a blister applied to the head : besides which, ten grains of ginger, and five grains of the volatile salts should be given if possible in two or three latere spoonfuls of warm wine. 420 PHLEGMASIA. CLASS H. The kidneys are sometimes attacked with gouty affection, imitating a fit of the gravel, m which case warm fomentations, or bladders filled with warm water, constantly applied over the parts affected, together with laudanum by the mouth and by injection, are the most proper remedies. In persons who never have had any regular fit of the gout, but whose constitution and manner of living seem favourable to the production of the complaint, and of an age when it commonly makes its appearance, great caution is necessary in treating any disorder with which they may happen to be attacked. This re- mark holds particularly with respect to evacuations ; in the regula- tion of which it will be proper to pursue such a method of cure, as that, whilst adapted to the apparent disorder, it may not prove injurious should the real cause of the symptoms be the gout in dis :u se. It is a great desideratum in practice to devise a medicine calcu- lated to eradicate the gouty diathesis altogether from the habit, but no other means have yet been discovered than a strict atten- tion to diet and regimen. In the intervals we must endeavour to prevent a return of the paroxysms, or to render them less violent, by temperance in both eating and drinking, regulated according to the age, habits of life, and constitution of the patient; it seems very probable that a diet consisting of milk, vegetables, and water, would prevent the recurrence of the disease; but in general, fish, eggs, the white meats, and weak broths, may be taken in small quantities once in a day, and a little salted meat may be eaten oc- casionally, and weak wine and water or small beer may be taken at meals. In the decline of life, or when the constitution is much debilitated, this abstemious mode of living must be commenced with caution, as it might be the means of inducing more violent and dangerous fits of the gout; and in fact, a change from the use of animal food and strong liquors, can only be adopted with safety by slow degrees. To use light suppers, to avoid night watching, and to rise early, are objects of great importance ; and a circum- stance no less beneficial, is, to guard against vexation of mind. Moderate labour, or gentle exercise, as riding on horseback, or w.lkmg, is highly requisite; cold and moisture must be carefully avo.ded, and the feet should be kept constantly warm and dry, and the bowels in a soluble state. The tonic remedies, as cinchona, quassia, and chalybeates, ought to be occasionally directed, and '.LASS II. GOUT. 121 the alkalies in various forms, with lime water, soap, and the ab- sorbent earths, may be added to considerable advantage. It is deemed peculiarly proper here to notice what has been termed the French pacific remedy, the eau medicinale d'Husson, so highly famed for its almost infallible powers in the cure of gout. This remedy was discovered about forty years ago, by M. Husson, a French officer, and it has been so highly celebrated in different parts of Europe, as to command the enormous price of from one to two crowns a dose. After the most thorough investigation of the subject, Dr. Edward G. Jones, member of the Royal College of Physicians, London, has published the most unequivocal evi- dence of the superior powers of the eau medicinale, in curing the most distressing paroxysms of gout. His experience of its effica- cy has been extensive, and we have his authority for asserting that this singular remedy exerts an extraordinary influence over the gout; and that it will safely and almost immediately remove, often by a single dose, the severest paroxysms of this cruel disease. It is not, however, asserted, that it effects a radical cure, and elimin- ates the gouty diathesis altogether from the system, but its opera- tion is different from that of any remedy hitherto employed, and it removes the paroxysms as often, and almost as soon as they occur. It appears to be a powerful sedative, diminishing almost immedi- ately the irritability of the system ; hence it allays pain, induces sleep, reduces the pulse, and abates fever. The full dose of this medicine, according to Dr. Jones, is about two drachms for an adult, mixed with an equal quantity of water, and taken on an empty stomach; its operation may be promoted by peppermint, pennyroyal, or ginger tea. It in general occasions some nausea and vomiting, followed by bilious stools. A single dose will often carry off an attack, but it sometimes requires to be repeated in under doses, and much advantage has often been derived from small doses taken daily for a length of time. Some instances have been recorded of its violent effects when exhibited in a dose dis- proportionate to the constitution and particular circumstances. The discovery of the particular composition of the eau medici- nale was considered as a very desirable acquisition, and the impor- tance and popularity of the subject occasioned various attempts for that purpose. To the ingenuity of Mr. J. Moor, member of the Royal College of Surgeons, London, the public are indebted for a composition, which if not identically the same, bears a strong 422 PHLEGMASIA. CLASS 11, resemblance to eau medicinale, in smell, taste, and dose ; and also in all its effects, so far as it has been tried in the cure of gout. The composition of Mr. Moor consists of wine of opium, one part wine of white hellebore, three parts, made by infusing for ten days eight ounces of the sliced root of that plant in two and a half pints of white wine, and strained through paper. This compound when exhibited in doses of from one to two drachms, has in a vari- ety of instances effected a speedy cure of gouty paroxysms. There are indeed well attested examples where the most painful gouty affection has yielded to a single dose of about one drachm, and the instances of its failure have hitherto, it is believed, been more rare than can be said of any other remedy. It has been observed that beneficial effects may more certainly be expected when it excites some degree of nausea and vomiting, which an over dose like can medicinale seldom fails to induce. * More recently, however, the fact has been announced, that Mr. Want has discovered the composition of a medicine which pos- sesses the power of removing the paroxysms of gout in a degree fully equal to the genuine eau medicinale ; and has had ample ex- perience to satisfy himself of the identity of the two medicines. The basis of this composition is the colchicum autumnal, or mead- ow saffron. The tincture is made by infusing for two or three days four ounces of the root of this plant in eight ounces of alco- hol or wine. An infusion of the fresh or dried root in water is said to be equally efficacious. The dose of either the tincture or infusion should be the same, and should vary according to the con- stitution of the patient. Upon an average, two drachms, or two ordinary tea-spoonfuls is the proper quantity for an adult. Mr. Want's experiments have extended to at least forty cases, followed by results of the most satisfactory nature, the paroxysms being always removed, and in several instances, no return of the dis- ease having taken place, after an interval of several months. He }s authorized by Sir Joseph Banks, and other highly respectable characters, to publish their decided conviction that his medicine and the eau medicinale are the same, as far as they are enabled to judge from the appearance, taste, and smell. f LAPS 111. RUBEOLA, OR MEASLES. -113 Class III.—CUTANEI. Aitfxtions of the skin, manifested by discolorations, spots, and excrescences, and which have obtained various names, according to the difference of their forms ; some with fever, others without fever, and some affecting persons but once in their lives. Order III.—EXANTHEMATA. RUBEOLA, OR MEASLES. The measles is an infectious disease, and when genuine, it nev- er attacks the same person more than once ; it is most prevalent in the spring season, and generally disappears in summer. About twelve or fourteen days after exposure to the infection, the febrile symptoms usually appear; on the first and second days, the patient complains of irregular shiverings alternating with heats, general de- bility, languor, loss of appetite, has a white tongue, thirst, pain in the back and limbs, slight sore throat, hoarseness, with dry cough and sneezing, weight and pain across the forehead, giddinesss, drowsiness, frequent mid irregular pulse, costiveness, and high-col- oured ur-ne. On the third or fourth day, the symptoms become more severe ; the eyes are lender, watery, and appear as if inflam- ed, the eyelids and face are often swelled, the nostrils discharge a thin serum, and the patient sneezes more frequently, and some- times vomits. There is now often some difficulty of breathing, with pain and tightness in the chest. The eruption appears be- twixt the third and sixth day of the fever, but most frequently on the fourth. It is first visible in the throat and back part of the roof of the mouth, then on the forehead, after that on the face and neck. The next day it appears on the breast, and by the evening it covers the body and extremities. The eruption consists at first of small red spots, apparently a little raised, like papulae, but with- out vesicular tops. Then extending so far as to form an oval or irregular figure, slightly elevated, but flat, resembling flea bites, they run together in clusters or large patches. The eruption dif- fers from the small-pox in not rising into prominent pimples, but in passing the finger over the surface, the skin feeU unequal, from the elevation of the spots and patches. On the face, the eruption 424 UUTANEL CLASS III, maintains its redness for two days, but on the third, the colour is changed to a brownish red ; and in a day or two more it becomes dry, and, falling off in scales, at length entirely disappears. The fever, cough, and difficulty of breathing, are not abated by the eruption, but if there was any vomiting before, it generally ceases. Sometimes the measles are succeeded by a violent looseness ; and when this happens, the case is attended with danger. The most fatal period in this disease is about the ninth day from the be- ginning of the complaint, when many are carried off by an inflam- mation on the lungs. The most favourable symptoms are a mode- rate looseness, a moisture on the skin, and a plentiful discharge of urine. When the eruption suddenly falls in, and the patient is seized with delirium, or when the measles become soon of a pale colour, with great weakness, restlessness, vomiting, and difficulty of swallowing, and when purple or black spots appear, the greatest danger becomes apparent. When the disease is succeeded by a continuance of the cough, accompanied with hoarseness, a con- sumption of the lungs may be apprehended. In the mildest form of measles, the patient is scarcely deemed a subject of medical attention, and little is necessary to be done, ex- cept abstinence from animal food, or heating applications ; and drinking freely of barley-water, Infusions of mullein or balm, with decoctions of liquorice and marsh-mallow roots. If the efforts of nature be too weak to throw out the eruption, this must be assisted by blisters and proper cordials, as wine whey, or saffron tea, with a few drops of the spirit of hartshorn, or spirit of sal ammoniac ; but when the fever is too violent, and there be inflammation of the chest, with pain and great oppression of the lungs, these may be restrained by bleeding. Leeches may be employed for very young children, and the lancet for those of five or six years of age. The quantity of blood to be drawn should not exceed two or three ounces, and a repetition of the operation is not to be advised. An emetic should be early administered, and the saline diuretics with antimonials, must not be neglected, as they determine to the surface, and abate the febrile symptoms. But by far the most ef- ficient means of cure, are to be found in mild purgatives. The intestines require to be thoroughly evacuated from day to day. Moderate doses of calomel, or sulphate of magnesia and manna, will compose a laxative course by which those unpleasant symp- toms of pneumonia and catarrhal inflammation which often occur •ItOLR HI. SCARLATINA. 425 about the ninth day, are effectually prevented ; and if steadily per- sisted in from the beginning, will in general carry the disease to the desired favourable termination. Other remedies, however, are to be directed according to their respective indications. When the febrile symptoms are high, the head much affected, and the dif- ficulty of breathing is considerable, blisters should be applied to the breast and neck. When the cough and restlessness are urgent, recourse must be had to opiates, as the syrup of white poppies, or the elixir paragoric. Tho feet should be bathed in warm water, and the steam from an infusion of mullein flowers ought to be in- haled into the lungs, not indeed too hot, but moderately warm, and so managed by holding the vessel under the face and covering the head, as to give the mouth and eyes the benefit of the steam. The patient should neither be confined in close hot rooms, nor exposed to wet and cold air. For relieving the cough, the syrup of squills, or spermaceti, and sugar candy, pounded together, will be serviceable, or some of the preparations to be found in the Appendix. If purple or black spots, offensive breath, and high coloured urine, indicate a putres- cent state of the blood, the Peruvian bark and elixir vitriol, in due quantities, will be indispensably necessary. Should a diarrhoea succeed to the imeasles, blood-letting may be proper ; but the dis- ease will commonly yield to tincture of rhubarb, with a little cin- namon and a few drops of laudanum. After the patient has be- come convalescent, a few doses of physic will be advisable. But should a cough, with difficulty of breathing and other symptoms of consumption, remain, small quantities of blood, according to the strength of the patient, should be drawn at proper intervals, and a milk diet, free air, and exercise on horseback, should be directed Some attempts have been made in Europe to propagate the mea- sles by inoculation, with the hope of rendering the disease more mild, but the experiments have not in general been attended with the success anticipated, and it is not probable that the practice will ever be established. SCARLATINA. This generic term comprises the three species, scarlatina sim- plex, scarlatina anginosa, scarlatina nmlijrna- This disease has :>t 426 CUTANEI. CLASS III. long been considered as highly contagious, spreading epidemically through villages and districts, with an alarming degree of mortali- ty. In the years 1735 and 1736, it prevailed extensively through- out our country in its most malignant form, and it was estimated that in Massachusetts about one thousand persons became its vic- tims.* It is recorded that in 1741, 1746, and 1760, the disease termed anginosa maligna, or the putrid and ulcerated sore throat prevailed and extended through the colonies with mortal rage, in opposition to the united endeavours of the faculty. It swept all before it, and some villages were almost depopulated. It appear- ed again in 1784, and spread through the New-England States; at subsequent periods it has been recognized either as an epidemic, or as sporadic cases, without assuming in a high degree character- istic contagious powers. Scarlatina, in all its forms, is produced by the same specific contagion ; and frequently the symptoms arc so blended in the first onset, that the particular species can scarce- ly be designated. It may be communicated by the contaminated atmosphere, and by simple contact of the patient, either in the heat of summer or cold of winter ; but it most frequently occurs in autumn, and becomes a very prevalent epidemic, often continuing through the succeeding summer months. It frequently attacks young people in the most sequestered situation, where communica- tion with the sick had been impossible, appearing in some families and passing others contiguously situated. It produces its opera- tion on the system about the fourth or fifth day after exposure to the contagion, and it not unfrequently happens that persons expos- ed escape the disease, as in other contagions, and although in gen- eral persons are not susceptible of a second attack, some instances to the contrary have undoubtedly occurred. Children and persons of a weak lax habit are most commonly the subjects of this disease. In its mildest form it is known as the simple scarlet fever, receiv- ing its name from the singular colour which pervades the skin, re- * Dr. William Douglas, a respectable physician of Boston at that day, publishes! a valuable practical essay on the anginosa ulcusculosa, which prevailed in New- England in 1735 and 1736, in which he detailed the characteristics of the disease, and the method of treatment. He says, " most of those who died of the physi- cian, died by immoderate evacuations." It has been related by tradition, that the physicians of that day, or of some other period, adopted the plan of bleeding from the vein under the tongue, and although in almost all instances it proved fetal, the practice was persisted ia longer than could have been deemed warrantable. ORDER III. SCARLATINA ANGINOSA. 427 sembling the shell of a boiled lobster, or appearing as if diffused with red wine. It is generally ushered in with slight chills, like other fevers, but without much sickness; these are followed by heat of the body, thirst and head-ach, sometimes in a very mode- rate degree, at others more violent. The pulse is greatly accele- rated, the respiration is frequent or irregular, the eyes sunk and the eyelids turgid, and red on the inside. About the second or third day, the face begins to swell, and the eruption makes its appear- ance in the form of a red stain or blotch, which disappears upon pressure, but soon returns again. It now spreads all over the skin, which often appears uniformly red, and in three or four days the redness disappears, and the outer skin peels off in branny scales, which in many cases returns for two or three times. Sometimes spots break out on the body like the stinging of nettles, attended with troublesome itching ; but in three or four days, like the for- mer, they entirely cease, and are followed by a separation from the skin in extreme small scales. This is by some called canker rash when attended by a slight soreness of the mouth. The scar- let fever may be distinguished from the measles by the eruption being less uniform, and more like a red coloured effusion, than distinct spots, and by not being accompanied with any cough or watering of the eyes, and the efflorescence of the measles does not appear till two days later than scarlet fever. The simple scar- let fever, when unattended with sore throat, requires little or no medical prescriptions ; abstinence from animal food, and the avoid- ing exposure to cold air, drinking freely of diluting liquids, and taking a dose or two of epsom salts, will in most cases answer all the purpose. SCARLATINA ANGINOSA. This species assumes a more serious aspect, the morbid virus being chiefly directed to the fauces, and the cutaneous efflorescence is very slight, consisting of a few scattered patches only. It com- mences suddenly with shiverings, anxiety, nausea, and vomiting, succeeded by heat, restlessness, thirst and oppression of the breast; great dejection of spirits, with faintness when attempting to sit up. The pulse is extremely rapid, rising to 120 or 140 in a minute, though low and unequal. The tongue is moist, the eyes heavy and 428 CUTANEI. CLASS IU. watery, the countenance frequently full, flushed and bloated though occasionally pale and sunk ; the breathing is quick and la- borious, the skin extremely hot, and in many cases there is an eruption or efflorescence about the second or third dav, in large patches of a dark red colour, about the face and neck; which by degrees extend over every part of the body even to the extremi- ties of the fingers. The urine is commonly pale, thin and crude but in adults in small quantity, high coloured or turbid like whey. The patient complains of a stiffness in the neck, with acute pain in the back of the head. The throat is sore and inflamed, exhibiting a shining redness of a deeper colour than in common inflammatory sore throat, and interspersed with pale or ash coloured spots. In many cases the affection of the throat is among the first symp- toms, a dark red line extending along the velum pendulum palati, and lower part of the uvula. The breath is highly offensive, the tongue is covered with a yellow mucus or thick brown fur, and the inside of the lips is beset with vesicles containing an acrid matter, which excoriates, the corners of the mouth and other parts. In the progress of the disease, the inside of the nose becomes red and in- flamed, and a thin acrid matter issues from the nostrils whicli cor- rodes the skin wherever applied. There is sometimes a delirium, though the symptoms appear slight; the swallowing is difficult, and more so on swallowing the saliva only, than of any liquid or soft diet. A vomiting and purging is most common with children, and when the effloresence or eruption appears about, the second or third day these evacuations generally cease. But children have sometimes died on the second day of the attack. The more formidable and more malignant species of scarlatina is now to be noticed. The distinction, however, in the opinion of Dr. Good, is altogether unnecessary, and leads to no advantage, either pathological or practical. With the exception of a higher degree of danger in one than the other, from the fever assuming the character of a more malignant typhus, both forms are the same, they are equally produced by a specific virus, equally contagious and at times epidemic* * Professor Hosack, of New-York, coincides with Willan, Bateman and Thomas, in the opinion that scarlatina and cynanche maligna should be considered as distinct diseases, ORDER III. SCARLATINA MALIGNA. 42j) SCARLATINA MALIGNA. This is the cynanche maligna of Cullen, the ulcerated or putrid sore throat of Huxham and other authors. This form of the dis- ease has several symptoms in common with scarlatina anginosa. It comes on with rigors, dejection of spirits, pain in the head and liack, giddiness, vomiting and much general oppression. The eruption comes out in blotches, or small points scattered over the body and extremities of a dark purplish or livid hue. The fever is intense and progresses with rapidity, but manifesting an exacerba- tion in the evening and slight remission in the morning. The pulse is small, indistinct and irregular. There is a very great determi- nation of blood to the brain, producing redness of the eyes, intoler- ance of light, throbbing pain of the head and delirium or coma. The whole neck sometimes swells and assumes a dark red colour. It sometimes happens that cynanche ma'igna appears without any af- fection or efflorescence of the skin, as scarlatina in some cases pre- sents itself without any ulceration of the throat. As the sloughs about the fauces spread, they generally become of a darker colour, the whole internal fauces are at length covered with thick sloughs, which when they fall off discover ulcers very deeply sealed, and the parts appear quite black, and the sloughs often extend throughout the whole of the alimentary canal. The eruption sometimes sud- denly recedes, and alarming train of symptoms ensue, as also when the eruption suddenly assumes a very pale and livid appearance. The symptoms called putrid and malignant are now conspicuous, a dissolved state of the blood is indicated by inky petechia3, oozings of black gore from the nostrils, gangrenous appearances of the throat, spots upon the skin, and haemorrhages from various parts of the body. Cynanche maligna generally arrives at its height about the fifth or sixth day, but in some fatal cases the scene closes as early as on the third day. The inflammation, as in cynanche tonsillaris, on some occasions affects the eustachian lube, producing ulceration in the internal ear, and often extend- ing to the parotid maxillary and other glands of the fauces, which become swelled and painful. The malignant or putrid sore throat may be distinguished from the inflammatory, by tbe looseness and vomiting ; the puffy and dark coloured redness attending the swelling, and by the foetid ulcers of the throat, covered with white or ash coloured sloughs. It may also be distinguished by the slight 430 CUTANEI. CLASS HI, delirium appearing early in the disease ; and by the sudden weak- ness with which the patient is seized. Where the pulse about the fifth or sixth day of this disease becomes more moderate and strong- er, the respiration freer, the skin soft and moist, the florid colour begins to return to the fauces and a better matter to be discharged from the ulcers, and when the eyes are bright and there is no great degree of weakness or faintness, a favourable termination may be expected. But if the weakness be great, if the pulse should be weak and small, accompanied with a looseness or shivering; if the eruptions disappear or become livid ; if the e}'es look very dull, and the nose bleeds, and there be much foetor of the breath with a cadaverous appearance of the body, the event will be fatal. And if on the third or fourth day, respiration grow more laborious, with a peculiar kind of catching the breath, or double breathing; and an anxiety of five or six minutes continuance comes on, three or four times in an hour, such as induces the patient to bite his hands and arms, death may be expected on the fifth day. Scarlatina in all its forms is a disease of debility ; it prostrates both the body and mind, but it has in many cases a peculiar ten- dency to weaken the absorbent system, and produce dropsy. After a crisis the patient is affected with an universal tumefaction from head to foot, the cellular membrane being puffed up like a bladder, and the secretion of urine is greatly diminished. Another singular occurrence fell under the observation of Dr. Rush, when scarlatina anginosa appeared in Philadelphia, in 1783, and 1784 ; many pa- tients after a crisis were seized with a swelling of the wrists and ankles, accompanied with redness and great pain, in every re- spect similar to acute rheumatism. Mode of Treatment. In detailing the medical treatment of scarlatina, it is first to be observed that this must vary according to its appearances and forms, in different seasons and circumstances. In both forms of scarlatina, anginosa and maligna, inflammatory symptoms have been known to prevail to such a degree as to indicate the use of the lancet at the commencement, and the disease appeared in that character in Philadelphia and its vicinity in 1783, and 1784, when in many in- stances Dr. Rush was induced to have recourse to blood-letting, ORDER III. SCARLATINA MALIGNA. 461 but this evacuation has been considered as rather out of course in practice in this complaint, and it should not be resorted to without the most careful discrimination. When about the year 1735, the malignant ulcerous sore throat prevailed as a mortal epidemic in New-England, and New-York, it baffled the skill of physicians, till, at length, recourse was had to the sovereign powers of mercury, to which the scourging pestilence yielded in a surprising manner. The awful mortality was speedily checked, and the disease brought in a great measure under control. The administration of calomel has been generally adopted in practice as the most efficacious remedy in the first stage of this disease in all its modifications ; as it ope- rates upon all the excretories it is commonly to be preferred to any other purgative, or it may be combined with jalap or rhubarb. But the administration of an emetic is of the first importance, and the earlier it is exhibited, the greater will be the probability of di- minishing the violence and shortening the duration of the disease. Dr. Rush adopted the practice of adding calomel to his emetics, after which he gave calomel in small doses, and combined it also with his gargles. If the calomel did not sufficiently deterge the intestines, he directed it to be followed by some mild laxative. By thus evacuating the stomach and bowels of their offending con- tents, the disorder has sometimes been arrested at the beginning. The powder of ipecacuanha will in general prove sufficiently pow- erful and less debilitating than antimonials ; but on some occasions it may be advisable to add two grains of turpeth mineral, and the prescriber must not rest satisfied until he is assured of its having had its due effect, in cleansing the stomach. During the whole course of this disease emetics should be occasionally administered ; they have an excellent effect in equalizing the circulation, arousing the system from a state of torpor, encouraging perspiration, and in cleansing the mouth and throat of a load of mucus, by which those parts are clogged. Calomel as a purgative, aided by some mild laxative, as sulphate of magnesia or laxative injections, must be re- peated according to the effect produced. In the mean time a mo- derate course of calomel as an alterative, may be considered as the most successful mode of practice. This method, however, must be considered as inadmissible when the putrid tendency is great, and considerable debility has ensued. In this state every debilitating medicine should be employed with the greatest circumspection, as it too frequently happens that even the mildest cathartic depresso* 432 CUTANLi. CLASS Hi and sinks the patient. With the view of determining to the sur- face, the spirits of Mindererus or the neutral mixture, with a small quantity of tartarized antimony, should be directed in doses of a table-spoonful every two or three hours, and on some occasions Dover's powder may be preferred. A powder consisting of four grains of camphor, and ten of cream of tartar, or when much febrile heat attends, the same quantity of sal nitre will be productive of beneficial effects. A blister has sometimes been advised to the throat, but it will be preferable to apply a poultice of mustard with meal and vinegar, and continue it as long as it can be endured. Cold water applied to the throat, and by way of gargle, has been known to be useful. Should the eyes appear much inflamed and delirium prevail, drawing blood from the temples by leeches might be likely to afford relief. Scarlatina in its mild form is not often attended with great danger, but we ought to be constantly on our guard in this insidious disease, as the severest cases of cynanche maligna often make their attack in so mild a manner, that for some time the disease assumes the most favourable form, when in an un- expected hour the symptoms denoting its most malignant type are ushered in, and the patient is sometimes cut off" before danger'is suspected. Those rheumatic, and anasarcuous swellings which sometimes appear after a crisis, maybe cured by the use of diapho- retic and diuretic medicines, joined with t*mics and a nourishing diet. But Dr. Rush succeeded in removing these complaints in every instance, by the use of cathartics of calomel and jalap. The affusion of cold water, or sponging the surface of the body, has been practised in scarlatina of late years with remarkable suc- cess. According to Dr. Currie, the cold affusion in several in- stances has extinguished scarlatina in its incipient state, so as to prevent either efflorescence, or any affection of the throat from taking place. The great utility of this remedy is fully corrobo- rated by the experience of Dr. Thomas, and other respectable au- thorities. This very efficacious agent, however, is to be employed only on the first onset of the disease, when there is intense heat and dryness of the skin. When the least chilliness prevails, or where there is any tendency to perspiration, the application of cold Water might be productive of much danger. In cases where from several days continuance of fever, extreme debility, with small ir- regular pulse have ensued, the cold ablution is deemed improper? It will be advisable to sponge the body with tepid water or with the ■tlDF.P. II'. SCARLATINA MALIGNA. 433 addition of vinegar. On the other hand, should a coldness and torpor of the surface and extremities occur, the warm bath, or other means of restoring warmth and equable excitement must be employed. But so soon as a putrid tendency and a great prostration of strength has become manifest, the objects which should excite our chief attention are, to support the patient's strength, to obviate the putrid tendency of the humours, and to cleanse the ulcers of the mouth and throat. Should, therefore, the inflammatory symptoms not run high, or these having subsided, the tonic and antiseptic remedies are to be applied with the utmost assiduity. The cincho- na and wine must be administered to the fullest extent of the con- dition of the stomach to receive them. If the bark in substance cannot bo retained on the stomach, the decoction or infusion should be substituted, and the elixir of vitriol, or muriatic acid ought at the same time to be freely employed as directed in typhus gravior. Vs an excellent cordial and antiseptic, I can with great confidence recommend a wine made from the officinal black currant. If this be administered in a manner suited to the urgency of the case, eveji a bottle in ttoeniy-four hours, it will produce the happiest effects by counteracting the putrid tendency and supporting the energy of the system. When children cannot be prevailed on to lake the bark in any form, it should be injected into the intestines with a syringe. Information has reached me from a source deserv- ing of confidence, that a decoction of the root of sophora tinctoria, has been exhibited in this disease with the most satisfactory sue cess, and is even esteemed by some, as a more efficacious antisep- tic than the cinchona. It is given in doses of a table-spoonful every few hours, but in diminished doses, if it prove cathartic. Used as a gargle, it certainly deterges and heals the aphthous ul- cers in a wonderful manner. As auxiliary remedies, nothing can be more essential than the application of proper gargles to the mouth and fauces ; and particular attention should be paid to this point in cases of children, who are incapable of gargling, that the remedy be properly and thoroughly applied by injecting with a svringe, to clean the throat before swallowing any food or drink, as otherwise, the sloughs and putrid discharge from the ulcers may he carried down and greatly aggravate the complaint. Much ben- efit will be received by a few grains of calomel, either by itself or mixed with honey, and often applied to the tongue and ulcerated .OS 434 CUTANEI. CLASS HI. parts of the mouths of children. The following may be regarded as among the best preparations for the purpose of gargling. Take a handful of red rose leaves, a piece of myrrh the size of a nutmeg and three or four figs ; simmer the whole in a pint of pure old cider the older the better, then strain and sweeten it with pure honey. An excellent gargle may be prepared by diluting the muriatic acid, and sweetening with honey so as to be in some degree palatable; in cases of troublesome aphthae, or erosions of the mouth and ton- sils, it allays the intolerable heat and dryness of those parts, and induces an agreeable cooling sensation. But a simple decoction of the root of marsh rosemary, (statice CaroKana) forms one of the most efficacious gargles that can be employed. It is considered as one of the most intense and powerful astringents and antiseptics in the vegetable Materia Medica. In the ulcerated sore throat, in 1785 and 1786, Dr. William Baylies, of Dighton, and other prac- titioners experienced the greatest benefit from the use of this arti- cle as a gargle. It appears by Thomas' Modern Practice, that the throat distemper prevailed among the children in the West-Indies a few years since, with the greatest mortality, in despite of the ut- most endeavors of the physicians, till at length the superior effica- cy of the following remedy was discovered. Take two table- spoonfuls of capsicum, or Cayenne pepper, and two tea-spoonfuls of common salt, infuse these in half a pint of boiling water, and then add the same quantity of warm vinegar ; after standing for about an hour the liquor is to be strained through a fine cloth, and two table-spoonfuls given for an adult every half hour, using it also as a gargle. " The speedy and good effects," says the author. " produced by the use of this medicine in every case in which it was tried, evidently points out the utility of giving warm aromat- ics, which will bring on a timely separation of the sloughs, as well as other antiseptics to correct the tendency in the parts to gan- grene."* The carbonic acid gas, has of late been employed as an anti- septic in angina maligna with some advantage ; the most eligible way of introducing it into the stomach, is to direct the patient to swallow ten grains of salt of tartar, or other fixed alkaline salt, dissolved in a cup of water, immediately after which two table- spoonfuls of lemon juice, or sharp vinegar, must be swallowed. * Dr. Kellie, first introduced the Cayenne pepper, in this disease. See Med Comment, of Edinburgh, ORDER HI. SCARLATINA MALHtNA. 435 During the act of effervescence, the gas will be extricated, and exert its immediate effect on the stomach. It is on the principle of its containing a portion of fixed air, that yeast has been recom- mended in both malignant sore throat and putrid fever. When given in doses of two table-spoonfuls every three hours, yeast has proved manifestly beneficial. If the patient should be troubled with a diarrhoea, every attempt should be made to restrain it, as in every stage of the disease, this is a dangerous symptom. A decoc- tion of catechu, or the root of tormentilla, being excellent astrin- gents, may be employed for this purpose with decided good effects. A little wine or brandy mulled up with cinnamon or nutmeg, may also be advised, and small doses of laudanum will sometimes be re- quisite. Violent vomiting is to be appeased by the saline draught in the effervescing state, by small doses of laudanum and pepper- mint, and by the application of tincture of opium and camphorated spirits to the region of the stomach. There is some diversity of opinion respecting the employment of blisters in any form of this complaint, their utility it is said has not been experienced in practice, and as they are attended with incon- venience, and interfere with more useful applications, they may perhaps in most cases be omitted. When angina visited Boston in 1802, Dr. John Warren observed that " for swellings of the parotid glands; nothing was so efficacious as the application of cold water, or vinegar and water, by cloths kept constantly wet with these fluids. The drinking of cold water was in some instances attended with tbe happiest effects." In some instances a suppura- tion of the parotid glands will take place ; when this is indicated emollient poultices should be applied till maturation is complete, when the tumour must be opened, and the ulcer is then to be dress- ed with digestive ointment. In some cases there happens a discharge of blood from the nose. mouth or ears, which not being critical, but on the contrary threat- ens the greatest danger, ought to be restrained if possible by ad- ministering freely the mineral acids internally, and by the external application of tents dipped in some powerful styptic, as a solution of blue vitriol or alum. The safest rule, in the treatmeut of this disease,-is to have no general rule at all. Each epidemic varies in its character, and the treatment must be modified accordingly. It has already been mentioned that it was the Ne-.v-F.ngland prac- tice on former occasions, to administer a moderate course of mer- 436 ctTTANEi. CLASS III. cury so as to act upon the system at large for the cure of scarlatina and that mode of treatment was eminently successful. Dr. Rush also employed calomel in small doses in all stages of scarlatina an- ginosa which appeared in Philadelphia, in 1783 and 1784. In sub- sequent visitations, however, the disease has appeared to be some- what different, and the predominant symptoms of putrid diathesis, arid of debility, have deterred many physicians from resorting to the same mode of treatment. This shews the high importauce of a judicious discrimination at different seasons of its prevalence, as well as peculiarities of personal circumstances. Through the whole course of this disease the patient should be supported with nourishing food, light and easy of digestion, con- sisting chiefly of vegetable substances, as oat gruel, rice, sago, ar- row root, and panado. The ordinary drink may be wine whey, and barley water, acidulated with any of the vegetable acids. When the patient is happily brought to a state of convalescence, some geritle laxative medicine should be given occasionally, to carry off the putrid dregs that may remain in the intestines ; and if he continues weak he ought to persevere for some time in the us» of the Peruvian bark, and elixir vitriol, with daily exercise and a clear air. It is of great importance to guard against a relapse dur- ing convalescence. Dr. Armstrong has seen many instances of relapse in fever, and some of death, from eating apples, or the pulp of oranges, or broth. A boy, in convalescence, after scarlet fever, was allowed to eat two raw apples. The fever returned and put on the form of typhus. Purgatives were given for five or six days, the apples were evacuated without being digested and the child died. Those dropsical swellings, which occur in this disease, are generally produced by exposure to cold air and other irregularities. As respects the management of the patient, the greatest atten- tion to cleanliness must be observed. Whatever is voided by stool ought to be speedily removed, the linen and every infected article should be frequently changed and cleansed. The chamber should be sufficiently ventilated, but not so as to give any check to the perspiration, or efflorescence, and the floor should be often sprink- led with vinegar. The patient must not be surrounded by more attendants than are necessary, and those should carefully avoid in- haling the breath of the sick. The Cayenne pepper as mentioned above is affirmed to be an excellent preventive medicine. Ac- cording to Dr. Thomas, " by giving the attendants of the sick and ORDER 111. SCARLATINA MALIGNA. 437 others who may unavoidably be exposed* to infection, a tea-spoon- ful everv two or three hours, using it at the same time as a gargle, the orcventive effect of the remedy is said to have proved cer- tain. It seems to act by producing and keeping up a regular ex- citement in the tonsils, uvula, and fauces, and thereby enabling them to resist the sedative effects of the poison which is inhaled." But an expedient still more important consists in. a speedy separa- tion of the sick from the well, and of such as have been exposed to infection, as much as possible from all others. The period which elapses from the reception of the contagion, to the appearance of the symptoms, is said to be from three to six days. Whenever the disease is recognized, whether in a private family or boarding school, or other assemblage of children, every person affected should be separated without delay from all the rest, until a sufficient time has elapsed to secure from danger of infec- tion. These are the most probable means of checking the pro- gress, and effecting the total extinction of this fatal disease. According to Dr. Willan, persons under the influence of conta- gion do not communicate it until they are actually affected wj|h the fever and efflorescence, but it may be conveyed from one to another, by means of cloths, or a handkerchief, which has received the vapour from the lungs, or any of the discharges from the mouth or nose of the patient. Convalescents, he observes, from the dis- ease, notwithstanding the minutest attention to cleanliness and change of apparel, remain for two or three weeks capable of affect- ing others. Even the slightest case of simple scarlet fever, he thinks may produce in some, scarlatina anginosa, and in others scarlatina maligna. In consulting the English authorities, we find them altogether at variance respecting the propriety of abstracting blood from the system in scarlatina. Drs. Thomas and Good, are of opinion that it is scarcely admissible, in any instance ; while Dr. Armstrong is a strenuous advocate for the use of the lancet, and other depleting means, when cautiously and judiciously directed. He- divides scarlatina anginosa and maligna into three stages ; the primary or forming stage, the stage of excitement, and the stage of collapse. His rules of treatment are as various as the character of the dis- ease. In the early stage of simple scarlet fever, he directs a brisk purgative of calomel, after which an antimonial emetic, or a com- bination of the tartrite of antimony with the sulphate of magnesia, or 438 CUTANEI. CLASS IfL of the pulvus anlimonialis with calomel. This will rapidly reduce the heat and quickness of the pulse by acting as an emetic and cathartic at the same time. If, however, much external heat should remain, the tepid bath is to be applied, and often repeated until the circulations are equalized. In more formidable cases of scar- latina anginosa or maligna, Dr. Armstrong, as early in the first stage as possible, administers a full dose of calomel, after which a mild emetic, and immediately has recourse to the warm bath jn which some salt is dissolved. If decided marks of congestion, or visceral oppression are observed, he takes a small quantity of blood from the arm. In the stage of excitement, with a hot skin, he employs the cold or tepid affusion, preferring the latter, which to be efficient should be used six or eight times every twenty-four hours, and the purgative medicine should produce four or five copious motions in the day. In some of the most alarming cases of cynanche maligna, as soon as the stage of excitement became apparent, by the whole surface being morbidly hot and dry, Dr. Armstrong has known the disorder to he completely arrested by fije or six repetitions of the cold affusion, when promptly employ. ed, and repeated for the first twenty-four hours as often as the burning heat and dryness of the skin returned. When the excitive stage of this form of the disease is fairly revealed, we should act with the greatest decision, it should not be allowed to proceed many hours without being checked ; every moment is precious, as the general excitement may soon effect the destruction of some vital organ. Instead, therefore, of wine, bark, and aromatic cor- dials, as recommended by some authors, Dr. Armstrong would not pause an instant, but open a vein in the arm or neck, or a branch of the temporal artery, and allow the blood to flow until it is stop- ped by approaching faintness. Although one large bleeding is preferable to repeated smaller ones, yet if a marked relief be not obtained, the operation may be repeated in a few hours after, or some leeches should be applied to the temples or to the region of the liver. Dr. Armstrong has, in some instances, bled twice free- ly, in children from the arm, the external jugular vein, or from the temporal artery, to eight or ten ounces. In bleeding in the highly conjestive variety of the scarlet fever, the finger should be kept constantly upon the pulse, and if it should be found rising in force, the evacuation may be carried to a moderate extent; should it con- tinue to sink, it will be no longer safe to continue it. Venesection 0RDKR HI. URTICARIA, OR NETTLE RASH. 439 must never be carried to fainting in great venous congestions, as it may prove fatal. The head should always be much raised, and after being shaved, it should be repeatedly covered with folds of linen soaked in cold water. This application, in cases so violent, is much superior to blistering the scalp. Immediately after blood- letting, large doses of calomel and jalap, aided by sulphate of mag- nesia, should be administered, and persisted in until there be a visible change for the better, in every respect. Let it be carefully recollected, however, that these powerful proceedings should be solely confined to the stage of excitement, and within the first thir- ty hours of that stage. In the stage of collapse, every depleting step will plunge the patient into still greater hazard, if not prove mortal. It must rest with the observing physician to decide wheth- er bleeding or the omission of it will place his patient in the great- est safety. In the stage of collapse, mild laxatives are to be given occasionally combined with some cordials, and in this stage also milk, light animal broths, and similar articles should always be pre- ferred to wine and cordials, because they restore the strength much sooner without the risk of creating any secondary fever. URTICARIA, OR NETTLE RASH. This is an eruption in the skin in the form of red spots with white tops, resembling the stinging of nettles, breaking out on the second day, commonly disappearing in the day time and returning at night, with slight fever, and after a few days wholly falling off in minute scales. It is attended by a troublesome heat and itching, and has been known to continue to recede and return at intervals for several months. In some instances, urticaria has been charac- terized by large wheals or bumps, which.oy pressure appear of a solid nature, without any cavity or head; nor do they contain any- kind of fluid. This is a mild disease, not contagious and seldom requires the use of remedies, though an antiphlogistic regimen is always proper. The itching may be allayed by bruised parsley or camphorated vinegar. An infusion of serpentaria has produced favorable effects, and the cooling saline purgatives will be advisa- ble. An eruption of a very similar nature has been known to ■ rise iu particular constitutions from eating mushrooms, crab-fish. 440 CUTANEI. CLASS III. clams, muscles, and lobsters. The effect in these cases is rapid. and the symptoms violent for a few hours, but relief is soon ob- tained by the operation of an emetic. Order IV.—PEMPHIGUS, OR VESICULAR ERUPTION. This disease is of so rare occurrence, that Dr. Cullen and most modern authors confess themselves to be unacquainted with it by personal observation. We have no authentic account of its hav- ing appeared in the United States. Pemphigus is classed among the exanthemata, and is said to consist " in eruptions dispersed over different parts of the body, internal as well as external, which gradually rise up into vesicles of about the size of a large nut, con- taining a yellow serous fluid, that is in some instances of an ichor- ous nature, and wdiich again disappear in the course of three or four days. By some authors it is described as being attended both by fever and contagion ; and by others as being accompanied with neither." An intense burning heat of the skin appears to be a prominent feature of the disease ; the sensation it conveys to the patient being somewhat similar to a common scald, with a train of Concomitant febrile symptoms. In this conditioh of the patient; saline purgatives with calomel are indicated. But where the disease exhibits a putrid tendency, the cinchona bark with wine and the mineral acids must be relied upon for a cure. Dr. Parr mentions several cases which had fallen under the notice of Dr. Withers, in which the fever attend- ing pemphigus was extremely putrid, with many gangrenous sloughs, of a foetid smell and most dreadful appearance, following the eruption of the blisters, attended with a low delirium for many nights, the greatest dejection of countenance, and prostration of strength. In these cases cures were performed by tonics and anti septics. W -.Rnr.H > SMALL-POX. 441 ORDER V. Porrigo,* or Scald Head, Crusta Lactea, and Chilblains, or Kibes, diseases of the class Cutanei, will be found among the Diseases of Children in the latter part of the volume. VARIOLA, OR SMALL-POX. Few, among the numerous catalogue of diseases, have been a greater scourge to the human race for ages past, than the small- pox. It is a disease highly contagious in its nature, and destruc- tive in its tendency, seizing all descriptions of persons, and spread- ing consternation and dismay wherever it makes its appearance. This disease appears under two different forms, which are termed the distinct and the confluent, the latter of which is always the most dangerous. The distinct small-pox is preceded by a sense of languor and weariness, redness of the eyes, soreness of the throat, with pains in the head and back. These are soon succeeded by the symptoms of severe inflammatory fever, accompanied by alter- nate iils of cold and heat, violent oppressive pain at the pit of the stom;.:e, with nausea, and sometimes vomiting. The patientgen- e. !iy becomes exceedingly restless, and even delirious, the skin burning with an uncommon degree of heat. There is generally a costive state of the bowels, and young children are sometimes ser/.ed with startings and convulsion fits, which in this disorder are not unfavorable, but indicate a speedy appearance of the erup- tion. On the third or fourth day from the first seizure, the eruption is thrown out in distinct red spots, like flea-bites, on the face, arms, and legs, which soon extend over the whole body; and when the eruption is completed, if not very numerous, the febrile symptoms subside. The pustules are from their first appearance distinct from each other, gradually assuming a conical form, and on the fifth or sixth day, begin to turn white on their tops; and by the eleventh day, having filled, and acquired their greatest size, they are entirely white or of a yellowish colour. Their bases, however, are red and inflamed, during the whole course of the * Dr. Willan has substituted the term Porrigv for that of tinea capitis,, and D Hosack has adopted it in his Nosology. 56 442 C'fJTANEl. CLASS III eruption ; but when the pustules are entirely filled, they assume a brownish hue, and soon begin to shrivel, and the matter which ex- udes forms a dark coloured crust on the skin. These in a few days fall off, leaving a redness, and sometimes a small pit, which remains during life. A tension of the^skin, and swelling of the face and neck, with some difficulty in swallowing, generally ac- company even the mildest sort of this disease. The confluent small-'pox is preceded by a much greater degree of fever, and that of the low kind. The eruption also appears sooner, is much smaller, and more numerous; the spots assume a crimson colour, and do not rise and fill like the distinct kind, but run into one another, and often cover the whole face, very much resembling the measles, during the first days of the eruption. A swelling of the head and neck takes place at the commencement of the eruption, and becomes formidable in appearance, often closing both the eyes, but subsides about the tenth or eleventh day. The inside of the mouth and throat become swelled in a very considerable degree, and is accompanied in children with a diarrhoea, and in adults, with a copious discharge of saliva, which is frequently so acrid as to excoriate the mouth and throat. When the pox are of a livid brown colour, or small and flat, with black specks in the middle, and contain a thin watery humour ; and when they are very numerous on the face, and run into one another, an unfavourable event may be apprehended. But still greater danger is indicated, when purple, brown, or black spots are interspersed among the pustules, as they afford a sign that the blood is in a putrid state ; and if accompanied with bloody stools, or urine, and a swelling of the abdomen, a speedy dissolution will inevitably ensue. When the face does not swell, or the swelling subsides be- fore the pox comes to maturity, the case is unfavourable; but when at the same time that the swelling of the face subsides, about the eleventh or twelfth day, the hands and feet begin to swell, we may in general pronounce the case to be favourable. In the confluent small-pox, the secondary fever, as it is termed, makes its appearance about the time of maturation, or when the pustules begin to blacken on the face. In those cases where the disease terminates fatally, the fever increases, the whole surface of the body becomes of a pallid hue, the pustules are flaccid, and the swelling of the head subsides without that of the hands and feet succeeding. ORDER V. SMALL-POX. 44b It is truly fortunate for mankind, that ignorance and prejudice, which formerly held such unbounded sway in this destructive dis- ease, have at length given place to a more rational and successful method of treatment. The absurd practice of increasing the heat of the body by every means which folly could suggest, and of al- lowing dirt and filth to accumulate, by wearing the same linen and bed-clothes during the whole disease, has been the bane of thou- sands. Universal experience and observation have decided the point, that by augmenting the febrile heat, either by external appli- cations, or by the administration of internal heating medicines and drinks, the number of pustules and violence of the disease may always be increased, and that by a contrary mode of treatment, these evils may be prevented. A strict pursuance of the antiphlo- gistic plan, ought undoubtedly to be recommended. At the early stage, and during the eruptive fever, the patient should abstain from animal food, and from every thing that can tend to inflame the blood. He should drink freely of barley water, balm tea, with other cooling and acidulated liquors ; his face should be often ivashed, and his throat gargled with cold water, to prevent a too free eruption about those parts. He should not be confined to bed, and a mattress, lightly covered, should always he preferred to a feather bed ; he should expose himself to the cool air, which is by far the most effectual remedy for abating the febrile heat produced by this disease. The more the heat of the body exceeds the nat- ural temperature, the greater will be the benefit of refreshing cool air, in moderating the distressing symptoms. Besides cool air, we are advised by Dr. Thomas and others, (Modern Practice) to apply cold water, by partially or generally washing the body, dur- ing the eruptive fever. This practice has been adopted in Europe, and it is asserted that the most beneficial effects have resulted from it. The author just mentioned observes, that when the pa-r tient is seized with variolous fever, and the febrile symptoms run high, cold water should be thrown over the body every four or six hours, and continued till the eruption is completed. This he says usually mitigates the head-ach, pains in the back, ayd other fe- brile symptoms ; a slow and gentle perspiration succeeds, a mild eruption takes place, and the violence and danger of the disease- are diminished. The chamber of the patient ought to be kept freely ventilated, he should have his linen and bed-clothes fre- quently shifted, and except he complains of being actually chillv, 444 CUTANEI. CLASS III, there will be no danger in carrying the cool regimen to the full extent. When the disease proceeds in a favourable manner, little more will be requisite than the means above advised. If, how- ever, the general inflammation should run very high, and many alarming symptoms be present, the judicious physician may find it necessary to take away a proper quantity of blood ; but much pre- caution is to be observed, lest a malignant or putrid fever accom- pany the disease, when bleeding might prove highly injurious. Local blood-letting, by scarifications, or by the application of leeches, should perhaps be preferred as being a more safe remedy. Strong purgative medicines will seldom be required, but gentle laxatives, or softening clysters, should be given every two or three days, through the whole course of the disease, in order to obviate that costive state of the bowels which generally attends the pa- tient. After the eruption is completed, and also during the matu- ration or ripening of the pox, the efforts of nature, if too feeble, should be assisted in the important process, by the use of some cordial medicine, as wine whey, snake-root, or saffron tea, care being taken not to overheat the patient. The filling of the pox is often prevented by great restlessness, in which case gentle opi- ates must be administered, and repeated till the desired purpose be answered. If a strangury, or suppression of urine, should oc- cur, as sometimes happens, the patient, if able, should walk about the room with his feet bare, and cold water may be dashed over his legs and feet, which has sometimes succeeded. A valuable remedy in this complaint, is equal parts of spiritus nitri dulcis and laudanum, one drachm of which may be given to an adult every hour until relief be obtained. When purple or black spots appear among the small-pox, indicating a putrid state of the blood, the Peruvian bark should be immediately given, to the greatest extent that the patient's stomach can bear, to which should be added the elixir vitriol, and all the means which have been advised when treating of putrid fever. Much danger is to be apprehended when the small-pox strikes in, as it is termed, or the pustules suddenly sink, and become flat before they have arrived at maturity. The effects which arise from this circumstance, ought to be immediate- ly counteracted by the application of blisters to the wrists and ankles, and sharp poultices composed of mustard seed, oat meal, and vinegar, to the feet and hands, administering at the same time some mild cordial medicine internally. If on the approach of the OKDER V. SMALL-POX. 445 secondary fever, it be accompanied with high inflammatory action* and affecting the breast or lungs, blood must be drawn, in a quan- tity suited to the urgency of the case, and the strength and age of the patient; but if on the other hand the pox become suddenly pale, attended with coldness of the extremities, and faintness, blisters should be applied, and generous cordials with the Peruvian bark exhibited. We are advised by Dr. Buchan and others, to open the pustules with a lancet or needle, for the discharge of the contained matter, the absorption of which, it is said, produces or increases the secondary fever. It should be done when the pox begin to be of a yellow colour, and as they fill a second or third time, the operation may be as often repeated. Besides the bene- ficial effects of this practice, in diminishing the fever, it tends to prevent the pitting, which is an object of some consideration. Purging is in general necessary after the small-pox; but when the patient has suffered under the confluent kind, great care must be taken that the doses, or the frequency of them, be not such as to occasion excessive debility. VARIOLOID DISEASE, OR SECONDARY SMALL-POX. This is a variety of distinct small-pox. The premonitory symp- toms are the same, and the eruption comes out in a similar manner. It has appeared as an epidemic. It attacks indiscriminately those who have had the genuine small-pox, naturally or by inoculation^ or those who have been vaccinated, and it has been known to oc- cur the second or third time in the same individual. But this modification of small-pox is not very readily communicable by in- oculation. Tt is generally mild, the patient not being confined more than one or two days, and but eight or ten pustules appear. Sometimes, however, the pustules are numerous, but smaller and harder than in the genuine disease. The peculiarity of varioloid is, that it stops as it were in the middle of its progress, about the fifth or sixth day ; the pustules not unfrequentlv dry without matu- ration, and it seldom or never proves fatal. INOCULATION. The discovery of communicating the small-pox by inoculation, which was first practised in this country in the year 1720, (see page 11) may be considered as making an important era in the 44G CUTANEI. CLASS in. history of medical improvement. So confessedly great have been the advantages resulting from this practice, that most of the preju- dices and objections against it have lost their influence, and all classes of people have resorted to it whenever the small-pox con- tagion has prevailed. By inoculation, the shocking ravages of this most disgusting and fatal disease are in a great measure prevented. It has been computed that one third of the adults, and about one seventh of the children die, who take the small-pox the natural way. By inoculation, if properly managed, not more than one in five or six hundred have been known to become its victims. But kind Providence has recently bestowed a more inestimable blessing on the human race, in the discovery of the cow-pox, as an infalli- ble antidote to the fatal malady in question. Since the inocula- tion of cow-pox is so universally adopted, that we have much reason to hope that the time is at hand when the small-pox will bid a final adieu to the civilized world, it is scarcely deemed justi- fiable any longer to perpetuate it, by inoculation. A few brief di- rections, however, belong to this place. The manner of perform- ing this operation is perfectly simple and easy. Take a little matter from a pustule on a healthy subject, when the pox are fully ripened, on the point of a lancet,' and insert it in the arm, midway between the shoulder and elbow, by making one or two small punctures between the true and scarf-skin, wiping the point of the lancet at the edge of the incision, and afterwards pressing down the skin with the flat side of the lancet. Some care is requisite to prevent the discharge of blood from washing out the matter ; and to insure success, it is advisable to inoculate in two places, or in both arms. In three or four days after the insertion of the matter, the part appears inflamed, and in about three days more the symptoms of infection come on. The most eligible season for inoculation, is when the weather is temperate and healthy ; and the most proper age for children is between three and five years. The greatest at- tention should be paid to the state of the child's health at the time, as it would be absurd to inoculate when the condition of the body is such as to be incapable of resisting the effects of the complaint. It is likewise proper to pay some attention respecting the medicin- al and dietetic preparation, as this may have considerable influence in the future eruption, and other circumstances. Those that have been accustomed to high living, and are of a gross habit of body, or abound with bad humours, ought to be put upon a spare diet for bRDER V. SCABIES, OR ITCH. 447 ten days or more before inoculation. They should abstain from much gross animal food, and every thing of a heating quality ; and two or three doses of physic, at the distance of three days from each other, suited to the age of the patient should be given. When the signs of infection have begun to appear, the proper manage- ment is to keep the patient cool, and his body gently open ; by which means the fever is kept low, and the eruption greatly les- sened. The food and drink during the disease, are to be regulaU ed in the same manner as in the natural small-pox, and should medicine be requisite, the same directions will be found applicable. When the disease has ceased, some purgative medicines will be equally necessary as in the former kind of disease. SCABIES, OR ITCH. This loathsome and unpleasant disorder consists of little watery pimples of a contagious nature, which first appear between the fin- gers, and on the wrists, afterwards affecting the arms, legs and thighs, and in process of time spreading over the whole body, except the face, and attended with a great degree of itching, es- pecially when warm in bed or exposed to the heat of a fire. The hot vesicles contain an acrid serum, to which by scratching, dry rough scabs succeed. A want of cleanliness is frequently the original source of this disease, by producing animalcula, or small insects in the skin, which occasion the violent itching, and by which the infection is supposed to be communicated by contact with the body, or by wearing the same clothes, or lying in the same bed-linen that has been used by a person already infected. The itch is seldom attended with dangerous consequences unless neglected or improperly treated ; if suddenly repelled or driven in without proper evacuations, it may give rise to fevers or some in- ternal inflammation. Persons affected with this disease, if to any considerable degree, should never neglect to take as much flowers of sulphur and cream of tartar internally as will have a laxative effect, before or during the employment of the proper external remedies. Among the numerous forms of ointment recommended and employed for the removal of this disorder, experience confirms that no one is to be preferred to those which have sulphur as a principal ingredient; the unpleasant sulphureous smell may be cor- 443 CUTANEI. CLASS 11L rected by the addition of the essence of lemons or burgamot. Dr. Good prefers mixing the sulphur with cream. But as the applica- tion of the sulphur ointment over the whole body is attended with many inconveniences, various substitutes have been proposed. The oil of turpentine applied to the parts affected will sometimes cure. The sanguinaria canadensis dissolved in vinegar, if well ap- plied has been known to effect the desired purpose. The proper proportion is half an ounce of the powdered root to six ounces of vinegar. But the most delicate, and at the same time a most effectual remedy is the following : a drachm of muriated quick- silver dissolved in half a pint of water, adding two drachms of crude sal ammoniac and half an ounce of sal nitre. The hands are to be washed with it night and morning, and a little of it applied by a sponge to the parts most affected. It is safest to use it grad- ually, and during its use there will be no danger of communicating the infection, and after a few days application the cure in general is complete. The unguentum citrinum, or yellow ointment of the Dispensatories, is a safe and in general a very effectual remedy. A neat and efficacious ointment may be formed by mixing half a drachm of sulphuric acid with two ounces of hog's lard, but this is apt to corrode the person's linen when applied. There are vari- ous vegetable productions possessing properties adapted to the cure of this filthy disease, as digitalis, the two species of laurel, tobacco, and the root of white hellebore, found in our meadows and swamps. A strong decoction of either of these, applied as a wash, will sel- dom fail to effect a cure. In some instances where the patient is of a full habit, it will be proper to bleed, or to administer one or two purges before the application of the ointments, which are to be rubbed upon the arms, legs and thighs, or other parts, at bed- time every night, it being seldom necessary to apply the ointment over the whole body. When the cure is completed, which gener- ally requires two or three nights, the patient's body should be thor- oughly washed with soap and water, and all the infected clothes ought to be well fumigated with sulphur or otherwise effectually cleansed. Some attention should be paid to the diet while labour- inff under this disorder ; high seasoned or salted meats and heating liquors should be avoided, and milk and vegetables, with a small proportion of animal food preferred. The patient should shift his linen frequently, and attend carefully to the means of cleanliness. ORDKR VI. CHICKEN POX. 449 It frequently happens that children are afflicted with eruptive disorders, having a similar appearance with the itch, but it is not always safe to treat them in the same manner, for those eruptions are often salutary, and ought not to be suddenly repelled. Order VI—SARICELLA. CHICKEN OR SWINE-POX. This complaint is propagated by infection, and persons can be affected with it but once during life. It is attended with no danger, although sometimes accompanied with unpleasant symptoms, such as slight head-ach, lassitude and other febrile complaints. The pustules or pimples sometimes make their appearance without being preceded by any illness or signs of their approach. They never are very numerous, nor run together. On the first day of their appearance, they are of a reddish colour, and on the second there is at the top of most of them, a small bladder, about the size of a mil- let seed. This is sometimes full of a watery liquor, and the skin breaking, a thin scab is formed on the first or second day, on the top of the pustule, and on the fifth day of the eruption, they arc almost all dried and covered with a crust. This disease as above described requires no medicine, care only being taken to keep children who are ill with it from the cold damps of the evening air, and to regulate their diet, which should consist chiefly of broth, light puddings, and bread and milk. This disease may be distinguished from the small-pox, by its ap- pearance on the second or third day, and from the bladder of watery liquor, upon the top of the pox. It may likewise be dis- tinguished by the crust which covers the pox on the fifth day, at whicli time the small-pox is not come to a state of maturity. VACCINA, OR COW-POX. Although this singular disease has been known for more than half a century, in some districts in England, and in Germany, as affecting the udder of cows, and also the extraordinary fact of its being a preventive of small-pox, it was not till 1797 and 1798, that the intelligence was promulgated and the disease artificially propa- gated among mankind. Dr. Edward Jenner, an eminent English physician, was the first wno made it a subject of medical investiga- 450 CUTANEI. CLASS 111. tion, and by his unexampled industry and perseverance, has demon- strated the infinite importance and utility of this heavenly blessing to the whole civilized world. The fact had fallen under the obser- vation of this celebrated physician, that cows, in some parts of Eng- land, have long been liable to an eruption, and sores on their teats and udders, which was occasionally communicated to the hands and arms of those who were employed in milking them, producing ulcerous sores and some degree of fever, and from the hands thus affected, the same disease was frequently communicated to other cows by the operation of milking. Hence the disease obtained the name of kine, or cow-pox, (vaccina, or vacciola;) and it was likewise satisfactorily ascertained, that the person who has once undergone the disease so communicated, is ever after secure against the infection of the small-pox, either in the natural way, or by inoculation. It appears that Dr. George Pearson, of St. George's hospital, first suggested to Dr. Jenner, the application that might be made of the facts familiarly known for years before, that the dairy maids were proof against the small-pox, and this distinguished physician, it is believed, united his efforts with those of Dr. Jenner, for the establishment of vaccination, as a substitute for small-pox. Dr. Jenner, however, was the principal agent in this noble employ- ment, and he has been justly and liberally remunerated by the British Parliament. Those persons who are conversant with cows, during the season when they abound most in milk, will recollect that, various exter- nal causes, such as rough handling, stinging of flies, &c. will pro- duce small white blisters, cracks and pimples, on the teats and udder, which however, are seldom more than skin deep, and are of short duration. Cows, too, whose udders have been suffered to remain full for some days, have been observed to be affected with severe inflammation of those parts, succeeded by large eruptions upon the teats and udder, leaving large and troublesome sores, the matter from which will communicate a disorder to the hands of the milk- ers and often produce foul and extensive ulcers, which prove tedious and difficult to cure. The genuine cow-pox, however, is a distinct disease from those which have been just mentioned. It generally makes its appearance in the spring, and shows itself in irregular pustules on the teats and the udder. They are at first of a palish blue, or rather a livid colour, ORDER VI. COW-POX. 451 and contain a thin watery and sharp fluid. The surrounding parts are inflamed and hardened. These pustules, it seems, are very apt to degenerate into deep corroding ulcers, and constantly discharge a matter, which commonly increases in thickness, and hardens at last into a scab. In some instances, the cow becomes evidently indisposed, loses her appetite, and gives less milk than usual; but it often happens that the disorder though severe is entirely.local. It appears that the cow-pox never proves fatal to cows, nor is infectious, in the usual manner of contagious distempers, but can only be communicated to them, or to the human species, by actual contact with the matter which proceeds from the sores. Hence the cows which are not in milk, escape; the disease entirely, though constantly in the same field with those that are highly infected : and it seems to be only from the circumstance of the milker hand- ling the teats of the sound cows, after touching the diseased, that the cow-pox ever spreads among them. The matter discharged from the sores on the udder and teats of the cow, when affected with the genuine cow-pox, is found by ex- perience to possess the power of infecting the human species when applied to any part of the body where the skin is broken or natu- rally thin. The following appearances are exhibited on the hands of the domestics who are employed in milking cows affected with cow- pox. Inflamed spots begin to appear on the hands, wrists, and es- pecially the joints and tips of the fingers; and those spots at first resemble the small blisters of a burn, but quickly proceed to sup- puration. The pustule is quite depressed in the middle, and of a blueish colour, and is surrounded with a considerable redness. The blue colour which the pustule almost invariably assumes when the disorder is communicated directly from the cow, is one of the characteristic marks by which the cow-pox may be distinguished from other diseases which the milkers are likewise liable to receive from the cow. The matter of the pustule is at first thin and colour- less ; but as the disorder advances, it becomes yellower and more purulent. In a few days from the first eruption, a tenderness and swelling of the glands in the armpit comes on, and soon after, the whole constitution becomes disordered, the pulse is increased in quickness, shiverings succeed, with a sense of weariness and pains about the loins, vomiting, head-ach, and sometimes a slight degree of delirium. These synmtoms evince that the general system is 452 CUTANEI. CLASS 111. affected by the absorption of the virus of cow-pox, and they con- tinue with more or less violence from one to three or four days, and when they abate, they leave sores about the hands which heal very slowly ; resembling in this respect the ulcers on the nipple of the cow from which they derive their origin. The cow-pox erup- tion, though very severe on the hands, and occasioning much gene- ral illness, never produces a crop of pustules over distant parts of the body, arising spontaneously as in the small-pox. The lips, nostrils, eye-lids, and other parts of the body are, however, affect- ed with sores in consequence of being heedlessly rubbed, or scratch- ed with the patient's fingers when infected with the matter. " It was at first conceived to be no unreasonable conjecture that the cow-pox, and small-pox, were originally one and the same dis- ease, the latter having undergone in the lapse of years, and by the influence of various constitutions, the changes which it now ex- hibits, but no facts have occurred to verify this opinion, and it ap- pears that the two diseases are not susceptible of intermixture, each preserving its distinct character under all circumstances ; and ex- periments have demonstrated that when persons have been inocu- lated with the two sorts of matter mixed together, sometimes the vaccine pustle, at others the variolous has been produced, each of them retaining its characteristic marks throughout. It is likewise ascertained, that when persons are submitted to the influence of variolous and vaccine matter at the same time, both prove ef- fective ; for the vaccine vesicle proceeds to its acme in the usual number of days, and the maturation of the variolous pustules is at- tended with a pustular eruption on different parts of the body ; but when variolous matter is not inserted until the ninth day after the inoculation with vaccine matter, the action of the variolous seems to be wholly precluded. Both fluids being introduced about the same time, restrain the action of each other. The vaccine vesicle in this case, is smaller and proceeds more slowly to its maturity, and the variolous pustules are small, hard, and shining, producing only a small particle of matter at their apices." The cow-pox in many instances has proved a severe disorder in those who receive it immediately from the cow, numerous pus- tules appear, and the feverish symptoms run very high. Bat it is ascertained to be an undoubted fact, that the vaccine virus is great- ly modified, and rendered much milder by passing through different ORDER VI. COW-POX. 4'j-i habits by inoculation ; when therefore proper matter taken from the human subject is used for inoculation, few or no pustules are to be observed, except immediately round the inoculated part, and little or no inconvenience is experienced during the whole course. The fact which is of the greatest magnitude and interest to man- kind relative to this subject, is, that the cow-pox having had its proper operation, as designated by the usual constitutional symp- toms, is a perfect security against the attack of that most formidable and loathsome malady, the small-pox. Whatever objections and doubts may formerly have subsisted, the principle has now become 10 universally notorious, and established, that no uncertainty re- mains, and no arguments need be urged in its support. By direct experiments conducted by numerous practitioners, it has been proved in the most satisfactory manner, that the susceptibility of the small-pox, is totally destroyed by inoculation with the vaccine matter.* Incredulity itself, can no longer deny, or question the in- teresting fact, and such is the confidence now reposed in its effica- cy, that the practice of vaccination has been adopted not only in various parts of the European continent, but extended to the re- motest regions of the civilized world. The armies and navies of Europe, are by vaccination preserved from the ravages of the small-pox, and there is good ground to hope, that by the same pro- vidential means this most desolating scourge will soon be wholly exterminated from among the calamities of the human race. It has been asserted, that although the cow-pox supersedes the small-pox, still it docs not secure the system from a seeond or third attack of the same disease. It will not be denied that instances have been adduced of repeated attacks of the cow-pox in the same person, but they are of very rare occurrence and should be con- sidered as irregular. It is well known that persons who have been the subjects of small-pox, are liable to be affected in some slight degree with the symptoms of the same disease when exposed to the infection. If among the many thousand successful cases of vaccination, a few * Dr. Fanchcr, a very experienced inoculator, in a communication published in the New-Haven Register, s»ys, " Having vaccinated upwards of 85,000 persons within 24 years, and tested many hundreds of them afterwards with small-pox mat- ter and infection, I am happy to proclaim to the world that I have never known one of them to have taken the small-p^x." 454 CUTANEI. CLASS III, instances are recorded tending to invalidate the supposition of the preventive power of the cow-pox, with regard to small-pox infec- tion, they are probably to be viewed as cases of a spurious disease arising from the imperfect quality of the matter employed, or some irregularity in the habit of body. The board of the British nation- al vaccine establishment, in their report to the government, in July 1812, observe, " that in some instances the small-pox has affected persons who have been most carefully vaccinated, is sufficiently established, nor ought we to be surprised at this, when we consid- er that the inoculation for the small-pox sometimes fails, and that several cases may be produced in which persons have been affect- ed with the natural disease more than once in the course of life. The number of instances of small-pox after vaccination, however, is very small, and we may fairly presume, that in proportion as improvements are made in the practice, such occurrences will be still more rare. " The board have infinite satisfaction in stating the two follow- ing important and decisive facts, in proof of the efficacy and safe- ty of vaccination, viz. that in the cases which have come to their knowledge, the small-pox, after vaccination, with a very few excep- tions, has been a mild disease ; and that out of the many hundred thousand persons vaccinated, not a single well authenticated in- stance has been communicated to them, of the occurrence of a fatal small-pox after vaccination." (New-Ejigland Medical Journal, Vol. II. p. 84.) Those who undertake to inoculate for the cow-pox ought to be well instructed in regard to the regular process of the pustule, and the most proper time for taking the matter. In the hands of some early and inexperienced inoculators, several failures are known to have occurred, and there undoubtedly are innumerable instances of persons having imprudently been inoculated by those who are totally unqualified to perform that service in a proper manner. Persons in this predicament, who have not been tested by the small-pox, or who have not experienced the most unequivocal con- stitutional symptoms of vaccine affection, should by no means con- ceive themselves secure, until by re-vaccination under the direc- tion of some experienced inoculator, their safety be completely ascertained and established. At an early period after the promulgation of vaccine inoculation, attempts were made first by individual physicians, and afterwards ORDER VI. cew-pox. 455 by the Massachusetts Medical Society, to diffuse the benefits of this invaluable blessing among the people of the New-England states, and it has since been extended throughout the Union. From the novelty and singularity of the project, strong prejudices were imbibed against it, and some unfortunate failures in unskilful hands tended to confirm and increase the opposition, and it was only by the most persevering exertions, and influence of the friends to vac- cination, that the public mind was at length brought to acquiesce in its great utility. A more universal and unbounded confidence in its efficacy is yet extremely desirable, that all classes of people may avail themselves of this glorious victory, which if improved, will rescue millions of the human race from the grasp of the king of terrors ! Parents ought to consider it a point of moral obliga- tion to vaccinate their children in early life, and it should be made an indispensable requisite to qualify those who engage to serve in military or naval stations. Every seaman ought to hold vaccina- tion in the highest estimation, and rank it among the most impor- tant of" the sailor's rights." It has been found that the matter of a single pustule being mix- ed with one quarter of an ounce measure of warm water, such diluted matter excited as distinct a vaccine pock by inoculation, as an equal quantity of undiluted matter; which points out a very easy method of inoculating a considerable number of persons from a single vaccine pock. Mr. Bryce's Test of Genuine Cow-pox. " Five or six days after the first inoculation, Mr. B. makes a second. If the disorder be of genuine character, the second inoc- ulation, though performed some days after the first, will have its progress so much accelerated as to have an areola formed a few hours after the first; and during the remaining stages of the cow- pox, the peculiar appearances of the two inoculations will take place nearly at the same time ; for the constitutional action excited by the first is extended to the second. Those engaged in vacci- nation have frequently witnessed that punctures and eruptions in the neighborhood of the vaccine vesicle, often assume the appear- ance of cow-pox. " Even a whole flock of the eruptions of chicken-pox have been seen to exhibit a semi cow-pox character. Mr. Bryce usually in- 456 CUTANEI. CLASS In. oculates with the crust dissolved in cold water. He recommends that the crusts should be carefully selected, and that the central dark coloured part be employed." (New-England Medical Journ- al, Vol. I. p. 311.) It may be worthy of remark, that vaccination produces little or no pain, no danger nor loss of time ; persons of all ages, and un- der almost all circumstances may become the subjects of it with perfect safety, and often to the relief of many complaints under which they have previously suffered. Children, under the influ- ence of the hooping cough, have experienced the favourable ten- dency of vaccination in lessening the severity of that disease. The important fact has been ascertained by Dr. Fancher, an experienced vaccinator, that both small-pox and cow-pox are capable of being expedited in their operation by means of an ac- cumulated number of punctures. Thus, let a person be inoculated in the usual way for the small-pox, and twenty-four hours after vaccinate by a number of punctures in the body and limbs, and the vaccine will take the lead. To rescue a person from the small- pox, six or seven days after exposure to the infection, he must be vaccinated by about six punctures in each thigh, six in different parts of the body, and the same number in each arm. In such cases it is obviously of the utmost importance that the vaccine mat- ter be of the most active and genuine kind. In order to supersede the inoculated small-pox, one or two days after the matter has been inserted, in addition to the above it will be necessary to encircle the variolous, or small-pox puncture with a number of vaccine punctures, about three-fourths of an inch from the small-pox puncture, and the same distance apart from each other. " By this lucky stratagem, we out-general and vanquish the gigantic foe. In this experiment, the triumph of vaccination will first be marked by the vesicle of the small-pox changing its colour from a cranberry or livid, to a dull blue, and then, instead of progressing, it speedily dries up, and a premature light brown scab will form, which is full evidence that the monster has let go his gripe, and that the patient is out of all danger of the small-pox." The following valuable instructions and remarks from a late publication are subjoined, as being particularly deserving the atten- tion of inoculators, and all ranks of society. ORDER VI. COW-POX. 457 Vaccine Inoculation, fl Effectually prevents the small-pox, is never dangerous, re- quires no particular diet nor medicine, and may be practised at all aires and at every season of the year." To collect the Vaccine Matter. " The matter may be taken from a pustule that is making its progress regularly, and which possesses the true vaccine character, by puncturing with a lancet in several points, and charging small square pieces of glass with it by gently pressing them on the open- ed puncture, and putting two of them together, with the sides con- taining the matter in contact; wrap them up in a piece of paper, and preserve them from heat and moisture." " The best time for taking the vaccine matter is from the seventh to the ninth day, before the efflorescence or red appearance takes place. An unnecessary irritation of the pustule is thereby avoid- ed : and it is also advisable not to take a great deal of fluid from one pustule. " Or, the internal, central part of the first scab that falls off, which is the true vaccine scab, may be used. " The scab of a vigorous pustule should be chosen, and may be kept in a cool dry place for a twelve month : so that vaccination may be performed from it at any time." To introduce the Matter. " The proper place for introducing the matter is on the arm, about midway between the shoulder and the elbow. The mode of doing it is by impregnating the point of a clean sharp lancet with the matter, and inserting it by means of a very slight scratch or small puncture, and wiping the point of the lancet on the part where the blood is drawn. Fluid matter tal CUTANEI. CLASS If) Signs of true Vaccine Inoculation. " A little red spot will appear on the punctured part on the third day, which on the fourth or fifth day, becomes a watery or vesicat- ed pimple : It goes on increasing, with a depression in the middle of the pustule, until the ninth or tenth day, when it is generally surrounded by a rose coloured, circumscribed appearance or efflor- escence, which remains nearly stationary for a day or two. " The efflorescence then fades away, and the pustule gradually becomes a hard glossy scab, of a dark mahogany colour. This efflorescence is also called the areola, and the vaccine ring, from its being circumscribed. It is most commonly in size rather larger than a dollar. " These progressive stages of the pustule are commonly com- pleted in sixteen or seventeen days. One pustule only is produced. On the eighth or ninth day, when the efflorescence is forming, some fever often occurs in children, and lassitude in adults." Signs of unsuccessful Vaccine Inoculation. " The most frequent deviation from the perfect pustule, is that which finishes its progress much within the time limited by the true. " Its commencement is marked by a troublesome itching ; and it forms a premature efflorescence, sometimes extensive, but sel- dom circumscribed or of so vivid a tint as that which surrounds the complete pustule ; and it exhibits one peculiar characteristic mark of degeneracy, by appearing more like a common festering, pro- duced by any small extraneous body sticking in the skin, than a pustule excited, before described by the vaccine virus. The suc- cessful progress of the vaccine pustule is frequently rendered un- certain by being rubbed. " An attention to the progress of the true vaccine inoculation, impresses on the mind of a practitioner the perfect character of a vaccine pustule. Therefore, when a deviation of any kind arises, common prudence points out the necessity of re-inoculation with vaccine virus of the most active kind, and, if possible, taken fresh from the pustule." ORDER VI. COW-POX. 459 Cautions respecting the Vaccinated Part. " To preserve the patient from suffering inconvenience in the vaccinated part, it is necessary that it should not be rubbed ; that it should be entirely loose and exposed to the air, and during the time of the efflorescence, should be constantly dusted with rye or buck-wheat meal. Tbe arms of adults are often inflamed from their wearing tight clothes, or using too much exercise at the period of the inflammation taking place—this might easily be prevented by avoiding the cause. " If" the pustule is rubbed and becomes a sore, the part should be covered with Goulard's cerate, or a salve composed of sweet-oil and bees-wax melted together, spread on a piece of clean linen rag, and kept in its place by a piece of soft linen sewed round the arm; the same application should be made if any sore remains after the scab has dropped off." Since the publication of the first edition of this work, many in- stances have occurred wherein the prophylactic powers of vaccina- tion have failed to protect the constitution against the attack of small-pox, by which the confidence of the public has been in some degree impaired. From a close investigation of this subject, it ap- pears most certain, that cow-pox is a security, to a very considerable extent, and for some length of time though indefinite; and it raa\ be safely affirmed that the variolous disease is in a great measure conquered by its substitute. We have tli£ most substantial sup- port in this assertion, by the honourable and candid report of the British national vaccine establishment, dated April, 1821, as fol- lows : {( After every reasonable deduction, we are compelled to allow that too many cases still remain on undeniable proof to leave any doubt, that the pretensions of vaccination, to the merit of a perfect and exclusive security in all cases against small-pox, were admitted, at first, rather too undeservedly. Yet, the value of this important resource is not disparaged, in our judgment, for after all. these cases bear a very small proportion to the number of those who are effectually protected by it," (eight only are stated, out of nearly sixty-seven thousand vaccinated since the establishment of the board.) " We have undoubted proofs from experience, that where vaccination has been performed perfectly, small-pox occur- ring after it, is almost universally a safe disease, and though usher- ed in by severe symptoms, has hardly ever failed to be cut short. 460 CUTANEI. CLASS 1U, before it had reached that period at which it becomes dangerous to life." HERPES. According to the arrangement of Mr. B. Bell, all the varieties of herpes of any importance may be comprehended in the four fol- lowing species, viz :— Herpes Farinosus, or what may be termed the dry tetter, is the most simple of all the species ; it appears indiscriminately in dif- ferent parts of the body ; but most commonly on the face, neck, arms and wrists, in pretty broad spots and very small pimples; these are generally "very itchy, though not otherwise troublesome; and after continuing a certain time, they at last fall off in the form of a white powder similar to fine bran, leaving the skin below per- fectly sound ; and again returning in the form of a red efflores- cence, they fall off and are renewed as before. Herpes Pustulosus. It appears in the form of pustules which originally are separate and distinct, but which aferwards run to- gether in clusters. At first they seem to contain nothing but a thin watery serum, which afterwards turns yellow; and exuding over the whole surface of the part affected, it at last dries into a thick crust or scab; when this falls off, the skin below frequently appears entire, with only a slight degree of redness on its surface; but on some occasions, when the matter has probably been more acrid, upon the scab falling off, the skin is found slightly excoriat- ed. Eruptions of this kind appear most frequently on the face, behind the ears, and on other parts of the head ; and they occur most commonly in children. Herpes Miliaris. This breaks out indiscriminately over the whole body ; but more frequently about the loins, breast, perinae- um, scrotum and inguina, than in other parts. It generally ap- pears in clusters, though sometimes in distinct rings or circles, of very minute pimples, which from their resemblance to the millet seed, has given rise to the denomination of the species. The pim- ples are at first, though small, perfectly separate, and contain no- thing but a clear lymph, which in the course of this disease, is ex- creted upon the surface, and there forms into small distinct scales; these at last fall off, and leave a considerable degree of inflamma- ORDER VI. HERPES. 