: kit! S: W$'- ■ *mm m ■H&& /',\ . f^'. \jy, I % H.[) 'GIGPF f#W«*4^W&4j&Mty4^#^;%4sZ($ ■ ",> WBA H335p 1891 63580140R NLM QSlbMM57 7 NATIONAL LIBRARY OF MEDICINE SURGEON GENERAL'S OFFICE LIBRARY. Section.. W.D.S.G.O. N0.21M3Z. ?$?- NLM051644577 I DUE TWO WEEKS FROM LAST DATE LF£B* m GPO 322808 I THE PRACTICAL HOUSEHOLD PHYSICIAN. A CYCLOPEDIA Family Medicine, Surgery, Nursing and Hygiene FOR DAILY USE IN THE PRESERVATION OF HEALTH AND CARE OF THE SICK AND INJURED. CONTAINING A PLAIN DESCRIPTION OF THE PARTS OF THE HUMAN BODY AND / THEIR USES; CHAPTERS ON "OUR HOMES," CLIMATE, FOOD AND DRINK, USE / OF INTOXICANTS AND NARCOTICS; SPECIAL CHAPTERS GIVING IMPORT- / ANT INFORMATION FOR EVERY WOMAN; WITH CLEAR AND FULL INFORMATION FOR ASSISTING THE SKILLFUL EFFORTS OF THE DOCTOR, AND FOR THE TREATMENT OF ACCIDENTS AND DISEASES. ARRANGED FOR READY REFERENCE TO ENABLE ONE TO DO INSTANTLY WHAT CAN AND OUGHT TO BE DONE IN EMERGEN- CIES TO RELIEVE SUFFERING OR SAVE LIFE. BY HENRY H^RTSHORNE, A.M., M.D., LL.D., Formerly Professor of Hygiene in the University of Pennsylvania, and Professor of Physiology and Diseases of Children in Woman's Medical College of Pennsyl- vania; Author of "Our Homes," "Essentials of Practical Medicine," "A Conspectus of the Medical Sciences," Editor of the American Edition of " Reynolds' System of Medicine," etc., etc. WITH EIGHT COLORED PLATES AND NEARLY THREE HUNDRED WOOD-CUT ILLUSTRATIONS. NEW AND REVISED EDITION JOHN C. WINSTON & CO., PHILADELPHIA, PA.; CHICAGO, ILLINOIS; SYRACUjKjUf^ 1891. >\335P Entered, according to Act of Congress, in the year 1889, by JOHN (J. WINSTON & CO., In the Office of the Librarian of Congress, at Washington. Copyright, 1891, By JOHN C. WINSTON & CO., Philadelphia. PREFACE. TT is the aim of this book to convey, in a simple manner, all the information likely to be wanted by unprofessional persons, concern- ing the preservation of health, and the care of those who suffer from disease and injury. No intention is herein implied to supersede the attendance of physi- cians or surgeons upon persons who are ill or seriously hurt. On the contrary, it is hoped that the readers of this book will be thereby better prepared to appreciate and assist the skilful efforts of medical practition- ers to relieve suffering and save or prolong life. But there are, especially in the country, many instances of sudden illness, or of accident, when no physician can be obtained, perhaps for several hours. It is then very desirable that some one, at least, if not all concerned, should know enough to do promptly what can and ought to be done; as delay may sometimes, indeed often, make the difference between life and death. Moreover, many ailments occur in families, particularly among children, hardly severe enough for it to seem necessary to send for a physician; and yet in which it is important not to neglect symptoms and conditions, which, without early care, may grow worse and give much trouble. The " stitch in time " is here a very applicable byword. Such treatment as can only be safely and advantageously carried out under the direction of a physician or surgeon is, if mentioned at all, not dwelt upon in the present work; the reader being referred, for special and extended in- formation of that kind, to professional medical treatises. The outline of Anatomy and Physiology given in this book is pur- posely brief; but, aided by the illustrations, it may suffice, for those before unacquainted with the subject, to make more intelligible the statements and allusions occurring in the rest of the volume. v VI PREFACE. Hygiene, the science and art of the Preservation of Health, is system- atically treated in the second division of the work. The author hopes that a careful perusal of what is said in these pages upon that subject will reward some readers, at least, for the time devoted to them. Under Domestic Medicine, after general considerations concerning the Nature, Causation, and Symptoms of Diseases, and upon the modes of action of Remedies, attention is given at considerable length to Nursing. Then, in regard to Special Diseases, Accidents, Injuries, and Poisoning, information is supplied in detail, such as appears to be suitable for a work on Home Medicine and Surgery. Those portions of the book are arranged alphabetically; for easy and convenient reference. As there are, besides a very full General Index, several special Indexes, it is hoped that few if any questions appropriate to such a work will occur, to which answers may not be readily found in it, expressed in terms which will be understood by all. PRRFACE TO THE FOURTH EDITION. The author has made, for this edition, a careful revision of the book. While no extensive change seemed to be called for, numerous additions and emendations have been introduced, bringing the infor- mation given down to a later period. Also, many new references to pages, in the course of articles, are put in, to make the book more handy for every-day use; and the language has been made, in several places, still more simple and popular. The author and publisher are grateful for many commendations of the plan and execution of this work, from physicians and other com- petent judges. Some persons who have looked at it rather hastily observe that, in dealing with special diseases, the reader is not alwavs told of a sure and immediate cure for each complaint. On this it may be remarked that so-called "certain cures" are nearly always useless or dangerous; possibly good in some cases and bad in others. The object of this book is to set forth what is safe, leaving perilous responsibilities to the physician. HOW BEST TO USE THIS BOOK. Two purposes belong to it: 1. To impart such knowledge as will enable every one to keep good health. 2. To give information about what to do for those who are sick or hurt in any way when no phy- sician or surgeon is at hand. It is not meant to take the place of a doctor in severe illness or injury (see p. 515), but to show how to do the best possible in the absence of a doctor. One who knows little about physiology will do well to read care- fully the sections on Anatomy and Physiology (pp. 35-112). All who possess the book are advised to read the whole of the section on Hygiene (pp. 117-457). It is meant to tell all about how to keep well. The author has tried to make it interesting and easily under- stood. Heads of families or those who expect to become such may find it to their advantage to read, in the Domestic Medicine (Part I., from p. 461 to p. 495), on the Causes and Nature of Diseases ; also, Part II., from p. 514 to p. 551, on Remedies; and especially Part III., on Nursing, from p. 620 to p. 647. Mothers and nurses should also read carefully from p. 640 to p. 660. Part VII., on Old Age and Death, pp. 917 and 918, is short and easily read. As action in cases of poisoning must be very prompt, it will be well for every one to know beforehand the main facts given in Part VI., on Poisoning, from pp. 887 to 915. Signs and Symptoms of Disease, from p. 498 to p. 513, will be worth studying by those who have patience for it; but that part of the book is very condensed, and is somewhat hard reading. Special Diseases are arranged in the alphabetical order of their names, from p. 661 to p. 836, and Accidents and Injuries, in the same way, from p. 837 to p. 883; Poisons, from p. 887 to p. 915. These portions of the book are suited either for reading or for ready reference in time of need. Most persons will use them chiefly for refer- vii viii HOW BKST TO USE THIS BOOK. ence. In the treatment of diseases and injuries all is told that can be safely done without a doctor. For information about what more a doctor will find and may do, readers may be referred to strictly medical books (as, for example, the author's Essentials of Practical Medicine or Flint's Practice of Medicine, etc.). Doses of Medicines are given from p. 615 to p. 617, and Giv- ing Medicinp:s is considered from p. 640 to p. 642. Sick Foods are told about from p. 631 to p. 639. Management of Labor (childbirth) is fully dealt with, giving all necessary particulars, from p. 649 to p. 660. There are seven Indexes: 1. P. 921, of Local Disorders and Injuries. 2. P. 923, of Diseases. 3. P. 928, of Accidents and Inju- ries. 4. P. 929, of Poisons. 5. P. 930, of Classes of Remedies and of Sick Foods. 6. P. 931, of Medicines and other Pemcdies. 7. P. 934, General Index of all subjects mentioned in the book. The use of the special indexes will often be convenient, but if a subject is not at once so found, look for it in the General Index. The Glossary contains definitions of all technical and otherwise out-of-the-way words used in the book. While convenient for ready reference, it is made almost unnecessary by such words being explained where they are used (which is as little as possible) throughout the book. The author has endeavored to write so as to be easily understood by all readers. CONTENTS. ANATOMY. PAGE General View of the Subject........35 The Human Skeleton..........35 Head and Face............35 Spinal Column............36 Thorax or Chest............38 Pelvis, Hip-Bones, etc...........38 Shoulder, Arm, and Hand.........38 Thigh, Leg, and Foot..........40 The Joints............40 Muscles.............41 The Skin.............44 Stomach and Bowels..........45 Other Abdominal Organs.........47 Breathing Organs..........49 Heart and Blood-vessels.........49 Lymphatic (Absorbent) Vessels.......53 Organs of Reproduction.........53 Brain and Nervous System........54 PHYSIOLOGY. General View of the Subject........60 How we Take Food..........61 Digestion.............62 Absorption and Nutrition.........62 Circulation............64 The Heart............64 Arteries............66 Capillaries............67 ix x CONTENTS. PAGE Veins.............67 The Blood......,......68 Breathing............70 Animal Heat............72 Excretion............73 The Liver............74 The Kidneys...........75 The Bowels............76 The Skin............77 Our Moving Powers..........77 Muscles, Voluntary, Involuntary, and Mixed......79 Rigor Mortis............81 How we Feel and Know.........81 Reflex Action............82 Xcrve-Centres............83 Nerves . ...........84 Ganglia.............86 Spinal Marrow............86 The Brain.............90 Sensory Ganglia............93 Muscular Sense............95 Cerebellum.............96 Medulla Oblongata...........97 Ideas, Emotions, and Will.........98 Our Special Senses..........98 Sight.............98 Hearing............109 Conclusion.............112 HYGIENE. History of Sanitary Progress........117 Foundations of Hygiene..........120 Healthy Breathing..........121 Our Homes............123 Situation.............124 Construction............128 Light..............133 Warmth............ CONTENTS. xi PAGE Ventilation.............146 Water Supply............160 Drainage.............176 Disinfection............193 Population.............197 Workingmen's Homes..........201 Seasons.............204 Climates.............207 Causes of Climatic differences........207 Kinds of Climates..........213 Effects of Climates on Living Beings......216 Relation of Man to Climate........220 Acclimatization...........223 Unity and Diversity of Human Races......224 Improvement of Unhealthy Regions.......228 Diseases of different Climates........228 Best Climates for Consumptives........230 Food and Drink...........232 Varieties of Food of Animals........232 Causes of Demand for Food........235 Questions as to the Hygiene of Food.......236 Manner of Eating..........236 Frequency of Meals..........237 Quantity of Food..........239 What to Eat............240 Elements of Food..........241 Organic Condition necessary........241 Solubility in Digestive Fluids........242 Not Poisonous ; containing no Parasites......242 Not Offensive to Taste.........242 Uses of Foods............243 Food Groups............244 Nitrogenous Foods..........244 Oil or Fatty articles..........245 Starch-like substances..........246 Salts.............254 Acids.............255 Xll CONTEXTS. r.vciE Vegetable and Animal Food........257 Bread.............260 Vegetables............263 Scurvy.............264 Variety essential...........265 Fruits.............267 Eggs.............269 Meats.............27d American Gifts to the World's Food.......272 Curiosities of Diet..........275 Theory of Cooking..........276 Soups.............278 Adulteration of Food.........279 Comparative Digestibility of Foods......2S1 Diseased Meats...........2S1 Excess of Food...........282 Starvation............283 Poisonous Food...........284 Condiments............287 * Drink.............291 Milk..............291 Stimulant Beverages..........297 Unintoxicating Stimulants.........29S Tea.............298 Coffee.............302 Cocoa.............300 Coca.............307 Arsenic-Eating...........308 Alcohol.............309 Study of its Effects..........310 CONTENTS. xiii What Alcohol will not do...... 3-^3 Dosage.............314 Difterence between Disease and Health .... . 316 Secondary effects........ ^IQ Delirium Tremens........ _ 316 Gout.............316 Chronic Alcoholism....... t 317 Methomania......... _ 317 Strength of Beverages.........31g Beers, Wines, and Spirits.........315 Various Beverages..........320 Tobacco.............322 Opium..............326 Other Stimulant Narcotics..........329 Hygiene of the Circulation........330 The Heart............331 Balance of Movement of the Blood.......332 Care of the Skin...........333 Uses or Functions of the Skin........333 Clothing.............335 Conditions of wholesome Clothing.......335 Sufficiency............335 No Excess............335 Distribution over the Body.........337 Allowance of Transportation........338 Changing often enough.........339 Bed-Covering...........339 Cosmetics and Hair-dyes.........341 Bathing.............342 Cold and Cool Baths..........342 Tepid Baths............343 Warm Baths...........343 Hot Baths............343 Vapor Baths...........343 XIV CONTENTS. Hot-Air Baths S(_ii-Bathing The Hair..... Care of the Hair in Health. After Disease Early Baldness . Hair Lotions and Dyes The Beard .... The Teeth .... Causes of Early Decay in America How to Preserve the Teeth Toothache .... Treatment of Toothache Excretion .... The Liver .... The Skin and Kidneys The Bowels .... Constipation and its Treatment Regular Habits . Muscular Exercise How People are made Strong Good Blood and Nerve-Force Exercise and Repose . Health-Lift . Rowing Walking Riding on Horseback . Driving and Sailing Skating. Swimming . Games ; Cricket, etc. . Over-Straining in Matches, etc. Hunting Gymnastics . Calisthenics . Maxima of Labor and Exercise Dr. Winship Ilealthfulness of Kinds of Work CONTENTS. XV PAGE One Day's Rest in Seven.........366 Sexual Hygiene...........368 Physiological Considerations........36b1 General Principles..........808 The Social Evil...........370 Ilealthfulness of Marriage.........371 Advantages of Society.........372 Coeducation............372 Needful Limitations..........373 Hygiene of Girlhood..........374 No Normal Disability..........374 Invalidism............375 Timely Precautions..........375 Gestation............376 Bodily and Mental Care required.......376 Mother and Infant..........377 Who should not Marry.........378 Consanguineous Marriages.........378 Mental Hygiene...........382 Positive Influences..........382 Hereditary Transmission.........383 Age.............384 Sex.............387 Bodily Health...........38S Air.............389 Food and Drink...........389 Exercise............390 Sleep.............391 Education............392 School Hygiene...........393 Mental Excitement..........397 Sympathy . ........400 Summary on Mental Hygiene........401 Hygiene of the Senses : Eyesight.......402 Errors of Vision...........402 Correction............405 Color Blindness........ . 406 Weakness of Sight..........407 xvi CONTENTS. TACT Hearing.............408 Deafness............408 Temperaments...........410 Sanguine............410 Nervous.......... . 411 Lymphatic............411 Fibrous............411 Mixed Temperaments..........412 Modification of Temperaments........412 Hygiene of Infancy..........414 Birth.............414 Nourishment—the Breast.........415 Weaning............417 Bottle-Feeding...........417 Milk.............418 Other Foods...........419 Clothing............421 Bathing............422 Exercise...........423 Airing.............423 Sleeping............424 Discharges............425 Teething.............425 Cries of Infants...........427 Lancing the Gums..........428 Summer Dangers...........429 Rules for Care of Infants..........430 Vital Statistics...........433 Approximate Tables..........434 Longevity of Occupations.........435 Curiosities of Vital Statistics........430 Mortality of Cities..........4;$S Infantile Mortality..........440 Statistics of Philadelphia.........44:5 Results of Sanitary Improvements.......44:5 Unhealthy Employments.........445 Preventive Legislation.........443 CONTENTS. xvii PAGE Life Assurance........ # 450 Great Longevity...... 455 How to Live Long........ _ 457 DOMESTIC MEDICINE. PART I. causes, Nature, and Signs of Diseases......461 What is Disease ?....... # 451 Caoses of Disease........ # # 462 Hereditary Disease....... 462 Functional Causation..........463 Mechanical Injuries..........464 Conditional Causes........ 464 Digestive Morbid Causes.........464 Obstructive Causes..........465 Contagion............465 Infection ; Atmospheric Causation.......406 Theory of Disease-Germs.........467 Influence of Time of Life.........477 Malaria............477 Causation of Yellow Fever.........479 Causation of Cholera..........481 Cholera Infantum..........483 Diphtheria............483 Nature of Diseases..........484 Local Disorders...........484 Irritation............485 Hypersemia............485 Inflammation...........485 Hypertrophy...........487 ' Atrophy............488 Degeneration...........488 Dropsy.............488 Mortification...........489 Morbid Growths...........490 9 xviii CONTENTS. rji.ii General Disorders........ • ^M Debility............VM a • 492 Anaemia............ Plethora............4i)- Cachexia............'''^ Neurataxia............494 Toxaemia ; Blood-Poisoning........494 Fever.............49.) Classification of Diseases.........497 Signs and Symptoms of Diseases.......498 Symptoms Affecting the Skin........498 Symptoms Presented by- the Mouth, etc......499 Symptoms Presented i;y the Throat......499 Symptoms Presented BYr the Stomach......500 Symptoms Presented by the Circulation.....500 Hemorrhage............501 Symptoms connected with the Breathing Organs . . . 502 Symptoms Affecting the Muscles.......503 Symptoms Affecting the Senses.......504 The Eye in Disease...........505 The Ears.............505 Headache.............500 Expression of the Face..........507 Delirium.............507 Stupor.............507 Dizziness; Vertigo...........508 Loss of Speech . . . . (.........50S Sytmptoms Affecting the Secretions......508 The Bowels............508 Constipation............508 Diarrhoea............508 Dysentery............50S Excretion of the Kidneys.........509 Retention of Urine..........509 Suppression of Urine..........509 Qualities of the Urine..........510 Gravel.............511 Stone in the Bladder..........512 Gall-Stones............512 CONTENTS. Xix PAGE Perspiration........ ^ 510 Menstruation......... 5^2 Physical Diagnosis........ _ 5^2 Temperature in Disease........ ^ 513 PART II. Remedies........... > 514 Self-limited Diseases..........514 Need of Physicians..........515 Scope of Home Remedies.........515 Classification of Remedies........515 To Relieve Pain...........517 Composing Nervous Disturbance.......523 Promotion of Sleep..........525 Purgative Medicines..........527 Injections............528 Suppositories...........528 To Check Diarrhoea..........528 To Check Dysentery..........529 Sick Stomach...........529 Indigestion............531 Continued Indigestion..........532 To Reduce Inflammation.........533 Fever.............540 Cough.............543 Hemorrhage...........544 Nose-Bleeding...........544 Bleeding in the Mouth.........545 Spitting of Blood..........545 Intestinal Bleeding..........546 Monthly Irregularities..........546 Dropsy.............548 Prostration ; Debility..........549 General Debility...........550 Anaemia and Nervous Weakness.......550 Tonics.............550 Remedies for Special Diseases.........551 Principal Medicines, and Other Remedies.....553 Alphabetically arranged, to........614 xx CONTENTS. PAOR Doses of Principal Medicines........615 Household Medicines..........618 PART III. Nursing.............6)2(1 Qualities of a Good Nurse..........620 The Sick-Room............624 Warmth............624 Light.............625 Air.............625 The Sick-Bed............627 Sick-Garments ............ 629 Washing and Bathing..........630 Food of the Sick...........631 Receipts for Sick Foods..........633 (oving Medicines...........640 Weights and Measures..........6)41 Metrical System............641 Excretions.............643 Sleep..............645 Mental Management...........646 Rubbing ; Massage...........647 Management of Labor.........649 Signs of Pregnancy..........649 Duration of Pregnancy.........650 Preparation for Child-Birth........650 First Stage of Labor..........652 Second Stage of Labor.........653 Favorable and Unfavorable ........ 654 Support of the Perineum.........655 Care of the Cord...........655 Third Stage............655 Hemorrhage...........656 Attention to the Infant.........656 Put to the Breast..........658 Prevention of Fever..........659 Time of Sitting up..........659 Care in Recovery .........660 CONTENTS. xxi PART IV. PAGE Special Diseases...........661 Alphabetically arranged, to........836 PART V. Accidents and Injuries.........837 Alphabetically arranged, to........883 Transportation of Injured Persons.......883 PART VI. Poisoning.............887 General Account of Poisons........887 Irritants............887 Neurotics............887 Complex Poisons...........887 Special Poisons, Alphabetically arranged, to......915 PART VII. Old Age and Death.........- 917 Natural Decline...........917 Causes of Death ...........918 Sudden Death...........'.US Conclusion.............918 Index of Local Disorders and Injuries.......921 Index of Diseases...........923 Index of Accidents and Injuries........928 Index of Poisons...........929 Index of Classes of Remedies.........930 Index of Sick Foods...........930 Index of Medicines and Other Remedies.......931 General Index............934 Glossary.............955 ILLUSTRATIONS, FIG. PAGE 1. Human Skeleton...........36 2. Spinal Column...........37 3. Front View of Thorax.........38 4.' The Scapula............39 5. The Humerus...........39 6. The Ulna............39 7. The Radius............39 8. The Wrist............39 9. The Bony Foot...........40 10. Striped Muscle, Magnified.........41 11. Muscles ; Front View..........42 12. Muscles ; Back View..........43 13. Hairs and Oil-glands..........44 14. Sweat Glands and Ducts........• . 44 15. Alimentary Canal..........46 16. The Stomach...........46 17. Abdominal Organs..........47 18. The Liver, under Surface.........47 19. The Kidney, laid open....... .48 20. The Kidneys, Ureters, and Great Blood-vessels . . . .48 21. The Larynx............49 22. The Heart, laid open......... 50 23. Capillaries............51 24. Capillaries of a Tooth, much Magnified......51 25. Lacteals and Lymphatics.........52 2(5. Lymphatic Vessels and Glands........52 27. Ovaries and Uterus..........53 28. Mammary Glands...........54 29. Under Surface of the Brain........55 30. One Hemisphere of the Cerebrum.......55 31. Inside View of the Brain.........56 32. Half of the Cerebellum and Parts near it......57 33. The Optic Nerves...........57 34. Brain and Spinal Cord, together........58 xxiii xxiv ILL USTRA TIC)NS. FIG. PAGE 35. Nerves of the Body..........59 36. Hand of Man and Gorilla.........r.0 37. Section of Head and Neck.........61 38. Lacteals and Lymphatics.........63 39. Plan of the Circulation.........64 40. A Human Heart, laid open.........64 41. Valves of the Heart, open and shut.......65 42. Valves of the Aorta (Magnified)........65 43. Comparative size of Blood-corpuscles in different Animals . . 68 44, 45. Blood-coagula..........69 46. Capillaries of Finger and Intestine.......69 47. Air-cells and Capillaries of a Lung, Magnified......69 48. Wind-pipe, Lungs, and Heart........70 49. Plan of Air-tubes and Air-cells........71 50. Section of a Kidney..........75 51. Structure of Kidney, much Magnified......75 52. Section of Skin, Magnified.........77 53. Hairs and Oil-glands, Magnified.......77 54. The Three Kinds of Levers........78 55. Mechanism of Movement of the Head......78 56. The Biceps Muscle..........78 57. Striped Muscular Tissue, Magnified.......79 58. Elongated Cells of Smooth Muscle.......79 59. Simple Reflex Action..........82 60. Lower Part of Human Brain........82 61. Brain and Spinal Cord.........83 62. Connection of a Ganglion with the Spinal Marrow .... 83 63. Section of Spinal Marrow, Magnified.......87 64. Section of Spinal Marrow, showing Roots of Nerves . . .87 65. Ferrier's Psycho-motor Centres........90 66. Interior of the Brain..........92 67. Base of the Brain..........94 68. The Cerebellum...........90 69. The Medulla Oblongata.........97 70. Refraction through a Prism........99 71. Refraction and Inversion of Light in the Eye.....100 72. Section of an Eyeball..........101 73. The Optic Nerves..........103 74. Choroid Coat, Iris and Pupil, Enlarged......104 75. Stereoscopic Picture..........100 76. Muscles of the Right Eye.........107 77. Tear-gland and Duct..........10$ ILL USTRA TIONS. XXV rIG- PAGB 78. The Ear, in Section....... _ HO 79. Small Bones of the Ear.........HO 80. Labyrinth of Internal Ear........HI 81. The Cochlea...........HI 82. Porosity of Building Materials........128 83. Old Style Fire-place..........131 84. A Roman Brazier..........135 85. Medieval Fire-place..........136 86. A Furnace Heater..........138 87. Reynolds' Furnace..........140 88. A Radiator Furnace..........141 89. Grate, with Air-chambers.........142 90. The Diffusion of Gases.........149 91. Window Ventilation..........153 92. Sherringham Valve..........153 93. Maine's Ventilator..........154 94-101. Inlets and Outlets.........156 102. Barker's Ventilating Flue.........157 103. Living Things in Water.........167 104. Life in River Water..........170 105. Out-of-door Earth Closet.........177 106-109. Water-seal Traps.........179 110. Bell-trap............180 111. Bower's Trap...........182 112. Untrapped Sink........... .183 113. Faulty Over-flow Pipe.........183 114. Rightly-trapped Sink and Drain.......184 115. Rhoads' Hopper Closet.........184 116. Trap, with Arrangement for Inspection......185 117. Jointed Drain-pipe, right.........185 118. Jointed Drain-pipe, wrong........185 119. Misplaced Pipe...........186 120. A Leaky Drain...........186 121. Open Trap............187 122, 123. Ventilation of Water-closets.......188 124. Double Ventilated Trap.........190 125. Well Contaminated with Sewage.......191 126. Poison-tree of Java, and Rafflesia.......217 127. Victoria Regia...........219 128. Gigantic Cedar of California........221 ---Females of Various Races........222 129. Head of Apollo Belvidere.........224 xxvi ILLUSTRATIONS. FIG. PAGE 130. A Chinese............224 131. Indian Warrior...........~~ 132. A Kamtchatdale..........2'2i5 133. Mozambique Negro..........22G 134. Female Bushman..........— 135. Living Things in River Water........234 136. Tapioca Roots...........24S 137. Arrow-root Starch Corpuscles........24<,) 138. Potato-Starch Corpuscles.........2l9 139. Wheat-Starch Corpuscles.........2r>0 140. Rye-Starch Corpuscles.........250 141. Indian-Corn Starch Corpuscles........251 142. Rice-Starch Corpuscles.........251 143. The Sugar Mite...........2r>'2 144. Meal Mite, Magnified.........261 145. Weevil, Natural Size..........262 146. Weevil, Magnified..........2('2 147. Trichinae in Muscle, Natural Size.......271 148. Trichina, Magnified..........271 149. A Tapeworm...........2^ 150. Pure Coffee, under the Microscope.......280 151. Coffee with Chicory, Magnified........280 152. Black-Pepper Plant..........287 153, 154. Mustard-Plant..........287 155. Cinnamon............288 156. Vanilla-Plant...........289 157. Milk, under the Microscope........292 158. Cream, Magnified..........292 159. Tea-Plant............299 160. Leaves of Tea-Plant..........300 161. Leaves used in Adulteration of Tea.......300 162. Egyptian Coffee-cup..........302 163. Coffee-Plant...........303 164. Cacao-tree............307 165. Yeast-Fungus, Magnified.........318 166. Yeast-Fungus, in Advanced Growth......319 167. Opium Poppy...........326 1(58. Capsules of Opium Poppy.........327 169. A Simple Shower-Bath.........343 170. A Hip-Bath...........343 171. The Health-Lift...........360 172. Development of Teeth ... , .... 420 ILLUSTRATIONS. FIG. 173. 174. 175. 176. 177. 178. 179. 180. 181. 182. 183. 184. 185. 186. 187. 18S. 189. 190. 191. 192. 193. 194. 195. 196. 197. 198. 199. 200. 201. 202. 203. 204. 205. 206. 207. 208. 209. 210. 211. 212. 213. 214. Inflammatory Lymph-Bands Hypertrophy of the Heart Tuberculous Lung Feeling the Pulse Urinometer A Leech Leeches Applied. Cup, with Elastic Top Cupping Apparatus Scarificator . Cantharides Palma Christi Colchicum Plant Digitalis Purpurea Gentian Spray Apparatus Croup Kettle Enema Syringe . Lobelia Inflata . Poppy Flower Capsules of the Poppy Spigelia Marylandica May-Apple . Poultice, covered with Gauze Cinchona Calisaya Rhubarb Plant . Valerian Medicine Chest . Air- or Water-Cushions A Bed-Table A Bed-Rest Medicine Glasses Bed-Pan . Slipper Urinal . Skull at Birth, showing Fontanelles Breast Suspended Ophthalmoscope. Aneurism of Aorta Apoplectic Clot . Cerebro-Spinal Fever Club-Foot; Varus Club-Foot; Talipes Equinus XXV FIG. 215. 216. 217. 2 IS. 219. 220. 221. 222. 223. 224. 225. 226. 227. 22S. 229. 230. 231. 232. 233. 234. 235. 236. 237. 238. 239. 240. 241. 242. 243. 244. 245. 246. 247. 24S. 240. 250. 251. 252. 254. 255. 256. 257. n ILLUSTRATIONS. Shoe for Club-Foot . False Membrane in Trachea Bronchial False Membrane Ear-Trumpets .... Embolus of an Artery Exophthalmic Goitre. Gall-Stones in Gall-Bladder Goitre...... Position of the Heart, in a Healthy Man Hvstero-Epilepsy Laryngoscope .... Intussusception of Intestine Wasting Palsy .... Male Louse, Magnified Female Louse, Magnified . Pleuritic Effusion, displacing the Heart Lungs and Heart in Place. Trusses for Hernia Elephantiasis of the Arabs Itch Animalcule Microscopic Vegetation of a Skin Disease Spine Disease .... Curved Spine .... Uric Acid Stone .... Mulberry Calculus Syphilitic Teeth .... Vaccination Scratches Elastic Bandage, Applied . Hodge's Pessary A. H. Smith's Pessary Lumbricoid Worms . A Tape-Worm .... Trichina, Magnified . Trichinae, in Muscle, Natural Size Bandaged Limb .... Rolling a Bandage Reversing a Bandage. 253. Artificial Respiration . A Simple Sling .... Broken Arm in Splints Finger Bandage and Figure of 8 Dressing for Fractured Ribs ILLUSTRATIONS. XXIX FIG PAGE 258. Bandage for Fractured Jaw........853 259. Extension for Fracture of Thigh.......854 260. Dr. Hamilton's Fracture Bed........855 261. Invalid Lift............856 262. Bandage and Splints on Leg........857 263. A Fracture-Box...........8;>7 264. Various Knots...........862 265. Dislocation of Shoulder.........863 266. Self-reduction of Dislocation........864 267. Pressure on Artery of the Arm........877 268. Spanish Windlass..........8/7 269. Pressure on Artery of the Thigh.......8" 270. Pressure by Elastic Band.........878 271. Wheeled Litter...........884 272, 273, 274. Modes of Carrying an Injured Person . . . 885, 886 275. Rocking-Chair for Carrying a Patient......886 276. Aconite Root...........888 277. Aconite Leaves and Flowers........889 895 278. Cantharides.......... 279. Spurred Rye...........900 90° 280. Hemlock........... ,,, -o , .....902 281. Parsley.......... Q03 282. Fool's Parsley • •....... 283. Jamestown Weed . ....... I PLATES. Bones of the Head, ...... Human Skeleton, front view. .... Human Skeleton, back view, .... Heart and Heart-vessels and Arteries of the Head and Neck, Anterior View of the Muscles of the Body, . Posterior View of the Muscles of the Body, . Organs of the Chest and Abdomen, . . , Scarlet Fever and Measles,..... Pustule's of Varioloid, Vesicle and Pustule following Vaccination, Vesicles with Lymph of Varicella or Chicken pox, and Eruption in Scabies or Itch, . " 822 facing page 33 K 34 " 40 ck, " 49 • " 359 « 362 k 460 a 722 (xxxi) ANATOMY AND PHYSIOLOGY. A GENERAL VIEW OF THE HUMA.N BODY: TTS STRUCTURE AND FUNCTIONS. 8 33 \ 1. Frontal Bone. 2. Parietal Hone. :!. Nasal Bones. 4. Occipital Bone. 5. Orbits of Eyes. f>. Malar Bone. 7. Upper and Lower Maxilla. "\ Nasal Cavity. Cervical Vertebra/. Clavicle. Scapula. . Sternum. , Ribs. 14. Dorsal and Lumbar Vertebra'. Innominata. Sacrum. Humerus. Kadius. Ulna. Carpus. Metacarpus. Phalanges of Hand. Femur." Patella. Fibula. Tibia. Calcis and Astragalus. Cuneiform and Cuboid. Metatarsus. Phalanges of Toes. 2G. A FRONT VIEW OF THE ADl'LT SKELETON. ANATOMY. OUR purpose in this work is to place before the reader such an account of the living body as will enable any one to understand the essential truths concerning the preservation of health, the causes of diseases, and their management. Anatomy, with which we begin, is the study of the parts or organs of which the body is made up, and of the way in which they are put together. We may look upon these parts or organs as consisting of a number of sets, or systems: as the Bones, Lungs and Air-Tubes, Muscles, Heart and Blood-Vessels, Skin and Fat, Reproductive Organs, Stomach and Bowels, Brain and Nerves, Liver, Spleen, Kidneys, Eye, Ear, etc. THE HUMAN SKELETON. Two hundred and six bones make up the solid framework of a human body. Of these, twenty-eight are in the head and face; one in the throat; twenty-five in the chest; twenty-six constitute the spine or back-bone; sixty-four are in the shoulders, arms, and hands; and sixty- two in the hips, thighs, legs, and feet. Head, Trunk, and Extremities are the natural divisions of the skeleton. Eight bones make up the skull (cranium) of a grown-up person, and fourteen are in the face. Besides these, we count among the bones of the head three tiny ones in the interior of the ear, on each side. The Spinal Column (back-bone) in Man consists of twenty-six parts, attached in a sort of chain to each other. In very early (embryonic) life 35 36 ANA TO MY. they number thirty-two or thirty-three parts; but five of these, at thr lower portion of the spine, grow together into one bone, the sacrum ; and, later, the very last three or four (below the sacrum) unite, making the os coccygis, which is the rudimentary or undeveloped tail of man. Fig 1. HUMAN SKELETON. Each of these links in the spinal chain is called a vertebra; all animals having back-bones being called Vertebrates. They constitute the highest division of the Animal Kingdom; with Man at the summit of the whole series. THE HUMAN SKELETON. 37 Between each two vertebrce is a piece of thick gristle, or cartilage. These elastic pieces act like the springs of a carriage or railway car, preventing jarring in the movements of the body. Fig. 2. SPINAL COLUMN. One bone, the hyoid or U-shaped bone, in the throat, does not touch any other bone. It forms the base of the root of the tongue, and has several muscles and ligaments attached to it. 38 ANA TO MY. The thorax, or chest, is made of the breast-bone (sternum) in front, twelve ribs on each side, and the dorsal part of the spine behind. Naturally, it is largest below the middle ribs. Tight-lacing spoils this shape, by narrowing the chest below, to the great disadvantage of the heart and lungs, which are contained within the thorax, injuring the health and often shortening life. Sometimes sudden death has resulted from this cause. Below the chest are the hip-bones; which, with the wedge-shaped sacrum between them, include the cavity called the pelvis. The upper extremity of the body consists of the shoulder, arm, forearm, wrist, and hand. Fig. 3. For the shoulder there are two bones in Man: the shoulder-blade (scapula) and collar-bone (clavicle). Fig. 4 gives a view of the scapula or shoulder-blade; the flat portion of it, which rests against the ribs below, and the ridged part above, which makes the shoulder proper. One can feel either of the clavicles or collar-bones easily, in front, in his own person, below the neck, between the shoulder and the upper part of the breast-bone or sternum. We commonly speak of the " arm " as being all between the shoulder and the wrist. Surgeons and anatomists make the elbow-joint the boun- dary between the arm and forearm. In the arm proper there is but one long bone, the humerus (Fig. 5). The head of this bone fits into a shallow socket of the scapula, in which it is kept by ligaments and surrounding muscles. Much more THE HUMAN SKELETON. 39 easily, however, than the thigh-bone, the humerus may be, by violent falls or blows, with the arm in certain positions, forced out of place, that is, dislocated at the shoulder. Fortunately, it is not so very diffi- cult to replace, if this be attended to soon after the accident. Fig. 5. Fig. 6. Fig. 7. Fig. 4. THE SCAPULA. THE HUMERUS. THE ULNA. THE RADIUS. Fig. 8. At the elbow, the humerus connects with the two bones of the fore- arm—ulna and radius (Figs. 6, 7). The ulna has the most to do with the elbow-joint. The radius is more widely joined to the small bones of the wrist. Xo bone in the body is so often broken as the radius, because of its getting the main stress of a fall on the hand, naturally stretched out to save the body as one trips and goes down. Eight small and irregularly rounded bones make up the carpus, or wrist. This is a very hard joint to dislocate, bound together as the carpal bones are with tough, short ligaments. This is needful, on account of its frequent exposure to violence through the hand. Fig. 8 shows also the beginnings of the five metacarpal (next to THE WRIST. 40 ANA TOM Y. carpal) bones Avhich make the framework of the hand. A lthough covered by muscles and held close together under the skin, we cau easily trace the form of these by feeling for them : one bone for the thumb and one for each of the fingers. Every finger (digit) has three parts or joints; the thumb only two. Phalanges these are called by anat- omists; 1st, 2d, and 3d phalanx of each finger; 1st and 2d for the thumb. The lower extremity consists of the thigh, leg, and foot; with joints at the hip, knee, ankle, and toes. The thigh-bone, or femur, is the longest bone in the body. Tiro bones, tibia (the thicker one) and fibula (slen- der), make the skeleton of the leg. At the knee, in front, is the small round and flat patella, or knee-pan; which gives protection to the joint. Seven bones constitute the ankle and instep of the foot, called the tarsus. The heel-bone, one of these, is called in anatomy the os calcis. Next to the instep come the five long, slender, metatarsal bones of the foot; and then the toes, or digits, with three parts or phalanges for each, except the great toe, which has but two (Fig. 9). THE BONY FOOT. JOINTS. Bones are held together by tough, fibrous ligaments. Between their ends, or in the sockets of some joints, are pieces of cartilage. There are two principal sorts of joints—more exactly called articulations— fixed and movable. The sutures of the head are examples of fixed or immovable joinings or articulations of bones. Movable joints are various, as follows: hinge-joints, as at the elbow and knee; ball-and-socket, as at the thigh or hip-joint; gliding, as at the junction of the lower jaw with the temporal bones of the head. All the other bones which are connected together have their union secured by ligaments, variously (and yet simply) arranged : as, the pieces (vertebrae) of the spinal column; the collar-bone (clavicle), at one end with the shoulder-blade (scapula), at the other with the breast- bone (sternum); the ribs with the spine, etc. Oecipit.il Bone. Cervical Vertebral. Scapula. Dorsal Vertebrte. Lumbar Vertebra;. Ilia. Ischia. Trochanter Major. Trochanter Minor. Condvles of Femur A BACK VIEW OF THE ADULT SKELETON. . MUSCLES. 41 MUSCLES. Looking at a piece of butcher's meat as it hangs ready for sale, we may see a fair specimen of red voluntary muscles. Dissecting one of these lengthwise, we would find it made up of delicate fibres; and a microscope would show one of these to be composed of many lesser strands or fibrillae, each of which again is formed of roundish, cell-like bodies, placed end to end, like beads. Fig. 10. STRIPED MUSCLE, MAGNIFIED. 1. Lengthwise cleavage. 2, 3, 4. Crosswise cleavage. 5. A detached disk of muscle-cells. 7,8. Separate fibrillse, formed of cells end to end. Another sort of muscular tissue, pale, almost white, in bands rather than fibres, is found in the substance of the stomach and bowels (mus- cular coat of the alimentary canal), and in the walls or coats of the blood- vessels, especially the smaller arteries. Over these muscular parts the will has no power; their action is involuntary. All red muscles are voluntary, except the heart, and (partially) the breathing muscles, the lower swallowing muscles of the throat, and the muscles of the face by which our feelings are spontaneously expressed. The heart is almost altogether a muscular organ. Its fibres are spirally arranged, and con- tract regularly by a power residing in them, the exact cause of whose " rhythmic " timing is not very well understood. As the number of voluntary muscles is very large (between three and four hundred), we will not, in this work, undertake to describe them. Many are long, and thickest at the middle; others are broad, flat, and thin ; a few run through or over distinct pulleys, changing the direction of their action. By the origin of a muscle, we mean its attachment to a bone or other part at the end nearest to the centre of the body. Its insertion is its connection at the farther end; usually to a bone, by a round, white, fibrous cord, called a tendon. Sometimes tendons are flat instead of round. Figs. 11 and 12 show the form and location of a number of the muscles in the body. ANATOMY Fig. 11. ilUSCLES, FRONT VIEW. MUSCLES. 43 Fig. 12. MUSCLES, BACK VIEW. 44 ANA TO MY. THE SKIN. We have a true skin (cutis), which is laid bare by a blister, and is verv sensitive; and over that the protective, delicate, leather-like cuti- cle, epidermis, or scarf-skin. This has no feeling at all; as can be easily shown by clipping it carefully where it is thick, as near the sides of the fino-er-nails. The tough parts of corns and warU consist of cuticle. Of the true skin there are at least two layers; undermost, one com- posed of a fibro-elastic tissue; and on that another, having a multitude of little elevations on it, giving it a hill and valley character all over. Rows of hillocks, with valley lines between them, are easily seen on the palms of the hands. Fig. 13. HAIRS AND OIL-GLANDS. SWEAT-GLANDS AND DUCTS. Each little hillock (papilla) of the skin contains the ending of a tiny branch of a nerve, and a little loop (or more than one) of small blood-vessels. The warmth and nourishment of the skin depend on these vessels; its feeling resides in the nerve-endings. The epiderm or cuticle (scarf-skin) is formed of layers of flattened cells (epithelium); seen under the microscope to have that character. Under the epiderm and upon the cutis, or true skin, is the color- layer, composed of cells which contain a dark matter. Blondes, as we call fair-complexioned people, have but few of these; color-cells. Brunettes, such as Spanish or Italian beauties, possess more of them. Chinese, Egyptians, American Indians, and Mulattoes show still more; STOMACH AND BOWELS. 45 Negroes, and some natives of Southern Hindostan, enough to make them fairly black. But the sun evidently has a good deal to do with the growth of this color-layer; as any one may be tanned by summer exposure {freckles are tan spots), and, by several years of tanning, in a hot climate, even a Philadelphia^, New Englander, or Englishman may be browned as dark as many mulattoes are. Glands of two kinds are seated in the skin : sweat-glands and oil- glands. The latter abound near the roots of the hairs, furnishing them with a natural grease. The sweat-glands are distributed all over the body. Each of these has a curious, long, corksereAv-like tube run- ning up through the skin, by which the drops of perspiration find their way out. A good deal of moisture, however, transpires, like a vapor without gathering in drops. Both kinds, by evaporation, cool the skin. to our great advantage in hot weather and when exercising actively. Beneath the skin is the common connective-tissue ; serviceable as a packing material between parts everywhere. In that tissue, near the skin, and also sometimes at quite a distance from it, as around the eye- ball, heart, and kidneys, is the fat. Over the abdomen, in very corpu- lent persons, two inches or more of this may accumulate. STOMACH AND BOWELS. Central in the body, and indispensable to its continued life, is the stomach ; and, connected with it, the intestinal canal. In Fig. 15 is a view of the whole alimentary canal. The pharynx is the upper part of the swallowing throat; the lower part is the oesophagus, going to the stomach. The stomach is a large sac or bag, shaped something like an old shoe; with the larger end towards the left side. At the right end is the outlet (pylorus) from the stomach to the small intestine. The first twelve inches of the small intestine constitute the duodenum, into which pours the bile from the liver and gall-bladder, and also the pancreatic juice from the sweetbread, or pancreas. The whole length of the first or small intestine is about twenty feet; of the lower, or large intestine, between ten and fifteen feet; making from thirty to thirty-five feet for the length of the bowels of a full-grown man. Occasionally, a tapeworm has been known to live within the intestines until it has acquired more than half the length of the whole canal! This worm is, however, quite flat and thin, and not very wide. 46 ALIMENTARY CANAL. In Fig. 15, the beginning of the large intestine is seen at the lower Fig. 16. THE STOMACH. right side of the subject; its ter- mination (the anus) is shown on the left side, below. At the junc- tion of the small and large intes- tines is the ileo-colic valve. Not far above this is the place where there is usually tenderness on pressure in cases of typhoid fever. Sometimes, also, inflam- mation of the bowels begins near the same region. OTHER ABDOMINAL ORGANS. 47 OTHER ABDOMINAL ORGANS. Fig. 17. INTERNAL ORGANS : THE LIVER BEING TURNED UP AND BACKWARDS. 1, Great Blood-vessels of the Heart. 2, 2. Lungs. 3. Heart. 4. Edge of Diaphragm. 5. Liver. 6. Gall-bladder. 7. Bile-duct. 8. Stomach. 9. Omentum, or caul, cut off. 10. Another portion of Omentum. 11,12. Colon. 13. Small Intestine. 14. Rectum. 15. Worm-like Appendix. The Liver lies across the body, chiefly but not entirely on the right side, behind the lower ribs. In color and general form, a calf's liver is considerably like it. Underneath it lies the Gall- bladder. A tube or duct car- ries the bile from the Liver to the Gall-bladder, whence it passes out, from time to time, into the duodenum, already men- tioned as the first portion of the small intestine. The Spleen is a round, flat- tened gland, a good deal smaller under surface of the liver. 1. ARTERIES OF THE HEAD AND NECK. P.A. Post'r Art. of the Ear. T. F. Trans Facial T. Temporal (). Oeeipital. It lut'r Carol id EC. Ext'r Carotid. F. Facial. L Lingual. ST. Sup"r Thyroid. IT. Lit l• Thyroid. ('.<•. Common Carotid. A.i'. Ascending Cervical. S. Subclavian. S.c. Superf. trans Cervical. HEART AND BLOOD-VESSELS. 49 BREATHING ORGANS. In Man, these are the windpipe, lungs, breathing muscles, and the blood-vessels and nerves connected with these. Through the nostrils or the mouth air enters the Larynx. We can feel this, or see it in another, where the " Adam's apple " is in a man's throat. The Larynx is the organ of voice ; hence it is larger and less simple than if it were only to breathe through. Below the Larynx is the Trachea, chiefly composed of cartilaginous rings; and this branches into the two Bronchial tubes, one going to each Lung. The Lungs are light, spongy organs, pinkish slate-colored, which fill up almost all the space within the chest not occupied by the heart and great blood-vessels. After death, a healthy lung crackles softly when pressed by the hand; and will float on water, on account of the air contained in it. Six hundred millions of air-cells, it is calcu- lated, make up, with the little tubes joining them, the two lungs of a grown person. Each cell is about the one hundredth of an inch in diameter. The right lung consists of three portions, called lobes. The left lung has but two lobes. HEART AND BLOOD-VESSELS. Our blood is circulated throughout the body by the Heart, Arteries, Capillaries, and Veins. Another set of vessels carry along the white or colorless liquids called lymph and chyle ; those vessels being called Lymphatics and Lacteals. Of the latter, more hereafter. A man's heart is about the size of his fist. It is two hearts in one; that is, one half has its entrances and exits quite separate from those of the other half. Again, each half-heart has two chambers; an auricle and a ventricle. We have, then, the right auricle and ventricle, and the left auricle and ventricle, built against each other, like twin houses. The right half of the heart is almost all in front of the other half. The heart is placed behind the breast-bone (sternum), with its larger end upwards, and its tip (apex) pointing downwards and to the left. As its larger and stronger parts (ventricles) press out the blood from themselves into the great arteries, the heart-tip beats against the chest- wall, under the fifth rib. 4 50 ANATOMY. Into the right auricle enter two large veins, the largest in the body, one from above and the other from below. These bring all the blood of the body back to the heart. The right auricle opens into the right ventricle. From the right ventricle a large vessel, the pulmonary artery, passes out, and branches into the two lungs. Four veins from the lungs (pulmonary veins) enter and carry the blood into the left auricle. This opens into the left ventricle. Out of the left ventricle goes the aorta, the largest artery of the body; whose branches supply all parts of the system with blood. Fig. 22. THE HEART, LAID OPEN. Over the Heart is a covering sac, called the Pericardium. The Aorta forms an arch above, and goes down behind the heart (Fig. 22). It gives off branches all along, and descends in front of the back-bone (vertebral or spinal column). Right alongside of it lies the great vein (vena cava), which carries the blood from the lower part of the body and pours it into the right auricle. There are a great many arteries in the body. You can know where one lias by its pulsating or beating, like a little heart. There are still HEART AND BLOOD-VESSELS. 51 more veins, many of them right under the skin, where they can be seen, of a bluish color, as on the back of the hand. When an artery is cut, bright-red blood flows, with a jerking, pulsating spurt, a great deal of blood escaping in a short time. If a vein is cut, dark, blue-black blood comes out, with a steady flow. From a large vein, as the jugular of the neck, enough may come to cause death in a little while; but from a small vein much less, and it is more easily stopped by pressure than when an artery is wounded. One simple rule will enable any one to judge where the principal artery of each part of the body lies. The artery is always in the safest possible place which its destination allows. Fig. 23. Fig. 24. Small Intestine. CAPILLARIES OP A TOOTH. (Much Magnified.) Capillaries receive their name from their being smaller than a hair. Some of them are not more than the 3000th of an inch in diameter. They are arranged variously in different parts of the body. Veins receive the capillaries as rivers do rivulets emptying into them. Small veins then join to make larger ones, till at last all unite in empty- ing into the great ascending and descending veins (venae cavae), which pass from below and above into the right auricle. Some veins are deep-seated, companions to the arteries; others are at the surface, and can be readily seen. Nearly all the veins have valves along their course, by which their blood is prevented from flowing backwards. All blood-movement in the veins must therefore be towards the heart. None 52 ANATOMY. of the arteries have valves, except, as before said, just at the origins, in the heart, of the pulmonary artery and the aorta. One exception there is, in regard to veins always joining to make Fig. 2o. LACTEALS AND LYMPHATICS. larger and larger trunks. There is a large vein in the centre of the body, called the portal vein, receiving blood from the stomach, small intestines, and spleen, which divides up into capillaries. These then Fig. 26. LYMPHATIC VESSELS AND GLANDS. go through the liver, and are again united into a vein (Jiepedic vein), which runs out from the liver into the great ascending trunk (vena cava). ORGANS OF REPRODUCTION. 53 Lymphatic vessels are distributed all over the body, except in the brain, spinal marrow, and a few other parts. They are small and deli- cate (except the two large ducts which receive the rest), and contain a colorless fluid, called lymph. Those of the small intestines, however, convey a milk-like fluid called chyle; and these vessels are named lacteals. Most of the lymphatics and all the lacteals empty into the left thoracic duct. This passes up through the abdomen and chest (thorax); to discharge its contents into the junction of two large veins, one from the arm and the other from the neck (subclavian and jugular veins). There is a much shorter similar thoracic duct on the right side. All along the course of the lymphatic vessels are small flat and round " kernels," the lymphatic glands. They are most numerous in the deeper part of the abdomen, in the arm-pit, the neck, and the groin. When healthy, they are not large and hard enough to be seen or felt; but when diseased, they sometimes become quite large and conspicuous. ORGANS OF REPRODUCTION. Our purpose will be here best served by giving a veiy brief account of some of the organs (chiefly internal) which are essential to the contin- uance of the species. Those of the female system are the Ovaries and the Uterus. There are two Ovaries, one on each side, suspended in the " broad ligament" of the Uterus. Fig. 27. OVARIES AND UTERUS. Each Ovary is an oval body, about an inch and a half long, three- quarters of an inch wide, and a third of an inch in thickness. In the free margin of the broad ligament there is on each side a tube, four inches long, opening at its inner end into the body of the Uterus. The 54 ANATOMY. outer end of each duct widens out, and infringed (see Fig. 27). Ordi- narily, this end opens into the cavity of the abdomen; but at certain periods it presses upon the ovary, so as to receive from its surface a discharged ovum. The Uterus is a pear-shaped body, broadest above, suspended by its ligaments in the pelvis; that is, the lowest portion of the trunk. It is about three inches long, two inches wide at its upper part, and an FlG .28 inch thick. When in its right position, its upper end is directed upwards and somewhat forwards; its lower end, downwards and slightly backwards. Behind it is the bowel (rectum), and before it the bladder. Anato- mists speak of the fundus or body, the cervix or neck, and the os or mouth of the Uterus. The Mammary gland, or breast, is a part of the reproductive system, being designed for the nourishment of offspring. It is composed of a great number of cells, in which milk is secreted from the blood. These open into tiny tubes, which unite to form larger ducts, making of these at last fifteen to twenty lactiferous ducts. All these converge to the nipple, where the milk is supplied to the infant after its birth. The mammary glands commonly grow much larger at the approach of maternity. MAMMARY GLANDS. BRAIN AND NERVOUS SYSTEM. All vertebrate or back-boned animals, among which man is the highest in the scale, have a Brain, a Spinal Cord, Ganglia (nerve- centres), and Nerves. Man's brain is much larger in proportion to his body than that of the most manlike Apes, such as the Gorilla, Orang- Outang, and Chimpanzee. Nearly the whole cavity of the skull in man is filled with the Brain. It is made up of a greater and a lesser brain (cerebrum and cerebel- lum). Each of these is in two halves or hemispheres; but the division is deepest between the right and the left half of the upper, front, greater brain, cerebrum. Three membranes wrap and protect the brain ; an outer tough, fibrous one (dura mater) next the skull; then a thin layer (arachnoid), BRAIN AND NERVOUS SYSTEM. 55 always moist, like the pleura which wraps the lungs; innermost, very close to the brain, the delicate pia mater, almost all made up of blood- vessels. Fig. 29. Convolutions, that is, in and out winding irregular channels, cover the whole surface of each hemisphere of the greater brain in Man. So they do also in Apes, Lions, and many other animals; but some ani- Fig. 30. ONE HEMISPHERE OF THE CEREBRUM. mals are smooth-brained, Man has the greatest number of convolutions of all. They might, from their appearance, be imagined to be made 56 ANATOMY. at their beginnings in Fig Fig. 31. by the brain growing almost too large for the skull, and so becoming winkled, as clothes do when packed in a trunk without being folded. Anatomists speak of three lobes or portions of the cerebrum, one behind another; but these, as well as the inner structure of the brain, need to be described only in a technical or professional study of the sub- ject. We may say here merely that, while the outside part of each hemisphere, where the convolutions are, is composed mostly of gray nerve-cells, much the greater part of the cerebrum is of white nerve- substance ; and this, when examined with the microscope, is seen to be made up of myriads of tiny tubes; the same as those of which the nerves are constituted, all over the body. About a dozen pairs of nerves are connected with the base or lower part of the cerebrum. Among them are the optic nerves, for the eyes ; olfactory nerves, for the nostrils; auditory, for the inner ears; one pair for the muscles of the face; another pair for the tongue, etc. Several of these are shown 3. The cerebellum, or lesser brain, is behind, and, in Man, though not in all animals, below the cerebrum. It is, in Man, considerably smaller than the latter. Instead of convolutions, it is marked outside with lines, and within, when cut open, it has a branched ap- \WJ< fWl C~A pearance, fancifully called by some old ' anatomists the tree of life. It has no more, really, to do with life than the rest of the brain. Out from the cerebrum, and partly also from the cerebellum, there passes down the beginning (medulla oblon- gata) of the spinal cord (medulla spinalis). The Spinal Cord, or Spinal Mar- row, extends all the way down the back, encased within a channel immedi- ately behind the bodies of those pieces of the back-bone called vertebrce. Nerves which go in and out through the small holes on each side of the back-bone, are shown in Fig. 34. These spinal nerves carrv messages, so to speak, between the brain and the hands, feet, and other parts. Were any of them cut across, some parts of the body would be deprived of feeling and of the power of motion. In Fig. 33 we have a view of the two optic nerves; which are pecul- iar in joining and crossing each other between the brain and the eyes. AN INSIDE VIEW OF THE BRAIN. BRAIN AND NERVOUS SYSTEM. 57 Almost all the nerves are white and cord-like; they branch, so as to become smaller and smaller, and their final ends are connected with muscles, the eye, ear, skin, or other parts. Fig. 32. HALF OF THE CEREBELLUM AND PARTS NEAR IT. Ganglia are little knots of gray nerve-cells, scattered about in different parts of the body, but always having nerves connected with them. They are nerve-centres. Oysters, clams, and cuttle-fishes have no brain nor Ftc. 33. spinal marrow; only ganglia and nerves. Insects and worms also are without brains, or any real spinal cord; but their ganglia are laid in a double line, something like the spinal marrow in form. 58 ANA TO MY. The most regular arrangement of ganglia in Man is in a double row, on the two sides of the back-bone (spinal column), outside of it. These ganglia have nerves connecting with the spinal nerves, and they send branches also to the great organs within the body (stomach, liver, spleen, heart, lungs, kidneys, ovaries, uterus) and to the arteries, which have Fig. 34. BRAIN and spinal cord together. no other nerves. Moreover, there is a small ganglion on each of the hindmost of the two roots which every spinal nerve has. Behind the stomach lie the largest ganglia in the body, called, from their half-moon shape, the two semilunar ganglia. Near them is a great mesh (plexus) of nerves, called the solar plexus. Because of their close conuection with the spinal marrow, and also with the heart, BRAIN AND NERVOUS SYSTEM. 59 lungs, stomach, and other central organs, a severe shock to these ganglia is felt all over the body. That is the reason why a heavy blow upon the pit of the stomach may even kill at once. Anatomists have long been accustomed to call these ganglia and their nerves the Great Sympathetic System. They do connect a great many Fig. 35. NERVES OF THE BODY. parts together; yet as feeling belongs not to them, but to the brain, spinal cord, and their nerves, and these ganglia are most related to the central organs of digestion, circulation of the blood, etc., the best name for them and their attachments is, the Ganglionic System of Organic Life. (See Physiology.) PHYSIOLOGY. Physiology shows the actions and uses of those parts of the body (called organs, or instruments, their fabrics being called the tissues) whose shapes, sizes, and places in the system are set forth in Anatomy. Fig. 36. HAND OF MAN AND GORILLA. Two sets of functions or operations are performed by different organs or instruments iu the body. One set, being exceedingly like functions performed also by plants, are called vegetative functions; the others, peculiar to animals (including Man), are termed animal functions. Of the first set there are: Digestion, Respiration, Circulation, Excretion, Growth, Reproduction. Of the second set: Sensation, Intellection, Spontaneous Motion, Emotion. 60 HOW WE TAKE FOOD. 61 HOW WE TAKE FOOD. Man's teeth are in part like those of carnivorous animals (dog, cat, lion), being sharp all around in front; but our back jaw-teeth (molars) are more like those of the ox and horse, fitted for chewing our food. What is chewing for ? It is to break up and soften our food, and mix it with the saliva of the mouth. This makes it more easy to swallow, and begins its digestion. Much of our vegetable food (such as bread, potatoes, peas, beans, etc.) consists chiefly of starch. Now the saliva acts upon moist, warm starch, changing it somewhat. That particular change, the beginning of digestion, being less active while the food is in the stomach, goes on faster and is ended in the small intestine. Fig. 37. SECTION OF HEAD AND NECK. ?. Canal for Spinal Marrow. 3. Hard Palate. 9. Epiglottis. 11. Trachea. 30-34. Muscles of Pharynx. 35-37. CEsophagus. Swallowing is done in the gullet (pharynx above, oesophagus lower down) by its muscle. The first part of the act of swallowing we can manage by an act of the will; after the morsel is down apiece, it mil o-o farther, in ?pite of us. Even at the beginning it sometimes needs " coaxing," so to speak. A small pill is harder to swallow than a large one; because it does not stimulate (wake up) the swallowing muscles of the throat so well. Put the pill into a mouthful of jelly, or place it far back on the root of the tongue, and then take a drink of water,—and down it will go. 62 PHYSIOLOGY. DIGESTION. In the stomach is secreted (chiefly just after food has been taken) the gastric juice. This is an acid fluid, containing a substance called pepsin (from a Greek word meaning digestion; dyspepsia is bad digestion). It dissolves and changes, that is digests, the lean part of meat, the pasty part (gluten) of bread, and the cheesy part (casein) of milk. The fatty portion of our food scarcely begins to be digested till, after being made into chyme, it all passes out through the pylo- rus, from the stomach into the small intestine. Into the beginning of this, the duodenum, pour the bile from the liver, and the pancreatic juice from the pancreas. By these fluids, in the small intestine, the process of digestion is completed. ABSORPTION. Before food which is digested in the stomach goes from it (through the pylorus) into the duodenum, it is converted into chyme. Part of it, entirely dissolved, is soaked up, absorbed, by the small blood-vessels (capillaries) of the stomach, and is carried by these and larger blood- vessels (veins) into the general circulation. A good deal of the blood from the stomach (aud also from the small intestine) goes through the portal vein, into the liver. In this blood there is conveyed to the liver a large amount of nourishing material, which afterwards passes into the general circulation. Chyme, acted upon in the small intestine, is changed to chyle. This is a milky fluid, which is taken up, very much as the small rootlets of plants take water from the ground, by vessels called lacteals. All the lacteals empty into the thoracic duct (see Anatomy), a tube which ends at the junction of two large veins at the upper left side of the chest, just below the throat. Thus the chyle gets into the blood. But, all along their track, the lacteals go through small round, flat bodies (made of cells), called the mesenteric glands. These act upon the chyle, changing it, so that it becomes more like blood. This kind of change is called assimilation. Blood going through the liver and spleen also seems to be assimilated, that is, made like or similar to the tissues of the body; and the glands scattered along the other absorb- ent vessels, called the lymphcdics (see Anatomy, under Circulation), assimilate the lymph, which they take up everywhere in the body, to the blood-lymph, which nourishes all the tissues. ABSORPTION. 63 Nourishes; what does that mean ? Does not eating directly nourish? Not exactly. It prepares food to become nourishment; and so does digestion. Absorption then brings it, thus prepared, into the blood; and the blood directly nourishes all parts of the body. It is meant by Fig. 38. THE LACTEALS AND LYMPHATICS, this that, as every part is alive, growth and waste must be provided for by new material. That any part of the body, as bone, muscle, or brain, shall grow aud keej) healthy and strong, needs several conditions. 1. It must have a sufficient supply of blood. 2. The blood must be of a good quality. 64 PHYSIOLOGY. 3. There must be also a supply of nerve-force, through connection with a healthy nervous system. 4. The part or organ must have its natural and proper share of use or exercise. 5. Between the periods of exercise there must be time enough for sufficient rest for the repair of waste. CIRCULATION OF THE BLOOD. Beginning at the right ventricle of the heart (see Anatomy), the blood passes thence to the lungs. Thence, after being aired, it returns Fig. 40. A HUMAN HEART, LAID OPEN. to the left auricle. This pours it into the left ventricle. Out of that cavity it goes into the great aorta, the main artery of the body. Between each auricle and its attached ventricle there are bands and cords, making a sort of doors or valves, slmtting behind the current of blood when it passes from the auricle to the ventricle, and preventing its return. Some of these are shown in Figs. 40 and 41. CIRCULATION OF THE BLOOD. 65 At the beginnings of the aorta and pulmonary artery (the latter going to the lungs) there are three-pocketed valves, called semilunar, from the half-moon shape of the pockets. When the heart acts during life, two of these great valves are always open, and two of them shut. As the ventricles, right and left, squeeze out their contents into the great arteries (pulmonary and aorta), they Fig. 41. HEARTS CUT OPEN, SHOWING THE VALVES OPEN AND SHUT. close the membranous valves behind them, and at the same time the semilunar valves of the arteries are open. Then the ventricles relax; the semilunar arterial valves are shut by the back-pushing blood cur- rent, and the membranous auriculo-ventricular valves are open, allowing the blood to pass from the auricles into the ventricles. The heart in man, all mammals and birds, might be described as two Fig. 42. VALVES OF THE AORTA, SPREAD OPEN (MAGNIFIED). hearts laid together, like irregular " twin houses." The right heart (composed of auricle and ventricle) takes venous blood and sends it to the lungs. The left heart (auricle and ventricle) receives aired blood from the lungs, and sends it over the body, through the aorta and its branches. From those branches it is divided up among the capillaries (smallest blood-vessels), and they give it to the veins. 5 QQ PHYSIO LOG Y. Through the veins, joining together like branches of a running stream, the blood is at last (by the venae cavae) returned to the heart. Muscle (red, striped) makes up the substance of the heart. It nevei stops acting, whether we are sleeping or waking; taking no rest, except in the short pauses, one of which occurs after each beat, before the next begins. When the ventricles contract, the tip (apex) of the heart knocks geutlv against the inside of the chest, just below the fifth rib. As we feel this, we call it the impulse of the heart. If you put your ear ou any one's chest, right above where the heart is felt to beat, or a little nearer to the middle of the breast-bone, two sounds will be heard, lub-dup, lub-dup; the first the loudest aud strongest. These are of much importance to physicians, in judging about disorders of the heart. A grown man's heart beats, on the average, when quiet aud in health, seventy times a minute; a woman's, seventy-five times. There is no harm, however, in a pulse (as we call it when counted at the wrist) beating only sixty times a minute. Exercise, great heat, emotion, or stimulating drink, may hurry it up to more than a hundred per minute in any one. Standing, it is most rapid; a little slower, sitting; slow- est, lying down. Infants have pulses of a hundred or more beats per minute while perfectly well. Old people have the pulse slower than those of middle age, until they come to be very old, when it may be weak and rapid. Fever is always attended by a rapid pulse. Opium poisoning, apoplexy, aud compression of the brain from a broken skull, are marked commonly by a slow pulse. When one becomes very feeble, especially from long illness, the pulse is small and rapid. Dying persons most generally have a rapid, thready, small, weak pulse. The arteries have each three coats: the outer one tough and fibrous, the innermost thin aud very smooth; the middle one both muscular (white, unstriped muscle) and elastic. When blood is pushed into the arteries by the heart, they contract upon it; and so help to carry it farther, into the capillaries, and, through them, into the veins.* As the most assistance to the movement of the blood is wanted at the greatest distance from the heart, so the most muscular arteries are the smallest branches. By these, the amount of blood given to different parts is regulated according to their needs. * Many physiologists do not. acknowledge that the arteries assist the heart in forcing the blood onwards; thinking that they regulate its flow merely by resisting it, more or less But, after much study of the subject, the author is satislied that the above account is correct. CIRCULATION OF THE BLOOD. 67 Veins are easily seen on the back of any one's hand. They do not beat or pulsate like the arteries. In them the blood flows towards the heart; and there are valves along their course (which the arteries do not have) keeping the blood from going back again. Exercise of the muscles, by pressing on the veins, helps forward the circulation of the blood in them. Whales, reptiles, and fishes have no valves in their veins. As arteries have no valves, muscular pressure acts on them both ways, forwards and backwards; although in them the current onward is stronger. Several arteries go through long channels, which protect them from pressure. This is the case with the vertebral artery at the back of the neck on each side; it runs through holes in the side pro- jections (processes) of the pieces of the back-bone (vertebra?) of the neck. The whole bulk of the veins is three times that of the arteries. The blood moves, therefore, much more slowly through the veins. Altogether, it takes about half a minute for a drop of blood to go the whole round ; say from the beginning of the aorta to the entrance of the vena cava into the right auricle. Capillaries are the very minute vessels between the euds of the arteries and the beginnings of the veins. They are too small to be seen without a microscope. But iu them the blood goes to aud through all parts of the body (see Anatomy), and irrigates, so to speak, each part, by the oozing of lymph (the liquid part of the blood) through the capillary coats or walls. But one coat, however, and that a very thin one, belongs to the capillaries. The blood is pushed into these small vessels by the heart, aided by the arteries; and assisted somewhat by capillary attraction. This kind of attraction may be studied outside of the body also. Put a lump of sugar into a saucer which contains only a teaspoonful of water. Presently you will observe that the water has climbed up to the top of the lump, and is melting (dissolving) it clown. This happens because the sugar is porous; and each pore is a kind of small tube, in which the water is drawn upwards. So, too, in the little, delicate fibres of the roots of a plant or tree, capillary action takes place, forcing upwards the liquid from the ground. 68 PHYSIOLOGY. THE BLOOD. Many Caterpillars and AVorms have blood which is a reddish, greenish, or brownish liquid. Man's blood, and that of all the higher animals, is a colorless liquid, in which float multitudes of minute bodies, red corpuscles, which give it a red color. Eight millions of these corpuscles would not more than cover the head of a pin ! With a microscope these are seen, shaped, in Man, something like railway car-wheels. Less easily observed, and much fewer (only one to several hundred of the red) are the somewhat larger white or Fig. 43. SIZE OF BLOOD-CORPUSCLE3 IN DIFFERENT ANIMALS (ALL MAGNIFIED). colorless corpuscles. The white are rather more, and the red rather less, than one three-thousandth of an inch in diameter, in Man. Wasting diseases lessen the number of the red blood-corpuscles, and reduce also the amount of iron in them, which is important for their and our health. Hence physicians often prescribe iron to be taken as a tonic medicine; it might really, in such cases, be called a food. Blood has a saltish taste, aud contains " salts," as chemists call sub- stances more or less like common salt in their nature. When the blood dies, it clots or coagulates. That is, it separates into a watery liquid, called serum, and the clot, or coagulum. THE BLOOD. 69 About ten minutes after leaving the body the blood begins to clot; but, in a large quantity, it may be a good while, even hours, before the serum and coagulum are entirely separated. Even within the body, a portion of blood which is parted from the current (as in that sort of swelling on an artery which is called an an- Fig. 44. Fig. 45. BLOOD COAGULA. eurism) may " die," so as to coagulate. Now and then, when life is very low from exhausting disease, clots may form in the heart itself, and hasten death. Uses of the blood are two: to nourish all parts of the body, and to stimulate, that is, wake up and spur on, the actions of the organs. Fig. 47. CAPILLARIES. AIR-CELLS AND CAPILLARIES OF A HUMAN a, Of the skin of a Finger; 6, of the Small LUNG (MAGNIFIED). Intestine. Nourishment is given (as already explained) by the liquid part of the blood (lymph) oozing through the capillaries everywhere into the tissues. Stimulation of all the organs is ascribed to the gas (oxygen gas) in the blood, which needs to be renewed by breathing (respiration). 70 PHYSIOLOGY. BREATHING. Our lungs consist of about six hundred millions of air-cells, all sur- rounded by very fine capillary vessels, carrying blood. Thus the air, coming through the bronchial tubes to the lung-cells, acts on the blood through the thin walls of the cells and the delicate coats of the capillary vessels. How is the air made to go into and out of the chest ? By the action of the intercostal muscles (see Anatomy), we lift our ribs, somewhat as we open an umbrella. Also, the diaphragm, Fig. 48. HUMAN WIND-PIPE, LUNGS, AND HEART. the dome-shaped muscle arching across the middle of the body under the lungs and heart, contracts and goes down, becoming nearly flat. Thus, very much as with the two sides of a pair of bellows, we expand the chest, and draw the air in through the nostrils or mouth, or both. When these are closed, we cannot breathe at all. Women lift their ribs most in breathing; children depress the dia- phragm more, as shown by the bulging of the stomach (abdomen). Men breathe about equally in both ways. When one breaks a rib, a surgeon will bind the chest pretty tight with a broad bandage, so aa to keep the ribs nearly at rest. BREATHING. 71 Fig. 49. PLAN OF AIR-TUBES AND AIR-CELLS. When the lungs are diseased, or the breathing muscles are weak, so much cannot be taken in as when we are well. It is a good sign of health to be able to draw a very long, deep breath. Life insurance examiners sometimes use this as a test of what is called vital capacity. About sixteen times in a minute is the average breathing rate of a grown person, when quiet and in health. When ill, as with inflammation of the lungs, or even merely with fever, it may be hurried to forty or more times a minute. Children breathe more rapidly, taking much shorter breaths. What we breathe for has already been partly explained. It is to get oxygen into the blood, and carbonic acid gas out of it. We also exhale watery vapor constantly; as may be seen in the little mist before one's nostrils out of doors in cold weather. Also, the frost- ing of window-panes shows the freezing of moisture, part at least of which is from the breaths of people in-doors. Moreover, the odor of the breath of most persons gives proof of the giving off of ivaste matter (dead and dying particles) from the blood by the lungs. Carbon, to an amount equal to about half a pound of charcoal in twenty- four hours, is exhaled by every grown person, in the carbonic acid of the breath. Of watery vapor, each of us breathes out, in the same time, what would make, if condensed, nearly a pint of water. Carbonic acid gas, when unmixed with air, cannot be breathed at all; it " chokes " at once. When mingled with a large quantity of air, we can breathe it easily enough ; but if there is one-tenth or less of it in the air, it puts one to sleep; and this, if prolonged, is the sleep of death. Persons lying or sitting near a charcoal fire whose fumes are not carried off by a good chimney, are thus overcome in a short time. Common " coal gas," from a fire of anthracite or bituminous coal, is even more poisonous. No one should ever remain in a room where, from bad draught, a stove or other fire gives off gas enough to be known by the smell. Burning gas, used for lighting, is likewise very poisonous when breathed. Not a few persons have lost their lives, through ignorance, by blowing out the flame of a gas-burner, without turning it off, and then going to sleep where the gas is escaping. The Grotto del Cane, in Southern Italy, is a cavern from the ground of which there is a natural supply of carbonic acid gas. That gas is 72 PHYSIOLOGY. heavier than air, and lingers awhile near the earth. AY hen a man goes into the cave with a dog, the animal, being nearest the ground, is soon overcome, and falls as if dead. If taken out at once; it will revive again. Nitrogen gas, which makes four-fifths of the air, appears to have no important part therein, except to dilute the oxygen. ANIMAL HEAT. On our commonly used Fahrenheit thermometers, " blood heat " is put at ninety-eight degrees (98°). But it should be marked higher. In the armpit of a healthy man or woman, a thermometer with its bulb remaining for five minutes will mark 98.5°. In the heart itself, it is 100°. Our bodily heat does not increase much with hot weather, or in tropi- cal climates, because the perspiration modifies it. Evaporation, of water or any other liquid, cools the surface where it happens. Thus an engineer can attend to his fires where the thermometer marks 110° or higher, so long as he sweats freely; not otherwise. Flannel is the best thing for clothing under such circumstances; because it absorbs per- spiration well, and is also a slow conductor of heat—that is, heat does not go through it rapidly, as it does, most of all, through metals. All clothing is useful to us chiefly by its slow conduction of heat, either from or to the body. (More will be said of this under Hygiene.) Chabert, who was called the Fire-king, by special training and preparation of his clothing, was able to enter safely a large oven or fur- nace heated to 600° Fahr., nearly three times as hot as boiling water.* Hot-air baths are often taken at 150° ; some use them as high as 250°. Yet if the blood is really heated up to 110°, life is endangered. Many reptiles are killed by a temperature of 100° Fahr. AYhat causes the warmth of the body ? This has been briefly ex- ' plained already, when we referred to carbon being consumed, burned (along with hydrogen, etc.), in our bodies by oxygen. It is not in any one part of the system that this occurs, as in the house it does in a stove, grate, or furnace. It is going on in the blood everywhere, as it flows; but the heat is of course greatest near the centre of the body, in the heart and lungs, where there is the most blood; and is least in the parts farthest away from the centre, as the feet. * Water boils at 212° Fahr., and freezes at 32°. EXCRETION. 73 Children have rather more natural warmth than adult persons; but when exposed to severe cold, they suffer soonest and most. AVhen only the feet are frozen, they may mortify, and the sufferer may survive. Arctic explorers have sometimes thus lost their toes. If any one is in danger of being frozen to death, from continued exposure to extreme cold, great drowsiness comes on, which ought not to be yielded to; sleep then brings death. Fever is marked by increased heat of the body; the hotter it becomes, the more serious the case. In scarlet fever, for example, it may run up to 104°, 105°, or 106°, or higher. EXCRETION: DISCHARGES. " AYe all do fade as a leaf." All creatures that live on earth die, particle by particle—life and death are inseparable everywhere. As we have compared the heat-making process in our bodies to the slow burning of a fire, so our waste material may be compared to the gas, smoke, and ashes of the furnace. All such things must be removed, or the fire is smothered and extinguished. Breathing serves both to supply the draught to our inward combus- tion and to carry off a portion of waste, such as carbonic acid, watery vapor, and minute dead particles of organic matter, from the blood. Other organs help in this indispensable removal; most directly, the kidneys and bowels (large intestine); also, secondarily and partially, the liver and skin. Should any of these stop their work of purifying the blood, it must become poisoned by its own decay. If the stoppage of breathing did not kill at once by arresting the supply of oxygen, it would soon do so by accumulation of carbonic acid in the blood. AYhen the skin ceases to transpire for a day, or the kidneys fail to secrete for a week, or the bowels for two or three weeks, death will usually follow. Secretion is the process by which any fluid or solid material is sepa- rated from the blood. Excretion is the name given to it when such matter is entirely thrown off as waste. Milk is an example of a secre- tion for a purpose of use (to nourish offspring), not for waste. Tears also are useful, in moistening the eyes; and their abundant overflow at times gives relief to the brain under the excitement of strong feeling. Altogether excretory, in man, is the action of the large intestine and that of the kidneys. Perspiration, upon the skin, has its use in maintaining the softness, and moderating the temperature, of the surface of the body. Bile, secreted by the liver, is partly excretory, but also serves a purpose in digestion. 74 PHYSIOLOGY. THE LIVER. This is the largest of the glands. It secretes bile ; but that is not all that it does. It receives blood by an artery, coming from the aorta ; but it also receives venous blood, through the portal vein (see, on a previous page, under Physiology of the Circulation). Now this portal vein receives a good deal of blood from the stomach and small intestine. AAHien these have received and digested food, the chyme and chyle there formed are absorbed (taken up) both by capillary blood-vessels and by lacteal absorbents. And while the lacteal vessels take their chyle, through the mesenteric glands, to the thoracic duct, which empties into the great veins at the left upper corner of the chest, the capillary vessels go to the portal vein, and thus supply food-enriched blood to the liver. The liver then acts upon it; assimilates it to the stuff of the body which it is to build up and repair; that is, to nourish. Going into the liver as fluid food, the blood leaves it more like fluid tissue. The spleen, as already said, probably does a work somewhat like this; but exactly how these organs act, it is very hard to make certain. The greenish-yellow bile, when formed, goes generally from the liver into the gall-bladder under it. Then, an hour or two after a meal, it is forced from the gall-bladder into the duodenum, into which also is poured the secretion of the pancreas. Both of these liquids aid in finishing digestion. The bile, also, stimulates the muscular (peristaltic) action of the intestinal canal; in common words, keeps the bowels open. Costiveness is very apt to be accompanied by clay-colored discharges, having little or no bile in them. Very bilious ones are yellow, or vellowish-greeu. Their natural healthy color is a dark yellowish-brown. Black passages are not common, except when iron is taken as a medicine. Right action of the liver is very important to a healthy condition of the body. Its disorders are most common in hot climates, aud (in any climate) among those who drink alcoholic liquors. Jaundice is a yellow- ness of the skin from the coloring matter being thrown out on the sur- face of the body, instead of taking its usual course through the intestines. The " whites " of the eyes are then commonly tinged yellow also, and sometimes the tongue. Most of the bile is re-absorbed, with digested food, from the small intestine iuto the blood; but not all of it. And it is necessary to health—it would seem essential even to life—for it to go from the liver or gall-bladder into the intestines. Experimenters have found that if, by a tube, they turn off the bile from the body of an animal altogether, it will die. THE KIDNEYS. 75 THE KIDNEYS. These secrete the urine, from the blood; from arterial blood, in Man. In some other animals (reptiles and fishes) portal venous blood goes to the kidneys as well as to the liver, and there mingles with arterial blood. Only the rind or outer coating (cortex) of the kidney secretes urine. SECTION OF A KIDNEY. STRUCTURE OF KIDNEY, MUCH MAGNIFIED. to go to the ureter, the duct through which the urine runs to the bladder. There it waits until removed from the body by the urethra (see Anatomy). The urine is a true excretion ; mere waste. Two or three pints of it are thrown out daily by a grown person in health; the most in cold weather. The kidneys and skin take turns, as it were, in their work. Both act all the time; but the more we perspire, the less is passed from the kidneys; aud vice versa. Check of perspiration, from cold, may find relief in increased urination. If not, then comes trouble; we " catch cold," as we say; really, the cold catches us. AYhen both skin and kidneys have their secretion almost entirely stopped, or considerably 76 PHYSIOLOGY. lessened, dropsy may follow, from the water (commonly going out as perspiration and urine) escaping from the blood-vessels, under the skin, or into the abdomen, chest, or elsewhere iu the body. Slight changes in the quantity, color, or clearness of the urine are not important. When a physician suspects that something is wrong, he ex- amines the urine chemically and with the microscope. Sometimes there is a good deal of sugar in it, making the disease diabetes. More often, especially in somewhat broken-down people, there is albumen (very much like white of egg) in it. One sign of Bright's disease is this, albuminuria. Some things taken as food or medicine pass out but little changed with this secretion. Thus may be observed the odor of asparagus, and the color of rhubarb, etc. In jaundice, especially if there is less color of bile than natural in the passages from the bowels, the urine is often of a dark bronze-yellow or porter color. AYhen no secretion from the kidneys occurs at all for days together (suppression of urine) uraemia, or blood-poisoning from materials of urine not removed, occurs; with a tendency to stupor and death. Gravel and stone in the bladder result from a change in the urine, owing to a fault of the kidneys, and generally of the blood still more; the water secreted not dissolving all the mineral matter sufficiently. INTESTINAL EXCRETION. In Man, as already said, the large intestine takes no part in digesting food (as it does in grass-eating animals, such as the ox), but only carries out refuse aud waste; excreting, as physicians say, the feces, or discharges from the bowels. Not only what is left over, either because indigestible or because too much has been eaten, goes thus out from the body. Along the large intestine there are small glands, made of minute cells, which have the duty of taking from the blood the most offensive aud putrescible of all waste matters. These and the refuse of food, together, make up the excretion. Its necessity to health is well known to all. AYe shall refer to it again in connection with Hygiene. THE SKIN—OUR MOVING POWERS. tl THE SKIN. Two important uses, besides help in excretion and purification of the blood, belong to the skin : protection of the pails beneath it from injury, and feeling or sensation. SECTION OF THE SKIN (MAGNIFIED). (MAGNIFIED). The sweat-glands send up spiral tubes, which open slantwise on the surface of the skin, where, though they are too small to be seen without a microscope, we know of their existence when the perspiration collects in drops. The oil-glands are planted, so to speak, in the tissue under the skin near the hairs; as shown in Fig. 53. By slow transpiration and seen or felt perspiration together, we give off between one aud two pints of water from the skin daily; most in summer. OUR MOVING POAYERS. Muscles move the bones like any other kinds of levers. There are three sorts of levers. First, that in which the fulcrum, or place of rest, is between the power that moves and the weight to be moved. 78 PHYSIOLOGY. Fig. 54. 1 Fig. 55. \\ In the second, the weight is between the fulcrum and the power. In the third, the power is between the fulcrum and the weight. AArorking a pump-handle is an example of the first kind of lever. So is throw- ing; one's head back or for- ward; the fulcrum then be- ing at the junction of the head with the upper end of the spinal column. Of the second kind of lever, wheeling a wheelbar- row gives an example. In the body, we have it in rais- ino; one's self on the toes. Then the fulcrum is at the toes, the weight is the whole body, and the power is that of the muscles of the calf of the leg, applied by the tendo Achillis (see Anatomy) at the heel. The third sort of lever is used when we pull a ladder out from a wall by one of its lower rungs, while keeping the end on the ground with the foot. In our bodies it is exemplified by the muscle with which we bend the arm at the elbow (biceps muscle). Fig. 56. I I VV 3 P I W THE THREE KINDS OF LE- VERS. 1. Place of the Fulcrum. 2. End of the Weight. 3. The Muscle, which is the Poiver, when the Head is moved backwards on the Spine. THE BICEPS MUSCLE. Here the fulcrum is at the elbow; the power acts where the tendon of the muscle is attached to the radius; and the weight is that of the forearm and hand. In this arrangement, there is not more than one- OUR MOVING POWERS. 79 tenth as much lifting power as there would be if the tendon were in- serted at the wrist. But what would be thus gained in strength would be lost in speed; and such a formation would make a limb nearly or quite as thick as an elephant's; out of all proportion, and excessively awkward. AYe are made more wisely than that. Opposition of muscles is seen all over the body. Flexors bend the arm at the elbow, the hand at the wrist, and the fingers on the hand; extensors put them back again. Inhalation (breathing in) is effected by the intercostal muscles lifting the ribs, and the diaphragm flattening down under the lungs; expiration (breathing out) is made forcible (blowing) by the flat muscles outside of the abdomen pressing upwards. Adductors bring the fingers, or the legs, near together; abductors separate them from each other; and so on. There are many muscular parts of our bodies which are not under control of our will. Early in this book, some- thing was said of the fibres of red, striped, or striated muscular tissue. AAre can get at these fibres by splitting up a piece of an animal's red flesh lengthwise, with a fine knife, and then ex- amining a very small shred of it with a micro- scope. Fig. 57. STRIPED MUSCLE. The other kind of muscular tissue is not made of fibres, but rather of flatfish bands, each of which is composed of long, spindle-shaped cells, as seen under the microscope. This is the smooth, pale, or white muscle, found in the walls of the arteries, in the muscular coat of the stomach and bowels, and in some other internal parts. This sort of muscle is never under control of the will. It is not so quick in its action as the red kind. AYe may divide all our muscles into voluntary, involuntary, and mixed muscles. The voluntary are all those of the arms, legs, jaws, neck, and trunk, Fig. 58. SMOOTH MUSCLE. SO PHYSIOLOGY. which every one can do with as he will. Involuntary are chiefly those of the stomach, bowels, blood-vessels, iris around the pupil in the eve, and the heart. The heart is remarkable in being formed of red, striped muscle, and yet being not, like them, under the command of the will. Emotion acts upon it; as when it beats strongly from excited feelinc, drags weakly from sorrow, or comes almost to a sudden stop from fear. So, in many languages, " the heart" is said to be the seat of all our feelings. In fact, this is not true. The heart is affected by our feelings, but their real seat is the brain; of which more after awhile. Mixed muscles are those over which we have some power, but which also act without, and sometimes against, our will. Such are those of the lower part of the pharynx, or swallowing-tube of the throat. Get something half-way down, and (unless it is too large or sharp and sticks fast) it will go the rest of the way, whether you wish it to do so or not. Our breathing muscles are by no means altogether under the power of our wills. AYe may hold our breath for some seconds; it is difficult to do it for a whole minute; nobody cau do it for two minutes at a time. Suicide Mas never committed by a person holding his breath until he died. It would never do for a man to be able to manao-e his breathi 112 at his will. How, if one could, would we get on when sleeping? Some nervous people would be afraid to go to sleep at all, for fear it would stop altogether for waut of attention. Another set of mixed muscles are those of the face and of the vocal windpipe (larynx), by which we naturally express our emotions. Most people show in their faces whether they are happy or unhappy, pleased or angry, courageous or frightened. Also, by the tones of our voices we express joy, sorrow, anger, pity, or fear. All this is done by mus- cles ; those of the eyebrows, cheeks, lips, and organ of voice (larynx). AYe can frown or smile, or speak softly or harshly, at will; but the natural May is, for our feelings to express themselves involuntarily. An actor Mho wants to represent a character does it best by throwing himself into the person whose part he is taking, so as to suppose himself to be that character. An orator who wishes to arouse feeling in those to whom he speaks, must first feel strongly himself; and then he will express it so as to affect them also. Artificial, studied tones and gestures, are much less effective than those which are the natural language of emotion. Every muscle, whether voluntary or involuntary, acts by drawing its ends or sides towards each other. This is called the contraction of the muscle; its shortening. But, while it shortens, or becomes smaller in one direction, it thickens, growing larger in another direc- tion : its whole bulk remains the same. HOW WE FEEL AND KNO W. 81 A slight contraction belongs to every muscle during life. The stronger muscles get, of course, some advantage when no effort is being made. So our fingers are bent more or less when Ave are asleep, because of the flexors being stronger than the extensors. After death, the muscles stiffen. This is the rigor mortis, as it is called. It does not happen at once, but in a variable time ; beginning, at the earliest, ten or fifteen minutes after breath ceases; more com- monly an hour or tvvo later; sometimes not until six or seven hours have passed. All the muscles theu become firmly set. Gradually this passes off; and then decay of the body begins aud (unless prevented by cold or an embalming process) goes on rapidly. A body should be prepared, by an undertaker or some other proper person, for " laying out" before the stiffening comes on ; as the position of the limbs cannot be adjusted rightly during the time of the rigor mortis. All the muscles, inside and outside of the body, heart, arteries, stomach, intestines, and the rest, undergo this rigor. Indeed, it begins in the left ventricle, and the last part to contract is the right auricle of the heart. When one dies after a long aud exhausting illness, the rigor mortis comes soon and lasts but for a short time. A person struck down in the midst of vigorous health, will have the same change delayed for several hours, aud then passing but slowly away. Before the rigor mortis begins, electricity can be made to cause move- ment of the muscles. A fearful appearance is thus presented, when a dead man's face has its eyelids, brows, or lips to move. Occasionally, without auy such cause, especially in those dying of epidemic (Asiatic) cholera, an arm or a foot has been seen to move after death, of itself! HOAY AYE FEEL AND KNOW. Brain and nerves, every one is aAvare, Ave all have. Brain, spinal cord, ganglia, and nerves make the full list of the apparatus of the highest animals, for feeling, knoM'ing, thinking, and willing. Plants have no brains, ganglia, nor nerves. They do not feel, think, or will. In the simplest animals, there is no need of any ; just as a border-ranger, living in a hut, has no use for a front-door bell or a speak- ing-tube. Nerves are made to take messages. A nervous system is a telegraph system ; ganglia are, so to speak, the offices at which meaaao-es are taken and sent out. All animals that have nerves have ganglia. 6 82 PHYSIOLOGY. AYhy should a fly need a nervous system, M\hen an amoeba (single-cell animal) does not? Because the amoeba feels, so much feeling as it has, SIMPLE REFLEX ACTION. a, Seat of Touch, b, Ganglion, c, Place of Motion. all over at once. A fly does not. Suppose that, flitting about, it touches a foot to something burning hot. The message of pain goes through s nerve from its foot to its central nervous cord (where there are gauglj?, Fig. 60. LOWER PART OF HUMAN BRAIN; ALL THE UPPER PORTION CUT AWAY. though not brains like ours), and from that centre a message goes it- the wings, making them carry the fly away in safety. HOW WE FEEL AND KNOW. 83 The simplest movement under nervous communication is called a reflex action. It needs two nerves and a nerve-centre or ganglion. One nerve takes an impression (from a to b, Fig. 59) from a sensitive part to a nerve-centre. The other (from b to c, same Fig.) carries it from the ganglion to the muscle which is thus excited to motion. This is something like the reflection of a ray of light from a mirror; whence the term reflex action. It is of the same nature whether the sensitive part M'hich gets the impression is at the outside surface of the body, or Fig. 61. Fig. 62. CONNECTION OF A GANGLION WITH THE SPINAL MARROW. c, Spinal Marrow, s, Nerve going to a Ganglion, anywhere within it; also whether it goes to a simple ganglion apart from brain or spinal cord (see Anatomy), to the spinal cord, or to the brain. Or, again, whether from the ganglionic centre, whatever it may be, the impression is reflected to a muscle, causing motion, or to a gland, producing secretion; for instance, of tears. In those animals which, like the insect, have only ganglia, without true brains, reflex actions occur automatically. What is an autom- BRAIN AND SPINAL CORD. 84 PHYSIOLOGY. aton ? A clock, a Match, or a steam-engine is one. It is a machine that goes of itself, after you wind it up; or, if Mound up or fixed up, then a touch, or a shovelful of coal now and then in the right place (as with the steam-engine), will keep it going. A man is not an autom- aton, because he has a will of his own; but many subordinate actions in our bodies are automatic. In Fig. 60, the white substance of the cerebral hemispheres is shown on each side, bordered by the convolutions (wrinkle-marks), which are mostly of gray nerve-substance. The hollow spaces are ventricles (cavities) of the inner brain. At the lower part of the Figure, we see the cerebellurri. Below the brain, the medulla oblongata, which begins within the skull, goes down into the spinal marrow. Out of and into the spinal marrow and brain many nerves pass; afferent nerves taking impres- sions to nerve-centres, and efferent nerves taking impressions outward from nerve-centres to muscles or other parts. (Afferent, from ad, to, and fero, to bear; efferent, e, from, and fero, to bear.) Moreover, nerves connect the spinal marrow, all the Mray down, with a number of ganglia (once called sympathetic); a double row of them being outside of the back-bone, a large pair behind the stomach, and others near the different internal oreraus. NERVES. As shown above, the simplest possible nervous system consists of a ganglion and two nerves. One of the latter (afferent nerve) carries impressions from a part of the animal's body to the ganglionic centre; the other (efferent nerve) takes impressions out from that centre to some portion of the body. AYe find certain general facts, which may be called laivs, to be proved about nerves. 1. Each nerve-filament (of which there may be many in each nerve, which is a bundle of filaments) conveys im- pressions only in one direction. No filament is both afferent and efferent. This is different from telegraphic wires, which take messages either way; from Boston to Philadelphia, or from Philadelphia to Boston, for example, at the will of the operators. But, in our nerves, each bundle may have filaments, some of which are afferent (in-carry- mg) and others (out-carrying) efferent. And these filaments are so fine and so closely laid together as to seem in a nerve like one solid mass. By aid of the microscope, however, not only is each nerve shoM-n to NER VES. 85 consist of a large number of them, but each filament is found to be a tube, whose contents during life are almost or quite fluid; certainly very soft. 2. Each nerve of sensation (touch, sight, hearing, smell, taste) conveys only one kind of impression. This impression depends upon what centres and organs it connects. No one can hear with his eyes, smell with his ears, or see with the ends of his fingers. Should any one say that he can do so, do not believe it; whether it be called mes- merism or otherwise. Miracles are possible, under the power of the Creator of the world; but they show their Divine authority. Miracles apart, it is a question of science; and science ascertains the true usual order of nature ; whatever seems to violate that, must be either a trick or somebody's mistake. In public exhibitions, it is most likely to be the former; in private circles, it may be the latter. Either way, it is the part of good sense to maintain a strong confidence in the order of nature, as made known by the careful and many times tested inquiries of science. So general is this fact of the specialty of sense-nerves, that even common touch is not conveyed by the nerves of sight, hearing, taste, or smell. AYhen an eye has been removed by a surgical operation, touch- ing the end of the optic nerve causes not pain, but a, flash of light. So also a blow on the eye makes one " see stars." Such a blow causes pain also; but this is because nerves of touch go to the eye, as Mrell as the nerve of sight (optic nerve). AYe cannot bring this fact to the direct test with the other special nerves, but there is every reason to believe that it is true of them all. How, then, it may be asked, do blind people get about? By using the information given by such senses as they have. You see the blind man feeling his way with his stick (or his hands, in a room), and listening intently for all sounds around him. He learns to feel and hear more acutely thau others who have their eyesight. Blind persons can learn to read with their fingers, in books with raised letters, made on purpose for them. Laura Bridgman, the famous patient of Dr. Howe, who was blind and deaf from infancy, was, by great skill and patience, taught to know and do a great many things, by touch alone. 3. Sense-nerves commonly report their messages as coming from their ends. Experience may correct this; but such is the general fact. When the nerve (often called " crazy bone ") at the inner side of the elbow-joint is struck by accident, a tingling follows in the little finger and the finger next to it; not in any other fingers. This is because that (ulnar) nerve M'hich M7as struck goes down the forearm and gives its 86 l'H YSIOLOG Y branches to those two fingers; and it reports the effect as if it was m the fingers themselves. So, when a leg has been cut off while the patient was made un- conscious by breathing ether, he may for some days feel pain or itching, as he will say, " in his toes," when there are no toes there. The im- pression really is iu the stump, where the nerve M-as cut off. Pain from disease is, likewise, not always felt in the seat of the disease. Hip-joint affection (coxalgia) is attended usually by pain, not in the hip, but iu the knee; and there are other instances of the same kind, in different maladies. AYhen a tooth is partly decayed and inflamed, the impression of pain may become so strong in the nerve-centre to which its nerve goes, that the whole side of the face may seem to ache with the offending tooth. THE GANGLIA. Scattered in different parts of our bodies, these nerve-centres always have two sorts of connections: one (by nerves) with the spinal marrow, and the other with various organs. Those organs are always the ones concerned either in digestion, assimilation, circula- tion, secretion, or reproduction. Of these functions, a good deal has been said already, on previous pages. AYhile, then, the power used by these ganglia may come from the spinal marrow, it is almost certain that they mainly regulate the actions of the heart, arteries, stomach, bowels; liver, spleen, kidneys, ovaries, uterus, and lymphatic glands. To these actions or functions the name is applied, " the func- tions of organic (as distinguished from the more truly animal) life." They serve to keej) up the conditions necessary for the action of the organs, and thus of the organism, i. c, the whole living body. Animal functions are those which animals have and vegetables have not; as sensation, motion, and thought. All the ganglia now spoken of together make, with their connections, the Ganglionic System of Organic Life. SPINAL MARROAY. Up and down the M-hole length of the back, in a channel for it in the spinal column, lies the soft nervous mass called the spinal cord or marrow. (The marrow of bones is a fatty material, not of nerve-sub- stance.) SPINAL MARROW. 87 Fig. 63. Gray matter, formed of nerve-cells, is in the interior of the cord, and spreads out iu four horns (Fig. 63); tM'o in front (lower part of the Figure) and tMTo longer ones behind. Out from the spinal cord, through all its length, go aud come nerves, in pairs, one on each side, through holes (foram- ina) arranged for them. There are thirty-one pairs of spinal nerves. Each of these nerves has two roots; an anterior (front) and posterior (back) root. On each posterior root there is a ganglion; none on any anterior root. Experiment proves that feeling goes up to the cord through the posterior roots; motion is impelled by messages sent doMm through the anterior roots only. Cut the anterior root of a spinal nerve, aud Fig. 64. SECTION OF SPINAL MARROW. b, One Horn of Gray Substance, e, /, Parts of White Substance. SECTIONS OF SPINAL CORD, SHOWING ROOTS OF NERVES. A, Front view. B; Right side. C, Upper side. D, Roots alone. the animal v>n]\feel as usual; but it cannot move the part to which that nerve sends its branches. If you cut the posterior root, it will no longer 88 PHYSIOLOGY. feel anything done to the part which that nerve supplies; but motion can be effected through the anterior root. Impressions must go to the brain in order for us to feel them. Therefore the spinal marrow must carry them up to the brain. That, and bringing down from the brain commands for movements, are two of the uses of the spinal marrow. Under Anatomy, it has been shown that several nerves (of sight, taste, smell, hearing, and of touch for the head and face) are directly connected with the brain. No nerve of any special sense except touch ends in the spinal cord; but all the 31 pairs of spinal nerves are nerves of touch as well as of motion; that is, they contain filaments of both kinds. But the spinal marrow has some business of its own, besides being subordinate to the brain. When a frog's head has been taken off, if one of its feet be touched, that limb will be jerked away. How is that, when, as the brain has been removed, it is supposed not to feel any- thing? Some physiologists think that the spinal cord may feel as well as the brain. But this conclusion is not here necessary ; we can explain the foot-movement otherwise. It is a reflex action. A few pages since, we gave some account of such actions. In their simplest form these do not need a brain ; any ganglion will do. So there are reflex actions whose centres are the ganglia of organic life, referred to above, not long since. Others have their centres in the gray substance of the spinal cord ; still others, in the medulla oblongata, which connects the spinal marrow with the brain, within the skull. These last are the most important of all; breathing and swallowing. AAlien an animal is pithed by passing a knife through the uppermost part of the back of the neck, dividiug the spinal cord just below the medulla oblongata, it will die at once if it be one of the higher vertebrates (man, mammals, birds); aud after no great length of time if of a lower class (reptiles, fishes). Breathing is a beautiful example of a reflex action. AVant of air 'is felt by us only when rather extreme; but before that, an impression, not felt, of that M^ant, goes from the blood in the lungs up to the medulla oblongata. Thence is reflected downward through motor nerves the message of command to the breathing muscles, namely, intercostal muscles and diaphragm (see Respiration). They at once respond, lifting the ribs and flattening down the diaphragm, sucking air in through mouth or nostrils and windpipe; which air goes to the lungs aud freshens up (arterializes) the blood. This goes on regularly, 16 or 18 times a minute, day aud night, of itself, automatically ; with- out our atteutiou. If the brain proper (cerebral hemispheres) be stupe- fied by opium, or by pressure of a clot of blood, breathing will still go on, so long as the medulla oblongata is all right. Thus, when surgeons SPINAL MARROW. 89 give ether or chloroform by inhalation for surgical operations, or a dentist uses nitrous oxide when he extracts teeth, the brain may be so lulled that the patient feels no pain ; but the greatest caution is needful lest the anaesthetic (as chloroform, ether, and nitrous oxide, so used, are called) should extend its action down to the medulla oblongata. If it does so, death may result. Swallowing is, in part, another reflex action. AYhen the morsel has been pushed doAvn into the pharynx, its muscles contract by reason of the impression being conveyed to the medulla oblongata, and reflected thence, as a motor impulse or message of commandment. (This last expression is, of course, only a figure of speech.) Light shining upon the eyes causes their pupils to grow small by a similar reflex action upon the iris (muscle surrounding the pupil). If the retina has lost its sensibility to light, or if a cataract (opacity of the lens of the eye) prevents the rays from reaching the retina, the pupil will not contract under light. There are many other examples of re- flex action in the body. Under disease, we see morbid and excessive reflex actions. A child of nervous temperament has some difficulty in teething. AYorriment of the gums is " telegraphed " through nerves to the brain, and, by sym- pathy, the spinal cord also is disturbed. Then may folloAv a violent reflex action of muscles, knoAvn as a fit, or convulsion. Or, again, worms, or unremoved remainders of food, in the bowels, may irritate the spinal marroAV by impressions carried through nerves, and compulsions may result. The spinal marrow is much more irri- table in infants than in older persons. Convulsions are more often met Avith, and are less alarming (though ahvays dangerous), at about teething time than later iu life. Another form of reflex disturbance is quite common at the same period of life. Teething may, if not going on just right, irritate, reflexly, the secreting glands of the boAvels, instead of, or in addition to, the muscles of the body. Then Ave have diarrhoea. A moderate amount of this relieves the irritation. It should not be too much suppressed. Only Avheu it is so great as to weaken the little patient, should medicine be given to keep it in check. When the gums are swollen, or tense and tender, over a tooth not yet through, a neat, clean cut doAvn to the new tooth Avith a sharp lancet may give relief, and may prevent or put away either the motor or the secretory (excito-motor or exci to-secretory) reflex actions. Hysterical people, those who have lockjaw (tetanus), and those who suffer Avith hydrophobia (from the bite of a mad dog), all illus- trate morbid reflex actions, in ways which it would take too long to explain in this place. 90 PHYSIOLOGY. THE BRAIN. AYhen the skull has been partly removed, and the brain is seen un- covered, it looks like a wrinkled, gray mass of putty; in tAvo equal parts, right and left, with a split (fissure) part way down betAveen them. AYonderful, indeed, that such a material should ever have had to do with knowledge, love, fear, hope, right, wrong, conscience! Yet it was once so during life—the dome of thought, the palace of the soul. Already, we have spoken of the main parts of the brain. More particularly, we may now say that, in the human brain, they are as fol- lows : 1. The hemispheres of the cerebrum. 2. Under it, some parts, of gray and Avhite nerve-matter, conveniently called the mid- brain (thalami, corpora striata, tubercula quadrigemina, etc., of anat- omists). 3. The cerebellum. 4. The medulla oblongata. Many well knoAvn facts shoAV that the outer round and convoluted Ftg. 65. SIDE-VIEW OF BRAIN, SHOWING FERRIER'S PSYCHOMOTOR CENTRES. surface of the hemispheres of the cerebrum has the most to do with mind ; that is, knowing, feeling, and will. Gall and Spurzheim, founders of the system of phrenology, thought that they could map out the brain-surface (even by examining it outside of the skull) into a cer- tain number of organs, each connected Avith one of the faculties of the mind. Their system has been refused acceptance by physiologists, for Avant of satisfactory evidence. Something like it, in so far as it is an effort to show that certain pow- ers of the mind belong to particular parts of the brain, has been going on amongst physiologists ever since Gall's time; that is, during the last fifty years. By laying bare the brains of different kinds of animals, as monkeys, dogs, cats, aud rabbits, experiments have been tried, especially with elec- THE BRAIN. 91 tricity; and the actions of the animals, Avhen certain parts are touched and excited, have been noted. For our present purpose, it Avill be enough just to mention these ob- servations, referring the reader to larger works on physiology for their discussion. The subject is still comparatively a neAv one, and scientific men have not yet reached a final conclusion about it. One point only may be further noticed here. Of all these " locations " of functions in the cerebrum, the strongest case has been made out for that of the fac- ulty of language. In the third frontal convolution it is believed that the power of using words to express our thoughts and emotions resides, and almost, or quite, exclusively in the left hemisphere of the brain. Aphasia is a singular and not common disorder, in which the pa- tient cannot talk; not because of any ailment in his "vocal organs" (larynx), but from brain-trouble ; or, if he speaks, he gets the wrong Avords, and talks nonsense. Aloug Avith this affection, quite often (though not always) there is palsy of the right arm and right leg (right hemiplegia). Now it has long been known that, because of the crossing of nervous fibres at the uppermost part of the spinal cord, the right arm and leg communicate with the left half of the brain; and vice versd. So, when patients having aphasia and hemiplegia of the right side together have died, and their brains have been examined, there has often (not always) been found disease at or near the third frontal convohdion on the left side of the brain. But, after all, this subject is surrounded with difficulties. Although, by electricity acting on the convolutions of the cerebral hemispheres, motions, that is, muscular actions, are excited, this cannot do aAvay with the abundant evidence Avhich has proved that the chief use of the cere- brum is to act as the instrument of mind; of knowing, thinking, feeling (emotions), and Avilling. As a general thing, a large brain goes Avith large mental ability. There are, it is true, some very positive exceptions. The average weight of men's brains is about 3 pounds, say 50 ounces; those of women, 44 to 45 ounces. Very feM' brains have been knoAvn to Aveigh o\Ter 60 ounces. As women are mostly considerably lighter in their Avhole body weight, their proportionate weight of brain is scarcely less than that of men. Proportion, in this matter, is very important. Comparing other animals, the proportion of brain to the whole body for the class of Mammals (to which man belongs) is 1 to 186; in Birds, 1 to 212; Reptiles, 1 to 1321; Fishes, 1 to 5668. In Man, it is about 1 to 40. Only two creatures present a larger relative proportion; a little bird, called the blue-headed tit, aud the field-mouse. With d-2 PHYSIOLOGY. these, it is not that their brains are large, but that their bodies are very small. Also, in them, the cerebrum, thinking brain, is not so large in proportion to the rest as it is in man. The average size of the head, found by trying how much the skull, emptied of its brain-contents, will hold, is, with different races of men, from 80 to 90 cubic inches. The largest of 900 skulls measured by a distinguished German anatomist, R. Wagner, was that of a woman— 115 cubic inches. Famous large heads were those of Oliver Cromwell; George Cuvier, the French naturalist; Volta, the Italian natural phil- osopher ; and Daniel AYebster. The largest skull ever measured, how- Fig. 66. INTERIOR OF THE BRAIN. ever, is said to have been that of a not at all famous German baker, of Louisville, Kentucky—125 cubic inches! Likewise, the heaviest brain on record was that of an English bricklayer, who could neither read nor write. He was " not very sober, had a good memory, and was fond of politics." Perhaps, if he had been sober, and had kept out of poli- tics, he might have been a great man. Turgeuieff, the Russian novel- ist, had a very heavy brain ; Gambetta, the French statesman, one not above the average. Raphael, Charles Lamb, Lord Byron, and Charles Dickens had heads rather smaller than usual. The brain receives, in Man, a very large supply of blood ; about one- SENSORY GANGLIA. 93 fifth or one-sixth of all there is in the body. The supply of arterial blood varies in amount, according to our activity of mind, in thought or emotion. AYhen asleep, the least rapid Aoav occurs through the blood-ATessels of the brain. This has been observed in the heads of young infants, Avhose "soft spots" (anterior fontanelles) are large. On waking, the brain SAvells out the fontanelle somewhat; and still more, Avhen the babe is excited and cries. To prevent a sudden increase of blood in the head from doing harm by too great pressure, a AA'atery fluid moves in and out (under the arachnoid membrane, which covers brain and spinal marroAv), according to the pressure in the head. Also, the arteries (carotid and vertebral) which take blood to the brain are twisted spirally (cork-screw fashion), by which the change of pressure is made more gradual. In sleep, the brain rests; best, Avhen sleep continues for a number of hours unbroken, and without dreams. Only the brain, of all the organs of the body, needs and can get this long continued repose. The medulla oblongata, spinal marroAv, and ganglia keep up some of the actions connected Avith them (breathing, circulation of the blood, secretion) day and night. The heart beats, and the lungs breathe, all the time. Each of these organs, hoAvever, has its share of rest, in the short pauses betAveen the heart-beats, and between breaths; and in these bits of repose their nervous centres share. SENSORY GANGLIA. If the reader will look closely at Fig. 66, he mhII see, at b, a rounded mass shown at the base of the brain, someAvhat forward; and, just behind it, another, on Avhich are the letters c and d. Of these, b is called corpus striatum (striped body), and d the thalamus (chamber). (Plural, including right and left sides together, corpora striata and thalami.) Noav the corpora striata, which are in front, appear to have to do with the giving out of motor impulses. The thalami are probably the receivers of impressions of sensation from all parts of the body. At h and i, in the same Figure, are tAvo smaller bodies on each side; all four being together the tubercula quadrigemina of anatomists. To these, as Avell as to the thalami, go the optic nerves, which take from the eyes all impressions of sight. Not far from the same region of the brain, come the ends of the auditory nerves (of hearing), olfac- tory (of smell) and gustatory (of taste) nerves. 94 PHYSIOLOGY. Thus all sorts of sensations centre in this region of the brain, which may be called the Sensorium. The impressions of sense are sent up [reported, so to speak) from the sensorium to the convolutions on the outside of the hemispheres. There they are used as the " raw mate- rial" of ideas and to arouse emotions. The will deals Avith sensa- tions, ideas, and emotions, by its power of attention, choice, and direction. The Avill seems to act "everywhere," as boss or general superintendent, in the brain. But it is remarkable that the sensory and motor ganglionic centres (the corpora striata being the latter) are placed very near to each other. Fig. 67. BASE OF THE BRAIN. 23. Olfactory Nerve. 28. Optic Nerve. 35. Auditory Nerve. 32 and 36, in part, Gustatory Nerves. AYhy is this? Our common way of doing things shoAvs the reason for it. AYhen I begin to write this page, what do I do ? I look at the paper, and then, guided by my sight, trace out the letters and Avords over the page. AYhen you walk out of doors, do you keep your eyes shut? No. Try it (in a safe place) a little Avhile, and observe the difference. Blind persons can learn to sing or play well on an instrument, by ear. A "good ear" is necessary to every musician, as well as a good voice and a skilful touch. Those ivho are born deaf are mute, simply be- MUSCULAR SENSE. 95 cause, hearing no sounds, they cannot learn to speak. If they become deaf during childhood, they are apt to keep a childish tone of A^oice through life. So, also, a painter or sculptor must have an eye for the beautiful, in color, form, and proportion of objects. All our actions are guided by perception of sensations. There is, or may be, in this, something automatic. AYhat Ave are used to doing a great deal, comes to be so easy that we pay little or no attention to it. AYalking on a smooth street or road is an example. Some persons are said to be so proficient in piano music that they may fall asleep over an instrument in the middle of a piece, and yet go on and finish it. Soldiers, very much fatigued, have been known to go " marching on," with regular steps, asleep! Somnambulists (sleep-walkers) go about with their eyes open. Their seeing brain and moving brain (sensorial ganglia) are aAvake, while their thinking brains (or a considerable part of them) are asleep; as is shown by their remembering nothing of what they did the next morning. This observation shows that, although not believing in phrenology, Ave must admit that different parts of the brain have different functions and powers. One part may be quiet, even sound asleep, Avhile other parts are awake and active. AYhat makes it difficult and dangerous, to most people, to walk upon a narroAV plank at a great height ? On the same plank, laid in the middle of a broad floor, there is no difficulty at all. It is because the impressions made upon our sight, when Ave move on a single plank, are such as we are not accustomed to, and they do not guide us well. By training, Blondin learned to walk upon a tight-rope Avith a man on his back, and even with his eyes blindfolded, over Niagara Falls. MUSCULAR SENSE. This leads to the remark, that not sight only guides us in walking. Hearing: and touch assist; and the blind make constant use of both. But Blondin must have depended chiefly, when on the tight-rope blind- folded, upon another sense; the muscular sense. By this Ave are made aware of the kind, direction, and amount of force used by any of our muscles. Put a book upon your hand, and guess what its weight may be; or put one on each hand, and say Avhich is heavier. Such judgments are formed by aid of the muscular sense. Skating furnishes the best example of the us6 of this sense. A skater needs his sight only to know that nothing is in his way on the ice. Touch 96 PHYSIOLOGY. cannot guide him, because the soles of his boots or shoes, and the nar- roAV, stiff irons of his skates are betAveen his feet and the level ice, which is all the same, Avhichever way he turns* A blind man might learn to skate perfectly Avell, by his muscular sense alone, if he could be made certain of a wide space, with nothing in the way. CEREBELLUM. This is a partly separate portion of brain ; behind, and in Man and the higher Apes below, the cerebrum. Fig. 68. THE CEREBELLUM. m, Medulla Oblongata, c, Pons Varolii, w, Hemispheres of Cerebellum, i, Middle notch. 3 to 7, Nerves. Contraiy to the opinion of the phrenologists, who took quite a differ- ent view, observation, reasoning, and experiment have made it probable that the cerebellum has to do with regulating voluntary motion. ' Animals whose movements are active and somewhat complicated have it largest; those of simple motions, smallest. The Bear, which can stand on its hind feet and hug Avith its fore-limbs, has a larger cerebel- lum in proportion than the Dog, which always behaves (unless taught " tricks ") as a quadruped; and it is larger still in the Monkeys, which are Avonderfully nimble climbers. Among Birds, it is largest in SAvift and varied fliers, as the SAvallow; smallest in clumsily flying species, such as the Pheasants, Partridges, and domestic FoavI. * Nearly the same thing is true of the bicycle-rider; but he makes more use of sight than the skater does. MEDULLA OBLONGATA. 97 MEDULLA OBLONGATA. Already it has been explained that breathing and swallowing appear to depend for their regulation upon the medulla oblongata. Both of these are like those actions Avhich the spinal marrow regu- lates, in being usually automatic, and in serving purposes connected Avith mere living, not thinking, Avhich is done in the brain. But Ave need to have some control over breathing, for use of the voice, and to hold our breath under certain circumstanees. Also, it is of great advantage for the will to have poAver to control the first part of the act of swalloAving. So the medulla oblongata is placed as a link between the brain above and the spinal cord below. Fig. 69. MEDULLA OBLONGATA. M, Corpus Striatum. K, Thalamus. C, D, Corpora Quadrigemina. X, Pons Varolii. The pons (Pons Varolii) (X, Fig. 69) is a bridge across (under in the upright position of the body and brain) the medulla oblongata, from side to side of the cerebrum and cerebellum. The special uses or functions of the pons have not been made certain. Our readers Avill have noticed, that much is yet to be learned in regard to the functions of a number of the parts of the body; and especially about the different portions of the brain. Nevertheless, what Ave do knoAV is of interest and value; and Physiology is a constantly advancing science. 7 98 PHYSIOLOGY. IDEAS, EMOTIONS, AND AVILL. Most persons suppose, with the phrenologists, that our knowing and thinking poAvers are located in the front part of the brain, and the affectional and emotional feelings in the back of the head. But it appears to me more probable that, instead, the emotions are connected with the anterior, and the intellectual poAvers Avith the posterior, portions of the brain. Reasons for this belief are given in another Avork.* The will, or what Ave call self (ego of the philosophers), appears to have no special seat or organ; but to be consciously present wherever any of our faculties are in action. If any one treads on my toe, or mashes my finger, I seem to be there. Even our minds are to some extent automatic. Our thoughts wander on Avhile Ave are awake, with or without our consent. In dreams, they make still stranger excursions, which seem real because all other impressions are shut out. If we try, we can dwell on some one thing or thought, keeping it before us; and that is about all the power will has over thought. Emotion is still more spontaneous. Tears flow, not because we wish them to, but because something "touches our feelings." Passionate anger may be repressed, not by a direct effort of the will, but by think- ing of, or looking at, something Avhich will divert our minds from the object of Avrath. OUR SPECIAL SENSES. These (besides the muscular sense) are Sight, Hearing, Smell, Taste, and Touch. The last, although special in the fact of differing from the others, is general, in so far as it is common to many different parts of the body. SIGHT. AYhat is light? It is a wave-movement of the very thin, subtle matter (called ether) which fills space; extending as far at least as the re- motest star, Avhich is a long way beyond the sun. Let us try to illustrate the subject of Avave-motions. Throw a pebble into a pond ; the water breaks into waves around the place Avhere it was struck, these circling, * Hartshorne's Anatomy and Physiology for Medical Students; Second Edition, p. 293. SIGHT. 99 one beyond another, till they reach the shore. A church-bell is tolled. If you Avere to touch it while it is giving forth a long note of sound, your hand would feel the quivering vibration: and the air at the same time beats upon your ears with waves of sound. Air (as well as many other things) has sonorous vibrations. The subtle ether, so much lighter and thinner than air that it cannot be weighed at all, has luminous vibrations. Heat also is ether-wave-motion. A sort of gamut (as musicians call it) there is: water-waves, large and slow; air-waves, smaller and quicker, from the loAvest up to the shrillest note of sound; ether-waves, the loAvest being those of heat, and the higher Avaves those of light. Of the waves of heat and light, also, there is a regular scale. Put a rod of iron in a hot furnace, and watch the part just outside of the fire. For a A\rhile, although getting hot, it continues dark; there are then only the loAver heat-AvaA7es. Soon it may be seen to grow red; shoAving the high heat-waves, passing into the lower waves of light. Then, in rapid succession, it glows with orange, yellow, green, blue, indigo, violet (these last too near each other to be readily discriminated), and at last, white heat! Red, orange, yellow, green, blue, indigo, and violet. That is the order of the seven colored sets of waves, or rays. AYe see them so in the rainboAv. All these rays together make white light. By passing sunlight through a glass prism, it is di- vided into the seven rays. This bending of rays so as to take neAv directions is called the re- fraction of light. Red rays are least refracted; violet rays most; the others come in order (as above given) between. The arrangement of divided rays obtained by means of a prism is called a spectrum. A beautiful study (that of the spectroscope and its uses) is connected with it. But, beyond the violet end, there are yet shorter (higher) waves, which we do not see, but Avhich have chemical effects; of the kind which light shows, so usefully, in taking photo- graphs (light-pictures). If you place a straight stick slantwise in a stream, or in a vessel of clear water, it will appear bent from the place where it enters the water. Or, put a quarter-dollar in the bottom of an empty cup, and move slowly back urtfil you just don't see the coin over the edge. Then ask REFRACTION, THROUGH A PRISM. 100 PHYSIOLOGY some one to fill the cup with water. The coin will seem to rise, so that vou see it plainly. Both of these last are examples of refraction of light. It you let fall a stone, attached to the end of a string, into the water in which you have placed a slanting stick, the string will then be perpendicular to the surface of the water. As you see the stick by the rays of light coming from it to your eyes,—the rays coming through the wcder from the stick are shown to be bent away from the perpendicular string. Then we have a rule, or law, namely : A ray of light, passing from a denser material (as Avater) into a rarer material (as air), is refracted from the perpendicular. A ray pass- ing from a rarer into a denser medium, as from air into water, is refracted towards the perpendicular. Our eyes are optical instruments; more wonderful than any made by men. Rays of light passing through them are refracted, just as they Fig. 71. REFRACTION AND INVERSION OF RAYS OF LIGHT. are through the lenses of telescopes or microscopes; so as to make im- ages or pictures within the eyes. Reflection of light is also important. Its rules or " laAvs " are like those of the reflection of other things. Throw a ball straight doAvn on the floor and it bounds straight up again. Throw it slantioise, and it will rebound in a line slanting just as much the other way. Incidence is the long word for striking. The " line of incidence " is the direction in Avhich a thing is made to strike. Then Ave have a law about this. The angle of incidence is equal to the angle of reflection. This is true of ball-throAving, billiard-playing, of sound (in echoes), and in the reflection of light. You can observe it any time in a looking-glass. Schoolboys sometimes make this experiment with a bit of broken looking-glass, Avhich they get into the sunlight, so as to throw a bright ray into the teacher's or some schoolmate's eyes. AYe see things by the light which they reflect. AYhite things reflect SIGHT. 101 the whole light. Red things reflect only red rays, and keep (take up, absorb) the remaining rays; blue things reflect blue rays, and so on; black things (if perfectly black), none. As black things keep or absorb all the rays or Avaves, those Avaves do not cease their motion; but they are slowed (so to speak) into heat-waves. Hence a black hat is a very much hotter thing to Avear under a summer's sun than a white hat. AYhite is the coolest of all, for the same reason. Red flannel, worn as an under garment, is no warmer than white flannel; but a red-flannel shirt Avith nothing over it is warmer than Avhite Avhile the sun shines upon it. Take all the red rays out of white sunlight, and what is left? Fig. 72. SECTION OF AN EYEBALL. Green. If you take all the green out you have red left. These colors are therefore called complementary colors to each other. Blue and orange are likeAvise complementary colors; and so are yellow and purple. It is Avell known that in dresses, carpets, etc., complementary colors always look best together; as red with green, yellow Avith purple, blue with orange. This we commonly call the contrast of colors. AYe may reverse the separation of colors by the prism, simply by throwing them so as to pass in the opposite way through another prism. If in the same way, they would be parted still more widely. Or, 1Q2 PHYSIOLOGY. paint all the seven colors, like spokes on a Avhcel, upon a round piece of card-board, and make the Avheel revolve rapidly. As the colors run together in our eyes, their combination makes the wheel look white (or nearly so—not quite, because the colors are not perfect). Transparent bodies let almost all the light go through them. Translucent ones allow a portion of the rays to pass through them, but not enough to see things by; opaque bodies let no light through at all. A Avindow-pane is transparent; ground-glass is translucent; Avood is opaque. Light travels through space at the rate of about 190,000 miles in a second,—very much faster than sound passes through the air. One can get a good idea of the make-up of a human eye by care- fully examining the eye of a sheep, Avhich can be obtained from a mutton-butcher. The eye is almost a globe, at the end of a stem, which is the optic nerve. In front, however, there is set in, like a round glass in a round frame, a slightly projecting part, the cornea— the AvindoAV through Avhich we look. It is quite transparent. Examining the round frame or sash of this small AvindoAV, Ave find it formed of a thin outer coat (conjunctiva), a thicker one (sclerotic), another containing blood-vessels, and black Avithin (choroid), and a very delicate one innermost of all, connected Avith the branching of the optic nerve (retina). AYhen a ray of light strikes upon the eye, it first passes through the cornea; then through the front chamber of the aqueous humor to the opening called the pupil, surrounded by the iris, which draws together and makes the pupil smaller when the light is bright, and opens wider when the light is weak and faint. (Cats, by the way, ha\'e a pupil, not round, but a sort of slit; this shuts up closely in the daytime, and opens wide at night, so that they can see Avhen, to us, it is dark.) A little way behind the pupil is the crystalline lens. Next to that comes the large chamber of the vitreous humor, and then the retina. On this, like the " sensitive-plate " in the photographer's box, the sight- picture is taken. This picture must be upside down, because the rays cross each other at the pupil. (See Fig. 71.) Yet Ave do not see things upside down. This is because Ave folloAV the rays, in our sight, to the place they come from. So, Avhen rays are reflected from a looking-glass, giving us an image of an object, that object appears to be behind the mirror; following back the line of reflec- tion, as far as the object itself is in front of it. AYith two eyes, we see but one image. AYe explain this in two ways. First, the optic nerves join each other (as no other pairs of nerves SIGHT. 103 Fig. 73. THE OPTIC NERVES. do); also, they have filaments which go across from the right eye to the left side of the brain (tubercula quadrigemina and thalamus), and from the left eye to the right side of the brain; besides those Avhich pass from each eye to its own half of the centres at the base of the brain. Thus the two nerves, Tight and left, combine in their re- port (so to speak) of the impressions made upon the two eyes. Secondly, the eyes (Avhich do not, in Alan, really stand out in such different directions as they are made to in Fig. 73)* are directed toAvards the same ob- ject, so that straight lines drawn through the pupils of the two eyes perpendicu- larly to their corneas (making the visual axes of the eyes) will meet in the same point of the object. The two images formed on the two retinas will therefore correspond, and make one picture. AAlien any one squints (is cross-eyed) the axes of the two eyes do not meet on any object looked at, and the images do not correspond. A person so affected (Avith strabismus, as oculists call it) sees double; but he gets the habit of giving attention to one of the two images (or apparent objects) and neglecting the other. The same inconvenience results in another Avay, Avhen the refraction of the two eyes is not the same; one eye being far-sighted and the other near-sighted. To this subject some attention will be given in a later part of this book. AYe can put our eyes out of correspondence for a time, by pushing one eye to one or the other side with a finger; or by " looking cross-eyed " on purpose. This last is not, hoAvever, a good thing to do often, lest it become habitual. Looking at a far-off prospect, or at the blue sky (if not too dazzling), one's eyes feel a sense of repose. An effort, usually slight, is made iu bringing our sight to bear upon anything near us, as in reading a book. AYe can cause the effort to become quite perceptible, by gradually moving a book nearer to our eyes, until it is too near. Our sight then has to be adjusted for near objects. This is done by changing the form of the crystalline lens. Before age has hardened it, the lens is somewhat elastic. AYhen left Avithout * That figure represents rather a dissected, separated preparation of the parts; not their exact appearance and position. 104 PHYSIOLOGY. pressure, it is moderately convex. Being surrounded by the ciliary liga- ment (Fig. 74),* this pushes in its surface, making it flatter, that is, less convex in front. A muscle, not sliOAvn in either of our figures, called the ciliary muscle, Avhen it acts, draAvs this ligament aAvay; and thus alloAvs the lens to bulge out more, or become more con vex. f Let us remember, then, that rays going into a denser medium are bent towards the perpendicular. Passing through a pane of glass, their direction is little changed, because it is flat and thin; and the slight change that occurs is rectified, as the ray soon goes out from the dense glass to the rare atmosphere again. But, take a sheet of paper aud bend it over into THE CHOROID COAT, IRIS, AND PUPIL, ENLARGED. an arch; you will see, then, that its perpendiculars must point inwards; and rays bent toAvards them would meet somewhere in a centre. This is Avhat happens with a convex lens; and the centre is its focus. Then, the more convex the lens, the more the rays are bent. And, as the image is made, in sight, by all the rays from the object being focused * The tens is, in that figure, hidden behind the iris. f This is the account of it given in the Text-books on Physiology. It is not, however, quite certainly the true explanation. It seems to me not impossible that, instead, the ciliary muscle acts by compressing the circular margin of the lens, so as to make its cen- tral portion bi+lge forwards; that is become more convex. SIGHT. 105 upon one surface (or plane), the more convex the lens the sooner (nearer behind the lens) the rays from any object make their image. Rays from distant objects are nearly parallel. Those from near things going to the eye must diverge ; more or less according to their nearness. Noav parallel rays are, so to speak, easily bent to a focus; diverging ones (spreading out from a centre) much less so. Therefore the more convex lens is wanted for near objects, to bring their rays to a focus on the retina. Suppose the eye to be too long. Then the image will fall in front of the retina; and the rays, crossing each other, will cause imperfect sight. This is near-sightedness. It may be corrected by using concave glasses, which spread the rays and throAv the image farther back. A near-sighted person holds a book close to his nose (if he wears no glasses), because thus he makes the rays from it diverge a great deal, and pushes their focus back so as to reach the retina. Too short an eyeball has the image to fall behind the retina. This (long-sightedness) is to be corrected by convex glasses, bringing the rays sooner to a focus. Of this, also, more hereafter. AYe must not forget that, under the stimulus of more strongly re- flected light, the iris contracts Avhen we look at near objects. This shuts off the outermost rays, Avhich diverge too much, for the size and shape of the eyeball, to make a clear picture (spherical aberration). Also, the crystalline lens is most dense at the centre; so as to refract most the rays Avhich are nearly parallel, and least the outer rays. In using imperfect glass lenses, sometimes Avhite light is broken up (as in the prism) into colors. This is called chromatic aberration. It is prevented, in our eyes, as it is in good instruments by opticians, by the different transparent parts correcting each other's different refrac- tion of the color rays making up white light. Every eye has a blind spot. To prove this, make two dots on a piece of paper, about two inches apart. Then close the right eye and look at the right-hand spot with the left eye, holding the paper about eight inches from the eyes. The left-hand spot will then disappear. This blind spot is Avhere the optic nerve enters the eyeball. The centre of most distinct vision is a yellowish spot, about at the middle of the retina. How do we know how far off is anything that we see ? Only by using our knowledge, if we have such, of its size, and judging by experience of the effect of distance upon that size. Standing near a railroad track, Avhen a train of cars is approaching, we can see it grow- 10g PHYSIOLOGY. ing rapidly larger as it comes near to us. AYe can guess its distance at anv moment, because we are familiar with the size of engines and cars. But the distance of a cloud overhead, or of the sun, moon, or stars, we can form no estimate of, from their appearance; as we have no definite notion of their size. So it is with all other objects. Similarly, if we know the distance from us of a house, tree, 01 mountain, we can estimate its size ; otherwise, not In a fo-, the dimness of things produces one of the effects of distance; and, supposing objects seen to be far off, we imagine them to be larger than they are. On the contrary, in an uncommonly clear atmosphere, everything seems near and relatively small. ' An imao-e formed upon the retina remains there for a moment; not s<> strongly impressed as to interfere with another object, but so as some- times to blend or combine the tAvo images. On a Avhite card, draw on one side, the figure of a man, and on the other a horse ; or on one side a Fig. 75. STEREOSCOPIC PICTURE. bird and on the other side a cage. If you can then fix the card so as to revolve SAviftly, you will see the man and horse, or the bird and cage, both in one picture. AYhen a burning firebrand is whirled around in the air at night, it looks like a circle of continuous flame. The same fact about images explains the approach to whiteness of a wheel painted with the seven colors of the rainbow, and made to rotate rapidly. A pretty experiment is this.: fix your eyes intently for about half a minute upon a piece of bright red or clear green stuff (of any kind) laid upon a sheet of white paper. Then take the bit of colored stuff suddenly away, and you will see in its place a figure of the same size and shape, but of the complementary color. If the stuff be red, the spectrum following it will be green; if it be green, a red spectrum will appear; and so on. It would take too much space here to explain this and similar facts about color-spectra. Stereoscopes are now familiar to most people. SIGHT. 107 They act by throwing two pictures, representing the same object, into one, by the refracting power of a couple of lenses, shaped and placed properly for the purpose. Some persons (not many) can so ex- aggerate the action of the muscular apparatus of their eyes, as to throw the two pictures into one without a stereoscope. The effect, in either case, is toxmake a picture Avhich stands out solid, as it were. This is especially successful Avith views of things which are really solid; as statues, monuments, and buildings. Adjustment of the eyes to a near object requires, besides the action of the ciliary muscle upon the lens, the convergence of the eyes; that is, turning both eyes enough inAvard to look right at the object. This is done by two of the short and straight muscles of the eyes; the in- ternal straight muscles of the two eyes. Fig. 76. MUSCLES OF THE RIGHT EYE. Other movements of the eyeballs also are effected by their muscles, which are six in all, for each eye : internal straight (rectus internus), external straight (rectus externus), superior straight, inferior straight, superior oblique, and inferior oblique. The last two roll the eyes slightly. The superior oblique has its tendon to go through a pulley at the inner front edge of the orbit of the eye; Avhich reverses the direction of its action. A peculiarity of the straight muscles of the eyeball is that very often the external of one eye acts with the internal muscle of the other, and vice versa. For example, to look towards the right, Ave use the external straight muscle of the right and the internal straight muscle of the left eye. 108 PHYSIOLOGY. In a cross-eyed person, one of the straight muscles (external or in- ternal) of one or both eyes is too weak; and the opposing one gets the advantage, pulling the eye or eyes in its direction. Most common is " internal strabismus," in which the two internal recti muscles draw the eyes too much inwards. Surgeons sometimes remedy this, by dividing the stronger muscle, with a fine knife, so that the weaker one is enabled to keep up its proper proportion of action. TEARS. These flow from the lachrymal gland, Avhich lies in the upper and outer part of the orbit of each eye. Constantly there is a gentle flow of moisture over the eyeball; the slight excess of which runs along the gutter or channel between the gristly (cartilaginous) edges of the lids, to pass down from the inner corner of the eye into the nose by the lachrymal duct. Occasionally this duct becomes narroAved, and the tears overflow all the time. AYhen very troublesome, relief may be given to this by stretching the duct with a small silver tube. Weeping results from a large excess of secretion by the lachrymal gland, under strong emo- Fig.77. tion. The effect of emo- tion is to increase the Aoav of blood towards the front part of the brain; this finds relief from the escape of some of the watery part of the blood through the blood- vessels of the tear-gland in its secretion. Grief that is " too deep for tears " is the most apt to wear upon the health for Avant of that re- lief. Our eyelashes, which curve two ways, serve some- what the same sort of pur- pose as the " cow-catchers " in front of locomotives, to keep things from getting into the eyes. The eyebrows turn perspiration upon the forehead away from the eyes, besides aiding in deadening the force of bloAvs Avhich may threaten TEAR-GLAND AND DUCT. HEARING. 109 them. Winking is a generally automatic action (although control- lable by the will) of the round (orbicular) muscle which closes the eye. It spreads the tear-moisture over the ball from time to time, and, A\rhen anything comes very near to the eye, we Avink spontaneously to shut it out. As the eyes, the windows of the head, are very much exposed in their situation, and are extremely sensitive and delicate, the sufficiency of these arrangements for their protection is shoAvn by the rarity of serious injuries to them. Many a person gets "a black eye," but that is ou the outside only. How seldom, comparatively, does any one have an eye " put out" by a bloAv! HEARING. If a clock should be placed under an air-tight "receiver," or any kind of tight cover, and the air should then be all drawn out of this by means of an air-pump, we Avould probably hear it tick and strike, because the sound would be carried by the base upon Avhich it stood. But if it, or a bell, be hung by a slender cord in a receiver emptied of air, no sound made by it will reach our ears; because there is no air to vibrate ; and all ordinary sounds are brought as air-waves to our ears. Yet, as just said, or implied, solid bodies also may vibrate and give out or carry sounds. Put your ear doAvn on a piano, or a musical box, while it is playing, and you will find the sound to be much louder than Avhen listening apart from it. Sound goes through liquids also. Its rate of movement through the air is a little over eleven hundred feet in a second; through water, about four thousand feet in the same time; through solids, still faster, but not the same in all. Dense bodies, such as iron and other metals, convey it faster than wood; and a loose, porous body, like sponge, Avith much less rapidity. Light, as Avas said on a previous page, travels very much faster; about 190,000 miles in a second. AYhy does thunder often follow so long after the lightning flash? Because the clouds, whose electrical discharge we see and hear, are at a considerable distance; and the flash is seen with the speed of the progress of light-waves, while the thunder- peal reaches our ears by the slower sound-wave movement. If the clouds be right overhead, the lightning and thunder will come both at once. AYatch the cutting down of a tree a few hundred yards off; you Avill see the axe fall some moments before the sound of its bloAv is heard; and the same Avith the firing of a gun at a distance; you see the flash before you hear the report. 110 PHYSIOLOGY. The highest notes of sound we can hear are made by 38,000 vibra- tions in a second; the lowest, by twenty-seven or twenty-eight vibra- tions (waves, impulses) in a second. Probably insects, and some other animals, may perceive (either by hearing or by very delicate touch) wave-movements yet more rapid. AYe have already, under Anatomy, briefly described the outer, middle, and internal ear. The outer is the cartilaginous, flexible portion; Avhich, in the dog, horse, and some other ani- mals, can be turned about in several directions. AVe have, instead, fixed ears (with unde- veloped ear-moving muscles), but so formed that sounds from all quarters are poured to- gether into the meatus, as the passage is called. The hairs and wax in that entrance to the ear seem to be intended to keep out insects; which very seldom find their Avay in. At the bottom of the mea- tus is the drum-membrane (membrana tympani). Beyond it is the drum or tympanum ; hol- Ioav, but containing a chain of very small bones (magnified in Fig. 79), reaching from the membrana tympani at its outside to the membrane of the vestibule of the internal ear. The handle of the hammer-bone (malleus, g in Fig. 79) is fastened to the membrana tympani; then comes the an- vil (incus, sc, Ic, same figure), the little round bone (orbiculare, a) and the stirrup (stapes, s) Avhich is attached to the membrane of the £c vestibule of the inner ear. Three very small muscles tighten or loosen these together. The drum of the ear is air-tight only on its outside; it communicates with the back of the throat by a channel in the temporal bone called the Eustachian tube (e, Fig. little bones of the ear. 78). By this, air can enter it, to bcdance the air pressing or beating upon the outer membrane of the drum through the meatus of the external ear. This the ear. b. Part of the outer Ear. m, Passage called Exter- nal Meatus, d, Drum-membrane, t, Interior of Drum, called Tympanum, e, Eustachian tube, s, Semi-circular Canals, c, Cochlea. Fig. 79. HEARING. Ill Fig. m. is important. AYhen a powder-mill explodes, a house near it, Avith all its AvindoAVS and doors shut, Avill have all of the windows shattered; one Avith several of them open, will at least suffer less damage. So, during battles, gunners firing off big cannon open their mouths at the time of a discharge, so as to let plenty of air in by the Eustachian tube to the middle ear. If this tube is swollen or choked Avith phlegm from a cold, the hearing is for the time impaired. Three parts of the internal ear (making together the labyrinth) are, the vestibule, semi-circular canals, and cochlea. Atthe vestibule ends the chain of little ear bones; the stirrup fitting by its foot into an oval windoAv in the bony wall. Another round AvindoAV, covered by membrane, opens from the snail-shell-like cochlea into the tym- panum or middle ear. In the vestibule are some tiny gravel-stones (otoliths) whose use is doubtful. The vestibule, the cochlea, and the semi-circular canals are all filled Avith a liquid ; and in this liquid are spread out the fine ends of the branches of the nerve of hearing (auditory nerve). The cochlea is most remarkable for its double spiral staircase. Fig. 81. LABYRINTH OF THE INTERNAL EAR. n, Auditory Nerve, s, Semi-circu- lar Canals, c, Cochlea, a, Wall of the Cochlea, b, Spiral staircase. THE COCHLEA. AYaves of sound, striking upon the outer drum-membrane, are carried probably by the chain of little bones to the vestibule, and thence to the cochlea. Each Avave enters at the broad foot of the staircase, and, it may be supposed, rolls up to its top, and then doAvn the other side, to cease at the round membrane-covered window of the cochlea, opening on 112 PHYSIOLOGY. the middle ear or tvmpanum. Along the edge of the middle spiral of this staircase there are arranged some thousands of little rods or keys (rods of Corti, seen only by aid of a microscope), which may respond to the different notes of sound, like the keys of a piano or organ. The use of the semi-circular canals is not certainly known. I he prevailing opinion is that they have to do with our balancing our- selves especially in the erect posture. Animals in which they have been injured turn round and round, or over and over; and there is a disease of the labyrinth of the ear now and then met with (3Ieniere,s disease, so named from its first describer), in which the patient falls to the ground; generally inclining to one side more than the other. ' AYe probably judge of the direction from which sounds come, partly by comparing the impressions made upon the two ears, and partly by the sense of touch, which is very delicate at the openings of the ears. Mice and bats, which are very quick of hearing, have a par- ticularly large supply of nerve-endings in the lining of the external ear. Of the distance from which sounds reach us, we can only form an estimate from their loudness and character, as learned by experience. A skilful ventriloquist, by imitating the muffling of sounds in a closed box, or their softening by distance, and at the same time favoring the delusion by his Avords and actions, can readily deceive us, unless Ave are guarded against it. Dulness of hearing, of slight or moderate degrees, may result from irritation of the meatus of the ear, causing the formation of too much wax ; or from " a cold " inducing a swelling of the drum-membrane, or of the liniug of the Eustachian tube (like that which produces hoarseness in the Avindpipe). More serious deafness may come from disease (as scarlet fever or small-pox) partly destroying the drum- membrane, or filling the drum with matter (pus or mucus), or eating away more or less of the little bony chain in the tympanum. Total deafness comes only from paralysis (loss of sensibility) of the auditory nerve, or of that part of the base of the brain to which it goes. AYe can tell whether, in any case, it is this last kind of loss of hear- ing or not (as it, too, may be of various degrees—in old people it is often gradual), by trying the person with a watch or music-box. If the deafness is only from any of the other causes above mentioned, a Avatcli cau be heard tick, or a music-box to play, Avhen it is placed between or against the teeth. In total rierye-deafuess this will not make it audible. AYe have noAv given as much space as the plan of this Avork Avill allow to the study of the structure aud functions of the Human Body. HEARING. 113 As needs hardly to be said, hoAve\Ter, the body is not all. Man is more than an animal. Not in his bodily organs, nor eA7en in his su- perior brain, but in the gift of an immortal spirit, is the crown and glory of Humanity. This is brought to its normal destination only when the will, dominating over all the bodily and mental faculties, and freed from degrading imperfections, becomes assimilated, in its free choice, to the Divine AVill. 8 HYGIENE. THE SCIENCE AND ART OF THE PRESERVATION OF HEALTH. HYGIENE. OUR present subject derives its name, in English, from the French word, Hygiene. This may be traced back to a Avord meaning healthy, in the Greek. Hygiea, the ancient goddess of health, was the daughter (some say the wife) of JEsculapius, the god of Medicine. From the earliest days, men must have observed, more or less ex- actly, the favorable or unfavorable influences of the circumstances under which they lived. As an art, or practical study, in its rude beginnings, Hygiene must have preceded Medicine, and even Surgery. The early temples of iEsculapius, before Hippocrates, were sanitaria rather than medical schools. Hygiea Avas named, Avith other deities, in the oath which every physician was required to take as one of the Asclepiadse: " By Apollo the physician, by iEsculapius, by Hygiea, Panacea, and all the gods and goddesses." Hippocrates Avrote the first hygienic treatise noAV extant—on Airs, Waters, and Places. He therein pointed out the effects of climates and localities, not only upon health, but also upon the characters of races of men; anticipating, at so early a date (400 B. a), the conclusions arrived at in recent times by Montesquieu, Michelet, Guyot, and Buckle. Positive sanitary measures were probably first instituted by Acron of Crotona, of the school of Pythagoras, who is said to have dissipated the cause of a plague at Athens by means of fires burned in the streets. Empedocles afterwards found it possible to destroy or impede the action of malaria; in one instance by draining a swamp, and in another by building a high Avail to protect an exposed town. Phidias provided a water-supply for Athens by means of a tunnel under Mount Athos, said to have been eighteen feet in diameter. Herodicus was so famous for his application of gymnastics to the improvement of health that Plato accused him of doing an ill service to the state by keeping alive people Avho ought to die, because, being valetudinarians, they cost more than they Avere Avorth to the community. The Spartans reversed this, in their custom of exposing young children to the elements, Avhereby 117 118 HYGIENE. onlv those survived and grew up Avho Avere possessed of natural hardi- hood. Ancient Home shoAved an appreciation of sanitary art by extensive drainage of the base of the hills on which the city Avas built; by the immense seAver, Cloaca Maxima, of which a part is left, the oldest ruin in Europe, thirteen feet in diameter at the outlet; by the aqueducts; by suburban interments, Avhose number is still attested all along the Appian AYay; and by the appointment of officers (cediles) Avhose duty it Avas to inspect and regulate the construction, with a view to salubrity and safety, of all private and public buildings. In Egypt, the great pyramid of Cheops has an arrangement showing an early recognition of the principles of ventilation, applied to its interior chambers. Em- balming the bodies of the dead, not only of men but of animals, Iioav- ever it may have been associated Avith religious ideas, is so well adapted to the prevention of insalubrity in a populous land in a tropical climate as to make it appear likely that it sprang, in part at least, from the sanitary sagacity of the priesthood. Since a resemblance is traceable in many particulars between the Mosaic ceremonial laAV and the usages of the ancient Egyptians, it is likely that some measures for the preserva- tion of health, prescribed in the Levitical code, corresponded with usages knoAvn to the Israelites while in the land of bondage. Moses, however, must lmre much extended the provisions required for the care of the health of his people. His regulations concerning food, ablu- tions, and other purifications, and segregation of persons having certain diseases, Avere precise and imperative. All the most enlightened nations of antiquity held physical culture in high estimation. Socrates, the philosopher, Avas of powerful bodily frame. Plato also was a superior athlete, and so were Pericles and Alcibiades. It is not altogether improbable that the intellectual supremacy of the Greeks was in part owing to their sedulous care of the whole organization, brain and body together. In most of the cities of ancient Greece, public baths existed for the poor as well as the rich. Rome also had, at one period, hundreds of private and public baths; some of which, as those of Caracalla, Avere palatial in grandeur. Al- though at first designed for health, these afterwards degenerated into means for effeminate luxury; as did the gymnasia, at last, into scenes of gladiatorial combats of men and beasts. In the School of Salernum, in Italy, the oldest medical school of Europe, founded in the ninth century, instruction was given upon the prevention of diseases and the preservation of health. That institution gave forth, in the twelfth century, a very remarkable treatise, the Regimen Sanitatis Salernitanum, a poem on the maintenance of health, HYGIENE. 119 in rhyming Latin verses. Many of the precepts in this " Code of Salernum" are sound and good; some of them have passed into almost proverbial modern use. The institution of quarantine, in the fourteenth century, in Italy, to exclude the plague, was an event in the history of sanitary progress. From Florence this method of restriction of inter- course with infected places spread, first to Venice and Sardinia, and afterAvards throughout Europe.* Jenner's introduction of vaccination, for the prevention of small-pox, is perhaps the greatest of all the triumphs of " preventive medicine," as sanitary science is sometimes, and in this case at least not unfitly, called. Vaccination dates from 1798. The other benefits conferred upon mankind through the advance of knowledge in regard to the causes of disease, and the conditions necessary for health, especially in large communities, have been obvious, great, and numerous. In the time of the great medical author, Sydenham (1624-1687), the largest part of the mortality of London was produced by four diseases, —plague, small-pox, scurvy, and dysentery. Of these, the first has long ago disappeared from Great Britain and the continent of Europe; the second has been, by prevention, shorn of most of its destructive poAver; the third is now seldom known except in places remote from civilized life; and the fourth is at least very much less mortal than formerly, especially in cities. Macaulay, in his History of England, estimated that the difference between London in the seventeenth, and the same city in the nineteenth, century is as great in regard to mor- tality as between that of the time of prevalence of epidemic cholera and that of ordinary years. In Constantinople, in 543 A. d., 10,000 people died daily during one season of plague alone ; in 1665, 68,000 died of that disease in the city of London. In 1685, not a sickly year, the deaths in London were one in twenty of the inhabitants; uoav they average annually about one in forty. In France, in 1772, the annual proportion of deaths was one in twenty-five; in 1846, one in forty- five. The mean duration of life in France, in 1806, was 28J years; noAv, 34J years. At Geneva, the mean probability of life in the six- * The first occasional prohibitions of maritime intercourse on account of the plague were made at Florence in 1348. Viscount Barnabo enacted the first peremptory regu- lations at Venice, 1374. The earliest legal code of quarantine was put in force at Venice, 1448; the first lazaretto was established in Sardinia, 1453. A Board of Health was organized in Venice, 1485. Bills of health for vessels were first made out in 1527 ; they became general at European ports about 1665. Kegular quarantine was not enforced in England before 1710. William Penn, as early as 1700, instituted a quar- antine law at Philadelphia. The term "quarantine" is derived from the Italian quaranta, forty; this number of days of detention being apparently derived from the time of purification prescribed in certain cases under the ancient Levitical law. 120 HYGIENE. teenth century was about tAventy-one years; in the seventeenth century, tAventy-five to twenty-six years; in the nineteenth, about forty years. Life may be safely said to have been, on the average, in civilized countries, prolonged twenty-five per cent, during the last fifty years. AYhile improvements in medical and surgical practice have, no doubt, had their share in effecting such a result, the greater part of this very important change may be ascribed to increased knowledge and appre- ciation of the laAvs of health. Yet much remains to be done before the ideal of perfect sanitation is attained. Yellow fever and cholera are still at times the deadly scourges of cities and of some other places; malarial fevers render a few localities almost uninhabitable; and the mortality of toAvns, especially amongst young children, continues to be far in excess of Avhat it ought to be were the conditions of health prop- erly maintained. The best hope of the sanitarian and philanthropist is to be derived from the increasing interest in all that belongs to health, now prevailing everywhere amongst educated men and women, both in Europe and in America. No subject has, of late years, advanced more rapidly in public interest, or in the actual development of valuable practical knowledge concerning it. Hygiene has its foundations in Physiology and Sanitary experience. AYhat may be expected to favor the health of the body is known by the study of the action of its different organs; and such expectations are confirmed or corrected by observation of what really happens with individuals and in communities under various circumstances. Our best way of considering Hygiene will be to folloAV very nearly a physiological order, taking up the different functions or operations going on in the body, and noticing what is good and what is bad for their proper performance, and thus for the maintenance of the health of the Avhole system. Certain subjects incidental to these will receive attention on our way. HEALTHY BREATHING. 121 HEALTHY BREATHING. AYe have learned, in our Physiology, hoAV, and for what end, breath- ing goes on, so long as life continues. Little thought is needed, therefore, for every one to see that for good breathing there must be sound lungs and air-tubes, and strength in the muscles of the chest, as well as pure air. Consumption of the lungs interferes with breathing, because one lung is, or both are, greatly altered by the disease affecting them. Pneumonia is attended by short breathing for the same kind of reason, although the state of the lung or lungs is different, being that of active inflam- mation. Croup has for its Avorst symptom obstruction to the breathing, whose seat is high up in the windpipe, in the larynx or trachea. (See Anatomy.) Strength in the muscles used in breathing is of course necessary. It seldom gives out until everything else in the body, including the heart, is exhausted. But we find the limit to Avhat these muscles can do, even in health, when, in running, Ave " get out of breath." And sometimes, no doubt, in a very feeble person, this may, under exertion, cause death. For example, I remember the case of a patient prostrated by typhoid fever, who, Avhile for a few moments unwatched, rose and walked into another room. He there fell dead. There is need of great care with such patients, to save the little strength they have, until the attack of disease is over. Our breathing muscles can be strengthened by exercise. All active muscular movements of any part of the body, but especially brisk walking or running, quicken the action of the heart; and, as the blood then goes more rapidly through the lungs, it needs to be, and is, aired, accordingly, by quicker breathing. At great heights, as in climbing mountains or going up in a balloon, the thinness of the air makes it harder to breathe. On lofty mountains, men and horses pant and are worn out with moderate exertion. Those, however, who live for years at such heights, become used to it, and their chests grow larger than those of lowlanders. This is said to be the case Avith the people of the highlands of Patagonia, in South America. Using the voice a great deal (as in speaking or singing) in early life, promotes the groAvth of the lungs and the strength of the breathing muscles. Those Avho belong to consumptive families should, Avhile young, be accustomed to active out-of-door habits; and for them, read- ing or speaking aloud or singing (vocal gymnastics) will be wholesome 122 HYGIENE. exercise; that is, so long as they are Avell. AYhen the lungs are actually diseased, active efforts of all kinds should be avoided. Pure air, and plenty of it, is a constant necessity for health. The application of this truth belongs in many ways to our every-day life, especially, of course, within doors. Out of doors, in some places, the atmosphere is made unwholesome by what is called malaria, which is the cause of certain fevers; or by the infection or contagion of other diseases. These require to be considered hereafter by themselves. As several other important conditions of health are closely connected with the purity of the air, Ave may advantageously look at these together, making our next topic the house and its surroundings. OUR HOMES. 123 OUR HOMES. AYe should need no Danvin to teach us that man is a part of Nature. Though sovereign in the creation, his is but a limited monarchy, with an unAvritten but inexorable constitution, Avhich he must obey, or suffer the penalty. Apart from human interference, there is in Nature a bal- ance of formation and destruction, of life and death, food and waste, making a perfect natural economy everyAvhere. Man comes in with his artificial constructions, and sweeps away much of this economy of Nature. Under his tread the green earth groAvs bare. His habitations exclude multitudes of the loAver and lesser creatures, whose ordained functions as natural scavengers are thus impaired or annulled. Hence comes foulness of the earth, water, and air; stench, miasma, pestilence. A guerilla Avarfare seems to be waged all around the invader of Nature; yet man's conquest of the Avorld is legitimate. AYhat is Avanting ? Simply that our reason should be used in counting the true cost of civilization, and meeting all its conditions as they exist, Avisely. AYe must maintain or restore the original balance of primeval nature, by providing for the reappropriation of the products of life and the results of death and decay around us. Chiefly, the evils to be guarded against belong to the deterioration of the atmosphere and of drinking-water, under the influence of decaying matter. Every human being gives out constantly from his lungs, skin, and otherwise, about as much as is from day to day receiATed by him as food, drink, and air of respiration. AYe take air and water, and grains, fruits, roots, flesh, etc., into our systems; we organize or consume them, and then throAV them out again to be rapidly decomposed. The higher the life they have attained in us, the deadlier poisons they become in their effete molecular death. Thus crowd-poison breeds typhus fever, and promotes typhoid fever, diphtheria, cholera infantum, yelloAV fever, and malignant cholera; nay, gives special aid and sustenance to all con- tagious and epidemic disease-causes,—such as those of small-pox, scarlet fever, and the rest, and contributes greatly to the mortality from pulmo- nary consumption, pneumonia, and nervous affections, especially those of children. How are we to live, then, not as wanderers of the forest, nor yet as hermits, but in society, without abridging our lives and multiplying the 124 HYGIENE. "ills that flesh is heir to," is the question. The imperfection of the manner in Avhich this question has been, so far, generally answered, may be judged of by a late account given by the eminent statistician, Dr. Farr, of the proportion between population-density and mortality, in the six hundred and nineteen districts of England and AYales, from 1861 to 1870. In seven groups of those districts (excluding London), the number of persons to a square mile is, respectively, thus: 166,186, 379 1178 4499, 12,351, 63,823. The annual mortality for each 1000 inhabitants in the same districts is 17, 19, 22, 25, 28, 32, and 39. In other words, according to these results, the nearer people live to each other, the shorter their lives. In fifty-three districts, the average prox- imity of residents is 147 yards, and the mean duration of life is 51 years; in 345 districts the proximity is 139 yards,and the mean length of life 45 years; in 137 districts the proximity is 97 yards, and the length of life 40 years; in forty-seven districts the proximity is 46 yards, and life-duration 35 years; in nine districts, with an average proximity of 28 yards, the mean duration of life is 32 years. In Man- chester, the proximity is 17 yards, and the mean length of life 29 years; in Liverpool, the proximity reaches the maximum of seven yards, and the duration of life its minimum average, 26 years.* This brevity of human life Avas exceeded, it is true, a hundred years ago, in many places, —an important improvement having, in our own time, begun, Avhich needs yet to be very greatly extended almost everyAvhere. Our question, " How shall we have Healthy Homes f" may be best considered in vieAV of the folloAving topics concerning human habita- tions: I. Situation; II. Construction; III. Light; IV. AYarmth; V. Ventilation; ArL AA7ater Supply; VII. Drainage; VIII. Disin- fection ; IX. Population; X. AVorking-Men's Homes. SITUATION. " God made the country, and man made the town." So Avrote the poet CoAvper. AVith more philosophy he might have seen that it Avas meant that man should build toAvns; only in this, as in everything else, he should obey the laAvs of his creation. AYe ought not to make our towns so different from the country as they are. No doubt, for healthfulness of situation, a rural locality is usually the best; yet not ahvays, for, near a malarious swamp, or a shalloAV, * Popular Science Monthly, March, 1879. SITUATION. 125 sluggish stream, causes of disease exist, from Avhose influence the densely built city may be free. Charleston city is, in most seasons, more safe from injury to health than the rice plantations of South Carolina. Near Philadelphia many noAV living remember hoAV the region liable to autumnal fevers has been "cro\vded out" by the extension of the city, until noAV it can scarcely be said to exist Avithin its large extent. Suppose a person with unlimited means to desire to choose a salu- brious site for a residence. He Avill reasonably leave the city. He will then be especially careful to avoid a malarious locality. Such will gen- erally be found on low grounds of alluvial* formation, and in the vicinity of marshes or sluggish rivers, Avhere moist earth is exposed from time to time to the rays of the sun. Apart from specific " ma- laria," also, the soil has considerable importance. It acts by its absorp- tion and radiation of heat, by the reflection of light, absorption of Avater, and movement of water through and under it; formation of dust, and its chemical character, affecting the air about it. Pettenkofer has shown that a cubic foot of soil may contain one-third of a cubic foot of air; and Boussingault has found in this "ground-air" a great deal of car- bonic acid gas.f AYhile in the ordinary atmosphere out of doors the amount of this gas is from 3 to 5 parts in 10,000, in the air of a field recently manured there existed 221 parts in 10,000; in forest land, 86; loamy subsoil, 82; sandy subsoil, 24 parts. AYorse gases than carbonic acid may permeate the soil under some circumstances. Graveyard air, as interments are generally managed, is knoAvn to be unAvholesome in its influence. This results from the gases of decomposition Avhich escape through the soil. Drains, cess-pools, and seAvers, Avhen allowed to leak or pour their contents upon or into the ground, pollute it so that it may, when saturated, give off very injurious effluvia. Prof. Pettenkofer mentions an instance of illumi- nating gas from a leaky pipe penetrating through the earth to a distance of twenty feet, and so saturating the basement of a house as to cause the death of one of its inmates. It is Avonderful, however, hoAV much is done by the earth to purify the foulness Avhich, by necessity or from neglect, is alloAved to enter into it. This may Avell be regarded as one of the providential means of adaptation of the world we live in to the needs of its inhabitants. But ground-Avater, near the surface, injures the healthfulness of a situation more frequently and largely than ground-air. Sometimes the * That is, not hard rock, but such as is made by the washing of rivers, etc., in past times. f The same gas which is produced by breathing and by burning fuel in the air. 126 HYGIENE. very efforts made to please the eye by picturesque effects may almost ruin a locality as to salubrity. Prof. R. BartholoAV has sliOAvn * Iioav this has been done in some of the suburbs of Cincinnati, not only by streets and roadways obstructing the surface drainage, but by artificial lakes, Avhose beauty to the eye is but a disguise for the accumulation of causes of malaria. Dampness of soil, even if not specially contaminated, is unAvholesome. It has been sliOAvn, both in Great Britain and in this country, to pro- mote consumption of the lungs, besides the known liability of persons living in damp places to rheumatism and " colds." A certain relaxing effect, also, is felt by many people where the locality is damp, most of all in warm Aveather,—the very opposite of the bracing, tonic influence of a high and dry situation. Of different kinds of soil, sand absorbs and retains very little water; clay ten or twenty times more; and " humus," or rich arable earth, forty or fifty times as much as sand. Hard sandstone rock and the harder limestones, as Avell as the solid granite and trap rocks, alloAV very little movement of Avater through them. Very frequently, too, these rocks slope so as to let the Avater run over them and drain away. Clay ia more likely to lie flat, so as to have water accumulate upon it; hence clayey soils are apt to make damp situations. The Avorst soil of all for building is what is called made ground, composed of the refuse from various places, filth of houses, decaying vegetables, etc., carried and deposited to fill up Ioav spots in the suburbs of toAvns. Observation shows that at least three years will be required for such earth to undergo the changes necessary to make it innocent of unwholesome emanations; and even after a longer period it is impossible to be sure of its* health- fulness. Just as a question of health, Ave may, because of their porosity, prefer sand, gravel, or loose limestone to anything else upon which to build a house; although, even upon such ground a right construction is needful for this kind of security as well as for permanence. Our ideal site may be, in order to combine the greatest sum of advan- tages, upon a gentle slope, or the side of a hill not too steep, looking in our part of the Avorld towards the south or south-west. It must not, even though upon a height, be near a marsh or sluggish river-bank, as the vapors lifted by the morning sun and settling again with the decline of day, may be wafted by the Avinds hundreds of yards up the sides of the most beautiful laAvn-covered hills. A grove of trees will, it is true, afford a very considerable protection from malaria, by intervening be- tween a house and the source of its emanation. But, then, the inhabi- * Lecture on the Hygiene of Suburban Life, 1878. SITUATION. 127 tents of such a locality must be very careful in their excursions, espe- cially near sunset and sunrise, in the spring and autumn. Many thousands of men are unable to make any such choice as Ave have mentioned, of a rural home. In the cities, also, there is much room for selection on the part of those who are not limited by want of means. Elevation, in some cities, as Cincinnati, Baltimore, and even Philadelphia, varies sufficiently to make quite an important difference. AYe should ahvays, of course, Avhen possible, choose the higher part of the toAvn for a dvvelling. A wide street will be the best. No street should be allowed anyvvhere of less width than twice the height of the houses upon it; although so stringent a rule is probably nowhere, as yet, enforced. The least width at all tolerable, in the poorest part of a town, should be fixed at the height of the highest dwelling upon the street. A street with trees lining it is made thereby more healthy. There is no doubt at all that the leaves of all ordinary plants and trees improve the air for our breathing by taking from it carbonic acid gas, and return- ing to it fresh oxygen. On the sunny side of the street, too, it is advan- tageous to haA'e the glare of an American noonday mitigated by a mod- erate, but not excessive, shade. A corner of two streets will afford the best circulation of air. Houses erected back to back are always to be avoided. Squares built upon two (or even four) sides, with large gardens meeting each other, and also with at least small side lots between them, and each standing back twelve or fifteen feet from the sidewalk, with grass and shrubbery in front, will meet all the most desirable conditions for a city residence. Such can be, at present, obtained in our large cities only by the rich. But, if common understanding or law should make it usual to lay out and build upon only such lots in all new and growing towns, except in their strictly business portions, it would not be difficult for breathing-spaces to be perpetually maintained. How beautiful an effect may result in a city from such an open plan of construction, may be seen in East Avenue, and some other streets, in Rochester, N. Y. Yet that this is only one of the necessary conditions of the salubrity of towns, is shown by the reports of mortality in that city, from preventable dis- eases, owing to defective drainage and sewerage.* On the subject of tenement-houses and workingmen's homes, their situation and construction, we shall remark hereafter. *See the Sanitarian, October, 1879, page 477. 128 HYGIENE. CONSTRUCTION. Our purpose here is not to consider the architecture of houses Avith regard to ornamental effect, but only the conditions requisite for healthy dwellings. Under this view, of the materials commonly employed, either Avood, brick, or stone may be made to ansAver. A frame house allows the most air to penetrate its walls, unless they are specially pro- tected ; and, in a climate with severe winters, this is trying to delicate people. Those Avho begin with good health usually find an airy mode of living agree Avith them better than the pent-up atmosphere of most furnace-heated houses. Moreover, a frame house having double walls, with stone or brick foundations, good plastering, and tightly-jointed timbers, may be made as little permeable by air as it is desirable for any house to be. Brick is porous, and alloAvs more atmosphere and vapor to pass Fig. 82. A A through it than many people are aware of. So do sandstone, mortar, and cement. Marcker and Berthold, in Paris, lately found that these substances alloAv gases to pass freely through them, Avhile granite, slate, limestone, and marble are impervious. Prof. Pettenkofer, of Munich, has exhibited this permeability very Avell by a simple experiment. A cylindrical piece of mortar, half lime and half sand, is covered with melted Avax (making it impenetrable by air), except at the two ends. A funnel is then fixed upon each end. By bloAving through one of these funnels, a candle-flame opposite the other end may be bloAvn out. If AAater be dravvn into the mortar by suction through the funnels, so as to fill its pores, air can no longer be bloAvn through it. This represents the condition of damp Avails of houses. Another experiment of the same observer is made Avith compact broAvn sandstone. A block of this substance (A, Fig. 82), fifteen inches long, twelve Avide, and four and three-quarters thick, has on each side a depression (B, Fig. 82) one- fourth of an inch in depth. In each of these depressions is placed an iron plate (C, Fig. 82), in Avhich is inserted an iron tube (c, Fig. 82). CONSTRUCTION. 129 Melted resin is then poured around the edges of the plates, and the stone is thickly covered Avith asphalt, so that it is made impervious, except through the tubes. AYhen one of these tubes is connected with a burner of a chandelier, and the gas is turned on, the pressure is sufficient to force the gas through the block of stone and the other tube, so that it can be ignited beyond the latter. This permeability of the AAralls of houses, Prof. Pettenkofer believes, no doubt correctly, to be advantageous. If we Avere sealed up tightly, except so far as intentional openings afford access to the air, some peo- ple's fear of draughts and cold, if it did not endanger suffocation, might at least aggravate seriously the evils of defective ventilation. Here may be mentioned the unsuitableness (in a sanitary sense) of wall-papers in anv unless the largest and best-aired apartments. Not only green wall- papers, but those of several other colors, have been shown not unfre- quently to contain arsenic in sufficient quantity to produce poisonous effects upon those long confined in their rooms. Moreover, papers absorb organic matter in considerable amount, and they are therefore particularly objectionable in sick-rooms, and, indeed, in any chambers in Avhich persons sleep. AVhitewashed, calcimined, or painted A\Talls are more Avholesome than those covered Avith any kind of paper.* Even paint interferes somewhat Avith the permeability of walls. Nothing is more important in the construction of a house than that its foundations shall be protected from dampness. A Avet cellar is a fatal fault from the hygienic standpoint. Under-drainage may correct this Avhen it exists. A good under-layer of concrete f Avill be of great service, AvhateA7er the soil on Avhich the house is built. If it be still suspected of dampness, an asphalt flooring for the cellar may be used, supplemented, if need be, by one of zinc for the first floor over it A cheap material for making cellar floors practically Avater-proof is made by mixing together tAvo parts of coal tar Avith one part of pitch, and adding to each bucketful three handfuls of quicklime. Eassie,| an excellent authority, recommends vitrified stoneAvare tile as furnishing the best " damp-proof course," made in thicknesses from an inch to an inch and a half, and perforated, so as to ventilate the space between the ground and the joists of the floor, and to prevent dry rot in the timbers. * Worst of all is the really nasty practice of covering old papers again and again with new ones, sometimes three or four times in succession. They should always be scraped off before renewal. f A compound of broken stone, pebbles, and mortar, much used for such purposes. % Sanitary Arrangements for Dwellings, London, 1874. 9 130 HYGIENE. Dr. B. \Y. Richardson, of London, in his "Hygeia, a City of Health," recommends that every house should be built upon arches of solid brick- work, so as to alloAV air to pass freely and constantly beneath its founda- tions. Undoubtedly, this is a reasonable suggestion, and no more Utopian than many other of his proposals for the construction of his ideal city. No flooring of wood, at all events, should be laid directly upon the surface of the ground, but the joists of the "ground floor" should be raised at least two or three feet by stone or brick foundations. Double Avails are better than thick Avails. Even as a protection against changes of heat and cold, the layer of air between the outer and inner Avail will be a slower conductor than the solid Avail Avould be. The occasional omission of a brick near the loAver part of the house, or the insertion of perforated bricks at regular intervals under the base- ment flooring, will alloAV of a movement of air through the interspaces which Avill contribute to dryness as Avell as to ventilation. The distance between the outer and inner Avail may be two or three inches, the open space commencing above the foundations. Roofing must, of all things, be made and kept tight, free from leak- age. Some slope is necessary for drainage of rainfall, but it need not he great. Alansard roofs, now so common, do not seem to be attended by any inconvenience. Dr. B. AV. Richardson ad\-ises that roofs shall be covered either Avith asphalt or flat tile; but tin, zinc, or slate, well placed and kept in repair, will do. If rain-Avater is to be collected for use, slate Avill make the best roof. Other points in the construction of a healthy house yet remain to be mentioned. Every room for day or night use should be as large as its owner can afford, and Avith an abundance of windows and doors for air and light. Each room should have, if possible, at least one window on each of two of its sides. AVith opposite windows, a small room with a low ceiling may be well ventilated; but this involves more draught than many people wish; and a large room may always be aired with less perceptible movement of the air than a small one. AYindows should be high, reaching almost to the ceiling, and opening both at the bottom and at the top, unless the casement or "folding-door" arrange- ment of the sash be preferred, Avhich answers very well. Every room in the house intended to be occupied should have in it an open fire- place. This is left out, to a great disadvantage, in building a great many modern houses. Especially is it important for an open fireplace to be in every sleeping chamber. For a sick person the difference between a wood-fire on the hearth, or even a wood-burning stove, and the usual heated air, or coal-stove in the room, is immense. It mav, CONSTRUCTION. 131 in critical cases, make the turning-point between death and recovery. Besides this, an open chimney Avithout a fire is an excellent aid to ven- tilation. Even a stovepipe hole, left open, in a sheet-iron or other cover for the fireplace, will have a considerable influence in changing the air of a room. All fireplaces and furnace-heaters may to adArantage be placed near the centre of the house. AYater-closets should be located always on the outside, so as to have a AvindoAV or Avindows opening to the air. An extra and excellent precaution is to have a small Aving or annex, ex- pressly for water-closets, Avhich are placed over each other on different stories; each being separated from the house by a vestibule Avith double doors. Richardson, in his " Hygeia," places the kitchen in the uppermost story of the house. For this the principal argument seems to be that thus Fig. 83. OLD STYLE FIREPLACE. all smells may be kept out of the house itself. A kitchen-Aving, at the rear of the dwelling, may be made to answer this purpose. AYhile coal is used for fuel, its weight will be a serious obstacle to its elevation to a third or fourth story kitchen. AYhen gas comes to be used generally for cooking (as may shortly be the case), this objection will be removed. This is, however, rather a question of convenience than of health, as kitchen smells, when proper care is taken of refuse, are not especially injurious, although often unpleasant. If a basement, beloAV the ground level, is used for a kitchen or otherwise, an area several feet in Avidth should be kept around it to preserve it from dampness. Our remarks concerning drainage are reserved for another place. AVhat has been so far said upon the construction of houses for health lias been meant to apply mainly to those \vhose owners can afford to 132 HYGIENE. make them what they wish. But the same principles exactly apply essentially to all dAvellings, from the palace of the emperor down to the hut of the laborer, or the cabin of the forest pioneer. In all, the great requisites are dryness, air, sunshine, and sufficient protection from the cold. Some of these, at least, as air and sunshine, are most readily excluded from parts of the largest houses. AYhat experience has shown to be necessary in these, most of all Avhen inhabited by a number of persons, may be understood by referring to some recent sanitary legis- lation in New York. The new Tenement-House Act, 1879, gives the Board of Health of that city important poAver over these structures. The plans of all new buildings must be submitted for its approA^al, and it is required to secure the following conditions: 1. At the rear of every house there shall be a clear, open space of not less than ten feet. 2. No one continuous building shall occupy more than 65 per cent. of the lot. 3. The total area of Avindow space in every room communicating Avith the open air shall be one-tenth of its superficial area, and the upper half shall be so made as to open full width. 4. Air-shafts must communicate Avith every room having neither external AvindoAvs nor fireplace. That " shutting up," even in the variable and extreme climate of the northern United States, is not, as some persons think, the great neces- sity for health, is amply proved by the fact that, during the Civil AYar, tent hospitals (i. e., hospital tents) were found to give better results in the treatment of Avounded and sick soldiers than the very best con- structed and managed large hospital buildings. Not a few consump- tives have OAved the prolongation of their lives for years, and some complete recovery, to their resorting for months together to camp life in the midst of the primeval forest, where the Eden-like atmosphere, breath of the pine Avoods, untainted mountain water, and simple food and habits of life restore the strength exhausted by artificial living. In short, the greatest fault of the personal hygiene of our civilized habits may be summed up by saying, we live too far from Ncdure. LIGHT. 133 LIGHT. Although Ave are not, like plants, absolutely dependent for our groAvth upon the rays of the sun, yet we share Avith all nature their benign influence; and if they are Avithdrawn constantly, health suffers. Miners, passing all their days underground, as in some of the mines of Europe, are usually short-lived and prone to diseases of debility. A physician in NeAV Orleans, during one of its epidemic years, reported that there were more than six times as many cases of yelloAv feA^er on the shady as there were on the sunny sides of the streets; and a similar account was given of the prevalence of cholera at Buffalo, in 1849. Barracks for soldiers, so built that no sunlight enters them, have proved extremely unhealthy. For the sick, especially, who cannot leave their rooms, it is of great consequence to have the sun's rays penetrate their rooms freely a part of every day. Scarcely any exception exists to the benefit of sunshine in the sick-room, besides cases of acute inflammation of the eyes or brain. In chronic inflammation of the eyes, the practice, once common, of shutting the patient up for Aveeks in a dark room, has been almost entirely abandoned; it being found that the depressing effect upon the general health of the body more than counterbalances the good results in treatment of the eyes. Of all rooms in the house, the nursery should be the brightest and sunniest. A house is best placed so as to front north or south (preferably, in northern latitudes, the latter), in order that the rooms on each side may be shone upon during some part of the sun's course every day. If a house be built diagonally, there is an unequal distribution—some rooms are very sunny, and others ne\rer haATe any sunshine at all. Fronting east or west, particularly in cities the latter, will do Avell enough in many situations. The ancient Romans are said to have had terraces on their houses, called solaria, upon which to bask in the sun and air. Sun-bathing is sometimes remedial in sickness. I have known a severe attack of neu- ralgia to be relieved by the patient's sitting or lying in the direct light of the sun. All convalescents from illness gain most rapidly Avhen the} can get out into the full light every day. Dr. Arthur DoAvnes and F. P. Blount, on the basis of experimenta- tion, reported in a communication to the English Royal Society, assert that light prevents or retards tlie deArelopment of bacteria and of the microscopic fungi associated Avith putrefaction and decay. This pre- servative quality is most powerfully shown by the direct solar rays; 134 HYGIENE. although it is possessed, in a less degree, by ordinary diffused day- light. Yet there is such a thing, not only in the tropics, but in temperate regions, as too much sunshine. Heat-stroke, it is true, very frequently occurs in the shade, in people predisposed to it, from the oppressive effect of a heated atmosphere. But our mid-summer sun may well be tempered by the cool shade of trees not far from our dwellings. Ameri- can travellers in England notice, at first Avith surprise, how little shaded are the rural homes, even of the wealthy, as compared Avith those of the United States. But a season spent under the veil of mist and cloud, which so often hides or dims the sun in that country, makes it intelli- gible that too little rather than too much sunshine is the danger there. No more unreasonable impost than the English windoic-tax (propor- tioned to the number and size of Avindows in dwellings) Avas ever in- vented. But we may, in America, have our houses too densely shaded. This is a not uncommon mistake. The effect of it is not only exclusion of sunlight as such, but dampness of the roof, walls, and interior of the house. AYhile sentiment and association may plead Avith us to " spare that tree," whose venerable trunk and spreading branches Ave have loved all our lives, yet we must not allow too deep a shadow to chill the space beneath it. A safe rule is never to have trees so thick near a house that every part of it, Avhich, from position, is accessible to the sun, may not receive its direct rays during a part of every day. AYe need not be forgetful of the bleaching and fading power of those rays, which lead the careful housekeeper to be afraid of them for her carpets. But, Avhat- ever compromise in the way of shades, blinds, or curtains, may be allowed, we should at least forbid, unless in the height of our American midsum- mer noon, the prison-like gloom of tightly closed shutters. Even after a death in a house, it is a wrong to encourage gloom and invite disease by keeping the shutters closed, as some do, for many days together. Soon after the funeral they ought to be opened again. No child can grow strong and ruddy with the bloom of health; no invalid can respond favorably to the best of tonic treatment, in a constantly darkened house. Let the sun come in! WARMTH. 135 AYARMTH. Hardly anything has changed so much with the progress of artifi- cial living as have the modes of warming habitations. Those of the ancients Avhose usages are best known, the Greeks and Romans, suffered from no such extremes of climate as compel protective arrangements in northern Europe and in the United States. A wealthy Roman might warm his banqueting-hall sufficiently Avith a focus or central fire, or a clibanium or brazier; something like which is now, or was, not long since, used for the Pope's apartments in the Vatican. In Spain, King Alphonso Avas once nearly suffocated by charcoal fumes from a brazier. Anticipation of our furnace-heaters was, however, evinced in the hypo- caust, Avith which some of the Roman emperors warmed their palaces. This Avas a furnace with flues to distribute heat, but Avithout a chimney, smoke escaping by a hole in the outer Avail. It Avas subject to leakage; one emperor, Julian, was nearly, and another, Jovian, actually, suffocated in this Avay. In England, dur- ing the middle ages, the fire, in the castles of noblemen, Avas moved to a deep recess against the Avail, the smoke finding vent at a loop-hole in the roof, or by an open turret, or a louvre AvindoAV at the side. Chimneys first came into use in Italy in the fourteenth century. AYater-stoves, it seems probable, Avere employed by the ancient Egyp- tians for hatching eggs; a process now common in that country. Iu modern Europe, they were introduced in France by the Marquis de Chavannes, during the last century. Hans Egede, a missionary Avriter, is said to have knoAvn of their use in a Dominican convent in Green- land, in the fourteenth century. Hot-Avater pipes were employed to heat a conservatory for plants by Martin Triewald, a Swede, in 1716. For dwellings, these Avere brought into use in England about a century later. Steam apparatus for warming began as an application of the boiler of the steam-engine. AYatt so Avarmed his office, and his partner, Boulton, extended its employment in Birmingham. Among the first inventors of stoves, properly so called, were Cardinal Pplignac, Swedenborg, the visionary philosopher, and Doctor Benjamin Franklin. The stove of the latter Avas an open fireplace, brought out into the middle of the room, and having a supply of fresh air from k 136 HYGIENE. beneath. It is approximated by the " Franklin stove " of to-day. An- other celebrated American, Benjamin Thompson, Count Rumford, in- troduced a fireplace system Avhich is still much approved in England. One of the remarkable modes of Avarming apartments, little known in this country, is the kakelung of Sweden. It is described as "a great stove of masonry, covered Avith porcelain plates, having usually five flues, through Avhich the gases of combustion must pass up and down, a distance of thirty to fifty, or even sixty feet, before escaping into the air." The principle of its operation is to provide enough material to absorb all the heat from the fire, the gases being conducted through the long flues until they give up all their heat. If ventilation be Avell sup- plied by other means, this arrangement must be extremely economical at least. In Germany and Russia porcelain or brick stoves of a similar kind are still used, aud are extremely comfortable. Fig. 85. WARMTH. 137 tive, of the different modes of receiving communicated heat, viz., by radiei' tion. Nothing is equal to direct radiated heat in comfort and restorative poAver, Avhen one has been chilled Avith winter's cold. But it is the least economical of all methods, as but little effect is felt in those parts of the room which are not in front of the fire, or nearly so. Moreover, accord- ing to the physical laAV of radiation, the heat diminishes in proportion to the square of the distance; so that at the distance of ten feet from the fire it is one hundred times less than at the distance of one foot. Conduction through solid bodies, a very frequent mode of distribution of heat in nature, has been made purposely available to only a small degree in Avarming rooms. By the walls of the house, hoAvever, heated by smoke, gas, and warm air passing up through chimneys and flues, rooms are considerably warmed. It is probable that the best way of all (scarcely anyAvhere as yet tried) may be hereafter found to be, to heat steadily all the floors and Avails of apartments by Avarmed air circulating beneath and around or through them. This Avill give an e\Tenly warm climate, so to speak, to the house; imitating the plan of Nature, accord- ing to which almost all the heat of the atmosphere of a region is given to it by the sun's rays heating the earth, Avhich then communicates its warmth to the air. The Chinese have something like this, at least so far as providing Avarmth for their floors by sIoav fires underneath. This last kind of conveyance of heat, by conduction, Ave foliow, in part, in the use of stoves; Avhich give their temperature to the air in contact with them. By expansion, Avarrn air is made lighter, and so is displaced and forced upwards by the heavier cold air. Rising currents are thus caused, and a circulation of air results, as one can see by the curious undulating appearance of objects looked at over the top of a stove, as well as by the upAvard movement of light, floating particles above the heated surface. Convection is the technical term applied to this manner of diffusing heat. AYhen the fire by which air is warmed is in a cellar, basement, or hall, so that the warm air may be distributed, by flues and registers, into several apartments, we have the noAV common furnace-heater. It saves trouble and dirt—making one fire, out of sight, answer the pur- pose of as many as there are rooms to be Avarmed. But it is often unequal in the share of Avarmth given to the different apartments. If this difficulty be overcome by skilful and careful use of valves, damp- ers, etc., an important fact, often forgotten, remains, that Avhile the cellar-heater furnishes Avarm air to enter the rooms, it affords, of itself, no outlet for its escape. There may thus be produced a pressure Avithin a parlor or other room, so long as the doors and AvindoAvs are shut, which is sometimes unpleasant and unwholesome. Again, when a door 138 HYGIENE. is open, if there be no heat supplied in the entry or hall, a cold current creeps along the floor of the room, chilling the feet of those who are in it. In an apartment so warmed, there is often a difference of 12° to 20° Fahr. in temperature between the floor and the height to Avhich a man can reach. This is the reverse of what ought to be the case; since to keep the head cool and the feet warm is one of the most approved maxims of health. A room is only properly Avarmed Avhen there is no considerable, if any, difference by the thermometer between the floor and the height of an ordinary mantel-piece. Fig. 86. A FURNACE-HEATER. AYhat should the temperature be, say at the latter height, for health? Authors differ someAvhat upon this point. A bright wood, or gloAving anthracite or bituminous coal fire, will alloAV of a lower temperature of the air of a room than will suffice when there is no direct radiation of heat. Even the rays of the sun pass through the atmosphere without Avarming it, unless it contains floating vapors or solid particles. Yet Ave feel their warmth, often intensely, when they reach our bodies. A difference exists, moreover, according to whether we are sitting still, or moving about or Avorking in any Avay. A Avorkshop, gymnasium, or skating-rink may safely have a temperature many degrees loAver than a draAving-room, sitting-room, lecture-room, or school-room. Only, when those who have been exercising actively in a cool or cold apart- ment sit down to rest, they are in great danger of catching cold, unless they protect themselves immediately by some increase of clothing. For a sitting-room of any kind, my own conviction is that 70° Fahr. WARMTH. 139 at the height of a mantel-piece is the best temperature. Some Avriters, in England especially, have put it dovvn at 68°, or even 65°. I believe such to be suitable only Avhen open, radiating fires are employed. For a sick-chamber, 72° may sometimes be better, if the air can, by good ventilation, be kept fresh as well as Avarm. There is no necessary (although there is unhappily a frequent) connection between Avarmth and closeness of the atmosphere in a room. Of the harm done or endangered by overheated rooms, an account is given in another volume.* Returning to the furnace-method of warming houses, a few condi- tions may be named as essential to its compatibility Avith health. 1. The furnace should be large in proportion to the house; so that Avith a moderate fire, not pushed, it may Avarm a sufficient supply of air to give a good temperature to the rooms depending upon it. A very hot furnace bakes the air, as it Avere, producing an unpleasant odor and an uncomfortable feeling through the house. If the furnace be too small, it Avill not furnish enough heat, Avithout driving the fire hard, in cold weather. 2. Air should be supplied to the air-chamber directly from out of doors. A cellar atmosphere, at the best, cannot be equal in quality to the open air, and at its Avorst may be very bad indeed. In another place Ave may farther allude to its evil possibilities. 3. AYater should always be placed in the air-chamber, so as to evap- orate constantly, and preATent undue dryness in the air of the house. A certain amount of moisture in the atmosphere is essential to life itself. EArery one is familiar Avith the destructive effects of the Simoom, Khamseen, and Harmattan winds of Arabia and Africa, Avhich carry the scorching aridity of the desert Avith them, blasting everything that has life in their course. AYhile excess of dampness is a very frequent promoter of disease, it is equally true that artificial heat, such as that of stoves and furnaces, tends to create the opposite extreme. AYarming the air increases its capacity for retaining moisture Avithout saturation. The term relcdive humidity is employed to indicate the condition of the air at any time and place, as compared Avith saturation. Calling satu- ration 100, for example, the relative humidity of the air may vary in our climate all the way down to 12 or less. Dr. AYetherill, some time since, found the mean of several years at AVashington to be a little OArer 68. At Halle, Germany, Muller found the mean to be 75. In Phila- delphia, in tAvelve years, it Avas 68.5. Roscoe, in the House of Lords, in London, ascertained the range of agreeable humidity to be between * See Winter and its Dangers, by Hamilton Osgood, M. D., No. 5, of the American Health Primers. 140 HYGIENE. 55 and 82; the mean between Avhich extremes is 68.5. Best of all, no doubt, for health and comfort, is from 67 to 69. Now, by raising the temperature of the air in any apartment from 50° to 70° Fahr., its relative humidity may be reduced from 100 to 25 • that is, from containing moisture enough for saturation doAvn to one-fourth 'of that amount. Of course, then, there is reason for adding a sufficient quantity of vapor to bring it up to twice as much or more, say to 68. Dr. AYetherill estimated that the halls of Congress ought to" have nearly eight gallons of water evaporated every hour for the proper hydration of their atmosphere. Prof. Joseph Henry, so long the admirable head of the Smithsonian Institution, introduced into its building an arrangement for adding steam to the air of the air-chamber of the furnace by which it is Avarmed. Fig. 87. REYNOLDS' FURNACE. —(FROM PUTNAM.) From these examples Ave may understand hoAV important it must be to have an evaporator in every furnace air-chamber, and a shallow pan of water upon every stove used for warming our rooms. On the other hand, in the absence of fires, during the spring and autumn, houses in some localities and in rainy Aveather may become too damp. It is then a Avise and important precaution to light fires at such times; if the weather is not cold, opening the windoAvs. This removal of house dampness is especially of consequence in places Avhere autumnal fever* (intermittent and remittent) prevail. 4. Sedulous care must be taken that no leakage of gas occurs from any flue or pipe into the air-chamber. Coal-gas is poisonous Avhen con- centrated. Not unfrequently death has been produced by its insidious entrance into the air of occupied rooms. A telling instance was nar- rated, a few years ago, of what happened in a public school in one of WARMTH. 141 our cities. The lady teacher, sitting at her desk on a raised platform, observed that some of her youngest pupils were nodding, and shortly several of them fell over on the floor. Bench after bench they Avere overcome, when her presence of mind sufficed to get the AvindoAvs open, and to have the children carried to another room, Avhere they revived. The cause of the trouble Avas an obstructed and leaky stove-pipe, through which gas had been slowly escaping into the room and stealing their lives aAvay, first acting upon the smaller scholars, breathing the air nearest to the floor. Many a time, Avithout any such alarming im- mediate effects, gas from imperfect furnace flues in our city houses pro- Fig. 88. A RADIATOR FURNACE. duces headaches, general discomfort, and debility, often ascribed to some other imaginary cause. It is quite necessary that the box or tube Avhich admits air into the air-chamber shall be so tight that gas cannot be drawn into it Avhen the upper door of the furnace is open. If the draught be imperfect, there may be, especially Avhen fresh coal is put on, an escape of gas into the cellar. This possibility adds emphasis to the reasons for haAnng not the cellar, but the open air, to give the supply to the air-chamber for the house. 5. AYarm air should be supplied to the main hall or entry with which parlors or sitting-rooms are connected; so that the doors of the latter may be open without causing currents of cold air along the floor. 142 HYGIENE. 6. Since, as above said, no outlet belongs to the warm-air system of itself, the needful air-movement must be maintained by some method of ventilation. Barker's arrangement of flues and registers for intro- duction and exit of air, so as to warm and ventilate at the same time, Avill be referred to on another page, under the head of A'entilation. Open doors, at all events, into the entry or hall, or open window cracks, must be insisted on if nothing better can be obtained. Best of all, however, it will be to combine the two modes of warming, by having an open' fire, for instance a " low-down " grate, in one part of a large room, or in one of two communicating rooms. The open fire gives the gloAving, comforting, radiant heat, and sup- Fig. 89. plies ventilation by its upAvard draught into the chimney; Avhile the air from the furnace air-chamber, if properly arranged, makes sure the diffusion of an equable and sufficient warmth through the house. Open- grate fires, burning either bituminous or anthracite coal or coke, are cheerful, and give out a great deal of heat. AYhen the air for their draught is supplied from out of doors, entering from the back or beloAV, fire-Avard currents along the floor are not produced. AYhat is called, in England, the Galton system, has been found to work well also in this country—having fresh air introduced through a grating at the back into an air-chamber, and thence into the apartment above (or at the sides of) the fireplace. There is thus obtained a considerable economy of fuel. WARMTH. 143 Ventilating stoves, upon a similar principle, are also employed. Among the arrangements Avhich appear to have succeeded is the Ruttan " Air- AYarmer;" and the editor of the Popular Science Monthly * speaks in praise of Avhat is called the " fire on the hearth." Objectionable, beyond other means of warming living-rooms, is the "air-tight" coal-stove. Yet, from their economy and convenience, stoves more or less nearly air-tight are very largely employed. If air is introduced into the room in good amount, and Avater is kept constantly evaporating upon the stove, an ordinary stove can be managed Avithout necessary injury to health. Cast-iron stoves are somewhat more permeable to gas than those made of wrought- or sheet-iron. Careful experimentation has shoAvn, hoAvever, that no appreciable penetration of the metal (in the absence of cracks allowing leakage) by carbonic oxide or other gases takes place, unless at, or near, a red heat. According to chemical authorities, cast- iron contains in itself more or less carbon, sulphur, phosphorus, and sometimes even arsenic, products of Avhose combustion may be given out at a very high temperature. No stove ought ever to be heated red hot in an occupied room. A stove large for the apartment is always the best, on account of its giving off sufficient heat Avith a moderate fire, instead of needing, from deficient size, to be constantly urged to a high heat. In the homes of the poor, in large cities, from Avant of means to rent more than one, two, or three rooms for a family, a great evil in mid- summer is, sometimes, the excessive heat of the cooking-sto\re. Near this, in a small room, often in a narrow, crowded court, the mother is obliged to lay her babe, and to watch the older children, Avhile she cooks their meals or heats water to wash their clothing. No Avonder that the " summer-complaint" attacks infants in such places; and no Avonder that, Avhen they are so attacked, medical skill often fails to bring relief, unless the little sufferers can be taken aAvay to the open hill-sides of the country, or to the sea-shore. AAThat a blessing of bless- ings to these is the sea-side " sanitarium " or the " country Aveek !" Large houses, even private d\vellings, are not unfrequently warmed by pipes containing hot Avater or steam. Theoretically, hot Avater ought to be the best, from the hygienic standpoint; because the temperature produced by it, under ordinary pressure, is never Arery excessive, as that of steam may be.f Still, the positive and comparative usefulness, * November, 1879. f It is a singular mistake made by some persons to suppose that the heat furnished by steam- or hot-water pipes is moist. As the pipes are always (if rightly made) entirely tight, water for evaporation is needed just as much with them as with ordi- nary warm-air furnaces. 144 HYGIENE. and general advantages of both methods depend very much on the skill and care with which' the apparatus is constructed and managed. It has happened to me to become well acquainted, during two years, with the disadvantages of an ill-constructed apparatus for steam-heat. Yet in many buildings it appears to give fair satisfaction. It is of consequence to remember, at all events, that all pipe systems, vet more than warm-air furnaces, are absolutely without any arrange- ments for ventilation, which must therefore be otherwise supplied. Many authorities agree in recommending that, instead of having coils or lines of pipe as " radiators " in the different rooms to be warmed, the heat of pipes should be utilized by means of air-chambers, through which fresh air is passed in contact Avith them, and, after being warmed, is distributed through the house by means of flues. AVarming, as well as cooking, by means of gas, seems not unlikely to become common in our houses. It offers extreme convenience as its great attraction. Many years ago I proposed, in a communication to the Franklin Institute, Avarming and cooking by means of pure hydro- gen gas, conveved through pipes separate from those of the gas used for illumination. ' It has the advantage of giving off much heat in propor- ' tion to its volume, and, what is more important, the product of its com- bustion is simple Avater; Avhile ordinary burning gas produces also car- bonic acid, carbonic oxide, and sulphurous acid, besides other deleterious substances contained in it before burning, which may escape through leak- age. My proposition Avas set aside at the time on account of the expense of the manufacture of hydrogen compared with the cost of coal as fuel. Should coal become much more dear, or a very cheap process for making pure hydrogen be invented, the hydrogen stove may perhaps yet come into use. AYhen common gas is burned, unless a special arrangement is made to carry aA\-ay the results of its combustion, it vitiates the air considerably. A gas-stove needs a chimney, or at least an escape-pipe communicating Avith one, as truly, and for the same reason, as does a kitchen range or other stoAre. It is, however, more easy to provide this in connection with a gas fire, on account of its being less bulky than one of coal; and the gas- burner's escape-tube or pipe may be made an excellent means of ven- tilation. Eassie* describes a plan for a gas-stove, in Avhich fresh air is introduced by a pipe from the exterior into a cylinder which sur- rounds the burner, the latter being enclosed in, and receiving air through, a tube communicating Avith the outer atmosphere, the results of the combustion of the gas being carried off by the tube passing out * In his work on Sanitary Arrangements, etc., before mentioned. WARMTH. 145 above the stove. Thus there is no possibility of the air of the apart- ment being contaminated, and a good ventilation, as Avell as Avarming, is obtained. The necessity of removing the products of the combustion of gas, as well as those from that of candles or oil, is very pressing. Prof. Pet- tenkofer ascertained that a man exhales every hour from six- to seven- tenths of a cubic foot of carbonic acid gas; saturation of the air of an apartment Avith Avhich gas is fatal, and even four per cent, of it is dan- gerous to life. Angus Smith and Hartley assert that a good oil " mod- erator " lamp produces a little more than half a cubic foot, and a good candle threeTtenths of a cubic foot of carbonic acid gas in an hour. A common gas-burner, consuming three cubic feet of gas per hour, gives off about as much carbonic acid gas as three men would do in the same time.* Of course the larger size of the burners employed for Avarming or cooking purposes than for illumination must involve occa- sion for a proportionately increased supply of air in ventilation. Of this, however, we shall speak presently. * Lange's estimate is that a gas-burner giving a light equal to that of eight candles, produces nearly as much carbonic acid as six men. 10 146 HYGIENE. ATENTILATION. Ancient Egypt, the site of the earliest civilization whose remains have been spared by time, appears to have been somewhat acquainted Avith the needs of ventilation. In the Pyramid of Cheops, probably older than Abraham, a passage exists, seeming to have had the purpose of conveying air into and out from the chamber in the interior of the structure. Acron, a Greek philosopher and physician, in the century before Hippocrates, is said to have arrested an epidemic at-Athens by lighting fires in several places in the city to change the air. Celsus, the great Roman physician, alludes in his writings to the beneficial action of fire, the sun's heat, and elevated exposure, in purifying the air of sick-rooms. The ancient Romans sometimes employed great belloAvs for ventilation. In Germany, in the sixteenth century, bellows and also rotary fans were used to inject fresh air into, and force foul air out of, mines. Desaguliers imitated this in England in the eigh- teenth century; and also contriAred a revolving fan to ventilate the House of Commons by drawing foul air out at the top of the building. This arrangement was in use for nearly eighty-four years. Dr. Hale, of London, during the same century, invented Avhat he called " ships' lungs," for airing, by a kind of belloAvs, the holds and other parts of vessels at sea. Sutton, a London brewer, near the same time, attained a similar result by utilizing the cooking-fire on the ship's deck. Hos- pital ventilation, through aspiration by heated flues, Avas introduced into England by Sir George Paul, in 1820. Dr. Arnott, a little later, did a great deal to stimulate attention in Great Britain to ventilation. His chimney-place valve is still a good deal used. A curious but sensible proposal, made by Sir Humphrey Davy for the House of Lords, and afterwards carried out by Dr. Reid, was to make a great number of "gimlet-hole" apertures for the removal of foul air. No educated person denies the importance of ventilation; but scarcely one in a hundred of the best-educated people gives enough practical attention to it. It is proper, in this place, to go down to the elements of the subject. AYhy do we need to "ventilate" at all? Because we have to breathe; and in breathing Ave use up and spoil the air. Every- body knoAvs what happens in drowning; air is, for a minute or two, kept out from the lungs by water, and the submerged person dies. So when a man goes into a beer-vat, lately emptied of its liquid, but leav- ing some of the gas of fermentation, carbonic acid, behind, he falls VENTILATION. 147 over, and, unless at once rescued, loses his life. Sleeping in a room in which charcoal is burning, away from an open chimney, has likeAvise often been fatal. In these cases, it may be said, the air is poisoned. This is true; but it is not more certainly, nor even so badly poisoned, as it is by human breaths and the exhalations of our bodies. Charcoal gas is carbonic acid; we exhale that, and besides, with every breath, and from all the pores of the surface of the body, deleterious organic matter. This combination, Avhen concentrated, will kill more quickly than the gas produced by simple combustion alone. In the famous instance of the " Black Hole of Calcutta," ahvays cited in connection with this subject, one of the survivors of the night-long imprisonment (of one hundred and forty-six men in a room eighteen feet square) mentions, that although the room had in it tAvo small Avindows, all but tAventy-three men died; several of them with different symptoms from those produced by breathing carbonic-acid gas alone. Another example of the same thing is the folloAving: A steamer (the Londonderry) was overtaken in the Irish Sea by a storm. The passengers, about two hundred, having been ordered beloAv, the captain, to prevent water from getting in, battened down the hatches. Before their suffering and alarm compelled him to set them at liberty, seATenty-tAvo had died of suffocation. There is, then, immediate danger from Avant of ventilation. But this is far from all. An impure air may poison us slowly. Typhus fever (jail fever, camp fever, ship fever, of different places) may, I am Avell convinced, be engendered by this cause alone, as Avell as by con- tagion. Typhoid fever and diphtheria are, at least, much promoted by it; and, without any such diseases, a Ioav state of health, with increased liability to scarlet-fever, measles, etc., and a greater probability of death when they occur, is a constant effect of close living. Pulmonary con- sumption and other affections of the chest, as pneumonia and bronchitis, are much more common and more fatal with those who live all the time in ill-ventilated rooms than in those who, Avith an active, out-of-doors life, are exposed to the vicissitudes and inclemencies of the weather. This is a fact which, if it Avere generally appreciated, might make a great difference in the manner of living of many people. Air consists chiefly of two gases mixed together. Referring to larger works for more precise details, we may say that these are about four- fifths of nitrogen and one-fifth oxygen. The latter is the vitalizing, indispensable principle; the nitrogen merely dilutes it. Also, the air contains a variable amount of Avatery vapor, Avhich we cannot do with- out, but which may be more or less disadvantageous by excess; a quan- tity of carbonic acid, averaging, in the open air, three or four parts only 148 HYGIENE. in 10 000; and other ingredients,* gaseous, vaporous, and even solid (dust 'etc.), present or absent, according to locality and circumstances. Of these non-essentials of the atmosphere, the organic matter derived from human beings, other animals, and plants, living or dead, is the most important, because capable of doing the most harm by its decom- position and poisonous action. A man, by his breath, will spoil, in twenty-four hours, about three hundred and fifty cubic feet of air; as much, that is, as would be con- tained in a room a little more than seven feet square, with a ceiling seven feet high. Could all the carbonic-acid gas exhaled by a man in that number of hours be collected, and its carbon extracted from it, the latter would be equal to half a pound or more of charcoal, besides the organic matter given off, whose amount is not easily estimated. When people sleep in small rooms with closed Avindows and doors, or collect in numbers in church congregations, theatres, etc., with lights burning, and, in cold weather, with windows and doors shut to keep up warmth, foulness of the air is soon produced. Of this, an excess of carbonic acid is a part, and a sign of other impurity. If air con- tains more than six or seven parts of carbonic acid in 10,000, it must be counted impure. Yet the following are amounts of that gas actually found by examination in certain localities: Parts in 10,000. London school-room (Koscoe) ....•••• 29. Munich school-room (Pettenkofer).......72. Munich beer-saloon (Pettenkofer).......49. Hospital, Madrid (Luna).........43. Bedroom, Madrid (Luna).........48. Lecture-room, Paris (Leblanc)........67. Diminution of the oxygen of the air occurs, also, from breathing and burning of fires and lights. If this goes so far as a loss of two or three parts of oxygen in a hundred, life is endangered from this cause, as Avell as from the negative or obstructive effect of excess of carbonic- acid gas. This latter gas, when pure, cannot be breathed into the lungs; but, Avhen dilute, it enters them, and produces unconsciousness and death, more or less rapidly according to its amount. Where a lighted candle goes out, as in a beer-vat or an old dry well, or unventilated coal-mine, etc., it is known to be unsafe for a human being to go. Four per cent, of carbonic acid renders the air dangerous to life; ten per cent. Avill overcome any one almost immediately. * Ozone is oxygen gas in a peculiar state of concentration. There is but little of it present in the air of densely inhabited places; more in the open country and near or upon the sea. There is reason to believe that it is more stimulating than oxygen in its ordinarv condition in the air. VENTILA TION. 149 Fig. 90. Considering, then, the propensity of many people for shutting every- thing up, the porosity of our Avails, and the unintended cracks in doors and AvindoAVS of most houses, must be regarded as fortunate and pre- servative. A movement of the air goes on by diffusion, as well as by the Avinds and currents perceived by our senses. Pettenkofer devised a curious experiment to shoAv Iioav air penetrates through gravel. He half filled a glass cylinder with gravel, over Avhich a Avire netting Avas placed; on this a canary bird Avas put; over him another Avire netting, and above that the cylinder Avas filled to the top Avith gravel. So the bird lives all day, Avithout seeming to be incommoded for Avant of air. The warmth of its body induces a gentle ascendiug and descending current of air around it through the two layers of gravel, the upper one communicating Avith the atmos- phere. AVithout such a movement to reneAV the air for it to breathe, it Avould be fatally poisoned in a Arery feAV hours. Although birds consume and require more air in proportion to their bulk than Ave do, yet our larger size involves a demand for atmos- pheric movement much greater than, Avithout investigation, most people would suppose. This demand is too often very imperfectly met. Look, for example, at the following figures, taken from good authorities. First, we must premise that, as an adult consumes three hundred and fifty cubic feet of air in respiration in twenty-four hours, at least twice that amount of space ought to be allotted to every person in a living apartment, whether awake or asleep. In a hospital, it ought not to be less than 1000 cubic feet for each patient. Cubic feet per head allowed by regulation. English Poor-Law Board, dormitories......300. London Metropolitan Lodging-Houses......240. London School Board, per scholar......130. English Wooden Hut Barracks.......400. Prussian Barracks.........495. English Wooden Barrack Hospitals......600. But cubic space does not settle the whole question at all. Granting to each person in an unoccupied room 1000 cubic feet, the air in that space ought, for health, to be all changed about four times in an hour. Let us contrast, Avith the table above given, another, slightly modified 150 HYGIENE. Air per head, per hour, ' feet, from one calculated by Morin, an eminent French sanitarian* It states the requirements Avhich are uoav considered not too great, indeed quite moderate, for health : cubic Hospitals for ordinary patients.....2000 to 2500. Hospitals for wounded or lying-in......3500. Hospitals for epidemics........5000. Workshops.........2000 to 3500. Public assembly rooms........2000. School-rooms..........1000. But, say some of our readers, this is alarming. Hoav can any ordi- nary house be provided Avith such a movement of air ? It is, in fact, an easier matter than Avould at first thought be supposed. A good ordinary fire will cause from 6000 to 10,000 cubic feet of air per hour to enter and leave a room.f Hoav are the winds caused, Avhich SAveep over everything on the surface of our earth ? By differences of tem- perature, making the air heavier and lighter in different localities; the colder and heavier air moving so as to displace upAvards the lighter Avarm air, and thus making currents in the atmosphere. The same cause is constantly acting in our houses, more or less poAverfully. But it needs arrangement and encouragement to give it full effect. Before saying more about this, it will be well to dAvell upon another very important fact in Nature. It is remarkable that the proportion of the tAvo gases, oxygen and nitrogen, of which the air is chiefly com- posed, is almost exactly the same every Avhere, although they are only mixed, not chemically combined. From the " difficult air of the iced mountain top " to that which is filled Avith spray by the breakers at the margin of the sea, the same air is breathed by all, except Avhere it is spoiled in or near human habitations or other artificial constructions. The " laAv," or general fact, of which this is an example, is the law of the mutual diffusion of gases. Every gas tends to expand and occupy all the space to Avhich it has access; and different gases do not interfere Avith each other's liberty in this respect, Carbonic-acid gas is so heavy that, Avhen quite pure, it can be poured like Avater, from vessel to vessel; and yet, if a vessel of it is left open to the air, it will soon pass off and disappear. This is very important to us, as, otherAvise, the amount of this heavy gas produced by all the respiration of men and animals, and the combustion of fuel, in our cities, would make the continuance of life impossible.^ *For the exact table, see Buck's Hygiene and Public Health. Xew York, 1S79. Vol. I., p. 705. t Healthy Houses, by F. Jenkins, F. R. S. + A beneficent aid in the removal of carbonic acid from the air is provided by the VENTILATION. 151 This constant diffusion of air-constituents is not fully appreciated by all, even of those who have given attention to sanitary science. Some writers upon hospitals assert that the ceiling of a Avard may be too high for good ventilation. I am sure this is a mistake. Familiarity Avith hospitals for several years, and comparison of them by visitation in Europe as Avell as in this country, besides Avhat every traveller knoAvs of the great cathedrals abroad, has confirmed to my judgment practi- cally Avhat should be expected according to theory, namely, that the ceiling of no living-room, for the sick or the well, can be too high for health. Of course, it requires more consumption of fuel to warm suf- ficiently a room Avith a high ceiling than one Avith a low one; but this is au economical rather than a sanitary question. It is a maxim of pre-eminent importance, in regard both to breath- ing air and drinking Avater Avhen exposed to causes of contami- nation, that confinement and concentration intensify, while dilution and diffusion make innocent, most organic poisons. To put the case strongly, I would rather, Avith a ATieAV to the safety of health, have a Avater-closet ATentilated, even through a house by open doors and AvindoAvs communi- cating Avith it, than have it not ventilated at all, while used constantly. Indeed, the most terribly killing of all poisons of the kind noAV referred to is produced by shutting up old cesspools. Take, for example, such a case as this: Not very long since, at Cleveland, Ohio, four deaths were caused by opening a cesspool, Avhich had not been used for a number of months, and had been covered with planking, over which were eight inches of dirt. One of the men descended, in order to open it, into an adjoining privy vault, Avhich Avas in use and ventilated. As soon as he made a communication with the cesspool, so as to allow its gas to escape, he fell over unconscious. Three others, Avho entered after him, experienced the same fate, and all died.* The question of drainage and " conserv- ancy " will be considered later in this book; but I wish to place here large emphasis upon this most vital difference between concentrated and diffused organic poisons of air or Avater. It Avould be easy to bring together many instances of different kinds to illustrate the close relation of air-space and ventilation to health. I Avill here add but two, which are rather curious. The proprietor of a large factory in Alanchester, England, having a working-room too small for those engaged in it, and not well ventilated, enlarged it. He was, action of the leaves of trees and other plants, which, during the daytime, absorb this gas and give out oxygen in return. But this would not suffice without diffusion. * Report of Health Department, Cleveland, Ohio. 152 HYGIENE. soon after, obliged to increase the wages of his employees, because, with better air to breathe, their appetites became larger, and it cost them a good deal more to live. A dining-club, in Edinburgh, concluded that the ceiling of their dining-room was too low. They had it raised, and, in consequence, the amount of viands consumed at their prandial gath- erings was found to be notably and expensively increased. Yet, to show how singularly such simple sanitary principles may be misapprehended, a printed circular was distributed in Philadelphia by its Board of Health, in 1866, prior to an expected visitation of cholera, in which the families of the city were advised to shut up all their win- dows at four o'clock every afternoon, and keep them closed until ten o'clock the next morning! This august body has, undoubtedly, gained in wisdom by a dozen years of experience, or, with such ideas, it would not be a very safe guardian of the public welfare. AYe may see, from what has been said, how obvious and simple are the objects to be aimed at in ventilation, however complicated and diffi- cult sometimes may be their attainment from the interference of circum- stances. These objects are: 1. To move uniformly through a building the required amount of pure, fresh air. 2. Duly to distribute this air to the different apartments in the house. 