461 tion below, that still continues to exude fresh matter, which like- wise forms into cakes, and so falls off as before. The itching in this species of complaint is always very troublesome ; and the mat- ter discharged from the pimples is so tough and viscid, that every thing applied to the part adheres, so as to occasion much trouble and uneasiness on its being removed. Herpes Exedcns. So called from its destroying or corroding the part which it attacks ; it appears commonly at first in the form of several small painful ulcerations, all collected into larger spots of different sizes, and of variotls figures, with always more or less of an erysipelatous-like inflammation. These ulcers discharge large 'piantities of a thin, slffrp, serous matter, which sometimes forms into small crusts, that in a short time fall off; but most frequently ihe discharge is so thin and acrid, as to spread along the neigh- bouring parts, where it soon produces the same kind of sores. Though these ulcers do not in general proceed farther than the cutis vera, yet sometimes the discharge is so very penetrating and corrosive, as to destroy the skin, cellular substance, and on some occasions even the muscles themselves. It is this species that should be termed the depascent or phagedenic ulcer, from the great destruction of parts which it frequently occasions. In the opinion of Mr. Bell, every species of herpes is in a greater or less degree contagious, and easily communicated by contact. In the removal of these, as well as other cutaneous affections, much de- pends on the employment of the means of cleanliness, the warm bath, with frictions with a coarse cloth, will always contribute to the cure. The local applications best adapted as remedies, are, solutions of sulphate of zinc or of corrosive sublimate with lime water, or the unguentum citrinum. A strong decoction of the fresh leaves of digitalis has been successfully employed, as also the leaves or inspissated juice of phytolaria decandra. But the reme- dy which I have found to produce the most speedy good effect, is sanguinaria canadensis, dissolved in vinegar, as directed for the itch. The solanum dulcamara has, in numerous instances, mani- fested its superior efficacy in the cure of inveterate cutaneous dis- eases. Drs. Willan and Bateman, in treating of diseases of the skin, furnish ample attestations to the great utility of this medicine in the cure of various cutaneous affections of an inveterate charac- ter. Dr. Crichton, physician to the Westminster Hospital, hav- wj emploved dulcamara for a number of years, states, in a let'er 462 CUTANEI. •LASS III. to Dr. Willan, that out of twenty-three cases of lepra gra?corum two only had resisted the action of this remedy. His method of administering the dulcamara is as follows : take of stalks of dulca- mara, one ounce ; water, one pound and a half; boil to a pound, and strain when cold. Of this decoction, the patient took two ounces at first, morning, noon and night, but the quantity was af- terwards increased until it amounted to a pint per day. .75 quick and weak, the face pale, and the breathing hurried; the above symptoms are also attended with dyspeptic and hysteric af- fections, coldness of the extremities, and an cedematous swelling of the feet toward evening. Copious menstruation often proceeds from indulgence in high seasoned food, plethora, intemperate use of spirituous liquors, violent exercise, particularly dancing, contu- sions, sprains, or shocks of the whole body, or abdomen, violent passions of the mind, costiveness, cold applied to the feet, excess of venery, particularly during menstruation. It may also be oc- casioned by a general relaxation of the system induced by frequent abortions, difficult and tedious labours, heated rooms, and the im- moderate use of tea and coffee. In the treatment of this disease the patient must in the first place be enjoined to avoid tlie causes by which it has been produced. She ought to lie upon a hard mat- tress in a horizontal posture, with her head low, and lightly covered with bed clothes,and kept perfectly at rest both in body and mind; cool air should be constantly admitted to the room, and cold drinks liberally allowed ; the diet must be of the least stimulating nature, „ and costiveness must be obviated by the employment of mild laxa- tives or injections ; refrigerants must be administered, particularly sal nitre and the sulphuric acid. If there is a considerable degree of excitement with severe pains, and if the patient is of a full and ro- bust habit, it will be proper to draw from the arm a few ounces of blood ; and if the haemorrhage, takes place about the time of the cessation of the menses, gentle emetics of ipecacuanha and sul- phate of copper may be employed with safety and advantage. In cases where increased action of the uterine vessels is evident, the tincture of digitalis in doses of from twenty to forty drops, two or three times in a day, will sometimes prove 'eminently beneficial. When the haemorrhage is very copious, recourse may be had to as- tringents both internal and external, of the former class the most powerful are kino, catechu, alum, sulphuric acid, and the acctite of lead, the last of which is by far the most efficacious. Dr. James Mann has reported several cases of menorrhagia and leucorrhcea in which permanent cures were effected chiefly by the use of ace- tite of lead conjoined with calomel and accompanied with blisleis applied to the os sacrum. Two grains of the acetite and half a grain of calomel were given night and morning. See Massachusetts Medical Society's Communications, Vol. II. The form of pills of uetite of lead, opium, and ipecacuanha, to be found in the Appcn- 476 PROFLUVIA. CLASS IV. dix is a valuable preparation ; one of which should be given every third or fourth hour until the desired effect be produced. The fol- lowing preparation has often demonstrated its superior restringent powers in uterine haemorrhage, and will seldom fail of success. Take sulphate of copper, three grains, sulphuric acid, twenty drops, common water, two ounces, mix, and give from fifteen to thirty or forty drops in water and repeat it every hour, or according to the ur- gency of the case. It may be presumed that these two last prepara- tions will supersede the necessity of of all other internal astringents in any instance that may occur ; after the employment of which, the Peruvian bark with elixir of vitriol should be freely administer- ed to restore the tone of the system. The external astringents of greatest effect, are cold water or vinegar, or a strong decoction of oak bark with alum dissolved in it, constantly applied by means of wet cloths to the back, abdomen, and pudenda. Blisters applied to the lower part of the loins have been surprisingly successful and should never be omitted. As there generally is a considerable de- gree of irritation of the system and uterus, it must be allayed by opiates in conjunction with astringents. In the intervals of men- struation, the remote causes must be studiously avoided; and the system in general must be invigorated and strengthened by the cin- chona, the different preparations of iron, the sulphuric acid, mode- rate daily exercise, and the cold bath ; cold water may with much benefit be poured daily upon the back, or injected frequently into the vagina, in obstinate cases. The period of life at which the menses cease, as well as that of their first commencement, is undoubtedly to be" considered as cri- tical and important; for the constitution must undergo a very considerable change by a total suppression of a long accustomed discharge; hence it is not unfrequent for various chronic com- plaints to afflict the patient and lead to a fatal termination. When, however, women survive this period, without being affected with any serious disorder, they acquire a degree of constitutional strength that subsists to a very advanced age. The cessation of the discharge seldom takes place all at once, but becomes irregular and sometimes it is obstructed for two or three months, and then returns at uncertain intervals, often accompanied with symptoms which are mistaken for pregnancy. When a cessation of the dis- charge is sudden in women of a full habit of body, they ought to retrench a little their usHal quantity of food ; they should also take ORDER 1. HjEMORRHOIS, OR PILES. 477 daily exercise, and keep the bowels open by a few grains of aloes or rhubarb. If the person is troubled with giddiness and pain in the head, small bleedings will be advisable. If the cessation is fol- lowed by swellings in the legs which become ulcerous, they should be allowed to continue open, or a discharge by an issue substitut- ed in their place. It is to be observed that when blood is discharged from the uterus in large clots or concretions, attended with a considerable degree of pain or bearing down, the case is alarming and dangerous, for it indicates a diseased state of the womb, as the menstrual blood is well known to be purely fluid, and never in its natural state to coagulate. That morbid condition of the uterine system where the menses are either obstructed or much deficient in quantity, as well as where they are too frequent or profuse, is considered as among the causes of barrenness. H^MORRHOIS, OR PILES. This distressing affection is known by painful small tumours, distinguished into the external and internal, according to their si- tuation either without or within the anus. When blood is discharged from the tumours, it is called the bleeding piles, and when there is no discharge of blood, it has the name of blind piles. This complaint may proceed from habitual costiveness, plethora, hard riding on horseback, strong aloetic purges, and a stoppage of customary evacuations, sitting on damp ground, repeated and long continued pressure on the lower part of the rectum by the uterus during pregnancy, impeding the return of venous blood from that part. This affection is generally accompanied with a sensation of weight, pain, or giddiness in the head, difficulty of breathing, nau- sea, and sickness, pains in the back, loins, and anus, and some- times attended with febrile symptoms. A pungent pain is felt about the anus on going to stool, and if the tumours about the verge of the anus burst, a quantity of blood is voided, and much relief from pain is immediately obtained. Sometimes considerable blood is discharged without the faeces. 478 PROFLUVIA. CLASS IV. When the piles exist in the state of tumour, and the pain is se- vere, the principal objects are to counteract the inflammation and promote a discharge of blood from the part, in which case blood- letting from the arm has occasionally been of essential service, and the application of leeches as near as possible to the tumours will often be found no less advantageous ; but should these fail to draw blood, the piles may be opened with a lancet with ease and safety ; after which, emollient cataplasms and fomentations should be applied. As costiveness is the most frequent cause of piles, this must be obviated by mild laxatives, and none appears to be more effica- cious than the internal use of the flowers of sulphur combined with an equal quantity of cream of tartar, and double the quantity of the lenitive electuary, a tea-spoonful of which two or three times in a day ; or the extract of butternut may be substituted. The bal- sam copaiva in doses of forty to sixty drops morning and evening frequently produces a laxative effect, and relieves the pain arising from the piles, and on some occasions performs a permanent cure. Digitalis is said by Dr. Thomas to have afforded immediate relief in a most violent case of external and internal piles, when given in tincture to the extent of forty drops. But the method of curing the piles by the phytolacca decandra, or garget, by some called coa- kum, I conceive to be more eligible and successful than any other which I have experienced. It was first communicated to me by Dr. J. Leonard, of Sandwich, who directs a strong infusion of the leaves or roots of this plants to be given in doses of about two table- spoonfuls three or four times in a day, and if it fails to cure in about forty-eight hours, a quantity of the same infusion is to be injected into the rectum by way of clyster, and a few repetitions of this will in general answer the desired purpose. In some instances, how- ever, where considerable inflammation prevails, the cure has been facilitated by the previous administration of calomel and opium, in small doses for a few days. In some instances a prolapsus ani will be a troublesome attendant on the piles, in which case the intestine must be immediately re- placed after every evacuation by pressing gently upon the anus with the fingers until the reduction of the gut is completed, and its return »iust be" prevented by astringent applications, as a strong decoc- tion of oak bark or nut-galls in forge water applied cold ; vinegar in which a little alum has been dissolved may also be used for the ORDER II. CHOLERA. 470 ■>ame purpose, and the parts may be washed with cold water ; as a general tonic, the cold bath will be beneficial. When the bleeding piles return periodically, once in three or four weeks, as sometimes happens, it is to be considered as a salu- tary discharge, by freeing the constitution of a redundancy of blood, and ought therefore not to be stopped unless it becomes so exces- sive as to weaken the patient, in which case the Peruvian bark and elixir vitriol must be prescribed, and the astringent applications above mentioned assiduously employed; besides which, a weak solution of alum in the oak bark decoction may be injected into the rectum, or three or four grains of the acetite of lead dissolved in water may be substituted. When in the external piles the tumours are painful and swelled, without discharging blood, some relief may be obtained by making a firm and gentle pressure of the piles between the finger and thumb, and the patient may be further relieved by sitting over the steams of hot water, and afterwards applying a little of the simple ointment, with the addition of a tea-spoonful of laudanum, or a mixture of lead water and laudanum, or the stramonium ointment may be advantageously employed. All the remote causes, particularly plethora and costiveness, both during the disease and afterwards, must be studiously avoided ; riding on horseback, or a sedentary life, a full diet, and intemper- ance in the use of spirituous liquors, all have a pernicious tenden- cy in those who are afflicted with haemorrhoides. Order II.—CHOLERA. The characteristics of this disease are a profuse discharge of a green or dark coloured and sometimes acrid fluid in large quan- tity, and somewhat of a bitter taste, both from the stomach and in- testines, attended at the same time with painful gripings and great anxiety about the praecordia; there are cramps or spasms, partic- ularly of the lower extremities, and great prostration of strength ; there is a considerable degree of thirst, the pulse is extremely quick and weak, but the disease is seldom attended with fever,-ex- cept in severe cases, and the respiration is hurried and irregular : the fluid discharge is evidently bilious, but it is bile iu a very dis- 480 PROFLUVIA. CLASS IV, eased state, and by no means corresponds with the healthy state of that fluid. This disease is generally prevalent in the months of August and September ; and when it proves fatal, which it sometimes does in the course of twenty-four hours, the depression of strength becomes extreme, the pulse intermits and becomes more feeble, the ex- tremities become cold, and the patient is seized with cold sweats, hiccough, and fainting fits. This disease is in general occasioned by a redundancy and acri- mony of bile, exposure to very hot weather, obstructed perspira- tion, too free a use of cold or unripe fruit, strong acrid purges or vomits, and violent passions of the mind. The most successful method of cure in this disease, is by first diluting the contents of the stomach and intestines with the plenti- ful use of water gruel, chicken broth, and similar fluids, both by the mouth and by clyster; in the advanced stage of the disease, when the pulse is weak and the extremities cold, opiates joined with aromatics may be employed with advantage, but every medicine which has a tendency either to excite vomiting or purging mast be avoided. Venesection may on some occasions be requisite, and if a low depressed pulse should be found to rise in consequence, the operation may be repeated in small quantities. The warm bath, and blisters to the stomach and thighs will be useful, especially where the spasms are violent; but it is, however, to diluents and opiates that we are generally to trust for a cure. When the acri- monious humours have been in a great measure discharged, and the pains begin to abate, an infusion of toasted oat bread or of oat meal, made brown, may be taken to stop the vomiting, and the saline draught, with ten drops of laudanum in each dose, should be given every hour till the vomiting ceases ; in addition to which, lauda- num mast be injected by way of clyster from time to time as long as the irritation at the stomach continues. A cataplasm of opium and camphor, or the anodyne balsam, should be constantly applied to the region of the stomach. It often happens that the violent irritation and spasms cannot be subdued without the administration of opium in excessive doses. Dr. Fisher, of Beverly, relates a case of a gentleman of about sixty-five years of age, who was seized with cholera in so violent x manner, that in a few hours after the attack, every symptom in- ORDER II. CHOLERA MORBUS. 4$1 dicated his speedy dissolution. As soon as practicable, sixty grains of opium were given, ten of which were returned by vomiting. The quantity retained soon removed every distressing symptom : gradually, and with difficulty, he recovered his strength. This ex- ample, however, is not introduced for the imitation of inexperien- ced physicians ; but cases apparently desperate may occur in which from four to eight or ten grains of crude opium may bo considered as a warrantable dose, and to be repeated according to the effect produced. In cases attended with violent cramps and spasms, it is highly probable that an infusion of die skunk cabbage, administered by way of clyster, would procure essential relief; as it cannot inter- fere with the use of any other medicine, it surely will be advisable to give it a fair trial in every dangerous case. When opium cannot be retained on the stomach, we are advis- ed to apply it, by way of friction, over the region of the stomach and abdomen. Flannels wrung out of warm fomentations, with the addition of brandy applied to the stomach, and bathing the patient's feet in warm water, and rubbing them with flannel cloths, are likewise to be diligently employed. In the mean time, strong wine whey or brandy and water may be <^iven to support the patient's strength and excite perspiration. When the violence of the attack has in some measure subsided, it will be proper to direct a moderate dose of rhubarb, to carry off the remainder of the bile ; and it will be highly necessary to administer opiates, com- bined with the cinchona, columbo and chalybeates, for a length of time after the disease is gone off, and the patient should be restrict- ed to food that is light and of easy digestion. The powder of columbo, is considered by some as extremely useful, during the whole course of this complaint. The following simple remedy for cholera morbus has appeared in various newspapers and gained a share of confidence. Take a clean cork and burn it thoroughly, when it ceases to blaze, mix it upon a plate with a little milk and water or other liquid, and repeat the dose till the disorder ceases. which it commonly does in the second or third administration of the remedy; the acidity of the stomach is immediately connected and the favourable effect instantaneous. It has been ascertained that cork possesses the quality of astringency, and it is by this prin- ciple its eflicacv is produced. This article may be worth a trial where more certain remedies are not at command. 6! 482 PROFLUVIA. «!LASS IV. DIARRHOEA A diarrhoea consists in the frequent evacuation of more liquid stools than usual, of various colours and matter, as bile, mucus natural faeces, &c. attended with flatulence in the intestines, unea- siness in the lower part of the abdomen, gripings, nausea and some- times vomiting ; the patient is unusually sensible to the impression of cold, and the disease is rarely attended with fever. When the stools appear to consist of chyle, the disease is called cceliaca ; and when the food taken comes away in an almost unaltered state, it is termed lientery. This disease may be occasioned by a stoppage of perspiration, especially by cold applied to the lower extremities, by eating un- ripe fruit, or food hard of digestion, or in too great quantity ; the stoppage of any customary evacuation ; acrid substances received into the stomach ; worms and dentition, and emotions of the mind, particularly fear. The proximate cause is evidently a morbid in- crease of the peristaltic motion of the intestines. When this disorder proceeds from obstructed perspiration, it is to be treated as a cold, keeping the patient moderately warm, directing a plentiful use of weak diluting liquors, bathing his feet and legs in warm water, and giving a dose of Dover's powder at bed time. As indigestion and the presence of crude or acrid mat- ter in the stomach are most frequently the means of exciting this complaint, it will be proper to evacuate the noxious matter by emetics, which will at the same time tend to restore the determin- ation to the skin ; about ten grains of ipecacuanha, and the same quantity of blue vitriol, will probably answer the desired purpose, or it may be repeated if required. A moderate dose of rhubarb, or of Glauber's salts, is next to be advised, and this, too, repeated if the disorder continues, and Dover's powder or a dose of laudan- um after the operation. The patient ought to drink largely of diluting and mucilaginous liquors, with oil and fat broths, both to sheathe the acrid matter, and promote its discharge by vomiting and purging; interposing now and then small doses of laudanum to abate the irritation. When a looseness is to be ascribed to acidity in the intestinal canal, indicated by frequent eructations of air, green stools, grip- ings, &c. we must expect the greatest benefit from absorbents join- ed with opiates. Take of prepared chalk in powder, two ounces, ORDER II. DAIRRH03A, OR LOOSENESS. 48s gum arabic, half an ounce, water^ three pints ; beil to one quart, and after straining the decoction, add two table-spoonfuls of bran- dy, and sweeten withsuga when used : four table-spoonfuls for a dose every two or three hours, during the continuance of the looseness ; and as the frequency of the evacuations depends upon irritability of the intestines, it will be necessary to allay it by a few drops of laudanum after every loose stool. Alkalies are likewise of much use in correcting the acidity in the stomach and bowels, and frequent doses of the carbonate of potash, or sal aeratus should be directed. When the diarrhoea is occasioned by gout repelled from the ex- tremities affecting the intestines, the discharges ought to be pro- moted by gentle doses of the tincture of rhubarb, endeavoring at the same time to recall the gout to the extremities by warm fomen- tations and cataplasms. The perspiration must also be promoted by drinking freely of wine whey, rendered more diaphoretic by adding spirits of hartshorn, or sal ammoniac, or a few drops of laudanum. If diarrhoea arises in consequence of some violent affections of the mind, it requires to be treated in the mildest manner ; instead of irritating by vomits or purgatives, we must endeavor to allay the commotion of the body and the agitation of the mind, by giving small doses of opiates as often as circumstances may seem to require. Should the disease proceed from worms, or attend during den- tition in children, it must be conducted in the manner ahead}' re- cited under those particular heads. On some occasions diarrhoea has been observed to be epidemi- cal, in consequence of using unwholesome water ; in this case if the water cannot be changed, its noxious quality may be cousiderably corrected by mixing with it some lime, chalk or alum. In most instances of diarrhoea, it will be found requisite to administer as- tringents, aromatics, and tonics ; this class of remedies is particu- larly adapted to those cases which depend on great debility of the stomach and intestines, or of the whole system. But while the discharges continue of a dark colour and foetid, on astringents should be employed. The astringents most to be relied on, are, alum, logwood, tormentilla,geranium maculatum,oak bark, catechu, bark of the root of wild cherry-tree, and gum kino ; and the tonics chiefly in repute, are the cinchona, angustura, simarouba, quassia 484 PROFLUVIA. CLASS IV. and cascarilla barks, columbo root and chalybeates. These are to be administered either separately or conjoined, according to the judgment of the prescriber, and they ought to be accompanied with a liberal use of Port wine. We have been apprized of some obstinate cases of diarrhoea being cured by the acetite of lead, in doses of from one to three grains or more twice in a day, and in some cases of children, I have experienced its utility. The kalmia latifolia, or broad leaved laurel, prepared by boiling one ounce of the leaves in oight ounces of water till reduced to four ounces, cured a diarrhoea of eight weeks continuance. See American Dispensatory, 2d edition. The dose at first was thirty drops six times a day, but producing vertigo, it was diminished to four times a da}'. During the continuance of this disease we should recom- mend a free use of diluents and demulcents, such as barley, rice, marsh-mallows, calcined hartshorn decoctions, mutton suet dissolv- ed in milk, emulsions of gum arabic, &c. ; whenever it is found necessary to check a diarrhoea, the diet should consist of rice boil- ed with milk, and a little cinnamon added, together with prepara- tions of sago, arrow root with red Port wine, and the lightest sorts of animal food roasted. The most proper drink is Port wine, or brandy and water. Those who from a weakness and irritability of the stomach and bowels, are liable to frequent returns of this disease, ought always to wear flannel next to the skin, they should be tem- perate in the quantity of food, avoiding crude summer fruits, most kinds of vegetables, all unwholesome food and meats of hard diges- . tion ; practising exercise, and preserving tranquillity of mind. The following simple remedy has been mentioned as almost infallible in the cure of diarrhoea. Boil half a pint of molasses down to one gill, and let the patient eat the whole of it in the course of twenty- four hours. In chronic diarrhoea, attended with debility of the stomach and intestines, we are not acquainted with a more restorative medicine than the lichen Islandicus made into a syrup and eaten with milk. If persevered in for a length of time, it will seldom disappoint expectation. ORDER II. DIABETES. 485 DIABETES. A diabetes is a distressing, and in general a very obstinate dis- ' ease. The chief symptom is a very copious discharge of limpid, sweet urine, often exceeding in quantity all the liquids which the patient takes into bis stomach. It is clear, pale, commonly sweet to the taste, and has generally an agreeable smell, when it is call- diabetes mellitus ; and when the urine is limpid and not sweetish, it is termed diabetes insipidus, but this distinction is of no utility in practice. The patient complains of intense thirst with a keen appetite at first, a parched mouth, with constant spitting of a thick viscid phlegm, of a mawkish, sweetish, or bitterish taste, a whitish tongue with red, bright edges ; there is a head-ach and a dry, hot skin, with flushing of the face, and the pulse is small and quick. There is likewise an uneasiness of the stomach and kidneys, with a ful- ness of the loins, testicles, and feet, a weariness and disinclination to motion or exertion, costiveness, mental debilitv, weakness and emaciation. A diabetes may proceed either from too dissolved a state of the blood, or some fault of the stomach or kidneys, whether a relaxa- tion of those organs or a morbid stimulus applied to them. It is sometimes the consequence of acute diseases, in which the patient's strength has been reduced by excessive evacuations; it may be occasioned by hard drinking, and by strong diuretic medicines. But it has occurred in many instances without any obvious cause. Notwithstanding the splendid talents which for years have been engaged in the investigation of the pathology of diabetes, we still remain without a satisfactory explanation of its real nature and character. While some authors point to the stomach and organs of digestion and assimilation, others refer to a morbid condition of the kidneys as the seat of the disease. It is sometimes attended with febrile symptoms indicating inflammatory diathesis, in which case small bleedings and low diet are expedient; but the main ob- ject in tbe curative course is to obviate a tendency in the stomach to generate that superabundance of saccharine matter with which the urine in every instance is so remarkably charged. The pa- tient must in the first place submit to an entire abstinence from every species of vegetable matter, and adopt a diet solely of ani- mal food, and that in as small quantities as the stomach will bo 486 PROFLUVIA. CLASS IV. satisfied with ; jellies, sago, and shell fish may be allowed, and the drink should be lime water, in which some oak bark has been in- ' fused, or the white decoction mentioned in the Appendix. It will in most instances be advisable to administer an emetic of ipecacu- anha, and, as a mild laxative, ten grains or more of the powder of rhubarb may be taken daily, supporting at the same time the perspiration by wearing flannel next the skin, and taking every other night a moderate dose of the compound powder of ipeca- cuanha. The next class of remedies commonly employed in this disease, consists of astringents and tonics. Of equal parts of gum kino, catechu, alum, and gum arabic, all powdered and mixed together, the patient may take forty grains three or four times in a day, drinking after it a cup of lime water in which some oak bark has been infused. Alum whey, which is made by boiling over a slow fire two quarts of milk with three drachms of alum, till the curd separates, is likewise highly beneficial; and the infusion of nut- galls with lime water has been found useful. In some cases de- pending on general debility, the acetite of lead, in doses of two grains twice in a day, has proved successful. The pills of acetite of lead and ipecacuanha, mentioned in the American New Dis- pensatory, would probably be found a valuable preparation in this disease. Opiates will be requisite to allay the irritation of the kidneys, on which account the patient may take ten drops of lau- danum in a cup of drink, three or four times a day. The tonic medicines most commonly employed are, cinchona, myrrh, and chalybeates, as directed under the head of dyspepsia, together with the cold bathing. Dr. Ferriar has succeeded in three cases by giving twenty grains of cinchona, with the same quantity of uva ursi, and half a grain of opium four times a day, and lime water for the common drink. Dr. Rollo, a late and very excellent wri- ter on this disease, recommends, besides a diet consisting wholly of animal food, the hepatized ammonia, which is prepared by mak- ing a stream of pure hepatic gas pass through the aqua ammonia until the alkali is saturated. The dose to an adult should not at first exceed three or four drops, three or four times in a day ; and this dose is to be increased gradually so as to produce a slight giddiness ; it should be taken immediately after being dropped from the phial into a little pure water. The nitric acid is another re- medy reputed to have cured diabetes, when a total abstinence from ORDER II. INCONTINENCE OF URINE. 487 all vegetable food has been strictly observed. But upon the whole, according to the observations of Dr. Thomas, a total abstinence from vegetables, and the employment of animal food, together with the nitric acid, opiates, blisters to the loins, and the w#rm or tepid bath, comprehend the general and most successful method of cure, and that a steady perseverance in the proper regimen alone, will often arrest the progress of the diabetic symptoms, and bring the patient into a state of convalescence ; but that the bark, astrin- gents, and alkalies, either alone or combined with sulphur, (such as the hepatized ammonia,) afford little assistance in subduing dia- betes, or even arresting the progress of its characteristic symptoms. In order to restore the patient to general health and strength, an admixture of vegetable and animal food is to be gradually and cau- tiously entered upon, as soon as ever the saccharine impregnation of the urine, and the voracious appetite, have disappeared. " The variety of means by whicli nature is capable of attaining the same end, has been seldom more remarkably exemplified than in the successful treatment of diabetes. By the most opposite means, such, for instance, as blood-letting, and the internal exhibition of opium, the same end has been effected." In support of the effi- cacy of the former method, several very satisfactory cases have been published by the late Dr. Satterley, in one of which one hun- dred and twenty-six ounces of blood were abstracted in twenty days, and the relief was so evident even to the patient, that he requested a more frequent renewal of the operation than the doc- tor deemed it prudent to grant. All the symptoms gradually sub- sided, and a permanent cure was accomplished. ENURESIS, OR INCONTINENCE OF URINE. In this disorder the urine passes off involuntarily by drops, but does not exceed the usual quantity, nor is it attended with paiiu It may originate from the irritation of the neck of the bladder by stones, or from a paralysis of the sphincture muscle, or from the injury which the parts suffer from pressure in difficult labours. It is sometimes owing to the weakness of old age, and not unfre- quently to the habit of retaining the urine, from a false delicacy, until the bladder becomes so much distended as to lose the power '>!' discharging it. Oh some occasions, this complaint is produced 488 PKumu'lA. CLASS U. by a continued use of strong diuretics, or by injuries received about the neck of the bladder, in consequence of bruises, hard labour &c. The most proper remedies for this complaint, are, tonics in general, suc|j as cinchona, preparations of iron, the mineral acids uva ursi, and balsam of copaiva ; the cold bath is a valuable reme- dy ; cold water dashed upon the genital parts, and a cold solution of acetite of lead in vinegar and water applied to the perinoeum, will often have a powerful effect. But of all the remedies yet em- ployed, there are none so immediately effectual as a blister appli- ed to the os sacrum or lowermost part of the back-bone. Some surprising instances of complete cures in twenty-four hours, in ob- stinate and long continued cases, by the application of large blis- ters, are found on record, and this efficacious remedy should in no case be neglected. The tincture of cantharides, taken in doses of twenty drops daily, increased until some pain is felt at the neck of the bladder, has afforded essential benefit. To prevent in men the urine from galling and excoriating the parts, some convenient vessel must be worn to receive it as it drops from the urethra. The habit contracted by some children of passing their urine while in bed in the night, is said by a late writer* to be owing to their sleeping on their backs, for the occurrence never takes place but when the boy is in this position. The cure, he asserts, therefore is very simple, by turning himself round. He should accustom himself to sleep upon his side or face ; by so doing, the ill habit will be broken, and the urine not be passed, nor will he be excited to dream of making water while he keep this position. LEUCORRHffiA, OR FLUOR ALBUS. This disease consists in a discharge of a serous fluid from the uterus and vagina, and is most incident to women of relaxed con- stitutions, who have borne many children. At the commencement of the disease, the discharge is generally whitish, but in its pro- gress it becomes very much varied, both in colour and consistence ; it is at first generally of a mild nature, but afterwards becomes more acrimonious ; in its violent degree or advanced stage, it is accompanied with severe pain in the back and loins, great debility, dyspepsia, difficulty of breathing, palpitation of the heart, frequent * Mr. Charles Bell. *RDEP. II. LEUCORRIICEA, OR FLUOR ALBUS. -)89 I'aintings, paleness of countenance, loss of appetite, pain in the stomach, dejection of spirits, and there is often some degree of hectic fever, and the eyelids are sometimes very much swollen. The patient is seldom refreshed with undisturbed sleep ; her body becomes greatly emaciated, her mind dejected, and a state of me- lancholy supervenes, often attended with hysteria and an irregu- larity in the menstrual evacuation. Fluor albus may proceed from various causes which induce debility of the system in general, or a laxity of the parts concerned ; such are an inactive and sedentary life, poor diet, frequent abortions, difficult and tedious labours, im- moderate flowing of the menses, and other profuse evacuations. It often occurs in pregnant women, and not unfrequently in girls antecedent to menstruation, and even girls of eight or ten years of age have been known to be affected with it. It is a circumstance of great importance to distinguish fluor albus from venereal gonorrhoea, for if one be mistaken for-the other the most pernicious consequences may ensue. In the gonorrhoea, an itching, inflammation, and heat of urine precede and accompany the discharge, which proceeds from the parts contiguous to the urinary passage, the orifice of which is prominent and painful, and there is a frequent inclination to make water, and the discharge continues whilst the menses flow; there is often also an enlargement of the glands of the groin ; whereas in fluor albus the discharge issues from the vagina, comes on more gradually, is more offensive and redundant in quantity ; and the menses are seldom regular. The cure of this disease will frequently be attended with much difficulty. The principal object is to strengthen the system, and excite the action of the uterine and vaginal vessels by restoring their tone, which will be best accomplished by the administration of cinchona, bitters, chalybeates, and the sulphuric acid, with cold bathing in the sea when convenient. The patient who is afflicted with this disease should make use of solid and nourishing food, but of easy digestion. A milk diet alone has been found of great advantage; but if mixed with a fourth part lime water, it is still more efficacious. Red port wine is a useful and proper article of drink, to which some lime water may be added. The patient should abstain from tea and coffee, and avoid indulgence in a soft bed, and she ought to take dails exercise on horseback or in a carriage. 62 490 PROFLUVIA. CLASS IV. Emetics of sulphate of copper and ipecacuanha will in general be of much utility in the cure of this disease, and costiveness must be obviated by proper laxatives. Internal astringents should al- ways accompany the tonic medicines, and of this class there is none to be preferred to those advised in the preceding pages, par- ticularly the acetite of lead with calomel; opium may be combin- ed or given separately, when urgent symptoms demand the em- ployment of it. The application of blisters to the lower part of the back is of essential importance, and should on no account be neglected. Alum whey, made by boiling one drachm of alum with a pint of milk, will be of use "both in this disease and uterine haemorrhage, which sometimes alternate with each other. We are likewise advised to employ some of the stimulating balsams, as the balsam of Peru, balsam of copaiva, and the Canada balsam. The tincture of cantharides, in doses of twenty or thirty drops three or four times in a day, is of considerable repute in this disease. The partial cold bath should be employed by sprinkling cold water over the loins and thighs ; a plaster of Burgundy pitch should be worn on the loins and-lower part of the abdomen. The parts must be kept extremely clean, and injections should be daily thrown into the vagina with a syringe, such as a strong decoction of oak bark, in which some alum or acetate of lead has been dis- solved, or a solution of sulphate of zinc. But the most efficacious injection is said to be about two or three grains of corrosive subli- mate, dissolved in a pint of water ; a small quantity of crude sal ammoniac should be added, to enable the sublimate to be more completely suspended. An injection of green tea has been em- ployed with a favorable effect. A decoction of the root of sopho- ra tinctoria, or wild indigo, is recommended for trial; from its well known antiseptic properties, it is highly probable that if applied to the diseased part by injection, it will mitigate the complaint, but especially correct the foetor of the discharge. The patient should wear flannel next the skin, and make use of friction very frequently. The use of the mineral waters of Ballstown and Sar- atoga has been attended with much benefit in this complaint. ORDER II. BLENORRHCEA. 491 BLENORRHQ2A, OR GONORRHOEA- This disease is a well known offspring of a free indulgence in the sexual intercourse, by which, one of the parties being infected, the disease is commonly contracted, and again propagated from one individual to another. It is a local affection from impure co- ition, confined to the organs of generation, shewing itself by a running or discharge of matter from the urethra in either sex, and has been termed virulent gonorrhoea, or clap. It has long been a controverted question whether lues venerea and virulent gonor- rhoea are one and tho same disease, arising from the same matter of contagion. Although on each side of the question are found advocates of profound research and investigation, the subject seems still to be involved in a degree of obscurity. Gonorrhoea was for many years considered to be a local effect of that poison, which, when introduced into the system produced syphilis, as both affections are imbibed in the same manner, and by the same organs. The affirmative of this position is ably and zealously supported by names which will reflect honor on any cause which they may be induced to advocate. No less deserving of confidence, however, are those who have written in opposition to the opinions maintain- ed by the authorities above referred to. Among the latest practical writers who support the doctrine of two distinct diseases, besides Mr. B. Bell, are Drs. Parr, Good, and Hosack. They found their belief on the facts, that syphilis ex* isted more than one hundred years before gonorrhoea was observed or described, and that the latter often continues for several months without being attended by the former; that the matter of chancre introduced into the urethra will not produce gonorrhoea, and the discharge from the urethra inserted under the skin will not produce syphilis. However closely allied, therefore, the two diseases, there is in their real character a specific difference. In specula- tion it is the opinion of some that gonorrhoea was primarily deriv- ed from syphilis ; but that in a series of years, and successive in- troduction to different constitutions, it has been softened and as- Mimed a milder form, and become specifically a distinct malady. Gonorrhoea is undoubtedly at present a disease of a more benign aspect than when it first made its appearance. Gonorrhoea sometimes commences in two or three days after the infection has been received, and at others, not before ten 01 492 PROFLUVIA. CLASH I\. fifteen days. The first complaint is an itching at the orifice of the urethra, and a soreness extending along its whole course, which is succeeded by a discharge of a thin glairy matter from the urinary passage, at first whitish, but afterwards changing to a yellow or green colour, A slight degree of redness and inflammation begins to appear about the lips of the urethra, and a severe heat and smarting pain in most cases are felt in every attempt to make water, and at length the free passage of urine becomes in some measure obstructed. ' There is commonly a sense of fulness about the glans of the penis, and frequently a soreness along the course of the urethra, accompanied with more or less pain in erection, When the inflammation or irritability of the urethra is very con- siderable, the erections become more frequent and lasting than when natural, particularly when warm in bed, and the penis is curved downward, with considerable pain which is called chordee; and this is sometimes attended with a slight haemorrhage at the time of passing the urine. As the disease advances, the symptoms become more severe and distressing; the heat and scalding of the urine, as well as the chordee, are extremely troublesome, and there is a constant inclination to discharge urine, which is attended with much difficulty, and often is rendered only by drops. There is also a painful sensation of heat and fulness about the scrotum and perinaeum, and the running is very copious, of a brown, greenish, or a bloody colour. These symptoms are sometimes accompanied with a painful swelling of one or both testicles, or sympathetic tumefaction of the neighbouring glands, especially those of the groin, and when great local inflammation prevails, the prepuce be- comes so swelled at the end, that it cannot be drawn back ; which symptom is called a phimosis : or it may be so contracted behind the glans, that it cannot be brought forward, when it is named a, paraphimosis. When women are affected with gonorrhoea, they experience a train of symptoms similar to those just described, but in a much more slight degree ; but it must be carefully distinguished from the fluor albus, to which females are liable, as the matter discharged in both is often of the same colour and consistence, (See Fluor Albus.) If the patient, in gonorrhoea, receives early attention and assist- ance, and adopts a judicious mode of medical treatment, the vio- lence of the symptoms gradually abates, and in about a fortnight ORDER II. BLENORRHCEA, OR GONORRHOEA. 49b or three weeks, the discharge will become thick, white, and of a ropy consistence, and diminish in quantity, until it entirely disap- pears ; but if a contrary course is pursued, and the patient indulge in sensuality and intemperance, and partakes of stimulating, high seasoned food, and spirituous liquors, the cure will be protracted for several months. When any suspicion arises of having caught the venereal infec- tion, the person should immediately resort to a mild easy diet, consisting of milk and vegetables, light broths, puddings, rice, &c, lie must abstain from all animal food, spiceries, and stimulating liquors, and drink freely of barley water, milk and water, linseed tea, whey, or decoctions of marsh-mallow and liquorice. All severe exercise, particularly walking, or riding on horseback, as well as venereal intercourse, ought to be carefully avoided, as also exposure to cold and damp air during a state of inflammation. The time necessary for the cure of gonorrhoea depends not only upon the virulence of the infection, but the particular consti- tution of the patient. It will often, under the most judicious treat- ment, continue two or three weeks, and sometimes it may i>e pro- tracted to six or eight. When, however, the infection is slight, it it may often be removed in eight or ten days, by a strict attention to cleanliness, and by fomenting the parts with warm milk and water, and injecting frequently into the urethra a little sweet oil, or linseed tea, about the warmth of new milk. In almost every instance of gonorrhoea a cure may be effected by the diligent em- ployment of injections. These are varied according to particular circumstances, or as suggested by the discretion of the prescriber. When an astringent injection is preferred, it is composed of about half a drachm of sulphate of zinc, dissolved in a pint of pure water, or the proportion is increased if a stronger astringent be requisite. If a mercurial injection be desired, one drachm of cal- omel is suspended in two or three ounces of mucilage of gum ara- bic, or one grain of murias hydrargyri is dissolved in eight ounces of water. When much inflammation prevails, a weak saturnine preparation mixed with a large proportion of oleum amygdali, forms an excellent injection ; and when from excessive irritation a more sedative preparation is indicated, a few drops of the vinous tincture of opium added to this will be found exceedingly effica- cious. Whichever of the injections are employed, it should be iscd six or ei'jht times in the course of the day, be of sufficient 494 PROFLUVIA. CLASS ly strength to excite some degree of irritation in the urethra, but not so strong as to occasion much pain, and it should be thrown up in such a manner as to reach the seat of the disease. It too fre- quently happens, that by attempting to make a hasty cure of gon- orrhoea by means of astringent injections, on its first appearance, the discharge is speedily suppressed, and the patient is soon after- wards attacked with an inflammation and swelling in one or both testicles. During the inflammatory stage, therefore, it will be most prudent to use such as are of a mild and sedative nature, and begin with those of a moderate degree of astringency afterwards. If at the commencement, or indeed in any period of the disease, the patient should appear in a plethoric state, and the inflamma- tion be considerable, blood-letting and the antiphlogistic regimen will be proper and necessary. Cooling purges are advisable in the first stage of the complaint. For this purpose, one ounce of Glauber's salts, and half an ounce of manna, or of cream of tartar, may be taken every second or third day during the continuance of inflammatory symptoms. As a cooling diuretic medicine calculat- ed to abate the irritations and pain in the urethra, which is often very troublesome in the early stage, an ounce of cream of tartar and the same quantity of gum arabic, powdered and mixed, should be taken in a dose of a tea-spoonful four or five times in a day; and at the same time drinking copiously of mucilaginous diluting liquors, such as barley water, linseed tea, or solutions of gum arabic in milk. By this mode of treatment, both the inflamma- tory symptoms and the running will be diminished, and the latter will change both its colour and consistence, becoming gradually more white and ropy as the virulence abates ; under these circum- stances, astringent injections may be employed with safety and ad- vantage. The genital parts ought to be frequently fomented with warm milk and water, and emollient poultices, where they can be conveniently used, are also of considerable service in removing violent pains which often accompany the inflammatory stage of the disease. For the cure of blenorrhcea some practitioners depend altogeth- er upon the balsam copaiva, given in pretty large doses several times in a day from the heginning. With others we learn that eubebs is a favourite remedy, exhibited in powder to the quantity of about three drachms five or six times in a day. The cure, we have been told, is often completed in two or three days. But it is <»RDER II. BLENORRHCEA, OR GONORRHQU. 495 unnecessary to multiply remedies for this simple complaint, since stimulating and astringent injections, with proper attention to cleanliness and diet, will seldom be found to fail. Dr. Good pre- fers to all others an injection composed of one scruple of sulphate of zinc and two scruples of bole armenic, to half a pint of water. " The addition of the bole adds to the power of the zinc, proba- bly by giving an increased body to the solution, without diminish- ing its stimulant effect." He has never known this composition to fail during an extensive practice, nor has it ever produced any of the inconveniences of stricture or swelled testicles. The chordee will be relieved by the employment of opiates in- ternally and externally, and by rubbing along the course of the urethra an ointment composed of one part camphor, and two parts of the mercurial ointment. When phimosis occurs, the penis should be frequently immersed in warm milk or linseed tea, or the mucilage of slippery elm, and these should be injected under the prepuce, and the penis should be suspended. If we do not suc- ceed by these means, and by taking blood from the part by leeches, the prepuce must be slit upwards in the manner directed in books on surgery. If paraphimosis takes place, warm emollients must be applied, the parts should be rubbed with some mild ointment, and attempts should be made by gentle force to draw the prepuce over the glans ; if it arise from an enlarged state of the glans, cold astringent applications must be used, and a poultice should be ap- plied, in which it will be useful to put a small quantity of acetite of lead and vinegar, and if these means fail, the stricture must be removed by the knife. If phimosis or paraphimosis are attended with symptoms of mortification, the parts must be fomented fre- quently with a strong decoction of cinchona and chamomile flow- ers, and cinchona and the mineral acids should be freely given internally. Where the inflammation has extended farther than the membrane of the urethra, and has reached Cowper's glands, the prostrate gland, or the bladder, we should endeavour by the injec- tion of warm oil and other emollients, to increase, rather than di- minish the discharge, and we should obviate the effects of in- flammation by the usual means. Should the discharge stop sud- denlv, and the inflammatory symptoms continue, it will be impro- per to employ astringent injections, but emollient ones should be persevered in till the discharge return. 496 PROFLUVIA. CLKij. ,y A very common symptom attending a gonorrhoea is a swcllino of one or both testicles, termed hernia humoralis. This is often in consequence of cold, a sympathy of the parts affected by the im- prudent use of severe exercise, or of strong astringent injections This complaint is to be treated as inflammation in general by bleeding and purging, and applying fomentations and poultices. Leeches have often proved serviceable, as also the warm bath. The patient will be most at ease in a horizontal posture, and the return of the discharge should be solicited by the frequent injec- tion of warm oil, or warm milk into the urethra. Much relief may be obtained by suspending the testicle by means of a well adapted bag and bandage. When these are judiciously applied and adjusted, the patient need not be confined to a horizontal po- sition. If the testicle remains in an enlarged state after the in- flammation is subdued, emetics have been known to cure the com- plaint in the most speedy and effectual manner. Inflammation on some occasions extends to the neck of the bladder, inducing a distressing strangury, attended with heat, a Constant desire to void urine, and a troublesome tenesmus. If this complaint yield not to blood-letting and other measures direct- ed in the chapter on strangury, the catheter must be employed to empty the bladder, and should this mode of relief prove abortive, and the case become desperate, the operation of puncturing the bladder must be resorted to by the hand of a skilful surgeon. When strangury proceeds from spasm, as soon as the urine touches the inflamed and tender part of the urethra a sudden constriction ensues, and the urine is evacuated by spirts or by drops only. The profession, says Dr. Thomas, is indebted to Mr. Cline for the discovery of a very efficacious remedy in this complaint. It is the muriated tincture of iron, given in doses of ten drops every ten minutes until some sensible effect is produced. After six doses, the urine usually flows freely, the patient previously becoming a little sick and faint. Mucilages and emollients would be useful at the same time, to lubricate, sheathe, and dilute the acrimony of the urine. When in consequence of inflammation of gonorrhoea extending beyond the urethra, the mucous membrane of the bladder becomes thickened, indurated, or ulcerated, the purulent matter gives to the urine the appearance of whey, and sometimes it is mixed with blood. This is commonly a tedious and obstinate complaint, but MRDER II. GLEET. 497 may be cured by injecting emollient decoctions into the bladder, and by giving a drachm of uva ursi three times a day, and pro- per doses of balsam of copaiva, or balsam canadensis, at the same time. If the prostrate gland should become affected with inflam- mation from gonorrhoea, known by a pain and heat in the peri- neum, extending into the rectum, or by detecting a tumou: by the finger in ano, we should resort to topical bleedings by leeches to the perinaeum, and apply emollient fomentations and poultices. Warty excrescences which appear about the penis and the fe- male genitals, as a consequence of gonorrhoea or chancre, should be extirpated by a ligature applied round, or by the scissors ; and the caustic, or powder of savine, which is preferable, should be afterwards repeatedly applied to destroy the remainder. There are few complaints connected with the venereal disease more truly deplorable than strictures and callosities in the urethra; these cause the urine in its passage to spread abroad, or split into two or more streams, instead of flowing uninterruptedly in one direct stream ; and on some occasions a total suppression of urine takes place, especially when bougies have not been seasonably employed. This difficult affection can be successfully treated only by the careful introduction of bougies, and by continuing their use for a considerable length of time. On the failure of these, it notun- frequently becomes necessary to introduce bougies armed with lunar caustic, or some other escharotic ; but as the appropriate treatment of this form of disease is a point of much delicacy and importance, and as a detail of the rules to be observed would swell these pages to an undue length, the reader must be referred for information to the most approved authors on the subject, as Hunter, Bell, Home, Abernethy, Whately. and Cooper. GLEET. This is commonly the sequel of blenorrhcea when neglected ov mismanaged. It consists of a discharge of mucous matter from the urethra, unattended with pain or scalding in making water. The removal of this complaint must be attempted by astringent injections and the use of bougies. The injections should consist of sulphate of zinc, to which a few grains of alum may be added ; or a weak solution of corrosive sublimate may be tried. The 63 498 SUPPRESSIONS. CLASS \. injections should stimulate the part gently but not excite much inflammation. The perinaeum must be frequently bathed with cold water, blisters to the same part should be applied, and balsam copaiva freely taken, and small doses of tincture of cantharides should be administered. The tonic course of bark and steel ought to be directed, and these with the local astringents must be continued for a considerable time after the symptoms have disap- peared, as the discharge is liable to return with increased violence. The late Professor Barton considered the uva ursi as a valuable astringent, and was in the practice of employing it, internally and by way of injection, in cases of gleet, greatly to his satisfaction, but it must be continued for a length of time. But in despite of all our efforts, instances will occur in which a radical cure will not be easily effected. GONORRHOEA. This term in our nosology is applied exclusively to an involun- tary emission from tbe seminal vessels. It is mostly the conse- quence of an indulgence in libidinous ideas. The patient is dis- turbed during sleep with an erection of the penis, and dreaming of venereal engagements, and a discharge of semen follows. When it becomes an established disease, the patient is reduced to a de- plorable condition ; the mind is stupified, the body emaciated and debilitated, and it often terminates in hectic fever and tabes. The cure depends chiefly upon the patient's abstaining from the remote causes, by diverting his mind to different objects and keeping himself as much as possible free from every enticing thought or allurement. As respects medicine, we can only advise to balsams of Peru and copaiva, chalybeates, cinchona, and bitters, with a nutri- tive diet, cold bathing, and exercise. Class V.- SUPPRESSIONS. Diminished discharges, whether of the secretions or excretions; whether by suppression or retention ; for the most part without fever. «ENLS I. JAUNDICE. 499 Genus I.—ICTERUS, OR JAUNDICE. Jaundice in its genuine form commences with a sense of lassi- tude, languor, and a sensation of pain and tension about the region of the liver; there is frequently anxiety and some difficulty of breathing; a yellowness is diffused over the whole skin, and the whites of the eyes and the roots of the nails being tinged with the same colour, these are attended with an intolerable itching of the skin, and a bitter tase in the mouth with nausea and vomiting and dyspeptic symptoms. The stools are of a white colour, somewhat resembling pipe clay ; the urine of an obscure red colour tinging linen with a yellow hue; the pulse is generally more quick than natural, except during the passage of a gall stone, when it is slower than in health ; the bowels are costive, and a slight degree of fever is present. The immediate cause of jaundice is an obstruction to the passage of the bile into the intestines by various means, as gall stones found in the gall bladder and imparted in the biliary ducts; inspissated bile, or spasmodic constrictions of the ducts themselves, or the pressure made by tumours in the neighbouring parts com- pressing the biliary ducts, as in the case of pregnant women. From these causes the natural course of the bile into the duodenum is obstructed and absorption or a regurgitation into the circulation takes place. Hence the yellowness of the skin, and hence also from the absence of bile in the intestines, the clay coloured faeces and the costiveness are induced. The stoppage of custo- mary evacuations, the bilious or hysteric colic, strong purges, vio- lent passions of the mind, and the bites of some poisonous animals, may give rise to this disease. That species of jaundice which ori- ginates from biliary concretions or obstructions of the biliary ducts, by viscid bile or spasmodic stricture, frequently admits of a cure bv a seasonable resort to the proper remedies. The gall stones, although of a considerable size, frequently effectuate their passage through the biliary ducts, though with much pain. They have been evacuated of various sizes, from a pea to that of a common walnut ; some rough and angular on their surface, others round and smooth. During their passage into the duodenum, the patient is exercised with acute lancinating pains in the region of the liver and abdomen, but with intervals of ease. Sometimes the pain ex- tends up to the shoulders, the intestines are obstinately constipated, and frequently a vomiting attends. 300 SUPPRESSIONS. CLASS V. When the inflammatory symptoms are severe, in full plethoric habits, it will be advisable to evacuate a quantity of blood, accord- ing to the urgency of the case, having regard to the age and strength of the patient. He is next to be placed in a warm bath up to his breast, or warm fome ntationsmay be diligently applied to the parts most affected with pain ; and proper doses of opium given every four or six hours, until ease is procured. Emollient clysters, to serve as internal fomentations, should be frequently injected, and diluting drinks may be freely taken. When there is no reason to suspect the concretion to be of any great magnitude, and when the pain is not violent, the operation of an emetic may have a hap- py tendency to facilitate the discharge of the calculus; it would seem most eligible to exhibit small doses of ipecacuanha, so as to occasion for a time a degree of nausea, but ultimately, to produce its full effects, and as no remedy is better adapted for the purpose of dislodging biliary concretions, or viscid bile, obstructing the gall duct, it may be occasionally repeated during the cure of the dis- ease. The costiveness is next to be removed by the use of mild laxatives, as pills formed of rhubarb, castile soap and calomel, or a dose of castor oil if preferred. Gentle exercise on horseback is particularly serviceable in promoting the passage of calculi, and preventing the bile becoming stagnant and viscid in the gall bladder, and liable to obstruct the free passage of it into the duodenum. Electrical shocks passed through the liver and duct at proper inter- vals, is likewise a good auxiliary in promoting the passage of the calculus. Cicuta has in some instances been employed as a reme- dy in jaundice, occasioned by spasmodic constriction of the biliary ducts. Dr. Fisher, of Beverly, reports a variety of cases, in which he has experienced its efficacious and successful result. This medicine must be increased from small doses, to the full extent which the system can sustain, and continued with proper care un- til the desired object is attained. If it be discovered that jaundice is owing to scirrhosity, or fixed obstructions in the liver, which may generally be known from a weight in that part, and a darkness of the complexion, the symp- toms must be palliated by small doses of calomel and opium, and diuretic medicines. It has been the practice to exhibit neutral salts, with soap and alkalies, as deobstruents in cases of jaun- dice. They are sometimes useful, and the prescriber may direct them in such form and dose as shall be judged best adapted tor the CENUS I, JAUNDICE. 50t particular case. Many cures have been effected by living almost entirely on raw eggs for several days. On all occasions, when the pain is violent, and other symptoms urgent, recourse must be had to opiates, the warm bath, fomentations, and emollient clysters ; should they fail, and should nausea and vomiting continue to be severe, a large, blister applied to the pit of the stomach, and the sa- line draught in the act of effervescence, will probably be productive of favourable effects. During the continuance of the disease, the diet should be light and chiefly of the vegetable kind. If in any case a putrid tenden- cy is discovered, recourse should be had to the Peruvian bark and other antiseptic medicines, and after the cessation of the disease, the best preventive of its return, is a course of stomach bitters, with alkaline salts, together with regular and sufficient exercise dai- ly on horseback, as nothing will tend more to dislodge those con- cretions before they have acquired such size as to render their passage through the ducts an object of difficulty. It has been suggested to me by Professor Smith, of New-Haven, and by Dr. I. Allen, of Sterling, that the blood-root has been suc- cessfully employed in jaundice, and other affections of the liver. It is used in the same manner as digitalis, increasing and diminish- ing the dose from thirty to eighty drops of the tincture, according to the effects produced ; or it may be taken in the form of infusion, or powder, in doses of two or three grains twice in a day, and on some occasions it may be advisable to combine it with opiates. Although it produces its effects on the system more immediately than digitalis, and if given in large doses it occasions great prostra- tion of strength, yet it is not liable, like fox-glove, to produce fatal effects. The wild cellendine is said to be another valuable medicine in jaundice and biliary obstructions in general; it may at least be commended as a useful auxiliary, to be employed on all occasions with freedom, in strong infusion, during the use of other remedies. In cases of jaundice depending on spasmodic constriction, the extract of stramonium seems calculated to afford relief, and a trial of it should be recommended. We find in the Medical Re- pository, Vol. I. 3d series, the following preparation recommended by Dr. I. Mace. R. Salt of tartar, one ounce ; castile soap and gum arabic, of each half an ounce, to be dissolved in a pint of 502 SUPPRESSIONS. CLASS V. common spirits ; dose, two thirds of a wine glass full mixed with one third of a glass full of water every morning. Among the vegetable productions the dandelion is in some repute for the removal of visceral obstructions, and has been used with good effect in the treatment of chronic affections of the liver. The dose is half a drachm of the extract, or from two to four ounces of the decoction or the fresh juice, two or three times in a day. Every practitioner is apprised that the nitric acid has for many years engaged attention for its remedial powers in various affec- tions of the liver. More recently it has been employed exter- nally, by way of bath, and evident benefits have resulted from its use. We are indebted to Dr. Scott, of London, as the inventor of this mode of application. When in the East-Indies, he expe- rienced the utility of nitric acid in numerous instances of liver complaints. By some means he was induced to try the effects of the nitric aud muriatic acids, combined in the form of aqua regia, in a diluted state ; but finding some difficulty attending its internal use, it disagreeing with some stomachs, and injuring the enamel of the teeth, he was led to test its efficacy by an external application. Labouring himself under hepatic affection, he subjected his own person to the experiment. On the first trial the bath being merely acidulous, and nearly the temperature of the body, he staid in it half an hour, and felt no particular effect from it, but repeat- ing the application till on the fourth day, he experienced some pain in swallowing, and a burning sensation in his mouth, with a disposition to salivation. His complaints were immediately miti- gated, and in a few days entirely removed. In preparing the aqua regia for the bath, it is found necessary, to avoid the unpleasant consequence from the evolution of a volume of gas on the acids coming in contact, to put a quantity of water equal at least to both acids in a bottle, and add the acids separately. The proportion is three parts in measure of muriatic acid, and two parts of nitric acid ; a pint of this combined liquor is to be mixed with the same measure of water. The acid bath is to consist of three ounces of this diluted acid to every gallon of water. It should be about as strong as weak vinegar, trusting to tbe taste alone; but the strength should be regulated by the degree of irritability of the patient's skin. When of the proper strength, it will prick the skin a very little after being exposed to it from fifteen to thirty HENU9 1. JAUNDICE. 503 minutes. Dr. Scott, when in India, immersed the whole body in the acid bath, but he has since found that it is quite sufficient to bathe the feet and legs. A narrow tub for a knee bath, just wide enough to hold the feet and reach the knees, should contain three gallons of the prepared bath liquor, and consequently about nine ounces in measure of the diluted aqua regia. For a foot bath, half a gallon in a basin will be sufficient. The feet should remain in the bath for twenty minutes or half an hour, and the legs, thighs, and abdomen be in the mean time frequently sponged with the same. In the summer it may be used cold, in the winter mode- rately warm. The bath may be employed at first daily for a fort- night or three weeks, and afterwards only every other day, or twice a week. On some occasions sponging the skin will produce the same effect as bathing. In every case where mercurial pre- parations are indicated, except where active inflammation is pres- ent, the acid bath may be employed with safety and advantage, and in cases where mercury is injurious from delicacy or peculiar- ity of constitution, this will be found an excellent substitute. " Dr. Scott affirms that he has employed this process with de- cided advantage in almost all cases dependent on a morbid secre- tion of bile, whether the secretion be superabundant, defective, or depraved. He finds it often, within a few hours of the first bathing, increase the flow of bile, and ameliorate its character, and in con- sequence thereof excite an expulsion of dark coloured faeces, bright coloured bile, or bile of a brown, green, or black colour like tar mixed with oil. And when employed in the midst of a paroxysm of severe pain from spasm of the biliary ducts, or the passing of a gall stone, he has often known it operate like a charm, and produce almost immediate ease." (Dr. Good.) This mode of practice has received the concurrence of Dr. Good, in whose hands it has in some cases, been attended with complete success ; while in a few it has entirely failed. That species of jaundice, or liver affection which is produced by habitual intem- perance, is of such a deplorable nature, that it preys upon the con- stitution, often inducing abdominal dropsy, and brings down the miserable victim to the grave. The art of medicine can do but little here, unless the patient will resolutely and promptly abandon the use of ardent spirits, when the curative treatment already de- tailed might be adopted with some prospect of success. There is a species termed black jaundice, or green jaundice, from the col- 504 SUPPRESSIONS. CLASS V our which the skin assumes. This is commonly marked by signs of peculiar malignancy ; it is scarcely under the influence of med- icine, and generally runs its course to a fatal termination. Genus II.—OBSTIPATIO. A costiveness, or retention of the excrements, accompanied with an unusual hardness and dryness, so as to render the evacua- tion difficult and somewhat painful, is either constitutional or ac- cidental, and may prove the cause of different complaints. Se- dentary persons are peculiarly liable to this disorder, especially those of sanguineous and choleric temperaments, or who are sub- ject to hypochondriac affections, the gout, acute fevers, and bilious disorders. Costiveness often becomes habitual by neglecting the usual time of going to stool, and checking the natural tendency to those salutary exertions, by an extraordinary heat of the body, and copious sweats, by taking into the stomach a large proportion of solid food, or such as is dry, heating and difficult of digestion, by drinking hard water, rough red wines or other astringent liquors, and by too much riding on horseback. When costiveness is not constitutional, it is apt to occasion pains of the head, vomiting, flatulence, colics, and different disorders of the bowels. There is a species of costiveness incident to persons much relaxed, and which is attended with great pain in the lower part of the rectum ; the faeces being so extremely hardened that the person is unable to protrude them. In this case, the best rem- edy is clysters of oil, which by lubricating the passage will facili- tate the discharge. Those who are afflicted with this complaint, should visit the customary house of retreat every morning at a stat- ed hour, and thus endeavour to promote the natural evacuation by moderate efforts, even though they may not perhaps be much in- clined, and should not at first succeed ; for experience has proved that nature will in this respect by perseverance acquire a habit of regularity. The most proper time for that purpose is either ear- ly in the morning or late in the evening, and never neglect the solicitations of nature. It should be considered that as purgatives tend to weaken the bowels, and that a constant use of them rath- er confirms the complaint, it is better to obviate costiveness by means of diet than medicine. Let those; therefore, who are sub- it .,ENUS II. CONSTIPATION. 565 iect to it, avoid all astringent food and drink, and chiefly confine themselves to aliments of a moistening and laxative kind, such as veal broth, boiled meats, apples roasted or boiled, stewed prunes, raisins, and ripe fruits in general with a large proportion of vege- tables and soft pot herbs such as spinage and leeks, with the roots of turnips and parsnips. Butter, honey, and sugar, are likewise suitable articles of diet. Bread composed of Indian corn meal and rye, and eaten not till the day after being baked, ought to be pre- ferred. The most suitable drinks are molasses and water, whey, butter-milk, and malt liquors of a moderate strength. When lax- ative medicines become necessary to obviate costiveness, those should be chosen which occasion the least heat or irritation : noth- ing has been more popular for this purpose, than Anderson's pills, and in phlegmatic constitutions they are both convenient and use* ful, but in pregnant women and in bilious habits, a long continued use of these or other aloetic pills is apt to induce piles ; and besidesj every purgative medicine creates a necessity for its repetition, and by this repetition the bowels lose their energy and their delicate nerves become torpid. A very suitable laxative in costive habits is the extract of butternut, or flowers of sulphur and cream of tar* far, equal parts, a heaped tea-spoonful with molasses every night and morning ; or the person may chew a little rhubarb at his leis- ure. In bilious habits, and such as are troubled with indigestion no laxative is to be preferred to a pill composed of one or two grains of ipecacuanha, and the same quantity of rhubarb taken once or twice in a day ; if it excite nausea, reduce the quantity of ipeca* cuanha. The following composition has been found to produce the effect of a mild laxative in costive habits. R. Charcoal in fine powder, 3hj\ Lenitive electuary, i'nj. Carbon. Soda, 3 ij - M. Dose, from half to one ounce every day. In obstinate constipation, one of the best and most sure cathar- tics is equal parts of castor oil and the oil of turpentine ; half an ounce of this mixture, taken every two hours will seldom fail to procure a cathartic operation and give relief. A very active ca- thartic medicine lately introduced is the oil of the croton tiglium, one of its peculiar advantages is the smallness of the dose, two drops is the extent, this, when formed into a pill, will in general *.1 506 SUPPRESSIONIS. CLASS V. effect an evacuation after other purgatives have failed. In a very torpid condition of the stomach and intestines I have derived ad- vantage from a few doses of the volatile tincture of gum guaiacum, as a stimulant. For an account of the successful practice in obsti- nate constipation, by Dr. Hosack, the reader is referred to Enteri- tis,page 388, of this volume. Genus III.—ISCHURIA, OR SUPPRESSION OF URINE. A total suppression of urine is termed Ischuria, and refers more particularly to a defect of the secretion of urine by the kidneys, while a retention implies an inability to expel by the natural efforts the urine contained in the bladder. " Persons advanced in life are particularly subject to this complaint, which often arises from ne- glecting or resisting the calls of nature, and retaining the urine too long, or from a paralysis of the bladder. This complaint, to which all are liable, may proceed from a variety of causes, and the partic- ular symptoms commonly designate the original seat of the disease. It may arise from an inflammation of the kidneys or bladder ; gravel, or small stones obstructing the urinary passages; a spasm, or contraction at the neck of the bladder ; acrid injections, can- tharides, either internally or externally applied ; tumour or ulcer of the prostate gland ; hard faeces lying at the bottom of the rec- tum ; a large extension of the haemorrhoidal*veins ; pressure of the pregnant uterus, &c. When the cause of ischuria exists in the kidneys, the patient complains of pain or an uneasy sensation of weight in the region of the kidneys, without any tumour, or fulness about the bladder, or inclination to make water, and is often ac- companied with numbness of the thigh, nausea and vomiting. When the ureters are the part affected, there is a sense of pain or uneasiness in the course of those ducts. When the complaint pro- ceeds from the bladder, there is a circumscribed tumour, or dis- tention of the lower part of the belly, and an acute or obtuse pain is felt about the neck of the bladder, attended with a frequent in- clination to make water. If the urethra is the part affected, there is a pain in some part of that passage accompanied with the symp- toms last mentioned. If a scirrhus of the prostrate gland has oc- casioned the suppression, a hard indolent tumour, unattended with GENUS III. ISCHURIA. 507 any acute paift, may readily be felt in the perinaeum, or by intro- ducing the finger into the anus. In all cases of suppression of urine it will be advisable in the early stage of the disease, to have recourse blood-letting from the arm in a quantity proportioned to the strength of the patient and urgency of the symptoms; and this should be followed by gentle purgatives of senna and manna, or Glauber's salts; emollient clys- ters, which tend not only to obviate costiveness, but have the effect of an internal fomentation, and allay the spasm of the bladder and contiguous parts, ought to be diligently employed. The warm bath, by sitting up to the middle of the body in warm water, or the application of emollient fomentations to the abdomen, will in gen- eral be found of much utility. We are advised, in every instance of this complaint, whether arising from inflammation, stricture, gravel, or spasm, to administer repeated doses of opium, but it will be more efficacious if combined with mild diuretics. The follow-' ing preparation will seldom fail of affording more permanent ad- vantage and relief in all the various complaints of the bladder and urinary passages than any other remedy. Take spiritus nitri dul- cis, half an ounce, liquid laudanum, one drachm, two thirds or the whole for one dose, and repeat every half hour if necessary. The application of ice or snow to the pubis, or cold water to the feet and legs, while the patient stands on a cold 6tone, is said to have succeeded in removing a suppression of urine after other remedies had failed. Tobacco clysters and the tincture of tobacco in doses of thirty drops twice or thrice a day, have been known to have a happy effect. The simple application to the pubis of an onion poultice, has rendered very essential benefit. Dr. Thomas speaks with much confidence of the efficacy of the muriated tincture of iron in suppression arising from spasm ; he directs ten drops to be taken every ten minutes until some sensible effect is produced. After six doses, the urine generally flows freely. If a suppression of urine does not yield to the means above di- rected, the case becomes extremely urgent and dangerous, and the next resource consists in the introduction of the catheter, or a hol- low bougie, for drawing off the water, the latter of which is on some occasions more easily introduced. In attempting this opera- tion the greatest care is necessary to avoid the danger of injuring ihe ijrethra. If the catheter be directed incautiously, or unskil- fully, it may tend not only to increase the inflamed state of the 508 SUPPRESSION!*. CLASS V. urethra, but even to lacerate its membranous parts and force an artificial passage, and thereby render its introduction impracticable. When attempts to introduce the catheter have failed, it will be advisable to put the patient into the warm bath, and bleed from the arm to faintness, when the resistance will probably yield, and the instrument may be passed without difficulty. But there is a choice to be observed in the instrument to be employed. The elastic gum catheter is in most cases preferred by those who are most conversant in the operation. But whether this or the silver catheter be used, it should be as large as the urethra will easily admit. Under some circumstances much dexterity will be requir- ed to introduce the catheter. Sir Everard Home directs that it be introduced either towards the left or right side with the handle nearly in a horizontal line; and when it reaches the membranous part of the urethra, the handle should be gently and gradually brought towards the perpendicular line, the point all the time being kept in motion ; and when it is nearly upright, the handle should be depressed. If it does not enter in this manner, by in- troducing a finger into the rectum and pressing upon the curved point of the catheter, we may give it a right direction, so as to guide it into the bladder. When necessary to introduce the finger in ano, a recumbent posture must be employed ; but in other instances Sir E. Home prefers the standing position. Mr. Ware says, '* The mode in which I pass the instrument is as followst Being first thoroughly oiled, I introduce it into the urethra, with its convex part uppermost, and carry it as far as it will pass with* out using force; then I turn it slowly round so as to bring its con- cave side uppermost; and in doing this I make a large sweep with the handle of the instrument, and at the same time keep my attention fixed steadily on its apex, or inner termination, which 1 take particular care neither to retract nor to remove from its first line of direction. When the catheter is turned, it must still be pressed onward, and its handle at the same time gently depressed ; by this method it will be made to enter the bladder." The cath- eter made use of by Mr, Ware is twelve inches long, which is more than an inch above the ordinary length ; and the curvature larger than common ; and with which he has succeeded often, where others of a different size and curvature had failed. When from inflammation there is a constant irritation at the neck of the bladder, all straining to expel the urine should be GENUS III. ISCHURIA. 509 avoided, but it will be requisite to empty the bladder every six hours, in order to relieve the continued source of excitement by the acrid urine. It often happens that the internal surface of the bladder is so extremely susceptible of irritation, that a few ounces of urine retained in its cavity produces almost insupportable dis- tress. This may be in a measure remedied by means of an elastic gum catheter, to which a gum-bottle is properly fitted, through which tepid water is to be injected into the bladder; thus substi- tuting a bland liquid in place of the acrid urine. In all instances of ischuria, the patient should make a very liberal use of various bland mucilaginous substances, such as gum arabic, marsh-mallows, barley water, and linseed tea, taken into the stomach. The ad- ministration of opium will be found indispensably necessary, both by the mouth, and frequently by way of enema. Camphor is another medicine of value in this complaint, it should be combined with opium in the form of pill, of about four grains of the former and one of the latter, to be given occasionally. Or camphor may be given in doses of about eight grains mixed in milk, to which fifteen or twenty drops of laudanum may be added. The uva ursi and the pyrola umbellata are deserving of some confidence as reme- dies in this complaint; they will be more particularly noticed under the head of dysuria and strangury. If the suppression is pro- duced by small gravel imparted in the urethra, injecting sweet oil, or warm milk and water will be useful. Should it be ascertained that ischuria is caused by an enlargement of the prostate gland, our best means of relief are frequent bleedings from the perinaeum by the application of leeches, assisted by cooling purgatives, opiate clysters, and the tepid bath. When a total retention of urine continues, and all the means of relief have proved ineffectu- al, and the introduction of the catheter is found to be impractica- cable, it only remains for the patient to submit to the surgical operation of puncturing the bladder, either above the pubis, or with a trocar through the rectum. I have in one instance ope- rated above the pubis with a happy result in a case where the bladder was vastly distended, and thereby rescued the patient from the most imminent danger. SUPPRESSIONS. ' CLASS V. Genus IV—DYSURIA, OR STRANGURY. Dvsuria is a partial suppression of urine, and may be with or without a sensation of heat. When there are frequent painful or uneasy urgings to discharge the urine, and it passes off only by drops, or in very small quantities, the disease is called a strangury. When a sense of pain or heat attends the discharge, and it passes with difficulty, it is termed heat of ihe urine. Dr. Cullen distin- guishes six species. The causes of this complaint are various, as caruncles in the urethra, a stone in the bladder or urethra, spasm or inflammation, acrimony in the urine, the venereal clap, or a scurvy, cantharides taken internally, or externally applied, a deficiency of mucus for lubricating the urinary passages. Chronic dysuria is mostly occa- sioned by a translation of gout or some other disease to the urinary parts. I have observed one instance of dysuria from a repulsion of cutaneous eruption. In distinguishing the stone in the bladder from simple dysuria, we must observe that the former comes on in violent paroxysms, attended by tenesmus, and the flow of urine when begun is checked in its course, which is not the case in dysu- ria. A stone in the bladder may be detected by sounding, and calculi passing the urethra may be felt by the finger when far ad- vanced, or reached with a probe. Heat of urine does not arise from an increase of its natural heat, but from its irritating a tender and often an inflamed part. Dysuria is not a dangerous disorder, but it is both troublesome and difficult to cure, particularly in aged persons. Strangury is usually attended with a mucous sediment in the urine, which is sometimes mistaken for pus. In every instance of strangury, dilu- tion by the use of mucilaginous liquids is highly necessary: all in- jections are useless, as they cannot reach the seat of the complaint. Bathing the penis, and particularly the glans, will often relieve by communicating the relaxation to the vessels above, and warm brandy or other stimulant applications to the perinaeum, will be often beneficial, as will fomentations with emollient herbs. A starch clyster, with opium, almost immediately relieves. Inter- nally, opium and camphor are highly useful. Tbe cooling power of the latter is very soon felt in the urinary organs, and it often appears to be quickly effectual, according to Dr. Parr. In the <«ENUS IV. DYSURIA, OR STRANGURY. 511 form of Dover's powder, the opium is of great service. Cooling laxatives and diuretics which operate without any stimulus, ought not to be neglected. The uva ursi has long been known in medi- cine for its astringent and tonic powers, and for the cure of various affections of the urinary organs depending on debility. Dr. De Haen, of Vienna, has bestowed very high encomiums on uva ursi, as a remedy in ulcerations of the kidneys, bladder, and urinary passages. In our own country it has been employed in nephritic and calculous affections, with decided good effects. The late Pro- fessor Barton was well acquainted with its properties, and esteem- ed it highly for its astringent effects. If its reputation is on the decline, it may be ascribed in part to a want of a steady persever- ance in its use. The usual dose is from twenty to thirty grains of the powdered leaves, three or four times in the twenty-four hours. Dr. Ferriar combined opium with it, and found that it always re- lieved, and frequently effected a cure. Another of our indigenous productions has of late attracted notice as an efficacious diuretic, and well adapted to the cure of the complaints before us. It is the pyrola umbellata, or winter green of our woods. This ap- pears to be allied in its properties to uva ursi, and has certainly proved to be a useful palliative in strangury and nephritis, in the hands of respectable practitioners. Dr. Wolf, a German writer, has reported a number of cases of ischuria and dysuria, in which the pyrola produced the most evident relief, and even took prece- dence of a variety of remedies which had been tried. We have, in fact, the best authorities, both European and American, to war- rant the assertion that the pyrola deserves to be classed among our diuretics of superior virtues. It possesses the property of a tonic with its diuretic effects, so that the appetite is improved and diges- tion promoted during its employment. This medicine may be given in the usual form of decoction or infusion, to any extent that may be agreeable to the patient. The common parsley cultivated in our gardens, possesses diuretic properties, and is often used with advantage. We have the authority of the late Dr. Rush to speak in its praise. Professor Chapman, of Philadelphia, says, " Every part of this plant is actively diuretic, but an infusion of the roots is generally used. I have prescribed the seeds with equal advan- tage. No diuretic is more valuable in some cases than this. It is adapted to the ordinary suppressions of urine, to strangury from blisters, and to painful micturition from nephritis ; and what in- ~>12 SL'PPRKSSloNlS. CLASS V. creases its value is, its being retained under all circumstances of the stomach." That nothing may be omitted that is calculated to mitigate the sufferings attending strangury, I will introduce to no- tice yet another article, the produce of our soil, which has gained a share of confidence as a diuretic in domestic use. I refer to the button bush, or river bush, cephalanthus occidentalis. It is from common report only that this article has fallen under my observa- tion, having been informed that persons labouring under dysuria or strangury, who have been accustomed to the use of the button bush, place more confidence in its efficacy, than in the prescrip- tions of experienced physicians. That its diuretic and palliative qualities are very considerable, has been satisfactorily ascertained. A description of this article will be given in the Appendix. The author has been more diffuse on this subject, from the belief that too little attention has been paid by our physicians to the diuret- ics to be found among our indigenous plants. But although the articles above mentioned have been tested by pretty ample expe- rience, the reader should be reminded that occasions may occur in practice in which he may be disappointed in his expectations, Due allowance should always be made for amplification of lan- guage in giving account of the properties of remedies newly intro- duced. Genus VI.—AMENORRHEA. That periodical discharge of sanguineous fluid which takes place every month from the uterus, is termed menses or catameniae ; and upon the regular recurrence of which the health of females essen- tially depends. This evacuation commences at a much earlier period of life in warm climates than in cold ones, and ceases soon- er in proportion to its earlier or later commencement. In our cli- mate, the age of about thirteen or fifteen is the usual period in which this important change in the female constitution takes place, and the age of about forty-five or fifty is that in which it termi- nates, and with it the capability of bearing children. At the age of puberty, when the uterine evacuation first appears, the constitution undergoes a considerable change in many respects; it is to be regarded as an important and critical season in the life of females, and with their conduct, not only during the first men- tJGNUS VI. AMENORRHEA. 513 struation, but in all its subsequent returns, their future health and enjoyments are intimately connected. The interruption of the menstrual discharge is of two kinds ; when it does not begin to flow at the time in which it is usually expected, it is termed a retention ; but when, after having taken place, it ceases to return at the usual periods from other causes than conception, it is called a suppression of the menses; and both of these incidents are implied in the technical term amenorrhea. The quantity of the discharge varies according to the climate and constitution of the woman. About four or five ounces is the usual quantity discharged gradually, during the space of from three to six days, at each menstrual period. The menses are naturally suspended during pregnancy and while nursing; but if suckling be too long continued, the menses return, and the milk disappears or becomes impaired and unfit for the nourishment of the child. The revolution which the periodical discharge induces in the female constitution, is not effected all at once, a number of preceding complaints in some instances announce its approach. A general languor and weakness, depraved appetite, impaired digestion, fre- quent head-ach, a sense of heat, weight and dull pain in the loins, distention and hardness of the breasts, lassitude and paleness of the countenance, often distress the young female several weeks or months before the discharge appears ; but soon cease after the eva- cuation takes place. On the appearance of the above symptoms about the age at which the sexual discharge usually begins, every thing which may tend to obstruct that salutary evacuation should be studiously avoided, and every endeavour to promote it ought to be enjoined. If at this critical time of life, young females indulge themselves in indolence or unwholesome food, instead of practising active exercise and enjoying the invigorating quality of fresh air, amusements, and a mild but nutritious diet, they become relaxed, the natural functions are impaired, menstruation is obstructed, and a train of evils, both general and local, never fail to ensue, and often lay the foundation for consumptions or other fatal diseases. During the process of menstruation, all food of hard digestion, acid and unripe fruits, and whatever is liable to sour upon the stomach or chill by its coldness, must be particularly guarded against; but nothing is of more importance than to avoid catching cold, as the most dangerous consequences might result from such accident. In- stances have been recorded of obstructed catamenia being induced 65 514 SUPPRESSIONS. CLASS \ by drinking cold water during the period, and which have termi- nated fatally. All great affections of the mind, such as sudden surprises, frights, violent passions, particularly grief and anger, arc also extremely prejudicial; while wholesome diet, exercise and cheerfulness, are all conducive to the promotion of this salutary evacuation. The retention of the menses is frequently attended with chloro- sis, called also green sickness, known by a feeling of weariness and debility, with dislike to active employments ; a pale or sallow com- plexion, cachectic appearance, cedematous swelling of the legs and feet, flatulency and acidity in the stomach, loathing of food, but an inclination for indigestible substances, as chalk, lime, and sand; pains of the head, and different parts of the body, swelling of the abdomen, with hysteric symptoms, such as palpitation of the heart or dyspnoea ; and if this state be not soon removed, it is apt to end either in consumption or dropsy. The chlorotic condition just described, is in almost every instance to be ascribed to a gen- eral debility of the system ; and accordingly the most successful mode of treatment consists in improving the health and increasing the strength of the patient in general, and exciting the action of the uterine vessels in particular. Dr. Hamilton considers chloro- sis as depending on costiveness ; this inducing the feculent odour of the breath, disordered stomach, depraved appetite, and impaired digestion, which attend this disease. His first intention is to thor- oughly evacuate the intestinal canal, after that, if necessary, to promote the recovery by tonic medicines. The defective energy of the system will be restored by constant moderate exercise, par- ticularly walking: a nourishing and digestible diet with a proper proportion of wine ; the administration of tonic medicines, as aro- matic bitters and the Peruvian bark; but by far the most effica- cious remedies are the different preparations of iron, such as the chalybeate waters, the muriated tincture of iron, the phosphate or the carbonate of iron. Dr. Griffith's myrrh and steel mixture, or the same ingredients formed into pills, will be found eminently ser- viceable. The following composition is also well adapted to the various circumstances of the chlorotic patient. Take of filings^of iron, two ounces, Peruvian bark roughly powdered and orange peel, each one ounce, infuse them for a week or ten days in a quart of Lisbon wine or pure cider, and then filter the tincture and give half a wine-glass full of it twice a day. A large spoonful of OENUS VI. AMENORRHEA. 515 a saturated tincture of pennyroyal has been known to produce very favourable effects, composing and inducing sleep when taken at bed time. Strict attention should be paid to the state of the bowels, which in this disease are generally torpid, and have great power of communicating to the rest of the system a similar state. Some stimulating cathartic, therefore, should be administered once or twice a week, or small doses every night; for this purpose there is none to be preferred to the pills of aloes and myrrh, to each dose of which about two grains of the powdered root of our swamp hellebore should be added. In some instances, where ad- missible, the sexual intercourse may be recommended as the most natural and effectual remedy. With the view of exciting still far- ther the action of the uterine vessels, the patient should be en- joined to use active exercise and frequent friction of the body and limbs, warm pediluvium and fomentations to the lower part of the abdomen, and on some occasions the warm bath, or sitting up to the hips in warm water. Electricity, when directed in the form of either sparks or small shocks, about the region of the uterus, has frequently been attended with the most speedy and salutary effects. When the menstrual discharge, after having been once estab- lished, is interrupted in its regular recurrence, it is first to be as- certained whether the suppression is occasioned by a state of preg- nancy, as both the welfare of the woman, and the credit of the physician, may sometimes be affected by deceptive appearances. If, however, pregnancy be the cause, it will soon be decided by its peculiar progress and effects. A suppression of the menses generally arises from the opera- tion of those causes which induce debility of the system at large, and a defective action of the uterine vessels, such as cold at the time of menstruation, passions of the mind, fear, inactivity of body, the frequent use of acids and other sedatives. The symp- toms are head-ach, pains in the back, loins, and knees, accompa- nied with hysteric and dyspeptic complaints ; colic pains, nausea, oedematous swellings of the legs, and costiveness ; haemorrhages from the nose, lungs, stomach, and other parts, are often the con- sequence of suppression, and they sometimes observe a monthly period, but oftener appear at irregular intervals. In some in- stances, nausea, tumour of the abdomen, and other indications of pregnancy, are produced by uterine obstruction. When suppres- sion of the menses takes place in consequence of some obstinate 516 SUPPRESSIONS. CLA-SS V. chronic disease, as consumption or dropsy, it would be both use- less and hurtful to attempt, by stimulating emenagogues, to re- store the evacuation. But in suppression arising from cold, fear, or some removable cause inducing debility of the system, or con- striction of the vessels of the uterus, the curative remedies ought immediately to be employed. When obstructions arc occasioned by a relaxed habit of body, the proper remedies are those which brace the solids, promote digestion, and give force to all the pow- ers by which the natural functions are conducted. The means which have been advised for the removal of a retention of the menses, are those best adapted to our present views ; and the pre- scribef may select such forms as accord with his judgment, and are most agreeable to the patient. With the tonic plan of treat- ment it will often be requisite to employ some emenagogue me- dicines, such as savin, from twenty to thirty grains of the powder- ed leaves, or three or four drops of the essential oil twice in a day, or the tincture of black hellebore in doses of one drachm thrice in twenty-four hours ; and if this should not produce a pur- gative effect, the aloetic pills before mentioned ought to be given occasionally. In obstinate cases of suppression, it is recommend- ed as highly beneficial about the time when the menses are ex- pected to appear, to administer an emetic and direct the patient to sit during the operation in a warm bath, up to the middle of the body. It should be observed, that in general our endeavours to restore or promote the menstrual flux are most likely to prove successful when directed at the time of its expected return, or when some natural efforts for that purpose are observable. An- other medicine of approved efficacy in many cases of obstructed menses, is calomel, either alone, or combined with opium, in small doses; when judiciously administered it has proved peculiarly bene- ficial. When the* complaint depends on spasmodic constriction of the uterine vessels, and is attended with hysterical symptoms, the root of skunk cabbage, in doses of one drachm of the powder twice or thrice daily, will probably afford the most essential relief; and the extract of stramonium has been reported to have proved successful in similar circumstances. Camphor is also a valuable antispas- modic medicine in these circumstances ; about six or eight grains may be taken in milk twice a day. It must be recollected that irregularities in menstruation are sometimes symptomatic, and that the original disease should be re« GENUS VI. AMENORRHEA. 517 moved previous to any efforts for promoting the natural sexual discharge by means of stimulating emmenagogues. When a woman, upon the sudden suppression of the menstrual discharge, is affected with febrile symptoms, as a hot skin, accele- rated pulse, flushing of the face, pains in the chest, back, and ute- rine region, or in the bowels, stimulating medicines will prove in- jurious ; and should there be dyspnoea with pain about the side or breast, increased by inspiration, it will be necessary to take some blood from the arm, and to administer a saline purgative dis- solved in a large quantity of warm water, to which one or two grains of the tartrite of antimony may be added. After the febrile symptoms are removed, the myrrh and steel mixture or other cha- lybeate preparation will be advisable; and as an efficacious eme- nagogue, the black hellebore will often be found useful. It seems to be satisfactorily ascertained that ergot deserves to be classed among our most powerful emenagogue medicines. This has cer- tainly succeeded in the removal of obstructed catamenia in several instances. We find recorded in the New-England Journal, Vol. V. p. 162, seven cases of amenorrhaea in which ergot was adminis- tered, in six of which permanent cures were effected. In one case six ounces of the medicine was taken in about ten days, prepared by boiling one ounce in a quart of water down to a pint. But the usual quantity was half an ounce per day, and in no instance were any ill effects produced by the medicine. Amenorrceha succeeding to abortion, laborious parturition, or fever, on some occasions assumes the form of pulmonic consump- tion, from which it is difficult to discriminate, and if great attention be not paid to improve the health and restore the tone and energy of the system, it may lead to a fatal termination. In this instance, the pulse although frequent, is not liable to the same regular ex- acerbation as in hectic ; a full inspiration gives no pain and little excitement to cough ; the person can lie with equal ease on either side ; the cough is not increased by motion, nor by going to bed, but it is often more severe in the morning, and is accompanied with a trifling expectoration of phlegm. It is not short, like that excited by tubercles, but comes in fits and is sometimes convulsive, whilst palpitation and many hysterical affections, with a timid and desponding mind, accompany these symptoms. Under these cir- cumstances it will be of much utility to administer occasionally an emetic of ipecacuanha and sulphate of copper, as in phthisis pul- 518 NEUROSES. CLASS VI. monalis, and to keep the bowels soluble by saline laxatives ; mild pectoral medicines will be serviceable, and an opiate should be given at night. Exercise, a free country air, and a mild diet, chief- ly of milk, will be indispensably necessary. When obstructions proceed from violent affections of the mind, every endeavour calculated to soothe and tranquillize ought to be exerted; for this purpose a change of place, amusements, and cheerful company are of much importance. There is another irregularity or deviation from the natural pro- cess of menstruation, which is called dysmenorrhea, in which there is a deficiency in the quantity, and the evacuation is accompanied with severe pains in the head, back, and loins, owing probably to an imperfect menstrual action. This complaint may be obviated by chalybeates, the warm bath, or semicupium, which should be employed for a day or two previous to menstruation, and repeat- ed every night during its continuance; opiates combined with ipe- cacuanha should be given to relieve the pain, and the bowels aro to be kept open by mild saline laxatives. It remains to be observed that the use of the chalybeate waters of Saratoga and Ballston, are calculated to render important ser- vices to females labouring under the complaints of which we are treating. The change of scenes, air, and exercise, with the amuse- ments and cheering incidents to be found at this fashionable resort, are peculiarly conducive to a restoration to permanent health and spirits. Class VI.—NEUROSES, OR NERVOUS DISEASES. Diseases for the most part primarily resident in, or manifested by, affections of the brain, and other parts of the nervous system. Order L—ASPHYXIA. The characteristics are a sudden and total suspension of all men- tal and corporeal functions^ ORDER 1. ASPHYXIA, OR SUSPENDED ANIMATION. 519 Persons Apparently Drowned. It is now a well established fact that the principle of life may lie dormant in the body after it is apparently dead, and that it may be resuscitated and rescued from a premature grave by the means recommended by the various humane societies instituted in our country. As soon as the body of a person recently drowned is taken out of the water, it must be carefully conveyed with the head raised to a house or other place where it can be laid dry and warm, avoiding the destructive methods of hanging it by the heels, rolling it on a barrel, or laying it across a log on the belly. The clothes must be immediately stripped off, and the body wrapped up in blankets well warmed. It should be laid on its back, with the head a little raised. If the weather be cold, it should be placed near a fire, and a heated warming-pan should be passed over the body; but in warm weather it will be sufficient to place it between two blankets well heated, or in the sun-shine, taking care to prevent the room from being crowded with any persons who are not necessarily em- ployed about the body. At the same time the whole body should be rubbed with the hand or with hot woollen cloths. The rubbing should be moderate, but continued with industry, and particularly about the breast. Apply also heated bricks to the feet, belly and breast. The immediate application of frictions is of the utmost importance, as many have been recovered by frictions only, when early used. • As soon as it can possibly be done, a bellows should be applied to one nostril, while the other nostril and the mouth are kept closed, and the lower end of the prominent part of the wind-pipe (or that part which is called by anatomists pomum adami) is pressed back- ward. The bellows is to be worked in this situation ; and when the breast is swelled by it, the bellows should stop, and an assist: ant should press the belly upwards to force the air out. The bel- lows should then be applied as .before, and the belly again be pressed ; this process should be repeated from twenty to thirh times in a minute, so as to imitate natural breathing as nearly as possible. Some volatile spirits heated may be held under the valve of the bellows whilst it works. If a bellows cannot be procured, some person should blow into one of the nostrils through a pipe or quill, whilst the other nostril and mouth are closed as before : 01 520 NEUROSES. CLASS IV if a pipe or quill be not at hand, he should blow into the mouth whilst both nostrils are closed ; but whenever a bellows can be procured it is to be preferred, as air forced in by these means will be much more serviceable than air which has already been breath- ed. During this time a large quantity of ashes, water, salt, or sand, should be heated, and as soon as it is milk warm the body must be placed in it; the blowing and rubbing are then to be continued as before ; and when the water, ashes, or salt, are cooled, some warm- er must be added, so that the whole may be kept milk warm* Loud noises have sometimes proved successful in recovering such persons and restoring to life. When signs of returning life are apparent, the frictions must be continued, but more gently. These methods must be continued three or four hours, as in several in- stances they have proved successful, although no signs of life ap- peared until that time. When the patient is able to swallow, he must take some wine, brandy, or rum and water. The following process, recommended by Dr. A. Trowbridge, is from the Boston Medical Intelligencer. The application of a suitable degree of heat and friction to the surface of the body, and particularly to the extremities ; and in- flating the lungs with warm air mixed with vapor from hot alkali, artificial breathing, and stimulating cordials introduced into the stomach, are the most important means to be used. The following plans to effect these objects, can be made more effectual than any which I have known. To apply Heat.—Be provided with a woollen sack, seven feet Ion" and three broad, made tight at the bottom, with a leathern tube passing out two feet long of two inch caliber; let the upper part of the sack, near its edge, on the inside, be lined with velvet, and a worsted string put in, so that it can be drawn close round the neck of the patient; let there be an opening on each side, sufficiently large for the introduction of the hand and arm, for the purpose of friction ; this should be done with a dry flannel cloth, or a coarse woollen glove. Be provided with Jennings' apparatus for a vapor bath made of sheet iron, with a tube two feet long and one inch caliber with a stop cock, a gill of alcohol, and a lantern with a lighted candle. On receiving the body, stripped, and wiped dry, place it in the sack. Tie the leathern tube passing out of the lower end of the sack, to the tube of the vapor machine. Fill the cup in the ORDER I. ASPHYXIA, OR SI SPENDED ANIMATION. 521 base of the machine, with alcohol, and touch it with the lighted candle : the vapour, or gas, passes into the sack, and around the body of the patient, and gives a very agreeable and invigorating warmth, without moisture. The whole of this application can be made in two minutes, as much heat let on as is wanted, and regu- lated at pleasure. If a room, bed, matrass, &c. can be obtained without loss of time, improve them ; if not, the body may be placed on the ground, on boards, or any other dry substance, and your re- storative process carried on till other means are furnished: re- member that time is important at this juncture ; a few minutes de- lay loses the patient. Inflating the Lungs.—This can be best effected by a bellows communicating with a flexible pipe introduced into the larynx ; or if this cannot be readily done, through an aperture made between the rings of the trachea. It is folly to depend on blowing with the mouth, or through a quill or pipe; the accumulation of froth and mucous, will prevent a full inflation of the lungs in this way. The bellows recommended by Dr. Hunter in his Philosophical Trans- actions, is the best : but the small common ones will answer very well. For the purpose of introducing salutary gases with atmos- pheric air, a leathern tube may be fastened near the opening in the under part of the bellows, and to a bottle containing the gas ; when the bellows is filled, some of this gas would be received with the atmospheric air, and be thrown into the lungs. When the air is introduced, the thorax should be pressed, and the abdominal vis- cera raised against it, to change in some manner its capacity; for when a train of associated motions has begun, they are often con- tinued from whatever point they may have commenced. While the lungs are thus stimulated, the stomach, the important organ with which the whole system so evidently sympathizes, should not be neglected. By introducing a flexible tube, any stimulating fluid or cordial, can be injected. The body, during this process, should be placed in a semi-erect position. The process of reanimating a lifeless body is the most interest- ing that the physician meets with. Decision, promptitude, and energy, must attend every step ; not so much for the purpose of do- ing a great deed, as for the purpose of doing what is necessary, with despatch and correctness. Bleeding or purging ought not to be used without consulting a physician, who should be called in as soon as possible : but clysters 66 522 NEUROSES. CLASS VI of salt and water may be injected. Where either convulsions or stupor and head-ach remain after the person has come to himself, the physician will doubtless see the propriety of drawing off a small quantity of blood, either by the lancet or the application of leeches to the temples, but where these symptoms do not prevail, the loss of blood will be injurious. The means above recommended are likewise applicable in the case of suspension by the cord. But in the circumstance of stran- gulation, a few ounces of blood must be taken from the jugular vein or arm ; or cupping-glasses be applied to the head and neck. and leeches to the temples. Noxious Vapours. " Suffocation and immediate death may be occasioned by entering wells, cellars, caverns, or mines, that have long been kept closely confined from the atmospheric air. The deleterious fumes arising from burning charcoal, or those from fermenting liquors, &c. may likewise produce the same fatal effects, if imprudently received by any person into the lungs. The external appearances of persons thus suffocated are as follow : the head, face, and neck are swollen ; the eyes are propelled from their sockets; the tongue is protruded at one side of the mouth ; the jaws are firmly closed ; the face is of a livid, and the lips are of a deep blue colour ; the abdomen is inflat- ed ; the body is insensible to pain, and the person appears to be in a profound sleep. No person therefore ought to venture into any such place where a long stagnation of air has produced me- phitic vapours, until these have been sufficiently corrected by the explosion of gunpowder or some combustible substance burnt, and a free ventilation of the infected place. The safety of such sus- pected places may be ascertained by first letting down a lighted candle or burning fuel; if these continue to burn, it is a proof that the air is pure ; but if the flame be suddenly extinguished, no per- son can enter without immediate suffocation and death. Imme- diately on discovering a person apparently dead from such cause, the windows and doors ought to thrown open, and the body be un- dressed and exposed freely to cool air, the face be sprinkled with vinegar, and cold water be thrown from buckets over the whole body for some time. If this method fail, frictions and the other means recommended for the recovery of drowned persons should be put in practice. ORDER I. ASPHYXIA, OR SUSPENDED ANIMATION. 523 Fatal Effects of Lightning. The circumstance is worthy to be regarded in every family that lightning is conducted with more facility by some substances than by others, and indeed that some substances are non-conductors. The substances which are the greatest conductors are all metallic bodies, as gold, silver, platina, brass, iron, tin, and lead : also, wa- ter, ice, snow, green wood, and most earthy substances. Non-con- ductors are glass, sulphur, resin, silk, cotton, feathers, wool, hair, paper, ashes, and most hard stones and bricks. During the time of danger from lightning, we should carefully avoid standing or sit- ting near any of the conductors within doors, and when in the open field, no safety will be found by resorting to trees for shelter, es- pecially such as have dry or dead branches about them. Whilst within doors, it will be safest to avoid being near the furniture of the fire-place, the wires and cords of bells, picture-frames, and oth- er gilt furniture. The doors and windows should be opened for a free passage of the flashes of lightning, and the middle of the room should be chosen as the most secure situation for the family, and if sitting on matrasses or couches filled with hair, wool, or feath- ers, it would be an additional security. " When lightning exhibits a deep red colour, it is seldom accompanied with dangerous con- sequences ; but if the flashes be bright, pale, and in a zig-zag di- rection, destruction generally marks their course." Persons injured by a flash of lightning, though apparently dead, may in many instances be restored by proper and timely applica- tions. In general there are no external marks discoverable, though sometimes red streaks appear on different parts. The treatment to be pursued for the restoration of persons suffering injury from lightning, is precisely the same as that for persons suffocated by noxious vapours. The sprinkling with vinegar, and the affusion of cold water are the principal means to be employed. In some instances of suspended animation, electricity may be successfully directed. Of Frost-Bitten, or the Effects of Intense Cold. When persons are exposed to an intense degree of cold greater than the body is capable of sustaining, the vessels upon the surface, particularly the extremities, are constricted, by which the circula- tion is obstructed, an unusual quantity of blood is forced towards 524 NEUROSES. CLASS Vf, the brain, and a fatal apoplexy is generally the consequence. The first alarming symptom is a drowsiness or almost irresistible pro- pensity to sleep, and if this propensity be indulged, it will assured- ly prove the sleep of death. Whenever, therefore, a person is long exposed to extreme cold, it should be recollected that his safety greatly depends on the constant motion and activity of the body, and firm resolution to resist the propensity to drowsiness. If unfortunately a person has suffered by exposure to extreme cold, so that every symptom of life has disappeared, the only pro- per method of treatment consists in placing the naked body in a cold room or in a situation distant from a fire, and immediately •cover it, except the face, with a bed of snow, or plunge it into a bath of the coldest water for some time, and when taken out the whole body should be thoroughly rubbed with cloths wet with cold water. The immersion and the friction should be repeated and alternately applied for a length of time ; for instances have occur- red of persons being restored by a steady perseverance in the pro- cess, when no signs of life had been discovered for several hours. When symptoms of animation appear, external warmth must be very gradually applied, and when the patient is able to swallow, a cup of tea or a little wine or brandy may be allowed. When the hands or feet have been exposed to severe cold, and have become benumbed or frozen, the excitability of those parts will be so much stimulated that if they are brought near a fire, a violent inflammation, and probably a mortification, will ensue. External heat should on no account be applied, but the frozen parts ought to be immediately covered with snow, or immersed in cold water until they recover their natural warmth and sensibili- ty, and if necessary, the applications and the friction should be repeated, and continued for several days, and afterwards the exter- nal warmth must be applied in a gradual manner. The applica- tion of goose grease, or the fat of common fowls, has been suc- cessfully employed as a remedy to frozen limbs, even when the parts were perfectly black. The parts should be kept constantly covered with the grease. ORDER I. APOPLEXY. 525 APOPLEXY. An apoplexy is a sudden deprivation of the internal and exter- nal senses, and of voluntary motion, while the heart, lungs, and ar- teries, continue to perform their actions. It is most incident to persons in the decline of life ; and those of a corpulent habit, with a short neck and large head, and who lead an inactive life, use a rich and plentiful diet, or drink to excess, are the most liable to its attacks. It is in some instances preceded by a vertigo, and pain in the head, drowsiness, noise in the ears, loss of memory, and a difficulty of breathing. It may be occasioned by any cause which increases ibe motion of the blood towards the brain, or prevents its return i.oin that part, violent passions, rich and luxurious diet, and .: irce use of ardent spirits, excess of venery when advanced in life, the suppression of any*customary evacuation, suffering the body to cool too suddenly after being much heated, wearing any thing too tight about the neck, and the sudden disappearance of eruptions ; as also blows, wounds, and other external injuries. Some modern practitioners have advanced the opinion that apo- plexy has its origin in the stomach, and the brain is secondarily af- fected by sympathy. This opinion is reported to be confirmed by numerous dissections both in France and England, in which the cause was demonstrated to be a diseased state of the stomach, while in the brain little or no morbid affection was detected. It is, however, scarcely to be doubted that the brain and nervous sys- tem are in general primarily affected ; and that the usual distinc- tion between the sanguineous and serous apoplexy must be con- stantly kept in view, as the mode of treatment is essentially dif- ferent. In sanguineous apoplexy, there is supposed to be a preternatu- ral distention of the blood-vessels, or extravasation of blood upon the brain, while in the serous apoplexy, instead of red blood, the serum from the exhalant vessels is accumulated in such quantity, as to produce the compression. Apoplexy, in some instances, has been supposed to originate from some peculiar condition of the brain and nerves alone, by which the motion of the nervous power is interrupted, or it may be symptomatic of other diseases. The patient, when seized with this disease without much previous in- disposition, falls down suddenly, his face is flushed and bloat- ed, the veins of the head, particularly the eyes, temples, and :>eck. are turgid, the head feels hot, the eyelids are half open, and 526 NEUROSES. CLASS VI. rigid, the patient appears to be in a deep sleep, and breathes with great labour and difficulty, and with a peculiar loud snoring or stertor ; the pupils of his eyes are for the most part dilated, but in some instances remarkably contracted. One side of the body is commonly more affected than the other, which condition is term- ed hemiplegia. The pulse in most instances is full and strong, but slower than natural. In the serous apoplexy, the pulse is weaker, the countenance less ruddy, and the breathing less oppressed than in the sanguinary. The paroxysms continue from eight to forty- eight hours. Cases have occurred in whicli the patient has con- tinued for several days insensible and motionless, and yet gradual- ly recovered to a comfortable condition ; but more frequently, if not immediately fatal, the result is a permanent deprivation of the use of one side, and imbecility of mind and body during the re- mainder of life. Those who have once suffered an apoplectic fit, are sooner or later seized with a second or third attack, which has a fatal termination. Dr. Cooke considers a contracted pupil one of the most dangerous symptoms of the disease, never having known a person recover from apoplexy when the pupil was great- ly contracted. When a patient is seized with a paroxysm of apo- plexy, he should immediately be placed in a spacious apartment, in which cool air may be freely admitted, and put in a posture which the least favours a determination of blood to the head: all ligatures, especially those about the neck, should be speedily re- moved, and the legs and feet should be placed in warm water, or rubbed with stimulating applications. No time should be lost in drawing from the arm or jugular vein such quantity of blood as the urgency of the case imperiously demands. If evident signs of relief are not perceived, and there be no reasons to fear an exhaustion of the vital powers, the operation may be repeated a second or even a third time within two or three hours, or a number of leech- es or cupping-glasses may be applied to the temples, to diminish the pressure on the brain. " Dr. Rush carried bleeding in apo- plexy farther than had been usual before his time. He consider- ed the importance of the part affected and the urgency of imme- diate danger, to warrant extraordinary losses of blood in the most perilous disease. In his own energetic language, he advised his pupils * to bleed not only by ounces or in basins, but by pounds and by pailfuls ; and that the head of the patient should be sub- jected to a stream of the coldest water, from a pump or otherwise. OIIDER I. APOPLEXY. •»27 till a bleeder was procured.' It is well known in Philadelphia, that in conformity to these ideas, Dr. Physick, at one bleeding, drew ninety ounces, by weight, (or nearly one fourth of the usual quantity of blood in the human body,) from Dr. Dewees, in a sud- den attack of the apoplectic state of fever, and thereby restored him so speedily to health, that he was able to attend to his busi- ness in three days afterwards."* Cases will occur in practice in which the use of the lancet to the full extent will appear inadmissible, especially in serous apo- plexy, but the shades of distinction are so obscure, that the prac- titioner must be guided by existing circumstances and the effect produced. Immediately after a very copious depletion by the lancet, and indeed in all cases of apoplexy, the most prompt eva- cuation from the alimentary canal is of indispensable importance ; adequate doses of calomel and jalap should be given at proper in- tervals, until the object be fully accomplished. Solution of neu- tral salts, with infusion of senna, together with stimulating clysters, should at the same time be diligently administered. Blisters are next to be applied to the nape of the neck and to the extremities, accompanied with frictions and strong sinapisms to the soles of the feet, and cold water or vinegar may be applied over the whole head. Emetics have been sometimes advised in this disease, but in sanguine apoplexy the straining in the operation may have a tendency to increase the extravasation, if not to rupture a vessel; but in the serous species, or where there is good evidence that the disease proceeds from a surcharged stomach, an emetic is both safe and advantageous, by freeing the stomach from morbid acrimony, rousing the general system, and determining from the head to the surface of the body : and if by this means a gentle perspiration should ensue, the effect would be still more beneficial. After the depleting means have been pursued, and the pressure on the brain diminished, the powers of life, says Dr. Hosack, have in many in- stances been restored by the free use of the volatile alkali given internally, and applied externally so as to excite vesications. It remains to observe that although the apoplectic patient may have recovered from the first attack, yet he will be constantly subject to a recurrence of it, his constitution is greatly enfeebled, and at best he can have only a short respite from death ; hence the interval is of great importance, and much depends on diet and * Ramsay's Eulogy 528 NEUROSES. CLASS Vli regimen. He ought to avoid all extremes of heat and cold, and guard against all violent commotions of the mind; his feet should be kept warm and dry, and he should abstain from heavy suppers, and wear his clothes loose about his neck, and lie with his head high, and above all, obviate a costive habit. Perpetual issues or setons have a salutary effect in preventing a return of this disease. A course of tonic medicines, a light nutritive diet, and moderate exercise, should also be recommended. Lethargy, or Coma. This is a species of apoplexy, which is manifested by an invin- cible drowsiness, or inclination to sleep, from which the patient is with difficulty awakened, and if roused, he remains destitute both of sense and memory, and slumbers instantly again. The reme- dies applicable to this affection are the same as those advised in serous apoplexy, but especially topical bleeding from the temples by leeches, or from the nape of the neck by cupping, and cathar- tics frequently administered. All stimulating substances, such as ardent spirits, strong wines, and tobacco in every form, ought to be avoided. The Coup de Soldi, or Ictus Solarus of Dr. Parr. A Stroke of the Sun. This complaint is not unfrequent in hot climates, from an expo- sure of the head to the immediate and powerful influence of the rays of the sun, and appears to be a species of apoplexy. The symptoms are, a violent head ach, a hot dry skin, a redness and heaviness of the eyes, sometimes a continual involuntary motion of the eyelids, a loss of sleep, drowsiness occasionally with delir- ium on awakening, violent fever, faintness, loathing, and thirst. Persons on some occasions have been struck with such violence as to die on the spot; others fall into a lethargy, or die in a few hours with symptoms of raving madness. It is seldom that such unfortunate subjects can derive essential benefit from any applica- tions in our power to bestow ; but the remedies which have been directed in serous apoplexy may be tried, and also cloths wetted in cold vinegar and water to the temples and over the whole head, after cutting off the hair. o^OER I. PARALYSIS, OR PALSY. 529 PARALYSIS, OR PALSY. Phis disease is frequently the consequence of apoplexy, and '■(insists in the loss of the power of voluntary motion in certain parts of the body only ; sometimes it is accompanied with a loss of sense or feeling, and there is often stupor in a greater or less degree. It most frequently aflccts the whole of the muscles of one side of the body, and then the disease is called hemiplegia ; when the muscles of the lower half of the body, divided trans- versely, are affected, it is named paraplegia ; and when a single limb only, it is termed paralysis. This disease, if it is not the effect of apoplexy, is often' preceded by universal torpor, giddi- ness, and sense of weight or uneasiness in the head, dulness of comprehension, loss of memory, and a sense of coldness in the parts about to be affected ; there is also sometimes tremor and pain in the part. But in general, palsy comes on with a sudden and immediate loss of the motion and sensibility of the parts; when the head is much affected, the eye and mouth are drawn to one side, the memory and judgment are much impaired, and the speech is indistinct and incoherent. When palsy attacks any vital part, such as the brain, heart, or lungs, it soon terminates fatally. In some instances, there is a total loss of sense, while motion re- mains entire ; in others, a total loss of motion, with very slight, or even no affection of sense; and in some cases, while a total loss of motion takes place in one side, a total loss of the sense of feeling has been observed in the other. But most commonly there is a loss of voluntary motion while feeling remains. Palsy is induced by whatever prevents the nervous power from acting on any particular part of the body. The more remote causes are, intemperance, certain poisons received into the body, particularly lead, suppressed evacuations, wounds of the brain or spinal marrow, spasmodic colic, old age, and debility of the nervous system, worms, &c. When the part affected feels cold, is insen- sible or wasted away, or when the faculties of the mind begin to fail, there is little hope of recovery, though the patient may con- tinue for many years in a feeble helpless condition. A feeling of warmth, a slight pricking pain, or a sensation as if stung by ants in the part affected, are favourable symptoms, and if a fever ensue, there is a chance of its curing the palsy. When convul- sions succeed to a palsy, the termination is almost inevitably fatal. 67 330 NEUROSES. CLASS VI The curative plan in this disease is in the first instance similar to that in sanguineous apoplexy. If the patient be young, and of a full habit, bleeding, blistering, and strong purgatives and sharp clysters must be immediately employed. But when the disease proceeds from relaxation or debility, and the patient is advanced in life, an opposite method of cure must be adopted. The diet should be of a warm and strengthening quality, seasoned with spices or aromatic ingredients ; and the drink ought to be generous wine, mustard whey, or brandy and water. A stimulating clyster should be immediately injected, and an emetic must follow the operation of it, and repeated occasionally. Volatile and stimulat- ing medicines are next to be administered, such as the volatile alkaline salts and spirits. The seeds of mustard unbruised, a table- spoonful, and the same quantity of the root of horse-radish scrap- ed and swallowed without chewing, if given night and morning, will prove extremely beneficial; or two ounces of each of the above may be infused in a quart of boiling water for four hours, and add to the strained liquor two ounces of the tincture of pi- mento, and a tea-cup full may be given three or four times in a day. Frictions on the parts affected, and along the spine, with warm cloths impregnated with the flower of mustard or tincture of cantharides, should be assiduously employed, as well as blisters and the volatile liniment to different parts of the body. The warm bath has been frequently used as an external stimulant in cases of palsy ; the utility of this remedy, however, will depend entirely on the particular circumstances of the case. When there is evidently a diminished degree of vital heat or action, and the constitution is enfeebled, the warm bath will undoubtedly be pro- ductive of real beneficial effects. Electricity and galvanism are powerful remedies as external stimulants ; they are often success- ful when moderately applied, and should perhaps in every instance be employed, and long persisted in. The swamp sumach, (rhus toxicodendron,) has been extolled as a stimulant in cases of palsy and extreme debility, and even in the palsy of the lower extrem- ities from distortion of the spine. The powder of the dried leaves has been given from a third of a grain three times a day, to four or five grains ; but from its deleterious qualities, much caution is necessary in its administration. In a palsy of the tongue, the pa- tient should frequently gargle his mouth with brandy and mustard, and hold in it a bit of sugar wet with the compound spirits of f)RDER I. PARALYSIS, OR PALSY. 531 lavender, and the valerian root and mustard seed taken internally will also be useful. In that palsy of the lower extremities arising from a deformity of the spine, when the ligaments which connect the vertebrae to- gether are thickened, without any particular affection of the bones, the most successful mode of treatment is to insert issues as near as possible to the tumour; for this purpose, a large caustic should be applied on each side of the protuberant vertebrae, and the dis- charge promoted and kept up for a length of time, by sprinkling the sore with powdered cantharides ; or instead of this, a seton may be preferred. In those paralytic affections proceeding from the poison of lead, a moderate course of mercury has proved of the greatest utility. (See nervous colic.) Those paralytic shak- ings or tremblings of the hands or other parts, which are frequently owing to intemperance, may in general be treated as a partial palsy, but chiefly by the external applications already mentioned. When the patient from a long continuance of the disease, sinks into a state of debility, with loss of appetite, he should have recourse to Peruvian bark and stomach bitters. In every instance of palsy, the patient should take daily exer- cise if possible, either by walking or on horseback, as his strength will permit. Frictions with strong stimulants should on no account be neglected. Flannel must be worn next the skin, and all expo- sure to cold and damp air ought to be carefully avoided. In Townsend's Guide to Health, several cases are recorded of palsy occasioned by worms, and which were cured by anthelmintic medicines. The use of splints in cases of paralysis of the muscles of the extremities, has been found of great utility. They should be applied in a manner similar to that practised in fractured limbs, being long enough to reach from one joint to another, and suffi- ciently firm to support the limb, and the apparatus to be removed every four or five days, and again replaced. In many cases of paralytic limbs, this method is said to have been attended with obvious advantages, and had a considerable influence in accelerat- ing the cure. See New-England Medical Journal, Vol. IV. p. 33Z. The author is induced in the present edition to offer the follow- ing condensed abstract from the very learned and elaborate work of Dr. M.Good. 532 NEUROSES. CLASS VI. The boldness of the practice, says Dr. Good, should be regulated by the nature of the exciting cause. Where there is over eating, or intoxication, eighteen or twenty ounces of blood may be taken away with advantage at once, in a few hours after twelve or fifteen more, and the venesection may be repeated a third, or even a fourth time, if necessary. Even in atonic apoplexy, he adds, it has been observed that venesection is occasionally necessary; and it may be equally necessary in atonic paralysis, for here also effusion may take place both of blood and of serum. But there are some cases in which it is altogether a venture, and others in which it is allow- ed on all hands to be injurious. Even Mr. Hunter himself recoils from the practice where hemiplegia is apparently a result of retro- cedent gout, and we should be induced to abstain equally in all in- stances where there is alike diminution of sensorial power,in all instances of atonic paralysis, let the exciting cause be what it may, where there is no stertor, no stupor, or vertigo, no convulsion or other irregular nervous action, and the pulse, instead of being firm, is feeble and intermittent. For it should never be forgotten, that if many patients have recovered after bleeding, in suspicious cir- cumstances, others have died after it, and probably in consequence of it, while great numbers have derived no benefit whatever. The advice of Dr. Cook upon this subject is therefore founded in ihe truest wisdom, and cannot be too extensively committed to memory: Each individual case must be viewed in all its circum- stances, and by a careful consideration of them, our practice should be regulated. Before we prescribe blood-letting in hemiplegia we must investigate the age, strength, general constitution, and habits of the patient, and above all, the actual symptoms of the disease. In early, or even in somewhat advanced life, if plethora and the various symptoms tending to apoplexy be present, I should not scruple to bleed freely both generally and topically. On the con- trary, in great age, debilitated, leucophlegmatic habit, dropsical tendency, &c. I should think it right to abstain altogether from this and from every other powerful mode of depletion, unless there be an evident determination to the head, marked by flushing in the countenance, throbbing of the arteries, redness of the eyes. In purging, we may proceed with less restraint; for even in debilitated and dropsical habits, stimulating the bowels is almost uniformly found useful; should there be serous, or even sanguineous effusion, absorption is hereby powerfully promoted ; and if there ORDER 1. PARALYSIS, OR PALSY. 533 be none, a beneficial revulsion will often be produced, and the sti- mulus will always be one of the most useful we can adopt. In a very debilitated state of the constitution, however, we should choose the warmer in preference to the colder purgatives; and hence jalap, colocynth, or even aloes in preference to neutral salts : and it will also be serviceable to combine them with some distilled water impregnated with an essential oil, as mint, penny- royal, juniper, or rosemary. The next reducent remedy, worthy of notice, is emetics. If we have strong reason to apprehend a sanguineous effusion, this class of medicines ought not to be employed for a few days, and will hence always be doubtful in the first attack of entonic hemiplegia, as we have already observed they are in entonic apoplexy. But if we have no ground of such suspicion, they cannot be had recourse to too soon. In a certain sense they weaken, but they are at the the same time among the most powerful indirect tonics that can enter into our practice. They rouse the system generally, solicit the torpid fibres to a resumption of activity, stimulate all the ex- cretories, and especially those of the surface of the body, and thus promote absorption in every quarter and in every way. Having removed as far as we may be able all pressure upon the sensorium, and so far given an opportunity of healthful play to its function, our next business is to re-invigorate its general energy, and extend it to the parts which it has ceased in a greater or less degree to actuate. Stimulants external, or internal, or both, have been almost uni- formly had recourse to for this purpose; but I cannot avoid think- ing that the practice has been too indiscriminate, and, in many cases, far too precipitate. We have observed that in many cases of hemiplegia there is not only great local inactivity, but great irre- gularity of action : a tumultuous hurry of sensorial power to some parts, with an equal withdrawment of it from others. In all such cases we should proceed gently and palliatively rather than rapid- ly and forcibly : and to do nothing is better than to do too much. We should endeavour to allay the nervous commotion, and restore the agitated system to order, by internal and external quiet of every kind. The patient should be kept as still as possible in a warm commodious bed, and a well ventilated room. His diet should be plain, with the allowance of a moderate quantity of wine, or wine and water. Camphor, musk, valerian, and other warm 534 NEUROSES. CLASS VI. sedatives, as ammonia, neutralized with citric acid, are here to be chiefly resorted to, if, indeed, we resort to medicines of any kind, and to these may be added the less stimulant metallic salts, and espe- cially those of zinc and bismuth. The warm bath may be allowed two or three times a week, and if the nights be restless the inquie- tude may be subdued by hyoscyamus. But where the case seems altogether confirmed and chronic, and an entire side, or some other extensive part of the body, shows a fixed loss of sense, and volun- tary motion, wh/ile every other part has resumed its healthy function, we may then, with safety, have recourse to the stimulant practice. This will consist of external and internal irritants, and Dr. Cul- len has given a long and useful table of both. Of the former the chief are, friction by the hand or a flesh-brush; stimulating lini- ments prepared of the concentrated acids, or the caustic alkalies inviscated in oil or lard, to render them less acrid and corrosive ; brine, or a strong solution of sea-salt; the essential oils of turpen- tine, or other terebinthinate substances; and various vegetable acrids as mustard, garlic, and cantharides, or other blistering insects. In the rank of external stimulants we are to arrange elec- tricity and voltaism. In various experiments there can be no doubt that both have been found highly beneficial; but in various cases also both have been made use of in vain, and in a few instances, with apparent disadvantage. To run over the list of those who have chiefly espoused, and those who have chiefly opposed their employment, would be useless. It is of more importance to know that a very great number of physiologists and pathologists who employed them most extensively, and particularly in the form of electricity, for the fluids are most probably one and the same, and who were at first most sanguine of success, gradually lost their confidence as they proceeded, and confessed their general failure ; and candidly owned that where for a time they promised fair and and seemed to be of use, the benefit was delusive and merely temporary. Hot and cold bathing are the next external stimulants we are to notice as applicable to the disease before us. The stimulus of hot water alone is often serviceable in local palsy, and especially when produced by cold or damp, and in conjunction with the rubefa- cients and vesicatories we have just enumerated, or with friction to the part, effected by means of the hand or a flesh-brush, and particularly when aided by terebinthinate or other essential oils,. ORDER I. AMAUROSIS-, OR GUTTA SERENA. 535 will usually succeed in restoring to the affected muscles their wont- ed power. Cold bathing is also a stimulant as well as hot bathing, but a stimulant of a different kind, for it acts indirectly instead of di- rectly. The intention with which it is used is that of forcibly urg- ing the mouths of the cutaneous vessels into a general entastic or rigid spasm, in order hereby to excite a general re-action, as in the case of the first and second stages of an ague-fit, and thus to draw the torpid muscles into the common range of association. Dr. Cullen seems favourable to this practice under a prudent manage- ment. " Cold," says he, " applied to the body for any length of time, is always hurtful to paralytic persons, but if it be not very intense, nor the application long continued, and if at the same time the body be capable of a brisk re-action, such an application jof cold is a powerful stimulant of the whole system, and has often been useful in curing palsy. But if the power of re-action in the body be weak, any application of cold may prove hurtful." AMAUROSIS, OR GUTTA SERENA. This is a disease of the eye attended with a dimness, or total loss of sight, and arising generally from a paralytic affection of the retina and optic nerve. The eyes appear natural and the pupil is dilated, and does not contract upon being exposed to the strongest light; it is sometimes attended with head-ach. This kind of blind- ness is generally preceded by an imaginary appearance of nume- rous insects or substances like pieces of cobwebs floating before the eyes. Gutta serena has always been considered as not very suscepti- ble of cure, especially when it arises from a defect of the optic nerve. In some instances an imperfect amaurosis depends on some irritation existing in the stomach and bowels, and sometimes connected with a general nervous debility, in which the eyes par- ticipate. In these cases the cure must be attempted, first by ca- thartics and emetics, to free the primae viae from all irritating mat- ter, and afterwards by administering tonic medicines to strengthen the gastric organs, to promote digestion, and reanimate the ner- vous system in general, and the nerves of the eye in particular. Blisters to the temples and to the crown of the head, and electrici- 536 NEUROSES. CLASS VI. ty, are said to be of singular service ; sparks should be taken from the eyes, and moderate shocks sent through the head, and often repeated. Errhines are of considerable use ; one grain of turpeth mineral and eight of powdered liquorice root, well mixed, form a very proper sternutatory, one fourth of which should be snuffed up the nostrils once or twice in a day. A strong infusion of vale- rian root is to be freely employed, and a mercurial course is said to have succeeded ; galvanism is also recommended, as are like- wise issues and setons. CALIGO, OR CATARACT A cataract is an opacity of the crystalline lens or its capsule When it arises without any assignable external cause, a cloudiness of vision or a settled mist is always perceptible by the patient be- fore any opacity has become visible in the pupil. The cataract shews itself as a speck or spot in the pupil of the eye, occupying sometimes the whole, and sometimes only a part of this aperture. It is most commonly of a grey or whitish colour ; but sometimes of a deep white, and it may in all cases be easily distinguished from the naturally dark appearance of the pupil. In the commence- ment of the disorder it occasions a weakness or imperfection of sight, and it terminates sooner or later in total blindness. For a description of the different species of cataract and the proper method of cure, the reader is referred to books on surgery. Specks or spots on the eyes are frequently the consequence of inflammation. These may sometimes be removed by the applica- tion of a powder formed by mixing a small proportion of white vi- triol with refined sugar; this may be blown into the eye through a quill, or a simple solution of white vitriol, or a very mild one of corrosive sublimate, may be tried. When such means fail, the only remaining expedient is a surgical operation, which if judi- ciously performed, will sometimes succeed. A blood-shot eye in consequence of external violence, or strain- ing by vomiting or coughing, seldom requires any thing more than to be fomented with warm milk and water, or a solution of the acetite of lead. The watery or weeping eye, proceeding from a relaxation of the glandular parts of that organ, requires some astringent application, CARDER I. DISEASES OF THE EYES. 53? as a small proportion of brandy with water used cold, or the pre- paration of white vitriol with the whites of eggs, to be found in the Appendix ; besides which, blisters and purgatives will be proper. Fistula lachrymalis is a disease arising from an obstruction in the nasal duct, preventing the tears and mucus from descending into the nose. A tumour is thus produced in the inner corner of the eye, and the tears and mucus run off down the cheek. A cure of this troublesome complaint may be attempted by the frequent application of the extract of phytolacca decandra, and if unsuc- cessful, the only remedy is a surgical operation. Strabismus, or squinting, may proceed either from a nervous affection, or a vicious habit acquired in children by having their eyes unequally exposed to the light, or by imitation from a squint- ing nurse or other example. When this defect has not been con- firmed by long habit, it may be obviated by darkening the more perfect eye for some hours daily, by which means it will be gradu- ally weakened, and the defective eye will be gradually corrected by using it, or the child may wear a mask which will only permit him to see in a straight direction. That condition of the eyes called myopia or short-sightedness, may be in some measure remedied by the help of concave glasses, and in a contrary condition of the eyes convex glasses will be re- quisite and useful. When the sight is considerably impaired and weakened by too • constant application, especially night-watching and candle-light lu- cubrations, these causes should be immediately abandoned, and the use of green glasses will greatly assist in mitigating the com- plaint. When the great importance of the organs of vision and their very complicated and delicate structure are duly considered, it will appear obvious that too much care cannot be taken for their preservation,. On the least appearance of diseased eyes, excess of every kind should be carefully avoided, as the use of strong liquors, or long abstinence from food, sudden transitions from darkness or obscure light into that of the bright light of sunshine, or the glare of candles. All irritating causes, as smoke, the vapours of stimu- lating or volatile substances, vivid lights and glaring colours, are to be considered as highly prejudicial to the organs of vision. Among the preventive means to be employed by those who are subject to disorders of the eyes, issues or setons on the arms, food 68 535 NEUROSES. CLASS VI. of easy digestion, and occasional laxatives, are to be regarded as of no inconsiderable importance. PARACUSIS, OR DEAFNESS. Deafness may proceed from various causes, as a radical defect in the organ of hearing which admits of no remedy. It may arise from too great dryness of the ear, from a deficiency in the secre- tion of wax, from hardened wax obstructing the passage of sound. inflammation of the membrana tympani, inflammation or obstruc- tion of the Eustachian tubes, fevers, violent colds affecting the head, syphilis, and atony, or paralysis of the auditory nerves. Ac- cording to Mr. Saunders, all the diseases of the internal ear may be denominated nervous deafness; the term in this sense embrac- ing every disease the seat of which is in the nerves, or parts con- taining the nerves. The different species of deafness may in gen- eral be distinguished by their peculiar symptoms, and the mode of treatment should be varied accordingly. A deafness depending on hardened wax obstructing the auditory passage, may be effectual- ly removed by syringing the ear with warm water and soap, or Water saturated with common salt, which is found to be an excel- lent solvent of the wax ; the ear may afterwards be cleansed by syringing it with warm water. This kind of deafness is attended with noises in the ear, particularly a clash or confused sound in mastication, and of heavy sounds like the ponderous strokes of a hammer, but the existence of wax may be ascertained by examina- tion with a probe. If a thin acrid or foetid discharge attends the deafness, blisters should be applied behind the ears, or a constant discharge kept up by issues, and an infusion of the root of indigo weed should be injected into the ear. When deafness proceeds from cold affecting the head, this part should be kept warm, espe- cially by night. The feet likewise ought to be kept warm and frequently bathed in warm water, and purgatives occasionally taken. In that species of deafness occasioned by an obstruction of the Eustachian tube, the patient cannot feel the membrana tympani crackle as it were in his ear, or the membrane forced outward on blowing forcibly with his nose and mouth stopped, and there is no noise in the head like that which is known to accom- pany nervous deafness. To remedy this species of deafness, Mr. ORDER I. SYNCOPE. 539 \. Cooper has resorted to the mode of puncturing the membrana tympani, by which the air is conveyed into the cavity of the tym- panum, answering the same purpose as the Eustachian tube. This operation in the hands of Mr. Cooper has proved successful, and others have adopted it with the same result. A nervous deafness generally approaches in a gradual manner ; the person hears bet- ter at one time than at another; a cloudy day, a warm room, and agitation of the mind, increase for a time t[ie difficulty of hearing; the patient experiences different noises in the head, as the mur- muring of water, the hissing of a boiling kettle, roaring of the sea, rustling of leaves, the sound of bells, and blowing of wind. Sul- phuric aether dropped into the ear in such cases, answers a valu- able purpose in stimulating the torpid nerves; electricity, galvan- ism, and cold bathing, are also appropriate remedies ; and Mr. Wilson asserts that galvanism is capable of effecting a cure when deafness depends on a defective energy of the auditory nerve. Errhines will often be found useful auxiliaries. When deafness is induced by atony or paralysis, the sulphuric aether, the juice of garlic and other stimulants, should be applied and retained in the ear by dossils of wool or cotton. When deafness is the effect of fever, the hearing is commonly restored with the strength of the patient. In all cases of this complaint, it is of importance to keep the head warm and the feet dry. SYNCOPE. This is a sudden swoon or fainting, in which the action of the heart is decreased, and sometimes a total suspension of the pulse and respiration takes place. It is generally preceded by anxiety about the praecordia, a sense of fulness ascending from the sto- mach towards the head, vertigo or confusion of ideas, dimness of sight, coldness of the extremities, and paleness of countenance. In some instances the case is rendered more urgent by being at- tended with vomiting, convulsions, or an epileptic fit. When syncope occurs at the commencement of acute diseases, it #gene- i ally considered unfavourable. This unpleasant affection may be produced by an excess or a deficiency of blood, a loaded or dis- ordered stomach, violent pains, sudden emotions of the mind, pro- fuse evacuations, particularly of blood, aneurisms of the heart, and other organic affections. j40 NEUROSES. CLASS VI. During the fit, the patient should be exposed to the open cool air, and the neck and face sprinkled with cold water and vinegar ; volatile spirits or strong vinegar should be applied to the nostrils. The patient should be piaced in a recumbent posture, and the ex- tremities well rubbed with hot flannels; and soon as the power of swallowing returns, a glass of wine or brandy and water, or some volatile spirits, should be given. When persons are frequently affected with syncope, the peculiar cause should be ascertained. and the appropriate remedies applied. ORDER II. DYSPEPSIA, OR INDIGESTION Among the numerous diseases to which the stomach is liable, dyspepsia is one of the most obstinate and distressing. Though it seldom of itself proves fatal, it is frequently protracted to a length of time, in despite of every remedy that can be devised. The causes which give rise to this disease are various, such as indo- lence, intense study, grief and anxiety of mind, profuse evacua- tions, abuse of ardent spirits, and a too liberal use of strong tea or other relaxing liquors; immoderate use of tobacco or opium, wasting of the saliva, and exposure to cold and moist air. The more immediate causes are a deficiency in the quantity or quality of the gastric fluid ; and atony, or debility of the muscular coat of the stomach. This disease is generally attended with nausea, flatulent disten- tion of the stomach, vomiting*of viscid mucus,- heart-burn, eructa- tions either sour or rancid, and great costiveness; a sense of constriction and uneasiness in the throat, with pain in the side, paleness of countenance, languor, lowness of spirits, palpitation, and disturbed sleep. When with many of the above symptoms, there is an acute and constant pain in the region of the stomach, unattended with faintness or fever, often with a swelling of the stomal, it is termed gastrodynia: if a degree of faintness at- tend, cardialgia, or heart-burn. When the principal symptom is a sense of burning and distressing heat in the stomach, rising into the throat, and extending to different parts of the body, with a fre- quent and copious discharge of a watery or glairy insipid fluid from the mouth,, it has the name of pyrosis, or water-brash, ORDER II. DYSPEPSIA, OR INDIGESTION. 541 Dyspepsia may be defined a partial or entire interruption in the first stage of digestion, the proximate cause of which is the dimin- ished quantity or vitiated quality of the gastric juice.* When the assimilating powers of the digestive organs are greatly impaired, the stomach acquires such a state of irritability that the usual arti- cles of food create the most intolerable distress, nausea and vomit- ing arise, the bowels become costive and flatulent, or gripes and diar- rhoea ensue. From a peculiar sympathy with the stomach, there is sometimes great general distress, a sense of numbness in the extre- mities' and scalp," acute pain in the side, vertigo, convulsions, and apoplexy. Nor is the patient's mind in every instance exempted from disturbance. The temper frequently becomes irritable, easily ruffled, peevish and dissatisfied, as in the hypochondriac affection. Dr. Thomas adverts to cases of dyspepsia attended with a scirr- hosity of the pylorus, and also as connected with a morbid condi- tion of the functions of the liver. Dr. Hosack remarks that a scirrhous state of the pylorus exists more frequently than is gene- rally supposed, having been found in individuals of great feebleness of constitution, who have at all times been guarded in the choice of food, who have lived chiefly upon plain broths and milk, and have never been addicted to the use of spirituous and malt liquors. Respecting obstructions of the liver, as the cause of dyspepsia, such instances have frequently fallen under the observations of Dr. Hosack, in which, however, the hepatic affection had been entirely overlooked, an error which is too commonly committed by prac- titioners, and which has been productive of the most serious results. To assist in the cure of dyspepsia, the patient ought in the first place to avoid every species of luxury and intemperance, indolence, and late hours ; and should accustom himself to moderate exercise in a pure air, early rising, simple diet, cheerful company, and pleasing occupations. It must be apparent that a radical cure cannot be effected with- out a rigid perseverance in a suitable course of diet and regimen. The patient should be restricted to a few simple articles that will require the least possible exercise of the digestive organs, while in * This definition is given by Dr. J. Revere, of Baltimore, who, in the American Medical Recorder, Vol. IV. p. 50, has favoured the public with some excellent ob- servations on the nature and treatment of dyspepsia, which are recommended to the attention of the reader, i 542 NEUROSES. •LASS \i. a deranged and debilitated condition ; at the same time selecting such as abound in nutritive qualities and are most readily soluble in the gastric juice, and least liable to run through a chemical change in the stomach. The milk of cows is an article which, as I conceive, is'the one to be most relied on to answer these views. Nor is this assertion to rest on the experience of a single individ- ual only, but is supported by authority which will not be readily disregarded.* To obtain all the advantages of its valuable proper- ties, however, milk is not only to be taken in small quantities seve- ral times in a day, but it must be considered as the principal arti- cle of the patient's diet. When it can be procured directly from the cow, it should be preferred in that state, and the patient may take a cup of milk as often as the stomach prompts a desire for food. Although it may disagree at first, a fair trial of its effects shoukUalways be made, varying its condition by boiling or taking off the cream. But if much acidity prevails in the stomach, a wine glass full of lime water, added to half a pint of milk, will prove a valuable corrective, and in case of vomiting, this composi- tion will also be found one of the best remedies. Should a milk diet, however, on trial, occasion an oppression at the stomach, with head-ach and heaviness, and the patient should resolve to abandon its use, recourse must be had to a diet consisting chiefly of animal food, such as game, poultry, venison, the lean part of beef and mutton made tender by keeping, and fresh fish and oys- ters. Unleavened biscuit, rice, roasted potatoes, and light pud- dings of wheat flour, may be allowed in moderation, but all kinds of soft bread, cakes, and pastry, which have undergone a partial fermentation, should be avoided, as should every description of confectionary, nuts and crude fruits. Much depends on the mode of cooking even the most simple food. Meat, for dyspeptic pa- tients, should be roasted or broiled with a quick fire, that the nu- tritive qualities may be preserved, and the natural juice should be the only gravy used. But all salted meat, pork and veal, ought to be rejected, and also broths and soups, as being more difficult of digestion than meat in substance. Butter, when become rancid, and all fatty substances, should be prohibited. It should be ob- served as important that the food be taken only at fixed periods, * The learned Professor Chapman, of Philadelphia, in his practical lectures, as I am well informed, enjoins a strict conformity to a milk diet in all gastric affections'. ORDER 11. DYSPEPSIA, OR INDIGESTION. 543 allowing sufficient time for one meal to pass the process of diges- tion before the stomach is burdened with another. The pa- tient should be at rest and use no exercise for an hour or more after eating. Coffee, with milk and sugar, make a proper and pleasant meal for morning and evening, but neithersolid nor liquid food should ever be taken hot, as it will injure both the teeth and the muscular tone of the stomach. In regard to drink, all fer- mented liquors, as strong beer, &c. are pernicious : pure water, with or without a little brandy, old Madeira wine in small quanti- ties, and old bottled cider, form the most suitable drinks for dys- peptic patients. With the view of fulfilling the first and most important intention in the cure of dyspepsia, an emetic of ipecacuanha alone, or as some advise, with an equal quantity of sulphate of copper, should be administered and repeated when occasion requires. This re- lieves the stomach of offensive crudities, and prepares that organ for the reception of the proper nutriment. Besides, by the effort of vomiting the circulations are equalized, and cutaneous perspira- tion promoted. Costiveness, a constant attendant on dyspepsia, must be removed and obviated. If pills containing ipecacuanha one grain, rhubarb and calomel each two grains, be directed every day for a length of time, they will have the effect of a mild and efficacious aperient well adapted to this complaint, if the dose be not increased so much as to excite an unpleasant sensation of nausea; but their use may be regulated according to the effects produced. Should these pills however fail to remove constipation, and a more effectual carthartic medicine should be required, rhubarb in powder according to the experience of Dr. Good, is one of the best articles in the materia medica; this in doses of from 20 to 25 grains should be occasionally repeated, and if necessary let it be combined with aloes and soap, or two or three pills of the following formula may be occasionally taken with the best effects. R. Thoroughwort in powder, carbon soda, capsicum, and castile soap, equal parts, made into pills of common size with syrup. For the correction of flatulency in dyspepsia, magnesia is a remedy of peculiar value, and it may be taken to the extent of one ounce in a day. As a common carminative a strong infusion of the root of cow parsnip will be found beneficial. It often occurs in gastric af- fections that the patient is troubled with offensive eructations from the stomach resembling rotten eggs, indicating that the food is d^ :>44 NEUROSES. (LASS VI tained in the stomach till it becomes putrid ; here the mineral acids are found useful, but a far more sure and effectual remedy is pow- dered charcoal; if this be administered in doses of ten to twenty grains, three or four times daily, it will scarcely fail to afford essen» tial relief. But in order to derive all the benefit which this medi- cine is capable of imparting, it must be prepared as directed in the Appendix. Tar water is another article strongly recommended for the peculiar acid which it contains, as being signally useful in this complaint; a wine glassful for a dose, three or four times daily, prepared as directed in the Appendix. " That species of dyspepsia which has its origin in, or is ulti- mately connected with hepatic obstructions, requires a mode of treatment altogether different from that which proceeds from a de* ranged state of the digestive organs alone. With the view of un- loading the diseased liver and opening the biliary ducts, a deobstrm ent course of the blue pill or calomel should be adopted and per- sisted in, accompanied with the usual auxiliaries appropriate to a morbid condition of the liver. To accomplish the intention of correcting the morbid acidity in the stomach, alkalies and absorb- ents are chiefly to be relied on. Of the former we may employ either sal soda, sal tartar, or sal aeratus, dissolved in a mucilage of gum arabic or tragacanth, and taken in such quantities as the sto- mach can bear, and the symptoms of acidity may demand. The volatile alkali may, however, be preferred ; and this in the form of aqua ammonia may be given in a dose of a tea-spoonful two or three times a day. The absorbents and antacids, most useful in this disease, are calcined magnesia, chalk, and lime water, which may be alternated with the alkaline solution, with the best effects. The calcined magnesia should be preferred, and the lime water may be given to the extent of a pint in a day. When the patient is dis- tressed with pain and flatulence in the stomach and intestines, with vomiting, the application of a large blister to the stomach be- comes highly necessary, and the essence of peppermint, with the spirits of lavender, and a good proportion of laudanum, must be prescribed ; the saline mixture in the act of effervesence will also be useful. But in these circumstances, opiates must be administer- ed to the full extent required for the alleviation of the pain and other urgent symptoms. Or the hyoscyamus^may be substituted, as being less apt to occasion costiveness. When by the employ- ment of the foregoing remedies, the violence of the disorder is in f*ttDER II. DYSPEPSIA, OR INDIGESTION. 545 •ome degree mitigated, it becomes necessary to resort to medicines best calculated to restore the lost tone of the stomach in particular, and the system in general. Here the tonic powers of cinchona, with chalybeates and stomachic bitters, and the mineral acids, are indispensable^ and these will effect all that can be expected from medicine. The compound tincture of cinchona prepared with brandy, and combined with a due proportion of some chalybeate, wine or tincture, is one of the most eligible preparations, and this may be accompanied with decoctions of columbo, cascarilla, quas- sia, thoroughwort^ calamus aromaticus, and hops. Or the same in- dication may be fulfilled by the myrrh and steel mixture of Dr. Griffith.* In many instances of complaints of the stomach, as cardialgia, gastrodynia, and pyrosis, the oxide of bismuth had been employed with satisfactory success after other remedies had failed. This medicine is to be exhibited in doses of from three to ten grains three times a day. Five gr-ains may be Considered as a medium dose, but it will be prudent to begin with three and increase gradually. It should be combined with about twenty or thirty grains of gum arabic, or tragacanth, to guard against its irritating the stomach. I have combined it with a tea-spoonful of arrow root, and have experienced the great utility of the medicine. The use of the tepid bath, of about ninety-eight degrees of heat, for half an hour every other day, for two or three months, has in many instances, as asserted by Dr. Thomas, (Modern Practice,) proved of great service to dyspeptic persons. And on some oc- casions the cold shower bath will tend to invigorate the system, and admirably coincide with the tonic remedies in the restoration to health. There is a class of remedies yet to be mentioned, which in England have been found very efficacious in dyspeptic complaints ; these are the various mineral waters with which that country so * A powder composed of 20 grains of colomba, and 6 or 8 grains of phosphate of iron has been employed in gastric affections with advantage. The following is a valuable stomachic remedy. R. Infus. Gentiau lb j. Tinct. Rbei 3 ij, Syr. aurant 3 ij. Magnesia 3i. M* Dose, a wine glass full four times in a dav. 69 .»4(» NECROSES. CLASS VI. much abounds. These waters, being strongly impregnated with the properties of iron, impart their excellent tonic powers without exciting permanent heat, and thereby improve the general health and spirits*, which are so intimately connected with the functions of the digestive organs. In our own country we have springs at Ballston and Stafford, which possess similar chalybeate properties ; their medicinal powers have been demonstrated in a variety of in- stances, and are well deserving of further trial. The exercise and change of air, with the amusements and social company always to be found at such resorts, are admirably calculated to inspire hope and confidence, and to banish all gloom and despondency. The artificial soda water is likewise capable of rendering the dyspeptic patient very essential benefit if copiously employed. A sea voyage may with propriety be recommended to persons who are afflicted with dyspeptic or other similar complaints of the stomach. It has been remarked that cold and wet feet are frequently the cause of complaints of the stomach and bowels ; these therefore should be guarded against with the greatest care. It will be of great utility about half an hour before eating, and again soon after, to have recourse to brisk friction with a flesh brush or coarse cloth, over the region of the stomach and abdomen, and the same opera- tion should be practised every night and morning over the whole body and extremities while in bed. The operation of friction re- markably contributes to the health of sedentary persons; it invigo- rates and excites the natural warmth, promotes insensible perspira- tion and cutaneous absorption, increases the action of the stomach, and consequently its power of digestion. In short, friction is so highly conducive to the recovery of the patient, that it cannot be too strongly inculcated. But no less important to the restoration of the dyspeptic patient, is exercise on horseback and ehange of place and amusing seenes, remembering that riding should be per- formed on an empty stomach, and the most proper hour is in the morning before breakfast. ANAPHRODISIA, OR IMPOTENCY It is in consequence of general weakness that a debility of the genital system is induced, and that the venereal appetite and power «*RDER n. ANAPHRODISIA, OR 1MP0TENCY. 547 of procreation are suspended. Many are the causes assigned for complaints of this nature. Dr. Hosack enumerates as the princi- pal, the abuse of mercury in the treatment of syphilis, and of some other disorders, the unsuccessful management of gonorrhoea, the pernicious practice of using lead injections, neglected gleets, excessive venery, and particularly onanism. In this condition of the physical system, Dr. H. remarks, the intellectual powers of the patient largely participate ; and few cases have stronger claims on the attention of the practitioner, than those in which those cir- cumstances, arising from these causes, are united. Too frequently. the representations and sufferings of the patient are regarded mere- ly as the phantoms of the mind; and from an indifference both as to the real disease, and a want of confidence in the means that may be successfully employed, the most deplorable consequences ensue. The various methods by stimulants and restoratives hith- erto put in practice, have in general failed to renovate the consti- tution, thus broken down, and to remedy the evil. But of late years, the employment of the lytta, in cases of seminal weakness and impotency, when arising from the causes above stated, has been attended with the happiest success. The introduction of this practice in the treatment of cases of this nature, in the United States, is due to Dr. Francis, of New-York. Most generally any uneasy or distressing symptoms, occasioned by the internal use of the lytta, disappear of themselves by ceasing for a while to take the medicine, and that too within twenty-four or thirty-six hours afterwards. But should it in any instance produce mischievous effects, they can be removed by the readiest and mildest means ; an active antiphlogistic treatment, such as blood-letting, saline cathartics, a free use of diluents, as soda water, barley water, &c. and the warm bath, will answer the desired purpose. The claims of camphor in counteracting the action of the lytta, Dr. II. thinks, is not well founded, and his own experience does not enable him to recommend it. The lytta is not, as is generally supposed, local in its action, but produces a general excitement; it increases the sanguineous circulation, the flow of urine, and the discharges by perspiration : from its diffused action, the whole system becomes invigorated, and this altered state is manifested by an enlivened rendition both of the mind and body. The morbid discharge from the urethra becomes altered, and assumes a thick and opaque wspect, and ultimately the wonted functions of the body are ret tor- 548 NLUROSEs. CLASS U ed. In the administration of the lytta, the tincture seems to be the most agreeable, and in general the most manageable form. The extent of the dose depends materially on the peculiarity of the case. Robertson observes, " It seems an invariable rule, that the greater the existing debility either of the general habit, or of the generative organs, the greater quantity of the lytta is requisite to effect and keep up the irritation in the urinary passage ; and in such cases, the cure is always more tedious. In those apparently stout, small doses, comparatively speaking, can be taken ; while in those whose general health, or whose generative organs only, are most morbidly affected, can take the most; and as they ap- proach to health, the doses requisite to keep up the irritation must be diminished, the system, and also the generative organs, being more susceptible of its action." Experience strengthens the pre- ceding remarks of Mr. R. The dose of the preparation with which Dr. H. has generally commenced, is twenty or five-and- twenty drops three times a day, in a little wine, tinctura amara, or water. After the use of the article a few days, the dose is to be increased to thirty or forty drops, and as often repeated in the twenty-four hours. It has happened at times, that on the third or fourth day, and how and then even earlier, that the patient com- plains of some little uneasiness in passing water. This, if it does not increase, may be for a while disregarded. If the pain be- comes severe,' the remedy must be laid aside until the distress abates; after which it may again be prescribed to the same extent, if not greater, until similar effects are again induced: in this man- ner, the use of the lytta is to be continued. A practical precept must be here enforced, perseverance in the use of the remedy. The extent to which it may be carried would, unaided by experi- ence, seem incredible. Cures have been effected within a few days; at other times, from peculiarity of condition, as many months or years have been required to accomplish the object in view. But such disconsolate cases as call for this prescription demand all the preserver's skill; yet the great success which has followed this practice justifies the firmest perseverance equally on the part of the physician and the patient. Dr. H. states a case which came under the care of Dr. Francis and himself in November, 1816. The lamentable condition to which the sufferer had been previously reduced by the bad man- agement of a neglected syphilis, and afterwards still further by an ORDER II. ANAPIIRODISIA, OR IMPOTENCY. 549 injudicious use of lead injections of an unwarrantable strength for nearly two years, led him, in a state of extreme mental anguish, to disregard the advice given him, and to seek the termination of his anxiety by self-destruction. With this view, he took nearly six ounces of the tinctnre of cautbarides during the night ; yet no dan- gerous symptoms occurred. He admitted he felt a degree of warmth throughout his body, to which he had been a long time a stranger ; and that his mind was less depressed than before the commission of this act of folly ; he nevertheless went out as usual the next morning. He after this became persuaded that his situation was not altogether hopeless, and that his constitution, as he said, had still some stam- ina left to justify hopes of a recovery. He was now induced to take the tincture of lytta in the manner and quantity prescribed; two drachms and a half three times a day, united with a dessert spoonful of the tinctura amara; and generous diet was also re- commended. Within about three weeks from this period he was renovated, and considered himself an altered man. His virile powers resumed their wonted energy ; nor has he In the slight- est degree relapsed into his former state of weakness. This is unquestionably a rare instance in which the lytta, rashly taken, and to an inordinate amount, was not followed by any serious injury.* It nevertheless proves that the accounts generally given of this article exciting deleterious effects in mod- erate doses, are not to be received but with the greatest caution. The lytta, like the common spirit of turpentine, the effect of which was once supposed to prove fatal even in small quantity, experi- ence has now shown may be taken to an extent our predecessors could not have imagined. In obstinate gleets, after the ordinary vegetable and mineral tonics, the iron and gentian pills, the bal- sams and terebinthinates, have failed, Dr. II. has also given the tincture of lytta in the proportion of a drachm with a tea-spoon- ful or two of bitters, three times a day with permanent advantage. It should be remembered that the tincture does not generally pro- duce immediate good effects, but in a majority of cases it is the result of a continuance of the remedy for a considerable time. * The author has known three soldiers to swallow copious drams of tincture of lytta by mistake. Two of'them suffered the severest symptoms of strangury for twenty-four hours, until relieved by the usual remedies; one was tormented with painful erection, and th«> third escaped with trifling complaints. 7>7>0 NEUROSES. CLASS VF . spine. If it should appear that the patient has been in- dulging too freely in spirituous liquors, or has loaded his stomach with some indigestible and offensive substance, a strong emetic must as soon as possible be forced down, and the operation pro- moted uutil the stomach is cleared of its injurious contents, when the convulsions will entirely subside. Cathartics may be given and persisted in. The method to be pursued in the intervals of paroxysms, with the view of a radical cure in epilepsy, must be varied according to the cause by which it is produced. If the disease is sympathetic, and arises from worms or from teething, it should be treated as al- ready advised in those complaints respectively. In every instance, the particular cause, if it can be ascertained, should be remedied or obviated, as far as practicable. When the patient is of a plethoric habit, venesection will be proper in the paroxysm, to such extent as circumstances may require and justify, repeating the operation pro re nata. Blisters between the shoulders, and on the extremi- ties, and mustard, and other stimulating poultices to the feet, will produce beneficial effects. When the approach of a paroxysm is indicated by the epileptic aura, it may sometimes be prevented by a tight ligature applied to the limb above where the sensation of coldness begins. In many instances of epilepsy, which recur peri- odically, and which appear to depend on a debility, or irritability of the nervous system, the Peruvian bark, combined with chaly- beates, will be found particularly efficacious, and when aided by the well known strengthening powers of a cold bath, a radical cure may often be expected. Among the various antispasmodic medi- cines which have been celebrated by different authors for the cure of this disease, are musk, opium, and valerian ; the metallic tonics most extolled, are, the flowers of zinc, from half a grain to eight grains ; ammoniacal copper, quartei of a grain to five grains ; and the nitrated silver, one eighth of a grain to half a grain, twice in a day. With respect to their peculiar efficacy, it may be observed that each one has been known to afford flattering prospects, and again to disappoint expectation, and their success in any particular case can be known only by a fair and patient trial. The nitrated silver, from its successful employment, has, I am warranted to sa\% 72 570 NEUROSES. CLASS VI. the strongest claim to preference. Arsenic and fox-glove, have some repute as remedies in the present disease; and Dr. Rush has cured a boy by giving him two grains of sugar of lead, three times a day.—Opium is said to be the most effectual antispasmodic ; it should be administered in such doses as the patient can bear, a short time before the expected paroxysm, and repeated at proper inter- vals, increasing he dose in a gradual manner, in proportion to the violence or frequent recurrence of the fits. In those cases where the fits recur during sleep, a full dose of opium should be given at bed time. But the skunk cabbage root, is probably equally effi- cacious as an antispasmodic, and is not apt like opium to induce costiveness ; let this have a fair trial, in doses of half a drachm, twice or thrice in a day, and if it fail, it will produce no injurious effect. The application of a tobacco poultice to the pit of the stomach, if repeated for several days, just before the return of the paroxysm, has destroyed the diseased catenation and effected a permanent cure. There are two of our domestic productions which have been found to possess considerable efficacy in the cure of epilepsy. The common cow-parsnip was brought into notice by tbe late Dr. Joseph Orne, of Salem, who adduced five cases of its trial, in three of which complete cures were effected. In the three successful cases, the patients were remarkably affected with flatulency, and a morbid sensibility of the stomach, which complaints were remedi- ed by the carminative effects of the cow-parsnip. It was given in doses of two or three drachms of the powdered root every day for a length of time, and a strong infusion of the leaves and tops, to be drunk at bed time. This medicine undoubtedly possesses consid- erable efficacy, and merits further trials in similar cases, for if it does not cure, it often mitigates the symptoms of epilepsy. See Dr. Orne's communication to the Massachusetts Medical Society and American New Dispensatory. The stramonium, or thorn-apple, is another remedy much to be relied on in the cure of this disorder; though its failure is not un- frequently to be expected, it will often justify the most sanguine expectations. The utility of this medicine, like many others, is frequently lost for the want of proper management and due perse- verance. " Dr. Fisher, of Beverly, from extensive experience, as- sures us that great confidence may be reposed in the virtues of this medicine, in those cases of young persons where the fits occur ORDER III. EPILEPSY, OR FALLING SICKNESS. 571 daily or monthly, at regular periods, especially if assisted by chaly- beates, or such other medicines as particular symptoms appear to require. The patient must be kept constantly under the influence of the medicine, and will require every day one or two doses, ac- cording to the severity of the symptoms. The saturated tincture is the most convenient form for children, and the requisite dose may be known by the pupil being more or less dilated during its use." In one instance, a lady about fifty years of age was cured of alarming attacks of epilepsy by taking one grain of the extract of stramonium, once or twice in twenty-four hours; although she did not suffer another attack after commencing the use of it, she found it necessary to continue taking it, during several months, to remove all apprehensions of a recurrence, with which she was oc- casionally menaced. A single grain seldom failed to excite un- pleasant vertiginous sensations, accompanied with an efflorescence about her face, and some degree of stupor. In another instance, as I have been informed, a man took fifty grains daily, divided in- to two doses, which constantly obviated a recurrence of the fits, though it produced dilated pupils, blindness, and sleepiness. See stramonium in American New Dispensatory. Persons liable to fits of epilepsy should live abstemiously, carefully refraining from all gross animal food, and the poison of spirituous liquors. They ought to cultivate composure of mind, and guard against all violent passions. Moderate exercise ought to be practised, avoiding ex- tremes of heat or cold, and also such situations as may expose the patient to danger of accidents when suddenly seized with a fit. Dr. Hosack has treated epilepsy with success by bleeding, by abstinence from animal food, and other means of diminishing the current of blood to the brain, considering it more a disease of the blood-vessels than of the sensorium. He has never found antis- pasmodics, or the metallic tonics, arsenic, zinc and copper, of the least use in this disease. Epileptic fits are sometimes occasioned by imitation and sympa- thy ; the presence of a young woman during a paroxysm has pro- duced the disease in a number of young female spectators. The disease has also been known to arise from violent and outrageous fits of passion in children. Dr. Parkinson relates the following remarkable instance. A girl about seven years of age, having been habitually indulged by fond parents, was, whenever restraint was attempted, thrown into a violent gust of passion, which termi- 572 NEUROSES. CLASS VI. nated in an epileptic fit. After employing, without the least ap- pearance of success, every remedy which physicians could devise, her parents, in despair, declined any further attempts at a cure. At length a friend recommended a remedy, which he asserted would, if employed with a strict attention to every circumstance enjoined, infallibly effect a cure. He directed two ounces of blood to be taken from the arm of the patient, about the full of the moon, and having stirred into it a tea-spoonful of salt, she was to swallow the mixture whilst still warm. If any return of the fit should occur, the same operation, and the same potion, was to be repeated on the ninth morning. Such was the confidence reposed in this singular prescription, that it was rigidly complied with, not, however, without exciting in the unfortunate subject of the exper- iment, the strongest signs of repugnance and horror. Complete success was the reward of their resolution, for not only was the return of the fit prevented, but a most unexpected event took place ; the child was no longer prone to those violent gusts of passion to which she had hitherto been subject, wisely preferring submission to the alternative of drinking her own blood. CATALEPSIA, OR CATALEPSY This singular disorder very rarely occurs in practice, and authors are not agreed respecting its nature and causes. In our nosology it is defined, a temporary suspension of the senses and voluntary motion, unaccompanied by profound sleep or stertorous breathing, circulation and respiration continuing, the limbs usually flexible ; the body and limbs retaining the position in which they may be placed. The fits generally seize the patient at intervals, and last usually a few minutes, though sometimes they continue for some hours or days. It is rarely preceded by any signs that indicate its approach. In a few instances, a stiffness of the neck or a dull pain in the head has ushered in the fit. In the disorder, the patient is without sense or motion, continuing in the posture in which the fit attacked him until a recovery from it; the limbs are moveable by another person, but however they are disposed, the patient never alters their position until the paroxysm is at an end. He neither sees, ORDER III. CATALEPSY. 