3. Properly to diffuse it in each room. 4. To remove the vitiated air from every room in the building. 5. To Avarm the air sufficiently in winter. 6. To supply it with an appropriate amount of moisture. Most of the year, and for the majority of persons, it is necessary that the movement of the air through apartments in Avhich they live should be gentle as well as uniform. That is, we must avoid draughts, unless in the warmest and driest of summer weather, Avhen we court every breath of a zephyr, Avhose comings are " few and far between." * Yet there must be a movement through every room, not merely one opening into it; outlets as well as inlets must be provided.f A chamber with but one windoAv, with the door shut, and without either an open tran- som or a fireplace, is often insufficiently ventilated, except in Avindy Aveather. The best chance for such a room is to have the Avindow open both at the top and at the bottom. The cold air will then enter below * At 60° Fahr., air-movement is not felt as a draught unless it has a velocity of 1\ feet in a second. f In a private conservatory at Germantown, Philadelphia, every plant was killed in a single cold night, because, through oversight, although a warm-air flue opened into it, no outlet was left for the maintenance of air-movement through it. VENTILATION. 153 (being heavier), and the lighter warm air will escape at the upper open- ing. In order to get the most uniform air-movement through a room with the least draught, several inlets and outlets are always better than one or two. If there be two or more windows in a room, it is best to open each a little, both at the bottom and at the top. Thus the total of inlets and outlets may be greater than Avould be borne if a single windoAV afforded it all, either at the top or at the bottom. It is won- derful how small the cracks may be which seA^eral windows will need to have as openings, in order to keep the atmosphere of a room sweet and pure. Natural and artificial ventilation are often spoken of as two differ- ent and contrasted things. But since all human constructions, houses Fig. 91. a included, are artificial, spontaneous or accidental would be a better term than natural. The other term, artificial, may as Avell be retained; meaning the use of apparatus or special arrangements expressly for ventilation. By spontaneous or accidental ventilation, then, we mean, that of open fireplaces, doors, and windows. Of the fire- place, so serviceable even without a fire, a good deal has been said already. AYindoAvs and doors answer very well in a warm climate and in fair Aveather; but they are uncertain and variable, and so liable to excess of draught, as to induce Avith many persons a con- stant dread of catching cold. Yet they may be managed, Avith care, so as to maintain a pure atmosphere within doors, even in mid-winter, so long as sufficient heat is afforded by Avarming-apparatus, for comfort and health. They answer best, perhaps, with open fires. Many English Fig. 92. 154 HYGIENE. sanitarians prefer " natural" ventilation to any other kind, for dwellings and hospitals. Among these, Florence Nightingale, one of the highest recent authorities on hospitals, exclaims against the " abominable arti- ficial ventilation " of some European institutions. Next to the purely spontaneous or accidental methods come those which, in a simple manner, add to or modify these. One such is the ..ian ascribed to Hinkes-Bird, which is described and figured in Dr. 11. Osgood's " Winter and its Dangers." It consists in the insertion of a piece of Avood, made to fit under the lower sash of the Avindow, raised a few inches. Air then enters upwards, between the two sashes, at their place of junction. Still simpler, and equally effectual, is Dr. AY. AY. Keen's arrangement—placing, with tacks or pins (preferably the former, using loops of tape, which can be taken off and replaced, as wanted), a piece of cloth or paper across the lower ten or twelve inches of the AvindoAV frame, and then raising the lower sash more or less, according to the Aveather. Still another Avay of getting an upward-directed draught is by means of the Sherringham valve. For this, an opening is made through the Avail, near the ceiling; and inside the room is a small shoot, or sloping board, closed in at the sides. A lid or valve, above this, may be used to lift or close, so as to regulate the amount of air admitted. The same effect, however, almost exactly, can be obtained by fixing an upward-sloping board about six or eight inches beloAV the top of the AvindoAV, and then letting doAvn the upper sash a few inches. An excellent method was in use, some years ago, in the temporary building occupied by the Episcopal Hospital of Philadelphia. A pane Avas removed from each of the Avindows in a ward, and in its place Avas introduced a piece of zinc perforated with a number of small holes. AYire gauze will do about as well. This allows the air to come in sloAvly, Avithout draught; and, moreover, it tempers it by the conducting poAver of the metal, Avarmed by the heat of the room. The principle Fig. 93. here is the same, essentially, as that of the Davy safety-lamp for miners; viz., the rapid effect of short metallic tubes, or pores, communicating their own tempera- ture to gas or air passing through them. Nothing has pleased me more, after actual trial for a considerable time, than Maine's elbow-tube ventilator. This con- sists of a board (made in two parts, sliding on each other, so as to be adjusted to different windows), to be placed under a raised sash, as in Hinkes- VENTILA TION. 155 Bird's plan, but having passed through it two pipes or tubes, about six inches in diameter, each bent upward in an elbow; the top of each tube being open above, and supplied Avith a regulating valve. By means of this arrangement, the cool air from out of doors is directed upwards altogether, and is not felt as a draught, even by those who sit quite near to the open ends of the tubes. Inlets and outlets are both, as already said, necessary for due circula- tion of the air.* AYhen they are made expressly for ventilation, the question occurs, AAHiere shall they be ? An opening in the wall, ceil- ing, or floor of a room may be either an inlet or an outlet, or both, according: to circumstances. If it be connected Avith a flue from the air-chamber of a furnace, it Avill, of course, be ordinarily an inlet for Avarm air. If it communicate directly with the open air, it may be either an outlet for warm air or an inlet for cold air. AYhen there is an open fireplace in the room, it Avill generally be a cold-air inlet. In the absence of a fireplace, if there be a single opening only, besides the Avarm-air register,—this opening Avill usually be an outlet, relieving the pressure caused by the furnace air-chamber flue. A fireplace Avith a Avide-throated chimney, and either a coal-grate or a Avood fire burning in it, seldom needs any inlets or outlets for venti- lation besides the cracks Avhich, unintentionally, exist in AvindoAvs and doonvays. The chief problem concerns rooms warmed by heated air, or by steam or hot-Avater pipes. First, then, as to the Avarm-air arrange- ment. Several possibilities may be considered. Our diagrams may facilitate the comparison of them together. In Fig. 94, Avarm air is represented as entering at I, near the floor, on one side of the room, and escaping immediately above this, near the ceiling, on the same side. A great waste of heat must result, Avith, no doubt, some, but far from perfect, ventilation. Fig. 95 shoAvs Avhat will happen if warm air is admitted at the top of the room on one side, and allowed to escape, also, near the ceiling on the opposite side. Being lighter than the cold air of the room, the Avarm air will float over it, like oil over water, without affecting the room sensibly. In Fig. 96, we have the inlet at the middle of the floor, and an out- * Dr. Parkes, in his Treatise on Practical Hygiene, says, that in a hospital the sum of inlets and outlets should be not less than forty-eight square inches for each patient. Morin advises that the fresh-air inlet should equal fourteen square inches for every one hundred cubic feet of space. Whether inlets or outlets should be largest, sanitary authorities are not agreed. I am tempted to coin the word throughlet for an opening which may allow air either to enter or leave the room by it, according to the circum- stances of temperature, pressure, etc. 15(3 HYGIENE. Fig. 94. Fig. 95. 0 I Fig. 98. Fig. 99. o i ;> T M Fig. 100. Fig.101. r ^j J^ VENTILATION. 157 let directly over this (above a gas chandelier, for example), in the midst of the ceiling. This will ventilate, but with too much loss of heat. Better, decidedly, indeed quite good, will be the arrangement shoAvn in Fio\ 97, in which two warm-air registers are placed, one on each side of the room, at the floor, the outlet being at the centre of the ceiling. Fig. 98 illustrates the air-movement when the warm-air flue opens at the floor on one side, and the outlet is at the ceiling on the opposite side. This will give a good distribution of the air introduced before its escape through the outlet. In Fig. 99 this arrangement is reversed, warm air coming in at the ceiling on one side and going (or intended to go) out at the floor on the other side. In Fie:. 100 the inlet is at the floor on one side, and the outlet also at the floor on the opposite side. For this plan, or that of Fig. 99, to succeed well, there must be a compul- jrIG, 102. sory out-draught to compel the Avarm air to descend from the ceiling to the floor, and escape at the outlet. This compulsory draught can be afforded in tAvo Avays : by an upward current de- termined by heat, or by mechanical aspiration; that is, the use of an ex- hausting pump or fan. Figs. 101 and 102 are designed to represent the principle of G. R. Bar- ker's Avarming and ventilating flue. In it the Avarm air is introduced through c a coAvl-shaped inlet or register, elevated about a foot above the floor, while im- mediately beneath it is the outlet reg- ister, whose upward current is caused by the Avarmth of the metallic pipe through which the warm air is brought up from the air-chamber of the furnace in the cellar. Above this pipe and its cowl-like cover or top, and at its sides, the flue is open to the chimney. The course of air-movement, then, is this: warm air, entering by the upper register, rises on account of its comparative lightness, and is distributed through the room; descending as it cools, it finds its way gradually to the floor, and then is drawn out by the loAver register, where, being warmed by the exterior of the air-chamber pipe, it ascends to the chimney and passes out. This arrangement for warming and ventilation has been introduced success- fully into the hospital of the University of Pennsylvania, in AYest INLET. 158 HYGIENE. Philadelphia. It appears to me the best, as it is one of the simplest, methods of ventilating apartments Avarmed by a furnace-heater. AYhere an out-draught can be conveniently secured at an outlet near the floor, as in Fig. 100, the warm air entering on the opposite side of the room, also near the floor, an excellent effect is produced. But with- out such a provision for an upward current beyond the outlet (as by a pipe passing up through a chimney heated by a kitchen or other fire), cold air would often enter instead, and the ventilation would be uncer- tain and imperfect. For private houses, simplicity and convenience will usually decide in favor of an arrangement such as is represented above in Figs. 97 and 98 ; the latter, particularly, in rooms not very large, where a warm-air register, at the floor on one side, or at one end of the apartment, and a ventilating outlet, near the ceiling, on the other side, or at the other end, Avill give a very good distribution of air. AYhen the door of the room is open, instead of warmed air escaping, cold air may enter the room at the opening near the ceiling; but that, if moderate in amount, is not objectionable; as a circulation of air, with sufficient warmth, is Avhat is always wanted in ventilation. Hoav much air can be safely admitted into a sleeping- or living-room, is a common question. Rather, it should be considered, how rapidly air can be admitted, Avithout injury or risk, and at how low a tempera- ture. AYe cannot have too much fresh air, so long as we are warm enough, and are not exposed to draughts. AYhat is a draught ? It is a SAvift current of air, at a temperature lower than the body, which robs either the whole body, or an exposed part, of its heat, so rapidly as to disturb the equilibrium of our circulation, and give us cold. Young and healthy persons can habituate themselves to sleeping in even a strong draught, as from an open Avindow, if they cover themselves in cold weather with an abundance of bed-clothes. But those Avho have been long accustomed to being sheltered from the outer air by sleeping in Avarmed and nearly or quite shut-up rooms, are too susceptible to cold to bear a direct draught of cold air. Persons over seventy years of age, moreover, with lower vitality than in their youth, will not bear a Ioav temperature, even in the air they breathe. Like hot-house plants, they may be killed by a winter-night's chill, and must be protected by Avarmth at all times. As a rule, we may say that, except for the most robust, the air which enters at night into a sleeping-chamber should, in cold Aveather, be admitted gradually only, by cracks or moderate open- ings ; or should have its force broken by some interposed obstacle, as a curtain, etc., to avert its bloAving immediately upon a sleeper in his bed. The ancient fashion, hoAvever, of having bed-curtains, which exclude VENTILA TION. 159 almost all the air, has rightly become almost obsolete. No Avonder that people dream horrid dreams, and Avake in the morning Avearied rather than refreshed, when they sleep in rooms sealed up tightly on every side; breathing over and over again their OAvn breaths, Avhich grow more poisonous with every hour of the night. Many different systems and apparatus for ventilation of rooms and houses have been invented, more or less ingenious and successful in attaining their end—Muir's, McKinnell's, Tobin's, Ruttan's, Hulin's, and a host of others. For these we must refer the reader to larger treatises. Our aim has been to set forth, as simply as possible, princi- ples which may be applied and adapted to various circumstances. As already said, those who use open fires instead of stoves, furnace-heaters, steam or hot-water pipes, may be congratulated as not requiring, usu- ally, any special arrangements to supplement the action of their own chimney-places. If, as some estimate, so much as nine-tenths of the heat of an open-grate fire goes up the chimney and is lost, it is, at least, not wasted, since it does excellent Avork in providing what every one needs, but almost no one values aright—good ventilation. Almost everybody knows how dangerous it is to breathe the gas from burning charcoal (carbonic-acid gas), that from a common coal-fire, or the gas burned to give light in houses and streets. Charcoal gas has no smell. That from a coal-fire has smell enough to give Avarning, if it is noticed; as when a stove-pipe leaks, or a chimney draws badly. Gas, made at gas-Avorks for lighting, has an unpleasant smell. Yet persons have sometimes blown out the gas at their burners, without turning off the gas, and then, lying down, have slept to death. Nat- ural gas, now abundant in several States, is more dangerous, because it has no odor. 160 HYGIENE. AYATER SUPPLY. Thirst is more terrible than hunger. Nearly three-fourths of our bodies consist of water; and we part with a large amount of it, con- stantly, in different modes, including exhalation of a pint or two, daily, in our'breaths. AYe must, therefore, have a constant renewal of it. Half an ounce, daily, for each pound of our weight, is the average need of an adult; but some of this may be taken in soft, solid food, as bread, vegetables, and meat. Adding what is necessary for cooking and cleans- ing purposes, from fifteen to thirty gallons, daily, will not be too much of&a supply to provide for each person in a household or community. As a minimum, may be mentioned the allotment on a man-of-war—one gallon, daily, for each man. If travellers' accounts are true, the Avater supply of the city of Munich is, or has been, even less than this. Since the natural humidity of our Western hemisphere is greater than that of the Old AYorld, it is, in most places, easier Avith us than in Europe to obtain an ample supply of good, wholesome Avater; so that the excuse of " bad Avater," for indulging in less advisable drinks, does not exist among us.* The quality of Avater is of great importance. Its kinds are (besides that Avhich is artificially distilled), rain, melted ice or snow, spring, well, river, lake, marsh, and sea-Avater. The last named (sea-water) is quite undrinkable; it will not quench thirst, but nauseates and causes dis- tress. Marsh-Avater is almost ahvays decidedly unAvholesome. Yet that of the Dismal Swamp on the borders of Virginia and North Caro- lina is reported to be very good, and is in demand for sea voyages, on account of its keeping so Avell. AYhen water runs out on board of ves- sels at sea, distillation is often resorted to to make sea-water available for drinking and cooking. It might be imagined that the most desirable of all Avaters would be that Avhich is distilled, leaving behind all dissolved solid ingredients. But that is not so; distilled water is insipid and less agreeable, without being more Avholesome, than many natural waters. The fact is, that the substances contained in ordinary good spring- or river-water are very nearly the same as the mineral constituents of healthy human blood. AYe instinctively prefer a water which has some taste, and * There is, it is true, a region in our Western country, that of the " alkali flats,' where the surface water is not drinkable. Even there, probably, at some future time, driven or artesian wells may procure a supply of good water; although this, of course, is uncertain before trial. WATER SUPPLY. 161 this quality is promoted even by the presence of absorbed air, commonly present in it. Rain-water is not at all identical with distilled Avater, even when it is collected directly from the air. It contains washings of the atmosphere, different according to locality. In the country, besides oxygen and nitrogen of the atmosphere, and carbonic acid, there will be in it a little of some other gases (as sulphuretted hydrogen from organic decay) and dust, which consists of mineral, vegetable, and animal particles of various kinds. Over a city, rain as it falls gathers more impurity; among other things, sulphurous and sulphuric acids from combustion of coal and other fuel, ammonia, and other results of the decay of organic matter of every kind. From the roofs of houses, over which it usually Aoavs before it is collected, rain also Avashes a certain amount of the excrement of birds, etc. This can be avoided if the first portion that falls be allowed to escape ; Avhich, hoAvever, is not always easy to attend to in time, Avhere rain-Avater is systematically accumulated for use. Rain-Avater is not to be preferred to other waters when they can be had in abundance and of good quality. But, under some circumstances, it is the best and most Avholesome Avater that can be obtained. For example, the city of Venice, built upon a hundred islands in the Adriatic Sea, has long been partly supplied by rain-water, collected in filtering cisterns underground. Filtration should always be em- ployed Avhen rain-water is used for drinking and cooking. It is less necessary, of course, when it is employed (as, on account of its softness, it very frequently is) only for Avashing purposes. At one of the NeAV Jersey watering-places, a few years ago, there occurred a number of cases of typhoid fever. All those attacked were residing in houses supplied by driven Avells from the ground-Avater; all those Avho used rain-water for drinking and cooking escaped. This eminently illustrates one of the cases in which the clouds will furnish the only safe supply, the alternative being the drawing of water from a porous, sandy soil, into which is permeating all the filth of human . habitations, from soi4-wells, kitchen drains, and stables. Of this, how- ever, more hereafter. Enough rain-Avater can be collected in most places for family use, Avith filtration. A house forty feet by twenty, with a rainfall like that of the vicinity of Philadelphia (from forty-two to forty-five inches an- nually), Avill furnish from its roof an average through the year of sixty gallons daily. It may be collected in a tank near the roof, or in an underground cistern. The latter will be, on the Avhole, the most satis- factory. The best material for such storage is slate. Iron, coated with 11 162 HYGIENE. coal-tar paint to prevent rusting, will do; or brick-work, lined with cement. Lead, or even zinc, ought never to be used for a tank or cistern. Rain-water will dissolve enough lead to be certainly poisonous, and enough zinc to be at least possibly injurious. Every such cistern should be covered, to keep out rats, mice (in the country, squirrels), birds' excrements, etc. A strong but close iron wire cover over part of the cistern will have the advantage of allowing air to reach the water while protecting it from contamination. Such will not be ad- vantageous, however, unless the air around it be devoid of impurity. Certain cellars are sources of great insalubrity, having in them refuse of all sorts, decaying remains of vegetable and animal food, grease, and filth of every kind; and all this without sunshine and fresh air from out of doors to purify them even in a slight degree. AYater stored in such a place will be, however covered, in danger of generating or pro- moting typhoid fever, diphtheria, cholera infantum, or some other mortal disease. Bad air and bad water are the two most potent re- movable or preventable agencies concerned in inflicting these maladies Upon humanity. Every cistern, moreover, should be cleaned out regularly, at intervals varying somewhat according to their size and amount of use. Once in three months will never be too often for this. Other things being equal, flowing water will ahvays be the best. Stagnation alloAvs of the accumulation of the results of decomposition; movement and mingling with the air break up, dilute, and dissipate them. No beverage is better or more wholesome than good spring- water. It is rain- or snow-water which, falling from the skies on some mountain or other elevated land, runs through earth and rocks, dis- solving mineral matter as it goes, until, at some lower place, it gushes forth, clear and sparkling, to the air. Some springs have their waters so charged with saline or gaseous constituents that they are called mineral springs; carbonic acid, sulphur, and iron, with salts of magnesia, etc., being among their most common and important in- gredients. Springs coming from a moderate depth in the*earth are pleasantly , cool. They have about the average temperature of their locality for the year. Yellow Springs, in Pennsylvania, have a temperature of about 52° Fahr., which is the mean of Philadelphia for a term of years. Some other springs, from great depths, are warm or hot, even boiling; as the geysers of Iceland, Montana, Wyoming, and Cali- fornia. A country house is fortunate if it possesses, at a convenient distance, a good, cool, copious spring. Nothing is more attractive or more ser- WATER SUPPLY. 163 viceable about a Pennsylvania farm than the spring-house; often jutting out from a bank or hillside, built Ioav, but firmly, of gray stone, and shaded over by a few old trees. AYithin you see the clear, transparent pool of water, in its reservoir of stone, pure as the air or sky overhead; and around it, or carefully placed in it, the pans of milk or cream, or butter, Avaiting for family use. A draught from that supply, flowing out to make a limpid stream through the meadow below, gives more refreshment, on a midsummer day, than the most tempting beverage of man's contrivance. It has in it no horrors, no mockery, only health. AYell-water is like spring-water in many respects, but is not nearly always identical Avith it. Being detained, for a time at least, instead of flowing freely, it may become contaminated in many ways. Authors noAV refer constantly to the ground-water of a region as important in regard to Avater supply and influence upon the air. Wells are made by- digging doAvn to this, at a greater or less distance beloAV the surface of the earth. Two sources of supply exist for the ground-water itself. One is the local rainfall, penetrating directly through the earth; the other is the flow or soakage from neighboring regions. If the soil be sandy, or in any way loose and porous, rain-Avater and melting snow will be diffused through it, sinking till they reach clay, hard rock, or some other layer of resisting material. Such a supply will vary with the Aveather and the season, and may be exhausted by use at any time. There are shalloAV wells in some places which, having almost no other dependence, show nearly every year this unreliable character. Most Avells, however, receive their Avater from the general ground-water, which is continu- ously and sloAvly moving through an extended region towards a river or lake, which is the line or centre of drainage of the country. Along- side of a river or lake, or even but a few yards from the seashore, in not a few places, Avells have been found to furnish water considerably different from that of the sea, lake, or rivTer—the underground move- ment being to, not from, those great natural reservoirs. An important difference in the quality of well (or spring) Avater is its " hardness " or softness. Hard water does not easily make lather with soap. The reason is, that the " salts " Avhich it contains, especially those of lime (or its metal, calcium), yield bases Avhich make, with the fatty acids of soap, insoluble compounds; while none such are formed with any ingredients in rain or other soft Avaters. Two kinds of hardness exist—removable and permanent. The former consists chiefly in an excess of calcium (lime) carbonate, dissolved by aid of carbonic acid in the Avater. The latter depends upon the presence of calcium sulphate in excess. 164 HYGIENE. Three ways are resorted to for removing the first of these kinds of hardness. One, the simplest, is by boiling the water. This drives off the excess of carbonic acid Avhich has kept the calcium carbonate (as a bicarbonate) dissolved. It is then thrown cIoavu as a deposit, from which the Avater may be poured or strained away. Another method is the common use of " washing soda," sodium carbonate, Avhich combines with the carbonic acid, making a sodium bicarbonate. This also causes the excess of calcium carbonate to be " precipitated " from the Avater. The third method is the addition of quicklime, in suitable amount, to the Avater. This, like the soda, unites with the excess of carbonic acid, and throws doAvn the carbonate of calcium, M'hich was dissolved, by aid of that excess, in the water. All these plans act alike in ridding the water of the carbonic acid in excess, which keeps the superfluous calcium car- bonate in solution. AYithout either of them, an abundance of soap will overcome the effect of hardness, although wastefully as regards expense. Such, however, are questions of convenience, rather than of health. Is hard Avater more or less wholesome than soft Avater as a drink ? One English authority, Dr. Letheby, has endeavored to show that it is more favorable to health. Some French sanitarians have expressed the same opinion. Others dispute the inference from their facts. It is, indeed, difficult to separate the influence of drinking-Avater from other modes of local causation. It appears to be almost certain that cattle pastured upon a limestone region grow larger-boned than those upon alluvial grounds. Even men show some difference in their average stature in such regions. Nevertheless, an excess of calcium and magnesium sul- phates (the latter being " Epsom salt") is sometimes present to a suffi- cient amount to produce irritation of the bowels and diarrhoea, in persons accustomed to soft Avater. Travellers and new-comers often suffer this inconvenience,* Avhile residents habituated to it are not at all affected by it. A reason Avhy soft Avaters are not unfrequently charged Avith insalu- brity, is, that they Aoav through, or are used in, Ioav regions, in or near cities, Avhere impurities of various kinds get access to them. On the whole, our preference may safely attach to a moderately hard water; although soft water, in a locality free from all contamination, is unob- jectionable. It is quite supposable that those Avho drink rain-water only, may lack a sufficient supply of mineral matter for growth and repair of the substance of the bones. Yet, so much of all the mineral substances needful for building up our skeleton and the other tissues of the body exists in our articles of solid food, vegetable and animal, that * For this, the best corrective is essence of ginger, five or ten drops in a tumblerful of hard water. WATER SUPPLY. 165 we can hardly regard this as likely to be important. At all events, for it to be so, there must be a general deficiency of mineral elements in the soil of the locality from which plants are grown, and on Avhich animals are fed, as well as in the water.* AYells differ much in the nature of their water, according to their depth. Usually the deeper well drains a larger extent of country. Much depends, hoAvever, on the character of the ground, its slopes, and elevation or depression, as compared Avith the surrounding region, as Avell as on the nature of the rocks underneath. Driven wells may be shallow or deep. They are made by forcing through the ground a Avrought-iron tube, having a valved piston at its upper part, and at its lower end a steel point. Above this point, for some distance, the pipe (Avhich is usually an inch and a quarter to two inches in diameter) is pierced with holes, for the admission of Avater. In many places AAdiere no water at all appears upon the surface, a few feet of penetration will reach it and bring it up, sometimes even in abundance. Thus artificial oases have been made, as Avay-stations of refreshment for travellers, in some portions of the great African desert. It seems not impossible that, in the future, the desert may, by irrigation from such wells, be made actually to " blossom as the rose." Artesian wells are essentially of this character; but this name is only applied to driven Avells of great depth. They are said to have been used ages ago in China and Egypt. Now, many of them exist in Europe and America—some one, two, or three thousand and more feet in depth. They are uncertain of success, unless the selection of locality be guided by geological knoAvledge. One at Grenelle, Paris, eighteen hundred feet deep, yields a large supply for local use. The deepest one in this country, at St. Louis (Asylum well), 3843 feet, has been a prac- tical failure, after costing more than $10,000. Lately, it is stated that some brewers in New York city have been able to obtain, at one hun- dred and fifty feet depth, a thousand gallons a minute, through a pipe of six and one-half inch bore.f This water is said to have a tempera- ture of fifty-tAvo degrees Fahr. At greater depths the water is much warmer. That of the Grenelle well is 80.6° Fahr. One at Louisville, Kentucky, 2086 feet in depth, has a temperature of 76.5° Fahr.J This is a great objection, except Avhere, as in our cities, ice may be employed to correct it. A considerable excess of mineral matter is a more serious * I have often thought of the question, to solve which facts are wanting, whether early decay o£ the teeth is not most common where only soft waters are drunk. t Sanitary Engineer, November 15, 1879. + A well recently completed near Buda-Pesth, Hungary, 3200 feet deep, is said to yield water at 165° Fahr. 166 HYGIENE drawback to the use of water from very deep wells. That of St. Louis, above mentioned, is unavailable, chiefly for this reason. Yet a great advantage of very deep Avell-water is its almost certain freedom from organic matter resulting from animal and vegetable decay. This kind of matter often pollutes shalloAV well-water—most of all in cities. Pump-water in cities ought never to be drunk at all, no matter how clear and bright may be its appearance, or how agreeable its taste. Color and taste are not decisive of the quality of drinking-water. AYell-Avater in the country is often tainted badly by the Avell for the household supply being too near the privy or the barn-yard. It may be seriously injured, even by the draining into it of kitchen waste. Thirty feet should be the least distance ever to be allowed between a privy and a drinking-Avell.* Sixty feet will be better; and the slope of the ground is also important. A privy should always be located beloic (if there be a slope) the house and its Avell. In choosing a site for a house, Ave should look out for the distance and direction of our neighbors' drainage as well as our own, and carefully avoid having to receive that of other houses on its dowmvard course. AYells are sometimes liable to a less damaging, and yet considerable incoiwenience, from the roots of trees.f At my residence, near Haver- ford College, a feAv years ago, an old AvilloAv-tree sent out its roots to a deep well twenty feet distant from it. AYhen discovered, the root-fibres were actually filling the well, so that, on looking into it, one could see only the roots, no Avater being visible at all. Elm trees, and some others, have been known to do the same thing. The only cure for such an invasion is to cut down the overthirsty tree. Of the danger of injury to health from polluted wells, it is hardly possible to say too much. In one cholera season in London, six hundred deaths were traced to the use of a single street pump. Typhoid fever has been repeatedly, indeed many times, known to affect whole families who resorted to a well for a common supply, Avhile others m the same neighborhood, using different water, were not attacked. AYorse yet, perhaps, seems to be the subtlety with which orgauic poison may be conveyed, by water, through milk, in dairymen's supplies. Several times this has happened in London and elseAvhere in England. * Dr. W. W. Keen informs me that he knows of a case, in a town in New York State, where a cistern was placed with its wall but three feet from the privv-well, its sides only plastered and that not on brick, but directly on the earth. Continued sickness in the family and one death from typhoid fever, caused an examination of the cistern, revealing the above facts, and a direct stream of drainage from the privy-well into the cistern. l J • t K°ots are also sometimes sent into cracks of leaky drain-pipes or sewers, which may thus be obstructed. WATER SUPPLY. 167 In one instance, so far as appeared, the only mode of contamination was by the milk-pans at the dairy being washed in water from a stream into Avhich leakage had occurred from a neighboring privy. At another time, several well-to-do families in London, one of them that of a phy- sician, Avere affected with typhoid fever. It was found that they were all supplied with milk by a company which furnished milk from sev- eral dairies. At last it was ascertained that cases of fever occurred only in those families to whom had been sent the milk of one particular dairy; and a local cause of contamination of its supply Avas also traced. Fig. 103. LIVING FORMS IN WATER (MAGNIFIED). What exquisite cleanliness of all things is enjoined by this experience! Nothing is more sensitive than milk and cream to all impurity. Even the Avater which coavs drink, when marshy and bad, has been known to make their milk umvholesome. Butter can be made good only where the most scrupulous SAveetness, cleanliness, and freshness of everything is maintained. This is the chief secret of good butter-making; and the "moral of it" may be extended and applied by saying, that perfect cleanliness of Avater, food, air, and person is, everywhere, absolutely necessary to perfect health. 168 HYGIENE. Streams and rivers furnish, the world over, to the greater number of mankind their drinking-water. They have the advantages of copious- ness, facility of access, and movement, which favors agitation Avith the air and freshness. But they are liable to contamination on account of their exposure to solid and liquid refuse and waste of all kinds. AYorst, for this danger, are small, shallow, sIoav streams, running through or by towns or villages, or near factories, graveyards, slaughter-houses, etc. River-water is best when taken from the largest, deepest, and most rapidly floAving river, near its middle, and a few feet beloAv its surface Turbidity in river-water makes it look uninviting, but does not always affect its wholesomeness. Opacity is due almost entirely to sus- pended mineral matters, and they may be quite innocent. AYith all its solid material, giving cloudiness aud teste, the water of the Mississippi, for example, is drunk by very many persons, and has been found to keep well at sea. Those accustomed to such a water often consider common river- or well-Avater too insipid to be agreeable. Marsh-water, however, as alreadv said, is generally quite umvholesorne, promoting especially diarrhoea and dysentery. Lake-Avater taken from a large lake, far out, has all the good quali- ties of river-water, and is less often exposed to contamination. A small lake, or pond, if so exposed, has, on account of its actual or coinparath'e stagnation, less opportunity of purification than a flowing river. Organic matter constitutes the really serious impurity of streams and rivers. AYorst of all is excretory material, se\Arage, from human hab- itations. Next to this, drainage from slaughter-houses, bone-boiling, fat-rendering, and soap-making establishments, etc. Dye-stuffs may color Avater a great deal, Avithout a proportionately injurious effect, unless arsenic or copper be present in them. Vegetable impurity'of all kinds is less deleterious than that originating in animal decompo- sition. One grain of organic matter per gallon, chemists assure us, is all that a first-class drinking-water ought to contain; yet some pleasant and apparently innocent Avaters contain as much as ten grains in a gallon. One test is adding a lump of white sugar to a vial of the water, and keeping it corked for a feAV days. If it contain much organic matter, it will become in that time perceptibly turbid. Another sign of this kind of impurity in water is its acquiring an unpleasant smell when corked in a bottle and kept in a tolerably warm place (say at 70° Fahr.) for three or four days. Rivers have some power of self-purification, or else those which, near large cities, receive sewage and also furnish drinking-Avater, Avould be WATER SUPPLY. 169 still more destructive to life than they are. This evil is, it is true, so great as to receive at present much attention from sanitarians. The means of the spontaneous purification are chiefly deposit, oxidation, and diffusion. By deposit, solid particles are thrown doAvn, making the water clearer. Oxidation, under exposure to the air, does much more than this. Oxygen acts chemically upon organic impurity, break- ing it up into its elements, and destroying all its noxiousness in course of time. Hoav long this requires, it is difficult to determine exactly in any case. Dilution and diffusion accomplish the most beneficial results in natural Avater purification. AYith a sufficient mass of Avater, every- thing soluble, or capable of suspension in the form of minute particles, Avill be divided so infinitesimally as to become utterly harmless. The magnitude of this effect is shoAvn, for example, in the river Merrimac, Mass., Avhich receives all the seAvage of the manufacturing toAvns, Law- rence and LoAvell; and yet it has been computed that to increase the amount of its solid matter below LaAvrence, so much as one grain per gallon, Avould require the addition daily of one hundred tons of dry material to the river.* Yet, since the poison-causes of human diseases are very subtle (whether they consist of "disease-germs" or not), what we know of the morbid transporting power of Avater should make us very cautious about using water for drinking or cooking into which any drainage or sewage from human habitations or establishments can ever enter. Cities and smaller communities will never reach the ideal pointed out by sanitary science until all their seAvage is, in some manner, removed daily or constantly, and returned to the earth for use in fertilization. The manner in Avhich this is done in China, where those Avho bring pro- duce from the country to sell in the markets of the towns return laden with house-soil to manure their gardens and fields, seems to us rough and not aesthetic. But their idea herein is quite correct. It remains for our knowledge and invention to solve the problem in some better and more agreeable Avay. No one has written more elo- quently about this than Victor Hugo, in his chapter on the Sewers of Paris, in " Les MisSrables." Some organic material on the surface of rivers and lakes is innocuous Avhile in the living state. Over many ponds and along the edges of some rivers may be seen quantities of green scum, consisting of con- fervoid growths, algae, minute cryptogamous (i. e., not flowering) plants, of various species. Probably the growth of these vegetations is, in * W. R. Nichols, in Buck's Hygiene and Public Health; also, Report of Mass. State Board of Health, 1874. 170 HYGIENE. itself, advantageous to the water by using up material resulting from other decomposition. But when the same organisms die and decay, as they will do, especially when the margin of the pond or stream recedes with drought, then their decay becomes a cause of contamination. This is still by no means the worst kind of water-spoiling. It was, in 1876, very noticeable for a time in the Croton water supplied to New York city, giving the Avater an unpleasant odor and appearance. Yet this was a transient occurrence, and no considerable sickness was ascribed to it. Boston water has sometimes had a taste given to it by a kind Fig. 104. LIVING FORMS IN WATER (MAGNIFIED). of fresh-water sponge. A green scum on a water-surface may be re- garded as having its principal importance in its being a sign of stagna- tion, which is ahvays unfavorable to the good quality of a Avater supply. In the early part of 1883 the water supplied to Philadelphia from the Schuylkill River had a disagreeable taste, not fully accounted for; although the Avant of aeration of the water, from the river being closed with ice, was supposed to have to do Avith it. Melted snoAv and ice must be here briefly spoken of as sources of drinking-water. Snow, like rain, carries down whatever the air con- WATER SUPPLY. 171 tains. Over towns it will, therefore, contain a little ammonia and organic matter. Since a low temperature arrests decomposition, there is not apt to be much injury result from the latter in snow. In one Avay, however, snoAV-water has been known to become injurious. In Finland and Northern Russia it has been common for people to throw out near their houses all the refuse of their daily living, and then, in the winter, to collect snoAv from the same ground and use it for drinking and cook- ing. This has been believed to aid in explaining the lingering of epidemic cholera, in some years, in those countries in the winter, while elsewhere it disappeared at or before the end of summer. Water, in freezing, parts with most of the ingredients suspended or dissolved in it. Ice is therefore purer than the water from which it has been congealed. This, along with the already mentioned influence of cold in arresting chemical decomposition, makes the risk of unwhole- someness in melted ice very small. Yet, a few instances are on record of injury to health resulting from the use of ice taken from foul water. This can only happen Avhen the supply is obtained from a shallow, stagnant marsh or pond, where animal or vegetable decay has been going on. Such ice Avill be apt to exhibit its character by lack of clear- ness and transparency. The deeper the Avater from which ice is gath- ered for use, of course, the better. Much importance attaches to the mode of conveyance of drinking- water from Avells, reservoirs, or other sources of supply. Lead, iron, and tin are the materials most employed for this purpose. The great convenience of lead pipes causes them to be very largely re- sorted to for carrying Avater. Certain facts concerning them ought to be generally known. Distilled-Avater and rain-Avater will dissolve enough lead from pipes to make them poisonous; so also will very soft well- water, and even that of some streams. It requires but one-tenth of a grain of lead per gallon to affect susceptible people with lead-colic, or even lead-palsy. AYhen Louis Philippe, ex-king of France, was resid- ing Avith his family at Claremont, England, some of them were injured by lead dissolved in the water of a reservoir. I have known of two instances in which the same thing has happened in this country. Even the drippings of evaporated water, condensing on a leaden cover over a tank, have sometimes contained enough lead to do harm. Croton Avater, in New York, according to Professor Chandler,* always has traces of lead in it, but not enough to produce any effect, unless when * Sanitarian, May, 1875. 172 HYGIENE. the Avater is drunk after having lain long in the pipes. Fairmount Avater, at Philadelphia, is perfectly safe in this respect. Everybody should know that this security is due to a very simple action of the water on the pipes. River-water, and that of some, but not of all, wells, contains saline ingredients, which being partially decomposed, make a deposit, lining the pipe with a delicate crust, and thus protecting it from further action. Rain-water, and that of certain Avells, having an insufficiency of such constituents, dissolve the lead to a considerable&extent, and thus become injurious. Hot water may do the same, even with Croton or Schuylkill water. Some cooks have a bad habit of saving themselves trouble in heating water for cooking on the fire, by using that of the kitchen-range boiler. Besides the not improb- able construction of the boiler with copper, of which hot water will dis- solve enough to do harm, the action of heated water on the leaden pipes makes such Avater altogether unfit and unsafe to use. Lead pipes had better never be employed to carry rain-water, or that from wells, at least unless that of the last has, in every instance, been shown by chemical analysis to be safe. If there be doubt in this regard, a Avise precaution is always to allow the water to run for awhile, and empty the pipes, before using it for drinking or cooking* Inci- dentally, it mav be mentioned that water containing carbonic acid (soda- water, mineral Avater) dissolves a good deal of lead ; and therefore pipes made of it should never be employed for soda-water fountains. Iron pipes are acted upon by hot water, their rust sometimes being in sufficient excess to be disagreeable. Cold water may be passed through either cast- or wrought-iron pipes Avithout any disadvantage. Galvan- ized (zinced) iron has been shown to be acted upon to some extent, a little zinc being dissolved when Avater lies long in the pipes. Some chemists assert this to be enough to make the water unAvholesome; but authorities differ upon this point. No doubt, alloAving the Avater to run from such pipes for a few minutes before using it will prevent any injurious effect, as the soluble compounds of zinc are much less poison- ous to the human system than those of lead. Block-tin pipes are as free from objection as any others. Tin-lined lead-pipes are good so long as the lining lasts ; but this is not forever. Tavo metals, in contact with each other, are more easily acted upon (as experiments Avith galvanism show) than either metal Avould be alone. Therefore the lining must be thick and even, to be depended upon. * According to the Boston Journal of Chemistry, lead pipes may be artificially coated and made safe by dissolving one pound of sulphide of potassium in two gallons of water, and allowing it to remain in the pipe for twelve hours, or until the inside is thorough')' blackened. WATER SUPPLY. 173 The same is true of the " enamel" lining of iron pipes—made usually by dipping them in coal-tar or some form of cement. Glass-lined iron pipes Avere patented a few years ago, and have received approval from the editor of the Manufacturer and Builder, and from the consulting sanitary architect of the Board of Health of New York. These are so prepared as to avoid bursting from freezing, an inconvenience of which Ave see much in this country. To prevent this accident, care must be taken in the placing of lead pipes, as well as in having them made of the proper thickness and strength. If a pipe is necessarily exposed to cold, the Avater in it is much less likely to freeze, or to burst if it does so, Avhen the spigot is so turned that it drops a little all the time—thus providing space for the expansion which water always undergoes in freezing. AYrapping an exposed pipe with flannel (or strips of old carpet), through the cold weather, may save a great deal of trouble of this kind. Of all things care must be taken not to allow a water-supply for drinking to be exposed to impurity from the overfloAV or waste-pipe of a cistern being connected immediately with a drain. It is very impor- tant, also, for the same reason, to have different reservoirs (if such are used) for drinking and for water-closet use. Of these matters, more will be said in our next chapter. AYhat can be done to purify water for drinking, Avhen the use of that which is of imperfect or uncertain quality cannot be avoided ? Nothing is more effectual in annulling the injurious influence of con- taminated Avater (in the absence, that is, of a mineral poison, such as arsenic, copper, or lead) than boiling it before use. Many a time it has happened that, Avhen bad water has produced a local " endemic" of typhoid fever, all those affected have been drinking the Avater cold, while those who only took it in the form of tea or coffee have escaped. This Avas the case, for example, at St. Mary's Hall, Burlington, N. J., in 1875, Avhen, as related by Dr. Leconte, thirty cases of typhoid fever occurred Avithin two Aveeks from contamination of the drinking reser- voir by leakage from a privy vault. None of the servants of the house, who drank only tea and coffee, and almost never cold water, were attacked; while the boarders, often thirsty, drank cold Avater freely betAveen meals, and all the cases were among them. Filtration is often very serviceable upon a large as well as on a small scale. AYe are here concerned only with the latter. Most nations have practised this from the earliest times. On the Nile, travellers now have the yelloAV water of the river strained clear through the sides of 174 HYGIENE. the gooleh, ajar or pitcher made of a porous clay peculiar to Egypt. Similar to this is the alcarazza, for a long time in use for the same purpose in Spain. A filter largely used in the British navy is made of a very porous kind of Maltese rock. AYe imitate nature profitably in filtering Avater through sand and gravel. These, with animal charcoal, make probably the best possible filtering materials. Sponge is also used; for Avholesomeness it must be changed frequently, or at least scalded and avcII Avashed. This, indeed, is true of any filter. AVithout frequent cleansing, the pores become clogged, and instead of purifying, an accumulation of filth may make the water Avorse than it was. AYhen charcoal is employed, it may be reneAved by heating it strongly (short of combustion) in the open air. The action of charcoal and sand in filtration is of two kinds. Partly, it is mechanical—straining the water, that is, keeping back solid matters by simple resistance. Besides this, there is a chemical influence exerted, chiefly by oxygen of the air brought into very close contact with the particles of the water and its contents in the fine porosities of the filter- ing substance. This close contact is beautifully exemplified in the philosophical lamp, in which a jet of hydrogen is directed upon a piece of spongy platinum, within whose meshes it takes fire from the molec- ular action of atmospheric oxygen. Iron and some of its ores, especially in the spongy state, exert a purifying influence upon unclean water. Two such preparations have of late years met Avith considerable favor; magnetic carbide, and a new artificial mineral, recently employed in England, called carferal* Of the various patent filters on sale for household use, it may be said that, Avhile several of them produce tolerable results, none are perfectly satisfactory. Unless themselves carefully cleansed or reneAved at not very long intervals, they lose their cleansing poAver. For domestic use, I would rather trust to a home-made filter like that proposed by Dr. Parkes.f Take a large common flower-pot, and put into it a bit of zinc gauze or a clean bit of flannel, then coarse gravel to the depth of about three inches, over that the same amount of white sand washed very clean, and next four inches of charcoal in small fragments; animal charcoal when it can be had. On the top of all, a piece of well-cleaned sponge may be placed, making sure that this is changed or thoroughly cleansed once in a week or two; more or less often, according to the impurity of the water. But really suspicious water should, before using it for drinking or cooking, be boiled as well as filtered. Above * London Medical Times and Gazette, October 11, 1879. t Treatise on Practical Hygiene. WATER SUPPLY. 175 all, in regard to drinking-water, the great thing is to choose and provide for every household a supply which cannot be suspected. Here, as much as anywhere, is the maxim true, Avhich lies at the basis of all hygiene, that prevention is better than cure. On a large scale, the city of Philadelphia has this problem of pre- vention now before it. Many causes of contamination of the Schuyl- kill River exist, and are difficult of removal. AYhile improved and extended sewage-conveyance is urgently needed, and another source of water-supply, from a greater distance, must be at some time provided, Chief Engineer LudloAV advises at the present time the construction of works to aerate the water, for its purification. This will no doubt be useful, but only as a temporary resort. 176 HYGIENE. DRAINAGE. " Ours," says a late writer on house construction, " is the Age of Plumbino-." Egyptian, Greek, and Mediaeval architectures have, each in succession, had their day, and now the beautiful gives way, in a large decree, to the useful. Stramm, a German author, declares that the highest modern civilization is shown not so much by costly monuments and works of art as by the perfection of house conveniences. Yet these, too, have their dangers as well as their comforts. Security does not ahvays come with refinement. Ferocious beasts and venomous serpents are kept at a distance in the wilderness; but the subtle poison of disease may steal upon us in our beds, and, vampire-like, draw out the life from our veins. AYhen the Prince of AYales, some years ago, fell ill with typhoid fever, after a visit at Londesborough House, all the world Avas alarmed. It is probable, however, that the inquiry which this event, and its supposed cause, started, may have resulted in saving many lives. AYhen a house is being built for occupation in a chosen situation, its light, warmth, ventilation, and water-supply having all been provided for, there remains the question of conservancy; that is, the safe and sufficient removal of all waste. In the country, simple measures will answer, so far as health is concerned. On an acre of ground, there is space enough to place a privy at a good distance both from the house and from the drinking-well. If there be any slope, the last named must be ahvays above the first, and thirty feet at least (the more the better) must intervene between the tAVO Avells. Kitchen slops should have their OAvn separate drainage, or, at least, should run through a channel, open for a short distance before they enter the privy-Avell. But it is a question, Avith a cottage or small farm-house, Avhether a well for necessary waste is best. The farther from the house it is pos- sible to place it, the less need there is of a Avell. The common cottage privy above ground, the building being raised and open (below) at the rear for frequent removal, needs only a simple precaution to make it innocent. This safeguard is to throw over the deposit each time a small shoATelful of lime or diy earth. The latter is, of course, the more acces- sible, and Avill deodorize and disinfect perfectly, if enough be used. A pint and a half in bulk, or two and a half pounds in weight, will suf- fice each time. A box of earth and a troAvel may be left within reach. Frequent remoA'al is then important. Where there is a vegetable gar- den, the material thus accumulated makes the best possible manure. This has been proven not only in China, but in Europe and in this DRAINAGE. 177 country also. AYith a small family, however, when dry earth is used, once in three or four Aveeks will commonly answer for its removal. There are two sides to the question of advantage to health in regard to the distance of a privy from a country house. Delicate persons run risks in the exposure of going out of doors in cold or rainy weather. A covered passage-way, with Avindows, or otherAvise open at the sidee Fig. 105. beheen's out of door earth-closet. for ventilation, lessens, but does not entirely obviate, this evil. For those Avho cannot or ought not to leave the house, a convenience is needed. Much evidence favors the earth-closet as here the best resort. There are different patterns of this, but the idea is all the same. By a mechanical contrivance, each time that the closet is used, a suitable 12 178 HYGIENE. amount of dry earth or sifted ashes is thrown down from a recep- tacle in which it has been placed. Those Avho cannot afford to buy an earth-closet can substitute it by keeping within reach a small box sup- plied Avith earth and a trowel for its use. The disadvantage of this is the flying of dust into the room; which, indeed, the best contrived closet docs not always entirely prevent. Especially Avith the addition of a very little chloride of lime in powder to the earth when used, or even without this, an earth-closet is much more satisfactory than the old- fashioned chair in the sick-room or elsewhere in the house, for the avoidance of everything unpleasant. Earth for this purpose must contain some (but not too much) clay and some humus, or soil such as is fitted for cultivation. Common garden earth, or that of the average farm ground, will do very well. Sand Avill not ansAver. Sifted coal-ashes will, almost as well as earth. On a small scale, earth may be dried in any convenient receptacle over or near the kitchen fire. For a large family, a quantity of earth may be placed to dry gradually under a shed, with boards under it to keep it from the dampness of the ground. The earth-closet system has been introduced into several towns in Europe with success. But the requirement of bringing a great Aveight of earth into the city, and economically disposing of it after use, will make it sIoav to take the place of the Avater system in cities. Household em- ployment of the latter system, therefore, must next receive our attention. Every kitchen should have its drain, as it is against all laws of health, as Avell as of appearance and comfort, to throw slops out of doors on the ground. Garbage in cities is, or ought to be, removed daily in covered carts from all houses. In the country, a good plan is to dry hard materials (potato-skins, etc.) under the kitchen fire, and then bum them upon it. Otherwise, such things may be given to hogs, or dried at a distance from the house, and burned. Dust swept from floors may be thrown into the fire. Liquids from the kitchen must not be poured upon the ground near a well, or they will run or soak down into it and spoil the water. I remember once seeing upon drinking-water, taken from an excellent well, a film, Avhich broke easily into pearly particles, the origin of which nobody knew. The drainage Avas supposed to be all right. Chemical examination proved the film to consist of soap; and close inspection showed that an unnoticed obstruction had caused the kitchen-drain to send a good portion of its contents right down into the well. This could be soon corrected. But sometimes a foul kitchen- drain taints a drinking-well for a long time without suspicion, doing very serious harm. Sanitarians aver that kitchen drainage may become almost as bad as sewage from house and street waste. DRAINAGE. 179 Every kitchen-drain, therefore, should have a trap* Since this is true, also, of every Avater-closet, we may now at once consider Avhat traps are, and what is their use. They are intended to prevent foul air from getting back to a house from sewage or drainage, after the latter has been discharged. A water-seal is afforded, as shown in the figures (Figs. 106 and 107), by the portion of water detained after a quantity has passed through the pipe. Conditions necessary for the security of every trap are: that Fig. 106. Fig. 107 Fig. 108. Fig. 109. it be large enough; the "drown" or dip of water above the upper line of depression, at the middle, sufficient; that this dip be not lost by dis- tortion of the pipe (see Fig. 108, correct, and Fig. 109, distorted); that it be of material thick enough not to be soon corroded and perforated by sewer-air or water; that it be not clogged by solid and insoluble things thrown into it; that it be furnished with an abundance of water for "flushing," or cleaning it out frequently; that it be ventilated; * A grease-trap, arranged for easy and frequent cleansing, is an important addition, at least in a large establishment. 180 HYGIENE. and that, Avhen not used, it be not alloAved to become dry from evapor* tion. All these conditions are frequently violated or neglected; and hence some people have come to regard all traps as entitled to their name in a contrary sense, as snares or delusions. But Avhen properly made and used, they are very serviceable; and, whatever farther advance sanitary science and invention may hereafter furnish, Ave cannot, so long as we employ the " water system," do without them now. Cast-lead traps are generally used, of good weight, seven or eight pounds of lead for each square foot of surface. A trap for a soil-pipe four inches in diameter should have the same diameter, and should weigh twenty pounds. The "drown" or depth of Avater above the upper bend should be, for such a trap, at least an inch and a half. To prevent swagging down out of shape, every pipe, through its whole length, trap and all, must be securely fastened and supported. Nothing should ever be thrown into a Avater-closet or sink which cannot be soon softened and dissolved aAvay, so as not to produce obstruction. Every trap should have its OAvn water-cistern, distinct from any cistern sup- plying drinking-Avater; and the flow through it when used should be free and abundant. Its overfloAv-pipe should discharge apart from any sewage drain. The time when evaporation is likely to dry up traps, so as to permit the entrance of air from the drain or sewer below, is Avhen families are absent from their homes, as during the summer season, or Avhen a house is for any reason unoccupied for Aveeks or months to- gether. Bell-traps (see Fig. 110), according to the best authorities, ought never to be used, on account of their clogging more easily than other traps, and always allowing only a sluggish flow through them. Since all traps neces- sarily delay the movement of the contents of pipes, and stagnation makes everything Avorse, it may be asked, AYhy is it not better to avoid all such interruptions, and merely provide such abundant flushing as will sweep all impurity rapidly away? The answer is, that if such thorough and con- stant flushing were secure in the whole length of every drain and sewer of a con- nected system, no traps would be needful. As such thoroughness is not usually, if anywhere, obtainable, " Avater-seals" limit, to great advan- tage, the amount of exposure of the air above them to contamination. It has been proved by experiment that sewer-gas is absorbed by the water of a trap if it remains long there at rest, and then the gas is given DRAINAGE. 181 out above and beyond the water-seal. Therefore, frequent changing of the water is indispensable; and also measures for making sewer-air itself as innocuous as possible.* Ventilation of traps is of much importance. In considering it we must look at the general arrangement needed for good house drainage, taking a somewhat summary view of the whole matter. A house Avith " modern conveniences " has occasion for pipes (besides gas-pipes for light and warm-air flues) for the following purposes: 1. To introduce Avater for drinking, cooking, washing, bathing, and Avater- closet uses; 2. To carry off the overflow from drinking- and washing- hydrants, and from cisterns and water-closet supply; 3. Removal of kitchen and other slops; 4. AYater-closet drainage; 5. Ventilation, so far as required, of the above arrangements. Of reservoirs and pipes for Avater supply, it needs only to be repeated here that the same tank or cistern ought never (even if divided by a partition) to be used to furnish Avater both for drinking and for water- closet use. Moreover, the overflow pipe of a drinking-tank or cistern must be carefully kept clear of the soil-pipe drain and sewer. It is best for such overfloAV, as Avell as that from every " lavatory " or wash-basin, to discharge by itself. In the country this may fall into a surface or sub-surface drain at any convenient place at the rear or side of the house. If, in a city, all drainage has to be united at last, effort should be made to have drinking and Avashing overflows to fall upon an open (or at least well ventilated) catchpit or gully, leaving an interval, which if open may be covered by a grating, before it enters the common drain. Bath-Avater may take the same course as the above, leaving, Avhen possi- ble, some interval between the places of discharge. Kitchen drainage is subject to greater foulness than water from drink- ing-hydrants, lavatories, or baths. In a perfect system, it must be kept apart from them in its conduction and discharge. It ought much more urgently to be separated from the water-closet drainage. This last needs, for really good sanitation, to be entirely apart from all the other drainage of the house. AYe have, in this scheme, at least three desirably separate systems of discharge: A, that of drinking and other cistern or basin overflows, and bath-water; B, that of the kitchen-sink and other slop-wastes of no worse character; and C, that of the water-closets. The more com- pletely these three can be maintained in separation from each other the * All sanitarians agree that fresh sewage is neai-ly harmless to the atmosphere. It becomes more and more deleterious according to the time of its concentration and stagnation. 182 HYGIENE. better. Next best to their entire mutual isolation, Avill be the junction of A and B, Avith their conduction and discharge distinct from C. AYhen this last exclusion cannot be effected, we must look to traps and ventilation for the best practical means of protection. A plan of the plumbing of a house so guarded has a formid- able appearance; and yet the dangers are so real, that we cannot easily estimate the expense and trouble Avhich are worth while, in order to guard ourselves, our families, and our neighbors against them. If, then, the overflow-pipe under a drinking- hydrant, lavatory, or bath-tub must, iu any case, discharge into a drain which receives also the kitchen slops, or Avorse, the contents of the soil- pipe from water-closets, a trap must be interposed to prevent the ascent of foul air into the apart- ments concerned. For lavatories, BoAver's trap (Fig. Ill) has been found to ansAver Avell; best when it is all made of zinc or lead, instead of partly glass.* B, in the figure, represents a floating ball of rubber, which, being buoyed up by the water in the trap, makes a doubly efficient seal against the ascent of impure air to the lavatory from the drain below. In passing, it may be observed that every house which has two or more rooms on a floor ought to have a bath. Hellyer proposes that in humble houses it should be placed in the kitchen. Although this seems odd at first thought, yet it is not unreasonable. It secures warmth for both the water and the air Avithout trouble, and the bath-tub can be covered Avith a hinged board, making it a convenient bench at ordinary times. Every bath Avaste-pipe, also, Avhen it connects Avith a soil-pipe, house- drain, or seAver, should have a trap; such, for example, as is shoAvn in Fig. 106 or Fig. 107. So, also, must every kitchen-sink, and slop-sink of any kind, have the same protection. Otherwise, there is oppor- tunity for bad air to rise through those pipes, and to contaminate the air, food, and Avater in the kitchen or elsewhere through the house. How this may happen is easily seen by looking at Fig. 112. There the water-closet has been trapped, but not the kitchen-sink, and both communicate Avith a seAver. * The unequal expansion and contraction of glass and metal under changes of heat and cold (especially when hot water is used) make their connections somewhat inse- cure against leakage. DRAINAGE. 183 Not only the sink itself, or lavatory, or both, but in each instance, as Fig. 112. Fig. 113. already said, the overflow also must be protected by the trap. Figs. 113 and 114 (borrowed from Teale's " Dangers to Health") exhibit, respectively, the fault here indicated and its remedies. These remedies (Fig. 114) are: first, making the overflow-pipe enter that of the sink above the trap; and, secondly, having the lavatory escape-pipe to discharge over an open channel, instead of con- necting directly with a soil-pipe or sewer. The first of these measures of protection can always be had; the second should be, Avhenever it is practicable. Noav, for the most serious part of the problem before us, Ave must consider water-closet and soil-pipe arrange- ments. The water-closets most in use are of two kinds, pan and valve closets. The former has an iron" container" beloAv the basin or receiver. This iron vessel is hard to keep clean. In the valve-closet, a portion of water in 9999999� 184 HYGIENE. detained above the valve, which is quite an advantage ; and there is no large container. The valve-closet is decidedly the best, but also the most expensive. Simplicity is so desirable in such fixtures (as, indeed, Fig. 114. ?«S?P5J^?SS«8^ Fig. 115. in everything else) that good authorities are inclining toAvards a re- turn to the oldest form of the " hopper" immediately over the trap. Waring, the most esteemed American authority, has asserted his preference for such a plan. Fig. 115 gives a view of Rhoads' Cistern and Hopper closet, which carries out this idea very well. So also does Hellyer's Short Artisan Hopper (Fig. 116). Of other closets, more complicated, I believe Hellyer's vahTe-closet to be one of the best. Whatever form or plan of water-closet be used, it is of great importance to provide an abundance of water for flushing it. Mere drib- bling will not suffice. Neglected water-closets left to accumulate obstructive materials of any kind will, in time, grow very foul, sometimes even Avorse than the average open privy. Soil-pipes are now mostly made of iron* Enameled iron is the best material, with caulked * Among good authorities, Hellyer is almost the only one who still prefers thick cast-lead for soil-pipes. See his Dulce Doraum, London, 1877, p. 29. 95524543 DRAINAGE. 185 Fig. 116. lead joints. Four inches Avill be not too large for a house of moderate size; four and a half or five inches diameter will be enough for the largest mansion or hotel. All sanitary engineers now agree that it is a serious mistake to make drain-pipes too large. A drain six inches in di- ameter Avill suffice for more than a hundred houses. In a large pipe, but partially filled, the floAv must be sluggish. The same amount of ma- terial in a smaller pipe, nearly full, will move rapidly through it, and thus avoid stagnation. For changes of direction, and entrance of branches, right angles must be avoided, and as few inclined joints should be made as possible. Figs. 117 (right) and 118 (Avrong)* will illustrate this principle. Every soil-pipe should have a trap at or near its junction with the -ll—INCHES—1 \*A< Fig. 117. Fig. 118. VV, tz drain or sewer into which it discharges. It is well also for this to be aided by a flap-valve, to assist mechanically in the exclusion of sewer-air. f Some late authors recommend two traps in this position. Such a trap, or traps, should, when possible, be outside of the house, and accessible for inspection. This accessibility, it may be here remarked, should be provided for in the construction of oil drains and drainage-pipes what- ever. A plan of the house plumbing and drainage should be made when it is built, and kept for reference at any time. The absence of such a plan may sometimes cause great inconvenience and damage. In a house * From Ough's Hints on House Drainage, London, 1879. f Waring (Atlantic Monthly, July, 1879) advises the addition of mechanical arrange- ments to all water-seals. Such, however, are very apt to get out of order and disappoint expectations. Where storm-water is excluded from sewers, and they are ventilated, Waring (Sanitarian, December, 1879, p. 533) approves of the omission of the trap at the foot of the soil-pipe. This principle is now carried out in the drainage system at West Point; but it does not appear to be safe with ordinary city sewers. 186 HYGIENE. knoAvn to me, rented out by an owner who Avas absent in Europe, the need of such a plan Avas strikingly shoAvn. An odor near the centre of the house gave rise to repeated investigations without much result, until a carpenter, led by other similar experiences, took up part of a chamber floor, under which was found a pipe designed to ventilate a privy just at the rear of the house. This pipe passed into the kitchen chimney; one of its joints had become leaky, and gave out foul air immediately Fig. 119. MISPLACED PIPE. under the floor of the chamber, making it uninhabitable until the fault was remedied. House-drains running under or upon the ground should be made of salt-glazed earthenAvare. It is better for them to be made of iron, and suspended aboA^e ground from the loAvest floor. If on the ground, they should be laid Avith great care upon a bed of concrete, or at least with Fig. 120. A LEAKY DRAIN. good "clay puddling," and the joints secured Math the best cement. Sinking of the ground under a drain, unless effectually provided against, may result in broken joints, Avith leaking of sewage under or near the house, saturating the ground in the most injurious manner. No drain should ever run under a house Avhen this can at all be avoided. Next, ventilation must be supplied for all the house-drainage system. This is needed, first, for each trap; secondly, for the soil-pipe; thirdly, DRAINAGE. 187 for the drain or sewer into Avhich all the house-drains empty. (Fig. 114.) Every trap should be \Tentilated from the top of its outer bend. Its vent should not go into the soil-pipe or its ventilating-pipe, but should have a separate air-pipe. All the traps of the house, however, belong- ing to baths, laAratories, and cistern overflows, may be vented by branches connected Avith the same pipe, if this be quite disconnected with the Avater-closet system. The only satisfactory way to ventilate a soil-pipe is to continue it all the Avay up above the roof; best, to a height of ten or twelve feet above the eaves, and always in a direction clear of all windoAvs. Rain-water pipes must not be used to ventilate soil- pipes or drains. AYhen connected Avith these, they are of no use in this way during storms, and at other times, opening just at the eaves, they may, Avhen so connected, take bad air into upper windows. Some haA^e recommended an open trap (covered by a grating) for ventilation at the foot of the soil-pipe. (See Fig. 121.) Better than this is an air-pipe, Avhich need not be more than t\vo inches in diameter, ascend- ing from the foot of the soil-pipe to or above the highest part of the roof. This U-shaped arrange- ment of soil-pipe and foot ventilating-pipe together has been found to Avork extremely Avell. A patent has lately been taken out for the use of a venti- lating-pipe for water-closets apart from the soil-pipe; but there is excel- lent reason for believing this patent to be invalid.* For additional air-protection, a small vent may pass from the water- closet immediately under the seat. This must not enter the soil-pipe or its ventilator, but it may quite safely be led into and carried up through the flue of the kitchen chimney. Ventilation of a soil-pipe directly into the kitchen chimney is sometimes arranged for, but it is not ad- visable. DownAvard draughts (particularly when, for a time, the fire is out) may mingle impure air from the soil-pipe Avith that of the kitchen. If the ventilating-pipe goes through the flue and up the whole height of the chimney, there is no considerable risk of harm. As a rule, however, no pipe containing foul air should be allowed to go through a house Avhen it is possible for it to ascend or descend outside of the house. The chance of leaky joints within a house is too serious to be permitted when avoidable. If there be such a pipe carried through a house, it ought to be of metal (preferably enameled iron), not of earthenAvare, * Hellyer's Duke Domum advised this plan very clearly in 1877. See the Sanitary Engineer, Nov. 15, 1879. 188 HYGIENE. «,r, worst of all, of Avood. Arrangements intended to promote a healthy state of things may sometimes, through unskilfulness or negligence, have the very opposite effect. At Sandringham Palace, a residence of the Prince of AY ales, a mistake was committed of this sort. The vent of a water-closet, under the seat, above the trap, was made to enter the soil-pipe, thus giving full opportunity for the air from the latter to return into the open basin of the closet and the room around it. This error is sIioavii in Fig. 123. Fig. 122. The plan exhibited in Fig. 122, of ven- Fig. 123. tilating a bath-escape trap and a water-closet trap by the same pipe, is not perfect; although it is much better than some methods in common use. Experience shows it to be unwise ever to have a Avater-closet imme- diately communicating with a bed-chamber. The length of time spent in sleep, often without much reneAval of the air, and, it seems probable, a greater susceptibility than in the waking state to depressing causes, makes the danger of blood poisoning greater under such than under any other circumstances, if contamination of the air exists. AYhen a Avater-closet is not Avell supplied Avith window-ventilation, this may be supplemented, or in part substituted, by a pipe going upward through the roof, under Avhose expanded lower opening a small jet of gas is kept constantly burning.* So far, Ave have considered the ventilation of traps and soil-pipes only in vieAv of their air-purification. But there is another occasion for it. * The topic of downward ventilation of water-closets and latrines by adjoining heated air-shafts belongs to Hospital Hygiene. DRAINAGE. 189 When two or more traps, one over another, connect with the same soil- pipe, the discharge from an upper one may, in passing doAvnwards, suck (or " syphon ") out the water which seals a lower one, and thus leave it empty. This, of course, allows the ascent of foul air, passing the lower trap; and such a possibility is not at all a matter of theory merely, but of frequent, actual occurrence. A\rhen air is admitted not only through the open end of the soil-pipe, but also by a vent above each trap, such a syphoning and unsealing cannot occur. Supposing, then, that we have arranged to convey safely out of a house all its drainage: what are we to do with it ? First, in toAvns. Privy-wells ought never to be considered allowable, even in closely built villages, much less in populous cities. They can- not often—certainly they cannot generally—reach to flowing water, or to an entirely pervious sandy bottom. Therefore they will gradually saturate the earth, contaminating the " ground-water," and, in conse- quence, more and more, the ground-air. One fact in regard to air- movement we have not yet alluded to; namely, that, in all but the Avarmest months of the year, the whole of an inhabited house, and, through the year, that part heated by the kitchen fire, is, on account of its Avarmth being greater than that of out-of-doors air, drawing, suck- ing in air from the surface of the ground, and from the ground itself around it. Thus " sewer-air" (which, properly speaking, means all air spoiled by human waste) finds access to houses whose interior arrangements are, in themselves, without fault. If this be true, so long as the earth-closet system, or nightly removal by a pail system (both very good, but not yet made convenient for large communities in this country) cannot be maintained, we have no resort but connection with the common sewer. Opposition to this has grown out of numerous cases of harm done by the escape of sewer-air into houses through defective plumbing. But no bad plumbing should be allowed; * and the air of the largest seAvers may be kept innocuous by proper construction, good slope, ample water supply, and ventilation. We cannot enter, in this volume, upon the topic of city sewerage; but it may be said, at least, that the old style of immense square-built brick sewers is an abomination Avhich ought now nowhere to be tolerated. If made round, or egg-shaped (with the small end downward), of a size not large enough for stagnation, and of impermeable material, properly Municipal inspection of all houses when built, and afterwards when reasonable complaint occurs, is one of the needs of our great cities. Tenement houses in New York are now subject to it; and surely the rich ought to have at least as much protec- tion as the poor. 190 HYGIENE. cemented at the joints, they will need then only abundant flushing and numerous air-vents to make them safe throughout. In Croydon, Eng- land, the first construction of sewers was followed by an increase of typhoid fever; but after the sewers were well ventilated, the disease disappeared almost altogether. Yet the connection of house-drains with town-sewers must be very carefully guarded; the double trap (Fig. 124) with screw-plates for inspection and a ventilating-pipe, being now the most approved arrangement* In country houses, whose owners can afford carefulness for healths sake (and who, that lives in a house of his own, can not and ought not ?) Fig. 124. the same essential principles are applicable as in city residences. The most common method of rural house-drainage is, to convey waste under- ground to a cesspool, at a variable distance, the greater the better, from the house. By a cesspoolf is generally meant a large and moderately deep well, which, if used, ought to have a removable cover for exami- nation and emptying when needful. It is, with advantage, divided into two parts by a grating, separating solid from liquid waste. A good Avay of preparing the former, at proper intervals of time, for cleaning out, is to throw over it a quantity of earth. This makes its removal less unpleasant, and affords by the mixture a very serviceable manure. The liquid portion may be directly applied to the ground; best by irrigation through sub-surface tile-pipes, open at a portion of their joints to allow of the escape of the drainage into the earth. For this use, AYaring speaks very highly of Field's flushing-tank, as answer- ing, under experience, admirably, for fertilizing a garden or cultivated field. There are some situations which do not admit of any such distribu- tion of waste material; for instance, at the sea-shore; where hundreds * Of course the slope of every drain, after it reaches the ground, is of great impor- tance. One inch to the yard will afford a sufficient descent under ordinary circum- stances. Very many drains have a good deal less than this ; and not a few have been found, under careful inspection, to slope the wrong way. See Teale's Dangers to Health; and Report of Massachusetts Board of Health, 1879, p. 94. t In Scotland, this word ie said to mean simply a trap. DRAINAGE. 191 of cottages, as Avell as boarding-houses for summer occupation, some- times spring up in a single season. At Ocean Grove, NeAV Jersey, durino- the first two or three years of its settlement, driven Avells for drinking-Avater, and other Avells for house-Avastes, Avere dug side by side, on small lots, not many feet apart. The sandy ground permitted an easy mingling of waste and water-supply in the common ground-water of the place. As a consequence, almost every person who visited the locality went through a seasoning, or acclimating, diarrhoea, which, especially Avith young children, involved sometimes quite a serious ill- ness. Fortunately, the Ocean GroAre Association, becoming aware of the increasing contamination of their ground, took judicious measures for its protection. All waste-wells were made (as nearly as possible) Fig. 125. HOW PEOPLE DRINK SEWAGE.—(Teale.) water-tight; and, under strict regulation, they were all periodically cleaned out at sufficiently short intervals to avoid atmospheric contami- nation. A resident of the place informed me that the local diarrhoea at once disappeared under these appropriate improvements. Other watering-places have been known to suffer great disadvantage from analogous defects, not always ascertained until after they have cost some lives of visitors Avho had sought them as sanctuaries of health. For the evacuation of Avaste-wells and cesspools in town or country, but especially in cities, the " odorless pneumatic system," most largely carried out in Amsterdam by Captain Liernur, is undoubtedly a great improvement.* After all, hoAvever, the ideal method is, the return of all human * See Waring on Sanitary Drainage of Houses and Towns, N. Y., 1878 ; p. 284. 192 HYGIENE. Avaste, as soon and conveniently as possible, to the ground. Nature's OAvn disinfectants are the earth and growing plants. Together, these are perfect in their action; and they admit, satisfactorily, of no sub- stitution. Nor need any one be afraid of this effective transforming process, this alchemy of nature, when seAvage passes through (not lying stagnant upon) the soil on which there is abundant vegetation. The Craigentinny meadows, near Edinburgh, derive their luxuriance from sewage irrigation. At Clichy, near Paris, five thousand acres of barren sand Avere, by the sewage of Paris, converted into fertile fields and gar- dens. A manufacturer of perfumes chose this favored spot for the cul- ture of his aromatic herbs. The finest mignonette of Covent Garden market, London, has long been grown upon sewage-watered soil. Among the Alpes Mar'dimes, ground fertilized chiefly with waste of human habitations produces, for the use of the perfumers, an abundance of roses and violets. " Do you know," says Victor Hugo,* " what these piles of ordure are, collected at the corners of the streets, the frightful barrels of the night-man, and the fetid streams of subterranean mud Avhich the pave- ment conceals from you? All this is a flowering field; it is green grass; it is mint and thyme and sage; it is game; it is cattle; it is the satisfied loAving of heaAry kine at night; it is perfumed hay; it is gilded wheat; it is bread on your table; it is warm blood in your veins; it is health; it is joy; it is life. Restore this to the great crucible of the earth, and abundance will issue from it, for the nutrition of the plains produces the nourishment of men." * Les Misdrables. DISINFECTION. 193 DISINFECTION. The very best of all disinfectants, outside of the ground itself, are fresh air and pure water. Thorough cleanliness prevents all occasion for processes of correction; and such prevention is infinitely to be pre- ferred to any and all such processes; for, indeed, perfect disinfection is,, in regard to the causes of some of the most dangerous diseases, hardly possible, except by the powerful influence of heat. Almost every one now knoAvs that odorous substances, such as cologne, do not disinfect, or even improve the air, as to healthfulness; they only conceal or disguise the evil. If any beneficial agency can be obtained by such materials, it is to be had by burning aromatics, as myrrh, cloves, etc., or coffee. The latter Avill at least remove the unpleasant smell from a room in which the air is una\roidably affected by a bodily disor- der of a person confined Avithin it. Frequent changing of the clothing or covering of such a one, and burning or boiling every article that is soiled, are very important. No absorbent material should, when it can be helped, be kept in a sick-room, for the same reason. Bed-curtains, window-curtains, Avrall-papers, and even carpets, are subject to this objec- tion. Especially, also, everything passed from the body should be cov- ered at once, and removed as soon as possible.* Agents called disinfectants may act in several ways: 1. Those called antiseptics prevent or arrest putrefactive decay in animal and vegetable matter. Sulphate of iron and chloride of zinc are examples of this kind of action. 2. Some substances, as charcoal and lime, absorb gaseous emanations from decomposing bodies. 3. Others act chemically upon the results of decay, so as to make them harmless. One of the most common, unpleasant, and injurious of these resultant products is sulphuretted hydrogen, whose odor is that of rotten eggs. Against this, chlorine (in the form of chloride of lime or solution of chlorinated soda) is very effectual; and so, also, when applied to quantities of liquids, is solution of nitrate of lead. 4. Most important, but most difficult, is the destruction of those spe- cial and subtle causes of disease, to which, because many facts make it probable that they are minute living organisms, the term "disease germs " is commonly applied. Air is much improved in healthfulness by taking out of it sulphu- * An uncovered chamber-vessel under the bed is an intolerable barbarism at all times. 13 194 HYGIENE. retted hydrogen and other odorous products of mere decay. It may, however, still have left in it the contagion of small-pox or scarlet fever; the local infection of yellow fever; the miasm of autumnal remittent; or the migrating cause of epidemic cholera. To annihilate these requires a total change of the atmosphere, as well as of the surfaces exposed to it—such as can be effected only on a comparatively small scale; as, within a house, a railroad-car, a steamboat, or a ship. Without dwelling longer on these generalities, we may briefly enu- merate the most serviceable of disinfectants. The cheapest (besides dry earth, referred to in our last chapter) are quicklime, charcoal, and tar* These are all very effectual—in privies, for example. All of them, however, make some deposit, which must be remembered in regard to traps, etc., where it will not do to allow accumulation. But such things have very little action on the air, except, it is true, when quicklime or charcoal is spread or suspended iu different places within apartments. Whitewashing walls, as in cellars and kitchens, is an excellent means of " sweetening " them, which ought to be repeated often. We want, however, not unfrequently, to purify the already contaminated air of a house. For this, the two most pow- erful agents are chlorine and sulphurous-acid gas. The first of these was once regarded as the only valuable disinfectant; now, under a sort of reaction, it has come to be, with many persons, underrated. Not only Avill chlorine decompose sulphuretted hydrogen gas, but it will, when enough is used, also destroy bacteria^ (the best known of minute organisms present in decaying matter); whence it may be expected to aid in the destruction of all disease-germs. But, to secure this effect, a great deal of it must be used. In a very bad state of the atmosphere, the affected rooms had better, instead, be cleared of all human beings, and fumigated with burning sulphur. For every thousand cubic feet of space, a pound and a half of sulphur should be burned,—best over a pan of Avater, or a vessel containing sand, to avoid the danger of fire, No one can breathe sulphurous fumes with safety. The doors and windoAvs of rooms to be so disinfected must be closed for several horn's, and then thoroughly aired before being again occupied. Cold arrests putrefaction, and so lessens the activity of contagions and infections; but it does not destroy them. Heat (from 200 to 250° Fahr.) is the most effectual of all disinfectant agencies—the only perfect one. It will destroy all " disease-germs," and break up or dnve * A pint of tar, used once in a week or two, will deodorize (except with a slight odor of its own) a large privy-well. f See the Dublin Journal of Medical Science, September, 1879, for an account of recent experimental proof of this by Dr. Notter. DISINFECTION. 195 off all unwholesome emanations from whatever source. It is not, how- ever easy or convenient to apply high heat continuously to private houses, and it has been mostly so far reserved for especial emergencies. Clothing exposed to any infection or contamination ought (if not bad enough to be burned) to be avcII boiled before being used again. The disinfectants most commonly approved for practical use are the following: For privy-Avells or water-closets, a solution of copperas or green vitriol (sulphate of iron) may be made by diffusing ten pouuds in a bucketful of Avater. Of this, the whole, or more, will be required to disinfect thoroughly a bad privy-well. For a bed-pan or chamber- vessel, a teacupful of the same solution will .suffice each time the vessel is used. Or, for the last-named purpose, a solution of chlorinated soda may be employed, a fluidounce to a quart of Avater; or crude perman- ganate of potassium, ten grains to the quart of water. Carbolic acid, not long since, was lauded and trusted above almost all other disinfectants. Careful experiments have shoAvn that it is merely an antiseptic of moderate value, with very little power to destroy bacteria or other minute organisms. This being the case, its extreme disagreeableness may Avell justify its being generally disused in private houses. Chloride of lime may be safely and advantageously employed in cellars or other places where the air is not good, being placed in shallow vessels to give off chlorine gas. Vinegar, added to it, will increase its efficacy, which will not in any case last long. A solution of fresh chloride of Time in water will ansAver well to deodorize and disinfect privy-Avells. Its action on metals makes it unsuitable for Avater-closets, kitchen-sinks, etc. Chloride of zinc has similar antiseptic properties, but does not (unless Avith some other chemical agent added), like chloride of lime, give off free chlorine gas. Burnet's liquid is a solution of chloride of zinc. Labarraque's liquid is a solution of chlorinated soda. Bleaching salt is chloride of lime. Condy's liquid is a solution of permanganate of potassium; Ledoyen's liquid, solution of nitrate of lead; chloralum (a very good disinfectant), solution of chloride of aluminium. Of less certainly known value are a number of recently advertised preparations, many of them pat- ented, which are extremely unlikely to do so much good as those above mentioned.* * The following statement of the results of some recent experiments with disin- fectants is from the Philadelphia Medical News, 1883: "Nedwetsky proved, as far back as 1872, that cholera bacteria were not killed by quinine, camphor, carbolic acid, calomel, or chloral; that opium, nux vomica, and chloroform destroyed them verj> 196 HYGIENE. Standard Disinfecting Solutions Recommended by the Penn- sylvania State Board of Health. Xo. 1.__Dissolve chloride of lime or bleaching powder of the best quality in soft water, four ounces to the gallon. Xo. 2.__Dissolve corrosive sublimate and permanganate of potash in soft Avater, tAvo drachms of each salt to the gallon. This solution is hio-hly poisonous. It requires a contact of one hour to be efficient. It destroys lead pipe. It is without odor. Xo. 3.__To one part of Labarraque's solution of hypochlorite of soda add five parts of soft Avater. Xo. 4.—Dissolve corrosive sublimate in Avater in the proportion of four ounces to the gallon, and add one drachm of permanganate of pot- ash to give color to the solution as a precaution against poisoning. One fluid ounce of this solution to the gallon of Avater is sufficiently strong. Above all things, however, it is to be remembered that non-infection is a thousand times better than disinfection, and absolute universal cleanliness Avould insure this. The time will no doubt come, under the advance of knoAvledge and true civilization, Avhen no cholera will traverse the globe from the rising to the setting of the sun, and no yelloAv fever will put Avhole cities in mourning for their dead. As the plague has, even in the East, became a rare instead of a frequent visit- ant, not now, as once, invading European cities, so other terrible scourges of mankind may, and no doubt will, in time be overcome by sanitary prevention. In order for this to happen, every man must be the guardian of his own threshold; not only for his own advantage and safety, but also for the " common weal." slowly, while the dilute acids, sulphuric, nitric, and muriatic, decompose them very quickly, as did tannic acid, sulphate of iron, and chlorine water; also corrosive sub- limate, bromine, and iodine. But perhaps milder remedies may have the same effect; at least one per cent, of tartaric acid will kill the yeast plant, but allow bacteria to thrive, while a five per cent, solution will allow mouldy growths to appear; or a stronger solution will kill both these and bacteria. It is known that yeast plants, moulds, and bacteria feed upon each other, but that bacteria will destroy or eat up all the others. One part of corrosive sublimate in 20,000 of water will kill bacteria in ten minutes; 1 part in 5,000 is a certain disinfectant, and of course as safe as stronger solutions of the milder tartaric acid. But sulphurous acid, generated by burning sulphur, which is the most commonly used disinfectant, requires thirty minutes to kill bacteria, and their spores will sometimes live for ninety-six hours. A five per cent. solution of carbolic acid requires twenty-four hours, and a three per cent, will not kill them at all. A five per cent, solution of chloride of zinc requires one month, and they have even been found alive at the end of that time. Iodine, 1 part to 5,000 of water, destroys them ; and bromine, 1 part to 1,500 of water. The oils of mustard, pep- permint, turpentine, and cloves, even in dilute solutions, have a restraining influence upon bacterial development." POPULATION. 197 POPULATION. Already, in the early part of this book, some facts have been given, shoAving a close relation betAveen the mortality of places and the number of people aggregated together. Other facts of a similar kind abound. With more space, I might describe (were they not too horrible) the unAvholesome conditions under Avhich some thousands of people live. not only in China, India, and Egypt, but in Europe and America. We might dwell on the habits of the Icelanders, of whose children the greater part die during infancy; or on the croAvding in Naples and other continental cities of Europe; or on that of London, Avhere, says the British Quarterly Review* at least one-half of the houses are unfit for human beings to reside in; or, nearer home, on those evils still existing in some American cities, which make it remarkable not that yellow fever visits them, but rather that it ever spares them at all. Enough for our purpose to glauce at tAvo or three very sad but instruc- tive examples. One of these may be a toAvn on the naturally healthful island of Malta. Plimpsoll, the well-knoAvn English philanthropist, has been recently investigating the sanitary condition of Valetta, where the poor popula- tion live chiefly in cellars. He says of these cellars or pits: "They have no fireplace, and therefore no chimneys, and serve singly for a Avhole family—man, wife, and children. They have no Avindows, and some have no other aperture of any kind than the door; and Avhen you have reached the bottom of the well you find the floor, the solid rock, wet with urine and foul Avith the odor of the children. So little air reaches the bottom that the floor of the yard or well never dries, and so little light that when you are asked to enter and stand in the doonvay, it is dark as pitch, and you have to light a Avax match to avoid falling down the two or three steps within the doorway. . . . The excrement in many of them is put into a box over the seAver, about twenty inches square and high. It goes right down into the untrapped seAver, and there accumulates in the dry season, unmixed with ashes or dry dust of any kind." In one of these filthy dens, under a handsome house in the Strada Maza Muscetto, were founds in an area of 1,692 feet, three stories or tiers of six cellars in each, and in the lowest of all above thirty people were living, thirty-nine feet below the level of the street. With such sanitary arrangements, the death-rate in 1874 Avas 49.24 * April 1, 1879. 198 HYGIENE. per 1,000 of population. It ought to be not more than 15 or 17 per 1,000. Another case has been long familiar to readers of Carpenter's stand- ard treatise on "Physiology."* The island of St. Kilda, one of the Western Hebrides, Avhen visited in 1838, had an enormous mortality of infants, four out of every five dying. This Avas explained by the way of living of the people. " Their huts Avere small, loAv-roofed, and Avithout Avindows, and were used during the Avinter as stores for the collection of manure, Avhich Avas carefully laid out upon the floor, and trodden under foot to the depth of several feet. On the other hand, the clergyman, Avho lived exactly as did those around him, except as to the condition of his house, brought up a family of four children in perfect health; Avhereas, according to the average mortality, at least three out of the four would have been dead within the first fort- night," But Ave need not go farther than the lately much discussed tenement- houses of New York for an exemplification of over-croAvding and its destructive effects. Half the population of that great city live in 21,000 tenement-houses, and two-thirds of the deaths of the Avhole city occur annually among that population, mostly during childhood. Nearly half a million of people have allotted to them an average of less than seven square yards to each person. The tenement-houses are large, and often closely packed together, many rooms having no direct communication Avith the open air, and being never reached by a ray of sunshine from one end of the year to the other! So late as 1877, one such building (98 Mott Street) contained ninety-nine families, making in all nearly five hundred persons. Several families sometimes occupy a single room. It is not needful for us to say more in description of these dens of misery, upon Avhich the blaze of modern sanitary inquiry has now been fully turned, so that philanthropy and civic prudence have united to abate their evils. An extraordinary fact is, that the poorer portion of those brought up amid such circumstances are often umvilling to have them improved. They must be helped and taught gradually; they seem almost like owls or bats brought out into daylight, when any one attempts to better their condition. Says Dr. Stephen Smith (Sanitarian, July, 1875, p. 155): " The family reared in a cellar resists every effort to induce it to take rooms on the first floor. The struggle of the Board of Health to vacate cellars, and compel the underground population to live above ground, has been carried on with varying success for many years. * Chapter on " Kespiration," p. 545. POPULATION. 199 Again, we find a family always accustomed to a rear tenement will never take the front, and one always occupying a single room will be found averse to occupying tAvo rooms." Yet, Avhen once an improvement has been made, they become aware of its benefits, and are brought to assist in their extension. In 1866 a reform was begun in NeAV York, through which, according to Prof. Chandler, doAvn to the present year, 13,000 lives have been saA*ed. By the aid of seaside homes for sick children, excursions to the country and on the Avater, free medical attendance and sanitary advice, this lowering of mortality in tenement-houses goes on more and more rapidly. In 1876, 3,060 deaths occurred amongst them from summer diarrhceal diseases; in 1879, 2,084—a reduction of nearly a thousand in this death-rate alone. Besides some regulations referred to on a previous page, it is now enjoined, by the New York Tenement-House Law, that the space betAveen floor and ceiling must be in every room at least eight feet. Every bed-room must have direct communication with the outside air, and six hundred cubic feet of air-space must be allowed for every occupant. When this last enactment comes to be fairly carried out among the hundreds of thousands now packed together with an average, in some blocks, of from one to two hundred in a single house, the sanitary millenium will almost have arrived. Noav, upon two miles of Fifth Avenue, 400 families dwell in wealth and comfort. Less than tAvo hundred yards from this elegant thoroughfare, a single block of tenement-houses has long contained 700 families, aggregating 3,500 souls. Hoav much disease and how many deaths in Fifth Avenue may have been derived from such a block ! It has been shoAvn that no skill or ingenuity can suffice to build a healthy and comfortable tenement-house of several stories for a large number of people upon a lot twenty-five by a hundred feet. The best that can be done with such lots is to erect upon them (at most, two or three on a single lot) small tAvo- or three-storied dwellings of improved construction. This has been done lately in Brooklyn, each house costing about $1,100. These, at a rent varying from $13 to $20 per month, Avill produce a fair return to their owners. Upon this topic more will be said in our next chapter. Boston, as Avell as New York, has long been overcrowded upon the tenement-house system ; and some smaller manufacturing cities of New England have had of late an increasing excess of population. A com- mittee of the American Social Science Association not long since reported that in Boston the average proportion is more than eight persons to a dwelling, some of the old wards having an average of eleven and twelve. 200 HYGIENE. In Fall River it is betAveen ten and eleven. In Ncav York, according to the census of 1870, it Avas nearly fifteen persons to each dwelling; in nine wards, twenty-tAvo. At the same time, Philadelphia had one house for every six persons, as the average for the Avhole city; while its worst wards had one house for every eight.* No Avonder, then, that this city has been called the " City of Homes! " * The actual number of houses in 1870 was, in New York, 64,440 ; in Philadelphia 112,366. Population of the former city, nearly a million ; of the latter, about 675 000. In 1876, by count of the police, there were in Philadelphia nearly 144,000 houses. In New York, by the State census of 1875, the number of dwellings was 67,126; popula- tion, 1,041,886 ; average for each house, 15.52. The average for each house during the same year in London was 7.8 persons. (See Report for 1878, by J. T. Nagle, M.D.- Hospital Gazette, Dec. 13,1879.) WORKINGMEN'S HOMES. 201 WORKINGMEN'S HOMES. In Dr. B. W. Richardson's imaginary model city, Hygeia, a method is proposed by Avhich the Avork of men and women may be kept quite apart from their dAvellings. This separation is to be effected by the establishment of blocks of buildings expressly for the purpose; Avhere, in appropriate rooms, the tailor, dressmaker, lacemaker, etc., may go through with his or her daily task, and return home Avhen it is done. Day-nurseries, meanwhile, are to take care of the children while their mothers are aAvay at Avork. This is carrying the co-operative principle very far; too far, probably, ever to meet with universal favor or success. But a certain degree of approach to it already exists in connection Avith many avocations; and the question of the maintenance of good homes for Avorking-people has become one of the most pressing in sanitary and social science. Naturally, most workmen Avish to have their dAvellings near their places of business, so as to save time, effort, and expense in going from the one to the other. With those Avhose occupations are sedentary, involving but little muscular labor, it is really better that there should be distance enough betAveen home and Avork to secure some exercise in the open air in the morning and evening Avalk. But Avith those Avhose labor is prolonged and fatiguing, it is desirable that the home should be either near the place of Avork, or accessible by some cheap and- rapid conveyance. Workingmen's trains, Avith reduced fares, noAV run to and from several of the largest cities in England, and in our oavii country; and they are very useful. Horse-cars, in Philadelphia especially, render a similar kind of service, though Avith much less saving of time. Where ground is greatly in demand for business purposes, it is impossible to get a good interest from dAvellings upon it, unless they pay a high rent. If this rent is to be obtained from poor tenants, there must be a great many of them in one building. Other portions of large cities are usually rendered unavailable for homes for the working-class by the high prices growing out of social preferences for localities. After awhile, the valuation of health will prevail more reasonably than now, and then a toAvn-lot on the highest and most open quarter of the city Avill command at least as good a price as one on lower ground, closely built Avith marble or brown-stone fronts, on a fashionable street. Such a comparative equalization of land-values may, before long, aid in mak- ing it practicable for capitalists, or well-to-do artisans on a smaller scale, to erect houses in good jiarts of the toAvn, at a small or moderate ex- 202 HYGIENE. peuse_such as will be within the reach of workmen who must live not very far from city establishments. But the best and highest aim ahvays will be for every man to own his dwelling. Building associations admirably promote this result. Some of these, in&London, have been started and managed by men of capital for the benefit of the poor. Others are truly co-operative. This is the character of those which have become very successful and useful in Philadelphia. Ground-rents, irredeemable so long as the interest is paid, make the purchase of land for building more practicable. One Avho owns a small lot (say eighteen by ninety feet, on a fifty-foot street), on which there is a ground-rent, may join a building association, and by paying one dol- lar5 a month he may have opportunity to borrow from the association, at a moderate premium and interest, enough money to put up a small house. It may be of brick—fourteen and a half feet front (leaving a passage at the side of three and a half feet) and thirty-two feet deep. Thus^by paving dues, in all amounting monthly to about twelve dollars and a' half, lie is enabled, in eight, ten, or twelve years, to clear off his indebtedness on the house, and have it for his possession as well as his home. Multitudes of such two- and three-storied houses, with two (seldom three) rooms on a floor, and mostly OAvned by their occupants, are to be seen in rows and blocks in many parts of Philadelphia. George Peabody did an immense amount of good, by presenting a large sum of money for the erection of model lodging-houses in London for the poor; but much more advantage has resulted from this happy series of enterprises, which have made it possible for thousands to erect homes for themselves. Morals, as Avell as comforts, are thus often signally improved. Of course, philanthropists may and must, especially at first, assist and direct such reforms. Prince Albert Avas herein a truly noble example and leader. John Ruskin and Octavia Hill in London, the Board of "Trustees" in GlasgoAv, and the "Association of Physicians" in Copenhagen, have alike shoAvn not only that the comforts and decency of the very poor can be thus greatly aided, but that vice and intemper- ance are thereby discouraged, and municipal order promoted—and all this Avithout loss, indeed with a very fair return, to the owners on their investments. Yet, alas, hoAV many of the poor, in all our cities, still need to be lifted out of their squalidness and taught Iioav to live ! For these there is excellent training, as Avell as health-giving and much enjoy- ment, in the summer-days' excursions and the " country week."* I" * This is an arrangement by which families living in the country receive, for a week or more at a time, children of the poor from the city. It is managed by a vol- untary organization of benevolent ladies, who have reported excellent results from it. WORKINGMEN'S HOMES. 203 the latter, especially, there is a rich combination of all these advantages. SIioav the unAvdlling but ignorant prisoner of Five Points or Alaska Street hoAV the humble farmer or farm-laborer lives, in a neat and airy cottage among green fields, and he or she must be inspired with longings for something better for himself or herself, and for their offspring. The sights and odors of the fresh, open country Avill long live in the dreams of children Avho are taken out to be refreshed and revived by them; and then they cannot so easily afterwards be content without cleanli- ness, which is possible everyAvhere, and thus sweetness in the working- man's home. They Avill be better, safer, more patriotic citizens there- for ; and so it is the interest, nay, almost the necessity, of every mem- ber of the Avealthier class to aid and encourage all that can be done toward so important a reform. Even a single day's lesson in healthy living Avill help this much. Six hours of sunshine! six bright hours of gladness! Six hours of joy 'mongst grasjs, and flowers, and trees; Six hours' escape from want, and woe, and sadness; Six hours of butterflies, and birds, and bees! That's all they pray for; all these tiny creatures, Stunted and squalid, ask of you one day, To let God's breezes fan their wee, wan features,— One day from their dark homes to get away. One day to leave the fetid court and alley, To breath pure air, to hear the wild bird's song; One day to track the brook adown the valley ; One day !—Oh! say, my brothers, is 't too long ? * * From London Truth, 1879. 204 HYGIENE. SEASONS. What a wonderful influence upon the history of our earth is con- nected with the tilt of its axis to the path or orbit in which it moves around the sun ! But for this, producing a difference of direction, and hence of heat, in the sun's rays, according to the part of its orbit in which the earth is at different times in the year, Ave should have no Spring, Summer, Autumn, or Winter; only a perpetual summer at and near the equator, and unchanging winter around both poles. Our common division of the four seasons is someAvhat arbitrary. With the ancient Greeks, Spring was made to consist of but forty-eight days; Summer, of one hundred and thirty-one; Autumn, fifty-one; and Winter, one hundred and thirty-five days. It is hard to realize, unless one crosses the equator, that people living in the Southern hemi- sphere have their summer at the same time with our winter, and their coldest Aveather when ours is hottest. On the average, January is our coldest month. North of 48° N. latitude, July is the hottest month; between that and the equator, the period of greatest heat is usually in August. A curious fact is, that the immense city of London has seasons of its oavu. Throughout England generally, the second Aveek of Jan- uarv is the coldest time; in London it is the third AAreek instead. Of the summer, the second week of July is the warmest; it is three weeks later in London. Among three million deaths in different countries in Europe, it Avas found that the greatest number took place in spring. In the most Northern countries, and in Great Britain and Ireland, Avinter is the most fatal season. So it may be also in our Northern States and British America, outside of the great cities. In them, however (New York and Philadelphia, for examples), summer makes so many victims amongst young children as to turn the scale. The difference between the Northern and the Southern summer in this country lies chiefly in the length of the summer in the South. Quebec and Montreal have a feAv very hot days in their short summer; and some of those of July and August, in Cincinnati and Philadelphia, compare closely with the hottest of Charleston, Savannah, or NeAv Orleans. The highest temperatures in the sunshine reported any \vhere (with a thermometer uncovered in the air) are 146° Fahr. at Bagdad, in West- ern Asia, and 150° in Thibet. Dr. Livingstone found it 136° in the sands of Sahara, in Africa. In Maryland, one August day, I found it 134° in the sun. 120° in the shade has been observed in India and Southern China, even at night. 40° beloAv zero Fahr. has been known SEASONS. 205 within the limits of the Northern United States; —50° to —90° in the far Arctic zone. In Philadelphia, the range is from about 16° below zero, the coldest, to 101.5, the highest ever knoAvn.46 With regard to health, the year may be divided into the colder and the warmer half. In the colder months diseases of the breathing organs are most common: croup, bronchitis, pleurisy, pneumonia; also rheu- matism, especially in old people; and complaints Avhich are promoted by close air in houses, as small-pox, measles, diphtheria, erysipelas, typhus fever, etc. Summer-time is most apt to bring Avith it affections of the stomach and boAvels, as cholera morbus, diarrhoea, and dysentery; disorders of the liATer; and fevers, as remittent, intermittent, and yelloAV fever. Typhus fever is (as aboAre said) rather a Avinter disease; typhoid fever occurs at all seasons of the year. When exposed to cold, young chil- dren and very aged persons suffer most. It is not uncommon for old people to die in a very cold spell of Avinter Aveather. Protection against extremes of heat and cold and sudden changes of temperature is indispensable to health. Nothing is more absurd than (as some people are said to do) to change clothing Avith the seasons by the almanac instead of according to the Aveather. More common and equally imprudent is putting out fires too early in the spring, and leaving their use till too late in the autumn*. Many people are thus made sick. When rain falls and it clears up again, the out-of-door temperature in spring or fall may soon become mild; but, without fires, the dampness lingers Avithin doors, and its effect is made greater there by sitting; Avhile out of doors we are usually in more or less activre motion. Is it not a good thing to be hardened t Yes; but the way to bring it about is not always Avell understood. Severe exposure Avill not ahvays harden; it may kill instead. The ancient Spartans had a custom of leaving young infants out on the bare ground over-night to try their natural hardiness. Some lived, others died; and so the State had fewer invalids and stronger soldiers to groAV up. But the way to harden any one is to subject him often to moderate exposure, Avith enough protection to enable him to meet it Avithout depression of the system. It does nobody any good to be really chilled or exhausted, even for an hour. It is Avith this a good deal as it is Avith credit in business. A man builds up his credit by meeting all his obligations as they occur, and by never incurring any indebtedness Avhich he cannot meet. So Ave become hardier under exposure only Avhen Ave can bear it without injury at the time. * Sept. 7, 1881. Higher has been reported; but with doubtful accuracy. 206 HYGIENE. Take the baby out, then, every day, even in cold Aveather; but put on it enough clothing to keep it comfortably Avarm. Let the boys and girls play out even in the snoAv; but don't let them sit Avith Avet shoes and stockings after coming in. If a man is really warm enough in Avinter Avithout an OATercoat, let him do Avithout it; but it is a great mis- take to alloAV oneself to be chilled under a notion that to do so is more manly, or is hardening. One of the dangers of midsummer is of sun-stroke; better called heat-stroke, because it very often occurs in the shade. On the sea, off the south of China, persons haATe died from heat on board of a close vessel (d night. It is Avorthy of notice that heat-stroke is much more common in cities than in the country. Very seldom does a farm-hand have sun-stroke on the harvest field, or a cricketer during his active game. Soldiers, in India or Egypt, have sometimes been struck down on the march. But there is no doubt that the unhealthy atmosphere of cities promotes it. So does exhaustive labor; and, most of all, intem- perance. We shall have something to say about the treatment of heat- stroke in another part of this book. Enough here to mention that as heed is the cause of the attack, cooling down is the main thing in its management. CLIMATES. 207 CLIMATES. What is climate ? It is the sum of all the conditions of a place which affect men, animals, and plants. Causes of Climatic Differences. Latitude, North or South of the Equator, Outline of Coasts, Altitude, above the sea-level, Mountains, Deserts, Nearness to the Ocean, Lakes, Rivers, etc., Prevailing Winds, Oceanic Currents, Rain and Clouds. From these, or some of them, come, in every case, the following ele- ments of climate: rp, (Annual Mean, f -p, lemperature, ' J Pure, or ,T . , < Extreme Range, Atmosphere i M , . Moisture, ) , .,. fe ' r (. Malarious. I Mutability, Every one is familiar Avith the effect of latitude; that is, distance north or south of the Equator. By a tropical climate Ave mean that of the region between the tropic of Cancer and the tropic of Capricorn. Arctic climate is that beyond the Arctic or Antarctic circle, near either pole. But latitude alone does not determine climate. Alexander Humboldt, the great German traveller, first marked out some of the curious curves made by isothermal lines; that is, those which on the map pass over countries having the same average heat through the year. Altitude, height above the sea-level, makes a great difference always. For every 300 feet, we find it about one degree of Fahrenheit colder. So we may get a temperate, or even a cold, region in the neighborhood of the Equator, when we climb a high mountain there. Plants and trees flourishing on the upper Alps are like those of places far north of their latitude in low countries. The snow line, above which it never melts entirely aAvay, is at 8,000 feet on the Alps; 18,000 feet on the South American Cordilleras. The highest inhabited spot in the Avorld is a Buddhist cloister, in Thibet, 16,500 feet above the level of the ocean. The highest dwelling of men in America is the post-house of Ape, in Peru, 14,367 feet. The city of Potosi, in Bolivia, with a large population, is at an eleva- tion of over 13,000 feet. At greater heights, as 17,000 or 18,000 feet, mountain explorers have found it almost impossible to live for more than ten or twelve days at a time. One misses, at such elevations, the ordinary pressure of the air, to hold one together, so to speak. Some aeronauts, as Glaisher, Cox, and Tissandier, have gone up in balloons 20,000 (one account says more than 30,000) feet; but they have come 208 HYGIENE. doAvn again hardly alive. Two of three, in Tissandier's ascent, died from the sudden exposure to cold and rarefaction of the air. Very much less than this, of course, is the effect of rapid changes of climate in moving one's residence North or South; but people often suffer in health from this cause. Our great Arctic explorer, Dr. E. K. Kane, after having had tropical African fever in the Gulf of Guinea, impaired his health by voyages toward the North Pole. Many Englishmen lose their lives by going from their temperate climate to reside in tropical India. Nearness to the Ocean moderates all climatic extremes. In cold countries the shore is Avarmer, and in warm regions colder, than far inland. Water absorbs heat more slowly from the sun than does the land, but also gives it out more slowly. At Long Branch, Atlantic City, or Cape May, sea-breezes appear to be capricious and uncertain. So they really are, to some exteut, as many causes interfere Avith their regularity. Yret there is a law about it, nevertheless. Nothing seems so uncertain as the Avinds everyAvhere. Yet our Signal Service officers at Washington can tell, seventy-five or eighty times in a hundred, Avhen a storm is coming, and thus order cautionary signals at certain ports for hours beforehand. All this belongs to the science of Meteorology. On the sea-shore one of the laAvs is this: Avhile the sun shines through the long summer day, the land becomes very hot, and the ocean less so. Now air, as it is heated by contact Avith the earth, expands, and becomes lighter. Cold air is heavier; so the colder air of the sea-surface at noon presses over to the land, displacing some of the warm, light air on the shore. This gives us the sea-breeze. At night the land radiaks heat into space, cooling off very rapidly; the ocean, sloAvly. A cool breeze (land breeze) moves then from land to sea. As has been said, various causes (too complicated for us to consider here) disturb this enough to prevent it from being constantly observed; but it is the general rule. What happens thus every day and night at the brink of the ocean, some regions have, instead, in six months' periods. Southern India, for example, has its monsoons ; Avinds bloAving half a year one Avay (nearly from the north), and the other half in the opposite direction (almost from the south). Winter and summer mark these changes. But this subject belongs a little farther on. Lakes, Avhen as large as our great Superior, Michigan, and others, Avhich are little seas, have an effect in moderating climate like that of the ocean; but less in degree. The perfection of water influence is found upon islands ; even when as large as Great Britain. CLIMA TES. 209 Moisture is, of course, another quality of the insidar climate; not necessarily Arery much rain, but dampness in the air, and cloudy skies. CoAvper, patriot as well as poet, recoguized this as true of England: " Though thy clime Be fickle, and thy year most part deform'd With dripping rains, or wither'd by a frost, I would not yet exchange thy sullen skies, And fields without a flower,* for warmer France With all her vines; nor for Ausonia's groves Of golden fruitage, and her myrtle bowers." On the continents much difference is made by the coast-lines; Avhether they are much indented Avith bays, gulfs, and inlets, or smooth, round, and almost uniform in contour. In the first case, the water has access farther into the land, and the climate is moderated by it. Africa, for example, has a comparatively even outline all round; Europe (as the map shows at a glance) is indented and cut into on every side. Europe has, therefore, a moderate, maritime climate; that of Africa is continental and extreme. Asia has also a continental climate, its areas being so vast; but that of Hindostan and Cochin China is mari- time through their peninsular outjutting into the sea. Oceanic is the best term to apply to our OAvn continent, on account of its situation; North and South America stretching far along between the Atlantic and Pacific Oceans. But so much land lies, in North America, in a cold, almost Arctic, region, that its chill Avinds SAveep doAvn and undo much of the moderating effect of the ocean. Our American climate is, beyond most in the Avorld, changeable. It is also, in the Northern States, extreme, haA'ing cold Avinters and hot summers. Mountains make often a difference betAveen tAvo neighboring lands in Avarmth and moisture. Alpine travellers meet sometimes Avith a ridge which has on its north side almost perpetual siioavs, and on the south side evergreen Avoodlands; loAver doAvn, pasture lands. A pretty sight it is in spring, when a company of peasants ascend to these Avith their cattle, sheep, or goats, to spend the summer among the higher nooks of verdure, from Avhich they retreat again at the first Avarning uf Avinter. Here and there, by turning around the edge of a cliff, you may pass from a green, Avarm spot, with its gentians, Alpenrosen, and other flowers, to a bleak, icy scene like a bit of Labrador. Moreover, moisture is condensed on the side of a mountain (especially near its top) and falls in rain. Thus, the side towards the sea comes to be Avell watered; Avhile the Avind, stripped of all its vapors, passes on, * So only in winter, however. 14 210 HYGIENE. vvith nothing to enrich the laiuhvard side. WestAvard of the Andes, a part of Peru is rainless for this reason. Not eastward, there; why so, Ave shall see presently. East of our Rocky Mountains there is an American desert also; bad lands those regions are very well called. All the Avorld knoAvs that Egypt, south of the Delta, is a rainless land. Not mountains there (for there are none) but great deserts on each side drink up, so to speak, under the almost equatorial sun, all the moisture of its eastern and Avestern winds. Here again is a law of Nature. Air holds moisture, more or less, according to its temperature. As you squeeze a sponge, and thus rid it of its water, so chilling the air makes it deposit its moisture. Every night the dew-fall takes place in this manner. Radiation of heat into space, in the absence of the sun, cools the earth. The deAV is simply moisture laid down by the condensation of atmospheric ATapor. Some things have more deAV on them than others; it is because they radiate heat more freely. Did Ave say that dew falls every night? This is not quite true. Clear nights have the most of it; since, then, nothing checks the outgoing of the heat of the earth into space. On cloudy nights, the blanket of clouds keeps the earth Avarm, as it Avere, return- ing a good deal of the radiated heat, and on such nights {here is often little or no dew. More moisture is in the air at some times and places than in others. Rainless regions are (almost) dewless also. The dew-point of meteorolo- gists is the degree at Avhich the mercury in a thermometer stands, when, on something Avhich is cooled doAvn gradually, moisture begins to be con- densed. On a hot day, you may see a glass of ice-Avater "sAveat" with such condensation. On the other hand, Avhen the air is dry, it will take up moisture from any Avet surface, by evaporation. So we can estimate the humidity (dampness) of the atmosphere by the " Avet and dry bulbs." That is, take two thermometers, exactly alike, and place them near each other. Then, keep one of them wet with pure water, and leave the other dry. If the air is full of moisture, the mercury will stand about as high in one as in the other. But if it is very dry, evaporation from the wet bulb will cool it down, so that the mercury in that thermometer Avill fall several^ degrees beloAv the other. According to this difference is the conclusion reached about the dryness or dampness of the air at that time and place. Sometimes this method is used, and sometimes " taking the deAv-point," as above mentioned. In a damp air, the deAV-point is high; in a dry place and time, low. England has a high dew-point generally; Egypt a very low one. In our climate, it varies very much. CLIMATES. 211 Here are some examples of relative humidity (100 being saturation) in different places. Jacksonville, Florida, during the five colder months of the year, averages 68.8 ; Washington, D. C, through the year, 68.15; Philadelphia, 68.5; St. Paul, Minnesota, 71.3 ; Mentone and Cannes, in Southern France, 72.4; Key West, Florida, 76.8 ; Atlantic City, N. J., 78.1; Avithin Mammoth Cave, Kentucky, 87.6. Probably the most agreeable and desirable mean relative humidity is about 68. The barometer shoAvs variations in the pressure of the air, Avhich is affected by moisture or dryness, but by other causes also. Other things being equal, low barometer attends dampness of the atmosphere; but this may be modified by the temperature, etc. At sea, a rapid fall of the mercury in a barometer generally portends a gale. The loAvest barometer of Avhich I have found record AAras during a typhoon in the Chinese Sea, in September, 1869, 27.62 inches; the highest Avas observed at Milwaukee, Wis., in January, 1866, 31.23 inches. Comparing Great Britain and Ireland, in regard to climate, Avith parts of North America in the same latitude, Ave find a considerable difference in temperature. In fact this is true all the Avay along the Avest side of Europe, as compared Avith the Eastern States of North America. Philadelphia has an annual mean temperature of 52° or 53° ; Naples, in about the same latitude, 62° Fahr. From Norway to Spain and Portugal, Europe has a milder climate. This is easily explained. The Gulf Stream accounts for it. By it Ave mean that great ocean-current Avhich navigators have knoAvn ever since Columbus dropped into it Avith his three ships, and thus got across the Atlantic, as otherAvise he might not have done. Another Aveek of sailing Avithout land, and then his sailors Avould probably have throAvn him overboard, and reversed their course. Moving westward, from the African shores, this majestic current sweeps across the Ocean. Reaching the northern coast of South America, it enters among the West India Islands, penetrates betAveen the North and South continents as far as the Isthmus of Panama, and there rebounds, so to speak, in the Gulf of Mexico. Thence it comes out (taking its name from that gulf) and moves eastward to the north of the path by Avhich it arrived on our shores. North-eastAvard soon becomes its main direction; and, Avith waters Avarm from the tropical south, it beats upon the coasts of Ireland, making it the " Emerald Isle;" upon England, Wales, and Scotland, giv- ing them a softened Avinter, never Avholly desolate; and upon France, Spain, and Portugal—all lands of vines, oliA-es, and floAvers, gifts of its bestoAval. For, prevailing winds have a similar course to the ocean-currents to a great extent. We have seen hoAV at the shore a "sea-breeze" com- 212 HYGIENE. monly bloAvs at noon-day from the cooler ocean upon the hotter land, this being reversed at night. Noav, in Hindostan, Avhen it is summer in Asia, all the land becomes Avarmer than the Indian Ocean, south of it. For half the year, therefore, there bloAvs the southern monsoon, a strong Avind towards the north. Then, Avhen it is winter in Asia, the northern monsoon bloAvs from the colder Indian lands toAvards and over the Avarmer Southern Sea. The tradc-ivind is that Avhich bloAvs almost steadily from east to Avest in the equatorial regions of the earth. As the lands near the equator receive the most direct rays of the sun, they are ahvays hotter than the polar regions. Therefore (as already explained), from the cold Arctic and Antarctic zones cold, heaA^y air moves toAvards the middle tropical belt; that is, from the North Pole soutlnvard, and from the South Pole northward. But the Avorld is rotating on its axis from Avest to east; and as the outer rim of a Avheel moves around much faster than does its hub, and at its centre there is no motion at all, so the rate of move- ment is much more rapid at the equator than near the poles. AVinds bloAving toAvards the equator are therefore left behind by the onrolling mid-earth; the effect of this being the same as if the earth Avas still, and the Avind bleAv from east to west along the equator. This westward Avind is the trade-wind. Meeting the continents in its course, it is made to vary considerably; but it is the prevailing Aviud' of the tropical regions. Brazil has such a Avind, bringing from the Atlantic the moisture which makes for it a forest-growth, the most luxuriant in the world. But this Avind, striking the Andes, is robbed of all its vapor, and thus Peru, west of the moun- tains, is (as before said) rainless. Since air, like water, seeks its OAvn level, there are return winds attending the trade-wind, one north and one south of the tropical region; blowing, the one north-eastwardly, and the other towards the south-east. It is the return wind that passes the Rocky Mountains of North America, and, being thus stripped of moisture, makes a barren land on the east side of those mountains. Both the Gulf Stream and the return (anti-trade) wind, then, conspire to make the crossing of the Atlantic from the United States to England or Ireland shorter in time than that from England or Ireland to Amer- ica, in the same latitude. In the Pacific Ocean the equatorial current and trade-wind move westward, as in the Atlantic. There is also a return ocean-current, the Kuro-Snvo, and a return wind, going from Eastern Asia over to TfW- ern J\0rth America. Thus Alaska, like Western Europe, has its coast climate softened very much. As a rule, it may be said that in both CLIMATES. 213 Annual Mean. . 80° Fahr. . 65° a . 60° u . 50° a . 40° a . 32° a . 0° a hemispheres the western sides of the continents are warmer than their eastern shores. For the same reason, they are more moist and better Avatered. Kinds of Climates. Torrid Warm Mild Temperate Cold Frigid Polar Perhaps the hottest torrid climate in the Avorld is that of Thibet, in Southern Asia. There at mid-day the sun may raise the thermometer to 150°; yet at night the earth cools doAvn sometimes as Ioav as the freezing-point. Other torrid lands are Senegal, Guadaloupe, Persia, and Southern Africa. Iu Cape Colony the summer heat in the shade may reach 105°. Syria, Arabia, Egypt, the Isthmus of Panama, Guiana, Columbia, Brazil, aud Paraguay are all hot countries. In them (except Egypt) there is a rainy season of about fhTc months' duration. North of the equator, near the tropic, there is usually a spring-like season from November to February; then, from February to May, the dry season; from May to July, variable, Avith storms; and from July to November, the rainy season. The highest summer heat in the United States, 113° in the shade, occurs in Texas, and near Fort Yuma, in Southern California. 107° has been noted at St. Louis; 103° at Washington; 100° in Philadel- phia. The greatest extreme range is probably in inland Alaska. At Fort Yukon, the temperature reaches 100° in the sun during the sum- mer, and falls to 50°, sometimes 70°, beloAv zero in Avinter. For the coldest temperature anyAvhere, one author (Cameron) asserts that 92° beloAv zero Fahr. has been observed in 55° North latitude. Others mention —74° as recorded at Melville Island in the Arctic region. The highest latitude at A\rhich human beings live was found by Sir John Ross, an isolated tribe of savages (Eskimo) at 75° N. At Bangor, Maine, the thermometer has marked —40° ; at Quebec and in Manitoba, still loAver; Hartford, Conn., —20°; St. Louis, —18°; Philadelphia, —14° to —16° ; possibly once —17°. But the extreme range is not all that determines the character of a climate. Its changeableness, and the frequent suddenness of great changes in heat and moisture, make our American climate more trying to the health than that of Europe. 214 HYGIENE. The amount of rain, the general dryness or dampness of the air, and the number of rainy and cloudy days, are all important. Taking Eovpt and the rainless part of Peru as at one end of the scale, differ- ences exist in various parts of the world, all the way up to the state of thino-s in Vera Cruz, Mexico, where the mean amount of rainfall for a year°is 183 inches; and Avhere once, in 1857, 342 inches fell in 24 hours; Maranhao, Brazil, 280 inches; and Chcraponjee, in India, where in one south-west monsoon, 605J inches (nearly 17 feet) fell. Southern Australia, without many rainy days, has 92 inches of rainfall in the year. These great outpourings generally occur during a season of rain ; the rest of the year in the same place may be almost without any. On the other hand, England, round about London, has an average of about 170 rainy, and many more cloudy, days in a year; yet the rain- fall in Southern England is but 20 inches a year, not half of that of Philadelphia.* In the latter city our rainy and cloudy days are but a fraction of those of Southern England. The Lake country, in the north- west of England, has much more rain, and some 200 rainy days in the year. The Stye, a wild pass among the English Cumberland Moun- tains, is the Avettest spot in Europe. Over 240 inches of rain have fallen there in a year. At Joyeuse, in France, 31 inches fell once in 24 hours; at Gene\^a, SAvitzerland, 30 inches in the same time; at Gib- raltar, 33 inches in 26 hours. The average in France is about 30 inches; in the lowlands of Germany, 20 iuches; certain parts of Russia have but 15 inches of rain in a whole year. Humboldt estimated the aver- age for the equatorial countries as 96 inches. For the United States, the extremes are a part of Louisiana, 68 inches, Oregon, 60 inches; and Fort Yuma, California, only 3 inches in a year, besides the almost or quite rainless region, a part of Avhich is in >>e\v Mexico. In Alaska, there are about 200 rainy days in every year. Comparing the Eastern and Western continents together, the tropi- cal average in the Old World is (according to Guyot) 77 inches, and in the NeAv World, 115 inches. In temperate climates, 34 in the Old World, and 39 inches* in the NeAv World. Our Western hemisphere is the Avettest side of the globe ; and this makes it the greenest side also. Ours are the great forests of North and South America; the vast bloom- ing prairies of the Western States; our Mississippi, Ohio, Hudson, DelaAvare, Orinoco, Amazon, and other magnificent rivers ; and a pro- ductiveness which now sends grain and meat in abundance to feed the mother countries of the Old World. Certain general facts or laws concerning rainfall are these: 1. n * The average annual rainfall at Philadelphia for 57 years has been 45.19 inches. f For every T^ of an inch measured by the rain-gauge, a ton of rain falls on everj acre of ground. CLIMATES. 215 decreases in quantity from the tropics toAvard the poles. 2. It de- creases as we pass from the seaboard toAvard inland countries. 3. It is less, in the temperate zones, on eastern than on western coasts; in the tropics it is the reverse. 4. More rain falls in mountainous than in levrel countries. Can man change the climates of any of the regions which he inhabits? As to temperature, it seems, from long continued and recorded observa- tions, that he cannot. In regard to rainfall, there is reason to belieAre that he can, and does, to an important extent. In the Canary Islands, Syria, Persia, Belgrade, and Hauran, near Damascus, the destruction of forests has been followed by diminution of rain and consequent barrenness of the lands. When, at Belgrade, speculators Avere acting upon contracts to cut doAvn all the Avoods, the reservoirs of Constantinople began to fail. Again, in India and Lower Egvpt, the planting of large numbers of trees has been rewarded by increase of rain in those countries. A beginning of the same result has attended tree-planting along the edge of the "Great American Desert," east of the Rocky Mountains. Forests, by their shade, prevent the too rapid heating and drying of the ground by the sun and Avinds. While they aid in draining an over- damp soil, they detain a large amount of moisture, which gradually finds its Avay to neighboring streams. Evaporation from the leaves of trees also goes on continually, and \Tapors arising thence are cooled in ascending, and fall in rain, instead of being carried away by the Avinds to a distance. For a large country, such as the United States, the amount of rain falling has been shoAvn to be nearly the same, taking a number of years together, through long periods; the difference made by the causation above mentioned extends to its distribution among the different parts of the country. Also, the destruction of forests makes the rainfall more irregular. Great droughts, folloAved by floods that wash aAvay bridges and raihvays, even sometimes almost drowning villages or tOAvns, are more frequent no\v in Eastern Pennsylvania and elseAvhere in this country than they were fifty years ago. All through our States and Territories Avasteful destruction of forests is going on. Very Avisely, scientific and practical men, with encouragement from the gov- ernment, are doing what they can to stop this, and to promote instead the planting of new trees in many places. Excess of dampness in the soil of inhabited places promotes malarial and other diseases. To some extent, under-drainage can be used to improve such localities. Some kinds of trees help this in their growth. The eucalyptus, or Australian gum-tree, an extremely rapid grower, 216 HYGIENE. has proved its value in this Avay by lessening greatly the unhealthincss of a part of the Roman Campagna. Our Southern Pine also is an excellent tree for natural soil-drainage. What are the comparative effects of different climates upon living beings ? The most favorable for plants in their highest and most varied development are the maritime tropical climate of the East India Penin- sulas and Islands aud the tropical oceanic climate such as exists in Brazil. Heat and moisture are the great fostering conditions of vegetation. Heat, unaided by much of the watery element, has somewhat, though less, of the same influence. Thus, in the Indies, says Guyot, in his admirable book ("The Earth and Man"): " What mighty, what ad- mirable vegetation ! We see at the same time plants Avith broad and numerous leaves, the excessive expansion of Avhich is always the proof of an exuberant humidity; and those shrubs Avith concentrated and elaborated gums, those spices, those aromata, that bear Avitness to the dry and intense heat of the continent. There is the country of the mighty Banian, the symbol of vegetable strength. There uplifts its head the majestic Talipot palm, a single leaf Avhereof, sixteen feet broad and forty feet round, is enough to give shade to a score of men at once; and in the bosom of those virgin forests grow the largest floAvers in the world, the Rafflesia, Avhose gigantic corolla alone measures no less than three feet across. There groAv the cinnamon, the nutmeg, the pepper, aud the cloves, Avhich all civilized nations have fetched thence from time immemorial." South America, east of the Andes, combines the warm and moist together in abundance. Let us again quote the same Avriter: " Behold, under the same parallel, where Africa presents only parched table-lands, those boundless virgin forests of the basin of the Amazon, those selvas, almost unbroken, over a length of more than 1500 miles, forming the most gigantic Avilderness of this kind that exists in any continent. And Avhat vigor, Avhat luxuriance of vegetation ! The palm trees, Avitli their slender forms, calling to mind that of America itself, boldly uplift their heads 150 or 200 feet above the ground, and domineer over all the other trees of these Avilds by their height, by their number, and by the majesty of their foliage. Innumerable shrubs and trees of smaller height fill up the space that separates their trunks; climbing plants, woody-stemmed training lianos, infinitely varied, surround them both Avith their flexible branches, display their OAvn flowers upon the foliage, and combine them in a solid mass of vegetation, impenetrable to man, which the axe alone can break through Avith success. On the bosom of their Avaters swims the Victoria, the elegant rival of the Rafflesia, that odorous and gigantic Avater-lily, Avhose white and rosy corolla, Fig. 126. POISON-TREE OR UPAS OF JAVA, AVITH THE FLOWER OF RAFFLESIA IN THE FOREOROU.VI). CLIMATES. 219 fifteen inches in diameter, rises with dazzling brilliancy from the midst of a train of immense leaves, softly spread upon the Avaves, a single one covering a space of six feet in width. The rivers rolling their tranquil Avaters under verdurous domes in the bosom of these boundless wilds are the only paths nature has opened to the scattered inhabitants of these rich solitudes." North America, outside of the tropics, dii-plays a less lavish Avealth of vegetative development. Yet, with forests, prairies, and well-wa- tered lands, it has become, under cultivation, a land almost "floAving Fig. 127. VICTORIA REGIA. with milk and honey." It has also its sky-pointing giants and Avide- spreading. trees: noble oaks, chestnuts, walnuts, maples, and, above all, the ancient and famous red cedars (Sequoias) of California. These "big trees" have, in their long-past prime, reached more than 400 feet in height, and some of them measure over a hundred feet around their trunks. For animal life the same conditions, heat and moisture, are beneficial; but not exactly in the same proportions. A continental Avarm climate abounds most with the great beasts of the world. Asia and Africa 220 HYGIENE. have native to them the Elephant, Rhinoceros, Hippopotamus, Lion, Tiirer, Camel, Camelopard, Buffalo, and great as well as smaller Antelopes. America names as its largest species the Bison, Grizzly and Polar Bears, the Moose and Elk, Puma and Jaguar. Highest, in some respects, of all animals beneath Man, are the great Apes, Gorillas, Oranos, aud Chimpanzees of the Old World. Our South American Monkeys and Marmosets are all inferior to these in size and intel- ligence. But, in the loioer species of animal organization, the moist and lealy New World, in its tropical part at least, if it does not excel, at least rivals the luxuriance and splendor of the Orient. Humming-birds, brilliant as rubies or emeralds, all of them American, cannot be called low in rank, although so small; and nowhere are there more brilliant Butterflies, Beetles, Fire-flies, and other insects than in South America. Our serpent fauna culminates in the enormous Boas (Anaconda, the most famous), sometimes twenty or thirty feet long; one of which will swallow a young heifer, slowly, whole, for a meal! Many other ser- pents, both venomous and harmless, as well as creatures of still inferior grade, are numerous in the damp, shady forests, rivers, and swamps of A merica. Man himself Avas first (there is no room for doubt) a creature of the Old World. But his laAV of development and perfection is not the same as that of the rest of the organic world. Man is not merely an animal, although he shares the animal nature in subordination to his higher being. The laAV which affects his distribution and elevation in the world is, as Professor Guyot says, " of a moral order." While, then, the vegetable and animal kingdoms are at their highest perfection in kind, number, and variety in tropical and subtropical countries, yielding gradually in all respects as Ave pass from the equator towards the poles,—the strongest, noblest, and most cultivated races of men are found dAvelling in the temperate regions of the earth. Originally, Man Avas subtropical. Eden lay in Western or South- western Asia. But, as the race degenerated, the ease of living without effort in the lap of nature enervated his higher powers. Like Samson with Delilah, he Avas shorn of his best strength. True, there were great empires, arts, and civilizations once, in and near the tropical countries: Egypt, Assyria, Babylonia, Persia, India ; but all, long ago, perished. "Assyria, Greece, Rome, Carthage, where are they ? " Xow, the foremost nations of the world belong to the old Aryan stock in its Teutonic, Celtic, and Italic branches: Europeans or Euro- Americans. If Ave leave Europe, and travel southwards across the Mediterranean, Ave come to Berbers, Algerines, Tunisians, Egyptians, Fig. 128. GIGANTIC CEDAR OF CAIIFORNIA. IVellingtoiiia GUjaatea. PORTRAITS OF FEMALES OF A'ARIOUS RACES. L Negro iW. Africa); 2. Barolong (S. Africa); 3. Hottentot; U. Gilyak (N. Asia); 5. Japanese; 6. Colorado Indian (X. America); 7. English, CLIMATES. 223 none of them equal to the populations of Southern Europe in physical, intellectual, or moral development. Beyond these are other semi-bar- barian tribes, deepening in color, and mostly in savagery, all the Avay to the centre of Africa, as yet but partially explored. Farther yet south come Caffres, Hottentots, Bushmen. South Africa is, by colonization from Europe only, rescued from total barbarism. XortliAvard, it is true, climatic conditions are too severe for man's best advancement. Amid sub-polar suoavs the struggle for life against inclement nature is too hard. Stunted races are there,—Eskimos, Kamtchatdales, Samoiedes, Yakutski, Lapps, and Finns. Neither extreme of poverty and desolation, nor of luxurious redundance, most favors man's best advancement. In the temperate climates are met enough occasions for arduous toil, enough of exposure, enough of con- flict, to draw out and train manhood and Avomanhood to their highest aud strongest maturity. Temperate climates have, since their first outstart from the ancestral cradle of mankind, been the home, through all their migrations, of the Teutonic race and nations. Entering Europe north of the Caucasus, they spread along the course of the Danube to the countries where the German language in its different dialects is noAV spoken; and farther, into the lands of Scandinavia: Denmark, SAveden, Norway. Angles, Jutes, and Saxons conquered England; Normans, France; then William the Conqueror concentrated the energy of his race in that island which Avas to become the centre of a Avorld-Avide empire. Our English tongue, essentially half Saxon and half Latin in its origins, is a perennial Avit- ness to the main facts of this long and Avonderful history of a ruling race. And through its language, if not otherAvise, that race appears to be destined yet to conquer or possess the Avhole world. Let us hear Avhat an American scholar says of this: * " Conqueror of the Roman Empire, and the legitimate inheritor of its glory, the race of Teutons has sent its sons broadcast over the earth, and has its offshoots, as flour- ishing communities, on every continent." " We are in this land to-day the representatives of a civilization Avhich has never lost a foot of soil to Avhich it has been transplanted, nor yielded by force of arms to any rival or competitor for supremacy; for wherever Anglo-Saxon domina- tion has been carried, there it has been permanently established." Another question : Can an individual or a race become, Avithout loss of health, entirely naturalized, acclimatized, in a climate entirely differ- ent from that of his or its nativity? This invokes the inquiry, Are all races of men of one common ancestral origin ? If they are, it has * Professor Joseph Carson, of the University of Pennsylvania. 224 HYGIENE. been proved already by the facts of history that branches of the human family have been, and therefore may again be, gradually adapted to the conditions of any part of the globe (except the poles) so as to live upon it for many generations, nay, for centuries. Thirty years ago a very lively controversy Avas carried on amongst scientific men as to whether the so-called Caucasian white man, the red American Indian, yelloAV Mongolian of Asia, and African negro, are or are not of one blood, of common origin, one species. Apart from the usual interpretation of the account in Genesis, the greater number of leaders in science* were, and uoav are, well satisfied, by several kinds of proof, that all races of men, of every complexion and language, as well as of every continent, have descended from the same stock: there is but one species, Man. HEAD OF APOLLO BELVEDERE. CHINESE. Evidence of this is derived: 1. From the likeness of all races in bodily structure; in their anatomy and physiology. Color is a most secondary thing; there are fair blondes and dark brunettes with light, medium, and black hair, in the whitest of races. 2. In the productive- ness of marriages among all the races. Mixed races are as durable as those of the purest separate stock. This is not the case (amongst animals or plants) with hybrids of different species. 3. Iu mind, all are human, and nothing else. Our Saxon ancestors were very far down in im-civilization. As they and Ave have risen, so may others, now savage, rise. All the faculties Ave have belong also to them. 4. Many other sorts of animals show greater diversities among the descendants oi *For examples: Linnaeus, Cuvier, Alexander and William Humboldt, Richard Owen, Huxley, Sir C. Lyell, Dana, Quatrefages, Max Miiller, and Sir J. Lubbock. CLIMA TES. 225 the same stock. DarAvin, in his book on the " Origin of Species," dwelt on this in regard to the varieties of pigeons. All dogs likewise—NeAV- foundland, Shepherd's dog, Bull-dog, Greyhound, Terrier, Lap-dog, and the rest—are knoAvn to be of one species. So are all horses and all cattle, various as they are in size, shape, color, and other qualities. 5. History traces the migrations of all mankind back towards, if not to, Western Asia. When history loses the track, tradition follows it on, though in the twilight of the past. 6. Common traditions of peoples in all the continents, differing in everything else, are so alike that it Avould seem they must have all derived them from the same original source. Such are: the belief that mankind have descended from one first created pair; that, because of their sins, all Avere destroyed by a deluge except one pair or family; a belief in the virtue of sacrifices to Fig. 131. Fig. 132. INDIAN WARRIOR. A KAMTCHATDALE. appease offended Deity; and also in the coming, past or future, of a Divine deliverer assuming the form of man. All these have been found by the first explorers of neAv regions in Asia, Africa, and Amer- ica, as Avell as in Europe. 7. Language alone gives facts almost enough to settle the question. With all the varieties of tongues over the world, enough is possessed in common by them all to make one origin a neces- sity. 8. But the most influential argument Avith those Avho travel much is the fact, that all the races grade into each other. There are noAvhere sharp dividing lines. Some persons suppose that all Africans are Negroes. Yet probably not more than one-fourth of the inhabitants of Africa are such. Egyptians are not Negroes; neither are Nubians nor Abyssinians; nor Berbers of the north, nor Caffres nor Hottentots of the south. So gradations occur in Asia also; and, of course, in Europe the differences make no one imagine difference of race origin. 15 226 HYGIENE. All over America, Indians are so much alike that Dr. Samuel G. Morton, who studied them with great labor, concluded that they, at least, must all have come of one stock, although he did not believe this of the races of other continents .* Concluding, then, Avithout hesitation, that all mankind are of one family, it follows that acclimatization in any place already inhabited must be possible. It may, however, be sIoav and difficult, and in certain cases may not succeed. Some English people assert that our American population, coming originally from Europe, are so unfitted to a Western climate as to be degenerating here; that we are all by degrees " turning into Indians." We, on our side, do not see this. Population increases in the United States (besides immigration) faster than in any European country. Fig. 133. Fig. 134. MOZAMBIQUE NEGRO. FEMALE BUSHMAN. Statistics taken during the Civil War showed that the average height and Aveight of men (especially in Kentucky and Tennessee) are some- what above those of England, Scotland, Ireland, or Germany. What nation can produce a man who will lift more than our Dr. Winship — over 2000 pounds? Our Harvard oarsmen, Creedmoor rifle-teams, and Philadelphia cricketers, as examples of activity and skill, if not ahvays victorious abroad, at least have proven their fair equality with our British cousins. Intellectually, within a couple of generations, Avhile they, in statesmanship and oratory, have had them Gladstone and Bright, we have had Webster, Lincoln, and Garfield. In poetry, Bryant, LongfelloAv, and Whittier rank well Avith the English laureates. As historians, Irving, Bancroft, Prescott, and Motley have * It is proper to mention that L. Agassiz, Prof. Leidy, and a few other noted scientific men, have doubted or denied the common origin of all races of men. CLIMATES. 227 had no superiors. So in art, Avith our Powers, Story, Church, and many others. In invention, America leads the world. The Patent- Office at Washington is a mechanical Avilderness of materialized brilliant ideas; a fair proportion of Avhich are practical and useful. ToAvards the relief of disease and suffering, Avhile Europe has gi\ren the world vaccination to control small-pox, America has originated anaesthesia (by ether or nitrous oxide) to make operative surgery painless. We, as a race, are not degenerating. Instead of that, the composite character of our people, made up of Anglo-Saxon English, Celtic Scotch, Irish and French, old Teutonic Germans, Swedes, Norvvegians, and Danes, Italic descendants of South Europe, besides a contribution from Eastern Europe, and some, though less important, from Asia, Africa, and the far-off islands of the Pacific,—this makes all the qualities of the nations to mingle in our blood, as the Avealth of the Avorld's four quarters is gathered into our garners and storehouses. Guyot has well sliOAvn that, as Asia Avas physically suited to be the cradle of our race, and Europe man's school and gymnasium for training and development, America is to be the arena for the largest, freest, fullest exercise of all his powers. " Westward the course of empire takes its way." It is true that some special bodily and mental characteristics are pro- moted by our climate in Avays not easily understood. Brother Jonathan is leaner and longer-faced than John Bull; the caricaturists are right in that. Typical Americans, such as Henry Clay and Abraham Lin- coln, not rarely exemplify it. Our national temperament is excitable; in this more Celtic than Anglo-Saxon; but we hold on hard, like the latter, in our grip. There is more quick movement in a stock-exchange, a prayer-meeting, or a lunatic asylum, in one hour in America than in two or three days in England or Germany. Some one has said that the American has " blood of fire coursing in veins of ice." All this, however, is no sign of inferiority; it marks the triumph of mind and race over conflicting circumstances. Our continent had to be conquered; during the warfare, hardihood and alertness have been specially de- veloped. Refinement may, and will, come later. America affords no instance of the impossibility of successful acclimatization. Again, India, it has been predicted, will be the grave of the English race,—a costly though splendid conquest and possession. Many official , and commercial British residents in India have shortened their lives there, and feAV have raised healthy families. But, why ? Not only because they go from a temperate to a tropical region. Also, they have taken their home habits there. Not good for them in England or any- where else, their wine, beer, and spirits are far more destructive under 228 HYGIENE. the equatorial sun. Moreover, India has many umvholesoine local conditions (making it the startiug-place for epidemic cholera) Avhich are removable. Florence Nightingale, one of the Aviscst of sanitarians, is no doubt right in her belief that India in most parts can be made, with prudent habits, habitable for Englishmen. It is simply necessary for this that they be, like their climate, temperate, and that they instruot and lead their Oriental subjects in local sanitary improvements. Accepting it as certain that all races, black, red, yellow, and white, are of the same original stock, Ave find complete acclimatization estab- lished in the African negroes. Their present climate, especially in Western tropical Africa, is a deadly one, with its fevers, to Europeans or Americans. Negroes do not suffer from malarial fevers, scarcely from vcIIoav fever. This immunity, like their dark skin and woolly hair, is the groAvth of many centuries. As to yelloAV fever, they lose someAvhat of their security in a few generations of residence in our Southern States. So, in the Northern States, they lose by degrees (even Avithout mixture of blood) a good deal of the deep tropical shade of complexion. There are feAV really black people uoav in the North; more in the Gulf or Cotton States; many more in Central Africa. Diseases of warm climates are essentially those of the hot season in temperate regions: affections of the stomach, boAvels, aud liver, besides endemic and epidemic fevers. Those of cold climates are predominantly disorders of the breathing organs and typhus fever, with those also Avhich are not specially under the influence of climate, as diseases of the kidneys, heart, brain, etc., typhoid fever, small-pox, diphtheria, and other contagious affections. Malarial diseases (fall and spring intermittent and remittent fevers) are worst in certain, though not in all, hot countries. But they prevail also in some Avarm temperate regions; their limits being pretty far north, farther in that direction in Europe than in this country. Early in the settlement of NeAv England, chills and fevers Avere not rare there, Gradually they disappeared for a long period. Noav within a few years a considerable number of instances of genuine malarial fever have oc- curred iu the valley of the Connecticut River. The United States may be, for climatic comparison, divided into three great districts: 1. The Atlantic, from the eastern coast to the Alleghany Mountains. 2. The Middle, from the Alleghanies to the Rocky Mountains. 3. The Pacific, from the Rocky Mountains to the ocean shore. Observation by medical officers of the army, through a number of CLIMATES. 229 years, has given an estimate of the mortality of these three districts as folloAVS: Middle region, much the greatest; next, the Atlantic; least, the Pacific region, Avest of the mountains. The cause of this difference is the large amount of malarial disease (fevers aud connected disorders and their results) in the Valley of the Mississippi. There is also a considerable prevalence of such diseases in the Atlantic region, and none in the Pacific. YelloAV fever (though irregular iu its visitations and malignity) belongs to the southern parts of the Atlantic and Middle, not to the Pacific, division. According to the United States Census,* Ave have the folWing dis- tribution of the greatest mortality from some principal diseases: Consumption: Parts of Maine, Virginia, Tennessee, Kentucky, Ohio, and Indiana. Malarial Diseases : Northern Florida, Eastern South Carolina, South-eastern Texas. Bowel Disorders: South-eastern Mississippi, Central Michigan, and the borders of Western IoAva and Eastern Nebraska. Typhoid, Typhus, and Cerebro-spinal Fevers : South-eastern Georgia, Eastern Mississippi, northern part of South Carolina, Eastern Missouri, and Central Minnesota. Besides the deficiency of exact reports from several places included in this statement, changes of population and sanitary improvements (or the reverse) may make considerable differences from time to time. YelloAV fever, Avhich has in some years been terribly destructive in NeAV Orleans, Memphis, and other Southern cities, bids fair to be more and more excluded; not by " shot-gun," or any other rigid quarantine, but by so improving the drainage, seAverage, Avater-supply, and cleanliness generally of the fever-nesting places, that the fever can get no foothold anyAvhere. Man, as Ave ha\re seen, is, by reason of his intelligence, cosmopol- itan,—a citizen of the Avhole Avorld. Borrowing the furs of the bear, seal, deer, and buffalo, and using the forest- and mine-fuel, or, far north, the fat of animals for burning, he defies polar cold. With prudence, also, he can exist under tropical heat. No other earth- creature can do so much in enduring all climatic changes; only some of his companions, either chosen or unwished-for, approach him in it, as the dog, cat, ox, horse, sheep, goat, rat, and mouse. Best climates in the Avorld for health are those Avhich are not extreme, * Imperfect registration in many places causes these returns to be only an approxi- mation to the real facts of comparative mortality. 230 // Y GIENE. and are equable, without sudden changes. Cool temperate, and warni temperate regions both afford such situations. A rather high locality in a subtropical latitude must be the perfection of climate. Such Avas, according to many converging lines of proof, alike of history, tradition, and language, the Eden birthplace of humanity. What is the best climate for consumptive persons to live in ? Our first ansAver must be Avhat has just been said above; moderation and equability are the most essential requisites. But, farther, shall it be cool or warm, high or Ioav, dry or moist, among the hills, or by the side of the sea ? Again, it may be said that the needful qualities are to be found, more or less completely, under any and all of these con- ditions. The least number of deaths from consumption in this country occurs probably among the natives and life-long residents of New Mexico; but feAV people Avant to live there. According to the statistical figures, there is a sliding scale of consumptive mortality in Europe and in this country corresponding Avith elevation above the sea-level; the lowest regions have most, and the highest least, of such mortality. But is not this almost exactly the scale, also, of thickness of population'? Baudelocque in France, McCormack in Great Britain, and Parkes for the British Navy, have shoAvn that closeness of living, breathing bad air in-doors, is a very great promoter of consumption and allied dis- eases. Also, BoAvditch in this country and Buchanan abroad have proATed a similar promotive influence in dampness of situation of dwell- ing-houses. Mode of living, then, is of consequence as well as actual locality. Out-of-door life as much as possible is best for the consump- tive, and dryness of his dvvelling, with sufficiency of clothing, is indis- pensable. On the whole, Ave may expect that those climates Avill be most favorable for lengthening the consumptive's life in which he can remain out of doors Avithout risk of injury the greatest number of hours through the greatest number of days in the year. Let us see Avhat places are most famous as resorts for patients with consumption. These are for Europe : Davos, in SAvitzerland; Biarritz and Pau, of the Pyrenees, as mountain-places; Mentone, Sorrento, Capri, and Malta, near or in the midst of the sea. Africa furnishes Algeria for the year round (according to French medical authorities), and Egypt for the Avinter season. The island of Madeira was formerly a favorite place with invalids. In our Western hemisphere the opinions of physicians and sanitarians are someAvhat divided about the comparative value of different localities of refuge for consumptives. The Adirondack Mountains, Minnesota, CLIMATES. 231 Colorado, Florida, and Southern California are all recommended, and each has ansAvered Avell for a certain number of persons. No one place is sure to agree with all. At Anaheim, in Southern California, there has been found an average sum of eighty-one fair days through the months of December, January, and February. Meutone, during the same months, averages sixty-seven fair days; Davos, SAvitzerland, fifty-four; and Aiken, South Carolina, about as many, in which an invalid can be out of doors all day long. The mean temperature for the winter months at St. Augustine, Florida, is a little over 60° Fahr.; Anaheim, 61°; Aiken, 53°; Mentone, 48J°. San Diego, Santa Barbara, and San Bernardino, in Southern California, are much praised by residents and visitors for their salubrity. Nassau, on one of the Bahama Islands, has a very mild and equable climate through the year. Probably the best thing for a consumptive in this country, if well enough to leave home at all (an important question in each case), is to migrate, like the birds, according to the season. If he be a dweller in an Eastern State, and can afford it, let him camp out in the Adirondack region, or live still more at ease in NeAvport, Rhode Island, from June to October; then let him Avinter, from October till May or June, in Florida. Should his home be Avest of the Mississippi, let him summer in Minnesota, and spend the winter months in Southern California. But it must be here urged that no one in the last exhausted stage of pulmonary consumption (or, of course, of any other disease) ought to travel anywhere. One Avho is clearly near his end had better remain to die amid the comforts and consolations of his home. Earlier in that often very sloAvly progressing disease, much is gained, in a great many cases, by a change to a milder climate than that of our Northern States for the Avinter months; with recovery in a feAv instances, prolongation of life in a greater number; some relief or mitigation of symptoms in nearly all. Recorded Temperatures for Oxe Year, San Jos£, California. Month. Deg. 6 a. m. Deg. 12.30 p. m. Deg. 6 p. m. June ..... 52.40 77.03 60.40 July 55.32 81.87 64.84 August . 53.16 83.17 64.84 September 55.63 79-68 65.16 October . 46.38 74.68 63.06 November 34.40 56.77 52.30 December 36.61 53.63 45.26 January . 36.68 54.42 48.00 February 38.93 58.32 48.61 March 39.99 62.58 51.29 April 50.37 69.23 54.00 May 48.26 69.90 54.97 232 HYGIENE. FOOD AND DRINK. One of the founders of the Academy of Natural Sciences of Phila- delphia, Thomas Say, so begrudged the time taken in eating his meals, as to Avish that he Avere made Avith a AvindoAV in his stomach, so that he could put in a day's supply all at once, and be done Avith it. But if that Avere so Avith us, probably the busy naturalist and some others would occasionally forget all about it, and let the body run doAvn for Avant of food. We are more Avisely created. Hunger and thirst remind us of our needs. Naturally, Ave desire food about three times every day; at least tAvice a day Ave must have it, or suffer in health and strength. Why must Ave take food so often ? Because change is the law of life. No particle in our bodies in old age is the same as Avhen Ave Avere born; much of our substance has altered a little even since yesterday. It is not true that all of the body is reneAved once in seven years. Our bones are neAv groAvn entirely only after long periods; the enamel of the teeth, once lost, is never formed again; Avhile the outer covering (epithelium) of the skin is being shed in scales, like tiny leaves, all the time, and our blood is undergoing hourly, momentary changes. We are, as is said in Genesis, made of the dust of the ground. The elements of "mother earth" are the very same as those of our bodies. These elements climb through vegetable life into a condition higher than that of the mineral kingdom, and then animals transform them into their own substances, and after a time, having used them for the purposes of their organs, throw them out again. This is the perpetual round or cycle of nature. What do plants live on? Chiefly Avater, carbonic acid, and ammonia. On Avhat do animals liA'e? Plants. Carnivora in eating each other do the same, only in- direct! y, secondarily. What are the results and products, the " smoke and ashes," of animal life? Ammonia, carbonic acid, and Avater. So every particle rises from the earth, as drops of Avater asceud in the fountain; after reaching its highest state, it soon begins to descend, and falls again " to the earth as it avus,"—dust unto dust. Every auimal, then, must have food; but how various their diet! Our domestic animals instinctively show this. The ox broAvses and chews the cud; the dog and cat tear and bolt raAv flesh; the hog is content with either kind of food. Wild animals likeAvise differ: the birds and beasts of prey tear their victims with teeth and claAVS, while deer, antelopes, and camels consume only vegetable food. Some eat the grass and herbs at their feet; the tall giraffe breaks off leaves and FOOD AND DRINK. 233 tAvigs of trees. Ducks a^id eeese find nourishing things in mud and Avater; king-fishers, pelicans, and cormorants seize and devour fish. The big, ugly hippopotamus feeds on fish by day, and at night steals ashore to consume herbage on the river banks. Some birds eat worms or flies; others grains or fruits; many both. The humming-bird lives on honey and insects, his long tougue being usable either as a sucking- tube or as a pair or nippers. Bees take for food both honey and the pollen of floAvers. Certain animals, mostly small, live in or on the bodies of others: parasites. Human beings are so inA'aded by round worms, tape-worms, trichinae, and others. But the smallest creatures do not escape such attacks. Silk-Avorms and flies are beset by tiny, destructive enemies. Prof. Leidy, Avith his microscope, has sIioavii that parasites themselves suffer from parasites; thus making almost true the doggerel: " Great fleas have little fleas, and these have fleas to bite 'em; And these again have lesser fleas, and so ad infinitum." Many animals, large aud small, are Avood-eaters: elephants, bea\Ters, some larvae of beetles, the teredo (enemy of the dikes in Holland), and white ants, for examples. In tropical climates, white ants (termites) attack houses in such numbers as to eat out all the interior of posts and beams, leaving them ready to fall Avith slight shocks. Even camphor scarcely protects our garments and carpets from clothes- and carpet- moths. In the sea are stone-borers (Pholades and Modiolae), Avhich, Avith their shells, can wear away solid columns. The famous temple of Serapis at Pozzuoli, in Southern Italy, bears Avitness to this in its pillars half submerged on the margin of the sea. One insect-grub (Sirex giganteus) has been knoAvn to gnaw leaden bullets in soldiers' cartridges; another (Cetonia) to pierce the leaden coverings of house- roofs. Blood-suckers are the mosquito and the vampire-bat; of the latter, extravagant stories are told: it does not often suck human blood. Sap-suckers upon plants and trees are the aphides (ant-coAvs); the birds of that common name (sap-suckers) pierce branches only in pursuit of worms or grubs. Literally, it is true that one animal's meat may be another's poison. On the JamestOAvn Aveed of this country (Datura stramonium), Avhose berries sometimes poison children, goats can browse unharmed. There is no drug most deadly to men that does not furnish food for some creature: lunar caustic, oil of vitriol (once thought to destroy eA*ery organic substance), opium, strychnia; even the Arenom of the rattle- snake ! These last poisons are fed upon at least by animalculce, AA'hich take the leavings evciyAvhere of the greater animal Avorld. Infusorial 234 HYGIENE. animalcules arc innumerable in many Avaters, and they, and equally minute fungoid vegetable forms, abound often in moist air This great variety of food is essential to the balance of nature _ A ,th- out it no check would exist upon the overproportion of a few kinds of beinoi; the sea would be filled with fishes, the forests, denser than Brazil, would become ciwded with animals, and the air clouded with Fig. 135. LIVING THINGS IN RIVER WATER. Magnified about 200 diameters.—(Parkes.) birds and insects, in a very feAV years of ordinary multiplication. But the struggle for existence keeps down this excess, and the flora ana fauna of a Avarm country may support together thousands of species. Oak trees alone feed 200 kinds of caterpillars; nettles, 50 different sorts of insects; pine trees, 400 species. In SAveden, one kind of yelloAV FOOD AND DRINK. 235 fly devoured in a single year 100,000 tons of barley; another fly in France, 3,000,000 of olives. Insects (among them the phylloxera of the grape-vines) are computed to destroy in France 100,000,000 of dollars' Avorth every year. In our Western country, the Rocky Moun- tain grasshoppers, during some years, do nearly or quite as much harm. But this immense need of food for animals, so much greater than that of plants (even of the largest trees), needs to be farther explained. It is not only because Ave waste, as fire does in burning, and the tree in groAving and shedding its leaves, but also because Ave work and go, that Ave must have so much nutriment, and must have it often. We are, so to speak, living locomotives. Action, as Avell as groAvth and wasting or decay, must be supplied. And this action is of tAvo sorts— within and without us. Every heart-beat uses energy; digestion is a kind of Avork; so is secretion, and, of course, respiration. Foot-tons are the measure in Avhich Ave estimate the daily Avork done; for ex- ample, in the circulation of the blood by the heart and blood-vessels. What fuel must be necessary for all this,—besides all that our muscles do in labor or exercise of every kind! A young bird has been knoAvn to eat once and a half its OAvn weight of food in a day; a robin, 800 flies in an hour. A pair of SAvalloAvs will carry 200 or 300 worms and caterpillars daily to their young ones in the nest. What becomes of all this ? Not all is appropriated in growth, for their increase in weight Avill not account for it. A good deal must be consumed as fuel, for getting up energy; very much as coal or Avood is burned, under an engine-boiler, to get up steam. When the fuel has been all used up, more must be provided, or the animal dies. A mole, kept Avithout food for tAvelve hours, Avill be starved to death. A cat (once to my knoAvledge) may starve in a Aveek ; a Avild-cat, in tAventy days; a dog, in thirty-six days. An eagle will survive Avithout food for five Aveeks. The boa constrictor of South America, after SAvalloAving an enormous meal, perhaps an animal as large as himself, lies still, digesting it for a month or more. A fat hog has lived 160 days Avithout food. The scorpion can first three months, the spider a year, the sacred Egyptian beetle (scarabseus) for three years! Man cannot compete Avith these sIoav livers in long abstinence. On the average, nine or ten days Avithout food Avill end a human life. After the Avreck of the steamship Arctic, a man floated nine days in the Avater and Avas picked up alive. Benjamin Lay, the eccentric "hermit of GermantoAvn," Philadelphia, fasted three Aveeks and then became de- lirious, and was fed by his friends, saving his life. Dr. Tanner's forty days' self-star\Tation and sunnval, in 1880, made him famous. Miss "Lizzie" Bradley died at White Cloud, Kansas, in 1884, of starvation, 236 HYGIENE. after a fast of fifty-three days. She had made a voav " never to eat or speak again," and kept it. Shipwrecked persons have not only hunger, but often thirst, as Avell as cold and fear or expectation of death, to aid in depressing vitality. This Avas the case Avith Lieutenant Greely's partv, Avhose sad story became so familiar in the year 1884. Their scanty rations, under long suffering from terrible cold, made it not incredible that some of them might have eaten the flesh of their companions Avho died the soonest. Yet a reliable author, Dr. Robert Willis, tells of the master of a Avater-logged ship Avho survived tAventy-eight days Avithout anv solid food, having also no drink except rain-Avater gathered in the palm of his hand as it trickled doAvn the mast. Captain Hopken, of the brig Shelehof, iu 1871, Avas taken aliAre from the Avreck of his vessel, October 19, having been there since its disablement, July 3, and the greater part of that time Avithout food. He had, before the Avreck, Aveighed 235 pounds; Avhen taken off, 120 pounds. All on board but himself had died some time before he Avas found and rescued. Questions about the hygiene of food are these: how should Ave eat, Iioav often, Iioav much, and what? That is to say, Ave inquire into the manner of taking food, the frequency of meals, their quantity, and their nature or quality. As to the manner of eating, the precepts are simple, but not Avithout importance. We should eat slowly, cheerfully, and, if possible, in good company; and Ave ought to rest aAvhile, in mind and body, before and after meals. SloAvly, in order to chew Avell what is taken; dividing all meat and other solids up, so that the chemical action of the digestive fluids may be complete, and mixing the saliva Avith everything, espe- cially Avith the starchy food. Hurrying our meals promotes dyspepsia (very common in America from this cause), and, probably, early decay of the teeth. Some business men snatch half an hour or less from their mid-day work to bolt some- thing, or else content themselves with General Scott's " hasty plate of soup." This is very bad. Merchants, as well as day-laborers, should have an hour at least free for a noon meal. " After dinner, sit awhile; after breakfast, read awhile; after supper, walk a mile." This sensible maxim refers to the need of the completest rest after the heaviest meal. Even reading, unless it be only a newspaper, is not beneficial immedi- ately after dinner. The habit some college men have of- taking a book for study to the table is, hygienically, a vicious one. After a rather hght meal, as breakfast, reading, at least, may come soon; and supper, which ought to be the lightest, may be followed by a moderate walk. FOOD AND DRINK. 237 What is the reason for this rest at and before and after meals? Sim- ply that digestion requires energy; it is internal work; and there is only a limited supply of energy available for work at oue time in the body. It is someAvhat like the fixed number of " horse-poAvers " furnished by an engine in a building, to be distributed for different operations; or the Avater-supply of houses according to our system in Philadelphia. When the steam or Avater is being used in one story or room, there is less or none obtainable in other parts of the building at the same time. All Avho ride or drive horses knoAV, likeAvise, that it will not do to drive an animal hard immediately after full feeding. The same principle applies with them as Avith ourselves. Stress of mind, anxiety, or disturbance of feeling, Avill often interfere with digestion. " Read o'er this, and this; and then To dinner, with what appetite you can." Hence cheerfuluess and sociability belong, so to speak, with the din- ner-table furniture. Mirth is better, at dinner-time, than metaphysics; " laughter, holding both his sides," more Avholesome there than all the Avisdom of the Egyptians. Mallock Avas Avroug, in his " New Repub- lic," in making learned men and Avomen discuss difficult problems of life at the table. It Avas like giving them stones for bread; they must have gone aAvay dyspeptics, and so have thought life hardly Avorth living. To the question, how often Ave should eat, there is no absolute or uniArersal ansAver. At least twice a day, it may be said Avith entire safety. Many people, in France, take (besides a cup of coffee on rising) but tAvo meals—breakfast and dinner. Most English people are accus- tomed to four repasts—breakfast, lunch, dinner, and supper. I have tried both Avays Avhile travelling, and found no difference in comfort, health, or strength ; the more meals, the less is naturally taken at each. But I believe three meals, the most common habit the Avorld over, to be the most natural, and best on the whole. Custom has much influence here. English people, in Edward the Fourth's time (fifteenth century), ate dinner at about ten o'clock in the morning. In Queen Elizabeth's day (sixteenth century) the hour Avas between eleven and tAvelve o'clock. CroniAvell brought it doAvn to one o'clock. Charles II. imported French usages into England; among them, lateness of hours. Addison dined at two; and Pope, the poet, complained of being invited out to a four o'clock dinner. Another century made it common, as noAV, for it to be later still. Germans have 238 HYGIENE. the dinner-hour mostly betAveen one and four o'clock'. In this country there is every variety of hours, Avith an increasing tendency toAvards lateness, at least in the cities. People say that it is reasonable to put off the chief meal of the day until the work of the day is clone. That is so, if the dinner is to be " the event" of the day—a tAvo hours' feast, after which no one is good for much. This Avas common in the old days, such as Burns Avrote of, when " Who first beneath the table fulls, He sball be king among us three." When great statesmen and authors (not to say preachers) Avere, as to their wine, one-bottle or tAvo-bottle men, an hour near bed-time Avas undoubt- edly the best for dinner. But all this is changing; and gluttony, as well as inebriety, has almost ceased to be a virtue. In the next generation both Avill probably be called vices. If Ave ask, then, Avhat are the best hours for most people, nature and experience furnish a reply. A meal is digested in from three to four or five hours, therefore the interval betAveen meals ought not to be less than that time. FeAV can comfortably take at once enough food to last well over six or scAren hours, at least Avhen they are doing work, bodily or mental. Hence we can name the limits : not less than four nor more than seven hours between meals. Best of all, I believe, are the old rural Avays: breakfast, an hour, more or less, after rising—say betAveen 6| and 8 o'clock; dinner within an hour or so of noon—12 to 1| o'clock; supper, early in the evening—6 to 7 o'clock. Hoav does it happen that English people often take a very solid (though not very bulky) supper, as a regular thing, just before going to bed ? Because, dining late in the afternoon, and no tea folloAving, the time elapsing before they retire alloAvs the meal and its effects to disappear, especially if they sit up late. Then they are ready for some food, which goes on to be digested during sleep. Late and heavy sup- pers, of indigestible superfluities, taken not for hunger but for gorging self-indulgence, are very apt to disagree. Nightmare, "biliousness," sick-headache, and dyspepsia naturally attend upon them. We are thus brought to recognize a principle in the hygiene of diet, namely, that hunger is the signal for the taking of food; and it may be minded Avith advantage, as a rule. Some people almost never feel hungry, even when long fasting. They, however, feel empty and weak (moreor less) Avhen their "blood-fuel" runs low; and such sensations mean with them what hunger means with others. Ought we to eat anything, then, betAveen meals? If the time is very long, yes; if DOt, generally, no. But, if hungry or exhausted, eat, FOOD AND DRINK. 239 between meals, a little. A crumb or a drop in time will do better than nine left late. Feeble persons, especially, ought to regard this as a rule, never to go very long without food. I have knoAvn attacks of sick head- ache, neuralgia, and even convulsions, to be brought on by the delay of meals; and, Avhen threatening, to be prevented by the timely ad- ministration of food. One Avho has to sit up at night with a sick person, or on any other duty should have some extra food to take during the night. A little may do; but that little Avill make much difference in the fatigue of long watching. About the diet of the sick, more Avill be said later in this book. Just uoav, we may remark that it is a subject much better understood noAV than formerly,—even half a century ago. Once " Ioav diet" Avas very Ioav, and was kept up long through illness. Now we know that disease weakens the body. There is a time at the beginning of a sick- ness Avhen a person, before strong, may abstain from food Avith advan- tage; but feeble persons cannot bear even this. We waste during illness; and although appetite is absent, and the stomach cannot digest ordinary solid meals, yet the body must be supplied. This is done by giving small quantities of strong liquid food often. Milk and beef-tea are thus advised; during some cases of typhoid fever, for example, every hour or tAvo a tablespoonful or tAvo at a time, day and night We have noAV seen the reasons for our need of "daily bread." How much food is required evrery day ? A grown person, on the average, during health, Avill consume two pounds and, a half of solids, —of which at least two-thirds may be vegetable food,—and about tivo and a half pints of Avater, including tea, coffee, or other beverages. A good supply Avill be three-quarters of a pound of meat (counting the lean only), a pound and a half of bread or other vegetable material, and a quarter of a pound of butter or other fat. Children have need of quite as much in proportion to their size as Avorking adults. Their groAvth requires new substance, and their active play takes the place of Avork in consuming " fuel-food." An infant, six months old, Avill take comfortably from two and a half to three and a half pints of milk in tAventy-four hours. Solid food should not be given to babies until they have some teeth Avith Avhich to cheAV it. Apart from starvation, it is interesting to knoAV the least amount any one can live on. An Italian gentleman, Louis Cornaro, Avhen about eighty years old, set himself to eat only twelve ounces of solid food, and 240 HYGIENE. wash it doAvn Avith fourteen ounces of light Avine, every day. He lived to be a hundred years old. Most probably his constitution Avas remark- able, and he lived a quiet old gentlemanly life, Avith nothing to wear him out. Under the pressure of necessity, Captain Parry, the traveller, Avith his men, lived for some time on rations of twenty ounces each of solid daily food. Nobody is likely to live long on less than this, or, at all events, on less than Cornaro's minimum. Maximum amounts Ave read of in the Arctic regions. Big fires, furs, and much food are needed there to keep out the cold. Warmth of the body is sustained by increase, especially, of fatty food. Seal's, walrus', bear's fat, the Eskimos consume freely. One of them is said to have eaten twenty pounds of fat meat in a day! An Eskimo boy is told of who devoured in one day ten pounds of meat and fat, besides a pound of talloAV caudles throAvn in for variety. Under the disease called bu- limia, with a morbid appetite, yet greater quantities have been taken; but instances of this are rare. Must Ave weigh or measure our food to get its right amount? No. Our appetite is, by nature, proportioned to our needs. When hunger is satisfied, it is time to stop eating. Not that Ave should eat as much as Ave can Avith enjoyment or comfort. Stop Avhile you could still take more, but feel that y/ou have had enough. We should newer feel our stomachs, Avhen in health; one ought not to knoAV, except by studying anatomy, that he has a stomach. But while, like other organs inside of the body, the sound stomach has no sense of touch, no feeling, it soon becomes sensitive Avhen not Avell treated. When Avorried by having more put into it than it is prepared for, it suffers, and, so to speak, complains. If there is a decided internal feeling after a meal, it sIioavs that something is wrong. Either Ave have eaten too much, or too fast, or have been worried at it, or Avere dyspeptic at the time. Dyspepsia is habitual indigestion. Errors of diet are its most common causes. We cannot, to-day, anticipate to-morroAv's dinner; nor, even, eat at breakfast (Avithout injury) enough to last the whole day. It is Avorth while to take much pains to avoid dyspepsia; for it is almost a kind of " horrors." Children very seldom eat too much of simple, wholesome food. When they are pampered Avith goodies, as sugar-plums, candies, and cakes, they often do hurt themselves by large excess. What shall we eat? Nature here furnishes our common ansAver; science simply interprets and explains nature. There are certain clear facts about all articles of food. First, they must contain some of the FOOD AND DRINK. 241 elements of the body. These elements are Carbon, Hydrogen,Oxygen, Nitrogen, Sulphur, Phosphorus, Iron, Calcium (the metal of lime), Potas- sium, Sodium, Chlorine, Fluorine, Silicon ; occasionally, Manganese, Mag- nesium, and one or tAvo others. In our Physiology, avc have seen that the most important of these are Carbon, Hydrogen, Oxygen, and Nitro- gen ; but a certain amount of Sulphur, Phosphorus, Iron, and Calcium is indispensable; and the body needs also, from time to time, a supply, not large, of all the rest. Carbon, Hydrogen, and Oxygen are in all the tissues, Nitrogen in all except fat, Sulphur is in the bile, Phosphorus in brain and bones, Calcium in bones and teeth, Iron in the blood- corpuscles, Potassium and Sodium in the blood and other animal fluids, Fluorine in tooth-enamel and brain-substance, Silicon in the hair. Here is quite a wide range; and most of our usual articles of food contain several of these elements together. Secondly, our food must be (except water and salt) organic, not mineral; that is, of vegetable or animal origin. Plants live on mineral food (as has been before said); animals, on plants or on each other. Lime is always obtainable from bones; but pure lime Avill not answer as food for us. Birds can peck a little of it, as it helps to make their shells. Infants sometimes profit by having limewater put with their milk; but that is rather medicine than food. We do not want to put lime in substance upon our tables. It is furnished combined Avith other things, in various articles of food, each giving a little; meat, bread, milk, vegetables, fruit; all organic. Plants, under the sunlight, have a marvellous poAver (which we have not) of working up mineral matters from the soil and air into the organic state; animals take this ready-made " life-stuff," and modify it as their own organs and uses require. Literally, then, as well as figuratiA'ely, " all flesh is grass." There would seem to be an exception to this, in the strange food of the dirt-eaters. Such people exist among the Indians of California and South America, and in Finland and other parts of Northern Europe. "Mountain meal" is a name given to earth, of Avhich cart-loads are used by Lapps and Finns in times of scarcity. Ottomakas in South America are said by travellers to live sometimes for months upon earth- food. They then become thin, weak, and pot-bellied. There is a fasci- nation in this habit, a morbid craving, which groAvs, like the taste for opium, tobacco, or alcohol. But the explanation of the undoubted fact that earth can take, in part, the place of food, is, that it contains some organic matter. Retzius, of Sweden, proved this, with the microscope, in " mountain meal." All mould has in it remains of dead animals and plants, not yet quite 16 242 HYGIENE. mineralized; and, also, some living germs, at least, of plants and animals of Ioav type. These are the food part of earth ; and very poor food it is, at the best. Thirdly, Avhat Ave eat must be capable of being crushed or broken up ; mechanically divided and reduced. Anthracite coal is nearly pure carbon; and carbon is an ingredient in all our food: but coal will not do in our diet, even though of " chestnut" size. Fourthly, it must be soluble in some of the digestive fluids. Because it is not so, charcoal, although pure carbon, is sometimes a good medicine, but never an article of food. Other examples might be easily brought, if needful. Fifthly, it must, of course, be not poisonous. We have no occa- sion to dAvell on this point. Along Avith poisons may be named para- sites ; such as trichinae (spiral thread-worms), tape-worms, and others. We aA^oid these, by eating only well-cooked meat and by drinking only pure water. Lastly, food must be not offensive to taste or smeSL Some excep- tion must be admitted to this in times of shipAvreck or famine. Men Avill eat anything rather than starve to death. Dreadful (and sometimes true) stories are told of those Avho, after shipwreck, have draAvn lots to determine which of a boat's creAV should be made food for the rest; and in besieged cities equally horrible things have happened. These are exceptions to all rules. USES OF FOODS. 243 USES OF FOODS. Already Ave have seen that these are two: to furnish material for growth and repair of waste, and to supply fuel to produce energy.'5* A locomotive, Avhen wearing out, has to be repaired from the outside by the machinist. Our bodies are self-repairing ; but the stuff from which they are made must be put into them for the purpose. Also, like the locomotive, we must have the fire supplied with fuel for keeping us going. External and internal Avork, that ife, walking, laboring, talking, and also breathing, digesting, circulating our blood, and even thinking, consume this fuel; so that Ave need a great deal of it. A farmer's pig may give us a lesson in Physiology. When about big enough to fill a bucket, the pig will eat in a day as much as the bucket Avill hold. Put him at night in the bucket he has emptied; then, what has become of the provender ? Our answer has been contained in Avhat has just been said. Part of it has been made into neAv tissues of his body, Avhich has groAvn a little larger; the rest has been used up; oxi- dized, consumed as fuel, and gi\Ten off in his excretions, from the lungs, skin, kidneys, and boAvels,—of Avhich account has been given in Physi- ology. Heat is one form of energy ahvays present in our bodies. Muscular motor energy is another. Electricity also can be detected by delicate instruments; the silurus and other electrical fishes have it abundantly. Light is given off by the fire-fly and gloAV-Avorm on land, and the sea- brightening noctiluca in the ocean. Chemical energy is constantly act- ing during our digestion and secretion. It Avas once thought practicable to classify articles of food, according to their action in supplying material either for building up and repairing the tissues, or for generating energy. It is now understood that such classes of food-materials often overlap each other. * Energy is force in action. Force (as that of gravitation) is any cause of change; when it is doing work, we call it energy, and measure it by the work done. What is called potential energy is measured by the work which a certain stress of force, or com- position of forces, could do, if a particular known condition were changed. 244 HYGIENE. FOOD GROUPS. Chemists have furnished the best arrangement of these, according to what they are made of. Eight groups of nourishing substances may he named: 1. Nitrogenous foods; that is, those containing nitrogen, ivith carbon, hydrogen, and oxygen. 2. Oily or fatty articles (containing no nitrogen). 3. Starch-like substances (also non-nitrogenous). 4. Salts (compounds chemically so called). 5. Acids of vegetable origin. 6. Water, as the universal solvent. Albuminoids is a name sometimes given to the nitrogenous sub- stances, because albumen, of Avhite of egg or of the serum of the blood, is oue of the most important among them. In flesh there is myosin, also nitrogenous; in gristle and in jellies, chondrin or gelatin; in blood (besides albumen), cruorin, globulin, and fibrin; in brains, such as we have in calf's-head soup, protagon and neurin; in milk, casein, with albumen; in bread, gluten. Lean meat, having in its substance myosin (or syntonin), and in its gravy albumen, cruorin, globulin, aud fibrin, is eminently a nitrogenous food. So is the gluten or pasty part of bread ; but bread contains also a good deal of starch. Among these " food principles," myosin of flesh is probably the most nourishing; next in order, albumen, globulin and fibrin, pro- tagon and neurin, casein, gluten, cruorin, and last, gelatin. This is, it is true, not a very well settled order of tissue-making values. All of them help out in their way. Casein is present in cheese, which consists almost entirely of it, solidi- fied. Cheese is decidedly nourishing, when digested. But its toughness stands in the Avay of that; and it agrees with the stomach best in small quantities. There is an old saying,— " Cheese is a surly elf, Digests all things but itself." This means that a little (especially old) cheese at the end of a dinner promotes digestion. Chemically, old cheese, casein beginning to decom- pose, is exceedingly like pepsin, the active " fermenting principle" of gastric juice; and it helps pepsin out in its action when the dinner is rather much for it. Several chemists have urged that gelatin passes through the body unchanged, and is worth nothing as food. This seems strange, when FOOD GROUPS. 245 we remember hoAV large a place the gelatinous tissues have in our frame • all the gristly parts (nose, ears, eyelids, between the bones, ends of ribs, and connective tissue all over the body) being such. Experience shoAvs that jellies are not strong food, and should never be depended upon alone; but they have some Avorth, especially for variety in diet with feeble and convalescent people. Amount of Nitrogen. Cheese........ Beef......... Mutton........ Oatmeal........ Indian Meal ....... Seconds Flour....... Baker's Bread ....... Rice......... New Milk....... Potatoes........ Beer......... Oily or fatty food is exemplified by butter, olive oil, and the fat of various meats. In these chemists find a number of definite substances; among which the main ones are butyrin, olein, palmitin, and stearin. The last named is the hardest at common temperatures, though easily melted by heat. Oils and fats consist of carbon, hydrogen, and oxygen; no nitrogen. There is not (chemically speaking) a satisfying amount of oxygen in them for their carbon and oxygen. When heated and exposed to the air, they will take more oxygen and burn; that is, become rapidly oxidized and saturated Avith oxygen. In our bodies the same thing happens sloAvly, producing heat and other forms of energy. This is Avhat is meant when Ave call them " fuel-food." All over the world something oily is craved and taken as food. Arctic dwellers and explorers eat the most of it; but near the equator, also, Hindus have their ghee (a sort of butter), Egyptians buffalo butter, other Africans palm oil, Spaniards and Italians olive oil; Avhile butter and lard are used among all the civilized nations. There are important uses of fat in the body. First, it is, especially, fuel-food for the Avorking power of all the organs. Then, stored up as fat, it rounds off the surface of the body, having much to do Avith its beauty; it cushions the muscles, bones, and some of the internal organs; and it is a natural clothing, keeping in our animal heat. Whales could hardly bear the cold of the North Atlantic, in Avhich they SAvim, but for their thickness of two feet, more or less, of blubber. They are made lighter by it, also, so as to float more easily. Grains per pound. . 300 . 184 . 181 . 136 . 120 . 116 . 88 . 68 . 44 . 22 1 246 HYGIENE. Very small quantities of oily material seem important for the diges- tion and appropriation of other food. Those who eat fat freely, or work in oils, as oilmen, cooks, butchers, tanners, appear to be less than others liable to consumption. Cod-liver oil, so often useful in this aud other wasting diseases, is an already assimilated fatty material, and there- fore more a food than a medicine. " Wine is good, but oil is better," says the peasant of Andalusia, as he gulps doAvn a mouthful of olive oil. An excess of greasy food is not Avholesome; it promotes indigestion. Worst is fat which has been overheated in frying; when an irritant product, acrolein is educed. Amylaceous is a big Avord for starch-containing or starch-like. All vegetables contain starch ; cabbages and caulifloAvers less than others; mushrooms also not much: they are almost as nitrogenous as meat. Besides starch, hoAvever, in the same group, are sugar, gum, cellulose (of leaves and lighter parts of plants), and lignin (of Avood). These are all composed of carbon, hydrogen, and oxygen ; the latter tAvo ele- ments being to each other in the proportion in which they exist in Avater. A hydrate is a compound of water with something; hence these substances are called carbohydrates; that is, water-compounds of carbon. They are, like oils and fats, most useful as fuel-foods. Being, in the body, also convertible into fat, they contribute much towards the deposit of fatty tissue, which, Avhen great, is called obesity. Persons growing too fat do well (like the celebrated William Banting) to avoid vegetables, especially potatoes, almost altogether; as well as sugar, but- ter, milk, and fat meat. By arranging his diet upon such a view, Banting reduced his weight in a feAv months from 200 to 150 pouuds.* * As a curiosity, this gentleman's thinning down dietary may be here given, as stated in his pamphlet on the subject: " For breakfast, I take four or five ounces of beef, mutton, kidneys, boiled fish, bacon or cold meat of any kind except pork, a large cup of tea (without milk or sugar), a little biscuit, or one ounce of dry toast. " For dinner, five or six ounces of any fish except salmon, any meat except pork, any vegetable except potato, one ounce of dry toast, fruit out of a pudding, any kind of poultry or game, and two or three glasses of good claret, sherry, or Madeira (!)- champagne, port, and beer forbidden. " For tea, two or three ounces of fruit, a rusk or two, and a cup of tea without milk or sugar. " For supper, three or four ounces of meat or fish, similar to dinner, with a glass or two of claret. "For night-cap, if required (!), a tumbler of grog (gin, whisky, or brandy, without sugar), or a glass or two of claret or sherry." Leaving out all the claret, sherry, Madeira, gin, whisky, and brandy, which are totally misplaced in any diet for health, this regime appears to be quite well adapted to its purpose. FOOD GROUPS. 247 As an example of the use of starchy and fatty articles of food to get up and sustain energy under hard Avork, Ave may mention the habit of chamois hunters on the Alps, of going for days together, during their expeditions, Avith bacon fat and sugar for their only food. Dr. Rad- cliffe says: " I once made the ascent of Etna Avith tAvo Sicilian guides, who scarcely ever tasted any animal food except a morsel of fat bacon, and AArho lived chiefly on polenta * and bread and olive-oil. More than once I thought I should neArer get to the top; they trudged upAvards with scarcely a sign of distress, though often pulling me up." But it is important to remember that neither starch nor any of its group can alone make or repair our tissues; since all the tissues, except fat, contain nitrogen. Babies are sometimes fed with arrow-root; if it be made with water, not milk, they Avill starve to death (some babies have no doubt done so) upon it, in a feAV days, if no other food be given them. Milk with it makes it sufficiently nitrogenous for tissue-making and repairing. Gum-Avater (made with gum-arabic) is not at all suited for use as an article of food. It is said that Arabs in crossing the desert travel far with nothing but a stock of gum-arabic for food on the way. This seems not likely to be true. They may probably go for a day or two upon it, as the chamois hunters do upon the Alps, with bacon fat and sugar as diet. But in both these cases some nitrogenous food (milk, meat, or bread) must be taken at intervals not very long. When only moderate exercise is undergone, the force or energy for it is supplied by the consumption of fuel-food in the blood. But in unusual efforts, as when a Weston, a RoAvell, or a Fitzgerald AAralks a hundred miles in tAventy-four hours, the blood-fuel runs out. Then the very substance of the tissues is called upon and consumed for fuel. It is like what is done by the captain of a Mississippi steamboat in a race; to hurry up steam, Avhen his coal or Avood is exhausted, he will pitch parts of his cargo, or whatever lies near, into the fire. The measure of tissue-waste in the body is, the amount of nitrogenous matter (especially urea and urates) in the excretions. Two physiologists, Fick and Wisli- cenus, on climbing an Alp, found the amount of such excreted material no greater than during a day of quiet at the foot of the mountain. Dr. Flint, of NeAv York, found it quite otherwise with Weston, during one of his great pedestrian exploits. Varieties of starch in common use are potato, corn, and wheat starch, arrow-root, tapioca, and sago. The last three are employed for the sick ; Polenta is a kind of flour; sometimes toasted barley-meal. 248 HYGIENE. tapioca and sago also for puddings. They are very soothing to the stomach and bowels, and are especially suitable in diarrhoea and dysen- tery. Corn-starch is almost as delicate; wheat next, and potato-starch the least agreeable in its effect. Potato-starch is often added to arrow-root (Bermuda arrow-root is the best) as an adulteration. It may be detected by the microscope. All starch is naturally formed of very small rounded grains or corpuscles, made of concentric layers, like an onion. These corpuscles are of different sizes and shapes in starch from the different sources above named. Those of potato-starch are meal-bag shaped, or somewhat Fig. 136. TAPIOCA BOOTS. like an oyster; and many of them are larger than any of those of arrow-root. Sugar, like starch, is a food; it is not only a condiment, although Ave take it commonly for its taste rather than its use. In moderation, it is not unAvholesome. Children are very fond of it; but the sugar- bowl, Avhen forbidden, is more dangerous to their morals than to their stomachs. I have known a child, much run down by disease, to be built up in a few weeks by eating plenty of rock-candy along with its milk. Of course, constant use of SAveets cloys and weakens digestion, n makes the child SAvalloAv more food than it has need of. Bread and molasses are therefore not ahvays AAdiolesome as a supper diet; at least FOOD GROUPS. ARROW-ROOT STARCH CORPUSCLES. Fig. 138. POTATO-STARCH CORPUSCLES. 250 HYGIENE. Fig. 139. WHEAT-STARCH CORPUSCLES. Fio. 140. RYE-STAKCH CORPUSCLES. FOOD GROUPS. 251 Fig. 141. INDIAN-CORN-STARCH CORPUSCLES. Fig. 142. RICE-STARCH CORPUSCLES. 252 HYGIENE. not every night. Cakes, moreover, and sugar-plums have indigestible qualities not dependent on the sugar they contain. Sugar is a fuel-food, aud a fat-producer also. West India negroes are said to grow fat always about cane-pulling time. Bees, fed on honey, form wax in their bodies; and wax is a kind of condensed fat. Of the several kinds of sugar, natural or made by chemists, we may notice two : cane sugar and grape sugar. The first is present in the sugar-cane, sorghum, beet-root, maple-sap, Indian corn, and dates. Grape sugar (glucose) exists not only in the grape, but in several other fruits and in honey. It is also often artificially made, and used as a cheaper substitute for, or adulteration of, cane-syrup. Fig. 143. YOUNG AND EGGS OF SUGAR MITE (ACARUS SACCHARl) MAGNIFIED. Cane sugar Avill crystallize (as in rock- candy) but will not ferment, except after being first changed to grape sugar. Grape sugar does not crystallize, but will ferment. Cane sugar is much the sweeter of the tAVO. Brown sugar is unrefined; coarse and sometimes impure. Poor qualities of it are not as cheap for use as Avhite sugar; they contain a good deal of Avater, adding to the Aveight, as Avell as dirt. Sometimes broAvn sugar has iu it a multitude of minute creatures, acari, which, Avhen it is much handled, produce " grocer's itch." Robert Nichol as- serts that he has found a hundred thousand of these in a pound of brown sugar. There is no objection either to beet sugar or maple sugar, if well purified, on the score of health. Beet sugar is largely used in France FOOD GROUPS. 253 and some other parts of Europe, and rather increasingly in this coun- try. Maple sugar is made quite extensively from the sugar-maple in our Northern States; Vermont, NeAv York, Michigan, Ohio, Penn- sylvania, New Hampshire, Indiana, Massachusetts, and also in Ken- tucky. Glucose or grape sugar is not unwholesome. Its being sold for cane sugar or syrup is a fraud, because the former is so much less SAveet; but otherwise it does no harm. Honey is too cloying to eat in much quantity. Occasionally it has been made dangerous by the bees having sipped it from poisonous Aoav- ers. Xenophon, the Greek historian, tells of this having happened to some soldiers during the famous retreat of the Ten Thousand. The sugar found by chemical tests in the urine of patients having the disease called diabetes mellitus is almost, if not exactly, identical with grape sugar. Glycerin, though sweet, is not of the same nature or composition as sugar; it is, chemically, rather more like alcohol. Many persons suppose that sugar promotes decay of the teeth. I be- lieve this to be a mistake. It has no action on sound teeth; but, on getting into a tender hollow tooth, it causes pain in it. This has pro- duced the impression that it injures the teeth. It also gives pain in the stomach, when that organ is ulcerated. Adulteration of sugar is most practised with pulverized fine white sugar. Marble and chalk are sometimes put into this. To find either of these in it, drop a pinch of it into a glass of pure water. If, on stirring, a part of the powder will not dissolve, it is no doubt a mineral substance. The granulated fine sugar is much less often adulterated; and the same is true, of course, of lump or loaf sugar. Cellulose and lignin, the fabric of leaves, stems, and wood, serve as food for multitudes of animals, from the grubs of beetles and still smaller creatures up to the beaver, the giraffe, and the elephant. Beav- ers cut bark and wood with their strong front teeth, and store it away for winter use. An elephant will, as I have seen it doing, chew up and SAvallow a piece of kindling-wood as if it were a crust of bread. Hu- man beings are not naturally wood-eaters, but in times of famine they sometimes become so. Beechwood sawdust has thus, in Northern Eu- rope, been made into bread, to keep off starvation. It is the hardness of Avood, and its not being soluble in water or in our digested fluids, that make it indigestible. We take, in bran bread, a certain amount of chaffy matter, Avhich is woody in nature. There is an advantage in this, when the stomach and bowels are torpid; the roughness of the particles stimulates the muscular coat of the alimen- 254 HYGIENE. tary canal, and aids in keeping the boAvels open. " Graham bread " is, partly for this reason, advised for dyspeptics. Late careful observa- tions, hoAvever, especially by Drs. N. A. Randolph and A. E. Roussel, of Philadelphia, tend to lessen somewhat our confidence in the judicious- ness of this.* Force-Food. Beef-fat, . Butter, Oatmeal, . Rice, Boiled Eggs, Bread, Lean Beef, Potatoes, Milk, Cabbage, . Ale, Required to lift a man 10,000 feet. ounces, 8.9 11.1 20.5 21.5 35.3 37.5 56.5 81.1 128.3 192.3 Nine bottles. Saline substances, except common table-salt, are not taken separately, but are naturally contained in our articles of food. Meat and gravy, as Avell as milk and vegetables, all possess some of them. So, also, does our drinking-Avater. Chemists give the name of salts to compounds of a neutral character, Avhose bases usually are metallic. Some of thero * These are their conclusions: " From the facts, old and new, which have been pre sented, the following deductions appear to us justifiable: " I. The carbohydrates of bran are digested by man to but a slight degree. " II. The nutritive salts of the wheat grain are contained chiefly in the bran, and, therefore, when bread is eaten to the exclusion of other foods, the kinds of bread which contain these elements are the more valuable. When, however, as is usually the case, bread is used as an adjunct to other foods which contain the inorganic nutritive ele- ments, a white bread offers, weight for weight, more available food than does one con- taining bran. " III. That by far the major portion of the gluten of wheat exists in the central four- fifths of the grain, entirely independent of the cells of the fourth bran layer (the so-called 'gluten cells'). Further, that the cells last named, even when thoroughly cooked, are little, if at all, affected by passage through the digestive tract of the healthy adult. " IV. That in an ordinary mixed diet, the retention of bran in flour is a false econ- omy, as its presence so quickens peristaltic action as to prevent the complete digestion and absorption, not only of the proteids present in the branny food, but also of other food-stuffs ingested at the same time; and, "V. That inasmuch as in the bran of wheat as ordinarily roughly removed, there is adherent a noteworthy amount of the true gluten of the endosperm, any process which in the production of wheaten flour should remove simply the three cortical protective layers of the grain, would yield a flour at once cheaper and more nutritious than that ordinarily used." FOOD GROUPS. 255 have but two elements, as common salt, chloride of sodium. Others are composed of an acid and a metal, as phosphate of calcium (formerly called phosphate of lime). There are, then, different groups of salts—chlo- rides, phosphates, sulphates, carbonates, and others; that is, compounds of chlorine, phosphoric acid, sulphuric acid, carbonic acid, with calcium, potassium, sodium, and magnesium. All these are, in small quantities, in our food and drinking-water; and all of them pass through our blood, being there built up into the tissues; in the wasting of these, being throAvn out in the excretions from the kidneys, skin, and bowels. A portion of them goes into the excretions as mere refuse, not first en- tering the tissues; some not even reaching the blood. What is the use of the salts of our food ? This is not quite certainly all made out. Probably some of them make the blood more capable of absorbing and holding carbonic acid, which acid gas is one result of tissue-Avaste, so as to give it out, in exchange for oxygen, in breathing. Table-salt (chloride of sodium) yields chlorine for chlorohydric (muriatic) acid, as a part of the gastric juice. Sodium is present also in the bile. But there is reason to believe that some of these salts have a partic- ular usefulness in promoting chemical changes, belonging to assimilation and nutrition, which are not yet fully understood. Plants are, in farm- ing and gardening, known to be helped in groAvth by adding phosphates (salts of phosphoric acid) to the soil in Avhich they are cultivated. Yet the amount of these phosphates really making a part of the substance of the plants is very small. So, in animal bodies, an influence may be exercised by the salts far beyond their importance otherwise in any of the structures or secretions in Avhich they are present. Liebig's extract of beef, by the manner in Avhich it is made, is deprived of the albumi- noid substances of the meat, but contains a large proportion of its salts. It is, therefore, not a perfect article of food for nourishment, but a stimulant to the assimilating powers of the body, making other food go farther toAvards the support of strength. Acids in food are often so combined with alkaline or earthy bases (potassium, sodium, calcium) as really to make salts; but the acid in these is more than enough to saturate the base; they are acid salts. In lemon-juice and orange-juice they are so combined. Vinegar is a free acid (acetic acid) dissolved in water. It comes from a change which alcohol, in Avine or cider, undergoes when kept for some time exposed to the air. The acids present in our food are the following: Acetic acid, in vinegar. ^ Pectic acid, in apples, pears, quinces, cherries, blackberries, raspber- ries, strawberries, oranges, tomatoes, carrots, beets, and turnips. 256 HYGIENE. Citric acid, in lemons, limes, oranges, and unripe grapes. Tartaric and Racemic acids, in ripe grapes. Malic acid, in apples, pears, and quinces. Lactic acid, in sour milk and buttermilk. A little acid, from time to time, in our food is not only pleasant but wholesome. Much of it at once disagrees with many persons. Singular as it may seem, acidity of stomach from indigestion is sometimes re- lieAed or diminished by the moderate use of acid fruits; especially cur- rants. This is, no doubt, due to the healthy stimulation effected by the latter; probably increasing the flow of gastric juice. One man, to my knoAvledge, has often been cured of " sick headache" by taking a wine- glassful of pure vinegar at a single draught. VEGETABLE AND ANIMAL FOOD. 257 VEGETABLE AND ANIMAL FOOD. Are vegetarians right, avIio insist that Ave should eat no meat at all ? Their argument is, that vegetables contain all the elements required for our nourishment, made up into organic stuff, ready to be digested and built up into our tissues and used as fuel. Hence, they say, it is use- less, cruel, aud expensive to slay our subject animals to gratify our carnivorous taste. True, plants, roots, seeds, and fruits do contain everything absolutely necessary for food. Men often live for years, many perhaps (after infancy) for lifetimes, without animal food. But that is not the Avhole question. Is a solely vegetable diet the best for health with all people ? On this Ave must inquire further: are the elements in exactly the same state of combination in vegetables as in meat ? Our ansAver is, no. They are more concentrated in animal flesh, are Avorked up already into animal substances, and therefore are more readily assimilated than vege- table food. A sheep's or an ox's digestive tube (including the four stomachs) is more than twenty times as long as its body. That of a cat or a dog is about three or four times its body's length. The ox, sheep, and horse have to cheAV their food all up small, either at the first or (Avith the cud cheAvers) the second SAvalloAving. A dog, a cat, lion, vulture, shark, or anaconda will SAvalloAV meat Avithout any cheAving in pieces torn from their victims' bodies, or else Avill bolt them Avhole! Such is the difference in the ease of digestion betAveen vegetable and animal food.* Can Ave judge by anything in our structure which Ave are best fitted for ? Flesh-eating beasts, as lions, cats, dogs, have only sharp, cutting, and tearing teeth. Grass-eaters have nippers in front, and all the back teeth broad-croAvned, nearly flat. We resemble the bear, hog, and rat, in having teeth for cutting in front, tearing (canines) at the sides, and broad, nearly flat, grinders back in our jaAvs. The length of the human alimentary canal (that is, stomach and in- testines) is about six times that of our bodies; intermediate betAveen that of the purely carnivorous and of the entirely herbivorous animals. It Avould seem then that, like the bear, hog, and rat, Ave are made fit for either animal or vegetable food. We are omnivorous, like them. * When a house-dog learns to eat bread or other vegetable food, he has sense (or instinct) enough to know that he must chew it before he swallows it; he does not gulp it down like meat. 17 258 HYGIENE. What does experience say about it? Scotch Highlanders, the Irish, the peasantry of Italy, Spaiu, and Portugal, Hindus, Chinamen, and multitudes iu Africa, thrive ou oatmeal, potatoes, corn, chestnuts, olives, rice, or lentils, Avith little or no meat. In Scotland, a mountaineer will Avalk thirty or forty miles a day on oatmeal porridge, Avith, perhaps, milk. An Indian palanquin-bearer carries his burden tAventy-fivc or thirty miles a day, with only tAvo meals of unleavened cakes and a little ghee, a sort of butter. SAvedes, Norwegians, Danes, Dutch, Germans, Russians, live to a great extent (the poorer classes, that is) on rye bread and other vegetable food. Chinamen Avill do more work for their money, aud cost less to keep, than Americans and Europeans, their principal food being rice. All this looks very Avell for the vegetarian side. But, again, the Eskimos subsist most of the time Avholly on animal food. So do the fishing population of the coast of Norway, and the Peclierais of the southern end of South America. For months the hunters of the American pampas have no food but flesh of animals they kill; and pemmican, a preparation of dried meat and fat, answers for the furriers of the North-west through long expeditions. Setting these against the other facts, it appears that either vegetable or animal food will do for men to live upon. Still Ave have not got to our conclusion, Avhich, or Avhat, is the best diet for all. We must obtain the facts for this from the accumulated experience of men under various circumstances. It is knoAvn that the Chinese and Hindus, rice-eaters, are not superior races. Neither are the flesh-eating Eskimos, nor the fish-eating Peclierais of Terra Del Fuego. When the East Indian rebellion against the English occurred, some years ago, the hardest fighters among the Hindus were the Sepoys, Avho had been trained under the English to use a mixed diet. On the Avhole, this is the conclusion to which physicians and sanita- rians have generally come—that, with healthy people, living in the open country, not working very hard, and having an abundance of good vegetable food, meat is not necessary. They can live long lives Avithout it. But, in close-built cities, where the air is not pure, where work is hard, and " vexation of spirit" abounds, a mixed diet is best. Although, in this country, Ave probably eat more meat than Ave need, or than is good for us, yet some of it, every day, is Avholesome for nearly all. Were London, New York, or Philadelphia, for one week, deprived of butchers' meat, poultry, and fish, more deaths Avould occur, and many, especially brain-ivorkers, Avould suffer considerably in strength and comfort. Should children eat much meat ? Why not as much, in proportion, VEGETABLE AND ANIMAL FOOD. 259 as adults ? One of the anti-vegetarian arguments is, that nature's first food for every child is animal food—milk. Youug birds are often fed with Avorms, although, on growing up, they live altogether on seeds or fruits. Children, it is true, Avhen Avell, have good appetites and digest- ive poAvers. They can, therefore, grow and get fat on any kind of wholesome food, and may be quite Avell, generally, without meat. But feeble, delicate children, who make blood slowly, should have plenty of animal food. Even in infancy this is so. I have knoAvn a baby, a year old, Avhich could not digest milk, to take daily for a long time the sub- stance of a pound of beef, in beef-tea, and thrive upon it. At the same time, it must be said to be quite probable that, after as well as during childhood, half as much meat as is noAV commonly eaten would be better for most persons in this country. The condition of body called plethora is met with not unfrequently in youth, as Avell as in later life; although it is subject to greater danger in old persons. 260 HYGIENE. BREAD. Time out of mind " the staff of life," made of brayed grain by our ancient forefathers before they left Western Asia, bread contains ni- trogenous and non-nitrogenous food principles; gluten and starch, as Avefl as salts. It is adapted both for tissue-building and for energy- producing use in the body. Wheat bread is as strong in nitrogen as any, and is richer than other kinds in phosphates, Avhich are supposed to be in part nerve-feeders. The whitest of flour does not make the most nourishing bread. The richest part of the grain is just beneath the chaff, making slightly yel- lowish flour. Improved ways of grinding wheat now retain nearly all of this strength of the flour, some of which was formerly wasted or left with the bran. Rye meal makes, by itself, a nourishing but less spongy bread than wheat. It is very largely eaten by people in Northern Europe. The best Avay to use it in making bread is to mix it with an equal or less quantity of Avheat flour. Bread must be properly raised to be good. This is done by a fermen- tation, Avhich takes place in the starch (it first becoming changed to sugar) of the dough, under the action of yeast. Sugar, Avhen it fer- ments, is converted into alcohol and carbonic-acid gas. The alcohol is very small in amount. The carbonic-acid gas is kept in by the sticky, pasty gluten, of Avhich good flour has about tAvelve per cent. Thus the dough is stretched or expanded into a spongy mass. Baking dries it someAvhat, and makes it more or less crisp, or at least takes away the adhesiveness of the dough. Faults of bread, Avhich make it less wholesome, as well as less agree- able, are heaviness, sourness, bitterness, mouldiness, and an excess of sa- line material. Heavy, ill-raised, and under-baked bread is very un- Avholesome. Sour bread is so also. It is made by oirr-raising, or by using spoiled flour. Bitterness comes either from bad yeast or too much of the yeast being used; mouldiness, from the flour or bread being kept too long. Saline bread is often made, especially in NeAv York and New England, by using too much cream of tartar and soda* to raise the bread. The resulting compound (Rochelle salt) makes the bread less easy to digest. * Cream of tartar contains tartaric acid combined with potassium; cooking-s'"1'1 consists of sodium with carbonic acid. Part of the tartaric acid combines with the ■odium, setting free the carbonic-acid gas, which expands the dough. BREAD. 261 Fig. 144. Other Avays of raising bread are: using salceredus, bicarbonate of potassium, from Avhich the carbonic acid is set free by warmth, or by adding sour milk, containing lactic acid; or putting in the dough sour milk aud bicarbonate of sodium; or carbonate of ammonium (smelling salt); or phosphoric acid and bicarbonate of sodium (Horsford's process). Still another plan is to make the carbonic acid as it is made for " min- eral Avater," and then by pressure to force it into the dough. This constitutes " unfermented aerated bread." When carefully made, it is very good, keeps Avell, and can safely take the place of ordinary bread. Unleavened bread, not aerated, such as the Israelites use at the time of the Passover, is less agreeable than good light bread; but it is not unwholesome. Crackers and hard biscuit are chiefly peculiar in being long or repeatedly baked, so as to become dry and hard. Good fresh crackers, Avell cheAved, are wholesome enough. Hot fresh bread has a someAvhat more adhesive or pasty quality than stale bread. The gastric juice, there- fore, does not so readily penetrate and digest it. Persons Avith entirely sound digestion have no trouble in disposing of it; but dyspeptics should ahvays prefer stale bread. Poor or spoiled flour, of course, Avill not make good bread. The quality of flour is best sliOAvn in the baking. If good, howeATer, flour is white, Avith a slight tinge of yelloAv; not lumpy, any lumps in it giving way at once on pressure; not gritty, as that shoAvs change in the starch- corpuscles, and sourness is apt to re- sult; when compressed in the hand, it should hold together and shoAV the prints of the fingers well. When throAvn against a Avail, some of it should stick. Good flour makes an elastic dough, Avhich can be draAvn out long Avithout breaking. Flour long kept is sometimes found to have weevils in it. These are not poisonous, but they consume some of the strength of the grain, and, of course, are not pleasant. Another live creature, the acarus farince, some- thing like the sugar mite, is also not very uncommon in flour. MEAL MITE (ACARUS FARIN-El) MAGNIFIED. 9(J2 HYGIENE. Adulterations of flour are most often alum, chalk, lime, and potato meal. A little alum is frequently put in by bakers to whiten the bread, as well as to make it weigh more when sold by the pound. Much alum makes it unwholesome, irritating the stomach and binding the bowels. Potato meal is harmless, but a fraud when mixed with wheat flour, as it costs much less, and is not so nourishing. The micro- scope Avill detect it. (See previous pages, on Starch.) Bran bread (as before remarked) is rougher than that of white flour, and so, by stimulating the muscular coat of the boAvels, it helps to keep them open. Rye bread is about as nourishing as Avheat. Oatmeal Fig. 146. Fig. 145. weea'il—nat ural size. WEEA'IL—MAGNIFIED. does not rise so well as wheat flour, but in cakes, porridge, gruel, and grits, it makes an admirable food. Buckwheat is nourishing, but proves to be rather better suited, in buckAvheat cakes, for an occasional luxury than for a stand-by diet. Barley is not a strong meal, though " John Barleycorn" makes a very strong drink when fermented and distilled. Barley water is often a good addition to milk when it disagrees with young infants. Rice contains but a moderate amount of nitrogen, but plenty of starch, and (like other grains) some salts; and it is very easily digested. China- men and Hindus, many millions of them, live chiefly on it. It is soothing to the boAvels, and particularly suitable in cases of diarrhoea. Corn (maize), so much used in this country and in Southern Eu- rope, is fairly nitrogenous, and is comparatively rich in fat. It affords good and serviceable food, whether eaten from the ear (sugar corn, boiling ears) or made into bread, mush, or gruel. It is not, however, quite so easily digested as wheat, oatmeal, or rice. VEGETABLES. 263 VEGETABLES. Peas and Beans are highly nitrogenous, besides containing a great deal of starch. But that their share of salts, especially phosphates, is less, and that they are more uncertain of digestion, they would rank along with Avheat bread in value. Indeed, under some circumstances, as on long voyages, dried peas and broAvn beans are more available than bread. During the Franco-Prussian Avar of 1870, erbswurst, the main food of the German soldiers, was made of pea-meal and bacon-fat, seasoned, pressed into skins, and boiled. It was easily carried, and enabled them to bear much fatigue. What Ave call the Irish potato is really of American origin. It has been found groAving Avild in South America and in Arizona. Abound- ing in starch, potatoes contain but little nitrogen. Their great merit is, that they produce largely for their cost; they can be made palatable by cooking, and go a great ways in bulk as food. Ireland, however, has suffered much from depending on the potato for food; a year of blight has, several times, caused a severe famine.* The sweet potato is an Old World plant, known long before the discovery of America. It is harder to keep than the round or white potato, easily undergoing a sort of sugary decay. At the best, it is not quite so easily digested as the round potato. The yam of the East and West Indies is a root someAvhat analogous to the sweet potato, and an- other similar root is a good deal eaten in the SandAvich Islands. The tomato is really a, fruit. It is more nearly ahvays wholesome for everybody than any other of what Ave call vegetables. Turnips, carrots, parsnips, the onion, cabbage, squash, aud salsify, all rank beloAv potatoes and tomatoes in digestibility. Those of us Avho never need to remember our stomachs can eat them all (not at one meal) and enjoy them safely. Rules about diet are for the weaker brethren ; like the law of old, they come in " because of transgression." Cauliflowers and cabbages, as Avell as broccoli, are plants of the same species, differently developed. But the caulifloAver is, under culti- vation, much the most tender and digestible. Beets, Avhen young, are very easily digested; quite otherwise after they groAv old and tough. Asparagus, of the best quality, is entirely Avholesome. It is notable for the transmission of its odorous principle * The stock of potatoes ought to be renewed every few years by seed cultivation. \\ lien very long raised only from the " eyes" of the tuber, they degenerate. This is in accordance with the laws of physiology in regard to bisexual plants. 264 HYGIENE. through the kidneys into their excretion. Spinach, in good condition, is not at all indigestible. Mushrooms are strong and meat-like food, Avholesome for most, but not for all people. The point of importance is, to be sure they are mushrooms. A number of other fungi (the truffle of Europe, for ex- ample) are safe and nourishing, but some are very poisonous. Never gather or eat Avhat are called mushrooms unless they have, underneath, pink gills, so called, and above, as Avell as on the stem, a skin Avhich can be easily peeled off; also, they have no unpleasant taste or smell, and groAV not in dark Avoods, but in rather open fields. Celery, when Avhite and tender, is, in moderation, very Avholesome, either raw or steAved. It represents, Avhen eaten raw, a class of food articles (the radish and lettuce are others) of more importance than is generally appreciated. We need, every feAV days, to take something in its natural state, which has " never seen the fire." Why this is the case, chemists as yet have failed to explain. But Ave find this need of the system proved by the harm done Avhen, for a long time, fresh food, both animal and vegetable, is Avithheld. Arctic explorers, ships' crews on long voyages, and armies on campaigns away from their homes, have often suffered badly from scurvy. Captain Cook, in his celebrated voyages around the Avorld, found out the reason for this: it Avas the want of fresh food, especially of fresh vegetables. Providing his ship, from time to time, Avith these, he and his men escaped the disease. Scurvy is an affection Avhich begins in the blood. From a change in its qualities, the Avhole body generally suffers. The gums SAA'ell and bleed easily, the legs also become SAVollen, the heart beats too quickly, the appetite and digestion give out almost entirely. The patient loses flesh and strength, and may die, if not relieved of his malady. This is regular scurvy. But modifications of it also happen. Sometimes it is mixed up with other ailments, especially of the boAvels. During the Crimean war the French and English soldiers Avere often troubled with scorbutic dysentery. The same thing occurred in General McClellan's army in its campaign in Virginia, during our Civil War. In both of these instances the men were deprived of fresh vegetable food for many Aveeks, even months, together. When, on being taken from camp to the hospitals, they got vegetables and fruit to eat, most of them rapidly recovered; a feAV Avere too far gone, and died. Fatigue and exposure, of course, make all cases of scurvy Avorse. Experience shows that, in the absence of fresh vegetables, dried po- tatoes aviII do, and that lemon-juice, or lime-juice, or oranges, will answer for a considerable time to keep off scurvy, but not indefinitely. Iu VEGETABLES. 265 the Arctic regions raw meat, frozen, was found to be, for this purpose, better than cooked fresh meat, and very much more antiscorbutic (pre- ventive or curative of scurvy) than salt meat. Some plants, not com- monly used as food, are antiscorbutic, as the leaves of the maguey plant, a Avild cactus, in NeAV Mexico and other places on our continent; the pokeberry, sorrel, and some others. Nordenskiold found a Avild plant far up in the Northern latitudes, Avhich rendered this service during his remarkable voyage around the frozen borders of Europe, some years ago. Physiologists and chemists haA7e endeavored to discover Avhat peculiar principle fresh vegetables contain that is so needful to health, but, so far, in vain. No medicine, and no substance that can be separated from plants or fruits, has been found capable of taking the place of fresh food. AYe must, at present, confess that nature is too subtle for so close an analysis, and, like Captain Cook, simply mind the lesson of expe- rience. No diet is good Avhich does not contain, every day, some fresh vegetable article: and, eArery feAV days, a portion of our vegetable food should be taken uncooked. Here Ave may emphasize another principle: variety in food is good for health. Not that Ave need to take many things at the same meal or on the same day. Each meal may consist of but two or three things; but from day to day we should vary them. This is not a mere matter of taste or pleasure. Monotony of diet is really unAvholesome. Starch food alone does not long support life, because it has in it no nitrogen. But Dr. Hammond found that Avhen, for days together, he ate only whites of eggs, he began to starve; yet they are nitrogenous. Dogs have been fed for Aveeks on fibrin of blood, or on syntonin or myosin of flesh, alone; but they Avasted, on such food, to death. Hence we gather the laAV of diet, that no one food-principle Avill suffice alone to keep the body in health. We require, almost or quite every day, articles of at least two of the three groups of food-principles: nitrogenous or albuminoid, oily or fatty, and amylaceous or starch-like. Fat meat furnishes two of these; the nitrogenous flesh and the fat. Bread and butter give (1) nitrogenous gluten, (2) amylaceous starch, and (3) oleaginous butter. Milk also contains representatives of all three groups, and it is therefore a perfect natural food. Of this, more pres- ently. Here may be mentioned the composition of some of the popular "foods" manufactured and sold for infants and for the sick. Farina, maizena, and revalenta are all starch; maizena is pure corn-starch, and revalenta is a Aveak preparation, professedly of arroAv-root. Cerealina (Moxev's, Philadelphia) is flour of the whole wheat, Avithout the bran. 266 HYGIENE. Hard's food, as Avell as Blair's, Hubbell's, Ridge's, and Imperial granum, are made from selected Avheat flour. Nutrina and papoma, also, are preparations of roasted flour. Nestle's food for infants is a milk food. Mellin's food is a soluble dry extract of Avheat and malt. This, along Avith HaAvley's, Horlick's, and Savory and Moore's foods, are called " Liebig's foods." They contain but little nitrogen, and their starch is partly or entirely changed to glucose (grape sugar).