573 hears, nor feels, whatever methods may be used to excite the sen- sations. H swallows greedily all that is given him ; the counte- nance becomes florid ; the eyes are open, seemingly fixed upon some object. At the close of the fit, he fetches a deep sigh, and then recovers. The following case was communicated to Dr. David Hosack, by Dr. John Stearns, of Waterford, State of New-York. " The occurrence of catalepsy is so unfrequent, that some writ- ers of celebrity have even denied its existence. A detail of the symptoms and treatment of the following case, may therefore shed some light on this branch of medical science. The subject is a boy of eleven years of age, whose constitutional health, strength, and activity, have sustained no injury from the repeated paroxysms of this complaint. He has ever enjoyed all the qualities common to boys of that age. " In the winter of 1804, he was first observed by his preceptor to pause in reading his lesson; this was then ascribed to a voluntary dumbness, and it was not till the recurrence of several paroxysms, that it was suspected to be the effect of disease. A few days after its first appearance in the school, it was discovered ia the family, by his mother, when one of his brothers, a schoolfellow, remarked that' Philo is dumb again.' This induced her to inquire into the particulars, of which she soon afterwards gave me full information. As she expected no relief from medical aid, I made no prescrip- tion, but occasionally called to learn the progress of the complaint. In the paroxysm I could observe no unusual variation in his coun- tenance, except an involuntary unmeaning stare, and a trifling di- latation of the pupil. His muscles were not generally in a state of rigid contraction, but relaxed and susceptible of motion, al- though they did not possess the power to move. He remained perfectly motionless, and during the continuance of the fit retained the posture he had assumed at its accession. To this observation there is one remarkable exception. If he was walking when at- tacked, he never stopped, but continued to pursue the same direct course until the fit ceased, unless prevented by some intervening obstruction. The voluntary muscles, in this instance, were in full exercise, while the power of volition was entirely suspended. The time passed in the paroxysm was to him totally annihilated ; he connected the last idea he had before the accession of the fit with the first one that occurred after its cessation, and resumed 574 NEUROSES. CLASS VI. the subject he was pursuing, as if nothing had intervened. If he was reading, or relating a story, or pursuing any amusement, or employment of any kind, he was sensible of no interruption. " The paroxysms occurred irregularly ten times in twenty-four hours, and never exceeded three minutes in duration. His pulse has ever been natural, and no morbid action has disturbed any of the functions of his system. " After the disease had continued in this manner four years, I prescribed the nitrate of silver, on the presumption that it was nearly allied to epilepsy, and required a similar treatment. This remedy was faithfully administered three months without producing any alleviation of the complaint. I then substituted the acetite of lead, the use of which was continued six weeks before any sensi- ble effects were produced. After this period he was never known to have any more of the fits. They did not gradually disappear, but suddenly ceased. " A few days after the final cessation of the complaint, he was affected with violent pains in his knees, and in the muscles of his thighs; they were suddenly transferred from these parts to his abdomen, where they were so violent as to require some medical aid, before he could obtain relief. Since that time, he has re- mained in perfect health, and entirely free from his original complaint." CEPHALALGIA, OR HEAD-ACH. The head-ach is so general a complaint that there are few per- sons who have not at some period of life been made experimentally acquainted with it. It is differently distinguished according to the degree of the complaint and the part which the pain occupies; as cephalalgia, when the pain is not very considerable; cephalea, when it exists in a high degree, and extends over the whole head; and hemicrania, when one side only is affected. When the pain occupies so small a part on one side of the forehead, that it may be covered with the end of the finger, it has been called clavis histe- ricus. Head-ach may be either internal or external, and is oftener a symptomatic affection than a primary one, and frequently ensues ORDER HI. CEPHALALGIA, OR HEAD-ACH. 3? 5 in consequence of a fever, or accompanies hysteria or some other nervous affection. It may, however, be occasioned by indigestion, foulness of the stomach, and by whatever distends the vessels of the head, or obstructs the circulation through them. It often proceeds from the suppression of customary evacuations; as the piles, bleeding at the nose, sweating of the feet, &c. A long exposure to the heat of the sun, a stoppage of perspiration, costiveness, or other causes which by impeding the motion of the blood in the lower extremities produce a greater fulness in the head ; and also an acrid state of the fluids and translations of gouty and rheumatic matter from other parts of the body, may be enumerated as among the causes of this disease. When the head-ach is owing to a fulness of blood, and the patient is of a sanguine habit of body, bleeding in the jugular vein will generally afford relief, and if necessary, cupping at the nape of the neck, or between the shoulders, and gentle purgatives may be re- sorted to. In most kinds of head-ach, especially if long continued and very violent, blisters should be applied to the neck, behind the ears, or any part of the head that is most affected. In some Cases it will be proper to blister the whole head ; sometimes they are more serviceable when applied to the back and legs. In persons of gross habit, issues, or a seton may prove beneficial. The feet and legs should be frequently bathed in warm water, aloetic wine or pills must be occasionally administered, and on some occasions it will be advisable to shave the head and wash with cold water and vinegar. In phlegmatic constitutions, a head-ach may be relieved by the use of aloetic purgatives, and by blisters, and if much debility at- tend, the Peruvian bark in powder with about four grains of salt of wormwood in each dose, will prove an efficacious remedy. Con- siderable benefit will also be derived from taking twenty or thirty drops of antimonial wine twice a day in a cup of valerian tea, as it tends to promote perspiration. From the great sympathy between the head and stomach, it frequently happens that a foul state of the stomach produces a severe head-ach. When this is supposed to be the cause, an emetic must by all means be advised, and if cos- tiveness attend, this should be removed by some proper stomachic purgative. After which, the Peruvian bark, with bitters and chaly- beates, will be necessary to strengthen the stomach. When this Complaint arises in consequence of some nervous affection, called 576 nluroseS. • class vi nervous head-ach ; after cleansing the stomach by a gentle vomit, and tbe bowels by some mild laxative, the most proper medicines will be, valerian, castor, asafcetida, and the root of skunk cabbage; and these must be accompanied with the usual tonic remedies, as Peruvian bark with steel, and stomachic bitter infusions of quassia, calamus aromaticus, and thoroughwort. In such constitutions, ex- ercise on horseback, and a nutritive diet, and probably the shower bath, will prove advantageous and salutary, as tendjng to render the habit more robust and healthy. The application of a tea- spoonful of aether to the temples, orjthe part affected, and covering it closely with the hand to prevent its evaporation too soon, will afford essential relief in the severest paroxysms of head-ach. Cephalalgia Spasmodica, or the sick head-ach, according to Dr. Fothergill, is not the companion of any particular age, sex, constitution or season, but it is incident to all. The sedentary, in- active, relaxed, and incautious respecting diet, are the most ex- posed to it. The patient, he observes, generally awakes early in the morning with a head-ach, which seldom affects the whole head, but one particular part, most commonly the forehead over one or both eyes. It is occasionally fixed about the upper part of the parietal bone of one side only, darting from one place to another. With this is joined more or less sickness, and vomiting is in some easily excited, by which the pain soon abates. In some instances the pain goes off in two or three hours, in others it continues twenty-four hours or longer, and with a violence scarcely to be endured, the least light or noise producing excruciating distress. The returns of this complaint in those habituated to it, are very irregular, recurring in some cases every two or three days, while others remain free from it as many weeks or months, depending on the various causes by which it is produced. For the most part it proceeds from inattention to diet, either in respect to kind or quantity, or both ; but this the sufferer will from experience be able to ascertain. The complaint is most readily removed by the administration of an emetic, or a mild cathartic followed by an anodyne. But to prevent a return of the complaint, costiveness must be avoided by the use of pills of aloes, rhubarb and soap, dai- ly repeated, and when acid abounds in the stomach, bitters with alkaline salts should be advised. The late Dr. John Warren was in the habit of prescribing a few grains of calomel in cases of sick head-ach from acidity in the stomach, and pften with relief. ORDER III, ANGINA PECTORIS-. $YT " Drinking a draught of warm water, at bed-time, dilutes the acid *nd gives temporary ease." In periodical head-achs, after pre- mising an emetic and cathartic, the cinchona or thoroughwort will generally effect a cure ; though I have met with a few instances of periodical head-ach in which such a degree of inflammation pre- vailed as to require bleeding and a moderate course of calomel pnd opium. In other similar Cases, the arsenical solution of Dr. Fow- ler will often succeed ; beginning with about three or four drops * repeated twice a day, and increasing the number gradually to ten or twelve. If the head-ach proceed from a vitiated state of the humours, as in scorbutic constitutions, or from a venereal taint, the decoction of sarsaparilla with raisins, or an infusion of the roots or leaves of phytolacca decandra, will prove advantageous if freely used, but in the latter affection, mercurials must be added to complete the cure. Instances will occur in which it will be found indispensably necessary to resort to opium in order to procure re- lief from the extreme violence of pain, continual watching, and even delirium with which the patient is afflicted. About twenty drops of laudanum may be taken in a cup of valerian tea, several times in a day, and bits of linen moistened with laudanum and camphorated alcohol should be applied to the part affected ; care being at the same time taken to avoid costiveness, which aggravates the complaint. That sickness of stomach and vomiting which women often experience after taking a dose of opium, may be greatly mitigated or prevented by a cup of strong coffee without milk, if taken before the narcotic effects of the anodyne are over. Persons who are constitutionally subject to head-ach, ought to guard against wet feet; they should on no account go to bed with their feet cold, and they ought always to lie with their head high, to avoid any thing tight about their neck, and to refrain from the use of spirituous liquors. STERNALGIA, OR ANGINA PECTORIS * In the American Medical and Philosophical Register, vol. I\, we find a review of an Inaugural dissertation on this disease, by —^ __ » * Dr. J. Mason Good, in his nosology, terms this disease Sternalgia, or Hreast Pang, and describes two species, acute and chronic, breast pang. The chronic species he observes has occasionally Gontinusd to harass a;nd weaken the eonstitu- 73 578 NEUROSES. CLASS VI Henry Bogart, A. M. member of the medical and surgical society of the University of New-York. The following is copied from that work as containing the valuable observations of the reviewer, which we consider amply sufficient for our purpose. Few diseases in the system of nosology, are more peculiar in their character, or fatal in their consequences, than angina pectoris. It therefore cannot but appear remarkably singular, that so impor- tant a disorder should have altogether escaped the attention of the ancients, and that we should be indebted to authors of comparative- ly late times for all that has been written concerning it. In 1768, Dr. Heberden read before the College of Physicians of London, an account of a disease of the breast, distinguished by very peculiar symptoms, and which he published in the second volume of the Medical Transactions. He denominated it angina pectoris, a name most characteristic of the disorder. The valuable treatise of Heberden gave rise to a spirit of inquiry on the subject, and in- teresting observations were soon after made and recorded respect- ing it, by Drs. Wall, Fothergill, and Percival. We shall give Dr. Bogart's description of the symptoms of this disease, in his own words : " The attacks of angina pectoris are, in most instances, sudden, and occur in those who have previously enjoyed perfect health. In a few cases, various painful affections of different parts of the body, have been observed to precede them. Spasms and indiges- tion of the stomach, and pains in the limbs, are not unusual, which are, for the most part removed, or diminished in violence, on the appearance of the disease, the first symptom of which, is an acute pain or stricture, commencing in the region of the sternum, and shooting, with peculiar pungency, in the direction of the pectoral muscle, confining itself chiefly to the left side, and sometimes af- fecting the left arm.* In two cases recorded of this disease, the sensation in the superior extremities was compared, by the patients, to the rushing of a hot fluid ; very often it is that of a numbness only. It is generally noticed when the disorder is considerably advanced, though sometimes it is altogether absent; being by no means, as' Dr. Parry observes, essential to angina pectoris. The tion, without actually destroying it for twenty years. His mode of treatment is not essentially different from other authors. * In twelve or thirteen persons whom Dr. Wall had seen, the pain was in the direction of this muscle, affecting one, or commonly both of the arms. It is remark" od by Dr. Heberden, that a soreness has been felt in these parts. ORDER III. ANGINA PECTORIS. 579 patient is usually seized in this manner while walking, or on going up an acclivity. Though the pain is violent, and comes on sudden- ly, yet it generally is of short duration, and in some instances, hardly engages the attention of the patient. A case, however, is related by Dr. Parry, of the Rev. Mr. S. in whom the pain con- tinued from the first attack of the disease, until its fatal termina- tion, and in which it was without an interval, subject only to ex- acerbations. On standing still, the pain in the commencement of the complaint ceases; but, after repeated paroxysms, it remains for some time, accompanied with oppressed breathing, anxiety, sighing, palpitation of the heart, and coldness of the extremities; an agonizing struggle for existence ensues, attended with an appre- hension of instant death. " This pain, or constriction, comes on in paroxysms, which in the beginning of the disease, do not take place so frequently, or so intensely, as when it is more advanced. 11 The paroxysms of this affection, as to their duration, are also various; they at one time, terminate in a few minutes, and at another, last hours, and even days, and occasion the severest dis- tress. Dr. Heberden met with one case in which the paroxysms continued for several days. Dr. Black, of Newry, Ireland, has re- corded a very interesting example of the disease, the last paroxysm of which commenced on Friday morning, and lasted till Saturday evening. When I visited my patient, says the author, I found him in exquisite torture; the pain was constant, but very minute, or every two minutes, it shot with peculiar violence and pungency from the left breast towards the scapula, producing each time a convulsive start, in which every muscle in the body seemed to be affected. He continued in the greatest agony till four o'clock, Sunday evening, when he expired. Repletion of the stomach, walking, the indulgence of the passions, especially those that are violent or attended with anxiety, are frequently their exciting causes. In the case of Mr. J. Hunter, the spasm was most usually excited by anxiety, or by the indulgence of the violent passions ; the more tender affections of the mind did not produce it; he could relate a story which called up the finer feelings, as those of com- passion and admiration, so as to make him shed tears, without suf- fering from a return of the pain. But as the disorder proceeds, no particular cause is essentially necessary for the return of the parox- ysms. The pain is often relieved by eructations of wind, by strait-. 580 NEUROSES. CLASS Vi ening the vertebrae of the thorax, and by resting after a full inspi- ration. It is always increased b}' motion, and mental irritation. " No uniformity is observed in regard to the state of the pulse during the paroxysms. It may be remarked, however, that the best written histories of the disease, do not afford satisfactory infor- mation on this point. It is represented to be sometimes not ma- terially affected. In two cases, recorded in the Medical and Phys- ical Journal, vol. VI. p. 321, the arterial system was not much affected, even during the fits of pain and oppression, although the patients suffered little short of suffocation ; and Heberden also ob- serves, that sometimes it is not in the least disturbed. At other times, essential deviations from its healthy state, have been noticed; the circulation being much affected, the pulse contracted, small, and irregular. Its condition probably varies, and depends on the severity and duration of the pain ; yet there can be little doubt that the pulse must, at times, give evidence of disturbed circu- lation. Dr. Hosack, who has frequently met with the disease, mentions, that in the case of a patient whom he attended, and who had suffered repeated attacks, the pulse was remarkably hard. In the intervals of the paroxysms, it is regular and natural, and th© patient is free from every symptom of the complaint." P. 24—49. Dr. Bogart enters at some length into a consideration of the causes of this remarkable affection, and succinctly delivers the opinions of the most eminent practitioners relative to them. Dr. Heberden concluded that the principal symptom was produced by a convulsion of the part affected. Dr. Wall, having discovered in- durations of the semilunar valves at the origin of the aorta, with other diseased appearances of the heart, attributed the origin of the complaint to a rigidity of those valves. Dr. Matthew Baillie maintains a similar opinion relative to the induration of the valves, of the heart. Dr. Fothergill believed that excesses of passion and anxiety contributed more to the increase of the disorder than a combination of all the other causes. Dr. Parry's theory is, that angina pectoris arises from an induration of the coronary arteries, and that this kind of mal-org'anization acts by diminishing the en- ergy of that organ. We have not room for the arguments Dr. Bogart has adduced in opposition to this popular theory of Dr. Parry: we think he sufficiently disproves it, from the experience and observations of many distinguished practitioners. The opinion which Dr. B. forms ORDER III. ANGINA PECTORIS. 581 of the nature of angina pectoris is, that it proceeds from a plethora of the blood-vessels, more especially from a disproportionate accu- mulation in the heart and larger arteries; an opinion maintained by Dr. Hosack, in a former number of the Register, and to which Dr. B. refers. He considers the large accumulations of fat, the effusion of water in the thorax and pericardium, the distended state of the vessels, and even the bony deposits occasionally met with in the valves of the heart, as the effects of such plethora. " We observe in confirmation of his (Dr. H.'s) opinions, that al- most every writer on the complaint, has commenced his cases by remarking the age and habit of the patient. The advanced life and corpulent habit are of so frequent occurrence, that no doubt can be entertained of their relation to the disease. The season of the year at which the first attack commenced, is not recorded with the same particularity ; but when noticed, it was most usually in the winter and spring of the year. Most of the patients afflicted by the disorder, had lived in a sedentary manner. Spontaneous discharges of blood from different parts of the body, giddiness, and numbness of the extremities, were often observed, and are all evidences of a plethoric state of the system." P. 40. The summary of morbid appearances, with which we are fui- nished, is taken from Dr. Parry's Inquiry, but considerably alter- ed and enlarged. On the cure of this afflicting and unfortunately too fatal disorder, we shall insert Dr. B.'s valuable remarks entire. " Instances of the angina pectoris have frequently occurred ; its symptoms and causes have been investigated ; but small is the pro-. gress which has been made in the discovery of remedies necessary for its cure. " The question naturally arises, to what is this to be attributed ? Previously to our answering, we shall examine, in as concise a manner as may be consistent with perspicuity, the principles on which the different modes of cure have been proposed, and the success that has attended them. " Dr. Heberden, considered spasm as the cause of the complaint, and therefore prescribed those medicines which relieve and quiet convulsive motions ; opiates effectually prevented or weakened the night fits. Bleeding, vomits, and other evacuants were of dis- service in his hands ; it is not mentioned whether they were used during the paroxysms, or in the intervals. 582 NEUROSES. GLASS VI. " The advocates of the theory that the disorder is occasioned by an accumulation of fat about the heart, endeavour to remove or diminish it by evacuating the thinner fluids of the body, by means of issues, and by increasing the secretions. " Dr. Parry, who attempted to prove that ossification of the arteries depends on an increased impetus of blood, more especially when amounting to inflammation, supposed that abstinence from bodily exertions, and attention to the means of obviating an in- flammatory diathesis would have considerable effect in preventing the organic lesion of the coronary arteries. "On the attack of this malady, his first indication is to obviate the fulness of the vessels, which acts by oppressing the heart, weakened by disease, and deficient in energy. Regimen and medicine are the means used for that purpose ; of the latter he recommends bleeding, purging, and issues. " Speaking of blood-letting, he remarks, that it must be em- ployed with great caution ; that a degree of stimulus may be left sufficient for the purposes of healthy circulation. He confesses that he is unacquainted with the actual effect of that remedy. " Purging appears to him to disorder the circulation in so great a degree that it cannot be safely employed. " In cases where there may be reason to suspect plethora, issues are recommended, especially when danger is to be apprehended from the more speedy evacuation by venesection. During the paroxysms, in cases of imminent danger, he advises bleeding, the use also of purgatives and enemata. Stimulants, he observes, can be safely taken only so far as they may be required to remove flatulency from the stomach; or their use should be referred to that period, when, after the failure of the other means suggested, the pulse is not at all, or scarcely to be felt. " In fine, Dr. Parry regrets that the most important part of his subject, that which respects the cure or relief of the complaint, should have been so defective. " On the supposition that a diminished energy of the heart is the cause of the disease, the argentum nitratum has been prescrib- ed ; taken into the stomach, it was supposed to produce its effects through the meuium of the nerves. " Fowler's solution of arsenic, the application of a solution of the tartrate of antimony to the breast, cicuta, hyosciamus, and other narcotics, are all said to have been used with some advan- tage. ORDER III. ANOLNA PECTORIS. 583 " Dr. Schmidt observes, that the radical cure is very difficult, especially if the disease has been of long duration, but that it is not to be considered as an incurable disorder; he had met with several instances of patients who had laboured under it, and were restored to perfect health. Regarding it as a case of spurious gout, he has two indications of cure, which it would be needless here to mention. The angina pectoris can have no farther relation to the gout, than as this latter disease depends upon an overloaded condition of the vessels, which, indeed, is one of its most common causes. " We have thus stated, as far as the limits of an inaugural dis- sertation will permit, the respective modes of cure adopted by different writers. That they should have differed so materially, was to be expected from the different views entertained by medical men as to the nature of the disease. Regarding some one remark- able symptom or appearance as characteristic of the disorder, to the exclusion of others, equally important, they have necessarily, in many instances, limited their view, and been inadvertently led into error. " We have already given the particular opinions entertained by Dr. Hosack relative to the nature and treatment of angina pecto- ris ; the successful result of his practice in the complaint, appears to afford sufficient evidence of their correctness. The remedies which he prescribes with most advantage, are those which are cal- culated to diminish the fulness of the system; for this purpose he has recourse to copious and repeated blood-letting, active cathartics, as jalap, calomel, gamboge, and other evacuants; and for the removal of the spasm, palpitation of the heart, and cold- ness of the extremities, aether, volatile alkali, the compound spirits of lavender, and other diffusible stimuli are exhibited. Opiates, by lessening and occasionally suspending the spasm, are also used with advantage, especially after blood-letting has been freely em- ployed. Warm bathing and friction of the extremities, from the experience of their beneficial effects, are also highly useful, by pro- moting the circulation in the extremities, and a determination to the surface of the body, and thereby proportionally diminishing the fulness of the heart and larger vessels. " Independent of the medicines here recommended, our chief hope for preventing the returns of the disease must be placed in the diet and regimen. The diet of the patient should be plain. 584 NEUROSES'- CLASS Vt> . easy of digestion, and composed of a due proportion both of ani- mal and vegetable food; but the use of wine, ardent spirits, and especially malt liquors, and the usual condiments of the table, should be carefully avoided, or very sparingly taken; late suppers should also be totally prohibited. " Regular and daily exercise, flannel worn next the skin and frequently renewed, by their effects in promoting the excretions, no less contribute to counteract the plethora to be guarded against. " A control of the passions, as has before been observed, is no less necessary to prevent a return of the paroxysms of this disease."—P. 49—56. Two remarkable cases of angina pectoris are recorded in the sixth Vol. of the Medical and Physiological Journal, Which were cured by applying cloths to the sternum wetted with a mixture of tart, antimony, one drachm, spir. camphor, half an ounce, water, one pound. The stimulus from this application produced a severe eruption on the skin, having the peculiar malignant appearance of carbuncles, many of which suppurated. As soon as the eruption appeared, considerable relief from the spasmodic affections was obtained in both instances, and the patients gradually recovered, after continuing the remedy two or three times a day for about a month. Dr. Macbride and Dr. Darwin adduce also several in* stances of cure by inserting a large issue on the inside of each thigh. (Thomas' Modern Practice.) " In some instances of angina pectoris, its paroxysms are unfre- quent and unalarming for six, twelve, or even twenty years ; but in other cases they have terminated fatally in a few days." In young persons, and when the disease is gradual in its progress, the hope of recovery may be entertained. According to Macbride, in a majority of cases, the persons affected were between fifty and sixty years of age. Seventeen is the earliest, and seventy-seven the latest period of life at which the disease has occurred. A patient of Dr. Fothergill, in a sudden and violent transport of anger, fell down and expired immediately. The case of the celebrated John Hunter was of this description; having suf- fered repeated attacks for several years, he died suddenly, while in a state of extreme mental agitation which he could not control. In the New-England Medical Journal, the late Dr. John Warren has detailed the case of Rev. James Neal, of New-Hampshire, whose habit was rather plethoric, neck short, inclining to corpu- ORDER HI. ASTHMA-. 585 lency. He was seized with a severe paroxysm in April, 1806, while performing his services in the pulpit. Repeated bleedings* and all the usual remedies, with proper regimen, were adopted and persevered in until the summer of 1808, when he expired in a paroxysm. An affecting instance of this disease has recently occurred to my observation in a respectable and valued friend, which termi- nated fatally in six days from the first attack, having however ex- perienced some intervals of respite from the paroxysm. A younger brother of this gentleman has for five or six years laboured under complaints of a similar nature, but by copious bleeding, and great abstemiousness and care, he keeps himself free from any violent attack. Another gentleman was seized about eight months since, who having adopted a similar course, enjoys exemption from vio- lent symptoms. It is remarkable that all these persons were cor- pulent, with short thick necks, and apparently plethoric. ASTHMA. This disease is characterized by very laborious respiration, attended with a wheezing inspiration, distressing anxiety, and a sense of oppression aud stricture across the chest, increased in the horizontal position ; usually with cough, and a mucous expectora- tion ; attacks most generally at night, occurring in paroxysms at uncertain intervals ; oftentimes periodicals It is most frequent in the decline of life, and more incident to men than women. It is frequently an hereditary disease, though it does not commonly ap- pear before the age of puberty. Infants, however, are not alto- gether exempt from attacks of spasmodic asthma. This disease has generally been divided into two kinds. When it is attended with a discharge of mucus or humours from the lungs, it is called the humid or pituitous asthma. But when no expectoration takes place, it is denominated the dry or spasmodic asthma; though, in fact, both species appear to partake of a spasmodic nature. The paroxysms, which generally commence in the night, are often preceded by lassitude, torpor, drowsiness, a sense of weight or pain of the head ; and symptoms of dyspepsia or indigestion seem to be connected with the disease. During the first sleep, or 586 NEUROSKS. CLASS VI soon after, the patient is seized with a sense of tightness and stric- ture across the chest, and a feeling of uneasy oppression in the lungs, impeding respiration. There is either no cough present, or it is not attended with any expectoration ; the patient, if in a hor- izontal position, is obliged immediately to become erect, and to fly for relief to the open window. The difficulty of breathing increases, and is attended with a wheezing noise, the voice is weak, and the exertion of talking is more or less painful: after these symptoms have continued for some hours, an expectoration of mucus or phlegm takes place, and the symptoms abate ; but there is a greater or less degree of tightness across the chest, and of difficulty of breathing, throughout the course of the following day. Towards evening, or about midnight, for several successive nights, the symptoms suffer an exacerbation, and a remission takes place towards morning, and after some days, on the expectoration be- coming more copious, the paroxysm ceases altogether. As the lungs cannot be sufficiently dilated with air, the passage of the blood through the pulmonary vessels is interrupted ; hence the face, in full and plethoric habits, appears red and bloated, the ves- sels of the eyes are turgid, and the pulse becomes weak, quick, and irregular. The patient having suffered one paroxysm, very rarely escapes subsequent attacks at uncertain periods during the remainder of life. On some occasions, when the disease has fastened its hold on the constitution, the paroxysms recur in the spring and autumn ; on others, it attacks periodically once in ten days or a fortnight, or regularly at the full and change of the moon; and indeed in- stances are on record of the unhappy patient being afflicted with the distressing symptoms to such a degree as to be unable to lie in bed, resting only in a chair for seven weeks together. By a long continuance of the disease, the vigour of the constitu- tion becomes greatly impaired, the intervals between each par- oxysm are shorter, the attacks more violent, the difficulty of breathing, the sensation of tightness over the breast, and anxi- ety, become so inexpressibly severe that the patient is constant-' ly alarmed with the fear of a total suffocation. Yet a fatal termi- nation seldom occurs; the sufferings are generally protracted to many years, when the vital powers being in a measure exhaust- ed, a dropsy, or some other disease supervenes, and severs the attenuated thread of life. ORDER III. ASTHMA. 587 In a fit of convulsive asthma, as soon as an easy, copious ex- pectoration takes place, it affords great relief; the evacuation coming immediately from the vessels which have been obstructed, it denotes a solution of the contraction of the bronchial air vessels, and thus the fit is commonly terminated ; but this secretion of mucus from the glands of the lungs continues in a greater or less degree to harass the patient, the glands are relaxed, the bronchial vessels obstructed with phlegm, and the freedom of respiration is constantly disturbed. Thus the humoral asthma is united with the convulsive, and both together existing in the same patient, and acting sometimes separately, and again conjointly, greatly aggra- vate the symptoms of each other. In most cases more or less blood is spit up, proceeding from a rupture of blood-vessels in the lungs. If the quantity is very considerable, or if blood gush from the nose, although it may afford present relief, it is an unfavourable symptom, denoting the greater violence of the disease. " The respiration becoming suddenly quick and short, the pulse weak and irregular, paralysis of the arms, great depression of strength, a scanty secretion of urine, and frothing at the mouth, indicate extreme danger." Asthma may proceed from any cause that obstructs the circula- tion of the blood through the lungs ; such as a stoppage of cus- tomary evacuations, violent exercise, noxious vapours arising from metals or minerals received into the lungs ; impure or smoky air, cold and foggy atmosphere, scrofulous, rheumatic, or gouty and scorbutic acrimony; and from a weak digestion, attended with great flatulency and general debility. In the treatment of asthma, if the patient is young and of a plethoric habit, moderate blood-letting in the paroxysm may afford some relief, but in general this operation is inadmissible, and el- derly persons have too often been injured by the practice. Cup- ping between the shoulders frequently proves beneficial; gentle laxatives and clysters should be employed at proper intervals to keep the bowels regular, and the feet and legs bathed in warm water. But gentle emetics of ipecacuanha should on no account be dispensed with, and when a paroxysm is about to occur in the course of the night, an emetic exhibited in the evening will gen- erally prevent it. The medicine, however, best adapted to excite vomiting in this distressing disease, is probably the lobelia inflata, or Indian tobacco. About a table-spoonful of the saturated 588 NEUROSES. CLASS VI. tincture, will in general induce a moderate vomiting, and if repeat- ed, a copious discharge of viscid mucus, by which great relief is obtained ; the medicine may be repeated as often as the operation is desired, and even independent of its emetic effect, when taken in small doses, this medicine procures a freedom of breathing su- perior to any other known remedy ; and experience has often induced asthmatic patients to take small doses of it every quarter or half hour during the severity of the paroxysm. With the view to assist and promote expectoration in the moist asthma, the lac ammoniacum and syrup of squills should be prescribed, either separately or conjoined, and it is believed that squills may be con- sidered as the most valuable expectorant of any in the Materia Med- ica. Squills may be combined with digitalis with great advantage. But asafcetida is to be preferred to the gum ammoniacum as an antispasmodic and expectorant. In spasmodic asthma, asafcetida, in doses of four or five grains, given every three hours, will sel- dom fail to procure essential relief. The volatile alkali has been known to relieve the dyspnoea during the fit, arid if given in the form of spiritus mindereri, a table-spoonful every half hour, with about one eighth of a grain of tartar emetic, considerable relief may be expected. Strong coffee, without sugar or milk, has been recommended as being well adapted to abate the violence of an asthmatic fit; it ought to be of the best Mocha, newly roasted, and made immediately after grinding, in the proportion of an ounce for one dish, which is to be repeated fresh after the interval of a quarter or half of an hour ; by this remedy, fits of spasmodic asthma have been entirely removed. Blisters and issues have been com- monly employed, but they seem to relieve in those cases'only which are occasioned by the stoppage of some habitual discharge, or repelled eruption, or in the complicated complaints of old peo- ple. When antispasmodics are supposed to be indicated, opium and aether are deemed the most efficacious when combined, and, on some occasions they have been taken in large and repeated doses with the happiest effects. Among our valuable antispasmo- dics, are skunk cabbage and stramonium, the former of which is capable of alleviating the most distressing symptoms in spasmodic asthma, and being a simple and harmless medicine, may be used in the freest manner, either in powder or infusion; the trial of it ought in no case to be omitted. The stramonium has of late years acquired great repute as a remedy in asthma. If no evidence ORDER III. ASTHMA. 589 can be adduced of its having effected permanent cures, ample ex- perience affords sufficient attestations of its efficacy as a soothing palliative. It is in general administered in the form of extract, beginning with one grain, and increasing gradually until it induceb some sensible effect on the system, or until permanent relief is obtained. Other preparations of this plant may be employed, as a tincture, syrup, or the dried leaves ; but the adequate dose may be properly adjusted. The smoking the prepared herb or dried root, has in numerous instances been remarkably beneficial in re- lieving the dyspnoea and wheezing, so troublesome to asthmatic patients. The severity of the paroxysm may be greatly mode- rated by the inhalation of the warm steams of infusions of white poppy heads, or chamomile or elder flowers. It has been observed that asthmatic patients are frequently troubled with flatulency of the stomach, acidities, and other symp- toms of dyspepsia; for the removal of these complaints, absorb- ents and bitter infusions, as recommended in dyspepsia, will answer a valuable purpose: opium combined with chalk, according to Dr. Bree, will produce excellent effects in allaying irritation proceed- ing from dyspepsia of the first passages. Two table-spoonfuls of vinegar and an equal quantity of cold water, has likewise been found very useful in counteracting the flatulence of the stomach, and relieving the asthmatic fit. When asthma is attended with symptoms of dyspepsia, I am informed by Dr. William Tully, president and professor of Vermont Academy of Medicine, that he has experienced the superior efficacy of equal parts of tincture sanguinaria and tincture lobelia inflata, in doses of two or three tea-spoonfuls every few hours until its effects were evident. The digitalis is another medicine recently introduced as a rem- edy in asthma; the tincture, in doses of fifteen drops, repeated twice a day, has in several instances, as appears by Dr. Thomas' Modern Practice, produced astonishing effects ; the most violent symptoms were greatly mitigated, and the general state of health visibly improved, but its efficacy is said to be increased by the addition of opium. When these two medicines have been given in the dose of half a grain of each every four or five hours, it has suspended the distressing symptoms, and been highly serviceable in cases of spasmodic asthma. Opium may be combined with other antispasmodics to advantage in some cases of nervous asthma, as follows ; take of the tincture of wood soot, one ounce, 590 NEUROSES. CLASS VI. tincture of castor and elixir paragoric, each half an ounce ; a tea- spoonful for a dose two or three times a day. For the attainment of permanent relief in the dry asthma, nothing, it is said, is found to answer a more valuable purpose than eight or ten grains of ipecacuanha, according to the strength and constitution of the patient, taken every other morning; this produces the happiest effects, acting sometimes as a mijd emetic, at others as an antispasmodic, or sedative, allaying the irritation of the nerves, and preventing a return of the paroxysm. In old people, affected with asthma or other disorders of the lungs, the balsam of Peru, in doses of thirty drops, three times a day, will be found peculiarly useful as a palliative remedy. In the intermission of asthmatic paroxysms, it is important that we have recourse to tonics, as the Peruvian bark, stomach bitters, and the preparations of iron, to strengthen the habit, and obviate the recurrence of the fits; and to assist the effects of these reme- dies, cold bathing or the shower bath, ought not to be neglected. Issues and setons are beneficial in both kinds of asthma, and the use of them should never be discontinued. In every species of asthma, the patient's diet should consist of such things as are light and easy of digestion, carefully avoiding whatever may tend to generate flatulency. Animal food of the lightest kind, taken in a moderate quantity, will be the most proper ; garlic and on- ions are salutary, but other vegetables, and all spirituous and fer- mented liquors, cider excepted, will prove detrimental; proper exercise, as riding and sailing, with .a change of air, ought to be pursued.* COLICA, OR COLIC. There are several kinds of disorders of the bowels denominated colic, and authors distinguish them accordingto the different causes from which they derive their origin. The characteristics of this * It may not be improper to compare an asthmatic patient with a broken-winded horse. The disease is identically the same in both. The remedies which have been found the most effectual in that noble animal, the horse, are lime-water, and the seeds of the common sun-flower, (corona solis); the seeds of this plant yield a large quantity of excellent oil, and when given freely with the food it js said to prove a very effectual remedy. f»RDER III. COLIC 59'1 disease are a painful distention of the whole lower belly, with a twisting round the navel, vomiting and costiveness. The colic is to be distinguished from inflammation of the bowels, by the spasmodic contraction of the abdominal muscles, by the absence of a trifling degree of fever, by the state of the pulse, which is scarcely affected, and by the diminution of pain upon pressure. I shall here but briefly treat of those species termed the flatu- lent or windy, the bilious, the hysteric, and the nervous colic. The flatulent or windy colic is known by a wandering pain in the bowels, with costiveness and rumblings, which abate when air is expelled, either upwards or downwards. There is no great thirst, and the pulse varies but little from the natural standard. Persons of a delicate habit are most liable to this complaint, and it often is produced by unripe fruits, meats of hard digestion, flatu- lent vegetables, and fermenting liquors. The most speedy relief in this case will be obtained by some stomachic cordial, combined with opiates, as spirit lavender compound, essence of peppermint, aether and landanum, repeated in proper doses and intervals, until the pain abates. This should be accompanied by infusions of cow parsnip, garden angelica, anise or caraway seed, and a little gin or brandy, may be added. Emollient and carminative clysters with half an ounce of oil of turpentine may be at the same time injected, and fomentations to the whole abdomen applied ; should clysters fail to produce evacuation from the bowels, the castor oil with half its quantity of elixir salutis, will form an excellent cathartic for that necessary purpose. If the symptoms increase, and threaten an inflammation of the bowels, immediate recourse must be had to bleeding, the warm bath, and blistering over the abdomen. The bilious colic prevails most in summer. It is attended with acute pain diffused over, or in different parts of the abdomen, often fixed about the region of the navel, and the abdomen is sometimes much tumefied. The patient is troubled with a bitter taste in the mouth, with great heat, thirst, and fever, and a vomiting of yel- lowish or greenish bile. He discharges little or no urine, and there is an obstinate costiveness. Instances of such violence have occurred that the peristaltic motion of the iwtestines become in- verted, and the faeces, and even the clysters have been thrown up by vomiting, which constitutes the true iliac passion. m NEUROSES i i.AS'S Vt. The bilious colic is considered as a highly inflammatory disease, for the removal of which recourse must be had to the lancet with a very liberal hand. A copious evacuation of blood amounting to eighteen, twenty, or even thirty ounces if the subject be a robust adult, will answer the first indication at the commencement. This, or a repetition of it by abating inflammatory and spasmodic action, will in general arrest the progress of the complaint, and pave the way for the operation of such cathartic remedies as the case im- periously demands. It will be altogether useless, however, to ad- minister purgatives until spasm and irritation are in a measure appeased. The means most proper to be adopted are moderate doses of opium, and if this cannot be retained on the stomach, the same medicine should be injected into the rectum, and recourse must be had to the warm bath, or immersing the patient up to his breast in luke warm water, and at the same time applying friction to the abdomen. These, or emollient fomentations occasionally repeated, will have a happy tendency in allaying spasm, mitigating pain, and promoting the desired evacuation. Emetics are often necessary unless spontaneous vomiting has emptied the stomach or exhausted the patient. Our next attempts should be directed to the removal of constipation by means of suitable purgative ene- mata. A strong infusion of senna, in one pint of which one ounce of Glauber's salts has been dissolved, often proves exceedingly efficacious. By some the following terebinthinate clyster is held in preference. Take common turpentine, half an ounce, or spirits of turpentine one ounce, rub it with the yolk of one egg until they are well incorporated, then add a pint of linseed tea or warm water. In obstinate constipation attending bilious colic, recourse is often had to the sedative powers of the fumes or infusion of tobacco with the happiest effects. We are however cautioned against the use of a strong infusion, as it has been known to induce fatal con- sequences; half a drachm of the leaves infused in a pint of water is the quantity not to be exceeded at one time. The smoke is milder in its operation, and is employed by blowing it from the bowl-of a common pipe into a tight bladder furnished with a tube and then injected by the way of clyster. I have more than once witnessed its exhibition to such extent that it has passed the whole length of the alimentary canal and escaped by the mouth. It has often been advantageous, but never productive of unpleasant effects. ORDER 111. COLIC. 593 During the employment of these remedies, or immediately after the irritation is by their means allayed, active purgatives must be diligently employed until a thorough evacuation of the canal is ef- fected. One of the best preparations as a carthartic, in obstinate colic, is equal parts of castor oil and the oil of turpentine, a large spoonful of this mixture given eVery hour, if not too offensive to the stomach, abates the pain and removes the obstruction in the spee- diest manner. Should this, however, be rejected by the stomach, the crotori oil, in doses of from half a drop to two drops, may be given with a good prospect of success. A solution of Glauber's or Epsom salts, or an infusion of senna, or both combined, may be given occasionally, and should these means prove unavailing, the following pills may be the next resort. Extract of butternut, three grains, calomel, three grains, opium, a grain. Three or four of these for a dose every two or three hours. The opium allays the irritation and spasm and affords opportunity for the other articles to produce a carthartic effect. Another remedy to be mentioned as efficacious in obstinate constipation is tartar emetic in the form of enema, from ten to fifteen or twenty grains of this dissolved in about four ounces of water, and injected into the rectum, have been known to rescue the patient from the most imminent danger. The application of blisters and cold water dashed over the abdomen and the lower extremi- ties, or injected by the way of clyster according to the favourite practice of Dr. Rush, have been highly commended and are well deserving attention. In cases which assume a desperate aspect and resist the ordinary course of remedies judiciously persisted in, we are by some advised to adopt the old practice of giving quick- silver to the extent of twelve or more ounces, but although in one instance I can vouch for the successful result of this, it must be deemed a precarious remedy and not altogether free from danger. When the vomiting continues to be urgent, it must be appeased by the use of the saline draught with liquid laudanum, drinking mint tea or water in which toasted bread has been boiled, and by the application of the leaves of mint wet with spirits to the pit of the stomach. A tea-spoonful of aether with thirty drops of laudanum in a cup of cold water will sometimes check the vomiting and alle^ viate distress, but laudanum must often be injected into the intes- tines. From its bitter and stomachic quality, the powder of Co- lombo root, in doses of twenty or thirty grains, has been found 75 m NEUROSES. CLASS VI. particularly serviceable in appeasing the vomiting and correcting the bile in these cases. In those persons who are subject to frequent returns of bilious colic, it is recommended as a valuable preventive to use a decoc- tion of the root of the common mulberry tree. Dr. Mease, in his edition of Willich's Dom. Ency. speaks of it with considerable confidence, having received accounts of some well attested in- stances of its successful employment. The hysteric colic is peculiar to women of an irritable disposi- tion. It resembles, in respect both of pain and vomiting, the pre- ceding species, but it is more particularly characterized by lowness of spirits, difficult breathing, and severe spasm and costiveness. In the cure of this kind of colic, neither bleeeding nor severe purging is in general deemed admissible. A mild emetic may be advised, and the costiveness should be removed by clysters and the mildest laxatives; after which, proper doses of laudanum ought to be directed occasionally, and antispasmodics, as valerian, castor, asafcetida, and the skunk cabbage, to complete the cure and ob- viate its return. A plaster composed of aromatic and anodyne ingredients, ap- plied to the pit of the stomach will be serviceable. Colica'Pictonum, or the Dry Belly-ach. This species of colic is attributed to the deleterious properties of lead, when it has been received into the system, either by swal- lowing into the stomach, or by its fumes absorbed by the pores of the skin, or received into the lungs. It has been denominated the Devonshire colic, from its great prevalence in that country, occa- sioned, as is supposed, by the drinking of cider kept in vessels of lead, or where this poisonous metal is used for fastening the nails in the vats. The colic of Poictou, and the dry belly-ach of the West-Indies, are of the same origin, and occasioned by rum dis- tilled through leaden worms. Painters, plumbers, and miners, and all who are employed in the manufacture or the use of lead, arc more or less liable to be affected with this species of colic. But this disease is not to be ascribed to the effects of lead exclusively, for long continued costiveness, acrid bile, cold applied either to the extremities or to the belly itself, a free use of unripe fruits, acrid food, or drink, such as sour wine or cider, are enumerated ORDER III. COLIC. 595 among its causes. The patient is seized with an acute spasmodic pain in the pit of the stomach, which extends gradually to the whole intestinal canal; particularly round the navel; the bowels are frequently drawn towards the spine, so as to render the injection of clysters impracticable. At the same time, there is a loss of appetite, yellowness in the countenance, slight nausea, and obstinate costiveness. Soon after, the stomach is distended as with wind, and there are frequent retchings to vomit. The whole re- gion of the belly becomes highly painful to the touch, the muscles of the abdomen are contracted into hard irregular knots, or lumps. The pulse is generally low, but a little accelerated by the pain. The patient discovers a lowness of spirits; the extremities are of- ten cold, and by the violence of pain, cold clammy sweats and faintings ensue. In this miserable condition, the patient some- times continues for three or four weeks, or even for six months ; in which case the pains become intolerable, and the patient's breath acquires a strong foetid smell. At length, when the pain in the bowels begins to abate, it is succeeded by a pain in the shoul- der joint and adjoining muscles, with an unusual sensation, and tingling along the spine of the back. This soon extends itself to the arms and legs, which become paralytic, with a total loss of mo- tion. Sometimes fatal convulsions occur ; at others, the true iliac passion is produced, which also soon proves fatal. The medical treatment in this dreadful disease, is in some re- spects similar to that of an inflammation of the intestines, to which it is nearly allied. With the view of obviating inflammation, we are advised, in the first instance, to draw blood in a quantity pro- portioned to the age and habit of the patient, unless from debility, advanced life, and mildness of the attack, the evacuation may be deemed improper. A gentle emetic of ipecacuanha, and repeated doses of castor oil, with laudanum, should be directed, and this last continued until, with the aid of emollient clysters, the obstructions in the bowels give way. For the purpose of removing spasm, we are directed to the employment of emollient fomentations, fre- quent immersion in warm water, but above all, throwing cold wa- ter over the legs and feet while the patient is walking barefooted on the cold floor : or if this prove ineffectual, the patient is next to be placed in a large tub, and a pail of cold water thrown over the abdomen and thighs, which it is said will seldom fail to remove both spasm and costiveness. Another remedy adapted to the re- 596 NEUROSES. CLASS VI. moval of constriction of the intestines, is the infusion or smoke of tobacco, used in the form of clyster, as directed in bilious colic, At the same time that the foregoing means are diligently employ- ed, the back, spine, and limbs, should be strongly rubbed with the volatile liniment, or camphorated spirits. In the colica pictonum, occasioned by lead, alum in doses of fifteen grains every four, five, or six hours, has been administered by Dr. Percival; but others affirm that a more powerful remedy is to be found in blue vitriol. Eight grains of it being dissolved in half a pint of water, two or three table-spoonfuls are to be taken fasting, for nine successive mornings. For the first four or five days, this medicine discharges much vitiated bile both ways ; but the evacuation of it lessens by degrees, and great relief is obtain- ed. The most efficacious medicine in this disease is calomel, either by itself as a cathartic, or combined with opium. About eight or ten grains of the former, with one of the latter, given every twelve hours, will in general produce the happiest effects. Dr. Joshua Fisher, an eminent physician of Beverly, administers opium in doses of from fifteen to forty grains, and has not, as he affirms, for many years past seen a single case of this distressing disease, which has not yielded to its efficacy in about an hour ; but this bold practice is not to be resorted to by inexperienced phy- sicians. Dr. James Mann, in the N. E. Journal of Medicine and Surge- ry, Vol. XI. states several cases of this affection which had fallen under his observation, in which he found large doses of opium in- dispensably necessary to ease the pain, after which the most active cathartics were required to rouse the torpid state of the intestines, and procure the alvine evacuations. In one case, from seventy to one hundred grains of sub-muriate of mercury were given, and followed by from four to twelve ounces of castor oil. He states, that unless purgatives are repeated every day for about a week, a recurrence of the pain will certainly take place, and a permanent cure cannot be effected. In one case in which he was consulted calomel was administered in doses of one drachm, until one ounce was taken in the space of thirty-six hours, and in another, six drachms were given, and it is remarkable that both patients re- covered without any unpleasant effects from the large quantity of palomel required to remove the constipated state of the bowels. ORDER III. HYSTERIA. 597 During the use of these remedies, the patient's diet ought to be mild and simple, consisting of broth made of lean meat, oatmeal gruel, rice, panado, and arrow root. When the violence of the disease has subsided, recourse must be had to the Peruvian bark and bitters, with a restorative diet and proper exercise. HYSTERIA. Those women who possess great sensibility of constitution, and who are frequently liable to obstructions of the natural sexual eva- cuation, are in general the subjects of hysteric complaints. It generally commences between the age of puberty and thirty-five, and is of all disorders one of the most various in its appearances. The disease generally begins with a sense of fulness, and rumbling noise in the bowels, attended with a sensation of a ball rolling round in the abdomen, ascending to the stomach and throat, and inducing a sense of weight and anxiety, nausea and vomiting; when this peculiar sensation arises to the throat, occasioning a sense of suffocation and difficulty of breathing, or swallowing, it is called globus hystericus. The extremities are cold, but some- times attended with a sense of heat in different parts of the body ; the colour of the face is variable, being sometimes flushed and sometimes pale ; there is a pungent pain in the head called clavus hystericus, swelling of the ancles, flatulence, spasms, lassitude, and palpitations ; the eyes are dim and suffused with tears. The fit sometimes ceases after these symptoms have continued for a cer- tain time, but more frequently the patient falls into a fainting fit. Sometimes she beats her breasts violently with her hands; at others, she lies quite motionless, as if in a profound sleep. The whole body is frequently agitated with convulsions, and the dis- ease assumes the appearance of epilepsy; sharp pains likewise at- tack the head, the loins, back, and bladder, and a very copious discharge of limpid urine takes place, which is one of the most characteristic signs of the disease. The mind, as well as the body, is greatly affected, and the patient is liable to sudden transitions from laughing to crying. The patient usually continues in this rondition for some time, when at length the heat returns to the extreme parts ; a gurgling noise arises in the bowels, and as if 598 NEUROSES. CLAS^ VI. awaking from a profound sleep she regains her voice, sense, and motion ; but complains of a heavy pain of the head, and a general weakness. The paroxysms are considerably varied in different persons, in having more or fewer of the above symptoms, and in the violence and duration of the fit. At the close of the paroxysm, a large quantity of wind is belch- ed from the stomach, with frequent sighing and sobbing, and when she recovers sense and motion, she has no recollection of what has passed during the fit. Sometimes there is little or no convulsions, and the fit seems to consist of a distressing hiccough, threatening suffocation, and this sometimes continues two or three days. This disease affects chiefly women of delicate habit, and whose nervous system is extremely sensible, and in whom a par- oxysm is easily excited by passions of the mind, as sudden joy, grief, fear, &c. Although hysteric fits may be exceedingly alarm- ing to by-standers, they are seldom accompanied with danger, and never terminate fatally unless some other disease be induced. The hysteric affection will be distinguished from the epilepsy, by the globus hystericus, by the the great flow of limpid urine, by the sudden transition from laughing to crying, and by the anxiety and fear of death preceding and succeeding the paroxysm. During a hysteric paroxysm, if the patient be in a plethoric state, blood-letting will be serviceable, but if the disease has been of long continuance, especially in delicate habits, this operation generally proves injurious. The nostrils should be stimulated by the application of volatile spirits, singed feathers, vinegar, &c. and cold water, with volatiles and aether, administered internally, as soon as the patient can swallow. Cold water and vinegar may be sprinkled on the face and breast, and free cool air should be ad- mitted to the patient, and her feet and legs placed in warm water. An'antispasmodic clyster of the infusion of skunk cabbage root, or of opium, will be beneficial; but a clyster of cold water, it is said, relieves the hysteric symptoms instantaneously. With the view of a radical cure, particular attention must be paid to the state of the menstrual evacuation ; if deficient, it ought to be promoted ; if too copious, it should be restrained. It is the opinion of Dr. Hamilton, and he is supported by other authorities, that this disease does not proceed from the uterus, as formerly supposed, but from some morbid affections of the stom- ach and alimentary canal. The leading indications, therefore, ar< ORDER III. HYSTERIA. 599 to evacuate by the frequent exhibition of cathartics, but these are to be preceded by the employment of the lancet, where a fulness of the vessels requires the depleting operation. Our great object should be to strengthen the nervous system by the employment of Peruvian bark, myrrh, and chalybeates, togeth- er with the cold bath duly persisted in. It will be advisable, occa- sionally to administer medicines adapted to allay irritation. Take the tincture of asafcetida, and of castor, each two drachms, spirits of lavender compound, four drachms : a tea-spoonful or more of this mixture may be taken in a cup of valerian or motherwort tea, on the approach of any languor ; and at bed time a moderate dose of laudanum maybe added for the purpose of composing any ner- vous agitation and procuring sleep. The volatile tincture of vale- rian is also a valuable medicine. It frequently happens that hys- teric women are afflicted with cramps in various parts of the body, which are most apt to seize them in bed, and when asleep. In these cases the patient's feet should be immersed in warm water, but when the spasms are violent, and of some duration, we must have recourse to opiates, skunk cabbage, aether, and camphor, in- ternally, and to the warm bath, and frictions with anodyne lini- ments, externally. Cramps in the legs may be prevented, and sometimes removed, by the application of tight ligatures, or by the exercise of walking. The volatile spirit of sal ammoniac has a happy effect in relieving cramps of the legs; a tea- spoonful may be taken in a glass of water every few hours. Hysteric women will experience great advantage by a proper attention to the mode of living, and to their conduct in life. The diet best adapted to this complaint, consists of milk and vegeta- bles, but those who have been accustomed to a more generous di- et, may sometimes indulge in light animal food ; the most proper drink is water, with a little red wine or brandy ; strong tea should be particularly avoided. Cold bathing, with proper exercise, and early rising, as they tend to brace the nerves, and invigorate the system, should be enjoined as of great importance. The mind must be constantly preserved in a calm serene state, and every- thing tending to irritate the spirits, or ruffle the passions, ought to be most scrupulously guarded against. It is with much satisfaction that I introduce on this occasion a domestic medicine, the valuable properties of which are not gene- rally understood ; the skunk cabbage, (pothos fcetida). I can as- 600 NEUROSES. CLASS VI sert from my own recent experience, and from trials in the hands of others, that it has displayed antispasmodic powers, surpassing most other medicines of that class. In several cases of obstinate hysteria and convulsions, this medicine alone has effected perma- nent cures, or afforded essential relief. It is free from the heat- ing and constipating qualities of opium, and the vast expense of musk, and may be given to any extent without producing unpleas- ant effects. The proper dose of the dried root in powder, is half a drachm thrice in a day, or of a strong infusion, a table-spoonful every two or three hours. During every stage of nervous and hysteric complaints, and in cramps and spasms, this medicine is strongly recommended as a valuable substitute for the various an- tispasmodic remedies commonly employed. See American New Dispensatory. A young woman, about eighteen years of age^ was harassed by severe convulsive and hysteric paroxysms, almost incessantly 4 in- somuch that her friends estimated the number at seven hundred in the course of a few weeks ; her abdomen was remarkably tumefied and tense ; and there was a singular bloatedness of the whole surface of her body, and the slightest touch would occasion intol- erable pain. At length her extremities became rigid and immove- able, and her jaw was so completely locked, that she was unable to articulate, and liquids could only be introduced through the vacuity of a lost tooth. She had been treated with a variety of antispasmodic and other medicines, by an experienced physician, without relief. Having prepared a strong infusion of the dried root of skunk cabbage, I directed half a tea-cup full to be given every few hours, without any other medicine ; the favourable ef- fects of which were soon observable, and by persisting in the use of it about ten days, the muscular contractions were removed, the jaw was relaxed, and her faculty of speech and swallowing, with the use of all her limbs were completely restored. Another young woman had been exercised with the most distressing parox- ysms of hysteria for several days, without obtaining relief by the medicines prescribed; when the skunk cabbage infusion was so successfully directed, that her fits were immediately arrested, and in a few days a cure was completely effected. The brother of this patient was seized with violent convulsions of the whole body, in consequence of a cut on his foot; the skunk cabbage was ad-' ministered, and he was speedily restored to perfect health. Since tlRDER IH. RABIES, OR HYDROPHOBIA. OUA writing the above, a woman was affected with violent spasmodic pains, twenty-four hours after parturition ; six doses of skunk cab- bage entirely removed her complaints. Ergot has of late succeeded in the cure of this disease. The following important case may be implicitly relied on. " A lady about forty years of age, of a gross habit, was afflicted with hys- teric paroxysms which returned as often as once in twenty min- utes. She took laudanum, asafcetida, aether, &c. till I despaired of success. I then gave her twelve grains of ergot in decoction, without her knowing it to be any thing different from what she had taken before. She immediately replied, 4 that goes to the right place, that reaches the difficulty.' In about half an hour she had a slight return of the fits, upon which I repeated the dose ; after this there was no further appearance of them. After her recov- ery I learned that she had been subject to this disease, and al- though she had applied to a number of the most respectable phy- sicians, she had never found a medicine before which stopped the fits." See Appendix, Ergot. RABIES, OR HYDROPHOBIA.. The animals particularly liable to communicate the rabid poisott to the human species, are those of the genus canis, as dogs, wolveSj and foxes : being those in which the disease is said to appear in the form of an original affection. But rabies has been received by a bite from cats, racoons, cows, swine, weasels, and even, as is said, from geese and hens, when in a state of madness. The specific nature of this subtle poison has hitherto eluded all investigation; nor has experience proved more successful with respect to the remedy for this most formidable species of infection. It is nevertheless a point of high importance to ascertain with precision the symptoms which characterize madness in those ani- mals, to enable us to guard against their fatal attacks. For several days previous to the invasion of the disorder, the dog is observed to manifest a change in his natural manners ; he grows dull and heavy, and shews an equal indifference to his mas- ter, and his usual meat and drink. He becomes solitary, and en- deavours to hide himself, does not bark as usual, but makes a 76 602 NECROSES. CLASS VI murmuring noise, is peevish and easily offended. His ears and head hang down, and he walks as if overpowered with sleep, but in this stage he remembers and respects his master. A disposition to quarrel with all other dogs, is manifested early in the disease. He breathes thick and heavy, keeps his mouth constantly open, and hangs out his tongue ; sometimes he walks slowly, as if half asleep, and then suddenly runs, but not always directly forward. At length he forgets his master, and will bite him if opportunity offers; his eyes look dispirited, dull, and full of tears, and red ; his bark is hollow and hoarse, and his tongue of a lead colour. He now strays from home, and follows any path or road he happens to meet, but seemingly without purport or design. If he be confined in this advanced stage of the disease, he bites and gnaws every thing near him, is furious for a moment when approached; and his chops are covered with tough frothy saliva. He now grows faint, thin, and weak, often falls down, again rises, attempts to fly at every thing, and soon grows furious. This second stage seldom continues thirty hours, death by that time putting an end to the disease. He can swallow both solids and liquids during the whole disease, and having no aversion to water, he never endeavours to avoid it. In most instances there is a very treacherous disposition manifested in rabid dogs ; if called, they will come, wag their tails, and show every mark of fondness, and seem pleased with attention ; but on a sudden they will turn and give a bite. It is also important to know, that many instances have occurred of dogs having given a fatal bite, while they were in apparent health, even many days before they discovered a single symptom of indis- position. The symptoms of rabies in dogs and other animals commence sometimes in ten or twelve days, but more commonly between three and eight weeks after having received the bite, and they seldom survive longer than four or five days after the first symp- toms appear, and we believe it may be affirmed that no instance of recovery among rabid animals has ever been known. Innumerable are the remedies which have for ages past been administered with the view of eliminating or counteracting the poison, or obviating the constitutional affection after a bite has been given. But on close investigation, they have been found to- tally inadequate to the purpose, and the most of them calculated rather to excite contempt than confidence. In fact, when once ORDER III. RABIES, OR HYDROPHOBIA. 603 this dreadful poison has been communicated by a bite, it is hardly to be expected that its fatal effects can be prevented by internal medicines alone. The most effectual preventive remedy yet dis- covered, consists in cutting out all the muscular parts with winch the dog's teeth have come in contact, or to which the virus may have penetrated. The earlier the operation is performed, and the more completely it is effected, the greater will be the chance of security. But when insuperable obstacles prevent the employ- ment of the knife, recourse must be had either to the application of the hot iron, or to some liquid caustics. A strong solution of the lunar caustic, or the caustic vegetable alkali of the Dispensa- tory, or the aqua fortis, should be applied to every part of the wound, and the application must be repeated at various times dur- ing several weeks. When neither of the above caustics can be seasonably procured, some powdered quicklime may be advantage- ously substituted. In some instances, it may be necessary to dilate the wound in such a manner as to admit the remedies to every part into which the poison may have insinuated. In every in- stance, it will be advisable to convert the wound into a running ulcer, and to keep up a discharge from it during six or eight weeks. Either the caustics, the quick lime, or blistering flies, may be em- ployed for this purpose. Another remedy of reputed efficacy, is the affusion of cold water to the wounded parts. The water must be poured forcibly over the surface of the ulcer, and continued daily, from the moment of the bite to at least thirty or forty days. A person having received a bite from a rabid animal, can scarcely be considered free from danger of an attack of hydrophobia in less time than one year. It is a point altogether problematical how long time the poison remains in the bitten part; on some occasions it is not absorbed into the system during several weeks or months, as supposed. It will therefore be a wise precaution, that whenever pain, or any uneasy sensation, is perceived in the wound, the application of the knife and the caustic remedies be made without delay. In fact, when it is ascertained that the animal which inflicted the bite was actually in a rabid state, even though the wound may have healed, the only security consists in a thorough extirpation of the wounded part; the knife should be carried even deeper than the dog's teeth have penetrated, and as the knife first employed may get tainted with the virus, the operator should have several at hand to be used 604 NEUROSES. CLASS VI, in succession. This operation should be followed with the most effectual ablution of the parts with a solution of the volatile alkali in water, in the proportion of one part of the alkali to four of water, and the same should be injected into the wound with a syringe. The nitrate of silver, or other caustics, should next bo applied, and a free suppuration promoted. The same process may be persevered in for a considerable time according to existing circumstances. With respect to the internal administration of remedies preventive of hydrophobia, very little dependence is to be placed on any class that can be selected. The volatile alkali in the liquid form, a tea-spoonful three times a day, and a course of Plummer's pills to the point of ptyalism, persisted in for several weeks may prove an eligible prophylactic course. If our utmost efforts to destroy the poison in the first instance, should unfortunately fail, it is not improbable that within a period of from ten days to six or eight weeks, or it may be extended to a year or more, after the bite, the miserable patient will be seized with that deplorable malady called hydrophobia. But amidst the horrors experienced during a period of painful suspense after hav- ing received a bite, there is a source from which the sufferer may derive considerations of a soothing and consolatory nature. Nu- merous writers of the most established credit have recorded, and experience fully verifies the fact, that a large proportion of per- sons bitten by dogs actually mad, are never affected by the dis- ease, even though they dispense with preventive remedies. These exemptions, however, ought not to induce a security which may prevent every precaution being taken to avert the awful calamity. From the consideration that one even in twenty may be the vic- tim, it would be the height of indiscretion and folly, not to resort to the most judicious and reputable source for early advice and assistance. The approach of the disease is known by the part bitten becoming painful, hard, and elevated, attended by a peculiar sense of prick- ing and itching at the part, and pain resembling rheumatic pain extends. into the neighbouring parts, and towards the throat. There are more general pains of a flying convulsive kind, which affect the patient in the neck, joints, and other parts, and a dull pain seizes the head, breast, belly, and along the back-bone. A lassitude and a vertigo soon come on; the patient is melancholy, mutters, is forgetful and drowsy; his mind seems disordered. ORDER HI. RABIES, OR HYDROPHOBIA, 605 his temper irritable and irregular ; his slumbers disturbed, and convulsive agitations immediately follow his waking. His eyes are watery, his aspect sorrowful, the face pale and contracted ; sweat breaks out upon the temples, an unusual discharge of saliva flows from the mouth, thoHgh the fauces are dry; the tongue becomes fpul, and the breath occasionally foetid. There is a Straightness and sensation of choking, and a horror and dread at the sight of water and other liquids, together with tremours and a loss of ap- petite. The person is, however, capable of swallowing any solid Substance with tolerable ease; but the moment that any thing in a fluid form is brought in contact with his lips, or even presented to his view, it occasions him to start back with much dread and hor- ror, although he labours, perhaps, under great thirst at the time. From the beginning there is a peculiar stricture and heaviness on the breast, a struggling, as it were, for breath, a sighing, a nau- sea, and often a bilious vomiting. This oppression, of the praecor- dia is one of the constant symptoms of the disorder ; it begins, in- creases, and ends with it. The second stage advances and a fever ensues, which at first is mild, but attended with momentary horrors, though there is sometimes little or no fever ; sleep is lost, the mind is more and more disturbed, a delirium approaches, and an aver- sion to liquids, to polished bodies, and even to light, rapidly in- creases. Iu some instances the peculiar symptom of the disease, the dread of water, comes on all at once, and augments so visibly that on the sight of any liquid, of a looking-glass, or anything clear or pellucid, a horror seizes the patient, and if he strive to drink, spasms, anxiety, and loss of strength follow. The air, although really warm, is very distressing to the patient, and the slightest touch or motion, and the least sound is offensive and painful. The patient mourns bitterly, and at times, loses all knowledge of his intimate acquaintance. But reason returns at intervals, and he laments his own calamity; thirst excites in him a desire to drink, but he strives in agony, and in vain, to swallow, and soon sinks in- to the most affecting despondency. He desires his friends to keep at a distance, and it is supposed that he feels an inclination to bite, and by some the greatest efforts are made for that purpose. There is constantly a great flow of viscid saliva into the mouth, which is exceedingly troublesome to the patient, as it has the same effect upon the fauces that other liquids have. At length the fever and •hirst increase ; the eyes are bright and furious; the urine is 606 NEUROSES. CLASS VI. high coloured, acrid, and in small quantities ; the tongue hangs out, the mouth foams, he gnashes his teeth, his pulse throbs and strength faiis, cold sweats come on, the tightness of the breast in- creases, and the miserable patient expires in spasms, often losing the difficulty of swallowing liquids for many hours ; so that the dread of water is by no means a pathognomonic symptom. I have now described the symptoms of this disease as they oc- cur in general, but they are so various that they cannot be enume- rated, for we seldom read of two cases of hydrophobia whicli do not differ very remarkably in this respect. Although medicine has hitherto proved ineffectual in almost all cases where the disease had fully established itself, yet humanity demands every possible aid and exertion in favour of the unfortu- nate sufferer. Death in its most awful form closes the scene most commonly on the third or fourth day after the appearance of the symptoms, The remedies heretofore employed for the cure of canine mad- ness, are blood-letting and the antiphlogistic course ; opium and antispasmodics of every grade and description ; the cold and warm bath, blisters, alkaline salts, the different preparations of mercury, antimony, arsenic, zinc, and copper. By none of these, either singly or^combined, has this formidable disease, in its genuine cha- racter, been vanquished in a single well attested instance. No re- medy has ever been more amply or more universally experiment- ed at various periods than that of blood-letting, and its failure has been no less notorious, than its trials have been numerous. It is not to be dissembled however that two or three authenticated in- stances of cures by means of copious blood-letting and mercurial frictions at the same time, have recently been announced. In two successful cases by Dr. Shoolbred, of Calcutta, venesection was re- sorted to immediately on the disorder becoming apparent, until faintness was induced, and the operation was repeated at intervals as long as firmness of arterial action or the symptoms of hydropho- bia remained. In another case the patient was bled by a Mr. Ty- mon, surgeon in the British service, and the bleeding continued un- til scarcely a pulsation in either arm was to be felt; and to this, the cure is chiefly attributed, although his head was blistered, and mer- cury both internally and externally was very liberally applied. The curative plan in hydrophobia therefore, should be prompt and decisive ; if bleeding is relied od, let it be from a large orifice, at ORDER III. RABIES, OR HYDROPHOBIA. 007 the earliest stage of the attack, and carried to the utmost limits of safety ; and the boldest administration of mercury should follow the operation. Twenty or thirty grains of calomel, repeated at short intervals, and half an ounce of the strong ointment, rubbed in the throat and chest three times a day, until symptoms of saliva- tion commence, will probably be a justifiable practice. But the mode of inducing a speedy salivation recommended by the late Dr. Darwin, may be preferred. He directs three grains of corro- sive sublimate to be dissolved in one ounce of rectified spirit of wine ; half of which is to be taken undiluted; it produces a copi- ous salivation for an hour and half, or longer, during which, the patient spits a quart. This is to be repeated according to its effect, and a dose of Glauber's salts should be taken the day after the operation. The atropa belladonna, is supposed by some German authors to possess properties eminently adapted to the cure of hydrophobia. Besides a remarkable narcotic power, it is said to be particularly useful in promoting the secretions by sweat, urine, and also by saliva. It is highly probable therefore, that belladonna may prove of real efficacy in the present disease. The dose is from two or three to six grains twice or thrice in a day. Opium has been administered in cases of hydrophobia to the ut- most possible extent, but it has uniformly failed to afford relief and respite. In the opinion of Dr. Thomas, however, when the patient loses the power of swallowing, introducing opium freely into the system by meaus of friction, appears to be a very eligible plan. Indeed, as the throat appears in this disease always to be affected with spasmodic contractions, it would seem that no remedy we can employ, promises better effects than the rubbing in, and particu- larly about the throat and chest, opium in the form of liniment or ointment. If the tincture of opium be conjoined with camphorat- ed spirit and aqua ammonia, these will probably assist its opera- tion. When a diaphoretic is required, the compound powder of ipecacuanha, with the addition of the volatile alkaline salt, wi|l be the preferable preparation. The sponging the body freely with warm olive oil, and pouring repeated doses of it forcibly down the throat, has been recommended as a successful remedy in hydro- phobia. As the canine virus probably lies dormant in the bitten part for a considerable length of time, it is a point of the greatest i mport- ance to pay proper attention to the state of the original wound 60S NEUR0SLS. CLASS VI. in this stage of the disease. If it has been suffered to heal, the cicatrix must be immediately opened afresh, and spirit of turpen- tine, aqua fortis, or some other stimulating or caustic medicine should be applied to excite inflammation and suppuration. This may be of great utility even after the symptoms of hydrophobia have commenced. Newspaper intelligence has lately been re- ceived from Europe, and it appears to be well authenticated, that in two instances, hydrophobia has been successfully treated by the use of vinegar, a pint of which was given morning, noon, and night. This may prove a discovery (although not new) of the greatest importance, and as the experiment will be a laudable and a harm- less one, it ought to be tested on every occasion that may be pre- sented. I must not omit to mention, that one case of hydrophobia has been promulgated from the most respectable authority, in which a cure was effected by the severest operation of galvanism.* It now remains to suggest the requisite precautions relative to the management of the hydrophobous patient, so as to avoid any ill consequences from a bite or contact of saliva. Should danger become apparent during the furious stage of the disease, the patient ought to be so confined, either by a straight waistcoat, or other means, as to prevent injury to himself or attendants. It would also be particularly proper to avoid the saliva Coming in contact with any part of the body ; and with a view of annihilat- ing every source of apprehension, it would be advisable to bury in the earth, all such clothes as have been in use, and are contami- nated with the saliva, as a small quantity of it applied to a part where the skin is broken, might be productive of disastrous con- sequences, as exemplified in the following case. Dr. Henry II. Childs, of Pittsfield, while attending a young woman labouring under hydrophobia, received accidentally by her nails, a scratch on his hand, which was then covered with saliva fro n her mouth. In about ten days he began to feel some indis- position, and the alarming symptoms of hydrophobia rapidly pro- gressed till his situation became extremely hazardous. After a confinement of thirty days, and pursuing a very severe course of mercury both internally and externally, the disorder was subdued and he gradually recovered. The reader is referred for a particu- * Medical and Chirurgical Review, Vol. X. 9RDER III. RABIES, OR HYDROPHOBIA. 609 lar detail of this case, and for a mass of information relative to the subject, to " Observations on Hydrophobia," by the author of this work, published in 1812. In Russia several articles are held in estimation, both as pre- ventive and curative remedies, with whose efficacy we are unac- quainted. The root of alisma plantago is given in doses of from 20 to 24 grains every two hours. The genista to the quantity of half a drachm three times a day, together with a decoction of the same plant. It is in Russia also, as we understand, that the doc- trine is prevalent that hydrophobia is a. local disease seated in the glands of the mouth. Small tumours or blisters make their ap- pearance under the tongue about the time of the approach of the hydrophobic symptoms. These tumours should be opened or re- moved by the knife or caustic, and this is affirmed to prove an in- fallible remedy. The degree of confidence to be placed in this statement is not satifactorily ascertained, as the accounts publish- ed have been contradictory. Dr. Nathaniel Miller has lately experienced the efficacy of Dr. Fowler's arsenical solution in several cases of tetanus and other spasmodic affections, and it should be strongly recommended for trial in every case of hydrophobia, and that the result may be pro- mulgated. The proper dose is ten drops repeated every half hour until relief is obtained. The fact is well established that the symptoms of genuine rabies canina may arise in the system from other causes than a bite from a rabid animal. Dr. Rush has produced ample testimony that spontaneous hydrophobia has frequently occurred, in some acute fevers, from topical inflammation of the thorax or neighbouring parts, histeria hydrocephalus and tetanus. It is said to have su- pervened also to a phrenitic attack, and to have proceeded from the bite of epileptic patients, and from a bite from persons in a violent fit of passion. Inflammation of the stomach has been accompanied with spontaneous hydrophobia, one example of this nature fell under my own observation a few years since in a lady who ulti- mately recovered.* " Dread of rabid madness has been so great in persons bit by a dog supposed to be mad, as to induce delirium and symptoms of hydrophobia, which seemed likely to terminate fatally; when the * Sec a detailed account of this case ia New England Med. Journal, vol- I 77 6ro NEUROSES. CLASS VI. sufferers have been suddenly restored to health on ascertaining that the dog was not mad." The Duke of Richmond, late Governor of Lower Canada, having cut his face while shaving, lifted a small family dog to lick off the blood, when unfortunately his Grace received a bite from the ani- mal, on his chin. Five months after he was suddenly seized with hydrophobia, venesection gave some momentary relief, but he died on the third day of the attack, August 28th, 1819. INCUBUS, OR NIGHT-MARE. The night-mare attacks a person during sleep, and when he lies on his back, particularly after eating a heavy supper. There is a sensation of a great weight, or oppression about the breast and sto- mach, and is generally accompanied with frightful apprehensions. The person groans, and sometimes cries out and makes ineffectual efforts to speak. In some instances he imagines himself engaged with an enemy, and in danger of being killed, and attempts in vain to make his escape. In others, the patient fancies himself falling over a precipice, and the horror of being dashed to pieces sudden- ly awakes him. This is a nervous affection, and arises chiefly from indigestion and oppression of the stomach, in consequence of eating a heavy supper just before going to bed. Wind in the stomach is also a very frequent cause of this complaint. Deep thought, anxiety, and a sedentary life may produce the night-mare. When indigestion, or any weakness of the stomach prevails, a course of tonics, as advised in other nervous affections will be high- ly necessary. In every instance the cause which gives rise to the complaint must be carefully avoided, especially flatulent or indi- gestible food, and heavy suppers late at night; let him preserve cheerfulness of mind, and sufficient exercise through the day, and at night take a glass of brandy or peppermint water, which is bet- ter, to promote digestion and obviate flatulency. MELANCHOLIA AND HYPOCHONDRIASIS. The diseases thus denominated are so closely allied, that it is difficult by any description to draw the line of distinction correctly. One distinctive mark however, is, that dyspepsia is commonly at- ORDER III. MELANCHOLY AND HYPOCONDRIASIS. 611 tendant upon hypochondriasis, but is absent in cases of melan- cholia. This last affection is in general the incipient stage of, or is itself a less degree of madness, and the highest degree of hypo- chondriasis. Each passes gradually into the other and they all often at last terminate in alienation of mind. Hypochondriasis is chiefly incident to persons of a melancholic temperament, of a studious and sedentary life, especially such as have indulged in grief and anxiety, and are advanced above the middle age. It is sometimes known, by the name of spleen, or low spirits, or the vapours, as there is commonly a peculiar depression of spirits, accompanied with absurd and ridiculous fancies. The mind of the patient is constantly disturbed with imaginary evils and suspicions, and a strong apprehension of death from the slightest cause, may be regarded as characteristic of the disease. The pa- tient is frequently troubled with a spasmodic constriction of the throat, sour belchings, and vomitings of viscid phlegm, of acrid cor- rosive matter. He complains of languor, listlessness, or want of resolution and activity, coldness of the skin, and disposition to seriousness, sadness, timidity, and gloominess. These symptoms are accompanied with spasmodic pains under the short ribs of the left side, and sometimes with a swelling of those parts, attended with flatulency, indigestion, watchfulness, palpitations of the heart, and generally a costive habit. But it would occupy many pages to enumerate the long train of nervous symptoms which sometimes harass the miserable hypochondriac. The hypochondriac disease may be occasioned by long and seri- ous attention to study, indolence and protracted grief, long con- tinued evacuations, obstructions of some of the viscera ; high and full diet, or crude flatulent unwholesome food, with irregularity and intemperance, by which the stomach becomes loaded with indi- gestible crudities and viscid mucus. This disease, however dis- tressing to the patient, and embarrassing to the physician, is seldom attended with dangerous consequences. The cure depends less upon medicine, than on the judicious manage- ment of the mind which requires the utmost address, as those pa- tients are capricious and irritable in the extreme ; the mind must be diverted from desponding and ill grounded apprehen- sions, by inviting to such agreeable amusements, and cheerful company, as will engage the attention to other objects than his complicated, and often, imaginary feelings. In order to gain hrs 612 NEUROSES. CLASS VI. confidence, and to flatter his hope, we ought to attend to his com- plaints as of real existence, and to change his medicines from time to time, as often as he expresses much disappointment in his ex- pectations of relief. Every cause of anxiety and fatigue must be studiously-avoided, or remedied, moderate exercise on horseback, when convenient, should be uniformly persisted in, that new and varied scenes may be presented to his view. The reading of en- tertaining books will also be useful in assisting to divert the mind to different objects. A proper diet constitutes an essential part in the treatment of the hypochondriac, as well as the dyspeptic patient. In general, light animal food is what alone agrees with the stomach, in these cases ; vegetables, and every thing of an acescent ten- dency are apt to generate crudities and flatulency. The drink should be old claret or Madeira wine, or occasionally a little brandy with water; but neither of these should be indulged in so freely, as to acquire an irregular habit. Strong tea and coffee, are to be avoided, as pernicious. Instead of these, cocoa, or chocolate, or infusion of chamomile, with some juniper berries, ginger, or mustard, should be preferred for breakfast. The cold bath is to be regarded as a powerful assistant in the strengthening and tonic plan of treatment, in all nervous and hypo- chondriac cases. Sea bathing, when it can be obtained, should be preferred. It ought to be practised three or four times in a week, from March to November, and the most suitable time is either an hour or two before, or two hours after breakfast. In some in- stances where a rigidity of the solids prevails, the tepid bath will prove more beneficial than the cold bath ; and the warm pediluvi- um will frequently prove serviceable. Another auxiliary highly conducive to recovery in nervous affections, is friction, which ought to be applied over the whole body with a coarse cloth, every night and morning, for a quarter of an hour at a time; this kind of exercise stimulates and excites the action of the extreme vessels, and has a peculiar tendency to invigorate the whole system. Much benefit may often be derived from a sea voyage and change of climate. In regard to the medical treatment in the present disease, the first step is to clear the stomach and intestines of their acrid or viscid contents, by means of gentle emetics and purgatives, whicli may be occasionally repeated if found necessary. With the view of couiiier;»rtiug the effects of the prevailing acid or acrimonious ORDER IU. MELANCHOLIA AND HYPOCHONDRIASIS. 6i3 humours in the stomach, we are next to prescribe alkalies and antacids, as in dyspepsia. The salt of tartar, sal soda, or sal aera- tus, mixed with some mucilage, should be exhibited in their proper doses several times in a day, and the absorbent powders, as chalk and magnesia, are well adapted to correct the prevailing acidity; about ten grains of rhubarb with a drachm of calcined magnesia, will answer the desired purpose of a gentle laxative to be taken occasionally ; but in a torpid state of the bowels, three or four grains of calomel may be added to advantage. The elixir pro- prietatis will be found useful as a warming invigorating stomachic laxative. After the stomach and bowels have been properly evacuated of their impurities, recourse must be had to those med- icines which are best adapted to the purpose of strengthening the alimentary canal, and promoting the secretions. A plaster of Burgundy pitch to the stomach and abdomen, will be beneficial, but our chief dependence must be in the employment of chalybe- ate medicines, and the form of Griffith's myrrh and steel mixture is excellently adapted to the purpose of corroborating and strength- ening the stomach and digestive organs, and is preferable to Peru- vian bark in torpid habits. If antispasmodics should at any time be required, the skunk cabbage root, as directed in hysteria, may be employed. Such is the capricious and fickle temper of hypo- chondriac patients that they become dissatisfied and impatient, unless they are liberally supplied with medicine ; and we are often obliged, in compliance with their whims, to vary our prescriptions, and to direct palliative remedies ; among those most commonly employed, are .ether, musk, asafcetida, castor, camphor, valerian, volatile salts, salt and oil of amber, and opium. From among these the prescriber may make a selection, but in regard to opium, it should be resorted to on urgent occasions only, lest the patient become addicted to a practice which can never be relinquished. Indeed those who accustom themselves to a regular use of this drug, ought to be apprised, that by taking about two ounces of lemon juice, or strong vinegar with each grain of opium, the un- easy sensation whicli the medicine often occasions, and its tenden- cy to induce constipation, will be in a great measure obviated. ■\n infusion of the tincture of hops will, in some constitutions an- swer the same purpose as opium. Wind in the stomach and bowels proceeding from a want of tone or vigour, is peculiarly incident to all nervous patients, and 614 CACHEXLE. CLASS VII. greatly contributes to aggravate their distress. This complaint is to be relieved by carminative medicines, and by such as have a tendency to restore the tone and vigour of the alimentary canal. When the stomach is empty, the eating a dry biscuit will often afford relief. The carminative medicines most in repute, are asafcetida, elixir vitriol, aether, and opium, to which may be added acorus calamus, the cow-parsnip, and the seeds of anise, caraway, coriander, and juniper berries. ./Ether may be given in the quantity of two tea-spoonfuls, or more, in a cup of cold water, and about fifteen drops of laudanum may be added, or given sepa- rately, when required. The tincture of castor and spiritus nitri dulcis, to either of which laudanum may be combined, will gene- rally afford much relief; and, in fact, aether and laudanum are superior to any other medicines in these cases, whether the flatu- lence be contained in the stomach or bowels. Some advantage may be derived from the application of the antihysteric or the stomach plaster, or from rubbing the anodyne balsam on the parts at bed time. When costiveness attends the complaint, four or five of the following pills will produce excellent effects. Take asafcetida, two drachms; socotorine aloes, salt of steel, and pow- dered ginger, of each one drachm; as much elixir proprietatis as will be sufficient to form them into pills. The tonic and chalybe- ate medicines mentioned in the preceding pages are to be advised, and active amusements and severe exercise, with temperance in eating and drinking, should be constantly practised. Class VII.—CACHEXIA. Order I.—MARCORES. MARASMUS, OR ATROPHY. This disease consists in a gradual wasting of the body, unac- companied with any remarkable fever, cough, or difficulty of breathing; but usually attended with a loss of appetite and im- paired digestion. It may be occasioned by too copious evacua- tions, deficiency of nourishment, unwholesome air, abuse of spir- ituous liquors, severe mental affections, and scrofulous obstructions of internal glands. This complaint is apt to seize young persons BUDER I. MARASMUS, OR ATROPHY. 6l5 of a delicate make and of rapid growth, before they arrive at mature age. In the beginning of this disease, the countenance is pale and squalid, the appetite loathes every kind of food, the pa- tient is constantly languid, and inclines to keep very much in bed, the urine is often small in quantity and high coloured, sometimes pale and copious. This disorder is for the most part very difficult to cure, and often terminates in a fatal dropsy. We should at- tempt in the early stage to remove this complaint, by first admin- istering a gentle emetic, and then occasional doses of rhubarb ; and afterwards by restoring the tone of the solids, and improving the state of the digestive organs, by the use of tonic and stomachic medicines, combined as follows : take of gentian root two drachms, orange peel, half an ounce, Peruvian bark, one ounce; infuse them in a quart of white wine or pure cider for two or three days, and filter through paper. Three table-spoonfuls twice in a day is the proper dose for an adult, to which ten drops of the tincture of muriated iron may be added, or the patient may take from five to ten grains of the carbonate of iron twice in a day ; or the myrrh and steel mixture, as directed in the Appendix. If the disease depends on a weakness of the nervous system, as in the hysterical and hypochondriacal affection, the same plan must be pursued, to which may be added pills of asafcetida and castor. The diet ought to be of the most nutritive kind, and proper exercise and free air should not be neglected. Atrophy in children is often accompanied with an enlargement of the glands of the mesentery, which is known by indigestion,. costiveness, or purging, irregular appetite, flushed cheeks or a total loss of colour, impaired strength and spirits, and remitting' fever. The abdomen is hard and tumefied and the limbs are emaciated. For the removal of the obstructions in the lymphatic system, and to effect a resolution of the indurated glands of the mesentery we must depend principally upon small doses of calo- mel and rhubarb, administered daily or every other day, until its good effects become evident. This course should be accompanied with antimonials, neutral salts, soap, and occasionally Dover's powder, with the tepid salt water bath, and the system is to be restored by a tonic course joined with daily frictions of the limbs and spine, and when we have been so fortunate as to remove the obstructions, the cold bath may be employed. 61 (5 c.vciiExr.r. cl\ss ni,. Order II.—INTUMESCENTL'E. POLYSARCA, OR CORPULENCE. This, if not a disease, is a state of the system which is often attended with great inconvenience, and may lay a foundation for serious consequences. It is in some instances constitutional, but " independent of peculiarity of habit, it is frequently produced by a free indulgence of the appetite in the use of very nutritive food and fermented liquors, conjoined with an inactive life." The bulk of the body has in some instances been enormous, having amounted to from five to six hundred pounds. " Bright, of Maiden, England, weighed 728 pounds; Lambert, of Leices- ter, 739 pounds, a little before his death, which was in the fortieth year of his age. The German journals give examples of men who weighed 800 pounds."* " When a person of a constitution which is predisposed to obesity is enabled to indulge in good feeding, leads a calm, indo- lent life, free from mental inquietude, and sleeps much, corpulence generally ensues. The causes of corpulence being thus well un- derstood, the means of prevention and removal are not less obvi- ous. In this the patient must, in a great degree, minister to him- self; the prevention and cure will depend upon the proper regula- tion of his diet, exercise, and sleep. Medicine will only be necessary to obviate particular symptoms, or diseases arising from or connected with it. The disease frequently, however, steals on so imperceptibly, that it becomes inveterate before people begin to think of pursuing any means for obviating it. To get rid of too much fat without any injury to the constitu- tion, the patient should in a very gradual manner diminish the usual quantity of his aliment, taking less nutritious substances' for food ; he should drink as little as he can with ease to his sensations, and particularly of malt liquors ; he should use regular and daily active exercise, abstain from suppers, take short rest, sleep but few hours, and rise early every morning. To assist these means' and compress the bowels, (increasing their absorption, probably, thereby,) he may put a proper bandage round the belly, so that * Dr. Good. ORDER II; EMPHYSEMA. 617 it can be tightened or relaxed with ease. An under waistcoat, with two or three rows of buttons, will answer this purpose very well. By a rigid pursuance of these means for a due length of time, I have no hesitation in affirming, that the most corpulent and unwieldy man or woman may be reduced within moderate bounds^ with an acquisition of health, strength and yigour, both of body and mind. " It will, however, be most prudent in all cases to reduce obesity in a gradual manner, which may be done effectually by keeping the eyes open, the mouth shut, and the legs in motion ; or in other words, by eating and drinking sparingly; by sleeping little, and taking much active exercise. "Vinegar and lemon-juice are too frequently used by young wo- men to reduce corpulence ; but an excessive use of acids is apt to destroy the digestive powers, and in the end to bring on a train of dyspeptic complaints."* EMPHYSEMA. " This disease consists in a collection of air in the cellular membrane. In general it is confined to one place; but in a few cases it spreads universally, over the whole body, and occasions a considerable degree of swelling. It sometimes arises spontaneous- ly, which is, however, a rare occurrence, or comes on immediately after delivery, without any evident cause ; but it is most generally induced by some woand or injury done to the thorax, and that af- fects the lungs ; in which case, the air passes from these throirgh the wound into the surrounding cellular membrane, and from thence spreads sometimes over the whole body. " Emphysema is attended with an evident crackling noise, and elasticity upon pressure, and sometimes with much difficulty of breathing, oppression and anxiety. " We are to consider it as a disease by no means unattended by danger ; but more probably from the causes which give ri^e to it, than any hazard from the complaint itself. " The intentions of cure which we should have in view, must be, first, to remove the cause of the disease, secondly, to relieve the ur- gent symptoms, and, thirdly, to evacuate the collected air. * Thomas's Modern Practice • 78 618 cachexia;. C.LASS VII. " To answer the*first of these, the assistance of surgery will be necessary, as arising most commonly from a wound or other inju- ry done to the thorax, which at the same time affects the lungs, as in the case of a fractured rib, the ragged edges of which penetrate the pleura and substance of the lungs, and, thereby admit of an ex- travasation of air into the cellular membrane. In such cases the air is to be evacuated by scarifications into the cellular membrane in different parts of the body, as circumstances may require, as- sisted by proper pressure with the hand. " Violent dyspnoea and anxiety are to be relieved by bleeding and laxatives; and the pain and uneasiness arising from the distention by relaxing applications to the skin, such as the unguentum ce- tarei, &c." TYMPANITES. This disease is a flatulent distention of the belly, and the wind is either pent up in the intestinal canal, or confined between the intestines and the membranes which line the muscles of the abdo- men. In the former instance, the tumour of the belly is often un- equal, and there is a frequent explosion of wind, alleviating both the tension and pain ; but in the latter species the tumefaction is more equal, and the emission of wind, which is less frequent, af- fords not such evident relief. This complaint is generally preceded by an unusual flatulency in^the stomach and intestines; as the disease advances, there is a constant desire to discharge wind, which is attended with much difficulty, and affords but transient relief; there is at the same time costiveness and occasional colic pains. The abdomen soon be- comes extremely swelled, which does not yield much to pressure, but is very elastic and sounds like a drum, and no fluctuation can be perceived. It may be distinguished from ascites by the tense feeling of the abdomen, by the quick reaction of the parts after removing the pressure of the finger, by the absence of fluctuation, by the frequent desire to belch, and by the urine being at first not altered either in quantity or quality. In almost every instance, this proves an obstinate and danger- ous disease, and the patient after long suffering, is frequently de- stroyed in consequence of a gangrene of the intestines. ORDER II. HYDROPS, OR DROPSY. 6l9 With the view of a cure, the patient should abstain from all flat- ulent vegetables and fermented liquors. If much fever and a full pulse attend, it may be proper to bleed ; the air in the intestines must be evacuated by mild laxatives joined with aromatics and the essential oils of anise and juniper ; opiates and other antispasmo- dics must be administered ; injections of the infusion or smoke of tobacco are particularly recommended. The abdomen should be frequently rubbed with stimulating liniments, and swathed with a flannel bandage ; a blister, or bags of warm bran, sand, or salt, may also be applied ; but to excite the action of the intestines, nothing is better adapted than snow or very cold water applied to the abdomen. The Peruvian bark and chalybeates should be given combined with carminatives and aromatics, such as the essen- tial oils, elixir vitriol, ginger, and a little Geneva, or other spirits diluted with water. A clyster pipe should be frequently introduc- ed into the rectum, and allowed to remain there for some time. When the air is known to be diffused in the cavity of the abdo- men, relief, in desperate cases, is sometimes obtained by the ope- ration of paracentesis or tapping ; after which the system must be invigorated by gentle exercise, and the stomachic and tonic medi- cines already recommended. This is a disease of rare occurrence. HYDROPS, OR DROPSY. This disease consists in a preternatural collection of watery hu- mours, either under the skin, or contained in some of the cavities of the body. When it occupies the cellular membrane, whether diffused over the whole, or a part of the body, it receives the name of anasarca or leucophlegmatia ; when contained in the cav- ity of the breast, hydrops pectoris, or hydrothorax ; when in the brain, hydrocephalus internus; if in the cavity of the abdomen, ascites ; in the uterus, hydrometra ; within the scrotum, hydrocele. Hydrops Celluraris, or Anasarca. The causes which give rise to dropsies are numerous, as exces- sive and long continued evacuations, especially copious bleedings and strong purgatives; frequent salivations ; abuse of spirituous liquors ; suppression of customary evacuations, as the menses and haemorrhoids, scirrhosities of the liver, spleen, mesentery, or other 620 CACHEXIA. CLASS VIT. abdominal viscera; preceding diseases, as jaundice, diarrhoea, dy- sentery, asthma, intermittents of long duration, scarlatina, the striking in of eruptive diseases, and whatever disposes the system to a state of relaxation. The anasarca commonly begins with a swelling of the feet and ankles, only in the evening, disappearing again in the morning ; the swelling is soft and inelastic, and when pressed with the finger, will pit like dough, and the impression remains for some time. The swelling^ gradually ascends, and occupies the legs, thighs, trunk of the body, and sometimes also the head ; the skin is pale and dry, there is great thirst, the urine diminished in quantity and high coloured; the body is costive, and in the advanced stages of the disease, a considerable degree of dyspnoea, cough, and a slow fever ensue. In the first stage of dropsy in a majority of cases in this climate, high arterial action and inflammatory diathesis unquestionably pre- vail. This is clearly evinced by the hard, tense, chorded pulse, hot and dry skin, parched tongue, and excessive thirst. To these may be added sizy blood, and the great relief obtained by vene- section and other depleting remedies. Who then will question the propriety, or even the absolute necessity of blood-letting in the early stage of dropsical affections "? This was the practice of the able Professor Rush, and the experience of his successors af- fords ample attestation to its utility. Although this remedy is ap- plicable to the different species of dropsy, it is not to be adopted indiscriminately under all circumstances that may occur. High arterial action and the ordinary signs of inflammatory diathesis, must be regarded as the correct criterion, and the discerning prac- titioner's only guide of safety. When anasarcous cedematous swellings arise from any tumour compressing some lymphatic, or from a lymphatic vessel of a limb being cut, or in case of a weakness of a limb, in consequence of a sprain or bruise, the best method of cure will be to remove the tu- mour if practicable, to support the weakened vessels by a circular bandage or roller applied from the lower extremity upwards, and at the same time to employ frictions daily with a solution of crude sal ammoniac and a decoction of white oak bark, with forge water which is strongly impregnated with iron, and the cold bath may also be useful. In some instances of swellings of the legs, pro- ceeding from a deficient action of the absorbents of the lower e.x-. ORDER II. DROPSV.--ANASARCA. 621 tremities, cures have been performed by an universal bath of warm sea water, or a substitute may be prepared by dissolving a proper quantity of salt in common water; the degree of heat should be moderate, and the immersion may be continued about half an hour every night for some time ; the action of the vessels upon the sur- face must be excited by friction, diligently employed from below upwards, but never in a contrary direction. The water collected in the cellular membrane may often be drawn off by scarifying or puncturing the skin ; the punctures must not, however, be made deep, nor near to each other, as gangrene is very apt to ensue in consequence of wounds made in dropsical cases, especially if in a very dependent part, the best preventive of which is embrocations with camphorated spirits, &c. to the scarified parts. Blisters and issues are of little use, and not altogether free from a dangerous ten- dency to gangrene, but the application of colewort and burdock leaves serves to moisten the skin and afford some relief. In those cases of dropsy where there is an evident increased ac- tion of the arterial system, the diet of the patient should be mild, soft, and easy, but where debility chiefly prevails, a more generous, warming, cordial diet will be requisite, such as roasted meat, gar- lic, mustard, raw onions, &c. Daily exercise is of much utility in all dropsical cases, as it promotes absorption, and increases the ex- cretions both by perspiration and urine; it ought to be practised to the full extent of the patient's strength, while the air which he breathes should be pure, warm, and dry, and flannel should be worn next to the skin. That emetics are adapted to excite the action of the lymphatic vessels, and promote absorption of the effused water is universally agreed. These should be occasionally administered in both ana- sarca and ascites. But still greater advantages will be derived from the judicious employment of carthartics ; among which it may with confidence be asserted that cream of tartar and jalap com- bined is of superior efficacy in the recent or inflammatory stage of dropsical complaints. The singular success of this remedy in the ' hands of many experienced and respectable physicians entitle it to the highest praise, and a steady perseverance in its use cannnot be too strongly recommended. In one instance, even where vene- section had been dispensed with, all the symptoms yielded to a few doses of cream tartar and jalap, acting powerfully both as cathartic and diuretic. From imprudent exposure, the disease re- 622 CACHEXIA. CLASS vn: curred a few weeks afterwards, and was completely subdued by the same remedy alone. The proper dose of this medicine is one drachm of the tartar and fifteen or twenty grains of jalap, to be exhibited at proper intervals until a very copious evacuation is ef- fected. Cream of tartar is also well established as one of the most efficacious diuretics in dropsical complaints. With this view, on© ounce is directed to be dissolved in a pint of water, and this to be taken in divided doses during the day. Among the mild diuretics well calculated to subdue febrile action in this disease, is nitre ia doses of twelve or fifteen grains three times in a day. Equally well suited to these views, however, is the dulcified spirits of nitre, if given in large doses, as a table-spoonful or half an ounce three or four times in twenty-four hours. This proves less offensive to the stomach than the nitre in powder, and produces favourable effects as a diuretic and in reducing arterial action. It is not in every case of dropsy that the antiphlogistic and depleting plan is to be long persisted in, nor will it on all occasions be deemed ap- plicable at the commencement. When the system is reduced to a state of debility, and all symptoms of inflammatory action have subsided, recourse must be had to a more appropriate course of treatment. It is here that the more stimulating and drastic pur- gatives, as calomel, scammony, colocynth, gamboge, and even elaterium, evince their peculiar efficacy, and that digitalis and squills display their diuretic powers. In every species of dropsy, but more particularly hydrothorax, digitalis remains in high repute, and is the favourite diuretic in modern practice. The rules first directed by Dr. Withering respecting the administration of digi- talis in dropsy, have from long experience and observation become established principles in practice. It is in cases of debility with feeble pulse, pale countenance, and coldness of the surface, and in these circumstances only, that digitalis is successfully adminis- tered. The dose in powder is from half a grain to two or three grains morning and evening, or one drachm of the dried leaves may be infused in eight ounces of water, and half an ounce of this given twice in a day, and gradually increased until the effects of the remedy appear. (See American New Dispensatory, article fox- glove.) Squills combined with nitre in the proportion of from five to ten grains of the dried root, and double the quantity of nitre, has been extolled for its efficacy in dropsical cases. The tincture of tobac- ORDER II. DROPSY.—ANASARCA. 62 J co, in the opinion of some, is entitled to much confidence as a powerful diuretic in dropsical swellings. One article more de- serving of notice is the oil of turpentine; this stimulating diuretic has produced favourable effects in doses of six or eight drops, but when exhibited in half ounce doses, undiluted, in cases of tape worm, it operates as a powerful carthartic, and it may probably in this manner prove also a valuable remedy in dropsies. But it is to be remarked, that diuretic medicines very frequently fail when given alone, but act with increased powers when administered in con- junction ; thus, digitalis may be combined with cream of tartar, tiitre with squills, and on some occasions, calomel may be added to each of these with the happiest effects. During the employ- ment of diuretics, the patient should be enjoined to make a liberal use of diluting drinks, as barley water with cream of tartar dissolved in it, and a little brandy or Geneva, and sugar added; mustard whey, pure bottled cider and water, &c. The eupatorium pur- pureum, or trumpet weed is a domestic plant well deserving of at- tention as possessing diuretic powers. A strong infusion of the roots of this plant is much used by country physicians as a diuretic, and it should be recommended in every species of dropsy. Among the articles of domestic and popular use are garlic, water-cresses, and parsley. This last article was recommended by Dr. Rush, and is said to be a valuable diuretic. The seneka root is a favour- ite remedy with Dr. Milman, it operates, he says, by expectora- tion, urine and perspiration, and sometimes as an active purgative. The atonic, or dropsy of debility, known by a weak and quick pulse, and by little or no preternatural heat or thirst, requires a method of treatment somewhat variant from that just described. It consists in the use of stimulating substances to increase arterial action, or to excite the urinary secretions. Here both the veget- able and metallic tonics claim our chief regard ; they are stomach bitters, angustura, and Peruvian bark, with chalybeates and mer- cury ; this last, when given so as to excite salivation, has often cured dropsical affections, and calomel combined with squills forms an excellent diuretic. Mercurial friction has sometimes been em- ployed till the mouth begins to be affected, when a course of diu- retics and tonics has completed the cure. Strengthening and to- nic medicines must be administered during the employment of purgatives, and after the water is evacuated, that class of remedies '? indispensably necessary in order to effect a permanent cure. 624 CACHEXIA CLASS 1 .' Among the expedients which Dr. Rush enumerates, as of salutary tendency in this disease, are hard labour, fasting or abstinence from food, and the passion of fear, each of which has been found to induce a sudden increase of the quantity of urine, by which cures were obtained. " In dropsical effusions, with debility, three or four drachms of the tincture of cantharides given in divided doses during the day will produce a powerful evacuation of urine." In old people this medicine is particularly indicated. In the inflammatory affection of the lower extremities accom- panying anasarca, Dr. Ferriar fonnd much advantage from an in- fusion of digitalis used as a lotion. The steam bath or the vapour bath of Dr. Jennings applied to anasarcous swellings may tend to excite the lymphatics into action and thereby increase the cellu- lar absorption, especially if assisted by friction. I have seen benefi- cial effects from the application of alaced stocking or flannel bandage to anasarcous limbs. In applying the bandage we must begin at the foot and carry it uniformly smooth and moderately tight to the thigh or hip, if this should be the occasion of a swelling in the ab- domen, it must be loosened or removed. We must not omit to apprise the reader that the Pyrola umbellata, an American plant, possesses diuretic properties well deserving attention as a pallia- tive in dropsy. Dr. W. Somerville, in a paper on this plant publish- ed in the fifth volume of the London medico-chirurgical transac- tions, seems to have fully illustrated the facts affording satisfactory evidence of the power of pyrola to promote the venal excretion, and to give relief to patients afflicted with dropsy in its various forms. A distinguished and remarkable instance presented by him is that of Sir James Craig, the British governor in Canada, who was affected with general dropsy, which in its progress assumed the forms of hydrothorax, anarsarca and ascites, and which was com- bined with different organic diseases, especially of* the liver. After having tried with little or temporary success, almost every variety of diuretic and cathartic medicines and submitted twice to the operation.of tapping, the patient had recourse toastrong infu- sion of the pyrola in the quantity of a pint every twenty-four hours. This gave relief not only on the first, but in the subsequent trials. It increased the urinal discharge, and at the same time produced an augmentation of strength, and an invigorated appetite. Several other cases of dropsy are detailed in which pyrola was administer- ed by Dr. S. and by other practitioners with decided advantage. OKDfcR II. DROPSY.—HYDROCEPHALUS. 623 The patients uniformly remarked that an agreeable sensation was perceived in the stomach soon after taking the pyrola, and this was followed in some instances by an extraordinary increase of appe- tite. Dr. S. considers it as having in,this respect a great advan- tage over other diuretics, none of which are agreeable to the sto* mach and most of them very offensive to it. Hydrops Cerebri, or Hydrocephalus. Hydrocephalus is generally the disease of children, and is al- ways attended with great danger. It has seldom been known to attack a child after it has arrived to the age of twelve or fourteen years, and most generally occurs in those families whose constitu- tions have a scrofulous taint. It is an affection which has been observed to pervade particular families, affecting the greater part of the children at a certain period of their life. It is one of the most insidious and fatal diseases to which children are subject; often commencing very suddenly and terminating fatally in a few days. But in some instances, its invasion is more gradual^ and the child lingers for a long time, even for many weeks or months. It may originate from the Various causes which induce dropsy in general, as acute inflammation, or from injuries done to the brain, by falls or blows, which have happened and long since forgottenj or from an original laxity or weakness of the brain, a thin watery state of the blood, a diminished secretion of urine, a sudden check of perspiration ; and lastly, it may be the consequence of lingering diseases whicli have wasted and injured the system. This disease is distinguished into external, when the water lies upon the sur- face of the brain, and internal, when it is contained within its membranes or ventricles. Such is the ambiguity of the symptoms, that it is difficult to determine what are its real characteristics. The indisposition of the patient is sometimes attributed to teething, or a disordered state of the stomach and bowels ; frequently it re- sembles the common febrile complaints of children. But it is often preceded by an unusual langour and peevishness, and the child frequently shrieks, and cries out suddenly without any known cause. A kind of slow fever appears, attended with a weakness of the arms and pains in the limbs, and often in the upper part of the neck. A vomiting of bile soon ensues, either with costiveness or diarrhoea, and the appetite is impaired. A pain in the fore 79 626 CACHEXIA. CLASS VII. part of the head follows, and the child becomes heavy and dull, it moans, and often puts its hands to its temples, and is unable to sustain an upright posture. The pulse becomes irregular, but com- monly much slower than natural. The faculties and senses are at length impaired, and tbe eyes are offended by the light ; the pa- tient sees objects double, and becomes delirious. The limbs on one side are sometimes affected with paralysis, the pupils are di- lated, and one or both eyes are drawn asquint. As the disease advances, the pulse grows more frequent, the cheeks become flushed, the skin is hot, and startings and spasms occur. The stools and urine are now discharged involuntarily, the child lies in a comatose state, or the thread of life is severed by painful convulsions. This delineation has been exemplified in three or four instances in my own family, besides many others in the compass of my knowledge. It is more easy to describe than to devise a remedy for this cruel disease. It is only in the first stage of the complaint that we can pre- scribe with any hopes of success. On the first attack of the febrile state, we should bleed, apply leeches to the temples, and purge the patient with calomel and jalap. Should these prove insuffi- cient to check the progress of the disease, we must have recourse to shaving the head, and apply a blister, and continue to give small but repeated doses of calomel as long as the discharges from the bowels are green or foetid. The application of blisters should be repeated, and the discharge from them encouraged by dressing them daily with savin ointment. Dr. Rush was decided in his opinion that hydrocephalus is of an inflammatory character, and that early and active bleeding is almost a certain remedy ; but in the hands of Dr. Parr, and some others, both the lancet and the means of topical bleeding have disappointed expectations. Professor Hosack, however, is very sanguine in his ideas, and I shall now cite his own language on the subject. " Hydrocephalus in its acute form is an affection of frequent occurrence in this city,, (New-York.) In three cases, for which I not long since prescribed, a cure was effected by blood-letting, active cathartics and blisters, all which were made use of during the inflammatory stage of the disease, before the symptoms of effusion had taken place in their greatest extent. In those cases ORDER II. DROPSY.—SPINA BIFIDA. 627 mercury was not administered exeept as a cathartic in combina- tion with large doses of jalap. This fact reminds us of the remark of Dr. Rush, that in consequence of his unsuccessful use of mer- cury in dropsy of the brain, he has declined the use of that medicine altogether in this disease, except when combined with some purging medicine, and that he administers it in this form chiefly with the view of dislodging worms. Query—Does not mercury, by the excitement it produces, add to the inflammation which character- izes the first stage of hydrocephalus ? Mercury, in my opinion, has oftentimes been the exclusive cause of this disease. Certain it is that dropsy of the brain has become of much more frequent occurrence, since the general, and I had almost said, the iudis" criminate use.of this metal, in febrile and inflammatory diseases." From the well known diuretic and purgative properties of cream of tartar, in other species of dropsy, I should confide in the free use of this medicine alternated with small doses of tartarised anti- mony, to such extent as the constitution can bear. In the 1 ist stage of the disease, a variety of medicines have been proposed to obviate its fatal tendency, but the case is in most instances, perhaps, hopeless, and nothing more can be expected than to palliate the distressing symptoms by the use of opiates in proper doses. When the hydrocephalus is a family disease, it will be advisable by way of prevention, to have recourse to the cold bath, a light nourishing diet, and to every mean which will have a tendency to strengthen the constitution. Be careful not to heal too suddenly any eruption especially about the head, and be particularly atten- tive to the state of the bowels. Hydrops Spina;, or Spina Bifida. This consists of a watery tumour of the colour of the skin, found within the spinal marrow, externally protruding in the course of the spine, and where it protrudes there is a considerable vacancy betwixt the two vertebrae, immediately above and below it. This disorder is congenital, and fs most commonly formed in the verte- bra of the loins, and is attended with a palsy of the parts below the tumour. It is supposed to be most frequently connected with a dropsy of the brain, and may be considered as an incurable mala- dy. All remedies will be applied in vain, nor can it be desirable 628 CACHEXIA. class vn. to protract a life which must inevitably be wretched and miserable. Children on whom these tumours are found generally die in a few days after birth, though instances are not wanting in which life has been protracted for several months, when convulsions close the scene. If the tumour is opened a watery fluid is discharged, and death soon follows; or if left to burst, death is equally certain. The only remedy which has been proposed, is a process of pres^ sure on the tumour with the view of promoting absorption of the deposited fluid ; but it has seldom if ever been attended with success, Hydrops Thoracis, or Dropsy of the Thorax. In the hydrothorax, the water may be contained in one or both sacs of the pleura, or in the pericardium alone, and they are often blended together. It commences with a sense of oppression and tightness at the end of the sternum, with anxiety and difficulty of breathing, the patient being unable to rest in bed in a horizontal position, and is afflicted with sudden startings during sleep from a sense of immediate suffocation. The pulse is small, and in the last stage extremely irregular, with palpitations of the heart; the skin is dry, the urine diminished in quantity, the lower extremities become oedematous, the "countenance is pale, with a purple hue of the lips and cheeks; there is a cough, at first dry, afterwards at- tended with expectoration of thin mucus. OZdematous swellings are not only observed in the feet, but also in the hands, which if united with a livid colour of the lips, may be considered as pa- thognomonic of the disease. Inspiration is more easy than expi- ration, and if there is much water on one side, the face, arm, and leg of that side are sometimes swollen. A fluctuation is sometimes to be perceived, the face swells and will pit upon pressure, and great debility and emaciation ensue. As the disease advances, these symptoms are greatly aggravated, or others still more dis- tressing supervene. In cases of hydrothorax in general, our prognostic cannot be other than very unfavourable ; little encouragement of a radical cure can be given, and it will be our happiness if we can even al- leviate the most distressing symptom. The cure, however, is to be attempted upon the same general plan with that of anasarca and ascites; the digitalis, or squills, combined with calomel and opium, are chiefly to be relied on ; antimonial diaphoretics and ORDER II. DROPSY OF THE THORAX. 629 blisters, applied in succession to different parts of the thorax, will probably afford some relief. On the failure of these remedies, and if a fluctuation of water is clearly perceptible, it will perhaps be advisable to have recourse to the operation of paracentesis of the thorax ; for particular directions respecting the mode of per- formance, the reader is referred to books on surgery. I again rjuote the words of Professor Hosack: "It were easy to relate many instances of hydrothorax, ascites and anasarca produced' by a fulness of the vessels, relieved by, blood-letting, calomel, and squills, and other depleting remedies, and the powers of the system again restored by chalybeates and other tonics. Digitalis, so gen- erally and so freely administered in dropsies, can only be servicea- ble when the disorder is in its forming stage. In the secondary stage of the disease, when symptoms of fulness or preternatural ex- citement do not exist, this active narcotic cannot fail to do harm." Dr Ferrier appears to have been solicitous to find a more certain hydragogue than any of those now in use ; and from the successful results of his own ample experience he recommends an extract of the elaterium as surpassing every other medicine in the power of removing serous accumulations, and as affording astonishing relief in the dyspnoea arising from hydrothorax and ascites. Dr. Ferrier has briefly related the particulars in twenty cases in which the elaterium was prescribed with various success. Upon its first ex- hibition to a patient, it is nearly as active and as dangerous, if in- cautiously given, as arsenic. " The sensible effects of the elaterium are, severe and constant nausea, frequent watery stools, and, in considerable doses, vomit- ing. It does not uniformly increase the urine, and for this reason it is generally proper to combine it with more certain diuretics. After continuing the use of the medicine for some days, the pa- tient will sometimes bear a considerable increase of the dose. I have gone to the extent of five or six grains a day in this manner, without producing any inconvenience. But it is always proper to begin with the lowest dose, which is the sixteenth part of a grain of the extract." " I have frequently had recourse to the elaterium, both in hos- pital and private practice. My experience coincides with that of Dr. Ferrier; the elaterium is a powerful, and in every instance in which I have used it, a certain hydragogue. I have begun with the eighth of a grain four times a day, and given it to the extent 630 CACHEXLE. CLASS VIT. of two grains three times a day. It produces copious liquid evac- uations from the bowels, under circumstances of great torpidity of the intestinal canal, when other powerful means have failed, and at times causes an additional increase in the urinary discharge. This latter effect, however, as remarked by Dr. Ferrier, is very uncertain. I have deemed it most expedient, notwithstanding its vigorous action, to unite the pulv. ext. elat. with small doses of cream of tartar, in preference to either calomel or squills. It does not appear to add to the debility of the system, as some other remedies employed to fulfil the indications answered by the ela- terium." Hydrops Abdominis, or Ascites. Ascites is not necessarily connected with a collection of water in any other part of the body, but is not unfrequently combined' with anasarca or hydrothorax. It commences with a tumefaction of the abdomen, which gradually increases until it is uniformly distended, and there is a distinct fluctuation perceivable by apply- ing one hand to the belly, and striking the opposite side with the other; the urine is diminished in quantity, and of a deep col- our ; there is a great thirst, and more or less fever; the face is generally pale and bloated, and the breathing is difficult when the water is accumulated in a large quantity, pressing against the dia- phragm. When the disease arises in consequence of morbid af- fections of the liver, or any other internal viscera, the general system is frequently not much affected, but the event is always precarious. In the ascites, the water is on some occasions con- fined in different cysts or in one of the ovaria, in which case the fluctuation is more obscure, and in the early stage of ovarian drdp- sy, the tumour is situated towards one side of the abdomen, and is less smooth and uniform than in genuine ascites. When, too, the water is very viscid, or when confined in hydatids, the fluctuation will be less distinctly perceived. It is often extremely difficult to distinguish between a dropsy of the belly and a state of pregnan- cy. When deception is intended, the most skilful physician, with all his care and attention, is liable to suffer imposition, and on cer- tain occasions the character both of the physician and his patient may essentially depend on a correct decision. " Dreadful to re- late !" says Dr. Parr, " the trocar has more than once within our own observation, happily not by our direction, been plunged into ORDER II. DROPSY.--ASCITES. 631 a pregnant uterus." Dr. Good relates the following singular inci- dent. " If dropsy occur at a period of life when the catamenia are on the point of naturally taking their leave, and where the pa- tient has been married for many years without ever having been impregnated, it is not always easy from the collateral signs to dis- tinguish between the two. A lady under these circumstances, was a few years ago attended for several months by three or four of the most celebrated physicians of this metropolis, one of whom was a practitioner in midwifery, and concurred with the rest in affirming that her disease was an encysted tumour of the abdomen. She was in consequence put under a very active series of different evacuants; a fresh plan being had recourse to as soon as a preced- ing had failed ; and was successively purged, blistered, salivated, treated with powerful diuretics, and the warm bath, but equally to no purpose : for the swelling still increased and became firmer ; the face and general form were emaciated, the breathing was labo- rious, the discharge of urine small, and the appetite intractable ; till at length these threatening symptoms were followed by a suc- cession of sudden and excruciating pains, that by the domestics, who were not prepared for their appearance, weie supposed to be the forerunners of a speedy dissolution, but which fortunately ter- minated before the arrival of a single medical attendant, in giving birth to an infant, that, like its mother, had wonderfully withstood the whole of the preceding medical warfare, without injury."* In forming our conclusion in all suspicious cases, we must attend with scrupulous exactness to the first appearances, the progress, the form and state of the tumour, with the appearance of the mammae and other circumstances. " If the menses continue regular ; if the mammae appear flat or shrivelled, with a contracted and light coloured areola ; and if the intumescence fluctuate to a tap of the fingers, there can be no doubt of its being a case of dropsy : but if, on the contrary, the mammae appear plump and globular, with a broad and deep coloured areola ; if we can learn, which, in cases where pregnancy is wished to be concealed, we often cannot do, that the catamenia have for some time been obstructed ; and if the swelling appear uniformly hard and solid ; and more espe- cially if it be seated chiefly just above the symphysis of the pubes, or provided it be higher, if it be round and circumscribed, though * Study of Medicine, by John Mason Good, M, D. F- R. S 032 Cachexia:. CLASS vlr we may occasionally err, there can be little or no doubt in most instances, of the existence of pregnancyt The most difficult of all cases is that in which dropsy and pregnancy take place simultaneously. It is a most distressing combination for the patient; and can only be treated with palliatives till the time of child-birth."* There is also considerable difficulty in as- certaining with certainty, whether the water is contained in the cavity of the abdomen, or whether it is an encysted dropsy. The young physician will often be embarrassed in forming his judg- ment ; but if the swelling from the beginning is equally diffused over the whole belly, the probability is strong in favor of the water being contained in the cavity of the abdomen. But if at its com- mencement the tumour and tension appear in one part of the belly more than another, we have much reason to suspect an en- cysted dropsy. With respect to the curative course to be pursued in ascites, a detailed series has already been given under the heads of anasarca and hydrothorax, in the preceding pages. Little variation will be required in any case that may occur, though in ascites the means are more imperiously demanded than in anasarca. It ought to be observed, however, that the best concerted plans most generally fail, as our remedies have to exert their powers upon decayed con- stitutions and enfeebled vis vita. No progress can be made to- wards a cure unless we are armed with the most efficient means of evacuating from the system. The lancet, where inflammatory diathesis exists, leeches or cupping in some instances, and cathar-1 tic and diuretic medicines, promptly administered, will comprise the principal means which the healing art affords. Sydenham advises purgatives every day, unless too great weakness prevents their use. If, however, they induce severe colic, and the evacua- tions be small, they must be given less frequently ; but if they produce large watery stools, whatever may be their number, purga- tives will be useful and should be continued. There is a class of cathartics termed hydragogues, as they are supposed in a peculiar manner to expel water. This is indeed the characteristic of many of the resinous purgatives, such as elaterium, colocynth, scammony, and gamboge ; but these are seldom to be employed alone; a combination of two or more quickens their operation, and proves ^Dr, Good. bfcDER II. DROPSY.--ASCITES. 63c more effectual. Jalap and cream of tartar united, are highly esteemed by some, but the elaterium combined with cream tartar, as mentioned in page 630, should probably have the preference. Diuretics are to be considered as of indispensable importance, and these may be conjoined with purgatives, or given separately, as may suit the views of the prescriber. The first in this class is digitalis; by some it is commended as surpassing all others, but it does not sustain its reputation in the hands of a majority of those who have given it a full trial in ascites. Dr. Parr says, (and this is high authority) " that the weak, languid, worn out constitution is chiefly benefited by the fox-glove, and the discharge of urine which it occasionally produces, is astonishing. We fear, how- ever," he adds, " that the injuries resulting from it have greatly overbalanced its benefits. In dropsy, death often suddenly seizes the patient, and we have thought this sudden termination still more frequent when the fox-glove has been taken." Other diuretics might be enumerated, but it would only appear as a repetition of the preceding pages. A singular expedient for procuring a discharge by urine in ascites, is by long continued friction over the abdomen with the fingers dipped in sweet oil, which has succeeded, it is said, when the operation has been repeated daily, and duly persevered in. It remains to notice the last alternative for the relief of the hydropic patient, which is, the operation of paracentesis, or tap- ping. When all means of cure have failed, and the pressure and tension of the abdomen have become insupportable, the evacuation of the water by. tapping will not only afford temporary relief, but will protract the period of fatal termination. Instances are on record of persons undergoing the operation more than one hun- dred times in twenty years, and the quantity of water evacuated is almost incredible. The operation is perfectly simple, and may be performed as follows. "Having placed the patient in a hori- zontal posture, with the head a little elevated, a flannel roller is to be applied on the upper part of the abdomen, and gradually drawn tighter as the water is drawn off, in order to support the patient by moderate pressure during the evacuation, as such a quantity of fluid being so suddenly drawn off would occasion fainting, &c.; then pass a trocar or lancet in the linea alba, from one inch to two or three below the navel, as on one side of that line there will be some danger of wounding the epigastric artery : if it Ije the trocar 80 634 CACHEXLE. CLASS VII. that is used and a sudden stop of the discharge happens when withdrawn, pass a blunt probe through the canula, in order to dis- charge any thing that may obstruct the free passage of the fluid through the tube." The celebrated Mr. A. Cooper prefers the lancet, and has known instances where it has been used, that the patients would by no means submit to the introduction of the trocar in a future operation. When the operation is finished, apply merely a piece of dry lint on the wound made, and support it by adhesive plaster, and bind round the abdomen a flannel ban- dage. By some practitioners it has been recommended to punc- ture the skin at the navel for the evacuation of the water. Hydrops Uteri. Dropsy of the womb is not a frequent occurrence. Dr. Cullen defines it a tumour of the hypogastric region, slowly and gradually increasing, resembling the figure of the uterus, yielding to, or fluctuating on pressure; without ischury or pregnancy. " It is distinguished from the ascites by its being confined to the region of the uterus, and by the thinness of the os tincse. This disease is soon followed by an anasarca, a slow fever, and a marasmus." Hydrops Ovarii. Dropsy of the Ovarium. This species of encysted dropsy usually begins without pain, and the general health is unimpaired. It is not perceived until it is much enlarged, and commonly appears but on one side. It is known by its being moveable when the patient is laid on her back, and by passing the finger up the vagina, the orifice of the uterus is found to move with the tumour, which distinguishes it from the ascites. But it seldom happens that the tumour rises above the pelvis, till general dropsy has come on, and obliterated the situation of the tumour. The fluctuation in this species is indis- tinct, and the disease is generally occasioned by hydatids. When there are several cysts, there are sometimes inequalities in the tumour, having the feel of scirrhus. Internal medicines are of little efficacy. Tapping may relieve for a time, and the operation is as safe as in the common ascites. But not, however, in the early stages of the disease, and no benefit could possibly accrue, as, if one of the cysts was opened, still others would remain ; and peritoneal inflammation might bo the consequence. The quantity ORDER II. DROPSY.--HYDROCELE. 635 of water in ovarial dropsy is commonly from thirty to thirty-five pints, and cases have occurred where it exceeded ninety-seven pints. It is in cases where the quantity is large that the operation is warrantable. Hydrops Testis, or Hydrocele. The hydrocele consists in a morbid accumulation of the water separated on the internal surface of the tunica vaginalis to moisten or lubricate the testicle. A tumour first appears in the lower part of the scrotum ; it gradually ascends from below upwards as the swelling increases in size; it becomes light and elastic, and affording resistance to the hand on pressure ; it extends over the anterior part of the scrotum, and is of a pyramidal shape, some- what resembling a large pear ; the upper part or base being con- siderably larger than the lower. It is unattended with pain in general, but in some instances it increases to a painful degree of distention in a few months ; in others its progress is more slow and it continues many years with little inconvenience. As it enlarges, the tumour becomes more tense, and is sometimes transparent; so that if a candle is held on the opposite side, a degree of light is perceived through the whole tumour. The scrotum is undiscolored and the size of its external vessels very little increased. On moving the scrotum, it is found to slip over the vaginal coat, wdiich circumstance adds much to the facility of ascertaining the true nature of the disease. When pressed with the fingers a fluctu- ation will be discovered from one end of the tumour to the oth- er. From the above description hydrocele may be discriminated from hernia, or from an inflammatory or scirrhous tumour of the testicle, with which it is liable to be confounded. The treatment of hydrocele is either palliative or radical. By the former only tem- porary relief is afforded ; by the latter an endeavour is made to produce an union of the coats of the tunica viginalis, by means of the adhesive inflammation, by which the natural cavity between the tunic and the testicle is obliterated. When the complaint is not very distressing nor incommodious to the patient, and especially if the constitution is irritable, and the patient naturally timid, he should be advised to content himself with the relief to be obtained by the operation of tapping, although it may be requisite to submit to it every few months. The tumour may be punctured either with a lancet or trocar for the evacuation of the water. The patient 636 cachexia:. class vm. being seated, the operator with his left hand should grasp the tu- mour on its back part, so as to push the contained fluid into the anterior and under part of the swelling; the trocar is to be pushed through the integuments and tunica vaginalis, the point being directed obliquely upwards to prevent wounding the testicle, which always lies at the back part of the tumour. Withdraw the trocar, and when the fluid is all evacuated, through the canula, the orifice may be covered with a dossil of lint and a sticking plaster. Some prefer dividing the skin first with a lancet, and then using the tro- car, but this is altogether unnecessary. Mr. B. Bell prefers a flat trocar, as being the easiest and best. Should any inflammation ensue, the scrotum may be washed with muriate of ammonia, dis- solved in vinegar. Young subjects, previous to the age of eight or ten years, are sometimes affected with hydrocele. In these cases, the disease is often cured by the application of stimulant lotions to the tumour. Linen wet with a solution of muriate of ammonia should be kept constantly on the part until a cure is effected. Various are the processes devised for the purpose of producing a radical cure of hydrocele, the main object being in all to induce adhesive inflammation. The use of the seton by Mr. Pott, and the caustic by Mr. Else, are pretty generally exploded, and the two modes now employed for the accomplishment of a radical cure, are by the incision, as recommended by Mr. B. Bell, and the operation by injection, proposed by Sir James Earle. In operating by the incision, the tumour must be embraced with the left hand, and the incision should be made with the scalpel from the superior part of the tumour, and continued downwards its whole length, quite to its bottom, through the skin and adipose membrane. The tunica vaginalis being thus exposed, a puncture with a lancet should be made at its upper part, and the finger of the left hand is to be introduced, when, with a blunt pointed bis- toury, it is to be laid open to the bottom. The sac should now be filled vvith.soft lint, moistened with sweet oil, and the parts cover- ed with a compress and secured by the T bandage. It may be objected to this mode of operating, that violent inflammation is apt to ensue. The present author performed the operation in two instances, a few years since. In tlie first, the result was remark- ably favourable, the cure being completed in about a fortnight, without any inflammatory symptoms. In the other, the most alarming inflammation supervened, attended with a total suppre^. ORDER II. DROPSY.--HYDROCELE. 637 sion of urine, requiring the use of the catheter for several days. When the injection is to be employed, if the tumour be very large, it may be best to draw off the water, and allow it again to accu- mulate to about six ounces, when the tumour is to be tapped with the trocar, and as much of a mixture of red port wine with one third water, made blood warm, is to be thrown in by a syringe through the canula, as will distend the tumour to its original size. Instead of wine and water, some practitioners prefer a solution of sulphate of zinc in the proportion of one drachm to one pound of rose water. The time commonly allowed for the liquor to remain is from three to five minutes, according to the degree of pain ex- cited, and when withdrawn, the orifice is to be covered with lint and a sticking plaster. The first symptom that the patient feels is a pain in the region of the kidneys, in the thigh, in the groin, and at the neck of the bladder. If the patient should not be affected with pain in the course of five or six minutes, it will be best to wait a little longer, or to leave a small portion of the liquor within the tunic. The first mark of cure is a redness of the scrotum, observable in about twenty-four hours. In forty-eight hours, the scrotum will be as large as it was previous to the operation. The swelling, in the course of a week, diminishes, and in a fortnight will be still further reduced, if not entirely removed. In Cooper's Surgery, to which I am indebted for some of these remarks, it is proposed in case the hydrocele be not transparent, and there is the least doubt respecting the nature of the disease, to make a small puncture with the lancet in the tunica vaginalis, by which the case may be at once decided, as without this precaution, un- happy consequences have been the result. It is necessary also to see that the canula be made so as to fit the trocar with exactness, as otherwise the injection will not be thrown into the tunica vagn nalis, but into the cellular membrane. When a hydrocele of the spermatic chord occurs, it is often liable to be confounded with the inguinal hernia. In such circum- stance it will be advisable to wait until the tumour is so far advan- ced that, the distinction may be easily made. There is another species of hydrocele, which consists in a col- lection of water in the cellular membrane of the scrotum. This is merely a symptom of anasarca, and is easily cured by puncturing the skin on the lower extremities, and administering the appropri- ate medicines. 638 CACHEXIAS CLASS v-ir. Hydrops Articuli. " A dropsy in the knee; water collected under the capsular ligament of the knee. Dr. Hunter observes, that if the sinovia is separated in too large a quantity, and the absorbents fail in their action, an hydrops articuli succeeds, causing relaxation of the lig- ament. Mr. Sharp recommends a tight bandage, leaving the su- perfluity to be absorbed by the lymphatics. To this might be added some attenuating and discutient embrocation, such as the aqua ainmoniae acetatae, or a solution of crude sal ammoniac in sharp vinegar." (Parr.) Order III.—VITIA. RACHITIS, OR RICKETS. A variety of opinions have been advanced by authors respect- ing the remote causes of rickets, but it is not necessary in this place to inquire how far they have been properly supported. It is well known that a damp and cold residence, impure air, inattention to cleanliness, want of suitable exercise, a deficiency of food, and de- bility, are the usual circumstances which conduce to this disease. The characteristic marks of the rickets are, a relaxed skin, flabby muscles, an uncommon size of the head, the sutures and fonta- nella unusually open, the countenance sallow or bloated, the joints swelled, the ribs flattened, the sternum pushed outward, the long bones more or less curved and variously distorted, the spine incur- vated, the belly preternatu rally tumid, the appetite and digestion impaired, the bowels costive, the pulse weak and frequent, list- lessness, debility, and general emaciation. Infants are seldom attacked with this disease before the ninth month, and very rarely after the second year of their age. In a few instances it has been cured spontaneously, without medical as- sistance, but in the greatest number of cases, it yields to appro- priate remedies within a year. If protracted beyond a. year, it will in that case often cease to advance, and the health be entire- ly established, excepting the incurvation of the spine, and enlarge- ment of the joints, which will remain permanently distorted for the rest of life. In a few cases, however, the disease has been known to proceed increasing till almost every function of the anj- 0RDER lit. RICKETS. 639 mal economy is affected, and death terminates the tragic scene. The mode of treatment to be pursued must be such as will bring the bowels into a proper condition, and invigorate the system. As the digestive powers are apparently injured, it should be the first object to clear the stomach and bowels from mucus and all impu- rities which would impede digestion or absorption. We are di- rected therefore by practical authors to begin with emetics, and repeat them as occasion may require, and they should be followed by gentle and steady laxatives. Rhubarb, from its astringent and bitter properties, may be the best adapted in obviating the tympa- nitic affection of the intestines which often attends this disease, and it may be conjoined with magnesia, and sometimes with a few grains of calomel. This is to be accompanied with warm stimu- lating liniments to the affected parts, with friction, and the tepid sea or salt water bath, and if the child should be able to bear the shock, the cold bath may be employed, and has been attended with much utility. The diet should be generous and nutritive, consist- ing principally of animal food; moderate exercise must not be neglected, the easiest and most convenient is that of swinging. It has been the practice to apply to the body and limbs of rickety children various kinds of bracing machinery, with the view of cor- recting or obviating deformity, but these have not been productive of such beneficial effects as to counterbalance the great incon- venience attending their use, and they are now pretty generally exploded. But it is nevertheless proper to keep the child as much as possible in a straight and natural position, and the spine and limbs should be carefully examined from time to time, and on the smallest deviation from the natural form being discovered, the faulty parts ought to be well washed every morning and night with brandy, or other spirits, and this may even be useful as a pre- ventive remedy. Of vegetable tonics we give the preference to the Peruvian bark, which may be administered either in substance, decoction, or infusion alone, or joined with some chalybeate. The most proper of the metallic tonics are, the carbonate of iron, and the muriate of ammonia and iron, formerly called martial flowers. The child may take morning and evening a powder composed of four grains of the carbonate of iron and four grains of rhubarb, mixed with eight grains of finely powdered white sugar; or the following preparation may be preferred ; take of the root of sweet scented flag, (calamus aromaticus) and gentian root? each three 640 CACHEXIA. CLASS VII. drachms; Peruvian bark, in powder, half an ounce ; iron filings tied up in a lineu bag, six drachms ; Spanish white wine, or Lisbon, one quart. Digest for the space of three days, and then filter the tincture. Four tea-spoonfuls of this tincture may be given twice a day. LITHIASIS, OR CALCULI These very painful diseases consist in a lodgement of calculous concretions, either in the kidneys, bladder, or urinary passages. If small stones or sand is discharged with the urine, the person is said to have the gravel ; but when calculous matter has accumulat- ed in the bladder, and acquired such size as to be incapable of passing through the common passage, the complaint receives the name of stone. Those persons who are in the decline of life, and who are en- gaged in sedentary employments, especially those who are much afflicted with the gout, are in general subject to nephritic com- plaints. Men are more liable to them than women ; and children from infancy to about fifteen years, are very frequently subject to the formation of calculi. The reputed causes of both gravel and stone, are high living and a sedentary life, with the free use of strong astringent wines, and water impregnated with earthy or stony particles ; on some occasions, an accidental introduction of some substance into the bladder, has appeared to form a nucleus for a stone. Calculi differ in their chemical composition. Those formed from uric acid are supposed to be the most common, and are solu- ble in alkalies and acids. The lithic or uric acid is that sediment in the urine which appears in the form of small red crystals depo" sited at the bottom of the vessel. Those formed from phosphate of ammonia and magnesia, have a whitish grey appearance, often transparent crystals on their surfaces, and are soluble in muriatic acid. That kind termed mulberry calculi consists of oxalate and phosphate of lime, and resembles the mulberry stone. The bone- earth calculi is composed of the phosphate of lime. The symptoms which attend the existence of small stones or gravel in the kidneys, are an obtuse pain about the loins, nausea and vomiting, and sometimes bloody urine. When the stone de- ORDER III. LITHIASIS, OR CALCULI. 641 scends into the ureter, and is too large to pass with ease through that canal, all these symptoms are increased; the pain extends along the course of the duct towards the bladder ; the thigh and leg of the affected side are benumbed; there is a retraction of one of the testicles, and the urine is obstructed in its passage. These symptoms constitute what is called a fit of gravel, and the pain is on some occasions so exquisite as to produce faintings and con- vulsions. When one or more stones are contained in the bladder, the patient first feels an excessive smarting sensation about an inch up the urethra, which increases to an exquisite degree of pain. When the stone is large, the patient finds it easiest to dis- charge urine when the abdominal muscles are relaxed ; he there- fore bends himself forward, resting upon his arms, and this is one of the surest signs of a stone in the bladder. It is known also by a weight in that part, and a pain at the time, as well as before and after, making water, from the urine being discharged by drops, or stopping suddenly in the midst of the evacuation ; or it can be passed only when lying on the back. There is also a pain in the neck of the bladder upon motion, especially on horseback, or in a carriage on a rough road; in consequence of which the urine is often bloody. There is likewise frequently a white, thick, and copious sediment in the urine, an itching at the end of the ure- thra, and an inclination to go to stool during the discharge of the urine. There is also a kind of convulsive motion occasioned by a sharp pain in discharging the last drops of urine. The existence of a stone in the bladder may be further ascertained by discharge of small pieces of such stony matter, but more certainly by sound- ing or searching, either by the introduction of the finger into the anus, or of the catheter into the bladder. Since all attempts to dissolve a stone in the kidneys or bladder have proved ineffectual, our remedies must be adapted to palliate the distressing symptoms. In a fit of gravel, as it is called, the patient must be bled once or more if necessary, emollient clysters administered, and warm fomentations or bladders filled with hot water, applied to the part affected, v/ith the use of diluting and mucilaginous liquors : and a similar mode of treatment with that detailed under the heads of inflammation of the kidneys and bladder, must be pursued. The preparation of spirit of nitre and laudanum, mentioned above, for the suppression of urine, will here also prove peculiarly advan- 81 642 CACHEXLE. CLASS VII. tageous. A common plant, called Philadelphia flea-bane, is said to have been given with evident relief in gravelly affections. Half a pint of a strong infusion of the plant twice a day is the dose pre- scribed. A jelly made of blackberries has likewise obtained con- siderable credit in different parts of the United States, for the es- sential relief which it affords in all gravelly complaints. Among the endless variety of lithontriptics the fixed alkali has been held in the highest estimation, and the form of caustic ley or soap leys, is that in which it has been generally employed; but a long exhibition of this active medicine commonly produces injurious effects on the stomach. This medicine, with the ali- cant soap and cockle-shell lime water of the late Dr. Whyte, appear now to be wholly superseded by the alkaline aerated water, lately introduced by Mr. Colbourne, Drs. Falconer, Percival and others. It possesses the alkaline properties, but rendered extremely mild by being impregnated with the carbonic acid gas, or fixed air; and although it is not considered as an absolute solvent of the stone, it is affirmed to be the most efficient and certain of all medi- cines as yet recommended to the public confidence, in alleviating the distressful symptoms of this most painful disease. Experience has evinced that it will prevent the farther accumulation of calcu- lous matter and wonderfully tend to render the urinary passages less sensible to the irritation of the calculous which exists, and thereby render the days of the unhappy patient tolerable and com- paratively comfortable. The quantity of the aerated alkalin* water usually taken is a gill thrice a day, before breakfast, dinner, and supper. When the stomach will bear a larger quantity it may be increased to a pint in a day. When it proves cold to the sto- mach, or occasions flatulency, a tea spoonful or two of brandy or gin may be added to each dose. The manner of preparing this liquid will be described in the Appendix. The artificial soda water sold in our cities, will probably answer the same purpose, and when neither can be procured, a medicine nearly similar may be prepared in the following manner; dissolve twenty grains of salt of tartar or sal aeratus in two or three table spoonfuls of water ; add to the solution a table spoonful of the juice of lemon or pure vinegar. This mixture should be swallowed immediately, and is the proper quantity for a dose, and may be repeated three or four times in a day as circumstances require. When the irritation of the urinary passages is great, it may be of use to take a few «RDER III. LITHIASIS, OR CALCULI. 643 drops of laudanum with each dose of the above ; but this ought to be discontinued whenever there is an abatement of the painful symptoms. In many cases where these medicines are not employ- ed the mixture of spiritus nitri dulcis and laudanum, taken as re- commended in suppression of urine, will afford considerable relief. No particular diet or regimen is necessary to be observed while using the above mentioned medicines farther than abstaining from acids, fat meat, and butter. The method of prevention and cure of gravel in the kidneys and stone in the bladder, recommended by the late Dr. Whyte, of Edinburgh, consisted chiefly in the use of alicant soap and oyster or cockle-shell lime water, to the quantity of one ounce of the form- er and three or four pints of the latter during the twenty-four hours, and to be persevered in for several months, or even years, if neces- sary. Preference however, has latterly been given to the caustic alkali or soap leys, in doses at first of thirty or forty drops, increas- ed by degrees as far as the stomach can bear it, which on account of its acrid nature must always be given in some mucilaginous li- quor, such as linseed tea, a decoction of marsh-mallow roots, or a solution of gum arabic. But it has been found that no stomach can endure the application of either of these medicines for a length of time sufficient to act as a solvent of the stone without material injury. An infusion of the seeds of daucus sylvestris or wild car- rot sweetened with honey, is a simple and much esteemed remedy in painful complaints of the kidneys and bladder; considerable benefit has also been experienced by the use of the garden-leek in strong infusion, to the quantity of a a pint a day. The u'va ursi, or bear's whortleberry, has been recommended as a most efficacious remedy for the stone, but it possesses no lithontriptic powers, and can be useful only in cases of relaxation or ulceration of the kid- neys or bladder, when it should be freely employed as a tonic, in doses of from half a drachm to one or two drachms in powder, or two ounces of a strong infusion twice or thrice in a day. From Dr. Seaman's Dissertation on the Mineral Waters of Saratoga and Ballston, we learn that those waters are a valuable remedy in all gravelly complaints, having afforded great relief in almost every instance in which they have been tried, and we have other autho- rities in favour of the efficacy of the Ballston waters in calculus and gravel and other diseases of the kidneys and bladder. Anoth- er simple remedy may be mentioned as having been prescribed 644 CACHEXIA. CLASS Vfft with great success by Dr. Macbride ; boil thirty berries of raw coffee in a quart of water until it acquire a deep greenish colour; of this liquor about half a pint is to be taken morning and evening with ten or fifteen drops of dulcified spirits of nitre; the use of this is said to have occasioned the discharge by urine of large quantities of earthy matter in flakes. The common hop is said to have been administered in nephri- tic calculous affections with such manifest advantage as to obtain high encomiums as a valuable antilithic. It has been ascertained bjr experiment, that the infusion is a certain solvent of the stone out of the body, and it is assserted by high authority, that it sel- dom fails to alleviate the pain and increase the secretion of urine when taken internally. Dr. Barton, however, found by experience in his own case, that the use of the highly hopped malt liquors subjected him more frequently to nephritic attacks. Although physicians entertain different and opposite opinions respecting the antilithic powers of this vegetable, there is sufficient evidence of its efficacy to warrant and induce a thorough trial of it in every instance of these distressing complaints. The infusion is directed in doses of about a wine-glassful every few hours, to the extent of a pint in a day. A respectable clergyman a few years since assured me that he was in possession of a secret remedy for -gravel and stone, which had been very successful employed, and obtained great celebrity. Having furnished him with some calcu- li of considerable size, taken from the urethra, I witnessed his ex- periments with them. The calculous substances being moistened with his liquid remedy, actually adhered together by chemical at- traction, and being immersed in the liquid, they were in a few days completely dissolved. I have since ascertained this liquid to be no other than a decoction or infusion of the hop. The muriatic acid is reported to have produced beneficial effects in many calculous cases, and to have proved a powerful lithon- triptic when given in doses of twenty or thirty drops, three or four times a day, properly diluted with water or some mucilaginous drinks. In most of the painful cases of gravel or stone which may occur, some of the above enumerated remedies will undoubtedly be the means of affording all the ease and comfort that the afflicting dis- ease will admit of, but the remedies must be varied according to the particular circumstances of each case. The reader is ORDER III. LITHIAS1S, OR CALCULI. 645 referred to the chapter on inflammation of the kidneys and bladder. Those who are afflicted with the gravel or stone ought to avoid all aliments that are hard of digestion, flatulent, or of a heating nature, as well as fermented liquors; wines, and acids in particular of every kind are prejudicial. The alkaline aerated water, or the common soda water, and sometimes a little gin and water, will be the most proper drinks. " When a person is conscious of having passed a small stone through the ureters into the bladder, it is re- commended to drink freely of diluting liquors, and to retain the urine till the bladder is so distended as to occasion a great desire to evacuate. He should then place himself on his knees, bend his body forward, and make water in that situation. The small stone by its weight will fall into the neck of the bladder, and very pro- bably be carried away with the urine which is rushing out. Sir James Earle is persuaded that if persons subject to calculous con- cretions were attentive to such directions, we should see fewer cases of stone in the bladder." (Dorsey's Cooper.) Dr. Ferriar speaks very favourably of the uva ursi in nephritic complaints, and in doses much smaller than the usual quantity. Having premised bleeding and gentle purgatives, he gives five grains of uva ursi and half a grain of opium three or four times a day, according to the urgency of the symptoms. This method, he observes, always relieves, and generally effects a cure. Many pa- tients have used the remedy for several months together before a permanent relief from pain was attained ; the fits became lighter, and at length ceased altogether. In cases of bloody urine, Dr. F. has found the uva ursi equally efficacious. He conceives that this remedy acts specifically as a tonic and astringent on the kidneys. In doses of a scruple or half a drachm, this medicine produces nausea, even when joined with opium. He further asserts, that he has met with no remedy which has answered so well in that distressing strangury which sometimes is produced by blisters. An infusion of the uva ursi, given during the use of the blisters, wilj effectually prevent the strangury. See New-England Journal of Medicine and Surgery, Vol. II. page 180. " Mr. Brande, in a paper printed in the London Philosophical Transactions, recommends magnesia in calculous complaints, as a substance well adapted to prevent the formation of uric acid, and thus arrest the progress of these disorders. Mr. Brande states 646 LACHEXI.E. CLASS VII. that the best method of giving the magnesia.is in plain water or milk, to be taken in the morning early or at mid-day. If the stomach is weak, and this produces uneasy sensations or flatulency, some common bitter, such as gentian, may be added ; and if it purges, a little opium should be combined. The dose of magnesia may be five grains twice or thrice a day to children below ten years of age ; fifteen and twenty grains to adults. Common mag- nesia has been usually employed, but calcined magnesia may be used occasionally. When a stone is already formed in the blad- der, this medicine cannot be expected to diminish it, but merely to prevent its increase." New-England Journal of Medicine and Surgery, Vol. II. pape 307. SCROFULA, OR KING'S EVIL.* This disease is in its nature peculiarly inveterate, and of all others is most generally handed down by parents to their offspring. It is not uncommon for scrofula to lie dormant for two or three generations, and afterwards to appear with redoubled violence. It is originally a disorder of the glands, but eventually seizes the bones, especially about the joints. Children possessing the most lively disposition, and a maturity of understanding superior to others of their age, are those most liable to scrofula. The predis- posing causes are all those which induce debility, and there al- ways is in scrofula a weakened action of the arterial as well as of the absorbent system. It most commonly affects children of a lax habit, with smooth fine skin, fair hair, and rosy cheeks. It seldom makes its appear- ance before the second year of age, generally from the third to the seventh, and rarely makes its first attack after puberty. Scrof- ula is seldom fatal at an early period of life, but most commonly continues almost without alteration till the age of fourteen or fifteen, when it recedes, especially in females, and the patient becomes * It is that form of the disease in which the glands of the neck are principally af- fected, that is known by the vulgar term King's Evil; from the preposterous belief that the touch with the royal hand will infallibly effect a cure ; and the same notion has prevailed in favour of a stroke with the hand of a seventh son. Instances of trial are not wanting, in which the imagination has been wrought to such a pitch as to encourage a belief in such agency. ORDER III. SCROFULA. 647 more robust and free from other disorders. On the other hand, after disappearing for several years, it has been found to affect some inward part, and in the end to produce a consumption of the lungs or other fatal disease. This disease is often preceded by a peculiar look about the eyes, which are generally large, and a thickness of the upper lip. The abdomen is sometimes observed to be hard and enlarged, and there is a remarkable softness of the skin. Small moveable tumours, about the size of a pea, bean, or chesnut, hard, indolent, of the natural colour of the skin, unless when inflamed, make their appearance about the sides of the neck, often in considerable numbers, and sometimes similar tumours, or kernels, occur in the armpits and groins. Scrofulous tumours, often remain stationary and harmless, for months, and even years, when at length a slow and imperfect suppuration takes place, dis- charging a thinnish, white, curdly matter, and leaving foul ulcers, with hard edges, which are difficult to heal, and producing unseemly and disagreeable scars. The scrofulous humour of long contin- uance, sometimes fixes in the joints of the fingers, wrists, knee, elbow, and ankle, creating tumours, swellings of the bones, and incurable ulcers. An enlargement of the mesenteric glands, termed tabes mesen- terica, is generally a concomitant with scrofula, and is marked by an increased size of the abdomen, a ravenous appetite, and matter similar to chyle is discharged with the stools. This is owing to an obstruction in the glands preventing the chyle being absorbed by the lacteals. In every instance of scrofula, the cure is attended with difficulty and uncertainty. It is always to be attempted, however, by such method as will tend most effectually to invigorate and strengthen the relaxed and debilitated system. This disease has a strong af- finity to the rickets, and requires a similar mode of treatment, so far as relates to a diet easy of digestion, and of a nutritious quali- ty. This should be accompanied with tonic and invigorating medicines, of which, bark and steel, with wine and aromatics, are chiefly to be depended upon. A persevering course of exercise and a warm pure air, should be considered as of primary impor- tance, and are on no account to be dispensed with. So great are the advantages of proper exercise, and a generous diet, in this dis- ease, that these alone have sometimes performed cures, when med- icines have rendered little service. Mild laxatives will be useful. 645 CACHEXLE. CLASS VII to cleanse the stomach and bowels of impurities, but strong pur- gative medicines must be carefully avoided, as tending to weaken the constitution, and increase the disease. Dr. Underwood re- commends one drachm of cathartic salts, dissolved in a pint of water, to be taken every day as common drink. The remedy- most generally employed for ages past, and highest in repute at the present day, is sea bathing. This should be put in practice at an early period, when a scrofulous disposition is apparent, and daily persisted in for months, or even years, unless the disease sooner yields to its powers. Where this practice cannot be com- plied with, sea water, or water in which salt has been dissolved, may be used in the manner of the shower bath. In children of a gross habit of body, a glass full of sea water drunk every morning, may be recommended, as also lime water for common drink. The use of the cicuta or hemlock, both inwardly and outwardly applied; has been found beneficial in many instances, and is deserving of trial, under the direction of a well informed physician. Scrofulous tumours in the neck have in some instances been dispersed by the powers of electricity or galvanism. Electrical shocks, passed through the tumours, may be tried with safety and probable ad- vantage. Considerable benefit has sometimes been derived from the repeated application, and friction, with oil of almonds fully charged with camphor. This tends to disperse the tumours in their incipient state, and to soften the parts after suppuration. When the tumours appear to advance towards a state of suppura- tion, we ought to promote and expedite the process, not, however, by poultices, and other warm applications, which tend to weaken and relax the parts, but it is requisite to increase the activity of the inflammation by a blister over the tumour, or by stimulant plasters, or vinegar impregnated with common salt. The tumours should be suffered to break of themselves, in preference to open- ing them with a lancet, and the ulcers which ensue are to be treat- ed according to their condition and appearance. In general, linen cloths dipped in a solution of sugar of lead, or in cold water, or sea water, may be applied to the ulcers with advantage ; and some- times their healing may be promoted by washing in a weak solu- tion of nitric acid in water. Inveterate scrofulous ulcers are said to have been cured by the application of the bruised leaves of wood sorrel. But the most extraordinary instances of success, in scrofulous affections, are some cases in which the inhaling of vital ORDER III. SCROFULA. 649 air, as directed of late by several European physicians, has per- formed a perfect cure after all the usual remedies had been tried in vain. In every instance of scrofula, and in its various forms and stages, the greatest dependence is to be placed on the tonic powers of warm pure air, exercise, and a generous diet, with sea bathing, the Peruvian bark, and chalybeates. Friction and warm clothing must not be neglected. It is asserted by Dr. Willich (Domestic Encyclopedia) that the coltsfoot has been found of considerable service in scrofulous complaints ; a decoction of these leaves hav- ing sometimes succeeded where sea water had failed. In our medical treatment it is a primary object to have constant- ly in view the original debility of the vascular system,'and loss of energy in the vis vitae. When it is desired to promote absorp- tion, small doses of the muriate of mercury will have that effect. About one sixteenth part of a grain is a proper dose, twice in a day, for a child two years old. In all the various forms of scrofu- la, particularly an enlargement of the mesenteric glands, and glands of the neck, swellings of the joints, or scrofulous ophthal- mia, the muriate of mercury is a medicine of superior efficacy^ not with the view of inducing a specific mercurial action, but to act as a tonic to the arterial and lymphatic systems, similar to the arsenical solution, to which it ought to have the preference. As an auxiliary to this course, and in fact under all circumstances at- tending scrofula, I should strongly recommend the use of py- rola umbellata. It possesses tonic and diuretic properties ; it cer- tainly improves the general health when continued for a length of time. It is the basis of an empirical remedy for scrofula, which has obtained considerable popularity. A decoction of the tops and roots may be employed, or the whole plant may be infused for about twenty-four hours in pure cold water, and taken to any quantity, and it may be made a Vehicle for the medicines adminis- tered. It appears upon the authority of the late Dr. Beddoes, and other European physicians, that a remedy for scrofula has been found in the muriate of lime. This, it is ascertained by chemists, enters into the composition of sea-Water, and it may be that the efficacy of the latter in this disease is to be ascribed principally to the muriate of lime which it contains. But, says Dr. Hosack, " as scrofula is usually attended with a general debility of the system. 82 650 CACHEXIA. CLASS Vll as well as a morbid condition of the fluids, the Ballston waters will probably be found peculiarly serviceable, inasmuch as they possess the means of invigorating the system at the same time that they contain the antidote (muriate of lime) to the peculiar virus of that disease." SYPHILIS, OR LUES VENEREA. It will not be the object of the present author to ransack the records of antiquity to ascertain the origin of syphilis; whether it first appeared in Europe in 1493, and was known at the seige of Naples, or that the followers of Columbus brought it from the West Indies, or whether its source may be traced to a much ear- lier period among the Greeks and Romans, nay, even that the li- centious among the ancient Jews were scourged with this odious disease, are points of little importance as respects its character and mode of treatment at the present day. The controversy respect- ing the identity of gonorrhoea and syphilis is a manner put to rest; the advocates for the affirmative of the question are less strenous than formerly and the decoction seems now to be pretty generally prevalent that gonorrhoea and syphilis are certainly distinct in their causes, their progress and effects. This principle being adopted on the present occasion, our views of gonorrhoea and its treatment are disposed of accordingly in page 491. It is a received truth, gonorrhceal matter applied to a wound or ulcer will not produce syphilis, nor will the matter of chancre inserted into the urethra produce clap, though it may excite a discharge similar to that which is the effect of any irritating substance on a secreting surface. We have been apprised of one singular instance of a Col. B. who received infection and actually had gonorrhoea from sitting on a necessary where a plastering gonorrhceal matter had been left and which came in contact with his penis.* Lues venerea was known at a period of one hundred years prior to any knowledge of gonor- rhoea. The venereal virus is communicated only when applied to some part which is soft and covered with a mucus membrane or else to some place where there exists an excoriation, ulcer or wound. It always produces an inflammation of a peculiar nature, * Cooper's Surgery. ORDER HI. SYPHILIS, OR LUES VENEREA. 651 and the disease may be communicated long after the inflammation has disappeared. The effects of the poison on the human body are both local and constitutional. The infection generally appears first in the part to which the matter is applied, as about the organs of generation, the nipples and breasts of women, who receive it from the mouth of a child, and on the contrary, the lips and mouth when it receives the infection from the nurse. In like manner the infection may be conveyed to the fingers, or any part on which there exists a slight scratch, or wound, as experienced by accouchers who officiate under such circumstances. Chancre. Chancres are small callous ulcers chiefly about the glans penis. A small pimple is first discovered most commonly near the fraenum, which contains a whitish matter incliningto yellow ; this soon bursts, and leaves a circumscribed painful sore, having foul edges ; it dis- charges a matter of a dirty green colour, often tinged with blood, and which is large in quantity in proportion to the size of the sore. The period of the appearance of chancre after receiving the in- fection varies from five or six days to as many weeks. They oc- casionally make their appearance on all the parts of generation, and often exend to the contiguous parts, most frequently on the glans and on the prepuce, about the fraenum, and even within the urethra. A real venereal chancre is seldom so large at the first as the base of a split pea, and the edges of the sore are elevated, somewhat hard and painful. By these marks a chancre may be known from other inveterate sores, or excoriations observed upon the genital parts. If a chancre be seated within the urethra, it may be mistaken for a gonorrhaea, but may be distinguished by the smallness of the discharge, the pain during erection being in the extremity of the penis, or a particular spot in the urethra. In females, chancres exactly resemble those in men, and occur chiefly on the internal parts of the labia pudendi nymphae, clitoris and the entrance of the vagina and urethra. The first appearance of chancre is a circumstance which ought to lead most decisively to the administration of mercurials internally. A chancre is suppos- ed by some to be merely a local affection, and a cure is attempted by local applications and dressings, but although cures may have occurred from this practice, yet, as we have no means of being ab- 652 CACHEXIA. CLASS VI' solutely safe, the cure of even the slightest chancre should never be trusted to external remedies alone. If, however, the pain and inflammation should be very considerable, and phimosis take place, there will probaby be a general and deep redness over the parts, with a copious discharge from under the prepuce ; immediately on observing these appearances the use of mercury must be abandon- ed for the present, as it will aggravate the symptoms. A purgative of rhubarb and calomel should be given and after the inflammation has yielded to the usual means, the employment of mercury may be resumed. Blood should be drawn from the arm or from the large veins of the scrotum in preference to leeches, as their wounds may prove difficult to heal. The irritation must be al- layed by opiates applied to the parts, and 60, or 80 drops of lau- danum thrown into the rectum with a syringe. The local applica- tions should be made while cold and renewed when they become dry and warm. The local applications best adapted to the indi- cations in chancre is tbe mixture called the black wash com- posed of about half a drachm of calomel and eight ounces of lime water, and this should be injected under the prepuce in order to remove the discharge which excites irritation and a little opium maybe added to the wash if necessary. The red nitrate of mercury, or calomel, is often sprinkled over the sore to much advantage and a lotion composed of one grain of muriate of mercury and eight ounces of water will have a salutary effect. But the most in- veterate chancre will Commonly yield to the efficacy of the nitrate of silver, if properly applied in the form of solution. The internal administration of mercury must be continued until its effects be- come evident and for a week or more after the sore has healed and all appearance of hardness is removed. The most eligible preparations of mercury to be employed will be noticed hereafter. Phimosis and Paraphimosis. ft These complaints have been already noticed, page 495 ; but some further observations seem proper, as, on some occasions they are connected with circumstances extremely embarrassing and for- midable. When phimosis has continued for some time, a slough- ing of a portion of the glans is apt to take place, which renders the operation of circumcision expedient. This is performed by cutting off a circular portion of the prepuce, after which the re* ORDER III. SYPHILIS, OR LUES VENEREA. 653 quisite remedies can be applied. But it sometimes happens that chancres occasion such excessive irritation, and so high degree of erysipelatous inflammation and pain, as to threaten the most seri- ous consequences. In this deplorable condition, mercurials must be laid aside, as their continuance will increase the irritable state of the local affection. A lotion composed of the nitric acid, six or eight drops to four ounces of distilled water, will tend greatly to appease the irritation. The root of the sophora tinctora, in the form of decoction, is to be strongly recommended as a salutary wash in all cases of chancre and venereal ulcers; it has a tenden- cy to cleanse and correct the foetor and to promote the healing process. The bowels should be cleansed by a brisk purgative, and opium combined with cinchona must be directed. But the most destructive cases are those in which sloughing of the glans and prepuce extends to a large portion of the penis and urethra, which are separated ; here, if mercurials are used, internally or exter- nally, they will induce the sloughing disposition to extend still far- ther to the contiguous parts. The applications required in these circumstances are, besides the nitric acid lotion, the black wash applied quite hot, poultices of carrots, and linseed or the mucilage of slippery elm, or half an ounce of yeast and half a pint of water made into a poultice with oatmeal; or a poultice of pulverized charcoal may have its use. Internally, opium and cinchona must be relied on, unless the latter should disorder the stomach, or ex- cite febrile symptoms. Opium is of great use, given in the form of enema, or introduced into the rectum in substance. Venereal Bubo. A bubo is generally the consequence of chancre, though some- times it is the first symptom of the disease. It is a hard, painful tumour, seated generally in the glands of the groin, distinguished into such as proceed from a recent infection, and such as accom- pany a confirmed lues venerea. A bubo commonly begins with a sense of pain, accompanied with some degree of hardness and swelling, which increase like every other inflammation that has a tendency to suppuration, and unless checked, pus forms, and ulcere ation follows. Venereal tumours do not, however, advance so rapidly to maturation as common abscesses, but more quickly than those arising from scrofula. 