* Of all of these articles it may be said, that they should not be thought of as substitutes for fresh milk under ordinary circumstances. AVhen good milk cannot be obtained, or is not well digested, one or other of them may be tried; and sometimes advantage results, Avith a delicate child, directly from change of diet. * Carnrick's " Soluble Food for Infants" probably resembles mother's milk more closely than any other artificial preparation. FR UITS. 267 FRUITS. As a rule, fresh fruits are wholesome. They promote the natural action of the bowels, and are refreshing and antiscorbutic. Av hen the boAvels are disordered, as in diarrhoea or dysentery (except Avhen these result from scurvy), they are not suitable. Certain people, moreover, find particular fruits to disagree Avith them; but this sort of idiosyncrasy (personal peculiarity) may occur Avith regard to any or all kinds of food. Exception as to eating fruits has been supposed to be proper at a time and place Avhere epidemic cholera is prevailing. But there is no good ground for this idea. Cholera (not the same disease Avith our common cholera morbus) is a malady of the whole system. The boAvels are affected in it, but the disease does not begin, so to speak, in the stomach and boAvels.* You can be best protected against cholera, if obliged to stay where it has broken out, by keeping the body in its best possible condition. This is done by moderation of living in all respects, Avith the usual variety of healthy food, including fruits. In 1832, Avhen cholera visited this country, my father, Dr. Joseph Hartshorne, alloAved his family to eat everything ordinarily Avholesome—corn, Avatermelons, canteloupes, aud all, except cucumbers. None of us had the disease except himself, and his attack was promoted by the fatigues and anxie- ties of a very large practice. In 1849, 1854, and 1866, I acted upon the same principle of careful liberty in diet during the presence of the epidemic, and saw nothing to change my mind as to its correctness and safety. All fruits are not equally digestible or desirable for persons of uncer- tain health. Peaches, apples, and oranges come the nearest to being good for everybody while in health; and oranges, as well as the finer and more delicate kinds of grapes, are often with advantage alloAved to the sick. Many grapes have a tough pulp, Avhich ought not to be sAval- loAved ; and the seeds never should be. They, and apple cores, and even cherry-stones, are often taken into the stomach, Avith no harm folloAving. But they are not digestible, and noAV and then they collect together and cause obstruction. There is a queer little offset to the large intestine (see Anatomy), into which, in a few instances, an apple-seed or some such thing has found its way, producing an inflammation ending in death. * I am aware that the famous Dr. Koch, discoverer of what he calls the " cholera bacillus," takes a different view. But quite too much confidence has been placed in his hasty and unsustained conclusions about cholera. 2G8 HYGIENE. Not enumerating all the fruits, each iu its season giving zest to the eniovment of our daily fare, the least Avholesome of our domestic kinds mav be said to be the cherry, and, doubtful for all dyspeptics, also, ■pears; of foreign fruits, figs and pineapples. Prunes (partly dried plums), figs, aud dates are especially laxative to the boAvels. Idiosyncrasies (before alluded to) are more apt to occur about fruits than Avith any other kind of food. Some persons ahvays have colic after eating Avatermelon; others are sure to break out Avith nettle-rash if they taste straAvberries. It is for such persons to find out their oavh special liabilities, Avhich make no rule for others. Stewed fruits are far less uniformly digestible than the same eaten fresh, in season. Preserves ought to be ruled out of the diet of dys- peptics, and taken, as a rare indulgence, in small quantities only, by all. Lemonade, made Avith the juice of lemons (not citric acid of the drug- shop), is not only refreshing but beneficial to most persons in hot Aveather, and Avhen sick Avith fever. But, in the last case, irritability of the stomach or boAvels may sometimes be in the way of its use. Canned fruits, put up Avith skill and care, may approach very nearly to fresh fruits in Avholesomeness; but the skill and care actually used are often far from perfect. Moreover, of the different materials em- ployed for keeping fruit or other food for a long time, the safest and best, undoubtedly, is glass. EGGS. 269 EGGS. Protoplasm was defined in our Physiology as the building-up mate- rial of the human and every other body, animal and vegetable, Avhich has life. It varies in some qualities wdth every kind of plant and animal • but, in its main composition and character, it is the same. Now it may be expected that food consisting of fresh protoplasmic matter, ready for the groAvth of a young animal or vegetable, will be the most available kind of food for animals or men. Such Ave have in milk, in the seeds of plants (Avheat, rye, corn, rice, etc.), and in eggs. There is excellent nourishment, mostly albuminoid, but Avith a small amount of fat (in the yolk) in eggs. There is, of course, no truth in the popular saying, that " an egg is as good as a pound of meat." In proportion to its weight, an egg is equally nourish- ing Avith meat; that is all. Eggs are more digestible cooked than raw. This has been proven both Avithin and without the body. Artificial digestion can be per- formed by mixing aud warming food in a tight bottle or vessel with an acid solution and pepsin, procured from the stomach of a pig or a calf. This being tried Avith eggs, it has been found that they are soonest digested Avhen cooked moderately hard.* AYhen very long heated, they become tough aud unsuitable. It does not require quite a boiling tem- perature to cook eggs, as albumen will coagulate at from 140° to 170° Fahr. It is, of course, of great consequence that eggs shall be fresh, Avhen eaten. This precept scarcely needs to be mentioned, because no one is likely to prefer, or even to tolerate, a bad egg. But, as Avith many other kinds of food, an egg may be stale, and so less digestible than Avhen quite fresh, without having begun to approach rottenness. It is not easy to keep eggs long Avithout spoiling. The main thing, for this end, besides avoidance of heat, is the exclusion of air; as egg-shells are someAvhat porous. A late number of the "Annals of Hygiene " says that " eggs that have been encased in clay and buried in a dry soil for many years, are esteemed great luxuries by the Chinese, and are by no means to be despised. No trace of decomposition can be traced in these an- cient eggs, Avhich, by their encasement and burial, are excluded from the attacks of bacteria, and the production of objectionable changes." The eggs of other birds besides our common poultry, and those of turtles, are often eaten. There is no reason to suppose that the eggs of any oviparous creature are unwholesome. * For a number of years the author has eaten at breakfast almost daily one or two hard-boiled eggs, with no sign of indigestion ever following their use. 270 HYGIENE. MEATS. All parts of the Animal Kingdom furnish food for men in some quarters of the earth. Vertebrates are represented abundantly; in mammals (as the ox and sheep), birds, reptiles (e. g. the terrapin), and fishes. Molluscs, as oysters and clams, are favorites with many, Ar- ticulates are familiar in the lobster, crab, prawn, and shrimp. Badiatcs do not enter into the common diet of Europe or America; but some tropical dwellers by the sea make the softer kinds a portion of their food. Protozoa abouud in the water of rivers, lakes, and ponds, but are too small to attract our attention, unless Ave use a microscope. A Brahmin, whose religion forbids him to put any creature to death, was horrified upon taking a look through a lens at the living things in a drop of Avater. He was consoled by being told that some one else could destroy them all for him by boiling the Avater before he used it. Beef is the strongest kind of meat, the most concentrated albuminoid food. It is, also, Avheu tender, as digestible as any other article of diet. Many dyspeptics eat only beef and bread every day. A larger range, hoAvever, Avould nearly always be better for them. Signs of good quality in beef are these: it should be of a fresh red color, neither pale- pink nor dark-purple; marble-veined lightly with fat; not wet, but firm to the touch; Avith little odor, none unpleasant; should shrink but little in cooking. If tested Avith litmus paper, its juice Avill shoAV acidity by reddening it. Under the microscope, few infusoria are seen in the juice of good fresh meat. Veal is not nearly so easily digested as beef. Some persons, not usually dyspeptic, have to avoid it altogether. A bad fraud in some city markets is the sale of too young veal (" bob " veal). It ought never to be eaten before it is four or five Aveeks old. The law in New York State forbids its sale under four Aveeks; but this law is said to be often evaded. Mutton is very nearly (some analysts say quite) as strong a nitrogen- ous food as beef, and scarcely less digestible Avith some persons. Either kind of meat may be tough or tender, and so may give the stomach, as well as the teeth, more labor in disposing of it. Tough meat does not pay; don't buy it. Internal Avork in digestion has to be economized or supported like external Avork, or the strength goes down. Lamb is more desirable every Avay than old mutton. It seidon jr never comes to our markets too young. Pork should always be avoided by dyspeptics and by persons i un- certain peptic poAvers. All rules about diet are intended for these. ME A TS. 271 Healthy people can digest almost anything, except bob veal and very ancient knife-resisting mutton, or leathery skirt of beef; anything, in short, that their teeth will chew. Fresh pork, for the hearty, active man or woman, or roast pig, the delight of the humorous essayist Charles Lamb, is good and nourishing; but it must ahvays he well done. All hog-meat must be cooked through (not only on the surface) to de- stroy any possible parasites which it may contain. Of these, trichince are the Avorst, being dangerous to life; but they are certain to be killed, and thus made harmless, by thoroughly cooking the meat. (Figs. 147, 148.) Smoking it without cooking Avill not make it safe. Freezing it may do so. Game, that is, meat of wild animals or birds, is generally more agreeable to the palate, and of easier digestion, than that of our domes- tic animals. Buffalo meat (that of the bison of the AYest) is very good; exceedingly like beef. The hump is said to be the most delicate part Fig. 148. Fig. 147. :| ••'.*• TRICHINA IN MUSCLE, NATURAL SIZE. TRICHINA, MAGNIFIED 150 DIAMETERS. Venison is, when young, delicious and wholesome. Of our smaller ani- mals the rabbit and squirrel are quite good. Opossums are often sold in the Philadelphia markets, but I have not become acquainted Avith their qualities. Our large country is naturally well provided with wild food. At a "game dinner," some years ago, all these were served to the guests: oysters, snapper, Avhitefish, mountain sheep, black bear, buffalo, Avild turkey, prongbuck, raccoon, woodchuck, canvas-back duck, black duck, Avild goose, prairie chicken, blue-Avinged teal, green-winged teal, red- head duck, spotted grouse, ruffled grouse, widgeon, opossum, leg of elk, black-tailed deer, jack-snipe, sand-snipe, reed-bird, quail, partridge, plover, fox-squirrel, gray-squirrel, red-squirrel, blackbird, wild pigeon, hare, terrapin. Birds haAre weaker, less nitrogenous meat than mammals, but gener- 272 HYGIENE. ally more tender and delicate. Most digestible of domestic birds are the turkey, chickeu, and guinea-foAvl; less so the duck (though often very good), and least fit for doubtful stomachs, the goose. Pigeons are moderately digestible, but one soon tires of them. Our Avild partridges, prairie chickens, and grouse (some of Avhich are often called pheasants, but there are uo true pheasants native to this country), and quails, are very good game-birds for the table. So are reed-birds (favorites for in- valids and convalescents), Avood'cock, snipe, and canvas-back ducks. Other wild ducks of American Avaters are rather apt to be " fishy;" the canvas-back is the best. The Avild turkey, a little richer perhaps in flavor than his fellow of the farmyard, is a truly native American bird. This cannot be said of the chicken, guinea-foAvl, duck, or goose—all natives of the old world. The turkey is perhaps our most valuable original contribution to the diet of mankind, unless we except the potato and maize (Indian corn). Other American gifts to the Avorld's diet may be here mentioned—the tomato, cocoa (cacao, used as a beverage, not the cocoanut), pineapple, cranberry, Avatermelon, cayenne pepper for seasoning, and vanilla for flavor. Tobacco is native American, but is not a food; and cinchona bark, from which quinine is obtained, is worth more to the world me- dicinally than any other drug, except opium and iron. Of reptiles, turtles are the only ones eaten in civilized countries, besides the legs of frogs, whose use at table has given the Frenchman in England the name of Johnny Crapaud. The terrapin is the Ameri- can favorite; in England, the green turtle. Our snappers also make very good soup. Lizards are eaten in parts of South America. Fish, of some kinds, are consumed in almost all parts of the Avorld. Thousands of people depend upon fishing for their living. There is still less nitrogenous material in fish than in birds' meat; some, as the salmon, have a good deal of fat. A larger proportion of the phosphates (salts containing phosphorus) is present in their substance than in land animals. Some persons imagine that fish are therefore especially a brain-making diet. But there is enough of the phosphates iu ordinary meat and bread for any one's brains, if he can appropriate and assimilate them AATell. Not all fish are wholesome; a feAV kinds are said to be poisonous. Dr. Letheby mentions one sort, eating which has produced death within an hour. The bladder-fish or toad-fish of the Cape of Good Hope has the reputation of being unsafe to eat. In some books the folloAving are called uneatable: old Avife, yelloAv-billed sprat, coryphcena, blue parrot- fish, conger eel, smooth bottle-fish, and barracuda. I have met with the assertion that the fish of the river Nile are miAvholesome. But the ME A TS. 273 natives of Egypt catch and eat them in large numbers; and in the Book of Exodus the Israelites are said to have sadly missed, in the wilderness, the " fish of Egypt." Certain fishes are not good at the spawning time of year. This is the case Avith the shad and salmon, which should ahvays be taken during their time of going up the streams which they frequent near breeding time. Idiosyncrasies, however, be- fore spoken of in regard to fruits, are also noAV and then met with about fish. Some people have nettle-rash, or other symptoms of indigestion, to follow eating particular varieties of fish. But, generally speaking, fresh fish, nicely cooked, are wholesome and nourishing. AVhoever has caught a mess of brook trout in a crystal stream, cold as snow, among the AVhite Mountains of New Hampshire, or near the head-Avaters of the Juniata, in Pennsylvania, has had as good a supper as Isaak AValton ever ate or dreamed of. DelaAvare shad, too, are delicious. Salmon were left out of Banting's diet as too rich; but they, and the Englishman's Avhite-bait, and halibut, black fish, sheep's-head, rock-fish, cat-fish, fresh mackerel, fresh cod, and twenty other kinds, make an excellent variety wherever any of them can be had for the table. One Avho has only eaten "cod-fish balls" inland, or salt mackerel some months old, can hardly imagine how good such fishes are when just out of the Avater. If you ever pass the banks of NeAvfoundland, try to get your captain to buy some cod of a fisherman there, and have it cooked for you. You Avill not then recognize its ordinary flavor or odor at all. This illustrates a fact, equally true of delicate fruits; the nearer their natural source, the less the time since they were gathered, the finer their flavor. Few things of exquisite taste (except wines, and not all of them) lose nothing by keeping. tSome fruits (although Avith pears it is not so) part with their best taste in a few hours; many, in a day or two. AVinter apples, nevertheless, are not to be despised. Neither are sardines and anchovies, put up along the Mediterranean in oil for exportation. It should be remembered, hoAvever, that a diet of salt fish for months together, Avith nothing else, will not keep any one in good health. Whole crews of men on long voyages have perished, before and even since Captain Cook's time, from trying to live entirely on salt food. Of articulates, lobsters, crabs, prawns, and shrimps have been already mentioned. Lobsters, at least, Avhen fresh, are not unwholesome for most people. Served as part of a great feast of superfluities at a late supper or an anaconda-like dinner, what food would not sometimes disagree? Moreover, everything taken out of the Avater spoils soon after it dies. The place to enjoy lobsters, crabs, and shrimps safely is IS 274 HYGIENE. at the sea-shore. Insects are eaten in some parts of the Avorld; of them again presently. Molluscs, as oysters and clams, are nowhere more appreciated than in America. Our oysters are probably the best in the world ; although in tropical waters they groAV a great deal larger. Those caught on the British shores are far inferior in taste to ours. Clams are tougher, and much less digestible; their soup can be enjoyed, hoAvever, Avithout risk- ing the hard clam itself. Oysters are really an important staple in our Eastern States. Many a valetudinarian almost lives on them, Avho has no relish for steaks, roasts, or " hot joints," and little even for poultry. Convalescents can begin with good sound oysters before they dare venture upon more solid food. One of their virtues is, that they can be cooked in so many Avays. Raw, they are digestible by the hungry man almost ahvays. Roasted in the shell, they are manageable by every stomach that has any gastric juice in it; no solid is more digestible. Panned, steamed, steAved, broiled—did ever Apicius or any Roman emperor taste more precious morsels, brought to him a thousand miles? Fried oysters must be, Avith the dyspeptic, placed on the index expurgatorius; quite for- bidden, under penalty of bad dreams or Avorse effects.* * Within the last two or three years, from some wrong notions about keeping and "fattening" them, the supply of oysters in Philadelphia has deteriorated. The nearer they are to their original, natural oceanic state, the better they are, and the more wholesome. CURIOSITIES OF DIET. 275 CURIOSITIES OF DIET. In Austria, even in Vienna, it is said that ants are eaten, sometimes served upon the table alive; and candied beetles also. Cockchafers are food for some people in Italy. John the Baptist ate locusts and Avild honey. Possibly the fruit of a locust tree (karob) is here meant; but, more likely, the insects, Avhich are a good deal like our Rocky Moun- tain grasshoppers. Arabs, Moors, and Hottentots all eat locusts freely. Humboldt saw South American Indians eat centipedes. Lalande, the astronomer, was ATery fond of spiders. Charles DarAvin called a certain kind of caterpillar delicious. In Ceylon bees are commonly eaten. In Africa monkeys are often eaten; Sir Samuel Baker there, and Hceckel, the naturalist, in Ceylon, liked them much, after getting over the idea of their resemblance to men. Cannibals still exist in some parts of Africa and Australasia, and, Avithin a feAV years, this has been asserted of an Indian tribe, almost extinct, in South America. Lizards are often eaten by some natives of that continent. The Chinese eat earthworms, rats, and birds'-nest soup. Mention has been made on a previous page of their fondness for eggs which have been buried for many years underground. According to a paint- ing of a Roman dinner, found under the ashes of Pompeii, ancient epicures in Italy ate snails and rats. Colonel Fremont, in his Rocky Mountain explorations many years ago, and Dr. Hayden near the same regions since, have shared dog-meat Avith American Indians. Bongos, on the Upper Nile, love their cats better than elderly maidens do : they eat them. During the siege of Paris by the Prussians, in 1870, not only horse-meat, there a common article before, but all the wild ani- mals in the Jardin des Plantes Avere consumed by hungry Frenchmen. Their skill in cooking would make anything agreeable. No doubt, unused treasures of food for our use abound everyAvhere. Why should not Professor Riley, the entomologist, be right, after try- ing them himself, in advising that the Western grasshoppers be eaten, in retaliation for their sometimes devouring the crops of Kansas and Nebraska? Men will need, some day, to give up their fancies and prejudices, and be more willing partakers of the varied bounty of nature. 276 HYGIENE. THEORY OF COOKING. Man is the only animal that cooks his food. Why does he do it? He could live, in the warmer climates at least, on roots and fruits, es- pecially with the addition of cow's, goat's, or other milk. But our range of diet is greatly enlarged by cooking many things not eatable raw; and appetite is favored also by greater variety of taste being given to our prepared dishes. Cooking is an artificial beginning of digestion. It commonly makes things soft and tender; that is, breaks up their resisting fibres, and makes them more easily soluble in the gastric juice and other digestive fluids. Take raw string beans, for example, and think of (don't try) digesting them. Dr. Beaumont's soldier patient would probably have given him trouble under that experiment. But, with four hours' boil- ing, they become tender and safe for most people. Boiling (that is, using a high heat with water) and stewing (exposing long in water to a heat less than boiling) are the most effectual ways of producing tenderness in articles of food. Roasting and baking have somewhat of this kind of influence also, except when continued so long, or at so high a temperature, as to dry up, and thus harden things* By dry heat, also, a different effect is produced on the flavor of Avhat is sn cooked. Ozmazome is a name for the brown material on and near the outside of roasted meat, which is very pleasant to many tastes. Roasting and baking are not the same in their effects on meat. Prop- erly done, roasting is cooking in front of the fire, the meat being exposed to the air. Baking is cooking in a closed oven. The difference is, that some vaporous matters, produced by heat, are driven off in the one case and kept in the other. Roasting is much the best and most agreeable in effect of the tAvo; but it is more troublesome, and not so often carried out, e\ren when ordered. An interesting point is as to the respective effects of quick and slm cooking, either roasting or boiling. When a piece of meat is put at once near a hot fire, or into boiling water, the albuminoids in it are coagulated at the surface by the heat, sealing it up against the escape of its juices. All the strength of the meat is thus kept in it. But when it is put near or on a slow fire, or at some distance from a hotter one, or when it is placed in cold water which is slowly heated, no such early coagulation takes place; the heat acts by degrees on the whole of the meat, and its juice oozes out. If roasted in this Avay, there is gravy! and if sloAvly boiled, the soup contains a great deal of strength; the med Avhich is then left retains very little. THEORY OF COOKING. 211 When, then, Ave wish to keep the strength of the meat in it, we must cook it quickly, at least at the start. If we desire, instead, to get a strong broth, we must put it into cold or tepid water, and first stew and then boil it slowly for a considerable time. Frying makes many things, especially fish and potatoes, pleasant to the taste, and, if it be skilfully done, innocent for people of good digestion. Good fresh butter is the nicest material for this use. Dyspeptics have to avoid fried oysters and other fries, as a rule; especially when too much lard is used, and Avhen it is overheated. Grease at a high heat, Fig. 149. TAPEWORM (TJSNIA SOLIUM). long continued, gives off acrolein, an unpleasant and unwholesome prod- uct, knoAvn to us by its smell in the wick of a candle just blown out. Broiling is more generally an acceptable mode of cooking, in view of digestion, than frying; but it also requires skill and care to do it well. With meats, the most necessary thing is tenderness. Those a little tough may be made eatable by hammering before cooking. Paw meat is digestible, if it be tender and fresh, and if the eater likes it. Freezing meat does for it someAvhat of the same service as cooking, by bursting the cells and breaking up the fibres, so as to tender it. In the Arctic 278 HYGIENE. regions frozen raw meat has proved a better preventive of scui-aw than cooked meat. Moreover, thorough freezing Avill kill trichince (thread- worms) when present in pork. Scrapings of raw beef are sometimes given to sickly infants as strong food, and so is the e.vpressed juice of meat. There is one objection to this: once in a while the eggs of tapeworms are in the meat, and may develop in the child's intestines. This has been a feAV times known to happen. (Fig. 149.) For this reason, the "raAV beef and brandy" feeding of consumptive patients is not so commendable as the use of beef essence or beef tea; in the preparation of which the heat is sure to kill all parasites. SOUPS. Broths will do very well, to please taste and make a variety, if they are not too thin and weak. When made sufficiently nourishing, the liquid form gives the least labor to the digesth^e organs, and is the best for very feeble persons. This is especially true of those ill with serious diseases; for example, typhoid fever. A meal of solid food cannot be digested by such an one; it Avould remain in the stomach too long, and might cause dangerous irritation. Therefore, Ave give the patient milk, or beef tea, or beef essence, in tablespoonful portions, every tAvo or three hours (sometimes even every hour), day and night. So given, the food sustains the patient's strength, without taxing the stomach by an effort of digestion. For a person in health a moderate distension of the stomach by solid food is natural and suitable. The modes of preparation of beef essence and beef tea will be set forth in another part of this book. Blood might be supposed from its nature to be an available liquid food. In the Mosaic laAV it Avas forbidden; but this may have had a reason in the rapid changes which animal fluids undergo in the warm climate of Palestine. Greenlanders consume a good deal of seal's blood; and blood-puddings are occasionally made in this country. Yelpeau, a distinguished French surgeon, advised consumptive patients to drink fresh blood, warm from the slaughtered animal. In Xew York, not long since, it Avas stated that as many as tAvo hundred people, men, women, and children, resort to it daily. A slaughter-house pro- prietor said, " they ahvays imbibe beasts' blood, never the blood of sheep. Some of them wince a bit at first; but, when you close your eyes, blood Avarm from the beast's neck has just the same taste as warm milk from the cow." ADULTERATION OF FOOD. 279 ADULTERATION OF FOOD. Volumes have been Avritten upon this subject; but the most impor- tant facts can be briefly stated. Much the larger number of adultera- tions are those which cheat the pocket without endangering the health— fraudulent but not poisonous substitutions and mixtures. Still, Avhile not involving peril to life, they often cause trouble in digestion, and lessen the nourishing power of foods; and this last may be of great consequence to feeble persons, and especially to delicate infants. Food adulteration is therefore a crime, Avhich ought to be punished severely. Alum in bread is a common addition. One part to a thousand of flour seems to be harmless; much more than that is astringent and harsh to the stomach. Chemists can readily detect it by a test. Chrome yellow in buns killed several persons in Philadelphia in 1888. Marble in pulverized sugar has been mentioned already. It is de- tected by the marble not being dissolved when the sugar is put into clear water. This fraud, as Avell as that of sanding brown sugar, is probably less common than formerly. Vinegar is often hurt by the addition of sulphuric acid (oil of vitriol). This gives it an intensely sharp taste, and, in large amount, an irritating quality. It is tested by chloride of barium (making a cloudy pre- cipitate). Olive oil (sAveet oil) is subject to dishonest mixture Avith oil of cotton- seed and other cheap oils. Spices are much adulterated, when sold after being ground, with inert materials, not injurious but comparatively worthless; potato meal, for example. Red pepper sometimes has mixed with it logwood or mahogany dust, brick dust, or red lead. The last mentioned is poison- ous, but is seldom present in large amount. It can be detected by throAving a little of the cayenne pepper into a tumblerful of water. The heavy red lead will sink rapidly, being a mineral substance; while the pepper will go down slowly to the bottom. Milk is proverbially weakened with water, as well as robbed of its cream. More will be said of this some pages later in the book. Cream of tartar, Avhich is not a food, but is often used with soda in making bread, is frequently adulterated with gypsum and other useless and cumbersome mineral substances. Arrow-root is apt to have mixed with it the much cheaper potato- starch. The certain mode of detection of this is the examination of the minute corpuscles Avith the microscope. The difference amongst these has been described already, in speaking of starch and its varieties. 280 HYGIENE. Baking-powders are not uncommonly Aveakened Avith starch; and candies, with both starch and plaster of Paris. Fig. 150. puke coffee, under the microscope. Fig. 151. COFFEE AVITH CHICORY, MAGNIFIED. Coffee, when ground, is often adulterated Avith chicory-root, wheatfl^h etc. This also is only a fraud, not injurious to health. DISEASED MEATS. 281 Tea has a great variety of leaves and flowers, not of the true tea- plant, mixed Avith it, even in China. Indigo and Prussian-blue are sometimes used to heighten its color, but never in poisonous quantities, as neither of these coloring materials has dangerous effects. Colored confectionery is liable to be made actually poisonous by the use of metallic colors containing copper, lead, or sometimes even arsenic. Protection against this danger, as well as that of adulterated wines and liquors, is easily secured by avoiding those articles entirely; this being the safest course even when they are at their best. Comparative Digestibility of Foods. Easily Digested. Moderately Digestible. Hard to Digest. Beef, Mutton, Veal, Lamb, Fresh Pork, Ham, Chicken, Duck, Goose, Turkey, Salmon, Salt Fish, Milk, Cheese, Preserves, Boiled Eggs, RaAV Eggs, Clams, SAveetbread, Liver, Kidneys, Trout, Terrapins, Sardines, Mushrooms, Lobster, Calf's Brains, Roast Oysters, SteAved Oysters, Fried Oysters, Stale Bread, Hot Bread, Batter Cakes, Good Butter, Melted Butter, Bad Butter, Rice, Potatoes, Pastry, Peas, Beans, Turnips, CaulifloAver, Cabbage, Cucumbers, Peaches, Apples, Cherries, Raspberries, StraAvberries, Pears, Oranges. Currants. Pineapples. DISEASED MEATS. We must suppose the flesh of an animal Avhich has died from disease to be ahvays unwholesome. It has happened, hoAvever, that much less harm has come from it, in many cases, than was to be expected. Ani- mals dying in Germany of the rinderpest (cattle plague) have, in times of scarcity, been eaten by the poor in large numbers, at least without fatal effects. Acute, rapid disorders, act most upon the blood, and cause but little change in the solid substances of the animal. Slow chronic, Avasting 282 HYGIENE. disease is more likely to produce alteration of the flesh, making it un- suitable for food. On the Avhole, Avhatever number of escapes from injury may have been reported, it is the dictate of reason never know- ingly to eat the meat of an animal Avhich either died from disease or Avas unhealthy before it was killed. It is, of course, also unsuitable to eat meat which has begun to spoil; although here, too, the mischief done is less than might be looked for, and some epicures imitate the vultures in preferring to have their game " high "; that is, a little tainted. Hard driving of cattle through long distances, especially in hot weather, makes their meat unwholesome. EXCESS OF FOOD. Most people, of the Avell-to-do classes at least, eat too much. When that is done, a person of strong digestion is apt to become plethoric; that is, to have an over-abundance of blood, containing more red cor- puscles than are needful or beneficial. Such an one is more liable than others to inflammatory diseases and to hemorrhages; such as bleeding from the nose, spitting blood, or, in an older person, apoplexy (blood throAvn out Avithin the head, causing death by pressure upon or within the brain). More commonly, the excess of food, if not very great, goes out as refuse through the bowels. Often, however, indigestion is caused by it, Avith flatulence, sick stomach, and headache, frequently called, Avithout good reason," biliousness." Habitual indigestion is dyspepsia. Degrees of this are various, and very many people keep themselves uncomfort- able half the time by stuffing themselves with all sorts of unwholesome things, superfluities, the " luxuries of the table." The common proverb is only not as strong as it should be—enough is better than a feast. Gout is produced, in some constitutions, by eating too large a propor- tion of animal food, with too little exercise; but much more certainly, by adding also wine or malt liquor to the regimen. An excess of fat in the diet, besides indigestion, seems to promote disorder of the liver, although this effect is not so frequent as is often supposed. Worms (or their eggs) are taken into the stomach either in food or in Avater. But they are a great deal more likely to remain, groAV, and in- crease in number when the stomach and bowels are kept loaded with undigested or half-digested food. STARVATION. 283 STARVATION. Some time back in this Arolume, mention was made of the time that various animals and men can live without food. Man can seldom sur- viA'e more than ten days or two weeks of actual starvation. During a famine some years ago, in France, a French physician, Chossat, found it possible to Avatch and note doAvn the symptoms of those who were starving to death. He observed that they, and animals experimented upon, lost weight, day by day, death occurring when tAvo-fifths of the original weight of the body A\rere lost. The heat of the body, also, Avas lowered; most of all in the last days of life. Hunger, which Avas a cause of distress for some days, then disappeared, and instead of it came pain, with a sense of sinking, in the region of the stomach. Sleepless- ness existed, with extreme weakness; toAvards the last, delirium (or con- vulsions) and a fetid odor from the skin and breath; often, also, diar- rhoea. The addition of cold, Avet, general discomfort and anxiety, to priva- tion of food, must ahvays hasten its fatal result. The mental faculties in some instances give Avay. Thus, perhaps, Ave may in part account for the terrible things Avhich sometimes happen amongst those exposed at sea after shipAvreck, or in the Arctic regions. There is little reason to doubt that some of Lieutenant Greely's party ate the flesh from the bodies of their dead comrades; and, in 1884, the captain of the Mign- onette Avas convicted of murder, iu England, for having killed a sick boy to save the lives of himself and his creAV, when without food out at sea. A deficiency of food, short of starvation, causes ancemia, the opposite of plethora, in Avhich the blood is thin and watery, the red corpuscles being too few, and containing less than their natural amount of iron. Neuralgic pains, various other nervous symptoms, and diseases of debility (among them scrofula and pulmonary consumption) are pro- moted by this state of the body. 284 HYGIENE. POISONOUS FOOD. Milk sickness is a malady of Avhich, twenty-five or thirty years ago, accounts came from some of the Western States, as far east as Ohio and West Virginia. One old gentleman's diary, in the last-named State, says that the disease Avas caused by drinking the milk of cows pastured in certain meadoAvs in the night, or at sunrise or sunset; those feeding only during the hours of sunshine not being affected. AYith the in- crease of settlement and experience in pasturing cattle, this disorder seems to have died out. Sausage poisoning now and then occurs, with even fatal results. Chemists have in a feAV instances found a peculiar deleterious principle in the sausages, but not ahvays. By reasonable care in the selection and preparation of sausage-meat, such accidents should always be avoidable. Uncooked sausages should never be eaten for fear of trichina, if of nothing else. Canned salmon made a family ill at Yonkers, New York, in 1875. It is charged that venetian-red and red lead are put in to color salmon for canning by some dealers. This is very wrong. Canned fruits and vegetables are sometimes made unAvholesome by scraps of the solder, containing lead, being partly dissolved, or even swallowed whole. Iron ware lined Avith enamel containing lead is unsafe for cooking. One infant in New York Avas fatally poisoned by having its milk boiled in such a vessel. Chrome yellow poisoning has been mentioned, p. 279. Some persons have entertained the opinion that pure tin is not a safe material for canning ATegetables, fruits, or meats. But careful chemical investigation makes it appear that if the tin is clear of lead and arsenic (as it ought ahvays to be for such a use), it is not capable of doing harm in any amount that could thus be dissolved and taken into the stomach. As, hoAvever, some tin does contain lead, acid fruits, as tomatoes (which contain acid), may become unsafe when kept for more than a year in cans, and also Avhen exposed to the air for some days after the cans have been opened. Dr. Johnson, of Brooklyn, was led, by several severe cases (occurring in one family) of poisoning from tomatoes, to examine the cans in Avhich the vegetable was put up. He found the sides aud bottom of the can Avere fastened by the usual resin amalgam, and were perfectly bright and sound; but a trained tinsmith pointed out that the cap of the can Avas fastened on Avith an amalgam made of muriate of zinc. The tin Avas corroded around the cap on the inside of the can. The mechanic explained that pieces of zinc are placed in muriatic acid and dissolved, and this saturated solution of zinc had been painted with POISONOUS FOOD. 285 a brush into the grooves of the head of the can. " He said this Avas a very favorite amalgam with roofers, on account of the quickness Avith which it could be applied; but that good architects and builders would not allow of its use, because it rotted the tin." Some of it had undoubt- edly got into the can's contents. This explained the cases of illness. In the State of Maryland, where legislative attention has been called to canned goods, there is a laAV prohibiting the use of this muriate of zinc flux. It is safe to conclude that, Avherever the inside of a can-lid shows that the tin has come off in patches, something has dissolved it, and it is mixed with the can's contents. Tin-poisoning, perhaps slow, but accumulating in the system, will be the result from eating food from such cans. Pieces of solder are sometimes loose in the contents of cans. A perfect can, to quote this authority, should show the same line of resin around the caps that it has on the sides. It should only shoAV one "solder hole" on the top. If there are two, that means that the cans have at one time fermented, and had become " SAvells," that is, the gases and ferment from inside have pushed out the head. Such cans are sometimes bought up, another hole punched in them to let the gases escape, the can then is reheated and soldered up again. A sound can should have its head bulged in rather than out, and must feel solid to pressure on the bottom. On the other hand, a commissary officer of the United States army, in 1884, published the statement, that, in the distribution of canned vege- tables during many years to thousands of soldiers, not a single instance of poisoning thereby had occurred. He is sure, therefore, that no such thing need ever happen; it being made possible only by some avoidable fault in the article used, Avhich ought to be capable of detection Avhen the can is opened, if not before. Pickles made or kept in copper vessels are rendered poisonous by the acetate of copper formed and dissolved by the vinegar. Such vessels should never be used for pickling. Neither should copper be employed to boil or strongly heat anything that is to be eaten. Under heat, the action of liquids on copper is greatly increased. The presence of car- bonic acid also promotes the solution of copper, as is shown by the injurious effect of using copper reservoirs to hold "mineral Avater" or soda-water for fountains. The enamel lining of such reservoirs Avears off in course of time, leaving the copper exposed to the carbonic-acid Avater. If such fountains are allowed at all, the mineral water ought to be frequently tested for copper, to prevent mischief being done. Dr. AValler, of New York, reported to the Board of Health that he found, in some cucumbers offered for sale in that city, thirty-seven grains of copper to the pound, added to give a bright green color to them. Th is 286 HYGIENE. is ATery bad. The conditions determining the action of ordinary drink- ing Avaters on lead have been treated of already in this book. It may be here repeated that water for cooking should never, with those Avho have boilers heated by kitchen ranges, be drawn from the hot water spigot. Cooks are often tempted to get it thence to save themselves the trouble of heating Avater on the fire. But it is unwholesome, because hot Avater may act on the lead pipes Avhen the same water cold Avill not. Some boilers also are made or lined Avith copper; and even iron, under a high heat, may give enough rusty material to Avater to make it not good to drink or to use in cooking. Other Avays of introducing poisonous substances into our bodies occa- sionally exist, but may be avoided by reasonable carefulness. Examples are, filling up holloA\rs of millstones Avith bits of lead ; and baking bread over a fire made of old bits of Avood coA^ered Avith paint, vapors from Avhich get into the bread. Such things, hoAvever, are very rare. AVbile this book is being printed, I have met with an example in my OAvn house, showing hoAV a filter, intended to purify water, may, with- out care, make it poisonous. A very good JeAvett's water-filter, through which all my family drinking water has passed for a year or more, was found to give out Avater containing small sand-like particles, of a green color. On examination, these were ascertained to consist of copper-rust, carbonate of copper, from the inside of the brass spigot of the filter. This shows the thorough cleansing of such spigots to be important. In 1886, Professor Vaughan, of Michigan, discovered a poisonous substance, tyrotoxicon, in very badly-spoiled cheese, rancid milk, and some ice-cream Avhich made those Avho ate it sick. The greatest care should ahvays be taken to have milk for use fresh; especially for young children. The Philadelphia Board of Health lately declared the use of the fol- lowing coloring matters to be not allowable in food or drink : " King's yellow, chrome yelloAV, chrome zinc, Mosaic gold, minium, purple red, colcothar, crocus, chrome green, Paris green, emerald green, Brunswick green, ultramarine, AntAverp blue, Vandyke brown, puce, chrome orange, Turner's yelloAV, Turpeth mineral, Naples yellow, orpiment, red lead, iodine scarlet, rouge, Rimner's green, Scheele's green, ScliAvein- furth green, mountain blue, soluble blue, sienna, kermes mineral, cadmium yellow, citron yellow, yellow ochre, Paris yelloAV, vermilion, realgar, red ochre, mountain green, verdigris, mineral green, Prussian blue, blue vitriol, umber, and all colors not herein mentioned, contain- ing or liable to contain appreciable quantities of arsenic, antimony, mercury, lead, copper, tin, zinc, barium, cobalt, nickel, cadmium or bismuth." CONDIMENTS. 287 CONDIMENTS. Seasoning is the common term applied to the use of salt, pepper, mustard, and spices, as additions to our food. Of these, salt has a ser- vice of its OAvn, as a necessary ingredient of our blood, and otherwise, as mentioned on previous pages. The other condiments are stimulants to the action of the stomach, besides being agreeable, in greater or less degree, to the taste, and favoring appetite. All spices are natives of warm climates. Under the relaxing influ- ence of such regions, stomach and boAvel affections are common, and the Fig. 152. PIPER NIGRUM. MUSTARD PLANT. internal warmth caused by aromatics is often beneficial. Yet, in all places, they need to be taken Avith moderation. Over-stimulation, like the over-driving of animals, is wasteful of energy, and, in the end, destructive. This is true even of the mild excitement of the palate and stomach by pepper, mustard, or other seasoning. Children do not generally like highly-seasoned food. They do not need it, and are better without it. Its right place is in the diet of those 288 HYGIENE. who are enfeebled by age or disease. If reserved for such occasions of use, its full advantage will then be gained. But those who, from early life, become accustomed to it, cannot be helped much by it when their poAvers of digestion fail, and they have need of it. AVhen, as an indulgence, people will take things difficult of digestion, or mere super- fluities, seasoning undoubtedly helps the stomach at the time to dispose of the excess. Pepper is of two kinds: black and red pepper. These come from Fig. 155. different plants; one is a native of the Old world, and the other of the NeAv. The black pepper is the fruit of a vine (piper nigrum), native to the East, but much cultivated also in the AA7est Indies. Red or Cayenne pepper (capsicum) is indigenous in South America and the AArest Indies. It is a kind of pod, familiar as raised often in Northern gardens. Red pepper is a much stronger stimulant than black, and needs to he used in much smaller quantity. For well persons the black pepf*' CONDIMENTS. 289 should, as a rule, be preferred, for the same reason. In an exhausted condition of the stomach or general system, cayenne pepper may be very useful; for instance, in seasoning the food of a patient having delirium tremens, or one who is breaking off the habit of drinking liquor. Most persons Avho are Aveak enough to need beef-tea or beef-essence as con- centrated food, will profit by having it moderately seasoned with red pepper, as this makes it more likely to be easily appropriated by the stomach. Mustard is the seed either of the white or the black mustard-plant (sinapis alba and sinapis nigra), both natives of the Old world. Fig. 156. VANILLA PLANT. White^ mustard is generally preferred for table use, as more delicate. It is an interesting fact, that Avhile a little mustard, put in as seasoning with food, is stimulating and comfortable to the stomach, a large dose of it is one of the surest things to cause vomiting. The same is true of salt, and of some vegetable bitters—as camomile, hoarhound, and boneset. In case of poison having been swallowed, the handiest emetic to rid the sufferer of it will mostly be a tablespoonful of salt or a tea- spoonful of mustard, in a teacupful of warm (not hot) water. Allspice (pimento) comes from a plant of the same genus as black pepper. Mace is the inner covering of the nutmeg fruit. Other well 290 HYGIENE. knoAvn and pleasant spices are cloves, unexpanded floAvcr-buds of the caryophyllus plant; cinnamon, the bark of an East Indian tree; ginger, the root of a plant (zingiber), originally Eastern, but now brought to North America chiefly from Jamaica; caraway, carda- mom, and other seeds, etc. Vanilla is a someAvhat aromatic plant of American origin, the taste of whose extract is agreeable in ice-cream and other luxuries. Orange-peel and lemon-peel both contain aromatic oils, making them pleasant flavoring materials. All the spices depend for their characteristic properties on the presence of peculiar volatile oils (that is, oils AA'hich are driven off by heat). Some of these oils are dis- tilled, and used variously in medicinal preparations, especially those of ginger, cinnamon, and cloves. DRINK.—MILK. 291 DRINK. Water, Avhich, after air to breathe, is the first necessity of life, has been sufficiently treated of in this book under the heading, Our Homes (Water Supply). Other beverages now require attention. MILK. Where shall we look for a perfect food, if not in that supplied by nature for the young of the highest class of animals, including Man ? Examination of its qualities, as well as abundant experience, proves that it fully meets this expectation. Cow's, goat's, ewe's, mare's, ass's, and buffalo's milks are used by people in different parts of the Avorld. They all contain the same nour- ishing substances in different proportions. Tartars use mare's milk; Egyptians, that of the buffalo; elsewhere, that of the cow and goat are much the most employed. Cow's. Ass's. Goat's. Ewe's. Woman's.* Casein and Albumen . 4.48 1.82 4.02 4.50 1.52 Butter .... . 3.13 0.11 3.32 4.20 3.55 Sugar of Milk . . 4.77 6.08 5.28 5.00 6.50 Salts .... . 0.60 0.34 0.58 0.68 0.45 Water .... . 87.02 91.65 86.80 85.62 87.98 Total . . 100.00 100.00 100.00 100.00 100.00 Solids . . . . . 12.98 8.35 13.20 14.38 12.02 As above shown, these contained substances are casein and albumen (nitrogenous); butter (oleaginous); sugar (amylaceous); and salts ; all diluted Avith Avater. A very small amount of a peculiar animal principle gives a difference of odor and taste to each kind of milk. EAve's milk is somewhat the strongest in nutritious solids; next goat's; then cow's; lastly, human milk and that of the ass. These last are the two most alike. But they are all available for food, with proper management and under different circumstances. Looked at it with a microscope, milk is seen to consist (like blood) of a watery fluid, in AAmich float a great many cells, or corpuscles. * Another analysis (Doyere) of human milk is the following: Water, 87.38; Butter, 3.80; Casein, 0.34; Albumen, 1.30; Sugar, 7.00; Salts, 0.18; Total, 100 parts. In recent discussions upon the chemistry of milk, some writers make very little reference to casein; applying the term albumen, or albuminous material, to all the nitrogenous portion of milk. 292 HYGIENE. Fig. 157. MILK, UNDER THE MICROSCOPE. Fig. 158. CREAM, MAGNIFIED. MILK. 293 Each of these little round bodies is composed mostly of butter, sur- rounded by a delicate coat of albumen (or casein), which holds it together. AVhen milk or cream is churned, or otherwise shaken or beaten these corpuscles are broken, and the butter is separated. This is the simple theory of the making, that is, getting out, of butter. All the world knows that, when milk stands awhile, the cream rises to the top. This takes place gradually; all of it not floating up until -' after several hours; hardly less than ten or twelve hours. The best temperature for raising cream is between 55° and 59° Fahr. In a warm place milk soon begins to spoil. We perceive this when it sours; lactic acid then being formed in it. A very small quantity of this acid is often present in cow's milk even when fresh. I haA^e found country milk, only half an hour from the cow, to slightly redden litmus paper—the test for acidity. Some authors mistakenly advise using litmus paper as a sufficient test for the sweetness and freshness of milk, asserting that, if fresh and SAveet, it is always alkaline; that is, Avill leave the blue color of litmus paper unchanged, but will turn the yellow of turmeric broAvn. But Professor Parkes, in England, and Drs. Meigs and Ashurst, as well as myself, in this country, have found that good milk right from the cow will generally redden litmus paper; not much while fresh, but enough to prove that it is not alkaline. Only Avhen litmus paper is strongly reddened does it show an excess of acid (souring) in milk. But the first "spoiling" change really occurs in the casein. This (which, when separated, becomes cheese) begins to decompose, and its breaking up starts that of the sugar of milk (lactin), from which lactic acid is produced by a chemical change. Then the remaining casein is curdled by the action of the acid upon it. Now it is what is called " sour milk." Further spoiling goes on, with rancidity, from the formation of butyric acid from the butter, and putrefaction (if a long while kept) of the albumen and casein. A microscope will then show in it some of those tiny organisms, bacteria or vibriones, which always abound in decaying animal and vegetable materials exposed, more or less, to the air. Very certainly milk is only good and wholesome when fresh. An ice-cold temperature will delay the changes above mentioned, which constitute spoiling; but in warm weather and in a warm place this goes on rapidly. A sick baby may be made seriously worse in summer by taking milk only three or four hours old, before it has any sour taste at all. If milk must be kept in hot weather without ice, it should be boiled as soon as possible; then it will keep Avholesome much longer. 294 HYGIENE. Other causes of injury to milk exist, besides keeping it in a too warm place. As they are important, Ave may name them all together: 1. Stateness (just referred to). 2. Mixing fresh with stale milk. 3. Using uncleaned cans. They must be scalded, a little soda being added (at least every day or two) to the water; then aired, and, if pos- sible, sunned, to make them perfectly clean. 4. Exposure of the milk to bad air. Nothing absorbs foulness like milk. (Butter does so almost as readily.) A dairy should never com- municate with a house, and milk should never be kept standing in rooms in Avhich people live. 5. Milking unhealthy cows. 6. Stall-feeding of cows all through the year, never giving them any natural pasture. True, with good stalls and plenty of good food, they may become used to this artificial living, and their milk may be good; but not the best. Such a mode of life is too far from nature. 1. Unwholesome food for coavs. About the worst of this is the swill- food from distilleries; in and near large cities such is not rarely given to cattle. This makes iwretched milk, not fit ever to be used. 8. Removal of the cream. Skim-milk contains the tissue-making (nitrogenous) portion, and is therefore nourishing; but it lacks the specially force-producing oleaginous part, which is in the cream. Some physicians of late years have prescribed a diet of skim-milk in treat- ment of certain diseases. I doubt its ever being so desirable an article of food for sick or well as whole milk, cream and all. 9. Addition of water. This is the " original sin" of dairies. It is so easily done, and not easily detected and proved; and it is (in lucre) so profitable! Prof. Chandler, of New York, publicly asserted, some years ago, that one quart in every four or five of the milk sold in that city was added water. My quondam milkman (not now continued in that function) once, when accused of such an addition, coolly said that no bad water was ever put in his milk, and added to this an invitation to go over and see his splendid hydraulic ram ! The difference between bad and good water added to milk, or used to wash milk-pans, is, it is true, very important. There is no doubt that typhoid fever and other diseases have been sometimes traced in numbers of cases to contamina- tion of milk at the dairy by impure water. Even allowing coavs to drink foul water appears at times to vitiate their milk. 10. Other possible additions. Chalk, magnesia, soda, salt, starch, and brains of sheep are said to be put into thin, poor milk to Avhiten it and neutralize its acidity, as well as to increase its density. The least used, no doubt, of these adulterations is sheep's brains. Chalk, starch, salt, and soda, perhaps magnesia, are probably often thus employed. MILK. 295 Hoav then, are we to know good milk ? First, by its appearance, taste and smell. One accustomed to that which comes fresh from the coav cannot be easily deceived in these qualities. Next, by the amount of cream which rises upon it. This can be measured in a glass vessel (which a druggist will furnish), marked to hundredths, or, for less exact estimation, tenths. Good milk should yield at least eight parts in a hundred of its bulk as cream. Some Alderney coavs Avill give a milk raising thirty or more per cent, of cream. The average of really good milk is probably about ten or twelve per cent. A vessel for measuring the cream is called a cremometer. Also, the specific gravity is important; that is, the weight of the milk compared Avith that of Avater. Milk always weighs more than the same bulk of Avater. Cream is somewhat heavier than Avater, although lighter than milk, and hence floating upon it. We take the specific gravity of milk by seeing hoAV far into it a certain Aveight will sink. A specific gravity tube, or hydrometer, is a small glass fixture having a bulb containing mercury, and a lighter stem above, graduated (marked) to thousandths. The 1000 line is fixed by finding to Avhat place the stem sinks in water. In milk, Avhich is heavier, it will not sink so far. If the milk has been thinned Avith Avater, the hydrometer* will go down lower accordingly, and the differ- ence can be read off on the scale. Such an instrument may be also called a lactodensimeter. The " lactometer" is constructed on the same principle, but is graduated differently, and the simple specific gravity tube (hydrometer) is to be preferred. The specific gravity of pure milk, measured as above, ranges from 1028 to 1030. It ought, with good milk, to be at least 1029. An uncommon amount of cream may lighten it, but very seldom below 1028; never beloAv 1027. If it be curdled by a few drops of acid, the whey then strained off from the curd should mark 1027 at least Avith the hydrometer. Skimmed milk should not mark beloAv 1029 ; it may often reach 1031 or 1032. Cream averages about 1025. AAre ought ahvays to use both the cremometer and the lactodensimeter (hydrometer) for a careful examination. If, then, a specimen of milk yields Avith the cremometer less than eight per cent, of cream, after standing twenty-four hours; if it has a specific gravity as low as 1027, and its skimmed milk has that of 1028 or less, Ave may be sure that it has been watered. In case of inspection of milk under a laAV forbidding its adulteration, * This name has been given because it was first used to ascertain the amount of water, along with alcohol, in spirits more or less rectified by distillation. 296 HYGIENE. the lactodensimeter standing in it at 1027, Avith the cremometer showing but six per cent, of cream, should condemn it Avithout further question. The lactodensimeter at 1028, and cremometer seven or eight per cent., should cause suspicion, Avhich should be confirmed or removed by chem- ical analysis. This analysis requires the skill and apparatus of a chemist. Enough here to say, that its purpose is to determine, in the milk examined, 1, its Avhole amount of solids (after evaporation); 2, its proportion of fat; 3, that of its solids not fat. The least allowable proportion of solids in good, unAvatered milk, is 11.5 per cent, by weight. It ought to contain 12.5 to 12.98 per cent, of solids, of which 9.2 to 9.3 are not fat, with 3.1 to 3.2 of fatty material, of Avhich ether is the solvent in common use by analysts. Good milk is a Avholesome nutriment for men, women, and children, Avith very few exceptions. For hard-Avorking adults, it is not sufficiently strong food to be depended upon alone. It is excellent for aged people, and the staple article for infants and children. Condensed milk has had a large part of its Avater removed by evaporation, and some sugar has been added. It angers very well Avhen fresh pure milk cannot be ob- tained, and is very much better than poor or bad milk. I say bad milk, because such is sometimes wrongfully sold. Diseases, especially typhoid fever, and possibly diphtheria and scarlet fever, have been carried around and dealt out, we may say, with milk from a dairy in which foul Avater Avas used to wash the pans, if not added to the milk itself. Condensed milk must, of course, aa lieu used, have Avater added to it—six table- spoonfuls or more of Avater to each tablespoonful of it, well stirred to- gether. This mixture looks and tastes like common milk, only sweeter. I have knoAvn a child to thrive on it alone as food, for months together. The constitution of a good specimen of condensed milk is as folloAvs: AVater (parts by Aveight) 51.12 12.11 13.64 20.36 2.77 Fat ... Casein Milk-sugar Ash (salts, etc.) 100.00 Buttermilk is nourishing, and, to many people, pleasant and whole- some. Pure cream is, with most persons, quite as easily digested as milk. During illness, Avith prostration, and in convalescence, it is often very grateful and strengthening, as a force-giving, though (except for fat) not a tissue-restoring food. Further remarks on the use of milk for infants (a very important sul>- ject) Avill be made later in the book, as a part of the Hygiene of Infancy I STIMULANT BEVERAGES. 297 STIMULANT BEVERAGES. All men and other animals live by stimulation as Avell as by nutrition. Our good temperance readers may be someAvhat shocked by this asser- tion, but it is true. AVhat makes any one faint and fall when, for a moment, the heart ceases to beat ? It is the absence from the brain of the stimulus of freshly-aired blood. Lay the body doAvn, and a little more of this blood Aoavs to the head by gravitation: then consciousness and animation return. Breathing goes on under the stimulation of the ends of certain nerves by carbon-saturated blood; circulation, under that of the blood acting upon the heart and arteries; digestion is kept up by the stimulus of food, Avhich, through nerve-reflex action, draAvs the gastric juice and other digestive fluids into the stomach and intestines. And so we might go on and shoAv, that all the operations of the or- gans of the body are maintained under the influence of stimulating agents or agencies, every part indispensably requiring one or more of such to keep it in action. Of course, these are natural stimulants, and therefore wholesome. AVhat are Ave to say about artificial stimulation? From China and Japan to Paraguay and Peru, and from Labrador to Abyssinia, hundreds of millions of people, probably nine-tenths of the human race, take every day, besides food, something Avhich exhilarates and refreshes them. Is this evidence of a law of nature ? At least it shows a want of mankind: Avhether it be wisely met or not, is another question. After childhood, in this " Avork-a-day" world, we all get tired from time to time. Civilized life has its regular succession of toils, cares, and rests, its worries as well as its labors. ATe rise expecting toil, we grow Aveary with it, and Ave go home looking not only for support but for refreshment. Even the idle crave excitement to break the monotony of doing nothing—often the most wearisome of all. AVell, then, if Ave admit that such a demand shows a laAV of human nature, it is to be farther asked about stimulation—of what kind shall it be ? for whom f when ? and how much f No more important ques- tions exist in connection with personal hygiene. First, let us notice Avhat are the stimulants most commonly in use. They are of tAvo kinds: those Avhich do not produce intoxication, and those which do; non-inebriant and inebriant exhilarants. 298 HYGIENE. UNINTOXICATING STIMULANTS. The principal of these, used in various countries, are the following: Tea, Thea viridis and bohea. Guarana, Paullinia sorbilis. Coffee, Caffea Arabica. Abyssinian Tea, Catha edulk Cocoa, Theobroma cacao. Labrador Tea, Ledumpalustrk, Mate, Ilex Paraguayensis. Tasmanian Tea, Myrtacea. North American Tea, Ilex Cassine. Chicory, Cichorium intybus. Coffee-leaf Tea. Grape-vine Leaf Tea. These are not nearly all; New Jersey Tea, for instance (Ceanothw Americana), is omitted, because it has little or no stimulant quality of any kind. Far the most important, in Europe and North America, are Tea, Coffee, and Cocoa. English, Dutch, and Russians (as well as Chinese), drink the most tea; Turks, French, Germans, and Americans, the most coffee; cocoa is the favorite beverage in Italy, Spain, and Central America. Mate is drunk by millions of people in South America; and chicory is taken instead of coffee by very many in Northern Europe. TEA. Native to China are at least two species of Thea, viridis and bohea. It is raised on hilly or undulating ground, not unlike that Avhich, in other climates, is genial to the grape-vine. Japan and Assam (in Cochin China) also produce a great deal of good tea. The best that I have lately met with came from the Island of Formosa. It has been found possible to raise the Tea-plant with success in some parts of the United States, as Virginia, California, and even Iowa. For green teas, the young leaves are gathered in the spring, heated in shallow pans over a brisk wood fire, thrown upon a table and rolled aAvhile with the hands; then put again upon the pan and quickly dried. Black teas (commonly called Oolong) are made of more mature leaves, which are first spread out or tossed about in the air for some time, then put in heaps and allowed to lie for more than an hour, so as to begin to ferment a little; rolled on a table, roasted in pans, and exposed for a few hours to the sun and air; lastly, dried slowly over charcoal fires. TEA. 299 Black teas are, as a rule, considerably less exciting to the nerves than the green, and hence are, in this country at least, much the most used. Both kinds of tea are very often adulterated. Other leaves are mixed in with them, and sometimes flowers; also, with green tea, Prussian blue; with the black, catechu, black lead (graphite), indigo, turmeric, etc. None of these, in the quantities used, are poisonous. AVhile some of the leaves are still whole, it is not difficult to make out the spurious kinds; if much broken up, the quality of the tea must be determined mainly by its odor, taste, and effect when used. Chemists have found the principal active substance in tea to be the Fig. 159. TEA-PLANT. same as that of coffee; hence it is called either thein or caffein. It is nitrogenous (consisting of C, H, O, and N), and is one of the vegetable alkaloids; that is, alkali-like vegetable principles. Many of these alkaloids are obtained from plants; some of them are very powerful agents, as quinia (quinine), morphia, atropia, nicotin, strychnia. All of these, as well as thein or caffein, act in different modes on the nervous system. They are used as medicines, but in over-dose are poisonous. Ten grains of pure thein, taken at once, Avould endanger the life of a man. HYGIENE. Fig. 160. LEAVES OF THE TEA-PLANT. A., Young leaf. B, Leaf of Black Tea of medium size. C, Leaf of Black Tea of largergrowth D, Leaf of the Green variety of the Tea-plant. Fig. 161 LEAVES OF CAMELLIA AND CHLORANTHUS, USED AS ADULTERATIONS OF TEA. A, Leaf of Chloranthus Inconspicuus. B, Leaf of Camellia Sasanqua; leaves used to adulterate Tea. TEA. 301 Composition of Tea. Thein.....1 to 3^ per cent. Volatile Oil . . . -1 per cent, or less. Gluten.....20 to 25 per cent. Tannic Acid, Starch, Gum, Fat, etc. AVith the thein, tea-leaves have as constituents also gluten, starch, a very little gum and fatty matter, enough tannic acid to blacken iron left long in contact with them, and a volatile oil. The last of these gives the pleasant aroma to tea of good quality. It is driven off by heat; therefore tea should not be boiled or heated very long before it is used. The Russians make tea by putting the leaves into a teapot, pouring boiling water over it, and letting it stand two minutes. They then pour it into glass tumblers, sAveeten, and flavor it with slices of lemon. In China and Japan it is made by pouring boiling water upon the leaves in the cup, just before it is used. Old teas, however, require a little more action of heat to bring out their strength; although the Tartar fashion of boiling it for a long time deprives it of all aroma, and makes it harsh in taste. Scald the teapot Avith boiling Avater first. Then put in the leaves, cover them Avith boil- ing water, and let the pot stand a few (three or four) minutes with the lid on. Then take the teapot to the fire (unless you boil your water on the table in an urn with a spirit-lamp) and fill it with water which is boiling at the time ; put on the lid again, and leave it to stand from tAvo to five minutes covered. This will make a good pot of tea, if the tea itself is good; if not, no other Avay will do any better. It is said that the Dutch East India Company first brought tea to England, early in the seventeenth century. The British East India Company began to import it about 1667, and kept the trade as a monopoly until fifty years ago. Before 1707 its price in Eng- land was twelve dollars a pound. Noav, there are imported into the United States every year from sixty to seventy million pounds of tea. Each person in this country is estimated to use (if it were all equally divided, Avhich, of course, it is not) from a pound to a pound and a quarter of tea annually. Tea is a direct 6ram-stimulant. Nothing more surely quickens the thought-movement, and sets the tongue going; it " cheers but not ine- briates." If obliged to write or speak when weary, I Avould rather have the push of a cup of tolerably strong tea than anything else, even coffee. An " old maid's tea-party " is famous for its abounding talka- tiveness. A successful lecturer Avhom I knew Avould take, after long 302 HYGIENE. habituation, six or seAren cups of tea (once seventeen) before beginning his discourse. This is an enormous excess, and unwholesome in its effects. Much use of strong tea promotes nervousness to a great degree • but, taken in moderation, it is, of all the positive stimulants, the safest and best refresher for daily use. Children are better without it—Avithout any artificial stimulation whatever. Fresh air is appetizer enough for them; sleep their true rest-giver. Let them wait till they are old enough to begin to grow jaded with work and Avorry, before they begin to push or prop their brains and nerves even Avith black tea. COFFEE. Abyssinia has the credit of being the native land of the coffee shrub or tree, and Arabia has that of first finding out its properties. A prior Fig. 162. EGYPTIAN COFFEE-CUP. ' a convent there, it is said, long ago, was told by a goatherd of the :citing effect of its berries when eaten by his goats. He thought it lght keep his monks awake during their devotions; on trying it, his COFFEE. 303 success brought coffee into the way of earning its world-wide reputa- tion. It was introduced into Persia in the ninth century. Coffee-berries grow on a small tree, about tAvelve feet high, with shiny leaves not unlike those of the Camellia Japonica. It begins to bear Avhen three years old, and will bear fruit for twenty or more years. The berries are red Avhen ripe. Each contains two (rarely three) seeds. Mocha coffee (from Arabia) is the best* The most delicious beverage Fig. 163. COFFEE-PLANT. I ever tasted was a cup of Arabian coffee, made for me by a Bedouin sheik, under the shadow of the great Pyramid of Cheops in Egypt. In that country they pound the coffee-seeds to powder in a great mortar, instead of grinding it, and make it in the cup, pouring boiling water upon it. Their cups are small, and until recently were made of a yel- lowish-brown clay from the banks of the Nile. Instead of a saucer * As we get it, however, it answers best when mixed with good Java coffee. 304 HYGIENE. they use a little under-cup, Avith a neck and bottom like a Avine-glass. The grain or seed of Mocha coffee is small, and of a dark-yelloAv color. Java coffee ranks next in quality. Its grain is larger, and of a paler yellow. Rio coffee, from Brazil, is inferior, but is very extensively used. The color of its seeds is greenish or bluish gray. Santo* coffee, from Southern Brazil, is very good. Liberia coffee (considered by some to be a different species) is latterly coming into use, being cultivated in Ceylon and elseAvhere, as well as in Western Africa. It is said, but I do not knoAV how truly, that keeping for several years will improve the flavor of the loAver qualities of coffee. Altogether, the world's annual crop of coffee is betAveen eight and nine hundred million pounds; of Avhich at least one-fourth part is con- sumed in the United States of America—about eight pounds a year for each inhabitant. The average amount of these beverages for Great Britain and Ireland is, each year, about one pound of coffee and four and a quarter pounds of tea; in this country, a pound or a pound and a quarter of tea to five pounds and three-quarters of coffee. As com- monly prepared, however, one pound of tea goes as far as three pounds of coffee in use. In France, the estimated average amount of coffee is, for each person, two and a half pounds; Germany, four pounds; Den- mark, five and a half; Switzerland, six; Belgium, eight and a half; Holland, ten and a half (one authority recently says eighteen) pounds annually. California (a fast place) beats the world in this, as it does in grapes and gold-nuggets, Avith about twenty pounds of coffee each for its population, excluding Indians and Chinese. Composition of Coffee. Caffein . . . . . |- per cent, or more. Volatile Oil (natural) . . . Less than in Tea. Empyreumatic Oil (from roasting) A variable but important amount. Gluten.....13 per cent. Astringent principle . . . Very little. Fat and extractives. All the effects of coffee do not depend upon the caffein in it. After all of that has been removed, a strong dose of it has been still found to be poisonous to small animals. The oils, no doubt, have a share in its action. The natural volatile oil is very small in quantity. By roasting (not burning, which spoils it), another, called empyreumatic oil, is produced. Certainly, experience shows a difference in the respective effects of coffee and tea. Coffee acts more on the blood-circulation. Bernard, the great French physiologist, in trying upon animals the in- COFFEE. 305 fluence of various things on the pressure of the blood in the vessels,* found that coffee increased this more than anything else. In some persons strong coffee causes decided over-action of the heart. My con- viction is that Avhile tea acts most on the brain, coffee stimulates more the spinal marroAv and the nerve-centres of organic life. Thus coffee is less suitable than tea for every-day use as a beverage, but is admirably serviceable as a special stimulant at times of great fatigue. It has been found so in Arctic explorations during exposure from threatened shipwreck at sea and in army campaign life. During our great civil Avar, coffee AAras often called " the soldier's best friend," while Avhisky Avas proved to be his Avorst enemy. For those who are obliged to sit up all night Avith a sick person, a cup of coffee will give more help than a glass of Avine. Apart from its Avarmth as taken from the fire, coffee has some ten- dency to raise the temperature of the body—just the opposite of the effect of strong alcoholic beverages. Another effect has been ascribed to it by some experimenters, in common Avith tea as Avell as Avith alcohol: to lessen the rate of waste of the substance of the body. This can only do good Avhen the rate of Avaste is too rapid. People Avho are underfed or overworked can get on better when they eke out their daily supply of food with coffee. It Avould be many times better, however, not to be underfed or ovenvorked. Besides wakefulness and over-action of the heart, the every-day use of coffee Avith some persons brings on dyspepsia. I haAe known this to happen Avith Avorking-people taking three boAvls of strong coffee daily; the mode of causation being proved by their getting Avell when the coffee Avas left off. One sign of the unfavorable action of coffee I have observed in myself: a sense of mental (cerebral) uneasiness or depression about iavo hours after it had been taken; a feeling as if "something Avas the matter"—I could not tell Avhat. The immediate effect of coffee (as of all stimulants) is so enlivening, that many Avho driuk it will not believe it capable of doing them any harm. They overlook the after results, or ascribe them to some other cause. But I am confident that most people are better without using coffee as a daily driuk, reserving it for times of unusual fatigue or exposure. Milk does not render coffee any more digestible, but it lessens some- what its exciting effect. If a dyspeptic should use it, he had better take a little "cafi noir," black and strong, Avithout milk. For others, half coffee aud half milk or cream will do the least harm. Ascertained by placing a tube in a large artery, and measuring the height of a column of mercury which the blood-pressure would sustain. 20 306 HYGIENE. Dandelion coffee is generally made from the dried root of the dande- lion plant, with about one-eighth part of real coffee added. It goes off freely by the kidneys, and stimulates the nervous centres much less than the same quantity of pure coffee. Chicory also is a weak nerve-stimulant, used Avithout apparent injury by numbers of people in Northern Eu- rope. Roasted wheat is sometimes made into an innocent drink, more or less reminding one of coffee. A stronger substitute lately proposed is the kola nut of tropical Africa, which has long been used by the natives of that land as a stimulant. It is said to contain more caffein than coffee, while otherwise resembling cacao (cocoa). Its properties and effects, hoAvever, have not yet been fully examined. COCOA. This is made from the hard fruit of a small tree, Theobroma cacao, native to South America. Most of it comes to the United States from Caraccas. It has nothing to do with the cocoanut,* which grows on a kind of palm tree. The cacao fruit is a kind of small compound melon. It is prepared for use in several ways. Sometimes they roast it whole, and grind it into a paste with starch and sugar; or the husk is stripped off, and the seeds or beans are broken into fragments (cracked cocoa). Lastly, it is ground and mixed in a paste with sago, vanilla, cinnamon, and cloves, forming chocolate. This gets its name from chocolatl, a native American name for the cacao tree. But manufacturers mix it up otherwise also, as in Baker's and Whitman's cocoa, broma, etc. Cocoa is nourishing, and easily digested, but veiy slightly stimulating. Composition of Cocoa. Theobromin .... A variable amount. Volatile Oil . . . . Chiefly empyreumatic. Fat (Cocoa Butter) . . Over 50 per cent. Starch and Gluten . . .A considerable amount. Theobromin is a nitrogenous principle, like thein or caffein; but,at least as met with in cocoa, much less stimulant to the brain and nerves than either tea or coffee. Cocoa may be taken freely, by people of all ages, Avithout risk of harm, so long as it agrees with the stomach. Eveo * Still different also is the coco (colocasia esculenta), whose farinaceous tubers are eaten. Coca will be spoken of presently. COCA LEAVES. 307 with the sick, this it usually does; and it is a very nice beverage for the sick-room; but, for a few persons, the amount of fat which it con- tains is too great for easy digestion. In some of the preparations of it that are sold, a good deal of the fat is removed. Fig. 164. CACAO TREE. COCA LEAVES. Peruvians have long been known by travellers to possess in their country a tree whose leaves they chew, with effects described as being wonderful. D'Orbigny, Von Tschudi, and Weddell tell of its enabling them to climb hills without getting out of breath, and to work day and 308 HYGIENE. night, without sleep and almost without food, for several days together. They cheAV it with a little lime. Sir Robert Christison, of Edinburgh, having obtained some of the leaves, tried them on himself and on some medical students. After getting tired with a sixteen-mile walk, two of the latter took some coca tea, felt refreshed, and Avalked for another hour Avithout further fatigue. Others walked thirty miles a day under its use, scarcely feel- ing weary. Making all allowance for enthusiastic expectation, it must be concluded that the leaves of this tree (Erythroxylon coca) have a great poAver of nerve-stimulation. But no one need suppose that its influence is inexhaustible. Old people cannot Avith it renew their youth, nor the feeble acquire great strength. Its action is of the same kind as that of tea and coffee, although more specially observed in connection with the motor system (spinal cord and muscles). The fascination which all nen'e-exeitants manifest is shown by coca in its having in South America victims of its habitual use in excess. These, called coqueros, grow so fond of it as to take it in enormous quantities, and to be rendered at last helpless "sots" by it; like drunk- ards, often irreclaimable. Arsenic-eating someAvhat resembles this habit. Stories about it were denied, several years ago, till some English physicians set on foot an inquiry concerning it. They found that in Styria (a part of the Aus- trian empire) a certain number of men and women were in the habit of eating a portion of white oxide of arsenic (from one-quarter of a grain to a grain or more) every day. The men took it to improve their " Avind" in walking or working, and gave it to their horses for the same purpose; the young women ate it to beautify their complexions, Beginning Avith a little, their daily dose Avas gradually increased till they would take what would be enough to kill a person unaccustomed to it. No marked injury was reported to result from the practice; but its sudden abandonment would cause great prostration and distress. It may be taken for granted, however, that no effect of habit can altogether do aAvay with the poisonous action of arsenic upon the system. It must, sooner or later, impair the health and shorten life. ALCOHOL. 309 ALCOHOL. Of all stimulants, this has had far the most world-wide influence upon human life. Since the discovery of the process of distilling in the days of the alchemists, by which " ardent spirits" are got from fer- mented liquors, its harm-doing has much exceeded all its possible benefits. Before that time drunkenness with wine (as ancient as Noah), and other drinks allied to it, had been known as a great evil. But the aAvful curse of deadly intemperance belongs especially to the spirit- drinking nations of Northern Europe and America. One may well Avish, for this reason, that it were possible to rid the Avorld entirely of the cause of so much evil. But this is not possible, although prohibition of the manufacture and importation of alcoholic beverages is uoav being agitated, and has been enacted in several of our States. AVe may be confident that a true knowledge of the facts con- cerning alcohol Avill be, in the end, better for mankind than the most extreme denunciation. Temperance itself should be temperate, stand- ing only upon the foundation of truth. AVhat, then, is the truth concerning alcohol ? Is it a food-substance ? Let us look at its composition. Formed by the fermentation of sugar, it contains the same elements Avith it, namely, Carbon, Hydrogen, and Oxygen. Like sugar, it might, chemically speaking, furnish energy as a fuel-food. Experience must decide the question. Large discussion about this, along with observation and direct ex- periment, have resulted in making the conclusion clear that alcohol is not a natural or suitable material of food for the human body during perfect health. Much, though not all* of it, Avhen taken in small amount, is passed unchanged from the kidneys and from the lungs in breathing. If SAvallowed in great excess, as by those long intemperate, a portion of it remains in the body, stored up in the liver, brain, and other organs, where it has been found after death. Stories are told (not, however, probably true) of old topers, who have caught fire and burned like the Avicks of spirit-lamps. It is just possible that enough alcohol may havTe been found after death in the interior of a drunkard's brain to take fire on the application of a lighted match. There are conditions of the body in which, under disease, its relation to various agencies is altered. Ordinary food, at such times, may be- come almost poisonous, and poison may then become medicinal food. We do not eat iron in our natural every-day diet; yet iron pills or tine- * Baudot, of Paris, Anstie, of London, and Binz, of Bonn, have proved this. 310 HYGIENE. ture of iron may, exceptionally, do great good. Quinine and opium, likewise, are unsuitable for us during health; but they are of great value, and sometimes may save life, in disease. So it proves to be the case with alcohol. It is not a natural food; it may be sometimes a medicinal food. The difference here is of immense importance. As a physician, I have given it and seen it given to a great number of patients, in hospital and private practice, and, when carefulli/ used, I have never seen it do any harm; it has sometimes saved and prolonged life, and has left no untoAvard consequences. But all this i.i in the treatment of disease. Its action in health is another question. AVhat are its effects on the body during health ? These are tAvofold —immediate and secondary effects. Its immediate action has sev- eral stages. 1. Exhilaration. Here alcohol resembles the "non-inebriant" stimulants, coffee and tea; but it acts, e\^en in small doses, more upon the heart than tea, and more upon the smaller blood-vessels throughout the body than coffee. Still, there is an action of very small amounts of alcoholic beverages, which cheers and refreshes without marked disturb- ance of the system. This is Avhat Avas meant by the ancient expression, "wine, that makes glad the heart of man." In Oriental countries, weak grape-juice wine, diluted with water (the custom in the times of Avhich the Bible tells), will only intoxicate when taken in quite large quan- tities. Indeed, this is true of many of the common light Avines made and used in European countries. Other wines, however, there made, and especially those prepared for exportation, are much more intox- icating. 2. Hypaesthetic action. I have to coin this word, as there is no term in the dictionary to take its place. Anaesthetics are such things as ether, chloroform, and nitrous oxide, which, when breathed, take away for the time all feeling. By hypaesthetic action I mean a lowering of sensibility only. One so affected does not feel pain, cold, or fear, in its usual degree, and, if left quiet, inclines to sleep. This is the action of the " night-cap " of Banting and of many others of " auld lang syne." 3. Intoxication. No description is (unhappily) necessary for this effect of large draughts of alcohol. Clearly, it is a case of poisoning. The word is well made up, from toxicon, Greek, meaning a poison. All the mental and most of the bodily powers are thereby deranged or impaired. The man staggers, because his motor nerve-centres are put all out of order. He talks nonsense or behaves outrageously; his higher brain-faculties are greatly disturbed, in the drink-frenzy. The face is flushed, the pulse is quickened, as alcohol excites the heart to over- action, and also promotes enlargement of the superficial blood-vessels. ALCOHOL. 311 The glow of redness which is seen on the face exists also in internal organs; brain,stomach, liver, kidneys, all are "flushed" with blood for the time; and when this effect is often repeated, it becomes habitual, to the great damage of those organs. 4. Narcotism. This last stage is that of dead-drunkenness—so well named. It is a stupor as deep as that of opium-poisoning, and it may, like that, end in death. Only large amounts of alcohol produce this result. But an important fact is, that habit makes a great difference in the susceptibility to the action of alcohol, as of all other stimulants and narcotics. An old toper will move about under a " load " of spirits which would kill at once any one not accustomed to it. AVe may now look more closely at some of the effects of alcohol when taken even in moderate quantity during health. 1. It hinders digestion. This is asserted on the ground of experi- ments with artificial digestion: mixing meat or other food, cut up small, with water, chlorohydric acid, and pepsin, and keeping the mixture for some hours at the temperature of the human body. When alcohol is added to such a mixture, the time required for the digestion is longer than when it is left out. Qualifying facts in regard to its action Avhen the body is not in a state of health will be alluded to hereafter. 2. It impedes oxygenation of the blood. Red blood-corpuscles, acted upon by alcohol, groAV irregular in shape, and have a tendency to croAvd together. Their absorption of the oxygen which is taken in by breath- ing, and their conveyance of it to the organs of the body, is interfered Avith. This effect is exceedingly like that of carbonic-acid gas, as we knoAV this to be produced by ill ventilation. 3. It excites the heart to over-action, and thus wastes energy. This has been made a subject of close observation and study by Drs. Rich- ardson and Parkes and Count Wollowicz. The last two observers selected a healthy young man, and first counted his heart-beats during days in Avhich he drank nothing but water; then they gave him alcohol in some form every day in increasing quantities through another period; counting and recording the number of beats of his heart from time to time. The average number of beats in tAventy-four hours during the water period Avas 106,000. Under the use of tAvo or three glasses of brandy daily, it increased to 127,000; under four wineglassfuls of brandy, to 131,000; that is, 25,000 beats more than are natural in health. Now, as every beat of the heart (a muscular organ) involves work, consumes force, this work has been carefully calculated in foot-tons. That is, if all the energy used in the heart's day's work were concen- trated so as to lift a Aveight, it would be enough, ordinarily, to raise 312 HYGIENE. about 120 tons one foot. But, under alcohol, the overwork of the heart amounted to one-fifth of its usual performance; equal to lifting, daily, twenty-four tons beyond its needs—all a pure waste of force! 4. It impairs the power of the muscular system. This, too, has been sIioavii by experiment, A man cannot lift nearly so many pounds after swalloAving two or three glasses of brandy or Avhisky as he could before taking it. AYe can explain this chiefly by the interruption which the presence of alcohol in the blood causes in the carrying of oxygen by the red corpuscles to the muscles. Here is a case given by Dr. AV'. 15. Carpenter: * " A captain of a vessel returning from Australia told me that she sprang a leak soon after leaving Sydney, and that as the wind did not alloAV him to put in at the Cape of Good Hope, nothing could be done but to endeavor to keep the ship afloat all the Avay home. At first, he issued to the men the regular alloAvance of grog; but he soon found that thev were running down in strength. Labor at the pumps so con- stantly, fatigued them so greatly that at the end of the watch they would drink and turn in. At the end of four hours they would awake unrefrcshed. He saw that this must be changed. He stopped the grog, and ordered that at the end of the Avatch each man should be given a mess of cocoa and sugar with his meat. This changed matters very much. They took this food before they turned in, and this sujraml cocoa reneAved the material of their muscles,t and put them into a con- dition in Avhich they could sleep soundly and awake refreshed. He assured me that he brought his men into harbor, after all that severe work, in as high a condition as ever a crew came home." 5. It retards tissue-change, diminishing the rapidity of the action of the oxygen contained in the blood upon the substance of the different organs. This is very much like the effect of a damper in checking the draught (supply of air) of a stove or furnace. AYhen a fire is burning too fast, lessening the draught is all right. If Ave stop off the draught Avhen the fire is already dull, it will go out, and even a partial check of the draught may cause it to become " choked" Avith cinders and ashes. So, in certain forms of disease, as advanced consumption and low fevers, it may sometimes be well to check the excessively rapid waste of the tissues which is going on. But in health it is not well to do any such thing. It causes the blood to become loaded Avith old and dead stuff that ought to be oxidized (burned) and carried out of the body. * Address on the Physiology of Alcoholics, Boston, 1882. t That is, furnished food-fuel for oxygen combustion there. WHAT ALCOHOL WILL NOT DO. 313 The organs themselves, also, are not renewed and refreshed, as they ought to be, by the oxidation and renewal of their substance. WHAT ALCOHOL WILL NOT DO.* Some popular mistakes exist about this Avhich have done much harm. 1. It Avill not "keep out the cold." Although there is a.feeling of warmth shortly after taking drink, this does not last. By the ther- mometer, an hour after swallowing half a tumblerful of whisky, a man's body Avill shoAV less heat than before it Avas taken. Throwing the blood to the surface makes the body give off its heat faster than usual. And, what is practically more to the purpose, it has been found, a number of times, that Avhen exposed to the danger of being frozen to death, those who drink much are the first to die, and habitual abstainers from liquor are the most likely to survive. Drs. Kane and Hayes, as well as Sir John Richardson, found hot tea and coffee, not whisky, to be the best refreshments for men during the severe hardships of Arctic exploration. The same experience has been reported by sea-captains, under the fa- tigues and exposures of storm-stress and shipAvreck. 2. Neither can alcohol make it easier " to bear great heat." The records of disease and mortality in the British army and navy, and among British residents in the East and AYest Indies, shoAV that, of all climates, the worst for the wine and whisky drinker is that of the tropics. Moreover, the cases of fatal sunstroke (heat-stroke) are much more numerous amongst those Avho drink liquor than amongst any others. 3. Alcohol does not increase working strength. Professor Parkes, of the Army Medical School, England, brought this to the test of careful experiment. He thus confirmed fully the account quoted on a previous page from Dr. Carpenter, of the sea-captain Avho, Avhen at a time of great fatigue, his men Avere giving out under the daily use of grog, found them to revive and get through their labor much better, after he withheld the grog and gave them cocoa and sugar Avith their meat instead. 4. It affords no protection against dangerous diseases. Many persons have imagined that, in malarious places, it would " keep off the chills." But the late Dr. Drake, of Ohio, who made a special study, by travel and correspondence, of the diseases of the Mississippi Valley, found that The substance of what follows under this head has been embodied by the authoi in a "temperance tract," entitled "Some Popular Delusions." 314 HYGIENE. this is not at all the case, either with regard to "country fever" (inter- mittent and remittent) or to yellow fever. Neither does it prove of any use at all in preventing epidemic cholera, in those present where it is prevailing. Also, it has been many times shown, that when an intem- perate man is attacked by cholera, he is almost sure to die. Hard Avater, containing an excessive amount of some saline matters, disagrees sometimes with travellers or visitors in regions where they drink it without having become accustomed to it. Very often, people put brandy into such water as a preventive of diarrhoea. But a much better as well as safer corrective (over and above drinking very moder- ately of strange Avaters while travelling) is the addition to the Avater of a few drops (five to fifteen drops in a tumblerful) of essence of ginger. There is no disease, in any part of the world, against Avhich the use of strong liquor can afford the slightest reliable protection. The best probability of escape from illness, or recovery from it if attacked, at the time of prevalence of any epidemic, is obtained by those who keep the even tenor of their way, with regular habits, in eating, drinking, sleeping, and all other particulars; maintaining the body at par; neither excited by stimulants nor depressed by living on rice-Avater or in con- stant fear. Probability of .Life.* temperate. intemperate. At 20, 44.2 years. 15.6 years. " 30, 36.5 " 13.8 " " 40, 28.8 " 11.6 " " 50, 21.25 " 10.8 " " 60, 14.285 " 8.9 " DOSAGE. Very many people, even in the medical profession, fail to appreciate the importance of the differences in the effects of alcoholic drinks, accord- ing to whether they are taken in large or in small amounts. A\ e have already seen that there are four stages or grades of their effects, when drunk during health. A small dose (say a tablespoonful of Sherry wine, or half as much whisky or brandy) Avill simply and slightly exhilarate, more or less, a person unused to it, without any approach to intoxica- tion. Four tablespoonfuls (a wineglassful) of sherry, or two tablespoou- * According to statistics of Beneficiary Societies. DOSAGE. 315 fuls of whisky, may be felt a little in the head, with perhaps a certain lessening of sensibility, but still with no loss of self-control. Four wineglassfuls of strong wine, or two of brandy or Avhisky, taken on an empty stomach, will intoxicate some persons; others will only become reeling drunk on two or three times as much. But a pint of whisky, taken at once, will make almost any one, unless a confirmed habitual inebriate, dead-drunk—narcotized completely. Now not only the immediate effect of alcohol is greater and different, according to the dose, but the danger of getting into the habit of using it is much increased therewith. This danger groAvs out of the imme- diate secondary effects of excessive stimulation. It is a law of vital activity, true of all the organs, that every over-action is followed by depression. This is as regular as the vibration of the pendulum. Bor- rowing a phrase from the stock-market, there is a natural par of action and excitement for each organ (heart, brain, etc.), and for the body as a whole. If forced above par by a special stimulation, relaxation and exhaustion follow; and the organ or the Avhole system will then fall below par just as far as it was pushed above it. This getting below par is an uncomfortable, often a distressed, condition; and Avhen one who suffers with it finds that it can be relieved by renewing the stimulation, he is naturally disposed to resort to this. Each time, hoAvever, some loss of tone, of strength, results from the over-excitement. This loss of tone shows itself by the need of a larger dose to produce the same effect. So it goes on—excitement followed by depression, and this again by craving for more of the stimulant; deeper depression, stronger craving, and less self-control, Aveek by week, year by year, till the man becomes a hopeless, helpless sot! The younger the victim, the more rapid usually is the ruin. More than in proportion to the dose is the increase of danger from excess. It may even be said to be according to the square of the quan- tity taken. If one takes a glass of whisky daily, his tendency to in- crease the indulgence will have some force. Should he take regularly two glasses a day, his probability of becoming a "toper" will be four times as great as if he drank but one glass daily. A man may get drunk once a year, and then be " sick and sorry" for some time after- Avards, without much difficulty in remaining sober between whiles. But one who goes to bed drunk every Saturday night, this year, will be almost certain next year to be more or less drunk every day and night of his life. This relation to excess is, as I have said, very important: it is the main gist of the matter. I cannot assent to the opinion that alcohol is necessarily and always poisonous and demoralizing, even when given in 316 HYGIENE. states of exhaustion and disease. During tAventy years of practice as a physician, nearly half of that time seeing large numbers of patients in hospitals, my mind Avas brought by observation to the clear conclusion that there is a place for alcohol in the treatment of disease; but that it requires as much skill and care for its employment remedially as do opium, strychnia, and other potent drugs, Avhich are poisons that kill. Avhen misused, but medicines that may save life Avhen timely aud prop- erly administered. In health it may be broadly laid doAvn as a principle, that all use of alcoholic drinks is of the nature of excess; and every excess is attended by some danger of habitual inebriety. This is a sufficiently strong and large foundation for the support of a sound temperance platform. If more is claimed, it endangers the permanent safety of the superstruct- ure. In other Avords, common sense, reinforced by science, refuses to accept the statement that alcohol is never useful or safe under any cir- cumstances, even as a medicine. And AvhateArer is rejected by well- informed common sense will not obtain a lasting control over the actions and institutions of men. Truth is ahvays best, and Avill ;;t last prevail. Before going farther here, the signs of alcoholic excess must be men- tioned. These are principally three: quickening of the pulse, flushing of the face, and feeling the liquor in the head. Either of these alone is mostly sufficient; all together they are decisive. I Avould never repeat the same dose, even in a serious case of disease, to a patient Avhose face Avas flushed and his pulse quickened after it, or Avho told me that he " felt it in his head" at the time. Either it should then be omitted altogether, or reduced iu quantity. SECONDARY EFFECTS. "Horrors" we may well call what physicians have named delirium tremens, or mania-a-potu. Hard drinking, even for a feAV Aveeks with some, for months or years with others, often brings this on. Trembling, weakness, loss of appetite and digestion, and sleeplessness, Avith dreadful visions, especially at night, characterize it. Each attack risks life. A second spell is doubly dangerous; from a third, unless with long inter- vals betAveen, the greater number do not recover. Gout is the penalty rather of the moderate drinker's indulgence; following Ae use of wines and malt liquors more often than that of ardent spirits. It is a painful affection, coming in repeated attacks of METHOMANIA. 317 severe inflammation of the small joints, the toes, or fingers. Instead, hoAvever, of this " old-fashioned" kind of gout, it may fall upon the stomach or the heart, Avith terrible and even dangerous force; or it may be substituted by gravel in the bladder, or (especially if inherited) neu- ralgia in different parts of the body. Chronic alcoholismus is a designation for the slow poisoning of the system by intemperance. It affects especially the liver, kidneys, heart, arteries, and brain. " Gin liver" is an old name for "cirrho- sis" of that organ, Avith Avhich many drunkards die. A farther account of this, and of other kindred disorders, may be best given later in this Avork, under Domestic Medicine. METHOMANIA. " Oinomania " means about the same thing in common usage, and so does dipsomania. It is the morbid and uncontrollable craving for in- toxicating drink. Tavo forms of it exist—the paroxysmal and the chronic methomania. Persons subject to the first go off, from time to time, on " sprees," so tremendous as to end with their becoming helpless for the time. This stage passing off, such an one may continue quite sober, even abstinent, for Aveeks, months, or years; then having another ruinous attack. I have knoAvn a young man of excellent qualities and promise otherAvise, in the midst of successful business, or Avhen engaged to be married under the most favorable circumstances, to break up every- thing by suddenly disappearing for days together, and then being found half dead in a low groggery, or some other den of disgrace. The constant inebriate, Avho, if he Avill, cannot escape from his habit, is still more often met Avith. Some English writers, very strangely, have denied the uncontrollableness of such intemperance. It has been very obvious to me, in a number of cases. A feAV authors, latterly, assert that real insanity ahvays comes first, the irresistible propensity for liquor afterwards. That this is true as a general rule, or even as a fre- quent occurrence, I must deny. Excess in the use of alcoholic bever- ages does tend, of itself, to beget a habitual craving, Avhich gains strength until, in time, the will is enslaved by it altogether. It ought not to be called incurable; but recovery from it is extremely difficult, and, in proportion to the great number of cases of it, rare. Trowbridge, the poet, has well expressed its power in the words of his "Vagabond" : " I would sell out heaven for something warm, To ease this horrible inward sinking!" 318 HYGIENE. Institutions are noAV maintained in several places (such as the Frank- lin Reformatory Home, in Philadelphia), where inebriates may live in retirement, out of the way of temptation, and under medical and moral treatment, for their restoration. One-third, nearly, of the number of those so cared for have regained health and sobriety. The time of seclusion, before returning to ordinary associations, ought not to be less than six months; better, a year. Any one who has ever been a habitual drunkard should never, after restoration, taste a drop of alcoholic drink, under any circumstances, of health or disease. For such persons, this rule should be quite absolute; the liability to the reneAval of their old morbid craving is so great. One of the Avorst results of intemperance is the injury to the health of the offspring of those who drink. Children of drunkards often die young, with convulsions or some form of acute brain disease. If they groAv up, they are apt to be idiotic, insane, blind, deaf, or epileptic. Dr. Howe found that of three hundred idiots in the State of Massachu- setts Avhose history was traced, one hundred and forty-five were the off- spring of intemperate parents. In one family, where both father and mother were drunkards, there Avere seven idiotic children. Moreover, such children inherit a predisposition towards intemperance. If they drink at all, they are, more easily than others, made victims of the be- setting habit. Physicians ought, when they know of such a family trait, to avoid prescribing alcoholic medicines for its members altogether. STRENGTH OF BEVERAGES. Beers are made by fermentation of malt, from grain, under the Fig 165 JNfi influence of yeast, the " ferment." Wines are spontaneously fermented from the juices of fruits. Grapes yield the best wines, but currants, elderberries, etc., will furnish vinous liquids; and cider from apples, as well as perry from pears, belongs to the same class. Mead is made by the fermentation of honey. All of these are examples of the change of grape-sugar into alcohol and carbonic acid. If yeast-fungus (saccharo- tne latter> the carbonic acid gas, is allowed to myces), magnified 400 escape, the beverage is " still," as Madeira, diameters. ol ™ -. , „ , Sherry, Claret, and a number of other win**. If the gas be retained by keeping the liquor in corked bottles, casks, STRENGTH OF BEVERAGES. 319 or otherwise, " sparkling " drinks result, as champagne wine, cider, ale, porter, ete. Spruce-beer, hoarhound beer, and similar home-made drinks, mead, and new cider, are the mildest, least alcoholic, of fer- mented beverages. Next come the lightest wines of the Rhine region, and of Italy and France; then lager beer and claret Avines. After these, porter, ale, and broAvn stout. Champagne and hock wines of the finer grades follow in strength, the strongest wines being port (if gen- uine), Madeira, and (real Spanish) Sherry. None of these last contain more than twenty-five per cent, of alcohol. Spirits are obtained by distillation of fermented liquors: brandy from wine; whisky from malt of grain (barley, corn, or rye); gin from , Fig. 166. yeast-fungus, advanced growth ; MAGNIFIED 220 diameters (hassald). rye or barley, with juniper berries added; rum from fermented molasses. They all contain, when made in the usual way, about half alcohol and half water, being thus twice as strong as the strongest wines. Undoubtedly, the danger of intemperance and of all the evils of alcoholism (except gout) is much greater, more than twice as great, with those who drink spirituous liquors, as whisky, brandy, gin or rum, than with those who use only fermented beverages. Suppression of the manufacture of distilled spirits, except in the form of absolute alcohol for the arts and for the making of medicinal preparations, would, if practicable, do very much towards arresting that grim procession of which we are often reminded, of 100,000 drunkards every year, going 320 HYGIENE. to fill untimely graves. " Saloons " and " gin palaces/' drinking ban of every kind, ought to be, and we may now hope will be, before a great while, everywhere abolished, by the improvement of laws and the advancement of civilization. So far, however, the most cultivated nations have taken their full share in the world's abuse of the " fruit of the vine " and of the product of the still. Alcoholic Strength. Lager Beer Ale Champagne . Rhine Wines . Claret . Sherry . Madeira. Port Brandy . AYhisky. Gin Rum The adulterations of Avines, beers, and spirits are various. Chemi- cally manufactured wines are often sold, the greater part of which never came from the grape or any other fruit. Cocculus Indicus ber- ries are sometimes added to English beer to give it a false strength. " Cognac brandy," so called, is now made in large amounts in France from potato spirit instead of from wine. This, as well as the fusel oil in some Avhiskies, and the compound called absinthe in France, are no doubt more rapidly poisonous, more directly promotive of delirium, insanity, and death, than " pure " liquors.* But the purest are danger- ous enough, Avhen taken in health, for us scarcely to need the alarm to be increased by dAvelling upon their possible adulterations. * Strychnia, there is reason to believe, is not, as has been popularly supposed, evei added as an adulterant to liquors. It would not pay so to use it. Most of the patent-medicine "bitters" and "tonics" contain a good deal of alcohol making them very dangerous when taken habitually. Dr. Davenport, Massachusetts State Chemist, found, for example, 29.3 per cent, of alcohol in Hoofland's German Tonic; Warner's "Safe" Tonic Bitters, 35.7 per cent.; Schenck's Sea-weed Tonic, 195 per cent.; &c. A report published in 1889 asserted that Buckland's Scotch Oats Essence contained 35 per cent, of alcohol; Boker's Stomach Bitters, 42.6 ; Parker's Tonic (ad- vertised as "a purely vegetable extract"), 41.6; Hostetter's Stomach Bitters, 44.3; and so on. Avoid them all! 7 " 10 " 6 " 12 " 6 " 15 " 6 " 15 " 15 " 25 " 16 " 25 " 18 " 25 " 50 " 60 " 50 " 60 " 50 " 60 " 60 " 75 " i VARIOUS BEVERAGES. 321 VARIOUS BEVERAGES. In almost all parts of the Avorld, people have found out the effects of fermentation upon natural juices, making them intoxicating; and, out- side of as Avell as Avithin Christendom, in several places, distilled liquors are made and drunk. One of the most curious of fermented drinks is the chica mascada of the South American Indians; produced by chewing grains of Indian corn (maize), so as to mix it Avith saliva, and then spit- ting it out and allowing it to undergo the change of its starch and sugar into a feebly alcoholic material. Travellers used to tell how the king of the Fiji Islands (before they Avere Christianized) had his morning drink prepared. A group of girls, selected for the purpose, would cheAV together a quantity of the native long-pepper root (macropiper methysti- cum), and spurt it out into a boAvl, Avhere it would soon ferment enough for the royal ava drink. This Avas then conveyed to his majesty, who, with a nourish of trumpets, Avould imbibe it; before Avhich, no business of the day Avas alloAved to be done by any one upon the islands. Even the chilly air of the Arctic regions does not prevent the Eskimo from sometimes becoming inebriated by means of a kind of fungous plant; the amanita muscaria. In all temperate and tropical regions, something of the kind is more or less employed. National Strong Drinks. Chinese . . Samshee, from Rice. Japanese . Sacie, a « Malays . . Arrack, it Rice or Areca. Greeks . . Raki, a Rice. Hindus . . Toddy, a Cocoanut Palm Hindus . . Minva, a Millet. Arabians . Boozeh, a Millet. Russians . Quass, a Rye. Tartars . . Koumiss, a Mare's Milk. Poles . Vodki, u Potatoes. Feeje.es . . Ava, a Long-pepper. South Americans . Chica, a Maize. Mexicans . Pulque, a Agave. Mexicans . Aguardiente, a Agave. West Indians . 21 . Guarapo, u Sugar-cane. 322 HYGIENE. TOBACCO. This "Aveed" is not a food for man, yet in universality of consump- tion nothing exceeds it except salt, and, perhaps, bread. Since Sir Walter Raleigh took it from America to England, its use has spread all over the Avorld. Pope Urban VIII. issued against those who smoked it a bull of excommunication; King James I. wrote a royal protest, a " Counterblast to Tobacco; " one of the Russian Czars made its use punishable with the knout, and even Avith death ; yet all in vain. Chinese, Turkish, and Persian monarchs have condemned it, and their priests have denounced it as contrary to their religion; yet, in those countries, every man, and many Avomen, will smoke Avhenever they are not Avorking, taking food, or asleep. Nicot carried the tobacco-plant to France, and was immortalized by its name, Nicotiana. There are, at least, tAvo species of it, A. taba- cum and N. rustica. The former is grown in America, and also in Southern India; the latter in Northern India, Syria, and China. Per- haps there is also a third species, N. persica. Three places yield the best tobacco in the world: a portion of Cuba, whence come genuine Havana cigars; Latakia, in Asia Minor, where the finest pipe-tobacco is produced; and Luzon, of the Philippine Islands, yielding the Manilla cheroots. In the United States, the plant can be raised successfully as far north as Connecticut. It exhausts the soil rapidly, as has been long since well known in Virginia. Analyzing it, the important ingredients are : an oily and volatile alka- loid, nicotin or nicotia, Avhich is deadly poisonous (tAvo to eight per cent. of it is present in the tobacco leaf); a more volatile aromatic oil, formed chiefly in drying ; and, Avhen burned, as in smoking, an empyreumatio oil, someAvhat volatile, whose odor is familiar in the smell of old pipes or stale tobacco smoke. It is curious that chemists have found in it also small amounts of those rather rare metals, lithium, caesium, and rubidium. The last two of these Avere discovered by means of the spec- troscope. Only one animal is found to live and thrive by eating to- bacco; it is a little black mouse of SAvitzerland, first observed in a tobacco factory. Elephants and monkeys, hoAvever, have a certain liking for it. Perhaps, in this, they only copy man, as the lower animals gen- erally take good care of themselves against poisons. It is not easy to persuade any animal (except man) to taste alcoholic beverages, after having once felt their effects. When forced or insinuated upon them, they sIioav similar disturbances to those of human inebriates, and, if long subjected to their effects, die early. I am not sure that any like TOBACCO. 323 observations have been made upon animals Avith the excessive consump- tion of tobacco. When SAvalloAved in large quantity, tobacco is a sedative (prostrating) poison. Vomiting may soon rid the stomach of it, otherAvise a table- spoonful of it might kill a man, at least if unaccustomed to its use. An infant is said to have lost its life by having a tobacco leaf, moistened with liquor, left too long upon its chest as a remedy for croup. As usually smoked or cheAved, after the first seasoning sickness has been passed through, its effects are those of a gentle exhilarant and tranquillizing narcotic. Certainly there is a great fascination about it, as the habit is exceedingly hard to break off. It is, moreover, the easiest of habits to fall into, after once beginning. With a cigar or pipe in the pocket, and a match-box, or Avith a " plug " in one's own or a neigh- bor's handy possession, hoAV naturally the weed finds its way to the mouth! Huxley's celebrated man-automaton, the French soldier Avhose brain had been damaged, Avas able to twist up and light a cigarette, Avhen he kneAv nothing, and could do nothing else. This makes the principal danger of harm, from gradually increasing excess, in so facile an indulgence. Worst of all the Avays of using tobacco is cheAving it; probably almost entirely an American barbarism. Next, is smoking strong cigars, es- pecially the last parts of them, containing the most empyreumatic oil, besides the nicotin. Smoking a pipe is somewhat less injurious, as, with the cigar, some of the active principles are absorbed by direct contact with the mouth. Long pipes are used by the lazy Egyptians, who, sit- ting cross-legged, rest the boAvl upon the ground. Some of them, also, with the narghileh, and the Hindus in like manner with the hookah, draAv the smoke through Avater, which diminishes the poisonous effect. Cigarettes, being small, may be supposed to favor great moderation in smoking. Enemies of the weed assert that they often (in their papers) contain arsenic or opium, or both, and are worse than cigars or pipes. This may be so; at all events, every one, and especially ladies and boys, may be safely encouraged to avoid them. Snuff-taking is less common in this country than it Avas fifty years ago; and probably the same is true of Europe. In the seventeenth century, it Avas said that She that with pure tobacco will not prime Her nose, can be no lady of the time. A magazine writer tells that Queen Charlotte was very fond of snuff. So were Frederick the Great and Napoleon; as well as Dr. Samuel Johnson. A tobacconist's advertisement, in 1740, named forty-six 324 HYGIENE. varieties of snuff; from good Scotch at two shillings a pound, to the best Brazilian, at tAvelve times that price. Lord Petersham owned a stock of snuff Avorth three thousand pounds; Avith boxes almost enough to use one for every day in the year. Snuff-taking is simply a dim- practice, that is all; it cannot do harm at all in comparison with chew- ing, or even smoking. Strangest of all, is the practice of " dipping;" said to be not uncom- mon amongst the women in some tobacco-groAving States. They dip a small stick in snuff and rub their gums Avith it; often in small compa- nies together. Odd devices, surely, people sometimes hit upon in the pursuit of pleasure! Does tobacco, then, Avhen used habitually, in plug, cigar, or pipe, seriously injure the health ? Unquestionably it does. I have known a man so unnerved by it that he trembled constantly, and could not fol- low a line in writing across a page. Dr. Chapman, in his medical lec- tures, mentioned cases of actual delirium tremens produced by it. It over-drives the heart, as alcohol does. Dr. EdAvard Smith, in England, made careful observations upon this. One man's pulse Avent up, under eight minutes' smoking, from 75 to 106 in the minute. Another, with a hookah, draAving the smoke through camphor Avater, had an increase in six minutes up to 93 pulsations in the minute. Here is shown a great waste of force, just as in the case of alcoholic stimulation. Moreover, the heart's action is often made irregular by excessive use of tobacco. Dr. B. W. Richardson found this to be the case in quite a number of habitual smokers. De Caisne, in France, observed the same thing. A noted oculist, Sichel, ascribed blindness to it; and Bricquet, nervous deafness. Paralysis and apoplexy have been sliOAvn to be promoted by it; and even insanity. Dr. Kirkbride, of the Pennsylvania Hospital, reported that at least six patients there treated Avere certainly knoAvn to have become insane from excessive use of tobacco. He declared, from obser- vation of its effects, that its use ought not to be allowed to insane patients and that he had never seen the slightest injury from the immediate and complete breaking off of the habit. With those inclined to intemper- ance, smoking or cheAving is believed to increase the craving for liquor. Young persons are more injuriously affected than adults by tobacco. The authorities of Berne, Switzerland, have forbidden it to all under fifteen years of age. Louis Agassiz, himself a great smoker, as well as a hard worker in science, protested at Harvard against young students acquiring the habit. Bertillon, at Paris, examined into the state of things at the Polytechnic School, where there were 160 boys. Of the-c 102 smoked, while 58 did not. In every grade, the non-smokers held TOBACCO. 325 the hio-her rank; and the smokers, as compared with the non-smokers, deteriorated from their entrance to the time of their leaving school. Hence the Minister of Public Instruction, in 1861, issued a circular throughout France, to the directors of colleges and schools, forbidding tobacco to their students, on the ground that the " physical as Avell as the intellectual development of many youths has been checked by its use." Some years ago, Parton, the essayist, in a brilliant paper, " Does it Pav to Smoke," in the Atlantic Monthly, urged that " it is certain the coming man will not smoke." As he tells us, Raleigh, Milton, Locke, Addison, Burns, Byron, Campbell, Scott, Lamb, Thackeray, and other literary celebrities have been lovers of the weed. So were Daniel Web- ster and Henry Clay; and General Grant's cigar has accompanied him around the Avorld. Goethe, the poet, and (probably) Washington, Franklin, and Jefferson, never smoked. John Quincy Adams Avas for a time a smoker, but abandoned the practice. The question about those Avho have so indulged, as it is well put by thisAvriter, is, does it pay them? He ansA\Ters this decidedly in the neg- ative. Sir Isaac NeAvton said, Avhen asked why he ne\Ter smoked a pipe, that it Avas because he Avas " umvilling to make to himself any ne- cessities." This is an excellent reason. A man Avho cannot get his cigar, pipe, or "chew" at the usual time is uneasy; he maybe unhappy— fairly miserable. Why should any one make himself a slave to a tAvisted leaf? Much better, let it alone. Besides, it is expensive, and annoys other people, especially the ladies. This, however, is not a sanitary reason; it is rather one of civilization and humanity. We may cite Parton a little farther still. " The winning boat of Harvard University,* and the losing boat of Yale, were not roAved by smokers. One of the first things demanded of a young man who is going into training for a boat-race is, stop smoking ! " " Let the Har- vard crew smoke during the last two months of their training, and let the Yale men abstain, and there is one individual prepared to risk a small sum upon Yale's winning back her laurels." But, if training is inevitably spoiled by even a moderate use of to- bacco, should not a man Avho values the healthy condition of so splendid a machine as his body, and still more his brain, be always in training ? None of us have anything to spare, in the constant conflict with the enemies to our health, everywhere around us. Nor should any one have a loAver ideal, than to maintain, when possible, a perfect condition of his whole being, " body, mind, and spirit." * In 1867, probably, as this article appeared in February, 1868. 326 HYGIENE. OPIUM. This, one of the most useful of drugs in the relief of pain and the treatment of disease, has wrought almost as much mischief as alcohol by its abuse, as an indulgence by those in health. Most, but far from all, its victims are inhabitants of the warmer countries of the globe.' More than five millions of pounds of it are said to be consumed annu- ally in China; but Great Britain also is credited with the use of a quar- ter of a million of pounds a year. Large amounts of it (very much beyond its medicinal demand) are imported into this country; perhaps the greater part for Chinese immigrants, but the " opium habit" has also become to some extent a naturalized American vice. Opium is collected from the seed-vessels of the poppy plant, papaver somniferum, whose floAvers, unlike those of our garden poppy, are Avhite. It flourishes in several Oriental lands, but is most largely cultivated in India. Thence, in spite of earnest and long- continued remonstrance by the Chinese government, it is sent to China, where its destructive effects may well be com- pared to those of intemperance in West- ern countries. Opium is generally smoked in the pipe by the Chinamen; cheAved in sub- stance by Mohammedans, in India, Persia, Turkey, and Egypt; drunk in the form of laudanum in Christendom. Since morphia, its most important in- gredient, has been obtained from it, the solution of that alkaloid (or rather of its sulphate or some other compound), being largely used in medicine, has the opium poppy. come to be substituted for laudanum to a certain extent as an excitant. Most singular is the fact that, as physicians not unfrequently inject morphia solution (in cases of great suffering) under the slvin, by the hypodermic syringe, the use of this, too, has come Avith not a feAV persons to be a confirmed and difficultly-broken habit. As with all other agents exercising much influence on the nervous system, opium has different effects according to quantity. Its first stage OPIUM. 327 of action, and the only one Avith a small or quite moderate dose, is brain- exhilaration. It quickens the Avits, raises the spirits, and inspires confi- dence. Imagination is enlivened ; some say that all the mental faculties are so; but this is doubtful. I cannot speak about it from experience; as Avhen, a few times, I have had occasion to take it as a med- icine, my system seemed to make no sort of pleas- ant response to it. But many of those Avho have used it speak enthusiastically of its influence. Visions of delight and exaltation, like those of Mohammed's paradise, are ascribed to it. De Quin- cey, Avho Avrote the " Confessions of an Opium- Eater," described it as "happiness that can be bought for a penny, carried in the vest-pocket, or sent by mail to a friend." Alas, hoAveA7er, for the opium poppy. dismal reaction of the after-time! When taken in full dose, the time of exhilaration is short, and is folloAved by narcotic sleep. Of all medicines capable of this effect, opium is the surest, or rather the most nearly certain; a few people are not put to sleep unless by doses so large as to be dangerous. As a general rule, a grain of opium, from thirty to forty drops of laudanum, or a quarter of a grain of sulphate of morphia (Avith a person unaccus- tomed to its use) will cause droAvsiness in less than an hour, folloAved by sleep, unless this be interfered Avith by great pain or excitement of the brain from some disturbing cause. When taken in much larger dose (say a tablespoonful of laudanum, or tAvo or three grains of sulphate of morphia), a fatal stupor is brought on. The breathing becomes sIoav and heavily snoring (stertorous); the pulse also is slow; the patient cannot be roused; he is comatose. Unless relieved before the brain has been entirely ovenvhelmed by the poison, exhaustion comes on after several hours, and death ends the scene. We may know a case of opium-poisoning from dead-drunkenness by the different odor of the breath. From apoplexy it is to be distinguished chiefly by the history of the case; and so with compression of the brain from fracture of the skull. A small pupil, seen on lifting the eyelid, is one of the charac- teristics of opium narcotism. Many persons, on Avaking from an opiate sleep, feel languid, inclined to headache, and Avith more or less tendency to sickness of the stomach. These effects are not universal Avhen only occasional and moderate doses are taken; but Avhen, as an indulgence, it is repeated, just as Avith every other stimulant, the system grows less susceptible to it, and the desired effect is reached only by increasing the quantity. Before very long, 328 HYGIENE. great misery follows: Avretchedness of body and mind. Digestion is almost ruined; the sallow face, sunken eyes, Avasted body, and bad breath show the human Avreck. All capacity for exertion is lost; business, family, society, become naught to one Avho falls down, down, down, into the opium abyss. From that bourne few travellers return; and they who do, like De Quincey, Samuel T. Coleridge, and others, tell a fearful tale of their suffering, struggle, and almost total despair. Marvellously large amounts of opiates are taken by some of its habitues. In China, from fifteen to tAventy grains (one grain being a medicinal dose) are very commonly smoked in a day. Some Chinese have been known to consume 200 grains daily for a time. At Aleppo, an European traveller saAV a Turk SAvalloAV 180 grains in the morning, and as much again at night. Dr. Alexander Fleming kneAV a Avoman Avho took an ounce of morphia daily. Coleridge, the poet and philoso- pher, after fourteen years of the habit, drank four pints of laudanum in a Aveek ; once, a quart within tAventy-four hours! The story of this man of genius, sage, and Christian, is among the saddest of modern times. Such Avas his craving for the drug, that even Avhen under the care of kind friends for the cure of his habit, he Avould secretly procure laudanum and take it, At last, through grace and faith, he conquered this " old man of the mountain," the enemy of his life; but Iioav much more and better might he have written, said, and done for the Avorld Avithout having needed such a conflict! And then his son, Hartley Coleridge, almost as brilliant as himself, inherited his proclivities; and sank to an early grave, a victim of intemperance. Is there anything good to put against all this ? Can any dne be recompensed for the evils attending the opium habit ? Never; ahvays it is against reason and without consolation. But experience sIioavs the need of caution in the use of opium in any form, even as a medicine. Both Coleridge and De Quincey began their acquaintance with its dangerous fascination while taking it to relieve the pains of illness. When a physician prescribes it, therefore, he must needs be sure first that it is really appropriate and important, then that enough and no more is given, and especially that it be withdrawn as soon as the occasion for its use has passed. Information of its dangers, too, ought to be given to those who are ignorant of them, when it is remedially advised. It must be added here that a similar peril attends the unguarded medicinal use of another narcotic drug, chloral. Employed Avith pro- priety by physicians in certain cases to promote sleep, it may be abused by being taken when not needed; and so the chloral habit may grow and be disastrous. Dante Gabriel Rossetti, the poet and painter, almost certainly shortened his life by this habit; and not a few others have committed the same fatal error. OTHER STIMULANT NARCOTICS. 329 OTHER STIMULANT NARCOTICS. Hasheesh is the most abused of all these, except opium. Millions of Asiatics, and many also probably in Africa, a few only in Europe, and probably none in America, smoke or cheAV it habitually. It is the extract of cannabis Indica, or Indian hemp. Common hemp, hoAvever, cannabis sativa, has similar qualities, though not quite in so great strength. The effects of hasheesh are more Aariable and uncer- tain than those of opium. It excites and disorders the sensory and active poAvers more, the intellectual less. Malays run amuck after get- ting under its influence, striking right and left as they run wildly about. Assassin is a Avord said to be derived from hasheesh, because of its rage- provoking nature, as displayed among the followers of a once famous robber-chief of Western Asia. Stimulaxt Narcotics. Opium, Papaver Somniferum Hasheesh, Cannabis Indica . Arsenic, Arsenious acid Coca, Erythroxylon Coca Betel Nut, Areca vatecha Long Pepper, Macropiper methysticum. Grains of Paradise, Amomum malagueta Kola or Guru Nut .... Laughing Plant ..... Amanita Muscaria .... China, etc. Wrestern Asia. Styria. South America. Southern India. S. Sea Islands. W. Africa. Western Africa. Southern Arabia. Kamtschatka. Chloral and cocaine (from erythroxylon coca) are both capable of do- ing much harm to those who get into the habit of using them : chloral being swallowed, and cocaine injected by means of a small hypodermic syringe under the skin. These powerful agents ought not to be used except under the advice and direction of a careful and skilful phvsician. 330 HYGIENE. HYGIENE OF THE CIRCULATION. As the " blood is the life " of the body, in so far as it furnishes both material and excitation for the activity of all the organs, a free and complete circulation is indispensable to health. For this, the heart must be in a sound condition, and there must he no obstruction in any of the arteries, veins, or capillaries. More- over, the due proportion of blood must pass to and through each part. Excess of blood anyAvhere is called congestion, either active or passive. The first is commonly attended by excitement; the latter, by torpor or disturbance of functional action. Over-excitement, hoAvever, is apt to be followed by passive accumulation of blood, Avith sluggishness of the organ affected. Deficiency of blood-supply to a part leaves it Avith feeble poAver, and, if long continued, causes it to Avaste aA\Tay. Cutting off the supply alto- gether endangers mortification ; that is, the death of the part (sloughing or gangrene). Most important to avoid overloading Avith blood is the head. For two reasons this is so. The brain cannot bear much pressure; and the close box, the skull, in Avhich it is contained, will not yield and expand to relieve it, Avhen more blood than usual enters it. Tavo natural pro- visions guard against great and sudden increase of blood-pressure within the head. One is, the spirally-twisted form of the arteries (carotids and vertebrals, see Anatomy) Avhich carry blood to the brain. The other is the easy escape, under pressure, of the serous (watery) fluid within the arachnoid membrane, from the brain to the spinal marrow, where it is gradually diffused through a long distance, and is thus prevented from doing harm. But, sometimes, the head is too full of blood. In fevers, it is often so; and it happens, occasionally, under other circumstances. Since the feet have no such delicate and important contents as the brain, and have no natural covering but the elastic skin, they may swell considerably without damage. Hence the very old and sensible rule, to " keep the head cool and the feet warm." Also, for the same reason, a Avarm foot- bath is often a good thing to relieve headache (from a cold, etc.), by draAving the blood doAvmvards. Arteries are mostly so deeply seated and so protected in their situa- tions as seldom to be subject to too great pressure. But the veins are, many of them, near the surface, and they may be obstructed, as by too tight a cravat, or too tight garters. Strangulation kills, not only by HYGIENE OF THE CIRCULATION. 331 arrest of breathing, but also by preventing the return of the blood from the head through the veins of the neck. Short of that, too tight pres- sure around the neck may cause fulness of the head, Avhich, in a person predisposed to apoplexy, may be dangerous. Tight garters swell the veins of the legs. When this is done long and often, these veins may become varicose ; that is, permanently enlarged. But the heart must, most of all, be protected from disturbance. It naturally beats faster Avhen any of the large muscles are Avorking actively, as Avhen Ave run or walk fast; especially up stairs. Our breathing is then hurried also; and thus, commonly, a check is put upon our doing too much : Ave " get out of breath," and have to stop or slacken our movement. It is, hoAvever, possible to overtax the heart by running too long at a time, and doing this often for a considerable period. Wrhen the Phila- delphia fire-engines Avere, formerly, draAvn entirely by men, some firemen injured their hearts in this AA^ay. During the civil Avar, a number of soldiers, especially in the " Peninsular campaign " in Virginia, tired out their hearts by too much " double-quick" in marching; all the more so, because they Avere weakened at the same time by poor food, bad water, and discouragement. When the heart is overworked, one of tAvo things happens. If the body is at the time Avell nourished, and its general vitality is good, the heart grows stronger, just as other muscles do, Avith exercise. In time it grows thicker also; and this is the " hypertrophy " of medical books. But, if the overwork is incessant, the blood is thin and poor, and the sum of energy in the body is low, the heart becomes Aveak instead; its muscular fibres become pale and thin. In this condition they are easily stretched by the blood Avithin the heart's cavities, and we have what doctors call " dilatation of the heart." It is interesting to knoAV that these opposite changes may occur, in different cases, from almost exactly the same immediate causes. When, from disease (such as rheumatic inflammation) one of the valves of the heart (see Anatomy) becomes obstructed, more effort on the part of the heart-muscle is necessary to force the blood through it. Then if (as above said) the blood is well nourished and the vital energy is good, this increase of work makes the heart groAv stronger and thicker (hypertrophy). If, on the contrary, the blood is poor and the energy Ioav, the muscular Avails of the heart give out; they become thin and stretched (dilatation with attenuation of the heart). Other causes besides active exercise may hurry the action of the heart during health. Strong feeling does so; as fear, anger, or passionate love. Thus, all the world speaks of the heart as the seat of the affec- 332 HYGIENE. tions and passions. Also, stimulating drinks excite the heart; espe- cially alcoholic beverages, and, Avith some persons at least, strong coffee. Smoking tobacco (except Avhen, as at first, it sickens) has a similar effect. This is the case, also, Avith all modes of sensual indulgence. It is true that overaction of the heart does not ahvays constitute disease; it may be "functional disorder" only. Palpitation of the heart is often produced by indigestion, from sym- pathy of the heart with the stomach. Drinking a great deal of strong tea or coffee, particularly if, at the same time, the person Hats a scden- tarv, inactive life, may bring on " nervous " palpitation. This is differ- ent from the overaction or irregular action of organic disease of the heart; in Avhich either the valves or the muscular Avails of the heart have undergone morbid alteration. One sign will generally suffice to distinguish betAveen these two things. If there be organic disease, the disordered movement of the heart is made worse by active effort of any kind; but if it be nervous palpitation only, moderate but frequent exercise, especially in the open air, lessens it and promotes its cure. Tight lacing does mischief and impairs health, sometimes causing suddeu death, by cramping the motion of the heart, as Avell as the expansion of the lungs in breathing. It is an enormous mistake; all the more intolerable because the wasp-like shape which it gives to the female figure is unlovely as well as unnatural. No sculptor of classic Greece, no painter of Italy, in the days of Raphael, Michael Angelo, and Titian, ever gave to a goddess or a Madonna such a form as modern fashion has sometimes tortured its victims to obtain. It is worse than the Chinese lady's bandaging of her feet; because that is merely the cause of a deformity, while the cramping corset half stifles the healthy action of the most central and important organs of the body. Happily, there is, of late years, some gain in fashion in regard to this matter; in the direction both of good taste and of hygiene. For the balance of the blood circulation to be rightly kept, there must not be much difference of cold or heat applied to different park Sunstroke exemplifies one possible effect of such a difference, Avhen it results from the immediate shining of the sun on the head. Taking cold is a much more common instance of an opposite kind. One sits aAvhile Avith his back to an open AvindoAV, through which a cool, damp air enters. The part exposed is chilled; the blood-vessels in it contract, and force the blood elseAvhere. If the lungs of the person be weak, blood may collect in them; congestion may follow, and then inflammation; pneumonia. This is worse than what takes place in most instances; but the general process at the beginning is of the same nature. Of this more will be said hereafter, Avhen we come to consider the Causation of Disease. CARE OF THE SKIN. 333 CARE OF THE SKIN. More than one use belongs to the " tegument" which covers the Avhole of our bodies. Some animals have a natural Avrapping AA'hich is only protective: as the shell of the oyster, snail, nautilus, or tortoise; or the armor-plates of the armadillo; or the bony mail of the sturgeon. Al- most as little endoAved Avith feeling is the hide of the hippopotamus, rhinoceros, or elephant; and the fur of the seal, bea\Ter, ermine, sable, and other animals, appears to be of use chiefly in keeping out the cold. Birds' feathers are spread out on their Avings for flight; while their colors, Ave need not doubt, may be designed specially for the purpose of beauty. Man's skin is, first, protective, Delicate as it is, its removal from any part shoAvs, by the suffering produced, the importance of this service. Secondly, it is sensitive. By touch, we learn much of the things around us, not only by our hands, but all over the body. Thus Ave are Avarned of danger when close at hand, and by experience come to avoid things which are injurious. Thirdly, the skin secretes and excretes. These words do not mean exactly the same thing. Secretion in physiology is the separation of any material from the blood by a gland or " follicle." The latter (fol- licle) is a very small folding of a membrane, into Avhich a little mucus or other fluid oozes by secretion. A gland is a collection of " cells," Avhich take from the blood a material peculiar in each case: the salivary glands in the mouth secrete saliva; the liver, bile; the kidneys, urine; etc. The skin has two sorts of glands. One kind, most numerous (on some parts of the body, over 2000 to a square inch) are the sweat-glands, secreting perspiration. The others are hair-grease glands, called "sebaceous;" they are most abundant near the hairs (see Anatomy). The latter keep the hair and skin supple and smooth. The perspiration prevents the skin from groAving dry and harsh; but also, by evaporation, it cools the body Avhen exposed to high heat; and lastly, it is excretory. That is, Avaste matter of the blood is thrown off by it, including some carbonic- acid gas and certain salts, which (although less concentrated) are not unlike those present in the excretion of the kidneys. Because of the sensitiveness of the skin, an extensive injury to it, such as a large burn or scald, causes a great shock to the nervous system. Thus a bad burn may kill. But, besides this, the excretory action of 334 HYGIENE. the skin is so important, that if it is suppressed over a large part of the bodv at once, the blood becomes poisoned by the waste (effete) matter retained, and this endangers life, or at least health. Frogs breathe out more carbonic acid by their skins than avc do; enough, it is said, to keep them alive for some time when air is not alloAved to enter their lungs. Moreover, if they are closely covered all over Avith something which air cannot penetrate, they Avill die, suffocated (in a sense); their lungs not airing their blood fast enough. A gum-elastic suit, fitted tight to the whole of a man's body, and kept there all day, Avould probably cause his death by suppression of perspiration. India-rubber is altogether unsuitable for use as a cover- ing next to the skin, and even when farther off, as in rubber boots or shoes, it should be Avorn only while needed to keep out water, and then removed. The subjects of most interest connected with the Hygiene of the Skin are Clothing and Bathing. CLOTHING. 335 CLOTHING. As Ave read in the Book of Genesis, clothes Avere first worn under a prompting of modesty after the fall. In some savage countries this is now hardly regarded. Amongst others ideas differ. In Mohammedan lands a Avoman's face must be concealed from the gaze of men under all circumstances, except Avhen alone Avith her husband or parents; as to the limbs, they seem not to be minded so much. This is someAvhat like the opposite Avays of shoAving reverence: Christians, during the act of worship, uncover the head ; Mohammedans, the feet. When barbarians, such as the Fiji islanders, become Christianized, they Avear clothes. Dr. Pickering, a great American traveller, says that in some of the South Sea Islands, as soon as the inhabitants, under the influence of missionaries, began to dress themselves, they grew liable to " take cold," Avhich had never happened to them, in their mild cli- mate, while they Avent Avithout clothing. In cold countries, hoAvever, man Avould be unable to live unclad; and in the Arctic regions, the thickest furs of animals are necessary to retain the warmth of the body. Clothing, for health, must be 1. Sufficient for comfortable warmth. 2. Not excessive in amount or pressure. 3. Properly distributed over the body. 4. Allowing transpiration of moisture. 5. Changed often enough for cleanliness. Some persons, on the idea of hardening themselves, wear as little clothing in Avinter as possible; no undergarments, and no overcoats or cloaks. If already very robust, they may bear this, and get used to it; if not strong, they become chilled through, and may be seriously injured in health. To be in a cold place and be warm enough of one's OAvn blood-heat is very well. But to be chilly is not good for anybody. The Avay to be hardened is to become gradually accustomed to exposures which one is quite able to meet. It is a good deal (as we have said once before) like the way one's credit is established in business; by meeting every obligation as it comes; never incurring any which you cannot meet. So excessive exposure does not harden, but rather injures the constitution. Still, it is a mistake to be too warm, or burdened with heavy unnec- essary clothing. The same is true of covering at night. People differ much as to Avhat they need. On the same night, one Avill want but a single blanket, another two or three; but every one ought to be warm enough to sleep comfortably. 33fi HYGIENE. Farmers haA-e found, by actual trial, that it costs more to keep cattle out in the fields all Avinter than to shelter them; because, in order to keep Avarm out of doors they must eat more food, to furnish fuel for the natural combustion which sustains their Avarmth. This reminds us of the adaptation shoAvn by the fact that the warmest-blooded of all mam- mals is the silver fox, Avhose home is in or near the frozen Arctic Zone. Of course it is disadvantageous to Avear too much clothing. It wearies and clogs movement Avith its weight, and promotes an excess of perspi- ration. Tight-lacing is even dangerous to life. Just before hoop-skirts for ladies became fashionable (the last time), it Avas common for ladies to Avear tAvo, three, or more skirts to make an appearance of expansion from the Avaist to the feet; a most absurd cus- tom, truly. The light hoops were innocent of much pressure at all eATents. The "chemiloou" and "skirt-suspenders" of the Dress Reformers of our times, must be decidedly better for health than gar- ments Avhich hang altogether upon the hips and press the abdomen doAvnwards, We should adapt the amount and quality of our clothing to the weather. Not by the almanac, however, as the seasons do not folloAv it exactly. Chinese people, it is said, having cool nights and very hot noons, begin the day Avith several light garments on. As the hours of morning bring Avarmth, off goes one thing after another, till by noon- day they have only one or two covers left. With the cooling of the afternoon they again begin to put them on; and so, hour by hour, they get back to the morning's raiment. This is reasonable enough. Many persons among us make the mistake of Avearing too little clothing (as A\rell as keeping their houses too cool) in the changeable and uncertain Aveather of spring and autumn; and a large number of "colds" are caught in that way. Of the materials in use for clothing, the warmest (besides furs) is avooI. An open, porous fabric, containing air, conducts heat more slowly than a smooth, dense one; because air is itself a slow heat-conductor. So a tight-fitting kid glove scarcely keeps the hand warm, Avhile a loose mitten is very comfortable in cold Aveather. Silk is a sIoav conductor also, and it is Avarm for garments in propor- tion to its thickness. It conducts electricity very sloAvly, which makes it particularly suitable for undergarments with those who are liable to pains and aches on damp days, or when the wind is " easterly." Next to avooI and silk comes cotton (muslin); and the coolest of all are linen garments. These are most fit for midsummer wear, when our American climate is, by fits and starts, at least, tropical. Every one should be prepared, however, at all seasons with extras to put on in case CLOTHING. 337 of sudden or unexpected changes. A prime rule of health is this: never allow yourself to be chilly, if you can help it, for a single minute. Does clothing or bed-covering make any one Avarm ? No. What do we use in summer to keep our ice from melting in the sick-room? Flannel. So also, in crossing the equator, sailors find flannel the best protection against unaccustomed heat; and the same service is rendered by it to engineers in boiler-rooms or other highly-heated places. The fact is clothing acts simply as a non-conductor. It prevents or retards the exchange of heat between the body and the outer atmosphere. If we are warmer than the air, it keeps us from being chilled ; if the air is hotter than we are, it prevents us from suffering so much with the heat. It is true, however, that thick flannel is not comfortable in warm weather. The roughness of coarse flannel also stimulates the skin some- Avhat. This, and the absorption of perspiration in its pores, make it especially useful in protecting against taking cold when one is heated by active exercise. In our variable climate, delicate persons, especially those liable to rheumatism or neuralgia, generally find advantage in wearing either light flannel or silk next to the body even through the summer, with a heavier kind, of course, for Avinter. Ignorant persons sometimes (as I have known) will put a sick, feeble child into a cold bed, and pile clothing upon it to " make it Avarm." It won't do it. You should first warm the bed (and the child too), and then the blankets Avill enable it to retain its heat. In the distribution of clothing over the body, the main part to keep warm is the chest. As it contains the heart and lungs, all the blood in the body passes through it constantly, and conveys its tempera- ture everywhere. Moreover, chilling the heart or lungs endangers in- jury to those central organs themselves. Next, the abdomen must be sufficiently protected. Great organs, the stomach, boAvels, liver, spleen, kidneys, etc., are contained in it, and are all (most of all the bowels) liable to attacks of disorder from cold. Sudden changes of temperature often bring on diarrhoea; sometimes, cholera-morbus or dysentery. A Avoman in the country, for example, in summer-time, lightly clad, remains at work in a hot kitchen for an hour or two, and then goes to her spring-house in the side of a bank or hill. In her kitchen the ther- mometer would show perhaps 90° Fahr. or more, the spring-house (or ice-house) 60° or below it. Is it any Avonder if she " catches cold " ? And summer colds are more apt to affect the bowels; Avinter colds, the organs within the chest. Thus we can see the advantage to Northern 338 HYGIENE. soldiers, in our civil war, of wearing a flannel band around the abdo- men Avhile campaigning in the South. Blacksmiths, engineers in boiler-rooms, furnace-men, glass-blowers, etc. find Avearing flannel an excellent protection against exposure to excessive heat. Then the extremities. Of these, the feet must be best cared for. Thev are farthest from the heart, and nearest to the ground. Hence, at the same general temperature, they suffer most from cold. Children, in mild climates, may groAv up accustomed to running about barefoot, if they have freedom and space to acquire active habits. But it is a great mistake to let the legs of city children (or their arms) be bare, for appearance's sake, in any but the Avarmest summer Aveather. At the same temperature, children are more likely to be hurt by cold than groAvn people. Here is a case, from real life. A man and his Avife, with two little children, had occasion to drive some twenty miles or so, on a very cold Avinter night, in an open wagon. They carefully Avrapped the little ones, placed them in the bottom of the wagon behind them, and drove on, facing the wind themselves. Supposing the chil- dren to be all right, as they Avere quiet, they left them undisturbed, until, at the end of their journey, they found both of them frozen to death ! The man and his wife were uninjured. Hence Ave should put as warm clothing, and under-clothing, on the arms and legs of children, as we need ourselves at the same time. As to bed-clothing, most people may have observed the fact, that Ave are ahvays colder when asleep than Avhen we are aAvake. One may lie comfortably under a light cover before falling asleep, and then almost at once be awakened by a chill. Old persons are like young children in their small poAver to resist cold. Very old people may die, as some delicate plants do, just from exposure; a kind of cold-stroke. Albert Barnes, the excellent com- mentator upon the Bible, was thus, at an advanced age, chilled to death, upon Avalking a short distance from his home on a severe Avinter evening. Transpiration (passage of vapor) from the skin through clothing i» an indispensable condition of health. As already said, therefore, india- rubber Avill not ansAver for close-fitting garments. On the accession of Leo X. to the papacy, there was a grand proces- sion at Florence in his honor. A little girl was made to personate the Golden Age, by being coated, from head to foot, with gold-leaf. Before the day was over, she died in convulsions: skin-asphyxiated by her metallic covering. Aubert, in Germany, in 1873, ascertained by careful experiments that in the course of tAventy-four hours a man exhales from his skin, in health and Avhen at rest, sixty-tAvo grains of carbonic-acid gas, besides effete (dead, Avorn-out) organic matter. CLOTHING. 339 Changing clothes for cleanliness is not only decent, but eminently Avholesome. Some of those who have been called the " great unwashed " among mankind seem, by living mostly out of doors, to keep tolerable health. But they are never well prepared to battle with disease or in- jury. Old clothes of soldiers in war time become, by long wearing, fearfully foul. Cases of fatal illness have been caused (I knew of two such during our war of 1861-65) just by exposure to their emanations. No one ought to sleep in the same clothing as that worn during the day. Under-garments and all ought to be changed at night. Sick persons, confined to bed, need change of clothing oftener, even, than when they are well. If they are too feeble to be moved, this is a very great disadvantage to them. Nearly always, however, with care, a clean night-shirt or chemise can be got on eA> ery feAV days. The clean gar- ment should be warmed, and a part of the patient's body only, a single arm, for example, should be uncovered at once, with as little sitting up (if weak) as possible. Bed-covering should always be throAvn doAvn when one rises in the morning, to air the sheets for some time before the bed is re-made. I think I can feel the want of freshness in the sheets of a bed which has not been aired—in which it may be almost impossible to go to sleep. Dio Lewis tells of a patient of his who slept badly, but who recovered his slumbers on carrying out the prescription—air your sheets every morning for two hours. While speaking of night-coArering, a little may be remarked about the bedding. Feather beds are not liked by many in this country. The hair-mattress, well made, is excellent; people of tender bodies may have a feather bed laid under it. Husks and straw make the cheap- est bedding; straAv can, at least, be made comfortable, and can be changed sufficiently often Avithout much expense. The ideal bed, to my mind, is a good, firm mattress, on a feather bed, and this upon a wire sacking, instead of the old style canvas sacking-bottom. Ladies of fashion used to suffer, not more than half a century ago, from many errors in dress. Tight-lacing Avas, perhaps, the worst. Besides, however, they wore thin shoes in the coldest of weather; and attended balls and parties with bare necks and shoulders, and then, becoming heated with the dance or the promenade in close rooms, would stand by open windoAvs to " cool off." Many a pneumonia, and not a few cases ending in consumption of the lungs, have thus been brought on. Another fault of female dress, hardly yet gone out, is that of high-heeled shoes. These distort the figure, rendering natural, whole- some exercise almost impossible. Men's feet, as well as women's, are often tortured, almost & la 340 HYGIENE. Chinoise, Avith tight shoes. The human foot has naturally a distinct arch, and spreads out Avith every tread. A good shoe should preserve this arch, and allow some room for the outspreading of the toes. How seldom does a man walk, in shoes or boots, with ease and grace! The most dignified walkers I have ever seen are the Egyptians (I was never in Turkey); Avho wear a kind of sandal, easy to the foot and without heels. Strangest of all are wooden shoes; still worn by some poor peo- ple in Europe, and even in England. They must be dreadfully clumsy for locomotion. Stockings may be light or heavy, according to the season or climate; ■ not many persons, however, out of the Arctic Zone, enjoy the feel of Avoollen stockings. For cold feet, exercise (when practicable) is the best remedy. Sick people must have their feet kept comfortably Avarm by artificial heat. Frosted feet are commonly got by going right to a fire or a Avarm-air flue with very cold feet. They ought to be ahvays grad- ually7 warmed on coming in. A few people have such a sIoav circulation, that it is well for them, in winter, to sprinkle red pepper inside of their stockings, to help to keep their feet warm. Hats are a modern invention ; although Arctic people must always have Avorn fur caps of some kind. Umbrellas have been very anciently used to defend against the heat of the sun in Eastern Asia; but only within a century or two have they been knoAvn iu Europe and America. The Greeks and Romans of historic times had little need of head-cover- ing, except A\dien journeying in bad weather. There was room, there- fore, for the croAvn, or the bay or laurel-wreath upon their brows, Avhen Avon in their many contests, mostly under the open sky. For the tarboosh or fez cap of the Mussulman, the head is shaved, except one lock at the crown ; and, when in full dress, he puts a turban OArer the cap. Englishmen, in India or Egypt, often put green veils over their hats, the more effectually to protect them from the sun. This was the purpose, also, of the " havelock;" a Avhite linen hood with a short cape falling upon the back of the neck and shoulders. Heavy beaver or silk "stove-pipe" hats are most unreasonable. It is nearly certain that wearing them constantly promotes early baldness. Felt is a much more suitable material for men's hats. As for those of women at the present time, little can be said against them on the score of quantity. What next may follow, nobody can now tell. One of the best things about Fashion, however, both for health and beauty, is, in our age, that for want of Parisian leadership (since Eugenie fled with the ruin of the French Empire), many styles often compete; and so taste has a chance to lead, and is coming more and more to have con- trol. Outri, semi-barbarous fashions, such as the Grecian bend 01 CLOTHING. 341 enormous hoops, will hardly come in again in Christendom. Most objectionable of all things now is the thick, heavy mourning veil. For its counterpart we have to look far away to Turkish or Egyptian women, Avhose faces are always thickly covered while men are near. Spotted veils, now sometimes worn, are said by oculists to be very trying and injurious to the eyes. All veils must more or less interfere with the breathing of fresh air. Concerning the skin, a Avord must be said of the evil of cosmetics and hair-dyes—rouge, face-powders, etc. Chemists have often examined and reported upon these. Nearly all of them contain mineral poisons in quantity sufficient to do harm, and sometimes to endanger life. Let them all be avoided. The best of all cosmetics is fresh air; the great beautifier is health. Active exercise in the open air is so healthful for girls and Avomen, as well as for boys and men, that it is a great misfortune for the fem- inine dress to be allowed to cramp or constrain the free moA'ement of the limbs. This it always does Avhen a long skirt is worn. The " gym- nastic" costume is to be commended, not only for mountain climbing, but for skating, rowing, pedestrian excursions, tennis, and all activities. Let us hope that, " Bloomerism " being forgotten, Ave may soon have a reign of common sense in women's dress. Tight-lacing appears to be not much now in fashion; may it never be so again ! Healthy women need no corsets, any more than men. Coroner's inquests were once not rare, over ladies who squeezed themselves to death, by impeding the right action of the heart and lungs with tight corsets. They are espe- cially foolish, because the figure of a wasp is decidedly not that of a beautiful woman. Look at the most famous statues, of ancient or mod- ern art. Had Venus or Minerva Avorn corsets, they never would have been idolized by the Greeks; for the ancient Greeks, whatever their faults, had good taste. 342 HYGIENE. BATHING. Almost all ancient nations made ablutions a part of their religion. Cleansing the body with water is a natural symbol of purification of the soul For this reason, and because of the refreshment it gives in hot climates, as well as for cleanliness, bathing was common among the early Egyptians, Greeks, and Romans. "Divers washings" made a part of the Mosaic ritual of the Israelites; and they were continued to some extent by the Mohammedans. In ancient Rome there were at one time over 600 public baths. Some of these were very extensive; as those of Caracalla, whose ruins yet exist. In the Middle Ages, bathing was largely practised in Europe as a preventive of leprosy. Michelet asserts, however, that for centuries Europeans neglected bath- ing altogether. Water-baths affect the body chiefly according to their temperature. They may be divided as folloAvs: Cold Cool Tepid Warm Hot. 32°-70° Fahr. 70°-85° " 85°-90° " 90°-96° " 96°-100° " Besides these, there are baths of Vapor Hot air . 100°-120°. 130°-250°. Of the cold or cool bath, the direct effect is sedative or depressing to the system. If one remains long in the water, this is its whole influ- ence. But if soon out of it, in a tolerably warm place, a reaction occurs, in which a glow of warmth is felt. On a careful trial with a thermometer, I found, in one case, that there was a real rise of temper- ature of at least one degree, at the surface of the body. Ordinarily it is this reaction after the cold bath that does good. Therefore one should not stay in it long at a time; the colder the water, the shorter the time of immersion. Some persons, moreover, have little or no reaction, and for these the cold bath is not suitable. The shower- hath answers for some who cannot derive benefit from the plunge-bath; the shock promotes reaction. Infants should not be bathed in cold water. At first, for them, it should be 90° at least. BATHING. 343 By degrees, in the summer time, it may be lowered, watching the effects, to 85°, or, with some, 80° or 75°. Tepid baths are always safe for adults and youth at least. When long continued, tepid water relaxes and softens the skin, producing the appearance seen on washerwomen's fingers. Warm baths are decidedly relaxing. They are not beneficial to persons in health, but are often of valuable service in the treatment of disease. Hot baths excite the circulation of the blood, quickening the pulse and flushing the countenance. This is not good for any one in health. In certain states of the system, depressed in vitality, or suffering with painful joints, etc., hot bathing sometimes does much good. Vapor baths are of use only in some states of disease. It is pos- A SIMPLE SHOWER-BATH. HIP-BATH. sian baths, must be always taken Avith dry air, so as to allow of free perspiration and evaporation from the body. This so mitigates the effect of heat that many people can bear an air-bath above 200° with- out inconvenience. Still, for persons in health, 130° to 150° Avill ahvays be safer and better. Its special benefit is the thorough change of surface attending it, removing more of the epidermic " scales " (scarf- skin) than a \vater-bath will, unless at a temperature too high to be borne. The Turkish bath includes immersion successively in water-baths of different temperatures, besides a good deal of rubbing. This also must very effectually cleanse and renew the surface of the skin. Those who have tried it consider it very enjoyable and refreshing. One should never take a bath immediately after a meal; not for less than an hour (better two or three hours) after dinner. Neither should a cold or cool bath be taken when exhausted, or when the pulse is much 344 HYGIENE. hurried by violent exercise. Best times for bathing are before dinner and before going to bed at night. A shower-bath may be very well taken before breakfast. Sea bathing differs from fresh Avater bathing (besides its temperature, not the same at different places), in the density of salt Avater, making more pressure upon the exterior of the body ; the stimulating action of the salt upon the skin, and the absorption of more or less saline matter, Avhich acts upon the bowels and kidneys of some persons. Because of the pressure being greater, it is easier to float in sea than in fresh Avater. But that pressure tends to force the blood towards the head; hence the importance of the rule, always to wet the head upon entering the surf, and repeatedly aftenvards, so as to keep it cool and prevent fulness of blood in the head. By the stimulation of the skin in sea water, it is made less chilling than fresh Avater at the same temperature. Still, experience (especially as observed by physicians stationed at Boulogne and other watering places) proves that a short time in the surf is much the best for health. Fifteen minutes Avill be long enough for the greatest adATantage to people generally. I haA'e knoAvn a few persons to stay in the Avater at Atlantic City or Cape May/ for an hour at a time without apparent injury. Others, after half an hour, come out with blue lips and fingers; some Avith headache and languor; now and then one will suffer with diarrhoea. There is no doubt that fifteen or twenty minutes at a time in the surf on our shores will be long enough to do good to any one. Not every one is benefited by sea-bathing. Very feeble, delicate persons, and those predisposed to apoplexy, should not risk it. For these, salt-Avater sponging may often be quite useful. Summer Surf Temperatures* Cape May Florida Coast Charleston, S. C. Norfolk, Va. . Nantucket, R. I. Portland, Me. . English Coast . Normandy . Baltic Sea . Mediterranean (Trieste) 70°-80° Fahr. 87°-88° " 86°-87° " 81°-82° " 75°-76° « 60°-61° " 68°-72° " 69°-70° " 65°-66° " 85°-86° " * The average temperature of the Atlantic, out at sea, is about 56° Fahr.; of the Gulf Stream, 65°. BATHING. 345 Daily bathing in fresh or salt water, at such a temperature as is fol- lowed by a good reaction and a feeling of refreshment, may be com- mended for all. But those Avho have not opportunity for it in the Avinter-time may keep their skins in a pretty good state by frequent ablutions Avithout whole bathing. A particularly good habit is to Avash the neck, breast, and shoulders (as well as face and hands) with cold Avater every morning upon rising. Wrhen this is done with a moder- ately rough rag or towel, it is sure to produce a brisk reaction at once; one is warmed by it. Sensitiveness to cold is thus lessened, and one is thus made a great deal less liable to take cold under ordinary exposure. At a time of sickness, hoAvever, warm or tepid water should generally be used for ablutions. Some persons are annoyed by a strong odor from the armpits, which in a feAV cases is perceived by others near them. This is owing to an excessive amount of excretion by the glands of the skin in those regions. To prevent or remedy it, the bowels should be kept regularly and well open; the general state of the skin needs to be made healthy by fre- quent bathing, as well as by change of clothing, especially the under- garments ; and the armpits should be well Avashed, morning and night, Avith soap and Avater. An agreeably scented soap Avill have in this case the best effect. 346 HYGIENE. THE HAIR. Hair is more like a vegetable groAvth than anything else belonging to the body. There is reason to believe that it and the nails may con- tinue to grow for a few days after death. Each hair has a root, which is planted in the skin, Avith one or two sebaceous (grease) glands close by it to maintain its suppleness. When left to grow naturally, the hair will acquire (as the eyelashes do, for example) a certain length. Cutting it promotes a longer growth, which, however, still has its limits. Many women have hair reaching to their waists or hips; a few, almost or quite to their feet. Were we all living in a warm climate (of AA'hich Man was, no doubt, originally a native), and otherwise in a state of unsophisticated nature, Ave should have no need of cutting the hair in either sex. But, with clothing, warmed houses, hats, caps, etc., men's and women's heads have often a poor chance of raising a healthy crop. Like an over- grown grass-plot, the hair may become too thick, unhealthy, and threat- ened Avith dying out at the roots. As mowing is good for the grass, so then is shearing, more or less close and often, for the hair. After severe illness, it is quite a common thing for the hair to fall out. Then it should be cut very short, or, still better, shaved from the scalp once or twice. Should the head be washed, like other parts of the body ? I believe this to be wholesome for the hair as well as for the system generally. Water alone does not easily remove the natural grease from the head. Soap should not be applied to the scalp, at least under ordinary circum- stances. Is it well to use hair-grease ? Certainly not, unless the natural supply of unctuous material is deficient; and then in very small amount, and not often. If much is applied, it thickens, crusts, grows rancid, and irritates the scalp, to a great disadvantage. A hair is a growing tube, filled with nourishing fluid. When old age comes on, the quantity of this fluid and its quality decline; hence the hair either grows pale and white, or withers, dies, and is not re- neAved. Some heads grow bald, others gray or silvery-white. An observing physician told me that all the very old people he had known have retained their hair on the top of the head, though Avhite, to the last of their lives. This has generally, though not quite always, beeD the case with those Avhom I have known to approach or pass their nine- tieth year. If, then, anything interferes Avith the healthy nutrition of the scalp, THE HAIR. 347 even in early life, it may suffer a premature " old age of the hair," Avhile the rest of the body is still young, or at least not senescent. This may result from the debility caused by illness, or, as has been suggested, from irritation of the skin of the head. Heavy hats, nasty " chignons," once too fashionable, and living in hot rooms, are among the causes Avhich may spoil the crop on the outside of the head, Avhatever may happen Avithin it. Also, excessive care, or, perhaps, hard study, may bring on baldness or whiteness of the hair; by affecting the circulation of the blood, which is intimately connected within and without the skull. Instances (though few) are authentically recorded, in which fright, or sudden grief, has been folloAved by the whitening of the hair in a single night, or at least Avithin a few days. What ought to be done for early baldness ? I believe in daily wash- ing the. head quickly with cold water. Adding a little whisky and salt to the water, and following the Avashing Avith a moderate brushing, pro- ducing a gloAV, without the least soreness (irritation), is alsp likely to stimulate the circulation favorably. Many hair washes are patented. The materials mostly contained in them are ammonia, cantharides, quinine, and castor-oil. These may do good, or, by excessive irritation, harm. If one Avishes to try a stimulant in such a case, one of these will be as safe as any: Take of Aromatic Spirit of Ammonia, Spirit of Rosemary, and Glycerin, each a fluidounce (two tablespoonfuls) ; Tincture of Canthar- ides (Spanish-fly), three fluidrachms (three teaspoonfuls); Rose-Water, enough to make eight fluidounces (half a pint). Mix, and use as a wash, daily. Or, as an unguent: Take of Balsam of Tolu, two drachms (by weight); Oil of Rosemary, twenty minims (twenty-five drops will do); Tincture of Cantharides, two fluidrachms (two teaspoonfuls); Castor-Oil, four fluidrachms (four teaspoonfuls); Lard, an ounce and a half (by weight). Mix, and rub nightly over the scalp. Hair-dyes are easily obtainable which will make white black at will; but they are dangerous. It is next to impossible to dye the hair Avith- out wetting the scalp a good deal with the dye-stuff; and the effective agent in hair-dyes is lead. By its poisonous action, absorbed in this way, it is believed that some lives (among them that of Mademoiselle Mars, a famous actress) have been lost, and many persons have been seriously injured. The King of Sweden, some years ago, suffered a severe illness, ascribed by his physicians to the use of a " hair-restorer "; which, on examination, was found to contain a large amount of oxide 348 HYGIENE. of lead. I subjoin Professor Chandler's account of his analysis of some popular preparations.* Hair Restorers. Grains of Lead in 1 fl. ot Clark's Distilled Restorative . 0.11 Chevalier's Life for the Hair . 1.02 Circassian Hair Rejuvenator . 2.71 Ayer's Hair Vigor . 2.89 Prof. Wood's Hair Restorer . 3.08 O'Brien's Hair Restorer, America . 3.28 Gray's Celebrated Hair Restorative . 3.39 Phalon's Vitalia . 4.69 Ring's Vegetable Ambrosia . 5.00 Mrs. S. A. Allen's World's Hair Restorer . . 5.57. L. Knittel Indian Hair Tonique . 6.29 Hall's A^egetable Sicilian Hair Renewer . . 7.13 Dr. Tibbett's Physiological Hair Regenerator . 7.44 Martha Washington Hair Restorative . 9.80 Singer's Hair Restorative . . 16.39 Lotions for complexion—no injurious metals found except " Perry's Moth and Freckle Lotion;" that had in one fluidounce Mercury in solution, 2.67 gr.; Zinc, 0.99 ; and the sediment a little mercury, lead, and bismuth. Of Enamels some are innocent of poisonous metals, but Eugenie's Favorite has in one fl. oz. ... 108.94 gr. lead. Phalon's Snow-white Enamel has in one fl. oz. . 146.28 " Phalon's SnoAV-white Oriental Cream has in one fl. oz. 190.99 " As the Beard is as much a natural growth as the hair, it is remarka- ble that it should be common anywhere to remove it. In remote antiquity, the Egyptians shaved off their beards only as an act of mourning; at Avhich time also the Jews sometimes tore their beards. One of the Levitical precepts is, " Thou shalt not mar the corners of thy beard." Alexander the Great, and, after him, the Romans, made their soldiers and gladiators go beardless, so as not to afford their adver- saries a good hold in personal combat. Scipio Africanus, the Roman general, shaved every day. But Pliny says that all Romans, not in the ranks, were expected to wear their beards at full length after the age of * New York Metropolitan Board of Health Eeport, 1869, pp. 565, 566, 567. I THE HAIR. .349 forty-nine years. Emperors of Rome were shaved until Adrian, Avho wore his beard to hide blemishes upon his face. His successors fob loAved the same fashion until Constantine, Avho changed it again. In more modern times, bearded faces were usual until a Papal nuncio at the Court of France originated the style of smoothness. Louis XIII. of France and Philip V. of Spain, being naturally almost beardless, confirmed this tendency; but, besides the shorn and tonsured monks, European men have mostly preferred nature's orna- ment and protection to remain upon their faces. Cromwell's " round- heads," in the days of the Commonwealth in England, made a strong contrast in this respect to the dashing " cavaliers " of the royalist party. George Fox's " Friends," in the same century, although some of them wore their hair long, shaved their faces. Among persons of refinement, in England and the United States, fifty years ago, the moustache was hardly ever worn. Clergymen never, and eATen laAvyers or "gentlemen" seldom, then thought of it. Gradually the custom spread from France and Germany to America, and more slowly to England. Now, ministers of the gospel often are " bearded like the pard "; and, in the United States, nine men out of ten wear the mous- tache, whether the cheeks and chin be smooth or not. What reason is there for shaving ? None at all, except ideas of ap- pearance. In cold climates the beard is useful to protect the throat from cold. Even the moustache, if thick, may Avar in the air a little before it enters the nostrils. The time required for the use of the razor every day, from nose to throat, and ear to ear, appears to be entirely wasted; unless one can do as a learned friend of mine did, acquire a language by glancing from his mirror to a book, all the time while shaving himself. 350 HYGIENE. THE TEETH. While travelling in a Nile-boat, many years ago, I was struck with the whiteness of the teeth of the native crew, who were Egyptians, Nubians, and Arabs. Yet it is not likely there was a tooth-brush among them. Was it race, climate, or food that gave them such an advantage ? On the other hand, I once saw a child, in Philadelphia, but three years old, every one of whose first teeth was already decayed. This, of course, Avas due to a constitutional defect. But most people in this country, and, I believe, in Europe also, lose some of their teeth by decay before they are forty, and not a few part with several before they are twenty years old, and have scarcely any left by middle age. The causes of this early decay have been much discussed. The fol- lowing have been suggested: 1. Deficiency of lime in our food, which is needed to make firm tooth-bone and enamel. This is not quite impossible, although our A-egetables and meats both contain considerable lime. Probably the soil of a country affects animal growth somewhat by the quantity of lime in the water drunk, as well as in the food raised upon it. Cattle are said to be larger boned when pastured in a limestone region than when brought up where the water is all soft; that is, containing no excess of lime salts. The tallest men in this country are the Kentuckians, and their State has a great deal of calcareous matter in its soil. Still, it does not seem probable that there is so little lime in our food and water anywhere as much to affect our teeth, especially as rickets and other bone- diseases are less common in America than in Europe. 2. Race. Very likely there is something in the constitutional ten- dencies of races of men, which makes them liable to different defects and diseases. Possibly this has much to do with the difference men- tioned in regard to the teeth. Negroes, brought up in this country, generally have good teeth, and keep them longer than white people, Avhile using essentially the same water and food. 3. Excess of acid in our food has been thought by some to have an influence. But sour things are not very much eaten among us, and the vegetable acids, as vinegar and the fruit acids, also the animal lactic acid of sour milk, have but little power to dissolve the mineral matter of tooth-enamel, the hardest substance in the body. More than in any other way, acidity may act upon the teeth, when there is indigedwn; some of the starch and sugar of the food undergoing the acetous fermen- tation, and the acid resulting finding its way to the mouth and remain' THE TEETH. 351 ing there for a time. This is connected with the last cause to be men- tioned, namely, 4. Eating too fast, without sufficient chewing of the food. No- toriously this is an American habit. INIost people in this country are too much in a hurry about everything, and especially in eating. Gen- eral Winfield Scott's " hasty plate of soup" was famously characteristic; but soup can be safely swallowed without cheAving, while meat cannot. We are not furnished, like the dog and the boa constrictor, with stom- achs capable of disposing of flesh in solid masses. Hence this practice makes many persons dyspeptic, and troubles them with acid eructations into the mouth. More directly, however, imperfect chewing acts by leaving fibres of meat and vegetable substances between the teeth. There they undergo partial decay, and become nests, so to speak, for parasites, microscop- ically small, which make their home upon the surface and in the cracks between the teeth. Thus, by degrees, a crust is formed, which is known as the tartar. Of these parasitic groAvths the most abundant and im- portant has received the name " leptothrix buccalis." Some dentists have thought "tartar" to be protective to the teeth, postponing their decay. Possibly it may so act to some extent; but much better for the duration of the enamel is a smooth surface, affording no lodgment for anything. How, then, are we to preserve our teeth for the longest time ? First, by taking care of our general health ; secondly, by always chewing our food thoroughly before swallowing it; and thirdly, by cleaning the teeth effectually and often. A rather hard brush is the best; not Avide, as it need not rub the gums. It should be used at least once daily, upon rising in the morn- ing. An excellent practice is to clean the teeth after each meal; to get rid (besides the use of the tooth-pick) of particles which may have lodged in the crevices between them. Are tooth-powders necessary ? Certainly not for children, or for any persons whose teeth are still perfectly sound and smooth. When rough- ness or tartar has begun to appear, a good tooth-powder may assist thorough cleansing. Instead, however, pure castile soap may ansAver the same purpose; touching a piece of it with the moistened brush just before using it. A tooth-powder must not be coarse and rough, or it may wear away the enamel. A good combination is of very fine charcoal poAvder, castile soap, myrrh, and Peruvian bark. Myrrh is one of the best of all preservatives of the teeth. A very convenient and useful Avay of employing it is to add about twenty or 352 HYGIENE. thirty drops of tincture of myrrh to a quarter of a tumblerful of water, ,and use this mixture in cleaning the teeth and in rinsing the mouth aftenvards. When decay has begun, and tenderness is felt in an imperfect tooth, pure tincture of myrrh, applied directly to the offending part, will very often relieve the soreness and ward off trouble. It is, however, not strong enough to cure severe pain in a tooth; its value is as a pre- ventive. Disagreeable breath, except in those who eat onions, use tobacco, or drink strong liquor, is nearly always caused by bad teeth. A skilful dentist will make the best of these; by cleaning and filling those which are Avorth preserving, and removing the rest, making Avay for artificial substitutes. But, meanwhile, nothing is more immediately effectual in SAveetening the breath than a strong mouth-Avash of tincture of myrrh, and water, used as just mentioned. On rising, before going into company, and before retiring to bed, the use of such a wash will miti- gate the Avorst of breath-odors, and will remove all unpleasantness in most cases. Not many persons, after childhood, have the natural breath perfectly sweet, especially on first waking from sleep. Toothache may be of three kinds. Least common is 1. Pure neuralgia. Face-ache, tic douloureux, and hemicrania are names given to this when, as is mostly the case, it extends all over one side of the face, or face and head. 2. More frequent is inflammation of the jaw. This may come from a " cold," when all the teeth are sound. But much most gener- ally it starts in and about an imperfect tooth. A severe attack is at- tended by a great deal of pain, heat, and swelling of the side of the face affected. A large " gum-boil" is very apt to form; and when this breaks of itself or is opened, the discharge of matter is folloAved by relief. In rare instances the gathering opens outside on the cheek, sometimes leaving an ugly scar. The longest continued attacks are those in which matter collects at the roots of one or more of the teeth (seldom more than one); entire ease not being obtained until pulling the tooth lets the matter out. 3. Much most common is the aching of a decayed tooth Avith an exposed and irritated pulp. For this, creosote, carefully applied, i* a seldom-failing remedy. Take a knitting- or darning-needle, wrap one end with a little bit of cotton, and dip this in a small bottle of pure creasote. Then, with a looking-glass (if the sufferer has to be the oper- ator also) for guidance, push the moistened cotton right into the holhw of the aching tooth. It will give no pain, but will relieve the pain as soon as the creasote touches the exposed end of the nerve. A red-hol THE TEETH. 353 iron wire will act in the same Avay; I remember seeing my father (who was a physician) cauterize his OAvn hollow teeth with this. But, as cre- asote burns like a caustic when it touches the gums or lips, this should be avoided as far as possible; and a glass of cold Avater should be near to rinse the mouth with, if some should Aoav from the cotton and burn the neighboring parts. Other local remedies for toothache which is caused by irritation of a holloAv tooth, are laudanum, tobacco-smoke, pure Avhisky, chloroform, oil of peppermint, and oil of cloves. But none of these is so prompt and so certain in its action as creasote. Some years ago, dentists discouraged the use of this remedy for tooth- ache, upon the supposition that, by killing the nerve of the tooth, it would hasten its farther decay and destruction. I am sure this is not the case. In my own mouth I retained for fifteen or twenty years four teeth Avhich had been thoroughly cauterized with creasote, to relieve pain, when they first began to give trouble from decay. I believe den- tists have noAV giAren up the apprehension of any such injury from its use, and some employ it freely to prepare teeth for plugging, by remov- ing their sensitiveness, through its cauterizing poAver. It seems to me cruel to plug a tooth without thus destroying the sensibility of the ex- posed end of the nerve, and the caustic action extends no farther. 23 354 HYGIENE. EXCRETION: DISCHARGES. As every fire, whether in grate, stove, or furnace, must have its ashes removed from time to time, or it will choke and go out, so every living body needs to be relieved of its refuse and used-up (effete) material. The kidneys and large intestine are, in man, altogether excretory; they have no other function. The lungs, liver, and skin are but par- tially so; they have other duties also to perform. Under "Healthy Breathing" we have already considered the im- portance of the elimination (excretion) of carbonic acid gas, Avatery vapor, and organic material, by the lungs. This must go on, along with the reception of fresh oxygen into the blood in breathing, from moment to moment. Experiment has proved that, no matter how much oxygen mav be supplied to the blood of an animal, unless its carbonic add in removed, it will die in a short time. We have, within a feA^ pages, referred to the share taken by the skin in purifying the blood by excretion, along with its other offices (protec- tion, sensibility, and moderation of heat). As to the liver, our power of influencing its condition and action is indirect and not very certain. Heat stimulates the liver; very high heat may bring it into a state of disease. The pate defoie gras of epicures is made of the liver of a turkey or goose which has been tied for some days close to a fire. The bird's liver is thus put into a condition of fatty degeneration; not healthy, but tender, and agreeable to a fantastic taste. Tropical climates, as that of India, are those under Avhich disorders of the liver are most common. Rich, fatty food, also, is believed to excite the liver oA^ermuch, and to promote its derangement. The term biliousness, hoAvever, is often vaguely and incorrectly used. People are said to be bilious Avhen they merely have indigestion from irritation of the stomach, the liver not being involved at all. Alcoholic liquors of all kinds, when freely used, act injuriously upon the liver. When there is disorder of the liver, its secretion of bile may be either increased, diminished, or altered in character. Alteration, again, may occur with either increase or diminution of the amount of bile secreted. Most generally there is a lessening, sometimes almost a suppression, of its formation. Then the matters which ought to be removed from the blood by the liver render the blood unhealthy (toxcemia, chokmia); Avhile some coloring and other material of the bile may be excreted by the glands of the mouth, in the mucous membranes of the eyes, and into EXCRETION 355 the skin. Then we have a bitter taste in the mouth, sickness 'at the stomach, dizziness, a yellowish tongue, yellowish eyes and surface of the body. If the last coloration be decided, it is called jaundice. Prevention of liver disorder is to be cared for by a\Toiding exposure to extreme heat, eating only Avholesome food in moderate quantity, drinking no alcoholic beverages, and keeping the bowels regularly open. Treatment of such disorders may be spoken of to the best advantage under Domestic Medicine. Over the kidneys also we have only indirect and imperfect control. A special relation exists between the skin and the kidneys. When the skin is chilled and perspiration checked, the secretion of urine by the kidneys is increased. Conversely, in Avarm Aveather, when Ave perspire most freely, the Aoav of Avater from the kidneys is habitually less than in Avinter. Thus the bad effects of exposure to cold are often mitigated. Check- ing perspiration suddenly always endangers the health; but the accu- mulation of waste material, including \vater, in the blood, would be much more serious, but for this relieving (vicarious) action of the kid- neys. Sometimes the effect on the body of prolonged exposure to cold and wet is so great that both skin and kidneys are made to cease their work of excretion. Then disorder of the system must follow. Dropsy is one not infrequent result of such a state of things. At the worst, arrest of the secretion of the kidneys poisons the blood badly. This is called urcemia; and, if long continued, it ends in stupor and death. We take care of our kidneys, then, as we take care of our skin; by maintaining a regular though not excessive warmth of the body, Avith sufficiently frequent bathing, change of clothing, etc. But it must not be forgotten that the kidneys, like the liArer, are affected by our diet also. Highly seasoned food (excess of pepper, mustard, or spices) stimulates the kidneys; but much more unfavora- ble is the action of strong or largely imbibed alcoholic liquors. Among the maladies included under the term chronic alcoholism, kidney disease (some forms of which are called Bright's disease) is very commonly met Avith ; and, when once produced in this way, it is not often recov- ered from. 356 HYGIENE. THE BOWELS. Here we have much room for care of the health. Man's large intes- tine (see Anatomy) has no office except the removal of tAvo sorts of waste: 1. Incompletely digested materials of food; 2. Effete matter excreted by the glands of the intestine from the blood. This matter \* the most putrescent (undergoing the most offensive kind of decomposi- tion) of all that escapes from the blood. Since such matters must be removed, whether Ave are active or inac- tive, and Avhatever the amount of food, Ave see why sick persons must still have their bowels opened, even Avhen they are lying still in bed, and take little or no nourishment. Indeed, as decomposition goes on in the blood during sickness more rapidly than during health, it is more important, during acute illness at least, for the sick person to be so relieved daily- than it is for those Avho are in health. One daily emptying of the loAver boAvel is natural and most suitable for ninety-nine in a hundred people. Exceptions are met with. Accounts are recorded of some extraordinary ones; as of the Dutch General Grose, Avho lived for thirty years Avithout an evacuation. A student of the University of Pennsylvania told me in 1874 of a blacksmith whom he knew to have lived to be seventy-four years old, Avho for forty years had a movement of the bowels but once in nine days; yet with ordinary health otherAvise. When at sea, I have passed seven days Avithout the least disposition toAvard a movement, and a relative of mine has, also at sea, been eleven dayrs Avithout it. On the other hand, a not inconsiderable minority of persons have the boAvels moved twice daily while in perfect health. Once should be regarded as the standard. It is a good thing to have a habit of such moA'ement at the same time every day. Most people can best arrange for this right after breakfast; some just before retiring to rest at night. AVhen there is sluggishness of the loAver bowel, gentle pressure, alter- nately on the two sides of the abdomen, may assist in getting relief. Several causes promote constipation of the bowels. First, negled in responding promptly to the call of nature. The rectum (loAvest and last part of the large intestine) is not constructed to retain anything, but only to transmit and throw out Avhat descends from the colon into it. If it is compelled to detain anything, it contracts upon it, render- ing it less easy of subsequent removal; and at the same time the coats or Avails of the rectum (through its mucous membrane) will absorb into the blood much of the Avatery material present. Thus the blood THE BOWELS. 357 becomes more or less poisoned; and the disposition of the boAvel to empty itself is gradually lessened, establishing a habit of constipation. Secondly, Avithout neglect, there may be sometimes a want of power in the muscular coat of the boAvels; their "peristaltic" action is slow and incomplete. Thirdly, often connected with this, and bringing it on, there is an insufficient supply of nervous energy to the intestinal canal. Studious persons, professional and much pressed business men, are most likely to use their nerve-force so exhaustively in their daily pursuits, that too little is left for bodily organic functions. Sedentary people also, as bookkeepers, clerks, and tailors, may suffer in a similar way, because of the want of stirring up of their bodily energies by active exercise. As a rule, out-of-door activity promotes the regular movement of the boAvels. Fourthly, under some circumstances the secretory action of the glands of the large intestine is not sufficient. In fever (except typhoid fever) this is quite generally the case; it is so in the first stage of most dis- eases (as measles, scarlet fever, small-pox, etc.), Avhich begin with depression, followed by fever. Many dyspeptics and others, hoAve\Ter, in their ordinary condition, without fever, have an over-dry state of the mucous membrane of the bowels, inducing constipation. It is not a trifling matter to be irregular in this excretory function. Although many persons get on tolerably with a costive habit, there are possibilities, Ave may say dangers, attending it, not to be overlooked. One of these is irritation of the bowels, which may be, by some aggra- vating cause, urged on to a serious inflammation. Another is the crea- tion of SAvellings called piles, or hemorrhoids, near the outlet of the bowel (within or without it), which are often painful, sometimes bleed- ing, and generally troublesome. ^orse is the forcing, by straining at stool, of a hernia or rupture. This is an escape of a knuckle of intestine or membrane (peritoneum; see Anatomy) out under the skin at the groin, or, especially in women, at the navel; making a soft SAvelling, sometimes difficult to get back into its place. If this becomes greatly swollen, it is caught and held at the place it escaped through. Then its circulation is cut off; it becomes a strangulated rupture or hernia. Mortification follows, unless this is soon relieved; and the sufferer more often dies than recovers from this. More uncommonly, neglected constipation may cause such a collec- tion of hardening material in the intestine as at last to obstruct it alto- gether, and not even purgative medicine will remove it. This is one form of obstruction of the bowels. It is one of the most dangerous of all the accidents (if so to be called) to which the body is liable. 358 HYGIENE. Also, Avhen the large intestine is worried with what it ought to be rid of, the stomach, liver, and head may sympathize with it; and we may have nausea, " biliousness," and headache, as well as a general sense of indisposition and languor. Dyspeptics usually suffer thus; and they are very apt to make their friends and neighbors sympathize Avith their affliction. Lastly, as has been said, want of action of the bowels allows the blood to be more or less tainted or poisoned by the retention in it of waste putrescent material. This again acts unfavorably upon the brain and other organs; the Avhole system being at a disadvantage for want of fresh, pure blood. How are we to secure regularity of the bowels ? Establish the habit as early as possible in life. Never, if it can be at all avoided, wait five minutes, after becoming aware of the occasion, before relieving the loAver bowel. If inclined to be costive, besides active exercise according to one's strength, eat every day some fresh fruit. If that which is fresh cannot be had; stewed fruit (especially stewed prunes) may answer the purpose. Bran bread, also, is laxative with many persons. Should these means not be sufficient, medicine may be required. Without advice of a physician, the drug most safe and suitable to ven- ture upon for costiveness is rhubarb. Dyspeptics»often purchase this (root) in lump, and cut off a nightly portion as an offhand-made pill. Simple rhubarb pills of the apothecary shop will, of course, do very well. Trial will soon sIioav how large an amount is needed; and in this, as with other use of drugs, the smallest sufficient dose is ahvays the best. Gluten suppositories (to be slipped into the lower bowel) made by the Health Food Co., Arch street above 7th street, Philadelphia, have been found by a number of persons very convenient and effective to relieve constipation. (On constipation in young children, see page 432.) Adductor Loiigiw. Sartorius. Rectus l-'emoOS. Vastus Kxternus. Vastus Interims. Tendon of Knee- pan. , , Double Muscle of the Calf. . Tibialis AnticiK Tibia. , v Tendons of the M- tensoroftheTnW A.NTERIOR VIEW OF THE Mt'SCLES OF THE BODY. MUSCULAR EXERCISE. 359 MUSCULAR EXERCISE. How are people made strong ? First, by natural constitution. We differ originally in the capacity of our muscular system, as we do in height, weight, and length of limb. But most persons never reach the strength they might attain. Secondly, by the best possible care of the general health. Unless there is a good sum of power in the body as a whole, of course the muscular system falls short in energy. Thirdly, by exercise. This must be rightly proportioned, however, or it Avill not increase strength. Oven^work causes not a gain of strength, but weakness. Some people misunderstand this very much in regard to the sick and those Avho are delicate. "Take exercise and get strong," they say. But perhaps they have not strength enough for any active exercise; hardly enough to sit up all day. Those who have ordinary strength can increase it only by using their muscles Avithin the mark of what they could do possibly. There is an old saying that "a horse that has run his best will never run very well again." Dr. Winship, not long ago the strongest man in America, lifting over 2200 pounds at once, told of himself that, when a young man, he had only average strength. Something occurring to make him wish himself stronger, he set to work to cultivate his muscular powers. He found the best way for it to be to exercise often, but not long at a time. Seldom did he prolong his practice with weights, bars, lifting, etc., for more than half an hour at once; and in that time several different things would be done. On this plan he doubled his strength in a few months, and trebled it in a year or two; and his opinion was that any healthy person, by frequent short exercises, especially in the open air, can double or treble his or her strength in the same way. The conditions necessary for keeping the muscles in good order are those required for the healthy nutrition of every organ of the body; namely: 1. Good, rich blood ; 2. Distribution of blood, and of nerve-force, without obstruction, to each part; 3. Exercise of the organs, according to their ability; 4. Sufficient intervals of repose. Everybody knows that we must have sleep for several hours in each tAventy-four, or Ave wear out. Besides sleep, however, which affects the brain only, there must be rest from action in all the muscles. Our hearts 360 HYGIENE. Fig. 171. beat on, day and night; they rest only between beats. Our breathing muscles heave the chest and loAver the diaphragm, sixteen to eighteen times in every minute; but Avhile Ave are breathing out, they rest. Nothing that labors can do Avithout shorter or longer periods of repose. Even very short times of rest help. After a muscle contracts, more blood floAVS towards it. This gives it neAv "fuel" for energy, and more "stimulation," too. Try the principle for your- self, in this way. Take a pair of (either light or heaATy) dumb-bells, and raise them above your head as many times as you can, Avithout being much fatigued by it. Then rest for two or three minutes, and try it again. Almost certainly, you can lift them two or three times more than before. Rest again. Probably then you can raise the weights severed times more than the first or second time. The health-lift is made to act usefully on the same principle. Finding, by trial, how many pounds one may lift with comparative ease, that weight is raised once. Then, after a rest of about three minutes, nearly always from twenty to fifty pounds more may be lifted, without any greater apparent effort. Again a rest; aud another addition can usually be made. Of course there is a limit to this, commonly found, after the third or fourth trial, each time. By this means good exercise for a number of muscles can be obtained in a short time; although the general effect on the system is much less beneficial than that of longer continued active out-of-door exercise. In rowing, it has seemed to me that this idea of short rests for accumulation of power may be, and has been (perhaps without thinking about it) carried out. Some years ago, I noted, on ac- count of its bearing on the physiology of exercise, the rate of pulling in the boats in the great prize contests, at home and abroad. It appeared not improbable that the Harvard creAv lost, in its admirably contested race against the Oxford University crew in England, about fifteen years since, by too quick a stroke. The Harvard men pulled 42 strokes a minute, the Oxford men 40. In 1870, the Cambridge crew (England) beat the Oxford men, the first time for several years, on 38 strokes to THE HEALTH-LIFT. MUSCULAR EXERCISE. 361 the minute. On our side of the ocean, in 1874, the Columbia College crew Avon against the other college boats at Saratoga, on 34 to 35 stroke!-: per minute; " a quick hard pull and redhcr slow recovery." The Oxford men beat the Cambridge crew in 1875, on 35 and 36 strokes to the minute- and in 1876 Cambridge again beat Oxford, both averaging 37 strokes; Oxford varying from 35 to 40, in " spurts." * (As to the relation of these great contests to health, I will have a feAV Avords to say presently.) About modes of exercise next. Walking is excellent; unsurpassed in benefit to the system if oue can afford time to get enough of it; a pleasant country, moderate Aveather, and good company being almost essential to its advantages. Beginners must not walk too fast or too far. Stop at the end of the first hour, and sit doAvn for five minutes. Rest ten minutes at the end of the second, and every successive hour, if you go on long; and never, Avhile unaccustomed to pedestrianism, go more than three miles in one hour. What Weston, Rowell, O'Leary, and Fitzgerald can do is, for the beginner, about as impossible as it Avould be for one of them to leap o\rer a barn. Riding on horseback is an admirable exercise; but it leaves neg- lected a number of useful muscles, Avhich are brought into action in Avalking. Farmers in some places ride on horseback almost always, if they have to go a mile or more; and, in consequence, they become poor walkers. They often almost Avear out in an hour's stroll over hard pave- ments in toAvn. Bicycling much resembles riding in effect. Driving in a carriage (unless with a hard-mouthed horse or over a bouncing rough road) is a gentle, indeed what may be called passive, exercise. It is good for " airing," a change of mental impressions, and enjoyment; but it does very little toward muscular cultivation. Nearly the same may be said of sailing in smooth Avater. Those Avho manage a sail-boat in a good breeze and on rough water may have an exercising time, and so, perhaps, may their passengers—whether they stomach it Avell or not. * In the race of 1883, Harvard won with 35, 34 and 37 strokes, and Yale lost with 42, 41 and 43 to the minute. On LalfB George, the same year, the Princeton College crew led at first with 40 strokes, but at the end came out third in the race ; Cornell beat all, with at first 34, and afterwards a spurt of 38 strokes to the minute. In the single scull race on Lake Calumet, in Michigan, July 4,1883, young Teemer won easily with an even stroke of 32 to the minute. A partial exception occurred in June, 1884, in the victory of Yale over Harvard with 39 strokes, Harvard rowing the same till near the end, when its rate was 35. A more decided instance was, on the same day, the Columbia College Freshmen beating the Harvard freshmen, the former with 42 to 40, and the latter 39 to 36, strokes per minute. On the whole, it is evident that the kind of stroke has a great influence, as well as the strength and endurance of those who handle the oars. 362 HYGIENE. Rowing is a capital exercise. More muscles are used in it than in Avalkiug or riding on horseback; hands, arms, back, legs, and feet are all strengthened by it. Enough has been said of it already, a few pages back. Skating is as Avholesome in itself as any exercise can be. Ahvavs in a cold, bracing atmosphere (except roller skating, of course, which may be anyAvhere), even in a " rink," Avrith freedom and variety of movement of the body and limbs, yet Avithout violence, it is excellent for both sexes. Not many years ago it Avas very popular in our North- ern cities. An alarm got about that skating is not good for girls and women. This is untrue, except so far as belongs to imprudence. Skating in pleasant company is, to those Avho are skilful in it, delight- ful enough to tempt some to keep it up too long, and get over-tired. This, of course, is beneficial to nobody, and may do considerable harm to those Avho are delicate. Again, there are times when the feminine system requires avoidance of all active and fatiguing exercise, especially on the feet; and, lastly, sitting down on the ice to cool off, after being very much warmed up, is an extremely easy way to catch cold. All these mistakes can and ought to be aA^oided; and then, I repeat, there is no more health-promoting exercise than skating. Of swimming, as an exercise, apart from the good obtained from bathing, Ave cannot speak so favorably. The pressure of the water, and its temperature if cool or cold, force the blood more or less from the sur- face of the body to the head. Swimming rapidly is, also, a violent exercise. But every boy and girl should learn to SAvim as early in life as possible, so as to lessen the danger when "overboard" unexpectedly anyAvhere. Out-of-door games, as tennis, cricket, base-ball, are all, in modera- tion, not only enjoyable, but Avholesome in their effect upon the bodily condition. Exhilaration of mind makes all exercise more beneficial. It is astonishing Avhat an amount of work people will do under the name of play. A Chinese mandarin, on seeing a number of English gentlemen engaged actively in a game of base-ball or cricket, said, " In my country we ahvays pay people for taking so much trouble to amuse us." No treadmill, hoAvever, Avould ever build up muscle like the cricket ground. Yet such things may be overdone. Cricketers sometimes bring on excessive action of the heart; the most famous one in England, Lilly- white, died a few years ago, under fifty years of age. The strain comes, not in ordinary playing, but in the public matches, in Avhich ambition and excitement lead some players to go beyond their strength. So it is in boat-racing. During one of the American contests, Renforth, a splen- did oarsman, fainted in his boat, and died a feAV hours afterwards. J Temporalis. occipital portion of the Oceipito- Frontalis. Complexus. Splenitis. Masseter. Slcnii.-cieido- Mastoidcus. Trapezius. Deltoid. Triceps Extensor. Tendinous portion of the Triceps. Anterior Edsje of the Triceps. POSTERIOR VIEW OF THE MUSCLES OF THE BODY. MUSCULAR EXERCISE. 363 In England, Dr. Morgan, himself once captain of a student crew, wrote a book, called " University Oars," in Avhich he collected answers to inquiries sent to all the Oxford and Cambridge rowing men in forty years about their health, aud the effect upon it of their roAving matches. Of 291 men Avho had all pulled in more than one race, seventeen, about one in fifteen of them all, reported themselves injured thereby; 162 considered that they were uninjured, and 115 benefited, by their expe- rience with the oars. This proportion of injury, one in fifteen, is quite large enough to strengthen the expectation reasonably founded on the nature of the case, that Avhile athletic exercises are, in moderation, useful to health, the strain of prize athletic contests is much more likely to do harm than good. I believe that it Avould be Avise for college authorities to forbid all intercollegiate contests during term-time- Tennis is a moderately active game, well suited for both sexes, and prettv safe from doing harm to anybody. Croquet is gentler still; quite innocent of bringing on heart-disease, unless in the sentimental sense. Hunting, except for needed food, is a barbarous sport. When one does not break his neck, hoAArever, he may probably gain strength through its activity. Excursions, for the study of natural science, as geology, mineralogy, botany, ornithology, entomology, or general natural history, become very delightful to those avIio take them with real intent to see something or get something. The exhilaration of a purpose makes such excursions much more bracing to the health than mere " constitutional" walks can be. Those Avhose pursuits are mainly sedentary, do well to find some obiect to take them out often to the Avoods and fields. Ham- erton, in his book on the " Intellectual Life," sIioaa^s Iioav a good degree of bodily activity is compatible Avith the best kind of intellectual labor. Sir Walter Scott, though lame, rode much on horseback; and he and the poet Wordsworth Avere both great walkers. Goethe, the German poet, delighted in riding, Avalking, swimming, and skating. Izaak Walton's fishing-rod is famous; and so, in our time, has been Tyndall's alpenstock; as well as Charles Kingsley's rambles by the seaside, and in the forests of the tropics. Gladstone, after a hard week or tAvo in Parliament, has often recreated himself by cutting down trees at Ha- warden; there are probably feAV better Avoodsmen than he in England. Gymnastics, Avithout the pleasant excitement of games, sports, or excursions, nevertheless rapidly increase and develop strength, if rightly managed. The ancient Greeks were A^ery fond of athletic exercises, which they enjoyed thoroughly in their Pythian, Nemean, and Olympic games. The Avord " gymnastics " comes from the Greek gumnos, naked, ou account of their often stripping themselves for the strifes of the arena 364 HYGIENE. Hence calisthenics (from kalos, beautiful, and sthenos, strong) is the better Avord to use for lighter exercises. Modern gymnastics are said to have arisen first in Germany, with Guthsmuths of Sclmepfenthal (1784) and Pestalozzi. Ling, a poet and scholar, started an institution for physical training, under aid of the government, in SAvedeu, about 1813; and Captain Rothstcin opened one iu 1848, iu Bavaria. Austria, Denmark, and France, a number of years ao-o, made gymnastic exercises a regular part of their systems of mili- tary education. Ling, the SAvede, is also credited Avith having introduced the lighter gymnastics, or calisthenics. In our country, this system Avas first de- veloped and made popular by Dr. Dio LeAvis. It consists of regularly varied successive movements, Avith light Avooden dumb-bells, rods, rings, etc.; no one effort requiring much use of strength. The order of exer- cises is often planned, like a piece of music or dancing, in detail. It may be timed by an instrument, and performed by a company together, so as to introduce the social element. In this Avay, some tAventy years or so ago, it became quite the fashion in this country, promising almost, for a Avhile, to rival or supersede the dance. It undoubtedly promotes ease and grace, by the variety of movements, causing symmetrical de- velopment of all the muscles of the body. It is very Avell adapted to girls, and may, with great advantage, be made a part of the daily regime of schools. Without looking bqck to Samson, Hercules, or even Thomas Topham (avIio could pull against a team of horses), we may notice a fenv of the more recent feats of strength, as maxima. Dr. Parkes, in his work on Hygiene, mentions a workman in a cop- per-rolling mill, Avhose day's labor sometimes amounted to 723 foot- tons ; that is, raising 723 tons one foot, or a ton 723 feet, in the course of the day. 400 foot-tons would be a hard day's Avork for most men; 300 foot-tons a fair average performance. In India, eight palanquin- bearers carried a Aveight of 200 pounds tAventy-five miles in a day, equal to 600 foot-tons for each man. Many palanquin-bearers will run with a Aveight up an ascent ten miles a day, equal to raising 500 tons one foot. In Aval king Avithout a Aveight, on a level, a man may be estimated to raise 2V of his weight to a height equal to the distance Avalked. In ascending, he lifts his Avhole Aveight to the height of the ascent. A walk of ten miles on a level is about equal to raising 200 foot-tons. Walking 1000 miles in 1000 hours, at first thought, may seem ea.y enough. But it is far otherwise, because of the short time obtainable for intervals of rest. It has, hoAvever, often been done. More remark- able are the performances of Weston, Rowell, and tAvo or three others MUSCULAR EXERCISE. 365 within a few years—going more than 100 miles within tAventy-foui hours and even over 600 miles in six days.* This is an unnatural strain of course; it is not likely that either of them will live long. Marching, Avith a soldier's accoutrements, is much more fatiguing than ordinary walking. Twelve miles a day are counted by authorities as enough for an average for troops. But, even in the hot climate of India, in 1809 three British regiments marched sixty-two miles in twenty-six hours, each man carrying from fifty to sixty pounds' weight. They lost only seventeen stragglers. A regiment of the same army (the Fifty- second foot), in 1857, marched forty-tAvo miles in twenty hours, partly in the sun; and the next morning marched ten miles farther, then en- gaging the enemy in battle. Two English companies, in India, once marched 195 miles in nine days—over twenty-one miles a day. Captain Webb's SAvimming exploits have been very notable, especially his crossing the British Channel, from Dover to Calais, iu about tAventy- one hours. The distance cannot have been less, and probably was more, than twenty miles, as he made it. His fatal attempt to SAvim through the whirlpool beloAv Niagara Falls, showed that he lacked in judgment as much as he excelled in strength. Turkish porters are famous for their lifting and carrying poAvers. One of them has been often known to carry 600 to 800 pounds at a time—of course, not very far at once. Mention has already been made of the great strength of Dr. Win- ship, of Boston. By a simple apparatus Avhich gave him opportunity to use all his muscular ability at once, he succeeded in lifting about a ton—2240 pounds. I saAV him put up a 180-pound dumb-bell, far above his head, Avith no more apparent difficulty than most men would have in raising one Aveighing thirty pounds. Yet his figure was not comparatively large; his weight, I should suppose, about 180 pounds. Such feats surprise us in men. But how far they are transcended by some lower animals! A canary bird in its cage, without use of its Avings, will leap to its perch with ease, tAvice or more its OAvn height. A flea Avill leap more than tAvo hundred times its OAvn length ; and the ob- scure tumble-bug will roll a load exceeding many times its own weight. Very strong men are sometimes said to be stupid. There can be no necessity for this. But muscular development promotes a quiet state of the nervous system ; and there may be such a thing as a disproportionate cultivation of the muscles, someAvhat robbing the brain and other parts * Fitzgerald, in New York, May, 1884, walked (or ran) 610 miles in six days; Row- ell, in the same contest, 602 miles in the same time. Tt is instructive that Eowell will drink nothing but water during his pedestrian feats, being sure that alcoholic potations would impair his endurance of fatigue. 366 HYGIENE. of their full share of vigor. Balance, symmetry, is Avhat is wanted for ideal health; "mens sana in corpora sano;"—a sound mind in a sound body;—Avith no excess or deficiency anyAvhere. A very impor- tant advantage of active daily exercise (ahvays best in the open air) from early life, is, that it so promotes the circulation of the blood, quickens the breathing, favors the escape of perspiration and of other secretions, as to do much towards the maintenance of the gen- eral health. Indeed, it is very difficult to keep good health without exercise. Sedentary employments are, as a rule, the least healthful. Those Avhose business does not take them out of doors, should go out vn purpose, day or evening, for as long a time every day as they can get for it. As a last resort, if nothing else can be done, the use of dumb- bells will prevent actual stagnation of blood in the muscular system. As to work, certain kinds are more favorable than others to health. Worst, are those in which a stooping position is required. Best of all, Avhen variety of muscular action is in place, without anyone effort being severe, or the whole labor prolonged too much. Women cannot, as a rule, do nearly so much as men; and children should never be put to severe task-work. Laws limiting this are necessary, and exist now in several civilized countries. They are, however, not sufficiently enforced, eATen in the United States. Sewing-machine work has been charged with being injurious to the health. I belieATe this to be a mistake. Some observation and inquiry among those who use the sewing-machine have given me the conviction that sewing with it is less tiresome, hour by hour, than sewing by hand; and a great deal less so than running up and down stairs, or even stand- ing all day; as shop-girls nearly all formerly had to, and some still (very wrongly) are compelled to do. Tom Hood's " Song of the Shirt" Avas, and could have been only, written before the sewing-machine was invented. ONE DAY'S REST IN SEVEN. Christendom has changed the order of its week from that which, among the Jews, made the seventh day to be its Sabbath. But the in- stitution of a weekly rest is older than Moses; and it has its justification in man's nature. Several nations remote from Palestine have had such a custom from a very ancient period. The experience of civilized nations establishes the physiological need of it. In the time of Robespierre, the French Revolutionists substituted one day's rest from ONE DAY'S REST IN SEVEN. 367 ordinary occupations in every ten days. But they soon found it did not Avork well; and religious influences were not Avaited for to return to the old order. It is true that a European " Sunday " is not a time of general cessation from occupation. Many people, especially those con- tributing to public amusements, are then very busy. But even Avith these and with the majority, there is a change of Avork, or from Avork to play; and so far as this falls short of real rest, it is a loss to the best advantage of the population.* Sir Robert Peel, many years ago, gave his experience and observation as a public man to the effect that no one can work seven days in every week Avithout prematurely breaking doAvn. William E. Gladstone, in 1875, made a public declaration of his conviction of the need of the weekly day of rest. Abundant evidence of this exists; Ave may lay it down as almost an axiom in Hygiene, that every man, Avoman, and child (and every Avorking horse and ox, also) requires for health the cessation, for one day in seven, of the occupation pursued during the other days of the week. This is true of 6ram-work as well as muscle- work ; of study as Avell as of labor. * In the programme electoral of the French Workingmen's Party, in 1883, while the suppression of State support to religion is called for, one requirement is, of repose for one day in seven, enforced upon employers by law. About the same time, efforts of the same kind were made in Milan and Genoa, and by the Mutual Help Shopmen's Society of London. Even in Germany, a growing demand for the day of rest has been recognized among the working classes. 368 HYGIENE. SEXUAL HYGIENE. Of the organic structures of animals and human beings, some, but not all, portions are essential in their action to life itself. This is the case Avith the lungs, because we must breathe; with the heart, since the blood must be made to moATe around in its course; and so with the stomach to appropriate food, the kidneys and bowels to excrete waste material, etc. But other organs, as even the brain, are not indispensable to life. A bird may have its brain sliced away, and yet live for a con- siderable time if it be fed and looked after. It is especially true of all that belongs to the reproductive system, that its activity is not necessary to the individual life. Its purpose is the continuance of the species; apart from that, it may remain virtually inert. Thus the mammary glands in women, while they are unmarried, may be quite inactive through a long lifetime. Should marriage and parentage occur, their service is called out by a spontaneous natural process (most admirable in design and effect) for the nourishment of offspring. It is true that a periodical formation, accumulation, and dis- charge occurs in and from the female system (ovaries and uterus) regu- larly, Avhile in health. But this is provisional only, and not a part of sexual activity, properly so called. Being then not necessary to the individual, is reproductive activity favorable or unfavorable to health ? We answer, it is only favorable under normal conditions. Let us here state some leading principles on this subject, and comment on them afterwards. 1. Action of the reproductive system is (as just stated) not needful for the life or health of the individual. 2. No harm results from the absence of reproduction, or of activity of its apparatus, through life. 3. Such activity is healthy and safe only in marriage. 4. The married state appears from experience to be, as a rule, more favorable to health of mind and body than that of celibacy. 5. Abnormal sexuality is injurious in proportion to a, prematurity; b, deviation from naturalness; c, frequency and amount of excess. 6. Such errors or excesses may produce great injury to health; not rarely causing epilepsy, disease of the heart, insanity, or general nervow debility. 7. Chastity of life requires purity of thought and feeling. Nothing is more clear in regard to design in nature than that sexual relations are providentially adapted to increase happiness upon the earth. They exemplify the highest kind of natural polarity. By this Ave mean SEXUAL HYGIENE. 369 the attraction of opposites, Avhich at the same time haA-e more of like- ness than of unlikeness in their nature. Thus the North pole of one magnet attracts the South pole of another; both are magnetic, but op- positely so. Anything electrified by rubbing glass attracts Avhatever is excited by rubbing with sealing-wax; one is called a manifestation of positive, and the other of negative, electricity. We call by the name of chemical affinity, that attraction by which, for example, phosphorus unites with oxygen, bursting into flame as they combine rapidly. Like- wise, even iron filings dropped into a jar of pure oxygen will catch fire, in a sort of " passionate " union. All through living nature we find sex to be present and dominant. Sometimes, in plants and certain of the lower tribes of animals, male and female are both upon the same organism. But in the higher ranks of plants generally, and in all the higher orders of animals, fertilization is effected by two individuals. Danvin makes great account of " sexual selection " in the animal kingdom ; believing that the choice, by those of one sex, of such of the other as have superior qualities, tends to per- petuate these, and so to eleATate the species. Love is the word by Avhich we express the attraction of one person for another. While the highest kind of love, that which is Divine, is not sexual, that which is next below this in grade finds its completest type in marriage. Here (Avhen well assorted) is seen the union of all that attracts, through the " congeniality " of race-likeness, with the sex-oppo- siteness which accords with the great law of polar affinities in nature. Yet, like many other of the best gifts in man's possession, this endoAv- ment of sexuality has been very often so perverted as to become the source of much evil; of many disasters. Both history and fable teem with such results. It was by a woman that Avas shorn the strength of Samson the strong, and by women was overcome the Avisdom of Solo- mon the Avise. A woman bred the great Homeric war of the siege of Troy, and many a royal and state trouble since. Every man finds himself called upon toAvatch against dangers connected with his passions in the world; and if he leaves the world, as many an anchorite has done, he may find that thus he has only narrowed, not avoided, the field of conflict; which, from Origen and Jerome to Abelard and since, is unavoidable. Every one, herein, must learn to be his own master. Society, in this, by its code of opinions, aids women more than men; and so far, men lose, on the whole, some advantage, both in the realm of hygiene and in that of morals. When sexuality is abused, no function is capable of greater injury to health. Reproduction is, of all the organic functions (see Physiology), the highest; being almost the creation of a neAv being. This requires 370 HYGIENE. elaborate preparation. In those insects, for example, Avhich have three stages of life, those of the larva, pupa, and imago, the duration of the last is the shortest; but in that alone can they reproduce; that is the culmination of their existence. Thus no error of life is so destructive (except, perhaps, that kind of poisoning called intemperance) as sexual immorality and excess. On this, further remarks must be here made. Prematurity increases the injury of sexual indulgence very much. A man is not fully fitted for marriage before the age of twenty-one, or better, twenty-five; a woman, not usually before twenty years at least. Marriages very often, of course, occur much earlier. In Eastern coun- tries, girls are commonly married at fifteen, fourteen, thirteen years; sometimes younger still; but the result of this is, deterioration of fami lies and of races under it. Sexuality, again, is safe or the reverse according to its naturalnm. With a true and complete union as in marriage, combining permanent and elevating affection Avith passion or desire, it is normal; although here also indulgence is capable of excess. But as sexuality or sensuality deviates from nature into a mere passionless self-gratification, it be- comes, in the same degree, more deleterious in its effects. Ruinous injury to health may thus folloAv; involving the heart, brain, and nei*vous system generally, often Avith great general debility. Cases illustrating this are seen iu most hospitals, almshouses, and hospitals for the insane. Moreover, the special diseases attendant upon irregular sexual life (of which syphilis is the Avorst) constitute a form of penalty terrible enough, when known, to deter any one having a spark of pru- dence, from risking their dangers. Under a single exposure, a healthy constitution may become involved for life; and not only that, but his offspring, too, may be tainted, even fatally, from their birth. There is no hygienic justification for what is called in England "the great social evil." To extend governmental protection to this in the form of license is a wrong not only against morality, but against sound principles of public health. Experience (attested, for example, by M. Lecour, avIio was for a long time chief of the " Bureau des Mceurs" of Paris) proves that it does not prevent, nor even lessen, the amount of disease Avhich it professes to antagonize. "Contagious Diseases Acts" Avere passed a number of years ago in England; but very wisely, in 1883, they Avere practically annulled. The remedy for the great social evil and its consequences must be moral and educational; not that of force, espionage, or law. Early marriages, favored by social customs, and especially by young married people being alloAved to live moderately in style and expense, so as not to have to wait half a life- SEXUAL HYGIENE. 371 time before their union, may do much for social morality, health, and happiness. We have already said that individual life and health do not need re- productive activity; and yet that the married state is, as a rule, the most favorable to health. How is this seeming contradiction recon- ciled? In the first place, all knoAV that, through the infirmity of human nature, sexuality is not nearly always confined to the state of marriage; and then its irregularity does harm in various ways. Moreover, the affectional relations of marriage, Avith the common aims, cares, and ties of family life, are mentally and morally, indeed in every way, Avhole- some for men and Avomen. Children are like "arrows in the quiver" of a married pair. Let no married person wish, much less endeavor, to be without them. Mis- chief of most serious kinds has thus been wrought, under wrong and mistaken ideas, in many households, especially in this country. No right-minded person should dare thus to tamper with the ordinance of nature to " increase and multiply." * On the other hand, a man may tyrannize over a wife so far as to make her the victim of incessant child- bearing, beyond what her strength and health can endure. This is inhuman altogether. The true ideal of marriage is that each should be a considerate " helpmeet" to the other. About the real salubrity of the married condition, many facts might be cited. Amongst others, Dr. Bertillon, of France, collected statistics, Avhich showed that, in various European countries, "a bachelor of twenty-five is not a better life than a married man of forty-five. Among Avidowers of from twenty-five to thirty the rate of mortality is as great as among married men of from fifty-five to sixty." In France, the rate of mortality among married men between twenty and twenty- five years of age is ten per thousand; among bachelors of that age, sixteen per thousand; and among widoAvers, nineteen per thousand. Dr. Stark, of Edinburgh, has proved that in Scotland, during nine years, the death-rate of single men between twenty-five and thirty years of age was double that of married men of the same age. Between fifteen and thirty years, married women have a greater death-rate, on the average, than single women; after that age, a longer expectation of life. In a perfectly well-regulated state of society this difference Avould almost certainly not be so great; but the facts are interesting and instructive. * In the year 1865, there were 200,000 married couples in New York State without children. 372 HYGIENE. It ought always to be remembered that the true relations betAveen the sexes have quite other and higher importance than that Avhich is merely organic. This may be seen in contemplating the ties of brotherhood and sisterhood, and those betAveen father and daughter, mother and son; and also those of mutual trust and benevolence, brought out by the circumstances of war or other calamities—of Avhich, in our age, Florence Nightingale has been the typical representative. " O woman, in our hours of ease Uncertain, coy, and hard to please; When pain and anguish wring the brow, A ministering angel thou!" One of the highest tests of civilization among individuals and nations is the respect shown towards women, and the right valuation of a true and pure Avomanhood. Upon these views we should be far from discouraging the frequent social and friendly intermingling of the sexes. The more constantly they mingle, of course with proper guards and influences, from early life, the less will be the tendency to morbid sexuality; much of Avhich springs from a combination of imperfect principle with injudicious constraint. That Avhich is forbidden is apt, in our human nature, to be most craved as well as most misapprehended. If, then, boys and girls, young men and women, were allowed to mingle frequently as playmates, schoolmates, companions, and friends, while some of the sentimentality, romance, and exaggeration, which so often overcloud the relations of the sexes, Avould be dispelled, a more safe and substan- tially useful, and altogether a happier, sense of fellowship Avould be established. For such reasons, coeducation may be expected to be more favor- able to the physical, mental, and moral health of both sexes, than the monastery and nunnery-like method of isolation during school and college days, which has until latterly so much prevailed. Within the last tAventy-five or thirty years, so many institutions, from kindergar- tens up to universities, have tried the experiment, Avith uniform success, that it may now be confidently said that coeducation will be the method of education in the next century, if not in the next generation. It unsexes nobody; it tends to make men more manly and women more Avomanlv. Those Avho, on theory, object to it (no one does so Avho ha.- seen it fairly tried), forget the great difference between the case of Paul and Virginia, alone together on an island, and that of a dozen, a .score, or a hundred Pauls and Virginias, in the school-room, lecture-room, or even on the cricket-ground, or in a debating society, together. As to SEXUAL HYGIENE. 373 morbid sexuality, the case is somewhat like that of certain electrical arrangements. How can you get up the most extreme electrical excite- ment? By putting, as in the Ley den jar, tAvo coats of metal, on opposite sides of a thin separating glass, and then charging them. A great shock comes when they are suddenly brought into communication. But if the same charge of electricity were put into a row of metal plates, already in communication with each other, it would be harmlessly diffused. Here comes in, however, an important qualifying thought. The social principle, natural and Avholesome as it is, may be abused. Under the above allusion to Paul and Virginia, some of this kind of danger may be recalled. Readers of that beautiful romance may remember how the sweet girl's heart grew troubled in its fondness, just before Paul Avas sent away. Sexual excitement, aroused and heightened by too familiar contact, becomes perilous. If, under unrestrained impulse, with opportunity, it be yielded to, one or two lives may be socially and mor- ally ruined. If, on the contrary, it be encouraged without satisfaction, it is ahvays more or less, sometimes very decidedly, injurious to health. Hence the waltz and the German, witnessing the ballet, and all other provocatives of strong sexual feeling in the unmarried, ought to be con- demned, on hygienic grounds, over and above Avhat moralists have to say about them. So, also, long engagements, sometimes encouraged for economical reasons, are far from beneficial. When once betrothed, it is better for marriage to follow as soon as prudence and circumstances Avill at all allow. We may venture also the suggestion, that our idea of " American liberty " has gone now pretty far, in regard to some social usages. No- body will ever Avant to get back, in Europe or in this country, to the customs of the Hindoo zenana or the Moslem harem, where Avomen, young and old, are kept in slavish seclusion from men. But there was something real in the experience Avhich long ago suggested, in the care of young people, the value of the " duenna" and the " chaperon." Pairing, or " arking," at our summer resorts and elsewhere, has been Avell satirized by humorous Avriters, such as Robert Grant.* It is not altogether impossible that less amusing occurrences may, sometime, shoAV that, even in America, liberty may be safer, and thus happier, under prudent limitations. * Author of the " Little Tin Gods on Wheels," etc. 574 HYGIENE. HYGIENE OF GIRLHOOD. About fifteen years of age (earlier in tropical countries) is the period of transition from childhood to adolescence, commonly called puberty. A great change is then effected, not suddenly, but by a development, in which the apparatus is perfected through Avhich maternity is made pos- sible. So regular, according to the natural laAV of organic economy, is its subsequent periodicity, that its interruption or disturbance may seri- ously affect the health. As Dr. Mary Putnam-Jacobi has shown in a very able treatise, the crisis in the system belonging to the monthly process begins a day or two or more before the IIoav, which is really its last event. Girls require more special care than grown women, in respect to the full establish- ment of regularity. The crisis ought to occur once in four weeks, to the age of forty-nine or sometimes later; interrupted, in the married, only during the months of pregnancy, and for a few months after its completion. Opinions and statements have differed, even amongst those who might be supposed to know, as to the amount of disability connected, in healthy girls and women, with the monthly crisis. On the general principles of Physiology, we should not expect any disability at all to belong to it. Several physicians of repute, however, assert that even healthy women are, at such times, altogether invalided; unfit for bodily or mental exertion. Dr. D. H. Storer, of Boston, has mentioned this as a reason against women undertaking to practise medicine; because, for about one week in every four, they have to be patients themselves. The late learned Dr. Clarke, of Boston, published a book on " Sex in Education" (which did, in my judgment, a great deal of harm), in which he asserted that the whole business of the education of girls and women must be conducted in view of this one-quarter-invalid life of the sex. But these gentlemen have, as practitioners of medicine, seen most familiarly, the invalid side of the subject. Many women, and some girls, are not healthy; and, in them, this periodical function is often prominently disturbed. This does not, however, determine the law of health concerning womanhood. Several able ansAvers to Dr. Clarke's book have been written and published. It will suffice for our present purpose to quote the words of Dr. Elizabeth Garret Anderson, of London; one of the first medical women of England. She says: * " It is, we are convinced, a great exag- * Contemporary Review, May, 1874. Anna C. Brackett, amongst others, has expressed the same judgment, in her book on "Education of American Girls." HYGIENE OF GIRLHOOD. 