654 tACHEXLX. CLASS VII. In every instance of bubo, it is a desirable object to procure its discussion in its early stage, before matter is formed to any consid- erable extent, as the distress and trouble they often occasion by proceeding to suppuration, are extremely severe. To effect this purpose, the mercurial ointment should be quickly introduced into the system by rubbing the inside of the thigh and round the edges of the tumour with it, in considerable quantities; in this way the mercury cannot enter the system, without passing through the dis- eased gland. The quantity at first may be about the size of a hazel- nut of the strong mercurial ointment, every night, and gradually in- creased to double that quantity, and continued till the tumour and induration have entirely subsided. The mercurial friction should be accompanied with all the usual means of abating inflam- mation, as bleeding by leeches, frequent saline cathartics, perfect rest, and low diet. If this process be adopted at an early stage, in many instances nothing more will be required. When the ten- dency to suppuration cannot be arrested, and circumscribed red- ness appears around the tumour, the mercurial frictions must be discontinued, and the suppurative process should be promoted by the application of warm emollient poultices and fomentations ; and when the end is accomplished, the abscess must be opened either by the lancet or caustic, and the ulcer be brought to a pro- per digestion by suitable dressings, and the internal use of mercury. But we are cautioned by some authors against giving mercury in- ternally while inflammatory symptoms are present, either before or after suppuration. If, instead of healing readily, the edges of the sore become hard, livid and retorted, discharging a thin, sharp, and foetid matter, and the ulcers spread or heal in some parts and break out in others, exhibiting a honey-comb appearance, attended with pain, the most efficacious remedies are carrot or hemlock poultices, and the application of caustic or the nitric acid round the edges ; the cicuta should also be administered internally, as in scirrhus. The black wash already mentioned with the addition of opium, will here prove serviceable, by cleansing the ulcer and abating irritation. Should deep sinuses form, they must be opened to the bottom if practicable. The cinchona joined with the nitric acid, the compound decoction of sarsaparilla, and opiates, in such quantities as will allay irritation and procure relief, are in these cases essentially necessary; and these should be assisted by a gen- erous diet, with wine, and if possible a pure country air. ORDER III. SYPHILIS, OR LUES VENEREA. 655 Of the Secondary or Constitutional Disease. The venereal virus is generally conveyed into the system from a chancre or bubo. It is asserted that the syphilitic poison may be introduced into the circulation without producing any evident local effect on the part to which it was first applied; and on some occasions it will remain dormant in the circulating mass for several months before any visible effects are produced. When, either by neglect or improper treatment, the venereal poison has contaminated the whole habit, the disease receives the name of syphilis, or a confirmed lues, and is attended by a train of distressing symptoms. Among the numerous characteristics are reddish and brownish blotches and eruptions, dispersed over differ- ent parts of the body; appearing first on the breast and arms, next on the shoulders, thighs, legs, soles of the feet, palms of the hands, round the nails, and at the margin of the hair. These eruptions have a branny appearance, and are superficial, unattend- ed with itching, and the scales being cast off, an ulcer of a copper colour is formed, which discharges an acrid foetid matter. In the throat, tonsils, and inside of the mouth, the disease generally makes its appearance at once in the form of foul ulcers, which are covered with a yellow coloured slough, and often accompanied with an erysipelatous redness. There is great heat and irritation of the fauces, which are covered with an acrid viscid mucus and the ulcer often spreads very rapidly, exhibiting the deep copper coloured complexion which is characteristic of lues, and which at length destroys the palate and injures the subjacent bones, making an opening from the mouth to the nose. When by its rapid spread, the disease attacks the cartilaginous parts of the nose the ulcers are foul with callous edges, discharging a thin offensive matter, and being suffered to spread still more extensively, the bones become carious, and so completely corroded that the nose is prostrated level with the face. Characteristic too of syphilis, are deep seated pains, particularly of the arms, head and shins, always fixed in the same place, raging chiefly, and with great violence, in the fore part of the night. Hard indolent tumours, or nodes, at length make their appearance upon the tendons, ligaments, perios- teum, or bones, especially on the forehead, tibia, arms, sternum and ribs, with distressing pain when the patient is warm in bed. Being thus severely afflicted, the patient becomes debilitated, his 656 CACHLXI.E. CLASS vi: countenance is sallow, his appetite diminished, his hair falls off, his strength and flesh fail, and a small fever of the hectic kind ensues. Besides the formidable train of symptoms just enumerated, there is an ophthalmia arising in consequence of lues, and when the venereal sore throat extends its effects to the eustachian tubes, or the membranes or bones of the ear, a deafness is the consequence. Frequent abortions, or premature births of dead foetuses, whose bodies are scabby, ulcerated, and half" corrupted without any man- ifest cause, may be regarded as almost an infallible sign of one of the parents being tainted with syphilis. Having detailed the symptoms characteristic of confirmed lues, it is proper to remark, that they are liable to ambiguity, and to be counterfeited by some other affections, as rheumatism, scrofu- la, &x. The local forms of lues venerea are so extremely equivocal and deceptive in their visible appearances, as on some occasions to baffle the discriminating powers of the most experienced physi- cian. Such discrimination, however, is of the utmost importance, as it too frequently happens that some excoriation, or trivial dis- eased action to which the genital parts are susceptible in common with other parts of the body, have been greatly aggravated, and rendered inveterate by a mercurial course, when they might have been speedily cured by the most simple applications. Venereal ulcers in the mouth are distinguished from those arising from a too free use of mercury, by their affecting in general only one place at a time, are circumscribed, of a dirty brown colour, and appear on all parts of the mouth indiscriminately ; whereas, those which are the effect of mercury, are diffused, appear in different parts of the mouth at the same time, and most frequently on the sides of the tongue, near the angles of the jaws, and on the inside of the cheeks. The mercurial ulcer as described by Mathias, or the mercurial disease, is commonly attended with more pain than the venereal. It will often heal, and after a time break out afresh, in the neighbouring parts ; and this it will continue to do for many months, particularly in throat cases. One of its striking character- istics is to heal in one part and grow bad in another; and we find this disposition to heal even in almost the incurable state of this disease, whether in the bubo, in the chancre, in the throat, or on the face. The mercurial ulcer is more irritable than the venereal ulcer. - pellations according to the contents of the tumour and the situation of the parts in which they make their appearance. The parts in whicli hernia most commonly appear, are the groin or labium pu- dendi, called bubonocele, or inguinal hernia ; when it protrudes into the scrotum it is termed scrotal hernia. If in the upper and fore part of the thigh it receives the name of crural, or femoral 676 LOCALES. CLASS VIII, hernia. When the bowels protrude at the navel the case is nam- ed an exomphalos, or umbilical hernia. The e-mtents of the tu- mour are a part of the intestinal canal or a portion of the omen- tum or caul, or both together. The most frequent causes of this disorder, are in children, crying, coughing, or vomiting; in adult persons, blo\,s, violent exertions of strength, as lifting or carrying heavy weights, straining at stool, parturition, jumping, running, &c. When a rupture is produced by bodily exertion, the tumour is formed suddenly, and is generally attended with a sensation of something giving way at the part and with considerable pain. If it come on in consequence of a laxity of the constitution, the tu- mour is small at first, and the protruded parts return into the abdo- men when the patient is in a recumbent posture, or may easily be reduced with the hand. A rupture that is reducible and free from strangulation, appears in the form of an elastic indolent colourless tumour, subject to change its size, being smaller when the patient lies down on his back, and larger when he stands erect. The tumour frequently di- minishes when pressed, and grows large again when the pressure is removed. When persons labour,under this description of hernia, although they may remain for some time free from severe pain or distress, their condition is nevertheless such as to require much at- tention, as neglect or mal-treatment may be attended with fatal consequences. When the protruded parts are found to be irreduci- ble, and considerable pain and inflammation ensue, the case be- comes an incarcerated or strangulated hernia, the peculiar symp- toms of which are, the tumour is very tense, painful to the touch and resisting the impression of the fingers, sickness and vomiting soon follow, and a suppression of all discharge by stool, attended with a frequent hard pulse and febrile heat. Under these alarm- ing circumstances every possible effort should immediately be made to effect a removal of the stricture, and a restoration of the re- lapsed bowels, or a mortification must inevitably ensue. The first attempt is always to be by the taxis, or the operation of reducing a hernia by the hand. For this purpose the patient should be placed on his back, and the foot of the bed be elevated about twenty inches higher than the head, the thighs should be bent towards the body, and that on the same side with the rupture in- clined inwards, by which position the muscles of the abdomen will be relaxed, By some we are desired to place the patient on the ORDER II. HERNIA. 677 side opposite to that of the rupture, which may be tried. The pressure which is made on the tumour by the hand of the opera- tor for its reduction, should always be directed upwards and out- wards in inguinal hernia; and first backwards and then up- wards in femoral hernia. The efforts may be continued about half an hour, but no violence ought on any account to be used, as it will tend greatly to aggravate the inflammation, and when the pressure becomes painful it should be discontinued. Should the taxis fail of success, the patient should be immediately bled from a large orifice if nothing forbid, and then another trial be made, and on failure of this also, resort be had to the warm bath, and the taxis repeated while the patient lies in the water. It has been my practice to pour gradually over the tumour from one to two ounces of aether, and allow it to evaporate. When the smarting which it produces becomes insupportable, I pour on cold water for a mi- nute or two and then repeat the aether. The three last cases which have fallen to my lot were cured within half an hour by the ap- plication of this remedy alone. The next remedies to be employ- ed are the coldest applications to the tumour, as pounded ice in- cluded in a bladder, or when this cannot be procured, a mixture of equal parts of nitre and sal ammoniac, in the proportion of ten ounces to a pint of water, should be tried by a constant applica- tion of it to the tumour. In conjunction with these means, opi- ates may be useful, but the sedative effects of tobacco clysters will probably be more effectual; the smoke of tobacco has commonly been employed, but the decoction on account of its more convenient administration, should be preferred ; one drachm of tobacco boiled for ten minutes in a pint of water, is the proper proportion. One half of this quantity only should be injected at a time, and the remainder after it shall be found'that the first does neither succeed nor operate with such extraordinary violence as to produce a dangerous depression of the system, as Mr. A. Cooper has seen two drachms, or even one when introduced at once, prove fatal. Some or all of the above mentioned remedies should be employed with the utmost assiduity, as no time should be lost in this very hazardous disease. If the strangulated parts are not re- lieved and the return of the intestine effected in a short time, of- ten in a few hours, all the symptoms become greatly aggravated, Still more alarming circumstances supervene, and unless relief be obtained by the only remaining resort, a surgical operation, a mor- 678 LOCALES. CLASS VHU tification and death will inevitably close the scene. " There are some cases," says the experienced Mr. Hay, "so urgent that it is not advisable to lose any time in the trial of means to produce a reduction. The delay of a few hours may cut off all hope of suc- cess, when a speedy operation might have saved the life of the pa- tient." Resort therefore, to a surgeon competent to this import- ant operation, should in no instance be delayed beyond the first twenty-four hours. With the view of guarding against the dreadful consequences of a strangulated rupture, every person subject to hernial complaints should immediately procure a well adapted elastic spring truss, which should be worn night and day without intermission. Very much of the utility and safety of a truss depends not only on its being properly constructed, but also on its being fitly adjusted to that part of the body where the hernia is situated. A great variety of trusses, formed on different principles, have been from time to time introduced to public notice, but with one exception, it may be asserted that, they have been found altogether deficient in those just principles upon which such instrument ought to be formed. It is within a few years that a truss has been in- vented by Dr. A. G. Hull, a very respectable surgeon and physi- cian of New York, and late president of the Oneida Medical So- ciety, which is incomparably superior, in its principles and proper- ties, to any of those previously in use. Dr. Hull is exclusively entitled to the credit of first adopting the true surgical principle for the radical cure of hernia. He happily conceived the idea that the pad of the truss should be so constructed as simply to support the muscular fibres around the ring or aperture, as much as possi- ble in the state in which they are maintained in perfect health. Un- less this be attained the parts never can recover their natural tone, whatever may be the degree of pressure applied. This great de- sideratum is admirably accomplished, by giving to the pad of his new invented hinge-truss a concave instead of a convex surface, by which it corresponds to the convexity of the abdomen. By this construction it is evident that the greatest degree of pressure is ap- plied to the circumference of the aperture, which tends constantly to approximate the hernial parietes, and afford them a mechanical support. The popular truss of Salmon and Ody, &c. though pos- sessing many advantages over the ordinary trusses, having a con- vex pad, must of course press constantly upon the ring, and tend •IRDER II. HERNIA. 670 to enlarge the dimensions of the rupture opening, and act as an effectual barrier against the desired union of the parts. It is now universally allowed that " Dr. Hull's hinge truss is constructed up- on principles different from any truss hitherto in use, and is supposed to be perfectly original; that it embraces advantages not to be met with in any other truss, being, 1st. The peculiar shape of the pad, which in the truss of Dr. Hull is concave instead of convex, as it is in other trusses : 2d. The peculiar connection between the spring and pad, being a combination of the hinge and pivot joint: 3d. The peculiar application of the pad and its accompaniments to the spring by means of the slide motion, and the facility with which the pad may be fixed to-any part of the spring : 4th. The pecu- liar construction of the double Inguinal truss, being simply the ad- dition of another pad attached to a short elastic metallic plate ; this plate with its pad, move on the same spring, by the same pow- er of adjustment and fixture as the first pad, the pressure of the pads being graduated at pleasure by an intervening cork wedge." Many other advantages peculiar to Dr. H.'s truss might be notic- ed, but we have not room to describe them here ;—it has now been in use several years, and the correctness of the principle upon which it is constructed has been abundantly tested by experience. Numerous instances have occurred in which hernia has been cur- ed by it, which had proved intractable to other trusses. Under the use of this instrument, Dr. Hull has not known a single case of hernia, in children, that has not been cured in less than 18 months, and few have exceeded six. The general conclusion which he forms in relation to cases is, that the complete cures which are effect- ed on persons from 40 to 75 years of age, may with safety be computed at an average of one to three, and universally in child- ren. Contrary to the general opinion of surgeons, Dr. Hull has found, by experience, that in most cases there is no necessity for continuing the application of the truss during the night. Since., therefore, Dr. Hull's truss has received universal approbation and preference, no other need be mentioned in this work. Mode of Application. After having stated the manner in which we conceive this truss produces its effects, and the authority in testimony of its superior utility, we deem it important to make a few remarks, particularly 680 LOCALES, < LASS Vllt. regarding its application. This is the more indispensable, since surgeons, who alone are sufficiently acquainted with the different species of the disease, the anatomy of the parts, and the proper adaptation of the truss, have abandoned their charge to apotheca- ries, and men entirely ignorant of the complaint. We also find that the most ingenious surgeons, misguided by the instruments formerly in use, and forgetting the important principle, that the pressure should be made perpendicular to the rupture, have very frequently applied them upon the wrong side of the patient. 1 n this manner the spring projects some inches beyond the body, (un- less it is much smaller than it should be when properly applied) making a very unseemly appearance, and by flinging the pressure upon the edge of the pad, destroys the principle of the instrument. For the purpose of rendering these instruments less liable to be Wrongly applied, these remarks are accompanied with a plate rep- resenting them as adapted to the different species of hernia. H—represents the umbilical truss. A-*-the situation of the rupture pad in umbilical hernia, resting with its centre directly over the rupture opening. The spring of the pad passes close to the side, as represented by the plate, D—represents the situation of the back pad upon the centre of the spine in corpulent persons, but a little beyond on spare or emaciated.* I—is a representation of the Double Truss, when upon the bo- dy the principal part of the pressure is made upon the end pad, C ; that should, therefore, be applied to the worst rupture. The degree of pressure upon the second pad, B, is regulated by a cork wedge, which is made to slide between the main spring, and small spring, to which the second part is attached. The application of this Truss is represented by the letters K B C. The back pad resting upon the sacrum, as shown by the letter E. The rupture pads should apply immediately over the rupture opening, the lower edge just touching the edge of the pubis. The spring should pass in a horizontal line, and be neither so large as to be inconvenient or so small as to press upon any part of the body. The force of the spring should be sufficient to keep the gut always reduced. The greater pressure the patient can bear, the more perfect is his secu- rity, and the greater prospect of a radical cure. * Except in cases where the greatest pressure is required, the counter pad should be made to rest on the muscular cushion on each side of the spinei ORDER III. ULCERS. 681 G—-represents the single Ing. Truss; it differs in no respect from the double, without the addition of the second pad. If the rupture be in the right groin, this Truss comes on from the left side, as represented by K. And the same Truss reversed for a rupture in the left groin. Fig. F—represents the instrument as applied in femoral her- nia. The curve in the spring at F, is for the purpose of dropping the rupture pad lower in the groin, while the back pad retains the position E. In these cases it will be generally found necessary to turn up a little the upper and lower edge of the pad to prevent its chafing the integuments of the abdomen and thigh. If proper attention is paid, it will not be difficult to mistake the application of this instrument. The one first applied may not be the best adapted, but the opportunity afforded of trying the sever- al degrees of pressure will at least secure the rupture, if it does not go to the extent of cure. Order HI.—DIALYSES. ULCUS, OR ULCERS. Although an essay on ulcers is peculiarly the province of sur- gery, it might be considered defective were not some reference to the subject to be found in this work ; but neither time nor room will permit of more than a few cursory remarks relative to the mode of treatment of such ulcers as daily fall under the observa- tion of the medical practitioner. When ulcers are of a recent na- ture, our endeavours should be directed to the promotion of the healing process as speedily as possible, but when of long standing, especially in persons of advanced age, the drain having become habitual, appears to be necessary for the preservation of the gener- al health. Ulcers of this description cannot with safety be sud- denly healed, unless some artificial drain be substituted and proper purgatives administered. There is some truth in the common adage, that a sore is the old man's best friend, and it is, in my opin- ion, an interesting truth, that a deprivation of such friend has too often been followed by a sudden deprivation of existence. In simple ulcers of a recent nature, the healing process is easily ac- complished without much aid from the hand of art. We have on- 86 682 LOCALES. CLASS VIII. ly to exhibit our skill in avoiding an interference with the efforts of nature; the most simple ointment of wax and oil, with a light bandage, properly applied, will be amply sufficient. But when we have the management of the foetid, foul, vitiated ulcer, with callous edges, broad surface, with granulations or fungous flesh rising above the skin, our particular attention will be requisite. The fungus and callosity must be repressed by escharotics, as the nitrate of silver, the red oxyde of mercury, the sulphate of copper, or what is equal to either, the sanguinaria canadensis, reduced to a fine powder and sprinkled over the sore. The foetor and acrid dis- charge may be corrected by frequent washing with a decoction of the root of indigo weed ; but on some occasions there may be a call for the bread poultice with charcoal, or a poultice of the pulp of boiled carrot. But Mr. Baynton has had the good fortune to present to us a process which has seldom been known to fail of a erne, even in the most obstinate cases. His view is to bring as nearly as possible the opposite edges of the ulcer in contact, and confine them in that situation. The ulcer being on the leg, the hair should be shaved off. He then prepares a plaster consisting of four ounces of diachylon and half a drachm of yellow resin; this, when beginning to cool, is to be carefully spread on pieces of calico; the edges being cut smooth, the plaster must be cut into slips of from two to three inches in breadth, and of such length as will pass round the limb and leave an end of about four inches. These slips are to be applied in the most precise manner round the limb, drawing them with as much gradual extension, and approxi- mating the divided edges as much as the patient can bear. The slips of plaster should cover the whole surface of the sore, and reach at least an inch above and below its edges. The whole of the af- fected parts should then be defended with pieces of soft calico two or three times doubled, and very evenly applied, and a calico ban- dage of about three inches in breadth should be applied with as much firmness as can be borne by the patient, beginning at the foot and ankle, and carried by regular and smooth turnings round the limb till it reaches the knee. The whole of these coverings should now be thoroughly wet with cold water poured on, and repeated as often as they become dry ; and the patient may walk about at his pleasure. The whole dressings may be removed and again re- newed once in twenty-four hours. ORDER III. BURNS AND SCALDS. 683 BURNS AND SCALDS. The degree of danger with which these accidemts are attendedj depends more on their extensiveness over the surface than on the violence of the injury suffered. A burn, for instance, that is so violent as to destroy the life of the muscular pans down to the bone, if not large, is far less dangerous than a scald which is en- tirely superficial, if it be very extensive. Much of the curative process also depends on the speedy application of the proper re- medies, so as to allay the violent anguish, and to prevent, if possi- ble, that extensive vesication and inflammation consequent to inju- ries by fire. The part scalded or burned should, without a moment's delay, be plunged into the coldest water that can be procured, or the wa- ter should be constantly applied by means of linen cloths, and continued till the violent pain has entirely subsided, and as often as the pain returns the same application should be assiduously re- peated. Another excellent application to recent burns and scalds is vinegar ; this may be used in the same manner as cold water, and in slight injuries, either of these assiduously applied will soon effect a cure. If large blisters arise on the part, they should be opened that the vinegar may act immediately upon the burnt flesh. In the cold weather of winter the vinegar may be made about blood warm, and although some pain will be excited, it is strongly recommended to persist in its use. After a few hours continuance of cold water or vinegar, we are advised by some to employ a lini- ment composed of equal parts of lime water and linseed or olive oil, but as I conceive, the volatile liniment is a remedy greatly to be pre- ferred; indeed, this last will be found a very eligible application as a common dressing from the beginning, being spread over the sur- face of the sore with a feather, and covered with lint or a linen cloth ; the smarting pain which it will at first occasion, will be of temporary continuance, and an agreeable soothing sensation soon follows. A decoction of the root of sophora tinctoria, applied as a lotion, is excellently adapted to abate inflammation and dispose the sores to heal. But in most cases of burns and, scalds attended with severe pain, permanent relief is only to be obtained by such means as tend to promote suppuration, and with this view emol- lient poultices composed of the mucilage of slippery elm bark, 684 LOCALES. CLASS VIi(. thickened with bread or meal, and covered with sweet oil, are of indispensable utility. When matter is formed on the surface, the sores may be cover- ed with chalk finely powdered, till it has absorbed the matter and appears quite dry. A poultice, or the stramonium ointment, should be laid over the chalk, and the same dressings repeated morrting and evening till the sores begin to heal, when the cicatri- zation may be completed by the employment of the cerate of lapis calaminaris, or the saturnine ointment. When the injury is of a very extensive nature, and much febrile heat ensues, the antiphlogistic plan must be pursued, gentle laxa-' tives and refrigerants should be employed, and opiates to allay pain and irritation. If the parts become livid and black, and there is reason to be apprehensive of a mortification, the cinchona and wine must be immediately administered internally, and the sore should be kept constantly moistened with a decoction of sophora tinctoria, and recourse must be had to all the usual means of ob- viating mortification. If the burn is occasioned by the explosion of gunpowder, and some of the grains are forced into the skin, they should be picked out as soon as possible after the accident, as they excite irritation and leavt marks during life. Cotton wool, when applied to recent burns and scalds, is said to have proved beneficial, and I have wit- nessed one instance of its good effects. It is to be spread over the whole surface of the injured parts, and suffered to remain for seve- ral days, when it may be removed with perfect ease, and the sores will often be found nearly healed. A plan of cure precisely the reverse of that just described, has been introduced and strenuously advocated by Dr. Kentish. His princi- ples are, " that any part of the system, having its action increased to a very high degree, must continue to be excited, though in a less degree, either by the stimulus which caused the increased action, or some other having the nearest similarity to it, until by degrees the extraordinary action subsides into the healthy action of the part." It might seem not inconsistent with his doctrine to have recourse to actual fire or the hot poker, as the best mode of relief, but Dr. K. relies on alcohol, made more stimulating by the addi- tion of essential oils, to be applied heated to as great a degree as the sound parts can bear without injury. He directs the injured parts to be bathed two or three times over with spirits of wine. ORDER III. RURNS AND SCALDS. 685 either with or without camphor, or spirits of turpentine heated by standing in hot water. After this, a liniment composed of the common yellow basilicon, softened with spirits of turpentine, is to be spread on a soft cloth and applied. This liniment is to be renew- ed only once in twenty-four hours, and at the second dressing the parts are to be washed with proof spirit, or laudanum made warm. When a secretion of pus takes place, milder applications must be made till the cure is effected. Dr. K. thinks it of importance that the injured surface should be left uncovered as little as possi- ble, as the air has an injurious effect. He advises powdered chalk to be used t© repress the growth of exuberant granulations and to absorb the pus. Our author is also of opinion that internal stimulants should be administered in proportion to the degree of injury during the few first days, or till suppuration takes place, when it will be no longer necessary to excite the system. Dr. K. observes, that by his mode of treatment the inflammation will in general be found to disappear at the end of forty-eight hours, when the dressings may consist of camphorated oil, Goulard's cerate, or the cerate of lapis calaminaris. The theory of Dr. K. is viewed as visionary ; it must not, how- ever, be dissembled that his practice has been successfully adopted and warmly approbated by some practitioners of great eminence. The success of the cooling method of cure is also corroborated by the highest medical authorities, and it may be asserted that this last still holds almost universal preference. All extremes should in these cases be avoided, and a medium course, varied accord- ing to particular circumstances, may perhaps be deemed the most eligible. In confirmation of the superior efficacy of cold water in scalds, I offer a striking instance communicated in a letter from Rev. Dr. T. Alden, President of Alleghany College, to Professor Hosack, who presents it to be inserted here. A boy aged 4 years, near Meadesville, fell into a vessel of boiling water in such a manner that the upper part of his thighs, groin and lower part of his belly, were fully immersed. He was instantly taken out, and on removing his clothes, his skin in sundry places came off in rolls. The geni- tals were supposed to be injured beyond the possibility of cure. The mother,Mrs. Neal, a woman of uncommon intelligence, had re- course to an application which she had known to be efficacious in some similar cases. She prepared a tub of sufficient dimensions 686 LOCALES. CLASS Vllt. and sat the child in it, and commenced pouring cold water upon the parts affected, and continued this operation without ceasing for twenty-one hours, when the patient was removed from his cold bath. In a day or two after, there appearing to be much redness in the parts whence the excoriation had taken place, Mrs. Neal applied some linseed oil. In one week, the little boy was as well, as lively, and as active as he had ever been. His flesh was perfectly smooth and sound where the skin had not been rubbed off. No suppuration ensued ! If it had not been for the application of the cold water, it is thought that the child could not have survived. The mother is fully persuaded that if the cold bath had been continued three hours longer, there would have been no occasion for the linseed oil. In ancient times, adds the writer, such a cure would have made a conspicuous figure in some temple of ^Esculapius. This may be considered as a remarkable example of firmness and persevering efforts in disastrous circumstances, and Mrs. Neal is amply rewarded by a consciousness of being instrumen- tal in preserving the life of her child. Order IV—TYCHICA. POISONS. It is extremely proper that every person should be made ac« quainted with the nature of poisons, and the means of counteracting their deleterious effects. Poisons are divided into mineral, vege table, and animal, to which may be added the aerial poisons. Among the mineral poisons, arsenic is the most corrosive and fatal in its effects. The symptoms which arise in consequence of swallowing this poison, are a burning heat, and violent prick- ing pain in the stomach and bowels, accompanied with extreme thirst, and an inclination to vomit. The tongue, mouth, and throat, are rough and parched, and an unquenchable thirst prevails, with great anxiety and restlessness. If relief be not soon obtained, and if the quantity of the poison swallowed be considerable, these symptoms are followed by faintings, hiccough, with coldness of the extremities, and the discharge of black foetid matter from the stomach and bowels, indicating a mortification of the intestines, and approaching death, ORDER IV. POISONS. 687 In this dreadful situation, the utmost exertion should be made to relieve the stomach of the corrosive poison. A strong solution of white vitriol, or proper doses of ipecacuanha, should be admi- nistered in such quantities, and at such intervals, as will be found necessary to excite a very copious vomiting. The patient must drink very large quantities of milk and honey mixed, of warm wa- ter, lean broths, and barley water, with gum arabic. It has been discovered that oils, aud all unctuous substances, add activity to arsenic, and greatly increase the danger ; they should, therefore, be avoided. Clysters of the same materials ought likewise to be injected in so copious a manner as to fill the whole tract of the ali- mentary canal with soft emollient liquids, both to dilute and to sheathe the poison. A dose of castor oil, or Glauber's salts, should be occasionally interspersed, but a rigid persistance in the use of some of the above mentioned emollient liquids, will be re- quisite for several days, as no other remedies can be equally use- ful. Instances may however occur, in which a full habit of body, strong and full pulse, and severe pain will justify bleeding to a certain extent, as the judgment of the experienced physician may direct. According to Dr. Hannemann, nothing is more efficacious in this deplorable case, than half a pound of white soap dissolved by boiling in a quart of water, and sweetened with honey. Half a tea-cup full of this solution should be taken every five minutes, that the patient may swallow several pounds in the course of two hours. It has recently been ascertained that when corrosive sublimate has been swallowed, it may be readily decomposed and resolved into an inert mass by albumen or the whites of eggs. These should be swallowed in very large quantities until the powers of the poison are entirely destroyed. Sugar or syrup, if swallowed in very large quantities, is a complete antidote to the poison of copper or verdigrise, by chemically changing its properties, and active purgatives should afterwards be administered. A strong so- lution of muriate of soda, or common salt, freely swallowed, proves an effectual antidote to the poisonous effects of nitrate of silver. Sulphate of soda, or sulphate of magnesia, destroys in a great measure the deleterious effects of the acetite of lead or oth- er preparations of that metal. When tartar emetic or other anti- monials have been taken in excessive doses, some powerful vege- table astringent, as a decoction of bark, or galls, will do much in 688 LOCALES. class vni. preventing their fatal effects. As an antidote or corrector to the mineral acids, calcined magnesia, in large quantities, is the most efficacious. The vegetable poisons, which 'most frequently exert their dele- terious effects, when taken by mistake, are the stramonium or thorn apple, and the atropa belladonna, or deadly night-shade, the seeds and berries of which, are sometimes eaten by children; some species of mushrooms, hemlock or cicuta; aconite or monkshood; henbane or hyoscyamus; water hemlock or cicuta maculata; fox- glove or digitalis purpurea, and opium. All the poisons of the ve- getable class, seem to produce their fatal effects by their narcotic or stupifying properties. The chief symptoms which they pro- duce are, a staring wildness in the eyes, confusion of sight, palpi- tation, giddiness, loss of memory and voice, stupor, or fury, vomit- ing, and convulsions. " An instance occurred of eight persons in one family, suffering the noxious effects of stramonium, the leaves of which had been eaten at table, mixed with other vegetables. They exhibited a scene scarcely to be described, and formed a group, in which were displayed the various grades fromidiotism, to mania; such as torpor, or abolition of sense, slow pulse, vertigo, tremour, wild delirium and raving, with glaring eyes, and dilated pupils. They all recovered in about twenty-four hours by the use of strong emetics." The most effectual antidotes against these poisons, consist in a speedy evacuation of the offending substance from the stomach. Immediately on its being ascertained that any of these poisons have been swallowed, about twenty or thirty grains of white vitriol, if an adult person, may be dissolved in warm vinegar and water, and the dose repeated every quarter of an hour, until a thorough evacuation be produced. The vomiting must be accompanied with large draughts of warm water, and olive oil, fat broths and gruel. In the mean time, emollient clysters must be injected, until the of- fending cause be entirely removed. The vegetable acids, as vine- gar and the juice of lemons, or limes, have likewise been found serviceable in correcting what remains of these substances in the stomach, and they should be freely given. In order to rouse the patient from a state of torpor, blisters between the shoulders, sina- pisms to the feet, and keeping the body as much as possible in mo- tion should be directed. ORDER IV. POISONS. 689 There is a species of rhus, or swamp sumach, commonly known by the name of poison dogwood, which is capable Of communicat- ing its poisonous effects to the skin, by means of contact, or by smelling of it, or even by the smoke, or the steam from a decoc- tion of the shrub. In about forty-eight hours an inflammatory eruption appears on the surface of the skin, attended by pain, swelling, blindness, itching, and fever. A man having incautious- ly expressed a quantity of the juice of a species of this shrub, was soon after seized with violent inflammation, and eruption over the whole surface of the body, with swelling of the head, and blindness, resembling the most malignant kind of small-pox, whicli occasioned the loss of his hair and nails, and it was several weeks before a cure was effected. There are some constitutions which are incapable of being af- fected with this species of poison. The remedies to be applied in these cases are bleeding, when the symptoms are violent, and ca- thartics of neutral salts. The application of cold water, or a so- lution of crude sal ammoniac, or the spirits of sal ammoniac, dilut- ed with water, a weak solution of corrosive sublimate, or of the su- gar of lead, as a wash to the parts, will soon effect a cure. When opium has been taken in too large quantities, either by mistake, or for the horrid purpose of self-destruction, the alarming symptoms induced, are vomiting, delirium, stupor, deep and diffi- cult breathing, convulsions and death. The remedies are, in the first instance, powerful emetics of white vitriol, twenty grains of which should be immediately given in a glass of warm water, and repeated every ten minutes, until copious vomiting is excited. Warm water is then to be freely given, and a smart purgative of jalap, with a few grains of salt of tartar administered. Frictions with salt should be thoroughly applied over the whole body, and the nostrils should be stimulated with the spirits of hartshorn, or of sal ammoniac, and blisters between the shoulders, and on the extrem- ities applied. In short, every possible effort should be made to rouse and irritate the patient, so as to counteract the effects of the poison. Both the animal and vegetable acids will be useful, as al- so the saline draught, and they should be liberally employed. But no internal medicine is to be preferred to a solution of volatile sal ammoniac, a table-spoonful of a strong solution of ammoniac, of- ten repeated, it is affirmed, has a wonderful effect in obviating the torpor of the stomach, and stimulating the whole system. When 87 690 LOCALE^. CLASS VI1I. symptoms of apoplexy are present, and great morbid action from the excess of stimuli is manifested, Dr. Rush advises copious blood- letting, having himself cured four patients by this remedy. As soon as the stimulus of the opium appears to be subsiding, and the system discovers marks of sinking, a new stimulus becomes highly necessary, and the frictions with salt, and the solution of ammoni-' ac, must be persevered in, and brandy or other ardent spirits should be freely given, and at length gradually discontinued. The poison from the bite of rabid animals, has been notic- ed in the preceding pages ; but another species of animal poi- son, to which we may be exposed, is that of the rattlesnake and viper. The remedies generally applied in these cases are, in the first instance, to cut out the bitten part, or to suck out the venom by the mouth, which may be done with safety provided there is no soreness about the mouth at the time. The remedies supposed to be the most efficacious in these cases, are the volatile sal ammoni- ac, or other alkaline salts, given as soon as possible after the bite, and as freely as the stomach will admit, repeating the dose every few minutes, as the danger increases with the greatest rapidity. The wounded part must also be constantly moistened with the solu- tion of the same medicine. Instances of this kind have been re- ported of cures effected by the use of olive oil, when taken freely internally, and thoroughly applied to the wounded part. One instance of this poison occurred to my observation in the year 1776; a soldier was bitten by a rattlesnake on the hand; the effects were astonishingly rapid. In a few moments a swelling commenced, attended with severe pain. It was not more than half an hour when his whole arm to his shoulder was swollen to more than twice its natural size, and the skin became of a deep orange colour. His body on the same side soon became affected in a similar manner, and a nausea at his stomach ensued. The poor man was greatly and justly alarmed ; his situation was dis- tressing and very critical. Having procured a quantity of olive oil, we directed the patient to swallow it in large and repeated doses, till he had taken a quart, and at the same time we rubbed in- to the affected limb a very large quantity of mercurial ointment. In about two hours we had the satisfaction to perceive the favour- able effects of the remedies. The alarming symptoms abated, the swelling and pain gradually subsided, and in about forty-eight hours he was happily restored to health. ORDER IV. WORMS. 691 We learn that the huntsmen in Missouri who are greatly expos- ed to the bite of rattlesnakes, find an effectual remedy in the roots of phytolacea decandra, or poke, boiled to a soft pulp and im- mediately applied to the wound by way of a poultice. This re- medy has so long and often been tested that it is now in general use, and is constantly relied on for safety. The stings of bees and hornets may be cured by the application of warm olive oil, or common salt dissolved in water or vinegar. The Maranta Arundinacea, or arrow root plant, is highly val- ued as an antidote to animal poison. It has its name from the In- dians, who heal with its juice wounds, inflicted by poisonous ar- rows. It is a native of South America, the West Indies, and Georgia. The bite of the Scolopendra or Centum Pes, which is almost as venomous as the sting of a scorpion, has often been cur- ed by the application of the maranta, which flourishes most where these noxious insects abound. It also effectually counteracts the fatal effects of the deadly night shade, (Atropa Belladona,) which is perhaps the most powerful of the vegetable venoms. Six slaves, in the West Indies, swallowed some spirits from a bottle which had been stopped with the leaves of the deadly night-shade. Four of them died shortly after by the effects of the poison. The re- maining two were saved by applying liberally the juice of the ma- ranta arundinacea. The juice of the young plant is the antidole. (Jacob Green, A. M. Phila.) The stings of bees and hornets may be cured by anointing the parts with warm olive oil, or vinegar. Should the stings however be so numerous as to excite very considerable inflammation, poul- tices of bread and milk, or of flax seed, with sweet oil must be ap- plied to the part; and the patient will perhaps require bleeding, and a dose or two of Glauber's salts. For ^Erial Poisons, see Nox- ious Vapours, p. 522. VERMINATION, OR WORMS. It is a prevailing opinion with many respectable physicians, that worms necessarily exist in the bowels of every child after it is weaned, and are conducive to health. And by others it has been contended that worms are the effect of sickness, and are only to 692 LOCALES. e.LASS VIII. be found in the bowels of such children as are debilitated by bad management, or by some acute disease. This is, however, a fact, confirmed by daily observation, that both children and adults, fre- quently evacuate a number of worms about the termination of a fever, or some other illness which has induced great debility. Worms are of different kinds, but those most commonly found in the human body are the small white worm, called ascarides, whicli occupies that portion of the intestinal canal denominated the rec- tum ; the long round worm, named teres, and the tape worm, or tccnia. This last is flat, consisting of many joints, and is usually of considerable length, sometimes extending to thirty or forty feet in adult persons. There are no infallible symptoms by which the presence of worms in the bowels can be readily distinguished; for any intesti- nal irritation, or morbid affection of the bowels will be attended with similar appearances. But it is believed by the commonalty, that the greatest number of children's complaints arise entirely from worms; and this belief has been encouraged and strengthen- ed by the bold assurances of quacks, who seize upon the easy cre- dulity of nurses to vend their dangerous nostrums and anthelmintic lozenges. Dr. Hosack has long been in the habit of considering those cases in general which are ascribed to worms, among the symptoms of dyspepsia ; and very rarely as constituting an idiopathic disease. Instead of the various anthelmintic medicines for the removal of worms, his only prescriptions are, after an active cathartic of jalap and calomel, and the removal of all febrile symptoms, to put the patient upon the use of the elixir proprietatis, in doses sufficient to keep the bowels soluble ; say from two drachms to half an ounce, in sweetened water, every morning fasting, for three days succes- sively ; renewing it afterwards as occasion may require. He then directs, if the child be greatly debilitated, the use of the carbonate of iron in combination with a small portion of ginger ; eight or ten grains of the former with two of the latter, twice a day, in syrup. Notwithstanding the symptoms of worms are equivocal, it is our duty to point out such as are more constant and less uncertain. The ascarides produce such a degree of itching about the anus, that sleep is interrupted, and often prevented. The child com- plains of pain in the belly, looks pale, picks its nose, and has a va- ORDER IV. WORMS. 693 riable appetite. The stools contain a preternatural quantity of mucus, or slimy matter, in which frequently is discovered the worms like small white threads. A cathartic of calomel and rhu- barb, assisted by an injection of aloes and water, or lime water and olive oil, will izenerally be sufficient to remove or destroy them. Suppositories of molasses candy, well rolled in calomel, answer the best purpose for the removal of ascarides. The symptoms denoting the presence of the teres, or long round worm, whicli exists in every part of the alimentary canal, are, a capricious appetite, foetid breath, pains in the stomach, and some- times vomiting, grinding of the teeth during sleep, picking of the nose, paleness round the mouth, and red spots in the cheeks ; swelling of the upper lip, a livid circle round the eyes, hardness and fulness of the belly, a short dry cough, disturbed sleep, ema- ciation of the body, an irregular fever, drowsiness, and unequal pulse. In some instances convulsions, epilepsy, and partial palsy of the lower extremities, occur. If convulsions, attended with a small pulse, and hiccough, are present, it may be almost certain that worms abound in the alimentary canal. Small substances in the excrements resembling melon or cucumber seeds, are symp- toms of the tape worm. It is not often that infants at the breast are afflicted with worms, though some instances have occurred in those not more than three or four months old. There is an erroneous idea prevalent among some persons, that to give an emetic in worm complaints may oc- casion suffocation and death ; but it should be considered that when worms are actually in the stomach, if they can be thrown off by vomiting, immediate relief will be obtained, and an emetic of ipe- cacuanha will not invite them there, for they loathe all bitter and nauseous sUDstances. It is very doubtful whether these vermin have ever united in the stomach in such a formidable body as to obstruct the passage and occasion suffocation. A great variety of anthelmintic medicines have been advised for the destruction and removal of these vexatious vermin. The com- mon wormseed is in considerable repute as a vermifuge. The seeds being reduced to a fine powder, are mixed with syrup and given to the quantity of a table-spoonful to a child two or three years old, early in the morning. The patient is to be kept with- out nourishment for some hours, and after supper another dose must be administered. It is often necessary to continue this course 694 LOCALES. CLASS VIII. for several days, and then a cathartic should be directed. But the essential oil of wormseed is found to be still more efficacious. It should be administered in doses of from four to eight or ten drops on sugar, to a child two or three years of age, twice in a day, until the worms are evacuated. The spigelia marilandica, Carolina pink, in the form of powder, about ten grains for a dose, or the infusion with the addition of senna or jalap, to assist its purgative effect, is in general use, and it seldom fails to answer the desired purpose, often affording relief or effecting a cure, even when no worms are discharged. But when exhibited in large doses without proper precaution, it has been known to produce very singular and dis- tressing effects on the nervous system. The great bastard black hellebore, or bearsfoot, is in great repute as a vermifuge for the long round worm. A decoction of about half a drachm of the green leaves, or about fifteen grains when dried, is a proper dose for a child between four and seven years old ; it is to be repeated for two or three days. The green leaves may be made into a sy- rup with sugar, and a tea-spoonful given at bed-time, and one or two the next morning. This medicine also requires to be used with much caution, as it has been known to produce deleterious effects. We have a more safe and no less efficacious vermifuge in the Melia azedarach, or pride of India, the produce of the southern states. The bark of the root of this tree is doubtless one of the most valu- able anthelmintics that has ever been discovered, and with many physicians where its efficacy is best known, it has superseded the use of all others. I have frequently employed it with the most satisfactory success. A large handful, or about two ounces of the bark, is to be boiled in a pint of water till it acquire the colour of strong coffee, or till half the water is consumed ; from half an ounce to an ounce may be given every two or three Irours until it operates by vomiting, or as a cathartic. It has on some occasions produced unpleasant effects, similar to those induced by spigelia, but they soon disappear without any perceptible injury to the system. The dolichos pruriens, or cowhage, is another vermifuge of su- perior efficacy; the stiff hairs which cover the pods, if applied to the skin, occasion intolerable itching, and they act mechanically as an anthelmintic. The pods being dipped in syrup until it is ren- dered by the hairs as thick as honey, the syrup containing the hairs is to be separated from the pod, and given from a tea-spoon- ORDER IV. WORMS. 695 ful to a table-spoonful in the morning, fasting. The worms are said to appear with the second or third dose, and by means of a purge, in some cases the stools have consisted entirely of worms. The powder of tin, in doses of from a scruple to a drachm, has been given as a vermifuge with considerable advantage, but it is more particularly useful for the removal of the tape worm in adult persons. Dr. J. Fisher, a very respectable physician of Beverly, is of opinion that the effect of tin as an anthelmintic, depends very much on its being minutely divided ; and he employs the amalgam of tin, which he says never fails to kill the long round worm. His method of preparing the amalgam is inserted in the Appendix of this vol- ume. Three or four drachms of this medicine is to be divided into twelve doses, two of which are to be given in a day. This quantity will generally be sufficient for a child ; but sometimes six or even twelve additional doses will be required. If we wish to keep the bowels more open, a proper quantity of calomel may be added. Worms killed by tin or its amalgam, are never discharged entire, but are either partially or wholly digested. This prepara- tion has in other hands proved an excellent remedy, and answered the most sanguine expectations. But of all the articles of the Ma- teria Medica, mercury has been considered as incomparably the most powerful vermifuge. Long experience has evinced that no remedy is so safe, so mild, or so certain, as calomel, given in a dose adapted to the age and constitution of the child; keeping him warm and avoiding cold and sour drinks for two or three days. A child between the ages of two and four years, in general, may take from one to three grains at a dose in syrup, and to be repeated ac- cording to circumstances: rhubarb, or jalap, may be added to quicken its operation. Ball's purging vermifuge powder is a valu- able preparation ; it is composed of equal parts of rhubarb, scam- mony, and calomel, with as much double refined sugar as is equal to the weight of all the other ingredients. These must be reduced to fine powder, and well mixed together ; and the dose, for a child, from ten to twenty grains. Attention must be paid to diet, and after the expulsion of worms by a proper course oivermifuge me- dicines, the Peruvian bark, stomachic bitters, and chalybeate pre- parations will be serviceable to strengthen the stomach and bowels. It has been recommended by Professor Barton, in strong terms, to apply the leaves of tobacco, after having been pounded with 696 LOCALES. OLASS VIII, vinegar, to the region of the stomach, or other part of the abdo- men, as a vermifuge. In consequence of this application, worms are often discharged after powerful anthelmintics have been exhi- bited internally in vain. The toenia or tape worm resides in the intestines of adult per- sons, and are so tenacious of their habitations that it has been found extremely difficult to dislodge them. The symptoms by which its presence may be ascertained, are those of worms in general, but a more certain, and indeed the only criterion, is the expulsion of one or more pieces of the worm itself. The great difficulty of expelling the tape worm has long been experienced; as in the attempt, portions consisting of a number of joints are frequently broken off and discharged, but, being endowed with'a power of regeneration, it soon acquires its former size, and ex- cites the same troublesome motions. One of the celebrated spe- cific remedies for the tape worm, is the male fern, combined with various drastic purgatives ; but it is needless to particularize res- pecting this or other nostrums, since we are now in possession of remedies more deserving the title of specific. Dr. Fisher is in the practice of exhibiting Fowler's arsenical solution, for the destruc- tion of the tape worm, and asserts that it is always successful. He directs the patient to take as large a dose as the stomach will bear, two or three times every day, till the worms are destroyed. For an adult, ten or twelve drops will be a sufficient dose. The oil of turpentine, taken in a little milk or gruel, has proved a very successful remedy for the tape worm, in doses of from one to three ounces. I have employed this remedy in two instances with complete success. The patients were females, and I directed half an ounce of the oil to be taken every three hours. The third dose operated as a severe purgative, by which the tape worm was expelled, and all the symptoms soon disappeared. The medicine produced no vomiting, nor any affection of the urinary passages, but created a great heat of the whole body, which continued for a few hours. Report has been made of six table-spoonfuls of the oil of turpentine having been taken at one time, and with the de- sired effect. * DISEASES OF WOMEN AND CHILDREN. DISEASES OF PREGNANCY AND THE PUERPERAL STATE. Pregnancy is frequently the source of numerous disagreeable sensations, and sometimes the cause of diseases which require the utmost care and the most judicious management. It is, however, universally acknowledged that those women who bear children, enjoy usually more certain health, and are much less liable to dangerous diseases than those who do not. The first sign of pregnancy is usually a suppression of the menses, to which soon succeed nausea and vomiting in the morn- ing, heart-burn, indigestion, peculiar longings, head-ach, giddiness, tooth-ach, and sometimes a slight cough ; the breasts become en- larged, and shooting pains extend through them. The areola round the nipple extends and becomes of a brown or darkish col- our. In some women, the catamenia flow with their usual regu- larity during the whole season of pregnancy. A feverish disposi- tion, with debility, emaciation, irritability, and peevishness of temper often occur, whilst in other instances no inconvenience whatever is experienced. About the twentieth week after conception, in some instances later, what is called quickening usually takes place, when the mo- ther becomes sensible of a slight motion of the child, and she is then liable to sudden faintings and slight hysteric affections. The sickness and vomiting in the morning may generally be prevented by taking some light food before rising from bed, and keeping the bowels constantly soluble by cooling, easy laxatives. Should this complaint, however, continue during the course of pregnancy, small bleedings will be highly necessary, and the sa- line mixture in the act of effervescence, with essence of pepper- mint, will in most cases afford essential relief. The elixir vitriol will also be found useful. The application of laudanum to the pit of the stomach, will often abate excessive vomiting, but if it still continues to be obstinate, a gentle emetic of ipecacuanha will be- come necessary, and experience has proved that it may be given and repeated during the pregnant state with perfect safety. After 88 6Qb OP DISEASES OF PREGNANCY, this operation, an infusion of colomba, or other stomachic bitters, will be of considerable benefit. The feverish disposition which almost always attends pregnancy must be relieved by bleeding and low diet. The head-ach, when attended with plethora and drowsiness, in robust women, will in general require a small evacuation of blood from the arm, and gentle laxatives. In weak irritable habits the application of leeches to the temples will be more proper, and camphorated spirits, aether, and laudanum should be freely applied. In cases of severe tooth-ach we have often extracted the one most affected with per- fect safety, although some authors assert that abortion has usually been the immediate consequence of the operation. The appli- cation of a few drops of the essential oil of cloves, savin, cajeput, or juniper, will often prove an effectual remedy. The heart-burn, which so often incommodes pregnant women, generally proceeds from an acidity in the stomach, and is best ob- viated by a free use of calcined magnesia, chalk, and the alkaline salts, or the aqua ammonia. When pregnant Women manifest some peculiar longings for par- ticular articles of food, they should always be gratified if possible, as miscarriage is sometimes the consequence of anxiety attending disappointment on such occasions. Costiveness is commonly a troublesome complaint during pregnancy in consequence of pres- sure of the uterus on the rectum; this should be prevented by a daily use of some laxative, as the extract of butternut; manna, cream tartar, &c. Pills of aloes and soap, or Anderson's pills, are commonly employed, and they are not found so injurious as some have represented. The various complaints which attend the more advanced stage of pregnancy, as suppression of urine, diarrhoea, retroverted uterus, oedematous swellings, convulsions, cramps, varicose veins, jaundice, incontinency of urine, &c. are to be treated in the manner re- commended by the different authors on midwifery, with which every practitioner ought to be acquainted. It not unfrequently happens that women at an advanced stage of pregnancy are attacked with spurious pains, somewhat resembling those of labour, which occasion an unnecessary alarm. In such instances, if plethora prevail, bleeding will be requisite ; laxatives and clysters to remove costiveness; and a quiet easy position, with opiates to allay irritation, will commonly prove effectual; but AND THE PUERPERAL STATE, 699 if spasm or hysteric symptoms attend, nothing is to be preferred to the root of skunk cabbage in doses of half a drachm, repeated frequently till the desired effect be produced. In every period of pregnancy, when there are evident marks of fulness, especially in the latter months, it should be removed by blood-letting, and all violent exercise or exertion of body or mind must be guarded against with the utmost care. Of Abortions. Every pregnant woman is more or less liable to disappointment in her fond expectations by the accident of abortion. It may hap- pen at any period of gestation, but is most frequent in the second or third month. If it happens within the first months it usually receives the name of a false conception; if before the seventh month it is termed an abortion or miscarriage, and at this period the infant although feeble and weakly, may often be reared by proper care and attention. Abortions are seldom dangerous in the first five months, but a repetition of them by weakening the system, frequently lays the foundation for chronic diseases of the most obstinate aud dangerous nature. Some women have a cer- tain tendency to miscarry, which renders the most trivial accident productive of that misfortune, while others suffer the most aston- ishing agitations of the mind and body with perfect impunity. This peculiar tendency to abortion sometimes occasions such repe- tition of the same accident as to render the woman incapable of being the mother of a living child, and is the cause of irreparable injury to her general health. It is therefore a subject of extreme regret that we sometimes meet with instances of unfortunate females who, to conceal their criminal indulgences, resort to various artifi- cial means to procure abortion in order to prevent a discovery of their situation; such attempts are frequently attended with fatal consequences.* * Applications are sometimes made to practitioners for this unwarrantable pur- pose, but every conscientious man will repel the solicitations with disdain, however desirous he may be to save the reputation and the feelings of individuals, as the in- tention can seldom be accomplished by ecbolic medicine without exposing the life of the mother to the greatest danger, and himself to just execration. In France the crime was formerly capital, but since the revolution the punishment is twenty years imprisonment. In every civilized country, it is decreed, that if a woman die in consequence of taking medicine to cause abortion, the person who administered it shall be held guilty of murder 700 OF DISEASES OF PREGNANCY, The usual causes of abortion are violent exercise or great ex- ertions of strength, as dancing, jumping, and severe coughing, sud- den surprises and frights, violent fits of passion, anxiety and grief, uncommon longings, overfulness of blood, drastic purges, profuse evacuations, excessive venery, general debility of the system, ex- ternal injuries, as blows and bruises. It is of importance to re- mark that instances have occurred, where in cases of twins, one child has been expelled and the other retained to the full time. Those women in whom abortion has become in a manner ha- bitual, should observe the greatest precautions in order to prevent a repetition of the accident; if of a full plethoric habit, she ought to be bled just before the usual time of her miscarrying; her diet should be mild and simple, consisting principally of milk and vegetables; costiveness must be particularly avoided, as also all agitations of the mind, severe exercise, violent efforts, and such objects as may be likely to make a disagreeable impression on her mind. She ought to exchange her feather bed for a mattress, sleep less than usual, and keep her body cool, and take daily exercise without much fatigue. Habitual abortion, however, is more frequent in women of a weak lax habit, where bleeding would be altogether inadmissible. Here a nutritive and generous diet, moderate exercise in a carriage, the cold shower bath, and a course of chalybeates, with other to- nics will be indispensably necessary ; the patient at the same time carefully avoiding all the exciting causes. The muriated tincture of iron, has in cases of this description, been employed with satis- factory success in doses of fifteen drops two or three times in a day. The symptoms attending the progress of a threatened abortion are, a pain in the loins, or about the bottom of the abdomen, with a dull heavy pain along the inside of the thighs, a slight shivering, sickness, and palpitation of the heart. The breasts subside and become flaccid or soft, the belly sinks, and their ensues a discharge of blood or watery humours from the uterus, sometimes coming away in clots, and at others flowing profusely for a short time, and at intervals again returning violently. When the pregnancy is advanced beyond the third month, these symptoms are generally increased, with sickness, faintness, and slight febrile heat, trouble- some bearing down of the uterus, and a most rapid discharge of blood, owing to the increased size of the uterine vessels. AND THE PUERPERAL STATE. 701 In some instances abortion ensues in a few hours, but in a majo- rity of cases in about three days from the commencement of the symptoms, though the process has on some occasions been prolong- ed to several weeks. On the first appearance of flooding or other signs threatening abortion, the woman ought to be laid on a mat- tress with her head low and hips a little raised, where she should be kept as quiet and comfortable as possible, perfectly cool, and debarring her of all food of a heating nature, and directing cold liquors acidulated with elixir vitriol or lemon juice. If the strength of the patient is not much reduced, and where the pulse is in any measure full and frequent, it may be proper to take a little blood from her arm, after which some gentle laxative or aperient clyster should be administered. Should a copious haemorrhage occur, it will be advisable to prescribe ten or fifteen drops of laudanum, to be repeated so as to keep up a constant effect, and this may be combined with astringents. In extreme cases, anodyne clysters may be injected from time to time, and linen cloths, wet with cold vinegar and water, be kept constantly applied to the back and lower part of the abdomen. Astringent injections, composed of a saturated solution of alum, white vitriol, or acetite of lead, or of a decoction of oak bark are often employed in violent floodings with good effect, and the various internal astringents as mentioned under the head of monorrhagia, will on many occasions of threaten- ed abortion prove the most efficacious remedies. In obstinate or protracted cases where great debility is induced, instead of bleed- ing we ought to trust to the efficacy of the digitalis in suitable doses, which has in some instances succeeded. But in fact uterine hae- morrhage, when it occurs in the three last months of pregnancy, is one of the most formidable and dangerous accidents to which women are subject. It sometimes happens that all the means pre- scribed fail of producing the desired effect, and, the woman be- comes exposed to imminent danger, and the most profound judg- ment and experience may be baffled in every attempt to preserve the life of the patient. It would be inconsistent with the plan of this work to detail all the particular circumstances which may attend the process of abor- tion in every instance; reference must therefore be had to prop- er books on midwifery, and to the assistance of an experienced practitioner. /02 OP DISEASES OF PREGNANCY, Of Child-Birth, and the after treatment. It is by no means intended here to enter into the particular cir- cumstances pertaining to the various cases of parturition, much less to detail the peculiar duties of the obstetric art; suffice it to offer some general observations relative to the management of wo- men in the parturient state, and the proper treatment after child- birth. It is generally estimated that nine calendar months, that is, for- ty weeks, or two hundred and eighty days, constitute the term of gestation, but the period is liable to some variation or inaccuracy in the calculations of particular individuals. It is from many ob- servations rendered highly probable that in some instances the term of pregnancy is considerably shortened, and in others some- what protracted. In by far the greatest number of instances the labour is accom- plished by the powers of nature, unattended with difficulty or dan- ger, unless rendered so by the officious interference of rash and unskilful practitioners. It is, however, indispensably necessary to have the assistance of some person well versed in the art, in or- der to guard against accidents, which might otherwise happen, and which might be attended with very serious consequences. The condition of every woman during parturition must be re- garded as extremely distressing; she is often dispirited and impres- sed with the most fearful apprehensions, which if indulged, may be productive of the most injurious effects. It is therefore incum- bent on the practitioner to exercise the duties of a humane and cheerful friend, endeavouring all in his power to soothe the distressing passions and acute sensibilities which unavoidably occur at the beginning of labour. When any alarming cir- cumstances are present, these should be concealed from the patient, or otherwise explained in such satisfactory manner as to gain her confidence and inspire her with resolution and courage, and animate her hopes of speedy relief. Every proceeding which may tend to increase her anxiety, but more especially every ap- pearance of indelicacy, must be scrupulously guarded against. During actual labour the woman ought to take nothing of a heating nature; confining herself to beef tea, panado, jellies, and broth, with barley water, and tea or coffee. If she is disturbed with spurious pains of the spasmodic kind, they may be effectual- AND THE PUERPERAL STATE. 703 ly removed by a few doses of the powdered root of skunk cab- bage, or the infusion, or by proper doses of laudanum. If the la- bour prove tedious and difficult, it will be proper to bleed for the purpose of preventing inflammation, and emollient clysters should be frequently injected. On some occasions sitting over the steam of warm water, or fomentations to the lower part of the abdomen, will be both useful and proper. When the patient appears to be exhausted by fatigue, so that nature seems to sink, some cordial medicine will be requisite, as the spirits of hartshorn, with the compound spirits of lavender, or a glass of generous wine. There is a pernicious custom still pre- valent among females in the middle and lower stations in life, which ought to be abandoned. It is that of taking during labour a variety of heating drinks, and rendered more stimulating by the addition of spices, wine, or spirits. Nothing can be more oppos- ed to the true indications in these circumstances, nor more detri- mental in its effects. All internal stimulants have a direct tenden- cy to increase the action of the heart and arterial system, which will not readily subside when the woman is delivered, and if there be any previous disposition to fever existing in her body, nothing is so likely to bring it into activity, and fevers of the most dangerous kind may be the consequence. The most proper drinks for wo- men in labour, are barley water, toast and water, lemonade, apple tea, with other weak and diluting liquids. Immediately after delivery a broad bandage should be applied round the abdomen moderately tight; the woman must be kept as quiet and easy as possible, carefully avoiding the heat of bed clothes, confined air, and every stimulating substance, whether inter- nally or externally applied. It will in general be necessary to direct a dose of tincture of opium to allay irritation and procure sleep, and to those who have been habituated to high living, a lit- tle light animal food and a glass of wine may be allowed, recol- lecting, however, that too much indulgence is more to be feared than too rigid abstinence ; all extremes ought'to be avoided. Instances sometimes occur of dangerous floodings immediately after delivery, in which case the patient ought to be laid with her head low, kept cool, and to be treated in the same manner as for an excessive flow of the menses ; should the haemorrhage be vio- lent, linen cloths wrung out of a mixture of vinegar and water, 704 OF DISEASES OF PREGNANCY, should be applied cold to the abdomen, the loins, and thighs, and repeated doses of opium must be given. Although the patient should be particularly careful to avoid too much heat, it is no less necessary to guard with the greatest attention against the danger of taking cold. As soon after delivery as the mother's strength will permit, and she and the child have taken some sleep, her breasts should be washed with warm milk and water, in order to remove the bitter viscid substance which surrounds the nipple, and the infant should be applied and invited to make its natural attempts to draw nour- ishment from the breast. If this operation be attended with diffi- culty, on account of the nipples not being sufficiently prominent to afford a proper hold for the child, the breasts should be drawn by afi adult person, or an older child, or the glasses made for the pur- pose may be employed ; but cautiously avoiding every degree of violence, as it may be productive of considerable injury. It must be remarked as of some importance, that in every in- stance a mild laxative should be given within forty-eight hours af- ter delivery. A. table-spoonful or more of castor oil, or a dose of salts and manna, will generally be sufficient, and should always be preferred to irritating aloetic pills. After Pains. For some time after delivery, the contractions of the uterus are apt to continue, and occasion pains, which in some cases are so vi- olent as to resemble the throes of labour. This complaint, termed after pains, is seldom to be regarded as dangerous, though pro- ductive of considerable distress; it is usually temporary in its du- ration. After pains occur more rarely in the first than in future labours, owing probably to the womb not contracting so readily af- ter several deliveries as at first. These pains may be distinguished from other affections by their alternating with intervals of ease, by the breathing not being impeded, and by the pains being followed by the expulsion of coagulated blood. This complaint is to be removed by the application of warm fomentations to the abdomen, and repeated doses of tincture of opium, accommodated to the se- verity of the case. If spasmodic affection be evident, the skunk cabbage root will afford the most effectual relief. AND THE PUERPERAL STATE. 705 The Lochia! Discharge. There is in all women a certain degree of haemorrhage from the uterus after delivery, but the appearance and duration of the dis- charge is very various in different women. For the first four or five days the discharge consists of florid blood, after which it as- sumes a mucous appearance, and at last the evacuation ceases en- tirely. When a suppression of the lochia ensues before the ac- customed period, great pain is felt in the lower part of the abdo- men, which is somewhat tumid and tender to the touch, and. febrile symptoms appear. In these cases a return of the evacuation must be attempted by the application of warm fomentations to the abdomen, by the use of warm diluent drinks, as gruel with a little white wine or cream of tartar dissolved in water. The saline mix" ture, with the addition of antimonial wine, should be freely taken, together with laxatives and opiates, to allay the pain and irritation. Milk Fever. The secretion of the milk about the second or third day is com- monly attended with a slight degree of fever, and the breasts be- come turgid and painful. These symptoms, however, are of short duration if properly managed, seldom continuing longer than twen- ty-four or thirty-six hours, when they terminate by a profuse sour smelling sweat, a gentle looseness, or a copious discharge of milk from the breasts. The milk fever may often be prevented by ap- plying the child to the breast soon after delivery, and by giving a purgative medicine about the second or third day. During the hot stage, mild diaphoretics, as the saline mixture with antimonial wine, will be proper, and when the breasts are much distended, they should be softened by rubbing in some warm olive oil with a little camphor twice in a day, and covering them with flannel. We are decided in our opinion that every woman ought if pos- sible to suckle her own child ; but if from ill health or any suf- ficient cause, the mother should determine not to suckle, a proper method must be adopted with the view of diminishing a too copi- ous flow of milk. This, however, is not to be effected by the use of repellent applications to dry up or put a stop to the secretion, as it may be attended with dangerous consequences. Her breasts must be drawn three or four times a day ; she should use a very 89 706 OF DISEASES OF PREGNANCY, spare diet, regulate her bowels by laxative medicines, and abstain as much as possible from all liquids. A curious fact relative to this subject is asserted by a late sensible writer, the author of the Maternal Physician,* which is this; when the mother is unable to suckle on account of sore nipples, if the milk can -be drawn out with sucking glasses, and the child fed with it, the milk may be preserved in the breasts for a length of time ; for, while the babe is nourished by it, it will continue to flow let it be obtained from the breast how it may ; whereas, if it is drawn out and thrown away, the quantity will gradually diminish, until it dries away en- tirely. This fact, however inexplicable, is analogous to that which experience has long since taught every observing dairy woman, that by milking their kine on the ground, the quantity may be daily diminished until it cease altogether. It may be deserving of notice here that Dr. Erastus Sergeant, of the county of Berkshire, has found by experience that the small winter grape-vine taken by way of infusion, or mixed with milk in the manner of milk punch, has a strong tendency of increasing the secretion of milk in nursing women. Diseases of the Breasts. Women who suckle are particularly liable to inflammation of the breasts, which often is a source of infinite pain and distress. It may be excited by the direct application of cold, retention of the milk in consequence of sore nipples, or by bruises and other ex- ternal injuries. A sudden fright has been known to produce it. When any hardness or painful swelling is perceived in the breasts of lying-in women, immediate attempts ought to be made to arrest the progress of inflammation and the consequent suppu- ration. A slight hardness may often be removed by rubbing the volatile liniment or sweet oil diligently into the part with a warm hand for a quarter of an hour twice in a day, and then covering it with a cabbage leaf, which promotes perspiration and contributes to the dispersion of inflammation ; or spirit of mindereri applied cold, or the ointment of stramonium, may be applied to the tumour as an excellent remedy for the same purpose. The breasts should * The Maternal Physician is a production replete with interesting matter, worthy the attention of every nursing family. AND THE PUERPERAL STATE, 707 be frequently but tenderly drawn through the whole course of the complaint, either by the child or a grown person who has been ac- customed to the operation ; saline purgatives must be occasionally administered, as also anodynes whenever pain and irritation require their use. If the local inflammation continue to increase and the febrile symptoms become violent, blood must be taken from the arm or by leeches to the part, and the patient restricted to a low diet and cooling drinks ; and recourse must be had to the saline mixture with tartarized antimony. Should these means fail to dis- perse the inflammation, a large blister must be applied to the part, taking care to place it smoothly that it may adhere closely to the skin, a hole being cut in the centre for the nipple to protrude, and if necessary the tincture of cantharides may be used to increase the vesicating effect. After the blistering, the sore should be dress- ed with the spermaceti ointment. The above is reputed as the grand remedy, which will in general speedily disperse the most alarming swellings of the breast, and prevent the formation of pain- ful abscesses. Another method recommended by Dr. John Clark, who has been much conversant with the treatment of lying-in wo- men, with the view of dispersing inflamed tumours of the breasts, is first to apply several leeches to the part, and afterwards cloths wet with a strong cold solution of the acetite of lead, and to be renewed as often as they become dry. The peculiar advantages to be derived from the diligent employment of the saturnine solu- tion, so greatly preferred by Dr. Clark, to the common practice of employing emollient fomentations and poultices, are by their coldness and astringent quality ; the blood is repelled from the part, and the inflammation diminished ; the woman will suffer less pain, and the constitution will be less affected : the breast will not be weakened, and if an abscess should form, the extent of the sup- puration will be very much lessened, and the duration of the dis- ease considerably shortened. But when a resolution of the inflam- mation cannot be effected, and an abscess is about forming, any further attempts to discuss the tumour will be improper, and the suppuration must be promoted by the usual means of poultices and fomentations. The poultices to be preferred are composed either of the meal of linseed or the mucilage of slippery elm bark, ren- dered of a proper consistence by the addition of Indian meal, or the common one of bread crumbs and milk. Should any thing more stimulating be required, an onion cut fine may be added, or 708 OP DISEASES OF PREGNANCY, a little basilicon ointment spread over the poultice. \V lien the abscess has advanced to a state fit to be opened, if it; should not burst, a slight opening with the point of a lancet in the most dis- tended and dependent part must be made. The poultices should still be continued, and the wouud kept open for the discharge of the matter. It is, however, to be observed, that as a long contin- ued use of poultices has a direct tendency to relax and debilitate the parts, as soon as they can be dispensed with, compresses wet with a solution of crude sal ammoniac in vinegar, with the addition of a third part brandy, should be substituted, the sore at the same time being dressed with basilicon or the spermaceti ointment. Abscesses of the breasts sometimes heal and others form, or sinuses are insinuated into different parts, attended with a hardness of the whole glandular substance of the breast; in some instances these cannot be healed till freely opened from one sinus to the other. The remaining induration of the breast may be reduced by the employment of leeches to the part, and by the application of a poultice composed of hard soap dissolved in vinegar with a little crude sal ammoniac, and made of a proper consistence by the addi- tion of rye meal. The camphorated mercurial ointment and the discutient plaster, to be found in the Appendix, are remedies well adapted to the purpose intended, experience having confirmed their beneficial effects. When the patient is much exhausted and debi- litated by a long continuance of pain and discharge, her strength must be supported by the use of the cinchona and a nutritive diet. Dr. Hosack states in h s Medical Essays, vol. II. that in a case of inflammation of the mamma occurring after parturition, and which terminated in scirrhus, a great variety of means general and local, were employed to disperse the tumour, without effect. After many weeks obstinate obstruction similar to what occasionally takes place in the testes and inguinal glands, he directed a poultice of the elm bark, infusing the shavings of the bark in warm water until reduced to a thick mucilage: this tumour and obstinate en- largement of the breast, which had resisted the various mercurial and other discutient applications usually directed in cases of this nature, and which the Doctor expected would have called for the knife, to his great surprise was rapidly dispersed by this application in a few days, and without any permanent injury to the breast; for after a subsequent child-bearing she gave suck from that breast equally well as from the other. AND THE PUERPERAL STATE. 709 Excoriations and soreness of the Nipples. This is another tedious complaint with which nursing women are frequently afflicted. The action of the child's mouth when sucking, and the irritation which the stagnant milk occasions, are very apt to injure the delicate structure of the nipples unless kept very dry. On some occasions the pain, when the child sucks, is so exceeding- ly severe that the mother is actually unable to continue to suckle, and the sores can scarcely be healed until another nurse be substitut- ed. In some instances an aphthous state of the child's mouth ex- cites this affection, in others the child receives it from the nipple, and it is difficult to cure the one without the other at thg same time. The great object to be attended to in this complaint is to ob- viate as much as possible every cause which can tend to irritate these tender parts. It will be very useful to wear a sort of cup made of wax or lead over the nipple to prevent its being wet with milk or fretted with the clothes. When excoriations have made their appearance, a solution of alum, sulp"hate of zinc, acetite oT lead, or sulphate of copper, are the astringent applications most commonly recommended ; but there is not, in my opinion, a more truly valuable balsamic application to sore nipples than a solution of borax in warm water, with the addition of a little honey; or it may be reduced to powder and mixed with sugar, and applied for the same purpose as well as to>the aphthous mouths of children, with the happiest effects if freely used. There are various forms of ointments and liniments which may be esteemed as among the most efficacious remedies in this complaint, of which description is the elegant white ointment called cold cream, see Appendix, and also a popular one prepared from the solanum dulcamara, called also woody night-shade, or bitter sweet. Take a small handful of the bark of the root of bitter sweet, and add to it as much fresh butter or cream as will cover it in a proper vessel, and let them be simmered together over a very moderate heat during six or eight hours, and then strain it through a cloth, when it will form a beau- tiful yellowish coloured ointment, well adapted to the purpose. A valuable liniment may be prepared as follows : take of litharge and of vinegar, two drachms each, olive oil, six drachms; rub them well together in a mortar till the mixture be of a pale flesh colour, and of the consistence of cream. Either of the above 710 PUERPERAL, OR CHILD-BED FEVER. • preparations will be found of great utility in the cure of this trou- blesome complaint. It must, however, be recollected, that whatever may be the reme- dy employed, the child should never be permitted to suck until the nipple be thoroughly washed with warm water or covered with oil, lest it receive injury from the substances which have been applied. With the view of diminishing the sensibility of the nipples, and thereby preventing excoriation and soreness, it has been recom- mended to wash them frequently with some stimulating liquor for some time previous to delivery; brandy and water or alum water may be advantageously employed. But the pickle of salted meat, after heing boiled, has been recommended as an infallible specific for the purpose. Recent experimental trials have confirmed most satisfactorily that a simple infusion of the root of sophora tinctoria, applied as a wash, is one of the most efficacious remedies for sore nipples with which we are acquainted. See Appendix. PUERPERAL, OR CHILD-BED FEVER. The puerperal fever is a disease peculiar to women after delive- ry, and such is the danger and fatality of its nature, that in Eu- ropean hospitals, it is computed that three fourths of the number attacked, fall sacrifices to its power ; and it is supposed to occa- sion the death of nearly one half of those who die in child-bed. In private practice in our own country, the disease more rarely occurs, and is much less malignant and fatal in its consequences. There is a great diversity of opinion entertained by medical writers, respecting the nature and original cause of puerperal fever: according to some it proceeds from an inflammation of the uterus, peritoneum, or omentum ; others have supposed it to be the con- sequence of an undue secretion of the milk, or to a stoppage of the lochial discharge ; while by others, it is ascribed to improper man- agement during parturition, as violence used in dilating the os internum, a too hasty and rash separation of the placenta, and the binding the abdomen too tight: but it is well known that the dis- ease may, and often does follow a labour under the most favoura- ble circumstances. To these, others have been added, a stoppage of perspiration, the free use of spirits and other stimulants, and the neglect of procuring stools at a proper season after delivery ; PUERPERAL, OR CHILD-BED FEVER. 711 sudden frights and colds. The real cause, however, remains ob- scure, and not satisfactorily ascertained. Whatever may be the true cause assigned, such is the dangerous nature of the disease, as to require the most profound judgment, experience, and skill, for the successful treatment of it. This fever has evidently a strong tendency to a typhoid type, although at its commencement, it is frequently attended with inflammatory symptoms. In many in- stances, it has undoubtedly proceeded from contagion, and in European hospitals, it has frequently spread so rapidly among fe- male patients, as to baffle all attempts to arrest its progress, until the wards were thoroughly cleansed, and new painted. Puerperal fever commences generally on the second or third day, sometimes later, after delivery, with a chilliness succeeded by pains in the head, ringing in the ears, flushing in the face, great anxiety, and restlessness. The whole abdomen soon becomes af- fected, is extremely painful to the touch, and more or less tumefi- ed. The patient likewise complains of severe pain in the back, hips, and sometimes in the legs, with laborious respiration. The milk suddenly disappears on the approach of the disease, and the lochia are altered, both in quantity and appearance ; there is great prostration of strength with depression of spirits, a disinclina- tion to suckle, indifference about her child, and watchfulness. The skin, in some patients, is in the ordinary state, both with res- pect to heat and moisture ; but in others, it is very hot and dry at first, and afterwards covered with a clammy sweat. The pulse is weak, small and frequent, often from one hundred and ten to one hundred and sixty in a minute; the tongue is pale, or white at the beginning, but soon becomes brown; the teeth are covered with a black or brown crust, and in some, a low delirium ensues. The urine is turbid, small in quantity, and voided with pain, and a te- nesmus often attends. To these symptoms are added, a tensive pain over the forehead, and parts about the eyebrows, with a pe- culiar wildness of the eyes, and a deep red or livid colour fixed in the cheeks. Sometimes vomiting and purging attend from the be- ginning; but in general, at first, the body is costive ; when the dis- ease proves fatal, however, a looseness usually comes on, and the stools at last are involuntary, and afford a temporary relief. Such in general is the course of the puerperal fever; the symp- toms of which, however, may vary according to the constitution of the patient, the degree of the disease, and its earlier or later inva- 712 PUERPERAL, OR CHILD-RED FEVER. sion. When the woman is naturally weak, or her strength great- ly reduced by immoderate evacuations after delivery ; when the disease is violent, and immediately follows that period, its progress and termination are proportionably rapid and fatal. In such cir- cumstances, many have been known to expire in forty-eight hours from the first attack of the disease ; the decisive period, however, is usually from the seventh to the eleventh day. In the event of a favourable termination, the change is not marked by any critical symptoms, but the cure is gradually effected either by vomiting, or long continued discharge by stool, of that corrupted matter, the existence of which in the stomach, is usually apparent at the first attack of the disease. When the lochial discharge returns to its former state, and the swelling and tenderness of the abdomen abate, and there is a natural moisture on the skin, we have ground for hope that a happy termination will soon take place. There is a close resemblance between puerperal fever, and in- flammation of the peritoneum. In the former disease, the abdom- inal pain is not the most prominent symptom ; and there is more despondency, debility, and head-ach, less heat of the skin, less thirst and flushing of the face. In peritoneal inflammation, the pain in the belly usually increases rapidly after it begins, and ....j swelling increases at the same time, and pressure excites great pain. The symptoms of anxiety, and oppression at the breast, are common to both the puerperal, and miliary fever, but in the former, the chilliness is more violent, of longer duration, and not interrupted as in the latter. The pulse, too, is fuller and stronger ; the skin is more hot; the tongue is of a brownish appearance; and the urine is also higher coloured. The symptoms of puerperal fever, at the first onset, are in some degree similar to, and may be mistaken for those of the milk fever, but an attentive observer will soon be enabled to decide cor- rectly. The first essential point to be determined in the cure of puerpe- ral fever, respects the propriety of bleeding. While among the most experienced physicians, some inculcate the necessity of a free use of the lancet, others with equal confidence affirm, that in al- most every instance, the loss of blood proves injurious, and some- times if in great quantity, produces fatal effects. It will be con- ceded that this operation ought not to be resorted to indiscrimi- nately, and without real necessity. The hard full pulse, the ex- PUERPERAL, OR CHILD-BED FEVER. 