375 geration to imply that Avomen of average health are periodically inca- pacitated from serious Avork by the facts of their organization." Accepting this as the truth, confirmed by my OAvn opportunities of observation, I must add, that the examples of those Avhose health is below the average are not feAV in number. Some women, and more girls be- tAveen fourteen and eighteen years of age, are decidedly i invalided every month; and a much greater number require greed caidion in self-man- agement at such times. Indeed, all women need to be particularly care- ful of themselves just before and during the menstrual crisis. The things to be especially avoided then are, 1. Exposure to cold and wet; 2. Fatigue, especially long standing or exercise upon the feet, or on horseback; 3. Mental strain, or much mental excitement. By the first of these causes, the Aoav may be arrested, and subsequent irregularity brought on; or pain and illness may result at the time. By the second, the occurrence of excessive hemorrhage may be endangered; or conges- tion (overfulness of blood) of the uterus may take place instead, often having secondary consequences of various kinds. The third cause, mental strain or excitement, in some constitutions, puts off or inter- rupts the normal flow, or gives rise to painful attacks (dysmenorrhcea), from the nervous connection and sympathy betAveen the brain and the ovary and uterus. On the Avhole, it is probable that sedentary and luxurious, rather than active and laborious, habits, are the most likely to promote irregulari- ties and uterine sufferings in women. These do not so often appear, for example, amongst domestic servants as amongst their mistresses; the kitchen and the laundry try the system less than the parlor and the ball-room. A young lady avIio, rather than miss an occasion of enjoy- ment, will, at a time when she should be quiet, dance nearly all night, may be expected, next time, to have to lie still, whether she will or no. Almost the Avorst of all, howeA'er, is the morbid life of Avhich the most active exercise is the occasional drive in a carriage; the sofa and the novel characterizing the hours mostly spent Avithin doors. Along Avith uterine troubles, giving large occupation to professional specialists (gynaecologists), these are nearly sure to be affected Avith neurasthenia ; a term brought into use by an American physician to apply to the myriad-formed nervous debility, which some foreigners have latterly called " the American disease." 376 HYGIENE. PREGNANCY: GESTATION. Bv this (derived from a Latin Avord meaning to carrv/) is meant the period during Avhich offspring is undergoing development in the uterus. Its first signs are, the non-appearance of menstruation at the usual time, and the " morning-sickness," which is sufficiently described by that term. In the fourth month, perhaps at its beginning, comes quickening; i. e. the felt movement of the animated being within the maternal frame. About 270 to 280 days are occupied by the Avhole process of healthy gestation; the last-named period is probably nearest to the average of its duration. Much care is needful at this time, especially in delicate Avomen, and most of all Avhen it occurs for the first time, lest miscarriage be brought on; this being an occasion not only of disappointment, but of danger. Bodily fatigues or shocks, and mental disturbances, are the most likely causes of such a result. It is quite important for a woman in this condition to have the bowels regular. Active purgative medicines should not be used, nor any, except Avhen necessary. When constipation occurs, simple rhubarb pills Avill generally do; or, if not, a teaspoonful dose of floAvers of sul- phur, in syrup, or (especially if the kidneys do not act Avell, as shown by a free flow of Avater) Avith a teaspoonful of cream of tartar, mixed together in molasses or fruit-syrup. Such a dose at night, once, tAvice, or thrice a Aveek, Avill generally be enough. If not so, medical advice had better be obtained. The full-blooded state called plethora some- times occurs during pregnancy, and more important still is the inter- ference of the pressure of the enlarging uterus Avith the circulation of blood, affecting the kidneys, and sometimes endangering convulsions. These are \Tery serious. Mental tranquillity is very desirable during gestation, for the sake of both mother and offspring. Among the conflicting accounts and probabilities, it is rather difficult to decide whether marks really occur on children, in consequence of their mothers having seen striking or startling things. While such are more likely to be coincidences only, we cannot say that such effects of strong mental impression are entirely impossible. And it is certain that a fright or strong agitation of mind during pregnancy may produce abortion; or, Avithout that, may so impair the nourishing power of the parent that the child may have its development interfered with, and, if not a monster, or stillborn, it may be at the best but a Aveakling. Therefore much pains should be taken to promote the serenity of mind, as well as health and comfort of the body MOTHER AND INFANT. 377 of the mother, during this period. Hard labor is very unsuitable for pregnant A\ronien. Almost as bad is leaving the bed and going to Avork too soon after delivery. Many Avorking women are thus injured, and the lives of their children shortened, by their mothers not being able to furnish them Avith sufficient nourishment in early infancy7. The exam- ple of the generous French manufacturer, M. Dolfus, Avas an excellent one. He paid every married woman in his service, Avhen brought to bed, six weeks' Avages, without requiring any work for it. MOTHER AND INFANT. Parisian women haAre long had, whether they deserve it or not, the undesirable reputation of putting off the care and nutrition of their infants upon hired nurses, to a larger extent than is done anyAvhere out of France. It is said that ladies of wealth and fashion often send their babies aAvay from home, in charge of such nurses. This kind of " baby- farming" is very unproductive of healthy life. The natural law of maternity includes the nursing of every child by its own mother. Unless her supply of breast-milk fails, or her deficient general health and strength unfit her for it, this should be regarded as a sacred duty, as well as a source of happiness. Next best, when this is impracticable, is the service, near the mother, of a healthy wet-nurse. Last, is the resort to the " bottle," feeding by hand, of which more Avill be said in another place in this book. Under such customs as that above men- tioned, the natural increase of population in France is reported to be less annually7 than in any other civilized country in the world. Our own country has increased Avonderfully in population, Avhich has, several times, doubled itself in twenty-five years. Immigration from Europe has had a large share in this. Apart from that, it is by no means certain that our numbers would noAV increase very fast. Dr. N. Allen, of Lowell, Mass., has shown by statistics that the number of children born of foreigners resident in Massachusetts is decidedly greater than in native American families. It is not easy to make sure of the explanation of such facts; but they seem to show that something is wrong Avith our people. Climate may have to do Avith it; but we may fear that our life is, also, too artificial; too far from healthy nature; Avith not enough escape from money-getting on the part of men, and from social ambition and house-slavery, or society-servitude, with Avomen. At all events, let us look around carefully, and try to dis- cover the cause of this apparently growing anomaly; and correct it, if possible. 378 HYGIENE. WHO SHOULD NOT MARRY. Consumptive persons ought not to become engaged to be married ; not onlv because of the probable shortness of their lives, but because a tendency to consumptive disease is often transmitted to children. A man avIio has constitutional syphilitic disease ought never to think of marriage, unless after obtaining good evidence that he has been perma- nently cured. Insanity, Avhile it lasts, of course disqualifies any one from marrying; and it is a great personal risk to marry one avIio has ever had an attack of lunacy. Certain families are known to inherit a marked predisposition to insanity. Marrying into such families is imprudent. Intemperance ought to be considered, more positively than it generally is, a clear disqualification for marriage. Every one knoAvs that a Avoman joined to a drunken husband is, usually7, the most wretched of slaves; but not many appreciate the effect of intemperance upon off- spring. Here is an instance of this: Dr. Hills, of Columbus Hospital for the Insane, Ohio, reported the case of a man Avho in the first part of his married life Avas temperate, and had four children, perfectly sound and healthy. He then grew intemperate, and continued so for several years, during which he had four more children. Of these, tAvo became insane, another idiotic, and the fourth epileptic. Then he reformed entirely, and afterwards had three more children, all of Avhom Avere entirely healthy. Of diseases Avhich do not render marriage impossible, and yet should, in prudence, forbid it, epilepsy, also, may be mentioned. It is very apt to be inherited; and subjection to epileptic fits is a terrible misfortune to an individual and to his family. In regard to all these matters, the time to give or receive counsel is before the entanglement of the affections. After strong attachment has already been formed, it may be a very serious question Avhether the harm done to the individuals by disappointed affections may not out- weigh all other prudential considerations, and make their marriage the least of probable evils. Even death-bed marriages are sometimes right, for special, exceptional reasons. Near relations have been forbidden marrying Avith each other, from the time of the Mosaic dispensation down to our own. In ancient Egypt, for several generations, the Ptolemies married their OAvn sisters; the celebrated and beautiful queen Cleopatra Avas the descendant of such a union, and the Avife of her brother. But the common sense of man' kind almost everyAvhere has outlaAved such marriages. Practically, the only question in modern times has been, concerninj! WHO SHOULD NOT MARRY. 379 the marriage of first and second cousins. Until within a comparatively short period, it Avas held to be an undoubted principle, that all union of those nearly related, being against nature, must, for that reason alone, cause enfeeblement of offspring and family degeneration. Facts of a somewhat striking kind have been brought forward to support this vieAV. Boudin, in France, ascertained that from 25 to 30 per cent, of all deaf-mutes were born of parents nearly related; while parents, themselves deaf-mutes, are not particularly likely to transmit that defect to their children. Devay found in the children of 121 consan- guineous marriages, 27 deformed and 2 deaf-mutes. Boinet reported 5 idiots in 5 such families. Dr. Howe, in NeAv England, gathered statistics of 17 marriages of relations. Of these, 95 children Avere born; of whom 44 Avere idiots, 12 scrofulous and delicate, 1 a deaf-mute, and 1 a dAvarf. Dr. Bemis, of Kentucky, collected the results of 833 con- sanguineous marriages, having 3942 children. Of these 145' were deaf-mutes, 85 Avere blind, 308 idiotic, 38 insane, 60 epileptic, 300 scrofulous, 98 deformed, and 100 others defective in one way or another. This is a very ugly-looking record. We are not told, however, what Avere the circumstances otherwise of these marriages; whether or not other causes might have contributed to explain such deteriorations. On the other side, also, a good deal has been urged. Perier and Voisin in France, Buckle, Child, an anonymous writer in the West- minster Review (1863), and George H. Darwin, in England, have argued quite ably upon it. They recall the accepted history of the human race, as originating from a single pair, whose children had no choice of mates but among themselves. Besides Abraham and Sarah (half-brother and sister), and the Ptolemies, also, we are pointed to the kingdoms beloAv us, of animals and plants, for examples of close inter- union. Many plants, and not a few of the loAver animals, are hermaph- rodites ; that is, have both sexes upon one individual. It is true that, even Avith these, C. R. Darwin concluded that " Nature abhors self- fertilization." But with pigeons, in the domestic state, close breeding is the rule rather than the exception. Thoroughbred race-horses are often very close bred. I give in a note * a remarkable example of this. * The following is from the New York Herald, December 23,1874: " The filly, Lady Stout, three years old last spring, which won the second, third, and fourth heats in the stake for colts and fillies of that age, at Lexington, in 2.30i, 2.29, and 2.32£, was bred by John Stout, of Woodford county, Kentucky, is by Kerr's Mambrino Patchen (own brother of the great Lady Thorn), by Mambrino Chief, dam by Gano (son of American Eclipse, lie by Duroc, son of imported Diomed, dam Betsey Eichards, by Sir Archy, by imported Diomed, the winner of the first English Derby, in 1780); second dam by 380 HYGIENE. In the vegetable Avorld, a nearly parallel instance of this is in what is called " pedigree Avheat." But in all these cases, Avhile the stock is continued, and notable quali- ties seem to be perpetuated, it does not folloAV that there is not, after all, a tendency to degeneration. Youatt, the great authority concerning doo-s and horses, says that, in the latter, "strict confinement to one breed, hoAvever valuable and perfect, produces gradual deterioration." Sir John Sebright, another observer of large experience, writes thus of in- and-in breeding: " I have no doubt that by this practice being con- tinued, animals Avould in course of time degenerate to such a degree as to become incapable of breeding at all." Race-horses are, in a manner, equine monstrosities. Their speed is wonderful; but it is acquired at the expense of many other traits Avhich go to make up the perfect, original, ideal horse. In this exaggeration of family peculiarities we may see what is most important upon the practical question in human society. Few families are absolutely free from tendencies to disease of some kind. When, then, cousins (especially first cousins) marry, these morbid tendencies are almost sure to be doubly strong in their children. In communities shut up for centuries in the narroAV valleys of SAvitzerland, and in some other mountainous countries, intermarriages are common; all the people are more or less nearly related to each other. It is exceedingly prob- able that this is one (though not the only one) of the causes of the ex- tensive prevalence there of the deforming goitre of the throat, and the stunting and semi-idiotic cretinism.'* We are justified in the conclusion, that there is a laAV of sexual oppo- sition in nature, according to which those most nearly related, or other- Avise organically alike, are not the best adapted for marriage, and are a son of Sir William of Transport, he by Sir Archy, out of Transport, he by Virginius, son of imported Diomed, out of Khea, by Chatham, Lady Stout's dam, Puss Prail, by Mark Time, he by Bethune, son of Sadi Hamet, by Virginia, son of Sir Archy, by imported Diomed ; second dam by Webster, he by Medoc, son of American Eclipse, by Duroc, by imported Diomed. There are no less than seven direct crosses to imported Diomed, and three direct to imported Messenger. This pedigree is not extended as far as it could be, but it is sufficient to show that an admixture of thoroughbred blood not only does not destroy trotting action, but adds to it, and gives that most important and most vital quality, the ability to trot heats fast and repeat them. This filly, in three days after her race, was given a public trial in the presence of a large assemblage on the same course in 2.30}, 2.28J, 2.28. The latter performance stamped Lady Stout the fastest and best three-year old in the world." * Yet Voisin, in 1865, reported that at Batz, on a small peninsula near the mouth of the Loire River, in France, with a population of 3300 people, and almost no new- comers from year to year, there were no examples of physical deterioration: no blind' ness, deaf-mutism, epilepsy, idiocy, nor cretinism. WHO SHOULD NOT MARRY. 381 not so likely to have healthy and vigorous offspring as others. Between the blond (fair complexion, light hair, blue eyes) and the brunette (dark hair and skin, black eyes) there is naturally more affinity than between those who are both fair, or both dark; and so with other personal or family characteristics. While, then, it cannot be dogmatically asserted that the marriage of near relations must always end in deterioration of offspring, Ave may be sure that any morbid tendency of their common ancestry will be likely to be in them intensified; and since (as above said) scarcely any family is faultless in constitution, this alone is suffi- cient to condemn such marriages on grounds of health. It Avould be a gain to society if the marriage of first cousins should be forbidden by laAv; and that of second cousins ought to be discouraged. Farther than that we need not go. 382 HYGIENE. MENTAL HYGIENE. Health, of body or of mind, is wholeness ; soundness; therefore strength as Avell as freedom from disease; fulness of life and poAver for action. We do not need here to consider abstractly the theory of mind. Man is distinguished above the brutes not so much by his bodily structure as by his mental superiority. The higher animals have faculties in many respects much like ours. The dog, horse, elephant, and monkey, nay, even the ant and the bee, think and feel; and these are attributes of mind. But our capacities of thought, reason, and imagination, are much higher than theirs; and our emotional nature includes what theirs lacks, the obligation of conscience, and the upspringing of worship. These belong to that which is distinctively not animal, but human, and kindred to the divine; our spiritual nature.* As Ave are in this Avorld, however, brain being the organ of all mental capacity, it may be safely said that as the brain is, so is the mind. This vieAV of the subject suffices for the purposes of Mental Hygiene. Mental health and power are affected by several positive influences, which may be named as follows: 1. Inheritance. 2. Age. 3. Sex. 4. Material agencies and bodily conditions ; as a. General health. b. Atmosphere. c. Food and Drink. d. Exercise. e. Sleep. 5. Mental Influences; as a. Civilization. b. Education. c. Intellectual labor. d. Mental excitement, or the reverse. e. Sympathy. * In the Bible, three words are used in describing the being of man; soma, pmhe, and pneuma ; nearly corresponding with body, mind, and spirit. HEREDITARY TRANSMISSION. 383 HEREDITARY TRANSMISSION. Inherited organization is much, but far from all. Everybody knows what " family likeness " is; not only in faces and figures, but in char- acters. On the largest scale, we see mental as well as bodily characters in races ; all inherited, with gradual modification, through long periods. John Bull and Brother Jonathan are real types. Frenchmen are ani- mated and changeable; Germans slow and grave; Italians passionate; the American Indian seldom is either merry or tearful; the Negro, almost always one or the other. Like father, like son; mothers and daughters are often images of each other. Strange qualities, odd or desperate, crop out from one generation to another; the worst (except a hereditary tendency to crime *) is a melancholy form of insanity, tend- ing to suicide. The great Doctor Johnson spoke of his having inherited a touch of mental malady from his mother. Wise man as he Avas, he never could enter a room with his left foot foremost, or pass a lamp- post Avithout touching it with his cane. If he missed one, he had to go back and hit it. Lord Byron inherited a morbid temper from both father and mother. The gentle poet CoAvper struggled with insanity all his life, twice attempting suicide. Alexander Cruden, author of the Concordance, was half mad very often ; enough so to persecute, in the most annoying way, respectable ladies who refused his offers of matri- mony. Rarest of all is the inheritance of extraordinary genius. Talent of high degree is often transmitted. So, there have been tAvo Pitts, two Foxes, two Herschels, three Coleridges, and several distinguished Sher- idans, Kembles, Adamses, and Beechers.f But there have not been tAvo Plates in philosophy, two Raphaels in art, two Miltons or Shak- speares in poetry, tAvo Newtons in science, or two Cromwells in success- ful government. It is true, the mothers of great men have often been superior women, and their fathers may have possessed abilities whose outcome was not favored by circumstances. But genius (notwithstand- ing Galton's having written an able book on "Hereditary Genius") seldom appears more than once in the same family. * See Dugdale's History of the Jukes Family. t Dr. Elam observes that there have been also two Scaligers and two Montesquieus, and calls attention to the facts that there were eight Greek poets of the family of ^Eschylus the tragedian; that the father of Tasso was a poet; Flaxman's father was a plaster-moulder; Thorwaldsen's a sculptor; Eaphael's a painter; Vandyke's, Titian's, and Vernet's families had other painters besides themselves; Mozart's father was a violinist, Beethoven's a tenor singer, and Bach has been the name of a number of mu- sical composers. 384 HYGIENE. AGE. Instinctive childhood, impulsive youth, reasoning manhood, and judg- inci old age—lapsing, Avhen much prolonged, into second childishness— this is the natural order of mental life. Such stages succeed each other as regularly as green bitterness, sourness, and ripened SAveetness, folloAved by decay, in fruit. Shakspeare has fully set forth this progress in his " Seven Ages " : " At first, the infant, Mewling and puking in the nurse's arms: And then the whining schoolboy, with his satchel, And shining morning face, creeping like snail Unwillingly to school : And then, the lover; Sighing like furnace, with a woful ballad Writ to his mistress' eyebrow: Then, a soldier; Full of strange oaths, and bearded like the pard, Jealous in honor, sudden and quick in quarrel, Seeking the bubble reputation Even in the cannon's mouth: And then the justice; In fair round belly, with good capon lin'd, With eyes severe, and beard of formal cut, Full of wise saws and modern instances; And so he plays his part: The sixth age shifts Into the lean and slippered pantaloon; With spectacles on nose, and pouch on side; His youthful hose well saved, a world too wide For his shrunk shank ; and his big manly voice, Turning again towards childish treble, pipes And whistles in its sound: Last scene of all, That ends this strange, eventful history, Is second childishness, and mere oblivion ; Sans teeth, sans eyes, sans taste, sans everything." Precocious children noAV and then anticipate this usual order wonder- fully. Some of them keep superior ability afterwards, through life; others burn out early, or decline into commonplace people. Alexander the Great gained a battle at eighteen years of age, and conquered the Avorld at twenty-five. Zenghis Khan is said to have raised a large army and defeated a rebel enemy at thirteen. Henry IV., of France, com- manded an army at sixteen, and at nineteen was King of Navarre. Saxe was Field Marshal at twenty-four; Charles XII., of Sweden, was a conquering commander of armies at eighteen; Napoleon I. had the rank of General at tAventy-five. Mozart composed admirable music when only four years old. Ru- binstein and Liszt were musicians at the age of nine. Cowley wrote and printed poetry at thirteen. Victor Hugo composed a novel at six- AGE. 385 teen • and, at seventeen, Bryant Avrote his immortal Thanatopsis. Cole- ridge's Ancient Mariner was Avritten at seventeen. Blaise Pascal, when tAvelve years old, Avithout book or instructor, discovered many of the geometrical propositions of Euclid. At eighteen he wrote a work on a mathematical subject, and at nineteen invented a calculating-machine. Bernini, the sculptor, made a fine bust in marble at ten years of age; he lived until his eighty-second year. Not so fortunate Avas the prodigy Christian Heiuecken, of Lubeck. At tAvo years (it is said) he Avas versed in the history of the Bible; by his third year he had learned French and Latin; in his fourth he studied church history, and then died—of course! John Stuart Mill began Greek Avith his father at three, read Plato at seven, Avrote part of a history of Rome at nine, studied logic and political economy at tAvelve and thirteen, and Avrote articles for the Westminster Review at nineteen. Sir William Rowan Hamilton was a wonder of learning at tAvelve, and so Avere Visconti, Gassendi, and a number of other celebrities. Lamartine says that Byron fell violently in love at eight years of age, Dante at eleven, and Lamartine himself at ten! But, is such precocity desirable ? No! And least so of all is forced precocity; the child-mind being stimulated to premature and exhaust- ing effort. Better, Avhen the boy or girl is very ambitious, to retard its mental labors; and to encourage some active employment, so as to develop the body in right proportion to the brain. Not a few lives of brilliant promise have been cut short in youth by neglect of such prudence. Also, some men Avho became great in mature life have not been at all brilliant in boyhood. Such Avere Shakspeare, Moliere, Gibbon, Frank- lin, Scott, and Patrick Henry. Shakspeare's first poem is said to have been Avritten after he Avas thirty years old. CoAvper's first volume of poems was published Avhen he Avas fifty. The great surgeon Velpeau did not begin the study of his profession till he was near middle age. Gold- schmidt of Berlin, one of the leading astronomers of this century, spent his youth in business. At thirty he began the study of painting, and occupied himself for fifteen years with art. At forty-five he began astronomical observations ; and then, in nine years, he discovered thir- teen asteroids, and fixed the positions of three thousand stars not before marked on any chart of the heavens. Tissot, an able observer, said: "Often children, I should prefer that the one Avho is to study through life should be the least learned at the age of twelve." At the other end of life, Ave find some men and Avomen retaining all, or nearly all, their mental vigor to advanced age. Thus it was with 25 386 HYGIENE. Plato, the " divine " philosopher; with Sophocles, the great tragedian, who wrote "CEdipus" after he was eighty, and died at ninety; with Pindar, the finest lyric poet of the Greeks; with Hippocrates, " father of medicine," who lived to be more than a hundred years old; Isoc- rates, who wrote a work, " Pan-Athensei," at ninety-four; Titian, who painted master-pieces at Venice till he Avas ninety-six, and then died of the plague; Michael Angelo, great in marble as well as upon can- vas, till his end at eighty-eight; and Alexander Humboldt, the first scientist of our age, still accumulating knowledge till his ninetieth year. Hobbes, the English philosopher, translated Homer at eighty-seven. Lord Derby and William Cullen Bryant did the same literary work after they were eighty. Rogers, the banker-poet, died at ninety-three; Lord Brougham at ninety; Sir David Brewster at eighty-six; Caroline Herschel, astronomical assistant to her renoAvned brother, survived him and died at ninety-seven; Mary Somerville finished her remarkable scien- tific book at ninety, and died nearly two years afterwards. Joanna Bail- lie, dramatic poet, lived to her ninetieth year ; John Wesley, founder of Methodism, died at eighty-eight; Ranke, the German historian, is yet busy with his books at eighty-eight, as our George Bancroft is now revis- ing his History of the United States at not far from the same age. Rau- mer is still a professor at Berlin in his ninety-second year; and in 1883 Chevreul gave lectures on chemistry in his ninety-third year. Sir David Brewster's mind was ardent in activity till eighty-six. Rossini, in his seventy-fifth year, composed a magnificent " Hymn for the Em- peror," for the Paris Exposition of 1867. Auber, at eighty-seven,com- pleted an opera, considered to be equal to the compositions of his youth. Among men of affairs in public life, Cardinal Caraffa became Pope Paul IV. at seventy-nine, and continued to be a vigorous head of the Roman Church for several years. Cardinal Fleury Avas prime minister of France till ninety; Cardinal Richelieu Avas clear and active minded till ninety-three. The Duke of Saldanha, in Portugal, changed the government of his country by a military coup d'etat at the age of ninety years. Thiers, the French statesman and author, Avas nearly eighty when he became President of the French Republic. Several of In- land's most successful political leaders have kept poAver in their hands late in life; notably Derby, Palmerston, and the noblest of them all, Gladstone.* * Of other highly intellectual men, Euripides lived to be eighty-five years of age; Pythagoras, eighty; Thucydides, eighty; Buffon, eighty-one; Leewenhoeck, ninety- one ; Newton, eighty-four; Young, eighty-four; Kant, eighty; Goethe, eighty- * > Samuel Johnson, seventy-six; Leibnitz, seventy ; Franklin, eighty-five; W". Hersc , eighty-four; Voltaire, eighty-four; Chalmers, eighty-three; Coke, eighty-four; Har- Tey, eighty-one. SEX. 387 But Ave must not forget that these are exceptional persons; the gen- eral rule is quite otherAvise. Reason does not commonly mature fully much before thirty years of age, and the active intellectual poAvers are apt to begin to decline before seventy years. Even imagination is not at its best usually before tAventy-five; and it groAvs dimmer in bril- liancy toAvards middle age. Skill, acquired by time, may, it is true, then compensate for this in artistic Avork; many of the finest poems, and some of the most admirable paintings, have been perfected by those Avho had passed their sixtieth year. Does wisdom ahvays belong to old age? No. Experience is its possession, of course; but the ability of the aged to use knowledge lessens Avhen the step totters and the eyes groAV dim. Even the old doctor cannot ahvays give so good advice as the Avell- trained younger, or, at least, middle-aged one. Especially are old men less fitted for dealing successfully Avith new problems—neAv questions— neAv perplexities. What they have seen often, they understand well, better than others; but what differs entirely from their experience baffles them. SEX. Endless arguments have been Avrought out to prove or disprove the superiority of the masculine over the feminine mind. I Avill not go either with Mohammed, who denied that women have souls, or Avith Mrs. Farnham, avIio regarded man as only imperfectly developed woman. Suffice it to say that the sexes are mentally different; while absolute superiority should not be claimed by either. One is the complement of the other. Humanity needs both; the stronger reasoning intellect and mental persistence of man, and the quicker and more refined per- ceptions and intuitions, and the predominating affectional and impulsive nature, of woman. Every noblest man has some feminine traits, not to Aveaken but to adorn his manhood. Every noble woman has some- thing of manlike strength; which is perfectly compatible Avith the gen- tlest and most lovely womanhood. As Tennyson has written: " For woman is not undeveloped man, But diverse; could we make her as the man, Sweet love were slain; his dearest bond is this, Not like to like, but like in difference. Yet in the long years liker must they grow; The man be more of woman, she of man." Practically applying these thoughts, we may say that most men's minds Avant for their perfecting more tenderness, and most female minds more strength. Right education of both will promote such a con- 388 HYGIENE. summation for all. As this is not a book on education, Ave must l>e content here, AArithout discussion, Avith stating tAvo leading principles, not yet everyAvhere accepted, Avhich I believe to be important and true: 1. Nothing in the physical or intellectual nature of Avomen affords reasons for giving them a different school, college, or university educa- tion from men. 2. The best possible arrangement for the education of both sexes is that of co-education. The interest of this second proposition is so great that I am much tempted to dAAell upon the proof of it; but I hnist refrain. Just this much may be said: God's ordinance is for man to live in society; Avhat begins in the family, where brothers and sisters are brought up together, cannot be interrupted in school and college life without serious moral and mental injury to both sexes. This, more- over, is proved by experience ; that is, the testimony of those connected during the last fifty years with institutions in this Country (now large in number), Avhere boys and girls, young men and young Avomen, are educated together, has been, Avith no important exception, very strongly in its favor. Only those fear it Avho have never seen its trial. BODILY HEALTH. Soundness of body is necessary to full efficiency of mind. Once it was almost imagined that the contrary of this Avas true; that soul and body Avere, so to speak, enemies of each other, and that the student, at all events, must maintain the triumph of his intellectual powers at any cost to his body. Some excuse for this error is to be found in the number of remarkable persons avIio have accomplished wonderful things notwithstanding poor health: as Cardinal Richelieu; William of Orange; Descartes, the philosopher; Melaucthon and Calvin, the reformers; Blaise Pascal, Baxter, Paley, Locke, Watt, CoAvper, Campbell, Kitto, Robert Hall, Hannah More, Thomas Hood, Leigh Hunt, Frederick W. Robertson, John Stuart Mill, Charles DarAvin, Herbert Spencer, Dr. Channing, Margaret Fuller, and Prescott the historian. But many of these had short as well as brilliant lives. On the other hand, as long a list, or longer, might be easily made of those whose intellectual great- ness Avas sustained by a strong bodily constitution. Such were Julius Cresar, Charlemagne, Washington, Franklin, Napoleon, Wellington, Sir Walter Scott, John and Charles Wesley, Michael Angelo, Titian, Leonardo da Vinci, Cuvier, Humboldt, Audubon, Agassiz, Brougham, Palmerston, Gladstone, Daniel Webster, Abraham Lincoln, Shakspeare, Milton (except his blindness), Goethe, Bryant, and Tennyson. Ai- BODILY HEALTH. 389 though very fine Avork may be, and often has been, done by men and women frail in bodily frame, muscular intellectuality (to imitate a phrase of Charles Kingsley's) is that which, at least, is likely to last the longest. All influences, therefore, Avhich promote bodily soundness and vigor are favorable to mental excellence and performance. Pure air is one of these. Hoav dull one often feels in a close room! Frederick W. Robertson, an admirable speaker and Avriter, said that he could only compose Avell in a room whose AvindoAVS looked soutliAvard. In our OAvn climate some men are always melancholy (as others are neuralgic) when the Avind bloAvs from the east. Frenchmen and Italians can hardly exist in the Avinter atmosphere of England; while in Italy the Avind called the sirocco, blowing from the Mediterranean, is often very depressing to mind as well as body. Dr. Isaac Ray says (in his capital little book on "Mental Hygiene") that in La Plata, Avhen a certain Avind bloAvs, many people shut themselves in their houses and give up business. If any one is then quarrelsome or petulant, the excuse is, " It is the north Avind, senor." On the other hand, almost all riots and other popular disturbances (like fevers and the cholera) occur during warm or hot Aveather. Food and drink, also, affect the mind very much. " Drink beer, think beer," is an old maxim. Does this account for the cloudiness of German metaphysics ? Yet German learning is the most stupendous iu the world. What might that nation not have been and have done without its beer and " infinite tobacco!" Gluttony is sure to obstruct, if not to destroy, intellectual activity. Alcoholic stimulants quicken it momentarily with a false and fatal flame of excitation. There is some truth in the proverb, " When the wine is in, the wit is out." Men laugh loud and often over their glasses, and mirth " sets the table in a roar," not because of the Avit that circulates, but because they are easily made merry by their potations. Speeches that read Avell aftenvards are made commonly at cold-water dinners; or at least they were composed while the orator was sober. Exceptions to this occur Avith men so long accustomed to the spur of liquor as not to be up to par Avithout it. But what a sad humiliation is this! Think of a great man, a statesman, refusing (as in an instance of Avhich I knoAv) to attend a dinner where no wine was served, unless he had a bottle of whisky under his end of the table, without Avhich he could not make a speech! Such slavery to stimulation seldom allows its subject to live many years. Opium is no less dangerous as an artificial aid to mental brilliancy. Coleridge suffered half his life to be eclipsed by it; De Quincey, in his 390 HYGIENE. "Confessions," has described its terrible poAver; Dante Gabriel Rossotti was among its victims.* Even tea and coffee may be used as stimulants abusively, and to much disadvantage. I remember a distinguished lecturer, avIio Avould drink seven or eight cups of tea before an evening lecture. They Avould have hurt him less if he had taken at least half the amount after instead of before the mental effort. The time Avhen stimulation does the least harm is Avhen the body or brain is exhausted by severe exertion. Exercise of the muscles is Avholesome for brain-Avorkers, as Avell as for others. They may not need it to increase their strength to lift, to throAv, or to run; but to keep up a right movement of the blood; to promote digestion; and thus to favor the general health of the whole body. Sitting too long at a school-desk, or in a merchant's counting- room, or a laAvyer's consulting office, makes the blood centre too much in the head. No one should, if it can be helped, sit more than one, or at the most two hours, at a time, engaged in brain-AVork Avithout some change. Even getting up, running out of the room, and returning in tAvo or three minutes, Avill do a great deal of good. In a school, for example, it is desirable for all pupils to change their room, Avhen it is practicable, Avith every change of lesson. If not that, they should, once an hour or oftener, leaA'e the school-room, caper around a bit, and return. Recesses are, for the same reason, of great value in schools; especially if, in some of them, calisthenics (light gymnastics) be prac- tised. The longer the school session, the longer ought to be the recess. But, on grounds of mental and bodily hygiene, I do not believe in long school daily sessions. More can be taught, as a rule, to young scholars in four hours daily than in six. Why? Because, Avith the first allow- ance of time, they may be kept fresh and Avide aAvake for their Avork; under the longer session, or even if the same be divided iuto two sessions, they become so worn and jaded (teachers and scholars both) as to accomplish very little at last. Hedf-time industrial or manual labor schools, Avhich have been tried successfully in many places, have shown that boys and girls who Avork half of the day, and study or recite in school the other half, really learn as much in a year as those avIio spend the Avhole day in school. * Or possibly of chloral; whose power over its habitues is sometimes as absolute a* that of opium or alcohol. SLEEP. 391 SLEEP. Every one knoAvs that we must sleep some time, or die. But very many people do not appreciate the truth that we must sleep enough in every tAventy-four hours, or Ave suffer in health. Ambitious students have sometimes imagined that, by sitting up very late, or rising long before daAvn, they could excel, in mental acquirement and performance, those avIio are lazy enough to lie in bed until they are rested. But, if such do, in some fashion, more work in quantity, it will assuredly, in time, run doAvn in quality ; or else, the " waster of midnight oil " will waste his OAvn strength and become bankrupt altogether in health. So Hugh Miller, the Scotch geologist (author of " Footprints of the Creator") Avrought, until his overtaxed brain gave Avay, and in a frenzy of distress he put an end to his life. So Dr. Kane, the Arctic explorer, after sur- viving the dangers of the frozen zone, said of the immortal book in Avhich he recorded the history of his voyages, " that book will be my coffin." So haATe not a feAV other gifted men and Avomen toiled on, re- gardless of rest, until the inexorable laAV of nature cut short their work- ing days. Dr. Franklin's maxim, " Early to bed and early to rise, makes a man healthy and Avealthy and Avise," is true enough, if we take both ends of it together. But late to bed and early to rise Avon't Avork well at all. Sleep is a debt to nature; if it be not paid, execution of judgment fol- Ioavs, either soon or late. How much sleep is necessary? Babies just born ought to, and if healthy Avill, sleep more than half of their time. Children ten or tweh7e years old naturally sleep about ten hours every night. Up to eighteen or tAventy years they ought to have nine hours; and at all ages eight hours nightly will be better than less; except that persons over seventy often incline to be wakeful at night, making up with a nap at some time during the day. Wonderful stories are told about certain great men sleeping very little; Frederick the Great, Napoleon L, and Alexander Humboldt, as ex- amples ; only four or five hours of a night. But Prince Charles of Hesse does not confirm this account of Frederick; and Bourrienne, Napoleon's private secretary, in his Memoirs, says that he was com- monly a good sleeper. Before or after a battle, he Avould sometimes be awake for a long time together; but after the excitement was over, he Avould sleep for tAvelve or eighteen hours at once. General Pichegru, it has been asserted, slept, during a Avhole year, but one hour in the tAventy-four. I am not able to believe this. Nor is it probable that 392 HYGIENE. Alexander Humboldt slept so little as has been above said ; although he did not deny it Avhen the subject was mentioned in his presence. It is extremely improbable that any one can lead an active life, or do much Avork, especially brain-work, for a long time together, with less thau six hours of sleep in every tAventy-four. Seven hours may, perhaps, be named as the ordinarily necessary amount for health. Sir Isaac Newton spoke of his requirement of " eight or nine hours " of repose in the midst of his scientific labors. The brain is the organ which alone can be said to sleep absolutely; and it must do so, or the Avear and tear resulting from its action, in thought, perception, and emo- tion, cannot be repaired. Continuous sleep is much more restorative than that Avhich is inter- rupted. Sailors' " Avatches " of four hours each strain the brain, until habit somewhat modifies nature. Children, especially, should be al- loAved to finish their repose undisturbed. I Avould never Avake a sleep- ing child; when its sleep is out, its eyes will open of their own accord. If the house is on fire, carry it to a place of safety Avithout aAvakening it. Naturally, the time for sleep is in the night; but people must still have their sleep in the Arctic zone, Avhere the day and night alternately last for nearly six months. In civilized life, also, we have to change some things (the less the better) from the state of nature. If it is not possible to go to bed Avith the birds, we must not expect to be able to rise in the morning with their earliest song. Reading and Avriting men sometimes find they can work best when all is quiet, near the midnight hours; but then they must make it up in the daytime, while others are astir.* The secret of doing a great deal of brain-work is to take a great deal of rest. Keep the axe sharp, and it will cut down more trees in a day than one allowed to grow dull will do in a week. EDUCATION. " Next, the whining schoolboy, with his satchel, Creeping, like snail, unwillingly to school." Look into a kindergarten, some morning, and you will find it hard to realize Shakspeare's picture. Nor, even in schools for older boys and girls, is there ahvays now any umvillingness or whining. The rod of the old times seems almost to have budded, like that of Aaron. Yet, for girls at least, the doctors are afraid of education. Has the child a * More than half of this book has been written between the hours of ten and twelve at night. EDUCATION. 393 headache, or a pain anywhere ? " Take her away from school." We do not wish at all to condemn the proper caution of physicians; only, just now, the reaction is rather extreme, from the time Avhen this Avhole subject Avas treated with indifference. When a girl of sixteen complains of a pain in the stomach, the doctor probably asks, " what has she been eating?" When her head aches, it may be Avell also to knoAV hoAV late it Avas Avhen she returned home from yesterday's afternoon picnic, or from the party last night. In other words, school is often blamed for Avhat home or "society" really has done. Need education ever interfere Avith health ? No! The brain requires exercise and development as Avell as the body, and what is good for one part of the system is good for all. It only needs that the conditions of health be remembered and attended to in school as well as elseAvhere. What are those conditions ? First, the situation of the school ought to be a healthy one. Best of all, Avill be in the country. When in the city, it should be in a high and open place, having more than twice as much space as the building occupies, and with trees and grass. Next, as to construction. Two stories Avill be better for a school building than three or more, especially better for the teachers. Let it front so that its corners look north, south, east, and Avest; then the sun Avill enter all parts of the house every day, and at the same time the glare will be noAvhere excessive. The school-room should be large for the number of scholars; not more than thirty being seated in a room about thirty by tAventy feet, Avith thirteen to fifteen feet for the height of the ceiling. WindoAvs ought to be so many and so large as to equal one-fourth or one-fifth of the space upon the floor. They should be high, reaching nearly to the ceiling; but they need not go doAvn to the floor. Upper light is the best for reading or work in the room. WindoAvs should be so placed (or seats and desks so arranged) that the light, if coming from one side only, should fall upon the left of the scholars. Then the shadoAV of the hand, in writing, does not obstruct the vieAV. But windows on both sides will do, or on the left side and behind; never in front of the scholars. The ceiling should be Avhite, the Avails of some neutral tint. Night light, for study, must be abundant and steady; otherwise it often injures the sight very much. Gas and candles are both more apt to flicker than good coal-oil lamps. Eyes are often injured in schools and colleges; but they need not be so. The causes of such impairment of sight are, chiefly, imperfect light, a stooping posture in reading, bad type and paper, and a close atmosphere in the school-room. Under such influences, Avhile of boys entering primary schools in Germany only 394 HYGIENE. from fhre to ten per cent, may be nearsighted, of those in the gymnasia the number often rises to tAventy, and in the universities to fifty or sixtv per cent. In this country it is not quite so bad; but defects of vision, greater or less, are much too common here also. An important point is, that children Avhose eyes are naturally in any degree defective should have them examined by an oculist, and proper glasses selected, to correct their error of vision. Without this precaution, there may be a perpetual strain in using them; and thus not only their sight is made Avorse, but headache and general ill health may be brought on. (About eyesight more Avill be said in another part of this volume.) Ventilation and warming are as important in schools as in any other kind of buildings. Exactly the same principles and methods apply, hoAvever, as have been already considered in connection with Our Homes ; and therefore they do not need to be repeated here. Attitudes in school life have some consequence. Sitting, standing, or walking constantly Avith the shoulders rounded, not only gets the habit established, but, in early life, Avhile the body is growing, allows the bony frame to set permanently into an awkAvard, ungainly shape. Yet not every one can sit straight for hours together Avithout support to the back. There ought to be comfortable seats in school; but pupils should be taught to keej) the figure well up in shape habitually; Avith the shoulders back, the head not unnecessarily bent fonvard, and Avith no twist, or elevation (if avoidable) of one shoulder aboAre the other. Rising to recite is a good practice; every change of position is a refresh- ment. Standing long (more than five or ten minutes at once) at the blackboard is not suitable; especially for girls. Hours in school should not be too many, as already said a few pages since. A child six or seven years old cannot, generally, keep its atten- tion fixed for more than fifteen minutes at once, without some interval of change. At tAvelve years, half an hour will do; with older scholars, forty, forty-five, or fifty minutes. I believe that adult students do best (in attending university lectures, for example) with somewhat less than Avhole hour divisions for their class exercises. Four or five school hours in a day, at the most, Avith one or two hours besides for home study, will be enough anyAvhere, not only for health, but, in the long run, for the greatest amount of acquirement. Jonathan EdAvards studied sixteen hours a day. Some Germans and a feAV others may do so now, and survive it. But ninety-nine in a hun- dred Americans, at all events, will find ten hours the most they can give to brain-Avork daily Avith advantage, and eight hours will be a better usual average for effective results. Lord Buhver Lytton, Avho read and wrote a great deal, worked regularly only three or four hours a day; for k EDUCATION. 395 the special reason that thus he could best keep his head clear and bright. Over-work jades; and jading is ahvays fatal to good mental perform- ance. Exercise and recreation, schoolboys and girls, and college students must have, betAveen times; in recesses and intervals. Calisthenics (as before urged) are very useful in schools, particularly for girls; most of all, in properly adjusted moderation, for thin, pale, shy, and delicate girls (the very ones Avho at first don't like them), Avho lack muscular development. Light wooden dumb-bells are, for such exercises, much better than empty hands. For young scholars, fifteen to twenty minutes at a time will ansAver; best out of doors, but if not, march- ing through halls and rooms Avith all doors and AvindoAvs Avide open. Cricket, tennis, and other out-of-door games are also very good of afternoons. Task-work in study must ahvays be moderate in amount, propor- tioned to the capacity of each scholar. It Avill not do to remove all difficulties; poAver groAVS Avith action Avhich requires effort. Discipline is one means towards acquirement of self-command. But the Avisest teachers will always endeaA^or to induce their pupils to like their Avork as Avell as or better than play. Zest is the best stimulant possible for study. No one, then, should be asked to do more than he or she can reasonably do Avithin the time alloAved. Worst of all influences in regard to mental health in school and col- lege are those of competition for prizes and public distinctions. Girls, especially, are often injured by these. Instead of them, besides interest in the Avork itself, there should be, as impelling motives, a high ideal of culture and attainment, and such reAvards and honors as all may reach Avith proper industry; not such as only one, tAvo, or three may get, to the disparagement of all the rest. Out-of-school life, during the educational period, is of great, and frequently unappreciated, importance. Social distraction, and especially late hours at night, Avear upon the brain and nervous system, and try the general health much more than the ordinary Avork of the schools. Some time hence, the universal prevalence of co-education may solve the problem—Iioav the social nature may, along Avith the intellectual, have its development all through early and adolescent life. Two great physiological principles lie at the basis of mental hygiene in its relation to education. One is, that the brain, the mind's instru- ment, is a material organ; groAving, tiring, needing rest, having from time to time a limited amount of energy. To exhaust this is to injure ; to repeat or continue ovenvork may derange, wear out, or kill. Careful training gradually increases capacity, ease, and endurance in mental work. 396 HYGIENE. The other fundamental principle is, that the brain is a multiple organ, specially adapted to the functioning of all our faculties. Not believing in " Phrenology," as Gall and Spurzheim taught it, Ave yet know that persons differ immensely in their kinds of ability as Avell as in their disposition. Raphael could not solve NeAvton's problems, nor could NeAvton paint Madonnas and Transfigurations. Yet every one has some mathematical capacity; and Professor Walter Smith assures us that everv boy and girl can learn to draw respectably. Again, blows upon the head have been folloAved by partial and peculiar disturbances or losses of mental power; shoAving a definite relation (not yet avcII understood) betAATeen different portions of the brain and the faculties. Also, AAihen Ave tire of one kind of mind-AVork (as in reading or com- position), another kind rests us; or, at least, does not tire nearly so much as continuing the same, after fatigue from it begins to be felt.* From all these facts we infer, first, that some variety of study (like change in diet) is Avholesome. Two or three studies can be carried on together (dividing the day betAveen them) to greater advantage than one alone. Secondly, an " all-round" mental development, Avith all the faculties symmetrically brought out together, is the best. Hence the "elective" system, under Avhich each student picks out just Avhat he thinks Avill be most agreeable, is, during the brain-growing period, the Avorst possible. We ought to individualize in education. We ought to find out each one's capacities and peculiarities, and give no one more to undertake than he is able. But if Ave should find in an infant that one hand or foot is weaker and smaller than the other, Avould Ave cut this one off, or tie it up, and make the child only use that Avhich is strong? When, in a team, one horse pushes forward, and another is sluggish, it is common to urge the latter, not the former, with the whip. If a man has on his farm one field very rich and productive, and another of poor soil, to which does he apply his fertilizers and cultivation? Therefore, it may be insisted, on physiological and hygienic principles, that if a young pupil shows a deficiency in ability of a particular kind, his training should tend toAvards bringing out and improving that capacity up to the level of the rest. When men and women have grown up, and are about to begin their career in life, then is the time to choose their specialties. Before that period the great ends of educa- tion ought to be the acquisition (besides immediately useful knowledge) of mental power, balance, and self-command. * So, for example, Professor A. S. Hardy, when tired out with the preparation of an advanced mathematical text-book on Quaternions, went to Mount Desert and wrote his famous novel, " But Yet a Woman." MENTAL EXCITEMENT. 397 MENTAL EXCITEMENT. Stagnation of mind is never wholesome; but neither is extreme 01 very frequent strong excitement, or strain ; AArhether of the intellectual or of the emotional nature. Victims of over brain-Avork have been, as already said, not few. Among them have been Casimir Perier, Minister of State in France; Romilly and Castlereagh, English statesmen; Bec- lard, anatomist; Haydon, artist; Laman Blanchard, Henry Kirke White and Buckle, authors; F. W. Robertson, preacher; Buckland and Hugh Miller, geologists; Admiral Fitzroy, sanitarian; Moreton Stille, physician and medical Avriter. Louis Agassiz, splendid as Avas his natural constitution, probably shortened his life by his immense naturalistic labors. On the other hand, active intellectual lives are often long ones. Of one hundred and fifty-tAVO distinguished French savants, the average age at death Avas sixty-nine years. Of Harvard University graduates, through a long period, the mean longevity was fifty-eight years; of eminent British poets, fifty-six years; of celebrated preachers, of different countries, sixty-nine; prominent statesmen, seventy years. Dr. Elam gives the following table of the average age at death of riien Avhose pursuits have involved much mental activity. Of each kind, twenty Avell-knoAvn examples Avere chosen: Natural philosophers . Moral philosophers Sculptors and painters . Authors on laAV, etc. . Authors on medicine . Authors on revealed religion Philologists Musical composers Novelists and Miscellaneous Avrite Dramatists . Writers on natural religion Poets Emotional excitement, Avhile altogether safe in moderation, sets the world on fire, so to speak, Avhen extreme in violence. It maddens indi- ATiduals, disturbs communities, and sometimes embroils nations in Avar. How is it to be controlled ? First, by such educational training as gives a balance to the emotional as well as the intellectual nature, and establisheg the power of the will, acting upon principle, over the Avhole being. 75 years 70 a 70 a 69 (t 68 a 67 u 66 n 61 a 62| ce 62 a 62 (C 57 (i 398 HYGIENE. Hoav does the Avill act in controlling feeling ? Just as it does in regu- lating thought; not directly, as by a mandate, " be angry," or " be kind," but bv the selective preference of attention. We cannot create a train of thought; neither can Ave a mood of emotion. A thought comes; Ave dwell upon it, and it groAVS more distinct; it suggests other thoughts; our attention keeps these still passing before us. But, if Ave turn air ay from a thought, or a series of suggestions, they fade and disappear from the mind. So, certain objects, impressions, memories, and imaginations, tend, of their own nature, to aAvaken particular emotions in us. If avc dwell on such objects, either out of or in the mind, the emotions appropriate to them continue and increase in power. But if Ave remove our attention from the causes of any kind of feeling, it Avill pass aAvay. Marc Antony kneAV this Avell, Avhen, instead of speaking long of Caesar's death, he shoAved his body to the populace of Rome; letting his wounds, " poor, poor, dumb mouths," plead against his murderers. Every skilful orator uses a similar method, when he Avishes to arouse feeling among his hearers. Every personator of character succeeds best Avhen he endeavors to put himself in the place of him Avhom he repre- sents ; so that, by really feeling as he would, his action naturally fol- lows. With children, this is an important principle of management. If a child (especially a young infant) cries, not from pain, but from anger, disappointment, or fear, never tell it not to cry, for its automatic nature usually cannot help it at all. Put, instead, something before it, which Avill take its attention pleasantly; at once the phase of feeling shifts, and it is happy and "good" again. Cannot adults do nearly the same thing Avith themselves? Yes, they can ; and it is one of the secrets of self-culture, of charac- ter, and of happiness. Confucius recognized it, and expressed it in a maxim; but it Avas most wonderfully unfolded in the New Testament* Tavo examples will be enough for our present explanation. Suppose a youth to be enamored of a maiden, who rejects his addresses as a suitor. Will he be Avise to ask for the privilege of a close friendship, to linger near his Dulcinea, and to see her very often? No, indeed. Rather let him go West, go to Europe, go anyAvhere, and forget the cause of his trouble, as soon as possible. Again, Shakspeare tells of one who let grief take the place of a lost darling; sit in her seat, Avalk up and down with her. If grief is cher- ished by the constant presence of objects associated with its occasion, it ■ook not," etc. " Whatsoever things are pure .... think on these thing*." MENTAL EXCITEMENT. 399 will live, Avith a persistent shadoAV, such as is not designed by Provi- dence. Time is the great consoler, by substituting new impressions, and thus neAv feelings, for the old and painful ones. Such is the right order of events. Monarchies have long made the most of this natural suc- cession by encouraging the popular cry: " The King is dead; long live the King!" Balance, in the emotional nature, is, from early life, of great conse- quence, and it is closely connected Avith a proportional development of the intellectual faculties. Most commonly here referred to by a\titers is the undue prominence of the imagination. This faculty has its uses. The poet Wordsworth called it the handmaid of faith, the " faculty divine." It is not its poAver, or its culture, that is undesirable; it is its undue indulgence, its abuse. Let it be under control of the will, under guidance of sound reason, and it is one of the richest gifts in our nature. But the habitual " letting go " of the mind, in reverie, is not Avholesome ; Ave should live in realities, not in dreams. Novel-reading (unless in such moderation as reading but two, three, or four stories, only of the best, in a year) is a sort of mental opium-eating; it unfits the mind for real, earnest work. Over-active imagination, Avith untrained judgment, promotes credulity. This is not at all confined to ignorant or stupid people. Some very bright minds, for Avant of solid discrimination, are subject to it. These (especially Avhen not furnished Avith a satisfying religious faith) are often liable to be taken with each neAv " ism," every popular delusion, as it comes. Such intellectual and Avell-informed people I have knoAvn, Avho have, in turn, embraced phrenology, mesmerism, planchette, table-turn- ing, and spiritualism; as, during childhood, they probably had, in turn, mumps, measles, scarlet fever, and Avhooping-cough. Tavo maxims will afford help in avoiding these mental maladies, Avhich (especially spirit- ualism) sometimes lead to actual insanity. First, be content, at every stage of progress, to prefer that opinion Avhich has decidedly the most in its favor. Never expect all difficulties, on either side of any great question, to be removed. Secondly, of new things, never believe anything until it is fully proven. Suspect everything that contradicts general experience. It may be even more probable that your best friend has been mistaken, than that a somnambulist could read a sealed letter Avith his eyes blind- folded. It was much more likely that Katie King and the Davenport brothers Avere adroit tricksters, than that a " spirit" would come from the other world to untie knots or put out a hand from a box in a dark- ened room. I believe the Bible, because, after thorough investigation, I find that its truthfulness is fully proved. But I should look with 400 HYGIENE. very jealous and scrutinizing eyes upon any asserted modern miracle.* In short, beware of isms, and hold firmly fast to everything that you really do knoAV. SYMPATHY. Wonderful indeed is the influence of one mind upon another, acting through the ordinary channels of sense for the conveyance of ideas and emotions. Imitation gives many examples of this. Let one of a com- pany yaAvn; Iioav soon Avill tAvo or three others do the same. If one girl at a boarding-school has hysterical fits, probably several will soon be likeAvise affected. Worse than that, when a man hung himself to a certain post on a street in Paris, so many other suicides followed at the same place, that the police had to cut down the post. Perhaps most fearful of all is the sympathetic rage that some- times sweeps through a riotous mob in a great city. A "panic" during a battle exemplifies the same thing. Hence the prime impor- tance of having leaders who cannot be so disturbed; or who, if they feel Avith the rest, act bravely nevertheless. " He is not brave who never felt a fear; But he whose manly soul its fear disdains, And nobly dares the danger nature shrinks from." On the largest scale, great sympathetic movements affect, through the " nerves " of the telegraph, Avhole continents at once ; nay, through ocean cables, even the world. Thus it was throughout the North Avhen, at the beginning of our civil war, Sumter fell; and Avhen, at the end of it, Lee surrendered, and aftenvards Lincoln died. Garfield's death thrilled men's hearts with a common grief, in America, Europe, Asia, Africa, and Australia; wherever civilization had carried its means of communication. But these are natural, healthy modes of sympathy. History tells of some having the character of epidemic madness. Such Avas the fanati- cism of the Crusades; most sad and dreadful of all, the crusade of the children. Such Avas the witchcraft superstition of Scotland, and of New England, in Cotton Mather's time; and the bloodiest chapter in mod- ern history, the French Revolution. Writers tell also of the self- scourging itinerant "flagellants" of the fourteenth century; of the * The only thing of this kind I have had opportunity to examine closely, what « callec1 "mind-reading," came to be clearly explained, upon well known physiological principles. Faraday showed this, also, of "table-turning." SYMPATHY. 401 "dancin^ mania" of about the same period; and of other similar epidemics in Europe in the fifteenth, sixteenth, and seventeenth cen- turies. One of these Avas the " mal de laira," or barking mania, which occurred in a part of France; where eighty women and children Avere successively seized by a propensity to bark like dogs At one convent a number of nuns in like manner meAved, for days together, like cats. Also the " trembleurs," of Cevennes, shook terribly Avhile they preached and prophesied. The " convulsionnaires " of St. Medard were made to spring about with violence by lying for a short time upon the tomb of the AbbS Paris. In a convent of Ursuline nuns at Loudon, France, the Avomen, belonging to families of rank, were supposed to be possessed with demons. Clergymen endeavoring to drive out the evil spirits, became themselves affected. One priest, on this account, was con- demned to death and executed. Another died in fury and despair; and a third went into a profound melancholy for life. During the witchcraft period, the most remarkable thing was, that a number of the women accused of being witches confessed being guilty of the charge; although this led to their being put to death. Religious emotion is naturally intense, because of the supreme mag- nitude of the interests that aAvaken it. While a sound religious convic- tion and trust in the Divine government promote tranquillity of mind, agitation about religion is dangerous to some mental constitutions. " Camp meetings," of the old-fashioned kind, are not safe for those of all temperaments.* Let all things be in moderation, and promotive of a sound mind. " If the truth shall make you free, then are you free indeed." Summing up, we may say that the influences Avhich most favor men- tal health are these: a sound bodily constitution ; well-balanced educa- tion ; regular occupation, with some daily exercise in the open air; a sufficiency of regular sleep ; moderation in diet, and in all excitements and indulgences; lastly, a reasonable, well founded, and tranquilly sustained religious faith; or rather, "faith, hope and charity, these three." * The extensive revival in this country in 1856-7-8, and that led by Moody and *ankey twenty years later, were notably free from unhealthy emotional disturbances. 26 402 HYGIENE. HYGIENE OF THE SENSES: EYESIGHT. Already, while referring to education in connection Avith mental and general health, the care of the eyes in their use for study has been con- sidered. Of course, the same principles apply to their employment otherAvise; as in the close looking necessary for printing with small type, Avatchmaking, etc. Plenty of light on the work, without glare on the eyes, will be needed for every sort of work. Correction, by proper glasses, of defects of sight is also very important. Some persons have suffered for years with headache, sickness of stomach, and general dis- tress, produced by using their defective eyes (sometimes obliging them to give up the business in Avhich they Avere engaged), Avhom a suitable pair of glasses has afterwards enabled to get on without any trouble. A young relative of my own, at ten years of age, could not read a letter Avithout holding the page so as almost to touch the end of her nose. She could, in consequence, do almost nothing at school. But with glasses made, after examination, to suit her eyes, she was put for life upon the level of other persons. Such a change is almost like confer- ring a neAv sense. Only skilful oculists can deal successfully Avith serious cases of de- fective vision. But the general facts on the subject can be understood by all. Blindness may be due to either of several causes: original im- perfection of the eyes (born blind); paralysis of the optic nerve (am- aurosis*); opacity of the crystalline lens (cataract); cloudiness of the cornea, or of the vitreous humor; disorganization of the retina. (See Physiology.) Errors of sight, hoA\rever, far short of blindness, cause much incon- venience. One of these is nearsightedness (myopia). Here the eyeball is too long (or the lens too convex), so that the rays of light from an object come to their focus in front of, not upon, the retina; unless, that is, the object is brought very near to the eye, so that the divergence of the rays coming from it pushes back their focus, and thus the image formed by them, upon the retina. Some people are born Avith nearsightedness; others acquire it. Very often it is slight in childhood, and increases afterwards. If moderate in degree, it is partly corrected by the opposite change Avhich comes on with the approach of old age. All persons have a different range of vision at different times of life. * This was Milton's blindness. " So thick a drop serene hath quenched these orbe.' An old name for the affection was gutta serena. HYGIENE OF THE SENSES: EYESIGHT. 403 Our eyes are (as explained under Physiology) at rest Avhen we look at a far-off prospect, or at the sky. Accommodation is necessary for look- ino- at near objects. This has its limits. At ten years of age, a child with good eyes can " accommodate" its sight so as to see a thing clearly which is brought to Avithin three inches of its eyes. This is its near point. At tAventy years of age, this point is about four inches; at forty seven inches; at fifty, usually tAvelve inches; at sixty, two feet. With healthy eyes the far point is in remotest space, Avhere Ave see the sun moon, and stars; although the clearness of vision for distant ob- jects must, of course, depend upon their size and the amount of light coming; from them. But Avith nearsighted people the far point is, properly speaking, not fir off at all. Some of them cannot recognize their OAvn mothers at the distance of ten or twelve feet; many (without glasses) cannot tell a horse from a coav at twenty feet distance. Their range of vision, then, is very narrow. For things brought close to their eyes, their sight may be very good, indeed. Another defect is longsightedness (hyperopia, or hypermetropia). Here the lens is too flat, or the eyeball is too short; the rays diverging from near objects, and even, in some cases, those from distant ones (parallel rays) make their image, so to speak, beyond the retina. In other Avords, the image on the retina is a confused one; because the rays are not brought to a focus upon it. Old people have their " near point" pushed farther off (presbyopia), as above said. The lens in the eye becomes gradually harder, and will not yield to the muscle of " accommodation;" it remains at last per- manently flat. Moreover, the adjusting muscle itself loses strength. This change begins in most persons between forty and forty-five years of age. There are exceptions, however; a feAV, eA^en without ever having been nearsighted, can do without glasses to an advanced age. Even Avith these, more light is needed for old eyes to see well by; the retina, optic nerve, and eye-brain groAV less sensitive to the stimulus of light. Hence there may be need of glasses to magnify objects in a poor light, when there is no loss of accommodating poAver. Longsightedness (hyperopia, or hypermetropia) is met Avith not infre- quently in young persons. Those having it can see Avell things at a distance, but, Avithout glasses, not those brought close to them ; the very opposite of nearsightedness. Another far from uncommon error of sight is astigmatism. This is a kind of uneven or distorted vision. It results from the eyeball hav- ing its curves unlike; being someAvhat spoon-shaped instead of spheri- cal m form. This " spooniness " may be either horizontal or vertical; 104 HYGIENE. and accordingly, lines, forms, and spaces are changed somewhat in one or the other direction. Many persons have slightly astigmatic vision. It is important only Avhen considerable in degree. The test for it is easv enough. Horizontal. 30° so' 120' If, in looking at the large N and Z of the above series of letters, the lines of both look equally heavy and dark, there is no astigmatism, either vertical or horizontal. If this is so also Avith P and B, there is none in any direction. At least one in three or four persons, hoAvever, will see somewhat heavier lines either in the N or in the P. To show that this is not OAving to a real difference in the letters, let the book be turned half-Avay round; the lighter ones will then become dark, and vice versa. In order to examine the acuteness of sight, as Avell as to ascertain the presence or absence of nearsightedness or farsightedness, types may be used, prepared for the purpose. Jager's types range from 1 to 20; the extremes being these: Good eyes can read the smallest letters (Brilliant, etc.) within a range of from seven or eight inches to three feet. The R O M can be seen distinctly by them at from forty to sixty feet distance. Nearsighted and longsighted persons shoAV, in looking at them, their opposite defect*. Another, more conveniently available set of types, are those of SnelleD, of which the folloAving are examples: HYGIENE OF THE SENSES: EYESIGH'l. 405 A* Z N L One having perfect sight should be able to discern A in the above series at eighty feet distance; Z at forty feet; N at twenty feet, and L at eight feet. Strabismus, squinting, or cross-sight, is due to a want of proper balance betAveen the muscles which draw the two eyeballs outAvard (from each other) and those Avhich make them converge (towards each other). Those having this defect, although they must always see tAvo images for every object, learn by practice to give attention only to one object; and thus suffer but little inconvenience from the double vision. Squinting may be increased, indeed probably may be brought on in a child, by the habit of drawing the eyes often together to look at a very near object; as a hat-string dangling before the eyes. Children should, for this rea- son, not be alloAved to squint on purpose, as they do sometimes for amusement. AVhen strabismus is very bad, it may be cured by a surgical operation; the over-strong muscle being divided with a very delicate knife. As a symptom of disease, in those Avhose eyes, when well, were straight, squinting points to trouble affecting the brain. It is then usually of serious importance. Correction of nearsightedness is obtained by the use of concave glasses, which spread the rays from distant objects farther apart, so that they will form a distinct image by focusing upon the retina. The concavity must be greater or less according to the degree of error in each case; Avhich can be ascertained by careful trial. Those whose sight is only moderately shortened require glasses chiefly for reading and Avriting, or other close work. They see much more of the world, hoAvever, and to better advantage, if they use two pairs of glasses; the stronger pair for distant objects, and the weaker pair for reading or fine Avork. Longsightedness is corrected by convex glasses, Avhich bring the rays sooner to a focus, so as to make a clear image on the too short eye, or make up Avhat is Avanting with a flat lens in accommodation for near objects. Old people wear convex glasses, to read or write Avith. They 406 HYGIENE. do not need them to look at things far off, unless dimness of vision comes also Avith age. The old person looks over his glasses in conversation, or puts them aAvay for the moment, replacing them to read. Sonic, who have been moderately nearsighted in early life, find their " near point" put back, Avheu thev groAV old, so that they need convex glasses for reading, and yet their " far point" is close enough to require the use of concave glasses for distant vision. Dr. Benjamin Franklin contrived to meet this double difficulty by having the uj>per hedf of each glass concave, for far-off objects, and the lower half convex, for those which are near. A minister, so affected and assisted, can look at his congre- gation through his upper half-glasses, and read the Bible or his sermon Avith the lower halves. It is, of course, wrong for any one to use too strong glasses; they tend to make the eyes Avorse. But it is also a great mistake to put off using them Avhen the eyes are strained for Avant of their assistance. Get those Avhich make sight entirely comfortable, if you need them, and use them whenever they are required. One eye may differ from the other in its manner of sight. This is often the case with those Avho do not discover it until it is proved by a careful examination. Such should ahvays be considered in the adjust- ment of glasses to correct vision. Astigmatism is corrected by means of cylindrical glasses. By these, the " spooniness," as I have called it, is sufficiently reversed to make equal clearness of vision in both directions. Sometimes a combination of near- or far-sightedness with astigmatism makes suitable the putting together of double lenses; one face concave or convex, and the other a section of a cylinder. Color-blindness has, of latter years, attracted a good deal of atten- tion. Lives have been lost, on ships and railroad trains, by pilots or engineers mistaking a signal of one color for another. Red and green are the colors most apt not to be distinguishable by those having this defect. About one man in twenty-Jive is more or less color-bliud; of Avomen, not one in a hundred. Examinations are noAV made of railroad employes and others, to de- termine Avhether or not they see colors correctly. Merely naming the colors Avill not be enough, as that may be a matter entirely of education. The best method is, getting those examined to match, exactly, colored AA'orsteds, of various hues, selected and arranged for the purpose. Really bad color-blindness does not seem capable of any sort of cor- rection. Slight degrees of it, hoAvever, can often be improved upon by early and constant training in the use and discrimination of colors. Tt HYGIENE OF THE SENSES: EYESIGHT. 407 is by this practice, chiefly, that Ave can explain the rarity of color- blindness in women. Weakness of sight (asthenopia) is often quite troublesome, without any error of refraction. Those Avho have it cannot read or write long Avithout Aveariness and pain in the eyes. After an attack of measles this is not uncommon. It needs a great deal of care not to increase it or make it permanent. Having had personal experience of this diffi- culty from my boyhood, I have learned by necessity the advantage of frequent short rests for Avearied eyes. Often, I close them for half a minute or a minute several times in an hour. Thus the pain and sense of fatigue are relieved, and Avork can be continued; without such pre- caution, absolute inability to use the eyes may follow, as was the case Avith me once for a whole year at a time. Irritability of the eyes (Avhich are naturally sensitive to the touch) is easily increased by slight causes. There is some wisdom in the odd old saying, " Never touch your eye unless with your elbow." 408 HYGIENE. HEARING. Less exposed, as our ears are (that is, the inner ear, the real apparatus of hearing) than our eyes, to injury, they are nevertheless often sub- ject to disease, especially in early life, as Avell as to impairment of sensi- bility in old age. Diseases of the ear do not call for special consid- eration in this place. (See Special Diseases, in Domestic Medicine.) Deafness, or Avhat, in less degree, we call hardness of hearing, may proceed from either of several causes: accumulation of wax in the ear; thickening of the drum membrane ; obstruction of the Eustachian tube (connecting the middle ear with the throat); collection of matter in the middle ear; perforation in the drum membrane; destruction of the ossicles (little bones in the middle ear); loss of sensibility in the nerve of hearing, or in the " ear brain " (central termination of the neiwe in the brain). There is naturally always a small amount of Avax in the ears; as it is disagreeable and adhesive, it seems to keep insects out. Irritation of the ear produces an increased secretion of waxy matter, Avhich sometimes fills up the Avhole passage. With great gentleness, this may be taken out. A quill ear-pick may be very carefully used; but the inside of the ear is almost as delicate as the eye, and inflammation may be induced by even a slight degree of violence. What remains in the deeper passage may be softened by pouring in warm water, almond oil, or glycerin. Instead of a syringe, pouring in from a teaspoon will do, the head being turned well to one side. Best of all is the little rubber-headed tube, which cannot risk doing harm, as a syringe can, by the force of its jet against the drum membrane. With a cold in the head, sometimes, that membrane will thicken, just as the cords in the Avindpipe do when one is hoarse. Or, under the same causation, the small passage called the Eustachian tube, from the middle ear to the upper part of the throat, may be blocked up. Gen- erally, either of these effects of a cold will pass away in a few Aveeks. There is, at all events, no advantageous domestic treatment for them. And the same is true of the other causes of deafness named; Avhich (ex- cept nerve-paralysis) follow, in a certain number of cases, scarlet fever or small-pox. Gunners, on men-of-war, in time of action, may have their hearing impaired by the tremendous concussion of air from their caunon. Boiler-makers suffer likewise from the long continuance near them of loud hammering. Both of these, but especially the former, gain by opening their mouths at the time of explosion or other cause of loud HEARING. 409 sound, so that the air can freely enter the Eustachian tubes, and balance that which strikes upon the tympanic membranes through the outer ears. One precept of some authors who have written upon the care of the ears I must positively dissent from; that is, never to let cold water enter the ears. I am sure that cold or cool water is, for healthy people, the natural thing Avith which to wash every part of the body. From abundant observation and experience I can assert that Avashing the ears daily with cold water " strengthens " them, that is, gives tone to the surface, and renders them less sensitive and irritable; less liable to be affected by cold, and less apt to suffer with accumulation of AArax. I believe this to be true of sea- as Avell as of fresh-Avater. One does not need to stop his ears while bathing in the surf at the shore, unless they are already in a diseased condition; although it is well to avoid the dashing of heavy breakers against the ears. 410 HYGIENE. TEMPERAMENTS. Exaggeration has prevailed in regard to the distinctness and impor- tance of these. Yet the subject is naturally an interesting one. By temperament Ave mean a special constitution of body and mind, with tendencies of its OAvn, which, Avhen excessive, are morbid, but yet a marked degree of Avhich is compatible with health. An old classification was into the Sanguine, Choleric, Melancholic, and Phlegmatic temperaments. Later writers call them the Sanguine, Bil- ious, Nervous, and Lymphedic. But the term bilious is commonly as- sociated with an unhealthy condition of the liver, Avhose secretion is either excessive or altered in character and action. Better, therefore, Avill be the use of the term fibrous in its place; as nearly corresponding to the ordinary description of the so-called " bilious " constitution, so far as it involves no deviation from health. Our classification then is into the Sanguine, Nervous, Lymphatic, and Fibrous temperaments. Of the sanguine, characteristics are a redundance of blood in pro- portion to the solid tissues; a large heart and excitable circulation; complexion florid, or at least easily heightened in color. Less con- stantly, the skin is fair, eyes blue or bluish gray, hair light. Disposi- tion active, excitable, hopeful, fond of change and adventure. Under causes promotive of disease, acute inflammations and hemorrhages are frequent in such constitutions. Some writers, as Richerand and Hammond, overstate, in my judg- ment, the mental tendencies of the sanguine temperament. In the words of the latter (in his book on Hygiene): " Inconstancy is the predominating influence. Good resolutions are formed but to be broken. Friendships are contracted soon to be abandoned for other's, Avhich in their turn are given up. In love the individual of sanguine tempera- ment is fickle and faithless, and cares less for his honor than for his pleasure." This is quite too much to assert of the effect of any temperament upon character. There are friends as faithful, lovers as constant, and good citizens as honorable, among those naturally sanguine as among those of any other constitution. But the tendency to ardor, confidence, and mutability, no doubt, does exist; whether or not it be governed, directed, and restrained by the will, is, in each instance, the vital question. As examples of the sanguine temperament may be named Alexander the Great; Charles II., of England; Murat, the fiery soldier of the TEMPERAMENTS. 411 first Napoleon; and General Custer, American Indian fighter, who lost his life and the lives of a company of soldiers, in the far West, by his rash daring. General Gordon, the hero of China and the Soudan, was a splendid specimen of this temperament. In the nervous temperament we see a great development of the sen- sory and sensori-motor elements of the nervous system; Avhich is sus- ceptible, excitable, irritable, rather than strong. Persons so endoAved are commonly slender in build, pale, and " Aviry." Not always, but more often than not, their complexion is dark, or Avhite Avithout color; with dark eyes and hair. When disturbed by morbid causes, they are more than others liable to convulsions in childhood, hysterical attacks in youth, and to neuralgias ; to delirium Avhen ill, and insanity. Of this temperament Ave can trace signs in the lives of Frederick the Great of Prussia, and his friend, the Avit and philosopher, Voltaire; in the German poet, Schiller, as well as in the English poets, Pope, Cowper, Tom Hood, and Keats; in Beethoven, the musical composer; in John Randolph, of Virginia, and Rufus Choate, of Boston. One of the best instances of it under my knoAvledge was the late Professor George McClellan; a bold and skilful surgeon, father of General George B. McClellan. The lymphatic temperament exhibits a preponderance of lymph and lymph-vessels rather than of blood. In it the organic or vegetative functions are more developed than those of the animal system distinc- tively so called. Its subjects are inclined to absence of color in the complexion, and to sloAvness and languor of body and mind. But here, again, we must remember that the question of power is quite another one from tendency. There may be as big a brain, capable of great things, with this as with other temperaments. As to diseases, the lymphatic are most prone to dropsies and chronic affections, such as scrofula and fatty degeneration. Examples of this temperament among noted people are not easy to select Avith certainty. We may venture to name Rembrandt the painter, Dr. Samuel Johnson, Thomson (author of the "Castle of Indolence"), Wordsworth the poet, and Dante Gabriel Rossetti. In the fibrous temperament, solidity is a characteristic. The bones, cartilages, ligaments, and muscles are well developed in proportion to the blood and lymph-vessels and nervous apparatus. A broad, square figure, neither very lean nor fat, with a clear, not florid complex- ion, and eyes gray or brown, belong to the best marked examples of this constitution. It is, with less excitability than the nervous, and less activity than the sanguine, the best temperament for work and wear. No special tendencies to disease belong to it. 412 HYGIENE. Of famous people, such appears to have been, very nearly, the tem- perament of Socrates, Julius Caesar, Peter the Great, John Knox, Oliver CroniAvell, Cardinal Richelieu, Washington, Franklin, Napoleon, aud Ulysses S. Grant. Shall Ave venture upon an analogy Avith the creatures beloAv us, in illustration of temperament ? Is not the tiger a sanguine creature, the deer nervous, the bear lymphatic, and the elephant a big specimen of the fibrous make-up ? Among nations, at all events, we can see the characteristics already described; in the nervous French, the sanguine Irish, the fibrous Germans, the lymphatic Turks. In the different periods of eveiy one's life, some difference of tendency is usually ob- servable. Infancy is at its best for health Avhen inclined to be lym- phatic; less secure, Avhen nervous instead, youth is proverbially sanguine. Middle life ought to be established with a solid fibrousness, Avhatever be its other endowments. Old age, at its best, may retain this tough temperament; but it often runs rather into the lymphatic constitution. Nothing is more important, however, upon this subject, than the fact that pure, unmixed temperaments, such as those noAV classified, are rare. Almost always we meet with combined traits of two or more; as in the nervo-sanguine,fibro-nervous,fibro-lymphatic, or nervo-lymphatic systems. Of these every one may, with a little thought, recognize examples among his own acquaintances. Composite temperaments may be, at least conjecturally, referred to some distinguished personages. Lord Byron, I should say, was nervo- lymphatic; Louis Napoleon, nbro-lymphatic; Goethe, fibro-nervous; Robert Burns, nervo-fibrous. Exemplary Englishmen show the fibro- sanguine constitution; the typical American is fibro-nervous; Avith " blood of fire coursing in veins of ice." Henry Clay and Abraham Lincoln were fine (though not handsome) representatives of this strongly marked type. After all, mixed temperaments are the best; even those in which neither sort of constitution is predominant. Such have been seen in Goethe, Bryant, Webster, Humboldt, Garfield, and Gladstone. Can temperament be altered ? I believe it can, by careful manage- ment, especially in early life. Those of the sanguine constitution should eat moderately, especially of animal food ; should take a good deal of exercise, not violent, but producing bearable fatigue; should avoid stimulants of all kinds, and take a good amount, say eight hours, of sleep nightly. Nervous people should (unless exceptionally unable to digest it) drink milk instead of coffee or strong tea; exercise regularly, hut TEMPERAMENTS. 413 ahvavs short of fatigue; take a considerable amount of animal food in their diet; and sleep nine or ten hours in every tAArenty-four. Lymphatic persons ought to eat rather sparingly, especially of bulky vegetable foods. They need someAvhat less sleep than others; and should live as much as possible an active out-of-door life. Those having a fibrous constitution, as above described, need to make no endeavor to alter it, but rather to preserve its strength and endur- ance. On the one hand, over-excitement, over-Avork, or worry may sharpen it into the nervous temperament; or, especially late in a life of ease and leisure, it may lapse into lymphatic relaxation. By proper care in our habits, then, we can make the most of our natural endow- ments and tendencies, and even improve upon them; so as to maintain, or at least promote, that balance which is most favorable to health and long life. 414 HYGIENE. HYGIENE OF INFANCY. So much has been said already in this book concerning Food, Cloth- ing, Bathing, etc., Avhich applies to the care of infants as Avell as to that of the health of adults, that much less needs to be here presented than Avould be required in a treatise entirely devoted to the subject of Infaucy and Childhood. Some things, hoAvever, must be briefly re- peated, with additions. Tavo critical times, at least, belong to babyhood : those of birth and of teething. In our great American cities, as NeAv York, Philadelphia, Baltimore, Cincinnati, Chicago, and St. Louis, multitudes of children have added a third ; which may be repeated for them two, three, 01 four times before (if they survive) they pass into the comparative security of childhood. This is midsummer weather in town. We must say something especially about each of these dangers of infant life. BIRTH. A child is born into the Avorld ! It cries vigorously; very well. The doctor has tied the "cord" by which, till this moment, it had, during its months of gestation, been connected vitally Avith the mother. Through that both nourishment and air (without breathing) had passed into its system from hers, affording material and stimulus for its groAvth and development. Now, it must have a separate (though still depend- ent) existence. Nothing in the world is so utterly helpless as it! Exhausted with her labor, the mother must be allowed to rest awhile. Another (a nurse or friend) takes the babe to another room, sufficiently warm. She rubs it all over carefully with fresh lard or oil (some doctors now prefer vaseline or cosmoline; I do not). Carefully, all over; for the material on the surface of the body must be all removed. The mouth and eyes, and inside of the ears, should be well cleansed Avith a soft sponge, or soft rag or towel, dipped into warm Avater. Then, after the greasing, Avhite castile soap and Avarm water must be used to wash it thoroughly (gently, of course). Some babies, after this, will be as red almost as a brick. A few will have a fine red rash, called in the nursery the " red gum." Still feAver may be yellow for a few days: the " yellow gum." Neither of these is usually of consequence. Occa- sionally the yelloAvness may grow into a real "jaundice of the newly born." The cord, at the navel, will come off itself Avithin six or eight or NOURISHMENT. 415 nine days. At first, the best thing to do is to cut a piece of old linen or muslin about two and a half inches square; nip out in its centre with scissors a hole large enough for the cord, and after smearing the rag well with simple cerate, cold cream (from the apothecary's), or ben- zoated zinc ointment, pass the cord through it, and double it over tAvice. Then a light, soft flannel band may be wrapped over this around the babe's abdomen, not tightly; just tight enough to stay in its place. Every day, when the child is bathed, put a fresh greased rag upon the cord. If there comes to be any odor to it, sponge it (with a sponge kept clean just forthat)Avith lime-water instead of common water. Should any soreness or rawness remain after the cord drops off (as it should, after some days, Avithout being pulled), a soft doubled rag or compress, thickly spread with benzoated zinc ointment or simple cerate, should be kept upon it until it is quite healed. After two, three, or four hours of rest, the child may be put to the mother's breast. Before that, or later if the mother's condition cause delay, the babe needs no food or drink, and is better without it. The first milk, called " colostrum," is unlike what comes later, but will help to move the infant's bowels; Avhich is well. It is good for the mother (under usual circumstances) to have the child soon at the breast. Now we will suppose the first crisis to have passed. Babyhood has begun. Hoav must it be cared for ? Any mother of a second child can tell, as experience is better than any other teacher. But with the first baby, at least, much is yet to be learned. NOURISHMENT. Every mother should, if she can, nourish her own child, from her own breast. " It is as much her duty to suckle it as to bear it." This x is nature's law, as well as the law of love. At first, for a few weeks, every two hours will not be too often for the child to be suckled, even at night. But the night intervals should be gradually lengthened; so that by the third or fourth month three hours may intervene each time during the night, and two hours all day. Then, also by degrees, the between times should grow longer in the daytime. A child six months old may often be trained to take the breast every three hours through the day and evening, and not at all betAveen ten or eleven at night and five, six, or seven o'clock in the morning. 416 HYGIENE. Regularity is a great thing; to be aimed at and made a habit from birth. Never let a mother keep a babe, Avell or sick, dangling at her breast all the time, day or night; especicdly not at night, and most of all if it is sick. Then its digestion is sure to be weak, and its stomach needs intervals of rest. It may need more " coddling," carrying, and soothing, than when Avell; and, if feverish, it may be thirstv, and should have cold water, not milk, between times. This should then be given it, from a bottle or a teaspoon, instead of an excess of milk. Both breasts should be used, in turu, as nearly alike as can be. Othenvise the danger of "gathered breast" is. much increased. With- out early care as to this, a babe may " take a set" against one breast, and so give trouble. After nursing, the nipple should be carefully dried with a soft towel. In warm weather, it is a good plan to sponge it first Avith water in Avhich a little soda (bicarbonate) has been dissolved. If there is the least chafing, benzoated zinc ointment, or cold cream, may be applied; to be gently but thoroughly wiped off before nursing again. A mother's care of herself is of the greatest consequence to her child. If she be much agitated in mind, or tired out with company, or have her digestion interfered with by unwholesome food, or disturbed by poAverful medicines, her milk will affect her babe. Convulsions and death of an infant have resulted from a nursing mother being greatly excited by anger or alarm. Here, for example, is a case. A woman saAv her husband in danger from a quarrel with a soldier, who drew a SAvord upon him, which she snatched away. Soon afterwards she gave the breast to her infant, eleven months old, and before in good health. The child took it for a while, then quitted it with agitation, and died in a few minutes. Should a nursing woman take ale, beer, wine, or spirits to " make more milk " for her ? No, no, no! No healthy woman needs any- thing of the kind; if she takes much of anything alcoholic, it poison her milk for the child. Plenty of milk, and all other simple, nourish- ing, digestible food, after she has left her chamber, she should take. If these do not keep up her strength, she may have to wean, or partly Avean, her infant. But let her take no alcoholic drink whatever, unless ordered by a competent physician. Alcohol is to be regarded as medi- cine ; not food; especially for nursing mothers. Some mothers, unfortunately, cannot furnish nourishment for their offspring. Either they have no milk, or very little, so little that a child cannot live on it; or they are in such feeble health that it aviII risk their lives to afford it; or indisposition may make their milk unfit, unsafe for nourishment. What then ? Certainly, some other healthy mother's breast will be the next best WEANING.—BOTTLE-FEED lb vt. 417 thing ? Can this be had ? Far from always. A good wet-nurse may often be extremely hard to get. And one who is not good is worse than none. She must be sufficiently young, yet must have had some expe- rience ; tAventy-five is about a good age. She must be healthy, cleanly, kind, good-tempered, not stupid, and faithful. If all these qualities can be found, for love or money, in one person, by all means have a wet- nurse. If not, Ave must resort to the bottle. First, howeA7er, ascertain whether the mother has not some good milk, even though not enough. If she has half enough (as is the case with quite a number) let her give the babe the benefit of this, if it lasts, until the child has passed through the most of its teething, or at least has Aveathered its first summer. Let her nurse it two or three times in the day and evening, and give it (or have given to it) the bottle for the rest of the time. Indeed, it is a good plan, under all circumstances, for a child six months old to learn to use bottle-food, so as to make the change more easy later, especially if illness or some other cause should oblige the mother to wean it suddenly. WEANING. This never should be sudden, if it can be helped. How soon should it come ? American Indian squaws are said to suckle their papooses through their second year; some Asiatic mothers, even till near the end of the third year. Why not? Another gestation may interfere with it; making the supply of milk less in amount, and less wholesome. Some have thought that the return of the monthly period stands in the way; but of this there is not sufficient evidence. On the Avhole, if a mother can nurse her infant a full year, it will be well; if eighteen months, still better. When she has, up to two years, half enough for it, let it get what it can from her, and eke out the rest with outside nourishment. Never let a child be Aveaned in summer if it can be helped. BOTTLE-FEEDING. We speak of this at once, because the bottle is vastly better than the spoon. It imitates nature better; it allows the food to go more slowly into the stomach; and it gives the infant desirable exercise in taking it. If, then, the child cannot have the breast of its mother, or of a suit- able substitute, get for it a glass bottle, holding about half a pint, with 27 418 HYGIENE. a rubber nipple, but without a tube. Two bottles, or at least tAvo nip- ples, Avill be well to have, for alternate use and thorough cleansing of both. For a babe less than a month old, half a bottle at once will do for a meal. In a few months, it will readily take nearly or quite a whole one, several times a day. A child six months old can, and ought to, appropriate three pints of milk or more in tAventy-four hours. Re- member, a child has to grow as Avell as to live. Of course, Ave ought not to " stuff" it. When too much has been swalloAved, it will often (and had better) be thrown up. If it be milk, this is then usually curdled. Untaught persons are frightened at this; but the fact is that milk is always curdled at the beginning of digestion. The natural acid of the stomach acts thus upon it. After each time of use, the bottle ought to be scalded (that is, washed out with hot water); in summer time, or Avhere the child is delicate, an added precaution is to add soda to the water with which it is cleansed. MILK. What shall " bottle food " be ? Milk, of course, as the great staple article. Nobody has invented, or is likely to invent, anything half so good, as a rule. Ev7en Avhen some other foods are given, they are in most cases best added to or prepared with milk. Much has been said on our previous pages (under Food and Drink) about the qualities of milk; how to tell good milk from poor milk, etc. Let us, then, here only emphasize a few matters. Cow's milk is almost the only kind used in this country; here and there, goat's milk may be had. Cow's milk is stronger in " solid con- tents than woman's milk, but the latter is sweeter.* Commonly, then, during the first months, a little pure water is added (half, or less, of the amount of milk), and a little Avhite sugar. As the child groAVS older, * Professor A. R. Leeds (1884) gives as the result of eighty analyses of human milk, the following average composition for it: Albuminoids (casein and albumen).....2 parts. Fatty matter (cream)........4 Sugar of milk.........7 Ash (mineral salts)........0-20 Water ........86.80 100.00 Cow's milk contains more than twice as much of the (nitrogenous) albuminoids, a considerably less sugar. Woman's milk is rather more dense than cow's milk, navi g a specific gravity of 1031, water being 1000, and cow's milk 1029 to 1030. MILK. 419 less water is needed, and Avithin the year, often, none at all. A great mistake was formerly made, in mixing tAvo pints of water Avith e\7ery pint of milk; the poor things sometimes, no doubt, starved under such a reffimen. But, sometimes, the thicker and harder curds made in the stomach Avith cow's milk may be difficult for the babe to digest. It becomes colicky aud fretful, or it refuses the bottle. Then we must add rather more water, and something else to help to diffuse the clots, thus keeping them from forming solid masses. Starchy (farinaceous) materials will do this pretty well. Such alone will not nourish a child fully, as explained in our Physiology ; arroAV- root, farina, and other starches contain no nitrogen, and some of this element is indispensable for the growth of muscles, bones, and brains. Moreover, during the first three or four months very little saliva or pancreatic juice is formed, aud, without these, starch is not digested. But the mechanical qualities of starch fit it for mixing up the casein and albumen of milk in the fluids of the stomach, and so promoting its digestion. Simple articles, especially barley, rice, and oatmeal, are commonly available for this purpose. Either of them does best when ground (or beaten in a mortar) to a fine powder for use. Barley-water ansAvers Avell Avhen the boAvels are about right (that is, from tAvo to four moderate, natural passages daily); rice, Avheu there is diarrhoea; oatmeal, when the child is " bound," or not free enough in the boAvels. For barley-Avater, a teaspoonful of barley-meal for a tAvo or three months' old infant, two teaspoonfuls for one over six months, may be mixed Avith a tablespoonful or two of cold water, and then put into a pint of water. Bring this to the boiling-point, and boil it down to half a pint. (With an ordinary fire, this may require half an hour or more.) Strain it through a fine sieve or a clean linen cloth, and stir it in Avith a pint of milk, adding a little salt, and an even teaspoonful of granulated white sugar. Put what is not used at once, in a cold place (on ice, if it be summer time, or in the spring-house in the country) to keep for the next feeding-time. Never give milk twenty-four hours old to a young child, under any circumstances. Rice and oatmeal may be prepared in the same Avay, and used accord- iug to the state of the child's boAvels, when milk alone does not appear to digest well. Should neither of these simple additions meet the difficulty, you may safely try some of the " infants' foods." Mellin's, Horlick's, Xestle's, and Imperial Granum are, I think, the best. These " foods " are not, like arroA\7-root, sago, and tapioca, merely starches. They con- fain some also of the nitrogenous materials. Imperial Granum, for in- 420 HYGIENE. stance, is reported to consist of selected and carefully prepared ichrat. Similar in nature are nutrina and papoma, and cerealina. Dr. J. F. Meigs' food is particularly designed for infants with weak bowels. For making it, take a piece of gelatin tAvo inches square; soak it aAvhile in a little cold Avater, put it into a pint of Avater and boil it down to half a pint. While it is boiling, add to it half a pint of milk and a table- spoonful of cream, with a little white sugar; then it is readv for use. It would be hard to prove one of these foods, as a rule, to be much better than another. Some suit one child, some another; and all of them are valuable as occasional additions to, or variations from, never as total substitutes for milk. Condensed milk may be used Avhen you cannot get reliable fresh milk; only then. It needs no additional sugar. One or two teaspoonfuls of it will be enough for a bottle, at least for a young infant. It is not necessary, indeed it is hardly desirable, to ask a dairyman to furnish only the milk from one cow. You must know the coav very well to be sure that its milk is the best. A good dairyman is the best dependence of all; and there is no harm in mixing the milk of several cows, all equally fresh. What ought not to be done is to mix two days milks together. Thorough scouring of the pans, and keeping milk in a pure atmosphere (as well as a cool one), are of extreme importance. When milk is served only once a day in hot weather, it had better be brought at once to the boiling point,—to make it keep better,—and then set in the coolest and cleanest part of the house; best of all, put on ice. A young infant, under a year old, had better take all its food warm; unless in the torrid heat of our midsummer. With the thermometer from 95° to 98°, one does not, young or old, Avant anything warm, inside or out. If there be a sour smell on the breath, or sourness of the curds throAvn up, or colicky pain after feeding, or beginning looseness of the bowels, lime-water should be added to the bottle-food. A tablespoonful to the bottle will not be too much. It is always harmless, if the bowels are not constipated; and it often does a great deal of good. When very tough curds are formed after taking cow's milk, a pinch of soda (bi- carbonate) will help to dissolve them still more effectually than lime- water or the starch foods. But soda must be used in small doses, and occasionally only. Lime-water may be, if called for, an every-day rem- edy for sourness of stomach, especially with a disposition towards diarrhoea. For thirst, between feeding-times, in summer Aveather, the best plan is to give cold Avater moderately, and supply from time to time a soft clean rag containing pounded ice for the child to suck. When a sick child has fever, hoAvever, it may often need to drink a good deal of Avater. j CLOTHING. 421 CLOTHING. Referring again to Avhat has been already said in another part of this volume about clothing for persons of all ages, Ave may now shortly repeat some main things in regard to babies. Let their clothing, from birth, be warm enough and loose enough for comfort. No tight bands should ever be put on them. Some parents, in over-anxiety about cold, put on three times as much as is needed, and then shut all their chamber and nursery windows and doors, Avith big, hot fires; wondering, then, that their babies are fretful, get skin diseases all over, and ofteu seem to catch cold almost every time they are taken out! Babies resist actual cold less safely than older persons; but just enough clothing is ahvays better than too much for them. And they do not need to have the rooms they live in any warmer than Ave do—say 68° to 70° Fahr. usually. They are also more hurt by close, foul air than groAvn people are. When they are old enough to wear short clothes, a common mistake has been of an opposite kind: to leave their arms and legs bare; they are so pretty thus! But many an attack of croup and of inflammation of the lungs, sometimes fatal, has folioAved such exposure in a chilly atmosphere. Children should have no less protection of their limbs from cold than men and Avomen. Even though, when healthy and active, they do not seem to feel it; it is not safe. Very important is the changing of clothes Avith infants. When their thighs are Avet, and all next to them is soiled, they should be changed at once, always. Neglect of this may cause chafing of the skin, very disturbing to the child, and sometimes as bad as a burn. A soft sponge is, Avhen the skin is tender, better than a rag or toAvel; but a sponge must be well cleansed every time, Avith soap and hot water, to be used again. Dusting with a little "pat" filled with fine starch or arroAv-root powder is very soothing and protective. When the skin has become sore about the thighs, the child will show it by a sharp cry on wetting itself. Redness also, as well as tenderness to the touch, will be found on examining it. Then tallow, cold cream (of the apothecary), or oxide of zinc ointment, should be applied gently every night and morning (or oftener if need be) after changing it. The worst cases, such as come only from considerable neglect, may need to be treated like burns, with soft rags, wet with lime-water and SAveet oil (equal parts, mixed), and covered with oiled silk. Babies, as well as adults, should have the head kept cool, and the 422 HYGIENE. feet warm. Out of doors, a cap is all right—thick or light according to the season; but there is no need of any cap being Avorn in the house. They are better Avithout it. A frequent trouble is Avith the bed-covers at night. First, never for- get that covering makes no warmth of itself. It only keeps (l>v non- conduction) Avhat Avarmth the body has of its OAvn. So, if a baby is put cold into a cold bed, especially if it be sick, it may scarcely get Avarm all night. In that case the bed-elothiug should be wormed first; by passing a hot flat-irou under and over it; or, for an ill baby, keeping a Avarm brick or bottle or tin of hot water in the bed Avhile needed. Restless children will often fling and kick the bed-covers all off at night; and this exposes them to taking cold. AYatching thein all night is hard service. Much better Avill be the canton-flannel night-gown, seixn up tight (like mittens) at the ends of the hands and feet. If thev do throw everything else off, this will keep them still pretty warm. Must infants always wear flannel in the daytime? Delicate ones certainly should, in our climate; thick (though soft) flannel in winter, and light flannel in summer time. When an infant sIioavs itself, at two or three years of age, to be hardy, its summer flannel may be left off safely. Silk, or merino, will do for all but weakly children. BATHING. A new-born child should be bathed only in warm water, in a Avarm room. From 95° to 90° should be the temperature of its bath; the thermometer had better be used, as the touch is so uncertain.* As it gets older, at least if it seems " hearty," the water may be allowed gradually to go down to 85°; or, in Avarm weather, even 80°. The best test of its not being too cool is, the infant being rosy and merry after the bath. A child should like its bath, if it is rightly managed; never startling it with a sudden plunge, but accustoming it to it by de- grees. A mother had better bathe her OAvn baby, if she is well and strong enough to do so. One error especially to be avoided is, letting a child, once wet all over, sit half in and hedf out of the water; being thus chilled by evaporation from the uncovered part of the body. A little patient of mine, just * Some intelligence, also, is here wanted. Once, when my baby was to be bathed, its mother sent the nurse with the thermometer to see whether the room was warm enough. She came back in about five minutes, saying that at first it was too cold, D after she had put the thermometer to the fire awhile, it got quite warm! EXERCISE.—AIRING. 423 getting Avell after scarlet fever, lost his life through this kind of im- prudence on the part of a nurse. During our hottest weather, when the thermometer ranges between 95° and 100°, even a young infant may profit by a cool bath, say at 75° or 70°; but then it must be a short-time bath also. The cooler, the shorter the time of immersion. Much soap does not need to be used in bathing infants. If the child be bathed daily, it needs (after its first thorough cleansing) only an occa- sional employment, unless about the thighs, of a little of the best castile soap. Salt may be added to the bath if the child is Aveakly, for its tonic effect. In sickness, warm or hot baths may be of great service; but our account of the use of such belongs in another place. EXERCISE. After the first few months, a babe should be allowed and encouraged to sprawl; first on a Avide bed, being watched that it does not fall off; afterwards on a carpeted floor, or a rug. This will spread its chest, and bring most of its muscles into play. Thus it will gain strength, and get ready, in due time (elon't hurry it) to stand up and walk. Crawling conies first, according to the true nature of bodily development. AIRING. Very soon every baby ought to begin to be taken out in fine weather. In summer, no matter hoAV soon ; in Avinter, it requires care about keep- ing it warm, of course. But quite young infants may be, with proper out-of-door clothing, accustomed to being taken out into the sunshine and air every fine day. A nursery ought to be always a sunny and well-aired room. As already said, infants suffer more harm from bad air than groAvn people do. Scarlet fever, measles, Avhooping-cough, diphtheria, and all other diseases are commonly worst, killing the most children, in tenement- houses (like those of NeAv York and Boston); and, elsewhere, in crowded alleys, where people live too close together and do not have fresh, pure air to breathe. 424 HYGIENE. SLEEP. For the first month or two, an infant naturally sleeps more than half its time. All through the first year, many babies sleep from twelve to sixteen hours in the twenty-four. It is a grand thing for all concerned when the little one can be trained early to sleep most of the night. Habit may be formed, in such matters, very soon. On this something was said when we were considering the feeding of babies. Lay the child down to sleep, from the start; do not get it used to being carried about to go to sleep in somebody's arms. Put it to sleep in its crib alone, as a rule. Hard to believe as it seems, some Aveary slumbrous mothers have overlain their babies; that is, rolled upon them while asleep and suffocated them. Moreover, the vapors from another human body make the bed less Avholesome for the child. Yet, with a wide bed, convenience may sometimes afford reason for a child being laid beside, but not too near, its mother or nurse. Never rock a child in a cradle. This has, happily, quite gone out of fashion. If it has any effect, it is by causing a kind of dizziness (like seasickness) which cannot be good for the child. Let the baby soon get used to going to sleep in the dark. Otherwise, Avhen it gets older, it will be afraid to do so, Avith a fear often very hard to overcome. Put no curtains about a bed, for child or groAvn person. Bed-curtains were an absurdity of an almost inexcusable kind. It is hard to get enough pure air into a sleeping chamber; let alone inside of a closely curtained bed. If we slept out of doors, as men do in camps, Ave ought to cover our bodies warmly; and bald people, their heads; but even then, our faces ought to be out, anyAvhere at least short of the neighbor- hood of the North or South Pole. Most babies, when they do sleep well early in the night, wake very early in the morning, and then want food. Before noon they are apt to be ready to take a nap of two or three hours. Some will also want an afternoon nap of an hour or two. Let them sleep all they will; sleep and groAV fat. Never wake a young child (or indeed an older one) suddenly; it jars their brains. When their sleep is out they will Avake up of themselves. DISCHARGES.—TEETHING. 425 DISCHARGES. Every mother ought to know that it is natural for infants to have tAvo, three, or four passages from the boAvels every tAventy-four hours, Avhen perfectly well. In the first month or two the discharge is more or less fluid; afterwards it becomes more nearly solid, but ahvays softer than later in life; of a broAvn color Avhen nothing is the matter. A sick child may have the stools slate-colored, yelloAV, green, black, curdy, slimy, or bloody; all of Avhich changes are important, and will be noticed in the medical part of our Avork hereafter. (See page 508.) Water is passed from the kidneys of an infant several times during each twenty-four hours. If that is not the case, something is wrong, and requires attention. Warming the Avater of its bath more than usual is a suitable measure at such a time; and giving SAveet sp. of nitre, 3 or 4 drops at once, in a teaspoonful or more of water. TEETHING. Mothers and nurses ought to know what to look for in their babies' mouths, as the months follow each other in their first two years. Only twenty teeth, be it remembered, come in the first set, or " milk teeth." Thirty-two folloAV these, and take their place, in the second set. About the end of the sixth month (from the fifth to the eighth), it is common for the tAvo lower middle front teeth to appear through the gum; and not long after, even sometimes before these, the two upper middle front ones. These are called cutting or incisor teeth. So are the next to come out—alongside of the first—the lateral incisors (side cutting teeth), beloAv and above; Avhich appear between the eighth and the tenth months. Before the infant is a year old, then, it usually has at least its eight front teeth out: four below and four above. Next, we might expect those nearest these to appear; but they do not. Instead come the first jaw or molar teeth : two below and two above; betAveen the twelfth and the fourteenth months. Then follow, between the fourteenth and twentieth months, the stomach and eye teeth, as people call them; the four canine teeth, two below and two above; pointed teeth. After these, and last of the first set, come the second jaw or molar teeth: two beloAv and two above; between the eighteenth and the thirty-sixth months. In each jaw, in all, there are then four incisors, 426 HYGIENE. two canines, and four molar teeth; doubling these, Ave get the twenty of the whole set. The following diagram shows this, with the order of their succession: 5 3 4 2 1 1 2 4 3 5 M M c I I I I c M M M M c I I I I c M M 5 3 4 2 1 1 2 4 3 5 I stands for Incisor ; C for Canine; M for Molar. This order is the general mode of succession; but variations from it are far from rare. Often the upper teeth, front and all, come before Fig. 172. DEVELOPMENT OF TEETH. the lower ones. The time for each group of teeth is frequently later, and sometimes earlier, than that above mentioned. Last week, for example, I was told of a baby which has four front teeth out at five months; and I once had under my care an Irish child Avhich was born with two upper teeth. Historians tell the same thing of Julius Caesar. As the time comes near (about the sixth or seventh year) for the second dentition, the new set, whose germs were in the jaws at birth, grow steadily larger in the gums. The milk-teeth are vot forced out; but, under the wonderful natural adaptation of parts, their fangs arc gradually absorbed, and thus they loosen and drop out, or are easily taken out, and make Avay for the second set of permanent teeth. (Hoav often not very permanent in our country, all the dentists know.) i TEETHING. 427 These are thirty-two in number (see Anatomy). The first to come through the gums are the first molar or jaAV teeth. Next, at about seven years of age, the middle incisors ; then the lateral incisors, at or near the end of the eighth year. After these, the first pre- molars (bicuspids) or lesser jaAV teeth; and in the ninth year, the second premolars. Between eleven and twelve years, the permanent canines, tAvo above and two beloAv. From tAvelvre to thirteen or four- teen years, the second molars; and from seventeen to twenty-one years, the last molars, or wisdom teeth. These last are often imperfect from the start. Occasionally, even the second teething is attended by soreness and irritability of the mouth, nervousness, ete. But very often it Avould pass almost unnoticed, except for the " bother" of getting rid of the loosening first teeth, as the others come. The really trying teething time is Avith the first set of teeth; from the sixth month to about the end of the second year of infancy. Dentition is a process of growth. A great deal of blood is needed in the tissues of the jaws for this purpose. Moreover, for the teeth to " come out," the gums must give way, by absorption. Should this be sIoav, a tension of the gum may occur; and, through the ner\Tes, the whole system may be brought into sympathetic excitement. As the nervous apparatus is much more irritable, more easily disturbed, in babyhood than in adult life—we often have, from this cause, worry- ing; fretfulness; sometimes fits, or convulsions. A child AA'hich was "always good" before, now may cry a great deal, losing its reputation for goodness altogether. A Avord here about babies' crying. A healthy child, not teething, if well taken care of, will very seldom cry. Some mothers and nurses will not admit this; but from a good deal of observation I insist upon it. Mark, I say a healthy child, well taken care of. If a child's Avants, namely, food, warmth, sleep, and timely changing, are duly attended to, Avhy should it cry ? But if it becomes very hungry, and is not nour- ished, or is cold, or too warm, or is left Avith garments soiled and wet, of course it cries. And, the habit once formed, cry it will, though the Avhole household and neighborhood regard it as a " crying evil." Several sorts of crying may be observed, Avhich it is desirable to understand. First there is the cry of surprise, on the child being first ushered into the world. That is all right and natural. " On mother's knees, a naked, new-born child, Thou only wept, while all around thee smiled. So live, that, sinking in thy last long sleep, Thou then may'st smile, while all around thee weep." 428 HYGIENE. Next, comes the calling cry, of hunger, thirst, or other want. Sharper and shriller, sometimes a violent scream, is the cry of pain; as of colic or earache; or of fright, as Avhen a babe rolls out of its bed or crib upon the floor. Much like the cry of simple Avant, but habitually harsher in manner, is that of demand or command, of a child already spoiled; finding that whatever it cries for it will get. An aggravation only of this, is the (sometimes fairly impish) roar and succession of screams, of temper and passion. Disease has various cries; according to its char- acter. Sometimes it is only a faint moan, attending nearly every breath. Other times it is hoarse, as in croup; along Avith a short, barking cough. Or it may be the Avild scream of inflammation of the brain. Of these, Avhich are symptoms of diseases, more in another place. Teething is not a disease, a morbid process, at all. But it is an important change, Avhich for the time renders the child more than before or after liable to disorders, under any disturbing causes; and the process of penetration of the gums by the young teeth may some- times itself be imperfectly accomplished. The most common and least alarming effect of the " sympathetic irritation " of teething is diarrluro. This seems often to give a safe vent and relief to the disturbance of the system. Three or four, or even five moderately free passages from the boAvels daily, at such times, are not objectionable; are much better than constipation. Convulsions are frightful to behold, and attended by danger. Of these we will speak in the medical part of this work. Here, howeA7er, it may be suitable to refer briefly to lancing the gums. Once, this practice wras universal; every babe had its gums cut almost every time that a new tooth Avas about to appear, whether it gave much trouble or not. From this (as with bleeding from the arm, and some other old methods of practice) there has come to be a reaction, and some physicians never lance infants' gums at all. Having been brought up and beginning practice under the old regime, I have seen enough to con\7ince me fully that extremes are not right here, more than else- Avhere. Healthy babies may often pass through their teething without needing to have their gums lanced. But some may be, by this simple and harmless means, kept from having convulsions, Avhich, if brought on, may threaten their lives. I call lancing the gums harmless, because it should be and always may be so. Use a clean, sharp lancet, and divide the gum with a straight, firm cut; in the direction of the edge if it be an incisor, and across the crown if a molar tooth; and then there will never be any " scars" or other trouble. Perhaps once or tAvice in a century, in America or Europe, a child may be found whicn is naturally a "bleeder,"* so that the smallest cut will hardly be wife. * Haemophilia of medical language. J SUMMER DANGERS. 429 If so such a tendency must be a family trait, already well knoAvn and to be remembered. My belief is that it is well to lance the gums Avhenever they are much woollen, red, painful, and worrying, to the child, making it nervous and hard to get to sleep; or when, even though not SAvollen, the tooth is evidently not far Avithin the gum, Avhich seems tense, and a source of irritation, calling for relief. Many a child, once helped by this measure, will ask for it, Avith looks if it has no words (as I have seen) to have it repeated. A lesser, but not unimportant means of relief for Avorriment of the mouth during teething, is the use of rubber rings, bits of ivory, etc., smooth and firm, but too large to SAvallow, for the child to bite upon. When there is much heat of the mouth, a soft rag filled with pounded ice will, in.summer time, do the most good. At no time is it more needful than during dentition, to be very care- ful about the food Avhich the child takes. Indigestion is a very common exciting cause of convulsions. SUMMER DANGERS. In our American cities, hot weather kills more young children than any other cause. Look at the weekly record of deaths in NeAv York or Philadelphia, and you will find that ev7ery degree of noon temperature above 95° costs scores if not hundreds of little lives. In those cities, about one-half of the deaths of children in the first year of life, and nearly one-third of those in the second year, take place in June, July, and August. High heat, crowding, filth, and unsuitable food, conspire against chil- dren in the summer homes of the city poor. But the rich may suffer also, from excessive heat, town air, and improper diet, for their children ; and these causes produce many cases of summer complaint, or " cholera infantum." Whoever, of our city families, can take their infants out into the coun- try, during their first, second, and third summers, for the months of June, July, August, and September, ought to do it. With those who cannot, the next best thing is to take or send them out on frequent ex- cursions, on land or water, and to have them often in the open parks or squares ; for as much pure, cool air as they can get. It is the best pre- ventive, and often the best curative, of summer complaint. For those who are obliged to live in the crowded parts of towns of 430 HYGIENE. villages, the rules given by the Obstetrical Society of Philadelphia "for the management of infants during the hot season " have proved service- able. I Avill quote them here, in addition to Avhat has been alreadv said on our previous pages on the same subjects. Rule 1.—Bathe the child once a day in tepid Avater. If it is feeble sponge it all over once a day with tepid water, or with tepid Avater and vinegar. The health of a child depends much upon its cleanliness. Rule 2.—AA'oid all tight bandaging. Make the clothing light and cool, and so loose that the child may have free play for its limbs. At night undress it, sponge it, and put on a slip. In the morning remove the slip and dress the child in clean clothes. If this cannot be afforded, thoroughly air the day-clothing by hanging it up during the night. Use clean diapers, and change them often. Never dry a soiled one in the nursery or in the sitting-room, and never use one for a second time without first washing it. Rule 3.—The child should sleep by itself in a cot or cradle. It should be put to bed at regular hours, and be early taught to go to sleep Avithout being nursed in the arms. Without the advice of a physician, never give it any spirits, cordials, carminatives, soothing-syrups, or sleeping-drops. Thousands of children die every year from the use of these poisons. If the child frets and does not sleep, it is cither hungry or ill. If ill, it needs a physician. Never quiet it by candy or cake; they are the common causes of diarrhoea and of other troubles. Rule 4.—GiA'e the child plenty of fresh air. In the cool of the morning and evening send it out to the shady sides of broad streets, to the public squares, or to the Park. Make frequent excursions on the riA7ers. Whenever it seems to suffer from the heat, let it drink freely of ice-water. Keep it out of the room in Avhich Avashing or cooking is going on. It is excessive heat that destroys the lives of young infants. Rule 5.—Keep your house SAveet and clean, cool and Avell aired. In A-ery hot weather let the windoAvs be open day and night. Do your cooking in the yard, in a shed, in the garret, or in an upper room. WhiteAvash the Avails every spring, and see that the cellar is clear of all rubbish. Let no slops collect to poison the air. Correct all foul smells by pouring carbolic acid or quicklime into the sinks and privies. The former article can be got from the nearest druggist, who Avill give the needful directions for its use. Make every effort yourself, and urge your neighbors, to keep the gutters of your street or court clean. Rule 6.—Breast-milk is the only proper food for infants. If ""' supply is ample, and the child thrives on it, no other kind of low should be given Avhile the hot Aveather lasts. If the mother has not SUMMER DANGERS. 431 enough, she must not Avean the child, but give it, besides the breast, goat's or cow's milk, as prepared under Rule 8. Nurse the child once in two or three hours during the day, and as seldom as possible during the night. Always remove the child from the breast as soon as it has fallen asleep. Avoid giving the breast when you are over-fatigued or overheated. Rule 7.—If, unfortunately, the child must be brought up by hand, it should be fed on a milk-diet alone, and that, warm milk out of a nursing-bottle, as directed under Rule 8. Goat's milk is the best, and next to it, cow's milk. If the child thrives on this diet, no other kind of food whatever should be given while the hoi weather lasts. At all seasons of the year, but especially in summer, there is no safe substitute for milk to an infant that has not cut its front teeth. Sago, arrow-root, potatoes, corn-flour, crackers, bread, every patented food, and every article of diet containing starch, cannot and must not be depended on as food for very young infants. Creeping or Avalking children must not be allowed to pick up unAvholesome food. Rule 8.—Each bottleful of milk should be sweetened by a small lump of loaf-sugar, or by half a teaspoonful of crushed sugar. If the milk is knoAvn to be pure, it may have one-fourth part of hot Avater added to it; but, if it is not knoAvn to be pure, no water need be added. When the heat of the weather is great, the milk may be given quite cold. Be sure that the milk is unskimmed; haATe it as fresh as possible, and brought very early in the morning. Before using the pans into which it is to be poured, ahvays scald them with boiling suds. Iu very hot Aveather, boil the milk as soon as it comes, and at once put away the vessels holding it in the coolest place in the house—upon ice if it can be afforded, or down a Avell. Milk carelessly alloAved to stand in a warm room soon spoils, and becomes unfit for food. Rule 9.—If the milk should disagree, a tablespoonful of lime-water may be added to each bottleful. Whenever pure milk cannot be got, try the condensed milk, Avhich often answers admirably. It is sold by all the leading druggists and grocers, and may be prepared by adding, Avithout sugar, one teaspoonful, or more, according to the age of the child, to six tablespoonfuls of boiling Avater. Should this disagree, a teaspoonful of arroAv-root, of sago, or of corn-starch to the pint of milk may be cautiously tried. If milk in any shape cannot be digested, try, for a feAV days, pure cream diluted with three-fourths or three-fifths of water—returning to the milk as soon as possible. Rule 10.—The nursing-bottle must be kept perfectly clean; otherwise the milk will turn sour, and the child will be made ill. After each meal it should be emptied, rinsed out, taken apart, and the tube, cork, 432 HYGIENE. nipple, and bottle be placed in clean Avater, or in Avater to which a little soda has been added. It is a good plan to have tAvo nursing-bottles, and to use them by turns. Rule 11.—Do not wean the child just before or during the hot AAreather, nor, as a rule, until after its second summer. If suckling disagrees with the mother, she must not Avean the child, but feed it in part, out of a nursing-bottle, on such food as has been directed. How- ever small the supply of breast-milk, provided it agrees Avith the child, the mother should carefully keep it up against sickness: it alone Avill often save the life of a child Avhen everything else fails. When the child is OA7er six months old, the mother may save her strength by giving it one or two meals a day of stale bread and milk, which should be pressed through a sieve and put into a nursing-bottle. When from eight months to a year old, it may have also one meal a clay of the yolk of a fresh and rare-boiled egg, or one of beef- or mutton-broth into which stale bread has been crumbled. When older than this, it can have a little meat finely minced; but even then milk should be its principal food, and not such food as grown people eat. CONSTIPATION OF THE BOWELS IN CHILDREN. When an infant's bowels do not act, at least once or twice, freely, every day, sweet (olive) oil may be given, a teaspoonful at once; or manna, a quarter of a teaspoonful at a time (it is SAveet and easily taken); or simple syrup of rhubarb, a teaspoonful at once; or glycerin, a teaspoonful at a time. If the stomach is sick at the same time, mag- nesia (Husband's or Henry's is best) may do more good, a quarter or half a teaspoonful, according to the age of the child, stirred well up in a little water. If colic is present, castor oil, a teaspoonful mixed with two teaspoonfuls of spiced syrup of rhubarb will be the best thing to open the bowels. VITAL STATISTICS. 433 VITAL STATISTICS. In a book like the present, it is appropriate to occupy but a small space with a general vieAV of this subject, Avhose full consideration would require a large volume. Exact and certain statements, moreover, are not yet to be obtained upon it; a great deal is more or less conjectural. Still, the experience of those Avho make a study of statistics renders the results gathered by them of value towards understanding the causes of disease, and thus improving the means of preventing diseases and pro- longing human life. Our present purpose will be best served by a summary account of the main facts. Approximate Statistics. Population of the World, 1,475,000,000. Population of the United States, 60,000,000. Most Populous Regions, Egypt, China, Belgium, England. Marriages in Europe, 15 to 1000 inhabitants, annually. Marriages in United States, 17 to 1000 inhabitants, annually. Births to each Marriage, Europe, 5; France, 3; United States, 4. Births to Population, Europe and America, 1 in 30. Sexes: 9362 Females born to 10,000 Males. 9190 Females die to 10,000 Males. Deaths to Population, yearly, United States, 1 in 45. Deaths to Population, yearly, Census of 1880, 18 in 1000. Lowest Annual Mortality anywhere, 15 in 1000. Lowest Annual Mortality to be expected in a healthy locality, 17 in 1000. Average age at death in United States, 35 to 40 years. Average age at death the Avorld over, 33 to 35 years. Average age at death in England and Scotland, 41 years. Average number of cases of sickness for each death, 25. In regard to different classes of people, the modes of living, work, and surrounding circumstances, make a great difference; although those Avho live very long are found, noAV and then, under the most varied conditions. Of 112 peers in Great Britain the average age at death was sixty- seven.* At Berlin, the mean term of life in the upper classes, accord- ing to Casper, is fifty years; of the poorer residents of the same city, The same was the average age of the clergymen of the Church of England who died in 1869. 28 434 HYGIENE. thirty-two years. The Friendly Societies in England have found their members to average forty-three and three-quarter years; these being, however, usually persons who take more than average care of themselves. The following table (Wynne) is taken from statistics of the State of Massachusetts. Average Longevity of Men. Judges . . 62 to 67 years Paupers 65.19 u Gentlemen (of leisure) . 62 to 64 a Bank Officers 61.75 « Millers 61.5 it Clergymen . . 56.25 to 56.5 it Lawyers . 56.5 it Physicians . . 55 to 55.75 It Hatters 55 11 Farmers* , . 47 to 64 it Merchants . 52 tt Artisans . . 40 to 44 tt Clerks . 33.75 tl Laborers . 34 it Railway Conductors 37 it Brakesmen 27 it Flint Makers 19 it Women. Nurses......54.6 years. Housekeepers . . 51 il Shoebinders . 45.5 it Domestics . 44 it Seamstresses . 41.8 a Tailoresses . 40.5 it Milliners . . 35.5 it Dressmakers . 32.33 it Straw-braiders . . 35 it Teachers . . 28 it Day-workei s . 27.7 a There must be some important omissions in this last table. " Ladies who do not have to support themselves are not mentioned. Teachers are * According to the Massachusetts Report for 1864, farmers averaged more sixty-four years of life. VITAL STATISTICS. 435 not now (hoAvever they may haves been formerly) often worked to death by the end of their twenty-eighth year. Moreover, among persons known to have lived to be ninety or one hundred years old, there are more women than men. The main worth of such averages is relative ; that is, to show the general difference in the probability of life among those of different avocations and modes of living. According to the English census returns, Neilson finds the mortality in various occupations to be as follows: Mortality per 1000 Persons Living. Deaths to THE 1000. Church of England clergy . . . 10.02 Nonconformist clergy . 10.01 Roman Catholic clergy . 15.7 Physicians . 12.6 Surgeons and Apothecaries i . 18.7 Barristers-atelaw . 10.9 Attorneys . 16.2 Provision-curers . 16.8 Butchers . . 17.4 Poulterers . 21.1 Fishmongers . 17.4 Iron miners . 13.7 Coal miners . 14.8 Tin miners . 16.1 Lead miners . 20.3 Copper miners . . 24.7 Iron manufacturers . 12.7 Paper " . 13.0 Tin " 13.1 Nail . 13.2 Brass " 13.8 Glass " 15.8 Copper " 18.5 Lead " 19.3 Earthenware 19.7 Blacksmiths 13.8 Whitesmiths . 16.8 Coppersmiths . 17.1 Plumbers 18.3 Railway officers 12.8 " laborers 14.2 436 HYGIENE. Mortality per 1000 Persons Living—(Continued). Deaths to THE 1000. Railway porters . . . . .15.2 Engine drivers Domestic gardeners . " grooms " coachmen . " general servants Beer-sellers Wine merchants Licensed spirit retailers Inn and hotel keepers 16.3 7.9 9.8 14.7 13.6 20.6 23.3 23.9 26.8 Among the curiosities of vital statistics (not without partial explana- tion, however) are some referring to the JeAvish race now in Europe. From a recently published statement, it appears that the average life of the Jew in London is forty-nine years, while of the Christian it is only thirty-seven years. Of a given number of Christians, only one-quarter will, as a general rule, live to be sixty years, while among Jews one- quarter live to be at least seA7enty-one. Among children, fourteen per cent, of the Christian population die between one year and five years of age, while only ten per cent, of the Jewish children do so. In Prussia it requires fifty-one years for the Christian population to double itself, and only forty-one years for the Jewish. Other facts concern the ages at which people marry. The greatest number of marriages for men take place between the ages of twenty and twenty-five in England, between twenty-five and thirty in France, and between twenty-five and thirty-five in Italy and Belgium. Finally, in Hungary, the number of individuals who marry is .seventy-two in a thousand each year; in England it is sixty-four; in Denmark, fifty- nine; in France, fifty-seven, the city of Paris showing fifty-three; in the Netherlands, fifty-three; in Belgium, forty-three; in Norway, thirty-six. Widowers indulge in second marriages three or four times as often as widoAvs. For example, in England there are sixty mar- riages of widowers against twenty-one of widows; in Belgium there are forty-eight to sixteen ; in France, forty to twelve. In New York State, in 1865, there Avere 196,802 families without children. I have not at hand any reliable estimate of the ages at which mar- riages occur in this country. Probably the greatest number by tar take place between twenty and thirty years. In Oriental countries, Avomen are often made wives at tAvelve or thirteen years; in India they are given away by their parents as betrothed at still earlier ages. VITAL STATISTICS. 437 The numbers of the sexes, in our Eastern and Western States, differ remarkably. In 1860, in California, there Avere three men to one woman • in Nevada, eight, and Colorado, twenty. In NeAv England, there are about 60,000 more women than men. Again, the variations in stature in our large country are interesting. We have no very reliable statistics on this point except those taken during the civil Avar, recorded by Dr. B. A. Gould, in regard to the height of men in the United States army. IoAva sent the tallest men into the army, the average height of her troops being 69 inches. The loAvest average was in the soldiers of New Jersey, 66.7. Maine, Vermont, Ohio, Indiana, Minnesota, and Mis- souri volunteers Avere over 68 inches. New Hampshire, Massachusetts, Rhode Island, Connecticut, New York, Pennsylvania, Michigan, Wis- consin, and Louisiana recruits were over 67 inches. The average of the whole million of men Avas 68 inches, or five feet eight. There were individual cases of much greater height, one individual of six feet ten in- ches being in the army, and several hundred men over six feet four inches. The sailors turned out invariably to be shorter in stature than the soldiers. From NeAv York they only showed an average of 65.8 inches; from Missouri, 66 inches. Generally the sailors, it may be said, are little felloAvs—little but strong. Relative Proportion of the Height and Weight of the Human Frame. Height. Weight. Med. Chest. 4 feet 10 nches . . 105 pounds . . 32.56 inches 4 " 11 u 110 " . 33.06 " 5 " 0 a 115 " 33.56 " 5 " 1 u 120 " 34.06 " 5 " 2 a 125 " 35.13 " 5 " 3 n 130 " 35.70 " 5 " 4 u 135 " 36.26 " 5 " 5 n 140 " 36.83 " 5 " 6 a 143 " 37.50 " 5 " 7 (I 145 " 38.16 " 5 " 8 il 148 " 38.53 " 5 " 9 il 155 " 39.10 " o " 10 il 160 " 39.66 " 5 " 11 il 165 " 40.23 " 6 " 0 11 170 " 40.80 " G " ] il 175 " 41.30 " 6 « 2 a 180 " 41.80 " ft " 3 a 185 " 42.30 " 6 " 4 a 190 " . 42.80 " 438 HYGIENE. Quetelet, Avho has devoted more attention to this subject than any other writer, gives the average weight of an adult male 136.993 pounds, and the average height 5.333 feet. Dr. Gould, who examined a large number of students in the junior and senior classes at Harvard University and Yale College, together with some members of the professional schools, reports their average height 5.666 feet, and average weight 139.700 pounds. A. Maclaren, Avho has charge of the gymnasium connected with the Oxford Univer- sity, England, reports of the first one hundred names on his book, as they arrived at the University, their average height 5.825 feet, and average weight 132.970 pounds. From the vital statistics of all the members of Amherst College from 1861 to 1869 — making over 600 different students — their average weight was found to be 139.485 pounds, and average height 5.651 feet. Comparative mortality in cities A7aries much from year to year, espe- cially when epidemics prevail, as cholera, or yellow fever, or even diph- theria, typhoid or typhus fever, or (from neglect of vaccination*) small-pox. This variation may be easily seen by glancing at the following tables: Mortality in 1870. Philadelphia, deaths per 1000 . 22.72 New York, " . 28.8 St. Louis, " . 21.3 Chicago, " . 21.5 Baltimore, " . 25.65 Boston, " . 24.33 Cincinnati, " . 18.39 New Orleans, " . 36.34 San Francisco, " . 21.57 Washington, " . 16.80 Montreal, " . 31.3 London, " . 24 Vienna, " . 29.8 Liverpool, " . 31.1 Edinburgh, " . 26.3 1872. Philadelphia, deaths per 1000 .... 26.1 New York, " .... 32.6 * Every child born into the world should be vaccinated, when three or four months old ; or sooner if exposed to small-pox ; and revaccinated when fourteen or fifteen years old, to test and confirm its protection from the contagion. VITAL STATISTICS. 439 San Francisco, deaths per 1000 Memphis, " London, " Dublin, " Paris, " Berlin, " Vienna, " Prague, " Turin, " Christiana, " Florence, " Rome, " Bombay, " Madras, " 1873. Philadelphia, deaths per 1000 New York, " Boston, " Richmond, " NeAv Orleans, " St. Louis, " Brooklyn, " Baltimore, " Cincinnati, " San Francisco, " Memphis, " London, " Paris, " Bombay, " Valparaiso, " First Quarter of 1883 London, deaths per 1000 Paris, " Brussels, " Stockholm, " Vienna, " Madrid, " St. Petersburgh, " 17.2 46.6 22.7 29.9 24.4 29.9 31.8 48.9 30.4 20.7 31.6 36.7 29.2 35. 20.29 27.96 28.45 33.39 37.5 19. 25.19 29.96 22.84 17.2 40.6 22.4 23.2 24.2 66.9 22.1 27.3 25.7 27.8 31.1 36.4 40.6 The mortality rate of Philadelphia in 1881 Avas 22.41 in 1000; in 1882, 22.62 in 1000 of population. 440 HYGIENE. The following extract from a leading English periodical shows one of many interesting lines of inquiry on this topic: " Vital Statistics of France and Prussia.—A considerable sensation has been caused this week in France by the communication of M. De- caisne to the Academy of Medicine of an important studv on the depop- ulation of France, indicated by its present vital statistics. Comparing it with Prussia, he shoAvs that there 100 marriages produce 460 children while in France they give only 300. The percentage of births to pop- ulation in Prussia is 3.98 ; in France, only 2.55. The annual excess of births over deaths in Prussia is 13,300 per million ; in France, 2-100. As to the future, the French population Avould require one hundred and seventy years to double itself; that of Prussia, only forty-two; that of Great Britain, fifty-two; that of Russia, sixty years."—Brit. Med. Journ., June 15,1872. It is interesting also to note that the diminishing number of births seems not to be confined to the cities, but is characteristic of the rural districts as well. Since 1801 the rate of births per 1000 inhabitants has fallen in the Pyrenees-Orientales from 44 to 32; in Rhone from 36 to 26; in Tarn from 34 to 25; in Indre from 37 to 27; ami in La Creuse from 33 to 23. While in Germany the average number of chil- dren per marriage is 5.25; and in England 4.79; in France it is only 3.31. The total rate of births among the French is 26 per thousand; while in England it is 35 ; in Austria 38 ; in Prussia 38.5; in Saxony 40; and in Russia 50. On infantile mortality, I take the following paragraphs from a paper read by myself before the American Public Health Association, several years ago, in Philadelphia: It is, in my belief, a justifiable opinion that amongst those born with a normal constitution, and under entirely favorable circumstances, the mortality during infancy and childhood ought to be less than at any other period of life. Yet it is a fact familiar to every one, that the re- verse is the case in very many localities; most notably in large; cities. In France, according to Bouchut, one-sixth of all born die in the first year of life (Bertillon recently puts it at one-fifth); in SAveden and Fin- land, one-fifth; in Berlin, Prussia, one-third. Nor is the proportion very much less in some parts of England and this country. Before the war it was worst of all in New Orleans. In 1872, 1 death in 41 oc- curred under one year of age in that city. In NeAv York, in 1868, as reported by the Metropolitan Board of Health, more than one-fourth of the total mortality Avas of children under one year of age; Avhile in certain districts of that city eighty per cent, of the whole mortality occurred during childhood. In 1872, eon- VITAL STATISTICS. 441 siderably more than one in four of the deaths in New York occurred in children one year old or under. Philadelphia suffered last year (1883) a total mortality of 16,736 deaths at all ages, of which 5121 Avere under one year of age; and 7151, about 1 in 2J of all deaths, under five years. Yet this Avas below the infantile mortality of our city for the four pre- vious years. Boston, in ten years (1861-70), lost within the first year 51 of all born. San Francisco, in 1871, had one death under one year, or about 4^ of all deaths. Looking back through considerable periods, Ave find that in 1810, in NeAv York, one-half of all deaths took place in persons tAventy-four years old or upwards; in 1857 one-half of the deaths were of children not more than two years old. In Phila- delphia, in 1807, half of the deaths occurred after twenty-four years of age; in 1856 one-half were of children less than four years old. These last figures shoAV an increase of mortality, relatively at least, amongst children. Dr. Farr has shown that in London it has been otherwise. About the middle of the eighteenth century seventy-five per cent, of the deaths Avere of children uuder five years of age; at the beginning of the nineteenth century about fifty per cent.; and noAV about twenty-nine per cent, have fallen within the same period of life. The rate is de- clining someAvhat during the last few years in Philadelphia and New York. From 1860 to 1872, the deaths under five years Avere 44.78 per cent., and under one year 27.25 per cent., of the total mortality of Philadelphia. In England, Dr. Farr proves by his reports to the Registrar-General, that the diseases of childhood are twice as fatal in toAvns as in the coun- try. Other interesting points are, as to the season of greatest mortality of children in our great cities, and the nature of the most destructive maladies. As Dr. Elisha Harris has remarked, summer is the tentator infantum in NeAv York. In the summer quarter of 1868 in that city, the Avhole number of deaths being someAvhat less than 8700; of these nearly 5600 Avere of children under five years of age; almost all being from what are called " diarrhceal diseases." During one hot week of the summer of 1870, three-fifths of the aggregate mortality in New York (645 deaths out of 1048) occurred in children under five years: 400 deaths being from cholera infantum alone. In the hottest week of 1872, in Philadelphia, 852 deaths occurred; of which 497 were of in- fants under two years, 383 under one year; mostly from diarrhceal dis- orders. The week previous to this gave 1569 for the total mortality of New York, increased largely by the same mode of causation, such an aggregate of deaths probably having never been exceeded in that city; as the former (852) never has been in Philadelphia. But the excessive mortality of early life is by no means accounted 442 HYGIENE. for by seasonal influences alone; other causes, also, are of great impor- tance. The Medical News (Philadelphia, 1883) has the following paragraph: "The Enormous Mortality of Colored Infants.—One point of highest importance brought out by Dr. Billings is the small expecta- tion of life of the colored population of our cities, as shown by tables compiled for the first time, we believe, under his direction. From these it appears that of 1,000,000 colored infants born in Baltimore, one-half will ha\7e perished before attaining the age of two years. A similar mortality prevails in other cities Avhere the colored population is large. When it is remembered that of an equal number of white children born in Baltimore, one-half will live thirty-five years, the disproportion be- comes startling, and makes imperative a close investigation into the causes, conditions, and remedies for this lamentable state of affairs. Another interesting feature of these tables is the disproportionately greater number of aged colored females than of males. Of the colored males, there will be left at sixty-five years, 57,252; of females, 93,171; of males at seventy-five years, 19,440; of females, 56,283; of males at eighty-five years, 2929; of females, 12,726 ; of males at ninety-five years, 315; of females, 1477; while 75 males and 158 females will attain one hundred years of age. As will be seen, these figures show rather a remarkably short duration of life of colored men than of longevity of colored Avomen, who appear to be much shorter-lived than their white sisters." In regard to the causes of deaths, the London Echo quotes as fol- lows from official statements: " Taking an average for the thirty-three years, 1838-70, Ave find that the number of deaths in England to every 1000 of the population is 22.4. Of course, the death-rate varies with each year, the figures ranging from 20.5 in 1856 to 25.1 in 1849, Avhen the cholera visited us with fearful severity, destroying no fewer than 53,273 lives—13,161 in London alone, and in little more than three months. The tAvelve most fatal causes are as follow, the figures attached shoAving the number of deaths due to each disease in 1870: phthisis (consumption), 54,231; bronchitis, 46,699; scarlet fever, 32,543; atrophy and debility, 30,530; old age, 28,889; convulsions, 26,548; diarrhoea, 25,311; heart-disease, 23,957; pneumonia, 23,729; whooping- cough, 11,901; paralysis, 11,651 ; and apoplexy, 11,598." War (public and private) and accidents apart, consumption every- where takes the lead. In England, as above shoAvn, more than 50,000 deaths occur from it annually. In New York, of 10,000 deaths, 6000 are from this disease; in Ohio and Maryland, each 2000. Dr. E. Jar vis states that in Massachusetts, of every 1000 deaths VITAL STATISTICS. 443 during more than twenty years, 314 Avere from diseases of the lungs, 137 of affections of the digestive organs, 78 of disorders of the brain, and but 54 of old age. Philadelphia statistics give the following as the most usual order of causes of deaths*: 1. Consumption (phthisis). 2. Scarlet fever. 3. Pneumonia. 4. Convulsions. 5. Marasmus (a wasting disorder of children, involving the bowels mainly). 6. Typhoid fever. 7. Diar- rhoea and dysentery. Other maladies follow in more A7ariable pro- portion. Mortality has been much reduced in many places by improving the local conditions of health. Illustrations of this may be found in dif- ferent quarters of the Avorld. Nowhere, however, have they been more exactly ascertained than in England. Baldwin Latham ("Sanitary Engineering") gives this table of Results of Sanitary Improvements. — 5m .Si 2 o ~°J £aM. £« 4) CO 00 SgC 36* .aj S3 • g.3 Towns. rH a o Is ".a o to o °«2 32 = be50 ° 3 O bo o > c5 b £2 s gg B a p B P. o o>o.2 °> Ph < < M « tf Per cent. Per cent. Per cent. Banbury .... 10,238 23.4 20.5 12J 48 41 Cardiff . 32,954 33.2 22.6 32 40 17 Croydon 30,229 23.7 18.6 22 63 17 Dover . 23,108 22.6 20.9 7 36 20 Ely . 7,847 23.9 20.5 14 56 47 Leicester 68,056 26.4 25.2 41 48 32 Macclesfield . 27,475 29.8 23.7 20 48 31 Merthur 52,778 33.2 26.2 18 60 11 Newport 24,756 31.8 21.6 32 36 32 Rugby . 7,818 19.1 18.6 21 10 43 Salisbury 9,030 27.5 21.9 20 75 49 Warwick 10,570 22.7 21.0 71 52 19 A remarkable example of the good effect of "sanitary police" was afforded by the city of Philadelphia in 1866. Epidemic cholera, being in Western Europe, was expected here that summer. The Board of Health made uncommon exertions to cleanse the city throughout; and According to Board of Health reports, the order during the first six months of 1884, in Philadelphia, was as follows: Consumption of the lungs, 1445 deaths; pneu- monia, 782; convulsions, 424; scarlet fever, 386; typhoid fever, 325; marasmus, 298; diarrhoea and dysentery, 74. The second half of the year, including the hot summer months, will yield a much larger mortality from diarrhoea and dysentery. Ill HYGIENE. the citizens, in fear of cholera, promoted their labors. In consequence, although 908 deaths occurred during the year from cholera, the total mortality for the year was less than that of the previous year by o(JG! Here are the official figures: Total number of deaths in 1865 . . 17,169 Total number of deaths in 1866 . . 16,80:3 Decrease ..... 366 The New York Nation, in May, 1887, said : " The last report of the Registrar-General in England furnishes fresh evidence of the steady progress which is making in the prolongation of human life, especially through the influence of the sanitary measures adopted during the last thirty years. The death-rate for 1886 was 1!).3 per thousand of the population, which was lower than that recorded in any previous year since the registration system was started in 1H;>7, with the two exceptions of 19 in 1885 and 18.9 in 1881. The mean annual death-rate for the six years since 1880 did not exceed 19.3, which was 2.1 below the mean rate between 1870 and 1880. This means that 339,000 persons in England and Wales were alive at the end of those six years who would have been dead if the rate of mortal- ity which prevailed between 1870 and 1880 had been maintained. The reduction is largely accounted for by the falling-off in the deaths from the principal zymotic or ' filth diseases/ which have sunk from an annual rate of 4.15 per thousand between 1860 and 1870 to 3.40 between 1870 and 1880. The proportion of infant mortality has also been perceptibly diminished, falling from an average of 149 per 1000 births during the ten years preceding 1880 to 141 in the six years since then. The birth-rate itself last year was only 32.4, which is lower than in any previous year since 1848, and the natural increase of population by the excess of births over deaths accordingly shows a decline from 375,922 in 1884 and 371,520 in 1885 to 366,138 in 1886." Health of American Cities. According to a table of the mortality of twelve of the principal cities of the United States in 1890, the percentage of deaths to each thousand of residents is as follows : . 21.73 20.79 . 19.89 . 16.-JS New Orleans . 29.90 Washington . 24.08 Cincinnati New York . 26.49 Baltimore . 23.48 Philadelphia Cleveland. . 25.09 San Francisco . . 23 08 Chicago . Brooklyn . . 24.58 Boston . 22.70 St. Louis . UNHEALTHY EMPLOYMENTS. 445 UNHEALTHY EMPLOYMENTS. Those which are especially apt to injure health and shorten life are these: Working in lead, or with lead paint. Coloring wall-paper, artificial flowers, etc., with Paris green, or other arsenical colors. Making or working with aniline dyes. "Silvering" mirrors with mercury. Making and working in brass and brass-ware. Making lucifer-matehes containing phosphorus. Needle-grinding and fork-grinding. Cotton-spinning, and working in feathers, wool, hair, bristles, flints, or coal. Fur-sewers usually have short lives. Vulcanizing India-rubber (with bisulphide of carbon). Glass-blowing (interfering with natural breathing and circulation). By lead-poisoning, either or both of two maladies may be caused: lead colic and lead palsy. Arsenical poisoning sometimes occurs with those who live or sleep in rooms papered with wall-paper colored with arsenical green,* and with children playing with toys, baby-houses, etc., colored with the same. Other colored wall-papers, besides green, may contain arsenic. Its use in this way, when detected, ought to be punished with severe legal pen- alties. Slow poisoning under such causation may not always be recog- nized. The sufferer is apt to have inflamed eyes, headaches, bad sleep, and nervousness; even death is believed thus to have resulted in a few instances. Aniline dyes often contain a portion of arsenic, making them poison- ous; but even without this, they may irritate the skin considerably. Wearing stockings dyed with aniline red, with some people brings out painful eruptions upon the legs and feet. Mercurial poisoning, from working with quicksilver, may be attended by very serious palsy of the limbs; and bad nervous symptoms have repeatedly attacked workers in brass—" brassfounder's ague." Phosphorus, used in making matches, is absorbed into the mouth and nostrils from the air, and affects the upper-jaw, in some cases destroying the jaw-bone (phosphor-necrosis). Such may be tested, thus : drop on a piece of the paper two or three drops of water of ammonia (spirit of hartshorn); this will make the green blue. Next, put on it a little powdered lunar caustic (nitrate of silver); it will then become yellow. 446 HYGIENE. Needle- and fork-grinding are injurious because of the fine particles of stone (from the grindstone) and steel flying in Vie air, and getting into the breathing-tubes and lungs. Similar danger attends working with cotton, feathers, wool, hair, bristles, flints, and and. Of all particles breathed, those of coal-dust probably do the least harm. But coal- heavers may have an immense quantity of black dust collected in their lungs. I remember one of them, a patient with a chronic cough, who had a black expectoration for several weeks after entering the hospital. Vulcanizing India-rubber is injurious by reason of the use of the poi- sonous bisulphide of carbon in the process. Glass-blowing induces, as any one may see in looking at the work, a great interruption of the ordinary regularity of breathing, and so of the aeration as well as circulation of the blood. This is made worse by the heat to which the blowers are exposed. Yet some become, by habit, wonderfully adapted to the work, and endure it for years. Are not some means of protection to be had against the harm done in some of these occupations ? Yes; but the ignorance and recklessness of many defeat efforts made to so protect them. For lead-workers, always washing the hands carefully after work, and particularly before eating, is very important. When necessarily much exposed, drinking moderately of a weak sulphuric acid lemonade is said to be a preventive of lead-poisoning. (This must be very cautiously used, as sulphuric acid is itself a poison.) The same precaution about washing the hands thoroughly and often will apply to working in aniline dyes, or in arsenic, copper, or brass, etc. Where fine particles are flying into the air, one arrangement is to place a glass screen before the operative, with holes for his arms to pass through. Another plan is to have a fan to draw the particles constantly downwards, away from the face, and through gratings in the floor. Against jp/iospAonts-poisoning in making lucifer matches, a valuable preventive is said to be, hanging from the neck an open vial of spirit of turpentine; which antagonizes the influence of the phosphorus. Photographers are, unless they are careful, exposed to danger from the use in their work of the deadly poison, cyanide of potassium. Sewing-women are said to have sometimes been affected with lead- poisoning from putting frequently in their mouths (to thread their needles) threads made glossy with sugar (acetate) of lead. Poisoning from passing soft drinking water through lead pipes, or storing it m leaden cisterns, etc., has been treated of (under Our Homes) in another part of this book. Sewer-cleansing cannot be a wholesome employment. But it is re* markable how some men, at least, can get well used to it. A very UNHEALTHY EMPLOYMENTS. 447 hearty-looking contractor for cleaning wells, etc., told me lately that he had been in that business for thirty-four years. All sedentary employments, as those of bookkeepers, other clerks, seamstresses, etc., must be less favorable to health than such as take people actively out of doors. Those predisposed to consumption of the lungs ought especially, from childhood up, to prefer active out-of-door living. Miners are apt to be short-lived; and most of all those who (as in some mines in Europe) never or seldom come above ground; spending their lives in the dampness and half-night of their vast arti- ficial caverns. Accidental deaths do not come within our present scope ; or else we would have to refer to railway brakesmen as the shortest lived of all! Factory operatives, of both sexes and all ages, have long been in many countries sufferers from ill-health and short-lived. Some years since, the average age at death of the weavers of Leicester, England, was eighteen years. Of 1078 children working in English spinneries, only 22 reached the fortieth year, and only 9 the fiftieth year. The average age of factory people in the cities of France is nineteen years; while elsewhere in that country it is forty-three years. From the beginning of this century benevolent persons have been trying to better the condition of the children of factory populations, especially in England. Government commissions were appointed on the subject in 1840 and 1861. Elizabeth Barrett Browning's piece, the " Cry of the Children," has touched many hearts: " All day we drive the wheels of iron In the factories, round and round ; For all day the wheels are droning, turning— Their wind comes in our faces— Till our hearts turn, our heads with pulses burning, And the walls turn in their places— Turns the sky in the high window blank and reeling, Turns the long light that drops adown the wall, Turn the black flies that crawl along the ceiling; All are turning all the day, and we with all! ****** Our blood splashes upward, O gold heaper, And your purple shows your path ; But the child's sob in the silence curses deeper Than the strong man in his wrath!" At lace-making in Nottingham, formerly children not more than two or three years old were constantly employed; at earthenware manufac- ture, in the Staffordshire potteries, some under five years of age; and 448 HYGIENE. many children also in straw-plait manufacture, lucifer match-making, fork-grinding, etc. Probably no worse oppression has ever existed than that of the "gang system" of farm labor in parts of England. It was thus described sonic years ago: " The gang system, as recently exhibited in Parliament, in brief is this: In the Fen districts, covering nearly a million of acres of the richest land in England—Huntingdonshire, Cambridgeshire, Notting- hamshire, Norfolk, Suffolk, and iu parts of the counties of Northamp- ton, Bedford, and Rutland—about 7000 children, from five years of age and upwards, besides persons of both sexes of from fifteen to eighteen years of age, are employed in gangs numbering from fifteen to twenty laborers in each gang, under a master, and in a condition differing from slavery only because it is infinitely worse. " The gang-master is almost invariably a dissolute man, who cannot get steady employment as a laborer with any decent farmer. In most instances he actually purchases the labor of the children from poor parents; he sells this labor to farmers, pays the gang what he pleases, and puts the profit in his pocket. For seven or eight months in the year these gangs are driven, often seven or eight miles a day, to farms where they work at planting, weeding, picking, stone gathering, and like labor, from half-past five in the morning to seven or eight o'clock in the evening. The gang-master is paid by the day or by the acre; and he pays the little children from fourpence to sixpence per day, while the older lads and girls receive from nine to fifteen pence. The master, for driving his hands to the field and for keeping them up to their work, which he does with a stick, makes an estimated profit of a pound ster- ling, or thereabouts, a week." The French law of 1841 limited the age after which children might be put at work in factories at eight years. More recently, it has been made ten years; boys under thirteen, and girls under fourteen, being allowed only half-time; and night-work being forbidden for boys under sixteen and girls under twenty-one years. In Germany, the limit of age has long been twelve; and each day ten hours only are allowed for those under sixteen years. Machinery has rendered it possible to make more use than formerly of young laborers in factories. In the United States, in 1870, 739,174 children between ten and fifteen years of age were employed in various ways; in 1880,1,118,356. This increase occurred chiefly in the manu- facturing districts of the country. Pennsylvania laws now require ten hours to be the limit of daily labor in all cotton, woollen, silk, paper, bagging, and flax factories; UNHEALTHY EMPLOYMENTS. 449 and forbid any minor being employed in any such establishments under thirteen years of age. Those between thirteen and sixteen must be so engaged not more than nine months in the year, and then only when three months of the same year are spent in attending school. Also, no operative under twenty-one years of age shall be employed in cotton, woollen, silk, flax, or paper factories for more than sixty hours during one week. These laws are by no means always strictly conformed to; but public attention has lately been renewedly called to the matter by the " Society to Protect Children from Cruelty," with good and hopeful effect. Much depends in factory life upon the air supplied for operatives to breathe; as well as upon the conditions of their dwellings. In Phila- delphia, and in the great manufacturing towns of New England, it is not probable that the lives of the factory men and women are much shorter than those of other working people in the same liralities. 29 450 HYGIENE. LIFE ASSURANCE. Whoever has anything to lay by from year to year, and has a wife children, or others dependent upon his resources for their living, will do well to invest a part of his surplus in a life-insurance poliev. A safe company must be chosen; and then an early investment in this way has the advantage of lower rates, as these are adjusted according to age, in view of the estimated probability of life. Healthy people naturally expect to live long, and so incline to put off insuring their lives; but, if their health fails, no company will insure them; and if they wait till they are old, it may cost too much at the advanced rates. Here are two tables of Expectation of Life: the first foreign; the second American: Age. Expectation. Age. Expectation. Age. Expectation. Age. Expectation. 10 47-5 years. 33 31. years. 56 16. years. 79 5. years. 11 46.7 " 34 30.3 " 57 15.4 " 80 4.7 " 12 46. 35 29.7 " 58 14.8 " 81 4.4 " 13 45.2 " 36 29. 59 14.2 " 82 4.1 " 14 44.5 " 37 28.3 " 60 13.6 " 83 3.9 " 15 43.7 " 38 27.6 " 61 13. 84 3.6 " 16 43. " 39 27. 62 12.5 " 85 3.3 " 17 42.33 " 40 26.3 " 63 12. 86 3.1 " 18 41.6 " 41 25.6 " 64 11.4 " 87 2.8 " 19 40.8 " 42 24.9 " 65 10.9 " 88 2.5 " 20 40.1 " 43 24.3 " 66 10.4 " 89 2.3 " 21 39.4 " 44 23.6 " 67 9.9 " 90 2.1 " 22 38.7 " 45 23. " 68 9.4 " 91 1.8 " 23 38. " 46 22.3 " 69 9. " 92 1.6 " 24 37.3 " 47 21.6 " 70 8.5 " 93 1.4 " 25 36.6 " 48 21. " 71 8.1 " 94 1.2 " 26 35.9 " 46 20i*J " 72 7.6 " 95 1.1 " 27 35i r at 1917 « 73 7.2 " 96 1. " 28 34.( • 5 191. ' 74 6.8 " 97 92 " 29 33.8 " 52 18.4 " 75 6.4 " 98 .75 " 30 33.1 " 53 17.8 " 76 6.1 " 99 .50 " 31 32.4 " 54 17.2 " 77 5.7 " 32 31.7 " 55 16.6 " 78 5.4 " AMERICAN EXPERIENCE TABLE. Age Nearest Expectation Birthday. of Life. 25 38.8 26 38.1 27 37.4 28 36.7 29 36.0 30 35.3 31 34.6 32 33.2 33 33.9 34 32.5 35 31.8 36 31.1 Age Nearest Birthday. Expectation of Life. 37 30.4 38 29.6 39 28.9 40 28.2 41 27.5 42 26.7 43 26.0 44 25.3 45 24.5 46 23.8 47 23.1 48 22.4 Age Nearest Birthday. Expectation of Life. 49 50 51 52 53 54 55 56 57 58 59 60 21.6 20.9 20.2 19.5 IH.ti Kl 17.4 16.7 16.1 i.y il; 14.1 en en en Cn en o» *i )Coco cccocococo ecrorotoro tc i )«qOi V C jh o cC QG *-l Oi Cn rf*- CO CO t—> o Age. w CO co CO co CO J- G' Cn CTi tO to tO WOl CO CO CO CO rf* rf^ tt- » XCtCO >-» tc to CO ti l^tu^l^^ rf*. rf*. Cn Cn Cn en Cn Cn Cn Cn cn cn Cn Cn Cn Cn Cn Cn Cn Cn Cn C7s O d CT> OS Os 01 Ol OS OS OS OS -*-l 0© Q OO^DpOj-* ,|O.CC CO tf»-** G« OS OSj-Jj-J OOOOpo^COjD ^OOpO© ►"'^^JN'OS J^J^i^*-^* .P* ^ S"co © oo"bs '^."io'cD'^j 01 To"tcVj rf*.7-* a ojcctooi "co © bi to "to cih © "toVi *►—cn"cD"to os "goT-»,co os go ►—"cn'cc'os en "cc ©"cc'^'co "o o CtCOC^J rf^tOODrf^O rf-tPtOCngo tOOQOCM fcCC'CtO COtCQCh-'O Oi^CJ'tDO QC CO-4 (-• OS © IO CO ►&■ 0O -J h-CO tO © 5? ^ COCCOO^Jf— COCntOlO © Living. » 00 Q0 00 00 O0 00 GO "-I •*-! --1 *■! *J -^ -* h-» H-* M M h-» h-» l-i h-» h-h-» (-• h-1 H» M t-* l-» tO CO rf^ Cn CO 00 © CT'rf^COtOtO HOOJCJD 00 00 <1 <1 «S © © Cn Cn. Cn »£». ►(*. CO CO CO JOtOtOh-h-* P p JO JO 00 ^I^ipsCJiCji _rfi» tfc» CO CO jp*. »|*. pi »-l © rf* j-- © to p to p cn cn cn bi bo ►"-* cn cp "co -» bo be cn £. bo co tf*. © "^ o co © ©rf».©00Cn OOC0CCQ0 00OC000(& COCn©00© co^octooo tf*- © 00 CO Cn OOOQO^Oi CCOOCftOO ***-o«otrf* oooooooco o>«occo 00 Proportionate Mortality, per 1000. 1 h-* t-» I— i_i tOtOtOtOtO tOtOtOtOtO tCtOtOtOtO tO IO CO CO CO CO GO CO CO CO CO CO CO CO GO CO CO CO *£ ►£»■ tp. >JS> ^ ^ rfa* rfi.rf^tfi.^^ £. U- >fc- ►£- ►&. CO --->f-*joto co co je- ►£■ cn pammpc pc co © © t-* h-tococo*! jPcipp-^ po oc cd © h-1 to tocorf*pi © © m «^i oo pcr"'ptt---' p' "'J-*bs to^cocebt ©©to^co cc CHbiio bo>t-©©to bo cn J-1 been tocD©>t-io ©oo^icnco K-'bcIt-ccto fcc^vcnoc^i © ---0©CO© -J** tOCC© ►£. tO©COO0 *q-^*4-J0C «OW*4WH h-rf^CCCjiJk Cn *J © CO it* tO rf^ CD CO-3 Wrf^tOOCH CD hpico bsVi'gc'to'o 'o'n-'tclc'to lc'tc'Vc,h-*'o crtc ■ - h- £ 1-' 5 to g? tc cjj ^1 — g« COOih-'^CO tO-JOCt^-t OCIC^I »—* 1—•»—» to CO Js. cnC PIC* OlOSOSOiCS OCtOtOlfkOO COhJCOtOt HPMMM COl*>->t^C7>0' O3£1 to I—> HO^IICO ostocnoo*. O>O00t->Os -^ICOCJiOSOS OSOCMOSI-' 00Oi|-'" (—»>—» t—' )—1 t—' v-» 1—* h-» to fC tO to tO tO tO tO tO tOKHHH t—' M h-1 H* W h->K* GC~J ^1^1000000 tootococo *-*-ili*-CO tOCOOOStn l^ co to to >-* OOtCOOpp -J-JOSOsOS CJOi*-*.*- >t>.50C0CCC0 eocototo M00 OCtOOtOOS tOCnCji*k.tO CO*.COCOtO O'COCCtOOS -^OOtCK1^ ^JJ--C7>tOj& pCrf-tCOip OSCOtCpCO h-pOOS^-CO h-C00fe os icift.*. o'co b.i^ '#. to'v 'oh-botcb<- s'to^'t'S S£t;ifc'S'9? SP^J-' S?'°> 9:<1S9?t; sT-iStoi! ift-O OCOOOsfo OS-aift-O-^I OsOtOOtO it-CtOO^I OCOCOtOOs OS O )(>• (^ OS OSC0C0C00 l^tOO'O'it. (f>. to OS sft- 00 O1O1COO t-1 ^-I-1 tc to CO CO CO ►£■ rf»- [ft. jft. jft. jft. jft [ft. b> bo o i: '-1 to ^11-1 b> to co "~.i J-> b< to co be co be tn^jtcecob ift-toi-i-'to fto&uoi-' totococojft- a-C'C'Os gbecoboco bc'^tcbi H'tOtftOS tCCC^H-" Age. Living. Dying. Proportionnte Mortality, per 1000. Expectation, Number of years. * £^ 5' ^d !^ •*1 W feq t^ X tu ^** ►d Cn O ►-S 0s w ^ <3 L ' p to ^3 in t1* i-t- C5 ^0 4^ 452 HYGIENE. Years. Years. 48.08 33.44 43.78 43.73 35.09 24.62 310.56 257.74 20.49 Prof. Chase calculated also a similar table from the records of mor- tality amongst members of the " Society of Friends." Deductions feom the Foregoing Tables.* Friends. Philadelphia. Advantage of Per 1000. Per 1000. Friends. Proportionate Mortality (in first year) . . 124.66 180.38 44.70 per cent Average Proportionate Mortality, from twenty to sixty inclusive (the term during which insurances are most frequently effected) . 14.25 17.58 23.37 " Probability of Lifef ("vie probable") . General Expectation % (at birth) . Greatest Vitality. Age 12 If no diminution of vitality occurred in those existing at that age, the above is the term of life that would be reached by some one of those living. According to the records of the Society of Friends in England, the average age of its members at death, between 1860 and 1870, was be- tween fifty and fifty-five years. Next to them in special longevity come the Jews. The experience of life insurance companies in this country has demon- strated the fact that, both at the younger and older periods of life, the results of mortality experience have been less favorable, while that of middle life has been more favorable, than that experienced abroad. The classification of lives adopted by different insurance companies is much the same for all. The following may be considered an example. It is that adopted by the English and Scottish Law Life Assurance Association: Classification of Lives. Class I. Superior lives: having the prospect of more than average duration. Class II. Average lives: involving no peculiar hazard, or presenting * The Philadelphia table is based upon records of 425,502 interments, 265,590 births, and seven successive decennial census enumerations ; the Friends' table upon records of 14,666 interments, 4264 births, and eight enumerations. f Out of 10,000 born in the Society of Friends, nearly 5000 die before reaching the age of forty-eight; that age is therefore the probability of life; the probability of any one dying before reaching that age being as great as of surviving it. % Out of 10,000 born under same conditions as above, the 5000 dying under forty- eight will attain an average of about seventeen years. The 5000 dying over io ) eight will attain an average of about seventy-one years. The mean between these two, to wit, forty-four years, is therefore the general expectation. LIFE ASSURANCE. 453 only unfavorable features of so slight a nature as to form no objection to assurance at the ordinary rate of premium. Class III. Inferior lives: involving increased risk on account either of family history or personal condition, and therefore requiring an equivalent addition to the ordinary rate of premium. The information to be acquired by the medical examiner may be classed under three heads: 1st. Present state of health of applicant. 2d. His past history. 3d. The peculiarities of the family. It is usually required of any one applying to have his life insured, to obtain a certificate from his family physician, or some other practi- tioner well acquainted with him, giving answers to certain stated ques- tions in regard to his health. Besides this, the life assurance compa- nies have their own medical examiners, who make a careful inquiry into every applicant's " probability of life." Causes of Rejection. First. Where both parents have died of phthisis (consumption). Second. Where one parent has died of this disease, and it has appeared in the offspring, unless the applicant possess a healthy con- formation, and has reached at least the age of thirty-five years. Third. Where the party has been affected with paralysis, apoplexy, epilepsy, hereditary insanity, loss of sense and voluntary motion, or symptoms denoting softening of the brain. Fourth. Intermittence and irregularity of the pulse or heart's action, abnormal sounds in this organ, symptoms indicating hypertrophy of the heart, aneurism and ossification of the blood-vessels, habitual cough, difficulty of breathing, and asthma. Fifth. If the pulse be persistently over ninety, after repeated trials. Sixth. Diseases of the digestive organs, materially affecting the health of the applicant, psoas or lumbar abscess, coxalgia (hip disease), unless a long period of cure has elapsed. The existence of an open ulcer, scrofula, frequent attacks of erysipelas, and colic. Seventh. Gout, fistula, irreducible hernia (rupture), disease of the spine, and important tumors, etc. Eighth. Disease of the kidneys, bladder, calculus (stone), gravel, secondary syphilis, blindness, permanent stricture, and amputation at the shoulder-joint or above the knee. Ninth. Cancer or other malignant disease ; and where, after any ill- ness, its effect is perceptible in loss of vigor in the constitution, thereby predisposing to renewed attacks of the malady. 454 HYGIENE. Tenth. When from any cause the company has a well-founded doubt whether the applicant will reach his expectation of life the risk is de- clined. Habitual intemperance is always a cause of rejection, when it is known. Its omission from the above list is due merely to the difficulty exam- iners often have, with applicants who are strangers to them, in making it certain. It is included, however, under the expression, " any cause of well-founded doubt" as to the safety of a life. While the rates charged for life assurance, based upon estimates of the general expectation of life, are large enough to bring good profits to successful companies, yet experience shows that, with those whose earn- ings are the sole or chief dependence of themselves and their families, and who earn yearly more than they need to spend, no other investment of this surplus is likely to be better in the end than one which provides that, when those earnings pease, an accumulated principal shall take their place, in the form of life insurance. GREAT LONGEVITY. 455 GREAT LONGEVITY. Learned Biblical scholars are not agreed as to the true rendering of the account of the ages of the Patriarchs mentioned in the Book of Genesis. Some of them hold that by the term commonly translated " years " are meant periods each of not more than three months. It ia. however, altogether conceivable that during the fresh vigor of the youth of the human race life was much longer than now. " Threescore years and ten" are mentioned in%the Scriptures as, in Solomon's time, what would be called the " expectation " of human life. Yet, apart from the commonly understood centuries of Methuselah and others, good reason exists for believing that, at its early best, the longevity of man ought to have been at least two hundred years; and that now it ought to be, under the most favorable conditions and circumstances, a hundred years. Actually, nowadays, not more than about one in 3000 or 4000 people born is a centenarian; while, of every 1000 born, from 150 to 200 die in their first year, and from 250 to 400 under five years of age; the average duration of human life being under, or perhaps now about, forty years. Dr. Farr, a noted English authority, says that if one could watch the march of 1,000,000 people through life, the following result would be observable: Nearly 150,000 will die the first year, 53,000 the second year, 28,000 in the third year, and less than 4000 in the thirteenth year. At the end of forty-five years 500,000 will have died. At the end of sixty years 370,000 will be still living; at the end of eighty years, 97,000; at eighty-five years, 31,000, and at ninety-five years, 2100. At the end of one hundred years there will be 223, and at the end of one hundred and eight years there will be but one survivor. Tradition, beginning in the obscurity of antiquity, gives a considera- ble list of men and women said to have exceeded a century of longevity. Among these were Hippocrates, "father of medicine," 100 years; Saint Anthony, 105 ; James the Hermit, 104 ; Saint Jerome, 100; Simeon Stylites, 109; Cardinal de Sales, 110; De Belloy, Archbishop of Paris, 100; Kentigern (St. Mongah), 185! Ephraim Pratt, of Shutesbury, England, 117; his son, Michael Pratt, 103; Henry Francisco, in this country, 140. One record published in Eng- land names the following also: Robert Pooles, of Tyross in Ireland, 116 (died in 1742); Mary Power, aunt of R. Lalor Sheil, 116 ; David Ker- rison, a soldier of our Revolution (died 1852), 117 ; Ursal Chicken (!), of Holderness, England, 120 (died 1722); Charles Cottrell, of Phila- delphia, dying (1761) 120 years old, left a wife 115, they having lived 456 HYGIENE. together 98 years; a Duchess of Buccleugh, 20 years a maiden, 50 years a wife, 50 years a widow, died (1728) 120 years old; William Beatty, who fought at the battle of the Boyne (died 1774), 130 years; Mrs. Keith, of Newnham, 133; John McDonach, of Ennis, Ireland, 138; Countess of Desmond, who went to market on foot almost to the day of her death, 140! A slab on the floor of a church building in Hereford- shire is inscribed with the name of Elizabeth Lewis, dying in 1715, aged 141 years. One Eckelson, in Ireland, was reputed to be at his death in 1696, 148 years of age. A tombstone in Conway churchyard records that Lowry Owens Vaughan (a woman) died in 1766, aged 192! In Scotland (says another account), James Lawrence reached the end of his 140th year ; the Countess Electon, at death, counted 143; Thomas Winslow, 146; Elsphet Watson, 115 (only 33 inches in height); in England, John Effingham, 144; Francis Consist, 150; in Norway, Jonas Surrington, 159 ; in France, Jean Claude Jacob, a member of the Academy, 121; Fontenelle, Secretary of the Academy, 100; in Spain, Dr. Verdugo, oldest physician of his time (1868), 105; at Rome, Made- line Onofri, 121 ; Venice, Marquis Cornaro, 100; in the United States, Joseph Crele, of Detroit, 141. Very famous were the two English patriarchs, Thomas Parr, dying in London in 1635, aged 152 years by the records, and Henry -Jenkins of Yorkshire, dying in 1670, aged 169. Parr's death was, after all, premature. His renown took him to London, as a sort of lion in society; they feasted him so bountifully that the unaccustomed dissi- pation shortened his days. Other instances, less noted, have been those of Keziah Smith, of Vir- ginia (dying in 1868 or 9) 125 years; a Pole deceased about the same time, 139; Rachel Byer, said to be living in Iowa, in 1866, 114; a Canadian hunter and guide in Kansas, 134; Baron de Waldeck, a great traveller, dying in 1875, 109; George Labar, of Monroe County, Penna., who died in 1874, 111; Mary Loquaire, native of San Do- mingo, dying in Philadelphia in 1872, 107; Augustus Picard, of Quebec, 107; Kate Shepp, of Harrisonburg, Va., 120; Nancy Rob- erts, of Philadelphia, burned to death in 1871, 110 to 120 years. Mrs. Helen Hunt Jackson described in the Christian Union in 1883, a woman named Eumesia, whom she visited in the far West in 1882; who was shown on good evidence to have been born in 1760. W. J. Thorns, F.S. A., of London, published in 1873 an essay on Longevity ; in which he asserted that he had found reason to discredit the great ages ascribed by common report to Henry Jenkins, Thoma- Parr, and the Countess of Desmond, above mentioned. He admit.-, however, at least five centenarians: Jane Chassereau Williams, of I>»m- HOW TO LIVE LONG. 457 don, 1739-1841 ; William Plank, of England, 1767-1867; Jacob W. Luning, of Hanover, 1767-1870; Catharine Eden, of England, and David Rennie, of Scotland. His reviewer in the New York Nation, mentions also seven authenticated instances: Four Harvard graduates, Dr. E. A. Holyoke, Timothy Farrar, Sampson Salter Blowers, and Dr. Ezra Green, Daniel Waldo, Mehitable Barker Piper, and Anna Simp- son Dix. Sir Moses Montefiore, the wealthy and benevolent English Israelite, is now living (1885) in his hundredth year; and Chevreul, the great French chemist and professor still delivers lectures, although certainly more than ninety-four years old, according to one account nearly ninety-nine. Shall we wish longer life to them ? * Very great age is scarcely to be wished for, so many are its privations and infirmities. Yet, with all the appliances of our modern civilization, it may now be made more tolerable than ever before. HOW TO LIVE LONG. No one of the venerable company of those who have survived a hun- dred years has left behind any special secret of long life.f All that we * The following is from a Philadelphia daily paper of 1883: A Lively Centenarian.—Miss Sabra Gibbs, whose residence at Norwood, R. I., goes beyond the memory of the oldest inhabitant, has, according to the record, finished her one hundredth year. She lives alone, does all her own housework, saws wood for her own fire, and brings it on her back from the woods. She is a constant reader of the Bible and religious books, reads without glasses, and is always ready to expatiate upon any passage of Scripture, which she often does to those gathered around her. She is the last of her generation. She has buried two sisters, Esther dying at the age of one hundred years, and Hannah at nearly the same age. As remarkable, at a somewhat earlier age, was the statement made in the summer of 1884, that Captain John W. Andrews, of Sumter, South Carolina, the ninety-three year old pedestrian, who started to walk to Boston, arrived in that city from Hartford by rail. On reaching Hartford, where he gave up walking, he had made 700 miles on foot, at an average rate of 22 miles per day. f Horace Binney, of Philadelphia, who lived more than ninety years, said in answer to a question on the subject, " I have never taken any long steps." He meant, probably, that he was never in a hurry, and undertook nothing beyond his strength. William Lullen Bryant, the poet, who died in consequence of an accident in his eighty-fourth year, wrote thus of his habits when about seventy-six: " I rise early, at this time of year (March) about half-past five; in summer, half an hour or even an hour earlier. 1 begin immediately, with little incumbrance of clothing, a series of exercises designed to expand the chest, etc. These are performed with dumb-bells, with a pole, a hori- zontal bar, and a light chair swung around my head. After a full hour passed in this manner, I bathe from head to foot .... My breakfast is a simple one—hominy and milk, or, in place of hominy, brown bread or oatmeal, and, in the season, baked sweet £58 HYGIENE. can do, therefore, towards promoting such an end, is to observe the great laws of health, which we have been endeavoring to set forth at length in these pages. If, then, we fail, it must be from some un- controllable cause, under Divine providence; and, without fatalism, wc may say, like the devout Mussulman, " It is better so; God is good." As a brief summary statement of the most essential conditions of health and longevity, we may conclude our study of Hygiene with the following precepts. 1. Never breathe three breaths of foul air when you can get out from it into that which is fresh, or can get fresh air into the place where you are. 2. Eat when you are hungry, and only wholesome food. Eat slowly, and stop as soon as hunger is satisfied. 3. Drink pure water when you are thirsty; take milk as a part of your daily food; a cup of tea, not too strong, if you like it, or cocoa; but coffee only when you are very tired ; and alcoholic beverages, while in good health and strength, never. Also, make no use of tobacco. 4. Dress always with a view to comfort and convenience; not com- pressing the chest, nor impeding the movement of any of the limbs. 5. Be careful to maintain a regular habit of daily motion of the bowels. 6. Rest, if you can, when tired, and sleep when sleepy (unless in a place of worship). Take eight hours of sleep every night; more, if you feel the need of it, and can get it. 7. Work regularly at something every day, and do the best you can throughout; but avoid over-work. The sign of it is, that you wake up tired, not refreshed, in the morning. 8. Never do any regular week-day labor (simple unavoidable small chores excepted) on the first day of the week. Make it a day of repose and renovation for mind and body. 9. However rich you may be, do not make pleasure the aim and ob- ject of life; it will wear you out faster than work, or even worry. Lastly, let every day be cheered by sunshine from above, and bright- ened by the hope of a better life to come. apples.....Tea and coffee I never touch. Sometimes I take a cup of chocolate. . ■ • After breakfast I occupy myself awhile with my studies, and then, when in town, walk down to the office of the Evening Post, nearly three miles distant, and, after about three hours, return, always walking, whatever the state of the weather or the streets. ... My drink is water, yet I sometimes, though rarely, take a glass of wine. never meddle with tobacco, except to quarrel with its use." DOMESTIC MEDICINE. CAUSES, NATURE, AND SIGNS OF DISEASE. REMEDIES. NURSING. SPECIAL DISEASES. ACCIDENTS AND INJURIES. POISONING. OLD AGE AND DEATH. 469 }• Aorta. :•' J!!1'"10'"^ Arterv. ■ innominate Arterv. «■ Left Carotid Arterv OROAXS OF TlfE CHEST AXP ABDCLM KX. Left Subclavian Artery Vena Cava. Left Vena Innoniinata Kight Vena Innouiinata H. 1. L. g- Heart. Larynx. Liver. Gall B!ae er ceptions to this statement, being essentially country fevers. INFLUENCE OF TIME OF LIFE. —MAL ARIA. 477 INFLUENCE OF TIME OF LIFE. Infancy shows great delicacy of the stomach, irritability of the skin, and excitability of the nervous system. Its disorders are apt to be erup- tions on the skin, and, in some children, soreness of eyes, nose, ears, and glands of the neck; diarrhoea, and, in hot summers, cholera infantum and convulsions. Measles, scarlet fever, whooping-cough, mumps, chicken-pox, and varioloid, or (in the unvaccinated) small-pox, are all most commonly met with in children. This is simply because few children escape exposure to them, and they do not usually occur more than once in a lifetime. Grown people may, and not infrequently do, have them, when happening not to be exposed to their contagion during childhood. Youth is the period of activity. Inflammatory disorders are the only ones to which it is especially liable, except that pulmonary consumption often begins between the fifteenth and the twenty-fifth year. Middle age ought, under good care of oneself, to be free from predis- position to disease. Now, however, any tendency inherited, or promoted by imprudence in youth, will be likely to show itself; as gout, insanity, cancer, etc. The old show increasing debility and infirmity. Some aged people wither slowly away, like a tree or a bush in December. Others, instead, grow fat, but unwieldy, and less resistant, perhaps, than the lean ones, to increasing troubles. They are especially liable to fatty degeneration of the heart, liver, etc., and to apoplexy. All old people are, more than young ones, subject, under disturbing causes, to urinary troubles, drop- sical swellings, and catarrhal affections of the bronchial tubes and lungs. Although the causation of special diseases will receive attention in our account of them later in this volume, a brief allusion seems fitting here to that of a few of the most important, and in which most people are interested. MALARIA. This word, from the Italian, meant originally bad air, generally. Physicians, however, of late years, have commonly applied it to the supposed atmospheric cause of ague (intermittent) and bilious (remittent) fevers. These are especially diseases of the fall of the year, but in some places they occur also in the spring. Persons who have once taken 478 DOMESTIC MEDICINE. ague (also called chills, or chills and fever) may, if it is not properly treated, continue to have it all through the year, summer and winter. The main facts, about these affections, which bear on their causation, are these: 1. Malarial fevers are always local in their prevalence, having certain bounds even when epidemic. 2. They never prevail in the thickly-built parts of cities. 3. A mean summer temperature of at least 60° is necessary to their development; a continuance of decided warmth for more than two months being required. 4. They are most common and most severe in tropical or nearly trop- ical climates. Yet some regions, in which the summers are both hot and long, are exempt from them. 5. They prevail least where the surface of the earth is rocky, and most where the soil is loaded with organic matter. 6. The existence of surface-water favors their development. They haunt chiefly the borders of marshes, shallow lakes, and slow streams, but not exclusively. 7. Those dwelling upon the shores of large lakes are more subject to them than those who navigate their central waters. 8. The neighborhood of the sea is comparatively free from them, unless inland marshes lie near it. 9. In the midst of unbroken forests they are rare, but are apt to fol- low the clearing away of woodlands. 10. Heat and moisture sometimes exist together (as on the Gulf of Mexico) without (other conditions being absent) producing these fevers. 11. Draining dams or ponds, or other exposure of surfaces before cov- ered with water to the sun, has often been followed by fever. So has the first cultivation of a new soil; but continued culture is followed by a diminution of malarial disease. 12. Some seasons are healthy, and others unhealthy, in the same place, without any observed difference in its conditions, except that early heavy rains, followed by drought late in the summer, are apt to presage an unhealthy autumn. 13. A decidedly hard frost always puts an end, for that season, to the danger of exposure to malarial influence in the region where it occurs. Nearly all these facts point to the probability that an organic cause, of a vegetable nature, produces these fevers. Notwithstanding, how- ever, all the inquiries of Morsen, Salisbury, Tommasi-Crudeli, and others, we have not yet a complete demonstration of this subtle " disease germ " which has the power to impair the health of thousands of people in our own and other countries. CAUSATION OF YELLOW FEVER. 479 Important prere^/re measures may be deduced from the known facts concerning malarial fevers. 1. Avoiding localities, known to be subject to them, from frost to frost, but especially between the middle of July and the middle or end of October, will secure immunity. 2. Never going out upon or through a malarious place within two hours after sunrise or one hour before sunset (as well as, of course, not being there during the night) is an important precaution. 3. Even in a malarious district, burning afire in the house on every damp day, even in Summer, and all through the early Fall and late Spring, will, as I know from observation, contribute much to the escape of residents from Ague and Remittent Fever. CAUSATION OF YELLOW FEVER. Leaving for a later part of this book our description of this disease, we may here notice only the most prominent facts concerning its prev- alence. 1. All the places in which yellow fever ever has really prevailed, that is, where it has occurred in persons not brought to those places already ill, are upon or not far from the borders of the Atlantic Ocean and its connected seas, the Gulf of Mexico and the Western Mediterranean. Thus it never has been an endemic or epidemic on the Pacific Coast of America, nor has it ever been seen at Canton, in China; Bombay, India; Calcutta, in India; Alexandria, Egypt; Athens, in Greece; Constantinople, Turkey. Nor has it been known at any of the interior cities of Europe, as Rome, Vienna, Berlin, Dresden, Munich, Brussels, Paris. Often, yellow fever has prevailed on the West Coast of Africa, New Orleans, North Coast of South America, Mobile (formerly), West India Islands, Savannah, Vera Cruz, etc., in Mexico, Charleston. Occasionally, it has been known at Rio Janeiro, Gibraltar, Natchez, Marseilles, Vicksburg, Barcelona, iSO DOMESTIC MEDICINE. Memphis, Cadiz, Norfolk, Malaga, Richmond, Seville, Baltimore, Xeres, Philadelphia, Carthagona, New York, Leghorn, Boston, Sicily, etc. 2. Yellow fever only occurs in any place when there is continuous warm weather (usually 80° Fahr. for a month or more); most gener- ally, also, a good deal of moisture in the air. Like malarial fevers, it always ceases with a good hard frost. 3. It is a disease chiefly of sea-ports, or of towns on large rivers con- necting with the sea.* 4. It is promoted especially by vegetative decay, as decaying wharves, newly upturned soil, cargoes of rotting potatoes, etc. 5. The infection of yellow fever has mostly rather narrow limits; often they may be marked out infractions of a mile. So it was in its visitations in Philadelphia; certain streets and blocks of houses only were infected; all who kept awray from these were safe from the disease. 6. It is not personally contagious ; that is, the cause of the dis- order is not formed or multiplied in the bodies of those suffering with it; only outside of them. 7. It is seldom, if ever, conveyed by clothing, bedding, merchan- dise, etc. Still, the possibility of such conveyance affords reason for precautions concerning railroad cars, steamboats, baggage, ete. 8. Ships sometimes transport it, by carrying in their holds a quantity of infected air and foul materials from infected places. This fact justi- fies ship quarantine under certain circumstances. 9. But, when thus carried, no extension of the disease ever follows, un- less the place to which an infected ship comes has the promotive con- ditions of high heat, moisture, and foulness from decay abounding in it. 10. Thorough cleansing, airing, and disinfection of ships, steam- boats, railroad cars, clothing, and merchandise (except rotting vegetable matters) will always deprive them of the power of generating or extend- ing yellow fever. 11. Removal of the population of a place infected with yellow fever will certainly always put an end to the prevalence of yellow fever among that population. * I believe that this fact, or at least the prevalence of yellow fever only on or near the borders of the Atlantic Ocean and its connected waters, was first pointed out J myself. It is not generally referred to in books on the subject. CAUSATION OF CHOLERA. 481 12. Personal detention at quarantine, of either sick or well persons arriving on a yellow fever vessel, or coming from a place where it pre- vails is of no use at all, since the disease is not personally contagious; and it is often a cause of much inconvenience and distress. Still worse is the barbarous and inhuman "shot-gun" quarantine on land, for which there is no reason or excuse whatever. CAUSATION OF CHOLERA. About this, we must remember the difference between common cholera morbus, which may occur anywhere and at any season (though most common in summer) and epidemic, often called malignant or Asicdic cholera. This last disease is endemic, every year, only in India. There the circumstances are remarkable. The Delta of the River Ganges is over- flowed every year by the rising and swelling of the river during the rainy season, over a width in some parts of more than a hundred miles. Much of this, in the dry season, is uncovered again, but always damp, and under a tropical sun. Large numbers of animals are drowned during the river-flood, and their bodies decay afterwards, giving off foul emanations. Superstition also leads the Hindoos to throw their dead into the Ganges, as " the gate of heaven." The habits of the people about their houses are very uncleanly. All sorts of products of animal decay abound everywhere. This seems to be the great promotive cause of cholera. There must also be a specific cause (germ?) for it; but that has not yet been certainly found.* Physicians and others resident in India do not, as a rule, think of cholera as being contagious from person to person, in any way. It pre- vails at a certain place; avoid that place, and you are safe from it. An army encamped is attacked by cholera; the commander moves his soldiers to a higher and more open, healthy place, perhaps not more than a mile or two from the first camp, and no more cases occur. All the history of this disease shows the importance of animal filth (human and other, living and dead) in maintaining and extending it. Dr. Robert Koch, a German investigator, asserted his discovery (1883-84) in Egypt and India of a very minute " disease-germ " (bacillus) which he believed to be the cause of cholera. But, as in the case of the same sort of causation of consumption, it remains to be positively shown whether the presence of the bacillus is a cause, or only a coincidence. Careful examination of the evidence, pro and con, convinces me that Koch's "comma bacillus" is not the specific cause of cholera. 31 482 DOMESTIC MEDICINE. Its mortality has been greatest in Moscow, Paris, Marseilles, Liverpool, Manchester, Edinburgh, New York, etc., and worst of all, in the filthiest parts of those and other cities. Yet it does not depend on human intercourse for its migration over the world. It may pass from one town to another without affecting another town, lying right between and on the way. Most striking of all, it has several times attacked ships far out at sea, when there Mas no cholera at all at the ports from which they sailed.* No explanation exists for such facts but that the mysterious epidemic cause travels as a " cholera cloud," over sea and land, lighting and staying where it finds (like a cloud of insects or a flock of birds) material to feed upon. Such material is always present where men live in close houses, with foul cellars, yards, streets, slaughter-houses, graveyards, etc. Most plainly, bad drinking water has been shown to increase the number of victims of cholera. So much has been made of this, that the current popular theory of the extension of the disease (outside of India, where they can see it plainly otherwise) is, that the specific cause is only conveyed from person to person and from place to place by the discharges from the bowels of those having the disease. I am altogether satisfied (after a good deal of study of the subject, during three epidemics, 1849,1854, and 1866) that this theory is not true. All fecal discharges, and all foul water, foul air, everything that is foul, promotes cholera; the excrements of a patient with it are no worse in this respect than any other foulness. Not being contagious, then, quarantine against cholera is of no use at all; while detaining persons at quarantine in an infected vessel has repeatedly cost scores of lives. Foul ships ought to be cleared at once of their passengers as soon as they reach a port; they cannot give the disease to any one, wherever they may go. The worst possible thing is to detain them in an unhealthy steamer, or whatever it be, on which cholera has prevailed during the voyage. Personal detention at quar- antine, in fact, has no excuse in connection with any disease. It might perhaps have for small-pox, but that the true and efficient preventive of that is universal vaccination. Cholera is to be prevented by cleanliness, cleanliness, cleanliness I That one word sums up all there is about it. * I have given a full account of these facts in my little book, "Cholera: Facte and Conclusions upon its Causation, Nature, Prevention, and Treatment." Philada., low. CHOLERA INFANTUM.—DIPHTHERIA. 483 CHOLERA INFANTUM. We have said so much in our pages on the Hygiene of Infancy, upon the summer care of children, that it is needful now merely to re- capitulate the main particulars in regard to the causation of " summer complaint." These are three: high heat (90° to 99° or 100°); the foul atmos- phere of large cities; and improper food, especially milk not suffi- cientlv fresh. Symptoms of this disease, and its domestic management, will be considered later in this book. DIPHTHERIA. Although known to the ancients under other names, and at consider- able intervals several times visiting Europe and America, the prevalence of this disease in the United States has much increased since 1856. Rather more obscurity exists as to its causation than in regard to most other diseases. Some facts, however, are clear. 1. Diphtheria is generally a local disease; that is, infecting certain towns, villages, or houses, at particular times. 2. It may be taken by one person from another, but only upon con- tact or close approach. 3. Foul air, from filth, bad drainage or ill ventilation, contributes very decidedly to its prevalence and to the mortality resulting from it. 484 DOMESTIC MEDICINE. NATURE OF DISEASES. Children sometimes die of old age. That is, their original endowment of life energy was so small as to be exhausted during infancy. Others die very soon because of some defective development of a rital organ or organs. Monsters, now and then, are met with, born without a head or without a heart, etc. Spina bifida is what physicians call a cleft spine; the usual natural bony covering of the spinal marrow not being perfect. Most of those born thus die within their first vear. Cyanosis, the blue disease of infancy, is not always fatal, but is gener- ally so; the dark color resulting from the blood not being arterializrd properly; this being due to an imperfect development of the heart or of one of its great vessels (pulmonary artery). At any period of life the disorders to which we are all subject consist in one or both of the following changes: 1. Disturbance of the action of some organ or organs by a morbid cause. 2. Alteration of the structure or substance of one or more organs; inducing, of course, change also in its action. To the first of these the term "functional disorders" is applied; those of the second sort are " organic diseases." Temporary changes in the substance or structure of an organ often occur, as when it is in- flamed, from which there may or may not follow permanent organic alterations. Only slight affections of even small parts of the body can take place and last for any time, without involving the general system more or less in disturbance. Also, a disorder beginning in the blood, and thus being a general malady, nearly if not quite always puts some of the functions of the organs out of order. Still some cases do begin in, and chiefly affect, particular organs; these we call local disorders; others begin in the blood, and involve the body in many of its functions; those are well described as general diseases. We will give attention here, first, to the nature of the disturbances coming under the former of these heads. LOCAL DISORDERS. Medical books speak of irritation, congestion (hyperemia), inflam- mation, mortification, and degeneration, as affections of organs of the body. Atrophy, hypertrophy, and morbid growths are pueh also; and less purely local, but often more or less restricted, are drop- sical effusions. LOCAL DISORDERS. 485 Irritation. An eye is irritated when a spark from a locomotive, or a bit of sand, or an inverted eyelash, gets into it. A mustard-plaster first stimulates the circulation of the skin where it is applied; this may be quite within the bounds of healthy action, if the mustard be soon withdrawn. If it remain longer, irritation is shown by pain and soreness ; next, if still allowed to act, it will produce inflammation. Irritation of the stomach may be caused by indigestible food, or, more serious in degree, by cer- tain poisonous substances; as strong acids, alkalies, arsenic, or corrosive sublimate. Hyperemia. The older name for this is congestion. It may be an active flowing of more blood than common through a part, or a passive collection of blood in the part. Stimulation produces the former; when it passes beyond the line of health into irritation, passive congestion occurs at the centre of the irritation, active congestion in the parts around it. De- termination of blood towards any portion of the body may be, when very decided, called local hyperemia. A bloodless condition of an organ is called a local ancemia. The first simply means excess of blood; the second, deficiency of blood. Inflammation. All the world knows when a hand, a foot, or an eye is inflamed. Proverbially, the signs of this are redness, heat, pain, and swelling. The redness is owing to the excess of blood; the heat to the same cause, with also probably some increase of chemical change in the part. Pain is not quite so clearly to be accounted for. Pressure on a nerve is known to cause pain; and the excess of blood beating on a part at whose centre is stagnation, must induce considerable pressure. Nerve-pain (neuralgia), however, often occurs without inflammation and without pressure. Some one has wisely said that pain is always a sign of a tendency in the part towards death. It is, at least, indicative of lowered vitality, local or general; and that is present at the centre of an inflamed organ, while around it there may be the heightened activity of stimulation. In a boil, and yet more fully in a carbuncle, we see the dead centre (core) of the violent inflammation, when its force is nearly spent. The swelling of an inflamed part is also due in considerable degree to the accumulation of blood in it. But, under the pressure of the heightened circulation, some of the lymph (watery portion) of the blood escapes from the blood-vessels into the substance of the part. Some of the corpuscles, especially the colorless, or white corpuscles (leucocytes) 486 DOMESTIC MEDICINE. also, in some cases, pass through the walls of the vessels. Then the effused lymph, with or without corpuscles, undergoes changes, which are important. An active or acute inflammation may end in several ways: 1. Resolution is the early passing off of all the inflammatory symp- toms, leaving almost no sensible change in the part. 2. Effusion of lymph, not at once absorbed, shows itself in bauds which glue together tissues naturally movable, or in a collection of fluid (serum), constituting a form of local dropsy. In an attack of pleuriv/, both of these results may follow instead of resolution. 3. Suppuration is the formation of pus; that is, yellow matter, which is very seldom absorbed, and whose best destiny is to be got out of the Fig. 173. INFLAMMATORY LYMPH-BANDS. body by an opening, natural or artificial, at or near the external surface. Every " gathering " or abscess is an example of this. Pycernia is a gen- eral disorder of the system, with a disposition towards the formation of collections of pus in different organs, with fever and much weakness, endangering life. 4. Mortification, also called gangrene, or sloughing, is the actual death of the part. Frozen feet mortify, not from inflammation, but from the directly killing effect of cold. Inflammation does not often end in mortification; if it does so, it is either from the extreme in- tensity of the inflammatory process, or from a very low vital condition of the patient affected. Inflammation is modified considerably by specific causes of disease. A gouty toe is one example of this; a wrist or elbow inflamed with rheu- LOCAL DISORDERS. 487 Fig. 174. matic fever is another. The sore throat of quinsy, that of scarlet fever, and that of diphtheria, are all inflammations, yet each somewhat different from the others. The pustule of vaccination and that of genuine small- pox are not precisely alike; and still different is that of chicken-pox; and so on with other specific diseases. Chronic inflammation is not a desirable term, though it is used in all medical books. In it, redness, pain, or at least soreness, and more or less swelling, are present, in varying degrees; but there is no effusion of lymph, which really is the characteristic of a true inflammation. Irritability is a usual part of what is called chronic inflammation ; we might often with advantage speak of this in describing the disorder: thus, irritable eyes, irritable stomach, irritable bladder, irritable womb, irritable brain, etc. Hypertrophy. Overgrowth is the meaning of this word; increase in size without essential change in the nature of a part. An organ may enlarge very much, with a great change in its char- acter ; for example, a tumor of the breast, or a dropsy of the head. Again, an or- gan may be stretched or dilated without even an increase of its substance. The heart exemplifies two of these changes in different instances. If one of its valves through which the blood passes becomes obstructed from disease, the heart has to labor more than usually to compel the blood to pass by the ob- struction. Like other muscles (the heart being really a hollow muscle), this extra labor may have either of two results, according to the conditions present. If the person's constitution be strong, and his blood well nourished, the much-worked heart will grow thicker and more powerful with the exercise. This is hypertrophy. But, if the contrary be the case, with a feeble system and poor blood, the heart is weakened by its excess of labor, and it stretches or becomes thin (attenu- ated) and dilated. The thickening of the skin of a workingman's hands shows an in- creased growth from habitual rough usage. A corn is a hypertrophy, and so is aivart; both involving almost entirely the outer skin or cuticle. Wens and pimples show a greater change of substance with enlargement. HYPERTROPHY OF THE HEART. 488 DOMESTIC MEDICINE. Atrophy. This is the opposite of hypertrophy. Want of blood or of the supply of nervous energy will cause an organ to shrink away. So a palsied hand often, in time, withers to half its original size. Atrophy occurs naturally, all over the body, with old age. First the fat is absorbed, then the muscles, and afterwards other parts, until the " well-shrunk shank " is far within the " lean and withered pantaloon." Degeneration. Instead of lessening in size, however, from loss of life-force, an organ may grow larger, with change of substance. This is organic degenera- tion. The substance taking the place of the natural tissue of the part is always inferior in character to that tissue. Thus fat may take the place of muscle, as in " fatty degeneration of the heart." Or bone-like material may form in place of the proper substance of the arteries; making " ossification " (calcification) of those vessels. Or the liver or kidney may be enlarged, the normal cells of either organ being replaced by a material like the areolar (" cellular ") tissue of the surface of the body under the skin. Tubercle, of the lungs or other parts, is essen- tially a kind of degeneration; although it often (not always) follows attacks of inflammation. Acute and chronic inflammation of various organs is frequently followed by hardening or softening ; both of these being modes of degenerative alteration. Dropsy. Seldom does an accumulation of water occur in one part of the body without some previous general disorder of the system, or at least an affection of some of the great organs: the heart, liver, or kidneys. We do sometimes meet with " white swelling" of the knee; but nearly always there are also signs of a "scrofulous" constitution to predispse to it. Inflammation may, however, cause an effusion of serum, which re- mains after the acuteness of the attack has passed. The simplest illus- tration of this is seen in a blister. Suppose mustard to be applied to the skin; as mentioned already, when referring to irritation, etc. First, we see stimulation, shown by redness and heat, with very little if any swelling, and no pain. ^'Xt, irritation, with soreness and pain, perhaps quite severe; then inflam- mation, followed by effusion, which raises the skin with what we call a " blister." So, also, when the pleura, which lines the ribs and wraps the lung-, LOCAL DISORDERS. 489 is inflamed, it throws out in a few days more or less lymph as an effusion. If this is copious in amount, it presses the lung away, and interferes with its expansion in breathing. This is sometimes so serious a trouble as to induce physicians to tap the chest and draw off the water to relieve the oppressed lung. Likewise, inflammation of the covering of the heart (pericarditis) may result in a serous effusion within the pericardial sac, clogging the heart so as not infrequently to cause death. Hydrocephalus, or water on the brain, may originate in a similar way. Dropsy of the chest, however (hydrothorax), dropsy of the head (hydrocephalus), dropsy of the abdomen (ascites), and general dropsy (anasarca), are much more often brought on by obstruction of the cir- culation, with thinning of the blood, from disease of the liver, kidneys, or heart, or two or more of those organs at the same time. Ovarian dropsy attends a ("cystic") disease of one or both of the ovaries. (Edema is a watery swelling of a part of the surface of the body or limbs. Emphysema is a puffiness of the skin, or lungs, from accumulation of air in the cellular substance of the part affected. Mortification. When a part, as a toe, a whole foot, leg, or arm dies, while the rest of the body lives, it is said to mortify, slough, or suffer gangrene. Once in a wrhile the feet of an old person may undergo slow and dry gangrene. When an artery, as that of an arm, is plugged up by a clot (embolus), the arm is apt to mortify in consequence. Frozen feet or toes often die and slough off. Sometimes, especially in ill-ventilated hospitals, stumps of amputated limbs, and wounds of various kinds, slough instead of healing (hospital gangrene). Quite rarely, sore mouth in children may become gangrenous; and even a lung, or a portion of it, may become the seat of gangrene. In the last case, the patient is almost sure to die. Mortification of a part is always more or less dangerous to the life of the whole body in two ways. First, the sloughing process may extend gradually from the part affected towards the centre of the body; and thus, involving vital parts, it may become fatal. Or dead matter from the gangrenous portion may be absorbed by the vessels, and so poison the blood (septicaemia) in a manner seldom recovered from. A\ hen mortification is confined to a small part of the body, as a frozen toe or finger, the rest of the system being in a healthy state, a line of demarcation naturally forms, separating the dead from the living tissues. In some cases, a surgeon will theu consider it best to hasten and com- 490 DOMESTIC MEDICINE. plete the process, by removing the sloughing part, by an operation. In other instances, the dead parts will drop off, leaving a surface which will gradually heal. Morbid Growths. Warts, corns, bunions, wens, moles, bony enlargements, fibrous and fatty tumors, are all unsightly, and the last named may be considerably in- convenient. But they do not of themselves tend to undergo such increase or morbid changes as to be dangerous to life. They may there- fore, by comparison, be called innocent growths. Malignant tumors are generally included under the name cancer. They tend to grow indefinitely, at the expense of the neighboring parts and of the general system. They often change their character, becom- ing open, discharging, offensive sores; the seat, moreover, generally of severe pain. At last, the whole body of a cancerous patient becomes unhealthy; and the end, after various periods, is death. Cancers may be either schirrus, colloid, or encephaloid. Schirrus is hard cancer. Colloid is jelly-like. Encephaloid is soft, almost like brain substance. The parts of the body most liable to be attacked by cancer (especially after middle life) are the womb, the female breast, the stomach, and the lower bowel (rectum); but various other organs are sometimes invaded by it. Schirrus is most apt to be met with in the breast, stomach (pylorus), or bowel; colloid, in the stomach, bowel, or covering of the bowels (mesen- tery, peritoneum). Encephaloid may occur in any organ; it is the only kind ever seen in the eye, liver, kidney, lung, ete. Epithelioma will be spoken of on page 721. GENERAL DISORDERS. 491 GENERAL DISORDERS. We may name these as debility, anaemia, plethora, cachexia, neurataxia, toxaemia, and fever. Debility. One is apt to feel weak, when anything whatever is the matter. But there are different sorts of weakness. A soldier bleeding from a wound, is weak from loss of blood. An overworked man or horse is ready to drop, from excessive fatigue. One who has had typhoid fever for three weeks is feeble from continued illness. All these are examples of ex- haustion. But, again: a railroad car runs over a man's leg, or he is burned over half of his body, or has fallen from the top of a house to the ground, or has been terribly frightened, about himself or some one else. Either of these causes will or may, by its shock, cause depression or prostra- tion, of which the extremest degree is called collapse. Thirdly, everybody is " weak " who has taken a very heavy cold, or who has an attack of measles, scarlet fever, small-pox, intermittent, re- mittent, or other fever. In the beginning of all such affections, the weakness is that of oppression. The organs of the body are clogged, so to speak; skin, kidneys, bowels, etc., are, for the time, hindered in their action, and the loaded blood fails to stimulate aright the various functions. These states may be illustrated by a comparison. Exhaustion is like the running down of a clock. Depression, like arresting for a time the movement of the pendulum. Oppression, like something getting into the works, which does not stop their motion, but obstructs and alters it so that it goes out of time. We remedy the first of these by winding up the clock; the second, by starting the pendulum again; the third, by removing the obstruction from the works. So it is important, in treating debility, to distinguish of what kind it is. Exhaustion, as after long illness, is to be recovered from, with time, under nourishing food, rest, pure air, etc. Depression, or prostration, as from a severe shock, by warmth, rest, and stimulation, according to the nature and degree of the case. Oppression of the organs, at the onset of a disease, is best relieved by unloading the system, by purgative medicines, and those which pro- mote the action of the skin and kidneys; sometimes, in an early stage, oy the withdrawal of blood from the arm, or by leeches or cups from a central part. 492 DOMESTIC MEDICINE. Anaemia. Poverty of blood is what this word means. It may result from various diseases, or from loss of blood, too long nursing, etc. Weakness accom- panies it, of the kind above called exhaustion. An amende person is usually pale (though perhaps easily flushed by excitement), rather thin, and " nervous." In women, such a condition is apt to be attended bv monthly irregularity. There is a form of it called progressive jwrniciom ancemia, which cannot be accounted for by ordinary causes, and which (unlike simple, common anaemia) it is almost or quite impossible to cure by any treatment. Another serious affection of the blood is leukamia, of wli! h we will speak in another place. Plethora. This is the opposite of anaemia. In it, the red corpuscles of the blood are too numerous, and the blood itself is redundant in amount. A ple- thoric person is round and plump (not necessarily fat), with full blood- vessels and a high color. Such an one is more liable than others, in early life, to acute inflammations and active hemorrhages; after middle age, to apoplexy. Cachexia. By this we mean a bad habit of constitution. Leukcemia* (or leucoeythsemia) is a disease in which there is an excess of white or colorless corpuscles in the blood. Another cachexia is scurvy (scorbutus); brought on by deficiency of fresh food; especially vegetable food. Another is goitre or bronchocele ; whose main feature is a swelling in the neck, involving the thyroid gland. With this, in Switzerland, there is often cretinism; a depraved constitution in every way; stunted growth, mental imbecility, and general weakness. Chlorosis, or " green sickness," is a cachexia sometimes met with in girls or young women ; the name is given because of a peculiar sallow- ness of complexion belonging to it. Rickets occurs tolerably often among the ill-fed poor in the cities of Europe; much more seldom in this country. Those having it are feeble from childhood, with defective development especially of the bones; which are easily broken and subject to decay. Tuberculosis is the constitutional affection of which consumption of the lungs is the most familiar manifestation; but it often also aflects the bowels, brain, and other organs. Tubercles are the small, irregular, * Something more will be said of each of these affections in a later part of thu under Special Diseases. GENERAL DISORDERS. 493 roundish deposits found after death in the place of healthy tissues; which, however, frequently soften, leaving cavities. Tubercular menin- qitis is the name given to an almost always fatal form of inflammation of the membranes of the brain, in children. Scrofula is an old designation for a constitutional tendency showing itself, early in life, by swelling of the glands of the neck and elsewhere, sore eyes, sore nose, running at the ears, and sometimes inflammation and decay of the bones of the limbs, or " white swelling" of the knee. Cheesy matter is found in scrofulous glands, which closely resembles the tubercle of some consumptive lungs. Many physicians believe, I think correctly, that scrofula and tuberculosis are essentially varieties of the same cachexia. Its characteristic is, a tendency to slow and obstinate inflammatory affections of different organs of the body, with deposits of formless material, more or less cheese-like at first, but disposed to soften TUBERCULOUS LUNG. (occasionally, however, becoming chalky instead) and to cause abscesses (gatherings with pus) around it. Diathesis is another word used at times with very nearly the same meaning as cachexia. So, we may say, that the diathesis now men- tioned, which is often inherited, involves generally in childhood the glands, mucous membranes (of the nose, ears, eyes), and bones, making what is called scrofula; or, at the same period, the brain, with " tuber- cular " or scrofulous meningitis; in youth and early middle age, the lungs; producing phthisis, that is, consumption of the lungs. There is good reason to be sure, however, that tubercular consumption may occur and go on to a fatal end without depending upon any inflammation of the lungs to begin it; being simply, from first to last, a destructive gen- eral and local cachexia. 494 DOMESTIC MEDICINE. Netjrataxia. I have coined this word (from neuron, a nerve, in the Greek, and ataxia, irregularity) to signify nervous disorder. Neurasthenia has been much spoken and written about of late years, meaning nervous debility. The latter, debility, does very often predispose to and produce disorder of the nervous system; but the other term is wanted because an amount of irregularity in the nervous functions may and does often occur quite out of proportion to the weakness present; indeed sometimes in those who can scarcely be said to be in a condition of marked debility. Hysteria is the most common descriptive word for various ataxic (un- balanced, out of order) nervous symptoms. It covers not only what are known as " fits of hysterics," but also a great many freaks of disease, of body and mind, well known to physicians. Among special diseases, hereafter, we may consider more particularly epilepsy, infantile and other convulsions, lock-jaw, etc., as disorders of the nervous system. Toxaemia : Blood-poisoning. An old saying is that " the blood is the life." Everything that ever makes part of any organ of the body must reach its place therein through the blood. And all that exists to-day in the solid structure of our frames will, some day or other (unless it be on the skin or some surface connecting with the outside), dissolve in the blood, to be carried out and away. Moreover, every beat of the heart, every drawing of breath, every thought flashing through the brain, needs a supply of pure blood, that it may be done rightly and well. Blood-poisoning, then, can never be a trifling thing. We would be in deadly danger of it every day, but that so much is arranged in our bodies not only to prevent it, but to relieve it promptly when it begins to take place. Indeed, each particle of used-up matter, which has served its purpose in any organ, becomes poisonous the moment it gets into the blood. But then, at once, the lungs, skin, kidneys, and bowels, with help also from the liver, take from the blood these dead particles, and carry them out, in the exhaled breath, perspiration, urine, and excrement. Thus we are safe, although, most literally, " in the midst of life we are in death." If, however, either of these blood-purifying processes is stopped, or much obstructed, real danger comes. Waste material collects in the blood, and the organs, thus badly supplied, work badly. There are several forms of blood-poisoning. One is uraemia, from suppression ot the action of the kidneys; another is cholwmia, from non-secretion ot bile by the liver. Another might be called saprcemia, from retention GENERAL DISORDERS. 495 of putrefiable matter not carried off by the bowels; but that word is otherwise used by some writers. All these are forms of blood-poisoning from within ; that is, by mat- ter formed in the body. Next to these may be named septiccemia, pro- duced by the absorption of foul material from a surface of the body, or near it • as from a gangrenous wound or an unhealthy abscess; or from the unremoved " lochial" discharges following child-birth. Pycemia is the term applied to such poisoning when it is followed by a deposit of pus in various parts of the body. Uraemia, unless relieved (towards which the skin always does a friendly part for the kidneys), is fatal usually in a very few days. Cholmmia seldom shows such destructive power, but is manifested by dizziness, sickness of stomach, headache, bitter taste in the mouth, and yellowness of the skin, tongue, and eyes.* Obstruction of the bowels causes blood-tainting by non-removal of putrescent material through their secretion; thus, and by other means, it kills commonly in a week or two, unless some means of relief be found. Septiccemia and pycemia will be treated of hereafter by themselves. Outside poisons reach the blood through the mouth aud stomach, by the lungs, or by the skin. Not now considering gross poisons (such as arsenic, corrosive sublimate, etc.), we refer here to those of a subtler nature, as bad drinking-water, malaria, and the causes of those diseases which for a long time have been called zymotic, now more often named enthetic—as small-pox, scarlet fever, yellow fever, cholera, etc.—about whose causative history something has been said in our section on Eti- ology. Each of these has more or less characteristic effects, to be described hereafter in their due place. That which is common to them all will be our now next following subject. Fever. When one has a hot, dry skin, a glowing red cheek, thirst, a rapid pulse, and weakness of body, with more or less dulness or disturbance of the mental faculties, we say he has fever. Constipation of the bow- els, and scanty secretion from the kidneys, also commonly belong to the same condition. But of all this group of symptoms, the most constant one is heat. In health, a thermometer in the armpit will mark 98.5° Fahr. Fever often runs it up to 103°, 104°, 105°, or even higher still. These last symptoms result from the non-removal of the coloring-matter of the bile, ch may have been reabsorbed into the blood from the gall-bladder after being se« *d by the liver, when the gall-duct is obstructed, as by gall-stones. 496 DOMESTIC MEDICINE. What causes this excess of heat ? Several conjectures have been made about it; but not much has been proved. The most nearly certain ex- planation is, that it is owing to increased " combustion," that is, oxida- tion, going on in the blood. Always, oxygen is, during life, and still more rapidly after death, combining with and "consuming" the elements of the body, in the blood and in the tissues. This consumption or com- bustion, which produces animal heat, is controlled and regulated, during health, by the living energy (life-force) of the body; the nervous centres being the instruments of this regulation. But when a disturbing ele- ment is introduced, life-energy is lowered, and chemical changes go on more rapidly; hence a higher heat of blood-combustion. Fever is met with in connection with many diseases. Inflammation of any of the great organs, brain, lungs, heart, pleura, bronchial tubes, stomach, bowels, etc., will, when active, be attended by it. And, with- out any inflammation, we meet with it in typhus; also with inflam- matory affections secondary to the general disease, in scarlet fever, small- pox, measles, diphtheria; and with or without local inflammations, in yellow fever, in relapsing, intermittent, and remittent fevers; perhaps also sometimes without any true acute inflammation, in typhoid fever. Two sorts of origination of the febrile state seem thus to exist: one, when it follows a local inflammation—irritative fever; the other, when it precedes inflammation or occurs without it, having its morbid cause in the blood—toxsemic fever. The various examples of it will receive our attention again after awhile. CLASSIFICATION OF DISEASES. 497 CLASSIFICATION OF DISEASES. Various plans of arrangement have been proposed, and are in use. I prefer to name all diseases as either inflammations, toxaemic dis- orders cachectic affections, nervous disorders, or unclassifiable dis- eases. Under the first head we place inflammatory attacks affecting the brain (meningitis *), lungs (pneumonia), pleura (pleurisy), air-pas- sages (laryngitis, tracheitis, bronchitis), heart (endocarditis, pericar- ditis), tonsils (quinsy), throat (pharyngitis), stomach (gastritis), bowels (enteritis, colitis, dysentery), peritoneum (peritonitis), liver (hepatitis), kidney (nephritis), bladder (cystitis), etc. As toxaemic disorders may be mentioned : 1. Those caused only by contact or inoculation: primary syphilis, gonorrhoea, hydrophobia, vaccinia.f 2. Eruptive% diseases, which are contagious: small-pox, chicken-pox, scarlet fever, measles. 3. Allied affections to the above, but not eruptive, although contagious: mumps and whooping- cough. 4. Diseases generally epidemic or endemic: § typhoid fever, typhus, spotted (cerebro-spinal) fever, erysipelas, puerperal fever, influenza, diphtheria, plague, aud cholera. 5. Endemic and occasion- ally epidemic: yellow fever, relapsing fever, and dengue. 6. En- demic and "malarious": intermittent, remittent, and pernicious (congestive) fever. Of cachectic affections, a part of the long list will answer our pur- pose here. 1. Those which are always chronic (prolonged indefinitely, tedious, not tending to recover of themselves): anaemia, chlorosis, leukaemia, general dropsy, tuberculosis, diabetes, constitutional syphilis. 2. Acute or subacute (active, and of limited duration): scurvy, gout, inflammatory rheumatism, pyaemia, septic fever (septicaemia), etc. 3. Local cachexias (degenerations): as cancer, goitre, Bright's disease (of the kidneys), fatty heart, gin liver, etc. 4. Skin-diseases; which will be classified in another, more conven- ient, place in this book. Nearly always this term applies; meaning inflammation of the membranes of the brain as well as of its substance. t Glanders, sometimes taken from the horse, is another of this group. X Physicians often call these exanthemata. i These words have been explained earlier in the book. Endemic is from en, in, and demos, a people, in the Greek ; meaning among or in the midst of the people of a place. Epidemic comes from epi, upon, and demos; a disease which comes upon a people from somewhere else. 32 498 DOMESTIC MEDICINE. Nervous disorders may also be only in part named here: apo- plexy, paralysis (palsy), epilepsy, catalepsy, hysteria, chorea (St. Yitus's dance), tetanus (lock-jaw), asthma, angina pectoris, locomotor ataxy (one form of spine-disease), convulsions, neuralgia, delirium tremens (mania-a-potu), insanity. Of unclassifiable diseases, not easily fitting iu cither of the above groups, there are dyspepsia, cholera morbus, diarrhoea, colic, jaundice, hemorrhages, local dropsies, worms, etc. SIGNS AND SYMPTOMS OF DISEASES. On approaching a sick person, our first question, whether put into words or not, is naturally, Is there much the matter f Other inquiries follow, such as these: Has he fever f Is he very weak? Is his head clear? Does he suffer pain anywhere? "What organ or function of his body is not as it ought to be? So we proceed from one thing to another in forming what doctors call a diagnosis of a case. Experience makes such an examination more and more easy, rapid, and efficient. A besetting temptation, even with physicians, is, when enough has been found out to give a probable name for the malady of the patient, to conclude at once that this is the whole matter, and that we know all about his case. This cannot he true, however, unless we have carefully scrutinized all his organs, or at least have satisfied ourselves on good evidence as to the presence or absence of disorder in them all. Our plan here makes suitable only a short account of the principal symptoms found in connection with different parts of the body, and their meaning; or, at least, the conditions with which they are most likely to be associated. Symptoms Affecting the Skin. The skin is hot and dry in fever. Moisture is nearly always a favorable sign. Exceptions are, the cold and clammy perspiration of great prostration, and the copious sweat- ing of advanced consumption. Emaciation (wasting) is seen generally in those long sick. Some* times it occurs rapidly, as in severe diarrhoea, or in the summer com- plaint of children. The color of the skin may be changed considerably in disease. -Ihe face is— Pale, during fainting, with sick stomach, and in anaemic persons. SIGNS AND SYMPTOMS OF DISEASES. 499 Flushed, in fever, early stage of apoplexy, or intoxication. Cheeks brightly flushed, in hectic fever of consumptives. Purple or livid, in typhoid or typhus fever. Yellow, in jaundice, bilious fever, and yellow fever. Sallow, in chlorosis, dyspepsia, and cancer. Blue, in the collapse of cholera, and cyanosis. Black, almost, in suffocation from any cause. Eruptions upon the skin belong to certain diseases, which will be described hereafter. Symptoms Presented by the Mouth, etc. The tongue is pale, in anaemic persons; red, in scarlet fever, inflamed mouth, and sometimes when the stomach is inflamed (gastritis); furred, in indigestion, and very often in fever; brown, or black, cracked and fissured, in low fevers, as typhoid or typhus. It is pushed out with diffi- culty in low fevers, and after an apoplectic attack; going to one side, in paralysis affecting one side only. The teeth are covered with thick brown stuff called "sordes" in low febrile states. They are loosened, sometimes, by severe salivation, from large doses of mercury. Doses of mercurial medicines large enough to produce such effects are not now given by regular physicians. The gums are swollen, soft, and spongy, and disposed to bleed easily iu scurvy. A blue line along the gums is observed in lead poisoning; a red line, occasionally, in advancing consumption. Swelling and sore- ness of the gums, with tenderness of the teeth and a " coppery " taste in the mouth, are signs of mercurial salivation. Increase of saliva gives the name to this affection, once not uncommon in medical practice. Iodide of potassium, taken medicinally, will some- times salivate. Large doses of jaborandi, or its active principle, pilo- carpi^ generally does so. The taste is morbidly bitter in disorder of the liver; sour, often, in dyspepsia; saltish, with spitting of blood; putrid, in gangrene of the lungs. The Throat. Difficulty of swallowing may result from inflammation of the tonsils or gullet (pharynx); spasmodic closure of the throat; perma- nent narrowing or stricture of the pharynx or lower gullet (oesophagus); obstruction, as from a bone, etc.; paralysis, as after diphtheria, or extreme weakness, in the dying state. Thirst is excessive in two opposite conditions: high fever and low collapse. 500 DOMESTIC MEI) 1 CISE. The Stomach. Appetite is almost always deficient in both acute and chronic discus1; most so, however, in the former, as a rule. Perverted appetite occurs in cases of chlorosis, and in some hysterical subjects. Nausea (sick stomach), with or without vomiting, is met with in indigestion, colic, seasickness, pregnancy (morning sickness), gastritis (in- flammation of the stomach), hysteria (occasionally), cholera morbus, epi- demic cholera, bilious remittent fever, yellow fever, ulcer of stomach, cancer of stomach, strangulated, hernia (rupture), obstruction of the bowels, irri- tant poisoning. Symptoms Belonging to the Circulation. Palpitation, or disturbed action of the heart, may depend upon inflammation of its membranes (pericarditis, endocarditis), enlargement (hypertrophy or dilatation), valvular disease, anosmia, with weakness, ner- Fig. 176. FEELING THE PULSE. vous irritability (nervousness), as from strong coffee, tobacco, etc., dys- pepsia, brain disorder. The pulse may be, in disease, natural, strong, weak, firm, yielding, full, small, compressible, rapid, slow, quick, jerking, hard, soft, Uw, gaseous, corded, tviry, thready, imperceptible, regular, irregular, inter- mittent, double (dicrotous). A fever pulse is moderately rapid, and in the early stages of an attack, strong; later, soft and compressible. When violent acute in- flammation of any orgau is present, it is quickened, hard, and rather full, as a rule. . A nervously disturbed pulse is quick (jerking rather than rapv), aud variable, under excitement or repose. In extreme weakness, most of all in the dying state, the pulse is SIGNS AND SYMPTOMS OF DISEASES. 501 nearly always rapid and small, or "thready." A pulse of 150 or 160 in a minute, is almost always a sign of death. Very rarely is the pulse slow in the dying state. Slowness of the pulse is most marked in compression of the brain (as in apoplexy, fracture of the skull, or hydrocephalus, i. e., water on the brain), and in opium poisoning. Occasionally the pulse is very slow in cases of heart disorder. Irregularity of the pulse is natural to a small number of persons, at least in childhood or in old age, without other signs of disease. It may be otherwise, a transient symptom, particularly during convalescence from a fever. It is distinctly related to disease present, in certain cases of heart disease (when it is serious) and in the third stage of acute meningitis (inflammation of the brain). Excessive smoking of tobacco sometimes produces irregularity of the pulse, as was first shown by Dr. B. W. Richardson, of London. A double (dicrotous) pulse is met with in many instances of con- tinued fever, typhus or typhoid. Slowness of the capillary circulation is occasionally shown, in morbid states, by the tardy return of the blood when displaced by pressure, as on the back of the hand or the cheek. In the veins, likewise, this is notably seen in the collapse of cholera. Hemorrhage. While bleeding from any part of the body is often an important symptom, it needs to be interpreted with care. Its consequence depends greatly on its quantity and the source from which the blood comes. Thus, in bleeding at the nose, the flow of blood may possibly result from either of the following causes: a severe blow; congestion (fulness of blood) simply in the membranes of the nose; congestion of the brain (to which the bleeding may give advantageous relief); early stage of typhoid fever; suppressed menstruation (monthly discharge) of which it is an alternative. Spitting of blood may come from hemorrhage of the gums, the back of the nostrils, throat, windpipe (bronchial tubes), lungs, or stomach. If from the stomach, it is preceded by nausea, and is vomited. When from the lungs or bronchial tubes, it is coughed up instead. Hemorrhage from the lungs (hcemoptysis) may depend upon con- gestion (over-fulness of blood) of the lungs; heart-disease, tubercular consumption, suppressed menstruation, of which it may, occasionally, be vicarious," that is, au alternative or substitute; an injury, as a broken nb, wound of the lung, etc.; rupture of an aneurism of the aorta. (See the account of this affection later in the book.) 502 DOMESTIC MEDICINE. Vomiting of blood (luvmedemesis) may be one of the symptoms oc- curring in hysterical women ; or it may result from ulcer, or cancer of the stomach; or it may be (as above) substitutive or vicarious of absent menstruation. Uterine hemorrhage (other than the natural monthly flow) may come from congestion of the womb, or its ulceration, or cancer. During preg- nancy it threatens miscarriage, or results from misplacement of {he pla- centa (after-birth). Hemorrhage from the bowels may be connected with piles (hemor- rhoids), dysentery, ulceration of the bowels, cancer, rupture of an abdom- inal aneurism, typhoid, malarial, or yellow fever, or vicarious menstru- ation. Haematuria (bloody urine) may follow a mechanical injury, inflam- mation of the kidneys, stone in the bladder, or a bad state of things in cases of scarlet fever. Symptoms Connected with the Breathing Organs. Sixteen to eighteen times in a minute is the ordinary rate of breathing while at rest, in health, for a grown person. In fever it is almost ahvays a good deal faster than this ; often thirty, forty, or more respirations in a minute. When a person is poisoned with opium, the breathing be- comes snoring, and very slow, even only six times or less in a minute in heavy narcotism. Aj>oplexy, and pressure upon the brain from a piece of a broken skull, are also attended by sloiv, snoring respiration. Difficulty of breathing (dyspnoea) may be caused by Irrespirable gases (as chlorine, etc.) in the air; Obstruction in the air-tubes, as from croup, asthma, or bronchitis; Disease of the lungs or pleura, as in pneumonia, consumption, or pleurisy. Disease of the heart or aorta; Abdominal dropsy, pressing upwards. Coughing, also, may have a variety of causes, of the nature of which we may often judge by its character. Thus it is, commonly, Dry and tight, in early bronchitis; Soft, deep, and loose, in advanced bronchitis; Hacking, in the beginning of consumption; Deep and distressing, in advanced consumption. Short and sharp, in pneumonia ; Hoarse and barking, in an early stage of croup • Whistling, in advanced membranous croup; Paroxysmal (in spells) and whooping, in whooping-cough. Dry and hollow, when sympathetic or nervous. SIGNS AND SYMPTOMS OF DISEASES. 503 Expectoration is white, thin, and mucous, in catarrh and early bron- chitis; yellow and thick (purulent) in severe and protracted bronchitis; rust 11, in the middle stage of pneumonia; bloody, thick, and yellow, in developing consumption (phthisis); in heavy, round, small yellowish, lumps, in advanced consumption; putrid (rotten), in gangrene of the lung. The breath is hot, during fever; cold, in the collapse of cholera. The odor of the breath is seldom perfectly agreeable except in a healthy child. Bad teeth and imperfect digestion are common causes of un- pleasantness in it. It is very heavy at the commencement of a fever; sour, during an attack of indigestion ; rotten, in gangrene of the lung. Hiccough is produced by a spasm of the diaphragm, at the floor of the chest. It may depend upon indigestion, nervous disorder, or great exhaustion. In the last of these, it is generally a decidedly bad symp- tom. Snoring (stertorous), respiration results (as above-mentioned) from oppression of the brain; the cause of which may be either apoplexy, fracture of the skull, dead drunkenness, or narcotism by opium. (Of course we do not forget that some persons snore tremendously during their natural and healthy sleep.) Symptoms Affecting the Muscles. Position is often significant in disease. Inability to rise may be owing to general weakness, palsy, inflammation of the joints, etc. (as from rheumatism or gout), or an injury, such as a broken thigh or leg. Inability to lie down is generally the result of difficulty of breathing (dyspnoea), which doctors then call orthopncea, or straight-up breathing. In colic, the patient usually prefers to lie upon the belly. In peritonitis, the chosen position is on the back, with the knees drawn up. In the early stage of pleurisy, the patient lies of choice on the side not affected; after water collects (effusion) this is reversed. When the liver is enlarged from disease, the right side is mostly preferred. When the heart is much disturbed in its action, the sufferer generally cannot lie on the left side. Exceptions occur in heart disease, especially of long duration. In aneurism of the aorta, a favorite position often is sitting up and leaning over the back of a chair, or the edge of a bed. Muscular weakness may result from acute disease, as fever, or from exhaustion. Entire want of exercise weakens the muscles. When an arm or a leg has been long fastened up in splints on account of a frac- ture, its muscles are almost powerless upon first being taken out of their confinement. 504 DOMESTIC MEDICINE. Spasm may be of either of three kinds: fixed, or tonic spasm, as in lock-jaw (tetanus); regularly jerking, or clonic, as in fits or conculsionx; and irregularly jerking, as in St. Vitus' dance or chorea. Cramp is a short-timed tonic spasm. Tremor (trembling) is of two kinds : constant trembling, as in shak- ing palsy (paralysis agitans), and tremor only when doing something, as in one form of disease of the brain and spinal marrow. Rigidity of muscles is different from mere spasmodic contraction. It occurs in certain severe and continued cases of palsy (paralysis). Jerking of the tendons (subsultus tendinum), especially at the wrists, is met with in low states of continued fever, typhoid or typhus. Symptoms Connected with our Senses. Pain is variously interpreted, according to its place and character. It may be Acute, sharp, cutting, as in pleurisy; Shooting, darting, as in neuralgia; Piercing (lancinating), in cancer; Gnawing, tearing, in rheumatism ; Dull, heavy, aching, as in pneumonia; Griping, twisting, in dysentery ; Bearing down, in second stage of labor; Pulsating, in the formation of an abscess; Burning, smarting, in erysipelas; Stinging, nettling, in urticaria (nettle-rash); Constant, or intermittent; fixed or wandering. Tenderness on pressure is generally a sign of inflammation, although some neuralgic cases have it; possibly from inflammation of the sheaths of the nerves. Tired muscles also are often sore to the touch as well as on motion. Sometimes pain is relieved by pressure; this is often the case with colic. In such instances we conclude that there is no inflammation. Pain is not always at the place of disease. In disease of the hip-joint, the principal pain Ls at the knee; in dyspepsia, often, over the middle of the breast; when the liver is disordered, under the right shoulder- blade ; in irritation of the womb, at the top of the head. Loss of sensation (anaesthesia), occurring from disease, constitutes one kind of paralysis. The other form is loss of poiver to move the limbs or parts affected. When paralysis involves one side of the body only, as the right arm and leg, or the left arm and leg, we call it henu- plegia. Paraplegia is palsy of both legs at the same time. (See p. 51 <■) SIGNS AND SYMPTOMS OF DISEASES. 505 The Eye in Disease. Blood-shot eyes show either inflammation of them or fulness of blood in the head, which is often present in fevers. If one eye only is very red of course the trouble must be iu itself. Yellowness of the " whites " of the eyes occurs in bilious disorder. The eyeballs are notably prominent in that curious and rather un- common disorder called " exophthalmic goitre " (of which mention will be made again hereafter). Prominence or bulging of one eye only shows a probability of disease, as a tumor, behind that eye. Sinking of the eyeballs in their sockets is seen to some extent in consumption and other wasting diseases. Sinking of one eye must result from wasting of its own substance or of the socket behind it, the former being often observed in the blind. Rolling of the eyes from side to side is common in great nervous restlessness of infants or young children. Squinting (strabismus), which is natural with some, and an acquired habit with others, becomes a serious symptom when it occurs as the result of disease of the brain. The lustre of the eyes growrs dull often a short time, perhaps a few hours, before death. Bright eyes are commonly noticed in advancing consumption. They may glare in mania (insanity), or, for a time, in acute inflammation of the brain. Yery small pupils of the eyes are seen when either they are, or the brain is, the seat of inflammation. In opium-poisoning the pupils are contracted, at least until very near death. They are large (dilated), commonly, in apoplexy, water on the brain (hydrocephalus), and poison- ing by prussic acid or by Jamestown weed (stramonium) or belladonna. Great shrinking from light (photophobia) exists in severe inflam- mation of the eyes, and also in acute inflammation of the brain. Spots, rings, etc., floating before the sight (musca volitantes) show the presence of opaque particles in the interior of the eyeball (vitreous humor), which are not of much importance. Fixed dark spots are of more consequence; they often show a beginning of blindness. The Ears. Pain in one of the ears, earache, may be either inflammatory or neu- ralgic. Other signs must be considered along with it to show which it is. Ringing in the ears (tinnitus annum) occurs from either of at least two or three causes, to distinguish between which is not always easy. Large doses of quinine, and of one or two other powerful medicines, 506 DOMESTIC MEDICINE. will make many people's ears ring or roar. Disease of the ear will often produce this symptom, even when the disease is not severe at the time. In other instances, brain exhaustion, or congestion (overfulness of blood) of the brain, may give rise to it. If it be heard only in one ear we may be confident that the cause is in that ear itself. Deafness, or hardness of hearing, in various degrees, may proceed from Cold in the head; Yery large doses of quinine ; Typhus or typhoid fever ; Wax accumulated in the ears; Disease or injury of the ears; Brain disease. Headache. Pain in the head may depend in different cases upon Neuralgia; Rheumatism; Overfulness of blood (congestion, hyperemia); Blood poisoning (as by alcohol, opium, etc.); Fever (remittent, typhoid, etc.); Disease of the brain ; Sympathetic irritation (as with uterine disorder, etc.). Skill as well as care may often be necessary to make out, in an actual case, to which of these a headache (cephcdalgia) belongs. Neuralgia headache is nearly always on one side only or chiefly, and extends to the face also; it is shooting or darting, and there is with it some tenderness on pressure. Rheumatism of the scalp is usually accompanied by stiff- ness of the muscles that move the head and neck. Headache from ful- ness of blood or fever is attended by heat of the head; the pain is then apt to be throbbing in character. Pain from disease of the brain is gener- ally in one spot, either fixed or in spells (periodic or paroxysmal); and some other sign of brain disease is also present with it. (See p. 519.) Expression of the Face. Acute disease is apt to alter this more than that which is chronic; but it is often changed in both. An anxious or distressed expression giving way to serenity is always a good sign, unless it be the result 01 mortification or palsy coming on. Great anxiety is seen especially in organic diseases of the heart, ami in acute disorders of the abdomen, as well as in melancholy. Terror belongs habitually to delirium tremens, also called manto- a-potu, or the horrors. SIGNS AND SYMPTOMS OF DISEASES. 507 Rage is now and then seen in insanity (acute mania), and in some, not all, cases of hydrophobia. Insane persons, although not always very peculiar in countenance, have mostly an expression by which their derangement can be recognized by those accustomed to observing it. Collapse, that is, extreme prostration, as from the shock of a railroad accident, an attack of cholera, or the dying state from any cause, has its own characteristic expression, more easily understood when seen than described. Shrunken cheeks, pale or livid, with mouth drawn down at the corners, and white, glassy eves; these with clammy coldness to the touch, gasping respiration, and a thready or absent pulse at the wrist, mark this condition. Delirium. This is a disorder or confusion of mind, in acute disease, not fixed for a long time like insanity, but depending upon a temporary cause. It is present in many attacks of maladies atteuded by fever ; as severe remittent, typhus, typhoid, scarlet, or yellow fever, etc. A few persons are liable to transient delirium during almost any brief attack of illness. Mania-a-potu, as already said, has a characteristic delirium, in which, almost always, there is extreme terror, from imaginary enemies or dangers of some kind. Doctors speak of active delirium, in which the patient talks a good deal, and tries to go about; and passive or low, muttering delirium, when he lies still and only mumbles incoherent words. Grown people are affected by delirium usually under circumstances which, in a child, would bring on convulsions. Stupor. Coma is the medical word for this. It is an unnaturally deep sleep, from which one cannot be roused. We meet with it chiefly in the fol- lowing: alcoholic drunkenness ("dead drunk"); opium poisoning (narcotism); apoplexy ; very low typhus fever ; compression of the brain from fractured skull. It is not always easy to say, in a particular case, which of these is present. Intoxication is generally shown by the odor of the breath, and the general appearance of the patient, and his behavior before he became unconscious. In opium poisoning, the pupils of the eyes are, as a rule, strongly contracted, even when no considerable light is shining on them. Typhus fever is known by the history of the case; as, in it, complete stupor is never the condition at the very beginning of the illness. A broken skull, if not obviously accounted for by a known injur)', may be 508 DOMESTIC MEDICINE. found out by careful examination of the head. (Of this again here- after.) Dizziness (giddiness, vertigo) is accounted for in different instances by either of four causes: mere iveakncss; disorder of the liver (bilious- ness, cholcemia) and stomach; disease of the internal ear; disease of the brain. The last of these is the least common, unless in persons over sixty years of age. Loss of speech (aphasia), or getting the wrong words instead of those intended, comes from a disorder of the brain. It is often accom- panied by loss of power, especially in the right arm and leg. Loss of voice (aphonia) is another thing; resulting from thickening of the lining membrane of the windpipe (larynx), or paralysis of its muscles; or, in the dying or nearly dying state, extreme debility. Symptoms Affecting the Secretions : The Bowels. Constipation (tightness of the bowels; absence or rarity of move- ment, and smallness of amount discharged) is almost always present during the first days of a fever, of any kind except typhoid. Even in that, also, although early looseness of the bowels is more common, there is in a few cases a short time of constipation. Pregnant women are very apt to have the bowels constipated, from the partial obstruction produced by the pressure of the enlarging uterus upon the lower bowel (rectum). Sea-sickness, also, is very often attended by slowness of the bowels. But the most obstinate and alarming con- stipation is that of obstruction of the bowels; as in strangulated rupture, or in intussusception (both to be again mentioned in another place). Diarrhoea (excessive liquid flow from the bowels) is symptomatic of various disordered conditions. It is present as a rule in typhoid fever, and is common in advanced pulmonary consumption. It is an essential part of the attack in cholera morbus, epidemic cholera, and cholera in- fantum (summer complaint of infants). It occurs frequently by itself, particularly in warm climates, and in the summer season. Discharges in diarrhoea are either natural (fecal), mucous (slimy), bilious, or watery. In cholera morbus, which may he met with any- where, the passages are nearly natural or bilious, unless near the end of a very bad case. Epidemic cholera is distinguishable partly by the rice-water-like abundant discharges, with no biliary color at all. Dysentery is recognized by scanty but frequent bloody discharge-, with griping pains, and a disposition to bear down. Slime (mucus) \-> apt to be mingled with blood, also, and at a later period in severe cases there may be pus. SIGNS AND SYMPTOMS OF DISEASES. 500 Excretion of the Kidneys. Symptoms connected with this excretion are: strangury (difficult urination), incontinence of urine (want of control, especially during sleep) retention, suppression, and excess of the secretion (diabetes), and unhealthy character of the urine passed. Strangury sometimes follows the application of a fly (cantharides) blister. Now and then it is observed in children from the irritation of seat-worms in the lower bowel; and in young infants, owing to an irri- tating quality of the urine; which, in such a case, is pretty sure to be scanty and high colored. Nightly incontinence of urine is quite common in children, some- times up to their " teeus." Dribbling while awake shows a much greater loss of power over the bladder. This is seen in many cases of injury or serious disease of the spinal marrow. Retention of urine may be a very distressing symptom. Men suffer it who have " stricture " of the urethra (outlet tube from the bladder). Nervous disturbance may cause it in either sex, but especially often in hysterical women. After child-birth it follows pressure upon the neck of the bladder. In low fevers, as typhus or typhoid, it results from general debility. Its probability should always be remembered in such cases, as the patient may be " out of his mind" and so may give no account of it. We should make sure, in a fever case (or, indeed, in any other illness), how much and how often water is passed. If the quantity is certainly small, it is necessary to examine the abdomen at its lower • part, over the bladder. When urine is retained, there will be a firm swelling at the lowest part of the belly, just in front, above the bony ridge of the pelvis; and, on tapping there with a finger, a dull sound will be made. If the bladder be empty, the sound will be rather hollow. In some cases of spine disease, there is retention instead of inconti- nence of urine. This symptom, however produced, often calls for relief by the use of a tube introduced through the urethra into the bladder, called a catheter. It is short and almost straight for the female; longer and curved (if of metal or firm rubber) for the male subject. Suppression of urine is always a bad sign, in any case of disease. It is sometimes met with in low fevers, epidemic cholera, bad cases of scarlet fever, and long standing cases of disease of the kidneys. Urcemia (blood poisoning with materials of urine) follows it, and usually ends life in a few days at most. Excess of urinary discharge is called by physicians diabetes. It occurs not unfrequently, for a time, after checking of perspiration by exposure to cold. Hysterical or other nervous persons also may be affected with it. Common report says that soldiers almost always have 010 DOMESTIC MEDICI\R. need to empty the bladder just before going into a battle. The chronic (prolonged) disease called diabetes is attended by a remarkable change in the character of the urine passed; which is very heavy and contains sugar. Qualities of the Urine. About forty, or from thirty to fifty, fluid ounces (a quart, more or less) of urine is passed by a healthy grown person every twenty-four hours. It may be retained longer in the female than in the male bladder, but not many hours commonly in either. More is passed, and more frequently, during winter than in summer. Warm temperature promotes perspiration, cold, urination. The color of healthy urine is that of amber. It should be clear when passed, and should have very little settling at the bottom, even after standing for some hours. Yet some change in color, lighter or darker, or variations in quantity, and even deposit of sediment, may take place while the person continues in health. Such alterations often show the successful relief of the system, by excretion, of what, if not carried off, might have caused disease. Great and continued alterations in the urine, however, are important signs of something being wrong; and, under skilful examination, the nature of the disease may thus be found out. For this kind of inquiry the skill of the physician, trained in the use of chemical tests and the microscope, will be required. Our present plan calls only for an account of what any observant person may discover and understand.* We judge of the character of the urinary secretions by noticing, be- sides its quantity, its general appearance, weight (specific gravity), reaction with chemical tests, and the presence or absence of different kinds of sediments. In appearance, it may be clear or opaque, light-colored or dark. If clear and deep-colored, we infer a too rapid wasting of substance to be going on in the body at the time. In jaundice, the urine is generally very yellow, and sometimes is as dark as porter. When opaque, it is either white or dark. White opaque urine con- tains either mucus or pus, or undissolved earthy sediment, or all of these together. Mucus floats more as a cloud than pus ; the latter is apt to be opaque throughout, though with a more creamy layer at the bottom. Pus, however, can be readily diffused (more so than mucus) by shaking. (Mucus always shows a less violent, or less advanced, inflammation than pus.) * See the author's " Essentials of Practical Medicine," under Semewlogy, for further oarticulars on this subject. SIGNS AND SYMPTOMS OF DISEASES. 511 Dark-colored opaque urine is most frequently tinged with blood, giv- ing it a pinkish or brownish hue. Blood may be in the urine either from the kidneys or from the bladder ; or, after an instrument has been used from the urethra. Bile also may give a dark color to the urine, as in non-secretion of bile by the liver (or its reabsorption) in jaundice. The weight (specific gravity) of the urine may be easily determined by usino- a urinometer (hydrometer), which is a little glass upright, with mercury at its lower* end,, and a marked scale above. In F 17_ healthy urine (as in pure water the 1000 mark is just at the water-level) it should only sink so far that the 1017, or from that to the 1020, line just touches the level. In diabetes met- fpj^jf Bus (with sugar in the urine) it may rise to 1060 or 1070. In the clear and abundant urine of some hysterical persons it may be so light as to mark 1010 or loss. Tests require for their use, as alreadyr said, chemical skill. It is easy for any one, however, to find whether the urine is acid or alkaline. In health, and mostly also in disease, it is acid, more or less. This is shown by its reddening a strip of litmus paper dipped into it. If, instead, it be alladine, it will restore the blue color to litmus paper which has been reddened by another acid (as vinegar), and will change the yellow of turmeric brown. Alkaline urine is noticed particularly when mucus remains for some time in the bladder. urinom- Physicians use tests especially to find out whether, in cases of disease, the urine contains albumen (as in Bright's disease) or sugar (as in diabetes mellitus). For these processes we must refer to medical or chemical works.* In those also are described the various minute forms of crystals, corpuscles, etc., observed in the fresh or dried sedi- ments of urine, by aid of the microscope. Gravel is the term applied to small stony particles which are formed in the kidneys from disease, and pass, first along the ureters to the bladder, and thence out through the urethra with the flow of urine. Pain, sometimes very severe, may attend both of these short journeys of particles, if they be large. Often, however, they are more like sand than gravel, and escape without giving pain, except that both the kid- neys and bladder are apt to be in a state of irritation at the time of an " attack of gravel." It may be merely mentioned that nitric acid followed by heat will cause a milky appearance in albuminous urine. Both are needed to make the test sure. One test for sugar in urine is, to add a little strong solution of sulphate of copper to a portion of it, and then pour in half its bulk of solution ofpotassa. On heating the mixture, a yel- lowish or reddish-brown precipitate settles to the bottom of the vessel. Glass test-tubes should be used for such purposes, with a spirit-lamp. 512 DOMESTIC MEDICINE. Stone in the bladder is of the same nature, only the particles accumu- late into one or more masses, which may become very large, and cause great suffering; not seldom, unless removed by an operation, shortening life. Gall-stones are formed by thickening of bile in the gall bladder, wdiich lies under the liver, on the right side, near the middle of the body. Although the gall-duct, through which such stones pass to the small intestine, is short, a large gall-stone (biliary calculus) sometime* gives extreme pain in its passage. Complete relief comes when it enters the small intestine (duodenum); as is the case likewise when a grarrl- stone escapes from the ureter into the bladder. Perspiration. Besides deficiency and excess in this important secretion of the skin, it is a familiar fact that it has, in some persons, a very unpleasant odor, especially in the armpits and about the feet. Perhaps this is somewhat most manifest in the African and other tropical races, but much depends on individual constitution and cleanliness. A few persons, with all possible care of their skius, still have a considerable odor, at least in warm weather. For such it is important to bathe frequently, applying good soap and water daily to their armpits and feet; and also to keep their bowels regularly and sufficiently open. The odor seems to be due in part to an unhealthy misplaced (vicarious) excretion by some of the glands of the skin. In small-pox, typhus fever, and some other diseases, an odor peculiar to each is given off (in some cases at least) from the body. Menstruation. This is not truly a secretion, it is rather a periodical and natural hem- orrhage; although of somewhat altered blood. Its deviations from health, besides mere irregularity, are amenorrhcea, menorrhagia, and dysmenorrhoea. Amenorrhcea is absence of monthly discharge. Menorrhagia is excessive flow at such times. Dysmenorrhoea is the term applied when it is attended by pain. We must leave for another place further con- sideration of these affections. Physical Diagnosis. By this is meant the close examination made by physicians into the state of the organs in the chest and abdomen, by measuring, feeling, tapping, and listening (mensuration, palpation, percussion, and auscul- tation). Percussion is tapping with a finger end, or a small hammer, SIGNS AND SYMPTOMS OF DISEASES. 513 so as to compare the sound brought out with that of a healthy chest or abdomen. Auscultation is listening, either directly or through a tube (stethoscope), to ascertain the breathing sounds, or those belonging to the heart in its rhythmic action. An attempt to discuss at length this sub- ject, which can only be practically understood with the aid of consider- able experience, would be out of place in a work on Domestic Medi- cine. Temperature in Disease. Thermometers are made for ascertaining this (clinical thermometers). The bulb is commonly placed in the arm- pit (sometimes under the tongue, or in the bowel, by direction of the physician), where it should remain about five minutes, to get the tem- perature of the body. During health this will be, in an adult, 98.5° (from 98.4° to 98.6°); in a child, 99° or 99.5°, possibly 100°. In tropical climates, it is sometimes a degree higher than in temperate regions. In the latter, it is apt to be highest on waking in the early morning; lowest at midnight. In tropical regions, it is lowest in the early morning, and highest shortly after noon. During fever, however, it is always highest a few hours before midnight. A rise of temperature, in disease, of 1° Fahrenheit, corresponds, as a rule, with an increase of the rate of the pulse of from eight to ten beats in the minute. The thermometer has been known, especially in scarlet fever, yellow fever, and tetanus (lock-jaw), to mark as high as 108°, 110°, or even 112°. An authority on the subject (Aitken) says: "When the temperature is increased beyond 98.5°, it merely shows that the individual is ill; when it is raised as high as 101°—106°, the fever is severe; if above 105°, the patient is in imminent danger; with 108° or 109° a fatal issue may without doubt be expected in a compar- atively short time." Convalescence from disease does not begin until the natural tempera- ture of the body returns, and is maintained unchanged through the day and night. 33 PAET II. REMEDIES. REMEDIES. DO doctors, properly speaking, cure the diseases and injuries of theii patients ? Yes, and no. Cure comes from a Latin word meaning care; to take care of something or somebody. That a good physician will always do. Sometimes, also, he may and must actually interfere with what is going on; as when he gives an antidote for a poison, and so saves life that would otherwise be lost. But, in many other instances, he simply takes care of the patient, and Nature cures, in the full sense of that word. There is, as we are created, a tendency to get well, which was called by the ancients vis medicatrix naturce. A bone, for example, is broken. What does the surgeon do ? He draws it out straight, gets the pieces into their proper line, and puts on splints to keep them there. Then the bone knits, in a few weeks, of itself. So also with the heal- ing of a wound. Its edges are placed and kept close together, if that can be done, till they unite again; or, if that be not possible, the wounded surface is covered with something which can do no harm, and which protects the part from outside air and other things, until it heals, of itself. Here we see that certain conditions are wanted in each case, in order that the knitting or healing will take place. So it is with diseases, as well as with injuries. Some disorders are naturally self-limited; that is, they will, if the patient lives for a certain time, get well of them- selves ; they run a tolerably regular course, and then end. Scarlet fever either kills or is passing off, generally, within eight, nine, or ten days; small-pox runs its course, living or dying, within about three weeks; typhus fever, in four weeks; typhoid fever, in the same or a longer time; and so with other fevers, all of which are self-limited. What the doctor has to do in such cases may be shown by an 11111* tration. 514 REMEDIES. 510 He is like the captain or pilot of a ship. The wind, or steam, drives it on; he simply directs its course; steers it, away from dangers, and towards its intended haven. As however, sometimes, the captain of a vessel has more to do than only to steer it—in time of great danger, for example, to take in sail, cut down a mast, or throw overboard his cargo—so there are cases of disease in which the physician must actively interfere; and cases of injury, in which the surgeon must operate. These cases are fewer than those in which " steering" only is called for; but they are very im- portant ; and only a skilful physician or surgeon can with confidence ascertain when and how they are to be dealt with. Hence there will always be need of doctors, and of skilful, well-trained, and well-informed ones, too, however highly we may ap- preciate the powers of nature and the value of good nursing. Those who understand these best will be the most able to do justice to the real worth of a judicious medical or surgical practitioner. The purpose of this part of our book, on Home Medicine, is not to attempt to show how doctors can be dispensed with, but to enable those who, under cir- cumstances not very rare, cannot at once have competent medical advice, to judge what is the best thing to do while waiting for it. Also, it is hoped that the knowledge thus set forth may enable our readers to un- derstand better, and thus place more intelligent confidence in, what doctors advise in cases that are brought under their care. The times of super- stitious expectation of magical doings on the part of the physician (like those of the Indians' " medicine-men ") have well gone by. Every one knows that no skill will always avert death. But it is important to be sure, also, that by the timely and wrell-judged use even of simple measures, death may often be averted or long postponed; suffering may be much lessened, and recovery may be hastened from diseases which otherwise would be of very uncertain and far-off result. Looking at remedies from our present standpoint, we may classify their objects as follows.* Whatever their nature, they are used for one or more of the following purposes: To relieve pain; To compose nervous disturbance; To promote sleep; To open the bowels; To check diarrhoea; To relieve vomiting or sickness of stomach; This classification is also used, with some slight differences, in my little book enti- tled " The Family Adviser and Guide to the Medicine Chest;" Philadelphia, J. B. Lippincott & Co. 516 DOMESTIC MEDICINE. To allay indigestion ; To improve weak digestion; To reduce inflammation; To lower fever; To ease or quiet cough; To stop hemorrhage; To regulate menstruation; To relieve dropsical swelling; To support the system under prostration or exhaustion; To increase strength in prolonged debility; To cure certain diseases by special remedies; To expel worms; To antidote poisons; To obviate the danger and suffering of accidents or injuries. A full consideration of all the articles and procedures that are or may be used under advice of physicians for these different purposes, would make a work on " Materia Medica and Therapeutics." Many such technical and professional works have been written.* Our present aim will be to give a simple general view of the subject, and to dwell on such remedies as are safe and available in Home Medicine, when no physician is to be had; only briefly mentioning, also, some of those which are less suitable for domestic employment, although used in med- ical practice. * The most satisfactory information of this sort may be obtained by reference to the " United States Dispensatory," by Wood and Bache and their successors, or the " National Dispensatory," by Stille" and Alaish. REMEDIES 517 To Relieve Pain. Much depends on where the pain is, and of what sort. Anodynes are medicines whose action is to quell pain, by their influence upon the brain or nerves. But we do not nearly always have to resort to these on account of pain, especially when it first begins to be felt. Of all parts of the body, probably the abdomen is the most frequent seat of pain. " Stomachache " and " colic " are very common. The most general cause of such attacks is indigestion with flatulence (wind in the stomach and bowels). To make the muscular coat of the stomach and intestines contract actively and evenly, all along their length, will, at least if done early, be pretty sure to give relief. For this purpose we give warm and gentle stimulants to the stomach, as Essence of Pep- permint, Essence of Ginger, or some other aromatic (spicy) medicine. But a frequent cause of irritative pain in the stomach or bowels is the presence of acid from indigestion. Against this we have what are called antacids, because they neutralize acids by combining with them. Such are lime-water, soda, and magnesia. Often there is great advantage, in cases of colicky pain, in adding one of these to an aromatic* Further, the bowels are often constipated under the same circumstances, and this makes matters worse. It is of much importance then to move the bowels, by purgatives, or, as the milder ones are called, laxatives. Magnesia is one of these, being also, as above said, an antacid, thus having a double advantage. Rhubarb is another; it is combined with aromatics in Spiced Syrup of Rhubarb, an excellent preparation, espe- cially for children, and as a mixing liquid or "vehicle" for other stronger and more unpleasant medicines. Another, often good in colic, though nasty, is castor-oil. A safe and often very useful remedy for pain in the abdomen, or, indeed, anywhere else, is the outward application of a mustard plaster. When doubtful -what else to do, try that. Properly used, it can do no harm, and it will most probably do good, often a great deal of good. [How to make and use a mustard plaster will be explained later in this book.] A right hot piece of flannel laid over the belly will sometimes be almost as useful as a mustard plaster. Colicky pain may be lessened (in my own person it is entirely relieved) by firm pressure on both hip bones, near their front edge. This can be done with one's own thumbs and fingers, or by those of another. The An old name for aromatic medicines given for flatulence is " carminatives." Some "particulars about the medicines now and shortly to be mentioned, will be given here- after. 518 DOMESTIC MEDICINE. pressure should be pretty hard, though steady and not enough to hurt of itself. Gentle pressure, and still better kneading the bowels, at the seat of pain from flatulence, will often help to scatter the wind and promote its moving and passing downwards, which is very important in colic. Also, rubbing over the stomach and back with a hair-brush or clothes- brush, as briskly as oan be comfortably borne, will sometimes do a wonderful amount of good for colicky pains. If such palliative means as those just spoken of, as aromatics, laxa- tives, and outward warming appliccdions, do not, in a reasonable time, show signs of affording relief of severe pain—we may have to obtain medical advice, or in its absence to resort to anodynes. Of these, the quickest aud most effectual are those made from Opium, especially Laudanum (tincture of opium). A much weaker one is Paregoric (camphorated tincture of opium). Camphor is, in the form of Spirits of Camphor, both an aromatic and an anodyne; in the latter quality, however, less potent, at least in ordinary doses, than opium. Both, and especially opium, require great care in their use. [Doses will be men- tioned particularly hereafter.] Pain in the abdomen, however, results by no means always from in- digestion or colic. It may possibly be the beginning of inflammation of the bowels, or of dysentery; or of peritonitis; or of obstruction of the bowels; or it may be seated in the liver ; or in the kidneys (then rather in the back); or, if low down, in the bladder ; or, in the female, in the ovaries or womb ; or there may be an aneurism of the aorta, or a cancer; or it may be only a form of neuralgia. For each of these, which a good deal of knowledge may be needed to ascertain, a different kind of treat- ment will be called for; the pain being only one of the manifestations of disorder. Therefore any suspicion of so serious a possibility as either of these (or even severe or obstinate colic) will be a proper reason for promptly obtaining the advice of a physician. For the relief of pain in the side or chest, a mustard-plaster is to be considered, after trial of rubbing, and simple heat (by a hot flannel, hot flat-iron, bag of hot salt or sand, or a tin vessel filled with hot water) the first active remedy. So much here depends on the origin of the pain, that no further uniform treatment of chest or side pains can be advan- tageously laid down. Pain in the chest may result from pleurisy, pneu- monia, neuralgia, rheumatism, heart-disease, aneurism of the aorta, etc., or from so secondary a cause as dyspepsia ("heartburn," cardialgia). Each of these requires some difference of management. REMEDIES. 519 Physicians often use, for the relief of severe or obstinate pain, Morphia; which is got from opium. With them, a favorite way of employing this is by introducing a solution of it under the skin, by what is called " hypodermic injection." A small and finely pointed syringe is the instrument for this purpose; but it is hardly adapted for domestic practice. A full account of it is given in medical works.* Pain in the head has been, on a previous page, said to be of several kinds, and dependent on several causes. Very seldom are anodynes suitable as remedies for headache, because they all act more or less powerfully on the brain, and so, if they do not do good, they may do real harm. As a rule, we may say, never take opiates or other anodynes for headache, unless directly under medical advice. For " sick headache" which is habitual with certain persons, and then very hard to cure or even relieve, the most frequently useful remedy is a dose of magnesia and aromatic spirit of ammonia (doses and other particulars hereafter). When an aching head is hot, we are safe always in trying to cool it, by laying upon the forehead a light handkerchief wet every few minutes with cold water. A neuralgic headache will be more likely to be helped by application of heat to the part affected. Gentle rubbing with a pen- cil of menthol, such as is now sold by druggists, will often mitigate, if not relieve, it. Pain in the face is likely to be of one of three kinds: toothache in a decayed tooth (or more than one); inflammation of the jaw; or neu- ralgia (" tic douloureux"). For the first, the most certain remedy is, to apply to the hollow of the aching tooth the end of a bodkin or darning- needle, around which is wrapped a little bit of cotton dipped in pure Creasote. As this will burn the lips or gums if it touches them, care should be taken to have it overflow as little as possible; and a glass of cold water must be at hand to rinse the drop or two away, if such does escape into the mouth. If the creasote reaches the right spot, it will quell the pain at once. Oil of cloves, used in the same way, is nearly as effectual; and rather less so is laudanum. For inflammation of the jaw, advice had better be taken at once from a dentist or a physician. A hot poultice of Flaxseed-meal, into which has been poured a teaspoonful of laudanum, may be safely applied to the painful side of the face, and covered with oiled silk (or oiled paper, or thin sheet-rubber) to prevent it from drying up and getting cold too soon. Neuralgia may be best considered in another place, hereafter. See " Essentials of Practical Medicine," before referred to, on this and kindred sub- jects. 520 DOMESTIC MEDICINE. Earache is most common in young children. A simple//•«< remedy for it is a drop of warm sweet oil poured from a bottle or a teaspoon into the ear. If that fail to relieve, a drop (or in a child two or three years old, two drops) of Laudanum may follow it. Pain in the joints is usually called rheumatic; although this word is not always definitely used. When there is no swelling, or heat (signs of inflammation), warm applications are likely to do good. For the pain of the joints in inflammatory rheumatism, the most relieving thing is Laudanum; laying on the joint a bit of rag, doubled and wet with laudanum, aud binding over it a piece of oiled silk. It will not do to put laudanum in this way over too many parts at once; as some of it is absorbed, a large amount of it might narcotize the patient. Neuralgic pain in any part of the body is generally but one symp- tom of a general condition, depending on a predisposition of the nervom system and (in most, not all cases) poverty of the blood. The former, being constitutional, is to be attended to by all the ways we have of favoring the general improvement of health and strength. Poverty of blood is treated also by good nourishing food and Iron. For the immediate relief of attacks of neuralgia, many things are help- ful, while nothing is certain in every case; except that, if driven to it by great suffering or exhaustion from pain, anodynes (as opium, or morphia, or some of their preparations) will stupefy sufficiently to " drown " the agony. Temporary weakness often brings on attacks of neuralgic pain in those disposed to have them. Such persons should never wait too long for a meal. Likewise, hot food, as a cup of hot milk, or cocoa, or beef-tea, at the very beginning of the attack, may stop its progress. Heat applied to the painful part will frequently do good; any con- venient mode of application will answer. On some parts of the body a mustard-plaster is just the thing. Sunshine will (as I have seen) cure some attacks. On the other hand, I have read of ice applications hav- ing the same effect; but I have never witnessed its trial. The Japanese remedy, menthol, or oil of peppermint, is conveniently applicable in the form of rounded sticks, made by the druggists by mixing it with sper- maceti. One of these may be gently rubbed over the painful part for a few moments at a time. Various powerful anodynes are sometimes advised by physicians to be put upon, or hypodermically injected near the seat of severe and orr REMEDIES. 521 stinate neuralgic pain. For Home Medicine, I venture only to repeat what was said about rheumatic joints ; that a rag soaked in Laudanum, laid on the part and covered with oiled silk (or oiled paper) will often stupefy the nerves of the part so as to quell the pain. Anodyne liniments are often used with advantage. I may mention one which is moderate in strength and safe (applied outside only): mix one drachm of Chloral Il/drate with four fluidounces of Soap Liniment. This is to be gently rubbed in, for a few minutes at a time, over the part affected with pain. Pain at the time of menstruation (dysmenorrhoea) is habitual writh some women, and occasional with others. For its prevention, those liable to it should keep quiet for a couple of days before the expected time, and then for another day or two. When the pain has commenced, the proper position is lying down. Warmth, not excessive, but enough for entire comfort, is also needful. Hot drinks, such as Ginger-tea, or hot water with a little Essence of Ginger in it, or a teaspoonful of Com- pound Spirit of Lavender, will be suitable. So will Spirits of Camphor, or Camphor Water, and, in bad cases, Paregoric, or even (carefully) Laudanum. Cloths wrung out of hot water may be applied to the lower part of the abdomen. Very severe suffering of this kind may, in rare cases, call for injection of Laudanum into the bowels; of which again hereafter. Piles (small lumps at or near the anus, i. e. outlet from the lower bowel) are sometimes very painful, especially at or after the time of movement of the bowels. Constipation should be avoided, as far as possible, by those who are troubled with piles, and yet pmrging actively will not agree with them. Rhubarb is the best laxative in such cases; or Sulphur; not Magnesia. Inflamed piles may be soothed, if much heated, by application of very cold water. Yet, contradictory as it seems, warm, or moderately hot water, will give still more comfort in some cases. A flaxseed poultice into which a teaspoonful of Laudanum has been poured will be suitable when the patient is in bed with a bad attack. An ointment, as Cold Cream (of the apothecary), should be frequently applied. It is well to know that an attack of pain and soreness in piles (which are often pres- ent without giving much trouble) may be many times prevented by the early and/ree anointing of the parts with Cold Cream, Tallow, or Lard. Fissure of the Anus is a still more distressing affection, our fur- ther reference to which may be best left over for another place. 522 DOMESTIC MEDICINE. Strangury (pain in passing water) is to be treated by the warm bath or hip-hath (sitting-bath), followed by application over the bladder, or between the thighs, of cloths wrung out of hot water. Also, taking Cam- phor Wcder, and Flaxseed Tea containing a little Sweet Spirits of Nitre, as a drink. Severe cases may justify an injection of Laudanum into the bowels, or the placing in the lower bowel of a suppository of Opium (of which hereafter again). Under the name of anodynes (pain relievers) several other drugs are named in medical books. We need only mention here Hydrate of Chloral, Belladonna, Hyoscyamus, Stramonium, Cannabis Indica, and Chloroform. Every one knows, also, what a boon to those who have to undergo surgical or dental operations is the breathing (inhalation) of anaesthetics, as Ether, Nitrous Oxide, and Chloroform. These are called by that name because they annul sensation, for the time. For ex- tracting teeth, pure Nitrous Oxide is the best; for larger operations, Ether is much safer, though less convenient, than Chloroform. The use of either, in this way, requires much skill, judgment, and care. REMEDIES. 523 Composing Nervous Disturbance. What this requires depends very greatly on the cause and nature of the trouble. A wakeful and fretful babe, for example, may need simply to have a part of its clothing changed, or to be fed, or made more comfortably warm, or to have its gums lanced. Do not resort to Godfrey's Cordial, or Mrs. Anybody's Soothing Syrup, for restless babies. A little Fennel- seed Tea, or a drop of Essence of Peppermint in a small drink of sweet- ened water, or a teaspoonful of Camphor Water (not Spirits of Camphor in such a dose) or the same of Milk of Assafcetida ; either of these will be a good and safe infant's soothing draught. Overloading the stomach by keeping the child at the breast all night will have the opposite effect, making it worse instead of better. For infants, as well as older persons, nervous disturbance may vary all the way from slight fidgeting to fits or convulsions. Mild medicines for moderate degrees of, for example, "hysterical" nervousness, are Assafcetida, Camphor, Valerian, and Hoffmann's Anodyne. Physicians often prescribe also, Bromide of Potassium (or of Sodium), Musk, and others. Convulsions are very much more common in children than in grown people; and most so of all at teething time. They are least dangerous during infancy, but are always frightful. Just now, we are concerned only to speak of composing measures adapted to them. The same apply generally at all ages, so far as the attack itself is concerned. What is to be done between times to prevent or ward them off, is an important and often difficult question for even the physician to answer. When a child " has a fit," lay it upon a bed, loosening all its clothing, especially about its neck. Have good fresh air in the room, but also sufficient warmth. Let one or two persons make two mustard-plasters, one for the stomach and one for the back. Get a warm (almost hot) bath ready. If the plasters are prepared first, put them on; if the bath first, let them wait, and place the child in the warm water at once. In the last case, also pour gently cold water over the head while the child is held laid in the bath. The mustard-plasters (whether first or second in time) are only to stay on long enough to redden, not blister, the skin. This should be ascertained by looking under the plaster every few minutes. A very little while will be enough to redden and burn a child's skin if the plaster be strong of mustard. But it will be better for it to have, for an infant, only one third part of mustard, the rest flour or Indian meal. After the bath, have got ready a mixture of soap and hot water, and 524 DOMESTIC MEDICINE. into a teacupful of this put a dessertspoonful of Milk of Assafcetida (if at hand) and a teaspoonful of Castor- or Olive-Oil. Let this be thrown into the bowels with an injecting syringe; a towel being then held for a little while against the fundament to prevent the injection from escaping at the moment. By the time these things have been done, if not before, the Doctor, if sent for when the attack began, as he should be, when accessible, will have arrived; and, if the attack has not yet passed by, he must sav what else will be proper in the treatment. If the newly coming teeth are troublesome, it may be hoped that he will lance the child's gums. Adult men and women rarely (although they do sometimes) have convul- sions, except those which are either hysterical, puerperal, or epileptic. The principles of management of hysterical and epileptic convulsions, during the attack, are essentially the same as for that of infantile con- vulsions. Treatment between attacks is a more difficult affair—to be conducted by those who are skilled in medicine. Puerperal convulsions (that is, occurring during labor, or after child-birth) are more peculiar, and ought always to have immediate attendance from a physician. Few cases of illness are more serious and critical than these; not only in appearance, but in reality. REMEDIES. 525 Promotion of Sleep. What a great need is this! Whoever has fought for sleep (as the author has) for scores of nights, may appreciate it. If a single night could be taken alone, we might, as a rule, make short work of it, and force slumber by a good large dose of some opiate, as Laudanum, or solution of Morphia. But then, the next day, and the next night, and the next! So we have to look forward, and, for the best result in the long run, rather persuade than try to compel " coy " slumber. When sleeplessness comes as one of the symptoms of a disease, it may not have to be dealt with by itself, at least by medicine, unless it be more prolonged and distressing than usual. In all such cases, how- ever, and indeed in every case whatever, quietness is indispensable, through the evening and night. Little or no light should, during the night, reach the eyes of the patient; if accustomed to darkness, it will be best. If difficulty of sleeping (insomnia) result from nervous disturbance, exhaustion, over-study, or anxiety, management should always be perse- veringly tried before resorting to drugs so powerful .as the sleep-producers (Jnjpnotics, narcotics). Yery light, easily digested food should, under such circumstances, make the last meal of the day. Yet a person not strong will some- times be kept awrake by having an empty stomach late at night. A cracker, a drink of sugared water (a French beverage), or a small wine- glassful of beef-tea, may then make a better night. No excitement of the brain, as by reading or continued conversation, should be allowed for two hours before usual sleeping time. Being read aloud to, if the book be not too interesting, answers in some cases; but an objection to it is that it requires the presence of more light than is desirable. Mothers and nurses often sing their babies to sleep. That is a very good expedient, and may now and then succeed even with a grown person. Exercise, in moderation, and in proportion to one's strength, may be very well taken in the evening to promote sleep. A walk in the open air will do, or a few minutes' flourishing of not too heavy dumb-bells. Getting a little tired makes one sleepy; while real exhaustion has the contrary effect. Position is not without influence. Naturally we lie down to go to sleep. But, did you never feel " dreadfully drowsy " while down-stairs in the parlor, and then, after going to bed, get as wide awake as if it were morning? In fact, during sleep, less blood flows through the brain than while awake. In the sitting posture, gravitation (weight) tends to relieve the brain of much blood-pressure; when we lie down, more blood flows 526 DOMESTIC MEDICINE. into it. If all is healthy, we get asleep nevertheless; but not always when predisposed to sleeplessness. Best, therefore, in such cases, will be an inclined posture in bed, with the head and shoulders somewhat raised, in as comfortable a position as possible. When real sleepiness comes on, one may then lie down as usual. Some people imagine, that if they cannot get asleep at once, thev might as well be up and doing something, reading or writing, or walking about. This is a very great mistake. If not sound asleep, or even far enough towards that to entirely lose consciousness, we may yet get a good deal of rest in partial sleep; and the more of this we get the better, in the saving and renewal of strength. Keep still, then, in the dark, with closed eyes, and try to dismiss active thought. Count 100, 200, 300; repeat doggerel verses, as wrong as you can misremember them; watch imaginary sheep jumping over fancied stiles, one, two, three, four. and on, to twenty-five or fifty.- Fight your eyelids; after a while, the brain-vibrations, like those of a bell that has been struck, will lull by degrees, and sleep may come at last. Hardly without a doctor's advice, if that can be procured, ought any one to take strong sleep-compelling doses, such as Hydrate of Chloral, Laudanum, or Solution of Morphia. Lactucarium, which is obtained from the garden lettuce, used for salad, is much milder than opium; and Camphor Water will, when mere nervous restlessness is the matter, often compose so as to allow of sleep. Hoffmann's Anodyne is similar iu its effect, and Tincture of Hops, or a tea made of hops, is very quieting. Even a hop-pillow, made by sprinkling hop-leaves with alcohol and binding them in a pillow-case, will sometimes bring the tossing head to rest. As to the effect of the old English " night-cap," a glass of whisky, or the less dangerous ale or beer, for sleep-producing, I am afraid to say anything, lest the too perilous temporary remedy might prove at last worse than the disease. REMEDIES. 527 Purgative Medicines. A large number of drugs act upon the bowels; cathartics is a tech- nical name for these. Only a few of them need to be considered in connection with our present plan. Rhubarb is adapted to a greater variety of cases than any other med- icine for the simple purpose of relieving constipation. Simple Syrup of Rhubarb is very good for this use with babies. Younger yet, however (under a year), Sweet Oil (olive oil) is mildest of all, unless it be Manna or Glycerin. Fluid Extract of Senna, with one drop of Oil of Aniseed or OH of Fennel in a teaspoonful of it, is also a good infantile laxative. Castor-oil comes next, when a more active purge is wanted; or, when there is sourness of stomach, Magnesia. At any age, Magnesia is the best antacid laxative. Castor-oil is to be preferred wrhen colic or irritation of the bowels is present. [Give it in twice as much Spiced Syrup of Rhubarb, well mixed up.] Saline purgatives are useful generally at an early time of attacks of sickness with fever. The author's generation, in childhood, were dosed for " a bad cold," or at the beginning of measles, etc., with Epsom Salts or Senna Tea; nasty, both of them. Nowadays, one may have, instead, Citrate of Magnesium or Tarrant's Aperient. Seidlitz powders are of older date, but of similar cooling effect; and the same is true of Rochelle Salt and Cream of Tartar. Pullna and Hunyadi mineral waters please the taste of some. (On constipation in children, see p. 432.) At the beginning of acute attacks of disease with fever, when all the secretions are " locked up," I believe that the use of some purgative medicine, especially of the saline kind, is very serviceable and important. This is true, as a rule, of measles, scarlet fever, whooping-cough, smedl- pox, and varioloid; and, with more discrimination of cases and moder- ation in doses, also of diphtheria and typhus fever. Typhoid fever has diarrhoea as an early symptom generally. If, in it, the bowels are ex- ceptionally costive, only a teaspoonful of Castor-oil had better be ven- tured upon to relieve the bowels. In measles the bowels sometimes incline to be too free; but this should not prevent our making sure of their full movement during the first two or three days. When, after that, they become too loose, a weakening excess of purging may be checked by suitable means, such as will be presently mentioned. For habitual costiveness, either chewing at bedtime a small piece of Turkey Rhubarb Root (as big as a pea), or taking at that time a Rhu- barb Pill, will be the best thing to begin with. If that fails, take another piece, or another pill, also, before breakfast. Compound Rhubarb Pills are stronger; they will, with most people, 528 - DOMESTIC MEDICINE. purge rather actively. Compound Cathartic Pills, of the United States list, are too strong to use except when a very decided purgation is needed. Often, when the mildest and least disturbing way of emptying the lower bowel is required, an enema (injection into the bowels) will be the best. For this, a simple and generally satisfactory mixture will be made by dissolving a thumb-sized piece of Castile soap in warm (almost hot) water, and stirring into this a tablespoonful of Molasses, a table- spoonful of Table Salt, and a tablespoonful of Olive or Lard Oil, or a dessertspoonful of Castor-oil. There are different kinds of iujeeting arrangements. AVith the most convenient, a person can (unless ill) wait upon himself. If too sick for this, or if only the old-fashioned straight syringe can be had, its point should be greased with lard, and then, the patient lying (best on one side) on a bed, it can be very gently introduced into the opening to the bowel to the distance of an inch or so, and grad- ually the liquid may be forced through the syringe. Thoughtful common sense will find no difficulty in this, even the first time. Suppositories are sometimes yet more convenient, and are least dis- turbing of all; but they are not so sure to take effect, and their action does not extend far upward. A suppository is a small soft mass, pre- pared for the purpose; rounded, about as large as the last joint of a woman's little finger. Common Brown Soap, cut into such a size and shape, and dipped in castor-oil, or lard, may be so used. All that is to be done is to push it well into the anus (outlet of the bowel), and let it stay there. After either a suppository or an enema has been introduced, the patient ought to try to retain it for some minutes, for effective operation. To Check Diarrhcea. Not every looseness of the bowels ought to be stopped at once by medicine. Sometimes it is a relief to a condition of the system which would involve a worse illness if it did not come. Infants, especially, need to have the bowels moved two or three times daily; most of all while they are teething. We do not call it diarrhcea in them unless there are at least four or five large liquid passages in twenty-four hours. Of course when it is excessive it must be attended to, or weakness and exhaustion will follow-. Correctives, generally, should be the first things given in babies diarrhcea. Sourness of stomach is commonly present with it; therefore Lime-water^ being antacid, is particularly suitable. Another good cor- rective is Spiced Syrup of Rhubarb. On account of the spices in it, this article does not purge like Simple Syrup of Rhubarb ; it only promotes an even, regular action of the muscular coat of the bowels, and so tends to get things right again. REMEDIES. 529 Soda (Sodium Bicarbonate) is an antacid corrective, stronger in this effect than Lime-water; but less astringent or binding. Cinnamon Water is a gentle astringent; so is Camphor Water. These do well to come next after Lime-water or Soda and Spiced Rhubarb, if the complaint is not corrected by them. Should it still be obstinate, more potent checking medicines will be needful. Of these, Paregoric and Laudanum have much power; but they must be used very cautiously, on account of their containing Opium. Of the many astringent medicines employed by physicians, under whose advice, when it can be had, they had better be taken, we may mention here, as possibly wanted in home practice, Clicdk Mixture and Tincture of Catechu. A desperate and exhausting diarrhoea, which re- sists all such treatment as has now been spoken of, may call for the use of a Laudanum and Starch enema. This is introduced with a small syringe, even for a grown person; the object being to have it stay in the bowel; just the opposite of what we want from a purgative injection. A syringe holding an ounce will do for this purpose for an adult; half an ounce for a child. Two or three drops of Laudanum, with Starch made not too thick to run, will be the infantile dose for such an enema (even less for a babe under a year old); thirty or forty drops of Laudanum, with less than an ounce of Starch, for a grown person. Dysentery differs from diarrhcea, in having many small and bloody passages, with straining or bearing down, as well as pain. (Sometimes there is abdominal pain with or before each passage in diarrhcea.) The management of dysentery will be dealt with best in that part of this book (later on) which considers it among Special Diseases. Sick Stomach. As this occurs under a variety of circumstances, the main treatment of every case must depend upon its nature and cause. We may name, however, several remedies which will do good in most cases of nausea or vomiting, and which, therefore, it will be safe to use while awaiting medical advice. Ice is one of these. It may be taken into the mouth in small pieces, and melted before swallowing. This is helpful in nine out of ten in- stances of sick stomach, and in the tenth case will do no harm. Lime-water is beneficial in most of such cases ; when nourishment is needed, it may be given in equal parts with milk, from a teaspoonful to a tablespoonful of each. Effervescing waters (mineral-water, soda-water, Apollinaris, etc.), made cool with ice, very often assist in relieving nausea. When sea- sick, iced mineral-water will be likely to help more than anything else. 530 DOMESTIC MEDICINE. When weakness is present, teaspoonful doses of Brandy or (the best) Whisky may be appropriate. The smallness of the dose is here es- pecially important, and it need not often be repeated more than threa or four times, at intervals of half an hour or so, unless great exhaustion is impending. Very seldom ought anything alcoholic to be ventured upon as a remedy without the express advice of a medical authoritv. It is an edged tool, of the most dangerous sort. Children's doses, of such and of all strong medicines, should be very small. Ten drops of brand v or whisky will be enough at a time (if needed at all) for a child of two or three years, where a teaspoonful would be giveu to a grown or nearly grown person. Aromatic Spirit of Ammonia is reviving to one who is faint with sickness of stomach. It is antacid as well as stimulant. Soda (Bicarbonate of Sodium) is antacid, but not stimulant. It ia generally very comfortable to a disturbed stomach. Warming stomachic doses for nausea are Ginger, Cloves, Cinnamon, and other Aromatics (spicy articles) in small doses. Large draughts of ginger, hoarhound, Chamomile, or Boneset tea, or even of clove or cinnamon infusion, will bring on vomiting. This is an instructive exam- ple of the opposite effects, often produced by the same thing, in small and in large doses. (This gives, however, no sort of support to the absurdity of the infinitesimal doses, the thousandth dilutions, etc., of Homoeopathy.) Sometimes, with constipation, or even, especially in summer, with commencing diarrhcea, small doses of Magnesia are composing to the stomach. The same is true of veiy small doses of Calomel (^ to | of a grain), which, however, is another " edged tool," belonging to the physician's rather than to the home list of medicines. Still, out in th« country, where advice cannot always be had in time, a family medicine- chest may very well have in it, among other things only for possible or occasional use, a small box or package of ^-grain Calomel Powder*. They may be serviceable particularly at an early stage of summer con* pbdnt in children. Paregoric is the only other medicine needing here to be mentioned among those likely to assist in quieting a nauseated stomach. Outside, an early remedy for vomiting may, in any case, safely be, a Mustard-plaster over the pit of the stomach. For a young child, a Spice-plaster will, for this purpose, be preferable; made by mixing together one or two teaspoonfuls each of several spices—as Ginger, Cloves, and Cinnamon, or half as much Red Pepper, with a similar amount of wheat or Indian flour; wetting these with whisky, and spreading them on a piece of muslin or thin flannel. This, when laid REMEDIES. 531 over the stomach, should be covered with a piece of oiled silk or oiled paper or rubber-cloth, to retain its moisture for a longer time. Indigestion. A much overloaded stomach is best relieved by being made to throw out its contents under the action of an emetic. This is, however, a harsh remedy, not nowadays often resorted to. It is not easy to ap- preciate the passionate gluttony of the ancient Roman emperor; who Would, after eating a luxurious dinner, tickle his throat with a feather, so that he might disgorge and begin again! (About the use of emetics, something will be said under Poisons.) Ordinary indigestion requires, for one thing, to give the stomach rest. Let no food be taken for a number of hours; if the patient is strong enough, not for a whole day. Another " indication," as the doctors say, is to make sure that the bowels are open; to carry off the refuse of undigested or half-digested food. Besides these important things, if the stomach is still worried and un- settled, the aids to nature which we may resort to are those just above- mentioned, as suitable for cases of nausea and vomiting. Small and few doses, however, are likely to be necessary for common attacks of indigestion. If, with these, there are dizziness, headache, a yellow tongue or eyes, and a bitter taste in the morning on awaking—a set of symp- toms designated usually as biliousness—small doses of the old fashioned Blue Pill may be reasonably and safely given. I say small doses. When my father was a boy, the doctors gave Blue Mass and Calomel (the latter being three times as strong as the former) in ten to twenty grain doses. Even in families, such doses were very commonly taken for slight " bilious " attacks, without waiting for medical advice. As, in such quantities, these mercurial medicines almost always operate freely on the bowels, and so purge themselves off—this practice did not ap- pear to do harm. It is, however, not now approved, as other purgative medicines are more available; Calomel and Blue Pill are now given in much smaller doses, and not nearly so often as formerly. (The way in which they got their reputation for being injurious was by medium doses being given too often, and continued too long.) Practically speaking, of Blue Pill, a small dose for indigestion, with signs of participation by the liver, will be one grain at night, and again the next morning; and perhaps again the second night. What I call Compound Gentian Pills may be taken for two or three days, if entire relief does not come sooner. This is their prescription, written doctor fashion: 532 DOMESTIC MEDICINE. R. Mass. Ex. Hydrarg., gr. v. Pulv. Kad. Rhei et Extract, Gentian, aa£j. 01. Caryophyll., gtt. iv. M. et Div. in Pil. No. 20. S. One or two at once. Which, done into English, reads thus: Take of Blue Mass, five grains; Powder of Rhubarb Root, and Extract of Gentian, each twenty grains; Oil of Cloves, four drops. Mix these together, and divide the whole into twenty pills. One or two to be taken at once. When there is lingering indigestion, after an attack, with some flatu- lence, the bowels not being sufficiently free, yet not requiring a strong purge, two of the above pills may be taken, twice daily, for two or three days; not longer at one time, on account of their containing a small amount of mercury. It would take much more mercurial medicine than that, however, to salivate anybody; unless it were that rare and uncomfortable individual who is one in thousands for susceptibility; one who might be made happy by Oscar Wilde's sunflower; or who would " die of a rose in aromatic pain." We do not count upon such existing, unless we meet with them, and then they are to be managed all in a way of their own. Continued Weak Digestion. Expecting to say something about this later in the book, under the head of Dyspepsia, the remark may be made now, that the class of medicines which particularly tone up a weak and relaxed stomach are the simple Vegetable Bitters. Such are Quassia, Columbo, Gentian}nn(\ some others. Simple bitters we call these, because they have no other very positive quality except the bitter taste, and no marked effect upon the human system except as tonics to the stomach. (In large draughts, as already said, their infusions or " teas" will act as emetics.) Some bitters there are which have other very important actions. Quinia is one, got from Peruvian Bark; it acts powerfully on the ner- vous system, and is the special remedy for malarial fevers. The same bark contains also Cinchonia, and several other more or less bitter tonic and nervine " alkaloids,"as the chemists name them. Nux Vomica is a very powerful bitter nervine tonic. Out of it is obtained Strychnia, one of the deadliest of poisons, but also one of the most valuable of medicines, when used with judgment, care, and skill. With this information, we may venture to add that the Tincture of Nux Vomica, in ten-drop doses, twice or thrice daily, is one of the most effective of all the stomachic bitters, iu cases of continued weak- ness of digestion, with flatulence. REMEDIES. 533 These bitters generally improve the appetite, which is almost always poor when the stomach is otherwise weak. For the same end, as appe- tizers Mineral Acids are useful; Dilute Aromatic Sulphuric Acid, for example, under the common name of Elixir of Vitriol, and Chlorohydric Acid, formerly, and sometimes now, called Hydrochloric, or Muriatic Acid. Nitromuriatic Acid adds a special tendency to act upon the liver. One or other of these acids, and most of all the last named, is often given to the subjects of prolonged indigestion, along with the vegetable bitters. To Reduce Inflammation. A serious task, this is, iu many instances; taxing the doctor's skill, and not very rarely baffling him. How, then, can one say anything about it in a work on Home Medicine? A few clear principles seem to be all that can be here spoken of, referring the reader for a larger discussion of the subject to treatises designed for the medical profession.* Inflammation (as already said in that part of this book which dealt with the nature of diseases) may affect any organ or portion of the living body. When it attacks one of the more important organs, as the brain, spinal marrow, lungs, heart, liver, kidneys, pleura, peritoneum (see Anatomy), or even extensively involves the skin, life may be en- dangered by it. If only a small part, as an eye, ear, hand, or foot, is inflamed, there is usually much less danger, though there may be a great deal of suffering. Moreover, an inflammation may spread, as from the ear or the eye to the brain; or some poisonous (septic) matter may be formed in the inflamed part, and, by blood-poisoning (sepMccemia), the whole body may suffer and perhaps die. Septicaemia is very often fatal, but a vast multitude of people have inflamed hands, feet, eyes, noses, jaws, etc., without either it or the allied disorder, Pyaemia. The lia- bility to such accidents of inflammation is greatest where the atmosphere of {he place is foul. Taking a broad general view of inflammations as a class of disorders, it may be said that they have three stages, or progressive changes. First comes excitement. Towards the centre of the inflamed part, the arterial blood-vessels beat and throb; being roused to endeavor, so to speak, to overcome the obstruction there. Heat, redness, swelling, and pain, all belong to this stage. Then follows exudation. This is the forcing of some of the fluid portion of the blood (often with some of the white corpuscles ; occasion- ally also a number of the red corpuscles) out, under the pressure of the excitement and resistance together, through the walls of the vessels, into * See " Essentials of Practical Medicine," Section on General Therapeutics. 534 DOMESTIC MEDICINE. the substance of the part. If this fluid is thin, it mav collect as a "serous effusion;" such as is frequently the result of pleurisv. When thick and adhesive, it glues parts together (plastic lymph); this happens in the pleura, in the peritoneum, in the pericardium, and in the mem- branes of the brain (see Anatomy). If, again, there are many white corpuscles in it, and the vitality of the part is disturbed much, pus is formed ; we have suppuration ; with either an abscess, or, at once, a yellowish or greenish purulent discharge (as in severe bronchitis). This is one way in which the three stages of inflammation may follow one another. But, differently from this, there may be the first stage of excitement, and the second, of exudation (effusion), with, for a third, instead of suppuration, gangrene, or mortification. Happily, also, the most frequent of all is better than either of these; of which, of course, the last named is the worst. We may have in- flammatory excitement, and moderate or small exudation, followed by resolution ; that is, the inflammatory process ceasing, without either suppuration or gangrene; and the part and the patient getting well; with very little damage resulting; except that both the part and the general system are somewhat weaker than before. Now, what can be done by treatment against the*going on of inflam- mation to its worst (gangrene), or the next worst (suppuration), or the third in seriousness (liquid effusion) ? We can attack it in the first stage of excitement, with, in many cases, very good effect. This is what we mean by reducing inflamma- tion ; moderating the violence of the conflict between the surrounding throbbing blood-vessels and the obstructed centre, so that the least pos- sible damage shall be done by it. For this purpose, the means available in different cases are, chiefly, these: Rest; Position ; Cold; Diet; Purgation ; Blood-letting ; Cool- ing Medicines ; Nervous Sedatives ; Counter-irritation. Rest of the part is indispensable in all inflammations. Winn the part is small, and is not used in moving about, the body need not be absolutely confined. If it be otherwise, as when an ankle is inflamed from a severe sprain, and still more when a lung, or the pleura, or a bowel, is so affected, the rest must be complete, in bed. Carrying a sore hand in a sling rests it; covering an inflamed eye with adhesive plaster closing the lids, or remaining in a darkened room, gives it re- pose. But any one with an inflamed lung must be kept as still as pos- sible; and must not even speak, unless in a whisper. If the brain be inflamed, quietness and almost darkness will be necessary, to avoid mental as well as bodily disturbance. REMEDIES. 535 Position can be made to help when a hand or a, foot is inflamed. By keeping the part raised, the tendency of blood towards it will be lessened advantageously. Cold is often a powerful antiphlogistic, as old writers called Avhatever tends to reduce inflammation. It must, however, be steadily applied, to have this effect. Dashing cold water on a part and then leaving it, in a place not itself freezing cold, will, from reaction, make it warmer than before. When the brain is inflamed, a good plan is to shave the head, or at least cut the hair very short, and keep it half covered with light rags soaked in ice-water. For steadiness of effect, the rags must be dipped in the cold water every few minutes. A more effectual method, more convenient, however, for the abdomen than for the head, is to lay over the inflamed part a coil of light rubber tubing, through which cold water is made to pass. This is done by placing one end of the tube in a vessel of water somewhat higher than the body, and allowing the water to pass out at the other end, which is placed lower. Diet was formerly much relied upon, and low diet was made very low—almost to starvation. We know now, that inflammation is possi- ble in feeble as well as in strong bodies. Not every one can bear doing long without food, or even with too little food. Also, strength is necessary to shake off disease, so to speak. It is not strength, but excitement, that we want to reduce. A really low, thin diet, therefore, is only suitable for a strong person, and for even such a one, not for many days together, during illness. It is important, however, when fever is present, with which the power of digestion is always weak, to give food in a simple, liquid form, so as to give the stomach no trouble in appropriating it. Purging medicines act like an unstimulating diet, in cooling th« blood, and thus promoting a quieter action of the heart and arteries. This favors the reduction of the excitement which attends a violent inflammation of any part. The cathartics which have the most effect of this kind are the Salines, as Epsom Salts, Rochelle Salt, Citrate of Magnesium, Cream of Tartar, etc. Taking blood, either from a vein in the arm (venesection) or by leeches or cups, from an inflamed part (local blood-letting), is a very ancient remedy. Once overmuch used, the reaction in our time has gone quite too far against it. It is a very valuable means of reducing inflammation. This language is confident, because based on experience. I was brought up under the regime of the lancet. My father, Dr. Jo- seph Hartshorne, was, with a very large practice for many years, a fre- quent bleeder. He was a pupil of Dr. Benjamin Rush, who has been called (not very justly) the American Sangrado. Before I was of age, my two arms bore the scars of thirteen bleedings, at my father's hands, 536 DOMESTIC MEDICINE. besides many dozens of leeches having drawn their fill from my supply of blood. Yet I "still live," although I have passed, since maturity, through the dangers of a bad dissecting wound and of an attack of ty- phus fever; and, like others of my much-bled contemporaries, I have now as good health as need to be, in the early part of the .second half century of life. In fact, there have been, in my knowdedge, more people going on to their eighties and nineties of the generation of the bleeding- bowl and the lancet, than there seem likely to be in the present time, when these appliances are, with many physicians, obsolete. We may see, however, evidence that the " wave " of reaction against bleeding is subsiding. Many leading physicians, both in Europe and in this coun- try, have now the sagacity to see that, while our fathers bled oftener and more than they needed to do, yet there is a place of importance for blood-letting, local and general, especially in the treatment of the early, excited stage of violent inflammations. During an experience of twenty years in the practice of medicine, I have bled many people, and had leeches and cups applied to many more; and I never once had occasion to believe; that these remedies were otherwise than useful to my patients. Still, it is by no means all cases of inflammation, even of the great vital organs, that need, or all constitutions that bear, the loss of blood. It is a matter for careful judgment in each case. Few persons who have never seen a vein opened will feel like bleeding any one them- selves. It may be mentioned, however, that a full bleeding for a grown man from the arm will be about twelve ounces; for a woman, ten ounces. When a child is bled, if ten years old, four ounces; if five years old, three ounces will do. In using leeches, it is to be remembered that each leech will draw, on the average, a tea- spoonful of blood. American leeches (making the smallest bite) are always best for children, and for adults anywhere unless on the hand or on the back. European leech-bites sometimes bleed more freely than is desirable if applied on the neck, etc. Cut cups draw blood according to their size and number. They are more painful than leeching, which, indeed, gives no pain of any account. Leeching should be preferred upon parts that are tender to the touch; cups are especially available on the back. The cup is a small round glas-s REMEDIES. 537 from which the air is exhausted; sometimes by a pump applied to its top. Being placed closely upon the skin, this drawing out of the air makes the parts swell under the cup, and become there full of blood. Fig. 179. LEECHES APPLIED. Then the cupper takes off the glass, and, with an instrument made for the purpose, scarifies the blood-filled surface at several places. Then Fig. 181. ', WITH ELASTIC TOP. ANOTHER FORM OF CUPPING SCARIFICATOR. APPARATUS. the cup and pump are reapplied, and half an ounce or so of blood is withdrawn by each. I>ry cups draw blood to the surface on which they are placed, and 538 DOMESTIC MEDICINE. so help to relieve a loaded or inflamed organ beneath it. This is often very serviceable. It is easy to arrange for dry cupping without any special instruments. Take a number of egg-glasses, or lemonade-- REMEDIES. 639 nite is the common preparation. Its dose is from half a drop to one or two drops, in water, every one, two, or three hours. Some physicians of experience give it in almost all cases of inflammation of the lungs, pleura, etc., even in children. If it is kept in the family medicine-chest, it should be distinctly marked Poison. Opium has obtained a very large place in the treatment of one dan- gerous inflammation, that of the peritoneum (peritonitis), which lines the whole interior of the abdomen. Opium tends to constipate the bowels, and powerfully affects the brain. It also tends to diminish se- cretion in the air-passages, and therefore it does not appear to be suit- able, at least at an early stage, in inflammation of the bowels, brain, or lungs or in acute bronchitis. After the excitement has subsided, in dys- entery and in bronchitis, perhaps sometimes in pneumonia, it may aid in allaying pain and checking excessive discharges. Counter-irritation is a term which explains itself. Endeavor is made to draw blood and nervous excitement from an inflamed part by a harmless irritation or inflammation somewhere else. Blisters are strong means of this kind. A blister is raised by leaving on the skin for a time a plaster made of Ointment of Cantharides; or painting the part with Cantharidal Collodion, and covering it, while moist, with a piece of oiled silk. With a child, an hour or two will generally be enough to allow the Cantharides (Spanish Fly) to act. In a grown person, it may require three, four, or more hours. There should always be a piece of gauze between the skin and the blistering plaster, so that it can be entirely removed at the proper time. When it is taken off, the scarf- skin (cuticle) being raised in watery swellings, these may be pricked with a point of any kind, to let the water out. Then there should be placed over the sore surface a piece of muslin or lint thickly spread with Simple Cerate, to heal it up in two or three days. The time for blistering (which is only called for in rather bad attacks of internal inflammation) is not at the beginning of the case, but after the excitement of the circulation has ceased. The disorders, in the course of which, at such a stage, a blister is most likely to do good, are inflammation of the brain, pneumonia, pleurisy, and membranous croup. Other modes of counter-irritation (better, perhaps, called derivation) are, painting the skin with Tincture of Iodine; rubbing over a small surface a drop or two of Croton Oil; or with a little Tartar Emetic Ointment. Painting with Iodine is a milder measure than blistering with Can- tharides ; and it may be resorted to in a greater number of cases, of moderate violence. Croton Oil and Tartar Emetic Ointment are only 540 DOMESTIC MEDICINE. employed in obstinate chronic cases of irritation of internal organs. They produce very sore, pimply, or pustular eruptions.* Fever. Reminding the reader of what was said, a few pages back, of the ncdure and signs of fever, it may be said now, that what we want to do when those signs (heed, excitement of the circulation, locking up of secre- tions, and weakness) are present, is, first and chiefly, to ascertain and re- move, if possible, the cause of the attack. If this cannot be done, instead of it, or if it can be, then along with that endeavor, we should try to lessen the heat, promote the return of the secretions, and support the system through its period of weakness. To diminish the excessive heat, cold water is the great remedy. Almost incredible it seems, that physicians were once afraid to give cold drinks to patients suffering with raging fever. A man with small-pox, two hundred years ago, was shut up in a close room, with red curtains hanging about his bed, blankets piled on him to promote perspiration, and, for the same end, only hot and bitter drinks, herb teas, were al- lowed him! All the world knows better now, and follows nature's pointing better than that. Thirst is an almost universal symptom of fever; and frequent draughts of cold water are its best remedy. Ice- water is not the best, at least if the draughts craved and taken are large; it may be, to the most advantage, of about the temperature of deept well water; about 50° to 52° Fahr.; although nearer the freezing-point will answer well. If the stomach is very irritable, as is often the case in autumnal remittent and in yellow fever, small lumps of ice melted in the mouth and then swallowed, at short intervals, will do better than drinking much water at a time. Cold water outside is a remedy naturally thought of; and it may be used, but carefully. Sudden chilling is not safe. Some physicians, especially in Germany, now treat cases of typhoid fever by immersing the patient for ten minutes at a time in a really cold bath. This seems to me not a, plan to be approved. But the sponging of the face, arms, hands, and, part after part, the whole body, with cold or cool water, two or three times a day, is an admirable means of relief in fevers generally. Its service is perhaps most marked in scarlet fever, when * If either of these should be used, great care must be taken not to get the oil or ointment into any one's eyes. A patient of mine nearly blinded himself by neglecting this precaution ; putting his fingers to his eyes just after rubbing croton oil upon a part of the skin. f Very deep (Artesian) well water is much warmer than this; the temperature in- creasing with the depth, after the first forty or fifty feet. REMEDIES. 541 the surface of the body is often intensely hot; the whole skin seems to be inflamed. Bear in mind the great principle : we want to temper, to moderate the excessive heat; not to chill the body below its normal degree. Certain additions to water as a drink will contribute to its refrigerant action. Acids have this tendency. Lemonade and the juice of oranges are generally suitable. Citrate of Potassium and Acetate of Ammonium are the medicines most sure to be safe and beneficial for the same pur- pose ; the former when the bowels are natural or constipated, the latter when there is a disposition towards diarrhcea. Of the secretions, those of the bowels, skin, and kidneys require attention in fever. In most cases of typhoid fever and some cases of measles, the bowels incline to looseness from the start. When, in those diseases, they are not moved at all during the first day of the fever, a small dose of a mild purgative may be given; in typhoid fever, a tea- spoonful of Castor-Oil; in measles, a teaspoonful of Citrate of Magnesium (solid), or a half-wineglassful of effervescing Solution of Citrate of Mag- nesium ; or a teaspoonful of Rochelle Salt. These are exceptional febrile diseases. In Remittent (autumnal, bilious, malarial) fever, a good brisk purging early in the attack with a saline medicine, such as Citrate of Magnesium (an even tablespoonful, solid, or a wineglassful of the solution, repeated in six hours if it does not operate) or Rochelle Salt (a tablespoonful), will be pretty sure to be useful. Typhus fever requires caution, in expectation of great weak- ness; half of the above doses will be best for its treatment. Scarlet fever should be, as a rule, the occasion for a good cooling saline dose on the day the attack breaks out. Dr. Joseph Hartshorne, who had a very large experience in Philadelphia, used to say that the chief reason why some cases of scarlet fever and allied diseases had troublesome late symptoms and sequelce (after effects) was the neglect of proper evacuation at the beginning. Purgatives at that stage help to clear out from the bowels and from the blood impurities which, while they remain, are poisonous to the system. But real purgation belongs in fevers, as a part of the treatment, only to the early stage. After that, we need merely to see that the bowels are not constipated; a daily moderate movement will suffice. Some persons suppose that because a sick person takes only small quantities of food, he does not need to have his bowels open at all. But the waste of the substance of the body is going on even faster than during health, and the discharge from the bowels comes from this waste as well as from the refuse or excess of food. Dryness of the skin is a regular symptom of fever. The most fre- 542 DOMESTIC MEDICINE. quent exception to it is in the febrile state of inflammatory rheumatism; in which the skin, while hot, is sometimes quite moist. Generallv, the dryer the skin, the worse; the coming of moisture shows the subsidence of the fever. The high heat and dryness are connected together. Re- duce the temperature, and perspiration will break out. Therefore, the cold drinks and (careful) cold washing and sponging, spoken of as appropriate to lower the excessive temperature, will serve also to restore the secretion from the skin. Citrate of Potassium, Acetate of Ammo- nium, and some other medicines favoring this effect, are called diapho- retics in medical books. Diuretics are agents wdiich tend to increase the action of the kidneys, the flow of urine. They are among the more uncertain remedies; they do not always act as we wish them to. In this they differ very much from purgative medicines. The salines already mentioned (Citrate of Potassium and Acetate of Ammonium) as diaphoretics are commonly diuretics also. So are Cream of Tartar and Sweet Spirit of Nitre. The latter is very often given in fever, when the amount of urine passed is small. Do not forget that sometimes, in low fevers, the bladder is full, but the patient cannot empty it. This must be examined into. If there is retention of urine, it must be drawn off with a catheter. Weakness, in fever, is not quite the same thing early in the attack as towards its end. In the first place it is an oppression of the system; after a while there is more or less exhaustion. The first is best relieved by the evacuating (unloading) means above referred to; purgatives, dia- phoretics, diuretics. At that stage, with persons of average strength, the amount of food taken may be small and its character light. (Per- sons always feeble will need to have concentrated food from the begin- ning.) As the attack goes on, even towards the end of the first week usually, and in scarlet fever and small-pox sooner, the system loses strength, and support is necessary. Wrhat shall the means of that sup- port be ? Liquid, strong food in small quantities and often is the rule. Milk (with lime-water in it if the stomach be very weak) and beef-tea are the things to stand by. Strong mutton broth and chicken soup (with all fat fully skimmed off) will do for variation. Supporting treatment for great debility has always, with physicians, included the use of something alcoholic, wine and whisky being mostly preferred. Opinion in the medical profession on this subject has tended of late years (in the minds, at least, of its safest leaders) towards a les- sening of the amount of alcoholic stimulation in fevers, and towards resorting to it in fewer cases. Once it was almost a universal practice REMEDIES. 543 to give whisky in all cases of typhoid, as well as of typhus, fever. Now, many cases of typhoid fever are found to get through well without it. Typhus is attended by more positive depression ; yet in my own person, attacked while a resident physician in Pennsylvania Hospital, typhus was treated without alcohol, except one wineglassful of wine whey, which, as it did not seem to agree well, was not repeated. On such an important matter, in every actual case, the judgment of a physician should be obtained. The safest rule in Home management of the sick will be (unless in extraordinary emergencies) not to give or take alcohol in any form unless advised by a competent physician. Cough. How many different kinds and causes of cough there are, we have already mentioned when considering it among the symptoms of disease. It cannot be treated exactly alike under all these different circumstances. As a symptom, however, it is unpleasant, and often wearisome; and it is well to know of some domestic remedies which are safe and useful in many cases. First, a dry cough must be softened and loosened. The three best home remedies for this purpose are Ipecacuanha, Squills, and Wild Cherry Bark. Of the Syrup of Ipecacuanha, for this effect (not to cause vomiting) the dose is from a quarter to a half teaspoonful. Of Syrup of Squills, which does best at a later stage than Ipecac, half a teaspoonful to a teaspoonful. Of Syrup of Wild Cherry Bark, a tea- spoonful. This last may be given along with Syrup of Ipecac at first, and with Syrup of Squills afterwards. There is also real usefulness in the soothing effect upon cough of Lic- orice, and of pure and well-made candies ; hoarhound candy for exam- ple. The advantage of these is that a little of either can be taken very often, so as to keep up a nearly constant influence of the kind desired. Although such things only touch the swallowing part of the throat {pharynx), not the wind-pipe (larynx), yet the nearness and sympathy of these two surfaces cause the extension of the effect from one to the other. Spencer's Chloramine pastilles are useful in this way. After loosening, a wearisome cough may need to be quieted. This must be done with care, since to stop secretion and dry up a cough will make things worse. Opium and its preparations, including of course Morphia, have the most power of this kind. They are often added to cough-mixtures, to be used after free expectoration of phlegm has come on. Wistar's Cough Lozenges, when made after the regular formula, are composed chiefly of Licorice, with a little Opium added. Syrup of Lactucarium, also, is quieting to cough, and is a milder narcotic 544 DOMESTIC MEDICINE. than Opium. It may be used sooner and with less apprehension of excessive effect. Compound Tincture of Benzoin often has a very good effect, in fifteen to twenty drop doses, each dose taken on a lump of sugar. About other medicines adapted to particular kinds of cough, something will ,be said in connection with special diseases. A full account of them is given in all works on Materia Medica, under the title of Expectorants. Hemorrhage. What causes bleeding must ahvays be the first question. If from a wound, it will come under Accidents and Injuries, to be considered in the latter part of this book. If a symptom of a disease, the necessity of treating the disease rather than the bleeding is plain. In such a case, only a large and weakening hemorrhage calls for special measures on its account. This is true of the bleeding at the nose in the first week of typhoid fever, spitting of blood in consumption of the lungs, vomiting of blood in ulcer of the stomach, and bleeding from hemorrhoids or piles. If hemorrhage from the nose, stomach, or lungs takes the place of the monthly flow in women, we are less concerned to stop it than under other circumstances. It is well to state clearly that there are no remedies which are always certain to stop bleeding from any internal cavity of the body. Nose-bleeding. Often this is rather relieving than otherwise, in full-blooded young people, who without it would have had headache. The occasion for stopping it comes when it is so large in amount, or continues so long, as to weaken by loss of blood. How shall we stop it ? Tell the patient to avoid blowing his nose. Clotting (coagulation) is the natural way of stoppage of all hemorrhages. Bathe the forehead and outside of the nose and cheeks with cold water, or apply ice to the forehead (not too long at once, but enough to cause the impression of decided cold); or, if this does not suffice, to the back of the neck. Put a plug of cotton well into the nostril from which the blood come'-. If first dipped lightly in a strong solution of Alum, it will be more effectual. Let the person keep quiet, with the head and shoulders raised. Holding both hands high above the head is said to help to stop bleeding at the nose. Only one in a very large number of cases will be really dangerous. When all the above measures fail, a physician will be needed, who will effectually plug the bleeding nostril. For this a watch-spring arrange- REMEDIES. 545 ment is sometimes used, or an elastic catheter. If the latter, a string (waxed ligature) is put through the hole at the end of the instrument, and that is oiled and very gently passed back into the nostril until it can be felt at the opening above the throat. With forceps (nippers) one end of the string is then seized and brought out of the mouth. A piece of cotton is tied upon it, and then the catheter and the other end of the string are drawn out of the nose, and the cotton plug is held firmly against the back of the nostril. If still necessary, another plug may be again inserted in the front of the nostril. Bleeding in the Mouth. When a tooth has been pulled, or, in an infant, the gums have been freely lanced, sometimes considerable bleeding will occur. If from a tooth, a plug of cotton may be dipped in Creasote, or Tincture of Chlo- ride of Iron, and pressed into the bleeding cavity with the end of a bodkin or darning-needle. Ice may be applied to too freely bleeding gums, or they may have put against them a soft rag wet with Alum- water or a solution of Tincture of Chloride of Iron. Spitting of Blood. Is it from the lungs, or from the throat, mouth, or nostrils f Not unfrequentlyr, bleeding from the nose goes backwards, into the throat, and the blood, then hawked up, is naturally imagined to come from the lungs, sometimes causing great alarm. Inquiry and examina- tion will make it clear whether this, or bleeding from the mouth, is the case. Ulcerated throats sometimes bleed. The ulcer can then be seen, in a good light, if the tongue is pressed down with the handle of a table- spoon. This sort of bleeding, however, is not at all common. When vomiting occurs before blood appears, we ascribe it to the stomach. The blood is then, usually, rather dark and thick; not fresh- looking. If real bleeding from the lungs takes place, the blood is coughed up (perhaps quite softly and lightly); it is, as a rule, bright red. Only a little may come; sometimes merely streaking the expectoration; or it may be copious; mouthfuls all at once. In this last case, it is attended by danger of exhaustion from the loss of blood. No unprofessional person should think of taking charge of a serious hemorrhage without the aid of a physician, if one can be had. While waiting for one, however, wdiat ought to be done? Put the patient upon a bed, with the head and shoulders comfortably raised with pillows. He must keep very still and not speak. Let a 546 DOMESTIC MEDICINE. piece of ice be taken into his mouth every few minutes, and swallowed slowly. Then fasten around each arm, above the elbow, a shawl-strap, if such be at hand, or a long handkerchief, quite tightly; leaving each on, however, only a few minutes at a time. If the bleeding does not stop, let them be tightened again and again, several times. Should this not succeed, and the doctor has not yet arrived, similar straps or band- ages may be applied in the same manner to the lower limbs, just below the knees. If blood comes from the stomach, it may be from ulceration, or cancer; or it may be hysterical (that is, connected with general nervous disorder), or, in exceptional cases, may take the place of menstruation which is suppressed. (Bursting of an aneurism of the aorta is a possible source of hemorrhage, either from the stomach or from the lungs; but the existence of such an aneurism will mostly have been before discovered by an attending physician.) To moderate or check large bleeding from the stomach, as shown by free vomiting of blood, ice is the safest and most hopeful of remedies. Keeping quiet, and taking the least possible food in the liquid state, are important. Boiled milk with lime-water will be the most suitable nourishment; or arrow-root, tapioca, etc. In the absence of medical advice, no medicine had better be ventured upon; unless it be swallow- ing very small amounts of solution of Alum, or, once in two or three hours, a single drop of Creasote, dissolved in two tablespoonfuls of water. Intestinal Bleeding. For hemorrhage from the bowels, the same kind of management is applicable as that appropriate when blood is thrown up from the stomach; as just described. Bleeding piles (hemorrhoids) are, of course, troublesome, but the bleeding, as such, does not nearly always require treatment. If it continues very freely, the patient must lie still in bed, with a piece of oil-cloth or rubber-cloth under the lower sheet. A piece of sponge or a napkin dipped in ice-water may be held against the fundament. If anything else is to be done, it ought to be upon a physician's advice. Monthly Irregularities. Proposing to refer again to these hereafter, under the several heads of Amenorrhcea, Dysmenorrhoea, and Menorrhagia (our present aim being to bring forward general principles in regard to remedies), our most important statement now is that there are no certain specific medi- cines which will always bring on, or always delay, or otherwise regulate menstruation. REMEDIES. 547 A comparison will here be instructive. We can always make any one vomit with an emetic. We can be sure, if there be no obstruction of the bowels, of causing purgation by one or another of the cathartic medicines. Most probably, in a given case, we can, by cold drinks and diaphoretic medicines, produce sweating. Probably, but not certainly, diuretics, so called, will in given cases increase more or less the flow of urine. Farthest of all from certainty is our endeavor to act upon the ■uterus so as, when menstruation is postponed beyond its regular time, to hasten it, or, when it comes too often, to retard its coming. For delayed monthly courses it is desirable to produce a determina- tion of blood towards the lower part of the abdomen. Hot foot-baths, and warm hip- or sitting-baths, are the most effective means for this end. Opening the bowels rather briskly with a Lady Webster's or a Compound Rhubarb pill, or Warner's Cordial, or Tincture of Aloes and Myrrh, will also be helpful towards it. Especial care must be taken that the body, and most of all the feet, shall not be chilled at such a time. Lately, good medical evidence makes it appear that Permanganate of Potassium is a good promoter of regularity in menstruation. Manga- nese, which it contains, is a metal, chemically a good deal like iron. Two grains may be the dose, twice daily ; stopped or lessened, however, if it causes sickness of the stomach or irritation of the bowels. If it seems to agree with the patient, it may be continued through a month or two, discontinuing it at the time of the monthly return, when that takes place. For painful menstruation (dysmenorrhoea), lying still is very impor- tant from the beginning of the attack. Warm flannels (wrung out of hot water, or heated dry at a fire close by), may be applied to the ab- domen. A hot drink is likely to be comfortable, such as this: Put into half a teacupful of hot water, a teaspoonful of Warner's Cordial, a teaspoonful of Compound Spirit of Lavender, and twenty drops of Spirits of Camphor; stir them well together just before taking it. Should relief not come in an hour or so, Paregoric—a teaspoonful at once—may be given. Few cases will need any stronger anodyne; and they should be under the care of a physician. Gentle compression of the womb, with a warm hand upon the ab- domen, will sometimes lessen the pain. The same may be hoped for from firm and steady pressure on the two hip bones near their front edges; as mentioned in the case of colic. Menorrhagia is excessive menstrual flow; a variety of hemorrhage. The most important part of its management is usually during the in- tervals, to prevent it. Near the expected time the sufferer, who has 548 DOMESTIC MEDICINE. reason to fear it, should lie still in bed. When the excessive flow comes, cold wet cloths may be laid upon the abdomen, the rest of the body being kept comfortably warm. Only a decidedlv bad ease will fail to be thus moderated. Further treatment, such as injecting hot water, or vinegar and water, into the vagina, or squeezing a cut lemon therein, or plugging with cotton soaked in alum water, etc., had best be left, whenever possible, to a physician. Dropsy. For our purpose, in this place, it may be said that there are three classes of dropsical troubles: general dropsy (anasarca), superficial local dropsy (oedema), and local internal dropsies. After scarlet fever, the kind most likely to come is anasarca, general dropsy. From great weakness and thinness of the blood there often comes oedema, or local watery swelling, of the feet. Heart-disease, liver-disease, or kid- ney-disease will often bring on general dropsy; but, not infrequently, liver-disease will be attended by abdominal dropsy (ascites) almost alone. Chest dropsy (hydrothorax) is another local internal form; and water in the head (hydrocephalus) another. For the cure of any of these, the great thing is to find the cause, and remedy it, if possible. We have to mention this if, because, of all difficult diseases to cure, those which produce dropsy are, in many cases, among the most obstinate. It is often, though of course not always, one of the last results of disease, which itself may have continued for weeks, months, or years. The best hope of its being cured is in those cases in which there is not much else the matter, and when it has not yet lasted long. Just for the dropsy, as a symptom, when it is right to treat that, physicians give diuretics and purgatives. Of the first may be named Cream of Tartar, Juniper Berries, and Squills. Cream of Tartar (Bi- tartrate of Potassium) acts also moderately on the bowels. Another purgative used in this way is Jalap, frequently given with Cream of Tartar. More active is what is called the drastic cathartic, Efufcrinm; which, even in very small dose, will purge severely. All these medi- cines, indeed the whole treatment of dropsy, ought to come under the judgment of a skilful physician. Such an one, when unsuccessful m- may happen) in reducing dropsy by diuretics and purgatives, may con- clude it best to tap the patient; that is, to let out the water by intro- ducing a small tube into the swollen part. This gives immense relief, sometimes permanent. In a certain number of instances the fluid accu- mulates again, and the operation may have to be repeated. Tapping the abdomen has long been an approved practice; doing the same lor REMEDIES. 549 effusion in the chest, after pleurisy, has latterly been found suitable in a considerable number of instances; and even water around the heart (pericardial effusion) has been so relieved in some cases within a few years. Another relieving operation sometimes performed for great watery swelling of the legs and feet is to lance the skin in a good many places, so as to make the water ooze out gradually. When this is done, the parts should afterwards be greased with Cold Cream or Tallow, to prevent inflammation, which might become erysipelatous and trouble- some. One form of dropsy is peculiar to women, generally after or near middle life—ovarian dropsy. This is not often greatly helped by medi- cal treatment, or even by tapping. When it is clearly going to shorten life very much, surgeons increase the probability of longer survival by an operation, removing the tumor, which is the cause and seat of the dropsical swelling. This operation is called ovariotomy. Prostration : Debility. We have seen already that there is more than one kind of weakness from disease. There may be oppression, as in the early stage of almost any acute disorder; or depression (prostration) from a great shock, such as a railroad accident, crushing a limb, or from the lowering influ- ence of typhus or typhoid fever; or exhaustion, such as will be pro- duced by a large hemorrhage, an attack of cholera morbus, or a severe disease of some length of continuance. For oppression, in a person of good constitution and strength, unloading the system is needed—by sweating, purging, and action of the kidneys. For depression, support is called for. Not deeming it expedient to go here into an argument about it, only mentioning that some differ- ence of opinion has latterly sprung up on this point, my own judg- ment, based on experience, goes with that of physicians generally, to this effect: that alcoholic stimulation is, in sudden or great prostration from any cause, the most effectual. It may enable the system to tide over the time of weakness and danger, so that all will go on well again; whereas, without it, the patient may sink and die. Alcoholic stimulation is very often abused. It is employed when there is no occasion for it, and when required it is frequently excessive in amount. Every little feeling of weakness does not properly call for a glass of wine or whisky ; far from it. Fainting is better treated by fresh air, as much as possible; dashing or sprinkling cold water on the face, and Ammonia. Smelling salts (Carbonate of Ammonium) put, for 550 DOMESTIC MEDICINE. a moment at a time, under the nostrils, will hasten rccovcrv from a faint (syncope). When swallowing is possible, twenty or thirty drops of the Aromatic Spirit of Ammonia may be taken in a wineglassful of water. But wdien a person is almost dead from loss of blood, or an extensive burn, or the shock of a railroad accident, with white lips, shrunken cheeks, cold skin, and rapid, thready pulse, we need to stimulate with Alcohol, but not too much. A teaspoonful of whisky will be enough, in many instances, repeated in ten or fifteen minutes, if the patient does not show reaction. A tablespoonful will be a large enough dose at one draught in any case. More will do no better towards stimulation, and the after effect will be worse. Always, moreover, such stimulation must be withheld as soon as the depression has passed away, and then the less alcohol he has had put into his system the better. General Debility. After an acute disease with fever, as scarlet fever, measles, typhoid fever, etc., convalescence is accompanied by more or less debility. But when everything goes well, appetite is then strong, and the losses, of the system are made up by the appropriation of food. A person who was healthy before such an attack will commonly need no help from medi- cines to " build up " again. Running down in strength, however, with or without acute disease, and often without any fixed disorder of any great organ, is not uncommon, from various causes. Too severe, monotonous, and long-continued labor, out of proportion to one's strength; worry, particularly when it pre- vents refreshing sleep; living in a close air, without change and exer- cise ; these are some of the conditions in which people are apt to get down " below par " in strength. Poverty of blood (anaemia) is generally present in such cases. So is loss of appetite and digestive power; and nervous depression. These are the three elements of ordinary continued debility. To meet these, we have, besides rest from care, change of air, and generous feeding (all of which are of the greatest importance), three sorts of tonics : blood-renewers, appetizers, and nervines. Of the first class, referring to works on Materia Medica for others, the most valu- able, in the generality of cases, are Iron and Cod-Liver Oil. To the second class belong the vegetable Bitters, as Gentian, Quassia, Columbo, Chamomile, etc.; and the Mineral Acids, as Aromatic Sulphuric Acid (Elixir of Vitriol), and others. Under the third head may be named Quinine as most largely and safely applicable to general debility. Physicians also use, in some selected cases, Strychnia and Phosphorus, as powerful nervine tonics; but they are too dangerous to allow in the REMEDIES. 551 family medicine chest for use without medical advice. One preparation, if labelled Poison, and kept out of the way of the children and of igno- rant servants, may sometimes find safe use as a tonic both to the diges- tive organs and to the nervous system ; Tincture of Nux Vomica; safe in the small dose of ten drops twice or thrice daily. Remedies for Special Diseases. We have very few real and certain specifics for the cure of particular diseases. The great boast of the medical profession is of its power to stop "chills and fever" and control other kinds of malarial attacks with Quinine, and with some other preparations from the same source, namely, the Peruvian Bark. Syphilis is, undoubtedly, curable in the large majority of cases, timely attended to, by the skilful use of two remedies, Mercury (various preparations) and Iodide of Potassium. Itch is always conquerable by a sufficient application of Sulphur, in ointment or otherwise. Scurvy is curable, without much aid from medicines (tonics if any) by fresh vegetable food; as potatoes, onions, oranges, lemons, etc. Inflammatory rheumatism is beneficially influenced by Salicylic Acid and Alkalies (Potassa, Soda, Lithia); as Gout has been long known to be by Colchicum. Besides antidotes for actual poisons, and medicines which kill or drive out worms from the bowels, we cannot claim any other clear examples of special remedies for particular diseases. It used to be said that Iodine is a certain cure for goitre (enlargement of the thyroid gland in the neck). It is no doubt generally serviceable in that affection; but it will not always cure it. Quinine does not always cure ague. It " breaks" the chills, but in one, two, or three weeks they may come again; and the cure then has to be finished by a month or two of a course of Iron. There has not yet been discovered any specific remedy for scarlet fever, measles, whooping-cough, small-pox, typhoid or typhus fever, yellow fever, or cholera. All these diseases must be, therefore, con- ducted through the attack as safely as possible; meeting the symptoms as they occur, with the most reasonable measures we know of. I have sometimes told medical students, when talking of this subject, of what once happened to my father, while he was practising medicine. Having to drive several miles out of town to make an early visit to a patient, his horse was put into the carriage without any breakfast. On the way home, on a turnpike, the animal's hunger, and perhaps wrath, caused him to run away. My father, being alone, was quite unable to check his speed. As he dashed on, a turnpike gate came in view. What 552 DOMESTIC MEDICINE. was to be done? Stopping the beast was impossible. Had the reins been abandoned, although the gate was open, going through at full speed, not guided, would probably have resulted in knocking carriage, turnpike gate, and doctor all together into pi, as the printers call it. Therefore the doctor, being a man of good steady nerves, held the reins carefully, and drove through the gate, without even grazing a hub! After that, the runaway used up his excess of animal spirits without serious harm to anybody. So it is, then, that, in the self-limited diseases, above mentioned, we are to drive through, as skilfully and carefully as we can, attacks which we cannot abruptly stop; but which will come to an end of themselves after a while. Worms, Poisons, Accidents, and Injuries will have their special consideration in suitable places later in this book. PRINCIPAL MEDI-CINES, AND OTHER REMEDIES. 553 PRINCIPAL MEDICINES, AND OTHER REMEDIES. For the reader's convenience, we will now give a brief account of each medicine that has been spoken of in the preceding, or is likely to be particularly mentioned in the following, pages. As they are alpha- betically arranged, there will be no difficulty in finding any one of them for reference. Acetate of Ammonium Solution. This is a mild, moderately cooling medicine, very suitable to promote perspiration during fever. It is easily made by dropping small pieces of Carbonate of Ammonium into good Vinegar, piece after piece, until it ceases to bubble with effer- vescence. (This proceeds from the Carbonic Acid gas passing off, being displaced by the Acetic Acid of the Vinegar.) Dose of this Solution, a Tablespoonful every two or three hours. It is preferred to other sweating medicines especially in typhoid and typhus fevers; low fevers, so-called. It does not act upon the bowels. Aconite. Tincture of the Root of the Monkshood or Aconite plant. A deadly sedative poison in any but very small dose. It acts mainly on the nervous system, but indirectly on the circulation. Some phy- sicians use it in many cases of inflammatory fever, as in that of pneumonia, pleurisy, etc. Dose, one or two drops, in water, for a grown person, every two, three, or four hours. A bottle containing it should be la- belled Poison. Aloes. A powerful purgative medicine, having a particular ten- dency to act on the lower bowel. Therefore it is not a suitable cathartic in cases of Piles. Yet, in a very small, not purgative, dose, it is some- times added to other medicines for the relief of piles. Its action on the lower bowel makes it more appropriate when delay of the feminine monthly flow is treated by laxative medicines. The Tincture of Aloes and Myrrh (Elixir Proprietatis) has been much employed for this end. Dose of Aloes, from one or two to ten or more grains. Dose of Tincture of Aloes and Myrrh, from one to three or four teaspoonfuls, in water. Alum. A mineral, called a salt by chemists. It contains either Ammonium or Potassium with Aluminium and Sulphuric acid in combi- nation. (There is also an Iron Alum, in which, likewise, Ammonium is present.) It is crystalline, and has a peculiar taste, easily recognized after making its acquaintance. Alum is not often given as a medicine by the stomach, except as an emetic in bad cases of croup. For that purpose, its dose, in powder, is half a teaspoonful, with the same amount 554 DOMESTIC MEDICINE. of the powder, or a teaspoonful of Syrup of Ipecacuanha. Tn small dose, it is an astringent; that is, it tends to make the tissues which it touches shrink or contract together. Thus it helps to lessen the swelling of the mucous membrane, which is inflamed in sore throat, and it is much used for that, either in powder or in solution as a gargle. The powder may be blown into the throat through a quill, or, sometimes, put on the sore place with the end of one's finger. A gargle is made by dissolving a piece as large as a thumb in half a tumblerful of water. It is used by taking a mouthful of it and throwing the head back without swal- lowing it, letting it go as far down into the throat as it can without being swallowed. Alum should not be employed in mow^A-washes, because, when left long in contact with the teeth, the Sulphuric Acid in it acts somewhat upon their enamel. A solution of alum in pure water makes a good astringent eye-water, for inflammation of the eyes: an even teaspoonful of alum in a tumblerful of water will be strong enough. Ammonia. Volatile Alkali and Hartshorn are other names for this substance. When pure, it is a gas; but it is used either in the form of the Solid Carbonate of Ammonium, or in solution in Water (Aqua Am- nion ise), or in Alcohol. Smelling salts consist usually of the Carbonate. Druggists keep a stronger and a weaker watery solution of Ammonia. The medicinal form most used is the Aromatic Spirit of Ammonia (a solution in Alcohol, with Spices). This is a stimulant and antacid preparation. Its dose is from ten to twenty-five or thirty drops, in water. Aqua Ammonias (Water of Ammonia) is used to make Volatile Liniment, by mixing it with an equal quantity of Olive or Lard Oil. This liniment is a very warming thing to rub into the skin of the throat for a sore throat, as a counterirritant. Amyl Nitrite. See Nitrite of Amyl. Anise-seed is a mild aromatic or spicy article, warming and agree- able to the stomach. It is hardly ever used by itself, but is employed sometimes to flavor medicines. It gives the peculiar odor and taste to Paregoric. Apollinaris Water is an effervescing " mineral-water," having no marked property or action beyond that of the Carbonic Acid gas which makes it sparkling and pungent to the taste. Travellers in Europe often take it at their meals, so as to avoid the usual drinking-water at doubtful places. In this country, also, it is getting to be a popular table-water. (St. John's champagne!) Arnica. The Tincture of the flowers (or of the whole plant) is a popular application for bruises and sprains. It is a warming applica- tion, and not suitable where the skin is broken. Being poisonous when PRINCIPAL MEDICINES, AND OTHER REMEDIES. 555 swallowed in large doses, it should be kept so labelled, and so used as to prevent mistakes with it. Arsenic. A metal whose compounds are poisonous. Ratsbane is the White Oxide of Arsenic (Arsenious Acid). Paris Green, a good exterminator of potato-bugs, is an Arsenical preparation, with Copper. The medicinal form in which Arsenic is generally prescribed by phy- sicians is the Solution of Arsenite of Potassium (Fowler's Solution). Dose, from three to ten drops, twice daily; often given for chronic dis- eases of the skin. It should never be taken by an unprofessional per- son, without medical advice. Artificial Respiration. See Drowning, later, under Accidents and Injuries. Assafcetida. A gum-resin, of very disagreeable odor and taste; a good, mild, and safe composing medicine for disturbed nerves. Assa- fcetida pills, of three grains each, may be given now and then to hysterical people. This drug is also good for flatulence. Milk of Assafcetida is a very serviceable medicine for babies' colic. Dose, a teaspoonful, sweet- ened. Atomization. See Inhalations. 556 DOMESTIC MEDICINE. Bark, Peruvian. See Cinchona and Quinine. Baths. Enough has been said under Hygiene concerning bathing during health. In treatment of disease, the kinds of baths most used are the warm and the hot bath. We may call it warm from 90° to 96° Fahr., and hot from 96° to 100°. It never need be hotter than this last figure. Warm baths are very often useful, for relaxing and tranquillizing the system. In croup, convulsions, and lockjaw, as examples, such effects are often well obtained. Hot baths, though less frequently called for, are sometimes very serviceable; especially in cold and low states of the system. Chronic rheumatism is one of the affections likely to be benefited by it. Hot Dry Air Baths (Russian bath) are occasionally advised by phy- sicians, in obstinate prolonged skin affections, etc. Vapor or steam baths are occasionally' used for the application of heat and moisture to the body. They are not safe beyond the temper- ature of 110°, or possibly, for a short time, 120°. Moisture conveys heat to the body much more rapidly than dry air at the same temper- ature. A steam bath may be given, by the patient being stripped of clothing, and seated in a chair, wrapped, chair and all, in a blanket; his head only projecting above the latter. Then vapor may be generated by dropping very hot bricks into a pail of water placed between his feet. As above said, care must be taken about the temperature; and, on the whole, it will be hardly best to resort to a vapor bath without the advice of a physician. Hot and Warm Springs, as those of Virginia, are medicated by the sulphurous and other contents of the waters. Sometimes they do much good (bathing in the waters) for chronic troubles of the liver, kidneys, etc., and rheumatic joints. Belladonna. This product of the Deadly Nightshade (Atropa Bel- ladonna) is a powerful narcotic or brain stimulant drug. The Extract of the leaves is most used by physicians as a medicine, in neuralgia, ete. Atropia, a very strong alkaloid principle, is obtained from the root. Its solution is often dropped into the eyes by oculists, for the examination and treatment of affections of the eyes. It enlarges or dilates the pupils, giving them a more brilliant appearance. Ladies are said to take it sometimes before going into company, to make their eyes " brighter ; whence the name, from bella donna, fair lady. Dose of the solid Extract, a quarter of a Grain to a Grain; of the Tincture, ten to fifteen drops. Solution of Atropia for the eyes, two to four grains to a Fluidounce of water. Neither should be used withoul medical advice. PRINCIPAL MEDICINES, AND OTHER REMEDIES. 557 Benzoin. A resinous substance, from the Styra.r, an East Indian tree. The Compound Tincture of Benzoin is a good medicine for bron- chial cough. Dose, fifteen to twenty drops, on a lump of sugar, every three or four hours; or at the beginning of a spell of coughing. The same Tincture, applied with a camel's-hair pencil, is very healing to a sore nipple or a cracked lip, or even a fissure of the anus. Bismuth Subnitrate. A soothing stomachic medicine. Dose, 2 to 5 grains. Blackberry Root. Country people generally know the astringent property of this; but some make a mistake in supposing the berries to have the same ; which they do not. A tea made by cutting up a handful of the root and soaking it for two or three hours in boiling water (kept hot) will answer a good purpose in checking diarrhcea, in tablespoonful doses. Bleeding. An opinion concerning the occasional usefulness of this old-fashioned remedy having been expressed on a previous page, we have now only to say a few words about how it is done; although few people will want to try it before they have seen it done. At the bend of the arm is the most convenient place for venesection (opening a vein); choosing a cross vein if there is one, as is generally the case. First, tie a bandage or handkerchief around the arm, above the elbow; not as tight as it could be, as that would stop the flow of blood into the arm through the artery. What we want is to check the return fiW of blood towards the heart, in the veins, so that they may swell up and be easily seen and struck, and will then let out a good stream of blood. Of course the sleeve must be put out of the way for the operation. When the chosen vein becomes distended, it is opened by means of a lancet. There are two kinds of bleeding lancets. One is a simple small blade, tapering to a sharp point, which is dipped, so to speak, through the coat of the vein, nearly in the line of its direc- tion. The other is a spring lancet; the small pointed blade going forcibly into the vein when a button at the side of its case is pressed upon. Either will answer. When the opening is made in the vein, the blood, commonly dark-blue or purple, spurts a little, and then flows in a steady stream. If there is high fever, its color may be bright red, like that of arterial blood. Now and then, if the vein cut be just over an artery, the pulsation of the latter may make the blood come in an interrupted jet, as if from a wounded artery. Unskilful bleeders have sometimes opened an artery along with the vein, an accident which may give serious after-trouble. (If it should happen, pressure on the wounded artery, at and above the wound, will be required to stop its bleeding.) When enough blood has been taken, which may always be known to be the case if the patient becomes pale and faint from it, the bandage 558 DOMESTIC MEDICINE. should be removed. This alone will usually stop the bleeding at once. If not, pressure with a thumb or finger on the vein just below the cut will certainly control it. Ten ounces will be a sufficient bleedino- for most grown persons; much less of course for a child. The effect, how- ever, is the best guide. No patient is to be drained of blood; we need merely to reduce excitement or remove oppression. In inflammation of the brain, lungs, larynx (as in severe croup), pleura, or peritoneum, the former is desirable. In congestive apoplexy, or poisoning from breath- ing coal or burning gas, the latter is the mode of relief. Leeching and cupping will have most of the good effects of bleeding from the arm; and in doubtful cases may be substituted for it. Blisters. We use Jlustard-Plasters not to blister, but only strongly to warm and stimulate the skin. For raising a blister, Cantharides is mostly resorted to. The oldest way is to spread the Ointment of Can- tharides on a piece of buckskin, three or four or five inches square; cover this with a piece of gauze, and lay it on the part. This will draw a blister upon a grown person in four, five, or six hours; with a child, in two hours or less. Then nip (do not remove) the raised scarf- skin with the point of a pair of scissors, and lay upon it a soft muslin rag thickly spread with Simple Cerate, as a healing dressing. Cantharidal Collodion is a strong liquid preparation, which, when painted on a part with a small brush (camel's-hair pencil), and covered with oiled silk or rubber cloth, will draw a blister in from an hour and a half to three hours generally. Blisters are unpleasant things, but are sometimes very beneficial; especially at the middle stage of a serious inflammation, as of the brain, pleura, lungs, etc. In severe inflammation of the brain in a man, I have known great advantage to follow shaving the head and blistering nearly the whole head at once. Once in a while strangury (difficulty in passing water) will follow the application of a blister, from some of the Cantharides being absorbed into the blood, and so getting through the kidneys into the bladder. Flannel wrung out of hot water applied to the bladder and perineum (crotch, just between the thighs at the pelvis); Spirits of Camphor, taken in twenty-drop doses; and, if the difficulty lingers, a Laudanum injection into the bowels, are remedies for strangury. Blue Pill, or Blue Mass. This is a preparation of Mercury, one- third of the strength of Calomel. It is a soft solid, easily made into pills. Apothecaries usually keep on hand three-grain Blue Pills. Much discussion and some change of opinion have taken place in the medical profession within twenty-five years about the use of Blue Mass and other Mercurial medicines. Their power over the liver ha^ been PRINCIPAL MEDICINES, AND OTHER REMEDIES. 559 disputed and their control of inflammatory attacks is not confided in now as it formerly was. The doses of mercurials also have come to be much reduced. The late Dr. Joseph Hartshorne was one of the first to observe the necessity for this reduction. He gave two- and three- grain doses of Blue Pill, when many practitioners gave ten and twenty grains. The best established usefulness of Blue Mass is in the relief of what is called " biliousness," when there is a bitter taste in the mouth, espe- cially on awaking in the morning; with some degree of nausea (sick feeling at the stomach), and more or less yellowness of the tongue and of the whites of the eyes; perhaps of the face or the skin generally; the bowels also being constipated, or the stools slate-colored instead of brown or yellowish-brown, as is natural. One or two grains of Blue Pill at bedtime, and the same again in the morning or the next evening, taking in all from two to four grains, will do well, without any risk of salivation, at least in all but one case or so in a thousand. Calomel is better for a similar purpose as a baby's medicine. Indi- gestion and commencing diarrhcea in infants are often much helped by small doses of Calomel; powders, each of which contains one-twelfth of a grain of the medicine, with a grain or two of Soda (Sodium Bi- carbonate) or Magnesia, or only Sugar; the last for taste, and to give substance to the small dose of the drug. Borax. A very familiar article this is, in the nursery, for sore mouth. It is a mineral astringent, milder than Alum, and may be used more freely; either dissolved in water as a wash, or in powder with Sugar, put with the finger right on the sore spot in the mouth. Bromide of Potassium, Bromide of Sodium, and Bromide of Lithium. These "Bromides" are nervous sedatives; tranquillizing an excited brain in a different way from Opium; having less sleep- compelling power than it. Bromide of Potassium is largely prescribed by physicians for epilepsy and some less serious but obstinate troubles of the nervous system. Bromide of Sodium has the same sort of effect, but perhaps is more agreeable to the stomach ; and the same is true of Bromide of Lithium. Bromide of Ammonium is less often used for similar effects. Bromo-caffeine often helps nervous headaches. Dose, of either, five to fifteen or twenty grains, in water. The largest doses are best borne when taken at bedtime. Long use of large doses of either of the Bromides sometimes causes an eruption on the skin, and some other unpleasant symptoms, called bromism, by physicians. For any one who suffers greatly from the sting of a bee, or other insect, twenty-grain doses of Bromide of Potassium may be advised. 560 DOMESTIC MEDICINE. Cajuput Oil. An aromatic greenish (or, when old, reddish) oil, from the leaves of an East Indian tree; one of the best remedies for flcdident colic, especially when "gouty;" and also for flying gout and chronic rheumatism. Dose, from four to ten Drops, on a lump of sugar, followed by a drink of water. Calomel. Chloride of Mercury. See above, under Blue Pill. Calomel is a white powder. Dose, from one-twelfth of a grain, for an infant, to one-half grain, one grain, or sometimes possibly more, for an adult. Not to be used as a domestic medicine ; unless, after experience, the very small calomel powders, for indigestion of infants. Camphor. A most useful gum, from an evergreen tree native to the south and east of Asia. Every one knows its white or colorless trans- parency, its peculiar odor, and pungent and yet cooling taste. It is volatile; that is, if left in the air it will slowly go off in vapor. Very little of it will dissolve in water. Camphor-ivater is a very mild prepa- ration. Spirit of Camphor, made with Alcohol, is much stronger. Camphor is a composing medicine to the nerves; somewhat more stimulant than Assafcetida. In very large doses it is narcotic (stupe- fying). Camphor-water is an excellent tranquillizer for restless babies; being also, like the spices, warming to the stomach, and somewhat anodyne, it is excellent in colic. Spirit of Camphor is best when an anodyne effect is specially needed; as in colic of grown people. Fig. 183. CANTHARIS VITTATA. CANTHARIS VESICATORIA. Dose of Camphor-water, from a teaspoonful (an infant dose) to a tablespoonful. Of Spirit of Camphor, from ten to thirty Drops; on sugar, and stirred in water, or in a thick syrup, as Spiced Syrup of Rhubarb. When dropped into water, the Alcohol unites with the water and "throws down" the Camphor in little white flakes. Paregoric is a Camphorated Tincture of Opium. Cantharides. Powdered " Spanish Flies." These are insects; really beetles, not flies. They are rather pretty, having shining green backs; and are native to the south of Europe. From their powder Blistering Ointment (Cantharidal Cerate) is made. See Blisters. PRINCIPAL MEDICINES, AND OTHER REMEDIES. 561 Carbolic Acid. This (also called Phenic and Phenylic Acid, and Phenol) is a product of coal-tar, as Creasote is of wood-tar. It is not really an acid, chemically, though so called. When pure, and entirely dry it is in nearly colorless crystals; but it easily absorbs water and becomes liquid (deliquesces) when exposed to the air. Crude, impure Carbolic Acid has a brownish color. Its odor is disagreeable; its taste hot followed by tingling and perhaps numbness of the tongue. It Fig. 184. burns, like Creasote, when dropped upon the skin; but this is imme- diately followed by loss of feeling in the part. Carbolic Acid has no proper place as a domestic medicine. It has had great popularity as a disinfectant; more than it deserves, in com- parison with several other less unpleasant things. Surgeons often em- ploy it in " antiseptic " dressings and lotions. Cardamom Seeds, Compound Tincture of. A warming aromatic preparation, often added to Soda, etc., for sickness of the stomach. Dose, a Teaspoonful, in Water. 36 562 DOMESTIC MEDICINE. Castor-Oil. Expressed from the beans or seeds of the Palma Christi, a handsome plant, originally from Asia. It is nasty, decidedly; but is a good, effective, and yet mild purgative medicine. It is the best cathartic, even for babies, when any irritation of the bowels is present" as in threatening of dysentery, and in some cases of colic. Dose, from a Teaspoonful to a Tablespoonful. The best way to give it is to stir it well with twice the quantity of Spired Syrup of Rhubarb. So mixed, I have had patients to take it without finding out what it was. Catechu. An Extract from the wood of an Oriental tree. It is astringent, and is very useful in diarrhcea. Tincture of Catechu is the best preparation. Dose, Half a Teaspoonful to a Teaspoonful, in water. An excellent medicine to check troublesome diarrhoea consists of equal parts of Tincture of Catechu and Paregoric ; of this mixture, the dose is a Teaspoonful, repeated according to the urgency of the ease. Cathartic Pills (Compound). These are made of three strong pur- gative medicines, with a little Calomel. They are too active to be used for ordinary constipation of the bowels; but are very convenient when a decided purgation is needed. Catheter. A tubular instrument for drawing the urine from the bladder, when the patient cannot pass it. The one for the male is long and curved; that for the female, short, and with only a slight bend near the end. It is made either of silver or of prepared gum-elastic; the latter being flexible, the former firm. Both are open at one end, and closed at the other, which is rounded and smooth; but just above the closed end (which is introduced into the bladder) are several holes, to admit the water. Skill and care are needed for the use of the catheter. The difficulty is greatest with the male. Of course the instrument must be well oiled before being introduced. Caustics. Several of these are used by physicians. We may name here a few of them. Lunar Caustic is Nitrate of Silver. It is less de- structive than the Vegetable Caustic (so-called) Potassa. Strong Acids are caustic; as Nitric and Chronic Acids. All of these, when moist- ened, will burn the skin, or any other portion of the body. Lunar Caustic, if very lightly touched upon a part, will not exactly burn it, but will change the condition of the surface in a way often beneficial, espe- cially in chronic inflammations ; also, in destroying the specific char- acter of an inflammation, as of the throat in diphtheria or in scarlet fever. Warts are often destroyed by the stronger caustics. Care must be used to act only on the wart, and not on the parts around it. If any of the caustic runs over, it should be at once washed away; best, witti PRINCIPAL MEDICINES, AND OTHER REMEDIES. 563 an antidote to it in solution. For Potassa, Vinegar is an opposite or antidote; for either of the Acids, Soda. Cerate. This word means something made with wax. Simple Cerate is made of Spermaceti, White Wax, and Oil of Almonds. It is a very soothing and healing application to sore places of any kind, as after a blister, ete. It is harder than Cold Cream (Ointment of Rose Water), and this is sometimes a decided advantage. Chalk Mixture. A convenient medicine for common diarrhcea, made of Prepared Chalk, Gum-Arabic, Glycerin, and Cinnamon Water. Dose, a Tablespoonful for a grown person. Most frequently some- thing is added to make it more " binding " or astringent, as Catechu, Paregoric, etc. Chamomile. This is a plant (Anthemis nobilis), a native of Europe, but naturalized in parts of this country. The flowers are bitter and aromatic. Of these a tea is made with boiling water. It may be taken, half a pint daily, as a simple appetizer and tonic in weak di- gestion or general want of strength. It is not, however, one of the strongest tonics. Charcoal. Powdered charcoal is a good " sweetener " of a stomach oppressed with flatulence from indigestion. Dose, half a teaspoonful to a teaspoonful. It is often given with an equal quantity of Magnesia. Very finely powdered charcoal is also a useful ingredient in tooth- powders; on account of its cleansing action. Chloral (Chloral Hydrate). One of the medicines that promote sleep. It is less powerful than Opium, although a very large amount of it taken will poison fatally. It gets its name from its being made from Chlorine and Alcohol. It is a white crystalline substance, of a pungent taste and odor. Dose, from ten to thirty Grains for an adult; for a child, one Grain for each year of its age. It should be taken or given only as prescribed by a physician; and when so advised, left off as soon as his judgment will allow. The same sort of danger attends its use as does that of Opium, of forming a Chloral habit, depending upon it for sleep, and requiring larger and larger doses, with at last great injury to the health. Chloramine pastilles. Contain Chloride of Ammonium, &c. Use- ful in loosening cough. Chlorate of Potassium (Chlorate of Potash, commonly called). A favorite medicine with physicians and others, for sore mouth and sore throat. It often does more good to sore mouths, in babies especially, than anything else. But it must not be swallowed without limitation. VVhile safe in doses of a few grains, half-ounce doses of it are dangerous; sometimes even producing death. Dose, for a grown person, from ten to twenty Grains; for a child, three 564 DOMESTIC MEDICINE. or four years old, five Grains; dissolved in water. Its solution alsn makes a very good gargle for sore throat. Chloride of Ammonium (Muriate of Ammonia, old name); some- times also called Sal Ammoniac. A medicine of value in a variety of cases; in chronic bronchial cough; in torpor of the liver; and in some cases of neuralgia. Not well adapted, however, for use without sonic medical knowledge and experience. Dose, ten to twenty grains. Chloride of Lime. Chlorinated Lime is a more correct name for this white powdery substance. It is used as a disinfectant, chiefly on account of the free chlorine gas which it contains when fresh, and gives off slowly into the air. While it does, no doubt, something towards destroying foulness in the air of a place, when laid about in saucers, etc., this must not be considered as amounting to very much. It re- quires a great deal of Chlorine to really disinfect a room or building in which there has been contagious disease, or accumulated foulness. Chlorinated Lime dissolved in water is an excellent disinfectant of privies, etc. An objection to its being so used in water-closets and bath- pipes is, that the Chlorine it contains corrodes lead and iron. Chloroform. The most prompt and powerful, but also least safe, of the articles used by surgeons as anaesthetics; that is, for patients to breathe before and during operations, in order to prevent them from suffering pain. It may be taken into the stomach in larger quantity than by the lungs, without danger. In flatulent colic, it is often very relieving; but no more so than Camphor and Cuajuput, as well as Opium. Dose, by the mouth, ten to forty or fifty Drops; in a large draught of water, as it is very pungent. A teaspoonful holds more than 200 drops of Chloroform. I have given it to a number of patients in teaspoonful doses, without any bad effect; only sleepiness, like that produced by opiates. A Chlo- roform Liniment may be safely used as an outward application for rheu- matic or neuralgic pains. Cinchonia. One of the alkaloids of Peruvian Bark. See Quinine. Chlorohydric Acid. The name preferred by chemists for what was formerly called Muriatic Acid. It is not often given as a medicine; but is present in Nitro-Chlorohydric or Nitro-Muriatic Acid, a good appetizer and liver-tonic. Cinnamon Water. Made from the aromatic bark of the Cinnamon- tree of the East. It is a pleasant spicy solution, slightly astringent; good with other things in mixtures for diarrhcea. Dose, for a child, a Teaspoonful. Citrate of Magnesium. Commonly taken in effervescent solution. It is about the least disagreeable of all purgative medicines. Apoth- PRINCIPAL MEDICINES, AND OTHER REMEDIES. 565 ecaries mostly keep it already dissolved, in tightly corked and wired bottles. More convenient for keeping in a family is the solid Granular Citrate of Magnesium; which is to be dissolved when taken. Dose, of the bottled solution, a AVineglassful (more, or less, according to the amount of purging needed). Of the Granular Citrate, from a Tea- spoonful to a Tablespoonful. In the latter dose, it is quite an active cathartic; although not so rapid in its operation as some other medicines; aud all persons are not alike susceptible to its action. Citrate of Potassium. Like the Citrate just mentioned, this has for one ingredient Citric Acid, obtained from Lemon or Lime Juice. This is neutralized by Potassium (an alkaline metal) as it may be also by Magnesium; in each case making what chemists call a salt. Citrate of Potassium acts very slightly, if at all, on the bowels. It is used in solution to cool the system and promote secretion from the skin and kidneys in fever. One way of taking it is in Neutral Mixture (one Drachm of this citrate in four Fluid ounces of water); of which the dose is a Tablespoonful every two or three hours. Another way is in effervescent solution. (See Effervescing Draught.) Cloves, Oil of. A strong, warming aromatic, from the flower-buds of the Caryophyllus Aromaticus of the East Indies. A hot tea is sometimes made of Cloves, to be given in cholera-morbus. If the Oil should be taken, for colic, its dose would be not more than a drop or two, on a lump of sugar, followed by a drink of cold water. The tea may be made by pouring a Teacupful of boiling water on Half a Teaspoonful of Cloves, covering and leaving it to stand for a few minutes. Dose, a Dessertspoonful (two teaspoonfuls, or Half a Tablespoonful). Oil of Cloves is a good remedy for toothache in a hollow tooth. Wet a pledget of cotton well with it, and push it into the cavity of the tooth with the end of a bodkin or knitting-needle. Cocoa Butter. Cacao is the botanical name of the tree (Theobroma Cacao) from which this comes; out of the same nuts or seeds of which Cocoa and Chocolate are made. Cocoa Butter is a good soothing appli- cation for bruises of any part of the body. It is well always to have it in the house. Cod-Liver Oil. Obtained, as its name indicates, from the livers of codfish. It is very nourishing and fattening to wasted and wasting bodies, sometimes checking the progress even of pulmonary consumption. Its taste is quite disagreeable. Dose, from a Teaspoonful to a Table- spoonful (the latter best) thrice daily, for a grown person. Many ways have been tried to make it less unpleasant to take; following it with strong Mint-Drops, mixing it in Coffee, rinsing the mouth first with Brandy or Whisky, pouring it into the froth of Ale, etc. I doubt 566 DOMESTIC MEDICINE. Fig. 185. whether any way (unless it is put up in gelatin capsules, as some apoth- ecaries do it) is better than to salt and pepper it, as if it was (!) a fishv delicacy, and then bolt it down; afterwards rinsing the mouth with Tincture of Myrrh and Water. Children generally do not mind takhi" it, unless their fears have been aroused by talking about it. Colchicum. A bulbous (cormous) plant, whose root and seeds are both used medicinally. The Wine of the Root is the best preparation. In large dose it acts on the bowels; some- times irritating the stomach also. It is a diuretic, and influences the nervous system in a way not very well defined. It was formerly the favorite medicine in gout; and probably does as much as any medicine towards curing or mitigating gouty attacks. Dose of the Wine of the Root of Colchicum, ten to thirty Drops, in water. Cold Cream. This is the Unguentum Aquce Rosce (Ointment of Rose-water) of the apothecaries. It is a soft, easily melted, and very soothing application for sore places, chapped hands or lips, etc. It becomes rancid when long kept exposed to the air. Collodion. This is a solution of Gun-Cotton (Pyroxylon or Colloxylon) in Ether. When it is painted upon any surface the Ether evaporates, leaving a thin cottony film. Flexible Collodion, made a little differently, is less apt to shrink together in drying. It is a convenient article to cover a part whose skin is broken or ulcerated, as sore nipples, cracked lips, etc. Cantharidal Collodion has been mentioned already, as a blistering liquid. Columbo (Calumba, root of an African plant) is one of the simple vegetable bitters. Like the rest of its class, it is a tonic to the stomach. It is given sometimes for dyspepsia. Convallaria. See Lily of the Valley. Corrosive Sublimate. Bichloride of Mercury this is, or Mercuric Chloride. Calomel is the Mild Chloride, or Mercurous Chloride of Mercury. The Sublimate is a deadly poison, used often to kill bugs, ete. Physicians sometimes prescribe it in very small doses (one-twelfth to one-eighth of a grain) internally, and of late a Solution of it (one part COLCHICUM. PRINCIPAL MEDICINES, AND OTHER REMEDIES. 567 to 1000 or 2000 of Water) is a good deal employed externally as a pu- rifier and to destroy supposed disease-germs. It is certainly one of the most powerful disinfectants. Coxe's Hive Syrup. A medicine not suitable for family use, though once so employed, because it contains Tartar Emetic, a violently- acting medicine, not safe except in skilful hands. " Hives " is an old name for croup. No doubt this Syrup may relieve cases of croup, but the same kind of effect may be usually obtained with Ipecacuanha, which is milder and quite safe. An overdose of Tartar Emetic (Tar- trate of Antimony and Potassium) may kill an infant; not so with Ipe- cac. ; it is just vomited and purged away without damage. Cream of Tartar (Bitartrate of Potassium). This is a cooling, mild purgative salt, which also increases the flow of urine (diuretic). It is very often given in dropsy. Dose, one or two Teaspoonfuls, stirred in water. Very little of it will dissolve. Creasote. A product of Tar. A hot-tasting, sooty-smelling liquid; poisonous if swallowed in moderately large quantity; burning the mouth or skin which it touches. Physicians advise it in one-drop doses for sick stomach, ulcer of the stomach, etc. In domestic practice it should be on hand as the most effective remedy for toothache in a hollow tooth. The end of a bodkin or knitting-needle should be wrapped around with a little piece of cotton, and this be dipped into Creasote. Then, carefully, the cotton should be^ pressed into the hollow of the aching tooth. (It won't hurt, as it at once kills the sensibility of the exposed nerve-end in the tooth.) If any spills over and burns the gums or lips, rinse at once with cold water. Crea- sote, so used, does no harm to the teeth. Croton Oil. Taken from the seeds of an East Indian plant, this is one of the most violent of purgative medicines; a single drop will act like a large dose of salts. It is only used by physicians in rare cases, when other cathartics fail to act, or where it is impossible to get the patient to swallow anything in larger quantity. On the skin, Croton Oil, when rubbed in (a drop or two only), wall cause a sore pimply or pustular eruption. It is thus used sometimes as a powerful counter-irritant in chronic spinal troubles, chronic bron- chitis, etc. It is very important not to get any of it rubbed into one's eyes. Cupping. See Bleeding; and also, Taking Blood, page 535. 568 DOMESTIC MEDICINE. Digitalis. Foxglove is the common name of the pretty plant whose leaves furnish this medicine. The Tincture is most used. Phvsicians give it often when the action of the heart is too rapid, and perhaps irregular. It has also been given in large doses in delirium tremens. Its common dose is ten Drops, twice or thrice a day. Being diuretic, it is sometimes prescribed in dropsy. Its very powerful active principle is Digitalin. Of this, if taken as a medicine, the close is one-fiftieth of a Grain. Fig. 186. DIGITALIS PURPUREA. Dover's Powder. Made of Ipecacuanha, Opium, and a cooling salt (Sulphate of Potassium, or some similar compound), this medicine is composing and diaphoretic. Some persons find it agree with them at the beginning of a severe cold, taking it just before going to bed, after a warm mustard foot-bath. Dose, ten Grains; containing one Grain of Opium and one Grain of Ipecacuanha. As this is a full reg- ular dose of Opium, it needs to be slept, as well as sweated, off. Better not take Dover's Powder without the advice of a physician; at least the first time. PRINCIPAL MEDICINES, AND OTHER REMEDIES. 569 Effervescing Draught. This is a cooling medicine for fever; the Carbonic Acid gas in it also makes it acceptable to the stomach. It is composed on the following recipe: Dissolve two Drachms and a half of Bicarbonate of Potassium in four Fluidounces of Water. To make a draught, pour out a Tablespoonful of this solution, and add to it a Tablespoonful of Water. Then pour into these a Tablespoonful of fresh Lemon-juice. It will effervesce, and should be drunk at once. If Lemon-juice cannot be had, an apothecary may furnish instead a solution containing two Drachms of Citric Acid in four Fluidounces of Water. A tablespoonful of this, with one of water, may take the place of Lemon-juice. Elaterium. A substance from the juice of the Squirting Cucumber, so called from the way in which the pod of the plant throws out its seeds when ripe. It resembles Croton Oil in being a harsh and power- ful purgative, causing copious watery passages. It is seldom used by physicians except in certain cases of dropsy. Electricity. Physicians often advise (or themselves personally apply) different forms of electricity for the treatment especially of paralysis; also, for neuralgia, chronic rheumatism, old sprains, sup- pressed menstruation, lead colic, and many other affections. Powerful currents or shocks are frequently used to revive persons almost dead from drowning, suffocation, or narcotic poisoning. Referring to medical works* for a more extended account, the gen- eral principles only can be here considered. Three kinds of electricity are used: frictional, of the machine of glass with a rubber; voltaic (galvanic), the current obtained from a " battery," composed of metals with acid solutions, etc.; and faradization, by "induced" and inter- rupted currents, electro-magnetic or magneto-electric. The constant current produced by chemical action, in a battery or by the simpler arrangement of a "pile," of pieces of metal with a material between them moistened with acid, is the more penetrating of these methods; in chronic cases needing perseverance in alterative treat- ment. The interrupted current is most used to stimulate weak muscles and nerves, as in paralysis. It is the general opinion of physicians, that electricity is not likely to do good at an early stage of palsy, or while there is anything at all inflammatory about the attack which causes it. h or domestic use, -when recommended by a physician, the most con- venient apparatus is the magneto-electric arrangement. In this, as com- *See " Essentials of Practical Medicine," fifth edition, p. 171, for a brief summary on this subject. 570 DOMESTIC MEDICINE. monly made, the interrupted current is generated bv a "keeper" (n small piece of iron) revolving, when a handle is turned, so as alter- nately to approach and recede from a magnet. A very stronsr and rapidly successive series of shocks may thus be produced, controlled, however, by the sliding in or out, at will, of a rod provided for the purpose. In order to take effect upon any part, a "circuit" must be made, by each "pole" of the apparatus being brought in contact with the body (that is, both at once). For this handles are arranged, usual lv with soft sponges at the ends, to be moistened when applied. Too strong currents or shocks of electricity may do considerable harm. The application should never be allowed to be painful or dis- tressing, or be continued so long as to produce positive fatigue or ex- haustion. Various patent contrivances are sold to maintain constant currents of electricity when they are worn about the person. While it is not im- possible for an appreciable current thus to be kept up for some time, it. is seldom the case that such instruments act otherwise than through the imagination. That faculty, however, is very powerful in its influence upon the bodily conditions of many people. Perhaps it ought even to have a section among remedies by itself. Elixir of Vitriol. Aromatic Sulphuric Acid is another name for this, which is often prescribed as an appetizer; sometimes also for diar- rhoea, and occasionally for hemorrhages. Dose, ten to fifteen drops, in water; best taken through a glass tube, to prevent its touching the teeth; also, for the same reason, washing the mouth out well with water after it. Elixir Proprietatis (Elixir Pro). This is an old name for Tincture of Aloes and Myrrh ; which has a popular reputation as a medicine to bring on the monthly courses when delayed or suppressed. Dose, a tea- spoonful^in water, twice daily. Emetics. Articles which cause vomiting. The most important occasion for their use is when poison is known to have been swallowed. Then the quicker and the more thoroughly the stomach is emptied, the better. Handy emetics in every house are Mustard, a teaspoonful, or Salt, a tablespoonful, in a teacupful of warm, not hot, AVater. Let it all be swallowed at once; and follow it in ten minutes with another teacupful of AVarrn AVater, if it has not in that time taken effect. Among emetic medicines, Ipecacuanha is the mildest and safest, and it is usually active enough. In bad cases of croup, with formation of membrane in the throat, Alum may be added to it. Of powdered Ipecac, a teaspoonful will usually produce vomiting; of the Syrup, a teaspoonful, perhaps needing to be repeated; of the Fluid Lxtract, half a teaspoonful. PRINCIPAL MEDICINES, AND OTHER REMEDIES. 571 Tartar Emetic (Tartrate of Antimony and Potassium) has already been spoken of as too severe and prostrating an emetic for use, at least as a domestic medicine. There are other mineral emetics (Sulphate of Zinc, Sulphate of Copper, etc.) which ought never to be used except under medical advice. Epsom Salts. Sulphate of Magnesium. A very unpleasant medi- cine to the taste; an active, cooling cathartic. It is (its nastiness apart) useful as a purgative in some inflammatory affections of strong people; for delicate patients, milder medicines are better. Dose, from a Teaspoonful to a Tablespoonful, dissolved in Water. Ergot: Spurred Rye. A growth on grains of diseased rye plants. AVhen taken into the stomach, it has a tendency to promote contrac- tion of the womb and of the blood-vessels. On account of the first of these effects, it is given after child-birth, to aid in the expulsion of the placenta (after-birth), and to check hemorrhage. Its causing con- traction of the blood-vessels is a reason for its being prescribed for various hemorrhages, and also in chronic inflammations; especially of the spinal marrow. The Wine of Ergot is the preparation most em- ployed. Dose, of it or of the Fluid Extract, from Half a Teaspoonful to two Teaspoonfuls, in Water. Ether. A very volatile and inflammable liquid, colorless, and with a warm, strong taste. It is a quick stimulant when swallowed, or when injected under the skin by means of a hypodermic syringe. Its most im- portant use is as an anaesthetic, breathed before surgical operations, to render them painless. It is, for this, much safer than Chloroform. The usual way of administering it is to fold a towel into the shape of a hol- low cone (a chimney-sweep's hat, or sugar-loaf), in the bottom of which is placed a sponge, on which Ether is poured. This is then held over the patient's mouth and nose, for him to breathe, until he " goes to sleep," breathing hard, and dropping his hands, when they are held up, in un- consciousness. Then the Ether is removed. If an operation takes a great while, it may be necessary for the ether to be breathed again, to keep up the insensibility throughout. The pulse must be felt, however, constantly, besides watching the breathing ; so that fatal narcotism shall not be brought on. With Ether, this will not happen, if due care be taken; with Chloroform, it is not certain always to be avoided, even with great precaution. Eucalyptus. From the leaves of this Australian tree a tincture is made, as well as a solid extract, and the essential oil, eucalyptol. Loz- enges of this drug are serviceable as a warming expectorant, in bronchial catarrh. Eucalyptus is also useful in chronic irritability of the bladder. Dose of the tincture, a teaspoonful; extract, one to ten grains; of euca- lyptol, ten to twenty drops, in capsules or a mixture. 572 DOMESTIC MEDICINE. Fennel-Seed. A very mild aromatic ; sometimes made into a tea for babies' colic; more often added to Senna Tea, or Fluid Extract of Senna, to keep that purgative medicine from griping the bowels. Flaxseed. This makes a good soothing drink, Flaxseed Tea, for sore throat. Pour Half a Pint of boiling AVater upon a Tablespoonful of whole Flaxseed, and stir it up for a few minutes. Then let it stand covered for a few minutes more; but do not put it on the fire to boil, as that would bring out the oil (Linseed Oil), which is not good to drink. AArhat is wanted in the tea is only the mucilage of the seeds. Lemon- juice and sugar added will make Flaxseed Tea more agreeable. Flaxseed Meal makes a good warm and soft poultice. Mix a suffi- cient portion of the meal with hot water, into a mushy mass. Spread this with a tablespoon on a piece of thin flannel or old muslin; then double in half an inch of the edge all around, to keep the poultice from oozing out. The best way to have a poultice warm when put on, is to spread it on a hot plate, close by the person to whom it is to be applied. AVhen it is on, cover it at once with a piece of Oiled Silk, Oiled Paper, or thin Rubber Cloth, to keep the moisture in. AYithout this it will dry up very soon. A very little Sweet Oil or fresh Lard put over the surface of a poultice before applying it will make it more soothing and more easily removed. For the latter purpose a piece of tarletan or gauze may be laid over it before it is applied. When pain in the part is severe, a Teaspoonful or two of Laudanum may be poured over the poultice before putting it on. Fly-Blister. A plaster of the ointment of Spanish Flies (Cantha- rides), applied to draw a blister upon some part of the surface of the body. Such a remedy is only required for a rather severe case of inter- nal inflammation, or for that of an eye or an ear; in either instance, not during the first day or two of the attack. In serious inflammation of the brain, a blister to the back of the neck, or even over a large part of the shaven scalp, is sometimes one of the best of remedies. A blister is usually made by spreading a piece of buckskin, three or four inches square, with Cantharides ointment, covering this with a piece of thin gauze, and laying it upon the part. After from two to five or six hours (according to age and delicacy of the skin) the skin will feel very sore, and on taking the plaster off, the outer skin will be found to be raised in a blister. This may be tapped with the points of a pair of scissors, and the part may then be covered with a rag spread thickly with Simple Cerate. It will heal in a few days. For inflamed eyes, the back of the neck is the best place for a blister; for severe inflammation of an ear, just behind that ear; the plaster being cut to fit there. PRINCIPAL MEDICINES, AND OTHER REMEDIES. 573 Gentian. Poets as well as botanists are familiar with this European flowering plant, whose root is used in medicine. Its Extract is made into tonic pills (Compound Gentian Pills) for indigestion, and its Com- pound Tincture is one of the best tonic preparations given for weakness of the stomach. Gentian is a pure and simple bitter stomachic tonic. Dose of the Compound Tincture, a Teaspoonful, in a little AArater. As an appetizer it is best taken just before each meal. If given on account of slowness and discomfort in digesting food, shortly after the meal will be the best time for it. (See page 544.) Geranium. Our native plant of that name, Geranium maculatum of the botanists, a common herb of American woods, has a root which Fig. 187. is astringent. A tea may be made by boiling an Ounce (about two Tablespoonfuls) in a pint and a Half of Water down to a Pint. Of this the dose is from a Tablespoonful to a Wineglassful, given as a country remedy for diarrhcea. Ginger. A fine spice for culinary as well as medicinal use. Like the other aromatics, it is a product of tropical lands; a native of Asia, but now much cultivated in the West Indies. Jamaica Ginger is the most used with us. It is the root of a many-stemmed plant, three or four feet high. Essence of Ginger is a very good medicine to have in the house. It is a warming stimulant to the stomach, and aids greatly in relief of or- dinary flatulent colic. Dose of a strong preparation of it (as Brown's 574 DOMESTIC MEDICINE. Essence of Jamaica Ginger), ten to thirty Drops, in Water. It niav also be applied outside, over the stomach and bowels; wetting a piece of thin flannel well with it, laying it on, and covering it with Oiled Silk to prevent too quick evaporation. Ginger Tea is an old favorite stomach-warmer. A Tablespoonful or two of the bruised root may have a Pint of boiling Water poured on it, then leaving it to stand covered for an hour or so. We don't boil aromatic teas or other preparations, because that would drive off their volatile Oils, wdiich are their active principles. Of Ginger Tea, the dose is one or two Tablespoonfuls at a time. Glycerin. A sweet, transparent liquid, obtained from fatty sub- stances. Only pure Glycerin (Bower's or Price's) should be used. Its principal employment is as an external application; to chapped hands, sore lips, etc. To a very delicate skin it is, when pure, somewhat irri- tating. Adding the same amount of Rose-Water makes a very nice preparation. Glycerin and Borax mixed make a good paste to put upon sores in the mouth. In Teaspoonful doses, Glycerin is gently laxative to the bowels. It is given sometimes for this purpose to children. Glycerin is antiseptic ; that is, it tends to keep dead animal matter (meats, etc.) from putrefaction; and to ward off the effects of decaip poison upon or within surfaces of the body. It is therefore a good ingredient in washes for the parts involved after child-birth. Glycerin with Tannin makes a very good astringent lotion for frosted feet, also for enlarged tonsils, sore nipples, running from the cars, and fissure of the anus (of which an account will be hereafter given). For the Glycerole of Tannin, rub together one ounce of Tannin (Tannic Acid) and four fluidounces of Glycerin, in a mortar; heat this mixture gently (best in a porcelain dish) until a perfect solution is made. Gum-Arabic. A soothing (not nourishing) material for a drink, in cases of irritation of the throat, or cough. It is simply dissolved in water, a Tablespoonful to a Half Pint. Some persons like to chew and dissolve the gum in the mouth for the same purpose, instead of Licorice or Candy. [Compound Gentian Pills, mentioned on page 573, have in each pill one Grain of Extract of Gentian, one Grain of Rhubarb, one quarter of a Grain of Blue Mass, and a quarter of a Drop of Oil of Cloves.] PRINCIPAL MEDICINES, AND OTHER REMEDIES. 575 Hamamelis Virginiana is the Witch Hazel; principal ingredient in Pond's Extract. Tincture of Hamamelis is much used by some physicians in England for spitting blood; if the blood comes from the stomach, one drop of the Tincture, in water, every ten or fifteen minutes at first; after a few doses, at longer intervals until relief is afforded. If it be hemorrhage from the lungs, the dose of the same Tincture may be one drop every hour or two. Larger doses will cause throbbing headache with some persons. It is also given for bleeding from the bowels or from piles. Hoffmann's Anodyne. A strong warming stimulant to the ner- vous system, with some anodyne or pain-relieving power. It is useful in attacks of gout in the stomach or heart, palpitation from or with weakness, angina pectoris (which see, hereafter), asthma, etc. Dose, a Teaspoonful, in water. Hops. Familiar to many people as present in some kinds of beer; the product of the Hop vine, cultivated in many places. A Hop-pillow is sometimes used for sleeplessness. To prepare it, fill a small pillow-case with Hops, which have been sprinkled with alcohol to bring out the active principle. Tincture of Hops, dose a Teaspoonful, is a mild hypnotic or sleep- producer. Tincture of Lupulin (the active principle of Hops) has more power of the same kind; but both are far weaker in this action than Opium or Chloral and their preparations. Hot Water. Once in a while something becomes, in popular medi- cine, and even with physicians, " the rage." A few years ago, it was Blue Glass; a craze which added many tons to the importation of that transparent medium of delusion into this country. Now (1885) it is, with a large number of people, Hot AVater. AArhat is called the " Salis- bury treatment" of chronic disorders (which ones ? well, any that occur in imaginative patients; or, seriously taken, in low and sluggish states of the system), is about as follows : Three times a day, an hour before each meal, you must swallow a gobletful and a half of water at from 110° to 120° Fahr.; sipping it, if you wish, from a teaspoon, so as to occupy ten or fifteen minutes in swallowing it. This is to be kept up, in order for full effect, for six months. Its advocates claim that by this treatment obstinate cases of nervous affections, etc., have been cured, which had resisted all other management. AVhen a case of chronic disease does resist all ordinary management, it will be safe and reason- able to try this practice for it. No more need be said on this subject here, except the remark that Hot Water, as a means of conveying heat to the interior of the body, is a stimulant to the stomach, to the great nerve centres back of the stomach, and to the general blood-circulation. 576 DOMESTIC MEDICINE. Like rubbing, mustard-plasters, or other stimulants applied to the out- side of the body, such internal excitation may make a powerful and often serviceable alterative impression. Hot AVater is now much used by surgeons and obstetricians for the arrest of bleeding, from injured surfaces, from the womb after labor, etc. For this purpose, it should have a temperature of about 120° Fahr. Hunyadi Janos Water. A laxative (mildly purgative) mineral water, sold in bottles. Dose, a AVineglassful. Huxham's Tincture of Peruvian Bark. A good tonic in feeble conditions of the body, as in slow convalescence from an illness, running down with work in summer time, etc. Dose, a Teaspoonful, three times a day, in Water; best, a short time before each meal. Hydrochlorate of Cocaine. A preparation of the active principle of the leaves of the South American Erythroxylon Coca. It has been found, when applied (a few drops of a four per cent. Solution in water) to the eyeball, throat, etc., to render the part insensible to pain ; so as to greatly facilitate some surgical operations. Its uses as an internal medi- cine are just beginning to be investigated. Dose, five to ten Drops of a four per cent. Solution. Hyoscyamus. From the leaves of this plant (Henbane) are made a solid Extract, a Fluid Extract, and a Tincture. Hyoscyamus is an anodyne ; a good deal like Opium in its effects on the system, but weaker; and, instead of constipating, tending to act gently on the bowels. Of the Extract (solid), the dose is two or three Grains. Of the Fluid Extract, from two to ten or fifteen Drops. This last is a very good quieting medicine for the violent coughing spells of severe whooping- cough. Hypophosphites. Compounds containing phosphorus, in a pecu- liar state of combination with other medicinal substances. Much used as an effective tonic, in low states of the system, is the preparation called Fellows' Hypophosphites. Dose, a Teaspoonful, in water, after each meal. PRINCIPAL MEDICINES, AND OTHER REMEDIES. 577 Ingluvin. An extractive obtained from the gizzard of the common fowl, and, like pepsin, used as a tonic to the digestive organs. Some physicians report it to be very effectual in relieving vomiting; especially the " morning sickness " of pregnancy. Dose, from three to ten grains. Inhalation. This is breathing in vapor of some kind; which is Fig. 188. SPRAY APPARATUS considerably employed in the treatment of diseases, especially of the throat and lungs; as well as (by the use of ether, chloroform, and mtrous oxide), to prevent pain during surgical or dental operations. tonohng is a simple method of inhalation, acting most powerfully 578 DOMESTIC MEDICINE. Fig.189. when long pipes (narghileh, chibouk) are used, requiring chest-breathing to draw the smoke through the pipe. Chinese opium-smokers, however, actually inhale the vapor of the narcotic into their lungs. Pure steam is soothing to an irritated throat. It may be inhaled by placing a towel, or a paper funnel, over a kettle which is kept boiling, and breathing the vapor which emerge* from the spout. A simple inhaler may be made of a wide-mouthed bottle or jar, through whose cork two glass tubes are passed, one straight, the other bent in the mid- dle. The liquid to be inhaled from should not more than half fill the bottle. The straight tube should reach down a little below the surface of the liquid; the end of the bent one should stop an inch or so above it. Thus, when th« patient draws a breath from the latter, the air which he receives has to pass through the medicated liquid. Tar, creasote, iodine, hops, laudanum, etc., may be thus inhaled. A volatile mate- rial, like ammonia or nitrite of amyl, may be inhaled directly from a bottle, small or large. The former of these n a potent stimulant in cases of fainting; the latter (nitrite of amyl), often gives relief in attacks of angina pectoris. Instead of vapor, fine powders are sometimes blown into the throat For sore-throat in children, alum powder may be thus blown in with a glass tube or a long quill; or with one of the powder-squirts sold by apothecaries for blowing borax, etc., into cracks to destroy insects. Atomization is the introduction of a very fine spray of liquid into the throat and air passages. Such a spray is made by the odoraton which are used to spread cologne or other perfumes in the air. Instru- ments are made for atomizing in cases of irritated throat, with which solutions of ipecac, chloride of ammonium, etc., can be applied. A cigarette for medicinal- inhalation may be made by the use of a glass tube, six or eight inches long. Near one end of the tube put in a piece of fine soft sponge. Drop into the tube, from the other end, tin material to be inhaled; tar, creasote, tincture of iodine, gum camphor, etc. Then insert a second piece of sponge near the upper end of tn« tube; through this the patient is to breathe for the inhalation. Cotton or tissue-paper will do instead of sponge for the purpose. CROUP-KETTLE. PRINCIPAL MEDICINES, AND OTHER REMEDIES. 579 Injections (enema, enemata). These are used for various purposes. Most commonly, into the bowels, to empty the lower bowel, when this is considered more prompt and convenient than medicine by the mouth. The old-fashioned way was with a large syringe, holding about a pint. Now, gum-elastic ball-and-tube arrangements are employed, which one can use himself. Only common sense is necessary for the introduction of the oiled end of the tube of either kind; and gradual moderate force to cause the material to enter. It should then be kept by the patient for five or ten minutes, for an effectual operation. Smaller syringes, of course, half or quarter pints, are suitable for children. For a child, warm AAater alone will sometimes suffice. A common mixture for opening injections is made by mixing well together a Pint (nearly) of Fig. 190. ENEMA SYRINGE. Soapsuds (Castile-soap, at least for delicate persons), a Tablespoonful of Salt, a Tablespoonful of Molasses, and a Tablespoonful of Oil, either Sweet or Castor-Oil, according to the case. Injections are used sometimes to relieve severe pain, or to check obstinate diarrhcea. Of the former, the most extreme kind of colicA passing a gravel-stone from the kidney to the bladder, or of a gall-stone through the gall-duct, or strangury, or threatened abortion (miscarriage during pregnancy) are examples. In dysentery, as well as in diarrhcea, such injections may be called for; Laudanum being most frequently (in all the above-mentioned cases)»so employed. For a grown person, the smallest amount likely to do good in such a way is thirty or forty Drops of Laudanum. It is best to mix it, for injection, with a small amount of Starch (prepared as for the laundry, 580 DOMESTIC MEDICINE. only thin enough to pass through a syringe), and then to use a small syringe—holding from Half an Ounce to two Ounces only. The object here is to have the material injected to remain in the bowel, as lon<' as it will; so that the anodyne (Laudanum) may have time to take effect. Sometimes great suffering will justify sixty-drop injections of Laudanum, or even more; but such had better be used only under the advice of a physician. Other medicines also are occasionally presented for administration in the same way. Now and then four-Ounce ene- mata of Flaxseed-tea are employed in dysentery. Nourishing enemata are often resorted to, when, for various reasons, food cannot be taken by the mouth. Half or a quarter of a pint will be enough at a time for this purpose; as it is important for it to remain and be absorbed. Beef-tea, Milk, or raw Eggs beaten up with Milk, will be the best materials. Sometimes pure fresh beef's blood is so used. An example of a nourishing injection may be the following: To five ounces of finely scraped meat, and five and a half ounces of finel\r chopped swTeetbread freed from fat, add three or four fluidounces of lukewarm water. Stir together into a pulp. It will be well to wash out the lower bowel with an injection of warm water, about an hour before introducing a nourishing enema. Injections into the nostrils, vagina, and urethra, as well as the use of a syringe for the ear, had better be left, with rare exceptions, to be advised professionally, and carried out under careful direction. The same may be said of Hypodermic injections (into or under the skin). It may be just mentioned, in view of a possible emergency in the absence of a physician, that the instrument used for Hypodermic injec- tion is a small glass syringe made for the purpose, ending in a tube of steel or silver to puncture the skin and introduce the liquid. Having drawn into the syringe the amount to be used, the skin of the part selected (an arm, the back, abdomen, a thigh, or the calf of one of the legs) is drawn up with the forefinger and thumb of the left hand. A\ ith the right hand, the point of the tube (after being oiled) is pushed almost horizontally through the skin, and then the fluid is rather slowly pressed out of the syringe. The latter is to be withdrawn without twisting it; all must be done so as to cause as little irritation as possible. From one- third to one-half of the dose by the mouth is the quantity of any.drug employed in this way. Anodyne and stimulant medicines are, more than any others, used hypodermically. Sometimes the habit of taking hypo- dermic injections of morphia is acquired, and is as hard to break as smoking opium or laudanum drinking. Iodine. LugoVs Iodine Solution, the Tincture of Iodine, and Iodide of Potassium all have medical uses; but not, as a rule, in domestic PRINCIPAL MEDICINES, AND OTHER REMEDIES. 581 practice. We may except, perhaps, the outward application of Tincture of Iodine, which may be painted upon the chest (with a large camel's- hair pencil) for a continued cough (chronic bronchitis), or may be used as a counter-irritant in several other kinds of cases. Physicians prescribe Iodine in LugoVs Solution as an alterative in scrofula and in goitre (which see hereafter). Dose, ten Drops, twice or thrice daily, in water. Iodide of Potassium is a very important medi- cine in a number of diseases; most particularly and certainly useful in constitutional syphilis, and especially of all in syphilitic rheumatism; also, in aneurism of the aorta. Dose, from five to twenty grains, dis- solved in water, thrice daily. Iodoform. A powerful drug, kept in the apothecary shops in the form of a powder. Sometimes prescribed as an internal medicine in scrofula, ulcer of the stomach, etc., in one-grain doses; but it is much more often used as an outward application. It is very healing to foul ulcers, wounds not doing well, syphilitic sores, etc.; being antiseptic ; that is, corrective and preventive of decay and putrefaction. While, however, a little of the powder of Iodoform may be safely sprinkled now and then over a foul sore, to promote its cleansing and healing, it is not safe to use it without limit; as a large amount of it absorbed may be even poisonous. A bottle or box of it ought, when kept, to be labelled Poison. Ipecacuanha. This has been already several times mentioned. It is an active but mild emetic in large dose. In smaller quantities, it is an excellent loosener of cough (expectorant), and also a promoter of perspiration (diaphoretic). It is one of the best of remedies in dysentery, in a way not exactly explained. Used in Powder (chiefly as an emetic, except when made into pills), Syrup, and Wine. The Syrup of Ipecac, ought to be in every family medicine chest. It is the best first medicine in croup and in bronchitis (a heavy cold on the chest, with cough at first dry, and needing to be loosened). Also, it will answer as an emetic. Dose, to cause vomiting, a Teaspoonful, repeated in ten or fifteen minutes if it does not take effect. As a cough-loosener (expec- torant), five to ten Drops for an infant, a Quarter to a. Half Teaspoon- ful for a grown person. While moving about, a Quarter Teaspoon- ful will usually be enough ; Half a Teaspoonful will not often sicken the stomach if taken lying down, or just before going to bed. The Wine of Ipecac, is very similar in effect to the Syrup, but is rather stronger; and the form of Syrup has some advantage for use as an expectorant medicine. Iron. There is iron in the blood of every man, woman, and child. W hether we ever have too much of it is not certain; but, without doubt, 582 DOMESTIC MEDICINE. many thin, pale, and weak people have too little of it. Then, to add some of it to our diet is really to improve our food. Iron is a me- dicinal food. Its common designation in the books is "mineral tonic." The condition of poverty of blood is called, medicallv, " ancemia." Several preparations of Iron are used. Only a few chief ones need to be here mentioned. The strongest, and also the most convenient to keep and use, is the Tincture of the Chloride of Iron. Dose, ten to thirty Drops, in AVater. The only objection to it is that it has a dis- position to stain the teeth brown or yellow. This may be prevented by taking it through a tube, of glass, or of two quills put together. All druggists keep glass tubes for such purposes. The Tincture of Chloride of Iron is somewhat astringent; and therefore is useful in hemorrhages. Syrup of Iodide of Iron unites the properties and influences of Iron and Iodine. It is, therefore, an alterative tonic, good in many eases of scrofula and in some other chronic complaints. An alterative medi- cine is one which tends to change the condition of an organ, or of the whole constitution; setting up its own innocent and transitory action instead of the disturbing and life-shortening action of the disease. Dost of the Syrup of Iodide of Iron, ten to thirty Drops, in AVater, two or three times daily. Pill of Carbonate of Iron (Vallet's Mass) is a very good form to make up with Quinine in treating obstinate cases of chills (intermittent fever). Three Grains of the Pill of the Carbonate of Iron with one Grain of Quinine, three times a day, taken for a month, after "breaking" the chills, will cure ninety-nine cases in a hundred of that troublesome affection. Other " chalybeates," as preparations of Iron used to be called (Iron springs are still called chalybeate waters), are: Citrate of iron, a pretty red salt, not unpleasant to the taste, dose, five to ten grains; Phosphate, a green solid, dose five to ten grains; Solution (Liquor) of the \ if rut' of Iron, the most astringent of these preparations, and beneficial in chronic diarrhcea; dose, ten Drops, in water, thrice daily; Solution (Liquor) of Subsulphate of Iron, generally called MonseVs Solution; a good strong astringent for outward application, to aid in stopjnng bleeding from any part. For the rest of the compounds of Iron (Ferrum) the reader may be best referred to works on Materia Medim (" U. S. Dispensatory," " National Dispensatory," etc.). PRINCIPAL MEDICINES, AND OTHER REMEDIES. 583 Jalap. The tuberous root of a vine, native of Mexico and culti- vated in India. It belongs to the same family with the Morning Glory. It is a very active purgative ; too much so for common use, but sometimes valuable in particular cases. In dropsy it is occasionally prescribed, along with Cream of Tartar, or with Squills. I remember its excellent effect in a very bad case of scarlet fever, with stupor and constipation. Dose, ten to twenty Grains. Juniper. The berries of the Juniper tree or shrub. They are round, dark-purple in color, and have a sweet and somewhat spicy taste. Their use in medicine is as a diuretic in dropsy. A tea may be made by pouring a Pint of boiling AVater upon Half an Ounce of bruised Juniper berries, stirring and then leaving it to stand for half an hour before pouring it off or straining it. A Tablespoonful of Cream of Tartar may be added; and at least Half a Pint of this tea may be drunk (a little at a time) in twenty-four hours, for dropsy. Compound Spirit of Juniper is what pharmacists call an " elegant" preparation. It has the advantage of being given in small dose, a Teaspoonful or two, in AArater; and is also, from its stimulant property, best suited to feeble patients, or those with delicate stomachs. 584 DOMESTIC MEDICINE. Lactucarium. An extract from the common Garden Lettuce (Lac* tuca). It is mildly narcotic and anodyne ; promoting sleep like opium. but with much less power. The Syrup of Lactucarium (named Auber- gier's Syrup), is the most convenient preparation. Dose, one or twc Teaspoonfuls. Lady Webster's Pills. The important thing in these is Aloes. They are purgative, and, like other aloetic preparations, have some effect in promoting a tendency of blood towards the pelvic region of the body. They have much reputation as aiding to bring on delayed or suppressed menstruation. This is called by physicians an emmena- gogue action. Dose, one pill, at night. Some persons find half a pill enough to operate on the bowels quite as much as is best. A few will need to take a second pill for such an effect. It may be here repeated, that there is no certain emmenagogue medicine. We can only promote the restoration of the absent uterine flow, and succeed in a considerable number, but not in all cases. Laudanum. Tincture of Opium. One of the strongest of the Opiate Medicines. It is therefore a powerful anodyne and hypnotic (sleep-producer). Dose, for a grown person, from fifteen to thirty Drops. In diarrhcea, howrever, as small a dose as ten Drops will often answer. Children are more affected by opiates, in proportion to their age, than by any other kind of medicine. One drop will be more than enough for an infant less than a year old ; at least to begin with. Laudanum is often applied externally to relieve pain. On a sound part of the skin, in a grown person, Half a Teaspoonful may be so applied with safety; but only a few Drops at a time, even externally, in the case of a young child. Anodyne injections into the bowels are most frequently made of Laudanum and Starch. (See Injections.) For Hypodermic injection (under the skin) Solution of Morphia is preferred. In keeping Laudanum, it should be remembered that it strengthens with age, by evaporation of some of its Alcohol. (All tinctures are made with Alcohol.) AVhat is left at the bottom of an old bottle of Laudanum may be two or three times as strong as a fresh article would be. MeMunn's Elixir of Opium is a preparation of still greater opiate strength than Laudanum. It has no very certain advantages over it. The same may be said of Black Drop (Vinegar of Opium), except that both of these are less disagreeable than Laudanum, and agree better with some stomachs. Lavender. Aromatic flowers, well known for their pleasing per- PRINCIPAL MEDICINES, AND OTHER REMEDIES. 585 fume. The only preparation used as a medicine is the Compound Spirit of Lavender. It is an agreeable warming, gently stimulant article; good in colic, sometimes for nausea (sickness of stomach), and for dys- menorrhoea (painful menstruation). Dose, a Teaspoonful, in AArater; often given in hot water. Lead, Sugar of. Acetate of Lead. Sweet, but poisonous. A pow- erful mineral astringent. Physicians prescribe it in some cases of dysentery, after the first stage is over; and occasionally in obstinate diarrhosa, in hemorrhages, in aneurism of the aorta, and in enlargement (hypertrophy) of the heart. But it is not suited for internal use as a domestic medicine. Dose, half a Grain to a Grain, in pill or solution. Outside, Sugar of Lead is a cooling (sedative) application, often used for inflammations. Lead-water may be made by dissolving it in Water; but with greater convenience by adding to AVater the Solution of Subacetate of Lead (Goulard's Extract), which is a very strong liquid preparation. Of this last one Drop to four Tablespoonfuls of AVater will be generally strong enough for Lead-water. It may be applied to a much-inflamed joint, or (outside) of the eyeball or eyelids. For the eyes, the best way to use it is with a camel's-hair pencil, painting the outside of the closed lids frequently with it. Like Lime-water, Lead-water, when exposed to the air, absorbs Car- bonic Acid gas, and forms a white Carbonate. This gives a milky appearance to it, but does not impair its cooling action upon the sur- face of the body. All preparations of Lead are poisonous. Care must be taken with them accordingly, that none be swallowed unawares. Leeching. See Taking Blood, page 536. Licorice. See Liquorice. Lily of the Valley. Convallaria Maiedis of botanists. This charm- ing wild-flower is considerably employed by physicians as a tonic to the heart. It had better not be taken, however, without medical advice. Dose, of the Fluid Extract, five to fifteen drops. Lime-water. Simply a Solution of Lime in Water. Anybody can make it, by putting pure, clean, unslaked Lime in pure Water. Take a large bottle, and press into it enough Lime to fill about one-fourth of its depth. Pour in AVater enough to fill it full, then cork and shake it awhile. On standing, the clear Lime-water will be ready for use. If all the Lime is dissolved, add a little more, so as to be sure that the Water is saturated; that is, contains as much as it will dissolve. Lime-water is the main stand-by as a domestic remedy for vomiting, or for nausea threatening it. Dose, from a Teaspoonful to a Table- spoonful. AVhen nourishment is needed, a Tablespoonful of Milk may 586 DOMESTIC MEDICINE. Fig. 191. be added to one of Lime-water. Otherwise, it may be diluted with an equal amount of AATater, or Cinnamon-water. Lime-water is often added with great advantage to Alilk for babies, when they have sour stomach or diarrha'a, as it is antacid and some- what astringent. A Tablespoonful of it may be put in every Half Pint of the child's food, so long as such an occasion exists for it. No harm will be done if it should be taken in that way for days, or even weeks, together. Liquorice, also spelled Licorice. The root of an herb growing on the shores of the Mediterranean Sea. The Extract is chiefly used. It is black, hard, and sweet. There is also a Fluid. Extract. Neither has any important property except some soothing influence over the lining membrane of the throat. By"sym- pathy of contiguity" this influence extends from the gullet into the wind- pipe, and thus Liquorice helps to soften and loosen cough. It is the largest (though not the strongest) ingredient in AVistar's Cough Lozenges, which contain also a little Opium ; and it is used to flavor cough mixtures and other medicines. Lithia may be just mentioned here, as one of the alkalies, like Soda and Potassa. It is considered by physi- cians a useful medicine for gout. The carbonate is employed in one- to three- grain doses. It has no place in do- mestic practice. Lobelia. A common weed, Lobe- lia inflata. The cardinal flower of the swamps is another, more beautiful, species of the same genus, not used in medicine. The leaves and tops of this plant are employed best in the form of Tincture. It is a powerful sedative medicine; capable, like tobacco, in large doses, of producing fatal pros- tration. Its most important use i.« for asthma. It is often very relieving in attacks of that affection. It may be safely given (watching its effect^ LOBELIA INFLATA. PRINCIPAL MEDICINES, AND OTHER REMEDIES. 587 and stopping it at once if vomiting or great faintness result) in Half- Teaspoonful doses, every half hour or hour, until three or four doses, if necessary, have been given. Another way is to give twenty Drops of Tincture of Lobelia, with twenty Drops of Syrup of Ipecac, every twenty minutes, for three or four doses. Logwood. The reddish heartwood of a Central American tree. It was once more used than now, as a mild astringent for diarrhcea. A tea may be made of it by boiling an Ounce of it, with a Drachm of Cinnamon, iu a Pint of Water, for ten minutes. Dose, a AVineglassfuI or less. 588 DOMESTIC MEDICINE. Magnesia. A valuable home medicine, as an antacid laxative. It is particularly good when there is constipation, with sick stomach and headache. Even at the beginning of diarrhaa and cholera morbus, it is many times the best corrective medicine. Calcined Magnesia is the preferred form, and, in Philadelphia at least, Husband's is the best. It has almost no taste, but causes a gritty feeling on the tongue that is not pleasant. AVater does not dissolve it; so it must be stirred well in a little AVater when taken. Dose, a full Teaspoonful for a grown person, if designed to operate on the bowels. Much less will do to relieve acidity and nausea. Magnesia is not a good medicine to take wnen one has piles; as it sometimes produces a burning in operating freely. It is not, however, a powerful cathartic. Citrate of Magnesium has been spoken of on a previous page. Malt Extract. Especially in Germany, large use is made of prepa- rations under this name. As sold in this country, some of them are too sweet to agree well with the stomach. The best is Johann Hoff's " Malz-Extract;" made in Berlin, and imported in short thick bottles. The use of this extract is as a tonic, particularly when digestion is weak. It may be taken at meals, a quarter of a tumblerful at once. When taken at bed-time, it is promotive of sleep. Manna. A sweet substance obtained from the trunk of the flower- ing ash tree, in the countries bordering on the Mediterranean. Its only important use is to open the bowels of children and delicate people, in- cluding women during pregnancy. It may be eaten like sugar. The dose is not very definite; a little experience will show how much is re- quired for the desired effect. Massage (rubbing). See later, under Nursing. Mineral Waters. A volume would be required to treat fully of these; and such volumes have been written.* They may be classified simply as: 1. Alkaline. 2. Saline. 3. Sulphurous. 4. Chalybeate,con- taining Iron. 5. Purgative. 6. Limestone or Calcareous. 7. Thermal, i. e., AArarm or Hot Springs. AATiile some special properties and effects upon the system in states of disease belong to each of these classes of waters, with differences also among the members of each class, they all agree in exerting an alterative influence, which is especially likely to be beneficial in chronic disorders. Very much is added, also, to this effect by the pure atmosphere of the localities of mineral springs, with rest, change of scene, social enjoyment, etc. Still, something important may be ascribed in certain cases to the action of the mineral waters them- * See Walton, on the Mineral Springs of the United States and Canada: D. Applet* ii Co.. New York. PRINCIPAL MEDICINES, AND OTHER REMEDIES. 589 selves • although many of them fail to exhibit the same virtues when bottled up and sent to the city homes of invalids, as they do when these go and take them from their natural sources, or resort to the warm or hot natural medicated baths. Some particular waters are largely supplied for particular remedial uses; as the Apollinaris, an agreeable table carbonated (effervescent) drink; Hunyadi Janos, Pullna, and Fricd- richshalle, for purgative action; Vichy water (containing soda), to re- lieve acidity, etc. The most famous mineral waters in our country are those of Saratoga (several kinds, all more or less scdine ; with more or less sulphur also, or iron, iodine, bromine, etc.), Sharon (saline and sulphurous, with some iron), Richfield (sulphurous)—all these in the State of New York; Bedford (chalybeate, i. e., containing iron, and purgative), in Pennsylvania; and a remarkable variety of mineral springs among the mountains of Virginia—AVhite and Red Sulphur, AVarm Springs, Hot Springs, etc. In chronic rheumatism, liver and kidney disorders, obstinate affections of the skin, and nervous troubles of some standing, the best alterative effects from using mineral waters, internally or in baths, may be hoped for. A physician's advice had better always be obtained before they are resorted to in cases of serious disease of any kind. Morphia. The principal alkaloid or active principle of Opium. Its sidphate and other salts (chemically so called) are used in medicine. They are powerfully anodyne and hypnotic (sleep-producing). What is commonly called "Solution of Morphia" in this country is Solution of Sulphate of Morphia, one Grain to an Ounce of AArater. Dose, a Teaspoonful, containing one-eighth of a Grain of the Morphia Salt. Sometimes we meet with Magendie's Solution of Morphia, which con- tains sixteen Grains to the Ounce; sixteen times as strong, therefore, as the other. If using either, then, we must be very careful to know which it is. It is not necessary to have Morphia in the family medicine chest; Laudanum and Paregoric will do for Opiates under almost all circumstances. Muriatic Acid. See Chlorohydric Acid. Musk. A very strongly odorous substance, secreted by the musk- deer of the Himalaya Mountain region, in Asia. It is antispasmodic, that is, composing to disturbed nerves. Prescribed sometimes for whooping-cough and for convulsions. Dose, five to ten Grains, in pill or mixture. Mustard-Plaster. One of the most frequently useful of all domestic remedies. AVhen anybody is suffering pain, or, indeed, illness of any kind, if you do not know what to do, put on a Mustard-Plaster, near the seat of the trouble. Should you not find where that is, put the 5»0 DOMESTIC MEDIC1NH. mustard-plaster on the middle of the back. If properlv attended to it can do no harm; and in ninety-nine cases in a hundred it will du some good; sometimes a great deal of good. To make one, mix from one to three or four Tablespoon fuls of Mus- tard (either white or black, so called) with the same amount of Wheat or Indian Flour. Mix these with enough hot water to make a paste. Then, on a hot plate, near the person who is to have it on, lay a piece of soft old muslin, or thin flannel, twice as large as the plaster is to be; but spread the Mustard and Flour paste only on half of the rag. This done, double the other half over it, and stitch the edges together, all around ; or, turn the edges over instead, to keep the stuff in. It mav be put on at once, while warm, and left on until it is felt to burn quite smartly, if the patient is conscious. If not, it must be looked under, in a quarter of an hour or so, and, if the skin is decidedly red, take it off. As soon as it is removed, Lard, Tallow, Cold Cream, or Vaseline should be gently rubbed over it, or a fresh rag spread with one of them may be laid upon the part. AVe never intend to raise a blister with Mustard, it is too severe. The aim is just to heat the skin very actively, mostly for its use as a counter-irritant, to relieve some irritation of an internal organ. Ready-made Mustard-Plasters can be had now of Pharmacists, and are very convenient. One of them has only to be dipped for a moment or two in hot water, and it is ready to apply at once. It is well always to have a supply of these in the house. Mush and Mustard Poultices are often very useful in inflammatory and other painful affections. They are made with one part of Mustard to four parts of Mush (of Indian meal) mixed, and applied hot on the chest or abdomen, as required, and covered with Oiled Silk, or Oiled Paper, or Rubber Cloth, to retain the moisture. Such a poultice may stay on for hours, keeping up a moderate and bearable excitement of the skin (warming and counter-irritant) much longer than could be borne with a strong Mustard-Plaster. Myrrh. A gum-resinous substance, obtained from one or more trees in Africa and Arabia. From ancient times it has been known (" frank- incense and myrrh ") for its aromatic properties. Internally given, it is stimulant and tonic, and is an ingredient in some preparations intended to act upon the bowels or to restore suspended menstruation. For home use, the Tincture of Myrrh is very serviceable in the care of the mouth. A few Drops of it in a little water, say about twenty Drops in a quarter of a Tumblerful, used as a mouth-wash, will correct a bad odor in the breath. Such a wash may be used with advantage twice daily, in cleaning the teeth. When the teeth begin to decay, a PRINCIPAL MEDICINES, AND OTHER REMEDIES. 591 Btrono' myrrh wash, often used, will check or retard their destruction. If a hollow tooth becomes tender, and begins to ache, pure Tincture of Myrrh put into it will sometimes stop the trouble at the beginning. If, however, it does not at once give relief, the stronger application of Cre- asote should follow it. 592 DOMESTIC MEDICINE. Nitrate of Silver, or Lunar Caustic. Physicians often use this .v an alterative application to the throat, eyes, or ulcerated skin, in certain states and stages of inflammation. It is also sometimes given in pill as a mediciue; most beneficially in chronic (gastritis) inflammation of the stomach. Dose, internally, a quarter of a Grain (usually with as much of Opium), thrice daily, gradually increased, when it does good to nearly or quite a Grain. It was formerly much employed in the treat- ment of epilepsy. AVhen long continued, it has sometimes dyed the skin, making the face almost as black as ink. Nitre. A name for Saltpetre; called by chemists Nitrate of Po- tassium. It is a cooling, sedative salt, when taken internally. In ten-Grain doses it is a useful medicine in acute bronchial inflammation (bronchitis), and might be added with advantage more often than it is, to cough-mixtures of the loosening kind. Sweet Spirit of Nitre (Spirit of Nitrous Ether) is a liquid prepa- ration, whose properties are gently stimulating, diaphoretic, diuretic, and composing to the nerves. It has long been one of the most pop- ular of domestic medicines for fever. It does the most good, however, in the least inflammatory conditions, and, when fever is high, its dose should not be large. Half a Teaspoonful of it in a Tumblerful of cold Water, drunk, a little at a time, as thirst prompts, through the night, will be more likely to relieve a hot fever, with the coming of perspira- tion, than a whole Teaspoonful taken at once. This is because the large doses " stimulate the circulation above the secreting point," to use an old but true medical phrase. To increase the action of the kidneys, as a diuretic, Sweet Spirit of Nitre is very often useful. For this purpose, in the absence of high fever, larger doses will suit than when that condition is present. From Half a Teaspoonful to a Teaspoonful, well diluted with water, will be a diuretic dose for an adult; to be repeated in a few hours, if needful. Nitrite of Amyl is a powerful agent, used by inhalation, from one to four or five drops only at a time, as a remedy for the attacks or par- oxysms of angina pectoris. It commonly causes immediate flushing of the face. If used, it should be as soon as the attack (with distress and pain about the heart, and along the left arm) begins. Nitroglycerin, the explosive, from which dynamite is made, is occa- sionally used as a medicine for angina pectoris, etc., by physicians. Dose, one-hundredth of a drop. It is too strong to be employed as a domestic medicine. Nitro-muriatic Acid. Called Nitro-chlorohydric Acid by chemists. It is a mixture of Nitric and Chlorohydric (Muriatic) Acids, and contains some free Chlorine gas. It is important in the arts, as the only thing PRINCIPAL MEDICINES, AND OTHER REMEDIES. 593 that will dissolve gold. As a medicine, it is an appetizer, and a mild tonic to the liver. " Bilious attacks," in persons subject to them, may be treated first with Blue Pill, and afterwards with Nitromuriatic Acid. Dose three or four Drops, in AVater. It is best taken through a glass tube as it will act on the enamel of the teeth if left long in contact with them. Also, a silver spoon should not be allowed to touch it, as it dissolves silver as well as gold. Nitrous Oxide. Formerly called " laughing-gas," because of its exhilarating quality when breathed mixed with air. It is now the favorite material for dentists to use so as to draw teeth without pain. It is, thus, one of the anaesthetics, so called, and, when breathed for only a short time, it is probably the safest of them. It must, however, be pure for such use, and skill and care are necessary on the part of the dentist who employs it. Otherwise, it would be quite possible for a person to be anaesthetized to death, even with Nitrous Oxide. Horace Wells, the dentist, wdio first proved that this property belongs to it, is said to have at last become a victim to its over-use. Nux Vomica. A poisonous seed or nut (" dog-button " of country people) from a tree called Sfrychnos Nux Vomica, growing in the East. Its active principle is the alkaloid Strychnia. Nux (as the homoeopaths call it) is best used in Extract or in Tinct- ure. Both are bitter tonics, with a powerful action on the nervous system, especially the spinal marrow. Leaving what we have to say about this last action until we come to Strychnia, it may be mentioned that physicians often find Extract of Nux Vomica a good addition, in small dose (a quarter to half a Grain), to tonic pills for continued de- bility. The Tincture, in ten-Drop doses, in water, is an excellent med- icine for great weakness of stomach, with flatulence. Larger doses (if even these) should not be ventured upon without medical advice; on account of the very powerful nature of the active principle of this drug. The Tincture of Nux Vomica should be marked Poison. 38 594 DOMESTIC MEDICINE. Olive Oil. Probably the gentlest of all laxatives ; in Teaspoonful to Tablespoonful doses. For a delicate infant, needing to have the bowels acted upon, a Teaspoonful is very good. The imitation of tru< Olive Oil, sold under its name, or as " Sweet Oil," is less bland, but will answer if the genuine European article cannot be obtained. Sweet Oil, saturated with Camphor (Camphorated Oil), makes an ex- cellent application for more or less inflammatory swellings; as, for ex- ample, a mother's breast threatening to become inflamed while she is nursing; or, more often, when her infant ceases to draw milk, as from illness or the death of the child. Sweet Oil, with an equal quantity of Aqua Ammonias (water of Am- monia) or Aromatic Spirit of Am- monia, makes Volatile Liniment; an excellent outward application for sore throat. SEED CAPSULES OF THE POPPY. Opium. If all the medicines in the world were to be destroyed, ex- cept three, and we could choose the three, they should be Quinine, Opium, and Iron. The first cures the greatest number of cases of illness; the second gives the happiest relief to severe pain; and the last does the most to build up a debilitated body. Under the heading of anodyne medication, on a previous page, enough has been said on the general subject of the action of Opium and its preparations. Of these, also, Laudanum and Morphia have been mentioned. The dose of Opium in substance (got from the seed-capsule of the white-flowered Poppy plant of the East) is one Grain; equal to thirty Drops of Laudanum, or a full Teaspoonful of Solution of Mor- phia (not Magendie's Solution). Fig. 192. POPPY FLOWER. PRINCIPAL MEDICINES, AND OTHER REMEDIES. 595 Paregoric is the Camphorated Tincture of Opium. Its odor and taste are partly due to the Oil of Anise-seed with which it is flavored. It contains only one Grain of Opium in a Tablespoonful of Paregoric; being therefore a much weaker Opiate than Laudanum ; which has about four Grains of Opium in each Teaspoonful. Dose of Paregoric, a Tea- spoonful, more or less, according to the occasion for its use. In diar- rhoea for example, quarter-teaspoonful doses will often answer the pur- nose. Smaller doses, of course, are suitable to give to children. Pepper. Of the two kinds used with food, Red Pepper (Capsicum) is the more stimulating. It is sometimes given by physicians as a stim- ulant in five-grain pills. A much more common use for it is to excite the circulation of the skin, as a rubefacient ; a power which it shares (though in less degree) with Mustard. In cholera, when the skin is cold, rubbing with Whisky and Red Pepper is one of the best things to restore the circulation. It may be employed for the same purpose in any analogous, low and cold, condition. Peppermint. Essence of Peppermint is a pleasant, warm aromatic; given as good for colic and sick stomach. Dose, ten Drops for a grown person; for an infant, from two Drops down to Half a drop (that is, add one Drop to a Dessertspoonful of Water, and give of this a Tea- spoonful at once). Pepsin. Hard to get pure. Given for weak digestion. Dose, 5 grains. Permanganate of Potassium. This " salt," which gives a beauti- ful red color to AVater, has a remarkable action on all organic (animal or vegetable) matter. It is one of the best disinfectants. Five Grains of it in a Pint of AVater will make a solution suitable to wash out ves- sels used in the sick room with patients having contagious or infectious diseases. Internally, Permanganate of Potassium is highly recommended (in two-Grain doses, dissolved in distilled AArater, twice daily) by some physicians in amenorrhcea (delay or suppression of the monthly courses). As it sometimes disagrees with the stomach, it must be used with care, and can hardly be placed among the domestic medicines. Phosphorus. Too dangerous for use as a domestic medicine, this is sometimes given by physicians as a powerful nerve-stimulant. Dose, one-thirtieth of a Grain. Phosphates are safe compounds, often used. Parrish's and Horsford's are very popular tonic preparations. Of the latter (Acid Phosphates), the dose is Half a Teaspoonful, in water, just before or after a meal. Pink-Root. This American plant (Spigelia Marylandica) is a very pood medicine for worms (vermifuge). It may be made into a Tea thus: Put together Half an Ounce of broken and bruised Pink-root; Senna 596 DOMESTIC MEDICINE. Leaves and Fennel Seed, each two Drachms; Alanna, one Ounce; and boiling AVater, one Pint. Let it stand (after stirring) covered for an hour. Dose, a Wineglassful for an adult, Half a Wineglassful for a child two or three years old, thrice daily. It is best not to go bevond these doses; as, in very large amount, Spigelia acts poisonously. Fig. 194. SPIGELIA MAP.YLANDICA. There is a Fluid Extract of Spigelia, also, a convenient preparation; dose, a Teaspoonful; and still better (because the Senna makes it more sure to pass off by the bowels), the Fluid Extract of Spigelia and Senna; dose of this also, a Teaspoonful, repeated every two or three hours until it operates. PRINCIPAL MEDICINES, AND OTHER REMEDIES. 597 Podophyllin, or Resina Podophylli. This is an active principle obtained from the root of the common May-apple (Podophyllum pel- titum). The powdered root itself may be taken in doses of ten tc twenty Grains, Of Podophyllin, the dose is but from one-sixth to one- half or three-fourths of a Grain. It is a powerful, though slowly act- ing, cathartic; believed also to act more than most purgative medi- cines on the liver. Potassa (Potash). Solution of Potassa is sometimes given as a Fig. 195. MAY-APPLE (PODOPHYLLUM PELTATTTM). medicine by physicians. Caustic Potassa (vegetable caustic) is the solid stick, which, with care, may be used to destroy warts. More often, Bicarbonate of Potassium is employed as an antacid, in ten or twenty-Grain doses; and as an ingredient in Effervescing Draught (which see). This Bicarbonate is also the Sal Aeratus (gaseous salt) of the bakery; as, like Bicarbonate of Sodium, it gives off Carbonic Acid gas when an acid, such as Tartaric Acid, is added to it. Poultices. These are used to warm and soften the skin, when applied to inflamed parts of the surface of the body; particularly when 598 DOMESTIC MEDICINE. 3 a gathering (suppuration, abscess) is expected. Also, they often doo-ood in cases of internal inflammation (pneumonia, for example) by favorin« the return of blood to the skin, and thus unloading the part troubled with excess of blood. Flaxseed (Linseed), Bran, Bread, Mush, Slip. Fig. 196. pery-Ehn Bark, Charcoal, Chopped C«trots, and Lye are among the materials most used for poul- tices. Flaxseed meal, mixed with hot AVater, makes a good, soft, convenient poultice for common use in " gatherings " of different parts of the body. Mix the meal well with enough hot water to make it hold together and spread easily, and yet not too P01withEgauze. S0I>t to stay where it is put; a poultice .should never run. For use, it should be spread upon a piece of flannel or muslin laid on a hot plate or hot waiter; something hot, near the patient, so that it will be warm when applied. The edges of the rag should be turned over, to the width of about an inch, to keep the stuff in, and upon it may be laid a piece of thin and soft gauze or tarletan. The latter makes the poultice easier to remove, but is not otherwise necessary. A few drops of Sweet Oil (or Lard Oil) may with advantage be poured, or a little Vaseline spread, upon the surface of a Flaxseed Poultice. AVhen pain is great, Half a Teaspoonful to a Tea- spoonful of Laudanum may be poured upon it. As soon as the poultice is put on the part, it should be covered with a piece of Oiled Silk, Oiled Paper, or thin Rubber cloth, to prevent evaporation, and thus keep it moist. Without this, it will dry and become hard and cold in a little while. Bran will do as a substitute for Flaxseed meal, when the latter cannot be obtained. Bread and Mush poultices are made and applied in the same way. One made with crumbs of moderately stale bread and hot Water (better this always than milk, which may sour unpleasantly) is as soothing to the part as any poultice can be. Powder or slips of Slippery-Elm Bark are also very soft, and perhaps more cooling to an irritated skin. A Mush poultice (of Indian meal) is the warmest kind; very suitable for application in internal inflammations, as pneumonia, pleurisy, di/xni- tery, ete. It may be made by using hot mush, prepared just as if it were to be eaten; spread, applied, and covered in the same way as a Flaxseed poultice. In changing or renewing a poultice, be sure to have the fresh one warm, close by the patient, so that the part will not remain for a moment uncovered. Should it do so, the chill caused might more than undo a" the good effected by the poultice. PRINCIPAL MEDICINES, AND OTHER REMEDIES. 599 A Charcoal poultice is only suitable for a nasty, and especially a mor- tifuing (gangrenous), part suffering from disease or injury. Finely powdered charcoal should be used ; two parts of it with one part of In- dian mush. Warmth is not important for this kind of poultice unless the limb or other part affected is cold at the time. Such poultices need to be changed often. Yeast poultices are sometimes employed, but I am quite doubtful of their beneficial action. Lye (Ley) poultices may be made by mixing common lye from ashes, or a druggist's Solution of Potassa, with Flaxseed or Indian Meal. They are not often used nowadays, being formerly applied to punctured and torn (lacerated) wounds, as a means of preventing lock-jaw (tetanus). Better, for this purpose, is Laudanum, applied directly to the part. If a Lye poultice is so used, Laudanum should be added to it. Piillna Water. A strong, bitter German purgative Mineral Water. It, as well as Friedericshalle and Hunyadi Janos waters, are sold by druggists, in bottles, everywhere. Dose of Piillna water, one or two Tablespoon fuls. Pumpkin Seeds. These have a deserved reputation, as capable of driving a tapeworm out of the bowels. For such use, an ounce (about two Tablespoon fuls) of the fresh seeds should, after removal of their outer skin, be beaten, with a Tablespoonful of Sugar, into a paste, then mixed in milk or water, and drunk, either at once or in two draughts half an hour apart. Such a dose should be taken after fasting for from twelve to twenty-four hours, and should be followed in three hours by a Tablespoonful dose of Castor-Oil. 600 DOMESTIC MEDICINE. Quassia. The wood of a AVest Indian tree. It is bitter, and a good, simple stomachic tonic, suitable for dyspepsia. It is best taken iu the form of a Tea. Half an Ounce of it may be boiled for an hour or two in a Pint of AVater. Dose, Half a Wineglassful, two or three times daily. Fig. 197. ■0$ CINCHONA CALISAYA. Quinine. AVhat is commonly so called and used in medicine is the Sulphate of Quinia. The alkaloid Quinia is the most valuable of sev- eral obtained from Peruvian Bark; that is, the bark of different species of Cinchona tree. These are native to the Andes of Peru, growing naturally as evergreens, upon high grouud, from nearly 400 to over 10,000 feet above the level of the sea. The Cinchona tree has, however, PRINCIPAL MEDICINES, AND OTHER REMEDIES. 601 been found to be capable of cultivation in similar regions of the Hima- laya mountains of India. The trees are from forty to eighty feet in height, with laurel-like leaves and fragrant rosy-Avhite flowers. Expedi- tious lasting several months are made by the natives of Peru, to collect bark from trees which they fell for transportation. Having been known for a long time in Peru to be capable of curing chills and fever, the Countess of Cinchon, more than a hundred years ago, took some of it, with that knowledge, to Europe, and thus her name has been given to the tree. Yellow Calisaya Bark is the richest in Quinia; next to it come the Pale and the Red Barks. The most important alkaloids got from them are Quinia, Cinchonia, Quinidia, and Cinchonidia. Quinoidin is an extractive containing two or more of them. All of these have similar properties to Quinia, but require rather larger doses to produce the same effects. Because water dissolves very little of either of these pure alkaloids, they are chemically combined, for use, with acids, especially Sulphuric Acid—making Sulphates. Sulphate of Quinia, as already said, is Qui- nine. It is not very soluble in water; a little Aromatic Sulphuric Acid (Elixir of Vitriol), about two Drops to a Grain, is added in making a solution of it. Quinine is a bitter tonic, but not a stomach tonic only; it acts deci- dedly, also, on the nervous system. When this is debilitated, it will do as much good as any medicine, unless in cases where Iron or Strychnia is suitable, to improve its tone. But the heroic value of Quinine is in the treatment of malarial fevers ; that is, intermittent, remittent, and pernicious (or congestive) fevers. All of these prevail most in the autumn, although considerably also in the spring of the year. All of them are characterized by periodicity ; that is, more or less regular spells, following each other at intervals or periods. Chills occur either once a day, or every other day, or on the first and fourth days (quartan ague); sometimes, only once in seven days. Each chill, also, is followed by a fever, and that by a sweat. Remittent fever does not go off during the interval, but only remits (slacks up, so to speak) its violence; hence its name. [More about these hereafter.] So marked is the power of Peruvian Bark and its alkaloids, especially Quinia, to stop chills, and to cure remittent fever, that it may be well called a specific remedy, even an antidote for them. Dose of Quinine, as a simple tonic in cases of weakness, one or two Grains every four hours, until from six to eight Grains are taken daily. Ihe form of pills is most convenient for this use; one-grain or two- grain pills. For the cure of intermittent (chills, ague), more is needed; 602 DOMESTIC MEDICINE. from twelve to fifteen Grains daily for about three days, and then less- ening gradually, to ten, eight, and six grains a day, continuing the latter for two weeks. In pernicious intermittent, iu the Southern States vet larger doses are required. Remittent fever will be spoken of, and the principles of its management mentioned, hereafter; it may just be said here, that it needs the knowledge and judgment of a physician to deal safely with it. Cinchonia (Sulphate) agrees with some persons better than Quinine. The latter, in doses amounting to over eight Grains daily, makes many people's ears ring, or hum, or roar. Cinchonia hardly over does this; at least, in moderate doses. Quinidia and Ciuchonidia also suit certain patients the best. The popular idea that Quinine injures the health, especially when loug taken, is entirely mistaken. If prescribed only in ordinary doses (not more than fifteen or twenty Grains in twenty-four hours), it does no harm, and, in malarial cases, may often save life, as well as shorten the time of sickness very much. In over-doses, it may cause tempo- rary, or possibly permanent, deafness. Extreme doses might even kill, by poisonous action on the brain; but such amounts are never given by physicians. I have known Quinine to be taken, as much as from six to eight, or occasionally ten, Grains daily, by a delicate person, for years together, with good action as a tonic, and no disadvantage. Quinine may be taken in malarial cases, whether there be fever or not; for example, in periodic attacks of neuralgia. Other diseases, also, in certain localities, take on the periodic form: but for these we must refer to larger medical works. PRINCIPAL MEDICINES, AND OTHER REMEDIES. 603 Respiration, Artificial. See Drowning, later, under Accidents and Injuries. Rhatany. This is the root of Krameria, a South American shrub. It is astringent; its Tincture is the best preparation. Dose, a Tea- spoonful, in water. Used especially for diarrhcea. Rhubarb. The root of an Asiatic and European plant. Our pie- plant, whose leaves have such a pleasant fruity tartness, is another species of the same genus. Rhubarb is a gentle purgative, with also some tonic property, which makes it especially adapted to dyspeptic persons, and others disposed to constipation. Dose, for such a use, from three to six or eight Grains. Many people buy the root in pieces, as it comes in the shops, and cut off daily what, on trial, they find to suffice for them. Less trouble attends the use of Simple Rhubarb Pills; one or more as RHUBARB (RHEUM PALMATUM). may be necessary; if only one, bedtime will be the best time to take it; if two, one at night and one in the morning. Compound Rhubarb Pills contain also Scammony and Aloes (both strong cathartics), as well as Myrrh. They are at least twice as active as Simple Rhubarb Pills. Simple Syrup of Rhubarb is a very good opening medicine for infants. Dose, for a babe, about a Teaspoonful. Spiced Syrup of Rhubarb is one of the oftenest useful of all domestic medicines. It contains, besides Rhubarb, Cloves, Cinnamon, Nutmeg, Alcohol, Sugar, and AArater. It is therefore aromatic and gently stim- ulant, as well as promotive of action of the bowels. This last effect, that of a purgative, is so slight, that it is generally useful in correcting irregular intestinal secretion, and thus curing diarrhcea, if given at an early stage. It is also very relieving to colicky pain with diarrhcea; and is an excellent " vehicle" with which to mix other medicines of 604 DOMESTIC MEDICINE. nasty taste, as Castor-Oil; or those which do not readily dissolve in pure AVater. The dose of Spiced Syrup of Rhubarb is from a Teaspoonful to a Tablespoonful; not as a purgative, for which effect the Simple Syrup of Rhubarb is better; but to correct and relieve diarrhcea, especially when accompanied with pain, at an early stage. Rochelle Salts : Tartrate of Sodium and Potassium. A not very disagreeable, moderately active, purgative medicine; one of the most convenient and suitable at the beginning of an inflammatory or febrile illness; such as bronchitis, pneumonia, measles, scarlet fever, remittent fever, etc. Dose, from a Teaspoonful to a Tablespoonful, dissolved in a fourth or a third part of a Tumblerful of AVater. Rubbing (massage). See later, under Nursing. PRINCIPAL MEDICINES, AND OTHER REMEDIES. 605 Salicylic Acid. This powerful medicine has been found, within a few years, to be very efficacious in relieving and shortening attacks of inflammatory rheumatism. It generally causes free perspiration and flow of saliva. In large doses it produces ringing in the ears, head- ache, and trembling; sometimes vomiting. Physicians prescribe it in doses of ten Grains or more, several times a day; but more often now the Salicylate of Sodium is given; from one to two Drachms in the course of twenty-four hours for a few days, and then smaller amounts until recovery of the patient. It is not a medicine adapted for domestic employment; but is sometimes used externally as an antiseptic by sur- geons. Santonin. One of the most effectual vermifuges; that is, medi- cines which either kill or drive out worms. It must be used with care, as excessive doses are violent in their action; we may say poisonous. For lumbricoid worms, the commonest kind, one Grain will be a dose for an adult; a quarter of a Grain, or less, for a child. For seat-ivorms (those small ones which inhabit the lower bowel, and cause annoying itch- ing of the anus or outlet) Suppositories of Santonin are the best remedy. These are made of Cocoa Butter, with two or three Grains of Santonin in each; one being inserted into the bowel at bedtime. Sassafras Pith. A very soft material, which gives a soothing (de- mulcent) property to AVater in which it is placed. It is often used in this way for inflammation of the eyes. Seidlitz Powders. Made by mixing Bicarbonate of Sodium, and Tartrate of Potassium and Sodium (Rochelle Salt), in powder together, for one paper. For another paper, Tartaric Acid is put up, in propor- tionate quantity. When administered, each powder is dissolved in Water, and the two Solutions are poured together. It is a mild but prompt effervescing purgative, much in use before the invention of the effervescing solution of Citrate of Magnesium. Each saline powder contains forty Grains of Bicarbonate of Sodium (soda) and two Drachms of Rochelle Salt. Each Acid powder consists of thirty-five Grains of Tartaric Acid. Senna. The leaves of an Eastern plant; an active purgative, with a disposition to give some griping pain in its operation. This may be prevented by adding Fennel Seed (an aromatic) or Oil of Fennel to it when given. In my days of childhood, Senna Tea, in wineglassful draughts, was the domestic medicine for headache or a bad cold. AVe hated it much. Sometimes Epsom Salts was given instead, and that was a good deal worse. We would rather " creep unwillingly " to school than swallow either of them. My worst early experience of medicine, however, was in the country. The farmer's wife believed in " Thorn- 606 DOMESTIC MEDICINE. sonianism." One day, for a cold, she kindly mixed for me a pint bowl- ful of " No. 6." After smelling and tasting it, I asked her to leave it for me to finish by degrees. The first and last degree, when her house- hold chores took her from the room, was right out of the window. I trust that most people have thrown Thomsouianism, with its hot red pepper draughts and hotter steam-baths, out of the window, a good while ago. Fluid Extract of Senna is a neat and not very unpleasant preparation; with a drop of Oil of Fennel to each Ounce, it is a very good laxative for infants or older children. Fluid Extract of Spigelia and Senna has been mentioned already. Slippery-Elm Bark has a demulcent property which makes it soothing to an inflamed or irritated part of the body; iu erysipelas, for example. It is rather heavy to the stomach for internal use to ad- vantage. Soap. Castile Soap is the kind preferred when nicety is particularly desired. This is used by some people to clean their teeth. It is an ingredient, also, in some purgative pills, and is commonly employed for laxative suppositories, and to make warm suds for opening injections. A lather of Soap, made as for shaving, and applied with a shaving- brush, is one of the most relieving applications for itching; for exam- ple, in poison-vine eruption, or other affections of the skin. Soap Liniment. Camphorated Tincture of Soap. An excellent bathing material, so-called; that is, for rubbing a part, to warm and stimulate the movement of blood at and near the surface. It is good for sore-throat, sprains, etc., in this way. Soda. Bicarbonate of Sodium is the chemical name of the article which is used in baking and washing, as well as in medicine. It is an excellent and not disagreeable antacid, relieving sourness of stomach, and often nausea (sickness of stomach) better than anything else. For such a use it may be taken, in small quantities. AVhat would cover a little-finger nail, if it would hold it—a pinch, we may say—is an ordi- nary antacid dose, although twice as much may be taken for a single time. It is often prescribed by physicians for gravel. Soda Water, or mineral water, has no soda in it, but is made by forcing into common AVater Carbonic Acid Gas, given off by the Bicar- bonate of Sodium in solution, upon the addition of an Acid to it, as Sulphuric or Chlorohydric Acid. Chlorinated Soda is a liquid disinfectant, containing some free Chlorine gas. It is strong, a little going a great ways towards deodor- izing foul vessels, etc. It will not do to pour it often into water-closets, on account of the Chlorine corroding the iron or lead pipes. PRINCIPAL MEDICINES, AND OTHER REMEDIES. 607 Spice-plasters. AVhen a child's stomach is sick, or it is obstinately colicky, one of the most helpful things is a Spice-plaster. Take of Ginger, Cinnamon, and Cloves, all powdered, each one or two Teaspoon- fuls; of AVheat Flour, the same amount. Mix all up together on a hot plate, with enough AVhisky or Brandy to make a pasty mass. Spread this (not too thickly, on account of its weight) on a piece of thin flannel, with the edges turned in over it all round. AVhen applied to the abdo- men (it had better be large enough to cover the whole belly), it should have laid over it a piece of Oiled Silk, to prevent evaporation. Then it can stay on several hours, and, when dry, may be freshened up again by adding a little more Brandy or AA'hisky. Like the Spice-plaster in action, is the application of a piece of flan- nel wet with Essence of Ginger, and covered with Oiled Silk. This will be somewhat more irritating to the skin of young and delicate chil- dren than the Spice-plaster. Spiced Syrup of Rhubarb. Enough has been said of this under Rhubarb ; which see. Squills. The bulb of an onion-like plant, of which the Syrup is most used. It is an excellent cough-medicine (expectorant); rather less loosening than Ipecac, and therefore suited to a later stage in a bron- chial attack. Dose, from a Half-teaspoonful to a Teaspoonful. This Syrup should be in every medicine-chest. In Pill, Squill is often given as a diuretic (increasing the flow of urine). Dose for this use, one or two Grains, three times daily. Staphysagria. Stavesacre. A drug used in powder as an effective parasiticide ; especially to destroy the eggs or " nits " of lice. Strychnia. The alkaloid principle of Nux Vomica. It is a deadly poison, in even so small a quantity as half a grain. One-sixteenth of a grain has killed a child three years old. A special effect of its poison- ous action is, stiffening the muscles like lockjaw (tetanus). Of course it is not suitable to be kept and used as a family medicine. Physicians prescribe Strychnia (or rather its Sulphate), especially for certain cases of Paralysis (palsy). Also, in very small dose, it is a powerful general tonic to the nervous system in prolonged debility. -Dose, from one-thirtieth to one-twentieth of a Grain; sometimes cautiously increased. Extreme restlessness is a sign of its having an ex- cessive effect upon the nervous system. Sublimate, Corrosive. A very powerful poison; the Bichloride of Mercury. The most frequent family use of it is to kill bedbugs; painting or squirting a strong solution of it in and over cracks and holes in bedsteads, etc. It must not be kept in the medicine-chest, for fear of accidents. 