7J3 '^cssive heat of the body, the thirst, and other signs of morbid ex- citement, will evince the propriety of the evacuation. In the early stage, therefore, of puerperal fever, bleeding, it may be as- serted, is clearly admissible and proper in women of full habit of body, and in whom the inflammatory symptoms run high. The quantity to be drawn, must be determined by the constitution of the patient, and violence of the symptoms. If benefit be derived from the first bleeding, it will be perfectly justifiable to repeat the operation, provided the urgency of the case appear to render it necessary ; but of this the experienced practitioner must decide; in every instance, from existing circumstances. Where nausea and a vomiting of bilious matter attend an attack of this fever, a gen- tle emetic of ipecacuanha should be given, with a view of cleans- ing the stomach ; and circumstances may occur to render a repe- tition of it necessary during the course of the fever; In regard to the propriety of administering purgative medicines in this disease, it is a point in which practitioners are not altogeth- er agreed. It is undoubtedly a circumstance of much delicacy and importance, and requires to be decided, and conducted with the ut- most caution. Experience, it has been said, authorizes the asser- tion, that more women appear to have recovered from the pues- peral fever, by means of a looseness, than have been destroyed by that cause. If it be considered, that purging is usually almost the only sensible evacuation in the more advanced stage of the disease, and is that, which accompanies it to its latest period, there is the strongest reason to think, that it is critical rather than symptomat- ical, and, therefore, ought to be moderately supported, instead of being restrained. The indications of nature, certainly require, that we remove costiveness, and evacuate putrid feculent matter; and with this view, laxative medicines may be employed at the be- ginning of this disease with safety and advantage. A dose of cas- tor oil, or twenty grains of rhubarb, with ten of salt of tartar, are well adapted for this purpose, and they may be occasionally re- peated, or a few grains of calomel maybe combined with rhubarbj or jalap, if preferred. When in the more advanced stage of the disease, the strength of the patient is much reduced, aperient clys- ters, may be substituted, as answering the double purpose, of evac- uating putrid irritating matter from the intestines, and by acting as a warm fomentation to the womb and adjacent parts, and these should be assiduously employed; 90 7H PUERPERAL, OR CHILD-BED FEVER, With the view of expelling the corrupted matter from the stom- ach and intestines, Dr. Denman, strongly recommends the follow- ing preparation. Take of tartarized antimony, two grains, crabs eyes, or chalk prepared, two scruples, mix them well together. He gives of this powder from two to six grains, and repeats it as often as circumstances require. If the first dose does not produce any sensible effect, he repeats it in an increased quantity at the end of two hours, and proceeds in that manner, not expecting any benefit, but from some evident discharge produced by it. If the first dose produce any considerable effect by vomiting, procuring stools, or plentiful sweating, a repetition of" the medicine in a less quantity, will seldom fail to answer expectations ; but great judg- ment is required in adapting the quantity first given to the strength of the patient, and other circumstances. Dr. Burns has much confidence in the efficacy of the Peruvi- an bark, with the sulphuric acid, administered early in the dis- ease, with great freedom, as counteracting debility, and a putrid tendency. The carbonate of potash, or salt of tartar, in doses of ten or twelve grains, frequently repeated, or the saline mixture, will be found exceedingly useful in promoting the discharge by urine and perspiration. As a diaphoretic, however, there is perhaps none to be preferred in the present instance, to ipecacuanha, combined with opium, in the form of Dover's powder ; about six or eight grains of which should be given every four hours. Opium is to be es- teemed as a remedy of particular utility, in the child-bed fever, by alleviating pain, procuring sleep, and abating the irritation of the bowels, and of the whole system. In those cases where the pa- tient is in danger of being exhausted, and her strength greatly prostrated, by the continuance of spontaneous diarrhoea, a liberal use of opium will be indispensably necessary ; the extent to which it ought to be carried, must be determined by the observation of the attending physician, or by the pain and irritation being alleviated, and the diarrhoea restrained. Injections of starch, or the chalk ju- lep, with laudanum, will also tend to the same good effect. In most cases of puerperal fever, attended with much pain, and tension of the abdomen, the extensive application of blisters over the part, and sometimes on the thighs also, have been essentially beneficial, and they should be repeated in succession. Warm fomentations of a decoction of mallows, camomile flowers, or mullein, ought to PUERPERAL, OR CHILD-BED FEVER. 715 be employed as a remedy of considerable importance. When the violence of the febnle action has subsided, especially if a putrid tendency become apparent, it will be requisite to have recourse to the cinchona, and columbo root, with the mineral acids, as direct- ed in the putrid fever. But I have much reason to believe that the eupatorium perfoliatum will often be found more efficacious than the cinchona or any other tonic. During the whole course of this fever, a plentiful use of diluting drinks should be enjoined, with light nourishing food, such as ar- row root, sago, oat gruet, «fcc. to which wine may be occasionally added. Great attention should be paid to cleanliness in every particular, the chamber must be constantly, but prudently ventilat- ed, avoiding with equal care, the excess of heat, or undue expo- sure to cold. That temperature of body which approaches the nearest to the standard of health, will be the most proper for wo- men who labour under puerperal diseases. Dr. Sutton, of Greenwich, England, and some others, have em- ployed cold water, as a lotion, to the abdomen with great success. Five out of six cases treated with this remedy recovered, but we are not informed what other remedies were used at the same time. In the London Medical Repository for May, 1815, five cases of puerperal fever are reported by Mr. W. Gaitskill, surgeon. The cases were all very severe, and under the treatment adopted all recovered. The plan was simple, bold, and decisive. It con- sisted in bleeding, which was repeated six times, in one case, in four days, till the frequency of the pulse was diminished, and a sensible alteration for the better was made in the general state of the patient; and in purging, until the alvine discharges exhibited a more favorable appearance. The author of this paper believes in the highly contagious nature of puerperal fever, and in this opinion, he is supported by Dr. Haighton, who saw one of his pa- tients in consultation. It has been more recently promulgated that Drs. Gordon and Armstrong, and Mr. Hey, English practitioners of experience and abilities, have adopted the depleting practice in the epidemic pu- erperal fever. There is observable a striking coincidence in the opinions and practice of the above recited gentlemen. Mr. Hey, however, appears to carry the depleting plan to the greatest extent. " When I was called," says Mr. H., " at an early period, I seldom took away less than twenty-four ounces of blood at first, unless 716 PUERPERAL, OR CHILD-BED FEVER. some peculiar delicacy of constitution, or an excess of the previous evacuations, forbade it, and if this delay was protracted to eight or ten hours, or the symptoms were unusually severe, a larger quanti- ty, to the extent of thirty, forty, and in one instance more than fifty ounces, in proportion to the urgency of the symptoms, and the loss of time. If the pain and soreness of the abdomen are not remo- ved, or very materially alleviated, in six hours the bleeding ought to be repeated ; nor should a considerable degree of faintness or even a deliquium, make us suppose that further bleeding is either unsafe or unnecessary. In short, I know fiot from any experience of my own, that scarcely any other limit should be put to the quantity of blood, than the removal, or considerable diminution of the pain, provided all that is requisite be drawn within twelve hours of the first evacuation. If the disease is clearly ascertain- ed, no other consideration is of much importance. The state of the pulse affords little information, either as to the propriety of bleeding, or the quantity of blood to be taken away ; and if we are deterred, either by the apparent weakness of the patient, by the feebleness and frequency of the pulse, or by any other symp- tom, from bleeding copiously, we shall generally fail to cure the disease." Immediately after the bleeding, Mr. H. usually gives half a drachm of jalap, and three or four grains of calomel, and at short intervals small doses of cathartic salts, till copious evacu- ations should be procured. The purging when produced was maintained for two or three days, or longer if necessary ; and when the symptoms had entirely subsided, it was suffered gradually to decrease. The evidence in favor of the great success which has attended the foregoing method of practice appears to be unques- tionable. Dr. Good, an English author, of the highest standing, coincides with Dr. Armstrong, and his coadjutors, in opinion that in puer- peral fever, peritoneal inflammation, is always present, and that in some instances it spreads over all the cavity of the abdomen, even the intestines, omentum, and all the neighbouring viscera being in- volved in the common mischief. " This inflammation must be subdued, and that speedily, or the patient will perish ; and hence abstraction of blood and calomel purgatives are the arms on which we have chiefly, if not solely, to depend; and both should be em- ployed decidedly, and to as great an extent as we dare. Eighteen or twenty ounces of blood should be drawn from the arm, as soon as PUERPERAL, OR CHILD-BED FEVER. 717 possible after the commencement of the disease, and repeated with- in twelve hours, if necessary, and the strength will allow : but if venesection have not taken place before the third day, the debili- ty will have gained so high an ascendancy, and the general symp- toms put on so putrescent a complexion, that little benefit is to be gained from it. The bowels should at the same time be moved by six or eight grains of calomel given in the form of a pill; and the same preparation, to the amount of three or four grains, should be continued every six hours, till the tension and soreness of the ab- domen have abated.* It happens not unfrequently, however, that the patient's frame is so weak and delicate that we should risk more by drawing blood generally than even by leaving the case to nature ; as it does also that the stomach and bowels are from the first in a very high degree of irritation, with violent purging and vomitings and will not bear any additional stimulant. Instead of the lancet we must have recourse to leeches, by which twelve ounces of blood may be drawn, and by the exhibition of two grains of calomel, with one grain of opium, repeated every five or six hours, the irritation of the stomach has yielded to the commence- ment of a new action." Dr. Good prescribes a large piece of folded flannel, wrung out forcibly in as hot water as can be borne, to be applied over the whole of the pubes and abdomeh, and cov- ered by a broad flannel or linen swathe passing round the body, which is to remain for many hours, or till it becomes dry. This application, says Dr. G., answers all the purposes of a bread and water poultice, imparting warmth and moisture. In the mean time perspiration should be encouraged by the use of Dover's powder, with the addition of a solution of acetate of ammonia; and if the debility be considerable, camphor in doses from ten to thirty grains, every five or six hours, will prove very advanta- geous. In the New-England Journal of Medicine, &x. vol. XIV. there is an extract from the London Med. and Phys. Journal, purporting that Dr. Kinner, from his own experience and that of others, re- commends in strong terms from one to two drachms of the rectified oil of turpentine, with an equal quantity of syrup, and an ounce of distilled water, in the form of a draught, to be exhibited after * Dr. Armstrong, after copious bleeding, administers from twenty to thirty grains of calomel, and follows it by sulphate of magnesia and. castor oil, so as to produce constant evacuations, until relief be obtained. 718 MANAGEMENT OF CHILDREN. bleeding and purging every three or four hours, until abatement of pain and other symptoms take place. It will be rarely requisite to repeat the draught more than two or three times. The above draught in general has seemed to relax the intestines, or at least to sustain the cathartic operation produced by preceding remedies. It has been but rarely rejected by the stomach. In every instance of puerperal fever, Dr. K. thinks fomentiug the abdomen with te- pid oil of turpentine advisable, having frequently known females express in the most forcible terms the extraordinary and almost in- stantaneous diminution of pain which they experienced from its ap-. plication. The following was communicated by Dr. E. Sergeant, of Berk- shire county. In a case of puerperal fever, the physician admin- istered a cathartic, and made his daily prescriptions in form. But a female friend and nurse adventured to dispense with all the medi- cines directed, and administered internally, and applied to the ab- domen, a decoction of the root of sophora tinctoria, in the efficacy of which she had imbibed the fullest confidence. The effect was a copious evacuation of dark coloured foetid matter from the bow- els and uterus, and a speedy cure was effected. The physician, un- apprised of the artifice, exulted on the performance of an important cure. • \ MANAGEMENT OF INFANTS. It will not be inconsistent with the professed object of this pub- lication, to premise some brief directions for the management of infants, previous to treating of the diseases to which they are pecu- liarly liable. With regard to clothing, ease and simplicity are to be consulted as much as possible, at the same time adapting their dress to the season of the year, and the inclemency of our climate. Of whatever materials the clothing is composed, it ought to be ap- plied in such a manner as to allow a perfect freedom of the limbs, and not too closely compress or confine any part of the body. By undue pressure of the external parts of the body, the circulation of the blood is not only impeded, but the action of the lungs and the natural motion of the intestines are interrupted, by which the growth, strength, and activity of the infant are greatly retarded. Deformities of the limbs, distorted and crooked spines, are not un- MANAGEMENT OF CHILDREN. no frequently the consequence of tight bracing, and a cumbrous load of clothing. One simple rule is sufficient for parents to observe : " That a child have no more clothes than are necessary to keep it warm, and that they be quite easy for its body." Cleanliness among children is to be observed as a point of the utmost impor- tance. The practice of washing the whole body in tepid water regularly every day, is indispensably necessary to cleanliness, and conducive to health. But bathing in cold water is by no means calculated for strengthening or improving the health of infants. The sudden effect of cold is too violent a stimulus for the frame of a tender infant, in whose mind it perhaps excites the greatest emotions of horror and terror. The practice of plunging tender infants in cold water ought to be prohibited as bordering on cru- elty. At a more advanced age, the cold bath may be advantage- ously employed. With respect to food in early infancy, we need only advert to the dictates of nature, pointing to the breast of the mother, as affording an aliment the best adapted to the delicate digestive organs of children in the early stage of infancy. Milk from the breast of the mother ought unquestionably to constitute the chief, if not tile whole of the diet of infants, for the first months or even year of l'te. We are persuaded that there are few fe- males who are capable of bearing children but are qualified to suckle them, and even with an advantage to their own health. Those mothers, however, who may be affected with any heredita- ry disease, should be excepted from the general rule. It is of im- port^ice for the parent who commits her infant to the manage- ment of a hired wet nurse, to be assured that these women have reared their own children with satisfaction. No fond mother would be willing to consign the offspring of her bosom to a nurse whose health is impaired or her constitution broken down by in- temperance or contracted diseases ;—whose mind is continually agitated by passion or depressed by melancholy or grief;—whose body is enervated by sloth or bloated by indulgence, by which she is incapable of affording an adequate supply of milk of an healthy quality. The moral and amiable virtues are as essential qualifi- cations in a nurse, as the quantity and quality of her milk. Much of the future indisposition of the child will be traced to the conta- minated source of improper nurses, which unfortunately is seldom discovered until too late to.be corrected. A wet nurse should not be more than thirty-five years of age, enjoying good health, of a 720 MANAGEMENT OF CHILDREN. mild and placid disposition, attached to chddren, untainted by he- reditary disease, and exempted from norvous affections ; temperate in eating and drinking, capable of enduring fatigue with patience, cleanly in her person, and attentive to this particular in the object of her charge. The good qualities of milk are, its being thin, of a bluish colour, rather sweet to the taste, and in great quantity. The nurse's milk, when over six months old, is seldom proper for the stomach of a new-born infant, being thick and not easily digested, The diet of a wet nurse should consist of milk, broth, plain pud- pings, fresh meats of easy digestion, and a large proportion of ve- getables. One precaution should be observed by a wet nurse, never to suckle a child while she is under the influence of passion, as colic and sometimes convulsions in the child have been the consequence. When it becomes necessary to rear an infant with- out the breast, or by dry-nursing, as it is called, instead of feeding with the spoon the child should suck its food from a- glass vessel, or a tea-pot with a bit of parchment or bladder tied over the mouth, and perforated with holes. By this simple process the child is compelled to make considerable exertion to obtain the quantity necessary to satisfy the demands of hunger, and the food is duly mixed with the bland secretions of the mouth, which is ne- cessary for the promotion of digestion. It should be remarked that, infants ought never to be fed lying on their backs ; were the nurse to make the experiment on herself, she would soon be con- vinced that the position is an awkward and provoking one, and would learn to feed the child while sitting upright. The^most suitable food for children during the first three or four months, is cow's milk diluted with water in proportion to its richness, and sweetened with a small quantity of sugar. When older, a little sago, sallop, arrow root, &c. may be allowed, but the child should never have more forced upon it at a time than it is disposed to take readily. Perhaps there is no error in nursing more injurious than gorging and overloading the stomach of children. Whether rear- ed at the breast or otherwise, the nurse ought to be apprized that overfeeding is often attended by serious consequences. Before the appearance of teeth, children should hot be allowed animal food; all changes in diet should be gradual, and nothing given that is found to disagree with the stomach and bowels* Regular meals will be found very conducive to the health of children, and will prevent that idle and pernicious practice frequently observed in families, of eating as an amusement, not from the calls of hunger. MANAGEMENT OF CHILDREN. 721 Of Weaning. Much of the future health of children depends on the proper re* gulation of this great revolution in the mode of living. The indis- position of children sometimes arises from the bad quality of the milk; for when women protract the period of nursing too long, a natural change takes place in their system which renders the milk no longer possessed of the salubrious qualities proper for nourish- ment. The period of Weaning must be influenced by a variety of circumstances besides the health of the child. We have seen no opinion relative to the subject of weaning so satisfactory as that de- livered by Dr. James Jackson, in his valuable remarks on the mor- bid effects of dentition.* According to this acurate observer, chil- dren are benefited by living principally on the breast for twelve months, their vigour being in most cases evidently impaired if weaned before nine months. The safest period of the year for weaning is from the middle of October to the middle of March ; those children who are weaned in the summer months or at any period from April to October, are extremely liable to suffer by the cholera infantum, or the diarrhoea of teething children, in the ensu- ing autumn. At whatever time it is undertaken, it ought not to be permitted to interfere with the cutting of teeth, nor be attempted in the near prospect of any debilitating disease or immediately after its cure. Whenever the undertaking is resolved on, let it be accomplished at once and with resolution, with a total prohibition of the breast. No preparatory means are necessary, and to indulge the child with the breast in the night, and to withhold it during the day, is prolonging the evil which with so much toil and anxiety it is the intention to avoid. The most suitable food to be substituted for the mother's milk has been described in the foregoing pages. Should a costive habit attend this change of living, a little rhubarb and magnesia will be sufficient for its removal, and if a diarrhoea ensue, the preparation of boiled flour, as directed in the Appendix, will be found an excellent remedy, as well as nourishing food. The health of children greatly depends upon exercise and salubrious air. By exercise the actions of the heart, the motions of the lungs, and all the vital functions are greatly assisted, and the whole frame is rendered strong, firm, and vigorous. , While in the arms of the nurse, children will be much benefited by gentle friction, as rubbing * See New England Journal of Med. and Surgery vol. h 91 # 722 DISASES OF CHILDREN. them with the hand along the whole course of the back bone, and soon as they begin to learn the use of their own limbs, allow them to stand on their feet, or creep on the floor, as inclination may prompt them, at an after period they should have free indulgence ia their amusements and gambols in the open air. DISEASES OF CHILDREN. The attentive investigation of the disorders peculiar to early infancy by the physicians of the last century, and the accuracy with which they have described them, has rendered this part of the duty of the medical attendant less embarrassing, and has established a more rational and successful practice. The zeal with which these luminaries of the science of medicine have prosecuted their inquiries, and the light with which they have elicited by their col- lection of facts, and their repeated ftid critical observation, have only been surpassed by the laudableness of their intentions, and the benefits which their labours have conferred on mankind. The most general causes of their diseases are improper food, confined and unwholesome air, the want of due exercise and clean- liness, difficult dentition, and unhealthiness of the parents. The greater irritability of their nervous system, their general laxity, and the delicacy of their muscular fibres, may be enumerated as so many predisposing causes. Of the Retention of the Meconium. The dark coloured viscid matter, contained in the bowels of all infants, and is usually discharged by stool during the two or three first days after birth, is known by the name of meconium. The aperient quality of the first secreted milk of the mother, is better adapted to promote this discharge, in the greatest number of cases, than the common preposterous mixtures, with which their bowels are too frequently drenched. But when the milk is found to be insufficient to produce this effect, it will be necessary to have re- course to other means. In general, very little medicine will suffice for the purpose ; and the best we can employ is about a teaspoon- ful of castor oil. In a situnt\on where this cannot be conveniently procured, an excellent substitute will be found in a solution of manna in warm water ; or a little fresh whey and honey. Should not the meconium be evacuated by the application of these remedies, and no stool has been procured during twelve or diseases of children. 723 fourteen hours after the birth of the infant, it will be advisable to administer an injection of thin gruel, with a little olive oil and com- mon salt. This clyster may be repeated every few hours until the desired effect is produced. Of the Red, White, and Yellow Gum, and other Cutaneous Eruptions. Infants during the first month, and till after the period of teeth- ing, are liable to numerous cutaneous eruptions, which assume a variety of appearances, and proceed from many different causes; our limits will admit only of some general observations relative to ,their forms and treatment. The first in order, is that benign erup- tion, which in almost every infant appears soon after birth, and is well known by the name of red gum. It usually appears in small vivid red spots, resembling a fine rash, upon the face and neck, occasionally on the hands and legs, but more generally on the whole body; it is not, however, uniform in its appearance, for in some infants it assumes the form of small pustules, containing a limpid, and at other times a purulent or yellow liquor. In very young infants, a circumscribed redness is frequently the only evi- dent part of the eruption, but at a more advanced age, it will be of a pearl colour and opaque, and as small as pins' heads, or even their points. When it assumes this glistening appearance, it sel- dom discharges any fluid, but at the termination of the complaint, the cuticle is thrown off like a slight scurf. This harmless affec- tion is supposed to proceed from a predominant acid in the first passages, and nothing more is necessary for its removal, than to keep the child moderately warm, and to give a little prepared chalk, coral, or magnesia. Another variety of this complaint, to be noticed in this place, has obtained the name of white gum. It appears chiefly on the face, neck, and breast, in minute whitish specks, hard, and a little elevated, and generally surrounded by a very slight and narrow border of redness. The pustules contain no fluid ; and this eruption requires no treatment different from the one recommended for the cure of the preceding complaint. The yellowness of the skin, which appears about the third day after birth, and termed by nurses the yellow gum, is too trifling to be mentioned as a disease, and will soon disappear without the aid of medicine. 724 DISEASES OF CHILDREN. That scabby eruption which often affects the head and face of in- fants, appearing in different distinct patches, or spreading in ono continued crust, is known to nurses by the name of milk blotches, and called in medical language, Crusta Lactca. These scabs are always superficial ; consequently never leave any scar, unless they are improperly treated. Although this complaint exhibits a very unpleasant appearance it is attended with no fever, or obvious de- rangement of the system, but often continues for weeks, or months, while the child remains in health. Dr. Underwood thinks he never saw an infant much loaded with it, but it was always healthy, and cut its teeth remarkably well. From the anxiety of parents to have this disagreeable complaint removed, a variety of medi- cines have been applied, but most frequently without success. It might perhaps be useful to change the nurse, or for the nurse to change her manner of living, and abstain from much animal food, and from all fermented liquors. It should always be remembered that these eruptions are innocent and salutary, and that every active medicine must be avoided. It is only necessary to keep the child's bowels constantly loose, by mild laxatives and magnesia. To allay the excessive itching of the parts affected, a weak solu- tion of sugar of lead, or the mucilage of the slippery elm bark, will be proper, and the scabs ought to be kept clean by washing with milk and water, and castile soap suds. This complaint may be removed by the application of a tar cap, or washing with tar water, but a dose or two of physic should be given to the child soon as the scab disappears, to prevent ill consequences. Dr. Underwood describes a species of early rash, which often takes place about the time of teething, and not unfrequently at the decline of fevers, and severe bowel complaints. This rash very much resembles the itch ; it is confined to no particular part of the body, though it appears more frequently about the face and neck. This eruption, the Doctor says, is certainly salutary, and even critical, and requires nothing but to avoid taking cold. Another kind of rash, according to Dr. Underwood, appears chiefly in teething children, very much resembles the measles, and has been sometimes mistaken for it. In other instances, after children have cut all their teeth, an eruption appears in the form of round lumps as large as middle sized peas, very hard, with a red base, and white at the top, as if they contained a little lymph. Both these eruptions are perfectly harmless, if not repelled by cold DISEASES OF CHILDREN. 725 or improper treatment. The absorbent powders, to correct acidi- ty, and magnesia to promote a soluble state of the bowels, are all the medicines that seem requisite. These, and other anomalous kinds of rash, with which infants are often affected, are seldom at- tended with fever, and are considered as evidence of the connec- tion existing between the stomach and bowels, and the surface of the body ; they are therefore to be regarded as an exertion of nature to throw off something hurtful, and much care and attention is necessary, to guard against cold, or any application tending to repel the humour from the surface. It is a well known fact, that when the milk does not agree with the stomach, a cutaneous erup- tion is produced ; and on the other hand, when these eruptions sud- denly disappear, they are generally followed by sickness, and some- times the most serious consequences ensue. If, upon the disap- pearance of any such eruption, the child should be disordered, it will be necessary immediately to attempt its re-appearance by the employment of the warm bath, and a free use of saffron, or snake- root tea, and at the same time to open the bowels by a gentle laxative. Instances sometimes occur, where diseases of the skin become extremely obstinate and troublesome, indicating remedies more effectual than those above mentioned. The sethiops mineral, has long been in repute as an alterative medicine in cutaneous dis- eases, and may be given in doses of from four to eight or ten grains. The mucilage of slippery elm bark, both internally and externally applied, will in many cases be found useful. If an ointment should be preferred, the stramonium ointment, with a small proportion of calomel combined, will be found one of the most convenient, and efficacious applications in cases of tetters and other cutaneous af- fections. The ointment of nitrate of quicksilver, yellow ointment, is usually employed with beneficial effects in various affections of the skin. There are many scabby eruptions and sores on the skin of children, which may be effectually cured by washing with a de- coction of the root of sophora tinctoria (Indigo weed.) Of Excoriations and Ulcerations. From inattention to cleanliness, infants are frequently chafed in the wrinkles of the neck, behind the ears, and in the groins. In mild cases of excoriations, it is seldom necessary to do more 726 DISEASES OF CHILDREN. than wash the surface frequently with milk and water, or a weak suds of castile soap, and to apply a little lint spread with sperma- ceti ointment, or Turner's cerate. If there be any objection to oleaginous applications, the excoriated parts may be bathed with rose water, containing a weak solution of sugar of lead, and after- wards sprinkled with futty or calamine, and covered with a piece of scorched linen. In excoriations of the skin under the lap of the ear, a fascinat- ing American writer* recommends a little opodeldoc dissolved in warm water as the most efficacious application which has ever been employed. But if the complaint has been of long continu- ance, it will be dangerous to dry up the discharge suddenly by re- pellent applications, or astringent lotions, unless purgatives are fre- quently administered. Instances have occurred in which a dis- ease of the brain has been excited by speedily healing the surface, after having been long abraded, when the state of the bowels has been neglected. These excoriations are sometimes attended with a swelling of the lymphatic glands about the jaw and neck, and degenerate into large deep sores, which frequently terminate in gangrene. In such cases the child generally sinks, notwithstanding the sloughs begin to separate. An infusion of the root of sophora tinctoria, (see Appendix) will be found far superior to any other application. Should the parts become livid, or threaten to mortify, fomentations of bark, or camphorated spirits of wine, should be applied, and the strength supported by the administration of the bark inter- nally. When, from neglect, mismanagement, or other cause, ulcerations ensue, and are large and painful, fomentations of white poppy- heads boiled in milk, will assuage the pain, and expedite their cure. If under this treatment they manifest no disposition to heal, apply, morning and evening, a liniment composed of calomel, four grains, and the ointment of elder or stramonium, one drachm, spread on a bit of soft linen, or fine lint. This is no less a clean and elegant preparation, but of superior efficacy to any other re- medy. Perhaps in this stage of the complaint it may be necessa- ry to have recourse to alteratives, of which, small doses of calo- mel joined with magnesia, will be the best internal prescription. * The Maternal Physician; by an American Matron. DISEASES OF CHILDREN. 727 Under every circumstance of excoriation of the skin, or ulcera- tion, particular attention to the regularity of the bowels will be in- dispensably necessary. Of Acidities, Gripes, and Flatulency. Authors who have written professedly on the diseases of child- ren, have given a separate and distinct treatise on colic, costive- ness, sour eructations, green stools, gripes, wind in the stomach and bowels, inward fits, and acidities. No advantage can result from such attempts to simplify; and common readers are perplex- ed by discussions, in which symptoms usurp the place, and have all the importance attached to them of a specific disease. The causes of all these affections may be traced to occasional or habitual costiveness, bad milk, weak digestion, unwholesome or too much food, moist cold air, the sudden disappearance of some eruption of the skin, and that natural tendency in the stomach of all infants to generate acidity. When the aliment, instead of being concocted by digestion and converted into chyle, becomes acid, most of the symptoms enume- rated above, together with constant restlessness, frequent crying, drawing up of the legs forcibly to the body, hiccoughs, vomiting, diarrhoea, depression of strength, and, in very irritable habits, con- vulsion will probably be the consequence. The good or bad qual- ities of the milk undoubtedly depend very much upon the diet of the mother or nurse, if she indulge in much fruit or flatulent food, the infant will certainly suffer colic pains, and wind in its bowels in consequence. It is in this case, no less necessary for the moth- er to correct her milk, than to administer proper remedies for the relief of the child. She ought immediately to take infusions of some carminative medicine, such as pennyroyal, caraway, the root of sweet flag or ginger; but above all, the essence, or the distill- ed water of peppermint, which will produce the best effects. The same medicines will afford relief to the child, if given warm, but perhaps infusions of anise, and caraway, should have the prefer- ence; and a tea-spoonful of magnesia given in a little of those drinks will seldom fail to remove the complaints. In all cases of acidities in the stomach, or bowels of children, magnesia, will be found of excellent service, and if used in small quantities every day, it would tend greatly to prevent watery gripes and many oth- 728 DISEASES OF CHILDREN. er distressing complaints incident to children. But much of thft absorbant quality of magnesia, is often lost, by being too thorough- ly wet, or standing too long after being mixed ; it is only necessa- to break all the lumps, and give it in as dry state as it can con- veniently be swallowed. In those cases where there prevails a superabundant acidity, ac- companied with sour belchings, green stools, with curdled milk* it will be necessary to evacuate the contents of the stomach and bowels, by a gentle emetic of ipecacuanha, and a dose of castor oil; after the operation of which, the following laxative absorbent mixture will prove exceeding beneficial. Take of magnesia and prepared chalk, of each two drachms, rhubarb in fine powder, half a drachm, oil of anise seed, twenty drops, sugar, one drachm, simple cinnamon, or peppermint water, two ounces, common wa- ter, four ounces. First mix the powders in a marble mortar, and then add the oil and sugar, and lastly add gradually the water. One or two tea-spoonfuls of this mixture should be given every three or four hours, shaking the phial each time it is used. On some occasions it may be useful to add two or three grains of salt of wormwood, or tartar, or a few drops of spirit of sal ammoniac, to each dose. This mixture will be found in most complaints of children proceeding from acidity, a very eligible absorbent, laxa- tive and carminative preparation. Acidities in the first passages, are frequently attended with a se- vere purging, for which absorbent powders have been recommend- ed as highly useful; but the mixture just mentioned, is also a med- icine well adapted to the indications of cure, and will prevent the accumulation of acescency of the stomach, if properly employed. Infants are frequently attacked suddenly with colic pains, when acidities and flatulency prevail in a high degree, without any pre- vious warning. The accompanying symptoms are, violent crying and screaming, kicking, and drawing up of the legs, and hardness and tension of the belly. In such cases, it will be necessary to prescribe some mild laxative, or a clyster, and if the complaints are severe, recourse may be had to the warm bath, fomentations, and frictions, with warm brandy, or camphorated oil, on the belly. Although strong prejudices exist against the use of opiates, or an- odyne medicines for infants, they are of indispensable necessity in many instances. When these tender little creatures, are suffering the severest pain from colic, gripes, or even from colds and coughs, DISEASES OF CHILDREN. 729 it is really cruel to let them remain in that condition for hours, when immediate relief can be produced by a few drops of elixir paragoric, which is perfectly innocent and harmless. From ten to twenty drops of elixir paragoric, or four or five of laudanum, will on most occasions afford relief from pain, distress, and peev- ishness, so common with children at the breast; and if not too frequently resorted to, no sort of ill consequences need be appre- hended from the practice. Acidities, gripes, and flatulency some- times originate in costiveness, this is to be obviated by occasional doses of castor oil, or magnesia, in an infusion of the seeds of anise. It is a well founded remark, that the passions of the mind great- ly affect the state of the nurse's milk, occasioning gripes, and colic pains. The infant therefore, should never be admitted to the breast, while the mind of the nurse is disturbed or agitated. Of the Thrush, or Aphtha. However harmless the thrush, or sore mouth, as it is vulgarly called, may be considered, it is undoubtedly a disease of debility, arising from acidities in the first passages, or some other acrimo- nious humour lodged in the stomach and bowels, or from indiges- tion, whether occasioned by bad milk, or other unwholesome food. This disorder generally appears first in the angles of the lips, and then on the tongue and cheeks, in the form of little white specks. These increasing in number and size, run together more or less according to the degree of maliguity, composing a thin white crust, which at length, lines the whole inside of the mouth, and extends into the stomach and through the whole intestinal canal; producing also a redness about the anus. If the specks are of a pale colour, superficial, and easily fall off, they are not considered dangerous ; but when the crust falls off, and is succeed- ed by another of a darker colour, or livid hue, it is reckoned the worst kind. In forming our prognostic of the termination of the disease, it is necessary to attend to the sensibility of the stomach and bowels, and the appearance of the egestion. Frequent vom- iting, repeated thin stools, with griping, and a tender state of the abdomen, are very unfavorable ; drowsiness, oppressed breathing, moaning, spasms, and great languor, with frequent pulse are symp- toms indicating danger. 92 730 DISEASES OF CHILDREN. A remarkable propensity to sleep, fretfulness when awake, and an unusual heat in the mouth, are among the premonitory symp- toms of fatal termination of the disease. In its mild form, or when it is an original disorder, it is never attended with any fever; but when it has arisen in consequence of severe bowel complaints, or other infantile diseases, it is not unusual, in such cases, for the thrush to be accompanied with fever of the low kind. In mild and recent cases of this disease, when the aphthae is confined to the mouth, and appears in a few scattered spots re- sembling little pieces of curd sticking to the surface of the tongue, or within the lips, it may in general be easily removed by keeping the bowels duly open with a little magnesia given daily. Many regard aphtha? as a salutary complaint, and in conse- quence of this erroneous belief, the disease has been neglected un- til it has extended down to the stomach and intestines, producing cough, and great difficulty of breathing, with other symptoms of a disordered state of the stomach and bowels. Under these circum- stances the most active applications must be employed or we shall be unable to arrest its fatal termination. In the treatment of the thrush, it will be proper on its first ap- pearance to give a gentle emetic of the wine of ipecacuanha, in order to evacuate the stomach of acidities or other acrimonious humours. After the operation of the emetic, we may recommend manna, magnesia, or a course of the testaceous powders, if the child is of a costive habit. If the infant is robust, and the disease is violent, and has extended rapidly, suitable doses of calomel may be taken with advantage. But on the contrary, if its bowels are rather loose, and the constitution feeble and delicate, we may sub- stitute the compound powder of contrayerva, or the mixture of chalk, endeavoring at the same time to support the strength by cordials, and injections of a decoction of the bark, with the addi- tion of a few drops of the tincture of opium. A variety of local detergent applications in the form of gargles and lotions have been recommended, the most common of which is a saturated solution of borax in water, and mixed with honey, or a syrup of the wild turnips. Besides this preparation, a strong decoction of Peruvian bark acidulated with the elixir vitriol, a so- lution of white vitriol, and diluted muriatic acid have severally been employed with an expectation of their disposing the sloughs to fall off, and of constricting and healing the parts beneath, DISEASES OF CHILDREN. 731 Among the vegetable productions of New-England, the arum maculatum, better known by the name of wake-robin, dragon root, or wild turnip, is a remedy of approved efficacy. The com- mon method of employing it, is to mix about one drachm of the finely pulverized root into a paste with common honey, a small quantity of which being put upon the infant's tongue will be lick- ed to all parts of the mouth. This by being frequently repeated during the day, will keep the infant's mouth moist, clean, and com- fortable, and promote a separation of the aphthae. A few grains of calomel mixed with honey, and applied to the mouth and tongue, will also be found very serviceable in this complaint. See sophora tinctoria, Appendix. Canker of the Mouth. This complaint is distinct from aphthae, and is termed by prac- tical authors ulcuscula oris. It makes its appearance about the time of teething, and more especially in severe cases of diarrhoea, and cholera infantum. It commences with little white circular vesicles with a red line surrounding their basis, and occupies the tongues, gums, and inside of the cheeks, which become ulcerated, and discharge a quantity of thin foetid matter. There is frequent- ly an unusual discharge of saliva, and a very foetid breath. Such is the soreness and tenderness of the mouth, in many cases, that the infant cannot be induced to take the breast, or the mildest li- quids, even when the calls of hunger are urgent. It has been known to extend to the oesophagus, and throughout the whole ali- mentary canal, and even the anus becomes affected in the same manner, and we frequently hear nurses and mothers express then- apprehension of danger from the « inward canker. The cure ,s to be performed by gentle laxatives, and by proper local applica- tions such as those mentioned above for aphthae. The mouth should be frequently cleansed by a piece of sponge, or a little m0p well charged with the detergent gargles; and a few grains of calomel in dry powder, or mixed with honey, if applied to the tongue will be carried to the ulcerated surfaces, and its good ef- fects will soon be manifest. This should be repeated several times in the day, and if swallowed, no injury will ensue. The fullest confidence may be placed in the efficacy of the sophora tinctoria Let a decoction of the root be used as a gargle, 732 DISEASES OF CHILDREN. and taken internally, and it will be found to answer every pur- pose. Of Tumours of the Scalp. It sometimes happens, that after a laborious birth, the scalp of the child is considerably tumefied; this is seldom attended with se- rious consequences; and by the application of cloths wet with brandy, or camphorated spirits, the effused fluid is soon absorbed, and the swelling disappears. On some occasions however, such tumours do not readily subside, but rather increase, and continue for several weeks, and the mother becomes alarmed. Under such circumstances, it may be necessary to make an opening through the integuments, for the discharge of the contained fluid; there can be no danger from this simple operation, and by the applica- tion of spirits, or vinegar, in which some crude sal ammoniac has been dissolved, with proper compression, the incision soon closes, and a cure is effected. Of Cutting the Tongue. We are frequently importuned by mothers and nurses, to liber- ate the tongue, when on examination, it is found to be inexpedient; there not being one in many hundreds of infants, whose tongue is so confined by the fraenum, as to incapacitate it from sucking, and afterwards from articulating distinctly. Whenever the tongue is so confined, that the infant cannot move it over the gum, or take proper hold of one's finger, or a good nipple, the membranous string, which in this case binds it down, ought to be so divided as to enable it to suck with freedom. The operation may be per- formed with the common scissors, while lifting up the tongue with the fingers of the left hand. Some attention, however, is requi- site, to avoid cutting any of the blood vessels beneath the tongue, from which infants have sometimes bled to death. Another dan- ger to which careless operators are liable, is that of cutting the string to too great an extent, in consequence of which, the point of the tongue being entirely unconfined, may fall back into the throat and occasion suffocation. Whenever this accident does take place, the infant appears greatly agitated, the face turns black, and unless it be soon relieved by bringing the tongue in- DISEASES OF CHILDREN. 733 to the proper place, convulsions and death will be the conse- quence. Of Vomiting. It is not uncommon for healthy thriving infants at the breast, to puke up the milk, especially after a free indulgence, and when the child is shaken or dandled. When vomiting is evidently occa- sioned by overfeeding, and the milk comes up unchanged, it is to be regarded as a kindly exertion of nature to free herself from any superfluous quantity received into the stomach. This is not to be accounted a disease, and requires no other remedy but absti- nence after the stomach is disburthened of its load, and care not to overfeed it for the future. If the vomiting proceeds from acid- ity in the stomach, an emetic of ipecacuanha will be proper, after which, repeated doses of magnesia will probably effect a cure. If from an increased degree of sensibility, or too great an irritability of the nerves of the stomach ; the saline mixture, with a few drops of laudanum, will be beneficial, and in order to brace and strength- en the stomach and abate its sensibility, a cold infusion of Peru- vian bark, with a little rhubarb and orange peel will be essential- ly necessary. In cases of severe and obstinate vomiting, the operation of internal remedies may be assisted by the appli- cation of aromatic and spirituous fomentations, or an anodyne plas- ter to the pit of the stomach. In all cases of vomiting, mild ca- thartics, and laxative clysters, should be administered, as occasion may require. Infantile Remittent Fever. This fever, according to the experience of Professor Hosack, is of very frequent occurrence, and is often fatal among children from one to six years of age ; but is oftentimes met with between that period and the twelfth year. It comes on with fretfulness, dry lips, shortness of breath, pain in the head, hands hot and dry, pulse often 120 in a minute. The child is unwilling to stir or speak, the sleep is disturbed by startings, and the food is rejected, and a costiveness or looseness with slimy stools attend. Some children are delirious or stupid, many for a time speechless. There are several accessions of fever and in the intervals of the parox- 734 DISEASES OF CHILDREN. ysms the patient appears almost free from complaint, though more peevish than usual. At length after several days a shiver- ing fit and vomiting ensue, and are followed by a violent paroxysm of fever. The pulse now rises to 140 in a minute; the cheeks are flushed, the drowsiness much increased, and the child keeps picking almost incessantly at the skin of the lips and nose, and of the angles of the eyes. This species of fever is mild at its com- mencement, slow in its progress, and very uncertain in its event. " As in the bilious remittent of adults, it may be remarked of the infantile remittent that it is very generally traceable to a de- rangement of the digestive organs as its primary seat and source. This is evinced by the loss of appetite, the foul tongue, the offensive breath, and the confined state of the belly, in the forming stage of this disease, and which are generally considered as the evidence of worms, and treated accordingly. These symptoms in a few days are succeeded by those of fever, which is of very uncertain duration and violence, and not unfrequently displays itself either in irritation of the chest producing oppressed respiration and cough resembling pneumonia, or upon the brain, followed by the evi- dences of phrenitic inflammation, and ultimately terminating in hydrocephalus internus. This last termination, such is the natural tendency and force of the circulation upon the brain at that early period of life, may very generally be anticipated, if active means be not early employed to empty the stomach and intestines; and to unlock the surface of the body by warm bathing, the free use of antimony and other diaphoretics; or by blisters, to create a new and relatively safe seat of irritation, upon which the febrile symp- toms may expend themselves. Indeed so constantly is hydro- cephalus the sequel of other febrile diseases, that it may, with few exceptions, be considered as exclusively symptomatic. I have even known pneumonia to be its forerunner. Teething is fre- quently productive of fever, ending in phrenitis and hydrocepha- lus; and I believe, the arterial excitement occasioned by the use of mercury, so frequently and indiscriminately given in the diseases of children, has been a prolific parent of this fatal malady ; and which has oftentimes been remarked to have greatly increased in frequency and mortality, since the very general prescription of that metal. In as far, therefore, as increased arterial excitement of long continuance, whatever may be its type or its source, has a peculiar tendency to oppress the brain at this period of life, the DISEASES OF CHILDREN. 73.3 same consequence is to be apprehended from the form of fever under consideration ; and, on this account, not only calls for the most active means of obtaining a solution of such fever, but, in an especial manner, suggests the employment of such remedies as are calculated to divert the current from the brain to other parts of the system. When, therefore, in the progress of fever, the brain begins to manifest inordinate irritation ; either by pain, or by stupor, blisters to the extremities and active cathartics, viz. an in- fusion of senna, manna and cream of tartar, frequently administer- ed, until plentiful evacuations are obtained, are among the most effectual means of arresting the progress of the fatal train of symp- toms now to be apprehended. I notice particularly the infusion of senna, having administered it in many cases of approaching hydrocephalus with the most decided advantage." (Professor Hosack.) For Convulsions see page 563. Of Dentition, or Teething. . Dentition is often a painful and critical period with infants, in which the first appearance of indisposition should be watched with care and attention. For various and complicated are the com- plaints during this important crisis, which, though harmless in their commencement, become, through neglect, formidable in the progress, and frequently fatal in their termination. Many children appear to suffer greatly from the tension, irrita- tion, or inflammation of the gums, before there is any apearance of teeth. They suddenly become fretful and uneasy; disgusted rather than amused with their toys; sink upon the bosom, or in- cline to lay in the arms; and sleep with their eye-lids half closed, and frequently start, or groan. The teeth are formed within the jaw, previous to the birth of the infant; and evident signs of pain and irritation in the gums, and an increased discharge of saliva, are apparent about the third or fourth month, though they seldom cut all their teeth until nearly two years, and sometimes even later. There are only ten teeth in each jaw evolved during infancy, and these are not permanent. The two fore teeth of the lower jaw first appear, and in about a month those of the upper jaw come through. Then the two lateral ones of the lower jaw, and 736 DISEASES OF CHILDREN. next those of the upper one appear. These are succeeded by four grinders, and then the eye-teeth as they are called. These are the primary or milk-teeth, which are shed, agreeable to the order in which they cam»», and are replaced by other teeth, more permanent, larger and better formed, and their roots longer and more extended. A variety of circumstances may occur, whicli will interrupt the regularity of this process; but every deviation does not constitute disease, nor afford a sure iudication of more difficult, or more easy dentition. It has been observed as orie of the phenomena of teething, that, in the greatest number of instances, the first dentition commences at seven months, the second at seven years, and its progress is completed at the end of the third septenary, that is at twenty-one years. Many children pass through this important period with so great ease and regularity, as not to have any observable alteration in their usual health produced by it. But when dentition is difficult, there is no occurrence to which they are liable, attended with such grievous and distressing effects. The symptoms which usually pre- cede or accompany it, are a considerable irritation of the mouth ; the gums are hot, itchy, swelled, and spread; the secretion of sa- liva is increased, the child constantly drivels ; the actions of the stomach and bowels are performed imperfectly, or are occasionally suspended ; there is often a circumscribed redness in the cheeks, eruptions appear on different parts ; a looseness ensues, with grip- ings, and the stools are of a green, pale, or leaden blue colour, sometimes containing mucus, and often thick; and the child is watchful and peevish, starts during sleep, and sometimes general convulsions of the voluntary muscles take place. These symp- toms, in very irritable habits, when the tooth advances fast, or se- veral teeth push forward at the same time, are followed by fever, difficulty of breathing, spasmodic cough, scrofula, marasmus, and convulsions. Among the symptoms of less importance, which sometimes at- tend dentition, may be mentioned a swelling of the tops of the feet and hands, and also a transient palsy of the arms or legs, but these are seldom of long continuance. The influence of the seasons, and constitutional differences of the human system, are not more apparent in any disease, than in dentition. It has been observed that infants cut their teeth moro readily in the spring and winter, than in summer and autumn ;— DISEASES OF CHILDREN. 737 The lean more easily than the fat;—Strong and healthy earlier than the weak and tender; and those children whose bowels are regularly open suffer the least. The most troublesome and alarming disorders which attend dentition, and require the most prompt and efficacious remedies, are diarrhoea, cholera infantum, fever, convulsions, and affections of the lungs. Each of these shall be separately but briefly con- sidered ; reserving a more full and particular discussion of these subjects for another part of this work. Acidities, flatulency, gripes, costiveness, and sore ears, are to be obviated by those means which have been recommended when treating of these com* plaints. When a spontaneous purging arises during dentition, unattended with fever, not profuse, and the child preserve a good appetitite; it ought not to be hastily stopped. It is to be considered rather as a beneficial, than a prejudicial discharge, and may prevent the oc- currence of more serious symptoms. But if it should continue long and violent, so as greatly to weaken and debilitate the child, attended with a gradual emaciation, the countenance pale and de- jected, the eyes dull and heavy, a peculiar sinking of the features, and slight febrile paroxysms, it becomes an alarming disease, and is termed the diarrhoea of dentition. Under these circumstances^ the proper practice is to cut the gum over that tooth which is far- thest advanced, if inflamed and distended. The incision should be made on the anterior part of the gum, in the course which the tooth takes in the gum, and carried so deep as to reach the tooth. It is also necessary that the incision should be made in this man- ner, to prevent the connecting membrane between the first and second set of teeth from being divided. Attention to the quality and quantity of food is necessary, and the frequency of adminis- tering it. If the mother's milk is abundant, it will be all the food the child will require; and is to be preferred to all other food, as it is the most grateful to the palate, the most easily retained, and the most perfectly digested by the stomach. For a child which does not nurse, milk new from the cow is the best substitute for the breast. But if this cannot be procured, the next in order of preference is arrow root, or some aqueous nutriment as nearly re- sembling milk as can possibly be prepared. An excellent bever- age of this description can be obtained by boiling several hours, a handful of dry flour closely confined in a cloth, uotil it become? 93 738 DISEASES OF CHILDREN. perfectly hard ; when cold, a table spoonful of it finely grated, Is to be mixed with half a pint of boiling milk, sweetened, and a tea- cupful taken as often as necessary. Active purges, such as castor oil, senna, and calomel, must be employed in the commencement of the disease, in such quantities as will evacuate the contents of the stomach and bowels, or destroy the irritating effects of these substances on those organs. The operation of the cathartic may be followed by a gentle anodyne, given at bed time, to allay the irritation, and to procure a respite from pain and suffering. The remainder of the cure is to be conducted on general principles. This disease is frequently succeeded by the cholera infantum, which is peculiar to teething children, and in its mild form resem- bles a severe attack of the diarrhoea. There are certain symp- toms common to both diseases, but the cholera infantum may be easily distinguished by. the following characteristic appearances. It generally commences with flatulency in the stomach, and sharp griping pains in the bowels, succeeded by a severe and frequent vomiting and purging of great quantities of bilious matter, and a constant and urgent thirst. The child is distressed and restless for some time after taking food, which is thrown up again, almost as soon as swallowed, and from the very irritable state of the stom- ach, it is very difficult for any kind of medicine to be retained on it. The appetite is much impaired, and, in consequence of the weakened powers of the digestive organs, the stools contain small curds of milk, or portions of undigested food, but rare- ly much faeculent matter. The colour and consistence of these discbarges are various; they are sometimes yellow, but more com- monly either green, or white, or brown, and are thin, watery, or mucous ; and they smell sour or putrid. In frequency they vary from three or four to twenty during twenty-four hours. It sometimes happens, that robust children are attacked with a considerable degree of fever during dentition, in which case the loss of a little blood, either by the lancet, or leeches behind the ears, has been recommended as necessary. But it must be recol- lected that they suffer more from bleeding than from other evacu- ations. It will be advantageous to administer small doses of an- timonial wine, from six to ten drops according to the age and oth- er circumstances of the child, together with diluting liquors, if it does not nurse, in order to promote perspiration. As there is generally a constipation of bowels, it will be necessary to give a DISEASES OF CHILDREN. 739 smart purge, and keep the bowels open afterwards by magnesia. The spirit nitre dulcis, in doses of eight or ten drops added to the antimonial wine, and small blisters applied behind the ears, are of- ten employed with advantage. Opiates are not to be administer- ed unless the bowels have been previously opened, the pain se- vere, and the respiration free and easy. Children are sometimes attacked with convulsions, the most alarming and dangerous complaint that accompanies difficult den- tition. As these are produced by an irritable, or excitable state of the nervous system, we should without delay scarify the gum, through which the tooth is forcing a passage, and this operation may be repeated for several successive days, until either the tooth appears or the convulsions cease. If slight scarifications do not procure relief, the incision should be carried boldly down to the tooth, although no swelling be discovered. We are at the same time not to neglect the bowels, which should be kept perfectly open. We may further attempt to lessen the irritability of the system by anti-spasmodics, as assafcetida, castor, and valerian; or what is still more efficacious, the pothos fcetida, or skunk cabbage. A strong infusion of the root of this domestic plant may be given in doses of a large spoonful every few hours, until relief be ob- tained. Blisters and the warm bath, will prove useful auxiliaries. Should there be any objection to tepid bathing, the pediluvium may be at any time proper. As a general direction, light nourishing diet, preserving the bow- els in an open state, restraining immoderate evacuations, proper exercise, pure air, and all those means which have a tendency to promote general health, will contribute to the safety of dentition, and facilitate its process. Many of the ancient physicians recommended certain charms and amulets, but these futile inventions scarcely survived their su- perstitious patrons. And modern custom has adopted a practice equally ridiculous, if not worse than useless, of giving child- ren during teething, gum-sticks, coral, and other hard substances, to put into their mouth. But every parent and nurse ought to know, that the natural tendency of these means is to harden the gum, by which the process of absorption is rendered more diffi- cult. If any application is made to appease the anguish of the gums, let it be the finger, which is soft, yielding, and easy, and will serve every necessary purpose. 740 DISEASES OF CHILDREN. The Cholera Infantum, or vomiting and purging of Children. This is a prevailing malady in most of our cities during the months of summer and autumn, and a multitude of children are the victims of its "annual visitation. It has been the subject of investigation by many ingenious authors, and the accurate descrip- tion which follows, is nearly in the language of the late celebrated Dr. Rush. It sometimes begins with a diarrhoea, which continues for seve- ral days without any other symptom of indisposition, but it more frequently comes on with a violent vomiting and purging, and a high fever. The matter discharged from the stomach and bowels, is generally yellow or green, but the stools are sometimes slimy and bloody, without any tincture of bile. In some instances they are nearly as limpid as water. Worms are frequently discharged in each kind of the stools that has been described. The children in this stage of the disease appear to suffer much pain. They draw up their feet, and are never easy in one posture. The pulse is quick and weak. The head is unusually warm while the extre- mities retain their natural heat or incline to be cold. The fever is of the remitting kind and discovers evident exacerbations, espe- cially in the evenings. The disease affects the head, and in some instances violent delirium ensues; the child throws its head back- wards and forwards, and attempts to scratch and to bite the attend- ants. Swelling frequently occurs in the abdomen and in the face and limbs. An intense thirst attends every stage of the disease. The eyes appear languid and hollow, and the children generally sleep with them half closed. Such is the insensibility of the sys- tem in some instances in this disease, that flies have been seen to alight upon the eyes when open, without exciting a motion in the eye-lids to remove them. Sometimes the vomiting continues with- out the purging, but more generally the purging continues without the vomiting, through the whole course of the disease. The stools are frequently large and extremely foetid, but in some instances, they are not, and are small, resembling the drinks and aliment which have been taken into the stomach. The disease is some- times fatal in a few days. Its duration is varied by the season of the year, and by the changes in the temperature of the weather. A cool day frequently abates its violence and disposes it to a fa- vourable termination, It often continues with occasional varia* DISEASES OF CHILDREN. 741 tions in its appearance for six weeks or two months. Where the disease has been of long continuance, the approach of death is gradual and attended by a number of distressing symptoms. An emaciation of the body to such a degree, as that the bones come through the skin, livid spots, singultus, convulsions, a strongly marked hippocratic countenance, and a sore mouth generally pre- cede the fatal termination of this disease. We have also a striking delineation of this disease from the pen of Dr. James Jackson, medical professor in Harvard Univer- sity, in an elaborate and practical essay on the morbid effects of dentition.* According to the observations of this sensible writer, cholera infantum is peculiar to teething children. It rarely occurs before the eighth or ninth month, and seldom commences in child- ren who are past eighteen months of age. We seldom find this dis- ease in any of its severe forms among infants at the breast; and those children who are accustomed to the free enjoyment of open air, are comparatively very little subject to the cholera of infants. In his animated sketch, the professor presents the child " asleep in its crib, cold amidst the load of woollen in which it is wrapt, unless during a febrile paroxysm, when an arid warmth is spread over it; so peculiarly dead are the limbs in their appearance, that it would seem that life was preserved only in its sacred temple in the centre of this 'little world ;' its countenance more than death- ly, and with which the visage of pulmonary consumption will scarcely compare; its pulse quick and wiry, and its respiration scarcely to be heard. So strongly, under these circumstances, are the characters of death impressed on the little subject, that the in- experienced observer cannot doubt that a few hours will decide the case for ever. That the appearances have been the same for days, and even sometimes for weeks, seems to him impossible. But in this situation the patient may continue for weeks with some fluctuations, and at length recover." In all the forms of cholera infantum the breast milk Is unques- tionably the most suitable food ; where the patient does not nurse, cow's milk fresh from the animal should be employed. Cow's milk may often be rendered more particularly suited to certain cases, by mixing with it half its quantity of lime water, and some- * Vide New-England Journal of Med. and Surgery, Vol. I. This excellent sketch is recommended to the attentive perusal of every medical practitioner. 742 DISEASES OF CHILDREN. times they should be boiled together. Next to milk, unless when the stomach is in the most irritable state, animal food is to be pre- ferred, and this in a solid form moderately broiled or roasted, pro- vided the appetite and digestion are favourable to it. The pure juice of meat obtained by broiling, or extracted by boiling in a bottle as directed in the Appendix, will sometimes answer a valu- able pupose, when neither solid meat nor milk can be easily borne. On some occasions, the farinaceous and mucilaginous substances, as arrow root, sago, &c. will be found more agreeable to the patient's stomach than any other food. The quantity both of food and drink, should always be small, and in a state of great irrita- bility of the stomach not more than a tea-spoonful should be given at a time, and not too frequently repeated. In the medical treatment of cholera infantum, the first indica- tion is to discharge the acrid and offensive contents of the stomach and bowels. About fifteen or twenty grains of ipecacuanha may be given at the onset, and repeated occasionally, unless we except those cases where from a long continued spontaneous vomiting, the strength is greatly reduced, the pulse feeble, and the heat has receded from the extremities. If an emetic is deemed improper, a dose of calomel adapted to the age and strength of the patient will produce the happiest effects ; and in many instances calomel and ipecacuanha conjoined, about three or four grains of each, will be found of singular efficacy in expelling the offensive con- tents of the stomach and bowels. After the first passages are suf- ficiently cleansed, opium should be added to the calomel, and this forms one of the most efficacious and powerful remedies that can be prescribed. Experience has evinced, that these two active medicines correct, regulate, and soften the powers of each other. The proper proportion of this compound is three parts calomel to one of opium ; the dose of which, and frequency of repetition must be varied according to existing circumstances. About half a grain of the compound intimately mixed, may be given to a child eighteen months old, and repeated every three, four or six hours according to the urgency of the symptoms and the effect produced. It may be formed into pills with mucilage of gum arabic, or mixed with a few grains of prepared chalk. If the patient should be in- clined to be costive, magnesia may be freely administered; or a few grains of jalap may be added to the calomel, or a full dose of this last given and followed by a dose of castor oil. When con- DISEASES OF CHILDREN. 74'6 stant looseness prevails, absorbents are indicated, as lime water, and prepared chalk, or a few drops of laudanum may be combined in a chalk julep with peppermint. A solution of the alkaline salts of tartar, or soda, will in most cases be extremely useful in cor- recting acidity in the stomach, and mild carminatives, as infusion of aniseed, carraway, and calamus arematicus, will tend to relieve symptoms of flatulency. The spirits of turpentine is now gaining reputation for its efficacy in checking the disordered action of the stomach in cholera infantum. In doses of from ten to thirty drops, repeated three or four times in the course of the day, it is said never fails to produce the most favourable effects in relieving vomit- ing, correcting vitiated secretions and a tendency to griping and irritation of the intestines; and if continued at proper intervals during the continuance of the disease, it restores a healthy action through the system. Demulcent and diluting drinks, as infusions of marsh-mallows, the shavings of hartshorn, and gum arabic, with cinnamon, together with clysters of mutton broth or of starch, with a few drops of laudanum, are among the remedies often employed, and they may have their use. Great advantages may be derived from external remedies applied to the abdomen; these are warm or tepid bathing, flannels dipped in infusions of bitter and aromatic herbs, or warm spirits or wine. To these should be added friction, rubefacients and blisters. The tincture of flies of greater or less strength, is admirably calculated to answer the double purpose of rubefacient and vesication, and should in no case of severity be omitted. In the advanced stage of cholera infantum, when all acrid and offensive substances have been entirely evacuated from the bowels, astringent medicines become necessary, one grain of alum given two or three times in a day has been administered with great suc- cess, and sugar of lead, in doses of half a grain for a child a year old, and repeated according to the exigency of the case, has also effected cures, but these are to be cautiously employed. Catechu is a mild but excellent vegetable astringent, and may be adminis- tered in this disease, either in tincture or infusion with a prospect of superior advantage. In many instances of cholera infantum, a considerable inequality as to the heat of the different parts of the body is observable. Those parts of the body which are heated beyond the natural standard, should be exposed to a stream of cold air several times 744 DISEASES OF CHILDREN in a day, and should be washed with vinegar and water moderately cool, by means of a sponge. When the head is unusually hot, at- tended with redness of the face and eyes, and delirium, that part should be frequently washed in the coldest water. If the extremi- ties are too cold, they should be covered with flannel, and sina- pisms applied to the feet. Another remedy to be mentioned, is the injection of cold water into the intestines after their offensive contents have been thoroughly evacuated ; this is said to be of superior efficacy as an anodyne, sedative, and antispasmodic. When the force of the disease has been subdued, and a state of convalescence commenced, the vegetable tonics, as decoctions of the bark of cinchona, angustura, columbo, with cinnamon, and wine and brandy, will have the effect of restoring the healthy state of the system. But in every instance where the measure is practi- cable, the exhausted patient ought to be removed into the country for the benefit of fresh air, which is of the utmost importance. It is mentioned in Med, Repos. Vol. I. New Series, that a strong de- coction of a plant called Erigeron Canadense, or Fleabane, has proved an effectual remedy in this disease. Among our vegetable astringents to be employed after the in- flammatory symptoms have been subdued, there are none to be pre- ferred to the marsh-rosemary, the geranium, maculatum, and the common black-berry. A decoction of the roots of these, when free- ly used, will prove highly serviceable. Tinea Capitis, or Scald-Head. The scald-head consists of small ulcers in the skin of the hairy scalp, at the roots of the hair, which discharge a matter running into "a dryish scab, or thick scales of a white or yellowish colour, attended with an offensive smell. This disgusting complaint arises frequently from uncleanliness and improper food, or an unhealthy nurse ; but it is often communicated by contagion, either by using a comb imbued with the matter, from the head of a person affected with it, or by wearing his hat or cap, In its recent state, while it is merely a complaint of the skin< the scald head may be safely and successfully treated by topical applications. The hair is first to be cut close or shaved, and the scabby patches are then to be Washed daily with warm soap suds, or an infusion of tobacco, tak- ing care to remove the scabs at each washing; after which apply DISEASES OF CHILDREN. 745 an ointment made of equal parts of sulphur and flour of mustard, mixed up with hog's lard, or the ointment of nitrated mercury, Commonly called yellow ointment. If the disease has considera- bly extended itself over the headj and remains obstinate after se- veral days trial of the above method of treatment, it has been ad- vised to rub in forcibly the common tar ointment, with a good pro- portion of the powder of white hellebore, for near an hour at a time, while warm, and the head is afterwards to be covered with a bladder or cap. This process having been repeated three or four times, not only the scabs but the hairs also will, it is said; become loose, and must be pulled out. When new hairs spring up, free from scabs, it is a proof that the disease is subdued. From some recent experience, I am confident that we have a domestic plant, easily procured, which will seldom fail to cure this troublesome and loathsome disease, if properly applied. The plant I refer to is the kalmia, or laurel, of which we have two species in our woods and swamps ; the broad-leafed laurel, or win- ter green, and the narrow-leafed laurel, well known by the name of lamb-kill, from its fatal effects among sheep. The last species is said to be the most active.* Take the leaves of laurel or lamb- kill, at any season of the year, boil them till the water is strongly impregnated with their virtues, and then wash the scabby parts about the head twice in a day, until a perfect cure is effected. It will excite considerable smarting, but if it cannot be borne if may be made weaker. Another mothod of using this remedy is to re- duce the dried leaves to a fine powder, and make an ointment by mixing it with hog's lard, to which some of the powdered root of our swamp hellebore may be added, if desired. This remedy ought in my opinion to be preferred^ as it is far more neat and cleanly than either the sulphur or tar ointment, and unquestionably of equal efficacy. In those cases where this disease has been of long standing, and the general health is impaired, it may be advi- sable to put the patient under a moderate alterative course of Plummer's pills, or aethiops mineral, and to direct a purge at prop- er intervals. It may also be proper on some occasions to open an issue and keep up a discharge for several weeks after the cure is effected. There is in the Medical Repos. Vol. I. Hex. 3d. an ac- * See American New Dispensatory, where it will be perceived that I am indebt* fed to Drs. Barton and Thomas for the first information respecting this plant 94 74(3 DISEASES OF CHILDREN. count of the treatment of tinea capitis by a Mr. Morrison, which is represented as being remarkably successful in the most despe- rate cases. He directs the head first to be shaved closely as pos- sible, immediately after which he applies a common poultice to soften the incrustation. The head is then to be washed with soap suds, and the following paste spread on strong linen applied. Take of yellow resin, two ounces, best ale, one pound, of the finest flour, three ounces. The ale and flour are to be first mixed and then gradually added to the melted resin. This paste must be remov- ed and re-applied daily until a cure is effected. The ointment described in the Appendix, applied in the same manner as the above, will prove equally successful, as will common snuff formed into an ointment with fresh butter or lard. Chilblains. This troublesome complaint consists of purplish shining swell- ings of the feet, heels, and hands, attended with intolerable itch- ing and some pain. They are the effect of inflammation arising from sudden changes of temperature, and usually attack children in cold weather. Chilblains are particularly apt to occur in per- sons who are in the habit of going immediately to the fire after being exposed to a severe degree of cold, or who go suddenly in- to the cold while very warm. The best method of preventing chilblains is carefully to avoid the causes just mentioned, to wash the hands and feet in cold water daily, and to keep them covered in winter with woollen gloves and stockings. At the first approach of the complaint, the parts affected should be plunged into the coldest water, or rubbed with snow, and continued for a consider- able time, and frequently repeated until all unpleasant sensations be removed. When the skin becomes much inflamed and a swell- ing ensues, the patient ought to take a dose of physic, and to have the affected parts well rubbed with some warming applications, as mustard and brandy, spirit of turpentine, or vinegar and brandy mixed with the addition of a little alum. I have known the mu- cilage of slippery elm bark afford considerable relief; but I have experienced nothing so particularly useful as equal parts of the soap liniment or opodeldoc, and the tincture of myrrh applied to the parts. A mixture of the oil of turpentine and balsam of co- paiva in equal parts, is a celebrated application. The ointment of j snuff, advised for scald head, is deserving of triaL DISEASES OF CHILDREN. 747 Of the Venereal Disease in Infants. It is an established opinion that infants may be affected with sy- philis before birth, or during its expulsion through the vagina where chancres exist, or by sucking an infected nurse. The first is the most frequent method, and the consequence of infected parents, although we may not be able to trace any marks of the existence of the disease in either of them at the time, or it may be, many years after a cure has been apparently effected. In such cases it is common for the mother to have frequent abortions, or prema- ture births, without any evident cause, and the child appears half corrupted and ulcerated. These circumstances will serve to aid our diagnosis in any particular instance ; there is, however, no in- fallibility to be attached to them, for any cause occasioning the death of the foetus a considerable time before its expulsion may produce similar appearances. In some instances the child at its birth exhibits the symptoms of venereal affection, but more frequently these are not apparent un- til ten or twelve days afterwards, though it may be feeble and rath- er, emaciated. The symptoms are generally an inflammation of the eyes, the cuticle appears wrinkled, or peeled off, and some- times scabby eruptions cover the body; copper coloured blotches ending in ulceration appear on the surface, but more particularly about the genital parts. Foul sores cover the inside of the mouth and lips, surrounded by a whiteness of the skin as if the part had been recently rubbed with lunar caustic. If the child receive the infection from the nurse, ulcers are discovered on the nipples, and the disease appears on the child's mouth before the surface of the body be affected. The only method by which a cure of lues venerea can be effect- ed, is to administer a course of mercury either to the nurse or di- rectly to the infant; the latter is found by experience to be the most successful practice. About one quarter or half a grain of calomel may be given two or three times in a day according to the effects produced, and continued for some time after all the symp- toms have disappeared. If mercurial frictions be preferred, about fifteen grains of the ointment may be rubbed on the thighs every night until the mouth become hot, when it is to be intermitted or continued according to the state of the system and the effect on the disease. The following preparation has been found both safe. 748 DISEASES OF CHILDREN. and efficacious. Dissolve two grains of corrosive sublimate in one ounce of brandy, of which three drops may be given to an infant at the breast, and increased to four when a year old, and to six or eight when arrived to three years, and repeated three times a day. If the child's bowels be affected with the mercury, opiates in small doses must he given. See chapter on Syphilis in this volume, APPENDIX. OF LEECHES, (HIRUDO MEDIC1NALIS.) The employment of leeches as medicinal agents has become so universal in practice, that every physician will find it incumbent to make himself acquainted with their character and properties. Of this animal there are various species, some of which are more valuable than others for their use in drawing blood. The medicinal leech is commonly about two or three inches long, and its head is turbinated. Its back is of a dull olive green colour, divided into three nearly equal parts by four yellow longitudinal lines, the two lateral entire, the two central broken with black. Besides these, between the lateral and central lines on each side there are two others resembling a chain of black and yellow. The belly is turkey blue, irregularly marked with yellow spots. But the bite of those found in stagnant waters, or the horse leech as it is termed, being entirely brown, or only marked with a marginal yellow line, is said to cause pain and inflammation, and should be rejected. Leeches should be collected in the summer in ponds having a clear sandy bottom, and preserved for use in a bottle half filled with pure spring or river water, and covered with gauze or muslin. The water should always be kept in a moderate tem- perature, and ought to be changed frequently, although there are instances of their living many months, and even years in the same water, and it is remarkable that water in which they are kept con- tinues much longer sweet than by itself. Leeches are very useful and convenient remedies in every case requiring local blood-letting. They cause less irritation than cup- ping, and can often be applied neaier to the part. They are em- ployed in all local inflammations where general blood-letting will be improper ; the particular circumstances which require their use have been mentioned in the course of this work. The applica- tion of leeches is sometimes attended with* considerable difficulty. In cloudy weather and in the evening they do not readily bite. If kept out of the water some minutes and allowed to crawl on dry linen and then moistened with warm water before they are ap- plied, they are said to bite more eagerly. The part to which they are to be applied .should be well washed, and if covered with strong hairs should be shaved, and the skin may be moistened with a little blood or warm milk. The leeches should be confined by an inverted glass or cup over the part from which the blood is to be 750 APPENDIX. drawn, and when a sufficient number have fastened, the glass may be removed. A few drops of blood should be first put on tteskin, or it may be rubbed over with a piece of fresh beef, and having wiped the leech dry with a linen cloth, take it between the thumb and finger by the middle, and apply its mouth to the spot you wish, remembering that the small end is the head, although the tail is much broader. When first applied it is apt to twist and extend it- self, attempting to seize on some other part, but it must be re- peatedly drawn back and re-applied, until at length it will fix upon the desired spot, and when it has taken a firm hold it may be left to the enjoyment of its labours. When the animal has fastened it expands the tail and sometimes attaches it to another part, and does not let go till it is gorged with blood, when it drops off all at once, A large leech will draw about an ounce of blood ; but the quanti- ty may be much increased by bathing the wounds with warm water, or applying over them cupping-glasses. It is on some oc- casions found necessary to employ from ten to twenty, or even thirty leeches in order to draw a sufficient quantity of blood. When they have gorged themselves with blood, they drop off and not un- frequently die of indigestion, and cause a great mortality even among those that have not been employed. To avoid this danger, leeches which have recently sucked should be kept by themselves until they have recovered their usual vigour ; and a little salt ap- plied to the head of the animal will occasion it to vomit up the blood which it has received. These insects change their skin fre- quently ; at that time they are subject to indisposition and will not, bite. OF COLD AND WARM BATHING. Baths receive various denominations, not only according to their different degrees of temperature, but also as to the manner and form in which they are employed. They are distinguished in- to the cold, tepid or temperate, warm, and hot baths. To these may be added the steam or vapour bath, the air bath, and earth bath. Baths may be either generally or partially applied. When water, either cold or tepid, is thrown over the body from a bucket, or by means of a constructed apparatus, in a shower, it is termed affusion, or shower bath* The immersion of the feet in warm or ' tepid water is professionally termed pediluvium; and when the lower half of the body is immersed in a similar bath, it is denomi- nated semicupium, When the naked body is exposed for a consi- derable time to the cold air, this is termed the air bath, a practice recommended by Franklin as a substitute for bathing ; and when the naked body is surrounded with sand, or buried up to the shoul- ders or neck in the earth, it is said to be placed in a sand bath j from which, however, very little utility can be expected. appendix. 751 The " cold bath is that which possesses the ordinary tempera- ture of the atmosphere in the temperate climates, varying from 32 to about 65 degrees of Fahrenheit's thermometer." Whether bathing in sea water, or in ponds or rivers, the effects cannot be essentially different. On some occasions, however, the salt with which sea water is impregnated may act as a gentle stimulus on the surface; and this effect will be increased by heat, friction, or a long immersion; but in cases where the immersion is only momen- tary, or where affusion is employed, and where the body is imme- diately dried, salt water can have no advantage over that which is fresh. The immediate effect produced in a person in ordinary health, on being immersed in the cold bath, is a sensation of cold and a sudden shock to the whole system, which is almost imme- diately succeeded by as general a sensation of warmth ; the latter rapidly increasing, so as to cause the surrounding water to feel of an agreeable temperature. After a sudden immersion, if the body be immediately wiped dry and clothed, the agreeable sensation of warmth continues, the system is invigorated, and generally the natural perspiration is promoted. If, however, the body continues long immersed, and the water be extremely cold, the sensation of warmth ceases, and is followed by violent shivering and numbness of the extremities, a series of alarming symptoms supervene, and at length delirium and torpor ensue, and the person is destroyed by a fatal apoplexy. The increase of animal heat which takes place immediately after the cold, occasioned by the first immer- sion, constitutes that re-action of the system, which enables it to resist an external impression by which it might be injured. This re-action is in proportion to the intensity of the cause by which it is excited, and to the vigour of the vital powers. It is this re-ac- tion of the system by which all the advantage from the application of the cold bath is derived; and when the re-action does not oc- cur, or takes place only in a small degree, it is evident that the eold bath has been injudiciously or excessively employed. When, therefore, the system has been debilitated by long continued exer- tion or disease, where the temperature of the body is below the natural standard, or where a profuse perspiration has come on, cold bathing should be avoided as injurious. The employment of the cold bath, it appears, is attended with three principal effects : a sudden and powerful shock given to the body, a sudden abstraction of heat from the surface, and the re- action of the system to counteract the shock, and to restore the diminished temperature. In its general and primary effect, there- fore, the cold bath acts as a powerful stimulus to the whole sys- tem, and to this effect its advantages as a remedy are chiefly to be ascribed. Cold bathing has been found by experience to prove highly advantageous in all those cases where the temperature of the body continues steadily above the natural standard, as in acute or ardent fevers, the hot stage of intermittents, yellow fever, &c. by reducing excessive heat and producing a salutary re-action of the system. It has been employed with beneficial effects in tetanus or 752 Appendix. lock-jaw, in those convulsions which so commonly affect young children, in insanity, and in "several chronic diseases, particularly chronic rheumatism. When used by persons in health, it increases the tone of the muscular fibre, strengthens the digestive organs, and by diminishing the sensibility of the whole system, and particular- ly of the skin, renders the body less susceptible of atmospheric impressions from cold, wet, and sudden changes of temperature ; thus contributing to the production of what is termed a robust or athletic constitution ; and thus fortifying the system against conta- gious and febrile diseases. It is peculiarly adapted to those con- stitutions which are often liable to hysteric, hypochondriacal and paralytic affections^ as well as to frequent attacks of flatulency and consequent indigestion, as it stimulates the nerves and excites to those powerful exertions on which the vigour of the system so much depends. Cold bathing is eminently beneficial in cases of rickets in children, and is useful to preserve them from the bowel complaints which prevail in the summer months throughout the United States. This powerful remedy is to be regarded as inad- missible in all those cases where the heat of the body is below the natural standard, or where a profuse perspiration has come on ; where there is any considerable degree ofplethora, or unusual ful- ness of the blood-vessels ; where the person is subject to inflam- matory affections of the lungs, or any considerable determination of blood to the head ; it should also be prohibited in haemorrhages, in constipations, difficult breathing, short and dry coughs, &c.; in scurvy, in fits of the gout; in cutaneous diseases, and where from constitutional weakness, or unconquerable dread, the use of this remedy may be productive of unpleasant feelings. With respect to the condition of the body when recourse may be had to this powerful agent, and the most proper mode of employing it, it must be remarked, that the morning or forenoon is the most suitable time, either when the stomach is empty, or two hours after a light breakfast. It is an erroneous and unfounded opinion, that immer- sion in cold water when the body is considerably heated by exer- cise or other exertion, is a dangerous practice ; on the contrary, no person should ever enter into it while the body is in a state be- low the natural standard, but should first employ such a degree of exercise as will produce some increased action of the vascular system with some increase of animal heat. It is in this condition of the body only that the application is productive of a shock, without which not the smallest benefit arises from cold bathing. In bathing, it is unquestionably proper to sink the head and Whole body under water with all convenient expedition 5 but to effect this, a headlong plunge is by no means requisite ; yet the more speedily this process is performed, the less will the bather be affected by a sort of convulsive respiration. The sobbing and irregular breathing produced on entering the water, are always most harassing while one half of the body is under water, and the other half exposed to the air. If in consequence of going into the appendix. 