608 DOMESTIC MEDICINE. Physicians value Corrosive Sublimate for its antiseptic property • arresting putrefactive decay, and destroying "germs" of every kind, some of which are supposed to produce diseases. It is, for this eiliet employed as a wash, one part to a thousand of Water for the skin, and one part to two thousand for the vagina, etc. It is also given internally sometimes, in syphilis ; and latterly, attention has been drawn to its ap- parent usefulness in diphtheria. Dose, from one-eighth to one-half a Grain, twice daily, under medical advice. Sulphide of Calcium, in quarter-grain doses or less, has the confi- dence of many physicians as a remedy for boils, when one boil keeps following another. A fresh-made solution, of one Grain in a Pint of water will answer; two Teaspoonfuls being taken every hour or two for a few days at a time. Sulphites and Hyposulphites. These are "salts" or compounds of Sulphurous (not Sulphuric) Acid. Their power to arrest or prevent fermentation has suggested their employment as medicines in what have been called " zymotic " diseases; but the results have been, on the whole, less beneficial than was expected. Sulphite of Sodium, in doses of from five to fifteen grains, does good in some cases of indigestion, and per- haps in some of boils or carbuncles. Sulphur. Brimstone, the popular name of this, is a corruption of burnstone; given on account of its combustibility. It is a mild and good laxative; particularly suitable for piles, and for those persons who are often troubled with colic. Dose, a Teaspoonful; in molasses or milk. In recent cases of skin-disease, it is often given with an equal quantity of Cream of Tartar. Externally, Sulphur is the specific remedy for itch ; not the only one, but the most convenient and frequently used. It is applied in the form of ointment, rubbed well into the seat of the eruption, where it kills the aearus or itch-mite, which keeps up the disease. Sulphur, when burned, gives off fumes of Sulphurous Acid, which is a potent disinfectant. A pound or two of it burned in a large room (with all the people out of it, of course, as the gas cannot be breathed), with the doors and windows closed for two or three hours, will do more to purify it of any contagion or infection than anything else that can be done. Sulphuric Acid. Oil of Vitriol is the commercial name for this very strong acid. It burns (corrodes) any part of the body which it touches; being destructive of organic matter by means of its intense affinity for water. AVhen swallowed, it is a terrible poison. A boy under my care as a patient drank a mouthful of it by mistake, and very narrowly escaped death in consequence. His throat, including the PRINCIPAL MEDICINES, AND OTHER REMEDIES. 609 upper part of the windpipe, was so burned that he could scarcely breathe or swallow for three or four days. Pure Sulphuric Acid is not used in medicine. Aromatic Sulphuric Acid is the Elixir of Vitriol. This is a good appetizer in ten- or twelve- Drop doses, in water. It is also sometimes given for diarrhcea; and has some reputation as one of the remedies for epidemic cholera. A drink made of it is recommended to workers in lead or lead paint, to prevent the poisonous action of that metal; as the Sulphate of Lead (compound of Lead with Sulphuric Acid) is insoluble in water, and without much if any poisonous influence upon the body. Suppositories are small, soft solids, made for introduction into the lower bowel. Brown Soap is sometimes so used instead of an opening injection (enema). A piece of it or of Castile Soap may be cut of about the size and shape of the last joint of the little finger, and dipped in Oil (Castor-Oil or Sweet-Oil) for easy introduction. It must be pressed upwards gently until fully within the bowel, and retained for a little while by the contraction of the muscle at the outlet (sphincter ani muscle of anatomists). Cocoa (Cacao) Butter is a very common and convenient material for suppositories, with which are mixed medicinal agents so to be used. Opium may be thus employed, the dose being twice as large as when taken by the mouth. A suppository may therefore contain two Grains of Opium. Santonin suppositories (with three Grains of this drug in each) may be used with great advantage for seat-worms. 39 610 DOMESTIC MEDICINE. Tannin or Tannic Acid. This is the astringent principle of Oak Bark, of Nut Galls, and of many other vegetable materials. Its pres- ence in Tea-leaves accounts for iron spoons being blackened when left in Tea. Catechu and other vegetable astringent medicines contain Tannic Acid, some of them also the very similar Gallic Acid. Tannin is often given as a medicine in pill for diarrhcea and for hem- orrhages. A good astringent pill is made with three Grains of Tannin and a little Opium, from one-twelfth to one-half a Grain of the latter, according to the case. Tannin is also frequently made part of an astringent gargle, particu- larly in rather chronic (prolonged) cases of sore throat. Tar. An old-time remedy for chronic bronchial trouble; especially likely to do good by inhalation. A tin cup containing Tar may be kept over a slow flame, in the room with the invalid, so as to give off Tar vapor into the air. A good way is to have the cup of Tar in a vessel of hot A\rater; the heat acting upon the Water, so that it never heats the Tar so much as to decompose it. Or it may be used with a simple inhaler. (See Inhalation.) Tar Ointment is a valuable preparation in some skin diseases. It will generally cure ringworm. For this purpose, it should be rubbed gently but thoroughly over the ringworm at night (the part being, if practicable, then covered with a soft light rag, over which is oiled silk), and cleaned off carefully with warm water and Castile Soap in the morning. Taraxacum. Everybody knows the Dandelion plant (Dent-de-lion, French, for lion's tooth, from the form of the leaf). Taraxacum Dens- leonis is its botanical name. The leaves are liked by some people as a kind of " greens " for the table. The root has long been known, when chewed or drunk in the form of a tea, to act upon the kidneys, increas- ing the flow of water. Besides this diuretic action, it appears also to aid in relieving torpor of the liver. Extract of Taraxacum is the most convenient preparation. In ten- or twenty-Grain doses it may be taken by those who have symptoms threatening bilious colic, or who, from nausea, dizziness, a bitter taste, and yellow eyes and tongue, appear to suffer from imperfect removal of bile from the system. It is thus a mild and safe assistant to, or perhaps substitute for, Blue Mass. Tarrant's Powders. A moderately active and not unpleasant cool- ing purgative. Dose, from a Teaspoonful to a Tablespoonful, according to the amount of effect desired. Tartar Emetic. A very harsh drug in its effects upon the human body, unless it be given in very small doses. Other emetics are always PRINCIPAL MEDICINES, AND OTHER REMEDIES. 611 to be preferred when vomiting is to be produced. Its greatest value is in small doses as a sedative and expectorant in highly inflammatory cases of pneumonia or acute bronchitis. Once, in these affections, and in pleurisy, it was given (first in Italy) in one-Grain doses. This prac- tice is not now followed. From one-sixteenth to one-fourth of a Grain for an adult will be enough, every two or three hours. For children, Tartar Emetic is too prostrating to be used unless for quite exceptional reasons. Coxe's Hive Syrup, formerly a common medicine for croup, should be excluded from the family medicine-chest, on account of its containing Tartar Emetic. Antimonial Wine is open to the same objec- tion ; Wine of Ipecac, is similar in effect, but much safer. Tartar Emetic Ointment is occasionally employed as a powerful coun- ter-irritant, applied to the chest or spine. It causes a sore pustular eruption, more severe even than that made by Croton Oil used in the same way. Tobacco. Boys with their " first cigar " find out the sickening and depressing action of this narcotic weed. Under Hygiene we have dis- cussed its injurious effects as an indulgence, whether smoked or chewed. Country people sometimes relieve spasmodic croup by laying upon the throat and chest of the child a Tobacco leaf, sprinkled with hot water or whisky to bring out its strength. If left on long in this way, it is said in a few instances to have had enough nicotin absorbed through the child's skin to cause death. Physicians now and then inject a solution of Tobacco into the bowels to relax the muscles for the reduction of a strangulated hernia. (See Rupture, hereafter.) Turpentine, Oil or Spirit of. Used occasionally by physicians as a medicine internally, in ten-drop doses, in typhoid fever (as an altera- tive to the diseased bowel), and in chronic rheumatism; in larger quan- tities, even a teaspoonful or more, in cases of tapeworm, and as an anti- dote for phosphorus poisoning. Oil of Turpentine is a very heating, stimulating article, and had better not be taken internally without med- ical advice. It excites the kidneys, although not always producing an increased flow of urine. Externally, it is a good warming application (half and half with sweet oil, if the skin of the patient be delicate) for sore throat, pain in the side or back, etc. It may cause some soreness and a slight eruption, which, however, will soon pass away. 612 DOMESTIC MEDICINE. Valerian. The root of an herb native to the Old World, of which the Tincture and Fluid Extract are most used. It is a mild nervous stimulant and antispasmodic (composing agent). In hysterical cases, and in some cases of delinum tremens, it is very serviceable. Dose of the Tincture, a Teaspoonful; of the Fluid Extract, the same; either being diluted with AVater when taken. Valerianate of Ammonia is often given, in the form of an Elixir, in teaspoonful doses, to promote sleep in cases of restlessness at night. Valerianate of Zinc is a nerve-tonic ; sometimes prescribed by physicians, in one-Grain doses, for epilepsy. Veratria. A vegetable alkaloid of great power to affect the nervous system. Like Aconite, when applied to a part it causes a prickling sensation and numbness. In the strength of twenty Grains to an Ounce of Lard, it makes an ointment which may be applied to the seat of pain in severe neuralgia. It is rarely given internally as a medicine. Veratrum Viride (American Hellebore). A very powerful seda- tive ; too much so for domestic practice, without medical advice. It is given by physicians in inflammatory febrile attacks, and also in the pro- longed over-action of the heart and blood-vessels belonging to exophthal- mic goitre and aneurism of the aorta (which see). Dose, from three to six Drops every three or four hours; the effect being closely watched, lest, with nausea and vomiting, it produce dangerous prostration. Vichy Water. An alkaline (antacid) Mineral Water of France, more agreeable because of its containing some free Carbonic Acid gas. It is recommended for dyspepsia with sour stomach; for gravel, and for gout; especially when the last named affects the stomach and digestion. Vichy lozenges are sold by apothecaries, being intended to imitate ATichy AVater when dissolved. They are often found serviceable to persona subject to sourness of stomach after eating. PRINCIPAL MEDICINES, AND OTHER REMEDIES. 613 Warner's Cordial. Tincture of Rhubarb and Senna this is, by composition. It is a warming, stimulating laxative to the bowels; good in gouty cases, and many others. Dose, one or two Teaspoonfuls, in water. Watermelon-Seed Tea is an old remedy for dropsy. It is a diuretic, of considerable power, and quite safe, if it does not always cure. A couple of Tablespoonfuls of the seeds may be infused in a Pint of hot water, and left covered for an hour or two. It is least dis- agreeable when taken cold; dose, a Wineglassful (or less, if the stomach be weak) three or four times a day. Wild Cherry Bark. One of our native American medicines, of real value. Like the fruit and leaves of the Wild Cherry tree, and like Peach leaves and fruit-stones, this bark contains principles which, when water is added, make a small quantity of Prussic (Cyanohydric or Hydrocyanic) Acid. This is a decided sedative to the blood-circulation, while Wild Cherry Bark has also somewhat of the tonic property which is more largely possessed by the vegetable bitters. It is, therefore, a Sedative tonic. It is adapted to cases of bronchial inflammation, espe- cially in rather feeble persons. I have known it to do good even in consumption of the lungs. A cold infusion (tea) may be made by soaking pieces of the Bark in cold water over night. This may be drunk freely, so long as the stomach is not oppressed by it. But more convenient are the Syrup and Fluid Extract of Wild Cherry Bark. The Syrup is an excellent cough-medicine, at any stage of a cough, having a particularly soothing and quieting influence ppon the air-passages. It may be taken at first with Syrup of Ipecac, to loosen the cough; then with Syrup of Squills, to hasten the cure; and afterward, if need be, when it is well loosened and yet troublesome, with a little Paregoric also. Dose, a Teaspoonful. Much more at a time will sicken some persons. Fluid Extract of AArild Cherry Bark is more of a simple appetizing tonic, for general debility. Dose, a Teaspoonful, thrice daily. Wistar's Lozenges. These are made of Liquorice, Gum-Arabic, Sugar, Oil of Anise, and a little Opium. They are very quieting to a cough, but, as Opium tends to check expectoration, they are not suitable for the early, tight stage; their time is when cough is loosened thoroughly, but is annoying and interferes with sleep at night. From one to four Lozenges may be dissolved slowly in the mouth in the course of a night if required. 614 DOMESTIC MEDICINE. Many more drugs might be here named, and their properties and uses described. But I think it best to confine our attention to those best tried and known to the medical profession. Others may be read about in medical works. DOSES OF PRINCIPAL MEDICINES. 615 DOSES OF PRINCIPAL MEDICINES. Acetate of Ammonium Solution Aromatic Spirit of Ammonia . Assafcetida, in Pill. Assafcetida, Milk . 1 Tablespoonful. 10 to 30 Drops. 3 to 5 Grains. Teaspoonful to Tablespoonful. Blue Pill i Grain to 3 Grains. Bromide of Potassium or Sodium 5 to 20 Grains. Cajuput Oil .... Calomel .... Camphor, Spirit . Camphor Water Cardamom, Compound Tincture Castor-Oil .... Catechu, Tincture . Cathartic Pills, Compound Chalk Mixture Chloral Hydrate . Chlorate of Potassium . Chloride of Ammonium (Muriate of Ammonia) Chloroform, internally . Cinchonia, Sulphate Citrate of Magnesium, Solution Citrate of Magnesium, Granulated Cod-Liver Oil Colchicum, Wine of Root Cream of Tartar . Creasote Croton Oil, internally Digitalis, Tincture Dover's Powders Elaterium Elixir of Vitriol Elixir Proprietatis Epsom Salts . Ergot, AVine of 4 to 8 Drops. y1^ Grain to 2 or 3 Grains. 10 to 30 Drops. Teaspoonful to Tablespoonful. 1 Teaspoonful. Teaspoonful to Tablespoonful. Half-Teaspoonful to Tablespoonful. 1 Pill. Teaspoonful to Tablespoonful. 5 to 30 Grains. 5 to 20 Grains. 5 to 20 Grains. 5 to 50 Drops. 2 to 3 Grains. 1 or 2 Wineglassfuls. Teaspoonful to Tablespoonful. 1 Tablespoonful. 10 to 20 Drops. Teaspoonful to Tablespoonful. 1 Drop. \ Drop. 10 to 15 Drops. 10 Grains, at night. TV of a Grain. 10 to 15 Drops. 1 or 2 Teaspoonfuls. Teaspoonful to Tablespoonful. Half Teaspoonful to 2 Teaspoonfuls. 1TIC MEDICINE. 616 DOME Gentian, Compound Tincture Ginger, Essence of. Glycerin, internally Hoffmann's Anodyne Hops, Tincture of . Hunyadi Janos AArater . Huxham's Tincture Iodide of Potassium Iodine, Lugol's Solution. Iodoform, internally Ipecacuanha, Syrup or Wine Iron, Pill of Carbonate (Vallet's) Iron, Tincture of Chloride Jalap ..... Lactucarium, Syrup Laudanum .... Lavender, Compound Spirit . Lime-water .... Lobelia, Tincture . Lupulin, Tincture of Magnesia, Calcined Morphia, Magendie's Solution Morphia, Solution . Musk ..... Nux Vomica, Extract . Nux Vomica, Tincture . Opium .... Paregoric ... Peppermint, Essence Permanganate of Potassium, i nally.... Pink Root, Fluid Extract Pink Root and Senna, Extract Podophyllin .... Piillna AVater 1 or 2 Teaspoonfuls. 10 to 30 Drops. 1 or 2 Teaspoonfuls. 1 or 2 Teaspoonfuls. 1 or 2 Teaspoonfuls. 1 Wineglassful. 1 Teaspoonful. 5 to 10 Grains. 10 to 15 Drops. 1 Grain. 10 Drops to 1 Teaspoonful. ;'s) 3 to 5 Grains. 10 to 20 Drops. 5 to 10 Grains. 1 or 2 Teaspoonfuls. 10 to 30 Drops. 1 or 2 Teaspoonfuls. Dessertspoonful to Tablespoonful. 20 Drops to a Teaspoonful. 1 or 2 Teaspoonfuls. 1 Teaspoonful. 4 or 5 Drops. 1 Teaspoonful. 3 to 5 Grains. I to | Grain. 10 to 20 Drops. 1 Grain. nter- 1 Teaspoonful. 1 to 10 Drops. 1 or 2 Grains. 1 Teaspoonful. 1 Teaspoonful. I Grain. 1 Tablespoonful. Quinine DOSES OF PRINCIPAL MEDICINES. 1 or 2 Grains. 617 Rochelle Salt. Rhubarb, in Pill . Rhubarb, Simple Syrup. Rhubarb, Spiced Syrup . Santonin Senna, Fluid Extract Soda, Bicarbonate . Squills, Syrup Tannic Acid . Taraxacum, Extract Tarrant's Powders . Veratrum Viride, Tincture Warner's Cordial . Wild Cherry Bark, Syrup Wild Cherry Bark, Fluid Extract 1 Teaspoonful. [On Administration of Medicines, see Nursing.] Fig. 200. Teaspoonful to Tablespoonful. 3 to 5 Grains. Teaspoonful to Tablespoonful. Teaspoonful to Tablespoonful. 1 to 3 Grains. Teaspoonful to Tablespoonful. 2 to 20 Grains. Half Teaspoonful to Teaspoonful. 3 Grains. 10 to 20 Grains. Teaspoonful to Tablespoonful. 3 to 6 Drops. 1 or 2 Teaspoonfuls. 1 Teaspoonful. MEDICINE CHEST. 618 DOMESTIC MEDICINE. HOUSEHOLD MEDICINES. From the author's "Family Adviser and Guide to the Medicine Chest" is taken the following list of the most useful and desirable reme- dies needed. They may be adapted for every size of Medicine Chest, whether for Plantations, Ships, Families, or Travellers: Liquids in Bottles. Castor-Oil, Essence of Ginger, Laudanum, Paregoric, Spirits of Hartshorn, Spirits of Camphor, Sweet Spirits of Nitre, Hoffmann's Anodyne, Tincture of Arnica, Soap Liniment, Syrup of Squills, Aromatic Syrup of Rhubarb, Simple Syrup of Rhubarb, Compound Spirits of Lavender, Chloroform Liniment, Syrup of Ipecacuanha, Tincture of Chloride of Iron, Fluid Extract of Valerian, Chalk Mixture, Solution of Persulphate of Iron, Washed Ether, Aromatic Spirits of Hartshorn, Collodion, Diarrhcea and Cholera Mixture, Wine of Ipecacuanha, Wine of Ergot, Wine of Colchicum, Essence of Peppermint, Glycerin, Tincture of Myrrh, Tincture of Catechu, Warner's Cordial, Tincture of Aloes and Myrrh, Fluid Extract of Spigelia and Senna, Tincture of Lobelia, Aromatic Sulphuric Acid, Syrup of Senega, Tincture of Capsicum, Chloroform, Spirits of Turpentine. Pills, Powders, Etc., From which selections can be made and adapted to any of the Chests furnished by druggists. pills. Rhubarb Pills, Compound Cathartic Pills, Blue Pills, Compound Gentian Pills, Tannin and Opium Pills, Quinine Pills, Opium Pills, 1 gr., Assafcetida Pills, 3 gr., Lady Webster's Pills. POWDERS. Alum, Borax, Chlorate of Potash, Cream of Tartar, Sugar of Lead, HOUSEHOLD MEDICINES. 619 Husband's Magnesia, Tarrant's Aperient, Bicarbonate of Sodium, Citrate of Potassium, Gum-Arabic, Rochelle Salts, Calomel, 1 gr., Dover's, 10 gr. SUNDRIES. Opium Suppositories, 2 gr., Santonin Suppositories, 3 gr., Santonin Dragees, AVistar's Cough Lozenges, Simple Cerate, Cold Cream, Blistering Cerate, Cocoa Butter, Camphor Tablet, Adhesive Plaster, Court Plaster, Camel-Hair Pencils, Lint, Oiled Silk, Enema Syringe, Scales and Weights, Mortar and Pestle, Spatulas, Tweezers, Medicine Measure, Scissors, Castile Soap, Sponge, Thread, Cork-Screws, Lancet, Wax, Eye-Glass, Ear Syringe. Medicine Chest, No. 1.* Containing 28 Bottles—10 four-ounce, 12 two-ounce, and 6 half- ounce. With Drawers, Jars, etc. Price, $30. Castor-Oil, Essence of Ginger, Spiced Syrup of Rhubarb, Simple Syrup of Rhubarb, Camphor-water, Lime-water, Cinnamon-water, Paregoric, Spirits of Camphor, Spirits of Hartshorn, Laudanum, Syrup of Ipecacuanha, Syrup of Squills, Sweet Spirits of Nitre, Hoffmann's Anodyne, Chalk Mixture Powder, Compound Spirits of Lavender, Anodyne Carminative (Cholera Mixture,) Tincture of Arnica, Soap Liniment, Essence of Peppermint, Spirits of Turpentine, Collodion, Aromatic Spirits of Ammonia, Tincture of Capsicum, Aromatic Sulphuric Acid, Wine of Colchicum, Glycerin. * Sold by John Wyeth & Bro., 1412 Walnut Street, Philada. PAET III. NURSING. IN many kinds of illness, especially continued fevers, and other attacks attended by great debility, good nursing is well known to be as im- portant as good doctoring. A careful physician will direct not only the medicines of the patient, but also his food, and all other matters con- cerning him—as his covering, changes of clothing, air in his room, etc. But the carrying out of such directions must be left to those immedi- ately in charge of the sick person from hour to hour; and questions will occur in the doctor's absence, sometimes of much importance, which those who nurse the patient must answer and act upon at the moment, from their own knowledge. Moreover, the manner of doing things in the care of a sick person makes an immense difference in his comfort. In critical cases it may even decide between recovery and death. AVhat are the qualities that make a good nurse ? They are kindness, good common sense, carefulness, quietness, neatness, handi- ness, cheerfulness. Kind a nurse must be, or mere professional skill and obligation will fail to effect all that is needed for the best welfare of a patient. Sym- pathy is worth much to a sufferer. It is to the mind what warmth is to the body; and the absence of it, shown in face and manner, will act like a draught of cold, damp air or a wet blanket. Patience is often called for in attendance upon the sick, and selfish people do not have a large stock of this, which can be bought with money; it must come from love, or, at least, from genuine kindness of heart. Common sense, that is, intelligence such as most people, not par- ticularly deficient, possess, will enable any one to learn what is necessary in nursing, and to do it respectably, at least. Of course, really superior intelligence is a very good thing in nursing; and will bring the best results in this, as in anything else. But most people can become good nurses, if they try, with the help and advice of those who have had experience. * 620 NURSING. 621 Carefulness is indispensable. One who will give a dose of medi- cine without looking at the label on the bottle; or will spill out twenty drops when ten were ordered; or will upset a breakfast tray on the bed • or leave a vessel under the bed for hours uncovered; or sleep six hours when the patient should have food or medicine every two hours; or let the fire go out when the room without it is cold; such an one is entirely unfit to have charge of a sick person under any circumstances. Exactness in carrying out the orders of the physician is the first duty of a nurse. The doctor is responsible for the treatment of the case, and the patient and family are responsible for the choice of the doctor. He is chosen because he is believed to have the knowledge and skill re- quired. If the family thought they knew enough to manage the ill- ness, they would not send for the doctor. AVhen they have sent for him, it is wise and right to accept and carry out his orders. The nurse, whether man or woman, who thinks he or she " knows better than the doctor," is a very dangerous and unsuitable person to have about the house. Sleeping heavily is a weakness from which some suffer when in care of ill patients at night. It is a good thing to learn to wake with a sound or a touch. By fixing it strongly on the mind, most people can do this. It is best, however, for those who are nursing to arrange to be relieved at certain hours, when they can be best done without, so as to get enough sleep, whenever possible, in every twenty-four hours. To oblige the same person to be at the bedside of an ill person day and night, for weeks together, is not only cruel to the one so overtasked, but it risks unfitting the nurse for good service. A break-down may come, just at a critical moment, and then the family is left under a calamity which might have been prevented by proper consideration from the start. It is wonderful how thoughtless some people are about such things. Watchfulness in everything is the duty of a nurse. Without it, a patient may get out of bed in a delirium, and perhaps fall down stairs or out of the window. Or, the clothing may be thrown off, and a deadly chill will follow. Or the time for food may pass by, and nothing is ready; so that exhaustion comes, and all the symptoms are worse in consequence. In a thousand things the life of the sufferer may be in the hands of the nurse, as the safety of the passengers and cargo of a ship is in that of the pilot at the helm. (If, as we have suggested on a previous page, the doctor is the captain, the place of steersman may well be given to the nurse.) AVTien many doses of medicine or portions of food have to be given through the day and night, it is best that the times and quantities shall 622 DOMESTIC MEDICINE. be written down, instead of trusting to memory. And then, a mark of record of some kind being made when each thing is given, this makes ready a report of the treatment for the doctor to see when he comes. Quietness is very necessary in the sick-room. Stamping around in heavy or creaking shoes, talking in a loud voice or loud laughter, swing- ing in a rocking-chair, slamming doors or windows, or even much rust- ling of garments; all noises are utterly inadmissible and injurious. Yet whispering, and creeping on tiptoe in sight of the patient, are about as bad, because they attract his attention unpleasantly, and that is ahvavs to be avoided. Slippers or soft shoes should always be worn, and a wrapper or something that does not rustle. Rattling of spoons or dishes also must be prevented. Nothing should ever be cooked or washed in the sick-chamber. If coal is to be put on the fire, let it be wrapped in paper outside of the chamber, and put, paper and all, into the grate or stove. Never ask a patient whether he would " like to eat or drink " such- and-such a thing. Prepare and bring, under the directions of the doc- tor, what will be best and most likely to be taken, and offer it quietly. If not taken in a little while, remove it out of sight. Keep no food or medicine in sight of a sick person. The next room, or an entry near, may often be convenient for such things. When one room only is available, find a place out of his sight for them, or put up something as a screen to conceal them. Neatness is a very similar quality to quietness. Nothing should be allowed to be slovenly, much less dirty, around a sick person. A'et " fuss " and much movement in clearing up are to be avoided. A wet cloth will be better than a brush or broom in cleaning furniture and carpet (if there be a carpet, of which something presently). AVhen the restlessness of a patient puts all his bedclothes out of order, gently straighten them up again; not for his comfort of body only, but for the mental impression going with it. Handiness is an excellent quality in doing all sorts of things, in the sick-room, as well as everywhere else. While it is not absolutely indispensable, its opposite, clumsiness or awkwardness, may cause much discomfort. I have known one or two men who, in a surgical ward of a hospital, could hardly go near to a patient without somehow hurting him. Such persons as are naturally and unavoidably clumsy had better be called upon to do outside errands rather than bodily service immedi- ately about the sick. Great kindness, however, will often conquer this infirmity. Very seldom will a mother handle her baby so clumsily as to hurt it; although examples have occurred of their "overlying" them, that is, turning over upon them and smothering them while asleep beside them in bed. NURSING. 623 Cheerfulness is an excellent attribute in the sick-room. It is as pleasant as sunshine, and wholesome like it, without any of its glare. A long face or a whining voice should never enter where there is suffer- ing enough already. Let every one endeavor to make the best of all things, and the most of hope. Should we lie to patients, then, and tell them they are getting well, when they are about to die ? I have known one physician who had the very bad habit of doing this. It is morally wrong, and inexcusable. It only causes the worse shock when the truth makes itself known. But hope is to be encouraged. AVhen there is doubt, leaning toward the brighter side is well; and, as the proverb says, " while there is life there is hope." Speaking of a patient's symptoms in his presence (unless when need- ful questions have to be asked) is to be avoided. Also, there must be no discussion or mention there of other people's illnesses or deaths. Much talking of any kind is out of place in the sick-chamber; it inter- feres with that rest of brain which, in all kinds of illness, is important. So far, we have been considering the qualities requisite to adapt any one for the duty of nursing. Now we may look at the particular needs of the sick, on their side, which have to be attended to by those in charge of them. These concern the room, its warmth, light, and air; the bed, its pillows and covering, and the patient's clothing next his person; his washing or bathing; his food, medicine, excretions, sleep, and mental management. Rubbing, and the management of child-birth, will also afterwards receive our attention. 624 DOMESTIC MEDICINE. THE SICK-ROOM. When it is possible to choose, the room should be on the sunny side of the house, and on the second floor. It should be as large as can be; that is, as chambers are in most dwelling-houses. There will be no advantage in its being more than twenty or thirty feet square, with twelve to fifteen feet of height to the ceiling. If a room is necessarilv small, more contrivance will be required to meet all the conditions wanted in the care of an ill person. Plenty of large windows are desirable in a sick-room. Should there unfortunately be only one window, it will be almost impossible to air the room properly, unless there be an open transom over the door, or the door be left open most of the time. When two rooms communicate, one of them may with advantage be given up to the patient, and the other to the nurse and to various appliances, which may thus be kept out of the sick one's sight. But little furniture should be in the sick-room. A few chairs and tables will suffice, one being a bedside table for frequent use. A bed- chair (night-chair) or portable earth-closet will be very serviceable for a patient who is strong enough to get or be helped out of bed. No carpet should be on the floor, except movable pieces or rugs, placed where they are needed for warmth to the feet and to prevent noise in moving about. No bed-curtains should be allowed; nor heavy window-curtains. Good blinds or shades are needful to regulate the admission or exclusion of light. Warmth. A sick-room should, generally, be kept at a temperature between 68° and 70° Fahr. In a few exceptional cases, physicians may wish to have a room much warmer, at particular times. AVhen fuel is scarce, and the room is small, it will be best to secure good air to breathe, even at the loss of some degrees of temperature in the room; this being made up by sufficient covering for the patient. But, in most instances, air may be, with care, kept pure and sufficiently warm at the same time. The best kind of fire for a sick-room is an open wood fire in the chimney-place. Next to that is an open coal-grate, with a good draught to secure it from escape of gas. If only a stove can be had, a wood- burning stove should be preferred. With a stove which burns coal, the greatest care will be necessary to prevent coal-gas from getting out into the room, and also to keep the air moist enough by having water in a pan always upon the stove. THE SICK-ROOM. 625 Furnace-heated air is objectionable as a dependence in a sick-room, although very well to have within reach to supplement an open fire. The warmth of most furnaces is variable and uncertain; some of them allow gas to get into their air-chambers, and so to pass through the house; and, at the best, they require special pains to provide ventilation, which the heater itself does not furnish. For the body of a sick patient to be kept warm enough to be com- fortable, is one of the quite indispensable things. It should be ascertained from time to time, especially about the feet. Blankets and quilts will not always insure warmth ; they only protect it when the body has it of itself. Whenever a sick person's feet are cold, something warm should be at once put to them. A heated fire-stone, or a common brick, or a bottle, or pan of hot water, or a bag of hot salt, will do. Only never let your patient be chilled, for a single minute, when it can be helped. Light. AVhile the sunny side of the house is the best, and sunlight should be admitted (with few exceptions only) every day into the room, the sick person's eyes should not be exposed to a direct glare. The bed may be so turned that the window is out of the patient's sight; or, if this cannot be, a screen of some kind should be so placed as to shield his eyes from it. At times, when sleep is desirable, the light should be almost all shut out. At night, no flame of a lamp, candle, or gas-burner should be exposed to the patient's view. Either should be shaded, or otherwise concealed. A gas-burner may, of course, be turned down; and, besides, a movable tin burner-shade attached to it is a great convenience. Some persons, even when well, cannot sleep with the flame of ever so low- turned a gas-burner in their sight. It is not safe, moreover, to turn a gas-burner very low. A change of pressure at the source of supply may put out the light, and allow a leakage of gas, dangerous to any one sleeping in the room. Air. Under Hygiene, the principles of ventilation have been fully dis- cussed. In the sick-room, the things to be done are, to have the air changed constantly, and at the same time to prevent direct draughts upon the patient's bed. If there are several windows, all but the one nearest the bed may be open a little at top and a little at bottom; more or less according to the weather. In really warm weather, of course, everything may be opened wide all the time. With only one window in a room, as already said, there ought to be another outlet for air, such as a transom over a door; or, in the absence 40 626 DOMESTIC MEDICINE. of this, the door itself may be left open. This will require attention to •the air of the room, or passage, communicating by that door with the room. If the air of the house is foul, that will hurt the condition of the sick-room, when the door of the latter is left open. Yet, somehow, both an inlet and an outlet are needed, to change the air of the room. In very cold weather, when it is impossible safelv to have (as is always best) a constant and considerable movement of air through the room, the next best thing will be to have chosen times of airing it thoroughly. Cover the patient with extra blankets or coverlids, pro- tecting even the head and face for the time; and then open the window or windows and doors wide for a few minutes. Upon closing them, see that the patient keeps his extra cover until the room is warm enough again. Few people appreciate the value of pure air for the sick. During the Civil War, it was found that wounded soldiers, and those ill with fever, did better in the tent hospitals, or even out on the open field (where sometimes, after a battle, they were unavoidably left for two or three days), than in the close wards of an ordinary hospital in a town. I remember two patients suffering with inflammation of the lungs, one of them a lady more than eighty years of age, who felt the need of pure cold air so much, that they insisted on having the windows in their rooms open all the time, though the thermometer stood at several de- grees below the freezing-point. THE SICE-BED. 627 THE SICK-BED. What will be best ? A wide and rather low bedstead, for ease in getting in and out; a wire bed-bottom; next best to it, one on good springs, with a thick but soft mattress; if it be a slat bedstead, then with a feather bed upon the slats under the mattress. No curtains should be placed around the bed. AVhy ? Because they check the free and abundant supply of air to the patient. If the bed were out of doors, in winter, curtains might be endurable. They were, no doubt, invented when houses were almost as cold as out-of-doors. Pilloivs should be of full size, and as soft as possible. Extra little pillows are often useful, to put in spaces, in propping a patient up, or to relieve some particular pressure. A sheet, as a rule, not a blanket, should be next to the body. The blanket first is only proper when the patient is very hard to keep warm, or when one quite ill is lifted into and out of a bath. A down quilt is the nicest top-piece ; its lightness is a great advantage. Some patients can hardly bear the pressure of the bedclothes. Over an inflamed or injured limb, it is often necessary to put a support to keep them off. This may be made by breaking a barrel-hoop in two, and placing the pieces across each other (fastened at the middle for steadiness) under the clothes. Changing the bedclothes requires care, but it ought to be done often. When there is likely to be anything to soil the bed, a large piece of rubber-cloth or oil-cloth should be put upon the mattress, beneath the under sheet. In cases of labor, a second rubber- or oil-cloth had better be placed upon the lower sheet, and another sheet over it, so that the latter and the upper rubber-cloth may be removed, leaving the bed still protected. Sheets, especially, ought to be changed often. AVhen practicable, once in twenty-four hours will be desirable in a severe illness. To make the change, warm a sheet thoroughly (being sure first that it is entirely dry; a damp sheet may be deadly), and fold it, lengthwise. Then fold, also lengthwise, one side of the under-sheet on the bed, up against the patient's side. Push the fresh-warmed sheet along near him, and have some one to lift, first his head and shoulders, and after- wards his legs and feet. Then, while he is lifted, press the soiled sheet from under and beyond him, and roll out the fresh one (half of it) to take its place. It will then be easy to draw it smooth. To change the upper sheet, the fresh one, being first warmed, may be rolled either in its width or in its length, and passed under the sheet already over the 628 DOMESTIC MEDICINE. patient's body, into its place, Avithout disturbing him at all. It requires two persons, one on each side of the bed, to do this well. Bedsores are very troublesome occasional results of continued pres- sure, while one is lying long in bed; thev are especially apt to occur in very thin and weak persons. Most of all thev are liable to happen when, from an injury or serious disease of some part, the patient cannot change his position from time to time. This is the case; with fractures of the thigh or leg. In such instances the utmost care mu.st be taken to preserve the soundness of the skin where it is most pressed upon. It must be examined every day, and bathed gently with whisky or soap liniment. AVhen redness and tenderness of the skin begin to Fig. 201. AIR- OR WATER-CUSHIONS. appear, a protection to it must be supplied, by covering the part with a piece of soft, thick buckskin, upon wdiich soap-plaster has been smoothly spread; or, if that is not at hand, two layers of adhesive plaster, very smoothly adjusted to the surface, will do for the purpose. Small pillows, or air- or water-cushions, in rings or other shapes, are often employed to take the pressure off of tender parts. They may sometimes do good; but, in surgical practice, I have been repeatedly disappointed with them, especially with air- and water-cushions or pillows. AVhen bedsores actually occur, it is necessary to relieve the sores from pressure; and, besides, they must be treated like open wounds or ulcers. (See Ulcers, later, under Accidents and Injuries, etc.) SICK-GARMENTS. 629 SICK-GARMENTS. As simple as possible these should be. One sufficiently warm and long night-shirt or night-gown will, as a rule, be enough ; the less worn, the easier will it be to make changes. If the limbs incline to be cold, light drawers may be added; with the old and feeble, stockings also. Changes of garments worn constantly in bed should be frequent. One " robe " for the day and another for the night would be well, but for the fatigue of so many movements. There should be no exposure to cold during such changes. There need be none, if the room is moderately warm at the time (70° Fahr.) aud the fresh garment is well warmed near the bed. One arm should be taken out of the sleeve it is in, and put in the new one; then the old shirt should be lifted off over the head, and the new one put in its place; lastly, the other arm should be changed and the shirt drawn down. AVhen a long gown is ready to put down over the head and shoulders, the old one can be drawn off at the feet. If any garment becomes soiled, it must be removed as soon as possi- ble. There are, of course, some states of extreme debility in wdiich it is not safe to move the patient so often as above said. But, by having garments made loose, and cut or ripped if necessary to facilitate removal, the refreshment of such changes may be obtained in more cases of illness than many people suppose. When the disease from which a patient suffers is contagious, as small- pox, scarlet fever, measles or typhus fever, every article of clothing worn, as well as the sheets, blankets and bedding, must be (for safety to others) either boiled or burned. In malignant cases, or those attended by much soiling of the clothes, they had better be burned. In other instances they may be thoroughly boiled, and then spread out in the sun to dry. 630 DOMESTIC MEDICINE. WASHING AND BATHING. Every morning, at least, a sick person's face should be freshened up by washing, in whatever manner his strength best allows. ()ne really ill must have it done by another person. A soft " wash-rag " mav be used. The water may be cold, if there is fever, or if there is not prostration with a tendency to chilliness. In the latter case, warm water is better, even for the face. AArarm water should be used also to wash the arms and legs and other parts of the body. In weak conditions, whisky may be added to warm water for bathing the limbs, and pure whisky or soap liniment should be used to bathe any parts of the skin which are subject to pressure. This is often important to prevent bed-sores. If the skin is quite or almost broken, a piece of buckskin spread smoothly with soap-plaster, or a piece of elastic adhesive plaster, or even common ad- hesive plaster (two thicknesses) may be, as already said, put on to make an artificial protective cuticle. AAhen fever is hot and high, cool washing of the body is of great value. Some physicians now advise even cold baths for typhoid fever. I do not think well of this practice; unless, at all events, the patient is put in water which is at first warm or tepid, and cooled clown gradually; also, without exposure to a low temperature for many minutes at a time. But cool sponging, in scarlet fever as well as in typhoid, is, without doubt, not only relieving but useful. It may be repeated two or three times daily. In cases of low fever, and other cases in Avhich restlessness at night is a symptom, bathing the arms and legs (one at a time, so as not to chill by exposure) with whisky and hot water (equal parts) often gives much comfort and promotes sleep. Warm baths are frequently very beneficial in states of nervous excite- ment ; as in the convulsions of children. Prolonged warm baths are also advised sometimes for tetanus (lock-jaw), and to promote the reduction of hernia (rupture). In spasmodic croup in children, a warm bath is often helpful. Hot baths do good in cold or depressed conditions of the system; as in chronic rheumatism or neuralgia; and when the eruption does not come out or stay out well in scarlet fever, measles, or small-pox. (See pages 342 and 556 on Bathing.) FOOD OF THE SICK. 631 FOOD OF THE SICK. Appetite almost disappears in severe illness, especially when there is fever; and the capacity to digest food is then nearly lost. Yet, in acute febrile attacks of disease, as well as in prolonged maladies like con- sumption, the waste of the substance of the body goes on faster than during health. Hoav, then, are we to make it up? Evidently, by giving strong, concentrated food, in the liquid form, in small quan- tities, at short intervals. A young and robust person may, at the beginning of an illness, be better for a day or two with almost no food. After that, even such an one Avill gain by taking frequently small portions of liquid nourish- ment. Feeble patients need, as a rule, to be so fed from the start. The main staple article of diet for the sick is the same as for infants; namely, milk. And for the same reasons; that it contains all that is essential for the system, in a form easy of diges- F 202 tion and appropriation. In typhoid fever, for example, almost from the beginning, a patient may be fed with two tablespoonfuls of milk every two or three hours, day and night. Another concentrated article is beef-tea; and stronger yet, beef-essence. As Avas remarked under Hy- giene, the mistake has been very often made, and is encouraged in many books on such sub- jects, of straining or filtering beef-tea, after it has been subjected to a boiling heat. Its most ... . , , „ , ,, . , T , BED-TABLE (WITH RACK). nourishing part is thus left behind. It ought to be broAvn with finely divided particles (not solid pieces, of course) of the meat. The same is true also of essence of beef, made without the addition of water. (More about these preparations presently.) Next to these articles of food, come broths or teas of other meats; as mutton and chicken soups. They should, for the sick, be made strong, not watery; but should be thoroughly rid of their fat, by skimming. This can be most effectually done Avhen they have stood and become cool; but, except in the warmest Aveather, they should be heated again to be taken. Prepared extracts of beef are much in use, to save trouble in getting the fresh article. Liebig's has been the most famous; but, as it is pre- pared Avith heat and then filtered, it leaves out most of the nourishing part of the meat, and is rather a nutritive stimulant than a food. Valentine's beef-juice is prepared without boiling, and has the substance 632 DOMESTIC MEDICINE. of the beef in a very concentrated state. Most people can take it vorv well. Two teaspoonfuls of it may be added to about a quarter of a tumblerful of water (hot or cold, as preferred), this being given two tablespoonfuls, more or less, at a time. Johnson's fluid beef is agreeable to some persons, and, when so, an- swers a very good purpose. To my taste, it is unpleasant. Manv phy- sicians recommend it, and use it largely. Beef peptonoids are much used. Jellies are weak food; good only for variety, or to hold something stronger, as a matter of taste. Fruits are commonly pleasant during fever, but they are most of them ratlier too hard to digest. Malaga grapes Avill almost always agreu well. Orange juice (without SAvalloAving the pulp) does so also, and is often very refreshing to the sick. Lemonade is pleasant and cooling, but requires consideration of the condition of the stomach and boAvels at the time. One of the best things to clean afoul tongue during fever, is half a lemon, passed sloAvly over it now and then. Stimulants are often added to the diet of the sick, Avhen patients are much prostrated or exhausted. Their use requires great caution and judgment. As a rule, they should not be employed without the advice of a physician. Wine-whey and whisky-punch are most frequently ad- vised. They are most apt to be appropriate in typhus fever, in tha Aveakest cases of typhoid fever, and in the late stages of severe acute dis- eases. Also, they may be called for in cholera, and in certain conditions which are met with in advanced or advancing consumption of the lungs. Convalescence is generally attended by the return of a good appetite and digestive power. The system has to make up for what it has lost during illness. Care is necessary that the pa- tient does not venture too soon upon a varied diet, or the use of things hard of digestion. After typhoid fever, this is particularly necessary. From the special condition of the intestinal ca- nal in that disease, life may be endangered at that time by a single imprudence in diet. Grad- ually, however, after most diseases, recovery is marked by ability to eat all ordinary wholesome food, and a variety of digestible dishes may be indulged in, always, of course, avoiding excess. FOOD OF THE SICK. 633 We will now give directions for preparing a number of articles es- pecially suited for the food of the sick; those, that is, who cannot prop- erly take ordinary solid meals.* Different things are required for different cases. Of this the physician must judge, Avhen one is in at- tendance. In his absence, those in charge must be guided by the symptoms and conditions present. Beef-Tea. Chop a pound of good lean round of beef into very small pieces. Pour over it a pint, or less (never more) of cold Avater. Cover it, and let it stand for tAvo hours near the fire, or on a part of the range or stove where it will not become very hot. Then put it right on the fire, and bring it to the boil. As soon as it is fairly boiling, remove it, and take off all the scum from the top. Pour it off from the pieces of meat at the bottom, but do not filter or strain it, unless through a coarse sieve. Straining robs it of much of its nourishment. The fat must be care- fully removed, which can be done best Avith a clean piece of blotting- paper, or a small (salt) spoon. Salt may be added according to taste; when the stomach is weak, also black or red pepper. In the extreme weakness of delirium tremens, red pepper may he freely added; a little of it is suitable in nearly every case Avhere beef-tea is needed. Beef-tea should be stirred just before using it, so as to get a rich broAvn color. Beef-Tea, Cold-made. Chop finely a pound of good beef. Add to it a pint of cold water, in which have been put fifteen drops of chlorohydric (muriatic) acid, and a pinch of salt. Let it stand an hour, and then drain off the liquid. Pour another half-pint of cold water over the beef that is left, and add it to the first quantity. All may be then strained through a coarse sieve, and used cold. Frozen Beef-Tea. Put a suitable portion of Beef-Tea, made as above first directed, in a convenient vessel, Avithin an ice-cream freezer. Let it then be frozen aa if it were cream. This is particularly suitable in the summer complaint (cholera infantum) of children; also in some other cases in hot weather. To show that fluid food may suffice even for a length of time, I have just read an account of a man who died at the age of eighty-five years, who, when seven years old, swallowed by mistake some strong lye, the effect of which was to contract his oesopha- gus (lower gullet) so much, that he never afterwards could swallow solid food. 634 DOMESTIC MEDICINE. Beef Essence. Cut up a pound of good lean beef into small pieces, and put it into a pint bottle (or other handy receptacle), without any water. Cork the bottle loosely and place it up to its neck in Avater in a stewpan. Then boil the water in the pan for three or four hours. This will bring out the juice (essence) of the meat, Avhich should be poured off, not strained. The fat must be removed as with beef-tea. This is the most concentrated of all articles of food. It is often of the greatest value in conditions of prostration; as a little of it goes a great way, Avhile requiring almost no effort of digestion. Red pepper may usually be added to it in mod- eration, and salt according to taste. Broiled Beef Juice. Broil a pound of lean beef. Cut it into strips, and press out the juice Avith a lemon-squeezer or meat-press. A pound of meat will give about three tablespoonfuls of "gravy" or juice. AVmen salted according to taste, it may be taken either hot or cold, as preferred. Raav-Beef Extract. Cut up good lean beef very fine, and put a pound of it with half a pint of cold water in a bottle. Let it soak for about twelve hours, shaking it well half a dozen times or more during that time. Then pour it off through a coarse sieve, and salt according to taste. Raw-Beef Scrapings. Take a piece of good tender beef, and, with a rather dull knife, scrape off all of it that Avill come, leaving the tough, gristly portions behind. The pasty meat thus obtained may be salted a little and used at once as it is, or it may be rubbed up Avith half its quantity of granulated white sugar. The latter plan Avill be likely to suit children best. Good Avell-boiled ham (as well as dried beef) may be treated in the same manner. Infants recovering from summer complaint are some- times very fond of such food. Chicken Broth. Clean half a chicken and remove the skin. Pour on it a quart of cold Avater, and salt to taste. Add a tablespoonful of Carolina rice, and boil slowly for tAvo or three hours. Then skim it well to get off all the fat, and add a little parsley. This is one of the most agreeable of dishes for many sick people. FOOD OF THE SICK. 635 Oatmeal Gruel. Boil a pint of water, and while boiling, mix Avith it two tablespoon- fuls of (Canada, Bethlehem, or Ohio) oatmeal, Avhich has been first rubbed smooth in a little cold water; also, add half a pint of milk, and a little salt. Let all simmer together for half an hour, then strain it through a hair-sieve, sweeten, and add a little nutmeg. A few raisins may be added before the boiling. Indian-Meal Gruel. Stir a tablespoonful of Indian meal till it becomes smooth, in half a teacupful of cold Avater. Then mix it well with a teacupful of boiling Avater, and add half as much milk; then boil it until it is moderately thickened. Salt or sweeten according to taste. Raisins may be put in before boiling, if desired. Barley AVater. AATash Avell two ounces of pearl barley with cold Avater, throwing that water away. Put the barley into a pint and a half of fresh cold water, bring it to the boiling point, and boil for tAventy minutes in a covered vessel. Strain, SAveeten to taste, and flavor with lemon-juice and a little lemon-peel. In certain cases, as in using it to feed infants, the lemon had best be omitted. Rice Water. Boil an ounce of Carolina rice in a quart of Avater for an hour and a half. Pour off or strain, and add either salt or sugar and nutmeg, ac- cording to taste. Salt will generally be best. Toast AVater. Cut a slice of stale bread half an inch thick, and toast it brown all over, without scorching. Pour over it a pint of boiling water; cover closely, and let it cool; then pour or strain it off for use as a drink. Some patients like it better when a slice from an apple, and a very little lemon-peel, are laid on the toast before the Avater is added. Bread-and-Butter Soup. Spread a slice of well-baked bread with good fresh butter, and sprinkle it moderately with salt and black pepper. Pour a pint of boiling water 0ATer it, and let it stand a few minutes before use. This will do for patients who are not very sick, as a soft article of Ioav diet. 636 DOMESTIC MEDICINE. Panada. Cut two slices of stale bread, Avithout crust. Toast them broAvn, cut them up into squares about tAvo inches across, lay them in a bowl, and sprinkle with salt and a little nutmeg. Pour on a piut of boiling water, and let it stand to cool. Vegetable Soup. This may be made, of course, in many different ways. The follow- ing is about the simplest: put two potatoes, a handful of peas, one ripe tomato, antl a piece of bread, into a quart of Avater, and boil it down to a pint. Then throAV in a little chopped celery or parsley, and salt. Cover, and remove from the fire. A delicate stomach may require it to be strained for use. Boiled Flour. Tie up a quart of Avheat flour in a pudding-bag, tightly. Put it into a pot of boiling Avater, and keep this boiling for several hours (all day or all night will not be too long). Then take out the flour and dry it near the fire. Peel off and throAV away the thin outer portion, and grate doAvn the mass, Avith a nutmeg-grater, into a poAvder, for use as Avanted. One or tAvo teaspoonfuls of this may be rubbed into a paste with a little milk, and then stirred into a pint of milk, Avhich is to be scalded ; that is, just brought to the boiling-point, Avithout being boiled. This is often beneficial in the diarrhoeas of infants or older persons. Arrow-root. Mix a tablespoonful or rather more Avith a little cold Avater, till it becomes smooth and pasty. Boil a pint of water, stir in the arrow-root, and boil it for a feAV minutes, until it thickens sufficiently. Sweeten to taste with Avhite sugar, unless salt be preferred. A little lemon-peel or orange-peel added before boiling will improve the flavor. Tapioca. Cover two tablespoonfuls of tapioca with a full teacupful of cold Avater, and let it soak for several hours. Put it then into a pint of boiling water, and boil it until it is clear and as thick as Ls wanted. Sugar, nutmeg, lemon, etc., may be used to season it. Sago Jelly. Mix well together four tablespoonfuls of sago, the juice and rind of one lemon, and a quart of water. SAveeten to taste, let it stand half au hour, and then boil it, stirring constantly, until clear. FOOD OF THE SICK. 637 Farina Gruel. Mix two tablespoonfuls of farina Avith a quart of water, and let it boil long enough to become thick. Add a pint of milk and a little salt, and then boil again for a quarter of an hour. SAveeten according to taste. Rice Milk. Boil a tablespoonful of rice for an hour and a half in a pint of fresh milk, then rub it through a fine sieve. Add a tablespoonful of fine (granulated) white sugar, and boil again for two or three minutes. Oatmeal with Beef-Tea. Mix a tablespoonful of oatmeal quite smoothly Avith two tablespoon- fuls of cold water. Add this to a pint of strong beef-tea, and heat to the boiling-point, stirring all the time. Boil for five minutes. Then remove from the fire, skim off all the fat, and serve for use. Other occasional additions to beef-tea, which will agree with all ex- cept the most delicate stomachs, are (though not both at once) raw egg and cream. Dr. J. F. Meigs' Gelatin Food. Soak for a short time in cold Avater a piece of prepared gelatin two inches square. Boil it, then, in half a pint of water until it dissolves, which will take ten or fifteen minutes. Rub a teaspoonful of arroAv- root into a paste Avith a little cold water, and stir it into the gelatin water at the end of its boiling. Add also from six to twelve table- spoonfuls (according to the child's age) of milk, from one to four table- spoonfuls of cream, and a moderate amount of loaf-sugar. Imitation of Mother's Milk (Dr. A. V. Meigs). Obtain from a druggist packages of pure milk-sugar containing, each, seventeen and three-quarter drachms. Dissolve one package in a pint of hot water. Mix together two tablespoonfuls of cream, one of milk, two of lime-water, and three of the milk-sugar water. AVarm this mix- ture, and add it to the pint of solution of milk-sugar in hot water. It is then ready for use. The packages of milk-sugar, while dry, will keep for a long time. The solution of it should not, in hot weather, be kept on hand for more than a day or two, at most Egg Broth. Mix tAvo ounces of pearl sago in half a pint of cold Avater, and let it stand half an hour. Then boil it until it becomes smooth and suffi- 638 DOMESTIC MEDICINE. ciently thick. Beat the yolks of four fresh eggs with half a pint of cream; then mix with the sago, and stir the Avhole well with a quart of beef-tea, or chicken-broth, just made and at boiling heat. Egg with AVine. Beat up a raAv fresh egg, and stir with it one or two tablespoonfuls of Sherry Avine. This, as Avell as the preparations that next follow, is only suitable Avhere stimulation is required, under the advice of a physician. Caudle. Beat up a raAv fresh egg with a wineglassful of Sherry Avine, and add it to a half pint of hot oatmeal, Indian meal, or farina gruel. Flavor with lemon-peel, nutmeg, and sugar. AVine AVhey. Boil half a pint of milk, and Avhile boiling add half a glass or a glass of Sherry or Madeira wine. Strain off the curd through muslin or a sieve. Sweeten the whey to taste, and grate upon it a little nutmeg. Milk Punch. Into a tumblerful of milk put one or two tablespoonfuls of Avhisky, brandy, or rum. Sweeten, and grate nutmeg upon it. In some very low states of the system, punch may be directed by physicians made still stronger than this, even as much as a tablespoonful of Avhisky to one of milk; but the use of such a powerful means of alcoholic stimu- lation needs great skill and judgment. Koumiss. This mildly stimulant and someAvhat nourishing Tartar and Russian drink is made by fermenting mare's milk. It may be quite well imitated, however, by adding to a quart of cow's milk a teaspoonful of granulated white sugar, and a teaspoonful of brewer's yeast, and leaving the mix- ture to ferment in a covered vessel or corked bottle. AVhen this change has shown itself by the bubbles of effervescence, it is ready for use. If kept for any time, it should be in strong bottles tightly corked (the corks tied down) and in a cool place. Roast Oysters. Convalescents can sometimes relish and digest these sooner than any other solid food. (I speak partly from a personal experience, after typhus fever.) Place a dozen fresh oysters (that is, not long out of their native water) FOOD OF THE SICK. 639 in the shell (which is closed of itself if they are good) upon a moder- ately strong fire, and allow them to remain there until their shells open a little. Then take them from the fire, open them at once, retaining the juice if possible, and serve them hot, with perhaps a little black pepper, and salt if needed. If the " hard part" is at all tough, it had better not be eaten. To Keep Ice for the Sick. Cut a piece of clean flannel about eight inches square. Put this (after making a small hole in its centre) over the top of a glass tumbler, press- ing the flannel doAvn to half or more of the depth of the tumbler. Then bind the flannel fast to the tumbler Avith a tape or cord. AVhen ice is put into this flannel cup, lay over it another piece of clean flannel, three or four inches square. So covered, it will keep for hours, even in warm weather. Flour Food for Infants. Let from five to ten pounds of selected wheat flour be packed in a bag so as to form a ball, tied with a strong cord, and boiled with the water constantly covering it from four to seven days. The starch ap- pears to be so changed that it is more soluble and more quickly and easily digested. It not necessary that the water be constantly boiled, provided that it remain hot or warm—the fire may go out at night. The same change may be effected by dry heat, the flour being placed in pans in the oven or on the stove, but it is very liable to be scorched by an excess of heat. The flour removed from the bag and deprived of its external por- tion, which is wet, resembles a piece of chalk, but it has a yelloAvish tinge. The flour should be grated from it as it is required for use, and sifted to separate the small lumps which are likely to be broken off by the sieve. The infant will be better nourished if instead of diluting the milk with which it is fed Avith plain Avater, a thin gruel prepared by boiling a few minutes this flour in water, be employed. Two heaped teaspoonfuls of the flour to a pint of water suffice for infants under the age of three months, three teaspoonfuls for infants betAveen the ages of three and six months, and four teaspoonfuls to the pint of Avater after the age of six months. The proportion of the gruel to the milk should be the same as stated above when pure water is employed. 640 DOMESTIC MEDICINE. GIVING MEDICINES. No one who cannot read should pour out a dose of medicine. Bottl™ containing poisonous drugs should be labeled Poison, and such should, Avhen practicable, be kept apart by themselves; and should, especially, never be left Avithin the reach of children. Before pouring out or otherAvise preparing a dose of medicine, look carefully at the label. No medicine should ever be kept in a bottle or other receptacle with out a label. If a bottle Avhich has contained one medicine is Avanted for another, let it be thoroughly washed with hot water; and, on putting something neAV into it, change the label at once. If there is any doubt about the medicine in a bottle, throw it away, do not venture to use it without being sure of its nature. After looking well at the label, before beginning to pour from the bottle, turn the labeled side aAvay, so as not to pour over it; as some Fig. 204. MINIM GLASS. GRADUATED MEDICINE GLASSES. drops are apt to run down on the bottle, and might thus stain and ob- scure the label so that it could not be read. Dropping medicine requires care and skill. To do it, moisten one edge of the top of the bottle with the contents of the bottle, and then, holding and tilting the latter in the right hand, with the left very slowly and cautiously Avithdraw the cork or stopper, until a drop rolls out. As this comes out, at once push the cork in, and then repeat the same proc- ess again and again, until the right number of drops has been obtained. To give medicine (or liquid food) to a patient too ill to be lifted up in the bed, a bent glass tube is very convenient; and so are the half- covered spoons and cups sold by apothecaries. Glass vessels with the quantities marked on them are convenient. GIVING MEDICINES. 641 Some small ones are graded to minims; a minim is one-sixtieth part of a drachm. A drop of water is about a minim; two drops of lauda- num make a minim; between three and four drops make a minim of chloroform. This is because the size of the drops of different liquids is so different. Apothecaries' Measure. 60 minims ("l) . . Make one fluidrachm, f5. 8 fluidrachms . " " fluidounce, f§. 16 fluidounces . " " pint, O. 8 pints .... " " gallon, C. Apothecaries' AVeight. 20 grains (gr.) . . Make one scruple, 3 scruples, or 60 grains . " " drachm, 8 drachms ... " " ounce, 12 ounces ... « « pound, Common Measures. Equals about 1 teaspoonful. " " 1 dessertspoonful. " " 1 tablespoonful. " " 1 wineglassful. " " 1 teacupful.* Metrical System. This is a decimal system ; that is, all the divisions are reducible to tens, tenths, hundreds, hundredths, thousands, thousandths, etc. Be- ginning, first, to be used in France, its employment is now spreading (especially among scientific people) into all countries. The meter (about H yard, or 40 inches) is the standard of length; the liter (about a quart), of bulk or capacity; the gram (about 15 grains), of weight. A kilogram (1000 grams) is about equal to 2| pounds Troy, or 2\ Avoirdupois pounds. A millimeter is nearly 3V of an inch; a centi- meter, nearly f of an inch; a decimeter, not quite 4 inches; a deca- meter, ten meters, or nearly eleven yards; a hectometer, a hundred meters; a kilometer, a thousand meters, or more than half a mile. A milliliter is a thousandth part of a liter; centiliter, a hundredth, and * Many teacups at present in use, however, are smaller than this; not holding more than two or three fluidounces. .Variation exists also in tea and table spoons; but not to so great an extent. By a wineglassful is meant what will fill an old-fashioned Ma- deira-wine glass; not a hock or champagne glass. 41 9. 5. 5. ft. 1 fluidrachm . 2 fluidrachms. | fluidounce . 2 fluidounces . 4 fluidounces . 642 DOMESTIC MEDICINE deciliter a tenth part of a liter; a decaliter ten liters, hectoliter a hun- dred, and kiloliter or store, a thousand liters. A milligram is the thou- sandth part of a gram; centigram one-hundredth, and decigram one- tenth part of a gram; a decogram ten, a centigram a hundred, and a kilogram one thousand grams. These measures and Aveights are not yet much in use in this 'country; but they Avill probably, some time, be- come universal. Medicine bottles or similar fixtures should never be kept in sight of a patient; nor should the mixing, dropping, etc., be done where he can see it. If but one room is available, a screen had better be made (of a small clothes-horse, for example, with shawls, etc., hung over it) behind which such things may be attended to. AVhen possible, the next room, or a table in the adjoining entry, will be better. The times for the administration of medicines Avill, of course, be directed by the doctor. They had better, in all serious and continued illnesses, be written down as soon as ordered, to prevent mistakes. In the absence of a physician, no medicine should ever be given without a clear and good reason for it. The idea that somebody must " do some- thing " always for sickness, Avhether anybody present knoAVS Avhat to do or not, is absurd. Such may turn out to be " deadly doing," indeed. Better do nothing at all than risk harmful interference with nature. EXCRETIONS. 643 EXCRETIONS: DISCHARGES. Enough has been said under Hygiene, and Purgative Medicines. etc. upon the general subject of the necessary action of the skin, kid- neys, and boAvels. AVhen a patient is ill enough to be confined to his room, care must be taken by those in charge that the air of the room be not tainted by his discharges. No vessel should ever be left for a moment uncovered; and none should remain in the room after being used longer than is unavoidable at the time. AVhen it is important for the physician to examine the discharges, the vessel should be kept away from the chamber; out of doors if possible, or in a ventilated water- closet. As soon as the doctor has finished his inspection, let the vessel be at once emptied and Avashed with hot water. Hot soapsuds will be better. AVhen the disease is contagious or infectious (or even is suspected of being so), the vessel should, every time, be disinfected by adding to the water with Avhich it is washed a tablespoonful of a strong solution of permanganate of potassium, of corrosive sublimate, or of chlorinated Fig. 205. BED-PAN. SLIPPER UBINAL. soda. (Carbolic acid has been much used in this way; but it is less effectual than the above articles, and is much more disagreeable.) AVhen a patient is strong enough to get into a bed-chair, it should be placed close to the side of his bed; and then he can be helped to it by one, or, if very heavy, two persons; one supporting the head and shoul- ders, and the other the lower limbs. In most cases of typhoid fever, and in many other prostrating dis- eases, the patient has to remain in bed, and use a bed-pan; sometimes, a urinal. Either must be warmed before being placed under the patient. If his head and shoulders can be raised moderately, it will assist him. Some nervous patients cannot relieve themselves, especially the bladder, while any one is looking at them, or even is in the room. In low states of fever, retention of urine, which the patient cannot evacuate, is not uncommon. As already said, this must be remembered 644 DOMESTIC MEDICINE. and AA-atched for. If the amount passed is very small, or none, the loAver part of the abdomen should be examined. A full bladder will make that region firm, perhaps a little swollen, and giving out a dull sound Avhen lightly tapped (percussed) with the finger. In such a case, a catheter must be introduced; twice at least in tAvcnty-four hours, to draAV off the water. (See Catheter, on a previous page, under Reme- dies.) If nothing conies away through the catheter, there is suppres- sion of urine, which is a very bad sign indeed. See page 562. In persons AArho have had an injury of the spine, or avIio suffer from severe disease of the spinal marrow, the discharges from the bladder and bowels may come away involuntarily; perhaps without being felt by the patient. There must then be frequent inspection and attention by others, not only for the sake of cleanliness and comfort, but to prevent irritation of the skin, as well as contamination of the air of the room. Foul odors are always a sign of the presence of something unwholesome, making the air unfit to breathe. To prevent such odors is best. AVhen they cannot be prevented, airing the room well (with care to protect the patient from cold draughts) is the next best thing. Disinfectants strong enough to have much influence upon its atmosphere can hardly be used in an occupied room. Burning grains of coffee on a heated shovel is the most agreeable way of concealing or modifying unpleasant odors in an occupied apartment. SLEEP. 645 SLEEP. As important as food it is for every sick person to get an abundance of sleep. Disease often conflicts Avith nightly rest; where there is de- lirium, it is more likely to be present at night than in the daytime. Quietness, of course, is a prime necessity when sleep is sought; quietness of mind as well as of the body" and of sights and sounds in and around the sick-chamber. The night-light had better be in the next room, with the door open, or in the passage outside; if in the room with the patient, the flame must be screened from his eyes, and the light must not be a bright one. Bathing the arms and hands, legs and feet, Avith whisky and hot water (half and half) near the ordinary sleeping time, is a good tranquillizing measure. For remedies for sleeplessness, see on previous pages, what has been said of anodynes. Such should not, as a rule, be given without medical advice. No sick person should ever be waked, when sleeping, if it can possibly be avoided. It becomes a question, in some cases of great prostration, Avhich is most necessary—unbroken sleep or frequent nourishment. In typhoid and typhus fevers, there is mostly a drowsy habit; so that, after being aAvakened to take liquid food, the patient soon drops off to sleep again. In such cases, it is right to rouse him every hour or two to take something, lest he " slip through our fingers." I remember well, when going through an attack of typhus, the dreadful feeling of " goneness " on waking from an hour's sleep; relieved for the time by a tablespoon- ful or two of milk. In severe illness, the time of greatest weakness usually is between one and three o'clock in the morning. When sleep or drowsiness follows a severe blow on the head, it should be indulged and encouraged. It is then very needful, to allow the brain to recover from the severe shock. Quite otherwise is the case when stupor results from poisoning with opium (laudanum or morphia). Then profound sleep may end in death. The patient must be kept awake if possible, even by rough means; as slapping his back or limbs, or making him walk about. This is the only exception -to the important rule, that sleep is nature's restora- tive, not only from fatigue, but also from sickness. 646 DOMESTIC MEDICINE. MENTAL MANAGEMENT. In this, the nurse's judgment is sliOAvn as much as in anything else. A nurse must never be " gossipy "; must, indeed, seldom " talk " at all, beyond quietly asking and answering necessary questions. As few questions as possible should be asked of a patient. His wants should be anticipated and provided for. Never, for example, ask whether he Avould not like this or that article of food. Bring what is suitable, in as pleasant a way as can be; and, when it has been taken or refused, remove at once all dishes, etc., out of sight. Of all things, do not tell a sick person about others who have lately died of the same complaint, or any other doleful neAVS. As to his own case, encourage hope, without falsehoods; which are inexpedient as well as immoral. AArear a cheerful countenance, always, in the sick-chamber. Yet the sufferer must know that he has your sympathy. If there is delirium, do not contradict or argue against strange imag- inings. Rather accept them, silently; or, if a reply be wanted, turn them in the quietest way from anything disturbing. Visitors often do much harm to sick people. One person in the room at a time should be the rule in serious illness, and that one as near as the mother, wife, sister, or nurse; that is, one of these in turn Avith the others. It is intolerable cruelty, or else suicide, for one woman or man, alone, to be allowed to remain constantly, day and night, for weeks to- gether, in charge of a very ill patient. But the general principle is, that patients having fever, of any kind, and those having nervous symp- toms, should see no company. Even near and dear friends should be excluded, and should only send kind words of inquiry and sympathy. This often seems hard, but it may turn the scale at critical times, and ought to be insisted on. Chronic diseases, such as consumption, dropsy, etc., Avill often bear a moderate amount of company; but each case should be judged of for itself by the medical attendant. Convalescent patients, whose fever has all gone, will often benefit by seeing new faces, at least those of old friends, though even their visits should not be long. Change* is generally a good thing during convalescence. If the room of the patient cannot be safely or conveniently changed, alter the * Change of position in bed, so far as to sit propped up, is refreshing, when strength allows it. For this, in the absence of a " bed-chair" or frame made for the purpose, a common chair may be used, placing it upside down behind the pillows, so that the back of the chair makes an inclined plane. RUBBING: MASSAGE. 647 arrangement of the chairs in it, and of the pictures on the wall. Let flowers be put in sight. SomehoAV, make from time to time fresh and agreeable impressions, to remove those which illness has left. Yet much excitement or mental effort must be guarded against, as the brain and nerves are often Aveak and sensitive for some time after illness with fever. RUBBING: MASSAGE. Systematic rubbing over the muscles and other parts of the body is noAV often used, as a means of quickening a slow circulation, and re- moving torpor of nutrition and other functions. Such rubbing and kneading is massage, or manipulation. A rubber is, in French, a masseur; if female, a masseuse. It is an ancient practice, even among savage peoples; the lomi-lomi of the natives of the Sandwich Islands is an example of it. It has been familiar to the Brahmins of India, and is traced back as far as to the Egyptian priests, before the time of Hippocrates. It is uoav employed chiefly in cases of general debility and nervousness, with patients who are not in a condition to use much, if any, muscular exercise. Hoav it is done, is thus told by Dr. S. AVeir Mitchell, in his little book, " Fat and Blood, and Hoav to Make Them ": " An hour is chosen midway between two meals, and the patient lying in bed, the manipulator starts at the feet and gently but firmly pinches up the skin, rolling it lightly between his fingers and going carefully over the Avhole foot; then the toes are bent and moved about in every direction; and next, Avith the thumbs and fingers, the little muscles of the foot are kneaded and pinched more largely, and the interosseous* groups Avorked at with the finger-tips between the bones. At last the ankles are dealt with in like fashion, all the crevices between the articu- lating bones being sought out and kneaded, while the joint is put in every possible position. The leg is next treated, first by surface-pinching and then by deeper grasping of the areolar tissue, and last by industrious and deeper pinching of the large muscular masses, which for this pur- pose are put in a position of the utmost relaxation. The grasp of the muscles is momentary, and for the large muscles of the calf and thigh both hands act, the one contracting as the other loosens the grip. In treating the firm muscles in front of the leg, the fingers are made to roll the muscles under the cushions of the finger-tips. At brief intervals the * Between the long bones of the foot. 648 DOMESTIC MEDICINE. manipulator seizes the limb in both hands, and lightly runs the grasp upwards, so as to favor the Aoav of venous blood-currents, and then returns to the kneading of the muscles. The same process is carried on in every part of the body, and especial care is given to the muselcs of the loin and spine, Avhile usually the face is not touched." At first this is continued for but half an hour at a time; gradually it may be increased, if it appears to agree with the patient, to an hour daily or every other day. Men who are very hairy had better have the limbs and breast shaved, to prevent the irritation of the skin from pull- ing the long hairs, which sometimes even causes sore pimples or boils. Every " rubbing " should be folloAved by at least an hour's entire repose. Dr. Mitchell advises that, after the first few days, cocoa-oil or vaseline shall be used to rub Avith. I believe this to be a very beneficial ad- dition to massage, one not appreciated as highly as it deserves to be. Some oil is absorbed, with not only a soothing, but also even a nourish- ing effect. Cod-liver oil is sometimes thus employed, especially with feeble children. AVhen there is tenderness anyAvhere, rubbing should be practised alt around the sensitive part, gradually approaching it. In this Avay, as over the spine, or on some part of the abdomen, it can be at least all included in the manipulation, removing the tenderness, to great ad- vantage. AATiether rubbing will do good or not, depends largely on the judg- ment and skill of the masseur or masseuse. Dr. Mitchell's advice to disregard such effects as increased nervousness and loss of sleep, is, as I knoAV from observation, not sound or safe. " Professional" rubbers sometimes think they must rub their hour through, if they risk rubbing out the patient's life; and thus they may do harm to feeble patients. If the patient" feels worse " after the hour's massage, the length of time given to it had better be lessened, and the interval between times increased. Electric massage is practised by lightly passing over different muscles and other parts a metallic brush of fine wire, connected Avith a battery.* * To show what refinement of procedure is brought into " rubbing " by some prac- titioners, the following extract is taken from a medical journal: "The Technique of Massage.—Dr. Benster summarizes the method of practising massage, followed by the French, as follows: 1. Effleurage, gentle friction, consists in making long, gentle, centripetal strokes along the course of the veins and lymphatics with the oiled hand. The pressure is intermittently firm and gentle, so made as to produce a sort of passive peristalsis. 2. Massage d, friction, the rubbing stroke. 1 *'ia is accomplished by making elliptical strokes perpendicularly to the long axis of the limb with the finger-tips of one hand, while the fingers of the other hand pass from above downwards, parallel to the axis of the extremity. A subdivision of this class is the massage par ondulation, as used by Laisne in lumbago. 3. Petrissage, kneading, is MANAGEMENT OF LABOR. 649 MANAGEMENT OF LABOR. Before entering upon this, it will be well to go back so far as to con- sider the signs of pregnancy. First, usually, is the cessation of the menses. This may, of course, happen, in the married as Avell as the unmarried, from cold, mental disturbance, or other causes. But, with the married, in the absence of any such causation, it is to be noted as probably indicating what is to come. In the first month, morning sick- ness is generally a conspicuous sign; but it varies much in severity. Some scarcely feel it, Avhile others are prostrated by it for months, only obtaining relief with parturition. Moderate nausea and vomiting, during the first and second months, are the rule. Quickening, toward the end of the fourth month, is the first feeling by the mother of the movements of her child. It is a popular error to suppose that the child only then begins to live; it is a living being from the time of conception. In the first month, there is some sinking to be seen in the region of the navel, afterward, at least in two months more, that region begins to fill up and expand. Enlargement of the abdomen is not marked until at least the third month. It becomes conspicuous by the fifth or sixth. The breasts enlarge quite early. The " areola," or space around the nipple, often grows brown, with glandular lumps or tubercles in it. Physicians obtain other evidences of pregnancy by careful examination (especially hearing the sounds of the fcetal heart on auscultation of the abdomen). But when those signs just mentioned are all present, there can be no doubt; quickening, of course, if certainly felt, being the most conclusive. Discolorations of the skin over the abdomen are frequently observable in the seventh and eighth months. Swelling of the veins of the feet and legs is not uncommon about the same time. In the ninth month, vomiting occasionally returns; sometimes the pressure upwards causes difficulty of breathing. During the last week or two, hoAvever, before delivery, the abdomen often " goes down " perceptibly, relieving the breathing, but making walking uncomfortable. One who has piles, at such a time is apt to have them swollen and troublesome. made always in a direction from the periphery toward the centre, and in such a way that the morbid tissues are seized by the hand, raised up and kneaded. This is em- ployed in oedema of the skin, infiltrations into the subcutaneous connective tissues, and on muscles which have lost their pliability through infiltration, inflammation, or con- tractures. 4. Tapotement consists in a tapping or beating of the diseased parts by the finger-tips, the hollow hand, the side of the hand, the fist, the percussion-hammer, or a little rubber ball fastened to a piece of whalebone. This is employed chiefly in neuralgia."— Wiener Medicinische Wochensehrift, October 27, 1883. 650 DOMESTIC MEDICINE, Constipation of the boAvels is frequently present during pregnancy, with, in a certain number of cases, deficient secretion of water by the kidneys. Both of these are results of the pressure of the greatly en- larged womb upon the intestines, and upon the large blood-vessels, inter- fering more or less Avith their usual circulation and functional action. Keeping the bowels open is important, all through; but gentle meaiiH must be used. Such are, oatmeal mush or gruel; fresh or steAved fruit, especially prunes; rhubarb; sulphur; and small doses of mild salines, as Tarrant's Powder, or Piillna, Friederickshalle, or Hunyadi Yanos waters. For scanty secretion of urine, cream of tartar is a safe mv its sutures and fontanelles. (See Anatomy.) The sutures are rough lines, easily felt; the fontanelles are spaces Avhere the sutures meet. The pos- terior fontanelle is the one most desirable to find coming towards the central portion of the vaginal outlet. It is smaller than the other, aud is made by the meeting of three suture-lines (see Fig. 207). The ante- rior fontanelle is larger, is on the top of the front part of the head, and has going out from it four suture-lines. More unfavorable than the presentation of the occiput toAvards either side, is that of the face. Fig. 207. SKULL AT BIRTH, SHOWING THE FONTANELLES. Subject to much uncertainty as to its progress, and requiring skilful management, is presentation of the breech. Sometimes the knees or feet present, or a shoulder, or a hand. All of these, and their treatment, are described and considered, Avith their treatment, in professional works. Through the second stage of labor, the nurse should promote the sufferer's comfort and encouragement, by all the attentions that intelli- gent sympathy will suggest. She may want her back to be firmly pressed during each pain. She had better not get out of bed during this stage, but she may find relief in occasional changes of position. Do not urge her to " bear doAvn," as that -will come of itself. Give her cold Avater to drink, if she wants it. If the labor is long, she may have a cup of hot tea for refreshment. It seldom lasts less than an hour, and may continue all day or all night. AVhen the end of the second stage is at hand, a critical part of it is MANAGEMENT OF LABOR. 655 the stretching of the perineum; that is, the region just back of or be- yond the loAver part of the vulva (vaginal outlet). This may be rup- tured if the force of the final pains, with a large foetal head, be very violent; especially in a primipara, i. e. a mother in her first childbirth. Support may be, with great advantage, given to the perineum at this time. To give this support, as soon as any bulging there shoAvs that the child's head is approaching extrusion, part of it having already passed out, proceed as follows : if the nurse (in the absence of a physician) has to act, without loss of time, let her choose such a position (according to that of the patient) as will enable her, with either the right or the left hand, to place the palm firmly upon the perineal space (including the anus or outlet from the bowel), her fingers being spread out over the distended vaginal outlet. Now, with each pain, press, Avith a force as nearly as possible equal to that felt by the hand, upon the region cov- ered by the palm. For what ? To keep it from being burst open, or rent, an accident Avhich, if unavoidably it does happen, causes the patient great inconvenience and distress, often curable only by a surgical oper- ation. Another care must be taken by the nurse in the absence of the phy- sician. Sometimes the umbilical (navel) cord is around the child's neck, while it is being born. AAThen this is found so, by gently drawing upon it, it will mostly be easy to turn it off oyer the head. If this cannot be succeeded with, let the cord at least be loosened from the child's neck so as not to strangle it; and then, the head being already delivered, it will be proper to aid the delivery of the shoulders and trunk, during each pain; first by a finger in the nearest armpit, and afterwards by drawing gently upon both shoulders. Much the greatest difficulty and delay always belongs to the head delivery, whether it comes first or last to the birth. AVhen the child is actually born, it should be laid down in a conven- ient position, with the face uncovered and the body protected by some light covering at hand—not so far from the mother as to stretch the umbilical cord. Third Stage. Now, the placenta (afterbirth) is to be detached from the uterus, as well as separated from the body of the infant. All through gestation it has been the means of communication, by which nourishing and aerated blood was given by the mother to the " foetus," which, surrounded by fluid, could neither eat nor breathe, but lived much like an oyster, or like a silkworm or butterfly-pupa in a cocoon. AVith the beginning of respiration, the child has no farther need of this direct connection; the cord may be cut, and soon the womb then throws out the afterbirth 656 DOMESTIC MEDICINE. by its own contraction. It is well to promote this, by the nurse placing a hand upon the abdomen, and gently compressing the upper portion of the uterus. If it rapidly shrinks in size, and at the same time feels hard% that is all right. If it does not, but, in spite of gentle rubbing with the finger-tips, remains large, loose, and flabby, the placenta may be sIoav to come aAvay, or, Avorse, there may be " flooding," i. e. hemor- rhage. Suppose there is flooding, at the end of either the second or the third stage of labor, and the doctor has not come; Avhat is to be done? Keep up gentle rubbing with the fingers over the womb upon the surface of the abdomen. Send for ice, and pass a piece of it as large as a walnut slowly over and around the place Avhere the womb is felt under the hand. Raise the pelvis (region of the hips) of the patient by a pillow placed under it. Dip a sponge in iced vinegar, or cut a lemon in two, and squeeze it high up in the vagina. If these measures fail, try, in- stead, hot vinegar and water (equal parts of vinegar and water as hot as the hand can bear it) in the same way. Besides all these things, as wine of ergot ought always to be within reach when labor is expected, give half a teaspoonful of this every fifteen minutes from the beginning of flooding, or even without hemorrhage, if the womb does not contract firmly after the childbirth has been accomplished. But a slight bloody flow must not be considered a hemorrhage. AVe call it such when the amount is to be estimated at least in teacupfuls; the patient also becom- ing pale, cold, and faint, with sighing, and a small though commonly rapid pulse. It may be here noted (though not exactly in regular order) that when- ever bleeding from the womb occurs during pregnancy before the full time is up, as in any month previous to the end of the ninth, medical advice should be at once obtained. It tlireatens either abortion (mis- carriage) or misplacement of the afterbirth (placenta prsevia); which is very dangerous, both to mother and child. Mostly, in half an hour, more or less, the afterbirth will come away of itself. It must not be dragged out; gentle drawing upon the cord is all that will be safe. To pull hard upon it before it is separated from the womb might end in inversion of the womb; turning it inside out; a very ugly accident. Removal of an adherent placenta is an operative procedure to be ventured upon only by professional hands. Meamvhile, the cord having been cut shortly after the child showed, by its cry, that it breathed, and was ready for an outside life, some one must give proper care to it. It must be rubbed all over with lard, SAveet-oil, or vaseline; then all this and the material on the skin from the Avaters, etc., must be washed away Avith warm soap and water. A MANAGEMENT OF LABOR. 657 soft rag Avill be as good as a sponge for this purpose; a bath-tub being ready in Avhich to immerse the babe. Sponges are uoav banished from the lying-in room by many practitioners. No sponge ought ever to be used twice about a sick or Avounded human body; and a lying-in woman may be regarded as both sick and Avounded. Taking a fresh neAv sponge everv time is expensive; and so soft linen rags, napkins, etc., Avill mostly answer best. These, after once using, must be either burned, or boiled thoroughly before being brought into the room again. After well drying the infant, a two-inch square piece of linen may be pierced in the middle with scissors, smeared Avith vaseline or simple cerate, and put over the end of the navel-cord; which has been cut within about two inches of the child's body. Glancing backAvard, it may be here said, that it is best for the cord to be, in the first instance, tied in two places and cut between ; unless, at least, we are quite sure there is not a twin babe still to come. Some practitioners consider the second tying best anyhow, as promoting the contraction of the womb by retention of blood in the placenta; but this appears to me very doubt- ful. Suppose, hoAvever, that a child, AArhen brought into the Avorld, does not breathe Is it still-born? It may be; but perhaps not. Feel whether the umbilical cord pulsates; if it does, the child is not dead. Do not cut the cord iu that case. Keep up communication Avith the mother a little longer, until the child has a chance to get breath. Then, put a clean handkerchief-end, or something like it, over the forefinger, and pass it back over the child's tongue, to clear the mouth and throat of phlegm. Lay the child on its right side (for which there is a reason; see Physiology). Dip the end of a towel in cold water and slap its back several times Avith it. Have hot Avater put into the small bath-tub, and (Avhen the cord has stopped pulsating, and has been tied and cut) place the child in that; and, Avhile there, sprinkle cold water in its face. If it still does not breathe, use artificial respiration, thus: dry and cover it quickly, and then, holding its nose Avith a thumb and finger, take three deep breaths, and empty the lungs into the air fully as often; next, put your mouth over the baby's mouth, and blow, with considerable, though not excessive, force, into it, hoping thus to expand the lungs. Do this about twenty times a minute, which is a little oftener than your own natural breathing. MeanAvhile, some one else may raise the child's arms over its head while you blow into its mouth, and, when you cease that, bring its elboAvs down and press. against its two sides, to aid in expelling the air. Another way is to hold the child with your hands under its armpits, and swing its body and legs over your head and back again, repeatedly. 42 658 DOMESTIC MEDICINE. Once more returning to the mother; she must, after some minutes of partial repose (much longer if threatened Avith hemorrhage) be cleaned up by the nurse. Plenty of Avarm Avater and soap (to Avhich may be added some one of the antiseptic solutions before mentioned; say a tablespoonful of it to a pint of Avater) must be used. Towels or napkins are to be (as already explained) preferred to sponges. After this clean- ing, a large soft napkin should be placed well up between the thighs; the pelvis may be gently lifted, and the soiled sheet (and upper rubber- cloth, if there be two of them) draAvn aAvay, the clean sheet being then brought down under her. Lift her (Avithout raising her head) into a comfortable position in the bed, place a long toAvel or " binder " around Fig. 208. BREAST SUSPENDED. her body, and leave her for an hour or tAvo of perfect rest. If it should be three or four hours, with quiet breathing and general appearance of comfort, so much the better. After pains are, if felt at all, likely to be later. They need not be the occasion of any treatment, unless uncom- monly severe and long-continued. If so, half a tablespoonful of pare- goric may be given at or after usual sleeping time, to relieve them aud procure sleep. Within a few hours, as a rule, the baby should be put to the breasL The first milk (colostrum) is laxative, and thus beneficial. The act of suction promotes the secretion of milk, which is good for both mothei MANAGEMENT OF LABOR. 659 and child. While the mother is doing Avell, every tAvo hours, day and nio-ht, Avill not be too often for its nourishment. Gradually (as ex- plained under Hygiene of Infancy) the time may be lengthened, first at night. A child five or six months old ought to be trained to sleep all night (at least six hours) without the breast. Inflammation of a breast is least likely to happen Avhen both of the breasts are in turn emptied by the infant, AVhen a babe dies, the milk, if not at once dried up, should be draAvn out at intervals Avith a breast- pump, so as to cease gradually to be secreted. The best thing to bathe a hard and sore breast (threatening inflammation and " gathering " or abscess) with, is camphorated oil; SAveet-oil saturated Avith as much gum- camphor as it will take up. Sore nipple is occasionally very troublesome. Let the nipples be ahvays gently Aviped dry Avith a soft napkin after suction. If at all sore, bathe with pure lime-Avater, equal parts Avith oli\Te-oil, or paiut Avith glycerin, equal parts Avith rose-Avater. A cracked nipple (very painful Avhen touched) may be best treated by painting it (Avith a camel's-hair pencil) several times a day with compound tincture of benzoin. Earlier than such breast-troubles, is the time for danger of fever to the mother. A slight rise of temperature, and moderate quickening of the pulse, commonly called " milk fever," about the third day, is not alarming. A chill, followed by fever Avith very rapid pulse, severe pain in the abdomen, and stoppage of the vaginal {"lochial") discharge, lead to a suspicion of the onset of puerperal fever. AVe Avill consider this hereafter, in its place among Special Diseases. Prevention of puerperal fe\Ter is best secured by all the conditions and surroundings most favorable to healthy living. In a pure atmosphere, when perfect cleanliness is observed, and no possible communication ex- ists Avith any other sick person, it is not likely to occur. It is a disease preeminently of croAvdecl lying-in hospitals, and other uncleanly and ill- ventilated places. Recovery after child-labor must be favored by quietness and a simple but nourishing diet. Such a patient does not need to be stimulated; neither ought she to be starved. Oatmeal gruel first, then milk and broths (chicken soup is the most delicate), and in a few days, if she have no fever, meals of solid food may be given. Should a parturient Avoman sit up soon? No. A\rorking-women often have to do so. I remember one patient of my own whom I saw at the Avashtub the day after her babe was born. She suffered, in con- sequence, a womb-trouble lasting for years. Those who can do so (and employers ought to make it possible for all) should give nature time for everything to be restored to its ordinary state. On a moment's thought, 660 DOMESTIC MEDICINE. any one may perceive that this cannot at once take place. The uterus, so long distended to many times its ordinary dimensions, must return gradually to these. Its internal surface, from Avhich the placenta was detached, must heal, like a torn wound. The abdominal muscles and other tissues also have been stretched greatly by the foetal growth, added to, someAvhat, by its " bag of waters." They, too, must have time to shrink and regain their tone and elasticity. All these changes require time, and a mother is likely to do best, on the whole, Avho docs not sit up in bed under three, four, or five days, and does not leave her bed for the traditional nine days at least. Delicate Avomen may often require a longer time for entire recovery. PAET iv. SPECIAL DISEASES. IX order to make reference to this part of our book as easy and con- venient as possible, an alphabetical arrangement Avill be used. Ac- cidents, Injuries, Poisons, and Sudden Death will be treated of after our account of diseases has been concluded, making the last portion of this book. My purpose now is to give a brief account of all the disorders upon which a general and unprofessional reader is likely to need information. Of these, some will require only to be defined, so that their names will be understood Avhen met Avith. Others Avill be described, so as to be known when occurring in the family; and of these, the proper domestic treatment, in the absence of a physician, will be set forth. It should be understood that in many instances there are other remedies which are used by physicians, for the disorders spoken of, Avhich it would not be safe for an unprofessional person to give or take Avithout advice. For the full history of diseases and their medical management, technical works on the Practice of Medicine must be consulted.* For the doses and other particulars concerning the medicines mentioned in this sec- tion, see Remedies (pages 553, etc., and 615). Abdominal Dropsy. This troublesome affection is called ascites in medical books. It may be a part of general dropsy, or it may occur by itself. AAre knoAV its existence by the swelling of the abdomen evenly all over; dulness on percussion (tapping with the end of a finger) instead of the usual holloAV sound there, and fluctuedion. This last is got by placing a finger of the left hand upon the belly on one side, and then striking the other side gently with one or tAvo fingers of the right hand. We feel the liquid sent with ajar, so to speak, from one finger to the * See Flint's or Aitken's Practice; Hartshorne's Essentials of Practical Medicine; Reynolds' System of Medicine, American edition; American System of Practical Medi« cine; etc. 661 662 DOMESTIC MEDICINE. other. Verv thick fat may cause a slight dulncss on percussion ; a tumor may give a very dull resonance; but in neither of these eases Avill there be fluctuation. This may be present in ovarian (encysted) dropsv; but, in that, the SAvelling is not even all round. It begins on one side, growing toward the middle. Moreover, in common abdominal drops)- (ascites) the intestines float above the Avater, making a place of clear resonance on percussion about the navel. In ovarian dropsy this does not occur. Abdominal Dropsy is generally an obstinate complaint. Depending upon some disease already existing, of the liver, spleen, kidneys, or heart, or resulting as a part of general dropsy, from suppression (almost) of the secretion of perspiration and of urine; or, lastly, upon a thin and watery condition of the blood, it can hardly be cured Avhile those morbid states exist; and they are often incurable. Still, an important amount of relief may always be for a time obtained, and some cases may lie cured entirely. Remedies for abdominal dropsy are: diuretics,purgatives, and tapping. Diuretics are (as Avas said in giving an account of them under Rem- edies) uncertain in their action. Cream of Tartar, Juniper-berry Tea, or Compound Spirit of Juniper, Squills, and Watermelon-seed Tea, are the safest diuretics for family use.* Purgatives used to get rid of water in the abdomen are, besides Cream of Tartar, Jalap, Rochelle or Epsom Salts, and (under advice of a physi- cian only) in some cases Elaterium. HeaAry purgation weakens a patient, hoAvever; therefore moderation must be used with it. The strength of the patient must be considered. Tonics, as Iron, and alteratives, like Iodide of potassium, sometimes aid in recovery from Dropsy more than diuretics and purgatives. Tapping, of course, should never be undertaken by any but a pro- fessional hand. It is, simply, puncturing a small round hole in the water-swollen abdomen, and inserting in it a tube (canula) through Avhich the liquid can escape. The puncture is made with a trochar. The place for it is not far beloAv the navel. Some patients are tapped a number of times, to give relief to the difficulty of breathing (dyspnoea), from upward pressure of the Avater against the diaphragm (museular roof of the abdomen, under the lungs and heart). This is the most distressing symptom of severe and continued Abdominal Dropsy. Abortion. See Miscarriage. Abscess. Every large "gathering," or inflammation followed by * For the doses of medicines mentioned in this section of the book, look back, ui Remedies : page 615, and also, page 553 to 614. SPECIAL DISEASES. 663 suppuration (formation of matter or pus), may be called an abscess. A boil is a small abscess; a carbuncle a larger one; but abscesses are some- times much larger than either of these. Such, of various magnitudes, may form in the connective tissue under the skin, in the jaw near a tooth, in the tonsil, in the female breast, after childbirth, in the liver, lungs, brain, etc. In Pycemia, abscesses form in various parts of the body. They are not uncommon also after Typhoid Fever. An Abscess is usually painful from the start, with tenderness to the touch, showing inflammation. When suppuration occurs, there is usually a tendency toAvards " pointing," that is, softening of the skin (or of some internal tissue), and yielding, at last, of the surface, so that the Abscess " breaks," and the pus escapes. When this takes place at the outside of the body, or into the mouth, throat, or alimentary canal, re- lief is obtained safely, and recovery may be expected to follow. But Avhen it opens into the cavity of the pleura, outside of a lung, or into that of the peritoneum in the abdomen, much trouble is likely to result. It is often good treatment to anticipate the spontaneous opening of an Abscess, by opening it with a surgical knife. Only a professionally trained judgment should determine Avhen this is proper, and none but a surgeon or a physician ought to venture to perform such an operation. If unskilfully done, a tumor, or an aneurism may be cut into instead of an abscess; in the first case doing no good, in the second, endangering life by escape of blood. This last accident may attend the opening of a real abscess, if the knife happens to slip to one side, or to penetrate too far. AVhenever, therefore, the signs of an Abscess of any part appear, medical advice ought to obtained. It may be briefly mentioned, that some physicians have confidence in the effect of the early internal use of Sulphide of Calcium (gr. ^ to gr. I three times daily) in preventing threatened suppuration of an inflamed part; and that among the alleviating external applications employed for commencing Abscesses, Belladonna ointment, and Podoform mixed with Vaseline, are important to be remembered. Addison's Disease. A rare chronic affection, in which the skin all over the body assumes an appearance like bronze. After death, the most notable change found is, evidence of disease in the small bodies at the tops of the kidneys, called the supra-renal capsules. (See works on Practice of Medicine for a further account of it.) Ague, also called " chills," or chills and fever, and Pntermittent Fever. Certain neighborhoods furnish many cases of this; some parts of the world have never known it. It is a disease of the country, especially in marshy regions, and on the banks of sluggish streams, on all the continents. AVarm summers are necessary to its existence. It is pre- 664 DOMESTIC MEDICINE. eminently a disease of seasons, autumn especially, but also spring. Xo neAv cases originate after the first hard frost of early winter. Patients already affected, however, may, if not successfully treated, have their chills to continue all through the winter. Oue attack does not lessen, but rather increases, the individual's liability to the disease on exposure. Any one can recognize Ague when he sees it all through a paroxysm. First comes the chill or cold stage. Weakness, dulncss, headache, sick stomach, pain in the back and limbs, a feeling of coldness (though the skin may not be cold to the touch), Avith shivering, and paleness of the face, and blueuess of the lips and finger-ends: these are the symptoms. After a half-hour, an hour, or two, seldom more of the chill, comes the fever. Now the skin groAVS warmer, the face is flushed. Headache is severe; the pulse is rapid, the temperature becomes hot; Avith dryness of the skin and mouth, and thirst; the boAvels are constipated, and very little Avater is passed from the bladder. From two to four or five hours may be mentioned as the usual length of the hot stage. By degrees, the skin grows moist and cools doAvn ; the pulse slackens; thirst and headache diminish; and then the sweating stage conies on. AVith this there may be a copious discharge of urine. Thus ends the attack or paroxysm. A chill, with its following hot and sweating stages, may come enry day, Avhen it is called a quotidian intermittent; or every other day, named a tertian. Both of these are about equally common. After the third day, the seventh day is the most likely time of recurrence of a chill; once a week. Other periods are mentioned in medical books, as now and then met with ; but they are rare. Hardly any disease has so well-determined and reliable a method of treatment as ague. Since the Countess of Cinchon learned in Peru, and made known to the physicians of Europe, the virtues of Peruvian Bark, the world has possessed a true cure (very seldom failing) for this malady. The alkaloid principles, Quinia, Quinidia, Cinchonia, and Cinebonidia, have all the needful poAvers of the Bark, in much smaller doses than the Bark itself, and more acceptably to the stomach. Quinine is the sulphate of quinia. It is most generally depended upon; although sulphates of the other alkaloids named (and also quiu- oidine and dextro-quinine) will almost always succeed. If obliged to act, in the absence of a physician, in the care of a case of Intermittent, begin with quinine as soon as the sweating stage has fully come on. Many physicians give it in five-grain doses. My ex- perience leads me to consider it better to give one grain every hour (while awake), or two grains every tAvo hours, until at least fifteen or sixteen grains have been taken before the time when the next chill might SPECIAL DISEASES. 665 be expected. Under this dosing, that chill will not come, in at least ninety-nine out of a hundred cases. Then, the next day, let the patient take twelve one-grain, or six two- grain, quinine pills, or teaspoonfuls of a solution of quinine, eight grains to the fluidounce of water, with sixteen drops of aromatic sulphuric acid in each fluidounce. The acid is added to dissolve the quinine per- fectly. Each day let one grain of quinine less be given; until the seventh day. On that day, ten grains should be given. If no chill has yet oc- curred, then six grains every day for tAvo Aveeks will suffice. Most fresh cases Avill thus be cured; unless the patient lives in a malarial region, and no frost has yet killed, for the year, the local cause of the disease. But repeated exposures aud attacks may fasten the habit, so to speak, of having chills upon a person; that is, chronic intermittent. Qui- nine, in such cases, will break or interrupt the succession of paroxysms; but in three or four Aveeks they come again. AVhat are Ave to do now ? Give quinine as usual, so as to break the chills; and then begin at once with iron. It is a blood-medicine, and the blood is injured in malarial attacks. Let the patient take three pills every day for a month (or, if pale and weak, longer), each of which contains three grains of Vallet's mass of carbonate of iron, and one grain of sulphate of quinia (quinine). Outside of a positively malarious district, this will A'ery seldom (I have never knoAvn it once) fail to cure the complaint. It Avill not pay any one to remain as a resident in a place where he has contracted a chronic intermittent. It clings to one like the Old Man of the Mountain in " Arabian Nights." Better sell yrour beautiful country place, or giATe up your salaried business position, and move someAvhere else, rather than be run doAvn to a skeleton and have no enjoyment of life. Among the many substitutes for Quinine proposed and used in treat- ment of Ague, French authorities assert the power, next after the alka- loids of Peruvian Bark, of green or unroasted Coffee, made into a tea by boiling (decoction), and taken freely a feAV hours before the expected time of a chill. I have had no experience Avith this, Avhich I think is hardly known in American practice. Albuminuria. Presence of albumen (tested chemically) in the urine. Bright's Disease is principally recognized by this symptom. But there is often albuminuria without Bright's disease, and sometimes (not often) Bright's disease Avithout constant albuminuria. Scarlet feArer, diphtheria, and several other disorders, frequently have in their course that alteration in the condition and action of the kidneys which pro- duces albuminuria. Alcoholism. A general name for the results of intemperance; 666 DOMESTIC MEDICINE. Fig. 209. especially applied, hoAvever, to the sIoav poisoning and degeneration of the great organs of the body, liver, kidneys, heart, and brain, which end in ruin of the health and premature death. If these are not pre- vented, by abstinence or early reform of habits, they are not curable by medicine, and are very seldom recovered from. That is, after "gin- liver," or diseased kidneys, or a fatty heart, or an impaired brain, has shown that the fell destroyer has set his brand upon the victim of ex- cess, it is too late to restore perfect health in any Avay. Even then, reformation may greatly prolong life. At any stage, withdrawal of al- cohol is imperatively demanded. Anything is better than to die drunk. Alopecia. Baldness. (See Care of the Hair, under Hygiene.) Amaurosis. A name, not now much used by physicians, for blind- ness depending on disease or failure of the optic nerve or its centre in the brain. Milton's blindness was of this kind. " So thick a drop serene hath quenched these orbs." Gutta sercna was an old name for it; given because, unlike cataract and some other causes of blindness, it does not show, on looking at the eye, without the aid of an instrument (ophthalmo- scope). Amblyopia. Dimness or cloudiness of sight, short of blindness. The degree of this may vary in the same person, at different times. It is an important symptom, showing that the eyes are threatened, and must be taken great care of; but it does not necessarily end in blindness. Amenorrhcea. Absence or suppres- sion of the menses or monthly uterine floAV. Exposure to cold and wet, or mental agitation, may interrupt the menstrual process, after it has begun, or prevent it, when it is about to come. In such a case, rest and warmth, hot mustard foot-baths, or warm hip-baths, may reneAv it. Habitual absence of menstruation, one month after another, may occur under several circumstances. Weakening chronic disease, as pul- monary consumption, may be attended by it. Ancemia (poverty of blood) has to do Avith it in the greater number of instances. Occasion- ally it is met with in plethoric (full-blooded) women. Married women, or any Avho become pregnant, have cessation of the menses as the nr.it usual sign of that condition. OPHTHALMOSCOPE. SPECIAL DISEASES. 667 How great a degree of injury or inconvenience will result from Amenorrhcea, must depend on its cause chiefly, and on the state of the general system. A full-blooded Avoman may suffer with headache, and have risk of congestion of the brain. (Apoplexy is rare until after the time of the natural " turn of life," Avhen menstruation has ceased.) In an anamic subject, the poverty of blood appears to be the cause, not the effect, of the irregularity. We are first to be sure that pregnancy is not present. If it is, it is unsafe to interfere. Abortiou may be forced, but at the risk of the patient's life. (See Miscarriage.) Then, Ave ascertain whether she is plethoric or anaemic. If the former, a Ioav diet, purgative salts (p. 527,) and perhaps cut cups to the small of the back, Avill be suitable. Some will even gain by loss of blood from the arm. In the great majority of cases, the patient is pale, Aveak, and nervous. Such a one needs iron and nourishing food, Avith mental ease and tranquillity, and change of air—everything to build up the system. AVhen delay gives trouble, for one or more months, we advise (as above indicated) that at the time the change is due, a hot mustard foot-bath at bedtime be tried. If that does not suffice, the next night a warm hip- or sitting-bath may follow. Also, let there be taken a Lady Webster pill at night, or a teaspoonful of Elixir Pro., or tAvo teaspoonfuls of Warner's Cordial. Either of these will be most apt to do good Avhen taken iu hot Avater. A physician may advise permanganate of potassium, in one- or two-grain doses. Of all classes of medicines, even more than diuretics, ernmcnagogues (those intended to renew suppressed menstruation) are the most uncertain. For others than those above mentioned, Ave must refer to extended medi- cal books. Amyloid Degeneration. This is one of those morbid changes to which the liver, kidneys, and other organs are subject, when the consti- tution has been impaired by any cause. There is in the organ affected a change of a part of its natural tissue into a starch-like (amyloid) mate- rial, incapable of doing the duty of the healthy organ. There is no cure for such an affection, but its progress is usually A'ery sIoav, and its symptoms not marked until it has continued for a long time. Often it is scarcely recognizable, if at all, until discovered by post-m,ortem examination. Anaemia. PoA7erty of blood. This may be brought on (besides being predisposed to from birth in some constitutions): 1, by loss of blood, from disease or injury; 2, too long suckling, in a mother or Avet-nurse (especially with twins, or one's OAvn babe and another's); 3, severe con- tinued diarrhcea; 4, typhoid or some other fever; 5, malarial influence, 668 . DOMESTIC MEDICINE. in an unhealthy locality ; 6, deficiency of food, warmth, light, and fresh air, in croAvded and unhealthy parts of toAvns or villages. Signs of Anaemia are paleness, thinness of body, Aveakness, nervous- ness; sometimes palpitation of the heart. In extreme cases, the lips are white, and the tongue thin and almost colorless. Treatment of this condition requires good nourishing (not necessarily stimulating) food, of Avhich a considerable part should be animal, Beef, mutton, chicken, game, fish—if there is appetite and digestion for them; if not, beef-tea, strong chicken-broth, etc.; milk rather than tea or coffee; variety of food, but no unprofitable dainties of any kind. Iron and cod-liver oil are the stand-by medicines for Anaemia. In some cases physicians give arsenic, in very small doses. Change of air, sea-bath- ing, and mineral Avaters containing iron, all may contribute to recovery. Pernicious Anaemia is an almost or quite incurable, but rare alleetion. Upon this, see Essentials of Practical Medicine, or some other extended medical work. Anaesthesia. Loss of sensibility. Anaesthetics are agents Avhich, like chloroform, ether, and nitrous oxide, Avhen breathed, take aAvay for the time all feeling, so that surgical or dental operations may be performed without pain. See page 522. Paralytic anaesthesia is common in cases of palsy, being confined to one side in hemiplegia, to both lower limbs in paraplegia, and extending to all the extremities in general paralysis. Anasarca. General dropsy. It may result from exposure to cold and Avet, checking suddenly the action both of the skin and of the kidneys. Diuretics and purgatives are the medicines appropriate to it. (See Remedies, under the heading Dropsy, page 548.) Aneurism. An enlargement of a part of an artery, from bursting of its inner and middle coats, making a sac by stretching the outer fibrous coat. In this sac a por- tion of blood coagulates solidly. This may happen on any artery. The most serious of all Aneurisms is that of the aorU (largest artery of the body), in the chest or in the abdomen. Aneurism of the thoracic aorta (that is, of the part of the artery Avithin the chest) is known by a bulging, slowly increasing, in front of the chest, in Avhich a,pulsation may be felt, apart from that of the heart; Fig. 210. ANEURISM OF AORTA. SPECIAL DISEASES. 669 dulness on percussion over the bulging; a thrill, sometimes, felt when the fino-er is placed there; and signs of inAvard jircssurc, on the Avindpipe, causing cough; on the oesophagus (gullet) producing difficulty in swallow- ing. Pain also occurs in the middle of the chest; increased by mus- cular effort or active movement. When the abdominal aorta is the seat of the enlargement, no bulging exists, but a pulsating tumor may be felt, if the hand is firmly pressed upon the middle of the abdomen. Pain is in some cases constant, in others varying from time to time; increase of it results from any con- siderable exertion. It is important to knoAV that, in some cases of dyspepsia, the aorta pulsates Avith more or less violence, Avithout any aneurism. Also, pain in the belly may be accounted for instead by colic, gall-stone, stone in the kidney, etc. Therefore much care is necessary in making out the diagnosis of Aneurism. This affection is a very difficult disease to treat, with any hope of benefit. Quietness of body and mind is very important. A simple diet, of milk and other easily digested, not stimulating, food, Avill be best. Iodide of potassium, continued in moderate doses for a long time, appears to have done good in a number of cases. Electro-puncture has been used Avith success by several practitioners. The progress of aortic Aneurism is slow; occupying generally several years before its fatal end. Death comes at last, from either sudden breaking of the sac and exhaustion by hemorrhage; or leaking of the sac and gradual exhaustion; or wasting of all the strength by the press- ure interfering with breathing, SAvallowing, digestion, etc. Aneurism of other arteries is met with not infrequently. At the bend of the elbow, it has occasionally followed an accidental wound of the artery there in the operation of opening a vein (bleeding, venesection). ElseAvhere, disease in an artery may result in bursting of its inner coats; the outer coat then bulging out, and a clot forming in the swollen portion of it. Such a tumor throbs or pulsates, with more or less force accord- ing to the size of the artery and of the swelling. Thus there may be a brachial or a popliteal or a femoral aneurism, etc., according to the part in Avhich it is formed. For these different aneurisms, surgical treatment is often resorted to; tying the affected artery, either above or below the tumor; or applying continued pressure upon the vessel, for a number of days and nights together. (See works on Surgery.) Angina Pectoris. A disease consisting of attacks of severe pain about the heart, extending along the left arm. It seems to be a kind of neuralgia of the heart; connected in many, but not all instances, with 670 DOMESTIC MEDICINE. some change in its structure. Rarely, the first paroxysm is fatal. Mostly, many attacks occur, at variable intervals, of months, Aveeks, or days; in any of which it is possible for death to result. Dr. Chalmers of Scotland, the eloquent minister and Avriter, and Dr. Thomas Arnold of Rugby, died of this disorder. It seldom, if ever, affects young j>eo- ple, and is more common in men than in Avomen. For the relief of attacks of Angina Pectoris, many medicines have been tried. Among those doing good are Hoffmann's anodyne and laud- anum; also, tablespoonful doses of Avhisky. But the most eilective seems to be breathing a feAV drops of nitrite of amyl, just at the time of the attack. This is a powerful, even dangerous agent, to be used with extreme caution. A mustard-plaster over the chest or betAveen the shoulders, and a hot mustard foot-bath, will be suitable, if a paroxysm lasts long enough to alloAV them. It is generally over, hoAvever, in a few minutes. Anorexia. Loss of appetite. This is common in all acute, and most chronic diseases. It occurs also when no disease can be said to be present, other than Avant of tone in the stomach or in the general sys- tem. Besides improving the surrounding conditions, of air, light, cheer- fulness, etc., we may use as appetizers such medicines as chamomile txi, quassia, gentian, fluid extract of wild cherry bark, aromatic sulphuric acid ; or, if anamiia is present, some preparation of iron. (For doses of all these, see Remedies, page 514, etc., and page 615.) Anthrax. See Carbuncle. Anus, Fissure of. A very painful crack or furrow at the edge of the outlet from the lower bowel. It is most common in middle life. At first, there is a smarting at one spot, when the boAvels are moA7ed. This afterAvards becomes more severe, Avith burning, aching, and some- times throbbing at the part, lasting for an hour, or even several hours at a time. Coughing, sneezing, or in bad cases even sitting on a hard surface, will bring on the pain. For its treatment, soothing ointments may be first tried ; simple cerate, ointment of oxide of zinc, iodoform ointment; or Avasliing the parts every morning with castile soap and water. Dusting Avith iodoform powder will be good, especially for a large old fissure. So will painthuj (Avith a camel's-hair pencil) upon it collodion, to Avhich a very little glycerin has been added; or, used the same way, compound tincture of benzoin. This last should be applied at least twice every day; the last time on going to bed at night. Touching the sore lightly Avith a crystal of blue stone (sulphate of copper) will promote the cure, if it comes slowly; or with nitrate of silver, more carefully. When the attacks of pain are excessive, a one-grain opium suppository SPECIAL DISEASES. 671 may be introduced into the bowel, immediately after a passage. This had better, however, be avoided, if possible, as it tends to produce cost- iveuess, which rather aggravates the trouble. There are surgical operations in use for obstinate cases of this affec- tion, for which we must refer to works on Surgery. Anus, Prolapsus of. This is a falling out or protrusion of a por- tion of the rectum, or lower bowel, from straining at stool. Children not unfrequently suffer from it, especially in Avarm countries. The bowel will sometimes go back of itself, but in many cases requires to be pressed back gently, with Avell-oiled fingers. To prevent this incompetent and sometimes distressing accident, straining should be discouraged, and made unnecessary by care to keep the bowels regularly and moderately open. A high seat will be less promotive of Prolapsus than a Ioav one or chamber-vessel. If, when it occurs, moderate pressure does not succeed in replacing the bowel, send at once for a physician. Aorta, Aneurism of. See Aneurism. Aphasia. Loss of language, from brain disorder. In most, but not all cases, palsy of the right arm and leg (right hemiplegia) accom- panies it. In some instances the patient cannot say any words at all; in others he gets the wrong words, talking only nonsense. Recovery is not to be expected from this rare affection, but several restorations from it have taken place. It may continue with but little change for years. Aphonia. Loss of voice; quite different from aphasia. It depends upon an impairment of the healthy condition of the larynx, organ of voice; either a thickening of the vocal ligaments (as from a se\rere cold), or worse, a paredysis of the vocal muscles. Both are often temporary; the last named being the longest continued, though sometimes suddenly passing away. Electricity is one of the remedies employed for it by physicians. Aphthae. Very small ulcers, with whitish surfaces, in the mouth; most often seen in young children. Chlorate of potassium is a proper medicine and local application for these, but it must not be swallowed without limitation. In A7ery large (dessertspoonful or tablespoonful) doses, chlorate of potassium is poisonous. It is, hoAvever, safe in doses of two to five grains for a child, and ten to twenty grains for an adult, A poAvder of prepared chalk and gum-arabic, or a paste of glycerin and prepared chalk, may be applied frequently to the little ulcers. Borax and white sugar make a favorite nursery application; no better, how- ever, than the above, if so good. Apncea. Loss of breath. AVhen complete, it is a mode of death. Difficult respiration is dyspnoea (Avhich see). 672 DOMESTIC MEDICINE. Apoplexy. Brain-stroke, either from rupture of a blood-vessel within the brain, causing pressure by a clot of blood, or from an ex- treme congestion of the brain; that is, excess of blood in its vessels. Both of these, by pressure, cause stupor; coma. The patient falls or lies unconscious, with a flushed face, hot or warm head, full sloiv pulse and snoring respiration. If he regains consciousness, palsy of some part, as an arm and leg, or the organs of speech, or the muscles of one side of the face, remains. The first attack is very often fatal, either at once or after some hours or days. A second is still more likely to end life; a third is seldom survived. What is to be done Avhen an attack of apoplexy occurs? As above described, it is altogether different from fainting (syncope). In that, Fig. 211. APOPLECTIC CLOT. the head is cool, the face pale, the pulse absent or almost so, the breath- ing feeble or stopped for the moment.* We are, then, when we find a person falling unconscious with a flushed face and a full pulse, to place him in a reclining posture, with the head raised. Put a handkerchief wet with cold water upon his forehead or all over his head, and Avet it afresh every few minutes; meanwhile, some one having gone for a doc- tor. Never undertake, without medical knoAvledge, to deal with so grave a disorder as apoplexy. So, Avith the doctors we may here leave our supposed patient, so affected. I will only remark here (before the doctor comes) that the practice of bleeding from the arm in every case of apoplexy has ceased to be universal with physicians. Under a reaction from the "Sangrado * Mixed attacks are now and then met with, in fatty degeneration of the heart, hav- ing some of the features of syncope and some also of apoplexy. SPECIAL DISEASES. 673 practice of fifty years ago, some even omit the use of the remedy iu all eases. I believe a medium to be justified. AVhen a patient over seventy years of age, of known feebleness of system, is so attacked, Ave may be almost sure that degeneration of the blood-vessels of his brain has resulted in a hemorrhage therein, which cannot be undone by taking blood from the arm. But Avhen the attack occurs in a younger person, especially before sixty, it is always possible that extreme congestion (accumulation of blood) of the brain occasions the symptoms of brain oppression. For this, bleeding is a most rational and often effective remedy. It may, in such cases, save life, by diminishing the pressure upon the brain; and it may be helped by cups to the back of the neck, mustard- plasters to the loAver limbs, and purgative medicine (by the mouth, if it can be SAvalloAved; if not, by injection into the boAvels). Arcus Senilis. A Avhitish or pearly opaque arch or ring around the cornea of the eye, seen often in old people, and considered a sign of approaching or commencing fatty degeneration. Some of them, how- ever, live a good while after its appearance. Ascites. See Abdominal Dropsy. Asphyxia. Suffocation. It may be caused by choking (as by hanging, etc.), or by gases Avhich cannot be breathed. For its domestic treatment, see the last part of this book, under Accidents, page 871. Asthenopia. AVeakness of the eyes, shoAvn by a sense of fatigue and dimness of vision after using the eyes aAvhile in reading or work. It requires rest for the eyes; with other treatment, according to the judgment of special oculists. Asthma. Paroxysms of great difficulty of breathing. They come * on mostly late at night, and last from an hour to a dozen or more hours; generally not more than three or four hours. Some patients have an attack every night; others at long and irregular intervals; some only when they breathe certain vapors or odorous substances. Hay asthma is one of the names for "summer catarrh," Avhich a certain number of people have at the same time every year. The attack of ordinary asthma is often very distressing. The patient sits up, leans forward, goes to the windoAv, toiling and striving for breath. Death scarcely ever takes place during the paroxysm. At last, secretion of phlegm occurs in the air-tubes, the spasm relaxes, and relief comes. Treatment, in the absence of a physician, should have the aim of promoting relaxation and mucous secretion. As this affection (like all spasmodic disorders) has its nervous element, Hoffmann's anodyne often does good. Syrup or Avine of ipecacuanha, half a teaspoonful, Avith from a quarter to half a teaspoonful of tincture of lobelia, every half hour until relief is obtained or until the stomach is sickened, will 43 674 DOMESTIC MEDICINE. almost always shorten the paroxysm. Smoking cigarettes made of pajx-r dried after being saturated Avith a strong solution of nitre (nitrate of potassium, saltpetre) relieves some patients; stramonium papers burned in the room have still more poAver Avith others. A hot mustard foot- bath, and a mustard-plaster betAveen the shoulders, will assist the treat- ment. To make Nitre-tablets: Saturate a half piut or so of Avater with alternate teaspoonfuls of nitre and chlorate of potassium. AVliile this solution is being brought to a boiling-point on a fire, cut up some blotting- paper into pieces six inches square. Pile these, six together. Dip each pile well into the boiling solution of nitre and chlorate of potass.; thou pour on it one-quarter drachm of spirits of camphor. Dry. For use, fold a pile tent-wise, /\, and light it at one or both ends, on a shoArel or other metallic surface. It makes a dense smoke. For Nitre Cigarettes: Put a teaspoonful of nitrate of potassium in half a glass of pure water and let it dissolve; and then add more till it is saturated. Soak in this solution strips of unglazed, thick paper, or blotting-paper, of such shape as Avould be used to make " lighter- papers "; and dry these in the suu, or near a fire. Then roll them up, when dry, lighter-fashion—for Asthma, burning as cigarettes. In feeble patients, strong coffee may aid in relieving attacks of asthma. Prevention may be maintained in some cases, by finding out and avoiding the conditions that bring on the attacks. These are Avonder- fully various. Some always suffer if they sleep on a first floor; others do better there than higher up. Some never have asthma when at the sea-shore; others are Avorse there Avith it than elsewhere. Hay asthma, Hay Fever, or Summer Catarrh, is a disorder peculiar to a not very large number of persons, many of Avhom have otherwise fair health. It does not affect them all at the same time, but it always occurs during the warmer half of the year. Pollen of flowers, seeds of grasses, dust of different kinds, etc., in the atmosphere, have been supposed to have to do with it; but its causation is as obscure as its cure is difficult. Indeed it may be confessed that the art of medicine is, so far, mostly baffled by it. Palliation is all that quinine, variou- expectorants, inhalations, and local applications to the throat, have suc- ceeded in obtaining. The most important fact is, therefore, that some places afford security from it to all or nearly all its victims. A convention of those who are subject to this malady is held every year in New England. From a report to this convention by Dr. Alor- rill Wyman, the folloAving extract is taken. " Long and varied experience with numerous individuals has proved that in New Hampshire, the Glen, Gorham, Randolph, Jefferson, White- SPECIAL DISEASES. 675 field, Bethlehem Village, the AAliite Mountain Notch, Tavui Mountain House, the high level about Franconia Notch, are all Avithin the limits of safety. Other elevated tracts are safe. Mount Mansfield, at Stowe, ATermont, and the Adirondacks, are particularlyT safe, also the Ohio and Pennsylvania plateau (high table land), including the high range of southern counties in NeAv York, from the Catskill Mountains to the western border of the State; the plateau in these counties haATing an elevation of t\Aro thousand feet above the sea." " The Island of Mack- inaAV, and the country north of the great Lakes in Canada, and beyond the Mississippi, at St. Paul, Minnesota, have a certain immunity, but not equal to that of the Lake Superior region. Farther Avest are large tracts that may be resorted to. South, the Allegheny Mountains at Oakland and other elevated points, and Iron Mountain, on the Tennes- see and North Carolina line, are unusually free. To the east, the ele- vated interior of Maine and its extensive lakes afford both pleasure and safety. Mount Desert is not free, but some of the islands about it are thought to give relief. If the sea-coast is preferred, the Avhole coast east of the St, John, thence quite around to Labrador, is open to the subjects of autumnal catarrh. Sufferers Avho actually pitch their tents in these favored regions, as a general rule, not only escape their enemy, but may find themselves at the end of the month Avith a vigor that nothing but living under canvas seems to give." Astigmatism. Uneven sight, from the cornea of the eye (or eyes) being spoon-shaped instead of spherical. It is corrected by wearing glasses made of a cylindrical form; just reversing the error of the eyes. See Care of the Eyes, under Hygiene, page 403. Ataxy, Locomotor. A chronic and long-continuing affection of the spinal marroAv, in Avhich the patient loses, to a considerable extent, the control of his loAver limbs. Each step is made Avith a sort of jerk forwards, of one foot after the other. Severe pains in the legs are com- mon, at variable intervals. These, with gradually increasing Aveakness, are the characteristic symptoms. The disease is slow in progress, often lasting many years; but recovery is not to be expected. For palliative treatment, see extended medical Avorks. Any one suffering from this disorder should be under the care of a physician. Atheroma. A mode of degeneration of the arteries, rendering them liable to rupture, causing hemorrhage. If this happens in the brain, apoplexy is the consequence. Athetosis. An unusual nervous disorder, in which the fingers and toes, on one side or both, are in constant, involuntary, and more or less regular movement, It often, but not ahvays, is preceded by palsy of the side on which the extremities are most affected. 676 DOMESTIC MEDICINE. Baldness. See Alopecia; and Care of the Hair, under Hy. giene, page 346. * Barbadoes Leg. See Elephantiasis. Bedsores. See Nursing, p. 628. Bilious Fever. See Remittent Fever. Biliousness. A term of vague meaning, and often misused. Manv people say they are bilious, Avhen they have mere indigestion. There is a condition of disorder of the liver, to which such a name imv be ghTen; Avhen one or both of tAvo things may be present. One is de- ficient secretion of the liver; the materials Avhich it ought to remove from the blood being left in the blood, and finding their Avay out through other secretions. The other is, obstruction of the gall-duct; the collected bile being reabsorbed into the blood; then, also, afterwards escaping by the kidneys, as well as in the perspiration, and in the secretion of the mucous glands of the mouth, etc.; when the amount of bilious coloring matter is great, staining the skin, eyes, and tongue, yellow (jaundice). At such a time, the passages from the bowels, instead of being yellowish- broAvn, are slate-colored, or nearly a dull Avhite; the urine being dark, sometimes like porter, loaded with the coloring matter of the bile. This is because the bile is Avithheld from its natural course into the boAvels, and is, instead, thrown off largely from the blood by the kid- neys. A third kind of disorder may be, an unhealthy condition of the bile secreted; and in sea-sickness, and possibly in some other instances, still another—the pouring back of an excess of bile from the duodenum (first part of the small intestine, into which the bile is conveyed by the biliary duct) into the stomach. Signs of liver disorder, at an early stage or in a transient attack, are: sickness of stomach, generally Avithout pain or vomiting, headache, diz- ziness, especially on turning the head or the eyes; constipation of the bowels, with slate-colored stools; a bitter taste in the mouth, especially on waking in the morning; yelloAvness of the whites of the eyes, the surface of the tongue, and, in a marked case, the skin ; pain in the right side near the edge of the ribs, or under the right shoulder-blade. Treat- ment of this condition includes a simple and rather spare diet, of only easily digested food; toast and tea, oatmeal gruel, chicken or other broth Avell skimmed of all its fat, etc. Of medicines, for home use, magnesia is especially suitable, a full teaspoonful (if the bowels are, as Ls usually the case, not free) thoroughly mixed in a wineglassful of water, or in a tablespoonful of spiced syrup of rhubarb. Blue pill is the "auld Ian;.' syne " remedy for biliousness. I believe fully, from often repeated ob- servation, in its efficiency; but it is not a medicine to be carele-dy and promiscuously used. The practice of fifty or sixty years ago, of taking SPECIAL DISEASES. 677 ten or twenty grains of blue mass at random for every little attack of indigestion, has noAV, happily, gone out, When, hoAvever, the symptoms above described are present, it aai'11 be appropriate to take at least three grains of blue pill; best one grain at a time; a one-grain pill at bedtime, the next morning, and then at bed- time ao-ain. If the " bilious " symptoms are not relieved by this and mao-nesia (or, Avhen constipation is very decided, citrate of magnesium, Tarrant's poAvder, Seidlitz poAvders, or Rochelle Salts), it will be Avell to continue smaller doses of blue mass for several days. For this purpose, three daily of Compound Gentian pills (each containing one-quarter grain of blue pill, Avith one grain each of extract of gentian and rhubarb, and one-fifth drop of oil of cloves) Avill be convenient and serviceable. Bladder Disorders. Of these, the most common are Retention of urine, Incontinence of urine, Stone, Gravel, and Inflammation of the Bladder (cystitis). On all but the last of these, something Avill be said under the heads named hereafter. Inflammation of the Bladder is a not common but very distressing malady. It may be caused by7 blows or other injuries; by the presence of a large stone (calculus) or small solid particles (gravel); or by an obstruction (stricture) of the urethra (outlet from the bladder) inducing retention of urine, Avhich undergoes decomposition. Symptoms of this inflammation are: pain, and soreness on pressure, in the bladder; fre- quent desire to pass Avater, wdth disposition to strain, and burning in the urethra Avhen it is passed. In an acute case, there is often fever, per- haps with irregular chills. Bad cases have also sick stomach, delirium, cold perspirations, and bloody urine containing pus, Avith a fetid odor. No unprofessional person should, if possibly aA^oidable, undertake to treat such a disease. All that is in place here to mention about its home treatment is, that the patient must, in acute Cystitis, remain quiet in bed; Avith milk, gruel, arroAvroot, rice, etc., for diet; flaxseed tea (iced, if agreeable), betAveen Avhiles as a drink; a large warm flaxseed or mush poultice, Avith laudanum added to it if pain be great, may be kept (cov- ered Avith oiled silk) upon the loAver part of the abdomen. If the patient can be moved Avithout suffering, a warm Avhole bath or hip-bath daily will be relieving; and if pain be Arery distressing, a one- or tAvo-grain opium suppository may be inserted into the bowel at bedtime every night. Bleeding. See Hemorrhages. Blindness. See page 725. Boils. A boil is a small abscess. It begins as a red, sore, and roundly swollen rising, on any part of the body. It increases moder- ately in size; becomes more and more painful and tender, as well as 678 DOMESTIC MEDICINE. red, for tAvo, three, or more days; and then points, growing yellow and soft at one spot, generally near its centre. This will in time break and discharge, if not opened. At the heart of it there is a small dead mass, called the " core." Some persons are often troubled with Boils; others never have them. Now and then Ave meet with attacks, in Avhich one may have tAAro, or three, or four of them at a time, and crop after crop, almost all over the body, lasting eveu for weeks together. This niav be confessed to be an opprobium of medical art; for no certain means of cutting short such attacks have yet been discovered. Some physicians haAre confidence in the internal use of sulphide of calcium (one-tenth to one-quarter of a grain two or three times dailv) as a means of arresting a tendency to suppuration, Avhether in boils or in larger abscesses. It is worth trying, but is as yet far from being au established specific for this purpose. The treatment of single Boils is tolerably simple. If anything Avill " nip in the bud " a beginning one, it is either a piece of ice, held to it almost constantly for an hour or so, or spirits of camphor, freely applied at a very early stage. When it is clearly going on, a bread aud water poultice Avill soothe it best; covering the poultice Avith oiled silk, oiled paper, or rubber-cloth. Near the time of its coming to a bead, a far- seed poultice Avill most hasten the softening of the skin, making way for the breaking or opening for the discharge of pus. Should a Boil be opened, with a knife or lancet, early or late? Sur- geons generally advise quite early opening. Those avIio, like myself, have felt the pain of an incision during the height of an inflammation, in a tender part, as the hand, will incline towards mercy, and will want to Avait till pointing occurs. Then the skin at the soft yellow spot loses its sensibility, and can be cut with little or no pain. This maybe much lessened, however, by freezing the part with ice before it is cut. The incision ought to be large enough to let the matter out freely and fully, so as not to delay its emptying itself and then healing up. Bowel, Protrusion of. This is called by physicians Prolapsus Ani. It occurs most frequently in children, from straining at stool. The forced-out portion of the bowel may commonly be returned without much difficulty by gentle but steadily-continued pressure with well-oiled or larded hands. If not, a physician must be called in at once. To prevent the recurrence of such a protrusion, the child's bowels should not be allowed to become constipated (see Care of the Excretions, under Hygiene); and it should be made to sit, when having a move- ment, on a rather high seat, the body not being much bent at the time. Bowels, Inflammation of. Enteritis of medical books. Blow- or other injuries may cause it; or neglected constipation; or, sometimes, SPECIAL DISEASES. 679 exposure to cold and wet; also, strangulated hernia (see Rupture), ob- struction of the bowels, or corrosive poisoning. Spnptoms of enteric inflammation are, pain in a part of the abdomen, increased by pressure or motion ; constipation, fever, vomiting, abdom- inal swelling; later, passage of mucus, blood, or pus from the bowels. There is always danger to life in a decided attack of such a kind. Typhlitis is the name given by physicians to a circumscribed inflamma- tion of the beginning of the large intestine (caput coli), on the right side. Treatment of Inflammation of the BoAvels requires absolute rest in bed from first to last. Leeching over the part affected is, I believe, an important early remedy; after that, large, soft, but not heavy, flaxseed poultices, kept moist by an oiled-silk covering. The food taken must be soft and soothing, as arrowroot, tapioca, sago, rice-water. If thirst exists, ice may be swallowed sloAvly aud often. Physicians often advise small doses of opium every few hours, to relieve pain and quiet the bowels. Purgative medicines must be avoided. If the lower bowel is full, an injection of olive oil with soap and Avarm water may be used to empty it; or one of a tablespoonful each of limewater and oil. Typhlitis sometimes ends in an abscess, Avhich may require surgical skill to open it and let out the matter. Such cases are critical, and call for the best professional judgment. Brain Exhaustion. Under Mental Hygiene, enough has been said on this subject for the purposes of this work. It may just be re- peated, that most instances of Exhaustion of the Brain result from insufficiency of sleep rather than from the actual amount of mental labor; that worry is more exhausting, ahvays, than wrork; that monotony of labor is very much more wearing than that which is varied in character, and that the one indispensable remedy for Brain Exhaustion is complete and prolonged brain rest. Brain, Inflammation of. Since the membranes, or " meninges," which envelop the brain, are almost ahvays chiefly affected with inflam- mation, this affection is generally called meningitis in medical books. There are two forms of acute Inflammation of the Brain : simple, and scrofulous or tubercidous. The difference in the symptoms is, that the latter comes on more slouvly, after signs of a scrofulous constitution in the patient, who, nearly always, is a child; that the whole course of the disorder is somewhat sloAA^er, and that it is scarcely ever recovered from. A\ ith these distinctions in view, our general description will answer for both Ararieties. Most cases of simple as well as of scrofulous meningitis occur in chil- dren, but the number of instances of the former in adults is much 680 DOMESTIC MEDICINE. greater than of the latter. Causes of the former are: blows on the head, exposure to the sun, great or long-continued mental excitement, erysipelas of the head, scarlet fever, extension of inflammation from the ear to the brain. First, as signs, we observe complaint of severe headache and irrita- bility, Avith heat of head, flushed face, constipated bowels, and sick stomach, even vomiting. There is extreme sensitiveness to light, so that the room can hardly be made dark enough. Sounds, also, if loud or sudden, disturb the patient, who sleeps badly, talking or scrcamim/ when partially asleep. The pulse is full, strong, and rapid; the con- dition is one of fever. A second stage usually follows in a bad case, in which, instead of irritability and delirium, there is stupor ; the patient being unconscious, not able to be roused, Avith a slow, full, more or less irregular pulse. This is the time Avhen (as ascertained after death) effusion of water (serum) within the membranes of the brain takes place. The third stage occurs only in the Avorst cases, from which very few are restored. Now the patient continues unconscious, but has also con- vulsions, folloAved by paralysis of one or more of the limbs; a rapid and feeble but not irregular pulse; the contents of the boAvels and blad- der being involuntarily discharged. In a case of simple meningitis going through all these stages (which, hoAvever, pass gradually into each other), death results at the end of from eight 6r nine days to two weeks. Scrofulous meningitis lasts more frequently three Aveeks or perhaps more. But from simple meningitis recovery often happens. I have seen several such cures, even when the symptoms Avere very severe. In one case, that of a girl ten years old, a violent convulsion occurred, Avithout paralysis folloAving it, just before she began to improve and get well. For the treatment of Inflammation of the Brain, a physician must be called in. AVill he alloAV me to say to our readers Avhat I hope he will advise or do ? Should he differ from the present author, of course the book will be closed and put away for the time, as it is impossible to " serve two masters " in the care of one Avho is ill. But my hope is based on considerable experience iu this disease, with a good degree of success. What I would do is this: have the patient put to bed in the quietest room in the house, and give orders for all in the house to avoid noises of every kind. Let the light be shut out of the room, except just enough to see the way around in it. Have the hair cut very short all over the head; better yet, have the Avhole head shaved. This will not only promote the cure, but, as the hair is apt to come out after such au SPECIAL DISEASES. 681 illness, it will be better for the hair itself. I Avould feel the pulse, and if the patient is not old (and old people seldom suffer from acute inflamma- tion of the brain), and has been pretty strong in health before, I Avould, in a severe case, take a few ounces of blood from a vein in the arm. Or, if obliged to risk the patient's life by omitting this in deference to some- body's fears (and many, even among physicians, noAvadays have such fears), I Avould at least take blood from the back of the neck by leeches or cut-cups ; leeches, if they can be had, if not, cut-cups. I would also have the head kept Avet, day and night, Avith cold water; iced, if it be summer-time. For this, the handkerchief or other light cloth must be wet every few minutes, or it will become and remain Avarm, and do no good. I Avould give the patient, very early in the case, an active dose of a saline cathartic; Epsom Salts, Rochelle Salts, or Citrate of Mag- nesium ; the first for the strongest patients, the others being suitable for weaker subjects. I Avould have the diet liquid altogether, unless a little milk-toast or ice-cream once in a Avhile; at first, gruel, toast-Avater, milk ; as time Avent on, after the first Aveek, milk alternated \a ith beef-tea, or other broths; gradually returning to solid foods as convalescence pro- ceeds. If, in spite of all this treatment, my patient Avent on into the stupor of the second stage, I Avould apply dry (not then cut) cups to the region betAveen the shoulders, and a large blister, left on long enough to draAV, over the back and top of the head, just above Avhere the head touches the pilloAV Avhen lying doAvn. I Avould also repeat moderate doses of purgative medicine, once or twice, in this stage. If the third stage comes, Avith convulsions folloAved by paralysis, rapid, weak pulse and cooling skin, the patient being unconscious all the time, I A\rould simply have all done to keep him sufficiently warm and clean, and pre- pare the minds of the family for the approaching fatal end. In a case Avhere the history of the patient and the sIoav progress of the symptoms indicate tubercular meningitis, I Avould folloAV the same plan of treatment except the bleeding from the arm, and giving smaller doses of salts or other cathartic medicine, Avith an earlier recourse to beef-tea as a supporting diet. Brain, Softening of. The signs of this affection are so obscure, and the difficulty of distinguishing different forms of chronic disease of the Brain is so considerable, that it Avill be safest to refer to extended med- ical books for all that ought to be said on this subject. Softening is one form of degeneration, often folloAving chronic inflammation ; sclerosis or hardening is another form of degenerative change; both the causes and the symptoms of the two are exceedingly alike—the essential element m both being the morbid alteration of tissue, with consequent loss of power to perform the healthy functions of the organ affected. 682 DOMESTIC MEDICINE. Break-bone Fever. Also called Dengue. This has been oftcnest seen and best known in the Southern United States, though occasional I v met with in the North, and in the East and West Indies and in Egypt. It is not a dangerous disease, but is attended by severe pains in the head, back, and joints. There is generally at first a chill, and then fever lasting from two to fhre or six days. A slight rash is commonly seen toAvards the close of the fever. On this passing off, the patient is left very Aveak for a time. Treatment of Dengue requires rest in bed, mod- erate saline purgative medicine at the start, liquid diet, and good nurs- ing ; nothing else. Bright's Disease. So named after Dr. Bright, of England, who first gave a clear account of it, some fifty years ago. It has been very elaborately studied since, by many physicians. For our present purpose it is enough to say that it is a sIoav chronic disease of the kidneys (acute Bright's disease is also sometimes rather inaccurately spoken of), whose most notable sign is albuminuria; that is, the presence of albumen in the urine. It may be caused, especially in a person Avhose strength has been in any way reduced, by exposure to cold and Avet, or by the use of alcoholic liquors; even in what is called "moderate" drinking. It tends gradually toAvards death, a cure being not reasonably expected. Symptoms are, paleness or puffiness of the face, Aveakness, dryness of skin, general dropsy, headache, sick stomach, diarrhoea, frequent urina- tion, especially at night; often bronchitis and enlargement of the heart; last of all, urcemic stupor, convulsions, and death. The treatment is chiefly palliative and economical of strength; to prolong life, Avhich may often be done, Avith care, for months, sometimes for years. Bronchial Dilatation. A (not at all common) stretching and en- largement of the branches of the bronchial air-tubes, on their way towards and in connection Avith the air-cells of the lungs. Very trou- blesome cough, with thick and abundant expectoration, is the only marked symptom of it; the certain proof of its existence needing per- cussion and auscultation, by a practitioner skilled in those methods of examination. Palliation of the cough is the only reasonable measure of treatment for it. (See Physical Diagnosis, pages 512 and 513.) Bronchitis. Inflammation of the bronchial tubes. It may be aeuk or chronic. Acute Bronchitis is, simply, a " severe cold on the chest," in which there is neither pleurisy nor pneumonia present. There is weakness, fever, soreness on taking a deep breath, and a cough. The cough is at first dry, hard, and more or less painful; then soft and loose, with Avhite mucous phlegm; last, in severe cases, Avith yelloAV or greenish purulent expectoration. It is seldom fatal, except Avhen, as Capillary Bronchitis, SPECIAL DISEASES. 683 it affects the multitudinous smaller (capillary, small as hairs) branches of the air-tubes, as they enter the lungs. This interferes so much Avith breathing that it is quite often a mortal disease. In treatment of Acute Bronchitis, a good dose of saline purgative medicine should be given early; Epsom salts, Rochelle salts, or citrate of magnesium, according to the strength of the patient. Early, also, we must begin Avith something to soften and loosen the cough; that is, to promote relaxation and secretion. As a Home medicine for this, syrup of ipecac, is the best stand-by; from a quarter to half a teaspoon- ful every three or four hours. xV quarter teaspoonful Avill be enough generally through the day; the last dose at bedtime being a half tea- spoonful. Flaxseed-tea, made without boiling, and flaAored Avith lemon juice and sugar, will be a useful drink, taken a little and often. A mustard-plaster may be applied for half an hour or so to the upper front part of the chest; and after the soreness from that application has entirely gone, the same part may be bathed, night and morning, Avith volatile liniment, /. e., equal parts of hartshorn (aqua ammonise, or spir- itus animonise aromaticus) and sweet-oil (olive- or lard-oil). After the first day, syrup of wild cherry bark, a teaspoonful each time, may be given Avith the ipecac. As soon as the cough decidedly begins to soften and loosen, lessen the dose and frequency of use of the ipecac.; continuing the wild cherry. AVhen it amounts to considerable expecto- ration, the soreness of the chest giving Avay, leave off the ipecac, and giA'e instead syrup of squills, in half teaspoonful, or (Avith persons of strong stomach) teaspoonful doses, three or four times daily; still with teaspoonful doses of Avild cherry syrup. Leaving the management of bad cases of Acute Bronchitis, and espe- cially Capillary Bronchitis (known, even without skilled examination by auscultation and percussion, by the great oppression in breathing, and weakness of the patient) to the care of the physician, it will be almost always easy as Avell as expedient to have his or her advice also in cases of Chronic Bronchitis. AAre have alreadv, hoAvever, under Remedies, remarked upon the medication of cough, at different stages. AVhen once fairly loosened, and yet troublesome, especially at night, it needs quieting. For this Ave ha\Te the mild and innocent soothing action of candies (hoarhound the favorite), liquorice, marsh-mallow, gum-arabic, and eucalyptus. Also, to syrup of squills and syrup of wild cherry may, with a loose cough, be added at night a quarter, half, or whole teaspoonful (according to the urgency of the case) of paregoric, or syrup of lactucarium. Chloride of Ammonium, in ten-grain doses three or four times a day, is a good expectorant in such cases. Or Wistar's Lozenges, Avhich, when regularly made, contain a little opium, may be 684 DOMESTIC MEDICINE. at night, sloAvly dissolved in the mouth antl swalloAved; from one to four, as needed, in a night. Weak states of the system, lastly, may require stimulating expectorant medicine. Carbonate of Ammonium is the best representative of this class; dose, from two to five grains every tAvo hours, dissolved in some expectorant syrup (as Avild cherry, for example). On recovering from either Acute or chronic Bronchitis, protection of the chest from cold is of much importance. A warming-plaster (as Allcock's porous-plaster, or simple Burgundy pitch-plaster) is excellent for this purpose. Indeed, such a plaster ought to be put on early in the case, and kept on for several Aveeks. Aho, flannel next the skin, and, in cold weather, an extra piece of flannel, or a rabbit skin over the breast, Avill render good service in preventing reneAval of the cough on going out in American Aveather (the most extreme and changeable in the worldj. Bunion. This is an enlargement of one of the larger joints of the toes, commonest on the outside of the great toe {inner side in relation to its nearness to the other foot). The skin inflames and thickens, under the pressure of an ill-fitting shoe; the joint itself becomes then more or less involved in the inflammation. It may be very sore and painful in Avalking. It will be quickest cured by remaining in bed or on a couch until all the pain, heat, and tenderness have subsided, under the appli- cation of a bread or flaxseed-meal poultice. Then treat it like a large corn. (See Corns.) AArear a slipper in the house, and a loose shoe (with a piece cut out over the bunion, if necessary) out of doors. Pare off all the thick, hard outside skin, and put over the base of the bunion two circles of adhesive plaster (round pieces with the centres cut awayj and on the summit one small round piece. This will shield the tender part from friction and pressure. Burns. See Accidents and Injuries, in the last part of this book. Bursa, Enlarged. A bursa is a sac, filled Avith Avatery fluid, made by a collection of serum in part of the sheath of a tendon. Such en- largements are most common on the back of the hand, near the wrist. An inflammation, produced by a blow or sprain, causes adhesion of the fibrous sheath around or above the tendon, and thus the fluid, increased in quantity also by the inflammation, makes a round, firm swelling. It may become as large as a hickory-nut, or larger, but more in shape like a lima bean. There is no danger or great inconvenience in such swell- ings; they are merely clumsy and unsightly. A sudden sharp blow with a middle-sized book will often break up the adhesion, and make the swelling disappear. If this fails after a trial or two, it will not be best to reiterate it, as the inflammation produced by much violence may cause it to grow larger. A surgeon may safely puncture the bursa with a hypodermic injecting tube, or with the needle of an aspirator. SPECIAL DISEASES. 685 Cachexia. An unhealthy state of the system ; a morbid habit of body, or faulty constitution. See the Nature of Disease, at the early portion of Domestic Medicine. Calculus. See Stone in the Bladder. Camp Fever. See Typhus Fever. Cancer. A malignant tumor of any part of the body; that is to say, a SAvelling which grows slowly, is very painful, often becomes an open sore, and at last wears out the strength of the patient; causing death Avithin a year or two from its beginning. It most frequently at- tacks the womb, female breast, stomach, or loAver bowel; and is not often met Avith before middle life. There are three principal varieties of Cancer: hard (scirrhous), jelly-like (colloid), and soft (brain-like, encephaloid) Cancer. Best knoAvn to unprofessional persons is Cancer of the breast. It begins in a small hardening of a part of the mammary gland, which gradually and irregularly enlarges, and becomes the seat of severe pains. After seA;eral months, it turns to a large, open, dis- charging sore; Avith more and more pain, Aveakness, and distress. The lymphatic glands near it also enlarge; the Avhole system becomes en- feebled and " cachectic." The face is pale, the body wastes, and at last death ends the history of the disease. Cancer of the stomach is met Avith at the pylorus ; that is, the right end, Avhere the stomach opens into the small intestine. It so obstructs and interferes Avith digestion as to starve the sufferer in about a year. Cancer of the womb may continue for two years before death. There is no cure for Cancer. If discovered and cut away, Aery thoroughly, not long after its beginning (which can sometimes be done with Cancer of the breast), it may not always return. AVhen an ad- vanced Cancer is removed by an operation, either it starts again at the same place, or, Avithin a few months, im'ades some internal organ; as the liver, lungs, brain, etc. Were I to be affected with Cancer, I should have tried upon myself a treatment Avhich has never, so far as I knoAV, been tried, or even pro- posed, before; namely, introducing (if the part be Avithin reach, of course) pure alcohol repeatedly, and in several places, by means of a hypodermic syringe, into the substance of the tumor. I think it would probably act somewhat as it does Avith dead auimal tissues; shrink it up, alter its texture, and arrest its growth. The management of a case of Cancer, apart from the question of an operation, consists merely in taking care of the general health of the patient, and, in time, using measures for the relief of pain. Opium, or morphia, is the main dependence for this. It is important, for the patient's adArantage, not to increase the dose of the opiate too fast. Let 686 DOMESTIC MEDICINE. no more be used, of laudanum, for example, than is necessary, at first only at night, to keep the suffering abated enough for a fair amount of good sleep. If given too largely, not only will the effects at the tinu be disturbing to the stomach, to the boAvels (by constipation), and to the Avhole nervous system, but the anodyne influence will be wasted; the susceptibility of relief from it being lessened more and more. Canker-mouth. An ulcerative sore mouth, on the lips, gums, and also extending to the cheeks; sometimes reaching the throat. It is most common in children, from two to six years of age. It is quite painful. The child slobbers, and the odor of the breath is offensive. Touchiug the ulcers lightly Avith nitrate of silver or Milestone twice daily, and covering them often between times Avith a powder of prepared chalk and gum-arabic, equal parts, will be a safe treatment in the ab- sence of a physician; the general condition of the child being dealt with on common general principles. That is, if the child is thin and weak, give it cod-liver oil, iron, and beef-tea, as Avell as milk. If it is costive, open its boAvels gently and regularly with mild medicines; if it has diarrhoea, use lime-water, and, if need be, stronger means (see Remedies) to keep it in check. See page 529. Carbuncle. (Anthrax of medical books; though this term is also applied to a malignant and fatal disease of sheep.) The biggest and Avorst kind of furuncle or boil. Sometimes it is as broad as the top of a teacup or a small saucer. With an intense and most painful inflam- mation, the central part dies (sloughs), and there is no relief until it is somehoAV discharged. It is possible for death to follow a Carbuncle, especially if it invade the neck or chest. Surgeons generally take charge of the treatment of Carbuncles, and mostly think it best to cut them open early and freelyr. Less painful is it to freeze the part Avith pounded ice, which benumbs the feeling, and then burn aAvay the sur- face Avith caustic potassa. One eminent English surgeon, Paget, does not open Carbuncles, but feeds the patient Avell with beef-tea and milk, gives him quinine, and nurses him through ; trusting to nature to open out and relieve the inflammation and sloughing in good time. I am not able or willing to decide between this high authority and the ma- jority of other practitioners. It will be best to be governed by the judgment of the surgeon or physician called upon in each actual ease. Cardialgia. Heartburn. Really stomach-hum ; a symptom of dys- pepsia. The feeling seems to be, but is not, in or near the heart. Caries. Decay of a bone, resulting from inflammation. Necrosis is the death of a part or the whole of a bone, whether preceded by in- flammation or not. Caries of the Spine, See Spinal Caries. SPECIAL DISEASES. 687 Catalepsy. A rare nervous disease, in Avhich the person has attacks, in which he remains for a short time Avith all the muscles rigidly fixed in one position. (See extended Medical works.) Catarrh. Physicians mean by this a disorder of any mucous mem- brane as the nostrils, bronchial tubes, etc., in Avhich acute inflammation is accompanied or followed by a Aoav of phlegm (mucous discharge). Since such a disorder is most often met Avith in the breathing passages, in common language a Catarrh is a cold on the chest; or one affecting the nose and chest together. (See Bronchitis.) Cephalalgia. Headache; Avhich see. Cerebro-Spinal Fever. Often called Cerebrospinal Meningitis; also, Spotted Fever. One of the less common varieties of fever, but Fig. 212. CEREBRO-SPINAL FEVER. (j. LEWIS SMITH.) very fatal; more than half of those attacked Avith it die. Children are oftener its subjects than adults. Armies, and garrisons of forts, etc., have been the centres of its epidemic prevalence in a number of in- stances. It begins suddenly, with chilliness, terrible pain in the head, extend- ing to the back of the neck, nausea, and vomiting. Delirium follows, ending not infrequently in stupor. Tetanic spasm, or rigidity of the muscles of the back of the neck (and sometimes of the back and limbs), is common. Convulsions are much less so, but do occur, particularly in the young. Painful sensitiveness of the surface of the body is present in most cases, Avhen there is not stupor. Loss of sight and hearing may take place during the middle period of the attack. The pulse is at first slow, then rapid and weak. The boAvels are costive or about as in health. The skin is at first rather cool; later, it is often hot; dry, usually, unless toAvards the last. A certain number, not nearly all, of the cases have spots—red, purple, or black—all over the body, from three-quarters of 688 DOMESTIC MEDICINE. an inch doAvn to a pin's head in size, not disappearing on pressure, These have given the popular name of Spotted Fever to the disease. An attack mostly ends either in death or Avith the beginning of recovery within three days. Hoav do Ave know this disorder by sight ? Its diagnosis is often more difficult than that of almost any other fever. Peculiar, however, are its suddenness; the stiffness of the muscles; and, when thev occur, the spots. Malignant scarlet fever sometimes resembles it; and so may the chill of pernicious intermittent fever; but each of these has differences of history Avhich, Avith care, may suffice for distinction. Experience amongst physicians with this disease has not led to so satisfactory an agreement upon its treatment as would be desirable. Home management, therefore, must include but a feAV simple measures. Let the patient's hair be cut very short. Apply cold (iced) water to the head frequently, if it be hot; not otherAvise. Put the patient, if a child, or an adult not too heavy to be lifted, into a Avarm bath, almost hot, say at 98° Fahrenheit, and keep him there for twenty minutes. After drying (with great care to prevent his being chilled), apply a long and wide mustard-plaster (half and half mustard and Avheat or Indian flour) from the back of the neck cIoavii the back; leave it on until, upon looking under it every few minutes, the skin is seen to be decidedly reddened by it. Besides this, dry cups may be applied to the back of the neck and betAveen the shoulders, and left on ten or fifteen minutes at a time. If anyr medicine is ghren, let it be a moderate dose of a saline cathartic— Rochelle salt, Tarrant's aperient, or citrate of magnesium. While food can be SAvalloAved, let it be beef-tea or milk only. All other treatment had better be omitted in the absence of a physician ; and happy is the practitioner Avho contends successfully with this mysterious and danger- ous, but happily not common, malady. Chicken-Pox. Called varicella in medical books. This term is a diminutive of variola, small-pox; and the disease resembles the latter, or rather varioloid (modified small-pox, after vaccination), a good deal. It is contagious from person to person, but is the mildest and least dan- gerous of all contagious or infectious diseases, not even excepting mumps. It commonly affects the same person but once in a lifetime. Four or five days after exposure to the contagion, pimples form, scat- tered over the face, limbs, and body. On the next day, they become Avatery vesicles; two or three days later, they scab, and shortly after fall off. They seldom fill Avith yellow matter, and almost never pit like small-pox. Little or no fever, generally, is present, though I have seen two or three children quite sick Avith it. The eruption often comes out in tAvo or three successive crops or sets of pimples. Like other SPECIAL DISEASES. 689 such diseases, children are much more frequently attacked by it than adults. Chicken-pox needs, in treatment, only careful nursing; keeping the boAvels open, Avith simple and soft food, the patient remaining in one room to avoid risk of taking cold. If fever should come on, solution of citrate of potassium (see Remedies) or acetate of ammonium may be given while it lasts. Care on first going out is important after any such disorder, as the system is then always especially susceptible of depression from cold and dampness. See page 541. Chigoe. This (also called jigger) is the penetrating flea of South America, Avhose bite is a much sorer affair than other common flea-bites. Chilblain. See Frost-bite. Child-bed Fever. See Puerperal Fever. Chills. See Ague. Chloasma. An affection of the skin, in Avhich dull reddish-yellow spots of various sizes and shapes appear on the chest or abdomen. It is curable by parasiticide applications, being dependent on the presence of a minute (microscopically small) fungoid vegetation. Tar ointment, mercurial ointment, and solution of corrosive sublimate, are examples of agents usable to destroy such parasites and cure the skin diseases caused by them. (See Remedies, pages 551 and 802.) Chlorosis. " Green Sickness." A disorder of girls, between four- teen and eighteen years of age, usually. The complexion is yellowish or greenish in hue; the lips are pale, the body is weak and nervous; often there is palpitation of the heart. A curious symptom present in many cases is a morbid appetite for ashes, slate-pencils, chalk, or other out-of-the-AA'ay things. Disturbance of the menstrual function, espe- cially its suppression (amenorrhcea), is apt to be present. No danger to life attends it, but it may last for months or years. Treatment of Chlorosis must aim to build up constitutional vigor. Good, but not stimulating, diet, change of air, sea-bathing, and light gymnastics (calisthenics) Avill be important. Iron is the medicine most depended upon. A feAV patients do not bear iron Avell, on account of fulness of the head, increased by it. Such can generally take it, at least in rather small doses, after being moderately purged with some saline cathartic. See page 616 for doses. Choked Disk. An expression used by oculists when, on examining the eye with an ophthalmoscope, they find the part where the end of the optic nerve-trunk enters the eyeball congested; that is, swollen with an excess of blood. Cholera-Morbus. Vomiting and purging together, coming on as an attack of disease, not caused by a poison. It may be produced by indigestible food at any season; but is much most frequently met with 44 690 DOMESTIC MEDICINE. in warm weather. Being chilled after getting very Avarm is especially promotive of it. Sometimes it occurs without any known error of diet. Put the patient to bed. Apply a large mustard-plaster (half and half Avith Avheat or Indian flour) over the pit of the stomach. If veru ill Avith it, make him use a bed-pan instead of rising to have the bowels moved; in any case, do not allow him to walk out of the room. Have ice at hand, and give him a small lump of it every few minutes to melt in the mouth and swallow slowly. While waiting for the doctor, or if none can be obtained, it Avill be quite safe to give the following simple, but very efficacious medicine : Put a Teaspoonful of best calcined Magnesia, and a Teaspoonful of Aromatic Spirit of Ammonia, in four Fluidounces (about a Teacupful) of Peppermint AArater. If that is not at hand, pure Water Avill do, tliough not so well. Shake the mixture in a corked bottle; and give of it a teaspoonful every fifteen or twenty minutes (shaking it ahvays be- fore pouring it out). If this be continued for an hour or two, right along, nine times in ten the patient will be relieved. Bad cases may require also an injection of laudanum and starch into the bowels (see Laudanum, under Remedies); and, perhaps, Avhisky or port wine in teaspoonful or dessertspoonful doses in arroAvroot or rice-water. But not many instances of the need of such stimulants occur; they had bet- ter be avoided unless great exhaustion (not mere sickness of stomach and distress) is present. At the beginning of an attack of Cholera-Morbus, alcoholic drinks of any kind will be likely to do harm rather than good. Cholera. An epidemic disease, whose original home is India; there it prevails, more or less, every year. Since 1832, it has visited Europe, Africa, and America several times; travelling in a way of its OAvn, as'' on the wings of the wind." It visits towns, villages, and ships, almost ex- clusively ; remaining seldom more than a month (often less) at one place. Of those attacked with all its symptoms, about one-half die. Very many cases of watery diarrhcea, u cholerine," occur before, during, and after its visitations. Filthy toAvns, and the nastiest places in towns or villages, as well as the steerages of ships, may be affected, while the clean and airy portions of the same are free from it; unless among those whose water-supply is bad. It is not contagious from person to person. I assert this without hesitation. It is generally so understood in India; yet many medical Avriters (elsewhere) cling to the altogether unproven notion, that it is only conveyed by the passages from the bowels of those sick with it. As if that could account for outbreaks of it, of Avhich there have been many, on ships two weeks out at sea; even Avhen there had not been, for years, a single case at the ports those vessels had left! (On this, see previous remarks under Causation of Disease, page 481.) SPECIAL DISEASES. 691 Symptoms of Cholera resemble, in a general Avay, those of cholera- morbus. But, Avhile in both there are vomiting and purging, in cholera- morbus the matters thrown up and passed from the boAvels have a yel- lowish or greenish-brown color; in Cholera, all that comes, either from stomach or boAvels, is colorless and watery ; often having tiny flakes in it, and therefore called rice-water discharges. Also, the Aveakness is much greater in Cholera from the first; rapidly deepening iuto the collapse. This is a condition of coldness and prostration, with thirst, shrinking and blueness of the skin, loss of voice, difficulty of breathing, cramps in the limbs, absence of pulse, suppression of urine, and large and frequent vomiting and purging of rice-water discharges. The worst casefe may fall and die in ten minutes. Most of them end in death, or in the be- ginning of recovery, Avithin tAvelve hours. Sometimes a low sort of fever lasts for tAvo or three days. Important to be attended to is the premonitory diarrhcea. In much the larger number of instances, a Avatery looseness of the boAvels, Avith- out pain,* precedes the regular attack for several hours. Any one so affected, in cholera time, ought to lie down at once, remain quiet, and take some Avarming medicine for diarrhcea. Treatment of Cholera has A-aried much, amongst physicians. Refer- ring to medical works (e. g., Essentials of Practical Medicine) for par- ticulars, I will here mention only the method Avhich I learned in 1849 from the late Professor AV. E. Horner, of Philadelphia; by which I am sure many lives haAre been saved. First, the premonitory diarrhcea requires, besides rest in bed, nothing stronger than essence of ginger and paregoric ; ten or fifteen drops of the former, with half a teaspoonful of the latter, every tAvo hours until relieved. Aromatic sulphuric acid (elixir of vitriol) succeeded so Avell in some of the later epidemics, that if Cholera comes again here I should confide much in its use for the premonitory diarrhcea; fifteen drops of it, in a small AVineglassfuI of Avater, every two or three hours. It may be alterncded with paregoric and ginger. If a case already approaches collapse, then give the folloAving, Avhich I have called " chloroform paregoric " : * My knowledge of this last fact stood me in good stead in 1854; when, on my way to render aid, with others, as a volunteer physician during the terrible epidemic at Columbia, Pa., I suffered with a painful diarrhoea all the night before reaching tliat place. Nevertheless, I went on; and was able to remain several days there on duty without being attacked by the disease. 692 DOMESTIC MEDICINE. Take of Chloroform, Laudanum, Spirits of Camphor, and Aromatic Spirit of Ammonia, each a fluidrachm aud a half; Oil of Cinnamon, eight drops; Creasote, three drops; * Brandy, tAvo fluidrachms. Mix, and keep in a glass- stoppered A'ial. Dissolve a teaspoonful of this in a AVineglassfuI of cold water, and give of that tAvo teaspoonfuls every five minutes; following each dose with a small piece of ice placed in the patient's mouth. Small and frequent drinks of ice-Avater may be alloAved, if wanted, as they are pretty sure to be. Intense thirst is almost ahvays present as a symptom. Also, mix together Avhisky and red pepper (exact proportions are here not of consequence; only it must run as a thick liquid), and rub the arms and legs constantly with them. Put bags of hot salt, or tins of hot water, to the back and belly, or on each side of the body, in the bed. (jive a tablespoonful (not more) of Avhisky every hour or tAvo, in about twice as much ice-water; this, too, being folloAved by a lump of ice. If, on this method of treatment, you do not save your patient, I do not believe there is any chance for him otherwise. Yet, as I have before said in regard to other diseases, Avhen your doctor arrives, close the book and trust to him. I hope he may approve the above practice; Avhich is, in principle, very much like Avhat Dr. Aitken, in his valuable Treatise on the Practice of Medicine, mentions as being used Avith success in India and England.f AVhen collapse has fully set in, if that should happen in spite of such measures as the above—all treatment remains to be desperate experi- mentation, Avith but little ground for hope. Consideration of such a subject belongs to more extended medical Avorks. One popular error about Cholera needs to be corrected; namely, that a particular kind of diet Avill prevent any one from being liable to it. Quite as many (probably more) persons are attacked, during an epidemic, Avho live on rice, arroAvroot, crackers, etc., as of those Avho take ordi- nary food; including meat, good sound vegetables, and fresh fruit. Of course it is necessary to be especially careful as to the quality and condi- tion of food at such times. Cucumbers among vegetables, and cherne- * This was not in Prof. Horner's prescription ; and I am not sure of its importan< in the treatment. f See " Essentials of Practice of Medicine," p. 495, foot-note. SPECIAL DISEASES. 693 and pineapples among fruits, may be omitted; hardly anything else need be if fresh and ripe. Alcoholic intemperance (even in moderate degree) greatly increases the danger of death from cholera; and so do excessive indulgences, or even great fatigues of any sort. The great principle of safety during all epidemics is, to keep the bodily condition at par; neither above nor beloAv its ordinary state and activity. Cholera Infantum ; Summer complaint. Medical Avriters are not all of the same opinion about the precise use of the term Cholera Infantum. For our purpose, liOAveA'er, Ave need not discuss the name of the disease; let us simply consider Avhat it is, and how best to manage it, Avhen left to our OAvn resources. Large cities, and the hottest summer weather, give physicians abundant experience with it. No child under five years of age, Avhose parents can afford to take or send it to the country, should remain in New York, Philadelphia, Baltimore, Cincinnati, or St. Louis, etc., during July and August. Infants one or two years old are far the most frequent subjects of summer complaint. Its symptoms are, diarrhcea, vomiting, rejection of food, languor, weak- ness; sometimes stupor. Occasionally the child may Avaste aAvay and die in a feAV days; oftener, it lasts from one to tAvo or three Aveeks. Sometimes the diarrhoea will linger on, after the vomiting is checked, for a still longer time. Treatment requires three things chiefly: correction of the morbid state of the digestive organs; checking the vomiting and diarrhcea; and sup- porting and restoring the strength of the little sufferer. Corrective medicines should come first. Such are, lime-water; soda (bicarbonate of sodium); calomel; mercury with chalk (hydrargyrum cum creta); and spiced syrup of rhubarb. In home practice, lime-Avater may be giAren Avith milk at the start; a teaspoonful of each, several times, at intervals of an hour or tAvo. Should vomiting and purging continue, then get calomel powders, one-twelfth of a grain in each; put one of these, rubbed up Avith a pinch of soda (about two grains, but exactness in this is not important), on the child's tongue, every three hours. Also, mix a spice-plaster (a teaspoonful each of poAvdered ginger, cloves, and cinnamon, made into a thick paste Avith whisky or brandy) large enough to cover the Avhole belly, and lay it on, covering it Avith a piece of oiled silk or thin rubber cloth. AVhen the spice-plaster becomes dry, take it off for a moment, Avet it Avith whisky again, and replace it. So used, one plaster will last a Avhole day and night. Pee, pounded in a clean linen rag into small bits, may be put to the babe's mouth often, for it to suck. Small drinks of iced thin rice-Avater may also, if seem- ing to be craved, be given iioav and then. For nourishment, milk, or. if diarrhcea is very bad, arrowroot made with milk (see Food for the 694 DOMESTIC MEDICINE. Sick, p. 636 in this book), should be given, in small amounts, every two or three hours. AVhen the skin is cold and the child takes little and is very weak, ten drops of the best whisky or brandy may be added to the food about once in three hours. NotAvithstanding a different view held by a feAV medical authors, I regard it as an unsafe practice to give tea- spoonful doses of Avhisky or brandy to young infants, under any cir- cumstances. Calomel poAvders and soda belong to the^r.s^ two or three days of an attack of Cholera Infantum. After that, if the symptoms continue severely, especially with much diarrhcea, astringents are Avanted, to check it. Blackberry-root tea, in dessertspoonful doses every three hours, Avith five drops of paregoric each time, Avill do Avell. So Avill geranium (wild geranium, of our woods) root tea, also; or fogirood tea; or ten-drop doses of the tincture of catechu, Avith paregoric. If the diarrhcea proves obstinate and exhausting, an injection (one or two tea- spoonfuls at a time, Avith a small syringe) of starch, Avith one or two drops of laudanum, will be suitable. Late in the attack, when prolonged, strong and varied diet being needful to support strength, beef-tea (iced or frozen Avill be best in this complaint), chicken-water, and mutton-broth may be given, turn about Avith perfectly good and fresh milk. The milk, by the Avay, should be scalded (brought to the boil) just before being used. Boiled flour food (mentioned under Food for the Sick) and Meigs' gelatin food, may have their place also, as alternatives. When slowly convalescent, to suck a piece of lean ham, or good dried-beef, may be relishing; and so may be the expressed juice of lean raw beef. Now, in all this, we should have been beginning at the wrong end of the matter, but for the statement already made, that no child under fire years of age should, if avoidable, remain in any of our large cities, dur- ing July and August. If, Avhile remaining in toAvn, summer complaint comes on, take it away to the country at once. Any high, open, real country place, where it can get good milk (if it has not its mother's in abundance, or has been Aveaned in its second year), will do. So Avill the sea-shore, if good fresh milk and good drinking water can certainly be had. Prompt removal to the country will often cure with very little medicine; the best medical treatment may fail Avhile the child remains in toAvn. Chorea : St. Vitus's Dance. A nervous affection, nearly always of young persons; characterized by irregular jerking movements, which con- tinue more or less all the time except when the patient is asleep. Gen- erally it lasts several Aveeks; sometimes months; in rare cases, years. It occurs mostly in rather thin, pale, and weakly boys or girls. Some* SPECIAL DISEASES. 695 times it is brought on by fright. The organs of speech are affected in a few eases, as Avell as the limbs. For its treatment, time will always be afforded for medical advice. It may be here simply said, that building up the system is usually required; iron, cod-liver oil, salt baths, rubbing and light gymnastics are among the remedial measures likely to be appropri- ate for it. Chronic Disease. This is, simply, continued, protracted, as distin- guished from acute disease. Acute attacks, such as measles, the differ- ent fevers, and severe inflammations (as bronchitis, pneumonia, etc.), have a time of days, or, as in typhus and typhoid fevers, of weeks (Avhooping-cough, months, often), in which they run their course. Fig. 213. Fig. 214. Tcdifies Equinus. Chronic disorders, as consumption, Bright's disease, diabetes, etc., have no such limitation. Some of them are, nevertheless, curable in many instances. This is the case with chronic bronchitis, chronic dyspepsia, and several other affections of indefinite duration. Cirrhosis. A mode of degenerative change in various organs of the body, most familiar to physicians as occurring in the liver. It is one of the most common and serious of the results of intemperance. From its cause, it is sometimes called gin-liver; from the appear- ance of this organ after death, hobnail-liver, or nutmeg-liver. Symp- toms of it are, nausea and indigestion, with furred tongue and slight yelloAvness of the eyes and skin; later, constipation, vomiting, 696 DOMESTIC MEDICINE. Fig. 215. debility, wasting of the body, dropsy, and enlargement of the veins over the abdomen. ToAvards the close, bleeding from the bowels (per- haps vomiting of blood), delirium, and stupor, Avith convulsions in some cases, occur before death. For all this course of events, besides with- drawal of the cause (if it be alcoholic) the physician can only prescribe palliative, not, Avith any hope, curative, treatment. Club-Foot. A deformity Avith Avhich some children are born; but which occasionally is acquired, from debility, and Avant of knoAvledge and care on the part of parents, during infancy. Only a child whose nervous system is defective almost or quite to paralysis, can suffer this last misfortune, Avith ordinary attention from its care-takers. There are several varieties of Club- foot. The foot may be turned in, so that in standing the child would rest on the outer side of the foot and ankle; or turned out, the Aveight of the body com- ing on the inner ankle and side of the great toe; or the toes may be extended, so that the heel Avill not reach the ground; or the foot may be bent up toAvards the knee, the heel only, Avithout the sole or toes, touching the ground Avhen the bodyiserect. (Figs. 213,214.) Many cases of Club-foot may be cured by proper treatment; some can only be improved, and rendered less inconvenient. The thing to do, of course, is to get the foot straight and keep it so. Surgeons effect this in certain suitable cases by cutting one or more of the tendons (" leaders ") of the muscles Avhich draw too much one way, and then, by means of apparatus made for the purpose, alloAving the healing of the divided tendon to take place at greater length. Other cases can be brought right by the long-continued application of apparatus (made to fit each case) which gradually forces the growing limb into its proper shape. If eA'en a cure is not thus effected, the child may often at least be enabled to Avalk much better than Avithout such assistance. Ortho- paedic Hospitals are established in various places for the special treat- ment of this and similar deformities. Colic. There are several kinds of abdominal pain, all often called Colic SHOE FOR CLUB-FOOT. SPECIAL DISEASES. 697 1. Common flatulent (Avindy) Colic; 2. Bilious; 3. Spasmodic, gouty; 4. Lead Colic. Also, passage of gall-stones, and of gravel-stones, causes severe pain in the abdomen; and some women have attacks of pain in one or both of the ovaries. Neuralgia and rheumatism sometimes affect the bowels painfully. Obstruction of the bowels (Avhich see) is attended with severe and obstinate pain, Avith entire absence of any passage from the lower boAvel. Strangulated hernia (rupture) likewise causes pain and great distress. In eArery case of protracted colic, the possibility of one of these mishaps needs to be considered and examined into by a physician. Flatulent Colic is brought on by indigestible food, in most instances. Cold and Avet, hoAvever, especially wet feet, predispose to it. The pain is chiefly felt in the colon (arched portion of the large intestine) across the middle of the belly; but it is not nearly ahvays confined to that part of the bowels. The abdomen SAvells and hardens more or less, but is not tender to the touch, unless after an attack has continued for a number of hours. Pressure often relieves the pain. Sickness of stom- ach is not uncommon in severe attacks; constipation of the bowels is present as a rule with scarcely any exceptions. A sign of the com- mencement of relief is rumbling of the boAvels, showing that the Avind moves doAvmvards; the spasmodic rigidity of the muscular coat of the intestine giving Avay to the natural "peristaltic" movement. In treatment of Colic, Ave have four things to aim at: to relieve pain and spasm; to open the boAvels; to Avard off inflammation; and to prevent repeated attacks. First, in flatulent bellyache, apply a mustard-plaster all over the ab- domen. AVhen it has been on as long as can Avell be borne without blistering, folloAV it Avith something to convey heat; a tin or bag of hot water is the most convenient thing for this. Give, as correctives, soda, essence of ginger, and spiced syrup of rhubarb ; a pinch of the first, fif- teen drops of the second, and a tablespoonful of the last. Should relief not follow this, or begin at least to come, within half an hour or so, next give a teaspoonful of magnesia, Avith twenty drops of spirits of camphor, a teaspoonful or two of Warner's cordial, and a tablespoonful of spiced syrup of rhubarb again. Or, a tablespoonful of castor-oil Avell mixed with twice as much of the same spiced syrup. When such (or similar) doses do not seem to make any sufficient impression, the bowels not being moved, give an enema (injection into the boAvels) of castor-oil, soap, molasses, and Avarm Avater. (See Injections, on page 579.) If the pain still continues severely, Ave must begin with some anodyne. Laudanum is the quickest for this purpose; fifteen drops, repeated, if need be, in half an hour. After the second dose, an unprofessional person should not venture further, if it is possible to 698 DOMESTIC MEDICINE. obtain competent medical advice. Physicians are, sometimes, obliged to administer opiates to relieve extreme pain, in doses too large to !«• safely taken under ordinary circumstances. A certain amount of re- lief is often given to Colic by gently kneading the bowcds Avith a warm hand, to aid in pushing the Avind through from part to part. In my own person, I can ahvays entirely relieve such pain by pressing firmly on the front edges or sides of the hip bones (acting on nerves passing there). Believing this to be a discovery of my oavii, not without value, it may often fail with others, from Avant of patience in its application, or from not applying the pressure in the proper place. I am about hav- ing made a pair of compressors, to ascertain how much can be done in this way towards the mitigation of abdominal pains. One of the simplest, and yet most nearly sure, means of relieving the beginning of flatulent colic, is rubbing the surface of the abdomen and back Avith a hair-brush or clothes-brush. It may be used as briskly ;is can be Avithout hurting; passing the brush from left to right over the loAver part of the belly, and then in a circle round from right to left at the upper part, above the navel. This is useful (the brisk brushing) also in fresh pains of other parts; as the muscles, from cold; what is commonly called rheumatism, although it may be just cold-pains and nothing more. One who has never tried this simple brush-remedy for commencing pains, may be surprised at the amount of relief it Avill give. Of course Ave cannot expect much from it in an advanced case. The above is an average treatment of a bad case of flatulent or crap- ulent Colic, which is the commonest kind. Bilious Colic is slower in progress, with more vomiting, and very obstinate pain. It may last from one to two or three days. The treat- ment of it, hoAvever, is essentially the same, with more patience and per- severance. Some practitioners will begin the treatment Avith a dose of calomel or blue pill; perhaps Avith opium (a fraction of a grain) added to either of those correctives. If a gall-stone passes from the gall- bladder to the small intestine, the pain will stop suddenly Avhen it enters the latter. The same is true of gravel-stones, when, passing from a kidney, through a ureter, they enter the bladder. Spasmodic (often gouty) Colic is frequently called cramp in the stom- ach. It is very apt to attack the stomach rather than the bowels. It comes on suddenly, and is very severe and prostrating. For it, the treatment must be prompt, warming, and anodyne. Paregoric or lauda- num may be given at once, in spiced syrup of rhubarb. Oil ofeqjupnt, six or eight drops on a lump of sugar, is very good for this kind of attack. A mustard-plaster over the stomach, and, if the feet be eold, a hot mustard foot-bath, will be proper. SPECIAL DISEASES. 699 Babies' Colic must be treated on the same principles as flatulent Colic in the adult. Moving the bowels, causing the wind to move, and re- lieving the pain; these are the " indications." SAveet- or castor-oil or magnesia (again in spiced syrup of rhubarb) will be right for the first purpose. Essence of Peppermint (a drop at a dose, or, for a child under six months, a drop in tAvo doses, in syrup) and camphor-water (not spirit) in teaspoonful doses, or milk of assafcetida, a teaspoonful, may represent the carminative (Avind-moving) medicines for infants. If they, with a hot flannel, wet if need be Avith essence of ginger, do not relieve, put the babe into a warm, almost hot, bath, and give it one drop of lauda- num. Seldom will it require more than this. Lead Colic is attended by shrinking instead of SAvelling of the abdo- men ; the bowels are also very costive. Pressure relieves or eases the pain. It is produced by lead-poisoning in some way or other. If ex- posure to this has just taken place, a moderate dose of Epsom salts will act as an antidote to the lead (making an inert sulphate of lead). Later, a milk diet will be important. Sweet-oil may be repeatedly given to act gently upon the boAvels; and suffering may be relieved by opium in some form, in moderate doses, especially at night. Collapse. The lowest possible state of the system short of death. The skin is cold, blue, or ashy Avhite, shrunken, and damp; the eyes are glassy and half open, or staring Avithout movement; breathing is short, quick, and laborious; the pulse is rapid and thready, hardlyT to be felt, or absent. Such a condition is seen in cholera, in bad cholera infantum, the chill of pernicious fever, and after extensive burns or scalds, heavy falls, or railroad accidents; whatever shocks the system beyond its poAver (at the time at least) of reaction. Stimulation, Avith warmth and perfect rest, is the approved treatment for Collapse. Am- monia (aromatic spirit, in half-teaspoonful doses) and alcohol (aa hisky or brandy, in teaspoonful to tablespoonful quantities), at short interATals, e\Ten every fifteen or twenty minutes at first, lengthening the time as reaction comes on; these are what we must chiefly rely on. Direct heat, by sand-bags, vessels of hot water, etc., may be applied to the body at the same time. As soon as the pulse fills up, the skin grows warm, the breathing free, and the countenance natural, all stimulation must be at once withdraAvn. If it be pushed too far, or kept up too long, feA'er and perhaps inflammation may follow, and interfere Avith recovery. Color-blindness. See Hygiene, Care of the Sight. Coma. Deep stupor, from Avhich the patient cannot be aroused. It is met with in apoplexy, fracture of the skull, dead-drunkenness, and opium-poisoning. 700 DOMESTIC MEDICINE. Comedones. See Acne, under Skin Diseases. Congestion. Accumulation of blood in a part of the body, more than is natural. Active congestion exists Avhen the blood flows through an organ in unusual amount; passive congestion, when it collects Avith- out quickly circulating through it. Congestive Fever. Better named Pernicious Fever; which see. Conjunctivitis. See Eye, Diseases of. Constipation. See Hygiene, on the Excretions. Consumption. Pulmonary Consumption (that is, of the lungs) is commonly meant by this; called phthisis pulmonal'is in medical Avorks. Some families are particularly liable to this; several of their members, occasionally all, dying of it. Other cases' begin after an attack of illness, especially a bad cold (bronchitis), measles, or whooping-cough. Sometimes, hoAveATer, consumption begins Avithout any such antecedent; perhaps first with loss of appetite and Aveak digestion; then a hacking cough, slight, but continued; pallor, loss of flesh and strength. No time of life is entirely free from the possibility of the setting in of Consumption ; but much the greatest number of cases occur betAveen the ages of fifteen and thirty. FeAvest, perhaps, are those Avhieh take place in childhood. Galloping Consumption (acute phthisis) goes through all its course, ending in death, in from four or five (seldom) to eight, ten, or tAvelve Aveeks. Much more often Consumption lasts for one, two, or more years; rarely, a dozen or twenty years. More than half the cases reach their end in from eighteen months to two years. Cough, at first hacking (unless it folloAVS an attack of bronchitis), and gradually deepening and increasing in violence, is one leading symptom. As the disorder advances, shortness of breath becomes more and more troublesome. Expectoration is at first moderate in amount, and Avhitish or yellowish-white : it becomes thicker and thicker; more and more abundant, streaked Avith blood, yellow or greenish-yellow; at last it comes in roundish lumps, Avhich will not all float on Avater. Wasting of the body is Avhat has given its name to the disease, Con- sumption. Appetite is poor, digestion difficult; late in the case, diar- rhcea comes on. From the first, the pulse is usually quickened. In an advanced case, hectic fever is characteristic. It conies once (possibly, though rarely, twice) a day, mostly in the afternoon; with heat and dryness of skin, greater rapidity of the pulse, and a bright red flush in the middle of each cheek. Copnous perspiration (night-sweats) also marks an adA-anced condition of the disease. The hair falls out, the eyes ha\Te a pearly lustre, the joints look as though enlarged, the feet swell, the voice is enfeebled, the night is disturbed with wearisome spells SPECIAL DISEASES. 701 of coughing; hemorrhage from the lungs occurs, early or late, perhaps several times, in two-thirds of the cases. Yet, Avith all these distresses, wonderful cheerfulness and hopefulness are more common than the re- verse. ToAvards the very last, in a protracted case, delirium may come on. Pleurisy noAV and then complicates the trouble. Death may result either from gradual exhaustion, copious hemorrhage, excessive collection of phlegm Avhich cannot be coughed aAvay, or the sudden breaking of an abscess (vomica) of the lung, producing suffocation. Prevention of Consumption, in those whose family or individual his- tory shoAArs predisposition to it, has been considered under Hygiene (that of the Breathing organs and their function). Its treatment is as much hygienic as medical. AVhatever promotes or economizes strength fiwors delay in the progress of the case, and adds to the chances (Avhich are not many, but exist) of recovery. Nourishing food, including milk (never skimmed, but rich with cream), beef-tea, and Avhatever else, easily di- gested, the appetite will accept, are proper. Cod-liver oil is a naturally prepared medicinal food. A tablespoonful of it thrice daily will not be too much, if the stomach Avill bear it. Get a good, reliable, not too thin, oil. Cod-liver oil is nasty; but most people can get accustomed to it, and can take it after a mint-drop, or in the froth of ale, or in coffee; or alone Avith the addition of a little salt, as if it Avere fish. Gclcdin capsules of it are now sold, Avhich preA^ent its being tasted at all. AVarm Aveather makes it harder to take cod-lhTer oil. Some can only bear it in the Avinter; a feAV cannot take it at all. For these, cream or rich milk will be a tolerable substitute; and plenty of good strong beef-tea (two pounds of beef to a pint) will help in the same direction. Dr. Robert Koch, of Berlin, in 1890, announced his supposed dis- covery of an almost certain cure for consumption of the lungs and other tuberculous diseases, in their early stage, by injecting under the skin a few drops of an extract of tubercle dissolved in glycerin. This, he thought, Avould cause the tuberculous matter to be thrown off, aud would prevent the progress of the disease. Great hopes Avere excited, and scores of patients, in Europe aud America, Avere subjected to this treatment. A number of them seemed for a time to improve under it; a few Avere apparently made Avorse by it; and Avithin six months it was given up by most physicians. The idea of this treatment was sug- gested by the belief that tubercles in the lungs and in other parts of the body are caused by minute bacilli (seen only through a microscope). A arious tonics, especially iron and quinine, are often given in Con- sumption. These may be left to the attending physician ; as may also be the cough medicines, after a few words of remark. A Aveak stomach 702 DOMESTIC MED I CINE. must not be Avorried with medicine of any kind, in such a weakeninj; disease. Syrup of wild cherry bark Avill be a good expectorant earlv in the attack; adding to it paregoric in small doses, Avhen the cough grows troublesome, at night. AVistar's cough lozenges will also then come in well. At a late stage, solution of morphia is usually relied on to pro- mote night-rest. Keeping the skin warm, by sufficient clothing, especially about the chest, is very necessary. Flannel under-clothing will be best, with an extra rabbit-skin, or doubly thick flannel, over the breast. Dr. AI ays, of Upper Lehigh, Pa., asserts the cure of several cases of consumption by thoroughly warming the patients' chests, in a manner thus described by him: "I had lately made, by Messrs. Tiemann & Co., of New A"ork, a steam-jacket of tin metal, which, from a somewhat protracted use, seems to fulfil all the ends I had originally in view. The inside surface of the jacket is covered by a lining, an inch in thickness, composed of cotton Avadding, covered Avith several thicknesses of flannel. This lining is moistened with Avater and heated before the jacket is adjusted to the chest. Thus arranged, it will be observed that it strictly fills all the requirements of a strong and powerful external stimulant, and, while its action is the same in kind to that of a hot flaxseed poultice, only a great deal stronger, it possesses many prominent advantages over ordinary poultices and other appliances previously employed. It envelops the whole chest completely. It is light and readily adjusted. It retains its position on the chest Avithout difficulty. It is easily managed and oper- ated. It maintains a constant and uniform temperature. It requires no renewal every hour. " The patients are allowed to remain in the steam-jacket for a varying period, from two to five hours each day. The steaming, besides causing an intense thirst, also calls forth a copious perspiration, and, as a pre- cautionary measure against a too sudden change in the bodily tempera- ture, the patients are advised to dress dry and go to bed, cover up well immediately after the jacket is taken off, and to remain there until suf- ficiently cooled off. The thirst is so great that a patient frequently drinks from two to three quarts of milk, or of milk and Avater, during three hours' steaming." * But the air is of more importance, perhaps, to a consumptive than anything else. Shall he change his climate ? If he live in our Northern States, it will be desirable for him, when practicable, to spend the winter (from the first of November to the end of March) in the South; in * Medical News, Philadelphia, March 8, 1884. SPECIAL DISEASES. 703 Florida, Colorado or California better than anywhere else. That is, if he is well enough to travel. If in the last stage of Consumption, a bed-confined invalid, it will be better to remain and die at home. I kneAv one consumptive to spend five successive Avinters in Florida and summers at NeAvport, losing very little from year to year. The first winter spent North, because of a lameness, was his last. Yet pure air, even in the North, may ansAver Avell. Dr. Trudeau, in his sanitarium near Lake Saranac, Adirondacks, NeAv York, reports recovery of many consumptives under a careful fresh-air treatment. Convulsions. Under Hygiene of Infancy, a good deal has been said on this subject. Convulsions may be, at any age of life, either occasional or habitual. The time when occasional commlsions are much most likely to happen, is the period of teething (dentition); between six months and thirty months of age. They are also less dangerous then than later, although sometimes even the first one may be fatal. A groAvn person may have a " fit," Avhen hurt by a bloAv on the head, when ex- hausted by bleeding, or Avhen much agitated in mind. Also, the condi- tion of pregnancy, and still more childbirth itself, predisposes to very serious (puerperal) convulsions. Habitual convulsions are either epileptic or hysterical. In the former, the patient is entirely unconscious; knoAvs nothing at all that is going on. In the latter, some consciousness is retained. The spasmodic mus- cular movements are usually less violent in the hysterical than in the epileptic convulsions; and the hysterical form is much the most frequently curable. Indeed, we may say that those having the former generally get well from them, and those affected with the latter only recover in exceptional cases. EArerybody knoAvs a fit when he sees it; by the regular jerks of the limbs and muscles of the face, on one, or more often on both sides of the body. Epileptics also frequently foam at the mouth. Hysterical attacks have uncontrollable laughter or crying, in many cases, before the "jerks" begin; and during the latter, the body is sometimes rigid; perhaps arched, resting on the back of the head and the heels. After an epileptic fit, deep stupor follows in some cases; in others, temporary but violent and dangerous frenzy (madness). AVhat to do for a convulsion is tolerably simple. AVe can seldom shorten it much; but Ave ought to try to do so, and may succeed at least in not promoting its continuance. If the patient is known to be epi- leptic, he should be laid on a soft bed or pillowed-floor, with everything loosened about his neck, and as much fresh air around him as can be obtained. Then it will pass off in a feAV minutes. AVhen a grown 704 DOMESTIC MEDICINE. person not epileptic has a convulsion, Ave should try to learn his previous condition and the cause of the attack. If he is of a full, strong habit, and the face is flushed, the head hot and the pulse strong, I think (but some other doctors may not) he ought to be bled moderately from the arm. Then apply a large mustard-plaster to his back, and cold Avalor to his head. Also, gi\Te him a purgative injection into the bowels (if there is time for it). The same treatment exactly applies to puerperal (child-bed) convulsions, Avhen there are proofs of a full-blooded and not exhausted state of the system. Otherwise (that is, in a Aveak and thin- blooded person of either sex), bleeding is out of place. A Avarm or hot bath Avill then be better; folloAved by mustard-plasters to the back, pit of the stomach, and loAver limbs; taking care, of course, that the skin be not blistered by them. If the feet be cold, apply hot bricks, or bottles, or bags of sand or salt to them at once. (Be sure the hot bricks, if used, do not burn the patient; I kneAV that to happen once, as the poor felloAV had no feeling at the time.) In weak, nervous cases of convul- sions, breathing ether (or even chloroform) is often a good remedy; it is so in the full-blooded cases after bleeding or cupping to the back of the neck. This can hardly be ventured upon, hoAvever, in the absence of a physician. For infants' convulsions (as said under Hygiene of Infancy), the same principles of management apply ; only bleeding from the arm is almost never suitable, and, as a nerve-tranquillizer, milk of assafcetida, a tablespoonful throAvn into the bowel by means of a small syringe, Avill be a help, if the fit lasts long. The warm bath also is more easily and beneficially used in infantile convulsions than in those of adults. Lancing the gums is a valuable means of relief, Avhenever they are swollen, or even tense and irritated (as shown by the child worrying Avith them before the fit). A clean cut down to the tooth is the right thing. A sharp penknife will do in the absence of a regular gum-lancet. Prevention of Convulsions requires all sorts of care of the general health; adapted, of course, to what that may be. Some may require purging and Ioav diet to render them less plethoric; more will need toning and building up. (See Epilepsy.) Corns. A Corn is an oA^ergroAvth of the epidermis or outer coat of the skin. It is nearly always caused by pressure, as that of a tight 01 ill-fitting shoe. Hard Corns may be sliced off carefully with a sharp knife, not cutting " to the quick." Then put on the place tAvo thick- nesses of adhesive plaster, cut into little rings, and a third piece, not so cut, to cover the central part. This will protect from pressure, and allow the corn (at least after the same has been done several times) to stop groAving. SPECIAL DISEASES. 705 A soft Corn is inflamed and tender. You must soothe it first, with bread poultices at night, and Avearing, Avhen moving about, a slipper or a shoe Avith a hole made for that toe. Then, Avhen the soreness is all out of it, treat it with careful paring and plasters as above described. Cough. See Bronchitis, Hooping-cough, and Remedies, p. 543. Coup de Soleil. See Sunstroke. Cow-pox. See Vaccination. Coxalgia: Hip Disease. A chronic inflammatory affection of the hip-joint; one of the manifestations of a scrofulous constitution. It begins almost ahvays during childhood. Pain is felt first in the knee; but the knee is not tender to the touch, nor SAvollen; and if the bent knee be tapped from beloAv, it will hurt at the hip-joint. Soon the child gets to walking lame, bending the knee on the affected side so as only to touch the toe to the ground. After a Avhile it is disabled from walk- ing ; the hip-joint is likely to have matter formed in it, and the head of the thigh-bone may undergo inflammatory decay (caries). It is not always so bad as this; if attended to early, recovery may take place in the course of a few months. The principles of treatment are two: to relieve the joint from pressure, and to build up the system of the child. For the first, splints are made, with arrangements for stretching the limb, so that the head of the thigh- bone is kept from pressing into its socket; or, if the limb is not stretched (as Avas the older practice), it is at least kept at rest. The " building up " must be done by good food, salt baths, sea or mountain air in sum- mer, iron, and cod-liver oil. Cramp. A spasmodic contraction of one or more muscles. It does not always shorten the muscle, but only makes it hard and painful. Some, especially elderly, persons often have cramps in their legs and feet. Others get them on stepping upon a cold floor, or when bathing in cold Avater. Lives have been occasionally lost by a SAvimmer being attacked with cramp when in deep water. Epidemic cholera almost always has cramps of the limbs among its symptoms. They are much less common in cholera-morbus. To relieve cramps, the best thing I know, besides sufficient warmth, is to grasp and press firmly the muscles affected. Bandage them tightly if the attack is obstinate, always being sure to apply the bandage to the foot as well as to the leg, so that the foot will not be made to swell from checking the return of blood through the veins. Cramp of the Stomach. See Colic. Cretinism. A kind of idiocy, with general stunting of the body, accompanied mostly by goitre (which see) of the throat. It is little known anywhere except in some of the valleys of the Alps. 45 706 DOMESTIC MEDICINE. Fig. 216. Croup. There are three varieties of Croup: 1. Sudden, spawnodie night Croup. 2. Moderately inflammatory catarrhal Croup. 3. Danger- ously inflammatory membranous Croup. The second may glide into the last, unless properly treated. Night Croup comes on Avithout Avarning, at or before midnight, in children from two to four years of age. The child, well on going to bed, wakes Avith a short, barking cough, and difficult hoarse breathing. This difficulty is distressing. By giving it half a teaspoonful of syrup of ipecac, at once, and repeating this in fifteen minutes if not relieved, and yet again if need be, there will be, in most cases, case given to the breathing, and the child will go to sleep. If vomiting follows the taking of the ipecac, no matter. If not, it Avill work off by the bow- els in the morning. Should this dosing not at once ansAver the purpose, put the child for ten minutes into a warm bath ; then Avipe it dry aud warm in bed, and bathe its throat with " hartshorn and oil"; that is, equal parts of either water of ammonia or aromatic spirit of ammonia and SAveet-oil. AVhen a child has fre- quent attacks of night-croup, milk of assafcetida is a good thing to add (in equal parts) to the syrup of ipe- cacuanha. Catarrhal Croup often begins in the night, though less suddenly; and while the above treatment relieves the breathing at the time, the child is not free from hoarseness and a short barking cough all day. AVhen night again comes on, near midnight, its cough grows sharper, and the croupy difficulty of breathing returns. This is likely to happen three nights in succession; FA™E^^tNEwith prompt treatment, seldom more. We should, in this kind of attack, give a good dose of purgative medi- cine in the morning; citrate of magnesium or Rochelle salts will do. Also, keep the child in doors; in one room if the house is not equally warmed throughout. Give it small doses of syrup of ipecac, (ten to twenty drops, according to age) every three hours through the day; then half-teaspoonful doses, only if it has real distress of breathing, in the night. Membranous Croup is a much more serious affair. Not a feAV phy- sicians consider all cases of it to be examples of diphtheria. I am sure this is a mistake. I saw many cases of membranous croup (and medi- cal books gave full accounts of such) years before diphtheria was known in this country. Diphtheria is an epidemic disease, and someAvhat con- tagious from person to person. Membranous Croup is an inflammatory disease, occurring in children (and occasionally in adults) anywhere and SPECIAL DISEASES. 707 at any time. General AVashington died of it. There is membrane formed in the Avindpipe in certain cases of diphtheria; but it is then first formed on the tonsils and in the " fauces " ; that is, the upper open- ing part of the throat. In true Croup it is confined to the air-passages, the larynx and trachea, or, even, sometimes, extending down into the bronchial tubes. AVe know a case of inflammatory, threatening to become membranous, Croup, by its beginning (at least as often as not) in the daytime; and continuing with little change through the day and night; also, and especially, by the fever that attends it. Ahvays be concerned about a case of croup in Avhich there is fever and illness all day. There are, hoAvever, times Avhen the difficulty of breathing is When the case goes on, these become Fig. 217. worse. more frequent and severe; and the breathing at last is no longer hoarse, but hissing and whistling; from the great narroAving of the windpipe, obstructed by membrane formed in it. If relief comes, the sign of it is a soft mucous rattling in the throat with the breathing. Otherwise, within two, three, or four days usually (sometimes less than two days), the Avindpipe becomes more and more obstructed, and death ensues at last from suf- focation. Treatment of membranous Croup cannot be rightly undertaken by an unprofessional person. All that we can say here about it is, that, when no medical advice can be ob- tained, the pressing need of relief for the paroxysms of difficulty of breathing must be met (as in night Croup) by something relaxing which promotes secretion; and for this, ipecac, is the safest thing; to it being added half-teaspoonful doses of powdered alum, in a case of alarming obstinacy. Tracheotomy (opening the windpipe by an incision), the last resort of physicians in cases otherwise hope- less, will not, of course, be ventured upon by any untrained and un- skilled hand. One measure may be mentioned as not difficult to carry out, and likely to soften the membrane, whose detachment gives the only chance of recovery; making the patient breathe vapor from water poured on unslaked lime. In the absence of an "inhaler," this can be done BRONCHIAL FALSE MEMBRANE. 708 DOMESTIC MEDICINE. most simply by placing a boAvl, containing the lime and boiling water, under the upper sheet of the child's bed; it being then covered with the sheet, face and all, for a feAV minutes at a time. A teapot may be used instead, Avhose spout (Avhen it is boiling) will give out the vapor from the lime near the little patient's mouth and nostrils. I have seen recoveries from membranous Croup; but it is one of the most dangerous of the acute disorders to Avhich children are liable. Crusta Lactea. Milk Crust; an affection of the skin in young children. See Skin, Diseases of. Cyanosis. The " Blue Disease." So called because the infant born Avith it is blue all over, from imperfect aeration of the blood. Its cause is incomplete development of one of the great blood-vessels (pulmonary artery) near the heart; or the non-closure of the opening, Avhich exists before birth, between the right and left sides of the heart. There is no cure for this affection. All that can be done is to place the child on its right side at once after birth, and to make sure also that the trouble is not merely a temporary imperfection of breathing ; in other Avords, that avc have not a case of asphyxia instead of Cyanosis. AVe conclude that it is the latter only when the child breathes and cries as usual, and yet continues blue, as a permanent condition. Such a child seldom lives many days. Rare examples, however, have been known of those par- tially cyanosed surviving for years. Cystitis. See Bladder, inflammation of. Cysts. These are cavities formed in various organs, containing fluid. They originate either in the enlargement of a natural cell or cavity, or from the development of a parasite (cysticercus, hydatid) Avithin the organ. Ovarian cysts are the seat of ovarian dropsy. On this, see Women, Diseases of. SPECIAL DISEASES. 709 Dance, St. Vitus'. See Chorea. Deafness. This is of several kinds and different degrees. 1. Con- genital ; that is, being born deaf. Such children are also necessarily dumb —deaf-mutes. 2. From advanced age. This is partial only; mostly a dulness of hearing; and some old people do not suffer any such loss. 3. From disease, as small-pox, scarlet fever, or severe inflammation of the ear destroying or impairing the condition of the ossicles (little bones), or the tympanic membrane, of the ear. 4. From a violent explosion near the head, rupturing the tympanic membrane. 5. Partial and often Fig. 218. EAR-TRUMPETS. temporary deafness, from a " cold," thickening the drum-membrane, and obstructing the small canal between the ear and throat (Eusta- chian tube) Avith mucus. 6. Matter filling the middle ear, from in- flammation. 7. Collection of wax, formed in excessive amount, in the outer channel of the ear. The last of these is the only kind Avhich can be properly attended to by any unprofessional treatment. Ears are almost as delicate and easily injured as eyes; they will not bear violence Avithout injury. When wax is thick and over-abundant in the ear, the outermost part of it may be, gently and carefully, got out with an ear-pick. When some 710 DOMESTIC MEDICINE. of it remains at the bottom of the passage, it may be softened and loosened by repeatedly pouring warm Avater, or glycerin and water (equal parts), or almond-oil, into the ear from a teaspoon or a little glass tube Avith an elastic suction-end. Syringing is often used for this purpose but the spoon-pouring is gentler and better. I have known persons to be made dizzy and faint by having their ears syringed. There are specialists avIio practise ear-surgery, and avIio are called upon to treat cases of chronic deafness. Far be it from me to disparage their skill and ability; but they Avould probably ackuoAvledge the great difficulty of their calling, and admit that it alloAvs of feAver successes than are obtained by oculists. Degeneration. See earlier in this volume, on the Nature of Disease. It may be added now, that degeneration consists in the substitution for healthy, active tissue in any organ or organs, of a lower kind of forma- tion. So, in the heart, fat may take the place of muscular fibre (fatty degeneration); in the arteries, mineral matter may form instead of the natural coats of the vessels (ossification). There are also other kinds of degeneration. In old age, such changes are simply modes of slow decline of life, ending at last in death. Intemperance, over-fatigue, acute diseases, etc., anticipate old age in certain cases, bringing on de- generations in different organs, such as have been mentioned. Delirium. A disorder of the brain, shoAvn by random talking, ges~ tures, and perhaps more active movements. It occurs often in fevers, especially in typhus and typhoid fevers. It is to be distinguished from insanity; in Avhich there is a more lasting mental derangement. Delirium may come and pass away Avithin a feAV hours. Delirium Tremens : Mania-a-Potu. This is the most horrible kind of Delirium; commonly well named " the horrors." It is brought on by intemperance; most frequently from the use of distilled liquors (ardent spirits, that is, whisky, gin, brandy, rum), but sometimes from fermented alcoholic drinks. It may be fatal in a first attack. If re- peated, it becomes each time more and more dangerous to life. Trembling, as one symptom, has given part of the name of this affec- tion. Sleeplessness also belongs to it. AVhen the patient gets a long sound sleep, he almost ahvays wakes up Avell, or nearly so. AVeakness of the stomach, loss of digestive power, is another part of the worst cases, making it much harder to get them through the attack. But the most terrible part is the brain trouble; the mental affection. All kinds of dreadful images beset the victim, and seem real to him. Snakes, rats, Avild beasts, and armed pursuing enemies, are around him day and night. The horror is in himself; most of all Avhen alone, and in the dark. He might say with Milton's fallen Lucifer, " myself am hell. SPECIAL DISEASES. 711 In rare instances only, the illusions which take the place of realities in this delirium are, though very real-seeming, without horror. If ever obliged to deal Avith a patient so affected, remember, first, that the cause of his malady is alcoholic poisoning. He must be rid of that. If you are afraid (as many are) to stop abruptly his supply of drink, at least make him "taper off" rapidly. For his habitual half gallon or quart or so of whisky daily, substitute at once a tablespoonful every three hours; which will make about two wineglassfuls in the day and night. The next day make the interval twice as long—every six hours. Then withhold it all day, and give him a single wineglassful at nine or ten o'clock at night. Let him drink also a pint of hop-tea in the course of the day. If seeming strong enough to do right off without whisky, let him have for a feAV days a bottle of ale or porter daily. Nourishment for such a condition must be strong and easily appro- priated. Beef-tea (not filtered, but well skimmed), to which plenty of red pepper is added, may be given freely; in the weakest cases, beef essence. Any light animal food that he likes may be added; as chicken broth, etc. Milk will be very suitable if he will take it, as is sometimes the case. If a warm bath can be prepared conveniently, a stay in it of half an hour, towards night, being rubbed dry quickly afterwards, Avill promote sleep. As to medicine. If you must act in this emergency without medical advice, laudanum is, on the whole, the best resource. Begin at night, with thirty drops. Should he not sleep after three hours, give him thirty drops more. Then, if he continues Avide awake, wait six hours, and begin with fifteen drops every four hours. Let the dose at half-past nine or ten o'clock at night be doubled—thirty drops. Dare we push this opiate treatment further, if it still falls short ? I hesitate to recom- mend it to any unprofessional person. But I may say that I have known larger quantities of it, similarly used for four, five, or six days, followed at last by a long sleep and recovery. For other plans of treatment, the reader must be referred to professional medical works. Dementia. Wreck of the mental poAvers; imbecility, coming on in a person whose mind was previously sound. It often follows acute or chronic insanity. It is more hopeless than mania or melancholia, the other chief varieties of mental derangement. Dengue. See Break-bone Fever. Diabetes Mellitus. A disease characterized by the presence of sugar in the urine. It is a wasting disorder, but slow in progress; often last- ing for months or years, but seldom cured. What does the sugar come from ? Certainly either from the food 712 DOMESTIC MEDICINE. taken, or from the substance of the tissues of the body. Since the body Avastes away gradually, and yet not very fast, and a good deal of su»-ar is passed daily, it is probable that both the food, after it gets into the blood, and the tissues, furnish the sugar. The liver always has in it some sugar after death, and contains a sugar-forming material, glycozen, during life. AATiether the liver is to blame in this case or not, a bad habit of sugar-making exists in the system. How may Ave discourage (if not prevent), instead of promoting, this habit ? Reasonably enough, it is thought, by letting the patient take no sugar-producing food. Not only sugar itself, but starch, everything containing starch, is to be with- held, in accordance with this view. As nearly all vegetables and fruits contain a great deal of starch, meat and bran bread are the chief ingre- dients of the commonly advised diet of diabetic persons. Milk is ex- cluded, because it contains lactose, the sugar of milk. As for medicines, there will always be time enough for these to be considered and directed, in Diabetes, by a competent medical authority. To discover the sugar in the urine requires some knowledge of chemistry. (See " Essentials of Practical Medicine;" or works on Medical Chemistry.) There are no special symptoms of Diabetes Mellitus (beyond the dis- charge of a very large amount of heavy urine) sufficient to make cer- tain the presence of the disease without a chemical analysis of what is passed. Diet tables for Diabetic patients have been constructed. The follow- ing Avill answer for that purpose. One so affected should not eat: Sugar, in any condition. Wheat, rye, or Indian corn Bread. Potatoes, Turnips, Parsnips, Carrots, Peas, Beans, Rice. Arrowroot, Sago, Tapioca. Pastry, Puddings. Fruit, fresh or preserved. Calf's Liver. Diabetics may eat: All kinds of butcher's Meat except Liver. Ham, Bacon, corned Beef, dried Beef. Poultry, Game. Fish, fresh or salted. Soup (except vegetable), Beef-tea, etc. Bran, gluten, or Graham Bread. Cheese, Butter, Eggs, Cream. Spinach, String-beans, Asparagus, Lettuce. Cabbage, CaulifloAver, Broccoli. Tomatoes, Onions, Radishes, Celery. Jelly, not SAveetened. Custard, made Avithout Sugar. Nuts and Pickles in moderation. SPECIAL DISEASES. 713 Diarrhcea. Excessive and liquid discharges from the bowels. Sometimes this occurs by itself, but in many cases it is a symptom of a general disease; as in typhoid fever, cholera, and advanced pulmonary consumption. There is also a form of " consumption of the bowels," with Avasting, in which diarrhoea is the most conspicuous symptom. Diarrhcea by itself (idiopathic) is the most common in warm coun- tries and in summer time. Infants are especially liable to it in summer. (See Cholera Infantum.) Treatment of Diarrhcea has been already considered pretty fully in this book under Remedies : How to Check Diarrhosa; which see, page 528. Diathesis. A morbid constitutional condition or predisposition: as the scrofulous, gouty, rheumatic, or syphilitic diathesis. Dilatation of the Heart. See Heart, Diseases of. Dilatation is enlargement of the heart, Avithout thickening of its substance. Diphtheria. An acute disease of the general system, with violent inflammation of the throat, in Avhich a thick yellowish-white membra- nous deposit occurs, sometimes extending into the Avindpipe and causing diphtheritic croup. The disease is generally epidemic; but, with close contact, as kissing, or inhaling the breath of one affected, it has been shown to be contagious. Princess Alice of Hesse, a daughter of Queen ATictoria, is considered to have been the victim of a kiss, by which she caught the disease from one of her children, just recovering from diph- theria. Several physicians have died of it, in consequence of inhaling the breath of patients on whom they were performing the operation of tracheotomy. Although described as sometimes seen by ancient writers, and in mod- ern Europe and America at long intervals (as in NeAv England in 1736, and NeAv York in 1771), Diphtheria never prevailed extensively either in Europe or this country before 1855-6. Now it is often absent from many places for years together, and then may break out, in a village quite as often as a city, or in a single family, even; destroying in such cases a number of lives in succession, especially among children. As to the causation of Diphtheria, the two most important practical points are, one, that it is sometimes personally contagious ; and the other, that it is promoted by an impure atmosphere; such as that of large tenement-houses, close alleys, leaky drains, stagnant sewers, etc. Reason exists for believing also that impure drinking water tends towards the same result. Diphtheria is, in part, like typhus and typhoid fevers, a filth-bred disease. How shall we knoAV an attack of Diphtheria from one of common sore throat ? Unless Diphtheria is known to be prevailing at the time, do not suppose it at all probable that any case is of that disease. Multi- 714 DOMESTIC MEDICINE. tudes of people haA^e quinsy, and greater multitudes slight inflammation of the fauces and pharynx, Avithout any Diphtheria. In the latter, there is a severe illness: the throat is very sore; and, Avhen you press down the tongue with the handle of a tablespoon, you may sec on one side or both, back of the tongue, patches, Avhitish or dull yelloAvish-white (late in the attack sometimes almost broAvn), looking like hardened phlegm. Thev are almost of the nature of mucus, only more solid, and not separated from the lining of the throat. Be sure not to mistake for such diphtheritic deposits, either 1, small bits of phlegm, ordinary mucus; or 2, small pimples or enlarged and inflamed follicles of the throat. To make sure, let the patieut (if old enough) wash out the throat Avith pure water; and then look again. If mucus, the patches Avill have been washed away. If either pimples (papules) or enlarged follicles, the Avasli- ing Avill make their small size and regular rounded shape distinct. A diphtheritic throat, moreover, is all red and SAvollen with inflammation. Bad cases have this to extend also into the nostrils, with an acrid, nasty discharge from them. If there be a raw place anywhere on the body, as from a blister, diphtheritic membrane will be apt to form on it also. Diphtheria is not generally a very rapid disease. Sometimes its prog- ress for several days is gradual and insidious. The child or other pa- tient does not appear to be so ill as he is. But in three days or so, most generally, it shows itself to be bad enough. Very many get Avell; but a considerable fraction of cases do not, but die within about a week. On recovery, great debility is commonly left, and sometimes partial paralysis, affecting the muscles of speech and of swallowing, or, it may be, the loAver limbs. AVhat are we to do for Diphtheria? I am reminded by this ques- tion of what I heard a celebrated physician, the elder Dr. Hodge, of Philadelphia, tell of himself. When he had been some time in practice, and married, a child of his had a convulsion. " For heaven's sake," said Doctor Hodge, " somebody go and run for a doctor!" So I must say to the reader when a case of Diphtheria occurs: go for a doctor. It is impossible for me to dogmatize about its treatment. A dozen or tAvo plans for it are set forth in medical books and periodicals. I will only say that those of my cases in practice have done best in which I gave early and large doses of chlorate of potassium ; five grains for a child under ten years of age, and twenty grains for an adult, every three hours, dissolved in Avater. Of course the patient must be kept comfort- ably Avarm and quiet in bed. An early moderate dose of citrate of magnesium, or Rochelle salts, or Tarrant's aperient will be suitable. The throat may be bathed repeatedly outside Avith soap liniment or "hartshorn and oil," and gargled Avith alum Avater or a weak solution of chlorohy- SPECIAL DISEASES. 715 dric (muriatic) acid mixed with honey. One of the most agreeable and useful things, hoAvever, will be the swalloAving slowly of small pieces of ice at tolerably short intervals. Liquid food must be given from the start; milk, beef-tea, chicken-broth, etc. For the account of further particulars, and various modes of treatment, I must refer the reader to " Essentials of Practical Medicine," or some other professional medical Avork. Diplopia. Seeing double; two objects instead of one. Hemiopia (more rare) is seeing only half of an object at a time. Dipsomania. See Methomania. Dissecting Wounds. Poisoned Avounds, got Avhile handling re- cently dead bodies; as in post-mortem examinations made by physicians, or in the dissecting rooms of medical colleges. Similar results folloAV from even very slight Avounds, as the puncture of a needle or a pin, into Avhich matter from ulcers, abscesses, or any unhealthy sores, has been allowed to enter. During my early medical experience, I suffered from three such wounds; two of them producing serious illnesses. They are often fatal. In my own, as in most other cases, inflammation of one or more of the lymphatic (absorbent) vessels took place. A bright red line, very tender to the touch, ran up my arm to the armpit. There, in my worst case, a glandular abscess formed, as large as an apple. When it softened and Avas opened, I began to improve and get well. Prevention of such poisoned Avounds is always attainable, even Avhen one's hands are immersed in the products of decay and death. First, never touch such things if there is the least scratch on the hand. Sec- ondly, if a knife, needle, pin, or edge of bone breaks the skin Avhile at work in such materials, at once wash and then suck the part thoroughly; and do not expose it to the same things again. This is not a pleasant precaution, but it is very effective and important. Diuresis. Excessive discharge of urine. Diabetes means the same thing; only in case of sugar being found in the urine the term mellitus (from mel, Latin for honey) is added to the latter name. Dracunculus. Guinea-Avorm; one of the parasites which, in trop- ical climates, occasionally live in the human body. Dropsy. A collection of watery fluid, either in the connective tissue all over the body, or in some of the great cavities; as hydrothorax, dropsy of the chest, hydrocephalus, of the head, ascites, of the abdomen; anasarca, general dropsy; oedema, Avatery swelling of a part of the body. Of the causation of Dropsy, enough for our purpose has been said under the Nature of Diseases. Concerning its treatment, see Remedies; under the heading Dropsy (page 548). 716 DOMESTIC MEDICINE. Drowning. See Accidents and Emergencies, in the last part of this book. Dumbness. Every one born deaf must be dumb (mute), because, Avithout hearing, he cannot learn to speak. Of latter years, a system has been invented by Avhich deaf persons can, Avith long perseverance, be taught to speak by looking at and folloAving the motions of the tongue, lips, and throat. A feAV are without speech from malformation or de- fect of the organs used; i. e., the cords and muscles of the larynx, the organ of voice. Impediments of speech from such causation are not un- common. Idiots (born imbeciles), and those Avho become imbecile from disease affecting the brain, are sometimes dumb, simply from Avant of sense. Dysentery. An inflammatory affection of the loAver boAvel; with frequent, small, and bloody discharges, passed with pain and straining. The belly is tender to the touch or on movement; fever is often present in severe cases. Dysentery is most common in and near Philadelphia in August and September; but it may occur in scattered cases at any season. Some localities, especially in tropical climates, have it every year as a sort of endemic disease. Eating unwholesome food, as unripe fruit, is one of its causes ; being suddenly chilled after great Avarmth is another. In treatment of Dysentery, rest in bed is indispensable. A large warm mush and mustard poultice should be laid over the abdomen, and covered Avith oiled silk. At the very start, half a tablespoonful of castor-oil, with ten drops of laudanum and a tablespoonful of spiced syrup of rhubarb, will be a good dose. Leaving to the physician to prescribe the rest, it may be said that ipecac, in small doses (not more than a grain at once, best in pill) is one of the most useful medicines in Dysentery; opium has to be resorted to tolerably early, also in small doses; from one-eighth to half a grain, according to the suffering and number of discharges, every three or four hours; later, obstinacy of the case may require sugar of lead, half grain to a grain several times a day, as a sedative astringent; and laudanum and starch injections into the bowels (twenty, thirty, or forty drops of laudanum in a tablespoonful or two of starch) constitute an important part of the management of severe cases. Food only of the simplest and most soothing kind is alloAvable in Dysentery; arrowroot, sago, tapioca, corn-starch, made Avith milk to make them more nourishing, will be the best things; Avith rice-Avater for a drink. Chicken-broth may be the first variation from these; after- Avards beef-tea, etc. In convalescence, care must be used not to get up and move about too soon; also, not to venture on all kinds of food be- fore the boAvels are altogether settled. Chronic Dysentery depends SPECIAL DISEASES. 717 usually on ulceration of the loAver bowels. It is sometimes difficult to cure, even under the care of a skilful practitioner. Dysmenorrhoea. Painful menstruation. Some Avomen suffer con- siderably every month; others only occasionally. Besides such treat- ment as belongs to professional skill and experience, domestic pre- cautions and measures suitable are these: Avoiding fatigue of body or mind for a day or two before, as well as at, the regular time for the change; remaining at rest in bed or on a couch through the needful time; applying a flannel wrung out of hot (not merely warm) water over the loAver abdomen; and taking some warming antispasmodic or anodyne drink. Such may be spirit of camphor, twenty drops, with compound spirit of lavender a teaspoonful, in a wineglassful of hot water, in a mild case. In a severe one, a teaspoonful or two of pare- goric should take the place of the camphor; and such a dose may be repeated, if pain is great, in two or three hours. Married women who have children are likely, if subject before to Dysmenorrhoea, to get rid of it. Dyspepsia. Habitual indigestion. Its most common causes are, eat- ing indigestible food; taking too much food ; eating too fast; SAvalloAving the food without proper cheAving; and mental worry. I have knoAvn it to be produced in a Avorkingman by drinking a bowlful of strong coffee three times a day. Symptoms of Dyspepsia are: pain or discomfort in the stomach, increased after eating; belching, from flatulence; sour taste in the mouth; sometimes " water-brash," i. e., a fluid coming up from the stomach into the mouth; in certain instances " heartburn," the feeling really starting in the stomach, though seeming to be about the heart; poor appetite; constipation of the bowels; Ioav spirits (hypochondria). Some dyspeptics cannot forget their stomachs at all, and also compel all their acquaintances to remember their unhappy condition. This is often a very hard disorder to cure; but it is not immediately dangerous to life. Treatment of Dyspepsia requires, first, great care in the diet. When everything disagrees, the patient is often not a good judge of Avhat is best for him. Meat, tender and good, especially beef, lamb, turkey, and chicken, must, with stale bread, oatmeal mush, and crackers, make the bulk of his nourishment. He must eat slowly, take time for it, with his mind as much at ease as possible. Secondly, his habits of mind and body must be improved. Some- thing to do every day, will be advantageous; exercise out of doors is very important; but over-fatigue, and worse, over-worry with business, Avill not suit him at all. Let him always sit awhile, talking or reading (not studying), after a meal. 718 DOMESTIC MEDICINE. Thirdly, constipation must be relieved. Fresh fruit, especially peaches, or the best apples, or in their absence stewed prunes or dried peaches, Avill generally help much. Rhubarb is the best of medicines as a "peri- staltic persuader" for the dyspeptic. Friederichshalle or Huuyadi danos Avater will do uoav and then for a change. Fourthly, tonics are appropriate, especially the simple bitter tonics; as gentian, quassia, columbo, etc. Probably the most convenient of all is the compound tincture of gentian; a small dessertspoonful, in a little Avater, after each meal. Fifthly, acidity may be counteracted by occasional doses of lime-Avater, soda, potash (bicarbonate of potassium), or, when costive, magnesia. Vichy lozenges and " soda mints " are good for this purpose. Sixthly, although the poor and irregular meals often necessarily taken in travelling are not beneficial, yet change of place, scene, and diet is generally good for a dyspeptic person. It helps to get his attention aAvay from his OAvn ailments; and it is a fact about a disordered stomach, that the more you think about it the more it won't behave itself. Dyspnoea. Difficulty of breathing. It is met with in croup, asthma, dilatation of the heart, dropsy of the chest or abdomen, epidemic cholera, and some other affections. Its worst degree (short of asphyxia, suffoca- tion) is called orthopncea ; the patient being obliged to sit up in order to breathe at all. Treatment of it belongs to the disease which causes it. Dysuria. Difficulty in passing water. See Urine, Retention of. SPECIAL DISEASES. 719 Earache. Most common in infancy and childhood. When a baby too young to talk screams with pain, not relieved at all by a hot flannel over its stomach, and not accounted for by pins, hunger, thirst, or tem- per, touch the central part of its ear. If this, on pressing it, makes it shrink and cry more loudly, you may be pretty sure it has Earache. Drop into it, first, a teaspoonful of almost hot water. Should this not seem to do good, folloAV it with tAvo drops of warm sweet-oil, added to one • drop of laudanum. Obstinate cases may be treated with poultices to the ear, of hops, mush, etc. For these send for a doctor. Ear, Inflammation of: Otitis. A painful ear, continuing so all day, and tender to the touch, must be inflamed. This may be, and often is, a slight affair, Avhich will get well of itself in a feAV days; but some- times it is extremely severe, possibly extending to the brain. A bad case Avill end in the formation of pus (matter), Avhich discharges either through the outer channel (meatus) of the ear, or, more slowly, by the Eustachian tube, into the upper part of the throat. Arery little treatment is available for ear inflammation. Almond oil to drop in, is soothing; and so is gently applying, all over the margin of the ear-opening, the cold cream of the apothecary. Severe pain may be relieved, as in simple earache, by a drop of laudanum, folloAved by a poultice of hops or Avarm mush. If a poultice is used, it ought to have a piece of fine gauze between it and the ear, to prevent the material from getting into the passage. Leeches are often applied Avith good result to an acutely inflamed ear; and,at a later stage, a small blister just behind the ear may hasten the cure. Ears, Ringing in : Tinnitus Aurium. This may have several causes. If it be in one ear alone, it is almost certainly due to some fault in that ear. When both ears are alike affected, the cause may be in the ears, or, quite as often, in the general state of the brain. Quinine, taken in large doses, produces in most people ringing or roaring in the ears; and so does salicylic acid. Staying in the house for days together without exercise Avill bring it on in some persons. General nervous exhaustion is frequently attended by it. All these are causes affecting both ears, through the condition of the brain. In the ear itself, obstruction to the conduction of sound, as by wax, or the stoppage of the Eustachian tube, will sometimes cause this symp- tom. It also comes, with dizziness, as premonitory of Meniere's dis- ease. This is a rare affection. On the whole, while it is unpleasant, ringing in the ears alone, without other signs of serious disorder in the brain, does not necessarily indicate anything very dangerous. Eczema. A disease of the skin, Avith a more or less watery erup- tion, often scabbing. See Skin Diseases. 720 DOMESTIC MEDICINE. Embolism. PLUG (EMBOLUS) OF ARTERY. Elephantiasis. Enlargement of a limb, or of the neck or trunk, " elephant-like." See Skin Diseases. Obstruction of a blood-vessel by an embolus; that is, a small fragment of blood-fibrin Avashed through the circulation from an organ AA'hich is the seat of inflam- mation. An embolus, acting as a plug, may so arrest the supply of blood by an artery as to cause the death of the part (as an arm or leg) by mortification (gan- grene). Emphysema. Distention of the cells of a lung, or of the connective tissue under the skin, by air. It is not a common occurrence, in either situation. Empyema. A collection of pus in the pleural cavity of the chest; following pleurisy, or suppuration of the lung from inflammation and abscess. Most frequently it is the result of severe pleurisy. If a spontaneous opening between the ribs does not give it exit, physicians often deem it best to let it out by an operation; as pus will not, like serum, be absorbed, and is ahvays a source of danger to life when it remains in any cavity of the body. Endocarditis. Inflammation of the lining membrane of the heart. It is attended by much distress, and may be fatal in a few days. AVhen not so, lasting injury may be left, in changes in the valves of the heart. See Heart, Diseases of. Inflammatory Rheumatism is the principal antecedent of endo- as well as of pericarditis. Enteric Fever. See Typhoid Fever. Epilepsy. The " falling disease;" habitual or periodic convulsions. The patient falls, after little or no warning, becoming unconscious at once. His limbs jerk, and his jaws are closed with violence; some- times biting the tongue. Foaming at the mouth is common. In a few minutes, usually, the attack is over; but droAvsiness, perhaps stupor, or occasionally wild frenzy, follows in a certain number of cases. The fits may come every day or oftener; or at intervals of days, weeks, or months. Epilepsy is hereditary in some families. Otherwise, it may be brought on by sensual excesses, abuse of tobacco, fright, or any other cause of great nervous disturbance or exhaustion. It is very hard to cure. Bro- mide of potassium has more poAver than any other drug in lessening the number of fits; but its large administration has inconvenient effects on the system. Epilepsy, after long continuance, mostly impairs the con- dition of the mental faculties. Yet several of the most celebrated men have been epileptics: Caesar, Mohammed, Petrarch, NeAvton, Peter the Great, Napoleon I., Lord Byron. SPECIAL DISEASES. 721 Epithelioma. A tumor or morbid growth, consisting chiefly of the minute forms called epithelial cells ; such as are natural to the sur- face of the skin, and to the mucous lining of the mouth, throat, etc. When these multiply irregularly, or are found growing in parts to which such cells do not naturally belong, the tumor is considered cancerous; and, as a rule with very few exceptions, it is incurable. Sometimes, when cut away, or otherAvise destroyed, very early, it does not return. Microscopic examination is necessary to determine the na- ture of such a tumor. Eruptions. See Skin Diseases; also, Exanthemata. Erysipelas. A spreading inflammatory affection of the skin. Be- ginning mostly, but not always, at a part Avhich is inflamed, or which has been Avounded in some way, it extends gradually over the skin. Sometimes a large part of the body is thus involved. Worst of all is Erysipelas of the head ; as delirium and other signs of inflammation of the brain may then follow, indicating great danger. Elsewhere, how ever, extensive Erysipelas may exhaust the strength, very much as in the case of a burn over half of the body; or deep inflammation, even of one or two of the limbs, may cause so much formation of pus under the skin as to give great trouble. Erysipelas prevails especially in ill-ventilated hospitals. Now and then, however, a single case occurs, under other circumstances, which we cannot explain. It is not contagious from person to person. Con- tact with it, however, seems to give a liability to generate the infection of puerperal fever. Physicians and nurses should never go from attend- ing upon or visiting a case of erysipelas to take charge of a case of labor. Early local treatment may avail much in this disease. When the first burning sensation, with tenderness to the touch and redness, comes on in a part, apply to it at once and repeatedly fresh cold cream or pure tallow or lard. As a conflagration may be prevented by the timely use of a bucketful of water, so we may prevent, at the start, a possibly very serious attack of Erysipelas. In treatment of the disease, when fairly developed, nothing is gained by trying to suppress the eruption. Soothing it is very proper; as by oxide of zinc ointment, weak lead-Avater, lime-water and oil, etc. Head- ing it off, to prevent its extending from the trunk or face to the head, is an old expedient; sometimes it may succeed, but not always. It is attempted by painting the skin thickly with tincture of iodine, just be- yond the inflamed part. Cooling medicine, as citrate of magnesium or Rochelle salts, citrate of potassium, acetate of ammonium, is appropri- ate to the early, feverish state of an attack of Erysipelas. Simple, un- stimulating, but nourishing liquid diet is also in place; milk, beef-tea, 46 722 DOMESTIC MEDICINE. oatmeal gruel, etc. Under such a simple treatment, I have seen a large number of cases of this disease recover, in hospitals as well as in private practice. The most trusted remedy for Erysipelas, however, with most physicians at the present day, is tincture of the chloride of iron; fifteen or twenty drops every three or four hours. Some also give alcohol freely to erysipelatous patients. That some of them, especially in hospitals, may require it, is entirely probable. I must mention, hoAvever, that of all the cases of Erysipelas under my care in tAventy years, all of wliom got Avell, not one took, by my advice, a drop of alcohol. Erythema. A mild superficial inflammation of the skin, spreading somewhat, but without the severity of erysipelas. See Skin Dis- eases. Exanthemata. The acute eruptive and febrile disorders; namely, small-pox, varioloid, chicken-pox, scarlet fever, and measles. Each of these has or will have its place and separate consideration in this alpha- betical series. They all come out Avithin one or two weeks after expo- sure to the contagion. Small-'pox has the eruption to begin on the third day, as pimples, becoming watery, and then suppurating, pitting, drying, scabbing, and falling off. It lasts in all about three weeks. Varioloid resembles small-pox, except that in all respects it is milder, and runs its course in a shorter time. Chicken-pox (varicella) looks like very mild varioloid, but with more scattered vesicles; coming out in successive small crops, and seldom suppurating. The whole attack may be over in from a week to ten days. Scarlet fever has generally (in this like small-pox) pain in the head and back, with sick stomach, perhaps vomiting, at the beginning. On the second day, soreness of the throat appears, the throat and tongue being very red. About the same time, bright diffused redness is seen on the face, trunk, and limbs, increasing until, in marked cases, the whole surface of the body has a red and swollen look, with a very hot fever also. Measles does not have the eruption to begin until the fourth day (sometimes later). Cough and redness of the eyes and running at the nose come sooner, perhaps Avith the first malaise of the beginning sick- ness. The measles eruption is in irregular patches or " blotches," and, on looking closely, Ave see that it is made up of small pimples, larger than any seen in the scarlet fever eruption. The redness, moreover, is less bright, and the heat of skin less intense, than in that malady. Soreness of the throat is occasionally met with in measles, but it is not a characteristic symptom. The duration of measles is from seven te 999999� 94 SPECIAL DISEASES. 723 ten days; of scarlet fever, about the same. Measles may leave behind it weak eyes, or a chronic cough. Scarlet fever, if severe, may, though recovered from, cause blindness or deafness. More often it is folloAved by dropsy. Scarlet fever is, of the two, much the most dangerous to life. Exophthalmic Goitre. A singular disease, in Avhich the eyeballs protrude, the throat SAvells as in common goitre (bronchocele, Derbyshire neck, enlargement of the thyroid gland), the heart and arteries throb Fig. 220. EXOPHTHALMIC GOITRE. with violence, especially upon exertion. It is a disorder of long con- tinuance, sometimes recovered from, but far from always. Its treatment is difficult, and a subject of different opinions among physicians. The two remedies that I have seen do the most good in its management are digitalis and iron. It is very important for the patient having it to avoid hurrying the action of the heart by quick or laborious movements of any kind. The nearer at rest from exertion he is, the better. (Fig. 220.) 724 DOMESTIC MEDICINE. Eye, Diseases of. Inflammation of the eye may affect only the sur- face covering of the eyeball and lining of the lids, Avhen it is called conjunctivitis ; or the cornea, corneitis ; the hard fibrous coat, sclerotitis; the ring around the pupil, iritis ; or the retina, retinitis. A general in- flammation of the eye is called ophthalmia. This is common; but the degree in which the different coats are involved varies much. In home practice, the care of conjunctivitis is most likely to occur. In that, the eyelids and ball are red, the lids swollen; moderate pain and great soreness of the eye are felt; light cannot be borne Avith com- fort. All use of both eyes must be given up for the time. Iced sassa- fras-pith water may be applied freely and often over both closed lids, with a camel's-hair pencil; or, less beneficially, by laying a light rag Avet with it upon the eye. The patient must remain in a ratlier dark room during the height of the attack; but this must not be continued many days, as it is unfavorable to the general health. Leeches may do good in a severe case, in Avhich the whole eye is painfully affected. An obsti- nate case, especially if both eyes are inflamed, may also call for the ap- plication of a small blister across the back of the neck. Chronic conjunctivitis is attended byT an enlargement of the superficial blood-vessels, causing " granular lids," which continue red and swollen, the eyes being irritable and " weak." Having suffered much inconven- ience from this during the first twenty years of my life, I may here mention Avhat (after trying many things) most aided in curing it. This Avas the frequent painting of the outer surface of the lids with lead-water; using a soft camel's-hair pencil. My lead-water was made by putting one drop of Goulard's extract of subacetate of lead in about a fluid- ounce of clean water; and my custom was for years to return to it when- ever March winds, or any outer cause, renewed the irritation of my eyes. After the lead-water, anointing the lids at night with cold cream is a good practice. Sclerotic inflammation is in most cases rheumatic in origin; fibrous tissues are the ones generally subject to rheumatism. It is more painful than conjunctivitis; but it is much less common. Wine of colchkum root is an anti-rheumatic remedy, and oil of cajuput, on the same indi- cation, may, in sclerotitis, follow a brisk saline purgative dose. Rags wet with laudanum may be laid upon the eye from time to time to assuage the pain. Iritis is not very common, but is in many cases connected with con- stitutional Syphilis. When there is room to suppose this (or, indeed, whether so or not), calomel, blue mass, or the protiodide of mercury, will be likely to be prescribed by the medical attendant in the case. Retinitis and optic neuritis (inflammation of the optic nerve), as welJ SPECIAL DISEASES. 725 as corneitis and choroiditis, are too difficult of diagnosis and special management to be considered except in professional works. Blindness may be caused by: 1. Failure or paralysis of the "eye- brain " or of the optic nerve, as happens in some old people, and in what has been until lately called amaurosis. 2. Cataract; that is, opacity of the crystalline lens in the centre of the eye. This opacity may, in an ad\Tanced case, be easily seen, as a milky appearance, behind (seemingly in) the pupil. 3. Destruction of part of the refracting appa- ratus by disease, as small-pox. 4. Opacity of the cornea, which is the transparent coat at the front of the eyeball, set (like a window in a sash) in the sclerotic coat. Other causes of partial or total blindness exist, but these are the most frequent and important. Oculists have pushed their special studies and experience so far of late years, that even general practitioners of medicine and surgery are accustomed to leave, when they can, the treatment of eye affections to them. It will, therefore, be quite beyond our present scope to go far- ther into that subject. On errors of vision, and their correction, see Hygiene : Care of the Eyes, page 402. 726 DOMESTIC MEDICINE. Faceache. Tic-douloureux (popularly called " tic doloroo!"). See Neuralgia. Facial Palsy. Although not unfrequently consequent upon brain disease, palsy of one side of the face is, in the larger number of cases, especially in young subjects, the temporary result of inflammation from cold of the sheath of the " seventh nerve," Avhich passes through an opening just below the ear. The effect of it upon the countenance is odd. The patient may smile with the healthy side of his face, while the other side is quite Avithout expression. As above said, such eases recover, as a rule, in a feAV weeks, requiring little if any treatment, be- sides what is suggested by the " cold " in Avhich the trouble took its rise. Fainting. Syncope. Under some depressing or exhausting causa- tion, the heart gives out, and refuses to send blood to the brain and other parts. Therefore, becoming unconscious, the person falls, unless supported. The face is pale, the pulse absent, the skin cold, the breath- ing almost null for the time. What shall we do ? Lay the fainting person down at once, so that aired blood may flow from the heart and lungs to the head, reanimating the " centre of respiration" (medulla oblongata) as well as restoring consciousness. Keep all crowding at a distance. Open the windows to let in fresh air; or carry the " faintee " out, still in the horizontal posi- tion. Sprinkle cold Avater in her (it is mostly a woman) face. If at hand, hold smelling salts (ammonia) near, but not too near or too long, to her nostrils. So, a mere faint will soon pass off. If kept in the erect position, in the midst of a croAvd in a close room, one who faints may have the " syncope " to pass into actual death. Prevention of a faint, when threatened, may be had upon the same principle; by the person who feels like it dropping a handkerchief, or anything else, and stooping down to pick it up. This will attract very little attention; and the lowering of the head will be apt to freshen up the brain and avert the attack. Famine Fever. See Relapsing Fever. Fatty Degeneration. As before spoken of, this is the substitution of fat for higher tissue, such as muscle, liver-substance, etc., of different organs. Fatty degeneration of the heart has been most fully studied by physicians. It is not common before late middle life. Coming on gradually, its existence may for a long time not be discovered. Some- times only death makes it certain. Its signs are those of Aveaknass of the heart; especially a sense of exhaustion and shortness of breath on exertion. The pulse is usually feeble and sIoav when at rest, often ir- regular. Fainting spells may occur; sometimes Avith snoring respiration, like apoplexy; but unlike that, in passing off Avith no succeeding palsy. SPECIAL DISEASES. 727 Also, in the " syncopal apoplexy" of heart degeneration, the skin is cold, the pulse Aveak; Avhile in true apoplexy, the head at least is warm, the face flushed, and the pulse full and slow. Fatty degeneration is not curable. AVhat can be done is to husband the strength, and avoid trying the heart by any great or sudden exertion or excitement. Rupture (breaking or tearing) of the fatty heart is a not uncommon mode of death in those affected with it. Favus. A very disagreeable disease of the hairy scalp. See Skin Diseases. Felon. A severe inflammation of a finger, ending in suppuration. If the matter forms or finds its Avay under the fibrous sheaths of the tendons (" leaders ") of the hand, it is very painful; and, unless opened by a surgeon, tedious. Professional opinion generally favors (besides poulticing with bread or flaxseed) early incision, dowm to the bone; so as to let out the matter before it spreads around in the deeper parts of the hand. Fever. General remarks on this subject have been made under General Disorders (page 495). Medical text-books give account of the following varieties of Fever: Cerebrospinal, Intermittent, Re- mittent, Pernicious, Puerperal, Relapsing, Scarlet (equally a fever with Measles and Small-pox), Typhoid, Typhus, and Yellow Fevers. On each of these something is said in the present alphabetical series. Filaria. A genus of minute parasites of men and animals. One of them, filaria sanguinis hominis, swims about in the blood-vessels of human beings, in some tropical climates. Mosquitoes (or kindred in- sects) are charged, not Avithout plausible evidence, with conveying them with their bills from one person to another. Fissure of the Anus. See Anus, Fissure of. Fissure of Nipple. See Nipple, Cracked. Fits. See Convulsions. Flatulence. Wind in the stomach or bowels; causing uneasiness and more or less pain, and tending to escape disagreeably either upwards or doAvnwards. See Dyspepsia and Colic. For slight occasional attacks of Flatulence, ten or fifteen drops of Essence of Ginger, or five to ten drops of Essence of Peppermint (diffused in water), or five or six drops of Oil of Cajuput on a lump of sugar, or a " soda mint," will be mostly a sufficient remedy. The cure of the disposition to indigestion, however, which causes the flatulence, should be attended to, when it recurs often. Frost-bite. Possibly sometimes the result of simple exposure of the feet to cold; more often, caused by suddenly heating them when they have been chilled. Coming in from walking or skating in cold weather, 728 DOMESTIC MED I CINE. and putting the feet at once to a hot fire, is an almost certain way of getting frosted feet. The manner of this is like that iu Avhich plants are killed by frost. Heat and cold alter the bulk of fluids more than that of the solids that contain them; and sudden expansion and then con- traction, or vice versa, bursts the delicate cells of the plant structure, and strains, if it does not burst, animal cells and tubes. Frost-bite is an acute inflammation of the skin, thus produced. H the feet are actually frozen, mortification is endangered. Several of Dr. Kane's companions in his Arctic expeditions lost their toes in this Avay. Treatment of Frost-bite (chilblain) may consist of the application, during the height of the inflammation, of lead-Avater, glycerin, and lau- danum (a fluidounce, i. e., two tablespoonfuls, of lead-water, half as much glycerin, and a teaspoonful of laudanum). Aftenvards, bathing the feet morning and night in tepid oak-bark tea or alum water (precise strength not important); followed by cold cream or simple cerate. Cabbage-leaves are often used for this trouble in domestic practice. SPECIAL DISEASES. 729 Gall-stones. Hardened bile, of which small masses pass along the duct from the liver and gall-bladder to enter the duodenum (first part of the small intestine). Very severe pain attends this passage; relieved as soon as the gall-stone escapes from the bile-duct into the bowel. Oc- casionally such stones remain in the gall-bladder for a considerable time. In a few cases, the gall-bladder, or duct, bursts, letting its liquid con- tents into the abdominal cavity. This is a fatal accident. (Fig. 221.) Gangrene. See general remarks (page 490) on Mortification. Dry Gangrene is the kind now and then seen in aged people, who thus die at the feet before the rest of the body. Signs of Gangrene are, cold- ness, " mushiness," blackness and loss of feeling in the part. Briefly, it dies and rots; then sloughing off; —a " line of demarcation " forming between the living and the dead tissue, if the process stops. Often, however, it goes slowly upwards towards the centre of the body, de- pressing vitality more and more until it ends in death. To arrest the progress of Gangrene is often impossible. Strengthen- Fig. 221. GALL-STONES IN GALL-BLADDER. ing the patient's system to endure it, and to throw off the dying part, is the main thing. Amputation of a limb is sometimes resorted to; this will only save life if mortification does not begin again in the stump. Washes of a stimulating character are suitable for Gangrene. I doubt whether any are better than pure whisky and dilute nitric acid (twenty drops to a half-pint of water), used, one or the other, twice a day. Charcoal poultices are sometimes applied for cleanliness (powdered charcoal mixed Avith bread and water). Antiseptic Avashes, to relieve the offensive odor, may be made of solution of chloride of soda (a tea- spoonful of Labarraque's liquid to a half-pint of Avater), or permangan- ate of potassium (ten grains in a half-pint of Avater). Gangrene of the lung is a rare but nearly (or quite) always fatal dis- order. It is recognized by the horribly offensive putrid odor of the breath. Supporting measures, by quinine, beef-tea, milk, and suitable alcoholic stimulation, are all that can be done for such a case. Gastric Fever. Old, rather than recent, medical books use this des- 730 DOMESTIC MEDICINE. ignation for cases, uoav recognized as not all of one character. Children Avhen suffering Avith indigestion, often have considerable fever with it; this is one ATariety. In children, also, malarial remittent may occur, Avith disorder of the stomach as a symptom; and typhoid fever, in chil- dren, has vomiting with it, tolerably often (in adults it is rare in that disease). Either of these may correspond with Avhat, sixty years a«-o, was called Gastric FeArer, or Infantile Remittent. Gastritis. Inflammation of the stomach. Acute Gastritis, by it- self, is very rare, except from an injury or from poisoning. Irritation, with moderate inflammation, of the stomach, duodenum, and liver, is what manifests itself in a bilious attack. Chronic Gastritis is not uncommon. It differs from dyspepsia (to which it has a resemblance so far as habit- ual indigestion is concerned) in the presence of tenderness on pressure at the pit of the stomach. Stimulating articles, such as ginger, pepper, etc., increase the distress of Chronic Gastritis. Bland, soft food is best for it; arroAvroot, sago, tapioca, rice, lime-Avater, and milk. Medicine appropriate to it had better be left to the physician. Sub-nitrate of bis- muth and nitrate of silver (pills of one-quarter grain, with one-quarter grain of opium) are favorites here with many practitioners. Gin-Liver. Cirrhosis; Hob-nailed Liver. One of the results or manifestations of alcoholic poisoning; often brought on by long-contin- ued intemperance. Symptoms of it are, indigestion, sickness of stom- ach, constipation, salloAvness of complexion, debility, wasting, abdominal dropsy, and enlargement of the veins over the surface of the abdomen. Treatment of it is null, beyond breaking off alcoholic indulgence, and promoting the general health by attention to all the obvious needs of a failing system. The course of the malady generally occupies several months, ending Avith delirium, stupor, perhaps convulsions, and death. Cirrhosis of the Liver, however, sometimes occurs without intemper- ance. It is a degenerative affection, and may, though seldom, be brought on by other causes which depress the vitality of the system. Glanders. A contagious disease of the horse, now and then taken by grooms or hostlers. Beginning with inflammation of the nostrils, it extends to the throat, face, and eyes; Avith fever, pustules on the skin, and diarrhcea. Death results in three or four weeks. Glaucoma. A painful disease of the eye, often ending in blindness. A characteristic of it is, excessive tension of the fluids of the eyeball; so that, to a delicate touch, it feels harder than natural. AVith the oph- thalmoscope (a mirror throAving strong light into the eye, and pierced with a hole through Avhich an oculist can look), there is seen a cup-like depression at the entrance of the optic nerve (cupped disk). 1 or the treatment of Glaucoma, see special books on Diseases of the Eye'. SPECIAL DISEASES. 731 Goitre. Enlargement of the thyroid gland, in front of the neck. It is occasionally met with in various places; but is very common in the valleys of the Alps, and in some other Fig. 222. mountain districts. What there causes it is not certainly known. Excess of mineral substances in the drinking water is a pos- sible cause; too little sunshine with too great dampness may be another; and a third may be (at least intensifying these) close intermarriage of families. Cretinism, Avhich is a stunted condition of the body, with imbecility, often accompanies the Goitre of Switzerland. Both are found to be, if not curable, at least capable of much improvement, when their subjects are re- moved in early life to other and more healthy situations. For the treatment of Goitre as it may occur occasionally anywhere, iodine has a high reputa- tion ; but it is not an infallible remedy. See Ophthalmic Goitre. Gonorrhoea. A contagious disease of impure intercourse; for which, see works on Surgery. Gout. Simple Gout is an acute and very painful inflammation of the toes and fingers, whose most frequent cause is high living ; that is, free indulgence in wine or malt liquors, with rich animal food, and but little exercise. In rare instances, it comes without using any alcoholic beverages. Once fastened upon the constitution, it may (as a diathesis) show itself as flying Gout; now in the joints, and then in the stomach or the heart. Also, it is hereditary in many instances. Children of gouty parents, as they grow up, may have regular gout of the toes (podagra, or arthritis, of old medical books), or, as often, gouty attacks of the stomach, or dyspepsia, or neuralgia. The last-named is very common in such families. In the treatment of attacks of regular gout, colchicum is a standard remedy; wine of colchicum root, in ten- to fifteen-drop doses. With it, at first, magnesia is a good medicine; aftenvards, soda or potassa (bicar- bonate of sodium or potassium) or lithia in moderate doses, continued for several days. The morbid agent of Gout appears to be an acid— uric or lithic acid—some of Avhich is always present as a result of " waste of tissue," but which is in excess in the system in this disease. Laudanum may be applied on light rags (covered with oiled silk) to relieve the pain of the inflamed small joints. Sometimes Opium may be taken internally; especially in the form of Dover's Powder (see 732 DOMESTIC MEDICINE. Opium, under Remedies), both to relieve pain aud to promote perspira- tion. Repeated gouty inflammations of the toes or lingers may leave the joints irregularly SAvollen with chalky deposits, Avhich almost crum- ble under pressure. For gouty attacks affecting the stomach or heart, prompt use of anodyne and stimulant remedies is called for: a teaspoon- ful of whisky or brandy, or of Hoffmann's anodyne, followed, if relief does not soon come, by tAventy-five or thirty drops of laudanum; also, a mustard-plaster over the seat of the spasmodic pain, and a hot mus- tard foot-bath, as soon as possible. Gravel. Small stones, or sand, formed in the kidneys, and passing thence to the bladder. There they cause irritation, with pain or burn- ing in passing Avater. Most generally, Gravel consists of particles or masses of uric acid or its compounds; the same that are found in excess in the blood in gout. Alkaline treatment is proper for it, along Avith something soothing, and a light, unstimulating diet. Bicarbonate of sodium (" soda ") in ten-grain doses, with half-teaspoonful doses of sweet spirits of nitre, taken several times daily in flaxseed-tea, will usually give relief. The use of the sweet spirit of nitre is to increase the flow of urine, aud so dilute and wash away the excess of uric acid or other deposit. Grip or La Grippe. A common popular name for the epidemic of Influenza (page 744), which spread over the world in 1889, 1890, and 1891. Beginning in Russia in 1889, it moved gradually westward, affecting several countries in Europe, and finally also the United States and Canada. A similar but more irregular course followed in 1890, and again in 1891. Multitudes of people Avere attacked, especially in the large cities. More prostrating than former epidemics of Influenza, a considerable number of deaths were ascribed to it, and the general mortality was largely increased on account of the frequent complication of pneumonia and the aggravation by it of other diseases. In London, during one week in the early part of 1891, 500 deaths occurred from diseases of the breathing organs alone. In Chicago, during one Aveek in March, 1891, 70 deaths Avere ascribed to the Grip and 240 to Pneu- monia—an unprecedented mortality from such diseases. In New York, about the same time, 146 deaths from all causes occurred in 24 hours, and 196 policemen were at that time on the sick list, chiefly from the Grip. In Philadelphia it was not quite so bad, although almost every one had an attack; and in the Aveek ending March 24, 1891, the deaths numbered 463, Avhich Avas 17 more than in the cor- responding week of the previous year, and largely beyond the average for that time in a number of years. In that Aveek 54 deaths Avere ascribed to consumption of the lungs and 39 to pneumonia. SPECIAL DISEASES. 732a The Grip varies a good deal in its symptoms. So much, in the beginning, does it resemble a common " cold " that every one avIio has caught cold from any exposure is apt to suppose that he has " La Grippe." (This term is from the French, but it is considered in better taste to translate it into our good short English word, descriptive of the strong hold it takes—the Grip.) Usually, first come headache, backache, often leg-ache, reminding physicians of dengue, or break-bone fever. But dengue has never spread o\7er the Avorld like this epidemic. Moreover, in almost all eases a cough occurs in the Grip, Avith running at the nose, and often sore-throat. Fever commonly conies on the first or second day. In a great number of cases it is slight, and passes off, as all the symptoms may, iu one, two, or three days. In other instances it may last a week or two ; rarely a sIoav fever keeps on for several Aveeks. Occa- sionally delirium occurs during the fever; some persons have, it is asserted, taken their oavu lives in the frenzy thus produced. Almost always recovery from an attack of this disorder is attended by weakness out of proportion to the violence of the symptoms, and this weakness may last for weeks, or eA^en, in some degree, for months. What to Do for the Grip.—In mild cases very little treatment is necessary. In all, early simple measures Avill be likely to have excel- lent effect. I have had some which began like severe attacks, to give way very promptly to this simple Avay of proceeding : Give the patieut first a tablespoonful of Tarrant's Aperient PoAvder, or of Rochelle Salts, or a AVineglassfuI of Solution of Citrate of Mag- nesium. Put a long mustard plaster, half mustard and half wheat flour or Indian meal, aud nve or six inches Avide, up and down the back, aud leave it on until it burns quite smartly, so that he quite wishes to have it off. (When it comes off, if the skin feels sore, apply a large piece of linen or soft muslin, covered with tallow or "cold cream " of the apothecary, with another piece outside of this to keep the grease from the bed-clothing.) Give him plenty of lemonade to drink—cold if his fever is hot; hot if, instead, he inclines to be chilly. If his feet are at all cold, or even cool, let him sit, near bed-time, for five or six minutes with them in a pail of moderately hot Avater in Avhich a handful of mustard has been stirred. If the cough is troublesome, make flaxseed tea (pouring a pint of boiling water on a tablespoonful of flaxseed, but not boiling it), and add lemon-juice and sugar, for his driuk. Seven or eight out of ten cases of the Grip, treated early in this mild fashion, Avill get Avell Avithout further trouble. The other two or three will need a doctor to take the responsibility. Physicians arc not all agreed as to the management of severe cases 7326 DOMESTIC M ED I CIS E. of the Grip. Some Avill give a great deal of quinine; others, whisky right along, in considerable doses; still others, opium or morphia. Dover's Powders, Avhich contain opium, are favored by many. Lar^e. use is made by a number of practitioners of a class of medicines called antipyretics, such as antipyrin, autifebrin, and phenacetin. In large doses these (of which the safest probably is Phenacetin) lower the heat of the body iu fever by a powerful action on the nervous system. My impression is strong that the use of very large doses of quinine is imt called for in the Grip; that Avhisky had better be omitted in the majority of cases; and that the employment of the "antipyretics" just mentioned is experimental; and as the mortality from the Grip has been greater than that of previous visitations of Influenza, such practice is not likely to be permanently confirmed and adopted. For the weakness attending and following the (irip, nourishing food, as beef-tea, <£e., is important, Avith avoidance of severe exertion, quinine (6 or 8 grains a day), iron in some cases, aud, especially in summer, change of air—to the mountains or the sea-shore. Guinea-Worm. See Dracunculus. SPECIAL DISEASES. 733 Haemophilia. A special disposition of the body towards bleeding, even from very slight wounds; as lancing the gums, extracting a tooth, etc. This is uncommon, but runs in families. There is no known cure for it; but it should always be remembered in connection Avith the management of those who have such a family history. Operations Avhich would be perfectly safe for others may, with them, be dangerous. Thus a well known clergyman of Philadelphia, in the prime of life, bled to death from the removal by a surgeon of a small wen on his side. Haemoptysis. See Hemorrhages. Hay Fever. See Asthma. Headache. Various causes may produce pain in the head; as, fulness of blood (congestion of the brain); neuralgia; rheumatism of the scalp; blood-poisoning, as by alcohol, etc.; fever; urcemia, from suppression of the secretion of the kidneys; sympathy with irritation of the stomach, bowels, or womb; disease of the brain. It is not always easy to make sure which of these accounts for a particular case of head- ache. Fulness of blood shows itself by flushing of the face and heat of the head; often, also, by the swollen arteries standing out at the temples. Neuralgic pain is almost always on one side (hemicrania), and extending down to the face; also, it is attended by tenderness on press- ure. In rheumatism of the head, the muscles which move the head are apt to be sore on motion; and rheumatic symptoms occur in other parts of the body. Blood-poisoning, fever, uraemia, and sympathetic irritation are recognized in view of the history of each case. When disease of the brain is the cause of pain, it is usually confined to one spot, comes in spells or paroxysms, and is accompanied by other signs of disorder of the brain. To relieve headache, we must endeavor to ascertain to which of these varieties it belongs, and act accordingly. There is, of course, no sum- mary or universal remedy for it. See Neuralgia, and page 519. Sick headache is a regularly or irregularly recurring affliction which some people are subject to all their lives. It may be hereditary, run- ning through several generations. Coming on either gradually or sud- denly, its subject is " laid up " for the time by its severity, with more or less nausea, perhaps vomiting, for from one to three days. Cure of the tendency to such attacks has baffled many a physician in its search. If anything will ward off the expected " spell," I believe it will be the use, from the first moment of threatening, either in the stomach or in the head, of compound gentian pills (see Gentian, under Remedies), two twice daily for two days. Towards relieving an attack which has come on, nothing is likely to 734 DOMESTIC MEDICINE. be better than a teaspoonful of magnesia, Avith half a teaspoonful of aromatic spirit of ammonia, mixed in a wineglassful of Avater. One of the most likely things to bring on an attack of sick-headache is, waiting an hour or two beyond one's usual time for a meal, especially dinner. Heart, Diseases of. Palpitation is not a disease, but a disorder of the heart; a good example of afunctional disturbance, as distinguished Fig. 223. POSITION of heart in a healthy man. from an organic disease. Palpitation is a violent beating of the heart, more or less distressing, according to its degree. It may be caused by strong coffee, very strong tea, tobacco, alcoholic drinks, sensual indul- gence, or indigestion (dyspepsia). Even sedentary life, all the time in- doors without exercise, promotes it, as one of the symptoms of nervous- SPECIAL DISEASES. 735 ness. Avoidance of all these causes is the substance of the treatment of simple Palpitation. Inflammation of the heart affects chiefly either the inner or the outer membrane covering it. One form, therefore, is Endocarditis, and the other Pericarditis. In the former, injury to the valves is endangered. In the latter, effusion of serum may clog the heart's movements, or they may be obstructed by adhesion of the pericardium to the heart. Both forms of heart inflammation occur most often in connection with acute inflammatory rheumatism. In both, life is in danger during the attack, besides the after-effects above mentioned. The symptoms of both are much alike: pain and distress about the heart, with violence of its movement, hurried breathing, bad dreams, perhaps delirium, and fever. Only by auscultation and percussion, which require trained skill, can their respective signs be distinctly made out. In treatment of such se- rious affections, of course, medical aid should be called for. In its unavoidable absence, Ave can only encourage perfect rest in bed, with the shoulders moderately raised; simple, unstimulating, chiefly liquid, diet; at the beginning, a dozen or two leeches, if they can be had, over the region of the heart; if not, a mustard-plaster on the back, opposite to the heart; and, later, a small blister just below the situation of the heart's beat. Valvular disease of the heart is, as already said, a frequent result of Endocarditis. It most frequently affects the valves of the left side of the heart—either the mitral or the aortic valves (see Anatomy). One or both of these may be distorted in shape, so as to keep the valve im- perfectly shut, or not sufficiently open, in the alternate contractions and dilatations necessaiy to the circulation. " Physical examination," that is, in this case, auscultation, enables physicians to determine, almost with certainty, the exact conditions of these valves. The effects of such im- pediments to the heart's action on the circulation of the blood are serious, according to the nature of the valvular change in each case; to the strength of the heart to overcome the difficulty presented; and to the amount of exercise, labor, or excitement, by which the heart's action is increased. A marked difference between mere palpitation and organic disease of the heart is, that exercise lessens the tendency to palpitation, but makes worse the suffering from valvular obstruction. In the case of Valvular Disease, however, neither medicine nor sur- gery can get at the heart to repair its injured mechanism. General care of the health, Avith avoidance of active exertion or much excitement, is all that can be advised or practised toward lengthening life. With such care, in a few instances, gradual restoration may take place; in many. the condition of the heart remains nearly the same, with tolerable 47 736 DOMESTIC MEDICINE. health, through months or even years. In many bad cases, and in mora moderate ones where care is not taken (as sometimes seems inevitable in patients of the laboring class), the results of heart-disease go on to show themselves. These are, greater and greater distress with the heart's action and in breathing, often worst at night; and dropsy, of the feet first, aftenvards of the abdomen and the body at large (anasarca). AVeakness increases, and at last death closes the scene. Enlargement of the heart may be either overgroAvth (Hypertrophy) or stretching (Dilatation). Hypertrophy is a true thickening of the muscular walls. Sometimes it may result from habitually excessive exercise; as in violent gymnastics, rowing in races, running at cricket, etc. More frequently it is brought about by the natural effort of the heart to overcome the resistance to the movement of the blood caused by valvular obstruction in the heart itself. Like any other muscle, the heart grows Avith exercise—that is, if it is well nourished, and has inter- vals of rest. But if not these, then over-labor weakens it; and, when the obstruction is considerable, the heart is stretched, dilated; its Avails at the same time becoming thinner (attenuated). This is Dilatation of the Heart. The " physical signs " of this, as well as of true Hypertrophy, are fully set forth in professional works. Besides dropsy and debility, gradually increasing, a special liability of sufferers with Dilatation of the Heart is to attacks of congestion of the lungs. The management of both varieties of enlargement of the heart re- quires the same carefulness to avoid exertion and excitement as in the case of valvular disease. This is all that, in Home Medicine at least, can be well specified about it. Fatty Degeneration of the heart has been spoken of in its own place. Heart-exhaustion has been met with in a number of cases, such as those observed by myself and others in our Army Hospitals during the Civil AA^ar. It was brought on, for example, during the disastrous " Penin- sular Campaign " in Virginia, by the soldiers having to march a great deal at " double-quick " rate, with very little rest at night, poor food to eat, and bad water to drink. Although some of these men looked pretty well, and might be supposed to be able to do something, their pulses Avere feeble and easily hurried; and slight exertion would knock them up at once. Heartburn. See Dyspepsia. Heat-stroke. Usually called Sun-stroke. Better described under the former name, because many cases occur in the shade; some even (in India and China) at night. Nine-tenths of the examples of this are met Avith in large cities. Very feAV people are sunstruck on the harvest- field, or when running upon cricket grounds. AVhat causes the differ- SPECIAL DISEASES. 737 ence ? Clearly it must be the atmosphere of toAvns. Depression of the vital energy by foul air makes excessive heat take worse effect. More- over, intemperance predisposes greatly to this kind of attack. Those who suffer Heat-stroke are nearly ahvays fatigued Avhen it comes on. To avoid it, the three things to do are: to live in the country during the summer if you can ; never to drink any Avhisky, Avine, or beer; and not to use sevTere exertion when the thermometer is over 90° in the shade. Symptoms of Heat-stroke may be of either of tAvo kinds, or of a mixed character. Perhaps the last are the most common. Extreme cases may be, 1. True Sun-stroke, or Heat Apoplexy; in which the head is chiefly affected, Avith congestion, from the direct effect of the rays of the sun; 2. Heat-collapse, Avith paleness and prostration, the patient being conscious even to the last. In both of these A'arieties, the pulse is generally rapid. In a feAV of the apoplectic kind it may be sIoav ; in most of those it is full, until near the fatal end. Both are very dan- gerous to life. What to do ? Very plainly, heat is the cause of the attack, and cold gives its main hope of cure. If the face be red and the head hot, the pulse full, the breathing snoring, and the patient unconscious, lay him in the shade Avith his head and shoulders raised, and apply ice-Avater freely to his head. At the same time put large mustard-plasters to his legs. If, on the other hand, the face is pale, the body as Avarm as the head, the pulse Aveak and rapid, the patient conscious but fainting Avith debility, lay him level in the shade, the head no higher than the feet. Pour cold Avater over his head, trunk, and limbs (taking care, of course, not to do this too often, so as at last to chill him). Give, by the mouth, half a teaspoonful of aromatic spirits of ammonia, or, if sooner on hand, a teaspoonful of Avhisky or brandy, or a tablespoonful of wine; and repeat the same, if need be, in half an hour. All other treatment had better be left to the judgment of an attending physician. Hemicrania. Pain on one side of the head. See Headache and Neuralgia. Hemiplegia. Palsy of one half of the body. See Paralysis. Hemorrhage. See Avhat is said on this subject under Remedies (p. 544). As to the origin and nature of Hemorrhages, they may be either, 1. Active; 2. Passive; 3. Traumatic (from injuries); 4. Symptomatic; 5. Critical; or 6. Vicarious. Active Hemorrhages are those preceded by an increased Aoav of blood toAvards the part. Passive are the result of weakness of the Avails of the small blood-vessels, or too great thinness of the blood. Traumatic bleeding, from wounds or injuries, belongs to 738 DOMESTIC MEDICINE. the domain of Surgery. (See Accidents and Injuries; nearly the U t portion of this book.) Symptomatic Hemorrhage occurs from the nose in the early stage of typhoid fever, and later from the bowels ; from the lungs in consumption; from the stomach, as black vomit, in yellow fever. Critical Hemorrhage takes place sometimes in that and in some other fevers; just before coiwalescence. Vicarious bleeding is now and then met Avith, from the nose, stomach, or bowels, in Avomen whose menstrual Aoav has been interrupted. Medical authors give the name epistaxis to bleeding at the nose; hcemoptysis is spitting of blood; heematcmesis, vomiting of blood ; luvma- turia, passing of blood in the urine. For the treatment of Hemorrhages, see Remedies (p. 544). Hemorrhoids. See Piles. Hepatization. A term applied to the condition of an inflamed lung, in the middle stage of pneumonia; in Avhich it is full of blood and lymph, making it red and firm to the touch, like the lh^er. Hernia. See Rupture. Herpes. Tetter; a watery eruptive affection. See Skin Dis- eases. Hiccough (pronounced Hiccup). This, called singultus by physi- cians, is a sudden spasmodic motion of the diaphragm (see Anatomy), causing jerking breathing. It comes Arery often from slight indigestion, or from prolonged laughter or crying. In a person of ordinary health it is of no importance. Drinking a wineglassful of cold Avater, slowly, Avill generally stop it; at any rate, it will go off itself. AVhen the system is greatly prostrated by disease or injury, hiccough is a very bad sign. It does not make the patient Avorse, but it shows that he is sinking, nigh unto death. In such a condition, the only proper treatment is that adapted to the general state of exhaustion. Hip-Disease. See Coxalgia. Hodgkin's Disease. First described by Dr. Hodgkin, of England, this consists of a general morbid enlargement of the spleen and lym- phatic glands, all over the body. It is now generally called J'seurfo- leukcemia in medical books, on account of the changes in the blood. Hooping-Cough. Pertussis, in medical books. A disease generally affecting any one but once in a lifetime; contagious, also, although without any eruption on the surface of the body. Coming on rather gradually, like a bad cold with cough, the spells of coughing become more and more severe. In about a Aveek, the child (or other patient) coughs .so violently as to get red in the face, often sick at the stomach, especially after eating, and out of breath. At the end of a paroxysm of coughing the breath frequently, in inspiration, makes a Avhoopm-; SPECIAL DISEASES. 739 sound; hence the name, whooping- or hooping-cough. But its subjects do not always whoop. The essential part of the disorder is the parox- ysmal cough, continuing also for six, eight, or ten Aveeks. The patient may, particularly Avhen in the open air, be for several hours Avithout couching; and then comes on a terrible spell, as though he might couch his breath away. As it goes on, considerable thick expectora- tion is brought up. Death does not often occur in the paroxysms, al- though they look very alarming. Feeble children are sometimes ex- hausted by the continuance of the disease. Now and then, in those predisposed to consumption, this may folloAV it. Treatment of Hooping-cough must at first, as with any other cough, be directed to soften and loosen the cough; as by syrup of ipecacuanha. Later, the spasmodic (nervous) element has to be dealt Avith. Assafcetida is here suitable; for children, the milk of assafcetida, in teaspoonful doses; Avith syrup of squills as a simple expectorant. Among the other antispasmodics used in Hooping-cough by physicians, the best are musk, and the fluid extract of hyoscyamus. Of the latter, I haAre knoAvn two-drop doses, to a child ten or twelve years of age, very effective in lessening the violence of the spells of coughing. A Avarming-plaster on the chest, or in the Avorst cases even a small blister, will contribute to the cure. While a child with Hooping-cough is not too ill to be moved, being often in the fresh air Avill be good for it, taking it out of doors eArery sunny day at least. If a case be much protracted, Avith Avasting and weakness ensuing, iron, cod-liver oil, and salt bathing may be called for, to build up its strength, Hydatids. AVatery groAvths in different organs, caused by the pres- ence of stationary parasites; echinococci. They may infest the liver, lungs, brain, or other parts. Little can be done for them, but they do not, as a rule, produce rapidly injurious effects, the patient often living for years after their formation. Sometimes relief is obtained by tapping the Avatery tumor and drawing the fluid off. Hydrocephalus. AVater in the head, literally; dropsy of the brain. Nearly always, this occurs in the first feAV years of life. Some children are born with it. The largest human head I ever saw was one in the Museum of the College of Surgeons in London ; it Avas that of a child two years old, enormously enlarged from water slowly forming upon the brain Avhile the sutures betAveen the bones yielded, and the mem- branes and bones all grew larger to accommodate the increase of the distending fluid. Commonly, hoAvever, death takes place from pressure within a feAV Aveeks or months. No active treatment is likely to cure this affection, unless it be the early use of saline purgatives and diuret- 740 DOMESTIC MEDICINE. ics, according to the patient's strength. Carefully tapping one of the distended sutures may be thought of by a physician in a case lasting longer than usual. Hydrophobia. A not Avell chosen common name for the ellect sometimes folloAving the bite of a mad dog or skunk. It occurs in about one-tenth of all those avIio are bitten by rabid animals. A verv remarkable thing about it is the length of time after the bite before the symptoms occur. This is generally a month, sometimes tAvo months, or possibly more. I doubt the genuineness of cases said to have hap- pened a year after the bite. Some people deny or doubt the existence of such a disease as hydro- phobia. Even physicians avIio have never seen it have sometimes sup- posed that the cases must be examples either of hysterics or of tetanus (lock-jaAv). But two cases which I saAV (one under my oA\rn care, in a boy eight years old) left no doubt Avhatever that it is an entirely specific disease. The characteristic symptom of Hydrophobia is, an irresistible spas- modic gasping, or sudden and forcible draAving in of the breath, Avhen- ever any strong impression is made on the patient's senses; as by at- tempting to drink, by a flash of light, or a loud sound; or even by the passing of a Avave of cool air over the face. There is usually also de- lirium. In my patient's case this Avas angry, furious. He did not, hoAvever, bite nor bark. I believe they never do, unless in the hyster- ical cases, imitating hydrophobia, in persons frightened into the belief that they have it, after having been bitten. There is no fear of water; great thirst exists. But the patient cannot SAvallow liquids, because the effort to do so causes gasping and choking. Death ahvays follows, in from three or four to eight or ten days. If exer a case of real Hydro- phobia has been cured, it has been by use of the most poAverful narcotics in heroic doses, as Avoorara (prepared in South America by Indians for poisoned arrows), chloroform, etc. I gave my little patient enough chloroform to breathe to have killed ten men, but it only mitigated the spasms from time to time. Certainly, hoAvever, his suffering Avas much lessened thereby. Prevention of Hydrophobia requires two things. First, kill every dog as soon as he is reasonably suspected of being mad. Secondly, cut out or cauterize (burn out) the bitten part, Avhenever practicable, as soon as possible. If a hand is bitten, for example, at once tie a handkerchief tightly about the Avrist, to check the Aoav of blood. Also suck the part promptly and strongly ; spitting out the blood, of course. Next, let a surgeon amputate the bitten finger, or cut out the bitten flesh, or apply to it a red-hot Avire, or a piece of caustic potash or lunar caustic (nitrate SPECIAL DISEASES. 741 of silver). Burning thoroughly will almost certainly ansAver without amputation. Pasteur has confidence in carbolic acid. Hoav shall one knoAV Avhen a dog is getting mad ? He is at first sick, indeed ill; uneasy, restless, snapping at things in the air; out of his common habits and temper altogether. He may be still kind to his master; but this is not to be trusted. AVhenever a dog barks or groAvls hoarsely, moves around crazily, and fights or snaps at imaginary enemies, muzzle him, tie him up, and watch him. He ceases to eat his natural food, swalloAving dirt instead; and soon, if loose, will run aimlessly at large, biting at every living thing, large and small, in his Avay. But it is unmerciful to suppose a dog to be mad Avithout good reason. If suspected, and chained up out of the reach of any one so as* to do harm, he can be watched safely, and perhaps saved from an unde- served death. (See page 742.) Hyperaesthesia. Excessive sensibility; shoAvn by a very slight touch of a part giving pain. It shows a morbid state either of the nerres at the surface, or of the nerve-centres of sensation in the brain. Hyperopia or Hypermetropia. An error of sight, the opposite of near-sightedness or myopia. In the latter, the image of an object falls short of the retina, unless the object is brought very near to the eye. In Hyperopia, the image falls behind the retina, except when the object is at a considerable distance. The far-sight or long-sightedness of old persons is in part of this nature; but Hypermetropia occurs not unfrequently also in young persons. It is corrected by convex glasses; myopia, the opposite, by concave glasses. (See page 405.) Hypertrophy. OArergroAvth. (See Heart, Diseases of.) A corn is a Hypertrophy of a part of the skin; and so, Avith some change, is a wart. It is not common for overgrowth of any organ to interfere seriously Avith the health; but it is considered possible for this to hap- pen ; the brain, for example, becoming too large for the skull. As a rule, the soft parts, as the brain, govern the groAvth of the hard parts in adaptation to them. Hypochondria. Loav spirits; despondency about one's OAvn health. The derivation of the word is from two Avords in the Greek, meaning under the cartilage; that is, of the rib; referring to the liver. The ancients supposed dull spirits to proceed from disorder of the liver or of the spleen. Hence also melancholy ; literally, black bile. See Dys- pepsia. Hysteria. A many-sided derangement of the nervous system, nearly, but not quite ahvays, affecting Avomen. Young women of anaemic habit (i. e., Avith poverty of blood) are its most frequent subjects. Its symp- toms sIioav morbid excitability of the sensori-motor and emotional appa- 742 DOMESTIC MEDICINE. ratus; now in one Avay and then in another, oven in the same case A'arving; from time to time. "Hysterics" are paroxysms of crying or laughter, or of A'arious movements, beyond the patient's control. Sometimes real convulsions occur; imitating epileptic convulsions, but Avithout loss of consciousness. Imitation of various diseases is common in those avIio have Hysteria • not only imitation, indeed, but functional disorders of a Arery positive kind, yet transient in duration. Such are hysterical palsy, hystero- epilepsy, hysterical blindness, and hysterical hydrophobia. Morbid men- Fig. 224. HYSTERO-EPILEPSY. tal traits are often very remarkable; a strong craving for sympathy sometimes leading to pretended disorders. In treatment of Hysteria, moral and hygienic management are gener- ally as important as medicine. The patient must be instructed and influenced to exert self-control. Her general system also must be strengthened. Iron is apt to be needed, to improve the quality of the blood. Salt-bathing, milk for food, and abundance of sleep, are to be recommended. Light gymnastics, or active exercise in rowing, riding on horseback, etc., will do good, if kept within the limits of the patient's strength. To mitigate the nervous disturbance in hysterical attacks, assafcetida, valerian, and camphor are often serviceable. Some physicians believe that (as its name indicates) disorders of the Avomb have much to do Avith Hysteria. Undoubtedly they sometimes produce or increase it; but they are not essential to it. [Hydrophobia is asserted by Pasteur, of Paris, France, to be often prevented by inoculating the person bitten with a specially-modified matter taken from an animal which has had the disease. An institution for this treatment has been established in New York under Dr. Gibier (1890). It is not proved that it is a certain preventive; but, if sure that a bite was that of a mad dog, the desperate danger may justify, when practicable, so desperate a remedy as soon, if at all, as possible.] SPECIAL DISEASES. 743 Ichthyosis. Fish-skin disease. See Skin Diseases. Icterus. See Jaundice. Idiocy. See Imbecility. Ileus. A painful attack, depending on some form of obstruction of the bowels ; Avhich see. Imbecility. Feeble-mindedness; sometimes congenital (beginning at birth), when it is called idiocy ; in other cases produced by disease or injury affecting the brain. It varies in degree very much; from mere dulness or natural stupidity down to absence of all intelligence or even affection. In some cases the moral nature seems to be the most involved; the child lacking attachment to its mother, brothers, or sisters. Often one or tAvo of the mental powers may remain in considerable develop- ment. I have knoAvn an imbecile to have a real talent for mechanical construction, although he could hardly be taught to speak at all. With an immense amount of patience and loving attention, almost every imbecile person can in time be so improved as not to be burden- some ; many can even be made useful and self-supporting. This can be best accomplished in institutions established for the purpose; such as the Pennsylvania Training School for Feeble-minded Children, near Media, Pennsylvania. Impetigo. A pustular eruption upon the skin. See Skin Dis- eases. Incontinence of Urine. Much most frequently, this is a trouble of children at night. In adults it may be caused by a severe injury or disease of the spinal marrow; or, possibly, by disease of the bladder. Cure of this difficulty in children is sometimes quite hard to obtain. Important directions about it are these: let the child drink but little liquid of any kind within two or three hours before going to bed. Be sure that it empties tlie bladder just before getting into bed; and that it does not then have the feet cold. If, notwithstanding these precautions, it still wets the bed, let some one take it up late in the night to relieve the bladder. Impressions upon the mind, of the nastiness and (not too heavily condemned) discredit of such a habit, will mostly assist much in the final cure of incontinence. Infantile Paralysis. A form of palsy in children, not very un- common, and more frequently recovered from than almost any other variety of paralysis. It comes on rather suddenly, with feverishness, and perhaps disorder of stomach; in bad cases, Avith convulsions. The loAver limbs are chiefly affected, and the palsy is seldom complete ; that is, some ni6tion, although feeble, is possible, and sensation is not entirely lost. One important fact is, that, unless care be taken to prevent it, the , helpless fimbs will, from wrong positions, become deformed. Club-foot 744 DOMESTIC MEDICINE. is thus sometimes accounted for; which might, with attention, have been prevented. Treatment of Infantile Paralysis requires Avarm rubbing of the spine and limbs; the Avarm or even hot suit-bath every day or two, dryhn' the patient quickly afterwards; and sun-baths, or, at any rate, carryin«r the child frequently out into the sunshine and fresh air. Cod-liver oil is generally suitable; electricity is, as a rule (used with moderation and caution) beneficial; and physicians are likely to prescribe strychnia in very small doses, Avatehing its effects. If, while a child is taking strych- nia or nux vomica, it becomes very restless, inform the physician of the fact, and meanwhile withhold the medicine until he gives further ad- vice. Infantile Remittent. A name given by medical Avriters, down to near the present time, to a combination of symptoms, not very regular, which are now considered to be better otherAvise classified. The term gastric fever was also similarly used. There is reason to believe that most of the severe cases are really typhoid fever; some, in malarious regions, genuine remittent fever; and those of short duration, indiges- tion with feverish symptoms. Under those heads, therefore, all that need be said in regard to treatment Avill be found. Inflammation. See this heading under Nature of Diseases, in an earlier part of this volume (page 485). Inflammations of the different organs of the body are also treated of, each under its own head, in this alphabetical succession. Influenza. Epidemic catarrh. This appears to be a real epidemic, not dependent on bad weather or individual exposure; but, at certain times, like the epizootic of horses, passing over the whole country and affecting almost everybody, old aud young. Its symptoms are those of a " bad cold all over " ; with rather more headache, pain in the back, disturbance of the stomach, fever, and Aveakness, than in ordinary bad colds. Old people, and very feeble younger persons, may die of In- fluenza ; with others it can seldom be said to be a dangerous illness. Treatment of this affection does not need to differ from that of a severe general " cold," except that it bears better and gains more from the use of quinine. If, when the first symptoms commence, tAvo- or three-grain doses of quinine are begun Avith, repeated Avithin two or three hours until eight or ten grains are taken Avithin tAvelve hours, the attack may often be aborted or aArerted. If not, there Avill be no advantage in taking more than six grains of quinine afterwards, distributed through the day. • Other measures, if an attack be actually developed, are, a brisk dose of a saline cathartic, as citrate of magnesium, Rochelle, or (if one don t SPECIAL DISEASES. 745 mind a nasty dose) Epsom salts; flaxseed lemonade as a frequent drink; a warm or hot mustard foot-bath at night. Of course the patient must keep Avarm, in one room; if ill, in bed. Allusion may be here made to other Avays often used to abort a cold or an attack of Influenza. Some try to do it by taking a hot alcoholic drink (egg-nogg, Avhisky- punch, etc.) on going to bed. Others, by a ten-grain dose of Dover's powder (containing a grain of opium) at bedtime. Such measures do succeed, in a certain number of cases, in producing free perspiration, and Avarding off an expected attack. But if they do not succeed, they make things worse; more headache, hotter fever, and greater Aveakness following. It is a " kill or cure " kind of practice; an objection Avhich does not apply to the use of quinine in the way above mentioned. In-growing Nail. See Nail, In-growing. Insanity. Derangement of the mind. Idiocy is deficiency of men- tal capacity, from birth; Imbecility, such deficiency Avhether the person was born with it or has lost his faculties from disease or injury. Insanity is understood to depend upon disorder of the brain, the instrument of mind. If any examples of it occur from purely mental "entanglement," the brain being sound, they must be very feAv; and such are not recognized as possible by most authorities on the subject. Varieties of Insanity are: 1. Mania. 2. Melancholia. 3. Dementia. Mania is divided into General Mania and Monomania; in the lattcT, the patient being deranged chiefly on one subject only; also, into acute and chronic Mania, according to its duration. Either the intellectual or the emotional poAvers may be predominantly im7olved; when the latter are most so, it is often called moral (emotional or impulsive would be better) Insanity. Melancholy is characterized by gloomy and desponding thoughts and feelings, which occupy the Avhole mind for the time. It is less often cured than acute mania; but recoA7eries from it do occur. Dementia is the total Avreck of the mental capacities. Its subjects are more helpless than any other human beings except infants in arms. From it, recovery is never to be expected. Treatment of Insanity requires the skill of those devoted especially to it. Experience shows that, since the immense improvement in the hospitals and asylums for the insane, Avhich dates from about the begin- ning of this century, almost every insane patient has the best possible chance of cure Avhen he is taken early to such an institution. There he Avill be secure from danger of injuring himself or others; and Avill have, besides skilful medical treatment, every surrounding circumstance to promote the healing of his perturbed mind. Comfortable rooms, beautiful grounds, books, musical instruments, evening entertainments, 746 DOMESTIC MEDICINE. tranquillizing religious services; and, latterly, in many such places, op- portunity for Avork; all these are abundantly furnished in the best modern retreats, as they might be called, Avhich are fitted out as hospitals for the insane. There, nearly or quite half of those entering with first attacks are cured, Avithin from three to six months; and of those not cured, the condition is so much more tolerable than elsewhere, that a visit to such a place may give rise to the question, whether anyAvhere else in the Avorld there is a larger proportion of enjoyment to suffering, than Avithin the domain of a well-constructed and well-managed hospital for the insane. It is true that in a certain small number of cases of patients avIio are not inclined to violence, and who are only partially deranged, treatment at their oavh homes, or at least in private houses, may answer well; and may even be better than to disturb their feelings by taking them to an institution. But these are exceptions, and ought always to be judged of by a physician who is well acquainted Avith insanity. Insolation. See Heat-stroke. Insomnia. Sleeplessness. Much has been said of this under Hy- giene (Mental Hygiene). It may be brought on by alcoholic intemper- ance, excessive use of strong coffee or tea, or brain-strain by worry or ovei'Avork. In every case, the first thing in its treatment must be the removal of the cause. Without this, a cure cannot be expected. When the cause is removed, sleep may be promoted in several Avays; Avhose success will depend chiefly upon the nature of each case. All of them may be tried when necessary. Such are, a Avarm bath just before bedtime; lying Avith the head and shoulders moderately raised; avoiding study for an hour or two before the usual hour for retiring; dumb-bell exercise for twenty minutes just before getting into bed; rubbing all over near bedtime (see Massage, under Nursing, page 647). Medicines for Insomnia need to be used Avith much judgment, or they may do harm instead of good. Such is the case especially with ale, Avine, etc.; as well as with bromide of potassium or sodium, chloral, and all kinds of opiates. These cannot be recommended to be taken or given Avithout competent professional advice. Intercostal Rheumatism. Rheumatic pain and soreness between the ribs. It is sometimes troublesome and tedious; but, by itself, not dangerous. Warming applications, of any convenient kind, constitute the substance of its particular treatment. At the very beginning, direct heat is often the best thing; for instance, a flat-iron, as hot as can be borne, laid upon or passed over the part re- peatedly. A flesh-brush, or a common hair- or clothes-brush, may rub out a considerable pain, in some cases. A mustard-plaster is always SPECIAL DISEASES. 747 safe and likely to do good; later, a Burgundy pitch or Allcock's porous plaster, to remain on for a week or tAvo, for continued relief and pro- tection of the part from cold. One Avho is liable to Intercostal Rheu- matism should Avear flannel, silk, or thick merino next the skin all winter, and thin flannel all the year round, for security against Aveather changes. Intermittent Fever. See Ague. Intestinal Obstruction. See Obstruction of the Bowels. Intussusception. Stove-pipe-like inclusion of one part of an intes- tine in another portion, above or below it. See Obstruction of the Bowels. Iritis. Inflammation of the iris, the circular arrangement of mus- cular fibres around the pupil of the eye. It is recognized by the occur- rence of irregularity in the form of the pupil, from adhesions of the iris when.inflamed. In order to prevent these from permanently narrowing the pupil, it is usual to drop into the eye a (two to four grains to the fluidounce of A\-ater) solution of cdropia, every day or tAvo. See Eye, Diseases of. Itch. See Skin Diseases. 74S DOMESTIC MEDICINE. Jail Fever. See Typhus Fever. Jaundice. YelloAvness of the skin, from biliary coloring matter de- posited in it. This must result from either, 1, the liver not removing the coloring matter from the blood, and its finding its avuv out through the small bloodvessels over the body; or 2, the bile being secreted from the blood by the liver, but being then reabsorbed into the blood from the gall-bladder, on account of obstruction of the gall-duct by gall- stones. There is no special remedy for Jaundice. The treatment of those having it must be addressed to its cause, so far as made out; and to the general condition of the system at the time. In a recent case, calomel or blue pill, taraxacum aud nitromuriatic acid, are usual remedies. Kidneys, Diseases of. Pain in the Kidneys is felt in the back, on each side of the spine, about three inches beloAv the edges of the ribs. Congestion of the Kidneys may be produced by cold and wet. It is attended by pain, Avith scanty, high-colored urine. Inflammation of the Kidneys (nephritis) is yet more painful; Avith bloody urine in some cases, and other changes in that fluid, discovered with the aid of the microscope. Bright's Disease is a more prolonged affection, with albu- minous urine, and changes in the structure of the Kidneys. (See Bright's Disease.) Congestion or commencing inflammation of the Kidneys may be ad- vantageously treated by the application of cups ; dry in a feeble person, cut so as to draw blood in a patient of tolerable strength. If this be not done, a large mustard-plaster should be applied to the small of the back. Placing the feet in hot mustard water will be suitable; and so will be the free drinking of flaxseed-tea ; sweetened to taste, but Avithout lemon-juice. It is desirable in such cases to promote the free action of the skin to relieve the kidneys. When pain is very considerable, Do- ver's poAvder at night will be appropriate, to favor sleep and perspira- !: \ Other treatment Avould better be left to a physician. SPECIAL DISEASES. 749 Larynx, Diseases of. Inflammation of the Larynx (upper Avind- pipe; see Anatomy) is called by physicians Laryngitis. The most common form of acute Laryngitis is Croup ; which see. Chronic La- ryngitis is a slow affection, always giving time for treatment by a phy- sician. For its further consideration, therefore, the reader is referred to technical medical books. (See Fig. 225.) Lepra; Leprosy. For these (which, as the terms are used, are not the same), see Skin Diseases. Leucocythaemia; Leukaemia. Both of these names refer to the same disease. It is characterized by the presence of an excessive pro- portion of white (colorless) corpuscles in the blood. Symptoms of it are: debility, swelling of the abdomen, general dropsy, often vomiting or diarrhoea, jaundice, and bleeding from the nose or gums. The liver, spleen, and lymphatic glands are often enlarged in various degrees. Ten- derness to the touch of some of the bones exists in some cases; a chronic Fig. 225. LARYNGOSCOPE. cough in others. The only certain recognition of it is obtained by ex- amining blood taken from the patient with a microscope. Then the number of the Avhite corpuscles (leucocytes) is found to be, not, as in health, one to fifty or a hundred of the red corpuscles, but one to six, four, or three of the latter. There is no reasonable expectation of recovery from Avell-marked Leucocythaemia; but the patient may live Avith it for several years. Medicine can do very little for it; general hygienic management is very important toAvards prolonging life. Leucorrhoea. In popular language, "the Avhites." A feminine disorder, consisting of a mucous vaginal discharge; coming either from the uterus or from loAver doAvn. It results from irritation, folloAved by relaxation of the parts. Prolapsus (falling of the wonib) is a very com- mon cause of it. Even Avithout that, it is often quite chronic. Treatment may be needed with iron or cod-liver oil internally, to " tone 750 /; 0 M ESTIC M E DICIN E. up" the general system. Tincture of the chloride of iron Avill be the best preparation, or ammonio-ferric alum; the latter best when the dis- charge is profuse; as that medicine is astringent. Local applications are important, used either as suppositories or by means of a -var/inul syringe as injections. A suppository for this purpose may be made bv mixing ten grains of tannin with enough cacao butter to make a mass for the vagina. For washes, used by injection, oak-bark tea, lime-ivater, and solution of alum (a drachm to the pint of Avater) may be mentioned as available. Some practitioners advise simple hot water (110° to I'H)3 Fahr.) as the best. Leukaemia. See Leucocythaemia. Lice. See Parasites. Lichen. A pimply (papular) eruption. See Skin Diseases. Lithiasis. A disposition in the constitution to the formation of an excess of lithic or uric acid ; sIioavii sometimes in gout or graved, in other cases by neuralgic or other manifestations of the action of uric acid in the blood. Liver, Diseases of. This organ is frequently the scat of conges- tion ; produced by "catching cold," by errors of diet causing indiges- tion, or by the chill of intermittent fever. Its symptoms are: pain under the loAver ribs on the right side and under the right shoulder- blade ; constipation, Avith lead-colored passages; a furred tongue, bitter taste in the mouth, sickness of the stomach, dizziness or headache, and yelloAvness (Avhich may be slight) of the eyes and skin. Treatment of this condition requires a simple, not fatty, diet, and medicine to act moderately on the boAvels, and, if possible, to increase the floAV of bile from the liver. Much experience has shoAvn that blue mass or calomel, in small doses, will help to relieve liver-torpor. I advise, therefore, two grains of blue pill at bedtime, followed in the morning by a teaspoonful of magnesia; or, if constipation has been great, and the system feverish, a dose of citrate of magnesium or Pochette sedts. Should the " biliousness " not be entirely relieved, a grain of blue pill may be taken night and morning for a day or tAvo more. Chronic Congestion of the Liver has some of the same symptoms continued, in varying degree, for weeks or months ; pain in the side and under the shoulder-blade, indigestion, a bad taste in the mouth, cor^ti- pation, and more or less yelloAvness of the eyes and skin. It will not do to go on taking blue pill, even for a week at a time. We may fol- low it Avith nitromuriatic acid, three drops twice daily, in water (in a glass; do not put a silver spoon into it, as it acts upon silver). Thi.« may be continued, if need be, for Aveeks together. Dandelion root-tea, or extract of dandelion (taraxacum) is a favorite medicine for thistrou- SPECIAL DISEASES. 751 ble with many Avho have tried it. Of the extract, ten grains may be taken once or tAvice daily. Chloride of ammonium (muriate of ammonia of the old chemical system), in five-grain doses, twice a day, Avill be likely to assist in improving the action of the liver. The Liver is also subject to acute inflammation (hepatitis). This may occur as part of an attack in Avhich also the stomach and small in- testine are involved ; called a " bilious attack " in common language; by physicians, " gastro-hepatic catarrh." But liver-inflammation also conies sometimes alone. It may follow acute congestion. The symptoms are the same as those of the latter, only the pain is more constant and severe, and there is tenderness on pressure on the right side, along the edge of the ribs. Vomiting also may be present, from sympathetic affection of the stomach; and diarrhoea, caused by the irritant quality of the bile. Fever attends in severe cases. Abscess of the Liver may folloAV acute inflammation. Sometimes the symptoms of the latter (inflammation) are quite obscure, and the existence of the abscess is first made knoAvn by some of its con- sequences. There is danger connected Avith liver-abscess, because the pus formed in it may escape into either the chest, through the dia- phragm, or into the peritoneal cavity of the abdomen. In the latter case, collapse and death will result. If it enter the chest, it may pass into the lung and be coughed aAvay. If not, an empyema remains (which see). Best, of course, and most frequent, is the opening of the abscess either into the bowels or through the skin, Avith the external discharge of the matter contained. By using the aspirator, Avith a fine IioIIoav needle, physicians can, in case of suspected abscess, examine Avhether pus be present or not; and Avhen this is made certain, it may be let out by means of a careful puncture or incision. Such treatment requires much skill and judgment in the practitioner. The early treatment of acute Inflammation of the LhTer is nearly the same as that of acute Congestion. Cut cups, hoAvever, or leeches, may be one of the first measures used ; and aftenvards a blister upon the right side. Blue pill had better be gh^en in smaller doses than in cases of congestion; half a grain three times a day for three days will be enough. Cirrhosis of the Liver has been considered already under the heading, Cirrhosis. For other affections of the Liver, as cancer, fatty and waxy degenerations, yellow atrophy, etc., the reader must be referred to pro- fessional Avorks. Lock-jaw. See Tetanus. Locomotor Ataxy. A sloAvly progressive disease of the nerATous system, centring in the spinal marroAv. Its most marked symptom, which has given the disorder its name, is a loss of control over the legs in walking. This is shoAvn in a kicking or jerking Avay of stepping 48 752 DOMESTIC MEDICINE. out; very different from the dragging Avalk of simple palsv (paraplegia). If the patient shuts his eyes Avhile standing, he Avill fall, the ordinary guidance by the sensibility of his feet being lost. Another curious symptom is the absence of the tendon-reflex movement of the legs. That is, Avhen one leg is crossed over the other, and a smart blow is made Avith the hand just beloAv the knee, the leg does not jump, as it does in a healthy state of the nerves and nerve-centres. Severe darting pains also, chiefly in the legs, belong to this disease. Gradually, perhaps after a number of years, the patient weakens, with increasing loss of muscular control, until death. There is no cure for Locomotor Ataxy. Medicine has been so far sliOAvn to have only palliative, if any, effect. As Avith all sIoav chronic diseases, care of the general health may do much to prolong life and lessen suffering. Lumbago. A painful affection of the small of the back, generally met with in elderly people. The same name is given commonly to tAvo different kinds of attack. One is muscular ; a form of rheumatism. This may come on very suddenly, making it impossible for the patient to rise and walk, almost to move at all. Keeping very still, and having Avarming applications made to the part (mustard-plasters; or spirits of turpentine and SAveet oil, or, Avith tougher skins, pure oil of turpentine; or painting with tincture of iodine) will generally bring on recovery in a feAV days. Some old people, hoAvever, have frequent attacks. Such should always Avear flannel, and be careful to avoid having Avet feet or sitting in draughts. The other kind of Lumbago is neuralgic. See Neuralgia. Lungs, Diseases of. Inflammation of the Lung is pneumonia; pulmonary consumption is phthisis. For the purposes of this Avork, a sufficient account of these diseases is given under the two headings, Pneumonia and Consumption. Lupus. A creeping, eating disease of the skin, hard to cure. Dr. Koch, of Berlin, Germany, in 1890 claimed to be able to cure it with "tuberculin," Avhich he made by dissolving tuberculous matter in glycerin. The difficulty of making and preserving such matter is much in the Avay of its use, even by skilful surgeons. SPECIAL DISEASES. 753 Malarial Fever. The three varieties of this, all produced by the same causation, are Intermittent, Remittent, and Pernicious Fever. See, for the first and last of these, Ague; for the second, Remittent Fever. Mania. See Insanity. Mania-a-Potu. See Delirium Tremens. Measles. One of the Exanthemata (which see), or eruptive febrile diseases. It is contagious; and usually occurs but once in a lifetime. To this general rule, however, there are many exceptions. Symptoms. First, the eyes become red, the nose runs, and the pa- tient begins to cough. His head aches, and he feels badly all over. One would suppose he had a very bad cold. On the fourth day of this, how- ever (possibly a day or two later), a red, small-pimply, blotched or patched eruption breaks out on the face, neck, breast, arms, abdomen, and legs. It is not of so bright a red color as scarlet fever, nor so hot and savoI- len; nor so continuous over the body and limbs. There is fever, and perhaps sick stomach or moderate diarrhoea; in young children some- times convulsions. The attack passes its height usually in about a week; often in even less time. FeAV patients die of measles, except under unfavorable local conditions (as in camps during Avar), when epi- demics of malignant (black) measles occasionally break out and are quite fatal. On convalescence, weak eyes are often left behind, or a chronic cough; endangering consumption in those predisposed to it. Treatment of Measles is simple. Nursing is the main thing, to con- duct the patient safely through it. If the bowels are bound at the start, I would give a moderate dose of a saline purgative (citrate of magnesium, Rochelle salts, or magnesia); moderate, because of the pos- sibility of diarrhoea coming on in the course of the attack. Yet I be- lieve the greater danger attends constipation, in all such diseases. The blood, in them, needs purification; and purgation of the bowels pro- motes this by carrying off waste matter freely from the body. The cough may be treated with small doses of syrup of ipecac, and, later, syrup of squills; also flaxseed lemonade; perhaps even a small blister on the upper part of the breast in severe cases. There is no specific remedy for any of the " exanthemata." Much care must be taken on first going out after recovery. The air-tubes and lungs will be very sensitive at such a time, and exposure to cold and wet must be avoided for several Aveeks. A warming-plaster on the breast Avill be a good protection. Hardly any disease is more contagious (catching) than Measles. Therefore, children who have not had it should be carefully kept away from any one sick Avith it; in another house, if possible. The disease 754 DOMESTIC MEDICINE. may be taken by another just before the rash is out; and also for a Aveek or more after recovery has taken place. Forty days, from the beginning of the attack, is the period of absence from school prescribed by some authorities on the subject. Thirty days, in the case of Measles, appear to me to be enough. Danger to life is much less from this dis- ease than from scarlet fever; and, as hardly any one is likely always to escape from it, a healthy child over five years of age may about as avcII have it at one time as another. A third person, as a physician or w nurse, going right from the chamber of a patient having Measles, may possibly gh'e it to another liable to it; but such things seldom happen; especially when considerable time and distance intervene between their visits. German Measles appears to be a sort of hybrid or cross between Measles and Scarlet Fever. It has a rash Avhich is redder (deeper red] than that of Measles, and more in patches than that of scarlet fever. There is also more decided sore throat, and less prominent cough, than in Measles. It is less dangerous than scarlet fever, and not so conta- gious as Measles. It requires no peculiarity of treatment; only good nursing to steer the patient through it. Some call it French measles. Megrim, migraine; hemicrania. See Neuralgia. Melancholy. See Insanity. Membranous Croup. See Croup. Meniere's Disease. See Ear, Diseases of. Meningitis. See Brain, Inflammation of; also Cerebro-Spinal Meningitis. Menorrhagia. Excessive menstrual Aoav. This may be either its too frequent occurrence, or too great an amount of discharge; but both often occur together. Causes of this trouble are: general relaxation of the system; over-excitement; thinness of the blood; and over-fatigue, especially long standing, or walking too far. Hemorrhage from the womb, not menstrual (metrorrhagia), may be due to ulcer, cancer, or other tumor of the womb; or, during pregnancy, miscarriage (abortion), or misplacement of the after-birth (placenta prcevia). (See Miscarriage.) Treatment of Menorrhagia must depend on the general condition of the patient. Most of those so affected are thin-blooded, i. e., anomw. For these, iron is called for; the tincture of the chloride, taken thrice daily in fifteen-drop doses, for several Aveeks at a time. If headache follows the use of the iron, leave it off for a feAV days, and then try it in smaller doses. It does not agree Avith all. Near the expected time, or at once if it occur sooner than expected, the patient must lie down, and remain at rest till it is over. If very profuse, fluid extract of ergot, half a teaspoonful every hour or two, SPECIAL DISEASES. 755 may be taken. Not often will this be needed if the patient keeps quiet. For really exhausting uterine hemorrhage, local measures are needed, as squeezing half a lemon in the vagina; injecting, with a vaginal syr- inge, hot vinegar and water (110° to 120° Fahr.). As a last resort, plugging must be used. This is Dr. T. Gaillard Thomas' plan: Pieces of cotton soaked in Avater, pressed and flattened out by the fingers, each about the size of a very small biscuit, may be pushed into the cavity of the vagina, until it is entirely filled. When, however, there is no time to spare, wads of dry cotton may be pressed in for the same purpose. We need hardly repeat that such a procedure is only appro- priate for an extraordinary hemorrhage, by which the patient is evi- dently being Aveakened at the time. Menstruation, Errors of. These are, Amenorrhcea, suppression of the monthly change; Dysmenorrhoea, painful menstruation ; and Menorrhagia, excessive discharge, either in amount or frequency. See these three headings, respectively. Methomania. Also called Oinomania and Dipsomania. A morbid and uncontrollable craving for intoxicating drink, the result of continued intemperance. The only hope of its cure, short of a miracle, is to be obtained by its subject being kept in a retreat where he cannot get liquor, for at least from three to six months. A year Avould be much better. All temptation to indulge being out of his reach, in time the morbid appetite will pass away; so that, if he Avill, he may avoid a return of his bad habit. It is necessary for such a one, hoAvever, always to abstain from eA'erything alcoholic. Wine tasted at the "commu- nion table " has, in a number of instances, caused the doAvnfall of re- formed inebriates. Institutions for the treatment of this terrible pen- alty of excess are now maintained in several places in this country; the Franklin Reformatory Home in Philadelphia is one of such, where about one-third of all entering are restored. Milk Crust. An infantile eruption, occurring during dentition. See Skin Diseases. Milk Leg. Phlegmasia Dolens. This has nothing to do Avith the milk, as was once imagined, although it is an affection of mothers after childbirth. We may quote, in its description, Dr. Dunglison: " It occurs, for the most part, in the second or third Aveek after de- livery : it is limited to the lower extremity, and chiefly to one side, exhibiting to the touch a feeling of numerous irregular prominences under the skin. It is hot, Avhite, and unyielding, and is accompanied, sooner or later, Avith febrile excitement. After a few days the heat, hardness, and sensibility diminish, and the limb remains oedematous for a longer or shorter period. The disease frequently, if not generally, 756 DOMESTIC MEDICINE. consists in the obstruction of one or more of the lar I Avas brought up by my father, Dr. Joseph Hartshorne, a private pupil of Dr. Benjamin Rush, in this practice; and I never lost a case of simple Pneumonia in my life. Dr. Louis Gebhard, a contemporary of my father, told me, after fifty years of practice, that he had never lost a case of Pneumonia. People do nowadays often die of Pneumonia; even young, vigorous men, from thirty to forty yrears of age, among them; and these have not been bled. This point must not be further argued here, as this is not a professional book. But if any of my readers should be attacked Avith Pneumonia, Avhile in the prime and vigor of life, I hope that his physician, if he will not bleed, will at least cup or leech betAveen the shoulders or over the inflamed lung, and allow a good purgative dose, on the first or second, or even the third day of the attack. Time enough to feed up and stimulate, except in feeble patients, when the height of the acute inflammatory attack has been passed. In Home practice, I will name here no other medicine except ipecacuanha, to soften and loosen the cough; free early secretion being very serviceable in lower- ing the inflammation of the lung and oppression in breathing. Poulticing the chest (after leeching or cupping, or, if such must be, instead of it) is very useful and important. A large and thick mush or flaxseed-meal poultice should be put Avarm on the diseased side, and covered Avith oiled silk. As soon as it begins to dry and get hard, have another ready and replace it, without alloAving the side to be uncovered for a single second. Later a blister will be suitable, if the symptoms show obstinacy or slowness in " resolution " of the attack. Some patients, especially broken-down people (from intemperance, etc.), such as are often seen in hospitals, Avill not bear the loss of blood well, Avhatever their disease. In hospitals, moreover, they are likely not to come under care until after the third day of the attack; and then it is too late for bleeding. In such cases, and in all very feeble persons, 778 DOMESTIC MEDICINE. quinine, beef-tea, and, carefully, alcoholic stimulants, may constitute the essential parts of the treatment. I am bound to add this much, after the somewhat sanguinary observations above made, on the treatment of Pneumonia. Typhoid Pneumonia is inflammation of one or both lungs, with a low state of the system (not constitutional, but a part of the attack), more or less like that seen in typhoid fever. Physicians who may look at this must pardon me for suggesting that some cases become " typhoid " for want of active relieving early treatment. Others, however, are genuinely low in their course all through. These will bear no bleeding, and only dry cupping and poulticing; and they must be supported; not by pro- fuse potions of alcohol, but by carefully regulated doses, watching their effects; also, by milk, beef-tea, or beef-essence, etc. Pneumothorax. Air escaping from a lung into the cavity of the pleura; an opening being made from the lung by a Avound, or by the breaking of the wall of an abscess or " cavity " of a tuberculous lung. This is a not uncommon occurrence in pulmonary consumption. Podagra. An old name for Gout; Avhich see. Poisons. See the last part of this book, after Accidents, etc. Poison-Vine Eruption. Most persons have seen this; \rery many have felt its unpleasantness. It conies from touching either the poison- Arine (Rhus toxicodendron), or, Avith fewer people, the Swamp Sumach. The eruption is made up of a multitude of very small water-blisters (Aresicles) on a red and sore surface. It itches and burns, very annoy- ingly; on the face and hands mostly, sometimes on the lower limbs and body. I Avas once tAvo Aveeks in bed Avith it. Generally, the attack is over Avithiu a week. Nobody, I believe, ever died of it. Treatment. Unless on a small surface of the body (as it sometimes appears) it is seldom possible to " nip in the bud " this eruption. Like murder and scandal, it " will out." I am not sure that it Avould be safe to " drive it in," if Ave could do so; an inflammation of some internal organ might result from retention of the poison in the blood. On a hand or arm, however," a stream of hot water will sometimes kill it after three or four applications. Caustics (as nitrate of silver) may do the same thing, but they require more care, and may leave marks. Cooling and easing the irritation of the skin is the aim in this affec- tion. Where the skin is not broken, painting (with a hair pencil) with Aveak lead-water is relieving. If burning is very intense, dipping the part, as the hand or the face, in cold water, and holding it there aAvhile, several times a day, will lower the heat. Lime-water, and a solution of soda in Avater, pretty strong, are, among many remedies of Avhich I have SPECIAL DISEASES. 779 known the trial, the most generally useful when the eruption is at its height. I Avould try both alternately; laying soft light rags Avet with the solution of soda or lime upon the part, and renewing them often enough to have a cooling effect. Lately, Dr. S. A. BroAvn, U. S. N., has asserted that Bromine, ten or twenty drops dissolved in Oil or Glycerin, and rubbed gently over the poisoned part three or four times daily, is a specific for Rhus poisoning. I do not knoAV of its being yet extensively so used. Polypus. A swelling, rather hard, with more or less of a stem or narrow base, where it is connected with the body. Polypi are met with in the nose, and in other cavities communicating with the exterior. Their treatment (mostly by removal) belongs to special Surgery. Porrigo. See Skin Diseases. Presbyopia. Old sight. After forty-five, most people who have not been near-sighted are obliged to hold their books or newspapers farther off than before, to read Avell. Also, they need better light to read or Avork by, and cannot make out fine print at night. Three changes haA^e now begun, Avhich usually continue to go on slowly: 1. Sensibility is less in the eyes, requiring stronger light to make objects clearly visible. 2. Adjustment of the eyes to near objects is feebler, the muscle of accommodation (ciliary muscle) being one of the first muscles of the body to Aveaken with the commencing decline of life. 3. The crystalline lens becomes flatter and harder, so that its refraction is altered, and images are thrown too far back (behind the retina) unless objects are at some distance from the eyres. Correction of old-sight is obtained by using convex glasses, which bring the rays of light from objects sooner to a focus. It is Avell to begin to use glasses as soon as the need of them is felt, but not to have them any stronger than is necessary at the time. Oculists are now veiy exact about this adjustment. More- over, one eye is often older (so to speak) than the other. When this is so, a differently focused glass should be chosen, after careful trial, for each eye. Prolapsus Ani. A falling of the last part of the lower bowel through the outlet (anus). This is most common in children, from straining too long at stool. The gut can be replaced, Avith well oiled or larded fingers. The child should then not be allowed to strain when the bowels are moved. A high seat or chair Avill be best to prevent this. Only bad or long-standing cases will require surgical treatment; possibly, a feAV, an operation. Prolapsus Uteri. Falling of the Womb. See Women, Dis- eases of. m 780 DOMESTIC MEDICINE. Prurigo. Itching, as a continued disorder. See Skin Diseases. Pseudo-membranous Croup. See Croup. Psoriasis. A scaly disease. See Skin Diseases. Puerperal Fever. An acute malady of mothers, beginning not many days after delivery. First there is a chill; then heat of skin, Avith a very rapid pulse; pain and tenderness, often SAvelling, of the abdomen; vomiting; in bad cases, delirium and collapse. About half the cases of it are fatal, Avithin a Aveek or ten days. Post-mortem exam- ination shoAvs, in most instances, the results of peritonitis. But, besides that (and inflammation of other parts, as the Avomb, abdominal veins, and lymphatic vessels), in Puerperal Fever there are evidences of a gen- eral blood-disease, of which the peritoneal inflammation is a secondary symptom—as sore throat is in scarlet fever, bronchitis in measles, ete. Causation of Puerperal Fever is traceable to foulness: of the air, as in hospitals; of contagion, Avhen carried by a physician or nurse from one patient to another; of decay, when perfect (vaginal) cleanliness of the person is not maintained after delivery, \n the last of these cases, at least, absorption of foul material, from decomposition, is inferred, producing septiccemia. Some physicians consider all cases of this dis- ease to be varieties of septicaemia; others regard it as an entirely spe- cific disease. In the places of its prevalence, it resembles erysipelas. It is at times endemic in lying-in hospitals, where a number of women are confined together. Worst, in predisposing to this, is the conjunction or nearness of such a hospital or Avard to a surgical hospital. Practitioners find, from experience, that there is a risk in going from attendance on cases of erysipelas, as well as from those of Puerperal Fever, to attend in the lying-in chamber. If obliged to do this, physicians and nurses lessen the danger to those under their care by changing all their clothing, and Avashing their hands ATery thoroughly in solution of corro- sive sublimate, chlorinated soda, or solution of carbolic acid. Puerperal Fever is sometimes epidemic in large cities; never in the open country. Treatment of so serious a disease Ls never properly left to merely do- mestic care. It may, therefore, be said here only that, like other endemic and epidemic diseases, it does not bear reducing measures, such as bleed- ing from the arm, as single (sporadic) cases of peritonitis usually do; that poulticing the abdomen first, and blistering it aftenvards, are as safe as any measures in its management; and that in its prevention, as well as treatment, washing out the vagina tAvice or thrice daily with a cleans- ing solution (lime-water, or glycerin, or corrosive sublimate solution, one part in 2000 of Avater) is very important. Of course, perfect rest • SPECIAL DISEASES. 781 in bed is necessary throughout the attack, the bed-pan being used with as little motion as possible. The diet must be liquid, but concentrated in nourishing strength, for the support of the patient's system. Purpura. A singular disease, in Avhich, from a sort of leakage of blood from the small vessels, spots of various sizes, at first red, after- wards purple, broAvn, or yellow, form on parts or nearly the Avhole of the body. In a few cases actual hemorrhage from the skin takes place. There may be fever at first; afterwards prostration. The disorder is not without danger to life. Causation of Purpura is obscure. The blood must be in fault; but some things tend to sIioav that the state of the nervous system has much to do Avith the disorder. It is not likely to occur in a person whose general condition is that of balance of the different functions, as A\Tell as of tone and strength. Purpura is not the same thing as scurvy. In that disease there may be purple spots o\Ter the body; but other symp- toms also occur in it, and it is distinctly traceable to a fault of the blood from deficiency of some of the needful materials of food. (See Scurvy.) In treatment of Purpura, the condition of the patient must be consid- ered. As a general statement, the medicines most Avorthy of confidence for it are tincture of chloride of iron, aromatic sulphuric acid, quinine, and ergot. Nourishing liquid diet (milk, beef-tea, chicken-broth, etc.) will be required. When the skin comes off over the purple patches, it Avill need protection, as by double layers of adhesive-plaster, or buckskin spread Avith soap plaster. Sponging the unbroken parts of the skin Avith alum-AA'ater, or whisky and water, will help to lessen the tendency to blood-leakage. When real hemorrhage from the skin occurs, death may be anticipated, with a bare hope of exceptional recovery. Pyaemia. Literally, purulent blood; pus in the blood. When a vein is inflamed, or any part of the body undergoes suppuration, from which pus may be taken up by one or more veins, it may be deposited elseAvhere; as in the lungs, liver, or under the skin, forming abscesses. This state of things is denominated Pyaemia. Its symptoms are: chills; low fever; rapid but feeble pulse; vomiting; delirium; swelling of the joints; and " gatherings," with formation and discharge of pus, in the lungs, liver, neck, face, armpit, or elseAvhere. These symptoms are very much the same as those of septiccemia (blood-poisoning from matter of decay) except in regard to the formation of gatherings or deposits of pus. There does not seem to be any practically important difference between these tAvo affections: although the causation of septicsemia has, so to speak, more opportunities than Pyaemia. The treatment of Pyaemia is ahvays attended by discouragement. 782 DOMESTIC MEDICINE. The aim of it is, to support the patient's energy in the struggle of nature to get rid of the intruding and disturbing matter. Quinine, concentrated liquid food, and alcoholic stimulation carefully regulated, are our dependence. Each abscess as it forms must, of course, have its OAvn management. Pure air to breathe is very important in the care of cases of Pyaemia. Pyrosis. Water-brash. See Dyspepsia. SPECIAL DISEASES. 783 Quinsy. Tonsillitis; inflammation of one or both of the tonsils. These are small glands, one on each side of the upper part (threshold, as it were; called the fauces in Anatomy) of the throat. These glands SAvell when inflamed, and groAV red, sore, and painful. Swallowing gives much distress; and even speaking rnay do so. In a very bad case, one or both tonsils may be so enlarged as almost to check breathing. In a few days, suppuration is likely to occur; and Avhen the gathered tonsil breaks and discharges its matter, relief at once follows. Tonsillitis appears to have the same causation as common " sore throat," namely, " catching cold;" but some persons are much more liable to it than others. Those Avhose tonsils are large from infancy not unfre- quently have several repeated attacks. Physicians sometimes cut off a large part of a permanently swollen tonsil, to get rid of such a tendency or habit. This is a simple and scarcely painful operation when the ton- sil is not inflamed at the time. Treatment of Quinsy is essentially that of a " cold " Avith sore throat. Give a good dose of a saline cathartic; citrate of magnesium, Rochelle salts, Tarrant's aperient, or, if the patient be robust, Epsom salts. Make some flaxseed lemonade, aud let the patient drink a little and often of it. Gargle the throat (gently) Avith alum-water, or tincture of myrrh in Avater, or hot strong tea (an excellent gargle), three or four times a day. Bathe the throat repeatedly Avith soap liniment to Avhich water or spirit of ammonia (a tablespoonful in four ounces) has been added. If it is evident that a tonsil is going to " gather " (suppurate), poultice the neck with flaxseed-meal. When spontaneous opening is delayed, and the SAvelling in the throat is alarming, a physician may think it best to make an incision to let out the matter. No unprofessional person, of course, Avill undertake that operation. For enlarged tonsils, not acutely inflamed, various applications are used to " shrink them up;" not always Avith much success. Nitrate of silver has always disappointed me in this employment of it. Strong solution of tannin or glyrcerole of tannin may do better; but I doubt whether anything short of the " guillotine " operation, above mentioned, is likely to have more effect in this way than will follow from frequently gargling the throat with simple ice-wcder. 50 784 DOMESTIC MEDICINE. Rabies. Rabies Canina; canine madness; Hydrophobia (which see). Red Gum. A queer nursery name for a rosy redness over parts or the Avhole of the body of an infant, with more or less of a pimply erup- tion. Starch or arrow-root powder and oxide of zinc ointment are suitable applications for it, Avith magnesia if its bowels are costive, lime-water if it has diarrhoea. Indigestion is a common provocative cause of this affection, which physicians call strophulus, or lichen strophulus. Relapsing Fever. This disease, Avhich none of my readers are likely to see, is almost described by its name. There is a continued fever for from five to eight days; Avith headache, vomiting, constipation, perhaps yelloAvness of the skin, pains in the back and limbs. Then conies a copious perspiration, and the fever goes off. But, on the four- teenth* day from the beginning of the attack, the fever returns (relapses), and lasts for another time of from three to eight days. About one in ten, or a less proportion, of white persons, and a larger number of colored patients, die of the disease. Relapsing Fever has been called " famine fever," because it so generally occurs as an epidemic or endemic among the poorest and Avorst situated classes in large cities; often in Northern Europe; a few times only in New York and Philadelphia. In its treatment, a mild saline purgative medicine will be proper at the beginning. If headache is severe, dry cups may be applied to the back of the neck. Citrate of potassium or acetate of ammonium in solution will ansAver Avell through the fever period to lower the temperature and promote perspiration. During the remission of the fever, moderate doses of quinine (ten or twelve grains in the course of a day) will be appropriate for tonic effect. Quinine has been shown to be not capable in this fever, as it is in intermittent, of preventing the coming of the relapse. In the second fever, weakness may be so great Avith some patients as to require concentrated liquid food and alcoholic stimulation or support. Remittent Fever. Autumnal Remittent; Bilious Remitting Fever. This is one form of malarial fever (see Ague); differing from inter- mittent in that the fever does not go off (intermit) during the attack, but only remits or lessens in violence, to return in full force within a few hours. Remittent Fever generally, but not ahvays, begins Avith a chill. Then follow all the symptoms of fever; headache, flushed face, hot dry skin, rapid and rather full but soft pulse, thirst, constipation of the bowels, scanty, high-colored urine. Vomiting is common; delirium occurs m bad cases; yellowness of the skin after a feAV days is not unusual. The remissions come generally in the morning, but sometimes late in the SPECIAL DISEASES. 785 dav; seldom at night, at least before midnight. In them the fever does not go off, but the pulse becomes slower, the skin less hot, and perhaps a little moist; the headache is lighter, thirst less intense, the breathing sloAvcr. So the attack may continue for a number of days. Mow long it Avould run Avithout being interrupted by treatment, I do not knoAV. All the cases I have seen Avere broken and cured by quinine, which is the remedy here, as it is in intermittent fever. In treatment, begin Avith a good, though not too large, dose of saline cathartic medicine (does the doctor begin everything Avith such a dose ? Well, yes; nearly so, and Avith good reason, sustained by experience), as citrate of magnesium, Rochelle salts, etc. Then during the height of the fever give, every tAvo hours, citrate of potassium solution (neutral mixture, or effervescing draught; see pp. 565, 569). On the beginning of the first remission begin to put in quinine; two grains every tAvo hours, while the patient is aAvake—until a full remission comes, with free perspiration, and copious or at least considerable discharge of urine. Then lessen the dose of quinine to one grain every two hours; and after another day get it doAvn to eight grains a day; this may be con- tinued on for two or three weeks Avith advantage. Plenty of cold water to drink Avill be important during the fever heat. [f vomiting is troublesome, ice, a little very often, will agree best with the stomach. Lemonade or orange-juice is generally acceptable. Food can only be taken in small quantities, and in the liquid state; oatmeal gruel, toast-Avater, milk Avith lime-Avater, etc. For the vomiting, a spice- plaster Avill be good, or a piece of flannel Avet Avith essence of ginger, laid over the pit of the stomach and covered Avith oiled silk. If any one should be (as may happen, as Remittent is a country, not a city disease) caught in charge of a case of this malady without a phy- sician, the above described treatment will be pretty sure to carry the patient through. There are, no doubt, especially in some intensely malarious places, as South Carolina rice plantations, or tropical "jun- gles," fatal cases of Remittent Fever. But I never saAV one, although the disease has not, until during the last feAV years, been rare in the suburbs and rural vicinity7 of Philadelphia. I have met with a feAV tedious cases, requiring some variation of treatment; but the considera- tion of such may be left for more extended medical works. Complica- tions of Remittent Fever, such as pneumonia, inflammation of the brain, etc., require treatment (besides the use of quinine) appropriate to each of the special complicating affections present. Convalescence from the attack Avill be likely to call for building up, Avith iron, etc. Change of (or, especially if frost has not yet come, will be highly important. \) hoever has had one attack of malarial fever in a place had better 786 D 0 MES TIC M ED I CINE. get out of it as soon as practicable, and never go back to it. It is quite possible to survive a number of such attacks; but they are sure to in- jure, and may ruin, the constitution for life. Retention of Urine. The most frequent cause of this, in men, is stricture of the urethra, through Avhich passage the urine passes out from the bladder. For this there must be surgical treatment, includim'- the use of the catheter (see Nursing), the consideration of which Avould be out of place here. See pages 509, 562. Women sometimes have retention of urine Avithin a short time after childbirth, from pressure on the neck of the bladder. A catheter anu- ria ve to be used for this. Hysterical Avomen also occasionally suffer from such retention. In either sex, it may occur as a symptom of low fever, as typhus or typhoid fever. It should be thought of and ex- amined for, in all Ioav states of the system. If very little or no Avater be passed, ascertain whether there is fulness or moderate SAvelling at the loAver part of the abdomen. Percuss there (tapping upon one finger, laid on the part, Avith the tip of another) to find Avhether it gives a clear or dull sound. If the latter, a catheter should be introduced carefully into the bladder to draAV off the Avater; and, if Avater comes through it, this should be done twice in tAventy-four hours. If no water comes, there is suppression of urine, which is Avorse than retention; a very un- favorable sign in any disease. Now and then Ave meet Avith cases of spasmodic retention of urine, from irritation of the bladder or its outlet, for Avhich locally tranquil- lizing measures are found to be relieving. Such are, sitting in a Avarm hip-bath; applying cloths Avrung out of hot Avater to the genitals and the loAver part of the abdomen ; an opium suppository (a grain of opium iu a small piece of cacao butter), or a laudanum injection (thirty or forty drops of laudanum in half au ounce of starch), by means of a small syringe, into the bowels. Retina, Detachment of. The Retina (see Anatomy) is the ex- tremely delicate membrane at the back of the interior chamber of the eye. Upon it, as upon the "sensitive plate" of the photographer's apparatus, the images fall, by means of Avhich we see objects. It may be partially or almost entirely loosened from the tissue behind it: 1. By apoplexy (effusion of blood) of the eyeball. 2. By dropsical effusion in the same region. 3. By inflammatory action (retinitis) re- sulting in degenerative change. 4. By sIoav degeneration, not caused or preceded by inflammation. The retina being indispensable to sight, any degree of its detachment must impair vision; and a large extent of such a change must cause actual blindness. This, as an effect, makes itself knoAvn at once; but SPECIAL DISEASES. 787 the cause of the blindness can be made certain only by examination of the eye with an ophthalmoscope. Retinal detachment is, as a general fact incurable. Only in rare instances Avill the loosened fragments be dissolved in the vitreous humor, and a partial repair of the damaged part of the retina take place, so as to suffice for tolerable sight. Such a result is never, in any case, to be expected. Rheumatism. This name is commonly given to at least two kinds of complaints: sIoav, chronic, non-inflammatory Rheumatism of the muscles, and acute, febrile, inflammatory Rheumatism of the larger joints. The latter is much the more serious disease. Inflammatory Rheumatism only occurs in certain individuals and families. It appears to be brought on by exposure to cold and Avet, and yet it is not uncommonly met Avith in summer. One joint after another, or several at once, are apt to be affected; the Avrists, elboAvs, knees, and ankles all in turn or together SAvell, become hot, painful, and tender to the touch. Fever is present, Avith a rapid, full, and rather hard pulse, and high heat of skin; although moisture may be present at the same time. The great danger of this disorder is, the liability to heart inflammation as a part of it; endocarditis (Avithin the heart) or pericarditis (outside of the heart). (See Heart, Diseases of.) The attack often lasts three, four, or six weeks; sometimes longer yet; and its effects, in crippling the joints, or damaging the heart, may continue through a lifetime. Trecdment of Inflammatory Rheumatism is in part general and in part local. If in a gouty constitution, colchicum will do good in short- ening the attack. OtherAvise, the two remedies in Avhich physicians now have the most confidence are cdkalies (potassa and soda) and salicylic acid. The two may be very Avell combined; and so the attack may generally be abridged to one or tAvo Aveeks' duration, with much less suffering. (For doses of salicylic acid and salicylate of sodium, see page 605.) Care is requisite in using such powerful medicines, which are not well adapted for domestic practice. Overdosing Avith salicylic acid is poison- ous. Local treatment of the inflamed joints has for its intention the relief of pain. Cotton Avadding, rubber-cloth covering, and laudanum are the most effective applications for this purpose. My preferred plan is to lay over the painful joint a soft rag Avet Avith laudanum, and bind gently over this a piece of oiled silk. This will generally lull the pain very much. Some limit to the amount of laudanum used is necessary, as it is partly absorbed through the skin. A patient of mine once thus covered all his large joints with laudanum, and in consequence slept most of the time for tAvo days. With children, such outside anodyne 788 DOMESTIC MEDICINE. drugging Avould be dangerous to life, except with the use of only a few drops of laudanum at a time. Chronic muscular Rheumatism (sometimes stiffening also the joints) is quite a different disorder from the above. It is unfortunate, indeed, for them to go by the same name. In ordinary language, every pain, soreness, or stiffness of muscles or joints is called rheumatic. The first effect of a draught of cold air upon the shoulder or back of a person sitting or lying still, is pain. Next, soreness and stiffness on motion of the part. "Stiff neck" is a familiar example of this. It becomes inflamed in many cases; but this is a local inflammation, Avithout feArer, and not flying from part to part, as in acute Inflammatory Rheumatism. (Gouty subjects, it is true, have sometimes flying rheumatic pains; a mixture of complaints, constituting gouty rheumcdism; which does not receive enough attention in many medical books. See Gout.) AVhen such an attack begins, as the result of cold, heat is its natural and effectual remedy. Sitting near a hot grate or stove, or applying a (not too) hot flat-iron or bag of hot Avater to the part, will, if resorted to early enough, often give prompt relief. Should such measures not succeed at once, however, there will be no gain in continuing them long. Bathing with soap liniment, Avith or Avithout the adtlition of other things (as ammonia, oil of sassafras, and laudanum ; see Remedies) will then come in place. Warming-plasters may follow, and, lastly, protecting the susceptible parts with flannel, etc., from the reneAved action of cold. If there be any tinge of gout in flying rheumatic attacks, oil of cajujml (six or eight chops on a lump of sugar, three times a day for a day or tAvo) Avill prove an excellent remedy. As a local protective to an affected joint, some patients find a simple covering of thin india-rubber to ansAver well. Dr. John K. Mitchell, of Philadelphia, many years ago, pointed out that rheumatism often, if not generally, centres in the spine. Accordingly, I have repeatedly knoAvn the application of a dozen dry cups (left on fifteen or twenty minutes), or a large mustard-plaster, along the back, on each side of the backbone, to do good, even when the pains Avere only in the limbs. Chronic rheumatism may be, especially in old people, a tedious affair. There is a much more formidable affection of the joints, sometimes met Avith in persons past middle life, best named by physicians arthritis deformans, but also called, much less accurately, rheumatic gout. In this, one joint after another becomes stiff, deformed, and useless; the patient getting to be at last altogether helpless. This is an incurable disease. (See, also, White Swelling, of the Knee.) Rickets. A disease consisting chiefly of imperfect development of SPECIAL DISEASES. 789 the bones, with general debility; common among the children of the poor in the great cities of Europe, but rare in America. The bones are brittle; the spine becomes curved antl the limbs crooked ; the teeth fall out with early decay. Convulsions are not unfrequent, and the child so affected seldom lives long. The treatment of Rickets is, in a Avord, building up, if possible, the constitution of the child, Avhich is failing and dying from insufficient nourishment. Ringworm. A rounded patch of diseased skin, most common in children. See Skin Diseases. Roseola. See Skin Diseases. Rbtheln. German Measles; sometimes called French Measles; see Measles. Rubeola. One of the old medical names for measles; uoav confined by some authors to rbtheln or German measles. Rupia. A scabby disease of the skin. See Skin Diseases. Rupture. Hernia; a protrusion of a portion of intestine, or of its covering (peritoneum) through a natural or unnatural opening. There are three places through which a Rupture is most likely to take place: at the groin; just beloAv the groin; and at the navel. These are called by physicians inguinal, femoral, and umbilical hernia, respectively. Navel (umbilical) rupture is met Avith in neAvborn babes, and in women who have had children; seldom in men. The most common kind of all is inguinal hernia. In this a knuckle of boAvel, or a portion of per- itoneum, is forced out (by straining at stool, riding hard on horseback, or some severe muscular effort) through tAvo successive openings, called the internal and external rings. These, in man, are naturally penetrated by the spermatic cord. (See Anatomy.) AVhen a part so protruding is not soon returned and kept in its place, the rings are stretched; and more and more of the boAvel comes down. If still neglected, at last it becomes irreducible. Persons have been known to have a bag of this kind hanging doAvn almost to their knees. The proper thing is, for a rupture to be reduced as soon as it is dis- covered ; and then a truss should be worn. This is a spring belt made to go around the body, Avith a pad fitting over the rings, so as to plug them up, so to speak, and prevent the parts from coming out after being replaced. This will seldom cure the trouble, but it prevents much in- convenience from it. A truss must be made to fit well, or it is Avorse than none. It should be Avorn all the time except AAmile lying doAvn. Ruptures are not free from serious danger if neglected. When a por- tion of boAvel is pushed out through one or both of the " inguinal rings," or, a little loAver doAvn, in the " femoral" region, or at the navel, it may become swollen by gas, or by accumulation from constipation. This may 790 D 0 M E S TIC MED I CINE. cause it to be strangulated at one of the rings or other outlets. The circulation of blood in the gut being thus stopped, the part outside may mortify, and this is, in most cases, the cause of the patient's death. When a rupture threatens to be so choked or strangulated, it is of the utmost consequence for it to be at once reduced, if possible. Gentle pressure, to work it in again, as common sense suggests, and as tact may succeed in doing-, is the need of the case. It Avill not do to be violent about it; that Avould make things Avorse. If it Avon't be coaxed in, then (if the doctor has not arrived and may not soon come) a warm bath, for twenty minutes, may be tried; manipulating carefully Avhile the patient Fig. 232. Different forms of Self-adjusting Pads. TRUSSES. is in the bath. On coming out, let some one lift the patient's heels far above his head; and Avhile he is so held, let another coax again at the rupture. Other measures Avill be most safely left for professional skill. If the protruded part will not go back, the last resort is a surgical op- eration ; nicking the tight place at the neck of the tumor, so as to release it from the stricture and enable it to be returned. This may save life, but Avill not ahvays be in time to prevent mortification, ending either in death or in recovery Avith an artificial opening at the place of rupture; an extremely annoying result, lasting through life unless itself relieved by subsequent surgical treatment. Umbilical rupture in a neAvborn child is generally curable by early SPECIAL DISEASES. 791 treatment with a compress, acting like the pad of a truss. The compress may be made of soft rag of any kind, cut and folded so as to press steadily, upon the part Avhich protrudes at the navel. When rightly adjusted, it may be kept in place by adhesive-plasters, aided by a band, moderately tight, around the body. If the skin is irritable, the compress should be covered Avith simple cerate or vaseline Avhen applied. 792 DOMESTIC MEDICINE. Scabies. Itch. See Skin Diseases. Scald Head. Ringworm. See Skin Diseases. Scarlatina ; Scarlet Fever. With physicians, these mean the same thing. In popular language, the former term is sometimes applied only to the mildest attacks, Avith very little fever. The disease is contagious, and usually occurs but once in a lifetime; most generally during child- hood. It is seldom, hoAvever, seen in infants under three months of a<>-e. First symptoms of au attack of Scarlet Fever are, headache, weakness, and sore throat. Children may have Amounting; in severe cases, convul- sions. The throat, on being examined, is of an intense red color. The tongue often looks like a ripe straAvberry; red, Avith Avhitish spots over its surface. Heat of the body increases; the boAvels are constipated; the pulse grows more rapid, and toAvards the end of the second day the red rash conies out. It begins commonly on the face, but soon spreads all ovrer the body. It is very red; almost brick-red; the skin is savoIIcu ; there are' no patches (as in measles); but, on looking closely, it is seen to be made up of tiny points or pimples, close together. The skin is hot and dry, and feels burning to the patient. Thirst is great?; it is a condition of high fever. The throat becomes painfully sore and swollen, Avithin and Avithout. If all goes on pretty Avell, this state of things lasts Avith but little change for three or four days, and then gradually subsides through several days more. When the feATer has quite gone, the outer skin begins to peel or scale off. Sometimes almost a Avhole finger-cover Avill come aAvay at a time, like the finger of a glove. After the beginning of convalescence, on slight exposure to cold, or even in some cases without this, the kidneys cease to act Avell, and dropsy comes on. This is shoAvn by pufnness of the face and swelling of the legs and feet. Worse will be dropsy of the chest or of the head; of either of which patients may die. Even a mild attack of the fever has this danger left after it. But Scarlet Fever, though recovered from in the large majority of cases, is far from being always mild; and it is especially uncertain all through its course. Besides the possibility of general exhaustion in feeble infants, there are tAvo kinds of peril attending the attack. One is, of great severity of the throat inflammation. This may ulcerate, or suppurate, or may otherwise fairly worry out the patient's strength. If recovery comes, the disease may have reached the ears, leaving deafne.-s behind it. The other and greatest danger is, of Avhat is called malignancy in the attack. A malignant case is generally a bad one from the start; but now and then it seems to take a sudden change for the Avorse. The rash does not come out, or, after appearing, it groAvs pale again. The SPECIAL DISEASES. 793 child is cold instead of feverish ; its pulse flutters or almost disappears • or it becomes stupid, comatose, not capable of being- roused. In the extremest cases, it is from the first like one stunned or struck by light- ning, and may die Avithin tAvelve or tAventy-four hours. Treatment of Scarlet Fever must be upon the recognized principle that Ave have no specific remedy Avith Avhich to cut it short or " cure it." It has its course to run, and Ave are to get the patient through Avith as little damage as Ave can. A mild or average case requires little active treatment. A good dose of saline purgative medicine (ahvays that, doctor?) at the start, or at least as soon as the fever becomes hot, aaill be an important thing. My father, avIio had an immense experience, during a large practice for fifty years, used to say that " many of the troubles toAvards the end of cases of Scarlet Fever and other allied diseases came from neglect of evacuating and depleting treatment at the beginning." By evacuation he meant purgation; by depletion, bleeding, or leeching to the throat. In my early practice (before 1860), I bled six children ill with Scarlet Fever. They all recovered beautifully. I gaA'e up this practice, not from conviction, but simply in concession to the pressure in the medical profession against bloodletting, especially in such diseases. But early purging I do not give up; believing that, as a means not only of cooling fever but of elimination (getting rid of foul matter in the blood), it is of great consequence in all such disorders. Further, for the fever, plenty of'»cold water to drink should be giATen. A part of it may be in the form of iced flaxseed lemonade. Ice itself will be very comfortable to the throat. Also, solution of citrate of potassium, Avith or Avithout effervescence, a dose every two or three hours, as a cooling diaphoretic. (See Remedies, pages 565, 569.) For the throat, the early use of something to act as an alterative, chang- ing the specific inflammation to an ordinary sore throat, is reasonable. The old-fashioned gargle for that Avas of cayenne pepper and vinegar, (hot for hot; coals to put out a fire!); it is not a bad prescription. Physicians oftener use solution of nitrate of silver (from four to ten grains to the ounce of water) applied with a camel's-hair pencil. I believe in the value of early leeching (American leeches) when there is much heat and SAvelling of the throat. If not, free greasing Avith lard (some people tie a solid piece of pork around the neck; rather heavy, I think) Avill do some good. For the inflamed skin, the eruption, frequent sponging or otherAvise gently bathing with cold or cool water will give the most relief. Lard, vaseline, and glycerin are also used for this purpose; but I believe cool vrater to be the best. The last thing at night, lard, tallow, or cold cream 794 DOMESTIC MEDICINE. may be rubbed over the face, arms, and legs, if the irritation of the skin is great. What is to be done in malignant cases? If the attending physician agrees Avith my judgment, he will, if the rash docs not come out, or " goes in " again, the skin being cool, and pale or dark-red, and the pulse Aveak, have the patient put into a hot bath, in Avhich some salt has been dissolved. Then he Avill giATe, if the child can swallow, camphor, ammonia, Hoffmann's anodyne, or whisky (one or more of these), as quick stimulants, to bring about reaction, Avhich gives the only hope of life. If stupor is present, the boAvels, as is then apt to be the case, being unopened, he Avill give a strong cathartic, as jalap; Avith a diuretic, as squills. I am sure I saved the life of one child, comatose for thirty-six hours, by giving it poAvders containing each a grain of squills with three grains of jalap. Purgation followed, and the brain Avas relieved ; after which there Avas no further trouble. This Avas rather large dosing, but the case Avas desperate. Not many recoveries from malignant Scarlet Fever take place, whichever form it assumes. The dropsy after Scarlet Fever results from the poisonous effect of the disease on the kidneys. The urine, in such a case, is scanty and bloody; or at least tinged with blood. This is an unfavorable sign. Most physicians will apply either a mustard poultice or dry cups to the back, to draw blood from the congested kidneys. Of diuretics, to increase the floAV of urine, digitalis and SAveet spirit of nitre are then the most suitable. A AATarm bath, also, may assist to promote perspiration; the skin taking a part of the needful Avork of the kidneys during their oppression. I have said that Scarlet Fever is contagious. There is no doubt of this; although it misses taking, in those exposed to it, oftener than measles or whooping-cough. It clings, hoAvever, a long time to rooms Avhere patients have been sick with it; sometimes for months, unless much care has been taken to cleanse, ventilate, and disinfect everything. When the patient is well, say four weeks from the beginning of the attack, the peeling of the skin being pretty much over, let him have a daily warm (not hot) bath ; in a Avarm room, and being quickly dried after it, to avoid the risk of taking cold. As soon as he can leave his room, let him Avear clothing that Avas not in the room during the sickness. Let every article that Avas Avorn during the illness be boiled thoroughly (unless it be burned instead). Let the blankets be scoured, and hung all day in the sun and air, for two or three days. Carpets or mats in the room should be taken up and beaten, and then sunned and aired abundantly. Curtains or other hangings should be treated in a similar way; and lastly, sulphur should be burned in the room (everybody leaving it, the windoAvs and doors being then shut) so as to fumigate and SPECIAL DISEASES. 795 disinfect the walls, ceiling, and floor thoroughly. Why so much trouble? Because, although nineteen cases in twenty of Scarlet Fever end in recovery, the tAventieth may die, and they are all, as has been said, very uncertain. It is worth Avhile taking a great deal more pains to avoid getting Scarlet Fever than it is measles or Avhooping-cough. Sciatica. Pain, seated in the sciatic nerve; Avhich runs along in the posterior central region of the lower extremity. See Neuralgia. Sclerosis. Hardening of any tissue of the body from disease. It has been most carefully studied by physicians as it occurs in affections of the spinal marroAv. Full account of it is given in all recent treatises on the Practice of Medicine; but it is too pathological a subject for this work. Scorbutus. See Scurvy. Scrivener's Palsy. Loss of poAver in the right hand from incessant use of the fingers in Avriting. Conveyancers, bookkeepers, reporters, etc., occasionally suffer from it. The cause being exhaustion of certain mus- cles, the treatment must be total rest of those muscles; to Avhich may be added, the stimulus of pouring hot Avater over the forearm and hand, three or four times a day, for a feAV minutes at a time. Scrofula. Struma of old medical books; King's Evil, formerly, in popular language. A superstition existed, even as late as the time of Charles II. of England, that the touch of a King's hand would cure this disease. Dr. Samuel Johnson, Avhen a boy, Avas taken by his pa- rents to get the benefit of this royal remedy. Scrofula is hereditary in certain families. It is promoted by living in close houses, with insufficient clothing and poor food. But, once established, it may descend to children and grandchildren, eATen under comfortable circumstances. It is sliOAvn by sore eyes, sore nose, running at the ears, SAvollen glands of the neck, armpit, and groin, and disease of the bones of the arm or leg, or hip-joint complaint (coxalgia), or white-SAvelling of the knee; also, by a predisposition to scrofulous or tuberculous meningitis, a generally incurable affection of the brain. Not every scrofulous child has nearly all of these symptoms, but some of them may ahvays be observed as indicating this " diathesis." The treatment of Scrofula must be partly constitutional, and partly in adaptation to the local and special symptoms. Lea\7ing the latter for the present, it may be said that the best possible surroundings and other conditions of healthy living are of the greatest importance towards get- ting rid of this taint of the system. AVarm enough clothing, nourishing food (milk a staple, with cream and all), pure air, and out-of-door exer- cise, neArer carried to great fatigue. Of medicines, cod-liver oil, iodine, iron, and iodoform have sliOAvn the best reason for confidence in antag- 796 DOMESTIC MEDICINE. onizing the tendencies of Scrofula. It is so sIoav a thing in its progress that there Avill ahvays be time to obtain medical advice about it in every cast;. Scurvy. Before Captain Cook sailed around the Avorld, this Avas a common affliction of navigators, land explorers, especially in cold cli- mates, and invading armies at a distance from their homes. This famous namesake of the " Tourist's Guide " of to-day found that tin; lack nf fresh vegetable food caused Scui-aw, and abundant confirmation of his discovery has been furnished since. Drs. Kane and Hayes su if bred from it on their Arctic expeditions; the British and French troops in the Crimea, in their Avar against Russia; and many other examples of the same causation hiwe been knoAvn in recent times. Scurvy, Avhen completely developed, has these characters: the mouth is sore, the gums being soft, SAvollen, tender, and bleeding easily; the legs are enlarged behind the knee, Avith a rather hard fibrous deposit there; the skin is blotched Avith red or purple blood deposits on the limbs, breast, or abdomen ; appetite is lost, digestion is very poor; there is palpitation of the heart, Avith great general debility. Unless relieved, this goes on in a feAV Aveeks to a fatal end. Many cases occur, however, in Avhich some only of these symptoms are present. The -mouth sore- ness, Avhich, when it exists, is very striking and peculiar, may be absent altogether. So it Avas Avith those remarkable cases (of which I saw a considerable number in an army hospital) brought home from Merid- ian's Peninsular campaign in Virginia in 1862. They had no swelling of the gums at all, but they had purple blotches on their bodies and limbs, Avere Avasted almost to skeletons, and had scarcely any power of digestion left Avhen they reached Philadelphia. Also, they all suffered Avith bad dysenteric diarrhcea. Prevention of Scurvy is implied in Avhat has just been said. No one can long preserve good health without, nearly every day, taking some food of vegetable origin. Scurvy is ahvays liable to take place when some fresh vegetable food (or that which, in sealed cans, keeps some quality of freshness) is not taken at least every few days. Fatigue, exposure to cold, and Avorry, as homesickness or discouragement, promote the effect of this deficiency of diet. NoAvadays, sea-captains, leaders of exploring expeditions, and military commanders, usually take much pains to keep or obtain supplies of potatoes, turnips, onions, or fruit, as oranges and lemons, to prevent their men when aAvay from home from getting scurvy. Even desiccated (dried) potatoes have seemed to ansAver this purpose for some time. In the Arctic zone, fresh frozen meat has proved better than that A\Thich, even Avith ice, has been long kept. Treatment of Scurvy is, in toto, essentially the application of the same SPECIAL DISEASES. 797 principle—furnishing an abundance of fresh vegetable food. We plied our men in hospital from the Army of the Potomac with lemonade, oranges, grapes, potatoes, etc.; articles which, with ordinary diarrhoea, would probably have finished them all. Most of them recovered; a feAV had no digestive or blood-making poAver left, and so Avasted aAvay and died Avithin ten days or two weeks of their arrival from the field. Sea-Sickness. A prize may Avell be offered for the discovery of a sure remedy for that! Having suffered from it nine out of ten weeks at sea, this is said by the author feelingly. There is no need of a descrip- tion of this malady; the Avord nausea comes right from it in the Greek. Medicines for Sea-sickness I have not tried, unless mineral water (car- bonic acid Avater, "soda " Avater) be called such. This, a little at a time, with ice, helped me considerably. I doubt Avhether anything else is better. Advisers on ship-board differ on the question Avhether one should " give up " to Sea-sickness, or stand up and fight it out. There was no such question Avith me. DoAvn I must go; and I advise eATery victim of sea-sickness to lie doAvn till he is better. It is true, fresh air is very reviving; and the air on deck is much better than doAvn beloAv; but to obtain benefit from it, one should be Avrapped Avarmly, carried up, and laid doAvn on the deck. Of drugs, cocaine, chloral, and bromide of potassium have had the recommendation recently of some physicians. Also, Dr. John Chapman's ice-bags to the spine have obtained a measure of reputation for this complaint. But it continues yet to be, like boils and hydrophobia, an "opprobrium" of the medical profession. Seat-Worms. See Worms, and Santonin, p. 605. Septsemia; Septicaemia. Though the shorter of these words Avas earliest proposed, the longer term is still the most used. It means taint- ing of the blood by products of decay. Sepsis is organic decomposition, putrefaction; an antiseptic is something Avhich prevents or retards such changes. In the greatest number of cases, at least, under observation, the sep- tic matter enters the blood by absorption from a part of the body, at or near the surface, in which decay is going on at the time. A Avound not healing Avell; an abscess, not timely emptied of its discharge; the strained and partly torn tissues of a mother, shortly after the delivery of her child, in contact Avith Avhich decomposing material is left: these are examples of the origination of Septicaemia. Hoav does it differ from pycemia? In my judgment, the symptoms are essentially the same, except that in the latter pus is conveyed and deposited in different places in the body, forming a number of abscesses; Avhich, in simple Sep- ticaemia, do not occur. President Garfield, therefore, Ave say, died with 798 DOMESTIC MEDICINE. (hardly of, for his avouik! was mortal in any event) pyemia. This, 1 Avould say, is Septicaemia plus the formation of local deposits of pus. Symptoms of Septicaemia are, repeated chills; fever, Avith a very rapid but feeble pulse; vomiting; delirium ; great debility; cold sweats; sometimes SAvelling of the larger joints. Treatment of it (havin«- no special remedy to confide in) A\Te may lea\-e to the physicians; remark- ing merely, that the purest air possible is both preventive of and, if anything can be, helpful in Septicaemia; that concentrated liquid food, a little and often, by the boAvel if the stomach cannot accept it, is ap- propriate ; and that quinine, ammonia, and careful alcoholic stimulation are reasonably given Avith a view to supporting the sadly flickering flame of life. Shaking Palsy. Paralysis Agitans. See Paralysis. Shingles. Herpes Zoster. See Skin Diseases. Ship Fever. See Typhus Fever. Sick Headache. See Headache. Skin Diseases. A full account of these might occupy a volume larger thau this. Some definitions will be in place here, with general principles of management, and brief particular mention of those affec- tions of the Skin likely to be met Avith in household experience. Of various classifications of Skin Diseases I prefer this: Exanthemata, rashes: Erythema, Urticaria, Roseola. Papulae, pimples: Lichen, Strophulus. Vesiculae, watery eruptions: Eczema, Herpes, Pemphigus, Rupia. Pustulae, pustules: Ecthyma, Impetigo, Squamae, scaly diseases: Lepra, Psoriasis, Leprosy, Pityriasis, Pella- gra, Ichthyosis. Maculae, spots: Ephelis, Vitiligo, Chloasma. Hypertrophiae, growths: Naevus, Clavus, Verruca, Elephantiasis of the Arabs, Scleroderma. Tubercula, tubercles: Acne, Molluscum, Lupus, Elephantiasis of the Greeks, Frambcesia, Keloid. Hemorrhagiae, blood-deposits ; Purpura. Neuroses, nervous affections of the Skin : Prurigo, Anaesthesia, Neu- ralgia. Parasiticae, parasitic diseases : Itch, Sycosis, Tinea, Pityriasis Versi- color, Plica Polonica. Syphilida, syphilitic affections of the Skin. Erythema is a common and not serious inflammation of the skin, of A\mich a fair example is seen in " chapped" hands. This is pre- A-ented by ahvays Aviping the hands quickly and thoroughly dry in cold Aveather, after they have been in water. Cure of chapped. hands SPECIAL DISEASES. 799 or face is effected by greasing them Avell and often with talloAv, cold cream, or simple cerate. The same principle of treatment applies to other forms of Erythema; as that of infants' loins, etc., from Avant of carefulness in their daily toilet, and frost-bite (Avhich see). Urticaria is Nettie-Rash. Its eruption is in long or round red lumps or " Avheals," Avhich sometimes come and go Avithin a feAV hours, and Avhile they are present burn and sting very unpleasantly. Indigestion is the most common provoking cause of Nettie-Rash. It lasts usually a Aveek or two. Treatment, a dose of magnesia; light, cool, simple diet; starch-poAvder dusted on the Avheals; Avash with moderately cold vinegar and water, or glycerin and rose-Avater; oxide of zinc ointment, etc. Roseola is a damask-red eruption, in irregular patches, on the body and limbs; without fever, and lasting usually but a feAV days. It has no relationship to scarlet fever, nor to rothein or German measles; although this last disorder is sometimes miscalled Roseola, even by physicians. This rash requires no treatment except Avhat is suggested by the general state of the patient's system. Strophulus is the "red gum," or small-pimply, red rash of early infancy. Starch or arroAvroot powder and oxide of zinc ointment will be suitable in its treatment. Lichen is the name for numerous small pimples on patients of any age. A mild form of it is sunburn, Lichen Tropicus. This may be treated like erythema or strophulus, as above mentioned. Lichen Agrius is generally the result of neglected simple ordinary Lichen. It may scab, crack, run, and be very troublesome. The patient may need to be kept in bed, Avith poultices of bread or flaxseed to clean the sore parts, and then lime-water and oil dressing, folloAved afterAvards by simple cerate, to heal them. It is generally Avorst on the legs and feet, or hands. Eczema is iioav considered by physicians to take either, or successively all, the forms of eruption, pimples, Avater-blisters, pustules, and crusts or scabs; but through all its characteristic is that of an effusive inflam- mation of the skin. Its vesicles (Avater-blisters) are smaller than those of Herpes. Both of these are often, in popular language, called Tetter. Herpes has larger water-blisters, though still not very large. Fever- blisters around the mouth are an example of Herpes. /S7j ingles, Herpes Zoster, is a very curious but not common disease, in which a zone or girdle of inflamed vesicles goes half round the body at the waist, generally on the right side. Neuralgic pains attend this. It generally lasts but a week or two. Herpes Circinatus is non-contagious ringworm. It is knoAvn from 51 800 , DOMESTIC MEDICINE. Tinea Tonsurans, contagious ringworm, by having a great number of minute vesicles around the margin of the rings or round patches of which it consists. Treatment of Eczema requires skill in the management of each case. Get a doctor to attend to it; sometimes it becomes chronic and tedious. Milk Crust of infants (Crusta Lactea) is an example of it. The con- dition of the patient must be attended to; the stomach, the bowels, over- fulness of blood or the reverse (anaemia). Clothing must not be too heaAry, and must be changed often. Rooms must not be allowed to be hot and close. Food should be light and not rich (i. e., oily, fatty); easily digestible. If Eczema proves obstinate, arsenic is often prescribed for it; Fowler's solution (liquor potassii arsenitis), three drops at first, tAvice daily, increased two drops a day until ten drops twice daily are reached, interrupting its use if the patient has headache, sick stomach, diarrhcea, or puffiness of the face. Applications to the eczematous erup- tion may be : lime-water and oil; bran tea; flaxseed tea with soda in it; glycerin and rose-Avater (one part to four or five); etc. When chronic, some physicians keep the parts covered constantly (except daily Avashing with Castile soap, or lime-water) Avith light rubber-cloth. Others use adhesive-plaster all over it, Avith the same view of keeping out the air. Treatment of Fever-blisters (Herpes Labialis) about the lips may be by dusting Avith magnesia or applying cologne-water at the start, and afterAvards, if they continue to return, calomel ointment (half a drachm of calomel to the ounce of cold cream). Shingles may he treated Avith benzoated oxide of zinc ointment; to which, if there is much pain, opium may be added (five or ten grains to the ounce). Ringworm (scald-head) of either variety will generally be cured by two or three applications of tar ointment at night (covering the part with a soft rag, and over that oiled silk or rubber-cloth), washed off in the morning Avith Castile soap and water. Ecthyma consists of a few large pustules; Impetigo of a variable number of small pustules, scattered or in groups. In treatment of both of these, a good medicine early in the case Avill be wine of colchicum root ten drops, Avith wine of ipecac, as much, in water, three times a day (adult dose) for several days. If obstinate, arsenic will be in place, as for chronic Eczema. Arsenic is the heroic alterative in all continued Skin Diseases. With care, it may ahvays be prevented from doing harm. For this, the rules are: 1. Begin Avith not more than three drops twice daily, watching the effects. 2. Never go beyond ten drops twice daily. 3. Stop it at once for a week, if either headache, sick SPECIAL DISEASES. 801 stomach, diarrhoea, or puffiness (oedema) of the face appears. 4. In- terrupt it for several days, in any case, after it has been taken continu- ously for as much as three Aveeks. Lepra and Psoriasis are patchy and scaly chronic diseases of the skin, the principles of Avhose management are the same as those just set forth; but they are so hard to cure that any special application or variation of those principles had better be left to the judgment of a professional adviser. Leprosy has had an interesting history, from the days of the Old and New Testaments doAvn through the Middle Ages in Europe to our OAvn times. But as there were, in 1880, less than one hundred lepers in the United States, this disease is not likely to invade the households of any of our readers; we may, therefore, refer upon it to professional Avorks. (See " Essentials of Practical Medicine," fifth edition, p. 545.) Pityriasis is dandruff. Multitudes of small white scales form, espe- cially on the scalp of the head. This is generally cured (not at once, however) by keeping the hair short, and washing it well every day Avith Castile soap and cold water. If it lingers, a good wash will be Cologne water, half-and-half Avith water, to which one-fourth as much glycerin is added; or hot vinegar and water; or tannin (tannic acid) ten grains, glycerin a fluidounce, Avhisky and water each a fluidounce, well shaken together, and applied every night with a large camel's-hair pencil, fol- lowed by Castile soap and water in the morning. Pellagra is an often fatal disease of Southern Europe (especially Italy), with drying, thickening, and scaling of the skin. It has ne\rer been seen native in this country. Ichthyosis, fish-skin disease, is well described by its name. It is rare, mostly congenital (born with a person), sometimes hereditary, and, as a rule, incurable. I have only seen one case of it, and am not likely to see another. Ephelis is Sunburn. Only when intense from continued exposure to the direct rays of a hot sun, is this of any consequence, I have known a feAV persons of delicate skin, on the sea-shore for example, to suffer so much from glare and inflammation of the skin, as to be almost ill with A. One so affected must keep in a cool room in the house, on slop diet, drink cool lemonade, and cool the head at least, with ice-water often. On the face, arms, etc., starch-powder dusting, and cold-cream the last thing at night, will allay the irritation in a day or two. Freckles are generally not admired, that is all. Can they be taken out ? Not with certainty. If anything will have that effect, I believe it may be hoped from pencilling each freckle several times a day with either nitromuriatic acid solution (ten drops to a wineglassful of water) 802 DOMESTIC MEDICINE. Fig. 233. or solution of Labarraque's chlorinated soda Uavo teaspoonfuls in n wineglassful of Avater). Vitiligo is veal-skin; unnatural whiteness of the skin. If it conies on the head, the hair falls out; Alopecia, baldness. (See Hygiene, Care of the Hair.) It is, if curable, so only Avith difficulty, there being no specific remedy for it. Chloasma is a name for more extended spots than those Avhich we call freckles, being, like them, yellowish or brownish-yelloAV in hue. If any treatment Avill change them, it is likely to be that above mentioned for freckles. Noevus is a Mole. See Moles. Clavus is a Corn; Verruca, a Wart. See Corns and Warts. Elephantiasis of the Arabs is also often called Barbadoes Leg (lluc- nemia Tropica). It consists in an enormous groAvth of the connective tissue and skin, of the legs, and some- times the trunk of the body and the neck; so that the legs and feet, par- ticularly, become elephant-like indeed. It is a thing of sIoav progress, but is seldom cured. The only treatment Avhich has seemed capable of stopping the groAvth is tying a large artery which supplies blood to the morbidly enlarged and enlarging parts. Acne is a common kind of large- pimpled eruption, especially on the face. The pimples include "sebaceous follicles" (little grease-forming glands) in which their secretion is detained. Acne Rosacea is the form seen on the face; so called because of the redness of the pimple and of its environs. Often (not always) in each follicle -^EsSSS* there is a parasitic animalcule, acarus (or demodex) folliculorum, seen Avith a magnifying-glass in groups, each one-fiftieth of an inch in length. What may sometimes be taken for a parasite is a comedo ; that is, a solid spot of sebaceous matter, in a follicle, Avhich looks like a black dot, and can be squeezed out. An easy Avay of doing this is to push doAvn over it the barrel of a a\ atch-key. If Acne pimples pustulate (fill with yellow ELEPHANTIASIS OF THE ARABS. SPECIAL DISEASES. 803- matter), when ripe, they may be punctured Avith a needle, sidewise, to let the matter out. The other Tubercular affections named in our list, Molluscum, Lupus, etc., are not common enough to be appropriately considered in any but a professional Avork. Of Hemorrhagic affections of the skin, except that which is symptom- atic of Scurvy, the only one is Purpura. See Purpura, and Scurvy. Prurigo is persistent itching, without the specific cause (to be referred to presently) of Scabies or Itch. (Pruritus is the symptom of itching, merely.) Old people are particularly apt to suffer from this. There is often no eruption, until one is brought out by scratching; which is al- most unavoidable in the effort to obtain relief. Itching of the funda- ment (pruritus ani) is mostly caused by seat-worms. When this is so, they should be got rid of. (See page 605.) Treatment of Prurigo in- cludes attention to the state of the stomach, bowels, and general system. Local remedies may be many, but not unfrequently disappointing, at least as to producing permanent cure. Still, they are generally much better than perpetual scratching, which increases the irritation in the end. Among such remedies are: cold water; hot water; flaxseed-tea, with soda in it; lathering with Castile soap water, with a shaving-brush ; strong salt-Avater; Avhisky and salt-water; pure whisky; vinegar; creasote ointment; cerate of white lead (two drachms of carbonate of lead to an ounce of simple cerate); laudanum; spirits of camphor; camphor and hydrate of chloral, equal parts; glycerin; olive or almond oil; benzoated vaseline; boroglyceride; infusion of tobacco; etc., etc. Anaesthesia is loss of sensibility. It almost never occurs from disease except as a symptom of paralysis or of leprosy. Neuralgia of the skin is not common. When it does occur, it is a part only (as a rule) of a more extended affection of the same kind. (See Neuralgia.) Parasitic diseases of the skin are, wdth good reason, believed to depend on the presence of either an animal or a vegetable organism. The only animal cause of this kind on the human skin is the sarcoptes (acarus), which is the cause of Scabies or Itch. This disease is communicated from person to person, by the migration of the tiny acari. It appears as an eruption of small vesicles on a red surface, chiefly between the fingers and on the back of the hand; next often on the arms, legs, ab- domen, or scalp. It does itch terribly; worst at night. King James II. is the only person ever known to say that he enjoyed it. On looking closely with a magnifying-glass, a little line may be seen going frofn almost any one of the vesicles; this is the track or burrow of the ani- malcule, Sarcoptes Hominis ; one of the Arachnida—tenth cousin to the 804 DOMESTIC MEDICINE. Spider—a flat-bellied, round-backed, tortoise-shaped, eight-legged little pest. Treatment of Itch is simple. Several parasiticides Avill cure it; but sulphur is counted, on the whole, the best. The patient should take a Avarm bath, Avashing head and all well with soap; and then, at bedtime, rub the whole eruption over with sulphur ointment. Two or three ap- plications, with subsequent care Avith the clothing, as to cleanliness, etc., Avill usually effect the cure. Sycosis is Barber's Itch. It may be caught by being shaved with a razor just used on the face of a man having the disease. With a micro- scope, its causative vegetative parasite may be seen; called tricophyton mentagrophytes by scientific writers. Tinea is contagious Ringworm. In it, if there are any little vesicles, Fig. 2P.o. Fig. 234. MALE ITCH ANIMALCULE. MICROSCOPIC VEGETATION OF A SKIN DISEASE. they are very few; in the non-contagious kind (Herpes Circinatus), though small, they are numerous. In the tAvo varieties of Tinea two parasitic vegetations are seen Avith the microscope; a tricophyton and a microsporon: Favus or Porrigo is another analogous affection. Tar-ointment, applied at night, after the hair has been cut very short and the head cleansed, and washed off Avith Castile soap and warm water in the morning, will generally cure it. Still more powerful parasiticide applications are: mercurial ointment; solution of corrosive sublimate (both of these require much caution, the latter especially, as a poison); sulphurous acid solution; creasote or carbolic acid in solution or oint- ment; etc. Syphilitic affections of the Skin will be alluded to under Syphilis. SPECIAL DISEASES. 805 Sleep-Walking. See Somnambulism. Small-Pox. Variola is the technical name of this very contagious and often fatal disease; Avhich, before the time of vaccination, slew tens of thousands every year in Europe and America, and left its deforming marks on the faces of very many of those who survived its attacks. Symptoms. About tAveh^e days after exposure to the contagion, sick- ness begins with languor, headache, severe pain in the back, often vom- iting; soon folloAved by fever. On the third day of this, pimples, at first small and red, appear on the face, neck, arms, trunk, and lower limbs. The pimples go on to become vesicles (Avater-blisters), and then fill Avith yellow matter and become pustules; this change being complete by the ninth day of the fever. Next, they flatten and scab. Four or five days later, about the fourteenth day of the fever, the scabs begin to fall off; all being off usually by the end of the third week of the attack. The severity of Small-pox depends in each case chiefly on the amount of the eruption. When the pustules are so close together as to run almost together, it is called confluent Small-pox. The danger of an at- tack may be increased by the eruption invading the throat. I kneAv of one case made fatal by this, through interference Avith breathing and swalloAving. Malignant cases sometimes are seen; when, as in malig- nant scarlet fever, the poison-cause of the disease prostrates the patient almost or quite from the first. In such cases, the eruption either does not come out Avell, or takes on a dark or livid color; with a tendency to coldness of the skin, a small and feeble pulse, and extreme debility. Blindness and deafness are among the possible consequences of an attack of Small-pox; besides the " pitting" or pock-marking of the face, which is the rule rather than the exception. Like scarlet fever, measles, and hooping-cough, Small-pox generally occurs but once in a life- time. Yet instances are Avell known of a second attack; Louis XV. of France is said to haATe died of such • I knew of a fatal example also of it in Philadelphia some years ago. Treatment of Small-pox is not specific, as we have no antidote for its cause. Care should be taken that the bowels are Avell opened early in the attack, and are not constipated afterwards. For the fever, cooling- medicines are suitable, to promote perspiration ; as citrate of potassium or acetate of ammonium in solution. Plenty of cold Avater, or lemon- ade, may be drunk. The food must be liquid, but nourishing, and given often, in small quantities: milk, chicken-broth, beef-tea, etc. To prevent pitting on the face is worth considerable pains. The best way Avill be to abort (kill) the worst of the papules, on their second day, by touching each one in its centre with a small pointed stick of nitrate of silver. Then poultice the face with flaxseed meal, until all the pus- 806 DOMESTIC MEDICINE. tules flatten out; and, lastly,paint the Avhole face thickly with collodion, to Avhich one-fiftieth part of glycerin has been added. This will protect the eruption from the air, and promote healing Avith as little of marks as possible. Varioloid is Small-pox modified by vaccination. (See Vaccination.) It resembles the original disease in its whole history; but is less severe, and very seldom fatal. It goes through its stages sooner, and Avith less fever. Pitting does not often result from it; blindness or deafness never. Its treatment is the same in principle as that of Small-pox; according to the symptoms and the condition of the patient. No disease is more contagious (catching) than Small-pox and Vario- loid ; and an unprotected person may take the disease in its severest form from the mildest case of either. Protection is afforded, almost infalli- bly, by vaccination and revaccination (see Vaccination). But, since all persons are not certain to be thus protected, great care must be taken to lessen as much as possible the chances of contagion. In cities, special hospitals are, very properly, provided for such diseases. When a case is treated in a private house, the patient should be isolated as far as can be, from all others except needful care-takers. Upon his recovery, all garments and bed-clothing used during the attack had better be burned. Next best will be, thorough boiling, followed by long exposure to air and sunshine. A person who has had Small-pox ought, Avhen the scab- bing process has been completed, to take a warm bath (in a Avarm room) two or three days in succession, to clear the skin; and then should not be allowed to mingle with others, a child, for example, to go to school, Avithin forty days from the beginning of the attack. Snake-Bites. See Accidents and Injuries, later in the book. Somnambulism. Sleep-walking. The general nature of this was spoken of under Physiology, when considering the functions of the brain and nervous system. A part of the brain (chiefly the sensori- motor centres) is awake; the rest asleep. The sleep-walker moves about Avith his eyes open; sometimes going upon or into dangerous places, which, when aAvake, he would have shrunk from. At such times, it is dangerous to waken him suddenly; his alarm might cause a catastrophe. Children, or at least young persons, are much more apt to be somnam- bulists than grown people. Sleep-talking, moreover, is more common than sleep-walking. A few will hold a conversation Avith another Avhen in that state. To prevent somnambulism, a strong impression of its inconvenience and danger, made upon the mind, will most often take effect. When this is not so, the sleep-walker should not be left to sleep alone, and should be roused by his companion as soon as he begins to move. In some in- SPECIAL DISEASES. 807 stances, fastening the great toe to a bed-post by a cord has been found effectual. Sore Throat. See Throat, Sore. Spine, Diseases of. The bony spine (vertebral column) is subject to caries; a sIoav inflammation, followed by decay of the bone; especially in the middle of the back (dorsal vertebrce), in scrofulous children. The patient stoops from Aveakness of the back; and at last becomes hump- backed. When the disease passes off, this deformity remains. In the treatment of this affection, the favorite improvement of latter times is a contrivance for taking the weight of the upper part of the body from the diseased vertebra0, (separate bones of the spinal column; see Anatomy). This is done by suspending the Avhole body to a frame- work above it, by means of bands raising it by the armpits and head; and, Avhile it is thus held up, the spine being moderately extended, a SPINE DISEASE. CURVED SPINE. jacket is made, of bandages soaked in plaster of Paris, or of porous felt, so fitted to the body as to keep it in the extended position, after it is taken out of the suspending frame. By this relief from pressure upon the bodies of the inflamed vertebrce, their chance of recovery with- out damage is much helped; and also the tendency to humpbacked deformity is greatly lessened. Much skill is needed in this treatment. Spinal Irritation is an affection chiefly of the spinal marrow; but accompanied, as a sign or symptom, by tenderness on pressure in some part of the middle of the back. Other symptoms are, pains in the back, chest, stomach, and sides; sometimes indigestion, palpitation of the heart, nervousness, weakness; in some cases spasms of certain mus- cles, or even general convulsions. Patients so affected are generally pale and ancemic (thin-blooded). In treatment, they are likely to require 808 DOMESTIC MEDICINE. iron, perhaps cod-liver oil, salt-baths, and country air, to build them up. Also, advantage maybe expected from counter-irritation along the back; by dry cups, painting Avith tincture of iodine, Avarmiug-plas- ters, etc. Some other affections of the spinal marroAv, have been alreadv con- sidered. See Locomotor Ataxy, and Paralysis. Fracture of the Spine will be spoken of under Accidents and Injuries, near the end of the book. Spitting Blood. See Hemorrhage. Spleen, Enlargement of. Although met Avith also in typhoid fever, and some other diseases, this is most remarkable in prolonged cases of Intermittent Fever (Ague). In that affection, the Spleen sometimes gets to be four, five, or more times as large as is natural. When the " chills " are cured, it generally goes doAvn; but not always entirely so. Spotted Fever. See Cerebro-Spinal Fever. Sprue. See Thrush, under Mouth, Sore. Stammering or Stuttering. An annoying impediment of speech, Avhich some persons have from the time of their first learning to talk. It is OAving to a want of control over the muscles of speech; and is a nervous affection. It can almost always be cured by patient perseverance in vocal gymnastics. A simple method of self-training for this purpose is, to read or recite often, at first alone, and afterwards in company with others, in a deliberate, measured way; taking each syllable by itself, as in chanting or singing. Thus: " Will-iam Penn was the found-er of Penn-syl-va-ni-a; He-rod-o-tus Avas an an-cient Gre-cian his-to-ri-an." By holding on, so to speak, to each syllable until ready to bring out the next, practice gradually but greatly increases the control of the Avill over the speech. Stomach, Inflammation of: see Gastritis. Cancer of: see Cancer. Cramp of: see Colic. Ulcer of the Stomach may be here briefly re- ferred to. It is a rather uncommon affection, least rare in feeble Avomen, betAveen tAventy and forty years of age. Its symptoms are, sharp pain in one spot of the stomach, Avith or Avithout tenderness or pressure, but increased by eating, and especially by eating sugar; also, vomiting; a little blood being brought up. Sometimes, there is real and serious hemorrhage; hcematemesis. A very bad ending of an Ulcer of the Stomach is for it to perforate the Avails of the stomach, alloAving its contents to get into the peritoneal cavity. This is ahvays followed by death within a few days. The above symptoms are much like those of cancer of the stomach; but, in the latter, the pain is less limited to one spot, and is not in so marked a degree increased by any kind of .food. By aid of the microscope, also, the matter vomited Avill show SPECIAL DISEASES. 809 cancerous particles present; and, generally, a tumor can be felt upon careful examination if the disease is cancerous. Treatment of Ulcer of the Stomach includes the use of soft food, as arrowroot made with milk, chicken-broth with rice, limewater and milk, etc. As medicines, nitrate of silver, creasote, and iodoform are most Avorthy of trial. Opium may be called for on account of the pain; or hypodermic injection of solution of morphia; but it is safest to withhold these as long and far as practicable, on account of the danger of the opium or morphia habit. It will promote the cure of the ulcer, for a considerable part of the nourishment for a time to be given by injections (beef-tea, egg, milk, etc.) into the boAvels. Stone in the Bladder. Calculus. The stone really forms almost always at first in the kidney; but after passing into the bladder, if Fig. 238. URIC ACID STONE. MULBERRY CALCULUS. detained there, it may gradually increase very much in size. There are stones of several different materials: uric acid (the commonest), phos- phates, oxalate of calcium, etc. Symptoms of Stone are, pain in the bladder, and beyond it in the male; sudden stoppage of the stream Avhile urinating; distress on taking active exercise of any kind; bloody urine; feArerishness, and wasting of the strength. Certainty as to the existence of a stone is obtained by examining the bladder with an instrument. Treatment of Stone is, besides care to avoid anything to increase the irritation of the bladder due to its presence, an operation for its removal. This was formerly done by cutting into the bladder and draAving out the stone with forceps. That operation is still sometimes preferred ; but a 810 DOMESTIC MEDICINE. procedure lately growing more into favor is crushing the stone by an instrument introduced through the urethra, and then Avashing out the fragments. It is a serious operation, only to be done for the relief of ATery distressing symptoms. Strabismus. Squinting; Cross-eyes. This results from the muscles Avhich draAv the eyes in one direction being stronger than those which move them in the opposite direction. Double sight is the consequence, as the axes of the two eyes do not then meet in an object looked at. But, by habit, the cross-eyed person comes to attend only to one of the two images seen, and so is not greatly incommoded by it. For the sake of appearance, an operation is often performed for the cure of Strabismus; dividing, Avith a small sharp knife, the stronger muscle, so as to give the other opportunity to keep the balance with it in moving the eyeball. This operation, neAer giving much pain (being done in so short a time) may be rendered quite painless by the recently introduced use of hydrochlorate of cocaine ; a feAV drops of a two or four per cent, solution of Avhich render the eye for a time insensitive to the touch, and even to the knife. Considerable skill, however, is required to make such oper- ations successful. In children, habitual squinting is occasionally brought on by a habit of producing it just for amusement; or by looking a great deal at a hat or bonnet-string dangling between the eyes. Such things should be carefully avoided. Strangury. Difficulty or pain in emptying the bladder of urine. It is not often met with (except Avhen there is stone, or gravel, inflam- mation of the bladder, or stricture of the urethra) unless after a fly- blister, or when cantharides (Spanish fly) has been taken as a medicine. For the relief of Strangury, camphor or assafcetida may be taken; Avarm cloths (wrung out of hot water) may be applied over the bladder and perineum (the crotch, in front of the anus, between the thighs); a Avarm bath or hip-bath may be used; and, in a severe case, an injec- tion into the bowel of thirty or forty drops of laudanum, with starch, by means of a small syringe. A few drops of spirits of camphor on the surface of a blister Avill generally prevent it from causing strangury. Struma. See Scrofula. Stye. A small, but often painful, inflammation of one or more of the small glands or follicles at the edge of the eyelid. It becomes red, swollen, and tender to the touch; in a day or two, if not relieved, it may suppurate; getting Avell after the yelloAV matter has been dis- charged. To arrest the inflammation of a Stye, in its forming stage, a small piece of ice, frequently applied, will be the best thing. If that cannot SPECIAL DISEASES. 811 be had, some other cold thing, as a steel key, may do. When not checked at the start, no other treatment is worth while, unless it be severe enough for the application of a bread and hot-water poultice at night. St. Vitus's Dance. See Chorea. Summer Catarrh. See Asthma. Summer Complaint. See Cholera Infantum. Sun-Stroke. See Heat-Stroke. Syncope. See Fainting. Syphilis. A disease, primarily contagious, originating in vicious, Fig. 240. SYPHILITIC TEETH. unchaste living; at first local, afterAvards constitutional; and in that form hereditary. Among its manifestations are, copper-colored erup- tions of several kinds; ulcerated sore throat; inflammation of the iris of the eye; loss of the hair; rheumatic pains and swellings of the bones; and degenerative disorders of the brain, lungs, liver, spleen, etc. It is mostly curable, especially by early treatment; but is sometimes obstinate. Principal remedies in its management are the preparations of mercury (calomel, blue mass, iodide of mercury, corrosive sublimate), and iodide of potassium. For a more particular account of Syphilis, see special works on Medicine and Surgery. Any one who has seen, in a hospital or elsewhere, the victims of venereal or syphilitic disease, may Avell have a horror of the danger Avhich belongs to prostitution. Ugly red lumps scattered over the face, ulcerated open sores in the throat, painful SAvellings on the bones, and often very serious diseases of the brain, lungs, or other vital organs make life miserable; and, perhaps worst of all, if a syphilitic person has children, they may inherit the same disease, innocent sufferers from their parent's vice. (See page 370 on " the social evil.") 812 DOMESTIC MEDICINE. Tabes Dorsalis. See Locomotor Ataxy. Taenia. Tape- Worm. See Worms. Tetanus. Lock-jaw. An affection centring in the spinal marrow, and produced in most instances by the irritation conveyed by nerves from a wound; sometimes, however, it is brought on by exposure to cold, or cold and wet. Punctured wounds, as by a nail or pitchfork in the hand or foot, or extensive crushing of parts, as in railroad accidents, are especially liable to be followed by Tetanus. Symptomatic of it is stiffness of the muscles; first of the jaAvs, which are firmly closed, aud cannot be opened without external force; afterAvards, in marked cases, in all the muscles of the body. Sometimes the body is arched backward (opisthotonos); in other cases forward (emprosthotonos). Food cannot be SAvallowed ; the patient is sleepless; and, unless relieved, he will die within a week or ten days. More than three-fourths of those attacked with Tetanus die. The danger is least when it comes from exposure to cold ; greatest in traumatic cases (originating from wounds or injuries). Treatment of Tetanus requires absolute quiet; in a room nearly dark- ened, and all noises shut out or prohibited in and near the room. Pro- longed warm or hot baths are likely to be beneficial. If obliged to wait for medical advice, the only medicine I can suggest using to save time is opium, in the form of laudanum or solution of morphia. Pretty large doses of opiates are often given by physicians in Tetanus. I saw two recoveries under doses of a grain of opium (about twenty-five drops of laudanum) every two hours for three or four days and nights; also a tablespoonful of whisky every two or three hours. Milk and essence of beef are the most available kinds of nourishment for such cases. Sometimes it is necessary to gently pry open the jaws and insert a cork on each side, to leave room for a tube for the introduction of food into the mouth; or one or two teeth may have to be drawn for the same purpose. Tetanus or Trismus of the new-born babe is a very often fatal disease, particularly common among the negroes of the Southern States. Two causes are believed to produce it, at least in children predisposed to nervous disorders: pressure of the bones of the head (which are nlovable at birth) upon the brain, during or after delivery, and irritation of the navel, where the umbilical cord has been separated. The former is probably most often concerned in the matter. To prevent the tendency to it, labor should not, avoidably, be alloAved to linger for many hours; and, as soon as the child is born, it should be laid on its side (the right side), so that no pressure can act upon the back of the head (occipital bone). Treatment of Trismus Nascentium (of the new-born) had better be left altogether to professional judgment. SPECIAL DISEASES. 813 Tetter. A popular name for both Eczema and Herpes. See Skin Diseases. Throat, Sore. Common Sore Throat is an inflammation of the fauces (entrance to the throat) and pharynx (first portion of the swallow- ing throat or gullet). Everybody knows the symptoms. When looked at, opening the mouth wide and pressing the tongue doAvn Avith a paper- cutter or the handle of a spoon, redness and swelling may be seen. Pain on swallowing is a leading feature of the case; sometimes there is constant aching. If the tonsils, or one of them, be most affected, it is tonsillitis or quinsy (which see). Ulcers sometimes form, and can be seen Avhen looked for as above said. In diphtheria, besides redness and swelling, there is a Avhitish, grayish, yellowish or brownish deposit of false membrane on or near one or both of the tonsils, Avhich often spreads, even into the larynx (upper windpipe) and trachea. AVhen looking for such deposits, let the patient's throat be first Avell washed out with a gargle; lest a portion of mucus (phlegm) remaining at the moment, but easily removed, be mistaken for diphtheritic pseudo-membranous deposit. Never suppose a sore throat to be diphtheria, without good and clear evidence; much the largest number of cases of sore throat are not diphtheria. In scarlet fever, also, soreness of the throat is a general and prominent symptom. Ulcerated Sore Throat is common in secondary syphilis; and it sometimes occurs in the course of pulmonary consump- tion. Treatment of ordinary sore throat (acute pharyngitis) is simple in principle. A dose of cooling cathartic medicine, as citrate of magnesium, Tarrant's aperient or Rochelle salts; flaxseed lemonade to drink, a little, sloAvly, and often; alum-AATater, or tincture of myrrh and water, or hot green or black tea, to gargle the throat; bathing the throat outside with soap liniment, to which ammonia has been added, or with sweet oil and ammonia, equal parts; a hot mustard foot-bath at night, the first night, and afterAvards also if there is any coldness of the feet; these are about all that need be done as a general rule. (See Inhalation, p. 577.) Ulcerated Sore Throat needs, when not syphilitic in origin, touching of the ulcer or ulcers with either the solid stick of nitrate of silver (lunar caustic), or a solution of it (ten to twenty grains in an ounce of water); also, applying powder of iodoform, a little daily, on a slightly wet camel's-hair pencil. If it be syphilitic, the constitutional affection requires iodide of potassium (five to ten grains three times a day), besides similar applications to the ulcers in the throat. Chronic Sore Throat calls for astringent gargles (alum, myrrh, tannic acid) to be persevered in; also touching the throat with nitrate of silver solution (four to ten grains in an ounce of water) every day or two ; and 814 DOMESTIC MEDICINE. bathing outside Avith spirits of turpentine diluted with SAvect-oil (a quite heating application); or, in an obstinate case, rubbing three or four drops of croton-oil over a limited space on the front of the throat • taking great care not to get any of the oil into the eyes. This will cause a small pimply or pustular eruption to break out, Avhich lasts a few days, and affords a poAverful counter-irritation. Thrombosis. Formation of a clot in a vein, Avhich obstructs the movement of blood in it. Thrush. Sprue is another name for this. See Mouth, Sore. Thyro-cardiac Disorder. See Ophthalmic Goitre. Tic-Douloureux. See Neuralgia. Ticks. See Parasites. Tinnitus Aurium. See Ears, Ringing in. Toe-nail, In-growing. See Nail, In-growing. Tonsillitis. See Quinsy. Toothache. Three kinds of pain may affect the teeth : 1. Irritation of the exposed pulp of a decayed tooth. 2. Inflammation of the jaw. 3. Neuralgia. The first is the most common. The most summary remedy for it (the aching of a tender hollow tooth) is creasote. To apply it, wrap a small pellet of cotton around one end of a bodkin or knitting- needle, and dip this in pure creasote. Then carefully press the Avet cotton into the hollow of the tooth, and leave it there awhile. If any of the creasote runs over into the mouth, it will burn the gums or lips unpleasantly. Cold water should therefore be at hand to wash this overfloAV off as quickly as possible. Sometimes more than one such application may be necessary to kill the sensitive end of the exposed nerve. This is Avhat creasote does Avhen it has a full chance. No harm results afterAvards to what is left of the tooth. Some dentists have imagined that the tooth itself is killed, and will then rapidly decay; but I kept in my mouth several teeth for fifteen years after the ex- posed end of their nerves had been made insensible by creasote. Less disagreeable for the same use are oil of cloves, a drop of chloro- form, or laudanum, raw Avhisky to rinse the mouth, and smoke of tobacco. Either of these may often succeed; but nothing is so sure a cure for this kind of toothache as creasote, properly applied. Inflamed face is a different thing. At or near the root of a tooth there may be an inflammation, ending in a " gathering " (suppuration, abscess). Then there is no full relief until the matter finds its way out. This generally takes place after a feAV days of suffering. A " gumboil" may often be opened to advantage with a lancet, as soon as the SAvelling fairly begins to soften Avith matter. In a protracted case the advice of a den- tist will be very desirable. Occasionally the abscess will be in the socket SPECIAL DISEASES. 815 of the tooth, and its remo\Tal will be necessary. From experience, however, I will say, that the height of the inflammation is a time when the extraction of a tooth, unless under the momentary insensibility pro- duced by breathing nitrous oxide gas, is uncommonly painful. When made unconscious by that gas, Avhich may be safely breathed by any one in ordinary health, nothing hurts " the least bit." It is a Avonderful invention, for those Avho hate or fear pain. When a jaAV is inflamed generally, it swells, aches, and disables as Avell as disfigures the sufferer. Poulticing it (putting laudanum on the flaxseed poultice), and rins- ing the mouth Avith laudanum occasionally, are about all one can do for it, unless the early application of one or two dozen American leeches, and lancing AA'hen it softens. Neuralgia of the face may seem to fasten on some of the teeth. Sound ones have uoav and then been supposed to be guilty of the pain, and have been needlessly extracted. Treatment of this trouble is properly the same as for other forms of neuralgia. See Neuralgia. Trichina, Trichinosis. See "Worms. Trismus. LockjaAv. See Tetanus. Tubercle. A morbid deposit in the lungs, or elsewhere in the body, taking the place of the natural tissues there, and interfering Avith their functions. Tubercles often soften, making cavities in the lungs; in other cases they remain nearly stationary, or harden into a chalky ma- terial. Tuberculosis is a constitutional disease; not unfrequently hered- itary. It consists in a tendency to the formation of tubercular deposits in various organs; most often in the lungs, glands, and brain. Much has been said lately to make it appear that a minute bacillus (toI^s of an inch long) is always the cause of Tubercle. This has been referred to under the Germ Theory of Diseases. My present conviction is that, most probably, the bacillus makes its habitation in tuberculous lungs, just as rats, mice, and cockroaches make theirs in old, decaying houses; but that causation does not exist in the one case any more than in the others. See Consumption. Tubercular Meningitis. See Brain, Inflammation of. Tumors. Growths or enlargements in or upon any part of the body. A small and hard tumor is often called a wen. The most important dif- ference betAveen different tumors is as to whether they are or are not malignant; that is, tending to increase Avithout limit, and to undergo destructive changes, which exhaust the strength and shorten life. Can- cers may be said to include all malignant tumors, although other names also are given to some of them. (See Cancer.) Non-malignant tumors may be fibrous, fatty, bony (exostosis), glandular (adenoid), cystic, etc. When these are not much in the Avay, and not very unsightly, they^ may 52 816 DOMESTIC MEDICINE. as Avell be let alone. If they are so large, or so located, as to cause much inconvenience, surgeons often remove them to advantage. Internal tumors require much skill to determine their character. Tympanites. A drum-like SAvelling of the abdomen, from excels of Avind in the boAvels. Typhlitis. Inflammation of the caecum, Avhich is the first portion of the large intestine, on the right side of the abdomen, just Ioavci- than the navel. Perityphlitis is inflammation of the peritoneum (serous mem- brane) around the caecum. See Bowels, Inflammation of. Typhoid Fever. A low and sIoav fever, very prostrating; lasting from three weeks to two or three months. It is not contagious, but in many instances can be traced to bad drinking-water or breathing foul air. It comes on more gradually than any other fever. Early symp- toms are, headache, Aveakness, heat of skin, bleeding at the nose, cough ; sometimes diarrhoea. Then, greater weakness; soreness of the abdomen on the right side, low down; diarrhoea; decided fever, Avith pulse 110 to 130 in a minute; heat of skin 103° to 106° in the armpit; constant drowsiness, Avith Ioav muttering delirium, especially at night; dulness of hearing; rose-colored spots scattered over the surface of the abdomen; a foul tongue, at first white, then brown, sometimes almost black, cracked; and covered with a thick secretion (sordes); the face dark-purple, with a more or less glossy appearance of the skin. Bad cases will have also bleeding from the boAvels, retention or (worse) suppression of the urine, twitching of the tendons at the wrists, very rapid and feeble pulse (140 to 150), heat of skin in armpit 106° to 108°, clammy perspirations, coldness, collapse, and death. Much the larger number of patients with Typhoid fever recover; but it is always an uncertain disease, to the very last. Sometimes relapses occur, Avhen the patient seems to be getting Avell. During convalescence, an imprudence in diet may so irritate the not yet healed semi-ulcerated bowel (small intestine) as to cause perfo- rcdion, with escape of contents of the boAvel into the peritoneum, which will be almost certainly fatal within a feAV days. Good signs in Typhoid fever are: pulse under 120 in the minute; heat of skin not above 104° at night, 103° in the morning; tongue light red, and cleaning off early (within three weeks from the beginning of the attack); drowsiness not very deep, and delirium moderate; urine passed regularly ; diarrhcea not very frequent or copious; Aveakness not extreme. Bad signs have been already described above. Children often have vomiting as a symptom of Typhoid fever; adults very seldom. Irregular attacks are common in children, and not rare in adults; in Avhich some only of the above described symptoms are present; making the cases sometimes quite obscure. SPECIAL DISEASES. 817 Treatment of Typhoid fever is management; there is no specific "cure" for it. I do not believe it can ever be cut short (under three or four weeks) without risking cutting short the patient's life. Not a few cases will get well under good nursing, without a drop of medicine. The great needs are, quietness of body and brain ; freshness, but never coldness, of the skin ; sufficiency, but not exhausting excess, of the looseness of the bowels ; frequent small portions of liquid food, day and night; and care that the patient does not exhaust his little strength by getting out of bed, or even, in very weak cases, sitting up in bed too soon. As to food, milk, beef-tea, and beef-essence are the staple articles. After the disease has got into its regular course, the routine may be, a tablespoonful of milk one hour, and a tablespoonful of beef-tea (or, in the feeblest, beef-essence) the alternate hour, day and night. Two hours' intervals will do with those least prostrated; and when convalescence begins, of course the times must be gradually lengthened, first at night. But, in the midst of the fever, the weakest time is always between midnight and daylight; one, two, or three o'clock in the morn- ing. What do we say about stimulation f This must be a matter of judgment in each case. In the majority of cases of Typhoid fever, no alcoholic stimulation is necessary. It can usually be borne Avell, and, in a feAV cases, in all that are greatly prostrated, its use is important, and may save life. The test of its doing good and not harm is, that, after a feAV doses of it, the pulse grows slower, the skin more moist, the tongue cleaner, the delirium less, if that be present, or, if there is stupor, that becomes less profound. Should the pulse instead, un- der Avhisky or Avine-Avhey, become more rapid, the skin hotter and drier, the delirium more tedkedive, or the stupor deeper, it should be withdraAvn at once ; and, if reneAved because of seeming prostration, the dose should be less than before. The largest amount of alcohol I ever gave to a patient with Typhoid feATer Avas a tablespoonful every hour (for a time) of milk-punch, one-half of Avhich Avas Avhisky; the rest milk. A table- spoonful every other hour, of punch made of one tablespoonful of whisky and two tablespoonfuls of milk, will be enough for most of those who require such stimulation; and, setting aside those who were before broken down by intemperance or other causes, in the majority of cases (as before said), no alcoholic stimulation will be needed. Medicine is sometimes appropriate and important, for special symp- toms or complications of Typhoid fever; but these had better be left to the physician. I have no confidence at all in the violent practice (called "antipyretic") of some at the present time, especially in Germany; of dosing the patient with twenty grains of quinine at a time, or plunging 818 DOMESTIC MEDICINE. him once or twice daily into a cold bath. Spare me both of those, if ever I have Typhoid fever. One precaution further must be spoken of. A patient with this or any other continued fever must not lie too long at a time on his back. The circulation of the blood is sluggish in such a disease; it may stag- nate in the lungs, if one position be too long maintained, and then, first congestion, and afterAvards inflammation (of a low order, typhoid pneu- monia) of the lungs may result. Tavicc or thrice every day and night he should be gently turned over on one or the other side, so as to avoid this settling of the sluggish blood. After recovery from Typhoid feArer, the strength may return very slowly. This weakness may be shared by the brain; mental efforts of much severity (as study or business) must be very gradually and cautiously resumed. Typhus Fever. So similar is this to Typhoid fever, that until about fifty years ago the distinction betAveen them Avas not clearly made out by physicians. In both we have great prostration, a slow progress, drowsiness, deafness, delirium of a Ioav muttering kind, and a duration of the attack, in those who recover, of not less than three, oftener four or more Aveeks. But in Typhus, the causation is almost always clearly traceable, to either crowd-poison or direct contagion. Ship fever, camp fever, jail fever; those are names given to varieties of Typhus, under different circumstances, always those of crowded human beings, tainting the air with emanations from their bodies. Cold or cool weather favors the generation of Typhus. It is a disease of cold temperate climates, just as plague and cholera belong especially to tropical regions. A patient ill with Typhus seems to have in himself the poisoning power of a whole croAvd ; in other words, the disorder is " catching," as Typhoid fever is not.* Yet its contagion is not very strong, and can, as a rule, be dissipated by cleanliness of the person of the patient, and abundant ventilation of the place in Avhich he is cared for. Symptoms common to Typhus and Typhoid feA'ers have been mentioned above. Differences are these: Typhus is less sIoav in coming on, and more rapid in going to its fatal end, or to recovery Avhen not fatal; there is, in it, no bleeding at the nose, and no cough (unless pneumonia com- plicates the attack); there are no " rose spots " on the abdomen, but there may be a rash, a little like that of measles; the belly is not savoI- len nor tender, and there is no diarrhcea; the face has a dusky instead of a purplish redness; there is more tendency to stupor (coma) than in * I do not here discuss the opposite opinion to this, though it is held by many med- ical men, because my convictions are so positive on the subject. See " Essentials of Practical Medicine," or other professional works. SPECIAL DISEASES. 819 Typhoid fever; death may occur even Avithin the first ten days; and, after death, examination of the boAvels shows the absence, in Typhus, of changes which are characteristic of Typhoid feA^er. I have seen patients with the two diseases lying alongside of each other in a hospital Avard, and feel sure that I could tell, Avithout any information about them, Avhich was Typhus and Avhich Avas Typhoid fe\Ter, from their countenances alone. Still, now and then, mixed attacks do occur. Treatment of Typhus Fever must be, as Avith Typhoid, piloting, not disturbing, management. There is a tendency to greater prostration in Typhus. This needs ATery close watching, day and night; and there is occasion for alcoholic stimulation in a greater number of cases than in Typhoid Fever. I believe that the majority of patients with Typhus require some alcoholic medication; the minority only, of those with Typhoid really need it. Yet, Avhile a resident Hospital physician, I had an attack of Typhus (caught from ship-fever patients), for which, before the nature of the attack Avas suspected, I Avas bled and leeched. After that, the only alcoholic dosing Avas of one AVineglassfuI of Avine- whey, taken in the course of a day; and as that did not agree Avell, it was not given again. I am glad thus to have vindicated, by an example, the right and capacity of the minority to do Avithout alcohol through an attack of Typhus. Particulars of the objects of special care in management of Typhus fever, have been already referred to under Typhoid fever;—and else- where under Nursing. It may be repeated, that the passing, or not passing, of Avater from the bladder must be noticed all through the disease, and especially when there is stupor present. The same care must be taken, also, as in Typhoid, not to let the patient lie many hours at a time on his back, for fear of passive congestion of the lungs, from stagnation of the blood. The routine of frequent small doses of liquid food (milk, with or without Avhisky, as the case needs; beef-essence or beef-tea), hour by hour, day and night, until the time of danger from prostration has passed by,—all this is the same, Avith only greater need, usually, of such support, in Typhus as in Typhoid Fever; which, therefore, see on this subject. The use of quinine as a tonic, and of other medicines, in both of these fevers had better be left to the physicians in attendance. 820 DOMESTIC MEDICINE. Ulcers. Sore places on any part of the body which are slow to heal. They are most common and troublesome on the legs; especially in persons who have swollen (varicose) veins. In order to heal an ulcer, the part must be kept at rest. The sore must also be covered from the air. With a simple, not very large ulcer, this may be done Avith simple cerate, spread thickly on lint or soft linen, and changed every day. If healing does not go on under this, then use, instead, lint, linen, or soft muslin, soaked in lime-water; the rag being covered Avith oiled silk, or oiled paper, or rubber-cloth, to prevent evaporation. The lime-Avater rag should be changed night and morning. Troublesome ulcers may be either of the following: 1. Inflamed. 2. Indolent. 3. Sloughing. Inflammation of an ulcerated surface seldom occurs unless it is irritated by some sort of violence, as by Avalking about with a bad ulcer of the leg. It should be treated with perfect rest, and poulticing Avith bread or flaxseed meal. Indolent ulcers are those which look flabby; not of a bright red color, Avith a clean, smooth, whitish edge, but dull-colored, and often with jutting rounded parts, called " proud flesh." Such require stimulation; touching daily (lightly) with a crystal of bluestone (sulphate of copper) or lunar caustic (nitrate of silver); the lime-Avater dressing will, as a rule, agree with them better than simple cerate; or Ave may use this: alcohol one part, glycerin two parts, and lime-Avater three parts. Iodo- form in powder, lightly sprinkled over the surface, may be applied every other day. When the ulcer is large, this should be used in moderation, lest too much of it may be absorbed, with poisonous effect. This Avill not happen, however, if, as above said, it be lightly sprinkled, and not more than every other day. Ulcers very slow to heal are sometimes assisted in doing so by skin- grafting ; that is, nipping little bits of living skin from some sound part of the body, and planting them in the middle of the sore. The healthy skin soon begins to grow, and spreads over the ulcerated surface, covering it up. Sponge-grafting is another operation sometimes success- ful in an analogous way. Sloughing ulcers shoAV a low state of vitality in the part, and probably in the Avhole system. The patient's general condition needs attention. If he be suffering from anything that drains his strength, and especially if he does not sleep well, opium in some form is likely to be called for, at least at night; and quinine, as a tonic, eight or ten grains a day, Avith concentrated nourishing food; perhaps careful stimulation. To the part, cleansing and stimulating applications are necessary: as pure alcohol; solution of chlorinated soda (a teaspoonful in a teacupful of water); or dilute nitric acid (six drops in a teacupful of Avater) to Avash SPECIAL DISEASES. 821 the ulcer Avith, once a day; and a charcoal poultice (see Foultices, under Remedies), or a poultice made of chopped carrots, as a dressing. Iodoform poAvder will be useful to a sloughing ulcer, sprinkled over the surface before applying the poultice. Cancers have ulcerated surfaces, Avhich, instead of healing, spread and "eat," deeper and deeper. No local applications Avill heal these; they can merely be protected from outside injury, and made less offensive by cleansing trashes; such as pure alcohol, or alcohol (one part), glycerin (tAvo parts); or chlorinated soda solution ; or permanganate of potassium (ten grains to four ounces of water). Even lime-water, or Castile soap water, used tAvice daily, will lessen the disagreeableness of such sores. Ulcer of the stomach has been spoken of already. See Stomach. For ulcer of the Throat, see Throat, Sore. Uraemia. Presence in the blood of matters which ought to have been carried aAvay by the secretion of urine; sometimes called urincemia. It occurs whenever there is, from any cause, suppression of urine. This happens towards the end of cases of Bright's disease of the kidneys. Its symptoms are: headache, dimness of sight, vomiting, diarrhoea, convulsions, and, at last, stupor; ending in death. When coming thus at the Avinding up of an incurable disease, treatment Avill have no im- portant effect upon suppression of urine. If it should, in less degree, result from other causes, as exposure to cold and Avet, or scarlet fever, we should try to relieve the kidneys; by dry or cut cups or a mustard- plaster to the back; the Avarm bath; purgation Avith Rochelle salts, or cream of tartar (Avhich is diuretic); and action on the kidneys themselves, by lemonade, SAveet spirits of nitre, juniper-berry tea, etc. Urine, Incontinence of. See Incontinence of Urine. Reten- tion of. See Retention of Urine. 822 DOMESTIC MEDICINE. Vaccination. This may be rightly regarded as one of the three greatest benefits ever conferred upon mankind by medical science; the others being the introduction of ancesthetics, to obviate the pain of surgical operations, and the discovery of the use of the alkaloids of Peruvian ba?-k, for the cure of malarious fevers. Until about the end of the last century, it was common to inoculate young persons Avith matter from small-pox patients ; it being found that mostly the attacks resulting Avere milder and less dangerous to life than those taken in the ordinary Avay. But physicians concluded at last that this practice (introduced from the East by Lady Mary Wortloy Mon- tagu in 1718) ought to be abolished; because iioav and then the inoc- ulation was fatal; and the contagion of the mildest attacks v\ as as deadly to those not inoculated, as Avas that of natural small-pox. It Avas Avell knoAvn, however, that persons avIio had been inoculated suc- cessfully very rarely had small-pox afterAvards. Dr. Edward Jenner, living in the country in England, learned that it was knoAvn among dairymen, that cow-pock was sometimes taken by those avIio milked cows Avhich had pustules upon their udders; and that persons Avho had had coAV-pock did not take small-pox Avhen exposed to its contagion. Having a very philosophical mind, he reflected that if he could inoculate with cow-pock, it ought to have the same preventive effect. This he tried ; first in 1796. His success Avas such that he at once labored to bring this practice (called vaccination from the Latin vacca, a cow) into general use. It Avas introduced into America in 1799, and into Austria the same year; France and Spain, 1800; Italy, Russia, Sweden, and Denmark, 1801; India, 1802. To sIioav briefly the effect of the establishment of vaccination upon the ravages of small-pox, Ave may mention that for thirty years before Jenner's time the average number of deaths from that disease every year Avas, in Great Britain alone, 30,000; about 3000 in each million of people. Were such a mortality from it to occur now in the United States, we should lose in every year about 150,000 people by small-pox ! The greatest number of deaths from it ever recorded in the present century in America was about 4000, in 1881, in the cities of our country. Estimates of the most liberal kind of the probable number for the Avhole country in that year, could not reach beyond 10,000 to 15,000; at mo.-t, one-tenth of that of average years before vaccination ! As to pock-marked faces, one example Avill do. In one toAvn in Scotland, in the years from 1728 to 1764, of an average population of 4200, 3700 were more or less marked by small-pox. Vaccination is, as it is Avell known, very imperfectly attended to in our large cities. Philadelphia, for example, in 1870, with a population \M\ 2^1 Dav 4tli Day. 8th Day. 10th .Day. Fig. 1. A'ARIOLOID. 0 4th Dav. fith Day. Sth Day. Fig 4. ITCH. 10th Day. „,!lft © a« H ' €:> o 0Li: 0 , ipm,, miiiii, , #. rf1 * %& %/ If" » 1|!ii: Fig. 2. VACCINE. Fig. 3. CHICKEN POX. SPECIAL DISEASES. 823 of over 700,000 and from 20,000 to 25,000 children born every year, had but 7190 of these vaccinated. Under the panic of an epidemic of small-pox in 1871-2, the number increased to 30,000 in the first of those years, and 18,000 in the second ; but it Avent down again, in 1875, to 5685. If every child born was, properly vaccinated, and revaccinated Avhen betAveen tAvelve and fourteen years of age, there is good reason to believe that small-pox Avould be exterminated. Pcvaccination is important. Why ? Because the first vaccination may not have been perfect; and also, because, although in the large majority of cases the protection gh^en by \7accination lasts for a lifetime, in a certain minority of instances it does not; and the only Avay to be sure about this is to try it again. It is too trifling an operation to be with- held, in vieAV of the immense value of its protection when needed. Are there any sound objections to Vaccination ? No! I have read the strongest and boldest arguments * ever put forth by its opponents; and I declare them to be Avorthless against it. There is no room in this book to go into their discussion. The medical profession is almost literally unanimous on this subject. No leading medical authority, on either side of the ocean, is or has ever been against it. The antagonism to it must originate in morbidness of mind; such as makes some persons still believe in Avitchcraft, or others deny that the Avorld goes round once in tAventy-four hours. There is, with the simple care, Avhich it is easy and usual for physicians to take, in selecting the "virus" used, no danger of giving any disease by vaccination. Is it best to employ •' bovine " virus; that is, directly from the cow or heifer, or Avill that from an infant's arm do as well ? I have studied this question Avith much care; and conclude that, on the Avhole, the most secure and satisfactory way is to use humanized virus; that Avhich has been at least through a feAV (or even a few hundred) healthy human systems. It is very well for those skilful in the matter to start neAv virus, uoav and then, directly from the cow; the original dennerian vaccine. But this requires more skill and pains than are always reli- ably given; and there has been a good deal of disappointment of latter years Avith " bovine virus," both in Europe and in this country. An advantage of the humanized article is, that it has just shown its virtue by its effects. When should the first vaccination be performed ? If there be no exposure to the contagion, the second or third month of infancy will answer. If there is such exposure, let it be done any time after birth. How shall it be done ? Two kinds of material are used ; the one is * See a review by the author of several of these publications, in the Philadelphia American, Sept. 2, 1882. 824 DOMESTIC MEDICIXE. lymph, taken on quill-pieces from the sore in its Avatcry stage, about the eighth day of the vaccination. Always, a healtliy infant's first vaccina- tion is to be chosen for the supply. The matter dries on the quill-ends, and can be kept, if sealed up from the air, for a few days (seldom so much as a month) without losing its specific quality. Twenty-five years ago, it Avas the general practice in this country to vaccinate Avith the scab, from the matured pustule, coining off about the nineteenth day. With other practitioners, I have had every reason to be satisfied Avith this. One particular advantage of it is, that the ap- pearance of the scab goes much towards judging of its genuineness. It should be irregularly circular, nearly flat, rather thick, and of a mahogany brown color; larger than a scab from almost any other kind of sore; decidedly larger than a scab from a real small-pox pustule. To operate: take either the fresh lymph (arm to arm), if you can get it, or the dried lymph, not too old, or the scab, less than a month old, and kept out of the air. Moisten a small portion of either of the latter with pure tepid water; mashing the scab, if it be employed, into a paste. A very little piece will suffice for one vaccination; not more than the size of two pins' heads Avill be necessary. What is wanted, then, is to get this matter through and under the skin, so that some of it will be absorbed into the blood. You do not Avant the part to bleed; because that would wash it all away. You may push out a little flap of skin with the point of a lancet; or puncture the skin, Fig. 241. making several little dots near together; or scratch it in tiny lines, crossing each other, making a square; and, either way, pressing, laying, or gently rubbing scratches tne virus-paste in and on the part. The art of the operation consists in getting through the skin without causing blood to flow. When it has been done, keep the arm (the best place is the outside of the arm, halfway between the shoulder and elboAv) undisturbed until it dries; about twenty or thirty minutes. As to its course, nothing will show, if it goes on all right, for nearly four days. Then a little red point will appear, which groAVS larger, and becomes a vesicle (a little water-blister). By the tenth or eleventh day this has filled with matter, and sinks down, navel-like, in the middle; the characteristic " umbilicated " appearance. It has, then, a good deal the shape of a tiny hat, with the middle of the croAvn pushed down. Before that time, about the eighth day, a bright red circle has formed around the sore. This fades after the eleventh day, and the pustule (which, however, has little or no yellow matter in it) dries up into a thick, round, mahogany-colored scab; and this comes off of itself from the eighteenth to the twenty-first (usually the nineteenth) day. Of SPECIAL DISEASES. 825 course it may be accidentally rubbed off sooner. All these stages are important, as showing it to be a good, regular vaccination. No other kind of sore behaves in the same Avay. The scar left is also peculiar. It is, Avhen perfectly good, large for the size of the sore, and dotted or pitted, as if made of several little sores merged into one. If the first vaccination does not take, it should be done again. When twice done Avith the same matter, and yet no effect folloAvs, other virus had better be tried. Some infants are much less susceptible to it than others; in a very feAV it will not take at all. There is reason to think, hoAvever, that the system may be affected by it, and so protected, in some cases, Avithout any sore coming out on the arm. I knew one child to be vaccinated nine times, with at least three different scabs of virus, without any sore following; and yet when exposed to small-pox a year or two afterwards, it took only varioloid, having a mild case. If a rash or " breaking out" follows vaccination, the child's skin must have been unusually predisposed to such things. Revaccination should be done in precisely the same way. The usual time for it is about the age of fourteen years. Sooner will be better, if there is exposure to small-pox contagion. Also, it may wisely be re- peated, as a test and fresh means of protection, every time (at least after one, two, or three years) that one is again brought in contact with the disease. I close my remarks on this subject by saying, with emphasis, that everybody ought to be vacci- nated, and revaccinated at least once. Varicella. Chicken-Pox ; Avhich see. Varicose Veins. See Veins, Varicose. Variola. See Small-Pox. Varioloid. Modified small-pox, as it occurs in persons avIio have been vaccinated. See Small- Pox. Veins, Inflamed. See Phlebitis, and Milk- Leg. Veins, Varicose. Enlarged veins, without in- flammation. They are not uncommon in the legs; made Avorse by standing a great deal. Pregnancy is a promoting cause of varicosity of the veins, by the pressure of the gravid womb upon the large veins (especially the great vena cava) in the ab- domen. Varicose veins are sometimes cured by a surgical operation; but this is seldom necessary. The proper thing to do is to Fig. 242. ELASTIC BANDAGE, APPLIED. 826 DOMESTIC MEDICINE. Avear elastic stockings, Avhich compress the veins enough to prevent incon- venience from their enlargement. If such stockings cannot be had, bandaging is a tolerable substitute. A bandage of soft old muslin, twe and a half inches Avicle, should be worn Avhile walking or sitting up. It must be Avrapped first around the ankle; then around the foot; again around the ankle, and thence obliquely around the leg; turning or reversing it at each round, so as to make it lie smoothly on the limb; firmly, but not uncomfortably tight. Vertigo. Giddiness; dizziness; turning in the head. Sometimes one's own head seems to be turning around; sometimes everything else turns instead. Causes of vertigo are: most frequently, indigestion, with "biliousness"; i. c., the bile not being properly removed by secretion from the blood; secondly, general debility; thirdly, a disorder of the internal ear or ears, called Meniere's disease ; lastly, and most rarely, dis- order of the brain. Treatment of this symptom should, of course, be according to its cause. For "bilious" dizziness, a grain or tAvo of blue mass tAvicea day (taken only for a day or two); a teaspoonful of mag- nesia ; if the symptom comes often, omitting the blue pill, and using soda (sodium bicarbonate), a pinch at a time, instead of magnesia. Vertigo of debility requires that the patient's strength be saved by avoiding much exertion, and improved by good diet, tonics, change of air, etc. Ear disease and chronic affections of the brain are too difficult of discrimi- nation to be dealt Avith in Home medicine; they require skilful medical attention. Vomiting. This is a symptom of various affections, and has been specially considered earlier in this book, under Signs of Disease. Its treatment also has been dealt with in our section on Remedies, under the heading Sick Stomach. See page 529. SPECIAL DISEASES. 827 Warts. These are small outgroAvths of the cuticle or scarf-skin (epidermis); rooted, however, in the deeper middle coat of the skin [rete mucosum of the books). To get rid of them, pare aAvay all the outer hard part, Avhich has no feeling; then touch the remainder with a drop of nitric acid (taking care to put it only on the wart, Avhich requires management), or chromic acid, or a stick of caustic potassa, slightly moistened. A feAV such applications, a feAV days apart, Avill cause the wart to cease reappearing. Water-Brash. See Dyspepsia. It may be mentioned here that buttermilk is strongly recommended by some practitioners for the cure or relief of this symptom of chronic indigestion. The term Water- brash means the coming up of a watery fluid from the stomach into the throat and mouth. The great thing, of course, is to cure the dyspepsia of Avhich it is only a part. Water on the Brain ; in the Chest; etc. See Dropsy. Whitlow. See Felon. Whooping-Cough. See Hooping-Cough. Women, Diseases of. Many large books haAre been written upon this subject; Avhich now has a department of Medicine and Surgery to itself, called Gynaecology. Its management involves as great difficulties in practice as any other part of Medicine or Surgery. It would, there- fore, be quite Arain to attempt to dAvell at length upon it in a work like the present, Avhich is intended for unprofessional readers. Already, Ave have given consideration, sufficient for our purpose, to Amenorrhcea, Dysmenorrhoea, Menorrhagia, Leucorrhcea, and Chlorosis, in this alphabetical series. Other diseases peculiar to Avomen are: Inflammation of the Womb; Irritable Uterus; Prolapsus (falling) of the Womb, and other Displacements ; Tumors of the Womb ; Inflam- mation of the Ovary; Ovarian Neuralgia; Ovarian Displacement; Ovarian Tumor and Dropsy. A much longer list will be found in any professional Avork on Gynaecology.* Probably the most important remark to be made here is, that no one should too easily suppose herself to be affected Avith any of the disorders peculiar to the sex. Such disorders, in marked degree, are not very common; and they are aggravated by habits of invalidism. Constantly fixing " expectant attention" upon any organs of the body tends to derange their function. There is a quaint old maxim which may furnish us Avith a parallel precept. It is said that " no one should touch his eye, except with his elbow." This is easily understood. It is equally sound advice that no * Of such works, that of Prof. T. Gaillard Thomas, "A Practical Treatise on the Diseases of Women," may be especially commended. 828 DOMESTIC MEDICINE. Avoman should ever think of her ovaries or uterus, unless their condition compels her attention to them. It is not right, of course, that any real symptom of ill health, local or general, should be neglected; and the judgment of a competent physician in such a matter should be accepted aud obeyed. But imaginary diseases ought to be kept out of the way. The human body, in all its parts, is Avonderfully Avell made; its mechan- ism, until wrongly used or ill cared for, is perfect, and does not readily get out of order. It is proper for me to be very cautious in referring to liabilities of medical minds, in a work like the present; but I may safely extract a feAV sentences from the early part of the standard Treatise of Dr. T. G. Thomas, than Avhom, on such topics, there is no higher authority in this country. He observes: * " The excessive surgical tendency of many of the leading gynaecologists of our day is a matter to be deplored by all who wish well to gynaecology. Many cases Avhich time and patient medical treatment Avould readily cure are met boldly, and without sufficient consideration, by operations more or less formi- dable." " No one will suspect me of a Avant of appreciation of the op- erations to which I have alluded, nor of timidity in employing them. It is not to their use, but to their unquestionable abuse, that I am objecting. The last remark applies with equal force to the almost ex- clusive reliance which by many seems placed upon local treatment in the cure of uterine disorders. One who frequently sees cases of uterine disease in consultation, will meet Avith many in Avhich he is called upon to urge cessation of all local treatment, as the first step in the proper management of the case." Here also Ave may cite briefly Prof. Thomas's list of the main causes of disorders of the womb : " Want of air and exercise; excessive devel- opment of the nervous system; improprieties of dress; imprudence during menstruation; imprudence after parturition (childbirth); pre- vention of conception and induction of abortion; marriage Avith existing uterine disease." On the subjects of Inflammation and Irritability f of the Womb we must refer entirely to professional Avorks. Something may be said, hoAvever, in regard to Prolapsus and other Displacements. Prolapsus is falling of the womb. Its causes may be stated, in a general way, to be, 1. Influences increasing the weight of the Avomb; as fulness of blood therein (congestion) from standing or Avalking much during menstruation. 2. Influences weakening the natural supports of the Avomb; as general relaxation, from loss of tone in the Avhole system. * " Practical Treatise on Diseases of Women; Historical Sketch of Gynaecology." t This is not quite an exact term; "Areolar Hyperplasia" is Dr. T. G. ThoaWfl designation for it. SPECIAL DISEASES. 829 3. Influences pressing the womb out of place ; conspicuous among Avhich are, tight lacing, and the Aveight of heavy clothing on the abdomen. Not only Prolapsus or simple sliding downward of the uterus, but other displacements, are promoted by these and some other causes. Those just mentioned are the ones most under control. Symptoms of Prolapsus are: a feeling of dragging and wreight in the lower part of the abdomen; irritation of the bladder and loAver bowel; pain in the back and loins; unusual fatigue in Avalking, or in lifting anything heavy; and leucorrhcea (the " whites"). The presence of several of these symptoms together leads to a reasonable suspicion of the existence of prolapsus. The certainty of its existence is obtainable only by a professional examination. On account of its importance to health, it is right not to let false delicacy stand in the way of such a determina- tion of the real state of the case, Avhen considered necessary by an at- tending physician. The other most common displacements of the womb are anteversion (the upper part, or " fundus " of the uterus being bent too far fonvard), and retroversion (bending of the fundus backAvard). These are promoted by the same general causes as those above mentioned, as Avell as by pregnancy and its after events and conditions. In the treatment of prolapsus, the chief aims must be: to lessen as much as possible the pressure from above upon the abdomen, and to strengthen and supplement the uterine supports. The first of these is done by Avearing skirt-suspenders, putting the Aveight of the skirts on the shoulders instead of on the abdomen; by avoiding all unnecessarily heavy clothing; and by the use of an external abdominal supporter. This is of the nature of a firm but someAvhat elastic band or broad band- age, Avhich holds up all the contents of the abdomen together. The direct support of the womb within the abdomen is obtained by the use of a pessary. There are several kinds of pessaries: Hodge's, Meigs', Albert H. Smith's, Grailly HcAvitt's, Cutter's, and others. Prof. T. G. Thomas speaks very Avell of Cutter's; Avhich has a stem passing out of the body to go either backwards or forwards in a curve to a belt around the body. The others above named are placed entirely within the body. Simple prolapsus, anteversion and retroversion require differ- ently shaped instruments, which should be carefully adapted to each case. This can only be done by a skilful practitioner. We must add, that examination should be made after a pessary has been used for a few days, to see Avhether it suits or not, and especially whether it does or does not gall or excoriate the parts. If it does so, it must be removed at once. Even the best suiting pessary should be taken out once in every feAV weeks, and be Avell washed with Castile soap and water before 830 DOMESTIC MEDICINE. replacement. Sometimes the instrument is a good deal acted upon and spoiled by the natural fluids. One Avho Avears a pessary should use a wash every night, with a vaginal syringe : lime-Avater, alum-water, boroglyceride dissolved in glycerin, or, at least, Castile soap water. Cutter's pessaries can, and ought to be, taken out every night, after get- ting into bed, and replaced in the morning. Anteversion and Retroversion may need to have the error of shape of the Avomb corrected by the skill of the medical attendant, before a pessary can be employed with advantage. Tumors of the uterus are generally7 either 1. Polypi; 2. Fibroid; or Fig. 243. DR. HODGE'S PESSARY. Fig. 244. DR. ALBERT H. SMITH'S PESSARY. 3. Cancerous tumors. The last are, as a rule, incurable. Polypi are tumors Avith a small stem connecting them Avith the interior of the womb. The whole subject of the discovery and management of uterine tumors is too professional to be dAvelt upon here. Ovarian diseases Avould also, for particular consideration, take us beyond our scope in this book. A few words only are proper concerning Ovarian Dropsy. This results from the formation, in connection with an ovary (see Anatomy), of one or more watery tumors called cysts. These gradually enlarge, until they stretch the abdomen greatly; at last causing much distress, obstructing breathing, and wearing the patients life out. This may not happen, however, for several years. SPECIAL DISEASES. 831 OATarian Dropsy is distinguished from common abdominal dropsy (ascites), by the following signs: it begins almost always in Avonien between twenty and forty years of age; it increases sloAvly, seldom end- ing in death under two or three years, and often lasting much longer with very little change; it begins on one side, and spreads over so as to fill the whole abdomen; when large, the roundness of the abdomen does not flatten out Avhen the patient lies on her back ; besides other indica- tions obtained by percussion, etc., to be appreciated only by those Avho have had professional training. Treatment of Ovarian Dropsy can amount to but little unless an oper- ation be concluded upon. An ovarian cyst may be tapped. Most prac- titioners think it best to reserve this operation for the temporary relief of patients upon Avhom it is considered not prudent to perform the greater operation of removal of the diseased ovary, cyst and all. This last operation is called ovariotomy. First performed by an American surgeon, Dr. McDoAvell, of Kentucky, near the beginning of this century, it met Avith much opposition for a long time. Within several years, hoAveA'er, it has come to be recognized as proper in a con- siderable number of cases. Although recovery does not follow in every case, it does, in a majority of instances, lengthen life; sometimes for many years. All details concerning the operation must be left for Avorks on Gynaecology. Worms. About tAventy kinds of worms are knoAvn occasionally to inhabit the human body. Yet comparatively feAV people are consciously troubled by them. Sometimes the incomTenience caused by them is slight; and Avhen it is considerable, they are not ahvays found out as producing it. The most frequently troublesome Worms are: lumbricoids; Seat- Worms; Tape-worms; and Trichince. lumbricoid Worms are the most common of all, especially in chil- dren. They look a good deal like earth-worms. Now and then knots of them accumulate in the intestines of a child, " giving it fits." One of them may even craAvl into the stomach and be Aromited up, after a good deal of sickness of stomach. This happened to a patient of mine, an adult. These Avorms enter Avith either food or drink; probably in most cases in not very clean drinking-Avater. They are to be got rid of by two sorts of measures: 1, to make the boAvels unsuited to harbor them; 2, to drive them out by vermifuges, i. e., " worm-medicines." The bowels are most likely to harbor worms, Avhen they are all the time loaded by the refuse of food not digested; either because too much is eaten, or because it is unwholesome in kind; also, A\Then there is constipation. First, then, be careful of the child's diet; withhold all 53 832 DOMESTIC MEDICINE. cakes, candies, and other trash; and see that the bowels are moved once a day. Then, if a Avorm is still seen iioav and then in the passages (Avhich should be Avatched), worm-medicine ought to be used. Hoav do we know Avhen a child has worms? Only Avhen it passes one or more of them from the boAvels, or throAvs one up from the stom- ach. We may reasonably suspect Avorms, Avhen a child's or older per- son's appetite is bad or irregular; when the belly is swollen; Avhen Fig. 245. LUMBRICOID WORM. A TAPE-WORM (t^NIA SOLIUM). (whether it complains or not of itching at the nose) there is itching at the fundament; and Avhen there is grinding of the teeth and restlessness during sleep. But this suspicion needs confirmation by the actual sight of Avorms in the passages. For the lumbricoid Avorms, the best vermifuge is pink-root; spigelia Marylandica. The fluid extract is a good preparation ; or better, the fluid extract of spigelia and senna ; of which the dose is a teaspoonful. SPECIAL DISEASES. 833 With young children, an overdose should not be given; such might be even poisonous. On Seat-worms, see Santonin, p. 605. Tape-worms are chiefly of tAvo kinds, in this country; the arched tae- nia solium and the unarmed taenia mediocanellata. The "armor" is merely a circle of very tiny hooklets around the head of the tcenia solium; which is the smaller Avorm of the two. Both are flat, whitish, and in segments, like small bits of narrow tape put end to end as in a long string ; sometimes ten, twenty, even thirty feet long ! The " unarmed " tape-Avorm gets into human bodies in infested rare beef, and is the most common in the United States. The " armed " kind is taken by eating undercooked pork or bacon; as it naturally inhabits the hog, not the ox. Symptoms of Tape-Avorm are much like those of lumbricoid worms, with the addition often of an enormous appetite. The worm, as well Fig. 247. Fig. 248. «.o°.°u TRICHINA, MAGNIFIED 150 DIAMETERS. TRICHINA IN MUSCLE, NATURAL SIZE. as its entertainer, must be fed. But certainty, here also, can only be obtained by finding pieces of the Tape-Avorm in the passages from the bowels. As these come away, others groAV; until the head is removed, the worm lives and " tapes aAvay " for an indefinite time. Several vermifuges are used to drive out tape-worms: oil of turpen- tine ; oil (ethereal extract) of male fern; koosso, of Abyssinia, in half- ounce doses, etc. Before taking any of them, the boAvels ought to be Avell opened, and the stomach not much burdened with food. Trichina is a very small spiral thread worm. It may be taken in eating raAv or undercooked pork, or sausage; anything of hog's meat. Not nearly all hogs are infested Avith trichinae; with the microscope, butehers or others can tell Avhether the flesh of a particular hog has them in it or not. If present, they commonly count by the hundred thousand, or even by the million. The way to avoid trichinae, with 834 DOMESTIC MEDICINE. certainty, is never to taste any hog's meat, or anything made of it, unlet* it has been thoroughly cooked—cooked all through. When Trichinae get into the boAvels, they Avork their Avay gradually through the intestinal Avails, and at last fix themselves in various mus- cles in the body and limbs. The symptoms during this progress are not very unlike those of typhoid fever, but Avith more pain and irritation of the stomach and boAvels. When they are iu the muscles, an imitation of rheumatism, with more or less low fever, results. There has been, as yet, no vermifuge for Trichinae discovered; Trichinosis, Avell marked, is in most instances (not all) fatal, Avithin a few weeks at the farthest. Wrist-drop. A frequent kind of lead-palsy, met with among paint- ers or other Avorkers in lead. See Paralysis. Writer's Cramp. A disability of the muscles of the right hand, from too long-continued Avritiug, as in bank officers, etc., avIio have to sign their names, etc., constantly for a long time together. The main thing for its cure is, total and prolonged rest of the hand and arm from all such ATork. SPECIAL DISEASES. 