753 bath in an improper state of health, or of remaining too long in the water, the perception of cold and shivering should become painful or alarming,—the person ought without delay to be put into a warm bed, and a bladder filled with hot water should be applied to the pit of the stomach. The last experiment is the most effectual method of restoring warmth to the living body, in all cases where, from chance or necessity, it has been long expos- ed to intense cold. Independently of these circumstances, the practice of returning to bed, after bathing, is always to be repro- bated. Immediately after immersion the body ought to be rubbed with a dry and coarse cloth, and moderate exercise out of doors, if convenient, should be employed. If a glowing warmth pervade the whole body after retiring from the bath, beneficial effects will certainly follow ; but if the person feels heavy, inactive, or chilly, or finds himself affected with head-ach or tightness across the chest, it is evident that it disagrees, or that it has been too long continued, and may prove hurtful. The shower bath may often prove an eligible substitute for im- mersion, and on some accounts this possesses superior advantages, as considerable benefit is derived from the gravity as well as the tonic power Of the water. The head and breast are secured from danger by receiving the first shock, and the water is quickly trans- mitted over the whole body. The temperature and quantity of the water, too, may be more easily modified and adapted to the circumstances of the patient. From the foregoing observations it must appear obvious that the cold bath is capable of producing ex- traordinary effects ; and is not equally adapted to all constitutions and circumstances, nor can it be employed indiscriminately with perfect impunity. There is much reason to suppose that many invalids, delicate females, and young puny children, have been materially injured in their health by an injudicious and unadvised resort to this very powerful application. The tepid bath may be at the temperature of about 80 to 86 degrees, and the warmbath from 90 to 98 degrees of Fahrenheit's thermometer, or about the same temperature with the blood. It has been supposed till very lately that one constant effect of the warm bath is to relax and debilitate the body ; but numerous ex- periments seem to prove that this opinion was founded in error, and that, on the contrary, persons debilitated by disease, have felt stronger on the days when they used the warm bath, and were soon restored to their former strength. If in any cases relaxa- tion and debility follow the use of the warm bath, it is to be attributed to the heat of the bath having been too great for the constitution of the patient, or the immersion having been Contin- ued too long. The stimulant effects of the warm bath are very in- considerable, and it is found useful in allaying irritation, diminish- ing morbid frequency of the pulse, relaxing and purifying the skin, and in inducing sleep and repose. The warm bath will be attend- 95 754 Appendix. ed with advantage in those cases of fever where the heat is preter- naturally great, but where, from some affection of the lungs, or other unfavourable symptom, cold bathing is inadmissible ; in the paroxysms of hectic fever ; in several eruptive diseases attended with increased heat and dryness of the skin ; in atonic gout and rheumat.sm, accompanied with stiffness and swelling of the joints; in chlorosis ;* in slight cases of palsy ; in scrofulous swellings ; in some spasmodic and convulsive affections, where the cold bath might prove too violent; in all those affections of the bowels that seem to depend an an irregular or diminished action of any part of the alimentary canal; and in cases of debility attended with ner- vous irritation. In cases of predisposition to phthisis, it abates the frequency of the pulse, and tends to retard, at least, if it does not wholly prevent, the pulmonary affection. The time of contin- uing in the warm bath should be varied according to tbe temper- ature of the water and the feelings of the patient. In a bath of ninety-six, a person may remain fifteen, twenty, or thirty minutes ; but in one of ninety-eight or one hundred, which is the tempera- ture of the hot bath, ten minutes is the extent to which most per- sons can bear. When the warm bath is intended to produce in- creased perspiration, it is best employed in the evening, and the patient should be removed from the bath to a warm bed. Where, however, it is not intended to excite sweating, the most proper time is about two hours after breakfast; and after bathing, gentle exercise in the open air should be employed. Friction with a coarse cloth while in the water will often prove extremely benefi- cial. The vapour or steam bath is a modification of the hot bath. " It consists in the application of steam, brought by pipes from a vessel of boiling water, and either admitted to the whole body placed in a chamber for that purpose, or to any particular limb enclosed in a proper apparatus. The room is heated to a tem- perature considerably above that of the atmosphere, and the naked body is for some time suffered to remain in this heated air ; the common effect of which is to increase its temperature, and accele- rate the circulation of the blood. After some time the steam is admitted, and a profuse perspiration is soon produced. This is generally promoted by friction, and a removal to a warm bed. The general effect of this process is, to relax the body, remove ob- structions of the skin, alleviate pain and spasmodic contractions, and promote sleep." For the substance of the foregoing observations, the public are indebted to the late ingenious Dr. Currie, of Liverpool, and to Dr. Sanders on mineral waters, an account of which may be found in the original works, in Rees' Cyclopaedia, Edinburgh Encyclopae- dia, and American New Dispensatory, 2d edition. The vapor bath has been recently introduced into the United States. It consists in applying to the skin and inhaling into the lungs, a warm and rarefied atmosphere, charged with aqueous va- pour. This vapour may be medicated by containing the volatile APPENDIX. 755 principles of certain vegetable substances. In this bath the heat of the surface of the body is raised, perspiration follows, the blood- vessels of the skin being filled and excited to a brisk action. The temperature and fluids of the system are thus equalized and pro- perly distributed. This bath oures or relieves a greater number of morbid affections and derangements of the animal mechanism than any other form of bathing; and what renders it peculiarly valuable and acceptable, is the speedy and entire relief it affords in numerous instances. It is highly useful in rheumatism, cuta- neous complaints, scrofula, palsy, gout, catarrh, febrile affections, piles, scanty, difficult and painful, or suppressed menstruation, erysipelas, &c. &c. 0F THE ifflNERAL WATERS OF BALLSTON AND OF SARATOGA. THE DISEASES IN WHICH THEY MAY BE EMPLOYED AS REMEDIES. Among the numerous medicinal springs of which the United States can boast, those of Ballston and Saratoga have obtained the greatest celebrity, and become a fashionable annual resort of a train of invalids from various parts of the union. It is therefore essentially important thai their medical properties and virtues be clearly ascertained, and the diseases in which they may be success- fully employed accurately discriminated. " For it is an unques- tioned law in medicine, that that which possesses active curative powers in one set of diseases, is equally detrimental in others." Both Professor Hosack and Dr. Valentine Seaman, one of the surgeons of the New York hospital, have devoted considerable at- tention to the analysis and experimental investigation of the min- eral waters of Ballston and Saratoga. The sentiments of the for- mer gentleman have been promulgated in the American Med- ical and Philosophical Register, and those of the latter, in an in- genious dissertation on the mineral waters of Saratoga, &c. It appears from their experiments, that " the carbonic acid, salt and iron, are the principles upon which we should chiefly ground our cal- culations of the use of these waters ;" and that diseases of debility are those in which they are prescribed with the greatest advantage and success. In dyspepsia these waters have been found eminent- ly beneficial, and in dropsy, hypochondriasis, hysteria, paralysis, chronic rheumatism, gout in its chronic state, and in chlorosis, and fluor albus, they have been employed with much advantage. But in calculus or gravelly complaints, these waters have been found singularly efficacious. " Here, then," says Dr. Seaman, " we have in these waters all the remedies that have proved the most efficacious in such affections, viz. a superabundant carbonic acid, the carbonate of soda and lime. Indeed, the benefit experienced - by those who have drank of them fully answers our expectations. A number of cases have come within my own particular know- ) 756 APPENDIX. ledge ; and Dr. Powell, whose long residence at the springs has given him a full opportunity of ascertaining the fact, assures me they are a valuable remedy in gravel, and that he has rarely seen a case of it where relief was not obtained." Other diseases in which these waters have afforded relief, are phagedenic and gan- grenous ulcers, and various cutaneous eruptions, fevers and agues and scrofulous affections. In a plethoric state of the system, in consumption of the lungs, inflammation of the liver, acute rheumatism, and other inflamma- tory affections, these waters are invariably injurious. DR. JENNINGS' PATENT PORTABLE WARM AND HOT BATH. By the polite attention of Dr. Samuel K. Jennings, I am autho- rised to occupy a few pages with an account of his new method of restoring warmth and heat to the surface and extremities of the body, by his patent warm and hot bath. A concise detail of his practical instructions must suffice on this occasion. It may not be improper to premise, that the spirituous vapour bath has been test- ed by repeated practical experiments in various hands, and receiv- ed the sanction of the government of the United States; the Surgeon General of our late army, several hospital surgeons, and numerous individual medical and other respectable charac- ters. Since the visitation of the ravaging epidemic called spotted fever or cold plague, which is always attended with a torpid state of the vessels of the surface and extremities, physicians have been induc- ed more than formerly to appreciate the means of applying artifi- cial heat to restore the balance of excitement. Among the various applications employed for this purpose are, the warm bath, steams of hot water, billets of wood heated, twigs of pine or hemlock heated by hot stones, bladders or jugs filled with hot water, &c. The most of these have their inconveniences and defects, and it has long been a desideratum in practice to devise a more eligible mode of fulfilling the indication. In the discovery of Dr. Jennings we have the means of administering dry heat with the greatest facility and success, free from many of the evils and inconveniences of the usual methods of applying heat to the body. His method consists in conveying and diffusing the gas of burning alcohol or ar- dent spirits over the body of the patient. The tin cup containing burning spirits is placed on the floor, and a tin tube of proper length shutting over it, conveys the gas to the patient in bed. " By this invention," says the author, il every physician, and indeed every family may be furnished with a convenient, elegant and de- lightful method of applying heat. It may be put into operation in five minutes. The apparatus may be carried in a large pocket; it would scarcely incommode a pair of saddle-bags in travelling. It does not weigh three pounds. It may be applied to a patient APPENDIX. 757 seated in a chair or lying on a couch, sofa, cot, or bed. It is used without water. And it can be safely applied to patients in the most helpless condition. So far as I have been able to extend my inquiries, my system is original."* The following is an abstract from one of the author's pamphlets. " Heat is an agent which admits of such general application. Applied to the surface in an intense degree, it extinguishes vital power, and thus safely in a direct way lessens the force of feverish excitement. " In the same mode of application it necessarily must be a pow- erfully diffusive agent, and furnishes the most natural and certain method of correcting any local affection. And when gradually appli- ed in an agreeable temperature, it will never fail to produce cordial effects. And in fact in every delicate case, where a stimulant dose as wine or laudanum is absolutely necessary, these remedies would be infinitely more safe and effectual if a pleasant application of heat were first administered. With suitable variation in the degree and continuance of the treatment, according to the degree of violence of the disease, the patent steam bath will be useful in all the following forms of disease, viz. " In colds, catarrhs, coughs, pleurisies, and in fever in its vari- ous forms, including that form of it now raging in different sec- tions of the country and called by different names ; none of which perhaps is more appropriate than that of the western country, where it is called the ' cold plague or cold skin fever.7 In local inflammations and other local affections, as sore breasts in female cases, in swelled glands, anthrax or carbuncle, sore throat, quinsy, ear-ach, tooth-ach, head-ach, especially that of the nervous kind, and in inflamed wounds, &c. In scrofulous, glandular, ulcerous, and eruptive affections, including St. Anthony's fire, nettle-rash, scald head, &c. In suppression of urine and other painful affec- tions of the bladder, &c. In piles, whether blind or protruded. In haemorrhage, whether from the lungs,, as in hemoptoe, from the nose or urethra, &c. In excessive fatness, in old age, &c. And in gout, rheumatism, and other similar painful affections." * Directions for using the Steam Bath. " In any case of sudden emergence, the bath may be administer- ed by supporting the bed-cloihes with a staff or board of suitable length, or with any sort of a temporary frame, taking care to use a sheet or two of paper to defend the bed from being scorched, and to adjust the whole affair so as to secure a free diffusion of the heat over the body of the patient. " There should be provided in every family where the bath is used, a suitable frame for the purpose. It might be something * I have been apprised of the curious fact that the " apparatus of Dr. Jennings is exactly described in a German publication two centuries ago." It is by no means to be supposed, however, that the Doctor ever had access to that source of informa- tion. 758 APPENDIX. like the following description .-—Half a circle or a half-hoop of good strength and twenty-two inches in diameter, will form the end which is to stride across the body of the patient a little be- low the breast. A half circular plank, eighteen inches in diame- ter, will make the foot end of the frame. A thin board four feet long should cover the top, and a lath or two of similar length should secure each of its sides. A hole of suitable size should be made in the middle of the foot end for the introduction of the tube.* " The patient should be stripped of all his clothing except his linen which after the bath goes into operation, he may draw up to his chin. The frame is to be laid over him in bed, and a sufficient weight of bed-clothes should be used so as to confine the heat properly. A sheet and four or more blankets, or other covering to that amount for the winter season; a blanket less will serve for the summer. The bath is applied at the feet, which is most pro- per in all ordinary cases, and the gas has a free opportunity to diffuse itself all round the body of the patient, which is always im- portant. The weight of the bed-clothes being properly sustained by the frame, he can turn himself over at pleasure, which will give him the advantage of warming first one side and then the other, as it may be most agreeable to his feelings. " Complaints should always be met at their first appearance, before the patient is exhausted by disease. In cases of very ro- bust patients it is often safest to take some blood before the bath is applied, especially in the winter and spring seasons of the year. And it sometimes happens in recent painful cases, in which the propriety of blood-letting may be doubtful, that the bath produces partial sweating and temporary ease, but presently tbe perspiration suddenly dries up, and the pain increases. This circumstance will at once determine the necessity of blood-letting, which in such an instance will be found more effectual after the bath than it would have been if performed prior to its application. " In some instances also, when the bath is administered to pa- tients inclined to be feverish, when blood-letting has not been pre- mised, and especially when too small a cup has been used, an un- comfortable restlessness is felt. This circumstance, as well as the head-ach, if they continue any length of time after the bath, should be relieved by some agreeable cathartic dose, and blood-letting when necessary. " In cases where it may be used with great decision, it com- monly produces some throbbing of the head. When this appear- ance is considerable, the process may be discontinued, and if blood- letting is not necessary, the throbbing will quickly subside, leaving no inconvenience to the patient. In delicate cases, however, it ought not to be pushed up to this pitch ; the fire should be lighted up and extinguished alternately, as it may be found agreeable to the patient. * This frame is highly important, and in many cases indispensable. In pleurisies and other violent cases, the heat ought to act at once with considerable violem* upon the whole surface. APPENDIX. 759 " In cases of feeble and very old persons, the smaller cups ought to be used ; and in most instances it ought to be repeated once every sixth hour, sometimes once every third hour. Meanwhile the patient should be supported by nourishment and cordials.* " Sometimes it may be beneficial to remove the apparatus from the feet to the side of the patient, and so on alternately, as the judgment of the practitioner will quickly discover. " In cases of long standing debility, it sometimes happens that the bath is scarcely put into operation before the patient feels dis- tressing sickness and faintness. When this happens, let the fire be extinguished, and give a glass of wine and water, and when suf- ficiently refreshed, re-kindle the bath. In such delicate cases it is frequently necessary to use laudanum as well as the wine and wa- ter. Say ten, fifteen, twenty, or thirty drops, to be given at the close of the process. " In almost every enfeebled case of any standing, it is necessa- ry after the bath, to use jugs or bottles filled with boiling water, or hot bricks, to aid the weak excitement of the surface, that it may retain the advantages gained by the bath ; and in some cases blis- ters should be added. " When the patient is not much reduced, and seems to be too loag coming into a state of perspiration, I always add more heat. If two or more cups cannot stand within the base of the bath, I place it upon them in any way I can, propping it up with bricks, or any other convenient support. The heat of two or three cups will be drawn up by the tube. If the patient complain too much I remove one of the cups for a few seconds, and replace it so soon as the heat a little subsides. By this method my object is more speedily, certainly, and safely accomplished." WEIGHTS AND MEASURES EMPLOYED IN MEDICINE. The weights usually employed are those commonly called Troy weight. The pound is thus divided. A pound, frj") g C 12 ounces, 3xij. An ounce, 3j 1 "» J 8 drachms, 3 viij. A drachm, 3j | | ] 3 scruples, 9iij. A scruple, 9j 3 « ^20 grains, gr. xx. The wine gallon measure is divided as follows : A gallon, congj ") g C 8 pints, Oviij. A pint, Oj I -g I 16 fluid ounces, fgxyj. A fluid ounce, f 3 j [ % ] 8 fluid drachms, f 3 viij. A fluid drachm, f3j \ w (.60 minims, mjx. * In such a case the intention should be to warm the patient effectually, but nftt to produce a sweat. 760 APPENDIX. When medicines are directed in the quantities of a table- spoonful, and of a tea-spoonful, it is to be understood that the spoons are of the medium size, the former equalling about half a fluid ounce, and the latter a fluid drachm. When a dose is measured by drops, the size of the drops is lia- ble to vary according to the form of the mouth of the bottle, and specific gravity of the liquid, &c. But it is in general to be esti- mated that sixty drops of water, one hundred drops of spirits and tinctures, and one hundred and twenty of alcohol, are equal to a drachm by measure. OF MEDICAL PRESCRIPTIONS. Much accuracy and attention ought to be observed in the form- ing a medical prescription. This point, however, in practice is too often inexcusably disregarded, and not unfrequently the inten- tion of the prescriber is entirely frustrated by an unchemical mix- ture of substances of opposite virtues. Simplicity, neatness, and elegance, should always be regarded, so far as will comport with the object of the prescription. No unnecessary article should e_yer enter the composition, and the taste of the patient dught as much as possible to be consulted. The doses of medicines are to be ad- justed according to the age, sex, temperament, idiosyncracy, habit, and disease. Women in general require smaller doses of medi- cine than men; and the sanguine less powerful doses than the phlegmatic and melancholic. There is in some constitutions a pe- culiar disposition to be affected with certain causes, in a manner different from the generality of mankind. This, which is termed idiosyncracy, requires to be attended to by the prescriber. Habit too has an important influence on the operation of medicines. In general all strong stimulants and narcotics lose some of their pow- er by being long continued. Thus the inebriate, habituated to large quantities of ardent spirits, can bear ten times the quantity of opium, to that of other persons. In a state of disease, the doses of medicine must be regulated according to the greater or less degree of susceptibility to external impressions. The following table will shew the proportions from infancy to adult age. Let the dose for a person of middle age For one from 14 to 21 years, it will be 7 to 14 4 to 7 - of 4 years of age 3 - - - - I or eight grains. - ,*„ or five grains. be 1 or one drachm. § or two scruples. \ or half a drachm. \ or one scruple. \ or fifteen grains. A or half a srriinlf>. 2 - 1 APPENDIX. 761 GENERAL -HOSPITAL. It is with the highest degree of satisfaction that the author can greet the citizens of his native state on the noble acquisition of a hospital establishment in our metropolis. A more glorious monu- ment of private and public munificence, has not been exhibited in modern limes. The Method of obtaining admission into the Hospital is as follows: Application for admission, in writing, mentioning the place of residence of the patient, must be left at the Ho&pital. Upon the receipt of this application, the physician or surgeon will visit such patient, if residing in Boston ; and if the patient is free from a contagious disorder, and is a fit subject for the Hospital, a certifi- cate of admission will be granted. If such patient does not reside in Boston, the application must be accompanied with a certificate from a respectable physician, stating that the patient is free from contagious disorder, &c. The application of the patient and the certificate of the physician will be laid before the visiting commit- tee, at their stated meeting on Thursday. They will then fix the rate of board, which in the present state of the funds cannot be less than three dollars a week ; but such rate shall always be as low as the funds will permit; and the committee will also pre- scribe what security shall be given for the payment of the same. The sum fixed, will include medicines, medical attendance, nurs- ing, food, and every other expence. In case of accidents in the streets, or elsewhere, or of sudden disease, the Hospital will be open for the receiving of patients, without delay, both day and night, and no written application will be required. A Trustee, or the Physician, or Surgeon, may, at any time, dispense with the written application, and cause any pa- tient to be admitted by an order. The Hospital is also open to strangers, and persons from all parts of the Commonwealth, who will receive all possible attention, at a rate of board as low as the funds will permit. SOPHORA TINCTORIA, (Lin.) WILD INDIGO, INDIGO WEED, This plant is perennial, growing in great abundance in almost eyery barren pasture, and in w°°ds. The stem rises to two feet or more, is smooth, sending off numerous branches. The leaves are in threes, on short petioles inversely heart shaped, and sessile. In July and August all its branches display butterfly shaped gold- en coloured blossoms, which render this plant very conspicuous. The seed vessels are inflated, containing numerous seeds. The root is ligneous, roiiedi and irregular in shape, and sending off ma- 96 762 APPENDIX. ny slender branches. Its taste k unpleasant, sub-acrid, and nau- seous. The particular medical properties of this plant are yet to be ascertained. Internally, in a large dose, it operates as an emet- ic and cathartic; but a weak decoction of the root acts only as a mild laxative, but it is not much to be recommended for these in- tentions. My own experience of this plant for several years, has been confined to its qualities, as an external application to vitiated ulcers, of almost every description, and it has in many instances surpassed in efficacy any other remedy which I have ever employ- ^ ed,^ By my request, several practitioners of reputation and expe- ^wrience, have been induced to adopt the use of this article, in whose lrahifek4Lhas not disappointed the most sanguine expectations. In aphthous^rn^jjher ulcers of the mouth, sore nipples, in various painful ulcers, discharging acrid matter, the assuaging and healing qualities of an infusion of this root, by way of lotion, has been most strikingly manifested in practice. Reports have been made to me of its peculiarly pleasing effects when applied to obstinate syphilitic ulcers, mercurial sore mouth, and ulcers of a putrid and gangrenous tendency. It is undoubtedly, in some sense, an anti- septic. We are particularly indebted to William Tully, M. D. President and Professor of Vermont Academy of Medicine, for his experimental trials of the wild indigo root. His observations fully corroborate the foregoing remarks ; and, moreover, that when administered internally, it acts upon the absorbent and the nervous system, often increasing the secretions from all the glandular visce- ra, but more particularly from the liver, and is especially adapted to the atonic varieties of acute and sub-acute rheumatism, and the atonic variety of pneumonia. Its external application, he adds, is useful to vitiated, irritable, and painful ulcers, generally, as it is capable of correcting and restraining their foul discharges, and ob- viating their irritability and pain. It is capable of arresting or re- tarding the progress towards a gangrene, in many cases of erythe- matic or erysipelatous inflammations, and is of use in aphthae, ul- cuscula oris, mercurial sore mouth, ulcerations of the tonsils and fauces, burns and scalds, and chronic inflammations of the eyes, &c. For farther particulars relative to this article, the reader is re- ferred to the American new Dispensatory, 4th edition. CEPHALANTHUS OCCIDENTALS. BUTTON BUSH. " Button bush, or river bush, is a frequent ornament of the water side, its insulated thickets furnishing a safe retreat for the nests of the black-bird. The shrub rises five or six feet out of the water, its leaves are tough, spreading, pointed and entire. In the month of July it puts forth its spherical heads of flowers, which at a distance appear not unlike the balls of the plane tree. Re- ceptacle globules^ of the size of a large pea, covered with whitish APPENDIX. 763 funnel shaped flowers. The long projecting stamens give to the whole a bristly aspect." (Bigelow.) This shrub has been found to posssess very considerable diure- tic powers. It is frequently resorted to by those who are in the habit of prescribing without the advice of a physician, and by whom it is held in great estimation in cases of ischuria, dysuria, or strangury. The leaves, flowers, and twigs, gathered in the flowering season, are infused in boiling water, and taken to any quantity. It seldom fails in a few hours of giving relief so much desired in complaints of the urinary passages generally, and of promoting a free discharge of urine, even in some cases where the use of the catheter would seem to be the only remedy. COLCHICUM AUTUMNALE. MEADOW SAFFRON. This plant has not been discovered as a native of the United States. From the root the Eau medicinal is prepared as follows. Take two ounces of the root of colchicum, cut it into slices, mace- rate in four fluid ounces of Spanish white wine, and filter. The root should be taken up from the beginning of June to the middle of August. The virtues of the bulb of the root must be extracted as soon as gathered, as the bulb will continue to grow although out of the earth. The dose of the saturated vinous in- fusion, the only form in which its successful operation can be in- sured, is from half to one drachm, whenever the patient is in pain. A vinous tincture of the seeds may be employed, but the seeds need not be bruised when made into tincture. The medicine is found to be almost infallible in the cure of paroxysms of gout, and is of great use in rheumatic affections. ARACHNE. COBWEB. This extraordinary article has been taken from empirical hands, and sanctioned by medical authority as a remedy in diseases. It has been said, however, that the web woven by a particular species of spider is to be selected as the most efficacious, but we are un- acquainted with the means of designating the genuine species. The web commonly to be met with has been employed, and with complete success, in various hands, in the cure of intermittent fe- vers. Dr. Robert Jackson, a distinguished English physician, in detailing his successful experiments with the spider's web, in the cure of intermittents, goes on to say, that he can attest by living evidence, that cobweb diminishes morbid irritability, and calms irritations, both of body and mind, in a degree far exceeding any drug or medicine within his knowledge. Other practitioners, in- duced by the evidence afforded of the virtues of this substanre. 764 APPENDIX. have given it a trial, and are satisfied of its palliative and anodyne properties, producing the most delicious tranquillity, resembling the effects of opium, and followed with no bad effect. Although few will be willing to swallow the disgusting animal itself, the deli- cate fabric which it forms may be received by the most squeamish stomach when enveloped in a mucilage of gum arabic. About three or four giains of the web is given every few hours until the ague fits are subdued, and with the view of appeasing nervous irri- tations and mental inquietude, it may be taken in the form of pills of two grains, until relief is obtained. It were to be wished that cobweb may have a trial in delirium tremens. A more extensive experience will, we hope, develop the peculiar properties of this singular remedy. SULPHATE OF QUININE. This is a preparation from the Peruvian bark with sulphuric acid. Two pounds of bark it is said will yield from five to six drachms of the sulphate, of which eight grains are considered equivalent to an ounce of bark ; of course one grain will be a large dose. It is given with satisfactory success in intermittents, and generally in those cases where cinchona has proved efficacious, and as a febrifuge it has gained a high reputation. R Sulphate of Quinine, one scruple, Lemon Syrup, one ounce, Distilled water, three ounces, Diluted Sulphuric Acid, fifteen drops. M. Rub the sulphate with the syrup and the acid, and then add the water. Dose, a tea-spoonful three or four times in a day. , SANGUINARIA CANADENSIS. BLOOD ROOT. This indigenous plant is common in the United States, and its valuable properties as a substitute for digitalis in coughs and pul- monic affections, are pretty generally known, but its active powers as an external application are not so well understood. It is one of the best escharotics when in fine powder it is sprinkled over ulcers, especially those ulcers of the leg peculiar to old people that have baffled the skill of many surgeons, the daily application of blood-root has been employed with wonderful cures. The ich- orous discharge generally soon exhibits a healthier appearance, and granulations rapidly close the ulcer. In those obstinate and troublesome ulcers of the mamma which so frequently occur, by the continued use of the blood-root the spongy appearance and fiery redness soon disappear, and a speedy recovery generally takes place. Blood-root, when strongly infused in vinegar, cures APPENDIX. 76j the itch, herpes, and other cutaneous affections, if properly applied to the parts. The following preparation has proved a valuable auxiliary remedy in coughs and pulmonic affections attending tho influenza. R Blood-root, bruised, Lycopus Europeei, a a, three ounces, Distilled Water, six pints. Boil to three pints, strain and add of loaf sugar three pounds, to make a syrup, which, before it is quite cold, flavour with essence of checkerberry, q. s. Dose, a table-spoonful for adults, three or four times a day. PHYTOLACCA DECANDRA. COAKUM, POKE-WOOD. It grows in waste grounds, and by sides of roads, having branch- ing purple stems, five or six feet high. The leaves are large, flowers in long simple racemes of a dull white, succeeded by large flat berries, affording a juice which gives a purple dye. All the parts of this plant are endowed with medicinal virtues. An extract may be made by boiling down the root in the same manner as other extracts. When the leaves are to be employed, they should be gathered in July, when the foot stalks begin to as- sume a reddish colour, dried in the shade, and powdered for use. A tincture may be made by dissolving the extract, or macerating the root or leaves in proof spirits. From eight to ten grains of the dried root or the leaves, or a table-spoonful of the saturated tincture, may be considered as a proper dose ; an over dose will operate as an emetic and cathartic, The cases in which this arti- cle has been found of great utility, are rheumatism, but more es- pecially in those rheumatic affections which sometimes occur to syphilitic patients, in which it far exceeds the use of opium or guaiacum, as it possesses a degree of narcotic power. The leaves or root infused in water, has proved an admirable remedy in piles. It is given freely internally for this purpose, and if it do not give speedy relief, it is to be injected into the rectum. Externally ap- plied, it cures scabies and herpes, and it has the effect of a mild vegetable caustic, cleansing and healing foul ulcers better than most other remedies of that class. It should be tried in syphilitic ulcers, as a substitute for the nitrate of silver. LYCOPUS EUROP^US, WATER HOREHOUND ; OR LYCOPUS VIRGIN1CUS, BUGLE WEED. This grows spontaneously about creeks and low lands, rising from eighteen inches to four or five feet; the stalk is square, grooved, giving off branches, leaves opposite and alternate upon 766 APPENDIX. different sides, thin, narrow, the lower ones deeply, the upper ones more slightly toothed. Flowers in whorls, small, white, in August and September. This plant has been brought into notice recent- ly, by some persons who have experienced in themselves and others the greatest benefit in the cure of hemoptysis and other similar complaints. It has attracted the attention of practitioners, and is found deserving of further trials as an auxiliary in coughs and many pulmonic affections. CARBO LIGNI. CHARCOAL OF WOOD. It is important that this article be properly prepared for medi- cinal use. The most eligible process for preparing charcoal free from all impurities and disagreeable taste, is to enclose small billets of wood (oak, walnut or maple are best) in an iron cylinder hav- ing a tube fixed to one end, and distil them until no more smoke or water escape from the tube. Then put out the fire, and close the mouth with clay until the cylinder cool. The barrels of old guns may serve for this purpose ; or the pieces of wood may be put into a pot not closely covered, and surrounded with live coals, until all smoke from the pot shall cease. Then remove the coals, and closely lute the cover with clay until the pot cool. Any com- mon well-burnt charcoal, if pulverized and heated in a covered crucible to a glowing red, till it cease to give out any inflammable vapour, will answer the purpose. But by whatever process it be prepared, charcoal should be immediately secured in well stopped glass bottles, and in that way it may be preserved unimpaired for any length of time. Charcoal is of great use in various diseases, in doses of from twenty to thirty grains. It cures intermittents, and is useful in dyspepsia, habitual costiveness, foetid breath, and is a good tooth powder. Externally applied, it arrests the pro- gress of mortification, corrects the foetor of vitiated ulcers, and pro- motes the healing process, and will cure tinea capitis. WATER OF ACETITE OF AMMONIA, SATURATED WITH CAR- BONIC ACID GAS. R Take one ounce of pure sal ammoniac (carbonate of ammo- nia), and one pint and a half of distilled vinegar ; put the latter in a decanter, provided with a close glass stopper, then introduce the salt previously broken into lumps, but not too small, as by plung- ing it too suddenly into the liquor the extrication of the gas would be too quick, and a quantity of it dissipated. Next the stopper of the bottle should be tied over with a bit of leather, and the whole be left undisturbed. It would be further useful, to add on the top APPENDIX. 767 of the bottle some weight or pressure, by which means the combi- nation of the gas with the water will be greatly facilitated. After having stood a few hours, the ammonia will be dissolved, and the gas will be absorbed by the liquor. By this simple process the water of acetite of ammonia becomes strongly impregnated with fixed air, while it is almost entirely deprived of that disagreeable taste which is peculiar to this medicine when prepared in the usu- al way. This preparation possesses superior advantages as a feb- rifuge, and it generally agrees with weak and irritable stomachs which can retain scarcely any other medicine. Tincture of Guaiacum Volatile, by Dr. Dewees, R Powdered Gum Guaiacum, three ounces, Carbonate of Soda, or Potass, three drachms, Pimento powdered, two ounces, Diluted Alcohol, two pounds. Digest. The volatile spirit of sal ammoniac to be added pro re nata, in the proportion of a drachm to every four ounces of the tincture. If to one ounce of the above tincture be added one ounce of the tincture of blood-root, and two drachms of the tincture of bark Hux. we have an excellent preparation for dyspepsia. Two tea- spoonfuls of this compound half an hour before eating, or two or three times in a day, will effectually prevent the food from op- pressing the stomach. Essence for Head-ach. R Alcohol, four ounces, Gum Camphor, two ounces, Spirit Sal Ammoniac, or aether, two ounces.. Mix thoroughly, and apply with the hand. Emulsion for Catarrh and Cough. J§, Oil of Sweet Almonds, one ounce, Barley Water, six ounces, Best White Sugar and Gum Arabic powdered, of each half an ounce, Liquid Laudanum, forty drops. Incorporate the sugar and gum arabic together in a mortar with a small quantity of the barley water, then gradually mix the oil, and afterwards add, by little at a time, the remainder of the water with the laudanum. A cupful of this emulsion may be taken fre- quently. 768 APPENDIX. Pectoral Decoction for Colds. R Linseed, four ounces, Liquorice root, one ounce, Raisins or figs, four ounces. Simmer them moderately in two quarts of water till reduced to one, then add a quarter of a pound of sugar-candy, powdered, a table-spoonful of old spirit, and the same quantity of vinegar or lemon juice. Drink half a pint at going to bed, and a cupful whenever the cough is troublesome. Efficacious Mixture for Cough in Hectic. R Balsam Copaiva, half an ounce, Compound Spirits of Lavender, and Sweet Spirit of Nitre. each one drachm, Laudanum, one drachm, Gum Arabic, two ouncesj Distilled Waterj four ounces. M. Dose, a table-spoonful morning, noon and night. Cough Mixture. R Paragoric elixir, one ounce, Powdered gum arabic, one ounce, Simple water, two ounces, Sweet spirit of nitre, two drachms, Antimonial wine, one drachm. Mix and dissolve. One table spoonful to be taken whenever the cough is trouble- some. But in the first stage of catarrh, when inflammatory syrap* toms are present, this and all opiates are improper. Receipt for a Cough. R Gum ammoniac, two drachms, Syrup of squills, half an ounce, Liquid laudanum, fifty drops, Pure water, six ounces. Reduce the gum to powder in a marble mortar and gradually add the water, and triturate till the gum is dissolved, then strain from, the impurities and add the other articles. Dose, a table- spoonful three or four times a day. Another. R Elixir paragoric, one ounce and a half, Wine of antimony, one ounce, APPENDIX. 769 Syrup of Squills, one ounce, Lac ammoniac, four ounces, Syrup bal. tolu, one ounce. Dose, half a table-spoonful every two or three hours. The following is highly esteemed by those who have experi- enced the use of it. R Tincture of opium, one drachm, Wine of Ipecacuanha, half a drachm, Oxymel of squills, half an ounce. M. Dose, seventy drops every two hours while.the cough is severe. Cough mixture. R Bal. traumat, two ounces, Liquid laudanum, one ounce, Syrup bal. tolu. two ounces. Dose, tea-spoonful three or four times in a day. Pills for Coughs. R Calomel, twenty-four grains, Squills powdered, half a drachm, Tartarized antimony, six grains, Gum opium, eighteen grains. M. f. pills No. 24, Dose, one every nig&t. Domestic Remedies for Hooping Cough. Dissolve thirty grains of salt of tartar or sal aeratus in a gill of Water, add to it ten grains of cochineal finely powdered, sweeten this with fine sugar, and give an infant a tea-spoonful four times a day. To a child of two or three years old, two tea-spoontuls, from four years and upwards, a table-spoonful or more may be taken. The relief is said to be immediate, and the cure in general. within five or six days. Another, Take equal portions of new milk and the ley strained from hickory ashes, of which one table-spoonful may be given every hour through, the day to a child of seven or eight years old. This remedy is strongly recommended in the National Register, a very respectable newspaper, in which it is stated that the good effects of this remedy have been witnessed in upwards of ntty cases. Febrifuge Mixture R Glauber's salts, one ounce and a half, Lemon juice, one ounce, 97 770 APPENDIX. Boiling water, half a pint, Loaf sugar, two ounces. Mix and dissolve. When cold, add sweet spirit of nitre, two drachms. Dose for an adult, two table-spoonfuls every hour until it pro- duce a cathartic effect, afterwards in small doses as an alterative. Or, R Sal nitre, half an ounce, Simple water, half a pint, Lemon juice, half an ounce. Mix and dissolve. Let it be kept in a corked bottle, and give a table-spoonful every hour during the continuance of fever. Febrifuge Powder. R Sal nitre, one drachm, Tartarized antimony, three grains, Gum opium, six grains, Calomel, ten grains. Mix and divide into ten doses.—To be administered one every third hour. Solution of Tartarized Antimony. f Let six grains of emetic tartar be dissolved in eight ounces o water; distilled water is preferable. If to promote vomiting, give two table-spoonfuls every fifteen or twenty minutes. If to excite a diaphoresis in fevers, one table-spoonful is to be given every six hours. Dr. G. Fordyce asserts that he has seen in less than five hours after the exhibition of this medicine, the symptoms of a crisis, and the fever has ceased in less than twelve hours ; in a large pro- portion of cases it will succeed if exhibited within the first three or four days of continued fever. The same author observes, that if tartarized antimony be dissolved in a large quantity of water, it will be decomposed in case the solution be suffered to stand with a surface exposed to the atmospheric air, as in an open vessel. It is therefore m'ich better dissolved in wine in the proportion of a quarter of a grain to half a drachm of wine. But in every instance care should be taken that the antimonial powder be fairly dissolved, and not permitted to subside to the bottom, and be unequally distributed. This preparation is much employed by respectable physicians for the purpose of increasing the gastric secretions, and maintaining for a length of time a soluble state of the bowels. Yeast for Medicinal Use. Thicken two quarts of water with about three or four spoonfuls of rye maal or fine flour; boil for half an hour, sweeten with half a pound of brown sugar ; when near cold, put into it four spoonfuls of fresh yeast, shake it well together in a jug, and let it stand one APPENDIX. 771 day to ferment near the fire without being covered. Pour off the thin liquor on the top, and cork up the remainder for use. Or, Boil one pound of clean washed potatoes to a mash, when half cold add a cup full of yeast, and mix it well. It will be ready for use in two or three hours. Another Method. ] Take one pint of yeast, and add half a pint of molasses and one quart of hike warm water. Stir these well together, and let it stand in a moderately warm place till active fermentation becomes evi- dent; then it may be kept in a cool place for the patient's use. In warm weather it should be prepared fresh every day. Yeast has acquired considerable celebrity for its virtues in the cure of putrid fever and malignant ulcerous sore throat. It is to be exhibited in doses of two spoonfuls every two or three hours; should it purge or gripe, the dose must be diminished. Cathartic Pills. R Calomel, three drachms, Jalap in powder, three drachms, G. gamboge, one drachm and a half, Squills, forty grains. M. Mucilage of gum arabic, q. s. f. pil. No. 160.—Two or three pills for a dose. R Gum aloes, G. gamboge, sal nitre, equal parts. M. Mucilage of gum arabic, q. s. f. pil.—To contain five grains each.—Two or three for a dose. Pills Foztida with Opium, R Gum asafcetida, three ounces, Aloes sue, one ounce, Opium, one drachm, Soap, half an ounce. M. Common syrup, q. s. f. pil. No. 480. In nervous cases attended with flatulency, three or four pills taken at night will produce excellent effects. Pills of Digitalis for Cough. R Digitalis, in powder, eighteen grains, Opium, in powder, six grains. M for 24 pills. Take one pill 3 or 4 times daily. Cough Pills. R Ipecac, in powder, and squills in powder, each 8 grains, Opium and conserve of roses, each 10 grains. M for 20 pills. Take one every night and morning. 772 APPENDIX. Chalybeated Myrrh Pills. R Myrrh powdered, two drachms, Carbonate of soda, sulphate of iron and sugar, each one drachm. Rub the myrrh with the carbonate of soda, add the sulphate of iron, and rub them again, then beat the whole together until they are thorflighly incorporated. These pills are intended as a substitute for Griffith's myrrh and steel mixture, as it may occasionally be convenient to prescribe it under the form of pill, or to form the mixture from it extemporane- ously by diffusion io water. Two pills of about five grains each may be given morning and evening. Saturnine Anodyne Pills. R Acetite of lead, Ipecacuanha in powder, of each one drachm, Opium, ten grains. Beat them with simple syrup into a mass to be divided into 40 equal pills. In cases of uterine haemorrhage, fluor albus, &c. attended by debility and pain, these pills taken one every three or four hours, seldom fail to produce the desired astringent effect; and if their use be duly persisted in, will often induce that salutary change in the system upon which a radical cure depends. Plummets Pills. R Calomel, sulph. aurat. antimony, of each two drachms, Gum guaiacum powdered, four drachms, Hard soap, two drachms. Let the calomel and sulphur be thoroughly triturated together, then add the powder, and beat the whole into a mass with jelly of soap. This formula differs from the original one of Dr. Plum- mer, in omitting the extract of gentian, and adding the guaiacum. These pills for many years sustained a high reputation, and may still be considered as a very efficacious remedy in venereal and in various cutaneous affections. The proper dose is from four to eight or ten grains morning and night, observing the same rules as when under a course of any mercurial preparation, Compound Aloetic Pills. R Castile soap, aloes, powdered rhubarb, equal parts, Mucilage of gum arabic, or simple syrup, q. s. f. pills. Two or three of these pills of five grains each, prove mildly laxative, and are a good substitute for Dr, Anderson's pills. APPENDIX. 775 Calomel Pills. R Sub muriate of mercury, (calomel,) half an ounce, Starch powdered, one ounce, Mucilage of gum arabic, q. s. f. mass, divide into two hun- dred and forty pills. The compound calomel pills are formed by adding eighty grains of opium to the foregoing mass. These pills are well adapted to most cases where a mercurial course is proper. The dose and frequency of administration is to be regulated according to cir- cumstances. Absorbent Laxative Mixture. R Magnesia alba, two drachms, Rhubarb in powder, half a drachm, Oil of aniseed, twenty drops, Loaf sugar, one drachm, Simple cinnamon water, one ounce, Pure water, four ounces. M. First mix the magnesia and rhubarb in a mortar, then add the oil and sugar, and lastly add gradually the water. One or two tea- spoonfuls of this mixture is given with much advantage to child- ren whose stomach and bowels abound in acidity, whicli occasions griping and colicy pain. On some occasions it may be useful to add a few grains of alkaline salt, or a few drops of aqua am- monia. Gargle for Canker. R Red rose leaves, a small handful, a piece of myrrh the size of a large hazle nut, three or four figs. Simmer the whole in a pint of old cider, the older the better, then strain and sweeten it with pure honey ; gargle the throat and wash the mouth with a lit- tle mop wet with the liquor. Remedy for Angina Maligna, or Putrid Sore Throat. R Cayenne pepper, two table-spoonfuls, Common salt, two tea-spoonfuls. Infuse in half a pint of boiling water, and add thereto the same quantity of warm vinegar. After standing for an hour, the liquor must be strained through a fine cloth, and two table-spoonfuls giv- en internally every half hour. The most speedy and good effects were produced by this medicine in almost all the numerous cases of putrid sore throat in which it was tried in the West Indies, where it was first introduced. (Thomas' Modern Practice.) 774 APPENDIX. Styptic Tincture. R Sacchar. saturni, one ounce, Sal martis, half an ounce, Alcohol, eight ounces. M. Infuse for two days, and strain through paper. Dose for adults, twenty drops three or four times in a day, as a remedy in profuse haemorrhages. Or, R Sulphate of copper (blue vitriol,) three grains, Sulphuric acid, twenty drops, Pure water, two ounces. M. This efficacious remedy for uterine haemorrhage, is to be given in doses of from fifteen to forty drops in water, repeated every hour, or once in six hours, according to the urgency of the case. Anti-Dysenteric Mixture. R Lemon juice or best vinegar, two ounces, Common salt, as much as the acid will dissolve, Strong mint tea, half a pint, White sugar, sufficient to sweeten it. Dose, a table spoonful in two spoonfuls of hot water every two or three hours in cases of malignant dysentery, in which it has been found very efficacious. Collyria, or Eye-waters. R Acetite of lead, five grains, Sulphate of zinc, three grains, Liquid Laudanum, one drachm, Pure soft water, four ounces. M. This will be found extremely useful in ophthalmia, after the ac- tive symptoms of inflammation have subsided. A rag wet with the fluid should be applied over the eye-lids, and occasionally they should be opened so as to admit it into contact with the ball of the eye. R Water of acetite of ammonia (spirit of mindererus,) Pure water, of each four ounces. Mix and strain. To the above may occasionally be added tincture of opium, ope drachm. R Acetite of lead, one scruple, Water eight ounces, Tincture of opium, one drachm. M. R Sulphate of zinc (white vitriol,) twelve grains, Acetite of lead, sixteen grains, Water, eight ounces. M. APPENDIX. 775 Tar Water. R Tar, half a pint, Water one quart. Stir them together with a wooden stick for a quarter of an hour, and after the tar has subsided, strain the liquor and keep it in well corked phials. In obstinate ophthalmia, Dr. Physic jemployed tar water with complete success after the usual remedies had proved ineffectual. This may be made weaker by the addition of water, if too strong. Tar water is also an excellent remedy in dyspepsia, it is found to strengthen the tone of the stomach, to excite appetite, promote di- gestion, and the excretions of urine. Dose, a wine glass full three or four times in a day. Alum Curd. R Alum, half a drachm. Agitate it well together with the white of an egg until a coagu- lum be formed. This has been found greatly beneficial when applied to inflamed eyes, to allay heat and restrain the flux of humours. It should be spread upon linen, and not be kept on above three or four hours at a time. The following astringent eye water is said to prove peculiarly useful in obstinate inflammation of the eye-lids from debility of the parts. Take the whites of six eggs after being boiled quite hard, cut them into small pieces, and while warm sprinkle over them half an ounce of white vitriol, in powder; keep this for twenty-four hours in a moderately warm place, and when the vitriol is dissolved, strain the liquor through a fine cloth for use. Let this liquor be diluted with soft water to such strength as the eye can bear with- out much sensation of pain, and apply it at night, avoiding expo- sure to the cold air the next morning. Cold Cream. R Oil of sweet almonds, two ounces, Spermaceti, half an ounce, White wax, half an ounce. M. Put them into a close vessel, which put into a skillet of boiling water; when melted, beat them up with rose water until the whole becomes cold. This forms an elegant ointment, and is a useful application to sore nipples and other excoriated parts. Compound Powder of Ipecacuanha. Dover's Powder. R Ipecacuanha powdered, opium, of each one drachm. Sulphate of potash, one ounce. M. Triturate them thoroughly together. 776 APPENDIX. This powder is the most efficacious sudorific we possess in doses of fifteen or twenty grains frequently repeated. Sal nitre may be substituted for the sulphate of potash when that is not at hand. Alkaline Solution and Neutral Mixture. R Carbonate of potash (salt of tartar,) half an ounce, Water, six ounces. Mix and dissolve. The neutral mixture may be formed by adding gradually to the foregoing an equal quantity of the vegetable acid, or in such pro- portions as to neutralize the mixture. Dock-root Ointment. R Blunt leaved dock root, three ounces, Distilled water, one pint, Boil to half a pint, strain, and add of lard, one pound, Simmer until the water is dissipated. This is employed%as a useful remedy in herpes and other cuta- neous affections. Ointment for the Itch. R Hog's lard, two pounds, Flowers of sulphur, one pound, Sal ammoniac, crude, in fine powder, one ounce, Root of white hellebore, in fine powder, one ounce. Essence of lemons, one drachm. M. A more elegant and efficacious Ointment for the Itch, R> Red precipitate in powder, one ounce, Burgundy pitch, one ounce, Oil of turpentine, one and a half ounce. Hog's lard, eight ounces. Melt, and mix them thoroughly together. Another Remedy. Corrosive sublimate, one drachm, dissolved in half a pint of water, and add crude sal ammoniac, two drachms, sal nitre, half an ounce. The hands are to be washed with this solution night and morning, and a little of it is to be applied with a clean sponge to the pustules in other parts. Spirits of turpentine, properly mixed with hog's lard, will also prove an effectual cure for the Itch. APPENDIX. 777 Wash for Gutta Rosea, or Pimpled Face. R Rose water, six ounces, Flowers of Sulphur, half an ounce, Acetite of lead, one grain. M. Shake it well, dip a soft rag in it, and wet the affected part of the face night and morning. Let it remain on the face as long as convenient. Beef Tea. Cut one pound of lean beef into thin slices or shreds, and boil it in a quart of water for twenty minutes, taking off the scum as it rises. After it grows cold, the liquor should be strained, in which state it resembles a light infusion of green tea, has a very grateful flavour, and is more strengthening than other broths. Another. Cut a pound of beef, first deprived of its fat, into small pieces so as to be put into a quart bottle. The bottle well corked, with- out the addition of water, should be put into a small pot of cold water, which should be boiled for three or four hours. The liquor should then be poured out of the bottle and made savory with a little salt and any agreeable spice. Rush. Instead of boiling the meat, Dr. Mease advises to reduce it to a pulp with a wooden pestle in a mortar, and then to express all its juice. After straining this liquor, a little spice may be added, and an equal or larger proportion of boiling water. Thus the whole essence of the meat will be preserved, part of which would be Volatilized by cooking. Haifa pound of beef in this way is nearly equal to one pound used according to the former method. But on mature deliberation it appears to be a common error that any liquid substance whatever is more easily digested, or bet- ter suited to weak and impaired stomachs than animal food in its solid form. Wine Whey. Pour equal parts of white (Lisbon) wine, and skimmed milk in- to a bason ; and after they have stood for a few minutes, add a double portion of boiling water. In a short time the curd will collect and subside at the bottom ; the whey is now to be strained and sweetened with sugar : a sprig of balm or slice of lemon will greatly improve its flavour. Dr. Mease. To render the preparation of this excellent article of diet and medicine more prompt and easy, says the late Dr. Rush, a single runnet or dried calfs stomach should be cut into small pieces and infused in a quart of sound old Madeira wine. One or two table- spoonfuls of this wine will turn two quarts of milk without exposing 98 778 APPENDIX. it to the action of fire. This tincture will retain its virtues for years. Mustard Whey. Boil one ounce and a half of mustard in powder in a pint of milk, and an equal portion of water, till the curd be entirely sepa- rated, after which the liquid is strained through a cloth. (Dr. Mease.) This preparation is one of the most pleasant and efficacious forms in which mustard can be given. A tea-cupful, sweetened with sugar, taken three or four times in a day, is exceedingly bene- ficial in low fevers as a cordial diaphoretic. Vinegar and lemon whey may be formed in the same manner as wine whey. Alum Whey, Boil two drachms of powdered alum in a pint of milk till it is curdled : then strain out the whey. This astringent preparation is often employed with advantage in uterine haemorrhage and in diabetes. The dose is two or three ounces, or as much as the stomach will bear, several times in the day. Various cooling and pleasant drinks, useful in fevers, may be prepared as follows ; Barley Water. Take a handful of either pearl barley or the common sort, wash it clean, first in cold and afterwards in boiling water, then simmer it in a quart of water for an hour; when half done, put into it a bit of fresh lemon peel and a litle sugar. Or any vegetable acid may be added to render it agreeable. Lemons or apples cut in slices, tamarinds, currants, fresh or in jelly, cranberries, dried whortleberries infused in boiling water and sweetened with sugar or syrup, these may be so prepared and va- ried in form as to suit every taste, and to answer the purpose of pleasant, cooling, and salutary drinks, in all febrile complaints. Such drinks should always be kept in a covered vessel. Toast and Water. Toast slowly a thin piece of white bread till extremely brown and hard, but not the least black, then plunge it into a jug of cold water, and cover it over, an hour before wanted for use. « Arrow-root Jelly, Be careful to procure that which is genuine, for it is often coun- terfeited. Mix a large spoonful of the powder with a tea-cup of APPENDIX. 779 cold water by degrees, then pour this into a pint of boiling water, stirring it well, and when it boils it is finished. A little sugar and nutmeg may be added. In this manner a sick person may be sup- plied with a fine supporting meal in a few minutes. Sago. First wash it well in cold water, then boil it slowly in water or milk until it swells to a proper thickness. If boiled in water, it will require a little sugar, spice, and wine, or a bit of lemon peel to give it a pleasant taste and flavour. Boiled Flour, Take a pound or two of fine flour, tie it up as tight as possible in a linen rag, dip it repeatedly in cold water, and dredge the out- side with flour till a crust is formed around it, which will prevent the water soaking into it while boiling. It is then to be boiled till it becomes a hard dry mass. Two or three table-spoonfuls of this may be grated down and boiled in milk and water to a proper thickness, and sweetened to the patient's taste, and a little nutmeg or other spice may be added. This forms an excellent food in dysentery and in bowel com- plaints of children. Lime Water. Pour one gallon of water gradually on half a pound of quick lime in a glazed earthen vessel, stir them well together, and after the lime has settled, strain the water through paper, or pour it off quite clear, which should be immediately put into bottles, closely corked. It is not material whether the water poured upon the lime be cold or hot, but the air must be kept from it as much as possible during the process. Lime water is directed in gravelly complaints, and in affections of the stomach from acidity. It ia also employed externally as a lotion to foul ulcers. Goulard's Extract of Lead. R Litharge, one pound, Vinegar made of French wine, two pints. Put them together into a glazed earthen pipkin, and let them boil, or rather simmer, for an hour or an hour and a quarter, taking care to stir them all the while with a wooden spatula. After the whole has stood to settle, pour off the liquor which is upon the top into bottles for use. With this extract Goulard makes his vegeto-mineral water, which he highly extols in various external disorders, such as in- flammations, burns, bruises, ulcers, &c. It is made by putting two tea-spoonfuls, or one hundred drops, of the extract 10 a quart of 780 APPENDIX. water, and four tea-spoonfuls of brandy. The proportion of the ingredients may be varied to suit the particular case. When used as eye-water it should be made of such strength as not to excite severe pain. This preparation is strongly recommended in all cases where saturnine applications in general are indicated. Use of Iodine in Wen, Bronchocele, Palsy, Scrofula, St. Vitus-s Dance, Lachrymal Fistula, Ophthalmy, Deafness. Difficulty of Swallowing, White Swelling, Spinal Caries, and Curvature. A drachm of iodine is dissolved in two and a half ounces of rec- tified spirit, of the spec. grav. .916—dose from five to forty drops, three times daily. An ounce taken by mistake produced no ef- fect but immediate vomition. The remedy is also used locally.— See Manson on Iodine, and Americ. Med. Rev. and Journ., IL, 288—also, N. E. Journ. of Med. and Surg., XV., 33. Blistering Plaster. R Venice turpentine, six ounces, Yellow wax, two ounces, Spanish or American flies in fine powder, three ounces, Powdered mustard, one ounce. Melt the wax, and while it is warm add to it the turpentine, taking care not to evaporate it by too much heat. After the tur- pentine and wax are sufficiently incorporated, sprinkle in the pow- ders, continually stirring the mass until it be cold. If the Venice turpentine is not easily procured, the common white turpentine, softened with a little tar, may be substituted. This form is pre- ferable to those made of oil or lard, which tend to retard the stim- ulating effect of the flies. Ointment for Chronic Sore-Eyes, and Cutaneous Eruptions. R Litharge and Lapis calaminarus, each 45 grains, Red precipitate, 25 grains. Reduce them to an impalpable powder, and, with one ounce of hog's lard, make an ointment to be applied to the eyes. Discutient Plaster. R Common litharge plaster, one ounce, Hard soap, four drachms, Sal ammoniac, crude, in fine powder, two drachms. Melt the plaster and soap together, and when nearly cold add the sal ammoniac. This is an excellent discutient application in cases of indurated tumours either of the female breasts or other parts. APPENDIX. 781 Plaster for Lumbago, or Sciatica, R Camphor, two drachms. Dissolve it in an equal quantity of spirits of turpentine, and add of Yellow basilicon, one ounce, Common black soap, half an ounce, Carbonate of ammonia, (volatile sal ammoniac,) half a drachm. Spread this on leather and apply it to the pained part. For the Scald Head. R Calomel, two drachms, Burnt alum, one ounce, Ceruse, one ounce, Venice Turpentine, six drachms, Spermaceti cerate, one ounce and a half. Mix and make into an ointment. For Ringworms, Spc. Dissolve from 6 to 10 grains of nitrate of quicksilver in one ounce of distilled water. For Corns. Apply a plaster of the extract of Phytolacca Decandra, after cutting off the hard surface of the corn, and it will seldom fail. Dr. Fowler's Arsenical Solution. R White arsenic in powder and salt of tartar, or other vegeta- ble alkali, each sixty-four grains ; boil them gently in a Florentine flask with half a pound of distilled water, until the arsenic is dis- solved. To this solution, when cold, add half an ounce of the compound spirit of lavender, and as much water as will make the whole equal to a pint, or fifteen ounces and a half in weight. The dose of this solution is as follows : from two years old to four, two drops, or three to five; from five to seven, five to seven drops ; from eight to twelve, seven to ten drops; from thirteen to eigh- teen, ten to twelve drops ; from eighteen and upwards, twelve drop's. These doses may be repeated once in eight or twelve hours, diluted with thick gruel or barley water. A peculiar sen- sation about the eyes and face is a criterion of the medicine having produced its effect on the system, and it is not proper to augment the dose or much longer to persist in its use. The diseases in which the arsenical solution has been most successfully employed, ar6 intermitting and remitting fevers, periodical head-ach, dropsy, 782 APPENDIX. hydrophobia, and obstinate cutaneous eruptions. Recently it hac been successfully administered in typhus fever, and in lock-jaw occasioned by wounds. In this last disease the dose must be larger than usual, and repeated every half hour until its effects be ascer- tained. Dr. Ferriar strongly recommends this medicine in hoop- ing cough after blisters and emetics have been employed. He be- gins with one drop daily for an infant, and for children under seven, two drops, repeated according to the symptoms, intermitting the use of it for a day or two. Artificial Mineral Waters. The immense improvements in the science of chemistry have enabled chemists to analyze with great accuracy thejiatural mine- ral waters, and to ascertain their nature and even the proportions of the several ingredients which they contain. " In the manufac- ture, therefore, of artificial mineral waters, the original water is perfectly imitated by the addition of all the ingredients in the pro- per proportions; and the gas by a peculiar and very powerful ap- paratus is afterwards forced in till the waters acquire a degree of briskness and activity far surpassing any thing which they ever exhibited in nature." " Every species of mineral water whatever, can be prepared by art, but the principal ones that have been at- tempted in this country, are the Ballston, Soda, and the Seltzer watersP Ballston Water. " The Ballston water is well known in the United States as a gentle cathartic, an active diuretic, a remedy against gravelly com- plaints, a tonic to the stomach, and generally to the system ; not to mention its efficacy against rheumatic and cutaneous complaints, when applied externally as well as internally. It remains only to be added, that the artificial Ballston water is found by experience to produce the effects of the natural water; it is, however, more powerful, and therefore an equal quantity produces more marked effects." See Mineral Waters of Ballston and Saratoga, p. 675. Soda Water. " The soda water is not an exact imitation of any natural water, but has been directed by medical men as a remedy in a number of common and troublesome complaints. It is ordered in the Phar- macopoeias and Dispensatories, and their prescriptions should be followed in this manufacture. It is a complete remedy against sourness of the stomach, commonly called heart-burn, a*nd in most cases of indigestion and weakness of the stomach it is very useful; gradually restoring the appetite, and with it the tone of the organ ; it is a preventive of many of the diseases of the stomach and APPENDIX. 783 bowels which proceed from acidity, and, for the same reason, it often removes or prevents the sick head-ach. " As a palliative, and even a remedy, in some cases of urinary calculi and gravelly complaints, it is preferable to the Ballston wa- ter. It may prevent, arrest, retard, or remove the complaint ac- cording to circumstances. " The soda water is also a very refreshing, and to most persons a very grateful drink, especially after heat and fatigue, and may be made a complete substitute for the beverages of which ardent spirits form a part. With wine and sugar it is very grateful." The soda water is made by dissolving two ounces of the carbon- ate of soda in ten pounds of pure water, and afterwards combining with it the carbonic acid gas to the fullest extent. This operation is performed by a powerful apparatus, affording so great a pressure as to be capable of impregnating the liquid with no less than five, or even six times its bulk of carbonic acid gas. The water should be afterwards preserved in glass vessels well closed, and kept as cool as possible. i Seltzer Water. " The Seltzer water has long been known, and is one of the most famous of the natural mineral waters of Europe. On ac- count of its agreeable taste and exhilarating effects, it is largely used at table, and as a beverage, at all hours. It is a diuretic, and possesses considerable efficacy in nephritic and urinary complaints; it is very useful against bilious and dyspeptic affections, and in many cases of cutaneous eruptions. " It possesses a peculiar power of allaying feverish irritation, and has done much service in slow hectic fevers ; it mixes well with milk, and is thus used with advantage by hectic patients. It is also used with sugar and wine." For the preceding quotations I am indebted to " Conversations on Chemistry." Appendix—New-Haven edition. The following is from the Emporium of Arts, &c. by Thomas Cooper. " The best method of combining the Seltzer water with a laxa- tive proportion of the purgative salts, is the following ; which will enable every body to make, at will, a mineral water, impregnated with cathartic qualities in any proportion that the palate will bear, or the bowels will require, combined with the lively, sparkling qualities of the Seltzer water. Take of supercarbonate of soda, or even the common carbonate, twenty grains, of the common carbonate of magnesia as much, put them into a strong black quart bottle ; fill it nearly, but not quite full of water; having previously ready a cork that will fit it. Pour in the quantity of strong vitri- olic acid, that you know from previous experiment will barely neutralize that quantity of saline matter. Cork the bottle, and tie down the cork instantly. The carbonic acid gas will thus be com- bined with a solution of Glauber's and Epsom salts, which must 784 APPENDIX. be kept in a cool place. In the same manner the dose may be altered or diminished, or sulphate of iron, in the proportion of three or four grains, may be added if the symptoms of the patient require it, and a mineral water produced more efficacious than any that nature presents to us. " As to the aerated waters generally, I am of opinion that every family should have an apparatus of the kind, in order to make them at any time, for the purpose of medicine and salutary bever- age. I found them in a recent complaint of more service than any other preparation. Owing to extreme debility, no medicine or food would stay on my stomach until I drank the Seltzer and soda waters ; and I am of opinion, that by their use, sickness may be avoided, and of course, health preserved." James Cutbush. Eatt Medicinale d'Husson. This much celebrated composition was discovered about fifty- five years ago by M. Husson, a French officer, and has been so highly famed for its almost infallible powers in the cure of gout, as to command the enormous price of from one to two crowns a dose ; and it still retains its high reputation in England, and in va- rious parts of the European continent. This remedy is consider- ed as producing a specific effect in removing the paroxysms of gout, as often, and almost as soon as they occur ; scarcely an in- stance of its failure having yet been known in practice. For more particular information respecting this subject, reference may be had to American New Dispensatory, 2d edition, p. 361. Numer- ous attempts have been made to discover the composition, or to devise a substitute for eau medicinale. " Mr. James Moor, sur- geon, London, has succeeded in compounding a medicine, closely resembling the original medicine in smell, taste, and dose, in its evacuant powers, and finally in its property of relieving the gout so far as it has been tried. This medicine, whose identity with the specific is thus presumed on, is composed of three parts of the wine of white hellebore, and one of wine of opium. The above wine of white hellebore is prepared by infusing for ten days eight ounces of the sliced root of that plant in two pints and a half of white wine. The dose of the compound is from one to two drachms." The root of our own species of swamp hellebore has been found equally efficacious as the imported root. This composition, since its promulgation, has been considerably employed in practice, and with the success anticipated by its san- guine advocates. In gout and rheumatism it has obtained a repu- tation in some degree proportioned to the original preparation of M. Husson. The dose above specified, however, is too large, as it is apt to irritate and induce nausea and vomiting. It is found more convenient to limit the dose to sixty or eighty drops, or in- crease as the stomach of the patient can bear; smaller doses twice in a day have on some occasions proved advantageous, APPENDIX. 7S5 UNIVERSITY OF THE STATE OF NEW-YORK. COLLEGE OF PHYSICIANS AND SURGEONS. In the notice of the College of Physicians and Surgeons in the city of New-York, at page 30 of this work, the list of professors was given as it stood at the time it was printed. Since then, there has been a change, and we now give the list of the present professors.. John Augustine Smith, M. D. on Anatomy and Physiology. Alexander H. Stevens, M. D. on the Principles and Practice of Surgery. James F. Dana, M. D. on Chemistry. Joseph M. Smith, M. D. on the Theory and Practice of Physic and Clinical Medicine. Edward Delafield, M. D. on Obstetrics and the Diseases of Women and Children. John B. Beck, M. D. on Materia Medica and Botany. MEDICAL COLLEGE OF NEW-YORK. JohnD. Godman, M. D. on Anatomy and Physiology. Valentine Mott, M. D. on Surgery. David Hosack, M. D. on Theory and Practice, and Clinical Med- icine. W. J. Macnevan, M. D. on Materia Medica and Therapeutics. J. W. Francis, M. D. on Obstetrics and Forensic Medicine. The arrangements for the course on Chemistry were not con- cluded when this went to press, September 15, 1826. The chair \vas to be filled in a few days. TRANSYLVANIA UNIVERSITY. The list of professors in the Medical School of Transylvania University, page 49 of this work, should stand as follows :-— Dr. Dudley on Anatomy and Surgery. Dr, Caldwell on the Institutes of Medicine and Clinical Prac- tice. Dr. Drake on Theory and Practice of Medicine. Dr. Richardson on Obstetrics and the Diseases of Women and Dr. Short on Materia Medica and Medical Botany Dr. Blythe on Chemistry. 99 ERRATA. As the author resides at a distance from the city, the proofs could not be sent him for correction without greatly delaying the work; in consequence of which, and of the copy being forwarded in parcels as completed, some errors have occurred, which would otherwise have been avoided ; viz. the insertion of" Book I." at the head of the pages from 190 to 217, and " Chapter XIII." at page 190, both of which should have been omitted. Page 160, line 1$ from top, for imprudently read impudently.—168, 1. 18 from top, for deceased read diseased.—197,1. 18 from, top, for ecchymosis read ecchymo' ses—1. 33 from top, for willingly, read willing.—225, lines 8, 9, 10 from bottom, add a period to each of the words Quinin, Vitriol, Zingib.—230, 1. 12 from bottom, for setting, read sitting.—237, 1. 13 from bottom, for baracks, read barracks.— 240,1. 7, from bottom, for either read ether.—252,1. 20 from bottom, for lytta', read lytta.—264,1. 7 from top, for minder ens, read mmdtrerui.—272, 1. 18 from top, for out, read ought.—352,1. 14 from top, for seventy-seven, read seventy se- vere.—354,1. 10 from bottom, for symptom, read system.—355,1. 18 from bottom, between the words symptoms and promptly, add were—1. 12 from bottom, for who, read which.\S78,1. 17 from top, for confined, read confirmed.—416, lines 2 from top, and 14 from bottom, for Sendamore, read Scudamore.—421, 1. 4 from top, for pacific, read specific.—650,1. 16 from top, for is a manner, read is in a man- ner—1. 18, for decoction, read doctrine.—765,1.10 from top, for poke-wood, read poke-weed. INDEX. ABORTION ... 699 Absorbent laxative mixture 773 Acidities in children - 727 Acne .... 464 Affusion of cold water in fevers 201 After pains ... 704 Ague - 217 cake ... 224 Air, various qualities of 67 of mines and wells, when stagnated, proves fatal 71 Aerial poisons. See noxious va- pours - - - 522 Alkaline solution - - 776 Alum curd ... 775 whey - - 778 Amaurosis ... 535 Amenorrhea - - 512 Anecdote of Charles 5th - 9 of a celebrated empiric 163 of the court of Madrid 9 of Vesalius 137 of the University of Salamanca 9 Anasarca - - - 619 Anaphrodisia - - 546 Anger, effects of - - 97 Angina maligna - - 429 pectoris - - 577 remedy for - 773 Aphtha - - - 729 Apoplexy ... 525 Apples, properties of - 93 Apricots, properties of - 93 Arachne, properties of - 763 cures intermittents 225 Ardent spirits, effects of 102 Arrow root jell}' - - 778 Arsenic, poisonous effects of 686 Artificial mineral waters 782 Arthritis - - - 412 Ascites - - - 630 Asparagus, properties of 92 Asthma - - - 585 Asphyxia - - - 518 Aspinwall, Dr. William 14 Atmosphere, constituent parts of 6^ Atropa belladonna, poisonous effects of - - - 688 Atrophy - - - - 614 iEsculapius ... 3 Aura epileptica - - 56o* B. Bacon, properties of - 87 Ballston waters - - 782 properties of, and diseases in which they may be employed 755 Bard, Dr. John - - 12 Barley water - - 778 Barnet, Dr. William - 13 Baron Haller ... 9 Bathing, cold and warm 750 Baths - - - - 756 Beef, properties of - - 86 tea, how prepared 777 Beer, a good beverage - 85 Bees, stings of - - 691 Birds' flesh, its properties 89 Bites of rabid animals - 601 a mad dog, &c. 601 a rattlesnake - 690 a viper - - 690 Bladder, inflammation of 401 stone in the - 640 becomesparalyticwhen over distended 124 Bilious remittent fever - 229 colic - - - 591 Bleeding from the nose - 466 from the lungs 468 Blenorrhoea ... 491 Blistering in fevers - 210 Blistering plaster - - 780 Biood, circulation of discovered by Dr. William Harvey 6 shot eye - - 536 vomiting of - - 472 Bloody urine ... 473 Boiled flour - - - 779 Bogart on angina pectoris 578 Bond, Dr. Thomas, notice of 12 Botanic garden at Cambridge 3fi 7b8 INDEX Boylston, Dr. Zabdiel; first in- oculator of small-pox in New- England - - - 11 Boylston, W. N. Esq. makes a donation of medical books to Harvard University, 34 ; ap- propriates a fund for the im- provement of medicine 35 Brain fever - - - 121 Brain, inflammation of - 286 Bread, properties of - 90 Breast, female, inflammation of 700 abscess of 707 cancer of 667 Buboes - 653 Burns and scalds - - 683 Butter, properties of - 88 C. Cabbages, properties of - 92 Cachexiae - - - 614 Cadwallader. Dr. - - 12 Calculi ... 640 Calomel pills - - - 772 Calvin, John, accessory to the death of Servetus - 6 Caligo 536 Cancer - 667 doctors, impositions of 159 a fatal instance 672 in the mamma, a re- markable instance of the operation for 673 Candidates for examination by Mass. Med. Society 42 for fellowship, how admitted - 4 Canker of the mouth - 773 Carbo ligni, charcoal - 766 Cardialgia - 546 Carditis - - - 334 Carrots, properties of - 92 Catalepsia - 572 Catalogue of periodical journals on medicine published in the United States - - 63 Cataract - - - 536 Catarrhus 296 Catarrh, epidemical - 302 Cathartic pills - - 771 Catheter, how introduced 508 Celery, qualities of - - 92 Cephalalgia spasmodica 575 Cephalanthus occidentals, or button bush - 762 Cephalea - - - 574 ■Chalmers, Dr. Lionel, notice of 13 Chancres - - - 651 Chapman, Dr. notice of - 25 Charcoal, how prepared, and uses of - 766 vapours, dangerous effects of - 72 Character and qualifications of a physician - - 141 Cheese, qualities of - 89 Cherries, qualities of - 93 Chicken pox - 449 Chilblains - 746 Childbirth, treatment of wo- men in 702 Children, management of 718 clothing of - 718 food of - - 719 weaning of - 721 diseases of - 722 retention of meconium 722 red, white and yellow gum - - 723 excoriations - 725 acidities, gripes, &c. 727 thrush, or aphthae 729 tumours of the scalp 732 vomiting - 733 dentition, or teething 735 cholera infantum 740 canker of the mouth 731 croup - - 307 hydrocephalus 625 convulsions - 563 hooping cough 324 rickets - - 638 worms - - 691 tinea, or scald head 744 chilblains - 746 milk blotches - 774 crusta lactea - 724 venereal disease 747 Chisholme, Dr. strong advocate for mercurial practice 18,213 Cider, a salutary beverage 85, 110 Chlorosis ... 514 Chocolate, properties of 94 Cholera morbus - - 479 infantum - 740 Chordee 492 Chorea 565 Churchyards, pernicious effects of 72 Clavus hystericus - - 597 Cleanliness, importance of 128 Clothing, observations on 129 Cobweb, cures intermittents 225 description and prop- erties of - 763 Coakum, pokeweed - 76S INDEX. 7S9 ('offee, proper-ties of 94 Coichicum autumnale 763 Cohl and warm bath 750 Cold cream ... 775 Cold water, affusion of in fevers 201 Cold, effects of 523 decoction for 768 Colica - 590 Colic, bilious - 591 flatulent 591 hysteric 594 Colica pictonum 594 Collyria - 774 Compound powder of ipecacu- anha - 775 Compound aloetic pills 772 Consultations, observations on 146, 149 Consumption, pulmonary 356 causes of 357 Contagion, definition of 165, 167 causes by which it is excited into action 179 method of destroy- ing by the mineral acids - 182 means of personal preservation from 184 Contagious fevers, how commu- nicated - 175 Convulsio, or convulsions 563 Corns, platter for - - 781 Corpulence - - - 616 Corsets, dangerous effects of 131 Costiveness - 504 Cough, common - - 299 recipes for 767, 768, 771 hooping - - 324 recipes for - 769 Coup de soleil - - 528 Cow pox - 449 when first introduced 19 prophylactic efficacy established - 453 directions for collect- ing vaccine matter 457 signs of true vaccina- tion - - 458 Cramp in the legs - - 599 Cream, properties of - 88 Croup - 307 Crusta laqtea - - 724 Cucumbers, properties of 93 Cutanei 423 Cummings, Dr. John, his dona- tion to Harvard University 32 Cynanche maligna - - 429 parotidoea - 295 tonsillaris - 381 tracheal is - 307 laringaea - 305 Cystitis - - - - 401 D. Dalhound Lawrence, opposed small-pox inoculation in 1720 11 Deafness ... 538 Dentition 735 Derby, E. H. Esq. his donation to Harvard University 34 Diabetes - 485 Diaphragmitis - - 334 Diarrhoea ... 482 Dietetics ... 67 Delirium tremens - 121 Discutient plaster - 780 Diseases of women and children 697 of the female breast 706 of pregnancy - 697 of the puerperal state 697 Dissection, first in America 27 Dissertations, inaugural - 57 Dissertation on mercurial prac- tice .... 41 District medical societies - 40 Dock-root ointment - 776 Dog, symptoms of madness in 602 bite of 602 Doses of medicine - - 760 Dover's powder, preparation of 775 Drink, what kinds most proper 85 Dropsy - - - - 619 of cellular membrane 619 of the belly - - 630 of the brain - - 625 of the chest - - 628 of the uterus - - 634 Drowned persons, treatment of 519 Drunkenness an odious vice 101 horrid effects of 102 how to be treated 115 examples of cures 118 Drunken physician, an odious character ... 146 Douglas, Dr. William on small- pox in 1722 - - - 11 Dysentery .... 262 mixture for - - 774 Dyspepsia or indigestion - 540 Dysmenorrhea - - - 518 Dysuria - - - - 510 790 INDEX.- Ear, inflammation of - - 292 Eau medicinale d'Husson 421, 784 Eggs, qualities of - - 89 Emphysema - - - 617 Empirics, their character and conduct - 157 anecdote of a cele- brated one - 163 Emulsion for catarrh and cough 767 Enuresis .... 487 Enteritis - - - - 388 Epidemic diseases - - 165 Epidemical catarrh - - 302 Epilepsy .... 567 Epistaxis - - - 0 - 466 Erithema mercurale - - 659 Eruptions, cutaneoiis, See herpes 460 Erving William a founder of the nied, school of Harvard Uni- versity ... 32 Erysipelas ... 282 Essence for head ach - 767 Evacuations - - - 123 by stool - 123 by urine - 124 by perspiration 124 by saliva - 127 Excitability ... 73 Exercise, importance of - 77 Excoriations in children - 725 of the nipples 709 Exhalations from putrid sub- stances - 168 Eyes, inflammation of - 288 blood shot specks or spots 536 Eye-waters ... 774 F. Fasting long injurious Fear, effects of 84 96 Febrifuge mixture powder Fees, medical - 769 770 152 Fermented liquors, properties o( Fever, definition of " 85 195 division of 196 causes of 198 symptoms of continued 199 238 inflammatory intermittent 233 218 remittent 226 bilious remitting 229 brain - 196 hectic - 196 Fever, miliary - - 462 milk - - - 705 puerperal or child-bed 710 scarlet - - - 426 typhus mitior, or nervous 237 typhus gravior, putrid 253 typhus icterodes, yellow 268 spotted or petechial 22, 335 Fish properties of - - 90 Fisher, Dt. Joshua, his practice in croup - 311 in cholera morbus 480 in nervous colic 596 in worms - 695 his opinion of stra- monium - 570 Fistula lacrymalis - - 537 Flannel should be worn next the skin - 131 Fluor albus - - - 488 Food and drink, observations on 81 Fowler's arsenical solution 781 Francis, Dr. his treatment of lues vinerea - 660 Friction, utility of 80 Frost bitten, how treated - 523 Fungus nematodes - - 666 G. Gale, Mr. Benjamin, notice of 12 Galen, notice of - - 4 Gallup, Dr. objects to mercury and to opium in fevers 214, 216 Garden, Dr. notice of - 13 Gargle for canker - - 773 Garlic, virtues of - - 92 Garnet, Dr. his account of ex- citability 73 Gastritis - - - - 386 Gastrodynia - 540 Gelston, Dr. Samuel, notice of 13 Gleet .... 497 Globus hystericus - - 597 Glossitis ... 379 Gonorrhoea, virulent - - 491 simple - - 498 Goulard's extract of lead - 779 Gooseberries, properties of - 93 Gout - 412 misplaced - - 414 retrocedent - - 414 atonic - 413 Gravel and stone - - 640 Gregory, Dr. notice of - 155 Green sickness - - 514 Grief, its pernicious effects - 96 Gripes in infants - - 727 INDEX. 791 Gutla rosea - 464 wash for 773 serena - 535 H. HaBmatemesis ... 472 Hematuria - 473 Haemoptysis - 468 Haemorrhois - 477 Harvey, Dr. William, discovers the circulation of the blood 7 Harvard university, med.school of 32 Haygarth Dr. his rules for pre^> venting infection - 180 Hayward, Dr. Samuel - 14 Head should be guarded against the solar heat - - 134 Head-ach ... 574 periodical - - 577 nervous - ■' - 376 sick - - - 576 Heart, its wonderful powers 136 Heat, effects of - - 73,74 Hemiplegia - 529 Hemicrania - - 574 Hemlock, poisonous effects of 688 Henbane poisonous - *• 688 Hepatitis ... 393 Hernia - 675 strangulated - - 676 humoralis - - 496 Herophilus, notice of - 4 Herpes - 460 farinosus - - 460 pustulosus - - 460 miliaris - 460 exedens - - 461 Hersey, Ezekiel ) their donation Abner $ to Harvard University 32 Hippocrates notice of - 3 Historical sketch of medicine 1 Hope, a mild passion - - 95 Hooping cough - - 324 remedies for 769 Holyoke, Dr. Edward, notice of 39 Hornets, stings of - - 691 Horehound ... 765 Hosack, Dr. David, his views of contagious diseases 167,173 on contagion of yellow- fever - - 173 his mode of treatment in croup - - 310 in consumption - 368 in syphilis - - 661 on ajagina pectoris. 5S0,583 Hosack, Dr. on impotency 546 his nosology - 190 Hospital for small-pox, first in New-England - 13 General, mode of ad- mitting patients 761 Hull, Dr. A. G. invents the best truss - - . . 678 Hunter, Dr. John, his remarks on noxions exhalations 170 Hydrocele - - - 635 Hydrocephalus - - 625 Hydrometra - - - 619 Hydrophobia - - - 601 Hydrops ... 619 cellularis - - 619 cerebri - - 625 abdominis - - 630 thoracis - - 628 spinas ... 627 uteri - - - 634 ovarii ... 634 testis 635 articuli 638 Hydrothorax 628 Hypochondriasis 610 Hysteria .... I. Icterus - 597 499 Iliac passion 591 Impotency • - 546 Incontinence of urine 489 Incubus ... 610 Indigestion 540 Indigo weed 761 Infants, management of 718 diseases of 722 remittent fever of 733 Infectious diseases 165 Infection may be communicated by means of clothing, bedding and uncleanliness, prevention of 176, , 181 Inflammatory fever 233 Inflammation of the brain 286 of the eyes 288 of the ear 292 ofthe lungs 331 of the liver 393 of the stomach 386 of the intestines 388 of the kidneys 399 of the bladder 401 of the spleen 397 of the mesentery 383 of the omentum 383 792 INDEX. Inflammation of the pancreas 398 of the peritoneum 385 Inflammatory sore-throat - 381 Influenza 18 description and treat- ment of - - 302 Inoculation of small-pox - 445 of cow-pox - 455 Intemperance ... 101 Intermittent fever - - 217 Intumescentiae - - - 616 Iodine .--- 780 Ischuria .... 506 Itch .-- - 447 ointments for - -- 776 Jackson, Dr. James, distributes vaccine matter 20 on cholera infantum 740 on dentition - 735 on weaning children 721 on tic doulouroux 556 Jaundice - 499 Jenner, Dr. Edward, discovered cow-pox - - - 19 Jones, Dr. John, notice of - 13 Joy a pleasing passion - - 95 K. Kearsley, Dr. John, notice of 13 King's evil - 646 Kissam, Dr. Samuel, notice of 27 Kuhn, Dr. Adam, notice of - 24 Lamb, properties of - 87 Leeches, description and uses of 749 Laryngitis ... 305 Lethargy 528 Leucophlegmatia - - 619 Leucorrhoea ... 4§8 Library, medical - - 152 Lientery ... 482 Lime water, how made - 779 Lining, Dr. John, notice of 13 List of books for candidates to read .... 64 Lithiasis ... 640 Liver, diseases of - - 393 Lloyd, Dr. James, notice of 38 Lightning, fatal effects of 523 Lochial discharge - - 705 Lock-jaw ... 550 Longevity, means of obtaining 136 Lovr, a strong passion - 96 Lues venerea - 650 Lumbago - - - 410 Lungs, inflammation of - 331 Lycopus Europaeus - 765 M. Malt liquors - - - 110 Malignancy, definition of 197 Malignant pleurisy - - 321 Marcores - - - 614 Marrion, Dr. Joseph, notice of 11 Marsh miasmata, cause of fevers 169 Marasmus - - - 614 Mastisis - - - 296 Mather, Cotton, patronized small-pox inoculation - 11 Means of medical instruction in our seminaries - - 57 Means of preserving health 136 in hot climates 186 Measles 423 Measures and weights used in medicine - 759 Meconium, retention of - 722 Medicine, origin of 3 Medical science, imperfection of 8 progress of, how retarded 9 Medical theories, numerous and fleeting - - - 8 Medical institution of Pennsyl- vania - 23 of New-York 27, 785 of Massachusetts 32 of Hanover - . 44 of Maryland - 45 of Connecticut 46 of western district of the state of New- York . - 47 of Ohio - - 48 of Transylvania 48, 786 of Vermont academy 48 of Maine - 49 of Rhode Island 50 of Vermont - 50 of Berkshire - 51 of South Carolina 52 of Jefferson college 53 of the Columbian college 53 of Auburn, state of New-York - 56 of the Valley of yir- ginia - '. 56 Medieal society of Mass. . 39 INDEX. 793 Medieal society of Mass., annual meetings - 40 counsellors - 40 censors, their meet- ings for examina- tion of candidates 40 qualifications of can- didates for admis- sion - - 42 officers of the society 44 Medical college of Massachu- setts, description of 36 of New York - 786 Medical publications In the Uni- ted States --- 57 Medical fees, how regulated 152 prescriptions * 760 libraries recommended 152 Melancholia ... 610 Menorrhagia ... 474 Mercury in fevers, observations on - - 212 adopted in yellow fever 213 Middleton, Dr. Peter, notice of 13 Miliaria, miliary fever - 462 Milk fever - - 705 Milk, properties of - 88 Milk diet recommended - 84 Military surgeons and physi- cians of the revolutionary army, examinedby a me- dical board in 1775 15 names of those who served 15 Miller, Dr. Edward, notice of 57,171 Mineral waters of Ballston and Saratoga - - - 755 Miner, Dr. Thomas, his defini- tion of malignancy 197 his treatment of ner- vous fever - 245 his essay on typhus syncopalis - 351 Miopia .... 537 Mitchell, Dr. John, notice of 12 Dr. Samuel L. notice of 57, 171 Morgan, Dr. John, notice of 24 Mumps - 295 Muscles, qualities of - 90 Mustard whey - - 778 Mutton, properties of - 87 N. Nephritis Nettle rash Nervous diseases Neuralgia 100 399 439 518 554 Neurosis ... 518 Nichols, John, Esq. donor to the medical school of Harvard University ... 34 Nightmare - - - 610 Non-naturals - * 67 Norcum, Dr. on remittent fever 230 Nurses, qualifications of - 151 Nostrums, absurdity of - 162 Noxious vapours - - 522 O. Oats, properties of * 91 Obstipatio - - - 504 Odontitis - - - 293 Ogden, Dr. on malignant sore throat - - - 13 Ointment for chronic sore eyes, and cutaneous eruptions 780 for the itch - - 776 Ophthalmia - - - 288 Opisthotonos - - 550 Onions, qualities of - 92 Opium, poisonous effects of 689 Oesophagitis - 385 Osgood on yellow fever - 275 Otitis - - - 292 Oysters, properties of - 90 Palsy - - - 529 Paralysis - - 529 Paricreatitis - - 398 Paracusis ... 538 Paracelsus, eccentric character 5 Paraplegia - 529 Paraphimosis - 492, 652 Parsley . - - - 92 Parsnips, properties of - 92 Parotitis - - - 295 Passions, observations on 95 Pastry, bad qualities of - 91 Patent medicines impudently palmed upon the public 160 Peaches, properties of - 93 Pears, properties of - 93 Pease, properties of - 91 Pemphigus - 440 Persons apparently drowned 519 apparently dead from lightning - 523 apparently dead from noxious vapours 522 Pertussis - - - 324 Pericarditis - - 334 Peripneumony, »r pneumonia 331 794 INDEX. Peripneumonia notha 314 typhodes 321 Perspiration, insensible 124 Peritonitis ... 385 Pestis tropicus 263 Pharyngitis - - - 384 Phimosis - - 652. , 492 Phlegmasia dolens 402 Phlegmasia? - - - 279 Phlogosis, or phlegmon * 279 Phrenitis - 286 Phthisis pulmonale 356 Physicians, qualifications and duties of 141 Phytolacca decandra, poke weed 765 Piles, description and cure of 477 Pills, cathartic 771 digitalis 771 foetida, with opium 771 chalybeated myrrh 772 of calomel 772 compound 772 aloetic compound 772 Plummer's 772 saturnine anodyne 772 for cough - 769, 771 Pimpled face 464 Plague, contagion of •- 176 Plaster, discutient 780 for lumbago, sciatica, scaldhead, ringworm, and corns - 781 Pleuritis, (pleurisy) -, 328 Plums, properties of «■ 93 Poisons, various kinds of 686 Pork, properties of 87 Polysarca ... 616 Potatoes, wholesome food 91 Pregnancy, and its concomitant diseases ... 697 Primitive inhabitants, their con- dition - - - 2 Pringle, Sir John, on contagious diseases - 168 Profluvia - 465 Progress of medicine in America 23 Puerperal fever - - 710 Pulmonary consumption - 356 Putrid and malignant fever 253 sore throat 429 remedy for 773 Pyrosis - 540 Q. Quacks, their conduct displayed 157 Quarantine regulations neces- sary - - - 181, 183 Quincy - - - - 381 It. Rabies - - - - 601 Rachitis, (rickets) 638 Raddishes, properties of 92 Rand, Dr. Isaac 14 Rattlesnake, bite of 690 Remittent fever 226 of infants 733 Rhsumatismus 406 Rheumatism, acute 406 chronic 410 Rice, a nourishing food 91 Ringworm ... 462 Rubeola - 423 Rupture, treatment of 675 Rush, Dr. Benjamin, notice of 24, 25, 156, 171, 184 on yellow fever 267 to 274 S. Sago - 779 Salads, properties of - 91 Saliva - - 127 Sanguinaria canadensis . 764 Saricella - r . 449 S,cabies - - - - 447 Scalds and burns . 683 Scald head - 744 Scarlatina - - 425 anginosa - 427 maligna - 429 Scarlet fever . 426 Scirrhus and cancer . 667 Scrofula . 646 Scurvy - - 665 Seltzer water, preparation of 783 Servetus, Michael, notice of 6 Sh^ecut, Dr. on contagions i and infections 166 , 188 his syllabus 166 on yellow fe' rer 275 Shippen, Dr. William, first Ame- rican lecturer- ■? - 24 Shortsightedness - 537 Shower bath - . 750 Sleep, observations on - 99 Small-pox - 441 inoculation . 445 Smoked ham, qualities of 87 Soda water . 782 Solution, alkaline - 776 emetic tartar . 770 Sophora tinctora, description and virtues of - 761 Spasmi ... - 550 Spinage, properties of - 91 Spina bifida - 627 INDEX. 795 Splenitis ... 397 Spleen, inflammation of 397 Spotted fever - - 22, ,335 Steam bath - 757 Sternalgia ... 577 Stings of bees and hornets 691 Stomach, inflammation of - 386 Stone in the bladder - 640 Strabismus or squinting 537 Strawberries, properties of 93 St. Anthony's fire 282 St. Vitus's dance 565 Strangury ... 510 Styptic tincture - 774 Stroke of the sun 528 Sugar maple affords a whole- some drink - 111 Suppressionis ... 498 Sulphate of quinine 764 Syphilis - 650 distinct disease from gonorrhoea 650 may be communicated from parents to chil- dren - - 663 remarkable instance of a woman communi- cating and receiving the infection by drawing the female breast - - 664 pseudo syphilis - 664 Suppression of urine - 506 Sydenham, notice of - 141 his disinterested sen- timents - 155 System of nosology - - 190 Syllabus of contagion and infec- tion ... - 166 Syncope . - - - 539 T. Tape worm ... 696 Tar water - 775 Tea, observations on - 93 Teething - 735 Tenant, Dr. notice of - 12 Tetanus - - - - 550 Tetters, .see herpes - - 460 Thatcher, Thomas, notice of 10 Theories, medical, revolutions of 8 Theoretical systems adopted in our seminaries - 58 Thermometer, moral and physi- cal one ... 105 Thompson, Dr. notice of - 13 Tic doloureux ... 554 Tinea capitis -. 744 Tincture guaiacum 767 Toast and water 778 Tobacco, injurious effects of 139 Tongue, inflammation of 379 palsy of 530 cutting of 732 Tonsillitis - 381 Tooth-ach 293 Trachitis - 307 applied ... 678, 679 Tumours on the scalp of infants 732 Turkies, properties of 89 Turnips, qualities of - - 92 Tussis epidemiea 18 Tympanites (tympany) - 618 Typhoid pneumonia - 23, 321 Typhus fever, how communicat- ed - - 314 mitior - - - 237 gravior - - 253 icterodes - - 268 syncopalis - - 351 U. Ulcus .... 681 Ulcers, treatment of - - 681 venereal, how distinguish- ed 656 Universal remedy, absurdity of 162 Underwood, Dr. notice of - 724 Urine, suppression of - 506 incontinence of - 489 Uterus, cancer of - - 674 dropsy of 634 Urticaria - 439 V. Vaccine inoculation - 457, ,459 Vaccina - 449 Variola - 441 Varioloid disease 445 Valetudinarians cautioned against ardent spirits 112 Veal, properties of 87 Vegetable acids salutary 86 Vegetable poisons 688 Venereal disease 650 Venesection in fevers 207 Venison, qualities of 88 Vesalius, notice of 6 anecdote of 137 Vesicular eruption 440 Viper, bite of 690 Vitia --.. 638 Vomiting 733 796 INDEX. W. Waring, Dr. on yellow-fever 272 Warren, Dr. John, notice of 33 first professor in New- England 33 his definition of con- tagion and infec- tion - 165 his dissertation on mer- curial practice 41,214 Water, cold, may be allowed in fevers - 207,243 affusion of in fevers 201 of acetite of ammonia, sa- turated with carbonic acid gas - - 766 Watery or weeping eye - 536 Weaning children - - 721 Weights and measures used in medicine - 759 Wild indigo, description and virtues of - - - 761 Williams, Dr. Nathaniel, notice of 12 Willich, Dr. his remarks on nos- trums, panaceas, &c. - 161 Wilson, Dr. his definition of contagion and infection 166 Wine, observations on the use of 85 Wine whey ... 777 Wistar, Dr. notice of - 25 Worms 691 Yeast for medical purposes 770 use of in putrid fevers 259 in putrid sore throat 425 Yellow-fever in Philadelphia in 1793 - - 16 contention respect- ing its contagious nature - 16 depleting plan of treatment, by Dr. Rush - 17 OI1VN 5NIDIQ3W JO ABVmn TVNOIIVN 1NDI0JW JO AHVJ9I1 TVNOIIVN 3 K-.^y i S/5l \My \ IBIARY OF MEDIC. 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