835 Yellow Fever. Only certain places are subject to endemics or epidemics of this disease. On the subject of its causation, enough Avas said, earlier in this book, under " Causes of Disease." It is mostly a malady of Southern countries, and ahvays of the summer-time. It is, moreover, a disease of cities or towns near a river or the sea. Havana and Ncav Orleans have had more of it, during the past century, than any other localities in the AVestern Hemisphere. Philadelphia formerly had a number of severe epidemic visitations; its last presence in this city Avas in 1855, and then only in a limited part of the city—"doAvn town," near the DelaAvare. In this frequenting of cities, YelloAV Fever is totally different from remittent (bilious, autumnal, malarial) fever, which is ahvays a country, or at least a suburban, disease. Symptoms of YelloAV FevTer are, in brief: an abruptly beginning fever, lasting tAvo or three days Avithout remission,Avith violent headache, flushed forehead and eyes, often delirium, vomiting, tenderness of the stomach on pressure, constipation, or at least but scanty and offensh'e passages. Next comes a remission, Avhich may go on to reco\rery; but more often it becomes a time of great prostration, with yelloAvness of the skin, and, in the Avorst (nearly ahvays fatal) cases, black vomit. Death, when it comes, happens generally on the fourth, fifth, or sixth day of the at- tack. When reaction folloAVS the collapse, secondary fever occurs, Avhich goes on either to a slow convalescence or to final death by exhaustion. As a general rule one attack of this disease acclimates a person; that is, he is not likely to have it again, hoAvever exposed. As in the case of small-pox, measles, etc., this rule has a certain number of exceptions. The same is true in regard to its being taken by negroes, who are certainly much less susceptible to it than white people. Treatment of Yellow Fever is beset with difficulty; on the average, one in three of those Avho have it dies. Opinions in the Medical pro- fession differ so much about this subject, that it will be best to leave the discussion of it to strictly professional Avorks. I remark these points only: there has been discovered no specific " cure " for it; quinine has been found to have no control over it, such as it has over malarial remittent fever (which resembles Yellow FeArer in some respects); among the most certainly useful measures of treatment are, leeches applied to the pit of the stomach, an early dose of a mild saline cathartic, as citrate of magne- sium ; ice and mineral-water freely during the fever, and, in the same stage, sponging the head, face, and arms with cool or cold water; in the period of prostration, small quantities of liquid food (milk, Avith wine or Avhisky in small amounts in the weakest instances, beef-essence, etc.), at short intervals, and quinine in tonic doses, ten or twelve grains in the course of each day. 836 DOMESTIC MEDICINE. I repeat the conviction already expressed under Causes of Disease, that Yellow Fever is never contagious from person to person ; it is a dis- ease originating in places, including foul ships; to avoid or leaA'e the infected place is to escape the disease. Thousands of people have, at many different times, in Europe and America, gone (both sick and avcU) from YelloAV Fever places to other healthy places, Avithout conveying the disease in any well authenticated instance. PART V. ACCIDENTS AND INJURIES. FIRST of all, let it be said in regard to all or any of these, that cool- ness and presence of mind are of the utmost consequence. Danger is increased by alarm and confusion. One Avho has his senses about him may, by simple and prompt action, in some instances, avert serious harm; in all cases, the chances are in favor of this result when one or two, if not all concerned, are possessed of their full intelligence. Our consideration of these, commonly called Surgical Emergencies, will be, as nearly as practicable, in alphabetical order; for convenience of reference by the reader. Bandaging. General remarks only are called for here in regard to this; some particulars being mentioned elseA\here, in connection with injuries or other occasions for using bandages. The purpose of band- aging is to retain certain parts of the body, or " dressings " upon it, in position, Avithout too much pressure; or, sometimes, to make pressure for a time (as in cases of bleeding), or even continuously (for varicose vTeins). Material for bandages may be unbleached muslin, about as thick as that Avhich is used for sheets; or soft unglazed linen. It must Arary in width and length according especially to the part upon Avhich it is to be applied. For the chest, as for a fractured rib, it should be about four inches Avide; for the thigh or leg of a man, tAvo and a half to three inches; for the arm, two to two and a half inches; if used for a finger, an inch in width will ansAver. Around the head, a two-inch bandage will be generally Avide enough. The length may vary from a yard or two to five or six yards in a roll, according to convenience. To make a long bandage of short strips, make their ends overlap a little, and stitch them evenly and smoothly together, without any seam. All doublings and thick edges are to be avoided in bandaging, as they make uneven pressure and cause discomfort. Hoav to roll up a bandage is a matter of simple management. After doubling an end for a beginning, take it in one hand, between the ends 837 838 DOMESTIC MEDICINE. of the thumb and fingers, with the rolled part doAvmvards; holding the bandage then between the side of the forefinger and the thumb of the other hand, so that it may slide betAveen the finger and thumb of that hand, as it is drawn and rolled up by the fingers of the other. In Fig. 249. Fig. 250. BANDAGED LIMB. REVERSING BANDAGE. hospitals they sometimes have a small instrument Avith which to roll bandages rapidly. Tavo rules are very important in bandaging. First, never make any bandage so tight as entirely to check the movement of blood, unless for ACCIDENTS AND INJURIES. 839 a short time (as with Esmarch's rubber-tube compression to prevent hemorrhage in operations) to arrest bleeding ; and second, never so apply a bandage as to compress veins in a way to cause swelling below it. To fulfil the first of these rules, the feeling of the patient, and one's own common sense, will generally suffice. In regard to the second, the neck, of course, must not be so bound as to interfere with the return of blood from the head through the jugular veins; and, when an arm, or any part of it, is bandaged, the hand also must be covered; if it be the thigh, or leg, all beloAv it, including the foot, must be equally compressed. Otherwise, the parts beloAv the bandage would swell up, and might, if so kept long, even mortify. When bandaging the forearm and arm, it is best to begin by passing the bandage around the wrist; then turn it doAvn over the hand and cover it; afterwards go, with reverses, up the forearm, and, if necessary, the arm. In covering the lower extremity Avith a bandage, begin in like manner around the ankle; next go around the foot; and then, with reverses, up the leg. To apply a bandage to any part, take the bandage in the right hand, with the outside of the roll held in the palm, and the thumb touching the part Avhich is being unrolled, along the edge of the roll, inside. The left hand is then to fix the end, and succeeding parts, of the band- age in place Avhere it is applied. Reversing is done to make the bandage lie smoothly on an uneven surface; as the hand, foot, forearm, leg, etc. It is effected by turning the right hand which holds the roll, so as to obliquely double the bandage, for one or more turns, as required. A little practice will make this easy enough. For farther specialties in bandaging, besides what will be said under Fractures, see works on Surgery. Bedsores. See Nursing, page 628. Bleeding. See Wounds, page 875. Broken Bones. See Fractures, page 849. Burns and Scalds. Burns are caused by dry heat, or by something else than water; scalds by boiling water, steam, or other hot fluids. The danger to life of either is in proportion to their extent of surface, and their depth. Even a superficial burn or scald will kill, if it involve so much as half, some authorities say two-fifths, of the body. Death is then produced in two ways; by the shock, and by the arrest of the neces- sary functional action of the skin. The treatment of burns and scalds is essentially the same for both. What to do when one's clothes have caught fire, is important. Seize a shawl, rug, mat, coat or overcoat, if any be within reach, and wrap it closely around the burning part. Or, if not, lie down and roll on the 840 DOMESTIC MEDICINE. carpet; at the same time crushing the burning garment with the hands. If one sees another person on fire, the same thing ought to be done. A man's overcoat or a rug, etc., may be thrown closely about the victim of the flames, who should be quickly laid doAvn on the floor, so as to be co\rered more readily and entirely. The reason for this is, that the way to extinguish any fire, large or small, is, to shut out the air from it. When a person is badly burned, the shock to the nervous system Ls folloAved by prostration or collapse. There is great Aveakness, pallor of face, flickering pulse, short breathing, and coldness of the body. For this condition, opium, in the form of laudanum (fifteen drops at once, repeated if necessary in an hour, until three or four doses have been taken) is a good stimulus. Small quantities of whisky or brandy also, one or two teaspoonfuls at a time, may be given, at half-hour intervals, for a while ; to be Avithheld at once when signs of reaction come. Such signs are, strengthening of the pulse, warming of the skin, and return of color to the face. For the burn or scald itself, there is no better application than lime- water and oil (flaxseed, olive, or lard oil) mixed together in equal parts. Lint, if it can be had, if not, muslin or linen rags, should be well wet with this, and laid all over the burn. If the burnt surface be extensive, over the lime-Avater and oil dressing put a layer of cotton wadding, for warmth. Should it be a small burn, put instead of this a piece of oiled silk, oiled paper, or rubber cloth. A burned hand or foot will obtain the best relief by being held in cold water for some time. A remedy for limited burns Avhich has lately become popular is, a saturated solution of soda (sodium bicarbonate). Other applications sometimes used are, simple oil (lamp-oil, castor-oil, etc.), and powdered starch. But nothing is equal in effect to the " Carrou oil," as the mixture of lime-Avater and oil has long been called. When the sufferer's clothing covers the burn, it should be carefully removed by untying, unbuttoning, and cutting everything needful, so as to get all off without pulling or much moving the injured body. Raised water-blisters should be merely nicked to let out the Avater; leaving , the cuticle to protect the true skin underneath. Then apply the dress- ing above spoken of. If the patient reacts and does well, the lime- water and oil rags must be renewed Avhen they begin to get dry; taking them off Avith extreme gentleness, so as to disturb the parts as little as possible. After two or three days, a dressing of simple cerate, thickly spread on lint or soft rags, may be substituted for the oily dressing. Deep and extensive burns are sometimes very sIoav to heal, and leave ugly contracting scars Avhich may require special surgical attention. ACCIDENTS AND INJURIES 841 Carrying Injured Persons. See Transportation; the last item in this series of subjects. Choking; Strangling. These are not the same in causation ; but the danger is in both the same,—stoppage of breathing by an obstruction in the windpipe. In choking, properly so called, the obstacle is Avithin the throat; in strangling, it is from a cord, etc., outside of and around it; as in hanging. (For arrest of breathing by charcoal gas, etc., see Suffocation.) Choking is most frequently caused by getting something " the wrong way " in SAvallowing. That is, what should go down into the gullet or SAA'allowing throat (pharynx and oesophagus) gets into the Avindpipe (la- rynx and trachea). The Avindpipe is just in front of the SAvalloAving gullet; the latter is next to the spine. When one laughs, or in any Avay breathes, Avhile SAvalloAving, this accident may happen. EA-en a drop of water going the Avrong Avay, will cause a distressing spasm of the Avind- pipe ; but this is over in a feAV moments. Danger follows AArhen a solid mass—as a mouthful of meat,—slips into the larynx; or Avhen a large piece of meat gets stuck fast in the pharynx (gullet) so as to press on the trachea (Avindpipe) forcibly enough to keep air from being breathed through it into the lungs. Commonest of all, perhaps, is a fish-bone, or a chicken-bone, getting crosswise, so that it neither goes up nor doAvn. Other things may slip into the Avindpipe. I know a lady whose health Avas impaired for years, Avith a threatening of consumption, by a little piece of gum-elastic, which she had in her mouth, getting into the bronchial tube; loAver than the trachea, near one of the lungs. No time is to be lost, Avhen any one is choking. A long-fingered per- son should try to dip a forefinger at once into the throat as far as it will reach, to draw up and out the offending bone, or Avhatever it is. If it is a child, lift him up by the heels and slap him smartly, Avhile in that position, between the shoulders. Children sometimes swallow pins; they stick, as bones are apt to do, across the entrance to the throat, pretty far up. Surgeons have long slender forceps and other instruments Avith Avhich to seize such articles and Avithdraw them. All such things, everything except a piece of solid food in the SAAralloAving throat, should be taken out, not pushed down. If time allows, a piece of Avire may have a loop made in its end, and then be curved near that end, so as to be passed down, behind or below the obstacle, to draw it out. A proof that the thing is in the Avindpipe is obtained if the person can swallow a drink of water, yet has great distress and difficulty in breathing. This dif- ficulty is great in expiration (out-breathing) as Avell as in inspiration. A physician being sent for immediately, in an urgent case, fatal suffocation being threatened, may find it necessary to open the larynx or trachea, 842 DOMESTIC MEDICINE. by an incision, in order to save life. If the immediate danger be pa.««od, the question of such an operation may still have to be considered, Avhen a foreign body remains in any part of the air-passages. Strangling is best knoAvn in the form of hanging. In the latter, however, as used for the execution of criminals, dropping several feet under the gallows adds another cause of death; displacement of the bones of the upper part of the spinal column, crushing the spinal mar- roAV. Simple strangling kills in two Avays: arrest of breathing, and prevention of return of blood from the head to the heart; through pressure on the great veins of the neck. Either would suffice for the result; but the former is the quicker. Hanging is a frequent mode of suicide. If any one is found hanging by the neck, hold up the Aveight of the body, and at once loosen the cord at the neck; cutting it will generally be the speediest Avay, if a knife is at hand. Then lay the person doAvn, and, Avith as much fresh air around as possible, dash cold water lightly on the face (if it be in a Avarm place, on the bare chest also). Rub the arms and legs briskly, especially upwards, to favor the movement of blood in the veins, Avhich is towards the heart. Heat a poker or flat-iron, not quite to a burning heat, but so that a hand cannot rest on it long Avith comfort; and touch that gently upon the pit of the stomach, and then draw it along down each side of the back. Apply mustard-plasters to the legs. But all these things should be got ready and done by the secondary as- sistant or assistants. If a person cut down from hanging does not breathe, he should be laid on his back on the floor or ground, wherever he is, without loss of time. A roll of clothing, like a round knapsack, should be placed under his shoulders; and then artificial respiration should be attempted, by Silvester's method. See Drowning. ACCIDENTS AND INJURIES. 843 Dislocations. Displacements of bones at their joints. See Joints, Dislocated. Drowning. One Avhole minute under Avater will, except Avith a feAV practised divers, end life in a human being. Still, by active means, those longer immersed, as much as fhTe minutes, have been restored. We read in books of this having happened after fifteen minutes' immersion. This seems to me doubtful. But it is ahvays worth Avhile and right to give every droAvned person the benefit of the doubt, and to work over him for at least an hour, even if no signs of life appear, before giving him up. DroAvning kills by exclusion of air from the blood in the lungs; Avater taking its place. OtherAvise, the water, as such, is innocent of harm. This is said to be an easy mode of death. Those recovered from it describe it as a sort of dreamy sleep, followed by entire unconsciousness. We may as Avell remark here how not to drown, Avhen in the water and not knoAving hoAV to SAvim. (Every boy and girl ought, hoAvever, very early in life, to learn to swim. It is not hard to teach one's self. The Avhole art of it is to strike out, slightly doAvmvards and outwards, with the flattened hands and closed fingers, both arms and both legs, all at once, time and again, Avithout loss of time by any unnecessary interval; keep- ing the mouth as high as can be all the time.) In that case, there are two ways of doing. One is, to tread water; that is, to let the feet go down, and tread, rapidly, one foot after the other, as if working a treadmill; paddling in the same way also with the hands, one after another. Any one having confidence, as those have Avho have learned to swim, can keep this up with ease for a long time. Less exertion, however, is required for floating. In sea-Avater, which is heavy with salt, this is easier than it is in the fresh Avater of a river or in- land pond. Still, it can always be done, if attempted right. Lie straight out on the back, with the arms at length by your sides, the mouth and nose out of water, the back of the head just under the surface ; the toes just above or at the surface, the heels submerged. Then paddle gently Avith the hands. In any other position, the greater weight of the head makes it go down first, and drowning must result. Dr. Franklin, it is said, used to go to, sleep floating on the water; so easy had habit made this position to him. A person has been, we will suppose, a fe\v minutes under Avater, and is dragged out. At once, on the spot (there is no time to take him any- where else) lay him first on his stomach, and raise his feet a little higher than his head, for a few moments; some one at the same time pressing with moderate force on .the sides of the chest. The object of this is to let avater flow out, if it will, from the lungs. My belief in this is con- 844 DOMESTIC MEDICINE. firmed by AAdiat happened Avith a dog, which, Avith the intention of droAvn- ing it, I had held under water about ten minutes. As it seemed to be dead, I took it out of the tub, and threAV it on the ground. This chanced to slope, so that the cur's head Avas lower than its feet. In about tAvo min- utes, the creature rose and Avalked aAvay, none the worse for his ducking Fig. 252. ARTIFICIAL RESPIRATION. Next, lay the patient on his back, and put under his shoulders a roll "of clothing, such as a rolled-up overcoat, a hard pillow, etc. Draw out his tongue, with a thumb and finger, and get some one to hold it until it can be fixed forward, to prevent it from falling back and closing the entrance to the Avindpipe. For this fixation, best will be a strong india- Fig. 253. ARTIFICIAL RESPIRATION. rubber band. If none such is on hand, a paper-cutter, or a small stick, may be held upon the draAvn-out tongue, pressing it against the lower teeth. Noav comes the effort to produce artificial respiration. Silvester's method is the best. ACCIDENTS AND INJURIES. 845 Stand or kneel behind his head, and take hold of his arms just above the elboAvs. DraAv them both gently and steadily upAvards, over and back of the head, at their full length ; and keep them there for a second or so.* Then carry them back again to" the patient's sides, and press the elboAvs firmly against his sides, for another second or so. Go on doing this, perseveringly, if necessary, for an hour or more. The object of it is, to promote expansion of the lungs to admit air, by the first movement; and its expulsion again, by the second movement. MeaiiAvhile, another assistant should cut the clothing so as to remoATe it, rub the skin dry, and cover the body Avith Avarm flannel. The legs may be rubbed briskly, upward, so as to fiwor the return of blood in the veins to the heart. Smelling-salts may be noAV and then held for a feAV moments under the nostrils. If a fire be near, heat a small flat- iron, or a poker or shovel, not quite to the burning point, but pretty hot, and touch it gently, again and again, to the skin over the pit of the stomach. This is a poAverful mode of stimulation. When natural breathing begins, stop the arm movements. Continue the rubbing, but also have hot bricks, flat-irons, or bags of sand or salt, bottles of hot Avater, or anything else Avarm, laid alongside of the patient's body, and put to his feet. Get him noAV upon a bed. Shortly, he will recover so as to swalloAV; and hot milk or hot coffee or tea will be better for him than anything else. Having Avitnessed, at Atlantic City, some years ago, the drowming of two persons, who, after not more than five minutes of submergence beyond the breakers, Avere draAvn out but could not be restored by the above usual measures, I have reflected a good deal on this subject of artificial respiration. It has appeared to me there ought to be some still better Avay of obtaining it. After various experiments, I have had made an abdominal tractor; a small hand-pump, to draw upon a large metal cup or boAvl, placed upon the abdomen. The object of this is, to lift the contents of the abdomen avray from the diaphragm (large breathing muscle at the floor of the chest; see Anatomy), and allow it free play in beginning respiration. This can be applied and used at the same time with the Silvester movements above described, and ought to assist them materially. So far, I have had no opportunity to give this appa- ratus a trial upon a drowning person. * The common direction is, for two seconds. I believe there is no advantage, but the contrary, in such slowness. 846 DOMESTIC MEDICINE. Ear, Foreign Bodies in. So disagreeable is the odor of the natural ear-Avax, and so sticky is it to insects' feet and the bodies of grubs or Avorms, that they very seldom find their way into any one's ear; even Avhen sleeping on open ground or in the Avoods. Once iii a great Avhile such a thing may happen. To get an insect out, let the person lie on the other side, and let some one pour in, sIoavIv, cold Avater. Alarm may then cause it to back out; if not, before long the Avater Avill droAvn it. Then the larger part, or the Avhole (if it be not too soft) may be got out Avith a pair of ear-picks, or with a hair-pin bent into a scoop at its round end, or a piece of Avire bent at one end into a small loop or ring. Particles still left can be washed out with Avarm water injected from a small syringe. Children sometimes put peas into their own or one another's ears. Then, Avater should not be poured in; it would make the pea swell up and give more trouble. Careful use of an ear-pick or bent Avire (as above), with a strong light thrown upon the ear-passage, Avill generally succeed in getting the pea out. A large hand-magnifier, such as is often used to look at engravings, etc., Avill help in this effort. If a shot has been put into the ear, pour in a teaspoonful of olive or almond oil, and then let the child be turned rather suddenly over, so as to cause the shot to roll or slide out. Eye, Foreign Bodies in. Small particles, of sand, dust, cinders from a locomotive, etc., often get under the upper or lower eyelid; most frequently the latter. If the particle be very small, closing the eyes and bloAving the nose hard several times, rolling the eyeballs at the same time, will be apt to Avork it, by aid of the Aoav of tears, to the inner corner of the eye; where it can be easily removed. To re- lieve another person of such an annoyance, first make sure Avhere it is. Open the eye in a strong light, and draw doAvn the loAver lid. Use a magnifying-glass, if one can be got (a good thing always to have in a house). If you see the speck, a camel's-hair pencil (small paint-brush) Avill be the best thing to get it out with. Draw the brush backwards against it; don't push at it with the point of the brush. If there is no such brush at hand, the corner of a soft handkerchief may be used instead. Should nothing be found under the lower lid, you must look under the upper one. Seat the person on a chair, and stand behind him; then, with his head leaning back, hold a lead-pencil or pen-holder in the right hand, and, draAving out the upper lid by its lashes, the patient looking doAvnward, you lay the pencil along the lid and turn the latter up over the pencil. It is not difficult, Avith a little confidence, to do this with a finger instead of a pencil, and standing in front of the patient. While ACCIDENTS AND INJURIES. 847 the lid is turned up, look closely to find the intruding particle, and remove it Avith a brush or a handkerchief, as above described. The eyes must then be kept at rest, closed for aAvhile, to get over the dis- turbance; otherAvise a troublesome inflammation may result. Quite often, Avhen there has been a particle in the eye, but it has been rubbed out, there will still be left a feeling, exactly as if it Avas still there. A»Vhen this is the case, a careful examination shoAving it to be so, the irritation will gradually disappear, if the eyes are kept quiet. Pieces of stone or iron sometimes fly into the eyes and are lodged in the front of the ball. Their removal will require surgical skill. A poAverful magnet may assist in getting out a fragment of steel or iron from the eye. After all, to get a movable particle out of one's eye, the best way in most cases Avill be for the person to open both eyes in a basin of clean cold water; Avhile they are open moving the head once or twice from side to side, so as to Avash the particle out of the eye. 54 848 DOMESTIC MEDICINE. Fainting. One Avho faints, falls, unless held up, as Avhen standing or sitting up in a croAvded place. But not every fall is fainting. It may be an epileptic fit; but then the patient is convulsed; that is, his limbs, and perhaps the muscles of his face, jerk. There is a modified form of epileptic attack, not common, in Avhich the sufferer lies still; in that, hoAvever, the pulse is not so Aveak as in syncope or fainting. One attacked Avith apoplexy falls; but his flushed (or at least not pale) face, warm or hot head, sIoav and full pulse, and sIoav, snoring breathing, make the case clear. An intoxicated person, or one stupefied Avith opium, may be found lying unconscious. The odor of liquor in the former, and the contracted pupils of the eyes of the latter, usually serve for distinctions. (Odor of liquor on the breath, hoAvever, does not prove that the person may not have apoplexy as Avell as intoxica- tion.) In a faint, the face'is pale, the forehead cool or cold, the pulse absent or extremely weak, the breathing noiseless and feeble. Once in a wliile we meet Avith mixed attacks; almost ahvays in those Avhose hearts have undergone some degenerative change ; in Avhich there is a partial stupor, perhaps with snoring breathing, along with the other signs of fainting. Such an attack differs from apoplexy in that it soon passes off, and leaves no palsy after it. But such spells are comparatively rare. Fainting is most common in young women; next so, in weakly old people of either sex. In these last it is most dangerous, and may in them easily end in death. What happens in a faint is this: the heart gives out, and sends no fresh blood to the brain; the brain fails, there- fore, to maintain consciousness, and the person falls. This fall is ad- vantageous, because it causes more blood to Aoav to the brain, and, con- sciousness being renewed, the heart also having less laborious work Avhen the body is level, all starts again. A croAvded and close room is a fre- quent place for fainting. Fright, the sight of blood, and other mental causes, as Avell as fatigue, may produce it, in those liable to it. Some persons never faint, through a long lifetime; others do so often, even on very small occasions. What to do for fainting ? Lay the person doAvn at once. Get the croAvd, if there be one, to move away. Open the AvindoAvs, or carry the unconscious patient (horizontally) out into the fresh air. Sprinkle cold Avater on the face; loosen everything about the neck and chest; hold smelling-salts, for a moment at a time, under the nostrils. An ordinary syncopal attack will thus soon pass aAvay. Fractures. Broken Bones. Most frequently broken is the radius; the thumb-side bone of the forearm, Avhich is most closely connected with the hand. We may break it by falling on the hand with force. ACCIDENTS AND INJURIES. 849 In the same way also the ulna may be fractured ; the other bone of the forearm. Next often broken is the bone of the arm (humerus) above the elbow; and frequently also the clavicle, or collar-bone. After these (besides fractures of the fingers), come fractures of the larger bone of the leg (tibia, shin-bone) below the knee; the thigh-bone (femur); of the ribs; of the knee-pan; and of the nose, loAver jaAV, and skull. We know a bone to be broken by the change in its shape; the pain caused by every movement; and the crackling noise (not loud), and crackling feeling to the touch, produced when the parts are moved. A broken limb is generally shortened; the muscles above and below the place of fracture draAving the two pieces so as to overlap each other. When the break is near a joint, it is sometimes difficult to be sure whether there is a fracture or a dislocation. This difficulty is much in- creased when SAvelling and inflammation folloAV, some hours after an injury. In examining to determine a change of shape in a limb, ahvays compare it with its OAvn fellow, on the opposite side of the body. The two are almost sure, when sound, to be alike; and if not so after one is hurt, this Avill help us to an understanding of the case. There is a change of shape also in dislocations; but in them the bones cannot be moved without great resistance; there is no crackling (crepitation) heard or felt; and when the bone is put back to its right place, it will stay there. The most serious fractures are those called compound fractures; in Avhich there is a wound of the flesh, communicating with the broken ends of the bone. Sometimes one end of a fragment is forced quite out through the skin. In the treatment of fractured bones, the two aims are, to get the broken parts into their right places again, and to keep them there until they " knit together." This takes place by a natural process of growth, exactly like that by which a wound is healed on the surface of the body. A thick colorless fluid, plastic lymph, is poured out around and betAveen the ends of the fragments of the broken bone. Gradually this fluid is, between those fragment-ends, changed to gristle (cartilage); and, in time, that gristle becomes solid bone. In one bone, when broken, the knee-pan (patella), it seldom gets beyond the stage of gristle or carti- lage ; because that bone, from its situation, receiAres too little blood to enable it to grow or repair so well as other parts. Putting a broken bone back to its right shape is called " setting " the bone. This is done, in most instances, by stretching the limb, so as to overcome the shortening action of the muscles; and at the same time adjusting the fragments by proper pressure near the place of fracture. After this has been effected, as nearly as possible, some means are needed 850 DOMESTIC MEDICINE. Fig. 254. to hold the parts in the same position. For this, splints, bandages, ad- hesive plasters, etc., are used. No unprofessional person should venture, if avoidable, to carry out the treatment of a broken bone without the aid and direction of a sur- geon. It often happens, hoAvever, that, at the time of au accident* no professional assistance can be obtained. It is therefore desirable that, besides the above general statements, something should be here said of the "first aid" required in the fractures most likely to occur. Forearm. Most often the radius, sometimes both it and the ulna, suffer fracture from a heavy fall forAvard on the hand. Except at the elbow and at the wrist, there is seldom difficulty in ascertaining the nature of this injury. Make a couple of splints of thin wood, or thick paste- board, or binder's-board, each rather wider than the forearm, and long enough to reach from the elbow to the tips of the fingers. Lay along on one side of each splint a layer of cotton; and, Avhile one person grasps the hand of the patient, Avith his thumb upward, and draws moderately upon it, put the splints one on the front, and the other on the back of the forearm. Then put on a band- age, about two and one-half or three inches wide, over the splints; begin- ning near the hand end, and turning and reversing until the whole length of the splints has been covered. This bandage should be firm, but not un- comfortably tight. I knew one case in which mortification took place from an excessively tight bandage on the forearm. When the doctor comes, he will examine and probably readjust the splints, and see to the farther care of the case. When the splints have been applied, hoAvever, the arm should be placed in a sling. That is, a large handkerchief, or a bandage, should have its ends tied together, so that, when it is hung over the back of the neck, the hand may be slipped into the loop; the limb will be thus kept at rest in one position. On lying down, take away the sling, and lay the injured arm at ease on a pillow. If it be necessary in any case to take care of a broken forearm or arm without a surgeon, one thing to remember is, that the fingers should be A SIMPLE SLING. ACCIDENTS AND INJURIES. 851 moved (bent and extended) every day or two, at least after the first week, to prevent their becoming stiff and useless. Near the end of the time of treatment, say after three weeks, the splint on the palmar side may be so shortened as to alloAV the fingers to be bent over its rounded end; and the patient should then be sure to give them such exercise several times daily, to keep their muscles in condition. Elbow and wrist injuries are so difficult of management that I hesitate to endeavor to specify particulars concerning them, as they will engage all the skill of the trained practitioner. Good sense, with presence of mind, will be likely to suggest whatever addition to the above first treatment will be safe AA'hile waiting for professional advice. I may merely add that the reason for not put- ting a bandage over the broken forearm before putting on the splints, is, that the difficulty, in fracture of the radius or ulna, is, to keep the two bones sufficiently apart; and a bandage alone, or one first applied, would force them too close together. There is no danger of their being pressed too far apart. Arm. The most common fracture of the humerus is not far from its middle; more troublesome, is a break near either end. The first of these is easily recog- nized, by the pain, mobility at the place of the break, and crackling on motion, to the touch if not to the ear. An angular splint, one piece from armpit to elbow, and the other at right angles with this from elbow to ends of the fingers, -will be here serviceable; also, three short splints, of the length of the arm, from shoulder to elbow. First, however, the whole arm should be bandaged; from wrist around the hand, then up over the wrist and forearm (the arm held at right angles at the elbow) and the arm, to near the armpit and shoulder. The bandage should he'evenly and firmly, but not too tightly applied. If no splints can be immediately obtained, a thin twelve- mo book, of one hundred to one hundred and fifty pages, may be pad- ded with cotton and placed under the arm to the armpit. Then pass a wide bandage (three to four inches) around the arm and body; the fore- arm being held against the chest Avith the thumb upwards. This will do to keep the injured arm at rest till proper surgical aid arrives. When a finger-hone is broken, its treatment is simple enough. Straighten it out, and put on its front and back small splints cut from a cigar-box, or made of thick pasteboard, or the back of an old book, BROKEN ARM IN SPLINTS. S52 D 0 MES TIC MED I CINE. Fig. 256. FINGER BANDAGE, AND FIGURE OF 8. etc. Sticking-plaster Avill here be more convenient than bandage, to retain the splints in place. Collar-Bone. This fracture is not an easy one to manage successfully. A number of kinds of apparatus have been invented and are used for it. The " indication," as doctors call it^is to press and keep the shoulder upwards, outwards, and back- wards. The natural tendency, Avhen the clavicle is broken, is for the shoulder to fall; the ends of the broken bone tilting up near its middle. Having seen a good many broken clavicles in hospital and private practice, my deliberate ad- vice to the unprofessional good Samaritan is, to get his patient who has suffered this accident to bed, on his back, to lie there as still as he can until the doctor comes. In justification of this advice, it may be added, that some very good cures of fractured collar-bone have been obtained by this method alone, carried out until the bone united. Ribs. We know a broken rib chiefly by pain in breathing, moving, or pressing on the seat of fracture. There is little displacement, one rib acting as a splint to its next neighbor. A bad rib-fracture may involve the pressure of a frag- ment-end into the lung; when there Avill be spit- ting of blood and much trouble. Commonly, fracture of a rib is one of the easiest of accidents to treat. The old method, of enveloping the whole chest in a broad (four-inch) bandage, answers very well indeed. The idea of it is, to keep the ribs at rest, the patient breathing almost en- tirely by the diaphragm (abdominal respiration). Recently, surgeons generally prefer adhesive plasters; a number of them, moderately wide, being successfully ap- plied only on the injured side of the chest. Under either method, while the patient may not need to remain in bed, he should move about very slowly, using his arms but little, and doing nothing to hurry respira- tion. A broken rib will knit in about four weeks. A radius or ulna fracture will be well usually in about the same time, or less; a humerus or clavicle in scarcely more. A broken leg (tibia or fibula) is commonly well in a month or so; a thigh (femur) will require eight or ten Aveeta for security. Fig. 257. DRESSING FOR FRACT- URED RIB. ACCIDENTS AND INJURIES. 853 Nose. One or both of the small bones of the nose (see Anatomy) may be easily broken by a bloAv. The change of shape of the nose may then be seen and felt, until SAvelling makes everything obscure. Im- mediately after the injury, or, if that has been neglected, then after the inflammation has subsided (under lead-water application and twenty- four to forty-eight hours' time), endeavor should be made to adjust the fragments aright. If this cannot be done from the outside alone, grease with tallow or oil a slender lead-pencil, or the tapering end of a wooden pen-holder, and very gently push it up the nostril on the side which is depressed. After so restoring its shape, if it does not stay so, insert a small roll of cotton, well anointed with oil, talloAv, or vaseline, to act as a soft splint. This should be changed every day as long as it is used. lower Jaw. This may be broken by a violent blow. The line of teeth may be easily examined and found broken; and the movement at the seat of fracture will be seen and felt. To set a broken jaAV is not difficult; but more pains will be needed to keep it right until the bone knits, which hap- pens in from two to three Aveeks. All food must be liquid, and introduced by means of a quill, or through a glass tube between the teeth. The jaws must be closed together evenly, and bound so. The required bandage is one under the chin and over the top of the head. To retain that in place, another bandage around the forehead and back of the head should be put on, and secured to the first over the forehead by pins. This simple apparatus will answer at least till the doctor comes. Thigh. The thigh-bone may be broken in either of several places. Old persons are especially bandage for broken liable to fracture of the neck of the bone, near the hip-joint. The shock to them is so great as to be often fatal in result. Yet I ha\re knoAvn tAvo Avomen over eighty to recover from this accident; always lame, hoAvever, as bony reunion seldom occurs under such cir- cumstances. In younger persons, the commonest fracture is not far from the mid- dle of the femur (thigh-bone); and oblique, so as to cause considerable shortening, by action of the muscles. Treatment of this requires surgi- cal skill and care; Avith the best of which, from a quarter of an inch to an inch and a half of shortening will sometimes remain. This will not prove of much inconvenience. Indeed it is quite common for the tAvo sound limbs of a person to differ half an inch or more in length. If an old man or woman (seventy years or more of age) falls and lies 854 DOMESTIC MEDICINE. helpless, Avith the toe of the injured limb turned outAvard, and much pain at the hip on moving that leg, even if no crackling is heard or felt Avith that motion, and Avith very little shortening of the limb, it is most probably a fracture of the neck of the thigh-bone. Carefully lift such a one, one person taking charge of the injured limb, and tAvo others the head, shoulders, and feet; and lay him or her on a bed. Make the hurt leg as straight as it can comfortably be, upon a pillow laid lengthwise. Then wait until professional advice can be had as to Avhether any appa- ratus is worth while or not in such a case. Should it be necessary, in the absence of a surgeon, to do something for a fracture of the thigh-bone in the course of its shaft (easily knoAvn by the deformity, pain, and crackling on moving the limb), the same care will be necessary in getting the patient to bed, with a pillow length- Avise under the broken thigh; if comfort seems to require it, another Fig. 259. EXTENSION FOR FRACTURE OF THIGH. pillow also under the leg and foot. Then pass long and broad strips of adhesive plaster in long spirals up the sides of and around the leg, as high as the knee (bandages will do if there is no plaster at hand), and make a loop of them below the sole of the foot. Attach a cord to this loop, and carry it over the foot of the bed, or over a piece of smooth round wood fastened there for the purpose; and to the lower end of the cord attach a weight; from four to ten pounds, according to what the patient bears without complaint. To stretch the limb as fully as possi- ble, draw him up by the shoulders, with some force, towards the head of the bed. The purpose of the weight is, to keep the limb all the time as much extended as it will bear, so that the bone will knit with but little shortening. If the thigh is broken straight across, instead of obliquely, and the fragments are set in place, end to end, there may be no shortening at all. Further to protect the broken limb from being ACCIDENTS AND INJURIES. 855 moved out of shape, we want a simple splint. For this, cut a piece of gutta-percha, if it can be had, just long enough to reach from the fold of the buttock to the bend of the knee, and wide enough, when bent over, to cover about half the thickness of the thigh. Soak this piece in hot Avater until it becomes moderately soft and flexible. Then fit it, by pressure, to the shape of the under side of the sound thigh, which can be raised for the purpose without disturbing the injured limb. Put a not very thick layer of cotton inside of this splint, Avhen it cools and hardens, letting the cotton overlap the upper and lower ends of it, to protect the skin there from rubbing. With great care, raise the broken limb and adjust this splint under the thigh; and secure it by passing around it and over the thigh several pieces of wide tape or narrow bandage, which may be tied Avith moderate tightness above the thigh. If gutta-percha cannot be obtained, felt, binder's-board, or tAvo or three layers of thick pasteboard, may be used in nearly the same Avay, but Fig. 260. dr. Hamilton's fracture bed. with less advantage. There are other ways of treating fractured thighs, with splints, inclined planes, and so forth, which you will find described in works on surgery; but the above is the simplest, and will do all that is likely to be well accomplished by unprofessional hands. One of the difficulties in treating this fracture is, arranging for the patient to have his bowels moved. For the bladder, a urinal will answer, with very little disturbance. The most complete way is to have a fracture bed; Avith a round or square hole in the bedstead, having a dropping lid be- Ioav, and a corresponding movable piece cut out of and fitting into the mattress, near its middle. Eight or ten weeks will generally be required after a fracture of the thigh before the patient can venture safely upon his feet. During that long time, much care must be taken to avoid bedsores, especially in a thin and weak person. Wherever there is constant pressure, the skin ought to be bathed every day Avith Avhisky or soap-liniment. If any 856 DOMESTIC MEDICINE. redness or tenderness appear, put on the part two layers of adhesive plaster, smoothly applied, or a piece of soft buckskin spread Avith soap plaster. Air-cushions, water-cushions, or small pilloAvlets made for the purpose, are often used, and have advantages; but the double artificial skin made by adhesive plaster will seldom fail to give protection to a tender part. It is Avorth Avhile to repeat here that shortening of the thigh of as much as an inch permanently will not cause any great in- convenience. A patient of mine who recovered with at least three quarters of an inch of unavoidable shortening, when I saw her a year afterAvards, had forgotten which limb it Avas that had been broken. Knee-pan (Patella). As already said, this is a very undesirable bone to have broken; it is so nearly impossible to have it knit solidly again. A fall upon the knee may fracture it; but it is quite as often broken Fig. 261. invalid lift. by a sudden and violent strain of the powerful muscles of the thigh attached to it; as in making a great endeavor to avoid falling back- Avards. A tall and active man, who became my patient, thus broke his patella in trying to save himself from a fall in skating. It is usually easy to make sure of the existence of this fracture, as the bone is small and covered only by skin, if it be examined immedi- ately after the occurrence of the injury. When swelling and inflam- mation have come on, there is sometimes difficulty. Ahvays, however, the leg is disabled from motion, every effort giving much pain; and, in the absence of swelling, the separation of the tivo pieces is observable,— unless it be (exceptionally) a lengthwise, up and down, instead of a cross or horizontal fracture. To treat this injury, the leg must be kept out straight, on a well- ACCIDENTS AND INJURIES. 857 cottoned long splint, reaching from beloAv the hip to beyond the heel. Then " figure of eight" pressure is Avanted, to draw the tAvo fragments (in horizontal fracture) as near as they will come together. If anything is tightly bound directly around the knee, it will check the circulation of blood in the limb more than is safe. But Avith the wooden splint beneath the knee, we may cause a great degree of pressure above the BANDAGE and splint on leg. limb, putting whatever is used around the splint below. Adhesive plas- ters will be more reliable for this purpose than a bandage. One strip of Martin's (or Grovenor & Richards) surgeons' adhesive plaster, which is elastic, may be put obliquely over the leg just below the knee-pan and around the splint; and another strip just above the patella, and obliquely doAvnward, being secured to the splint underneath. Then fix the whole limb to the splint with a long (2| or 3-inch wide) bandage, beginning below and wrapping it upwards as far as the upper part of the thigh. Leg. The larger bone of the leg (tibia) is much more frequently broken than the more slender outer one (fibula). A simple fracture of the tibia is easily discovered, by the change of shape, pain, and crackling (crepitation) when it is moved at the part broken. In treat- ment of it, if a doctor is expected, merely layT the patient on a bed, and place the limb (stretching it with moderate force by drawing upon the foot, if it seems shortened) on a pillow. Then pass around the pil- low and leg several pieces of broad tape or narrow bandage, tying them in bow-knots above the leg. If no surgeon can be obtained, it will be Avell to have a simple fracture box made, in Avhich the leg will rest on the pillow with more security. For this, it needs a piece of wood a little longer than the leg (from the knee down) and also a little wider than it, to lie under it; also two pieces of the same length and of about the same width, to make sides to the box. These should be attached with hinges to the under piece, which last is the bottom of the box. Lastly, a foot-board should be made to stand up 858 DOMESTIC MEDICINE. from the lower end of the under piece, being securely ftistened to it. This is to steady the foot, Avhen the sides of the box are brought up against the pilloAv on which the leg lies at rest. NarroAv bandages may- then go under the bottom of the fracture box and around it and the leg, to be tied above; and a handkerchief or bandage will keep the foot Avith sufficient firmness against the foot-board. Shortening is not common from fracture of the leg, if it be Avell draAvn doAvn and " set" in the first place. Extension of the leg can be practised, if necessary, by means of a Aveight and pulley over the foot of the bed, as for fracture of the thigh; but it is seldom required. Fracture of the smaller bone of the leg (fibula) is hard to ascertain, and more difficult to manage. This bone is the one that connects with the outer side of the ankle (side of the little toe; the great toe being on the inner side). There it can be felt, and, if broken, there will be some change of shape; more motion, though painful on pressure, than in the sound limb at the same part; and more or less crepitation or crackling, felt if not seen, Avhen such motion is made. If a surgeon cannot be had, which is very desirable, to treat this fracture, have a wooden splint made, a little longer than the leg, and of about its Avidth. Pad it rather thickly, but evenly, Avith cotton, fastened to it by means of a bandage; lay this splint along the inner side of the leg, from just above the knee to just below the foot, and bandage the splint to the limb, from below upAvards, as firmly as can be borne wdth comfort. This will be likely, if readjusted carefully from time to time, to promote the union of the bone without serious deformity or lameness. Fractures of the leg are often treated by surgeons with a dressing of splints and bandages soaked in a plaster of Paris mixture, or a solution of silicate of sodium (soluble glass); which becomes fixed, like wood or stone, so as to keep the bones in place even while the patient is walking about. But such applications require more judgment and skill than ordinary splints and bandages, and had better never be undertaken by unprofessional persons. We refer for the account of them to works on Surgery. Bones of the foot (tarsus, metatarsus, and digits; see Anatomy) cannot well be broken without great violence. This being the case, apparatus is seldom in place in their treatment. Such injuries will be considered under bruised and crushed Wounds. Compound fractures are those in Avhich an end of the broken bone projects through the skin; or, in some other way, a Avound is made, communicating Avith the seat of fracture. They are much more serious and difficult to treat than simple fractures. If such should occur Avhere no surgeon can be obtained for a considerable time, the patient should be ACCIDENTS AND INJURIES. 859 put to bed, and a fracture box should be made, whether the bone broken be an arm or a leg. Let this box, instead of containing a pillow, be half filled with clean bran or fine sawdust; and lay the injured limb, as straight as can be, in that material. Every day the wound near the fracture should be examined. If a discharge of matter (pus) occurs, very gently remove the bran or sawdust which has been soiled by it; washing the wound at the same time carefully with a little lime-water. Yery good cures have often been obtained, of compound fractures treated in this manner. ° Skidl fractures will receive attention shortly, under Head, Injuries of. 860 DOMESTIC MEDICINE. Hanging. See Choking. Head, Injuries of. Cuts and bruises of the scalp will be spoken of under Wounds. Blows on the head may be folloAved by either of two results: concussion or compression of the brain. Concussion is simply shock. A person falls and strikes the head. He is " stunned," and lies unconscious. His breathing is natural, his pulse feeble and rather more rapid than usual, his face pale. On shaking or speaking to him, he may be partly but not entirely' roused. Let him lie still, in a warm ^dace. Probably in a few minutes, possibly longer, rarely after several hours or even days, he will recover consciousness. Then, especially with a child, there is some danger, which is not over for at least tAvo weeks, of inflammation of the brain following. Therefore, any one stunned in such a way should be kept very quiet in mind and body for tAvo or three weeks after the injury; even if no unfavorable symptoms appear. Again, some one falls and strikes the head, very hard, or receives a violent bloAv upon it. He lies unconscious, snoring with deep, sIoav breathing; with a sIoav and full pulse, face flushed, and head warmer than natural. We infer that he has compression of the brain. This may result in either of two ways: the skull may be broken, and a piece of it may be pressed down upon the brain; or a clot of blood may be formed Avhere a blood-vessel has been ruptured. In either case, it is pressure on the brain which causes the stupor (coma). It is true, and important to be remembered, that the same sort of coma or stupor, with the same signs, may be caused in other ways. A man dead-drunk is in a state of coma. His breath will smell of liquor, and his whole " make-up " will mostly show his history. Poisoning with opium (as laudanum, or morphia) produces a closely similar narcotic coma. Such a one will, if his eyelids be open, be seen to have his pupils contracted. Lastly, apoplexy, without any blow or heavy fall, gives the same symp- toms ; pressure of blood on the brain existing in an attack of that disease; from either excess of blood in the vessels, or its escape from the vessels, forming a clot. When, then, a person has not been seen or known to fall, but is found lying in a condition of stupor, from Avhich he cannot be roused, all these possibilities are to be remembered. Examine his head, with your eye and hand, all over. If any bruised spot be found, cut the hair there vrery short, in order to make a more thorough examination. You may find a depression, or an inequality, showing a fracture of the skull; or, with evidence of a bruise, no break may be discovered, and yet the inner, more brittle plate of the skull may be fractured; or the jar may have extended elseAvhere, making a crack (by " contre-coup," as the ACCIDENTS AND INJURIES. 861 French call it) in the base of the skull. A symptom of this, sometimes seen, is bleeding from the ears. What to do ? Lay him on a bed and let him lie still. It is a griev- ous mistake to suppose that you must not let a person sleep Avhen he has had an injury of the brain. One case only, with somewhat similar symptoms, requires opposite management; namely, the stupor of opiate or other narcotic poisoning. When sure of that being the matter, it is right to keep the patient awake. (See Opium Poisoning, later in this book.) If there be a fracture of the skull, or compression of the brain by a clot of blood, the treatment proper is of a kind unsuited to non- professional hands. A surgeon should be had as soon as possible. In a clear case, he may lift up the depressed fragment of bone; or perhaps, Avith a trephine, may remove a small round piece of the skull so as to take off pressure. Life has in a number of instances been thus saved: although it is one of the most precarious of surgical operations as to its results. It is wonderful how slight a blow, in some cases, will destroy life; and again, what terrible-seeming injuries of the head may be sur- vived and recovered from. A man in Maine was famous some time ago for living twenty years after an iron rod was, by an explosion, driven clear through his head; and a distinguished physician lately lived in Philadelphia who, after being struck down by an unruly horse, had twenty-three pieces taken out of his frontal bone, Avhere it Avas fractured. I had under my care in the Pennsylvania Hospital a carter who broke his head by a fall while drunk. Four ounces of brain came out at the place of fracture, Avhere there was a ridge five or six inches long. Yet he recovered; and seemed about as good (or good for nothing) as before. 862 DOMESTIC MEDICINE. Fig. 264. SINGLE KNOT. SINGLE SLIP-KNOT. CROSSED SLIPKNOTS. DOUBLE BOW-KNOT. Used for fastening the muslin strips around fracture apparatus, and the threads securing the little bandages about the fingers and toes. BURGEON'S KNOT. Employed when a thread is tied around an artery. LOOP KNOT. Will answer to arrest the ve- nous circulation during venesec- tion, and enables the operator to graduate the compression in- stantly and accurately. DOUBLE KNOTTED AND LOOPED KNOT. PACKER'S KNOT. Is the one formed over the temple by the knotted bandage of the head. REEF OR SAILOR'S KNOT. Is the one mostly used by surgeons of the present day for ligaturing arteries instead of the surgeon's knot, for the reason of its less liability to slip, and the certainty with which it closes the arterial canal. DOUBLE NOOSE. CLOVE HITCH. Used in applying the extending bands for the reduction of dislo- cations, consists, as seen in the figure, of two packer's knots laid together. SINGLE NOOSE. Employed to secure the hands and feet of a patient about to un- dergo the operation of lithotomy, etc. ACCIDENTS AND INJURIES. 863 Joints, Displaced. Dislocation is the common name for a " hone being out of joint." Most common of dislocations are those of the thumb or fingers; next, perhaps, of the jaw; then of the shoulder; next, the thigh, at the hip-joint. In hanging, or on falling headlong, • dislocation of the head and first vertebra of the spine may occur; being usually called " breaking the neck." The jaw is sometimes knocked out of place by a blow, but is more often dislocated by being opened too widely, as in yawning or scolding violently. It then stays wide open, and the mouth cannot be shut. To get it back, some one must Avrap his two thumbs thickly with handker- chiefs or something else to protect them. Then place one thumb upon Fig. 265. DISLOCATION OP SHOULDER. the back teeth on each side, the fingers coming under the patient's chin. Press the jaw forcibly downwards (and a little backwards) with the thumbs, while the chin is at the same time raised by the fingers of the two hands. This will bring the jaw into its place; and as it begins to come, slip the thumbs out, to avoid the snap of the teeth upon them. Dislocation of a thumb is not uncommon; especially with the thumb pointing backwards. To restore it, we want to lift the round part of the thumb-bone over the slight ridge of the hand-bone (metacarpal bone; see Anatomy), at the same time drawing it forward to its place. This may require a good deal of force in the case of a strongly-knit person; but tact or management is of great value in reducing dislocations. The 55 864 DOMESTIC MEDICINE. skill of " natural bone-setters " is no doubt exaggerated ; but there is a difference in " knack " in such matters, Avhich may be improved upon by close observation and practice. Finger dislocations are to be dealt with in the same way as those of a thumb. The sooner the reduction is undertaken the better; as, in a* little time, SAvelling and inflammation will make it difficult. Having once dislocated the middle finger of my right hand by a fall in getting out of a horse-car, I pulled it at once into place, upon getting up, before reaching the side-pavement. An hour later, it Avould have given con- siderable trouble. The shoulder is not infrequently dislocated. This may happen in several different directions, according to the position of the arm and the direction of the force acting upon it, when the accident happens. Always, however, Ave may knoAV a shoulder dislocation by the depression at the shoulder, Avhere it is naturally rounded out, under the deltoid muscle Fig. 266. (see Anatomy); and by the constrained position of the arm, which cannot be moved without difficulty and pain. Often the round head of the arm-bone (humerus) can be felt in its wrong place; in the armpit, or more forward, nearly under the collar-bone. If a surgeon cannot be had, it will be well for a strong person to try to reduce such a disloca- tion ; as, if long left, the parts adhere together, and the difficulty of restoration is much greater. The way to do it is this: let the patient lie down on the floor. The operator, taking off a shoe, should sit down with his feet toAvards the head of the patient, and place his stocking-foot in his armpit. Then let him grasp the hand and wrist of the dislocated arm, and draw it forcibly towards himself, and someAvhat inward toAvards the patient's body. After thus pulling it out as far as he can, let it go suddenly. It will then generally slip into its proper socket. The arm should then be carried in a sling for a week or more, for the strained ligaments to heal. ACCIDENTS AND INJURIES. 865 TJiigh dislocation is a much more serious accident to deal with, as may be supposed from the force necessary to displace so large a bone at so strongly protected a joint. The head of the thigh-bone (femur) may be pushed or draAvn into either of several places; in which it may in many instances be felt and perhaps seen as an unnatural swelling of the part. The limb cannot be moved without great difficulty and pain; but there is no crackling (crepitation) heard or felt when the attempt to move it is made, as there is in fracture of the bone. The toes of the injured limb are turned inward in all but one variety of hip dislocation (turned outward always in fracture of the thigh); and in dislocation the fixed- ness of the limb distinguishes it from fracture. Formerly, surgeons ahvays resorted to great force in reducing dislo- cations of the thigh. I remember the pulleys and ropes in the hospital as used in my student days, reminding one of the rack of the Spanish Inquisition. Yet it was not cruel, because, when successful, as it usually was, it relieved the patient of a disabling lameness. In latter times, a more satisfactory method has been devised, of coaxing and working the bone into its place by skilful manipulation. The surgeon knowing well the anatomy of the bones and joints, ascertains by examination which way the head of the bone was forced (through its capsular ligament) out of its socket; and then he manoeuvres, by movements of the limb, to reverse that direction and get it in again. No one, hoAvever, not familiar Avith anatomy, will, unless he be indeed a " natural bone-setter," be likely to attempt so considerable an operation. It may be remarked, also, that some of those Avho, without real knowledge, claim to have the art or knack of bone-setting, have been known to break bones or do other harm by injudicious violence. Dislocations of the elbow, wrist, knee, and ankle are produced only by great degrees of violence; and are therefore injuries which demand scientific professional skill for their management; especially as they are often complicated Avith fracture of the bones near the joints. We must therefore leave them to books and practitioners of Surgery. Dislocation of the neck is almost always instantly fatal. Not quite always. In the Journal of George Fox, the founder of the religious Society of Friends, he tells that Avhile travelling on horseback in this country, a companion Avas thrown from his horse on his head, and lay as though dead. Fox went to him,, and finding his neck " limp," took hold of his head and gave it a good stretching pull. This brought it right; and the good man got on his horse again and travelled several hundred miles with his strong-minded and strong-handed benefactor. Professor S. D. Gross, of Philadelphia, is said to have had the good fortune and skill to save the life of a man Avhose neck was dislocated. 866 DOMESTIC MEDICINE. FeAV indeed, hoAveA^er, are the cases where any skill Avould avail; as the spinal marrow is generally crushed by the " process " of the second or axis vertebra. (See Anatomy.) Joints, Sprained. Any of the joints may be Avrenched or sprained, without actual displacement. This happens often Avith the ankle, knee, Avrist, elboAV, fingers, etc. The ligaments are then stretched, and some of their fibres may be torn or broken. Hence follows more or less in- flammation, and lameness until the ruptured ligaments haATe time to heal again. Since the " fibrous tissue " of which they consist has only a Ioav grade of vitality, and not much blood is given for nourishment of the joints, this process of repair in them is slow. A sprained ankle or knee may be longer in getting well than a broken leg Avould be. At least this is apt to be the case unless the sprained joint has given to it the best chance possible from the first. This is to be had by the pa- tient giving up to rest it completely as soon as it is hurt. Thus inflam- mation may be averted or kept Ioav, and a moderate sprain may get well in a few days. A sprained ankle, then, should be kept still from the very start; Avhich requires that the patient should not walk upon it. Best for it will be, remaining in bed; as all movements out of bed, even a\ hen the foot is kept from the floor, will jar the joint more or less. Of course this total rest will seldom be long needful. If the joint be very much swollen, hot, and painful, cool applications, as lead-Avater and laudanum, will be good for it. Tavo dozen American leeches may be applied to it; their bites being encouraged to bleed after the leeches drop off, by Avarm Avet cloths laid on. OtherAvise, the effect of the leeching may be to draAv as much more blood into the SAvollen part as they take out of it. If the SAvelling is moderate, and the heat of the joint not great, warm applications, or even cloths wrung out of hot Avater, will give the most comfort. Indeed there is no dogmatic rule to be laid doAvn about hot and cold applications for inflamed parts of the body. Whichever gives the most relief will be the best in any case. Bandaging is the next thing in the treatment of a sprained ankle. This will give support and take down or keep down swelling. A tAvo- and-one-half-inch muslin bandage Avill ansAver for an adult; tAvo-inch for a half-grown person. Begin by passing an end of the bandage around the ankle; then, Avith the fingers, not the thumb, in at the roll- side of the bandage, turn it doAvn over the foot, smoothly, reversing it obliquely to avoid projecting Avrinkles. Around the foot tAvice or more, and then obliquely around the ankle again. Firmness should be the ACCIDENTS AND INJURIES. 867 aim, without uncomfortable tightness; if too tight, it will do harm rather than good. A sprained knee will, still more imperatively, require absolute rest from the start. Its lameness, if protracted, will be a Avorse inconven- ience than that of the ankle; and either may, if neglected, be an affair of months, or even years. The treatment otherAvise of a sprained knee, should be conducted upon the same principles as that above mentioned for a sprained ankle. With either, when it is getting well, there should be 'a gradual return to its use; trying it, at every step, and giving up the movements if they make it worse again. Here " a day in time saves nine." Slow recovery, from the sluggish circulation and nutrition of the part, may be hastened by bathing the joint Avith soap-liniment; also by pouring upon it a stream of hot water several times every day. With vigorous persons, in summer-time, the tonic effect of a stream of cold Avater for a few minutes at a time seems to ansAver a still better pur- pose. Sprains of the elboAV, wrist, fingers, etc., should be managed in the same Avay as the above. It is wonderful how long after a sprain of any joint it may continue to be weak and sensitive on motion. 868 DOMESTIC MEDICINE. Lightning-Stroke. A shock of electricity from a cloud Avhich Avill shatter a large tree, Avill of course destroy in a moment the life of a man. EA'en the " dynamo" machines noAV used for electric-light currents gen- erate power as fearful, almost, as that Avliich Dr. Franklin drew Avith his kite from the skies. A wire from an electric lamp, fallen in a street of New York, was trodden upon by a horse. The animal fell dead at once; and the same thing happened again, before the current Avas dis- connected for safety and repair. But there are all degrees of electrical quantity and intensity, and moderate as well as severe shocks, even by lightning. The subject of protection from lightning is outside of the scope of this work. It may be said, merely, that the object of light- ning-rods is, to carry electricity through a good metallic conductor, doAvn into the earth, instead of alloAviug it to pass through the house. Its rapid passage through the conductor happens Avithout violence; in the house, interruptions of various kinds cause damage to people and things in its Avay. A lightning-rod then must reach higher than the house, and had better have a number of points to receive the electrical excite- ment. Then it must have no gaps on the way down to impair its rapid conductivity ; and it must be well connected with the earth ; best of all with a AArell or reservoir of water. A tin or other metallic roof does not draw the lightning, or in any way increase the danger from it. Rather, it diffuses the discharge, Avhich is perilous in proportion to its concentra- tion. It is advantageous, however, to have several lightning-rods to every large house, Avith Avhich the metal roof may be connected at its lowest parts. In a house, the safest place during a thunder-storm is near the middle of a room, aAvay from the Avails; also remote from any open windows or doors. Outside, the most dangerous place is under a tree. The exposure of the top of a tree, like that of a lightning-rod, makes it liable to be struck ; and the conductivity of a tree is not, like that of a metallic rod, sufficient to carry the discharge without some of it es- caping on the way doAvn to the ground. There are many instances of persons being struck avIio have taken refuge under trees from the vio- lence of storms. When any one is struck by lightning but not killed, he lies paralyzed for a time. He should be put to bed, with hot bricks or bottles to his feet, arms, and body. Ammonia may be held, for a feAV moments at a time, to his nostrils. If breathing has ceased, yet there is thought to be a hope of life, artificial respiration may be resorted to, as described under Drowning. A piece of iron, as a poker, may be heated, just short of the burning-point, and held for a moment, several times in succession, against the skin at the pit of the stomach. If these means do not produce reaction and restoration, the shock will prove fatal. ACCIDENTS AND INJURIES. 869 When a person struck does get over it, he is almost sure to be Aveak for a time; and will require rest of body and mind long enough to regain his usual condition of health. Muscles, Strained. A muscle or its tendon may be ruptured or torn across by violence. Under sudden and extreme exertion, a tendon may be entirely sundered, though this is very rare. The nearest ap- proach to it ever coming under my knowledge has been the tearing in two of the patella (knee-pan), the 6one at the knee in the course of the tendon of the great muscles of the thigh, by an effort to avoid falling backwards. When a muscle is simply strained, some of its fibres are no doubt partially divided. It then gives pain to use the muscle; it is sore also to the touch, and may perhaps become more or less SAvollen and inflamed. The treatment needed is, chiefly, to give the muscle perfect rest until it recovers, by the healing or knitting together of the divided fibres or fibrillce. The time required for this varies xery much. A strained muscle may be weeks, months, even sometimes a year or more in recovering all its previous strength. Bathing with a stimulating lini- ment, as soap-liniment, will promote the nutritive action necessary for such repair. Perhaps a bandage may be required, for a time, to secure the part at perfect rest. 870 DOMESTIC MEDICINE. Nail, Splinter under. To get out a splinter Avhich is beneath the nail, pare the nail carefully, over the splinter, making a narroAv groove, until its upper end is exposed. Then, with a pair of small nippers or tweezers, or less easily Avith a thumb and finger, one may seize and draw it out. When a nail is injured or destroyed, it groAvs from above, that is in the direction of the length of the finger or toe, doAvmvards or for- wards. This can easily be observed on Avatehing the change of position of marks made and left by the injury, as the nail is gradually restored. Needle penetration. A needle gives almost no pain in entering the flesh anyAvhere; and it may slip about and be pushed by the muscles in various directions, so as to come near or through the surface far from where it entered. An old lady, a patient of mine, had a needle, Avhich got into her hand, to travel as far as her side, beloAv her Avaist, Avhere it made its appearance and Avas taken out. If a needle should happen, in such wanderings, to reach the heart, it Avould no doubt so affect its movements as to cause death; but that is extremely unlikely to happen. Still, nobodyr wishes to have even so small and smooth a thing slipping about in his body. If a needle, or part of a broken one, is known to enter the skin, a doctor had better be asked to try to get at it, if it has not already passed beyond being reached by a small incision. A careful unprofessional person, with a sharp penknife and a pair of small forceps or tAveezers, may safely make such an effort, but it will not be Avorth Avhile to cut very deeply for it. The same may be said of bits of broken glass. If not seen and removed Avhen first getting in, they may remain a long time without much irritation or disturbance. I once removed from the sole of the foot of a serArant-girl a piece of glass more than two inches long, part of a larger piece on Avhich she had trodden two years before. The lameness caused by it, slight at first, had finally increased under some accidental change in the position of the fragment. Nose, Foreign Bodies in. Children noAV and then push peas, small marbles, etc., into their OAvn or one another's noses. If the intruding thing be not very large, bloAving the nose very hard, while the other nostril is closed by pressure, may force it out. If not, a piece of Avire (a hairpin will do) may be bent so as to form a small round loop at its end, and this (first being oiled) may be gently pushed up around and behind the offending object, to draAv it doAvn. Should this not succeed, the aid of a surgeon must be obtained, aaIio will use slender- bladed but strong forceps, made for such emergencies. ACCIDENTS AND INJURIES. 871 Shock. Several times already we have had occasion to speak of this; as, for instance, in connection with lightning-stroke. A shock to the whole system may be produced by a heavy fall; by a bloAv on the head, chest, stomach, or back; or a severe burn ; a gunshot Avound of any part of the body (unless only the hand); a railroad or machinery injury, crushing or tearing a limb or limbs; or a severe fright or other agitation of mind. The condition resulting is that of prostration or collapse, with paleness, coldness, a ghastly appearance of the face, feeble, flickering, or scarcely perceptible pulse, thirst, and loss of voice; breathing some- times gasping. It is a close approach to death. The " indications " for treatment of shock are, for rest, warmth, and careful stimulation or sup- port. In the Avay of rest, avoid carrying the person injured to any great distance. The nearest suitable home or hospital, or even temporary place of repose, should be chosen. Then let him be placed on a comfortable bed, well covered, and Avith direct heat to his body and limbs, by means of hot bricks, bottles of hot Avater, or tins of the same, bags of hot salt, etc., Avhatever can be quickly prepared. For stimulation, ammonia is quick and good; half-teaspoonful doses of aromatic spirit of ammonia, each in a small AVineglassfuI of cold water, eArery fifteen or twenty min- utes, for three or four times. Also, I have confidence in the value of careful alcoholic stimulation in cases of simple shock; but there is no adA'antage, and often afterAvards much disadvantage, to be expected from the enormous doses of Avhisky or brandy sometimes given. A dessert- spoonful (tAvo teaspoonfuls) in a wineglassful of water Avill be enough at a time; repeated, if need be, in a quarter of an hour at first, and with lengthening intervals afterAvards, until reaction conies on. After the first two or three doses it Avill be better to give the whisky or brandy in twice as much milk, instead of water. As soon as reaction decidedly sets in, stop the ammonia and Avhisky. Give, then, at hour-long inter- vals, strong soup or beef-tea, Avith some Cayenne pepper in it for the stomach's sake. If over-stimulation be practised during the time of shock after an injury, fever will be apt to follow, and the crushed limb, gunshot wound, or Avhatever may be the hurt, will be liable to inflam- mation or other troublesome consequences. Spine, fracture or concussion of. If at the neck, death is commonly immediate. A\rhen near the middle of the back, life may continue aAvhile, Avith loss of feeling and poAver in the lower half of the body; including the bladder and bowels. Severe injury of the loAver part of the spine may cause only paralysis of the legs and feet; with Avhich the patient may live for months, perhaps years, bedridden and helpless. Suffocation Avith foul gases. The most common danger of this kind is from carbonic acid gas, Avhich is produced Avhen charcoal is 872 DOMESTIC MEDICINE. burned, and is the chief, but not the only, result of the burning of wood, coal, coal-oil, illuminating gas, etc. Carbonic oxide also is formed in the burning of coal or gas, especially when the supply of air is not great. Both of these gases are poisonous; the latter the most so. Ten per cent, of carbonic acid gas in the air will make it fatal to any one Avho continues many minutes in it; and a less amount Avill cause a person to fall insensible in a short time. Pure carbonic acid gas causes a spas- modic closure of the Avindpipe against it, so that it is really irrcspi- rable. Sometimes a person, from ignorance or want of thought, will go to sleep Avhere charcoal is burning, with too little chimney-draught to carry off the gas. He will either die, or will narroAvly escape death, as Avas the case with a patient of my oavu some years ago, and as happened to a felloAV- student while I Avas attending medical lectures at the University. Or, again, a coal-stove may leak out gas from some defect. This gas is a mixture of carbonic acid Avith other gases; but the effect is of the same kind. The unpleasant smell should Avarn any one of this danger; but that is not ahvays regarded. A bad smell also sIioavs when illuminating gas is leaking into a room ; yet many instances have occurred of persons blowing out the gas in their rooms and then going to bed—never to rise again. Still another danger from carbonic acid is met with in descending into old empty wells, or into beer-vats; in the one case the gas coming from the earth, and in the other fermentation generating it. It is a heavy gas, and takes time and exposure to diffuse it through the atmosphere. Natural gas, used in many places, is almost without smell. What is to be done for any one overcome in either of these ways ? First, get the patient into fresh, pure air. Then dash or sprinkle cold water into his face. If he does not breathe at all, at once begin artificial respiration. (See Drowning.) Also, let some one rub his legs briskly upwards, to favor the movement of blood in the veins toAvards the heart. Warm bricks or bottles should be put to his feet. In the case of my felloAv-student (afterAvards Dr. W. M. Morgan, of Pittsburg) oxygen was brought from the laboratory of the University, and sup- plied for him to breathe; but this can seldom be got. It is often a pressing question hoAV to rescue any one overcome in a beer-vat, or in a well full of stagnant and poisonous air. One man after another may go doAvn (as has repeatedly happened) and fall sense- less like the first victim. Dashing water pretty freely into the Avell or vat will hasten the absorption and diffusion of the gas. So will letting doAvn an umbrella and drawing it up again as fast as possible. One Avho goes into such a place should bind a wet folded handkerchief over his mouth and nostrils; and this is also a useful precaution for firemen ACCIDENTS AND INJURIES. 873 in rushing into a burning building. There is no doubt that many peo- ple in houses on fire are suffocated by gas and smoke before the flames reach them. Another important caution is, Avhen illuminating gas has escaped into an apartment, not to take a lighted candle or lamp, or even a lighted match, into it, as an explosion Avill be likely to folloAV. Some one should, instead, grope rapidly for the AvindoAvs in the dark, and throw them open; and then get the suffocated person out as "soon as possible. Swallowing indigestible things gives alarm in many cases where there is little danger of real injury. Pins are apt to be swalloAved Avhen held in the mouth, wdiich is a very imprudent thing to do; but they Avill more often stick across the upper part of the throat than go doAvn. (See Choking.) When a pin is actually swalloAved, there is reason to believe that it is almost sure to find its Avay at last through the bowels and out Avith the discharges. If a horn button, or a piece of india-rub- ber, or a marble, is SAvalloAved, it will be pretty sure to take the same course in time. None of those things are poisonous. A metal button, hoAvever, as one of brass, or a copper coin, as a penny, is much Avorse. Such a thing may pass safely through ; but if it stays in the stomach or boAvels, gradually corroding, it will poison the system, perhaps fatally. A brother of mine, Avhile a child, lost his life in that Avay, two years after SAvalloAving a brass button. From such a result, no medical skill can provide escape; unless, Avhen such a thing is known at the time to have been SAvallowed, prompt dosing Avith an emetic will bring it up with Aromiting. A teaspoonful of poAvder of Ipecacuanha, or a teaspoon- ful of Syrup of Ipecac, repeated in ten minutes if necessary, and fol- lowed by a large drink of Avarm (not hot) Avater, will answer for this purpose. If no Ipecac, is at hand, a tablespoonful of salt, or a tea- spoonful of mustard, in a teacupful of Avarm water, will do. It is not? Avorth while to give an emetic on account of the swallowing of non-poisonous indigestible solids. Nor is it best to give, on their account, an immediate dose of purgative medicine. Let the person eat rather heartily of soft food, as mush, pudding, tapioca, ete.; and the next day, if the boAvels are not free, he may take a moderate dose of castor-oil. While, however, such things, in a majority of cases, do no considerable harm, exceptions to this do occur. Even an apple-seed or core has been knoAvn to lodge in the appendiculum vermiforme, a small tubular appendage to the large intestine, and, by inducing ulceration, to cause death. I have known swallowing cherry-stones in large numbers (as is often done by boys when up a tree after cherries) to be followed by severe pain and irritation of the boAvels almost like dysentery. On the whole, it is Avell to use our senses of touch, taste, and sight carefully, 874 DOMESTIC MEDICINE. knoAving Avhat is in the mouth ahvays before AAre SAvalloAV it. Among other things, Avhen eating canned ATegetables, fruit, etc., take care not to SAvalloAV bits of soldering metal, such as now and then become loosened in the can. As these contain lead, they may produce lead poisoning. This has been knoAvn to happen. Tendon, rupture of. This is a rare accident, but is knoAvn to have sometimes occurred, especially at the junction of the muscles of the calf of the leg Avith the " Achilles" tendon, which goes down to the heel. John Hunter, the famous English surgeon, met with this injury in dancing, at the age of forty years. Treatment of it requires rest in bed for two or three Aveeks; the foot being extended, so as to keep the heel well raised towards the calf of the leg, and bandaged firmly in that position. Transportation of injured persons. See the last part of the article on Wounds. Ulcers. An ulcer occurs only as a possible secondary result of an injury; as a large wound, burn or scald. For the treatment of such a result, see Ulcer, in Part IV., Special Diseases. Veins, injuries of. See Wounds (pages 875, 876). ACCIDENTS AND INJURIES. 875 Wounds. These may be either Bruised, Crushed, Cut, Lacerated (Torn), Penetrating, or Poisoned wounds. Bruises are familiar to everybody. If the blow or fall has been of such moderate violence as to injure only the surface of the head, body, or limbs, it is not a serious matter. Some blood will be forced out of the small vessels; SAvelling and discoloration Avill follow. It will be first red, then almost black and blue, and at last dull yellow or yellowish- broAvn. This is the history of a " black eye," or of a bruise of any other part. Early use of a soothing application Avill do the most good. There is nothing better for this than cacao (cocoa) butter, or " camphor ice." Arnica has a reputation for bruises far beyond its desert. In the family, hoAvever, for every hurt " something must be done " to ease the minds of those around. Arnica will ansAver this purpose at least. When a bruised part becomes painful, a cloth Avet with lead-water and laudanum will be suitable. Later, bathing with soap-liniment will hasten the absorption and disappearance of the blood-deposit Avhich causes the dis- coloration. Crushed Avounds are much more serious, often endangering life. Such, affecting the head, Avill cause fracture of the skull (see Head, Injuries of). Falling on the chest, ribs may be broken; or, Avorse, the heart or lungs may be so pressed as to kill at once or shortly. When a limb is crushed in a railroad accident, it may be wholly or partly seArered from the body. We might expect great bleeding in such cases; but it does not occur; the arteries are paralyzed, and bleed little or none, even Avhen torn across. The immediate danger then is from shock, going doAvn into fatal collapse. (See Shock.) When this is recovered from, the injured limb must be dealt with according to the methods of surgery. Amputation is often called for; the damage being too great for the limb to be possibly saved. Shock constitutes the greatest immediate danger in all crushing inju- ries. Afterwards, there may be inflammation (or perhaps mortification) of internal organs involved; lungs, liver, stomach, kidneys, peritoneum, etc. Such cases will require perfect rest in bed, Avith treatment which can only be judged of by an experienced practitioner of medicine or sur- gery. Tetanus (lockjaw) occasionally folloAvs a crushing injury. Cut Avounds are dangerous at first through bleeding. Bruised, crushed, and torn Avounds bleed, as a rule, very little. Much difference exists as to what is cut in an incised wound. If only small vessels, the capillaries, are divided, the blood flows steadily, of a moderately red color, being a mixture of arterial and venous blood. If a vein is cut, the Aoav is steady, and the color of the blood is dark-red, almost blue-black or dark-purple. When an artery has been cut, bright red blood comes out 876 DOMESTIC MEDICINE. in jets, timing Avith the pulsations of the heart. (See Physiology; Circulation.) Whatever the source of a Aoav of blood from a cut Avound, avc should endeavor (after cleaning out, best with a stream of cold Avater,any foreign bodies in it) to stop the hemorrhage by putting and holding the edges of the Avound together. Pressure may then be added, so far as needful and available. Over a solid bone, as the skull, this will always be practicable. Bleeding even from a divided artery of the scalp can ahvays be checked, by firm pressure on the A7essel against the bone. A compress may be made by folding up a fragment of handkerchief, or rag of muslin or linen, into a thick piece an inch square. Laying this right over the source of the bleeding, it may be kept in place by the firm application of a bandage around the head. ElseAvhere in the body the difficulty of stopping bleeding may be greater. Worst of all, of incised (cut) wounds at least, not penetrating the chest or abdomen, is the cut throat. For suicidal or murderous purposes, this is not rare. Many suicides divide only the ivindpipe, or the windpipe (larynx or trachea) and gullet (pharynx) together. They die a lingering death after several days. Others make a bolder cut, and sever also the jugular vein; commonly on one side only. This will bleed fearfully, enough to cause death in a very short time. If promptly seized betAveen a thumb and finger, and then skilfully stitched with a small surgical needle, it is possible that life may be saved ; but, with the best surgery, this has seldom been done. Noav and then a suicide may reach Avith the razor one, almost never both, of his carotid arteries, Avhich lie closer to the windpipe than the two jugular veins, but are deeper in the throat. Such a Avound, unless it be a mere -nick in the artery, will end life in a feAV seconds. A very slight incision in the carotid alone may, if at once seized and held firmly, allow of the tying of the artery Avith a ligature, beloAv the Avound. This operation not many surgeons have performed; and it does not always succeed in avert- ing death as the final result. To stop bleeding from a vein, large enough to be seen, when pressure at the wound will not do it, the rule is to press just below the wound; that is, on the side farthest from the heart; as the blood floAvs in the veins from the extremities towards the heart. When an artery bleeds, and pressure at the wound fails or cannot be applied, pressure must be applied above the Avound; that is, on the side nearer to the heart; the course of the blood in the arteries being from the heart. In Physiology this has been fully explained, and the way to find the main arteries of the body has been set forth. We may just repeat a few practical points. A C CID ENTS A ND IN J URIES. 877 If a finger bleeds from a deep cut very freely, pressure on the two sides of the finger will check the arterial flow and control it. If the hand or forearm has an arterial hemorrhage, the brachial artery (main artery of the arm) must be compressed. This is done by finding its pulsations behind the biceps muscle, on the inner side of the arm, and holding it there against the arm-bone (humerus). To continue such pressure, a Spanish windlass may be made. Pass a handkerchief around the arm, and tie a knot in it, close to the arm on the inside. Then put under the handkerchief, on the outside, the handle of a hair-brush, or a stick of any kind, and twist it until the pressure suffices to stop the floAV of blood. If the arm is held up with the hand raised above the Fig. 267. Fig. 268. Fig. 269. PRESSURE ON SPANISH AVINDLASS. PRESSURE ON ARTERY OF ARTERY OF ARM. THIGH. head, this will be the more easily effected. Such pressure cannot be very long maintained, without danger of mortification of the limb. Should the bleeding return as soon as the " windlass " is partially un- wound, surgical aid must be obtained to " take up " the artery; that is, to cut down to it and pass a silken or catgut cord (ligature) around it, and tie this so as to stop all movement of blood through the artery. Some hemorrhages from the forearm or hand may be held in check by forcibly doubling the arm at the elbow, in this way compressing the artery where it branches, in front of the elbow joint. If the foot, leg, or thigh is cut so deeply as to have an arterial hemor- 878 DOMESTIC MEDICINE. rhage, the place of pressure (if it cannot be applied sufficiently at the Avound) must be at the upper and inner part of the thigh; that is if the Spanish windlass be used, the application being just the same in method as upon the arm. But a still surer place of pressure is where the great artery of the limb passes over the bony edge of the pelvis; just half-Avay betAveen the middle of the pelvis in front and the promi- nent point of the ridge of bone at the front of the hip-bone (anterior superior spinous process of the ilium; see Anatomy). There its pul- sations can be felt; and the handle of a large key, wrapped Avith tape or ribbon to soften its pressure, may be held firmly doAvn upon it so as to keep the Aoav of blood back altogether. Suppose then that, having a cut-wound to treat, all bleeding has ceased, and no dirt or fragments of any kind are in the wound; avc must now try to prepare it for healing without delay or deformity. Fig. 270. PRESSURE BY ELASTIC BAND. Place the edges together. Will they stay so ? Not often Avithout sup- port. On many parts of the body this may be given by strips of ad- hesive plaster ;* if the Avound is large, several narroAv strips, with small spaces between them. When the edges are evidently not going to be securely held in that Avay, stitches will be important. Silk or shoe- maker's thread (or other thread, if necessary to save time), Avaxed, will answer; and a large common needle may be used instead of a sur- geon's needle, if professional assistance is not within reach. Tavo sorts of stitches are often employed: the continuous and the interrupted. The latter is generally to be preferred; each stitch can then be dealt with apart as it requires. For it, pass a threaded needle from within the wound out through the skin; then take off the needle and thread it with the other end, and pass it in the same way out through the other * Martin's (or Grovenor & Richards') rolls or spools of " Surgeon's adhesive plaster" are the most convenient for such use. ACCIDENTS AND INJURIES. 879 side of the wound. Then the two ends should be brought together and tied. Lips, noses, ears, and some other parts will be apt to have gaping wounds and ugly scars, when cut, unless stitches are used. We Avant a Avound, then, to heal " by the first intention," as it is called. That is, directly, without any pus or matter being formed. All that is necessary for this, with a clean-cut wound in a healthy body, is, that the edges shall be brought and kept close together for a few days, without disturbance. Put over the Avound, then, after the plasters or stitches have been applied, a doubled piece of lint or soft clean (mark this, clean) linen, spread Avith simple cerate, or clean tallow, and bind this on with a bandage, just tight enough to keep it in its place. The part must then be kept at rest, aud need not be disturbed, Avhile it seems comfortable, for four or five days. In that time, a surgeon's adATice can usually be obtained. If not, and the Avound does not seem comfortable, it must be carefully examined, and perhaps dressed over again. After five days, at all events, it may be very carefully uncovered; remoA'ing the outer cerate dressing, and seeing Avhether or not any of the adhesive strips need to be reneAved. If this be so, be sure to take them off one by one; draAving the strip towards, not aAvay from, the edge of the wound ; and replacing each strip by a fresh one, before another is taken off. Very little Avashing is necessary for healing incised wounds. Clean the parts near with Castile soap and water, but do not interfere with the plastic process going on at the wound itself. Water-dressing is preferred to cerate by many surgeons, even for simple incised Avounds; but it appears to me to have greater adA^antages in the management of lacerated and penetrating Avounds. Lacerated wrounds are those which are torn ; as by machinery, or bites of dogs, horses, or other beasts, etc. They are irregular in shape, seldom bleed much, but often inflame, sometimes mortify, and hardly ever heal " by the first intention." Machinery injuries may be dreadful in char- acter ; a Avhole limb being torn off at once; or a hand or a foot torn to pieces. Such may be speedily fatal by shock; or their results may entail a tedious and uncertain struggle for life; at least when an arm or a leg is badly lacerated. Erysipelas is one of the dangers attending such injuries; tetanus (lockjaw), another; septiccemia (or pycemia), another. Besides what may be needful on account of the general shock to the system (see Shock), lacerated wounds require to be carefully cleared of all fragments of foreign bodies, dirt, etc., and then protected from the air by a proper dressing. To cleanse such a wound, a stream of water should be allowed to Aoav over it from a clean sponge, dipped in warm water and squeezed above the wound. Water-dressing agrees well 56 880 DOMESTIC MEDICINE. Avith such injuries. Double a piece of lint or soft linen, and squeeze it out of clean tepid Avater or clear lime-water. Lay this upon the avouikI, and cover it with a piece of oiled silk, oiled paper, or thin rubber-cloth. Bandage it ou the part Avith just enough firmness to prevent its being displaced. Such a dressing Avill have to be moistened at least tAvice a day, and had better be changed once in twenty-four hours; disturbing the Avounded surface each time as little as possible. Before the dressing is reapplied, sprinkle iodoform poAvder lightly over it. This is antisep- tic, and promotes healing. Much is said in late surgical works of antiseptic dressings for Avounds. The idea of it is, by chemical solutions applied to injured parts, and to the hands of surgeons and nurses, etc., to destroy the "germs" in the air, water, and other materials Avhich are supposed to breed putrefaction, decay/, and disease. We have discussed this theory in connection Avith the Causation of Disease (Germ Theory of Diseases). Enough here to say that the importance of it is much the greatest in large hospitals, or other houses in cities, Avhere the air is apt to be foul; and that the practical results of antiseptic surgery, so called, are equaled, Avithout any special " solutions," Avhen absolute cleanliness is maintained, of air, water, and all other materials. When much irritation or inflammation of lacerated Avounds occurs, a poultice, of bread or flaxseed-meal, may be for a time beneficial. When healing is advancing favorably, instead of the wet dressing, lint or linen spread Avith simple cerate will ansAver, and is much less troublesome. Penetrating Avounds may vary much; from piercing Avith a pin to a bayonet, sword, or bullet wound. Even a needle or large pin may be forced into the heart, so as to cause death. One of the first Napoleon's generals so committed suicide. Usually, however, a needle glides almost harmlessly through skin and flesh, and the head of a pin prevents its deep penetration. The seriousness of larger penetrating Avounds depends almost entirely upon the parts reached by the puncturing instrument or Aveapon. A bayonet or bullet wound of the heart Avill always kill. One of a lung will be most frequently mortal; but the exceptions are many. General Shields, U. S. A., Avas shot through the chest, many years ago, and recovered. A patient of my OAvn, in hospital, got well after a load of buckshot had gone through a part of his right lung. A pene- trating wound of the stomach is nearly certain to be mortal; yet Dr. Beaumont, of Ohio, Avas made famous by his physiological experiments in the case of the Canadian soldier, Alexis St. Martin, Avho lived for years Avith a hole in his stomach through Avhich food could be taken out during digestion. Wounds of the bowels are only a little less dangerous, especially because peritonitis is so likely to supervene; and ACCIDENTS AND INJURIES. 881 the same may be said of injuries of the liver, spleen, kidneys, and other organs contained in the abdomen. Penetrating Avounds of the head have been considered already (see Head, Injuries of). When an arm or a leg receives a knife or bayonet thrust, or a bullet or shot wound, there may be hemorrhage, from a large vessel being pierced or divided. Then it needs the same kind of management as a bleeding cut or incised wound. If not this, there is little immediate danger to life; but inflammation, suppuration, mortification, erysipelas, pyaemia, and septicaemia are all possibilities in such cases. Every one receiving a severe penetrating wound, of any part of the body, must be kept in a condition of complete rest, awaiting results Avhich need to receive the best professional attention, to meet the dan- gers, seen and unseen, belonging inevitably to such injuries. Those who were old enough to read the daily bulletins of President Garfield's heroic struggle for life, under care of the best surgeons in America, and the best possible nursing, may Avell knoAV that a sentence of death may come Avith the entrance of a missile, which no human skill or power can avert. Poisoned Avounds. These are seldom met with, even in war, amongst civilized nations, except by unintended causation. This may happen especially to physicians and surgeons, in their operations, and to medical students in the dissecting-room. Matter from dead bodies, or from dis- eased living ones, introduced even into the slightest scratch with a knife, needle, or pin, may so taint the blood as to produce a dangerous illness. Not a feAV physicians have suffered a fatal result from pricking a finger in a post-mortem examination. To prevent such results (besides care to avoid letting an abraded or punctured part come in contact with morbid matters), as soon as such a thing has happened, the part should be im- mediately washed and sucked, and then kept out of the way of further danger. In the treatment of poisoned Avounds, there is nothing different from that of those which are penetrating or lacerated, unless the wound is made by rabid animals or by venomous serpents. For either of these last, immediate suction is a right precaution ; and at the same time a tight cord around the arm or leg, if either extremity has been bitten; then the end of an iron wire or rod, heated red hot, or a piece of caustic potassa, should be made to burn out the part; or a pinch of gunpowder may be exploded upon it. All these severe measures are designed to prevent the poison from getting, through the blood-vessels, into the sys- tem. Although not more, probably, than one in ten of those bitten by mad dogs have hydrophobia, that one will incurably suffer a dreadful death. Therefore it is Avorth while to do and suffer much to prevent 882 DOMESTIC MEDICINE. such a possible catastrophe. (See Hydrophobia, under Special Dis- eases.) Bites of rattlesnakes, copperheads, and moccasin serpents in this coun- try, and similar reptiles in the countries of the old Avorld, are often fatal. In India, thousands die annually of the bites of the cobra and other venomous snakes. The danger is greatest according to the amount of the poison introduced, and the part of the body bitten. After a rattle- snake has already bitten anything several times, his poison-bag is empty, and his fangs are almost innocent of venom for a time. Biting through a boot, or thick clothing, detains much of the venom, lessening the dan- ger. But if an unexhausted serpent of that species, or a moccasin, or a copperhead, bites the bare face or neck, or hand or arm, death will be likely to take place within an hour or two. If other parts of the body be bitten, it may still be fatal, but there are chances of recovery. Is there any reliable antidote ? You will read accounts of such in many books and neAvspapers. But Dr. S. Weir Mitchell, after a most elaborate series of experiments, con- cluded that, at the time of his researches, no true antidote to rattlesnake poisoning had been found. Since then, two such (for other serpent bites) have been asserted; ammonia in Australia, and permanganate of potassium in South America. Both are injected in solution, either into the poisoned wound or into the skin (hypodermic injection) elseAvhere. Observers in other countries have been disappointed with Dr. Fayrer's ammonia antidote. Dr. Lacerda's permanganate treatment has not yet had sufficiently extended trial for a final conclusion; but, were I bitten, I should wish to try the latter. It can be confided in only Avhen intro- duced immediately at the place of the poisoned wound. Popular rather than scientific has been the whisky treatment of rattle- snake poisoning. Yet science cannot object to it, since one poison is often an antidote to another. The practice referred to is, to dose the victim Avith Avhisky pretty largely, with quantities which would intoxi- cate if the state of the system did not prevent or at least retard it. There is reason to believe that patients do sometimes recover under this treat- ment who otherwise Avould probably have died. Another (now quite unpopular) remedy is suggested by some facts observed in experiments upon animals. In those bitten by venomous serpents, it has been found repeatedly that drawing blood from their veins has been folloAved by immediate improvement, and sometimes by recov- ery. As a method of getting rid of tainted blood, this appears to me a most reasonable procedure. Not anticipating its general acceptance under the noAV prevailing opposition to this remedy under almost all circumstances, I must be content Avith commending its consideration and fair trial to the coming generation. ACCIDENTS AND INJURIES. 883 Stings of bees, wasps, yellow jackets, and hornets, as well as of some spiders, and, in other countries than this, the tarantula and scorpion, are often decidedly painful; in a few persons, they may even endanger life. When, for instance, upon disturbing a hive, a whole swarm of bees fly out and light all over a man's head, face, neck, and hands, the amount of venom introduced by even such small " beasties' " stings is not trifling. Horses have sometimes been thus stung to death. The old simple country remedy I have found effectual—smearing the place at once Avith mud, from the nearest spot aa here earth and water can be mixed together. Ammonia (spirits of hartshorn) is nicer, and probably more certain to be effectual, applied at once to the stung part. If a person seems to be affected " all over " by even a single sting of a bee (which sometimes happens), half a teaspoonful of aromatic spirit of ammonia, in a wineglassful of Avater, may be taken as a draught, at once; and, as soon as it can be obtained, twenty grains of bromide of potas- sium, in the same quantity of water. The latter dose may be repeated in tAvo or three hours, if required. Hot water is recommended by some, to be applied at once to the part, as a remedy for the sting of a bee, Avasp, etc. I have not tried it, but suppose it may be efficacious, if very hot, by destroying the poison. A moistened cigar, or plug of tobacco, is said to give prompt relief to the pain. An onion is also advised, in some popular works, as a local remedy, even for the bite of a venomous serpent. I can give no opin- ion as to its value. Transportation of Injured Persons. On this subject we cannot do better than follow Esmarch, the distinguished German surgeon.* " When an accident occurs, be it in the country, on the high road, or in a toAvn, the first thing to be done is to transport the injured person as quickly and as carefully as possible to a doctor or to a hospital." " In such circumstances, stretchers or litters should, if possible, be used. These are simply light portable beds made of a framework of poles, Avith a piece of canvas stretched between them." " To place an injured person on a stretcher and convey him properly requires a certain amount of handiness—which, however, is easily acquired by a little practice. Only three bearers are required, unless the distance be very great; two of them carry the stretcher, and the third attends to the patient, and changes place with one of the bearers if necessary. * " Early Aid in Injuries and Accidents." Translated by H. E. H. Princess Christian. Philada., Lea Brothers & Co., 1884. 884 DOMESTIC MEDICINE. " To place the patient on it, put the foot of the stretcher at his head in a line Avith his body. If you put it at the side of the patient, it is in the way of the bearers, and they may stumble or fall over it. The two bearers then place themselves one at either side, join hands under- neath the back and hips of the patient, raise him up, lift him backwards over the stretcher, and loAver him on to it. The third bearer takes charge of the injured portion (limb or head), and steadies it with a hand on either side. The tAvo bearers noAV take their places at the head and foot of the stretcher, lift it up, and carry it off; while the third Avalks at the side of it, as a safeguard to the patient. " The following rules should be observed in carrying a stretcher : "1. It should be carried Avith the hands, or suspended by straps over the bearers' shoulders. WHEELED LITTER. " 2. The bearers should not keep step. If they keep pace, as in march- ing, the stretcher sways from side to side, and the patient is apt to roll. " 3. All jolting, hurried movements, the crossing of fences, ditches, etc., are to be avoided. Look out for gaps, gates, and doors, and make use of them. " 4. If possible, choose bearers of the same height. If this cannot be done, arrange the shoulder-straps in such a Avay that the stretcher may be balanced as evenly as possible. " 5. In ascending, the patient's head must be in front; in descending, behind; except in the case of a broken leg, Avhen, if such a course were adopted, the Aveight of the body would press on the injured part. " 6. The patient must be removed from the stretcher in the same manner in which he Avas placed on it. " Should no stretcher be at hand, one must be improvised—i. e., you must look about for a substitute, or put together a variety of thing* on which the injured person can be transported without further harm. ACCIDENTS AND INJURIES. 885 Amongst the articles to be found in inhabited houses Avhich can be used for such, are—bedsteads, bedframes, sofas, window-shutters, boards, benches, chairs, ete. Such hard materials should be covered by pillows, blankets, straw, etc.; mattresses, or sacks of straw, having rings or loops made Avith straps attached to their four corners, may also be used as stretchers. Counterpanes, blankets, rugs of all kinds, may be carried by the four corners by four men; or may have two poles sewn to their sides, and be carried by two men. Empty corn or flour sacks may be used for the same purpose. From Avoods and gardens you can take branches and young spruce stems, and, binding them together with birch twigs, make excellent temporary stretchers Avith supports." " If neither a stretcher nor material out of Avhich to make one can be found, then try to transport the wounded man with your arms, Avhich naturally can only be done for a short distance." " The Avounded man must place his arms around FlG- 2?2- the neck of the man carrying him." " Should there be two people at hand to render assistance, the Avounded man may be transported in a A'ariety of ways, viz.: 1. Sitting on the hands of the bearers, avIio pass two hands under the thighs and two behind the loins, the patient putting his arms round the necks of those carrying him. ^ 2. The persons transporting aA B wounded man join their hands firmly together, injured person. forming a sort of sedan chair, on Avhich they can carry him a long distance if he places his arms around their necks." We may add that a chair, especially an arm-chair or rocking-chair, in which the patient is seated, will answer Avell to carry an injured person. If he be faint, or if a lower extremity be hurt, the chair may be tilted backwards as far as his comfort may require. When two bearers carry a patient in any way without a litter or stretcher, they should keep step; as the motion is then more even, and there is no danger of his rolling out of their arms or out of a chair supported between them. When any one is so injured as to be in a state of collapse, approaching death, as from drowning, suffocation, or hemorrhage (bleeding), it is necessary to attend first to his prostrate condition on the spot; before taking him to a hospital, or anywhere else. (See Drowning.) When there is severe bleeding, its source must be found, so that it may be stopped (see page 876). For such inspection, do not wait to take off the clothing near the injured part; but cut or rip all that is necessary for the purpose. 886 DOMESTIC MEDICINE Fig. 273. Fig. 274. MODES OF CARRYING INJURED PERSONS. Fig. 275. ROCKING-CHAIR FOR CARRYING A PATIENT. P^R T VI. POISONING. POISONS are of several kinds: animal, as snake-venoms and can- tharides; vegetable, as opium, strychnia, tobacco; mineral, as irsenic and corrosive sublimate. But a more useful classification of diem is according to their effects: as Depressants, Irritants, Neu- rotics, and Complex Poisons. Depressants are Prussic (Hydrocyanic) Acid, Tobacco, Lobelia, Jlemlock, and Aconite. It is true, the effects of these, and indeed of ydmost all poisons, have some complexity; but their chief effect is de- pression, sinking, prostration; which, from a certain dose, is fatal. Irritants are strong Acids, as Sulphuric, Nitric, Hydrochloric, Oxalic, Citric, and Tartaric Acids; strong Alkalies, as Potassa, Soda, and Am- nonia; Phosphorus; Corrosive Sublimate; Tartar Emetic; Salts of Copper and of Zinc; Castor-Oil Seeds; Colchicum; Croton-Oil; Can- tharides; and certain Fishes and Molluscs (some Mussels, etc.). Neurotic Poisons either produce stupor, as do Opium, Chloroform, Ether, Chloral, Hyoscyamus, and Camphor (in excessive doses); or otherwise damage the nervous system, with either delirium, convulsions, tremor, or paralysis, as Strychnia (or Nux Vomica), Belladonna, Stra- monium, Calabar Bean, Cocculus Indicus. Complex (Irritant-Neurotic) Poisons are such as Arsenic, Carbolic Acid, Creasote, Digitalis, Ergot, Fungi (Toadstools, etc.), Hellebore, Iodine, Bromine, Lead, etc. As already said, Depressant Poisons cause prostration, sinking: with paleness, coldness, feeble pulse, gasping breath, with or Avithout nausea and vomiting; all the symptoms of collapse. Irritant Poisons produce burning and pain in the mouth, throat, stomach, and bowels; with nausea, vomiting, and purging; an artificial cholera-morbus. Neurotic Poisons have just been described as causing either stupor, delirium, convulsions, tremor, or paralysis. Complex Poisons may oombK ie several of either of these kinds of effects. 887 888 DOMESTIC MEDICINE. So far, we have been considering Poisons as taken into the stomach by the mouth. It must be remembered, however, that they may also enter the system by being breathed into the lungs; injected under the ekin; or even absorbed from the surface of the skin (especially with children; a tobacco leaf has beeu so fatally used); or inserted into the boAvels, etc. With these general remarks, Ave may uoav take up those poisons most likely to be met with, or heard or read about, alphabetically, for ease of reference by the reader. Acids. As already said, strong Acids are generally irritant poisons. Hydrocyanio or Prussic Acid is a powerful depressant. Each of these Fig. 276. ACONITE ROOT. will be considered in its place. Just noAV it may be remarked that the antidotes for Acids are Alkalies and Alkaline Earths; as Soda, Lime- water, Chalk, Magnesia, and Soap, etc. In like manner, Acids of the milder sort, as Vinegar, Lemon-juice, etc., are antidotes for poisonous doses of strong Alkalies or Alkaline Earths, as caustic Potassa, Soda, Ammonia, or Lime. Aconite. All parts of this plant (Monkshood, Aconitum napellus) are poisonous. The only form in Avhich any one is likely to take it injuriously is that of the Tincture of Aconite Root, in overdose (the POISONING. 889 proper dose is one, two, or three drops), or by mistake for something else. Death has been caused in this way: tAvo bottles are standing by a patient's bedside, one containing a medicine to be taken internally, and the other a liniment for external application; an attendant, by mistake, rubs a painful part Avith the medicine, and gives him a tablespoonful dose of the aconite liniment. Symptoms: burning, tingling, and numbness of mouth, throat, and stomach, extending afterwards through the whole body; sickness of stomach, dizziness, prostration, sometimes convulsions; no delirium, no Fig. 277. ACONITE LEAVES AND FLOWERS. stupor, unless in quite exceptional cases. Death, from a sufficient quan- tity, results in a few hours. Less than a half a teaspoonful of the Tinct- ure has proved fatal in some instances; a teaspoonful will always be likely to do so, if left long in the stomach. Treatment. There is no chemical antidote for Aconite. Vomiting should be produced at once to get rid of it. In the household, do not wait to send to a druggist, but give immediately a teaspoonful of mus- tard, mixed in a teacupful of warm (not hot) water. Repeat this in ten minutes, with large draughts of warm water, if vomiting does not 890 DOMESTIC MEDICINE. folloAV. If no mustard is at hand, a tablespoonful of salt, in a teacupful of warm, not hot, water, will ansAver the same purpose. Then mix pow- dered charcoal, a teaspoonful at a time, in water, and let it be drunk; and also very strong tea, freely taken. Let the limbs be briskly rubbed Avith warm hands, and place hot bottles or bricks alongside of the body and to the feet. If other treatment is used, it should be only at the judgment of a physician, avIio should be summoned as soon as possible. This remark Avill apply to all cases of poisoning; and need not there- fore be hereafter repeated. Alcohol. Hardly ever by accident, but sometimes through folly, men have taken at one time enough Avhisky or brandy, etc., to kill. The quantity necessary for this ATaries, especially with the habits of the person so doing. An old toper may SAvalloAV a half-gallon of Avhisky in a day, with no extraordinary effect. A man unaccustomed to liquor might be killed by a pint; possibly even by less. In such a case, the symptoms are those of narcotic poisoning; Avitli but little primary ex- citement, he falls soon into a deep stupor. The face becomes ghastly, the lips livid, the pupils of the eyes large, the eyes reddened ; the breath- ing is snoring, and an alcoholic odor loads the breath ; death may take place within an hour or two. Short of such an event, there are degrees of " dead drunkenness," in which the same symptoms appear, but the stupor is less complete; on being shaken and spoken to, the man Avill open his eyes partially and shoAV some consciousness. He will then relapse into stupidity, until, after several hours, he sleeps it off. Treatment of dead drunkenness, when there is not an actual mortal effect, does not gain by any violence. If the patient can swalloAV, an emetic dose of mustard (a teaspoonful) or salt (a tablespoonful) or ipecac. (a teaspoonful) in warm water, may be given. Wetting the head and face repeatedly with cold Avater will promote revival; and so may aro- matic spirit of ammonia; half a teaspoonful, taken in cold water, and repeated in an hour or two. Alkalies. See Acids. Aloes. This is an active purgative medicine, whose effects in over- dose are those of an irritant poison. The same account may be also given of Elaterium (much more powerful), Colocynth, Gamboge, lalap, and Scammony. Any of these in excessive dose will bring on painful griping, vomiting, and purging, Avith consequent exhaustion. Treat- ment of such a condition must consist in perfect rest (a bed-pan being used), and often-repeated small doses of laudanum or paregoric. An injection of laudanum (forty drops) in starch into the bowels will be well. Lime-Avater and milk, equal parts, may be administered by the tablespoonful to support strength; adding teaspoonful doses of whisky POISONING. 891 or brandy, a feAV times, if prostration be great. Warm bricks or bot- tles of hot water, etc., also, applied to the body and feet, Avill do good. Ammonia. This is the volatile alkali. It has the same chemical relations as the fixed alkalies, potassa, soda, and lithia; but flies off into the air when exposed, requiring, unless dissolved, extreme cold or very great pressure to condense it. It is intensely pungent to the taste and to the breathing organs, and acts as an irritant poison Avhen taken in large quantities. Tavo or three teaspoonfuls, at least, of the stronger Solution of Ammonia Avill be necessary to endanger a fatal result. Aromatic Spirit of Ammonia might have such an effect, if a tablespoonful or tAvo Avere SAvalloAved at once. Symptoms of such poisoning are, extreme burning and pain in the stomach, with nausea and vomiting, folloAAed by collapse (deathly prostration), Avhich may end fatally in a few hours. One case has been reported in Avhich this took place in a few minutes; another, after three days. Its being breathed freely hastens the effect. Treatment of poisoning Avith Ammonia is like that for other Alkalies. Give Vinegar and Avater, or Lemon-juice, quickly and largely. After- wards, Olive Oil; then Milk; or, if no sweet-oil is at hand, Milk alone. The Vinegar or Lemon-juice combines with and ncutrcdizes the alka- line Ammonia. Oil makes a soap With it, Avhich is innocent. Milk will then promote the required soothing action, and Avill also nourish and support the patient. Antimony. This metal is present in Tartar Emetic; Avhich is an ingredient of Antimonial Wine and of Coxe's Hive Syrup. The last of these Avas formerly (but ought neArer to be) a common domestic medicine for croup. Syrup of ipecac, has noAV very properly taken its place. All preparations of Antimony are poAverfully emetic, unless in extremely small dose. They are particularly severe in their action upon young children. Symptoms of poisoning by Tartar Emetic are: a metallic (" coppery ") taste, violent nausea, retching, and vomiting (the author suffered Avith it once, by accident, and found it worse than sea-sickness), thirst, pain in the stomach and boAvels, and Avatery purging; then great prostration, Avith coldness and clammy perspiration. When only a single overdose has been taken, death may be escaped by all the poison being vomited up. If repeated soon, the danger is increased. The quantity necessary to kill varies much, chiefly for the above reason. Less than a grain of Tartar Emetic has killed a child; four grains have proved fatal to an adult; but, more often, tAventy or more grains Avould be required for such an effect. Mostly, death does not take place for several days after the poison has been SAvalloAved. In treatment of poisoning by Tartar Emetic, Tannin (Tannic Acid) is 892 DOMESTIC MEDICINE. considered to haA-e some antidotal poAver. If infusion or tincture of Galls can be soon obtained, let it be given, pretty freely. In the ab- sence of this, very strong Tea may be given. At the same time admin- ister moderate but often-repeated doses of some opiate; laudanum or Paregoric. In my oavu case, above alluded to, teaspoonful doses of Paregoric gaAre relief in a feAV hours; the quantity taken, however, (through mistake of a druggist's boy) having been not very large. Arsenic. Both by accident and through suicidal or murderous in- tent, this is one of the most frequently fatal poisons. It is used in the manufacture of enamel, and of some kinds of glass, and in ship-build- ing and boiler-making; as well as by farmers to kill potato bugs (Paris green), and in houses and barns to destroy rats. A medicine containing it, often valuable in its place, is FoAvler's Solution of Arsenite of Potas- sium. Arsenic is present also in orpiment and in Scheele's green (arsen- ite of copper), as Avell as in Paris green (aceto-arsenite of copper). White Arsenic of the shops is Arsenious Acid. Metallic Arsenic is very seldom used, unless with Arsenious Acid in fly-powder. Symptoms of arsenical poisoning are complex. It is an irritant-neu- rotic in its action. About an hour after taking it, there are symptoms of faintness, heat of throat, thirst, and burning pain in the stomach. Violent retching and vomiting follow, and the pain extends through the bowels, with straining and severe purging; sometimes with bloody passages. Prostration soon results; Avith coldness, small, frequent pulse, and great feeling of weakness; not infrequently delirium, convulsions, or eAren stupor, Avill precede death. In slower cases, headache, trembling and other distressing nervous symptoms are common. There is, hoAvever, considerable variety in the symptoms of poisoning by Arsenic. Death results in most cases within twenty-four hours; exceptionally, but rarely, in an hour or less; occasionally, after weeks, or even months of pro- tracted suffering. Treatment. If vomiting has not been already copious, give a teaspoon- ful of mustard or a tablespoonful of salt in a teacupful of Avarni Avater ; and follow this with large draughts of warm water, in which Magnesia has been stirred and mixed. Magnesia is at least a partial antidote for preparations of Arsenic. The most effectual antidote is Hydrcded Per- oxide (sesquioxide) of Iron; in large doses, in the moist state, and freshly made. This maybe prepared by putting Tincture of Chloride, of Iron in AATater (quantity not of very great consequence, use plenty of it), and then adding Aqua Ammonias (solution of Ammonia or hartshorn). A thick poAvder Avill be thus precipitated;—which, after Avashing it with clean water, may be given in tablespoonful doses as an antidote for Arsenic After this has been freely given, or, in its absence, Magnesia, POISONING. 893 then an opiate, as Paregoric or Laudanum, may be administered in moderate doses, to mitigate suffering; and milk, at first hot (unless pre- ferred cold on account of thirst) will be for a time the most beneficial food. It may be here remarked, that a practical question of some impor- tance is, Avhether there is danger of arsenical poisoning from the use of Paris green to kill potato bugs or other injurious insects on growing plants, in gardens or fields. Good authority exists for the opinion, that no such danger exists, when reasonable care is taken. Growing plants, as potatoes, will not absorb arsenic into their substance so as to make them poisonous. The Paris green is entirely on the surface of the plants, or on the ground, Avhere it becomes so diluted Avith moisture and earth, as to be present, Avhen ordinary quantities are used, only in harm- less amount. Mention has been made on a previous page, of the existence of arsenic in the coloring material of many wall-papers. This is wrong, and should be made criminal under the law. When the paper is dry, arsenical dust may get from it into the air of the room, in a quantity sufficient to do much harm, and even endanger life. In one instance under my knowledge, it seemed probable that a lady suffered a fatal ill- ness from sleeping for several months in a room Avhose Avails Avere cov- ered Avith green paper containing arsenic. 894 DOMESTIC MEDICINE. Atropia : Belladonna. Atropia is the alkaloid active principle of the plant, Atropa Belladonna, called also Deadly NigJdshade. The berries of this plant have sometimes been eaten by children, Avith fatal effect. Symp- toms of this poisoning are, dryness and heat of the mouth and throat, difficulty of SAAralloAving, sickness of stomach, dizziness, dilatation of the pupils, imperfect sight, flushing of the face, delirium, convulsions, and finally stupor. When recovery occurs, some of these symptoms are sIoav to disappear. Atropia may cause death in doses of less than a grain; perhaps as little even as but half a grain by the mouth, and still less when intro- duced under the skin by injection. Treatment of poisoning by Belladonna or Atropia requires the prompt use of an emetic. GiAre at once a teaspoonful of mustard, or a table- spoonful of salt, in a teacupful of Avarm Avater. Repeat this (or ipecac. if at hand) in ten minutes if it does not cause vomiting; and accompany it Avith large draughts of warm Avater, in Avhich finely powdered cAar- coal has been mixed; or better, charcoal and magnesia. Physicians have much confidence in the antagonism between Atropia and Morphia (or Belladonna and Opium); but that part of the treatment had best be reserved for professional skill and judgment. The principle of it is to give, by the mouth or by hypodermic injection, rather large doses of the antagonist alkaloid (morphia for atropia poisoning, or the converse), at intervals of half an hour or so, until relief is obtained, or the characteristic effects of the antidote appear. Atropia causes the pupils of the eyes to become very large; Morphia makes them contract; in this Avay the predominant influence of one or the other can be seen. A large dose of Morphia (sulphate or acetate) would be a quarter of a grain ; of Atropia, one-thirtieth of a grain. Bitter Almonds. Oil of Bitter Almonds, Avhose flavor is agree- able, contains a small amount of Prussic (Hydrocyanic) Acid; and this is a deadly poison. Twenty drops of Oil of Bitter Almonds may kill. Symptoms of this poisoning, which come on usually in a feAV minutes, are, extreme prostration, coldness, nausea, dilatation of the pupils, sometimes convulsions'; in other cases stupor, with snoring respira- tion. Death is likely to occur Avithin an hour. In trecdment, we have no certain antidote. Dashing cold Avater repeatedly in the face and on the chest (drying it at once Avith a Avarm towel), or even over the Avhole body, is recommended; and the careful but repeated application of ammonia (smelling-salts) to the nostrils. Recovery from the effects of a large potion of this poison is, hoAvever, hardly to be expected. POISONING. 895 Camphor. This is not mentioned among the poisons in books on Toxicology. A young relative of mine, hoAvever, as a boyish experi- ment, SAvalloAved about a tablespoonful, or possibly more, of Spirits of Camphor. He lay in a stupor for six or eight hours, and then gradually recovered. I have never knoAvn another similar case; but this is men- tioned to shoAV the need of care in leaving powerful, even though familiar, drugs Avithin the reach of children. Cantharides. Spanish Flies. Ointment of Cantharides is used to raise blisters. The Tincture is occasionally employed as a medicine. In large doses it acts as an irritant poison, especially disturbing the uri- nary apparatus; strangury (difficult and painful discharge of urine) being its characteristic effect. Vomiting and purging also' occur, and sometimes convulsions before death, which may not result for two, three, or more days. In treatment, as there is no chemical antidote for Can- tharides, an emetic must be at once given (mustard, salt, or ipecac, with copious draughts of Avarm water), and may be followed by charcoal and Fig. 278. CANTHARIS VITTATA. CANTHARIS VESICATORIA. magnesia water, or, if at hand, flaxseed-tea. Strangury may be best relieved by an injection of forty drops of laudanum, with a little starch, into the bowels; also, cloths wrung out of hot Avater may be applied over the bladder; or the warm hip-bath may be used with advantage. Carbolic Acid. This is also called Phenol. It is to Coal-Oil (Pe- troleum) what Creasote is to Tar from wood. Symptoms of poisoning by either Carbolic Acid, Kerosene, or crude Petroleum, are those of an irritant narcotic. First there are burning of the mouth, throat, and stomach, pain in the abdomen, vomiting; then great prostration, faint- ness, coldness; lastly, insensibility and stupor, ending in death. A tablespoonful of the liquid Carbolic Acid will be pretty sure to cause death, in from half an hour to eight or nine hours. In treatment of this form of poisoning, we must first use an emetic (mustard, salt, or ipecac, with plenty of warm Avater), and then give the patient large draughts of sweet oil. If that is not on hand, lime-water and milk, freely given, will be likely to do good by shielding the coats of the stomach and boAvels from the poison. 57 896 DOMESTIC MEDICINE. Castor-Oil Seeds. From these the entirely safe though disagree- able Castor-Oil is obtained; but, Avhen SAvalloAved Avhole, the seeds have sometimes (three or four or more taken at once) caused death, in the manner of an irritant poison, in less than forty-eight hours. In treat- ment, give first an emetic (mustard, salt, or ipecac, Avith abundance of Avarm Avater), and then flaxseed-tea or lime-water and milk ; also tea- spoonful doses of Paregoric, or ten or fifteen drops of Laudanum, every hour, until forty to sixty drops (if the latter be used) have been taken, to allay pain, vomiting, and purging. Cheese. The daily papers, in April, 1884, mentioned two families having just been severely, but not fatally, poisoned in Brooklyn, by some English Dairy Cheese. A chemist who examined it thought the poison to be in the coloring-matter. The exact explanation of this oc- casional (rare) acquirement of a poisonous quality by cheese is yet want- ing. (On this see page 286.) Unless made so by malicious intent a cheese not so spoiled by keeping as to have a harsh, unpleasant taste, is extremely unlikely to be poisonous; especially in such small or moder- ate amounts as it is wholesome to consume of eA^en A^ery good cheese. Treatment for such poisoning must consist in the prompt use of an emetic (see Aconite, Treatment), folloAved by charcoal and magnesia or lime-water, and paregoric, or small doses of laudanum, to allay suffer- ing. The instances of a fatal result from this cause are very few. Chloral. Hydrate of Chloral is the right name of this medicine, Avhich is much used, especially to promote sleep. It is very uncertain in its action upon different people. While some are but little affected by drachm (sixty-grain) doses, others will be considerably narcotized by half as much. TAventy or thirty grains will be an ordinary medici- nal dose. Less than a drachm has been fatal in a few instances; three drachms would probably almost always kill; although some persons have taken much more Avith impunity. The symptoms of the poisonous action of Chloral are merely those of deep narcotism; the victim cannot be roused, and sleeps away to death, in a feAV hours. Treatment of it, in the absence of a certain antidote, consists in the immediate use of an emetic, followed by very strong coffee or tea ; dashing cold Avater on the face and chest; if the patient can Avalk, moving him about, slapping the back and limbs briskly, etc., to keep him aAvake, as in opium-poi- soning; for last resorts, the galvanic battery and artificial respiration. A physician may carefully try the antagonism which probably exists betAveen Strychnine and Chloral. Chloroform. This liquid is much used in Europe, but less than Ether in this country, as an anaesthetic, by being breathed to annul the pain of surgical operations. It is more dangerous, by far, than Ether POISONING. 897 or Nitrous Oxide, in this mode of employment; and, of course, it should never be taken or given in this Avay by an unprofessional person. I was the first physician to experiment Avith its internal use, on my OAvn person and afterAvards on a number of others, in the Pennsylvania Hospital, in 1848. I found that a much larger quantity is safe in this Avay, by SAvalloAving, than Avhen it is breathed; and have since given it many times in teaspoonful doses, Avith only moderate soporific effect. A case has been reported of a boy four years old being killed by a drachm of Chloroform taken into the stomach. Deep stupor resulted, in Avhich he died. While this gives reason for caution, it is not likely that less than four fluidrachms (half an ounce, about a tablespoonful), and prob- ably not often that much, taken by the stomach, would produce death in an adult. Symptoms of Chloroform poisoning are those of stupor, from which the patient cannot be roused. This may be preceded by signs of great irritation of the stomach; as Chloroform is very pungent and heating Avhen SAvalloAved. Treatment requires an emetic at once (see Aconite, Treatment); and then, as there is no chemical antidote, dashing cold Avater on the face and chest, and, if it can be obtained, the galvanic bat- tery ; as a last resort, artificial respiration. Citric Acid. This is the natural acid of lemons, separated from them by a chemical process. It is only poisonous Avhen taken in very large amount; an ounce or more. Treedment for this, as for other acid poisons, is, first, an emetic (see Aconite, Treatment), then magnesia, chalk or soda, or soap, to neutralize the acid. Coal-Oil. See Carbolic Acid. Cocculus Indicus. The berries of this Eastern tree are used in some places to poison fish. They are said also to be put, as an adulter- ation, into beer (in England), to increase its intoxicating poAver. Prob- ably not much of this is really done. Their poisonous principle is picrotoxin. A tea made of Cocculus berries is sometimes employed to kill bedbugs, etc; and occasionally this has been swalloAved by mistake, with fatal result, The symptoms are, irritation of the stomach (pain, nausea, and vomiting), folloAved by a peculiar sort of narcotism ; a half- awake lethargy, knowing what is going on, yet quite Avithout power to speak or moA-e. Treatment for this poisoning, in the absence of any knoAvn antidote, must consist in the use of an emetic (see Aconite, Treatment), followed by draughts of Avarm charcoal and magnesia Avater, and strong tea or coffee; when the Avorst is over, alloAving the patient to sleep it off at length. Colchicum. This plant, MeadoAv Saffron, Colchicum autumnale, is used considerably in medicine; the Wine of the Root and the Wine of 898 DOMESTIC MEDICINE. the Seeds. By an overdose (a teaspoonful or more) violent vomiting, pain in the abdomen, purging and prostration are caused; in some in- stances it is fatal. Treatment for this poisoning should be the same as for that from Castor-Oil Seeds ; Avhich see. Copper. While this metal, when pure, is not itself poisonous, its compounds are; and they are made by the action on copper of the fluids of the stomach, or by acids and other materials used in cooking, pickling, etc. In this way copper poisoning sometimes occurs, as well as among those working in copper. Mineral water (Carbonic Acid Water, Soda- Water) dissolves copper; hence reservoirs of that metal, without any, or with only an imperfect, lining of something not soluble, ought not to be used for it. The compounds of Copper most often acting poison- ously are, Blue Vitriol (Bluestone), the Sulphate; and Verdigris, the Subaceiate of Copper. In large amount taken at once, either of these will cause severe vomiting, pain in the abdomen, and purging; afterwards headache, and, in fatal cases, convulsions or paralysis before death. Slow poisoning Avill result from taking small amounts of copper daily, as in cooked or pickled articles, for a length of time. Symptoms of this are, a coppery taste in the mouth, Avith parched tongue and throat; nausea, retching, perhaps vomiting; pains in the stomach and bowels; diarrhoea, with straining; weakness, with nervous restlessness; dizziness, cold sweats, cramps, and at last convulsions. Treatment for rapid Copper poisoning (as it is itself an emetic) should consist in giving an abundance of whites of eggs; albumen making a harmless compound with copper. Milk may be given freely if no eggs are at hand; its effect is of the same kind. For sloio Copper poisoning, the main thing is to withdraw the cause, in whatever thing or things it may exist. Then, a milk diet, with moderate doses of an opiate, as Paregoric, or small doses of Laudanum, to assuage the pain and diar- rhoea, will be suitable. Corrosive Sublimate. This, the Chloride of Mercury, is a deadly poison; three or four grains of it may kill a man. Symptoms of its action are, in a marked degree, those of the irritant poisons; a metallic taste, burning in the mouth, throat, and stomach, pain in the abdomen, vomiting, purging, with straining, nervous anxiety, extreme prostration; often convulsions, sometimes stupor, before death. Commonly, death does not result under one or more days; but examples are recorded of its taking place within an hour after the poison had been SAvallowed. Treatment of CorrosiATe Sublimate poisoning requires (as for copper) free administration of whites of eggs; the more the better, until relief is obtained; or, if eggs cannot be had, large and repeated draughts of milk. POISONING. 899 Creasote. This, obtained from Tar, has poisonous properties much resembling those of Carbolic Acid ; which see. Croton Oil. Obtained from the seeds of the plant called Croton tiglium; this oil is a very powerful cathartic, as well as an irritant to the skin. One drop of it will purge severely. Thirty drops have been knoAvn to kill, Avith symptoms of irritant poisoning; namely, vomiting, pain in the abdomen, violent diarrhoea, and prostration. For trecdmcnt of these symptoms, so caused, see Castor-Oil Seeds. Cyanide of Potassium. See Hydrocyanic Acid. Digitalis. Foxglove is the common name in England for this purple- flowered plant. The leaves are used in medicine, chiefly in the form of a Tincture. Its active principle, Digitalin, is a powerful poison. Not many cases of death from taking either Digitalis or Digitalin have been reported. The symptoms resulting from either of them are, vomiting, purging, pain in the abdomen, dizziness, disordered sight, dilated pupils; the pulse full and slow while the patient is lying down, but becoming rapid and Aveak when he sits up. Later, prostration and faintness follow, Avith an irregular pulse; toAvards the last, delirium, convulsions, and stupor. Death does not generally occur under tAventy- four or thirty-six hours; although in one case it is asserted to have taken place within an hour. Treatment of Digitalis poisoning, as of that of other agents for which Ave have no certain antidotes,* must consist of the use of an emetic (see Aconite, Treatment), unless copious as well as frequent vomiting has already occurred; and then charcoal and magnesia-water, AArith such cau- tious use of stimulants (ammonia, whisky, external heat, the galvanic battery) as the symptoms appear to call for; and, if all else fails, arti- ficial respiration. * Aconitia is said to be a physiological antidote for Digitalin; but it is itself too potent a poison to be dealt with by any but skilful professional hands. 900 DOMESTIC MEDICINE. Ergot. Secale cornutum, or Sjutrrcd Rye; this is a kind of parasitic vegetable growth upon the grain of common live; most frequently met Avith on damp grounds in some parts of Northern Europe. Before its qualities Avere understood, Avhole communities avc re sometimes more or less severely poisoned by it; the Avorst symptom at- tending its use as food being gangrene of the ex- tremities. Wine of Ergot is largely used as a medi- cine, especially in cases of sluggish labor, or for the arrest of hemorrhage. I do not knoAV of any cases of fatal poisoning by overdoses of this preparation. If anv one should be made ill by such, or by the Fluid Extract of Ergot, taken by mistake, an emetic, folloAved by charcoal and magnesia-Avater, Avould be proper in the treatment. Ether. Although much safer than chloroform as an ancesthetic, breathed to produce insensibility under surgical operations, or to mitigate the pains of labor, Ether may possibly be inhaled to such an extent as to cause dangerous and even fatal narcotism. In such a case, the pulse fails; it flutters, and almost or quite ceases. When complete insensibility has been brought on by any anaesthetic, as shown by the arm dropping at once Avhen lifted, by deep breathing, and by the lids not closing forcibly when they are opened Avith the fingers, then the ether, chloroform, or nitrous oxide should be withdraAvn at once. In using ether in child-labor, it is not needful or desirable to produce entire in- sensibility. The " edge " may be taken off of severe pains in the second stage of labor (expulsive pains) by the patient beginning to breathe the ether from a sponge wet with it and held near the nostrils, as soon as a pain begins; and continuing it only for a minute or tAvo Avith each pain. If, under anaesthesia, the pulse ceases to be felt, the breathing becomes feeble, and the face shows collapse, dash cold water in the face; put a bottle of ammonia under the nose for a moment at a time; and, if reaction is sIoav, lift the patient's heels above his head for a feAV seconds; then, if necessary, begin artificial respiration. (See Drown- ing.) POISONING. 901 Fish, Poisonous. Accounts are given of certain kinds of fish, chiefly in tropical climates, being unAvholesome and even dangerous food. I have never heard of any such in this country. Most cases so reported are probably instances of " idiosyncrasy "; that is, peculiarity of individual constitutions. Those so affected may require an emetic, if the irritating undigested article remains in the stomach. If the boAvels are not already purged freely, charcoal and magnesia Avill be appropriate ; and perhaps moderate doses of paregoric or laudanum may be called for (although not nearly ahvays so) to allay lingering pain and distress of the stomach and bowels. Fungi. Mushrooms and Truffles belong to this group of plants; both being largely eaten, and agreeing Avith most persons. Botanists inform us that there are many species of innocent and nourishing fungi; but there are some, also, that are dangerously poisonous. While, then, the general rule is, that those whose color is not dark, nor taste harsh, nor odor disagreeable, are harmless, experiments are not safe in such a matter, Avhen made by those ignorant of the kind they have found. The true eatable Mushroom, Agaricus campestris, groAvs on open ground, has, pink "gills" or a frilled arrangement underneath its croAvn, a small " ruffle " also on its stem, and a thin skin on top, Avhich can be peeled off easily. The assertion made by some that even this plant is unsafe until cooked does not agree Avith my experience; as I have often eaten at least a small handful of mushroom plants raAv, Avithout any injury. Still, they may under some circumstances be less Avholesome, and cooking improA^es their flavor as Avell as secures their innoccncy. Symptoms of " toadstool" poisoning are those of irritant poisoning ; vomiting, purging, and abdominal pains; with, also, dizziness, partial blindness, delirium, perhaps convulsions and stupor, at least in fatal cases. Generally, the symptoms do not shoAV themselves for a number of hours, if the irritant effects are most prominent; but stupefying effects have sometimes ap- peared Avithin an hour or tAvo. No antidote for fungus-poisoning having been ascertained to exist, the proper treatment for it is, the use of mustard, salt, or ipecac as an emetic, followed by charcoal and magnesia-water, and then stimulants (ammonia, whisky, etc), if required by great debility; lime-water and milk for nourishment (later, beef-tea, etc.); and, if irritation and pain Avithout stupor be present, careful use of moderate doses of some opiate, as paregoric or laudanum, to assuage distress and procure relief. 902 DOMESTIC MEDICINE. Hellebore. Three plants go by this name: Black Hellebore (Hlle- borus Niger), Green Hellebore (Veratrum Viride), and Wiite lltdlebore (Veratrum Album). These are all poisonous Avhen taken in considerable dose; the White Hellebore the most so, containing as its active principle veratria * Black Hellebore is sometimes given, in the form of a tea, in England, for worms; but it is not a safe domestic medicine. Death has some- times resulted from its use, Avith symptoms like those of cholera-morbus. Green or American Hellebore, Veratrum Viride, is not infrequently prescribed by physicians as a sedative medicine, in the form of a Tinct- ure, in doses of two or three drops at a time. In large dose, it will kill, chiefly by prostration. Veratria, in a dose less than one-twelfth of a grain, has caused alarming effects. Two grains of it will kill a Fig. 280. HEMLOCK. PARSLEY. cat in less than a minute. White Hellebore depends for its action on this poAverful alkaloid. Treatment of Hellebore or Veratria poisoning requires, first a brisk emetic (see Aconite, Treatment), and then stimulants; as ammonia and laudanum. The last-named has seemed in several cases to be especially useful; but it must be given with caution, so as not to substitute one kind of poisoning for ano'her in an excessive degree. He ml ck. Socrates, the Greek philosopher, was put to death by this poison (Cicuta of the ancients; now Conium maculatum). It is a depressant; not very unlike Tobacco and Lobelia in its effects. Some- times Hemlock has been eaten by mistake for Parsley; to which it has Probably present also in Green Hellebore (Veratrum viride). POISONING. 903 some resemblance in appearance. Aethusa cynapium, Fool's Parsley, is another poisonous plant, growing Avild in New England, which has been sometimes, eaten by mistake for parsley. Prostration and loss of power to move are the chief symptoms of its action; the mind being clear of stupor or even delirium to the last. Plato describes Soc- rates as conversing calmly with his disciples until near his end. Treatment of Hemlock poisoning must be by an emetic (mustard pre- ferred), followed by stimulation, with ammonia, whisky (small doses at short intervals), heat to the body and limbs, and, as last resorts, the galvanic battery and artificial respiration. Fig. 282. fool's parsley. Hydrochloric Acid, Muriatic Acid, the old name for this, is still much used. It is not so strong an acid as Sulphuric Acid (Oil of Vitriol), but its effects are of the same kind. The smallest fatal dose recorded is half an ounce (about a tablespoonful). Much larger quan- tities have been taken without destroying life. The symptoms axe those of irritant poisoning. (See Sulphuric Acid for these symptoms, and also for their Treatment.) Hydrocyanic Acid. The common name for this is Prussic Acid. It is one of the most deadly of all known poisons. Yet, in small 904 DOMESTIC MEDICINE. amount, it is present (or is easily formed from) several familiar things; as peach-floAvers, lea\Tes, and kernels, bitter almonds, apple-seeds, stones of the cherry, plum, and apricot, the root of the mountain ash, and the floAvers of the cherry-laurel. Water distilled from this last (cherrv- laurel Avater) is quite poisonous. In all these, it is not the acid itself that is present, but tAvo substances Avhich readily form it, when mixed together Avith water. Prussic acid is used in medicine in the condition of Dilute Hydrocyanic Acid. It is of two strengths; the offeinal, two parts in one hundred of Avater; and Scheele's, containing about five parts in one hundred. The medicinal dose of the officinal Prussic Acid is one drop. Fifty or sixty drops will generally be a fatal dose. The symptoms are those of sudden and extreme prostration ; coming on in a minute or two, and ending life in from ten to fifteen minutes. Time for treatment is thus seldom alloAved. Dashing cold water repeatedly upon the face and chest, and careful breathing and swalloAving of Ammonia, are about all that can often be done. Dessertspoonful doses of Avhisky or brandy, a feAV times, Avill be appropriate. It would be right to try also in so desperate a case, the quick and powerful stimulation of limited strong heat; by touching the pit of the stomach and the middle of the back, alternately, with the end of a poker, or a piece of stout Avire, heated not quite to a red heat at the nearest fire, gas, lamp, or candle flame. Electricity, an analogous excitant, can seldom be had ready in time for this kind of poisoning. Cyanide of Potassium has precisely the same effects as Prussic Acid, in doses still smaller. It is used by photographers and in electrotyping. Treatment of poisoning from it should be the same as for Hydrocyanic Acid. Hyoscyamus. The Henbane (Hyoscyamus niger) has a root like a small parsnip, and has occasionally been eaten by mistake.for it. Poi- sonous effects result from this, as Avell as from SAvallowing the seeds or leaAres. An extract from the leaves is used in medicine. Symptoms of Hyoscyamus poisoning are: dryness of the throat, Avith difficulty of SAAallowing; enlargement of the pupils, and dimness of vision; head- ache, ringing in the ears, dizziness, vomiting; later, delirium, sometimes convulsions and paralysis, and stupor, Avhich may end in death1. Treat- ment of such poisoning, at least in the absence of a physician, should consist of the immediate use of an emetic (mustard, salt, or ipecac), fol- lowed by charcoal and magnesia-water, freely given. POISONING. 905 Iodine. Several preparations containing this substance are used in medicine; but they are not very likely to be taken poisonously. Were this to happen, the effects Avould be chiefly those of an irritant poison. The antidote for Iodine is starch ; if it is not on hand in a pure state, flour and Avater, or rice-water, made thick, will supply it sufficiently well. Jamestown Weed. See Stramonium. Jessamine. The Yellow Jessamine (Gelsemium sempervirens) con- tains an alkaloid, Gelseminia, which has produced death in the dose of one-sixth of a grain ; Avith symptoms of irritant and depressant poison- ing. Of course the plant itself is dangerous only Avhen SAvallowed in much larger amount. An emetic, charcoal and magnesia-Avater, and stimulation with ammonia and Avhisky, etc, would be the proper treat- ment for such poisoning. Kalmia. The common laurel of lower PennsA h^ania (Wissahickon ' woods near Philadelphia) and elseAvhere, also called Sheep Laurel, Kal- mia Latifolia, has long had the reputation of being poisonous. Thomas Meehan, one of the best scientific botanists in America, recently (Gar- dener's Monthly, 1884), on the basis of experiments by chemists Avho found no poisonous principle in it, denies its poisonous quality altogether. He is probably right; but there is no occasion for risking anything by eating it. Laurel. See Kalmia, above. The Cherry Laurel has in its leaves the ingredients which, with Avater, make Prussic Acid. See Hydro- cyanic Acid. Lead. While metallic Lead is not poisonous, many of its compounds are so. The one most nearly inert is the Sulphate of Lead. Hence Sulphuric Acid, and its salts, as Sulphate of Magnesium, are antidotes for it. Suo-ar of Lead (Acetate of Lead) and the Subacetate, present in Goulard's Extract, which are often used to make Lead-Avater, are sometimes taken poisonously by mistake. Violent vomiting and purg- ing, Avith very severe pains in the abdomen, folloAved by prostration, have been the symptoms in such cases; death taking place (if the quan- tity was very large) in from one to three days. Treatment for such acute or sudden poisoning by Lead, should consist in the use, if vomiting is not copious, of an emetic dose (twenty to thirty grains) of Sulphate of 906 DOMESTIC MEDICINE. Zinc, followed by Avhites of eggs in abundance, milk, and moderate doses of Sulphate of Magnesium (Epsom Salts); Avith warmth applied to the body, and opiates (as Paregoric or Laudanum) to relieve pain when the most urgent symptoms have been overcome. Slow or chronic Lead poisouing is much more common. Workmen engaged in the separation of Lead from its ores, or in the manufacture of " Avhite" and "red " Lead, lace-Avhiteners, card-glazers, painters, and also glaziers, plumbers, peAvterers, and those who glaze pottery, are all exposed to it. Sleeping in a freshly-painted room affects some persons. Cooking-vessels lined Avith glazing containing Lead, and fruit or vege- table cans in which it has been used in the soldering process, when acid fruits or vegetables have been kept for some time in them, make such articles of food more or less poisonous. Mineral (carbonic acid) water in leaden reservoirs becomes so. When leaden pipes are used to carry the liquid from such reservoirs, so much of the carbonic acid Avater as remains long in the pipes dissolves enough lead to be injurious. Beer or cider draAvn through leaden pipes is likewise tainted. Using shot to clean wine-bottles, leaving some shot in the bottles and again filling them with Avine, exposes it to this action. Wrapping tobacco in tinfoil (" patent" tinfoil) Avhich contains lead, as pure tinfoil does not, is un- safe for the same reason. Hair dyes, to blacken the hair, generally contain Lead, and serious poisoning, once at least fatal, has resulted from their free and frequent use; and the same is true of some enamels, etc., for the complexion. (Another objection to these last is the fact that sulphur, or sulphuretted hydrogen gas, will blacken such cosmetics; with a frightful effect occasionally upon the faces so meant to be adorned.) Water may be poisoned by passing through leaden pipes, under certain circumstances. Not always, clearly; as the tens of thousands of hydrants in the cities of New York, Philadelphia, and others, are so supplied. But so much has been said about this in a previous part of this book, that we may refer concerning it to Water Supply, under Our Homes, in Hygiene. Two kinds of sIoav Lead poisoning occur; Lead Colic and Lead Palsy. Both of these have been considered in our alphabetical series, under Special Diseases. As, also, they are ahvays sufficiently prolonged for opportunity to exist to obtain medical advice, their treatment does not require here to be dAvelt upon. Ley. See Potassa. Lime. Especially unslaked Lime, being strongly alkaline, is caustic, and irritating to the stomach and boAvels. Its effects, if largely swal- lowed, are those of the irritant poisons; vomiting, purging, abdominal pains, and subsequent prostration. Treatment, vinegar and water, or POISONING. 907 lemon-juice (both acids, to neutralize the alkaline earth, lime) and water, quickly and abundantly given. Lobelia. Indian Tobacco, Lobelia inflata, a common small plant in this country, has long been popularly used as a medicine. Tincture of Lobelia is a ATaluable remedy for attacks of asthma. In overdose, it is very poisonous, Avith a depressant action, resembling that of tobacco. The " Thomsonian " system of pseudo-medicine used Lobelia freely, and thereby has been charged * with sacrificing the lives of thousands of persons. Symptoms of Lobelia poisoning are; vomiting, sometimes purging, extreme prostration; in some instances convulsions before death. In treatment of Lobelia poisoning, as we have no special antidote, we can only depend upon an emetic (mustard preferred), folloAved by char- coal and magnesia-water, and stimulation, with ammonia, Avhisky, etc., and heat applied to the body. Lunar Caustic. See Nitrate of Silver. Its antidote is common salt. *'By Dr. Beck, in his Medical Jurisprudence. 908 DOMESTIC MEDICINE. Mercury. This metal, in the pure state, is not poisonous ; but several of its preparations are so; notably Corrosive Sublimate; which see. Morphia. See Opium. Mushrooms. See Fungi. Mussels. On the coast of Europe, in many places, these are used extensively for food ; but noAV and then thev make people ill; Avhether because of their peculiar " idiosyncrasy," or on account of a change in the mussels, it is very hard to ascertain. The symptoms are generally others of irritantpoisoning; an eruption on the skin like nettle-rash being also common. Death has sometimes resulted. In treatment, an emetic, and charcoal and magnesia-water, are appropriate. Nitrate of Silver. Lunar Caustic is the common name for this. It is a poAVcrful irritant poison. If SAvallowed by accident or mistake, the symptoms of its action will be like those of corrosive sublimate poison- ing, only less rapid and violent. The antidote for Nitrate of Silver is common salt (chloride of sodium); which makes Avith it the harmless chloride of silver. Let salt be taken, a tablespoonful at a time, in Avater; its emetic action will be an adA7antage. Nitric Acid. Aqua Fortis is an old commercial name for this pow- erful acid. Tavo teaspoonfuls of it swalloAved will generally destroy life. Breathing its fumes has repeatedly caused death within ten to fifteen hours. Symptoms of Nitric Acid poisoning, and their treatment, are the same as those of the other mineral acids. See Sulphuric Acid. Nux Vomica. See Strychnia. Oil of Bitter Almonds. See Bitter Almonds. Opium. This is the most powerful and frequently used of the sleep- producing (hypnotic) and anodyne (pain-relieving) medicines. Morphia is its most characteristic and important active principle. Laudanum, Paregoric, and McMunn's Elixir are familiar preparations containing it. The effects on the human system of all these are very much the same, in different degrees. Four or five grains of solid Opium Mall generally kill a person not habituated to it; and this amount is represented in a teaspoonful of Laudanum, in a wineglassful of Paregoric, and in a grain of Sulphate, Acetate or Muriate of Morphia. The regular American Solution of Morphia contains one grain of Sulphate of Morphia in each fluidounce; Magendie's solution of Morphia contains sixteen grains in each fluidounce. While, therefore, about tA\o tablespoonfuls of the American solution POISONING. 909 Avill be the smallest poisonous dose, a half-teaspoonful of Magendie's Solution Avill be equally dangerous. Under the heading of Stimulants and Narcotics, in Part IL, on Hy- giene, attention has been given to the enormous doses taken by those avIio have long been accustomed to the use of Opium. Those suffering extreme pain, also, sometimes bear much larger than usual medicinal amounts ; but the increase of the quantity in such cases requires a great deal of care. Children are remarkably susceptible of the influence of opiates. Very small doses of laudanum, paregoric, etc., should be given to a child, before ascertaining its individual liability in this respect. Laudanum, Avhen long kept, groAvs stronger; we should be especially cautious, therefore, in giving the last drops of an old bottle of laudanum. Symptoms of any kind of Opiate poisoning are: in not A'ery excessi\Te dose, at first a short period of excitement; in OATerAvhelming dose, this is absent and the deep stupor conies almost at once; with closed eyes, Avhose pupils, if the lids be raised, are seen to be contracted; pulse slow and full; breathing snoring (stertorous); face flushed and skin Avarm, until near the end, when pallor and coldness precede death. The sIoav- ness of the breathing in bad cases is very remarkable. The condition on the Avhole bears a close resemblance to apoplexy, dead drunkenness, and compression of the brain from fracture of the skull. In neither of these, hoAvever, are the pupils contracted as in Opium-poisoning. Death usually follows Avithin from seven to tAvehre hours. Treatment of Opium-poisoning calls first for an emetic; a teaspoonful of mustard, a tablespoonful of salt, or a teaspoonful of ipecac, in Avarm Avater, should be poured doAvn the throat at once, if the patient can swalloAV. When this is not possible, a physician will use a stomach- pump. After the emetic, if Tincture of Belladonna can be obtained, let twenty drops of it be giATen every half hour until the pupils begin to dilate. This is advised because of the frequent experience showing that atropia (the alkaloid of Belladonna) and morphia antagonize each other in their effects upon the human system. If a physician is on hand, he Avill be likely, instead, to administer atropia hypodermically; that is, through and under the skin, in doses of one-tAATentieth of a grain each time, Avatehing its effects. Also, cold Avater should be dashed upon the face, and the patient's body may be slapped vigorously, or, if he can, he may be made to walk about; anything to keep him aivake, or from sinking into the fatal degree of lethargy. (Observe how different a case this is from that of apoplexy, or of stupor from fracture of the skull. In either of those conditions, the patient should be kept as quiet as possible ; brain-rest is then indispensable to give a chance of recovery.) The galvanic battery, applied to the back and chest, and artificial respi- 910 DOMESTIC MEDICINE. ration (see Drowning) are last resorts in Opiate poisoning. Touching the back and pit of the stomach lightly but repeatedly Avith a very hot iron (e.g., the end of a piece of thick wire, etc.) Avill be Avorth trying for the same rousing effect. If the patient begins to improve so as to SAAralloAAT, strong tea or coffee will assist in removing the narcotism. Oxalic Acid. A small amount of this gives the sour taste to sorrel and to the leaves of rhubarb (pie-plant). When pure, it is a crystalline solid, enough in appearance like Epsom salts to have been occasionally taken for it. In taste, hoAvever, it is very different. The smallest amount ever fatal is a drachm; half an ounce or an ounce may easily be so. Symptoms of its action are those of an irritant poison (see Cor- rosive Sublimate, etc.), with extreme prostration, and also headache, delirium, and convulsions before death. A very large dose may kill in a few minutes; generally death results within an hour. In exceptional instances, it has happened after several days. Treatment of Oxalic Acid poisoning must be, the immediate use of something containing lime, mixed Avith water or oil. Chalk will ansAver best, unless lime-water is at hand, to be used freely. Magnesia will do, if there is no lime or chalk AArithin reach. Scraping plaster from a Avail and giving it to the patient will be better than to wait half an hour to send to a druggist, as there is no time to lose. POISONING. 911 Phosphorus. This substance, a small portion of Avhich is always naturally present in our brains and in our bones, is, Avhen in the separate state, a most destructive poison. It acts rapidly; when, for example, ends of lucifer matches are swallowed, through mistake or malice. It is known also to act slowly, in producing disease of the jaAvbones, with those engaged in making lucifer matches. Symptoms of acute or rapid Phosphorus poisoning usually begin to appear a feAV hours after it is taken. There is a garlicky taste, with burning in the throat, pain in the stomach, violent vomiting, sometimes purging; coldness, prostration, and either convulsions or stupor before death, Avhich may follow in from one to five or six days. The amount necessary to kill an adult is less than a grain. A child two years old is reported to have died in conse- quence of SAvalloAving the ends of eight friction-matches; and two of these have killed an infant two months old. Treatment of Phosphorus poisoning must be conducted Avithout any known antidote, unless old spirit of turpentine, in teaspoonful doses, be such, as some have asserted. First give an emetic (see Aconite, Treat- ment), with plenty of Avarm water; then charcoal and magnesia-water, abundantly. No oil (unless oil of turpentine, as above said) is to be given after Phosphorus poisoning; oil dissolves and diffuses it more rapidly. Rice-water, milk, or flaxseed-tea will be suitable to allay irritation, in a case which escapes death. Potassa. Caustic Potassa, or Potash, is a poAverful destroyer of animal tissues; having a very strong affinity for Avater. Ley contains it in considerable amount. Its effects, when SAvalloAved, are those of an irritant poison. (See Corrosive Sublimate, etc.) Injury of the throat may remain for a long time. Treatment must be by an emetic, and the neutralization of the alkali potassa with an acid; as vinegar or lemon-juice promptly and freely given, in an abundance of water. Af- terAvards, flaxseed-tea, milk, rice-water, etc., will be appropriate, to soothe the inflamed stomach and boAvels. Prussic Acid. See Hydrocyanic Acid. 58 912 DOMESTIC MEDICINE. Sausage Poisoning. The history of this is quite obscure. Most of the cases have been reported in Germany, Avhere uncooked sausage- meat is often eaten. Some of the deaths are undoubtedly to be accounted for by trichinosis. (See the account of the spiral thread-worm, trichina, under Worms.) Probably spoiled sausage may sometimes acquire a poisonous property Avithout these parasites. The symptoms described as following sausage poisoning are those of an irritant-narcotic kind. Fmetics and charcoal and magnesia-Avater Avill constitute a reasonable treatment for them. Soda. This alkali, Avhen pure, is caustic, like potassa. What is commonly called Soda, hoAvever, is the Bicarbonate of Sodium. This is not poisonous; although tablespoonful doses Avould be irritating and Fig. 283. JAMESTOWN "WEED ( STRAMONIUM). unwholesome for the stomach. For the symptoms and treatment of poi- soning by caustic Soda, see Potassa. Stramonium. Datura Stramonium is the botanical name of the com- mon JamestOAvn (often called limson) Aveed. Thorn-apple is another name for it. The seeds are sometimes eaten by children, with fatal ef- fect. Both the seeds and the leaA^es are sometimes used in medicine. Symptoms attend Stramonium poisoning, of the same kind, essen- tially, as those resulting from Belladonna or Atropia. For an account of these, therefore, and the treatment thereof, see Belladonna. Strychnia. This violent poison is contained in the fruit of the Nux Vomica (Dog buttons), a tree native to India. Brucia is another poi- sonous alkaloid present with it in the same fruit or seeds, and in a few POISONING. 913 other plants. One nut or seed of Nux Vomica is a fatal dose for an adult; of Strychnia, half a grain has killed a man. Symptoms of this kind of poisoning are quite peculiar. Almost immediately after taking it, great restlessness comes on, Avith a feeling of suffocation. Soon fol- Ioav jerking movements of the arms, legs, and head; and then a tetanic condition (like that of lockjaw) in which all the muscles of the body become stiffly contracted; the body making an arch, resting upon the head and heels. The mind is at the same time unaffected. After a minute, more or less, this spasmodic attack gives way; but it is repeated in half an hour or so; being hastened by any sudden sound, touch, or other sensation. Death results in some cases in a few minutes; in others, not under several hours. The average time is about two hours. Treatment. Give at once an emetic of mustard, salt, or ipecac, with large drinks of warm water. Then use chloroform, carefully, by inha- lation. Lay a handkerchief single over the patient's face; and drop upon it, near the nostrils, one drop at a time, of chloroform, until the breathing and other movements are quieted. Then remove the hand- kerchief, but renew the dropping Avhen another tetanic spasm appears to be beginning. The internal use of chloroform, in teaspoonful doses, Avell diluted with water, is also recommended; having saved life in recorded instances. This is heroic treatment; but there is hardly any more terrific poison to deal with than Strychnia, Sulphuric Acid. Oil of Vitriol. A heavy liquid, very corrosive. SAvallowing a teaspoonful of it may kill a grown person, within twenty- four hours; chiefly from suffocation. Sometimes death is almost im- mediate. With smaller quantities, burning pain, vomiting and pros- tration are the symptoms. Treatment. At once, soda, magnesia or chalk, freely given in large draughts of water or milk, if the patient can swallow; if not, there is little hope of recovery. A physician may, in bad cases, use the stomach-pump, or perhaps open the windpipe to prevent death by suffo- cation. 914 DOMESTIC MEDICINE. Tartar Emetic. See Antimony. Tartaric Acid. The natural acid of grapes. It is present in cream of tartar (bitartrate of potassium). In doses as large as an ounce, or perhaps less, it is an irritant poison. Its symptoms and their proper treatment are the same as those of Citric Acid ; which see. Tin. Pure metallic Tin is not at all poisonous. Water may be kept, boiled, or conveyed in vessels or pipes made of it, with entire safety. If it is ever alloyed with lead, which is said to be the case with one kind of patent tinfoil, and some other cheap tin now made, this is an inju- rious fraud. It is doubtful whether even the long-continued action of vine- gar, or of the acid of fruits, in cans of pure tin, will dissolve enough of the metal to become unwholesome. Bits of solder, consisting partly of lead, may sometimes drop into the contents of cans; and these frag- ments, if swallowed, will be likely to produce lead poisoning. Ont should use the tongue, watchfully, before swallowing each mouthful of anything taken from a tin can. Dyer's Spirit, a preparation containing the chlorides of Tin, is an irritant poison of moderate power. Very few instances of its being injuriously taken are recorded. Toadstools. See Fungi. Tobacco. Containing a very poisonous volatile liquid alkaloid, nicotin, the leaves of the Tobacco plant are capable of destroying life, Avhen a portion is swallowed, or even long applied in a moist state to a considerable part of the surface of the body. Two cases are recorded, also, of death from excessive smoking; one from seventeen, and the other from eighteen pipes at a single sitting. Probably a grown man, unaccustomed to the use of Tobacco, might be fatally poisoned by swallowing the Avhole of a single strong cigar. Symptoms of Tobacco poisoning are dizziness, restlessness, vomiting, sometimes purging, and extreme prostration. It is a depressant poison. T-eatment should be, the use of a mustard or salt emetic^ followed by ammonia as a stimulant, with warmth to the body and rubbing the limbs to excite reaction. POISONING. 915 Zinc. Pure Zinc is not poisonous. The Zinc commonly used, Iioav- ever, contains some antimony and lead, a little arsenic, and other im- purities. It is not a safe thing, therefore, to store Avater in, or to line cooking-vessels, etc, with. Sulphate of Zinc (White Vitriol) is a powerful irritant poison. It produces vomiting at once, and therefore seldom kills unless in very large doses; half an ounce or an ounce at once. Symptoms and Treat- ment of such poisoning are like those of other metallic irritants. See Corrosive Sublimate, or Copper. Chloride of Zinc is used in solu- tion as a disinfectant, under the name of Burnett's Fluid. It is still more corrosive and irritant than the Sulphate. See Copper, for symp- toms and treatment of such poisoning. PAET VII OLD AGE AND DEATH. WE ALL DO FADE AS A LEAF. NOT many persons die a perfectly natural death. This, as Avas said earlier in this book, ought to take place not much, if at all, before the end of the hundredth year. Yet many persons may truly enough be considered to die of old age, Avithout having any manifest disease, at ninety, or even eighty-five years; indeed, possibly, before their eightieth year. Opportunity to observe very closely the last stages of one sloAvly de- clining life, with a less direct acquaintance with several others, has con- firmed my view, that old age is, in several respects, a second childhood. The deATelopment seen in infancy, during the first five years of life, is, more gradually, reversed, in those who live to be from eighty-five to a hundred years old. The changes most noticeable are these: 1. Wasting. The least necessary part of the body, the fat, first dis- appears ; causing the shrivelled appearance of the figure, and the deeply wrinkled face and bony hands. Then the muscular flesh is absorbed, Avith accompanying loss of strength ; which, however, is less felt because of the little Aveight left to be moved about. 2. Food is Avanted to be taken often, though not in large amounts at once. After seventy, the old man should take food four times a day; after eighty, even five times will be better; milk being an important part of his diet. Near ninety, almost all his food should be liquid; especially as the teeth have (with few exceptions) gone long before. It is true that the dentist's art, by supplying artificial teeth, Avhen " the grinders cease because they are few," has noAV made very advanced age more possible. Beef-tea, or beef-essence, not filtered, but warmed and spiced moderately Avith red pepper, will greatly help out the diet of those who are very aged. 3. More and more hours of repose are required. They may not be all hours of sound sleep; as old persons often do not sleep so many 917 918 D 0 MES TIC MED I CINE. hours continuously as those who are younger. But every one over sixtv should spend at least eight hours of the twenty-four in bed or reclining on a couch. After seventy, the hours of repose should never be less than nine; after eighty, ten; and at or near ninety, half or more of the old man's time Avill most naturally and advantageously be spent at rest. 4. Childhood is repeated also in the feebleness of mental poAver, from the AArasting of the brain. The memory goes first; especially the recol- lection of recent events. Far off remembrances, of early days, and of those of middle life, come up almost as freshly as ever; but what hap- pened yesterday, or even to-day, is easily forgotten. The poAver to reason closely, or to give attention very long to one subject, next gives way. We need not dwell on the dimness of sight and dulness of hear- ing, Avhich are among the usual (but not universal) infirmities of age. In all these particulars, there is a very great variety in individuals. Some of those Avho live the longest retain till the last more of their original mental capacity, with good sight, hearing, and muscular strength, than those Avhose life-energy is exhausted not much after the end of four- score years. 5. Temperature is lowest in the aged; and resistance to cold is, Avith them, feeble. A very old person should be sure to wear a sufficiency of AArarm clothing, and should not sleep in a room Avhere the thermometer marks less than 50° Fahr. Such a one risks death from cold stroke by even Avalking out of doors when the temperature approaches zero. Life ends, before old age, through general exhaustion from disease, or through failure of one or more of the three great organs, the heart, lungs, and brain. Cessation of the heart's action may be called death by syncope; that by interference with the function of the lungs, as- phyxia ; from oppression of the brain, coma. Exhaustion of the whole system constitutes asthenia. Sudden death may result from apoplexy; or rupture of the heart, Avhich had undergone fatty degeneration; or very copious bleeding from the lungs or bowels; or bursting of an aneurism or an abscess A\ithin the chest, or of an aneurism within the abdomen ; or suffocation; or ex- haustion from violent over-exertion, or from effort too severe or pro- longed for the strength to endure; or shock; as from violent mental agitation, of grief, fear, or even joy. Observation of not a few death-beds has given the Avriter the impres- sion that much suffering at the time of death is the exception rather than the rule. A natural anaesthesia precedes the moment of dissolution; when the eye groAvs fixed, and the lips scarcely move, there is but little, OLD AGE AND DEATH. 919 if any, sensibility left; and even the last convulsive movements, which sometimes have the aspect of agony, are usually unconscious. The most natural mode of death has almost as little violence in it as the burning out of a candle in its socket. Pale Twin of Sleep, why do men dread to meet thee ? For all Earth's ills, thy anodyne is best. Come gently, Death ; then weary Life will greet thee, As greets the sun the rosy-curtained West. INDEX OF LOCAL DISORDERS AND INJURIES. Abdomen, dropsy of, 661. wounds of, 880. Ankle, sprained, 866. Anus, fissure of, 521, 670. prolapsus, 671. Aorta, aneurism of, 668. Arm, broken, 850, 851. Arteries, wounds of, 876. Bladder, disorders of, 677. Bones, broken, 848. Bowels, bleeding from, 546. costiveness of, 358, 508, 527. crack at outlet, 670. falling of, 671, 678. inflammation of, 678. looseness of, 528. symptoms affecting, 508. Brain, concussion and compression of, 860. exhaustion of, 679. hemorrhage in (apoplexy), 672. inflammation of, 679. softening of, 681. Breast, inflammation of, 659. Bronchial tubes, dilatation of, 682. inflammation of (bronchitis), 682. Chest, water in, 715. Clavicle (collar-bone), fracture of, 852. Cranium (skull), fracture of, 860. Earache, 520, 719. Ear, foreign bodies in, 846. inflammation of, 719. ringing in, 719. Eye, diseases of, 723, 767. foreign bodies in, 846. spots before, 505. Faceache, 762. Facial palsy, 726. Fibula (of the leg), fracture of, 858. Fingers, broken, 851. dislocated, 864. Gall-bladder, stones in, 512, 729. Gums, altered in diseases, 499. Headache, 506, 733. Head, injuries of, 860. Heart, diseases of, 487, 734. Hip-disease, 705. Humerus (arm-bone), fracture of, 850. Iris (of the eye), inflammation of, 747. Jaw, lower, dislocation of, 863. fracture of, 853. Joints, dislocated, 863. sprained, 866. Kidneys, diseases of, 748. Knee-pan, fracture of, 856. Knee, sprained, 866. Larynx, diseases of, 749. Leg, fracture of, 857. Lens, of the eye, opacity of (cataract), 402. Liver, disorders of, 750. Lungs, diseases of, 700, 752, 775. Membranes of brain, inflammation of, 679, 687. Mouth, bleeding in, 545. diseases of, 758. Muscles, pain in (myalgia), 761. strained, 869. Nail, in-growing, 762. splinter under, 870. Navel, started, 789. Nerves, pain in (neuralgia), 520, 762. Nipple, sore, 659, 765. Nose, bleeding, 544. 921 922 INDEX OF LOCAL DISO RDERS AND INJURIES. Nose, broken, 853. foreign bodies in, 870. (Esophagus, stricture of, 767. Patella (knee-pan), fracture of, 856. Pericardium (of the heart), inflam- mation of, 735. Peritoneum (of the abdomen), in- flammation of, 771. Pharynx, inflammation of the (sore throat), 813. Pleura, inflammation of (pleurisy), 774. Radius (of the forearm), fracture of, 851. Retina, detachment of, 786. Ribs, fracture of, 852. Shoulder, dislocation of, 864. Skull, fracture of, 860. Spine, diseases of, 807. injuries of, 871. Spleen, enlargement of, 808. Stomach, diseases of, 685, 730, 808. Tendons, rupture of, 814. Thigh-bone, fracture of, 853. out of joint, 865. Throat, sore, 813. Thyroid gland, enlarged, 722, 731. Tibia, fracture of, 857. Toe-nail, in-growing, 702. Tonsils, inflammation of (quinsy), 783. Trachea, inflammation of (croup), 706. Ulna, fracture of, 851. Uterus (womb), diseases of, 827. Veins, inflamed, 755, 772. injuries of, 875, 876. varicose, 825. "Womb, diseases of, 827. Wrist, sprained, 867. INDEX OF DISEASES. Abdominal dropsy, 661. Abortion, 756. Abscess, 662. Addison's disease, 663. Ague, 663. Albuminuria, 665. Alcoholism, 665. Alopecia (baldness), 346. Amaurosis (a form of blindness), 666. Amblyopia (dimness of sight), 666. Amenorrhcea (stoppage of monthly courses), 666. Amyloid degeneration, 667. Anaemia (poverty of blood), 667. Anaesthesia (loss of feeling), 668. Anasarca (general dropsy), 668. Aneurism (tumor on an artery), 668. Angina pectoris, 669. Anorexia (loss of appetite), 670. Anthrax (carbuncle), 686. Anus, fissure of (crack at outlet of bowel), 670. prolapsus of (falling of bowel),671. Aorta, aneurism of, 668. Aphasia (loss of speech), 671. Aphonia (loss of voice), 671. Aphthae (white sores in the mouth), 671. Apnoea (loss of breath), 671. Apoplexy, 672. Arcus senilis, 673. Ascites (abdominal dropsy), 661. Asphyxia (suffocation), 871. Asthenopia (weak sight), 673. Asthma, 673. hay, or summer catarrh, 674. Astigmatism, 675. Ataxy, locomotor, 675. Atheroma, 675. Athetosis, 675. Baldness, 346. Barbadoes leg, 802. Bedsores, 628. Bilious fever, 784. Biliousness, 676. Bladder disorders, 677. Bleeding, 544, 737, 875 ; see Hemor> rhage. Blue disease (cyanosis), 800. Boils, 677. Bowel, inflammation of, 678. protrusion of, 678. Brain exhaustion, 679. inflammation, 679. softening of, 681. Break-bone fever, 682. Bright's disease, 682. Bronchial dilatation, 682. Bronchitis, 682. Bunion, 684. Burns, 839. Bursa, enlarged, 684. Cachexia, 685. Calculus (stone), 809. Camp fever, 818. Cancer, 685. Canker-mouth, 686. Carbuncle, 686. Cardialgia (heartburn), 686. Caries (inflammatory decay of bone), 686. of the spine, 807. Catalepsy, 687. Cataract, 402. Catarrh, 687. Cephalalgia (headache), 733. Cerebro-spinal (spotted) fever, 687. Chicken-pox, 688. Chigoe (jigger), 689. Chilblain (frost-bite), 727. Childbed fever, 780. Chloasma, 689. Chlorosis (green sickness), 689. Choked disk (of the eye), 689. Cholera, 690. infantum, 693. 923 924 INDEX OF DISEASES. Cholera morbus, 689. Chorea (St. Vitus' dance), 694. Chronic disease, 695. Cirrhosis, 695. Club-foot, 696. Colic, 696. Collapse, 699. Color-blindness, 406. Coma (stupor), 699. Comedones, 802. Congestive fever (pernicious fever), 663. Conjunctivitis, 723. Constipation, 358, 508, 527. Consumption, 700. Convulsions, 523, 703. Corns, 704. Cough, 502, 543, 683. Coxalgia (hip-disease), 705. Cramp, 705. of the stomach, 696. Cretinism, 705. Croup, 706. Crusta lactea (milk crust), 800. Cyanosis (blue disease), 708. Cystitis (inflammation of bladder), 677. Cysts, 708. Deafness, 709. Degeneration, 710. Delirium, 710. tremens, 710. Dementia (wreck of mental faculties), 711. Dengue (break-bone fever), 682. Diabetes mellitus, 711. Diarrhoea, 713. Diathesis, 713. Dilatation of the heart, 736. Diphtheria, 713. Diplopia (seeing double), 715. Dipsomania (methomania), 755. Dissecting wounds, 715. Diuresis (excessive urination), 715. Dracunculus (Guinea-worm), 715. Dropsy, 488, 548, 661, 715. Drowning, 843. Dumbness, 716. Dysentery, 716. Dysmenorrhoea (painful monthly sic! ness), 717. Dyspepsia, 717. Dyspnoea (difficulty of breathing), 718. Dysuria (difficulty in passing Avater), 718, 786. Earache, 719. Ear, inflammation of, 719. Ears, ringing in, 719. Eczema (a form of tetter), 799. Elephantiasis, 802. Embolism, 720. Emphysema, 720. Empyema, 720. Endocarditis (inflammation of the inner lining of the heart), 720, 735. Enteric fever (typhoid fever), 816. Epilepsy, 720. Epithelioma, 721. Erysipelas, 721. Erythema, 798. Exanthemata (eruptive fevers), 722. Exophthalmic goitre, 723. Eye, diseases of, 724, 767. Faceache, 726. Facial palsy, 726. Fainting, 726. Famine fever, 784. Fatty degeneration, 726. Favus, 804. Felon, 727. Fever, 66, 73, 495, 727. intermittent, 663. relapsing, 784. remittent, 784. scarlet, 792. spotted, 687. treatment of, 540. typhoid, 816. typhus, 818. Filaria, 727. Fissure of the anus, 521, 670. nipple, 659, 765. Fits, 523, 703. Flatulence, 727. Frost-bite, 727. Gall-stones, 512, 729. :- Gangrene, 486, 489, 729. Gastric fever, 729. INDEX OF DISEASES. 925 Gastritis (inflammation of the stom- ach), 730. Gin-liver, 730. Glanders, 730. Glaucoma, 730. Goitre, 731. Gonorrhoea, 731. Gout, 731. Gravel, 76, 511, 732. Grip or Grippe, 732. Hamiaturia (bloody urine), 502. Haemophilia, 733. Haemoptysis (spitting of blood), 545. Hay fever, 674. Headache, 506, 733. Heart, diseases of, 734. Heartburn, 686. Heat-stroke, 736. Hemicrania (neuralgia on one side of the head), 520, 762. Hemiplegia (palsy of half the body), 91, 769. Hemorrhage, 501, 544, 737. from the bowels, 546. lungs, 545. mouth, 545. nose, 544. stomach, 546. throat, 545. womb, 547, 754. Hemorrhoids (piles), 521, 773. Hepatization of a lung, 738. Hernia (rupture), 789. Herpes (tetter), 799. Hiccough, 738. Hip-disease, 705. Hodgkin's disease, 738. Hooping-cough, 738. Hydatids, 739. Hydrocephalus (water in the head), 739. Hydrophobia, 740. Hvdrothorax (water in the chest), 715. Hypertrophy (overgrowth), 487, 736, 741. Hypochondria, 741. Hysteria, 741. Ichthyosis (fish-skin disease), 801. Icterus (Jaundice), 748. Idiocy, 743. Ileus, 743. Imbecility, 743. Impetigo, 800. Incontinence of urine, 743. Infantile paralysis, 743. remittent, 744. Inflammation, 485, 533. of the bowels, 678. brain, 679. bronchial tubes, 682. eye, 723, 767. heart, 720, 735. liver, 751. lungs, 775. pleura, 774. stomach, 730. throat, 783, 813. Influenza, 744. In-growing nail, 762. Insanity, 745, 757. Insolation (sun-stroke), 736. Insomnia (sleeplessness), 525, 746. | Intercostal rheumatism, 746. Intermittent fever, 663. Intestinal obstruction, 766. j Intussusception, 766. Iritis (inflammation of the iris of the eye), 111. Itch, 803. grocer's, 252. Jail fever, 818. Jaundice, 748. Kidneys, diseases of, 682, 748. Larynx, diseases of, 706, 749. Lepra, 801. Leprosy, 801. Leucocythaemia; leukaemia, 749. Lice, 769. Lichen (a pimply eruption), 799. Lithiasis, 750. Liver, disorders of, 750. Lockjaw, 89, 812. Locomotor ataxy, 751. Lumbago, 752. Lungs, diseases of, 700, 752, 775. Malarial fever, 663, 784. Mania, 745, 757. 92(5 INDEX OF DISEASES. Mania-a-potu, 710. Measles, 753. German, 754. Megrim, migraine (hemicrania), 520, 762. Melancholy, 745. Membranous croup, 706. Meniere's disease, 719. Meningitis, 679, 687. Menorrhagia (excessiA'e monthly dis- charge), 754. Menstruation, errors of, 521, 547, 666, 721, 754. Methomania, 755. Milk crust, 800. log, 755. Miscarriage, 756. Moles, 757. Monomania, 757. Mother's marks, 757. Mouth, diseases of, 758. Mumps, 760. Muscae volitantes (spots before the sight), 761. Myalgia (muscle-pain), 761. Myelitis (inflammation of the spinal marrow), 761. Myopia (nearsightedness), 402, 761. Myxoedema, 761. Nail, in-growing, 762. Navel, started, 789. Nephritis (inflamed kidney), 748. Nervousness, 523, 763. Nettle-rash, 799. Neuralgia, 762. Neurasthenia (nervous debility), 763. Neurataxia (nervous disorder), 494, 764. Night-sweats, 700. Night-terrors, 765. Nipple, sore, 765. Nurse's sore mouth, 758. Obesity (excess of fat), 246. Obstruction of the bowels, 766. Odontalgia (toothache), 614. (Edema (watery swelling), 715, 767. (Esophagus, stricture of, 767. Oinomania, 755. Ophthalmia, 723, 767. Ophthalmic goitre, 767. Opisthotonos, 7(»S. Ovarian dropsy. s;;i, Ozoena, 7t>8. Palpitation of the heart, 332, 500, 734. Palsy ; paralysis, 769. Parasites, 769. Parotitis (mumps), 760. Pellagra, 771, 801. Pemphigus, 771. Pericarditis (inflammation of the outer covering of the heart), 735. Peritonitis, 771. Pernicious anaemia, 668. fever, 772. Pertussis (hooping-cough), 738. Pharyngitis (sore throat), 813. Phlebitis (inflamed vein), 755, 772. Photophobia (dread of light), 772. Phrenitis (inflammation of the brain), 679. Phthisis (consumption), 700. Piles, 773. Plague, 773. Pleurisy, 774. Pleurodynia(intercostal rheumatism), 775. Plica Polonica, 775. Pneumonia (inflammation of one or both lungs), 775. Pneumothorax, 778. Podagra (gout), 731. Poisoning, 887. Poison-vine eruption, 778. Polypus, 779. Porrigo, 804. Prolapsus ani (falling of the bowel), 779. uteri (falling of the womb), 828. Prurigo, 803. Pruritus, 803. Pseudo-membranous croup, 706. Psoriasis, 801. Puerperal fever, 780. Purpura, 781. Pyaemia, 781. Pyrosis (water-brash), 717. Quinsy, 783. Rabies canina, 784. Red gum, 784. INDEX OF DISEASES. 927 Relapsing fever, 784. Remittent fever, 784. Retention of urine, 786. Retina, detachment of, 786. Rheumatism, 787. Rickets, 788. Ringworm, 799, 804. Roseola, 799. Rotheln (German measles), 754. Rubeola (an old name for measles), 789. Rupia, 789. Rupture, 789. Scabies (itch), 792. Scald head (ringworm), 799, 804. Scarlatina; scarlet fever, 792. Sciatica, 762, 795. Sclerosis, 795. Scrivener's palsy, 795. Scrofula, 795. Scurvy, 796. Sea-sickness, 797. Seat-worms, 605, 831. Septaemia; septicaemia, 797. Shaking palsy, 769. Shingles, 799. Ship fever, 818. Sick headache, 733. Skin diseases, 798. Sleep-walking, 95, 806. Small-pox, 805. Somnambulism (sleep-walking), 806. Sore throat, 813. Spinal irritation, 807. Spine, diseases of, 807. Spitting blood, 501, 545. Spleen, enlarged, 808. Spotted fever, 687. Sprue, 758. Stammering, 808. Stomach, diseases of, 685, 730, 808. Stone in the bladder, 809. Strabismus (squinting), 810. Strangury (difficulty in passing water), 810. St. Vitus' dance, 694. Stye, 810. Summer catarrh, 673. complaint, 693. Sun-stroke, 736. Syncope (fainting), 726, 848. Syphilis, 811. 59 Tabes dorsalis, 812. Taenia (tape-worm), 833. Tetanus (lockjaw), 812. Tetter, 799. Throat, sore, 813. Thrombosis, 814. Thrush, 758. Thyro-cardiac disorder, 767. Tic-douloureux, 762. Tinnitus aurium (ring in theears), 719 Toe-nail, in-growing, 762. Tonsillitis (quinsy), 783. Toothache, 814. Trichinosis, 271, 833. Trismus (lockjaw), 812. Tubercle, 815. Tubercular meningitis, 679. Tumors, 815. Tympanites, 816. Typhlitis, 816. Typhoid fever, 816. Typhus fever, 818. Ulcers, 820. of stomach, 808. Uraemia, 821. Urine, incontinence of, 745. retention of, 786. Vaccination, 822. Varicella (chicken-pox), 688. Varicose veins, 825. Variola (small-pox), 805. Varioloid, 805. Veins, inflamed, 755, 772. varicose, 825. Vertigo (dizziness), 826. Vomiting, 500, 529. Warts, 827. I Water on the brain, 739. in the abdomen, 661. in the chest, 715, 748. Water-brash, 827. Whitlow, 727. Whooping-cough, 738. Women, diseases of, 827. Worms, 831. Wrist-drop, 834. Writer's cramp, 834. Yellow fever, 835. INDEX OF ACCIDENTS AND INJURIES. Arm, broken, 851. Artificial respiration, 844. Bandaging, 837. Bleeding, 875. Bones, broken, 848 Burns and scalds, 839. Choking, strangling, 841. Collar-bone, broken, 852. Dislocations, 863. Drowning, 843. Ear, foreign bodies in, 846. Eye, foreign bodies in, 846. Fainting, 848. Finger, broken, 851. out of joint, 864. Fractures of bones, 848. arm and forearm, 850, 851. collar-bone, 852. finger, 851. jaw, 853. knee-pan, 856. leg, 851. nose, 853. rib, 852. skull, 860. thigh, 853. Hanging, 841. Head, injuries of, 860. Jaw, broken, 853. Joints, displaced, 863. finger, 864. hip, 865 Joints, neck, 865. shoulder, 864. sprained, 866. Leg, broken, 851. Lightning-stroke, 868. Mad-dog bite, 881. Muscles, strained, 869. Nail, splinter under, 870. Needle penetration, 870. Nose, broken, 853. foreign bodies in, 870. Rib, broken, 852. Shock, 871. Snake-bites, 882. Spine, fracture or concussion of, 871. Stings, of bees, etc., 883. Strangling, 841. Suffocation, with foul gases, 871. Swallowing wrong things, 873. Tendon, rupture of, 874. Thigh, broken, 853. Transportation of injured persons, 883. Veins, injuries of, 875, 876. Wounds, 875. bruised, 875. crushed, 875. cut, 875. penetrating, 880. poisoned, 881. torn, 879. 928 INDEX OF POISONS. Acids (sulphuric, nitric, hydrochlo- ric, etc.), 888. Aconite, 888. Alcohol, 890. Alkalies, 888. Aloes, 890. Ammonia, 891. Antimony, 891. Arsenic, 892. Atropia, 894. Belladonna, 894. Bitter almonds, 894. Camphor, 895. Cantharides, 895. Carbolic acid, 895. Castor-oil seeds, 896. Cheese, 896. Chloral, 896. Chloroform, 896. Citric acid, 897. Coal oil, 895. Cocculus Indicus, 897. Colchicum, 897. Copper, 898. Corrosive sublimate, 898. Creasote, 899. Croton oil, 899. Digitalis, 899. Ergot, 900. Ether, 900. Fish, 901. Hellebore, 902. Hemlock, 902. Hydrochloric acid, 903. Hydrocyanic acid, 903. Hyoscyamus, 904. Iodine, 905. Jamestown weed, 912- Jessamine, 905. Kalmia, 905. Laurel, 905. Lead, 905. Ley (lye), 911. Lime, 906. Lobelia, 907. Lunar caustic, 908. Mercury, 908. Morphia, 908. Mushrooms, 901. Mussels, 908. Nitrate of silver, 908. Nitric acid, 908. Nux vomica, 912. Oil of bitter almonds, 908. Opium, 908. Oxalic acid, 910. Phosphorus, 911. Potassa, 911. Prussic acid, 903. Sausage poisoning, 912. Soda, 912. Stramonium, 912. Strychnia, 912. Tartar emetic, 891. Tartaric acid, 914. Tin, 914. Toadstools, 901. Tobacco, 914. Zinc, 915. 929 INDEX OF CLASSES OF REMEDIES. Accidents, to care for, 837. Anodyne medicines, 518, 522. Antidotes (see Poisons), 88'. Baths, 556. Bleeding, to check, 544, 737, 875. Bowels, to open, 356, 527. Chills (ague), to siop, 663. Debility, to treat, 491, 549. Diarrhoea, to check, 528. Digestion, to strengthen, 532. Dropsy, to treat, 548, 661, 715. Emetics, 570. Fever, to mitigate, 540. Indigestion, to relieve, 531. Inflammation, to reduce, 533. Inhalations, 577. Injections, 579. SICK Arrow-root, 636. Barley water, 635. Beef-essence, 634. Beef-tea, 633. frozen, 633. Boiled flour, 636. Bread and butter soup, 635. Broiled-beef juice, 634. Caudle, 638. Chicken broth, 634. • Egg broth, 637. with wine, 638. Farina gruel, 637. Ice, to keep, 639. Indian-meal gruel, 635. Injuries, 857. Massage (rubbing), 647. Menstruation, to regulate, 374, 574. painful, to relieve, 521. Monthly courses. See Menstruation Nausea, to relieve, 529. Nervousness, to compose, 523. Pain, to relieve, 517. Poisoning, to treat, 887. Prostration, to raise from, 549. Purgative medicines, 527. Rubbing, 647. Sleep, to promote, 525, 645, 746. Stomach, sick, to relieve, 529. Vomiting, to check, 529. Worms, to expel, 831. FOODS. Meigs' gelatin food, 637. Milk, mother's, imitation of, 637. punch, 638. Oatmeal gruel, 635. with beef-tea, 637 Panada, 636. Raw-beef extract, 634. scrapings, 634. Rice milk, 637. water, 635. Roast oysters, 638. Sago jelly, 636. Tapioca, 636. Toast-water, 635. Vegetable soup, 636. Koumiss, 638. Wine whey, 638. 930 INDEX OF MEDICINES AND OTHER REMEDIES For Doses of Medicines, see page 615. Acetate of ammonium, 553, Aconite, 553. Aloes, 553. Alum, 553. Ammonia, 554. Amyl nitrite, 592. Anise-seed, 554. Apollinaris water, 554. Arnica, 554. Arsenic, 555. Artificial respiration, 843. Assafcetida, 555. Atomization, 577. Bark, Peruvian, 600. Baths, 556. Belladonna, 556. Benzoin, 557. Blackberry root, 557. Bleeding, 535, 557. Blisters, 558. Blue pill, 558. Borax, 559. Bromides, 559. Cajuput oil, 560. Calomel, 560. Camphor, 560. Cantharides, 560. Carbolic acid, 561. Cardamom seeds, 561. Castor oil, 562. Catechu, 562. Cathartic pills, 562. Catheter, 562. Caustics, 562. Cerate, 563. Chalk mixture, 563. Chamomile, 563. Charcoal, 563. Chloral, 563. Chlorate of potassium, 563. Chloride of ammonium, 564. Chloride of lime, 564. Chloroform, 564. Chlorohydric acid, 564. Cinchona, 600. Cinnamon water, 564. Citrate of magnesium, 564. Citrate of potassium, 565. CloA'es, oil of, 565. Cocoa butter, 565. Cod-liver oil, 565. Colchicum, 566. Columbo, 566. Convallaria, 585. Corrosive sublimate, 566, Coxe's hive syrup, 567. Cream of tartar, 567. Creasote, 567. Croton oil, 567. Cupping, 535. Digitalis, 568. Dover's powder, 568. Effervescing draught, 569. Elaterium, 569. Electricity, 569. Elixir of vitriol, 570. Elixir proprietatis, 570. Emetics, 570. Epsom salts, 571. Ergot, 571. Ether, 571. Eucalyptus, 571. Fennel-seed, 572. Flaxseed, 572. Fly-blister, 572. Gentian, 573. Gerauium, 573. Ginger, 573. 931 932 INDEX OF MEDICINES AND OTHER REMEDIES. Glycerin, 574. Gum arabic, 574. Hamamelis Virginiana, 575. Hoffmann's anodyne, 575. Hops, 575. Hot water, 575. Hunyadi Janos water, 576. Huxham's tincture of bark, 576. Hydrochlorate of cocaine, 576. Hyoscyamus, 576. Hypophosphites, 576. Ingluvin, 577. Inhalations, 577. Injections, 579. hypodermic, 580. nourishing, 580. Iodine, 580. Iodoform, 581. Ipecacuanha, 581. Iron, 581. Jalap, 583. Juniper, 583. Lactucarium, 584. Lady Webster's pills, 584. Laudanum, 584. Lavender, 584. Lead, sugar of, 585. Leeching, 536. Licorice, 586. Lily of the valley, 585. Lime-water, 585. Liquorice, 586. Lithia, 586. Lobelia, 586. Logwood, 587. Magnesia, 588. Malt extract, 588. Manna, 588. Massage (rubbing), 647. Mineral waters, 588. Morphia, 589. Muriatic acid, 564. Mush and mustard, 590. Musk, 589. Mustard plasters, 589. Mustard and mush poultices, 590 Myrrh, 590. Nitrate of silver, 592. Nitre, 592. SAveet spirit of, 592. Nitrite of amyl, 592. Nitroglycerin, 592. Nitromuriatic acid, 592. Nitrous oxide, 593. Nux vomica, 593. Olive oil, 594. Opium, 594. Paregoric, 595. Pepper, 595. Peppermint, 595. Permanganate of potassium, 595. Phosphorus, 595. Pink-root, 595. Podophyllin, 597. Potassa, 597. Poultices, 597. Piillna water, 599. Pumpkin seeds, 599. Quassia, 600. Quinine, 600. Respiration, artificial, 843. Rhatany, 603. Rhubarb, 603. Rochelle salts, 604. Rubbing, 647. Salicylic acid, 605. Santonin, 605. Sassafras pith, 605. Seidlitz powders, 605. Senna, 605. Slippery-elm bark, 606. Soap, 606. liniment, 606. Soda, 606. chlorinated, 606. Spice plasters, 607. Spiced syrup of rhubarb, 603. Squills, 607. Staphysagria, 607. Strychnia, 607. Sublimate, corrosive, 607. Sulphide of calcium, 608. Sulphites and hyposulphites, 608. Sulphur, 608. INDEX OF MEDICINES AND OTHER REMEDIES. 933 Sulphuric acid, 608. Suppositories, 609. Tannin, tannic acid, 610. Tar, 610. ointment, 610. Taraxacum, 610. Tarrant's aperient, 610. Tartar emetic, 610. Tobacco, 611. Turpentine, oil of, 611. Valerian, 612. Veratrum viride, 612. Vichy water, 612. Warner's cordial, 613. Watermelon-seed tea, 613. Wild cherry bark, 613. Wistar's lozenges, 613. [On administration of medicines, see page 640, under Nursing.] GENERAL INDEX. ABDOMINAL dropsy, 661. Abdominal organs, 47. Abductor muscles, 79. Abortion, 756. Abscess, 662. Absorbents, 74. Absorption, 61. Acarus farinse, 261. sacchari, 252. Accidents and injuries, 837. Acclimation, acclimatization, 223. Acetate of ammonium, 553. lead, 585. Acetic acid, 255. Acid, hydrochloric, 564, 903. nitric, 908. sulphuric, 608, 913. Acids in diet, 255. Acids, poisonous, 888. Aconite, 553, 888. Acron, first sanitarian, 117, 146. Addison's disease, 663. Adductor muscles, 79. Adjustment of vision, 103. Adulteration of food, 279. jEsculapius, father of the goddess of health, 117. Age, in relation to disease, 477. mental faculties, 384. old, and natural death, 917. Ague (chills, intermittent fever), 663. Aiken, S. Carolina, a health resort, 231. Air, in relation to health, 122, 146, 149, 466, 625. Airing infants, 424. Alaska, climate of, 212. Albumen as food, 244. Albuminuria, 665. Alcibiades an athlete, 118. Alcohol, in beverages, 309-316. as a poison, 890. Alcoholism, 665. Alimentary canal, 45. Alkalies, as poisons, 888. Alkali flats, 160. Allspice, 289. Almonds, bitter, 894. Aloes, as a purgative, 553. poisonously used, 890. Altitude, effect of, on climate, 207. Alum, 553. in bread, 279. Amaurosis (a form of blindness), 666. Amblyopia (weak sight), 666, 673. Amenorrhoea (stoppage of monthly courses), 666. America, foods native to, 272. American population, not deteriorating 226. Ammonia, as a medicine, 554. as a poison, 891. Amyl nitrite, 592. Amylaceous food, 246. Amyloid degeneration, 667. Anaemia, 283, 492, 668. Anaesthesia, 504, 564, 571, 593, 668. Anaheim, California, 231. Anasarca, 668. Anatomy, 35. Anderson, Elizabeth Garrett, on health of women, 374. Aneurism, 69, 668. Angina pectoris, 669. Animal functions, 60. heat, 72. Anise-seed, 554. Ankle, sprained, 866. Anodyne medicines, 518, 522. Anorexia (loss of appetite), 670. Anthrax, 475, 686. Antimony, 801. Antiscorbutic (scurvy-preventing) food, 264. Antiseptics, 193. Antiseptic surgery, 474. Anus, fissure of, 521, 670. prolapsus (falling) of, 671. Aorta, 50, 64. aneurism of, 668. Apex of heart, 49. Aphasia (loss of speech), 91, 508. Aphonia (loss of voice), 508. 934 GENERAL INDEX. 935 Aphthae (small white sores in the mouth), 671. Apncea (loss of breath), 671. Apollinaris water, 554. Apollo, god of medicine, 117. Apoplexy, 672. Appetite, loss of, 670. Arachnoid membrane, of brain, 54. Arcus senilis, 673. Arm, 38. broken, 850, 851. Arnica, 554. Arnott's chimney-valve, 146. Arrow-root, 247, 249, 636. Arsenic, as a medicine, 555. as a poison, 892. Arteries, 49, 66. wounds of, 876. Artesian wells, 165. Articulates, as food, 270. Artificial respiration (see Droiming), 843. Ascites (abdominal dropsy), 661. Asparagus, 263. Asphyxia (suffocation), 673, 871. Assafoetida, 555. Assimilation, 162. Asthenopia (weak sight), 407, 673. Asthma, 673. Astigmatism, 403, 675. Ataxy, locomotor, 675. Atheroma, 675. Athetosis, 675. Atmospheric causation of disease, 446. Atomization (spray), 578. Atrophy, 488. Atropia, 894. Auditory nerves, 56, 93. Auricles of the heart, 49, 64. Auscultation, 513. Automatic action, 83. BACTERIA, 194, 468. Baldness, 346, 666. Bandaging, 837. Banting, William, on reduction of fat, 246. Barbadoes leg, 802. Bark, Peruvian, 600. Barker's mode of ventilation, 157. Barley, 262. water, 419, 635. Barometer, 211. Baths, 118, 182, 342, 423, 556, 630. Beans, 263. Beards, 349. Bed-bugs, 770. Bed, for fractures, 855. for the sick, 627. Bed-clothes, 627. Bed-sores, 628. Beef, 270, 278. essence, 634. juice, 631. tea, 633. Bee-sting, 883. Beer, 318, 320. Beet-root sugar, 252. Beets, 263. Belladonna, 556, 894. Bell-traps, 180. Benzoin, 557. Bermuda arrow-root, 248. Beverages, strength of, 318. Biceps muscle, 78. Bile, 73, 74. Bilious (remitting) fever, 784. Biliousness, 676. Birds, as food, 272. brains of, 91. Birth, attendance on, 414. Biscuit, 261. Bison (buffalo) meat, 271. Bite of mad-dog, 881. of snake, 881. Bitter almonds, 894. Blackberry root, 557. Black hole of Calcutta, 147. Bladder, 48. disorders of, 677. Blair's food, 266. Bleaching salt, 195. Bleeding (hemorrhage), 544, 737, 875 from the arm, 535, 557. Blindness, 402, 724. Blind people, other senses of, 85. spot in sound eyes, 105. Blisters, fever (fever blisters), 800. fly, 558. Blondes, 44. Blondin, 95. Blood, 68. as food, 278. Blood-poisoning, 494. Blood-spitting, 501, 545. Blue disease (cyanosis), 800. pill, 558. vitriol, 898. Boiled flour, 636. 936 GENERAL INDEX. Boils, 677. Bones, 35. broken, 848. Borax, 559. Boston, over-crowding in, 199. Bottle-feeding, 417. Bowels, action of, 76. bleeding from, 546. care of, 356. crack at outlet of, 670. falling of, 671, 678. inflammation of, 678. looseness of, to check, 528. symptoms affecting, 508. Bower's trap, 182. Brain, anatomy and physiology of, 52, 82, 84, 90. exhaustion of, 679. inflammation of, 679. softening of, 681. Bran, in diet, 253. Brazier-heating, 136. Bread, 260. digestion of, 61, 62. Bread and butter soup, 635. Break-bone fever, 682. Breast-bone, 38. inflammation of, 659. Breast, care of, when nursing, 416. Breath, how to sweeten, 352. Breathing, 70, 88. healthy, conditions of, 121. symptoms affecting, 502. Bricks, porosity of, 128. Bright's disease, 76, 682. Broccoli, 263. Broken bones, 848. Bromides, 559. Bronchial dilatation, 682. tubes, 48. Bronchitis, 682. Brows (eyebrows), use of, 108. Bruises, 875. Brunettes, 44. Buckwheat, 262. Buffalo meat, 271. Building associations, 202. Bulbs (thermometers), wet and dry, Bullet wounds, 881. Bunions, 684. Burnet's liquid, 195. Burns, 839. Butter-making, 167. Butter-milk, 296. Buttons, dog (nux vomica), 912. Butyrin, 245. Byron, Lord, size of head, 12. CABBAGES, 263. Cachexia, 492. Caffein, 299, 304. Cajuput oil, 560. Calculus (stone), 809. California, climate of, 231. Calisthenics (light gymnastics), 366. Calomel, 560. Camp fever, 818. Camphor, 560. as a poison, 895. Cancer, 490, 685. Cane, sugar, 252. Canker-mouth, 686. Canned foods, 284. Cantharides (Spanish flies), 560. as a poison, 895. Capillary attraction, 57. vessels, 57. Caracalla, baths of, 118. Carbohydrates, 246. Carbolic acid, 195, 561. as a poison, 895. Carbonic acid, 71, 148. oxide, 143. Carbuncle, 686. Cardamom, 561. Cardialgia (heartburn), 686. Caries (inflammation of bone, with decay), 686. of the spine, 686. Carnivorous teeth, 257. Carpus (wrist), 39. Carrots, 263. Carrying injured persons, 883. Cartilages, 38, 40. Casein, 244. Cast-iron stoves, 143. Castor-oil, 562. seeds poisonous, 896. Catalepsy, 687. Cataract, 402. Catarrh, 687. Catechu, 562. Cathartics (purgatives), 527. Catheter, 562. Cattle-plague, 475. Caudle, 638. Causes of disease, 462. Caustics, 562. Ceilings, height of, 151. GENERAL INDEX. 937 Celery, 264. Cellulose, 246, 253. Celsus, early writer on Hygiene, 146. Cephalalgia (headache), 733. Cerate, 563. Cerebellum, 56, 90, 96. Cerebro-spinal fever, 687. Cerebrum, 55, 90. Chalk mixture, 563. Chamber for the sick, 624. Chamomile, 563. Changing bed-clothes of the sick, 627. Chapped hands, 798, 799. Charcoal, 193, 563. poultice, 599. Cheese as food, 244. occasionally poisonous, 896. Cherries, 268. Chest, in Anatomy, 38. water in, 715. Chewing tobacco, 323. Chicken broth, 634. in diet, 272. pox, 688. Chicory, 306. Chigoe, 689. Chilblain (frost-bite), 727. Child-bed, care of, 649. fever, 780. Childhood, Hygiene of, 414. Children, food of, 259, 415. Chills (ague), 663. Chinese disposal of waste, 169. Chloasma, 689, 802. Chloral, 563. as a poison, 896. Chloralum, 195. Chlorate of potassium, 563. Chloride of ammonium (muriate of am- monia), 564. of lime, 564. of soda, 606. of sodium (salt), 255. of zinc, 193. Chlorine, disinfectant, 193. Chloroform, 564. as a poison, 896. Chlorohydric (hydrochloric or muriatic) acid, 564. as a poison, 903. Chlorosis (green sickness), 689. Chocolate, 306. Choked disk, 689. Choking, 841. Cholera, 690. Cholera, causation of, 481, 483. infantum (summer complaint), 693. morbus, 689. Chorea (St. Vitus' dance), 694. Choroid coat (of the eye), 102. Chromatic aberration, 105. Chronic disease, 695. Chyle, 49, 62. Chyme, 62. Cigarettes, 323. Ciliary ligament, 104. muscle, 104. Cinchona, 600. Cinchonia, 601. Cinnamon, 290, 564. Circulation of the blood, 64. hygiene of, 330. symptoms affecting, 500. Cirrhosis, 695, 730. Cisterns, 162. Citrate of magnesium, 565. potassium, 565. Citric acid, 897. Clams, as food, 274. Clarke, Dr. E. H., on sex in education, 374. Classification of diseases, 497. Clavicle (collar-bone), 38. fracture of, 852. Cleanliness, best protection against cholera, 482. Climates, 207. effects of, on men, 216, 228. Cloaca Maxima, at Rome, 118. Clothing, hygiene of, 335, 421. Clotting of blood, 68. Cloves, oil of, 565. Club-foot, 696. Clysters, 579. Coagulation of the blood, 68. Coal gas, 71. oil, as a poison, 895. Coca, 307. Cocaine, hydrochlorate of, 576. Cocculus Indicus, 897. Cochlea (of the ear), 111. Cocoa, 306. butter, 565. Cod-liver oil, 246, 565. Coeducation, sanctioned by Hygiene, 372. Coffee, 302. Cohn on disease-germs, 467. Colchicum, 566. as a poison, 897. 938 GENERAL INDEX. Cold applications, for inflammation, 535. arresting decay, 194. catching, explained, 464. Colic, 696; baby's, 699. Collapse, 699. Collar-bone, 38. fracture of, 852. Colloid cancer, 490. Color of the skin, cause of, 44. Color-blindness, 406. Colored infants, mortality of, 442. Color spectra, 106. Colors, nature of, 99. Colostrum, 658. Columbo, 566. Coma (stupor), 507, 699. Comedones, 802. Complementary colors, 101. Complex poisons, 887. Composing medicines, 523. Compound cathartic pills, 562. gentian pills, 531. Condensed milk, 420. Condiments, 287. Conditional causes of disease, 464. Condy's liquid (disinfectant), 195. Confectionery, poisonous, 281. Congestion, 48"), 700. Conjunctiva of the eye, 102. inflammation of, 723. Connective tissue, 45. Constantinople, plague at, 119. Constipation, as a symptom, 508; treat- ment of, 358, 432, 527. Construction of houses, 128. Consumption, 700. best climates for, 230. tendency to, how to lessen, 121, 132. Contagion, 465. Contraction of muscles, 80. Convalescence, 633. Convallaria (lily of the valley), 585. Conveyance of drinking water, 171. Convolutions of the brain, 55, 90. Convulsions (fits), 89, 523, 703. Cook, Captain, 264. Cooking, theory of, 276. Copper, as a poison, 898. food poisoned by, 285. Cornaro, long life on low diet, 239. Cornea, of the eye, 102. Corns, 704. Corn starch, 248. Corpora striata, of brain, 93. Corpuscles of the blood, 68. Corrective medicines, 528. Corrosive sublimate, 566, 607. as a poison, 898. Cortex of the kidney, 75. Costiveness, 357, 508, 527. Cough, 502, 543, 683. Counter-irritation, 539. Country week for city children, 202. Courses, stoppage of, 666. Coxalgia (hip disease), 705. Coxe's hive syrup, 567. Crackers, 261. Cramp, 705. of stomach, 696. Cranium (skull), 35. Cream of tartar, 567. Creasote, 567. as a poison, 895, 899. Cretinism, 705. Cromwell, size of head, 92. Cross-eyed vision, 405, 810. Croton oil, 567. as a poison, 899. water, of New York, 169. Croup, 706. Crowd-poison, 123. Cruorin, of the blood, 244. Crushed wounds, 875. Crusta lactea (milk-crust), 800. Crystalline lens of the eye, 102. Cucumbers, poisoned, 285. Cupping, 536, 558. Curiosities of diet, 275. Cushions, for the sick, 628. Cuticle, 44. Cutis (skin), 44. Cut wounds, 875. Cuvier, size of head, 92. Cyanide of potassium (poison), 903. Cyanosis (blue disease), 800. Cysts, 708. DAMPNESS, effects of, 126, 215. Dandelion, 610. Dandruff, 801. Davos, a health resort, 231. Davy, Sir Humphrey, a plan of ventila' tion, 146. Deafness, 112, 408, 506, 709. Death, changes following, 81. modes of, 918. Debility, 491, 549. Degeneration, 488. Delirium, 507, 710. GENERAL INDEX. 939 Delirium tremens, 710. Delivery, management of, 649. Dementia, 711, 745. Dengue (break-bone fever), 682. Dentition (teething), 89, 425. Depressant poisons, 887. Desaguliers, ventilating fan, 146. Dew, 210. point, 210. Diabetes, 76, 711, 715. Diagnosis, physical, 512. Diaphragm, 70. Diarrhoea, 508, 713. treatment of, 528. Diathesis, 493, 713. Dickens, Charles, size of head, 92. Diet of the sick, 239, 535, 631. curiosities of, 275. Diffusion of gases, 150. Digestion, 61. weak, to improve, 532. Digestibility of foods, 281. Digestive causes of disease, 464. Digitalin, 899. Digitalis, 568. as a poison, 899. Digits (fingers and toes), 40. Dilatation of the heart, 736. Diphtheria, 713. causation of, 473, 483. Diplopia (seeing double), 715. Dipsomania, 755. Discharges, of infants, 425. Disease, causation of, 462. definition of, 461. nature of, 484. Disease-germs, theory of, 467. Diseased meats, 281. Disinfection, 193. Dislocations, 863. Dismal Swamp water, 160. Dissecting wounds, 715. Distance, how judged of, in sight, 105. Distilled water as a drink, 160. Diuresis, 715; Diuretics, 548. Dizziness, 508, 826. Dog buttons, 912. varieties of, 225. Doses of medicines, 615. Dover's powder, 568. Dracunculus (Guinea-worm), 715. Drainage, 176. Drink, 291. and food, 232. Driven wells, 165. Driving, as an exercise, 361. illustrating medical practice, 551. Drops, of different liquids, 641. Dropsy, 488, 548, 715. abdominal, 661. Drowning, 843. Duck, as food, 272. Dumbness, 716. Duodenum, 45. Dura mater, 54. Dust to be burned, 178. Dysentery, 716. Dysmenorrhoea (painful monthly sickness), 521, 717. Dyspepsia, 532, 717. Dyspnoea (difficult breathing), 502, 718. Dysuria (painful or difficult urination), 718, 786. EAR, care of, 408. Ear, foreign bodies in, 846. Ear, inflammation of, 719. ringing in, 719. structure of, 110. symptoms connected with, 505. Earache, 520, 719. Earth-closet, 177. Eating, manner of, for health, 236. Ecthyma, 800. Eczema (a kind of tetter), 799. Education, in relation to health, 392. physiological principles of, 396. Effervescing draught, 569. Effusion, 486. Egg broth, 637. with wine, 638. Eggs, as food, 269. Egypt, ancient, sanitation in, 118. climate of, 210. Elaterium, 569. Electricity, as a remedy, 569. Elements of the human body, 241. Elephantiasis, 802. Elixir of vitriol, 570. proprietatis, 570. Embolism, 726. Emetics, 570. Emotion, expression of, 80. how to govern, 398. seat of, in brain, 98. Empedocles, ancient sanitarian, 11"; Emphysema, 720. Employments, unhealthy, 445 ( Empyema, 720. 940 G EN El Encephaloid cancer, 490. Endemic diseases, 466. Endocarditis (inflammation of lining the heart), 735. Enemata (injections), 579. Energy, forms of, in the body, 243. Enteric (typhoid) fever, 816. Enthetic diseases, 495. Ephelis (sunburn), 801. Epidemic diseases, 466. Epidermis (scarf-skin), 44. Epilepsy, 720. Kpithelioma, 721. Epsom salts, 164, 571. Erbswurst, 263. Ergot, 571. as a poison, 900. Eruptions, 798. Erysipelas, 721. Erythema, 798. Erythroxylon coca, 308. Ether, 571. as a poison, 900. waves, the cause of light, 98. Eucalyptus, a dryer of the soil, 215. as a medicine, 571. Eustachian tube, of the ear, 110. Exanthemata (eruptive fevers), 722. Excess of food, effects of, 282. Excitement, in relation to mental health, 397. Excito-motor actions, 89. Excito-secretory actions, 89. Excretion, 73, 354. of the sick, 643. Excretory organs, 73. Exercise, 359. Exophthalmic goitre, 723. Expectation of life, 450. Expectoration, 503. Expression of feelings, 80. Eye, care of, 402. diseases of, 743, 767. foreign bodies in, 846. physiological account of, 98. symptoms affecting, in disease, 505. FACE, expression of, in disease, 506. Faceache, 762. Facial palsy, 726. Factory laws, 448. Fainting, 726, 848. Famine fever, 784. Farina gruel, 636. L INDEX. Fasting, how long possible, 235. Fat, excessive, reduction of, 246. Fatty degeneration, 488, 726. food, 244. Favus (a disease of the scalp), 804. Feeling and knowing, 81. loss of, 504. Felon, 727. Femur (thigh-bone), 40. Fennel-seed, 572. Fermentation, cause of, 470. Fever, 66, 73, 495, 727. blisters (so-called), 800. intermittent, 663. relapsing, 784. remittent, 784. scarlet, 792. spotted, 687. treatment of, 540. yellow, 835. Fibres, muscular, 41. Fibrin, 244. Fibula, 40. fracture of, 358. Fick, observations on excretion, 247. Figs, 268. Filaria, 727. Filters, 174. Filth, as a cause of disease, 476. Finger, broken, 851. out of joint, 864. Fire-places, 131, 136. Fish, as food, 272. brains of, 91. poisonous, 901. Fissure of the anus, 521, 670. nipple, 659. Fits, 89, 523, 703. Flannel, 337. Flatulence, 727. Flaxseed, 572. poultice, 578. Fleas, 770. Floors, should be above ground, 130. Florence, early quarantine at, 119. Florida, climate of, 231. Flour, boiled, 636. qualities of, 261. Fly-blister, 572. Focus of a lens, 104. Food and drink, 232. groups, 244. principles, 265. quantity of, 239. requisites of, 240. GENERAL INDEX. 941 30. Glanders, 730. Glands, lymphatic, 53. Glass-lined pipes, 173. Glasses, adaptation of, to the sight, ' Glaucoma, 730. Globulin, 244. Glucose, 252, 253. Gluten, 244. Glycerin, 253, 573. Goat's milk, 291. Goitre, 731. Gonorrhoea, 731. Goose, as food, 272. Goulard's extract, 585. Gout, 282, 731. Graham bread, 253. Grapes, 267. Grape sugar, 252, 253. Grate, low-down, 142. Gravel, 76, 511, 732. Greece, ancient, sanitation in, 118. Grip or Grippe, 732 Grocer's itch, 252. Grotto del Cane, 71. Ground air, 125. water, 163. Growths, morbid, 490. Gruel, 635. Guinea-fowl, 272. Guinea-worm, 715. Gulf-stream, effect of, on climate, 211 Gum, 246, 574. arable, 574. Gums, in disease, 499. Gunshot wounds, 881. Gustatory nerves (of taste), 93. Guyot, comparison of climates, 216. Gymnastics, 363. Food, sick, 631, 633. uses of, 243. Foods for infants, 419. Force, definition of, footnote, 243. food, 254. Forests, effect of, on climate, 215. Formad, inquiry concerning diphth 473. Fractures (broken bones), 848. bed, 855. box, 857. France, mortality of, 119. Freckles, 801. Freezing, effect of, on water, 171. Friedrichshalle water, 589. Friends, Society of, mortality in, 452. Fro6t-bite, 727. Fruits, as food, 267. Fuel-food, 245. Functional causation of disease, 463. Functions of the body, 60. Fungi, poisonous, 901. HEMATURIA, 733. Haemophilia (bloody urine), 502. Haemoptysis (spitting blood), 545. Hair, care of, 346. dyes, 347. Hale, ship's lungs, 146. Hamamelis (witch hazel), 575. Hammond, experiments of, 265. Hanging, 841. Hard water, 163. Hardening, 205. Hard's food, 266. Harmattan, of the desert, 139. Hasheesh, 329. Hats, 340. n ALL-BLADDER, 47, 74. U" Gall-duct, 47. Gall-stones, 512, 729. Galton, system of warming, 142. Gambetta, size of head, 92. Game, as food, 244. Games, for exercise, 362. Ganglia, 57, 59, 83, 86, 93. Gangrene, 486, 489, 729. Garments of the sick, 629. Gas, air spoiled by burning, 145, 159. ventilation by jet of, 188. warming by, 144. Gastric fever, 729. Gastritis (inflammation of stomach), 730. Gelatin, 244. food, 637. General disorders, 491. Generation, spontaneous, impossible, 474. Geneva, mortality of, 119. Gentian, 573. pills, compound, 531. Geranium, 573. German measles, 754. Germ-theory of disease, 467. Gestation, hygiene of, 375. Giddiness, 508, 826. Gin, composition of, 319. Ginger, 573. Gin-liver, 730. Girlhood, hygiene of, 374. 942 GENERAL INDEX. Hawley's food, 266. Hay fever, 674. Head, injuries of, 860. size of, 92. Headache, 506, 733. Health, affecting mental capacity, 388. Health-lift, 360. Hearing, hygiene of, 408. nerves of, 56, 93. physiology of, 109. Heart, diseases of, 734. enlargement of, 487. hygiene of, 331. structure and action of, 49, 50, 65. Heart-burn, 686. Heat, animal, 72. diffusion of, 137. disinfection by, 194. measurement of, in disease, 513. Heating of houses, 135. Heat-stroke, 736. Hellebore, American, 612. poisonous, 902. Hemicrania (neuralgia on one side of the head), 520, 762. Hemiplegia (palsy of half the body), 91, 769. Hemlock, poisonous, 902. Hemorrhage, as a symptom, 501, 737. treatment of, 544. Hemorrhoids (piles), 521, 773. Hepatization of a lung, 738. Herbivorous animals, 257. Hereditary disease, 462. mental traits, 383. Hernia (rupture), 789. Herodicus, early use of gymnastics, 117. Herpes (tetter), 799. Hiccough, 503, 738. Hill, Octavia, work of, in London, 202. Hinckes-Bird's window ventilation, 154. Hip-disease, 705. Hippocrates, 117. Hodgkin's disease, 738. Hoffmann's anodyne, 575. Homes, hygiene of, 123. Honey, 252. Hooping-cough, 738. Hoppers, 184. Hops, 575. Horlick's food, 266. Hornet-sting, 883. Horseback exercise, 361. Hot water as a remedy, 575. spigot, not to be used for cooking, 286. Hot water, warming apparatus, 143. weather, trying to infants, 429. Houses, construction of, for health, 128. Hubbell's food, 266. Hugo, Victor, on sewage, 169. Humanity, essential crown of, 113. Humerus (arm-bone), 38. fracture of, 850. Humidity (moisture), 139, 210. Humus (soil) for earth-closet, 178. Hunyadi Janos water, 576. Huxham's tincture of bark, 576. Hydatids, 739. Hydrocephalus (water in the head), 739. Hydrochlorate of cocaine, 576. Hydrochloric acid, 564, 903. Hydrocyanic (prussic) acid, 903. Hydrophobia, 89, 740. Hygiene, 117. Hygrometry, 210. Hyoscyamus, 576. as a poison, 904. Hypaesthetic action of alcohol, 310. Hyperaemia (excess of blood), 485. Hyperaesthesia (excessive sensitiveness), 741. Hypermetropia, 105, 741. Hyperopia, 105, 741. Hypertrophy (overgrowth), 487, 736, 741. Hypochondria, 741. Hypodermic injections, 580. Hypophosphites, 576. Hysteria, 89, 741. ICE, purity of, important, 171. Ice, to keep for the sick, 639. Ichthyosis (fish-skin disease), 801. Icterus (jaundice), 748. Ideas, seat of, in the brain, 98. Idiocy, 743. Idiosyncrasies, 268. Ileo-colic valve, 46. Imagination, in relation to mental health, 399. Imbecility, 743. Imperial granum, 266. Impetigo, 800. Impulse of the heart, 66. Incontinence of urine, 743. Incus (a small bone of the ear), 110. India, climate of, 227. Indigestion, treatment of, 531. Infancy, hygiene of, 414. Infantile paralysis, 743. GENERAL INDEX. 943 Infantile remittent, 744. Infants, mortality of, 440, 442. nourishment of, 415. Infection, 466. Inflammation, 485. treatment of, 533. Influenza, 744. Ingluvin, 577. In-growing nail, 762. Inhalations, 577. Injections, 579. hypodermic, 580. nourishing, 580. Inlets and outlets for air, 155. Insanity, 745, 757. Insolation (sun-stroke), 736 Insomnia (sleeplessness), 525, 746. Intercostal muscles, 70. rheumatism, 746. Intermittent fever (ague), 663. Intestines, 45. excretion of, 76. obstruction in, 766. Intussusception, 766. Inverted images in the eye, 102. Involuntary muscles, 41, 80. Iodine, 580. as a poison, 905. Iodoform, 581. Ipecacuanha, 581. Iris, of the eye, 89, 105. Iritis, 747. Iron, 581. in blood, 68. pipes for water, 172. Irrigation, sewage, 190, 192. Irritant poisons, 887. Irritation, 485. Itch, 803. grocer's, 252. JAIL fever, 818. Jalap, 583. Jamestown weed, 912 Jaundice, 748. Jaw, broken, 853. dislocated, 863. Jellies, 632. Jenner, and vaccination, 119. Jessamine, 905. Jews, long life of, 436. Johnson's fluid beef, 632. Joints, displaced, 863. in anatomy, 40. 60 Joints, sprained, 866. Juniper, 583. KAKELUNG, a Swedish stove, 136. Kalmia (sheep's laurel), 905. Khamseen, a wind of the desert, 139. Kidney, structure and functions of, 48, 73, 75. diseases of, 748. hygiene of, 355. symptoms affecting, 509. Knee, sprained, 867. Knee-pan, 40. broken, 856. Knowledge, how we obtain, 81. Koch, Robert, on tubercle, 473. Koumiss, 638. Kuro-Siwo, a wind of the Pacific, 212. LABARRAQUE'S liquid (disinfectant), 193. Labor, management of, 649. Labyrinth of the ear, 111. Lacerated wounds, 879. Lachrymal gland (for tears), 108. Lacing, tight, 332. Lacteal vessels, 49. Lactic acid, 256. Lactiferous (milk-bearing) ducts, 54. Lactucarium, 584. Lady Webster's pills, 584. Lakes, effect of, on climate, 208. Lamb, as food, 270. Charles, size of head, 92. Lancing babies' gums, 428. Languages, common origin of, 225. Larynx (organ of voice), 49. diseases of, 749. Lashes, eye, uses of, 108. Laudanum, 584. as a poison, 908. Laurel, 905. Lavatory traps and overflows, 183. Lavender, 584. Laxative medicines, 527. Lead, action of, on drinking water, 172. poisonous compounds of, 905. sugar of, 585. Ledoyen's liquid (disinfectant), 195. Leeching, 536. Leg, broken, 857. Lemonade, 268. Lens, crystalline, of the eye, 101. 944 GENERAL INDEX. Lenses, convex and concave, 105. Lepra, 801. Leprosy, 801. Leucocythaemia, 492, 749. Leucorrhoea, 749. Leukaemia, 492, 749. Levers, action of, in the body, 78. Ley, poisonously used, 906. poultice, 599. Lice, 769. Lichen (a disease of the skin), 799. Licorice, 586. Liebig's extract, 255. foods, 266. Liernur's pneumatic system, 191. Life, duration of, 120. insurance, 450. Lift, for invalids, 856. health (so-called), 360. Light, nature of, 98. in relation to health, 133. in the sick-room, 625. Lightning-stroke, 868. Lignin, 246, 253. Lily of the valley, 585. Lime, disinfectant, 193. as a poison, 906. Lime-water, 420, 585. Liquorice, 586. Lister, antiseptic surgery of, 474. Lithia, 586. Lithiasis, 750. Liver, disorders of, 750. hygiene of, 354. structure and functions of, 47, 74. Lobelia, 586. as a poison, 907. Lobes of the brain, 56. Local disorders, 484. Lockjaw, 89, 812. Locomotor ataxy, 751. Logwood, 587. London, mortality of, 119. Londonderry, steamer, suffocation in, 147. Longevity, average, 433, 434. of intellectual men, 397. unusual, 455. Long life, how to attain it, 457. Long-sightedness, 105, 403. Louis Philippe's family poisoned by lead, 171. Low-down grates, 142. Lumbago, 752. Lunar caustic, 592. as a poison, 908. Lungs, diseases of, 700, 752, 775. structure and functions of, 49, 70. Lupulin, 575. Lupus, 752, 803. Lymph, 49. Lymphatic (absorbent) vessels, 49. M ACAULAY, on mortality of London, 119. Mad-dog bite, 89, 740. Magnesia, 588. Maine's ventilator, 154. Malaria, causation of, 471, 478. Malarial fever, 663, 784. Malic acid, 256. Malleus, a bone of the ear, 110. Malt extract, 588. Mammals, brains of, 91. Mammary gland, 54. Man, only one species, 224. Mania, 745, 757. Mania-a-potu, 710. Manna, 588. Marriage, when to be forbidden, 378, Marriages, statistics of, 436. Married state, most healthy, 371. Marrow, spinal, 56, 83, 87. Marsh water, unwholesome, 160. Massage, 647. Maternity, hygiene of, 377. May-apple, 597. McMunn's elixir, 584. Meal mite, 261. Meals, frequency of, 237. Measles, 753. German, 754. Measures, apothecaries', 641. common, 641. Meats, 257, 270. Meatus of the ear, 110. Medicine chest, 619. glasses, 640. Medicines, for the household, 618. how to give, 640. principal, 553. Medulla oblongata, 56, 88, 97. Megrim, migraine, 520, 762. Meigs' gelatin food, 637. Melancholy, 745. Membrana tympani (of the ear), 110. Membranes of the brain, 54. inflammation of, 679, 687. Membranous croup, 706. Meniere's disease, 719. GENERAL INDEX. 945 Meningitis, 679, 687. Menorrhagia (monthly flooding), 754. Menstruation, hygiene of, 374. irregular, 547, 666, 754. painful, 521. Mental hygiene, 382. management of the sick, 646. Mercury, poisonous compounds of, 908. Mesenteric glands, 62. Metacarpal bones, of the hand, 39. Metatarsal bones, of the foot, 40. Methomania, 317, 755. Metrical system, 641. Microscopic organisms, supposed causes of diseases, 468. Middle ear, 110. Migraine, megrim, 520, 762. Milk, 73, 291, 418. adulterations of, 295. conveyance of disease by, 167. crust (a disease of the skin), 800. deteriorations of, 294. fever, 659. leg, 755. mother's, imitation of, 637. punch, 638. Mind, hygiene of, 382. Mineral waters, 588. Minnesota, climate of, 231. Miscarriage, 756. Mississippi water, 168. Mixed muscles, 80. Moisture, in relation to health, 139, 209. Moles, 757. Molluscs, as food, 270. Molluscum, a disease of the skin, 803. Monomania, 757. Monsoons, 208, 212. Monthly courses, irregular, 547, 754. painful, 521. stoppage of, 666. Morphia, 589, 594. as a poison, 908. Mortality, 435, 438. infantile, 440. Mortification, 486, 489. Moses, sanitary precepts of, 118. Mosquitoes, 770. Mother's marks, 757. Mountain-meal, 241. Mountains, influence of, on climate, 209. Mouth, bleeding in, 545. diseases of, 758. symptoms affecting, 499. Movement after death, 81. Moving powers of the body, 77. Mumps, 760. Muriatic acid, 564, 903. Muscae volitantes (flying specks in the eyes), 761. Muscles, hygiene of, 359. strained, 869. structure and action of, 41, 78, 107. symptoms affecting, 503. Muscular sense, 95. Mush poultices, 590, 598. Mushrooms, 264. poisonous, 901. Musk, 589. Mussels, poisonous, 908. Mustard, a good emetic, 889. in diet, 289. -plasters, 589. Mutton, 270. Myalgia, 761. Myelitis (inflammation of spinal marrow), 761. Myopia (near-sightedness), 402, 761. Myrrh, as a medicine, 590. use of, for the teeth, 351. Myxoedema, 761. N.EVUS (mole), 757. Nail, in-growing, 762. Nail, splinter under, 870. Narcotic poisons, 887. stimulants, 329. Nassau, climate of, 231. Natural ventilation, 153. Nature of diseases, 484. Nausea (sick stomach) as a symptom, 500. to relieve, 529. Navel, started, 789. Near-sightedness, 105, 402, 761. Needle penetration, 870. Negroes, race-acclimation of, 228. Nephritis (inflamed kidney), 748. Nervousness, to compose, 523. Nettle-rash, 799. Neuralgia, 520, 762. Neurasthenia, 763. Neurataxia, 494, 764. * Neurin, 244. Neurosis, 765. Neurotic poisons, 887. Nerve-centres, 57. Nerves, 57, 81, 84. Nervousness, treatment of, 523. Nestle's food, 266. 946 New York, density of population, 200. infant mortality of, 440. Newport, 231. Nicotin, nicotia, 322. Night-mare, 238. Night-sweats, 700. Night-terrors, 765. Nipple, sore, 659, 765. Nitrate of potassium, 592. silver (lunar caustic), 592. as a poison, 908. Nitre, 592. sweet spirit of, 592. tablets, for asthma, 674. Nitric acid, 908. Nitrite of amyl, 592. Nitrogen gas, 72. in foods, 244, 245. Nitroglycerin, 592. Nitromuriatic acid, 592. Nitrous oxide, 593. Nose, bleeding, 544. broken, 853. foreign bodies in, 870. Nourishing injections, 580. Nourishment of infants, 415. Nurse's sore mouth, 758. Nursing, 620. the mother's duty, 416. Nutmeg, 289. Nutrina, 266. Nutrition, 63. Nux vomica, 593. as a poison, 908. OATMEAL, 262. Oatmeal gruel, 635. Oatmeal, with beef tea, 637. Obesity (excess of fatness), 246. Obstruction of bowels, 766. Obstructive causes of disease, 465. Ocean, effect of, on climate, 208. Ocean Grove, sanitation of, 191. Occupations, in relation to health, 434. Odontalgia (toothache), 614. Odorless pneumatic system, 191. CEdema (local watery collection), 715. OZsophagus, 45, 61. stricture of, 767. Oil, sweet, 594. of bitter almonds, 894. of turpentine, 611. of vitriol,'-913. Oil-glands, 45. L INDEX. Oily or fatty foods, 244. Oinomania, 755. Old age, 917. people, retaining mental power, 386. sight, 403. Olein, 245. Olfactory (smelling) nerves, 56, 93. Olive oil, 594, Omnivorous animals, including man, 257. Onions, 263. Opaque bodies, 102. Opening medicines, 527. Ophthalmia (inflammation of the eves), 767. Ophthalmic goitre, 767. Opisthotonos, 768. Opium, 594. eating, 326. poisoning, 908. Optic nerves, 56, 93. Oranges, 267. Orbicular bone, of the ear, 110. Organic impurity in water, 168. Orthopncea, 768. Os calcis (heel-bone), 40. coccygis, 36. Otitis (inflamed ear), 719. Otoliths, 111. Ovarian dropsy, 831. Ovaries, 53. Overgrowth of parts, 487. Oxalic acid, poisonous, 910. Oxidation of running water, 169. Oxygen gas, 71. of the atmosphere, 148. Oysters, 274. roast, 638. Ozoena, 768. Ozmazome, 276. Ozone, 148. PAIN, as a symptom, 504. Pain, to relieve, 517. Pale muscles, 41. Palmitin, 245. Palpitation, 332, 500, 734. Palsy, 91,769. Panada, 636. Pancreas, 45, 62. Papillae of the skin, 44. Papoma, 266. Paralysis, 769. infantile, 743. Paraplegia, 769. GENERA GENERAL INDEX. 947 Parasites, 769, 803. in meat, 271. Paregoric, 594. Parotitis (mumps), 760. Parry, Captain, small amount of food, 240. Parsnips, 263. Parton, on tobacco, 325. Pasteur, observations of, 470, 474. Patagonians, long-chested, 121. Patella (knee-pan), 40. fracture of, 856. Peaches, 268. Peabody, George, model lodging-houses, 202. Pears, 268. Peas, 263. Pectic acid, 255. Pedigree horses, 379. Pellagra, 801. Pelvis, 38. Penetrating wounds, 880. Pepper, 288, 595. Peppermint, 595. Pepsin, 244. Percussion, for diagnosis, 512. Pericarditis, 735. Pericardium (outer covering of the heart), 50. Pericles, an athlete, 118. Peristaltic action, 74. Peritonitis, 771. Permanganate of potassium, 594. as disinfectant, 195. Pernicious anaemia, 668. fever, 772. Perspiration, 72. in disease, 512. Pertussis (hooping-cough), 738. Peru, a part of, rainless, 210. Pessaries, 829. Pettenkofer's observations, 125, 128, 129, 149. Phalanges, of fingers and toes, 40. Pharyngitis (sore throat), 813. Pharynx, 45, 61. Phidias, water-supply of Athens, 260. Philadelphia, a city of homes, 200. mortality of, 438, 451. Phlebitis (inflamed vein), 755, 772. Phosphates, 260. Phosphorus, 595. as a poison, 911. Photophobia (dread of light), 772. Phrenitis (inflammation of brain), 679. Phthisis (consumption), 700. Physical diagnosis, 512. Physiology, 60. Pia mater, of the brain, 55. Pickles, poisonous, 285. Piles, 521, 773. Pine, Southern, a dryer of the soil, 216. Pineapples, 268. Pink-root, 595. Plague, 119, 196, 773. Plato, protesting against prolonging weak lives, 117. Plethora, 282, 492. Pleurisy, 774. Pleurodynia, 775. Plica Polonica, 775. Pneumonia, 775. Pneumothorax, 778. Podagra, 731. Podophyllum, 597. Poisoned wounds, 881. Poisonous food, 284. Poisons, 887. food for some animals, 233. Poison-vine eruption, 778. Polypus, 779. Pond's extract, 575. Pons Varolii, of the brain, 97. Population, in relation to health, 124, 197. Porcelain stoves, 136% Pork, 270. Porosity of brick and stone, 128, 149. Porrigo, 804. Portal vein, 52, 74. Potatoes, 263. starch, 248. Potassa (potash), 597. as a poison, 911. Poultices, 597. Precocity, not desirable, 384. Pregnancy, hygiene of, 375. nursing in, 649. Presbyopia (old sight), 779. Preserves, 268. Prince of Wales, illness, 176, 188. Prism, action of, on light, 101. Prolapsus ani (falling of bowel), 779. uteri (falling of womb), 828. Prostration, 491, 549. Protagon, 244. Protoplasmic food, 270. Protozoa, as food, 270. Prunes, 268. Prurigo, 803. Pruritus (itching), 803. Prussic acid, 903. 948 GENERAL INDEX. Pseudo-membranous croup, 706. Psoriasis, 801. Puerperal fever, 780. Piillna water, 599. Pulmonary artery, 50. veins, 50. Pulse, 66, 500. Pumpkin seeds, 599. Pupil of the eye, 81. in disease, 505. Purgative medicines, 527. Purification of water, 168, 173. Purpura, 781. Putrefaction, supposed cause of, 470. Pyaemia, 495, 781. Pylorus, 45. Pyrosis (water-brash), 717. QUARANTINE, institution of, 119. Quarantine, personal, useless, 482. Quassia, 600. Quinine, 600. Quinsy, 78^. RABBIT, as food, 271. Rabies (canine madness), 740. Raceraic acid, of grapes, 256. Races of men, 224. Radiate animals, as food, 270. Radiator pipes, 144. Radius, of the forearm, 39. fracture of, 851. Rafflesia, enormous flower of, 216, 217. Rain, various amounts of, 214. Rainless regions of the world, 210. Rain-water, as a drink, 161. Raphael, size of head, 92. Rattlesnake-bite. 882 Raw beef extract, 632. Red corpuscles of blood, 68. gum, of infants, 784. muscles, 41. Reflection of light, 100. Reflex actions, 83, 88. Refraction of light, 100. Regimen Sanitatis Salerni, 118. Relapsing fever, 784. Religion, in relation to mental health, 401. Remedies, 514. Remittent fever, 784. infantile, 744. Reproduction, organs of, 153. Reptiles, as food, 272. Reptiles, brains of, 91. Resolution of inflammation, 486. Respiration, 70. artificial, 862. hygiene of, 121. symptoms affecting, 502. Rest, one day in seven, needful, 366. cure, 764. Retention of urine, 786. Retina, of the eye, 102. detachment of, 786. Rhatany, 603. Rheumatism, 787. intercostal, 746. Rhubarb, 603. Ribs, 38. broken, 852. Rice, 262. milk, 637. water, 635. Rice plantations, unhealthy, 125. Richardson, B. W., city of health, 130. Rickets, 788. Ridge's food, 266. Rigidity of muscles, 504. Rigor mortis (stiffening after death), 81. Ringing in the ears, 505. Ringworm, 799, 804. River water, 168. Rochelle salts, 604. Rochester, health of, 127. Rome, ancient, sanitation in, 118. Roofing, for health, 130. Room, for a sick patient, 624. Roots of trees, in wells, 166. Roseola, 799. Rotheln (German measles), 754. Rowing matches, facts concerning, 360. Rubbing (massage), 647. Rubeola (a name for measles), 753. Rules for care of infants, 430. Rupia (a disease of the skin), 798. Rupture, 789. Rye bread, 260. SABBATH, natural need of, 366. Sacrum, 36. Sago, 636. Salaeratus, 261. Salernum, school of, 118. Salicylic acid, 605. Saliva, 61. Salivation, 499. Salsify, 263. GENERAL INDEX. 949 Salts in food, 254. San Bernardino, California, 231. San Diego, California, 231. Sanitary improvement, progress of, 120. Santa Barbara, California, 231. Santonin, 605. Sassafras pith, 605. Sausage poisoning, 2S4, 912. Savory and Moore's food, 266. Scabies (itch), 803. Scald head (ringworm), 800. Scalds, 839. Scapula (shoulder-blade), 38. Scarf-skin, 44. Scarlatina, 792. Scarlet fever, 792. Schirrus (hard cancer), 490. School hygiene, 393. Schuylkill water, 170. Schyzophytes, 470. Sciatica, 762. Sclerosis, 795. Sclerotic coat of the eye, 102. Scorbutus (scurvy), 264, 796. Scrivener's palsy, 795. Scrofula, 795. Scum on water, 169. Scurvy, 264, 796. Sea-shore air-movements, 208. Sea-sickness, 797. Seasoning food, 287. Seasons, 204. Seat-worms, 605, 831. Sebaceous glands, 77. Secretion, 73. Sedentary employments, 366. Seidlitz powders, 605. Semicircular canals of the ear, 111. Semilunar ganglia, 58. Senna, 605. Sensation, loss of, 504. nerves of, 85. Senses, hygiene of, 402. special, 98. Sensori-motor actions, 94. Sensorium, 94. Sensory ganglia, 93. Septaemia, 494, 797. Septicaemia, 494, 797. Sewage, in drinking water, 168. Sewerage, 189. Sewer air, 189. Sewing-machines, 366. Sex, in relation to mind, 387. Sexual hygiene, 36S. Shaking palsy, 769. Sherringham valve, 154. Shingles, 799. Ship fever, 818. Shock, 871. Shoes, 340. Shoulder, in Anatomy, 38. -blade, 38. out of joint, 864. Sick headache, 733. stomach, as a symptom, 500. to relieve, 529. Sick-bed, 627. Sick-food, 631. Sick-garments, 629. Sick-room, 624. Sight, hygiene of, 402. physiology of, 98. Signs of diseases, 499. Silver, nitrate, 592. as a poison, 908. Simoom, 139. Sinks, traps for, 182. Situation, for health, 124. Size of objects seen, how judged of, 106. Skating, 95, 362. Skeleton, 35. Skin, 44, 77. care of, 333. diseases of, 798. Skull, 35. fracture of, 860. Sleep, physiology of, 93, 95. in relation to health, 391, 645. Sleeplessness, 525, 645, 74.6. Sleep-walking, 95, 806. Slippery-elm bark, 606. Small-pox, 805. Smell, nerves of, 56, 93. Smith, Dr. S., on tenement-house life, 19S. Smoking, 323. Snake-bites, 881. Snoring respiration, 503. Snow-line, 207. Snow-water, 170. Snuff-taking, 323. Soap, 606. liniment, 606. Social evil, not permissible, 370. Society, in America, needing limitations, 373. Socrates, athlete as well as philosopher, 118. Soda, 606. Soft water, 164. Soil, in relation to health, 126. 950 GENERAL INDEX. Soil-pipes, 184. Solar plexus, 58. Somnambulism, 95, 806. Sore throat, 813. Sound, nature of, 109. Sounds of the heart, 66. Soups, 278. Sour breath in infants, 420. Spanish windlass, 877. Spartans, treatment of infants, 117. Spasm, 504. Special diseases, 661. Specific Remedies, 551. Spectrum, solar, 99. Speech, loss of, 508, 671. Spherical aberration in sight, 105. Spiced syrup of rhubarb, 603. Spices, 287. Spigelia (pink-root), 595. Spinach, 264. Spinal cord, or marrow, 56, 83, 87. irritation, 807. Spine, anatomy of, 35, 37. diseases of, 807. injury of, 871. Spirit, in man, not in lower creatures, 113. Spirituous liquors, 319. Spitting blood, 501, 545. Spleen, 47. enlargement of, 808. Spontaneous generation not possible, 474. Spots before the eyes, 505. Spotted fever, 687. Sprains, 866. Spray, medicated, 578. Spring water, 162. Sprue, 758. Squills, 607. Squinting, 103, 108, 405, 810. as a symptom, 505. Squash, as food, 263. Squirrels, as food, 271. Stabbing wounds, 880. Stammering, 808. Stapes (stirrup-bone) of ear, 110. Starch, corpuscles, 249. digestion of, 61. foods, 246. Starvation, 283. Statistics, of height and weight, 437. vital, 433. Stavesacre (staphysagria), 607. Steam-heating, 143. Stearin, 245. Stereoscopic vision, 106. Sternum (breast-bone), 38. Stiffening, after death, 81. Stings, of bees, etc., 883. Stomach, 45. diseases of, 685, 730, 808. sickness of, to relieve, 529. symptoms affecting, 500. Stone in the bladder, 76, 809. Stoves, invention of, 135. Strabismus (squinting), 103, 108, 405, 81o Stramonium (Jamestown weed), 912. Strangling, 842. Strangury, 509, 522, 810. Streets, choice of, in cities, 127. Struma (scrofula), 795. Strychnia, 607. as a poison, 912. Stupor, 507. Stye, 810. St. Kilda, mortality of, 198. St. Vitus' dance, 694. Sublimate, corrosive, 566, 607. as a poison, 898. Suffocation, 871. Sugar, 248. mite, 252. Sulphide of calcium, 608. Sulphites, 608. Sulphur, 608. as disinfectant, 194. Sulphuretted hydrogen, 193. Sulphuric acid (oil of vitriol), 608, 913. Sulphurous acid gas, as disinfectant, 194. Summer catarrh, 673. complaint, 693. dangers of infancy, 429. Sun-burn, 801. Sunshine and health, 134. Sun-stroke, 736. Supporters, 829. Suppositories, 609. Suppuration (formation of pus, or matter), 486. Surf-bathing, 344. Swallowing, 61, 89. wrong things, 873. Sweat-glands, 44, 77. Swimming, as an exercise, 362. Swine-plague, causation of, 475. Sycosis, 804. Sydenham, account of London mortality. 119. Sympathetic system, in physiology, 59. Sympathy, effects of, on mind and body, 400. GENERAL INDEX. 951 Symptoms of diseases, 499. Syncope, 726, 848. Syphilis, 811. Systems of organs, 35. TABES dorsalis, 812. Taenia (tape-worm), 833. Tallest men in the U. S. Army, 437. Tannin, tannic acid, 610. Tape-worm, 278, 833. Tapioca, 247, 636. Tar, 610. disinfectant, 194. Taraxacum (dandelion), 610. Tarrant's aperient, 610. Tarsus, 40. Tartar emetic, 610, 801. Tartaric acid, 256, 914. Taste, in disease, 499. nerves of, 93. Tea, 281, 301. Tears, 108. Teeth, care of, 350. in disease, 499. Teething, 89, 425. Temperaments, 410. Temperature, best for health, 138. highest, localities of, 204, 213. in disease, 513. lowest, 204, 213. Tenderness on pressure, as a symptom, 504. Tendons, jerking of, 504. rupture of, 814. Tenement-houses, 132, 198. Tent-hospitals, 132. Tetanus (lockjaw), 89, 812. Tetter, 799. Thalami, of the brain, 93. Thein, 299. Theobromin, 306. Thermometer in disease, 513. Thigh-bone, 40. broken, 853. out of joint, 865. Thoracic duct, 53. Thorax (chest), 38. Throat, in diseases, 499. sore, 813. Thrombosis, 816. Thrush, 758. Thyro-cardiac disorder, 767. Thyroid gland, 722, 731. Tibia, 40. broken, 857. Tic douloureux, 762. Ticks, 770. Tight-lacing, 332. Tin pipes, for conveying water, 172. salts of, poisonous, 914. Tinea (a disease of the skin), 804. Tinnitus aurium (ringing in the ears), 719, Toadstools, poisonous, 901. Toast-water, 635. Tobacco, as a luxury, 322. as a medicine, 611. as a poison, 914. Toe-nail, in-growing, 762. Tomatoes, 263. Tongue, the, in disease, 499. Tonsillitis (quinsy), 783. Toothache, 352, 814. Torn wounds, 879. Toxaemia (blood-poisoning), 494. Trachea (windpipe), 49. Trade wind, 212. Traditions, showing common origin of races, 225. Translucent bodies, 102. Transparent bodies, 102. Transportation of injured persons, 883. Traps, 179. Trembling, 504. Tremor, 504. Trichina, 271, 833. Trismus (lockjaw), 812. Truffles, 264. Trusses, 790. Tubercle, 473, 815. Tubercula quadrigemina, of the brain, 93, 103. Tubercular meningitis, 679. Tumors, 490, 815. Turgenieff, size of head, 92. Turkey, 273. Turkish bath, 343. Turnips, 263. Turpentine, oil or spirit of, 611. Tympanites, 816. Tympanum of the ear, 110. Typhlitis, 816. Typhoid fever, 816. Typhus fever, 818. Tyrotoxicon in poisoned cheese, Ac, 286. ULCERS, 820. Ulcers of stomach, 808. Ulna, 39. fracture of, 851. 952 GENERA L INDEX. Unhealthy employments, 445. United States, climate of, 228. diseases of, 229. Unleavened bread, 261. Upas tree, 219. Uraemia, 76, 495, 821. Ureters, 75. Urination, symptoms affecting, 509. Urine, 75. changes in disease, 510. incontinence of, 743. retention of, 786. Urinometer, 511. Uses of foods, 243. Uterus (womb), 53. disorders of, 828. T7ACCINATI0N, 119, 822. V Valentine's beef-juice, 631. Valerian, 612. Valetta, unhealthy conditions of, 197. Valves of the heart, 65. Valvular disease of the heart, 735. Vanilla, 290. Vapor in breath, 71. Varicella (chicken-pox), 688. Varicose veins, 825. Variety of food, wholesome, 234, 265. Variola (small-pox), 805. Varioloid, 805. Veal, 270. Vegetable foods, 257, 263. soup, 636. Vegetarianism, 257. Vegetative functions, 60. Veins, 51, 57. inflamed, 755, 772. injured, 875, 876. varicose, 825. Venae cava?, 50. Venice, first quarantine at, 119. water supply of, 161. Venison, 271. Ventilation, 146. Ventricles of the heart, 49, 64. Veratrum viride, 612. Vertebra, 36. Vertebral artery, 57. Vertebrates, 36. as food, 270. Vertigo (dizziness), 508, 826. Vestibule of inner ear, 110. Vichy water, 612. Victoria regia, 216, 219. Vinegar, 255. Vision, errors and defects of, 402. Visual axes, in sight, 103. Vital capacity, 71. statistics, 433. Vitiligo, 802. Vitreous humor, 102. Voice, exercise of, beneficial to health, 121. loss of, 508, 671. Volta, size of head, 92. Voluntary muscles, 41. Vomiting, as a symptom, 500. treatment of, 529. WAGNER, anatomist, on size of skulls, 92. Walking, feats of, 364. Walls of houses, porous, 128, 149. Warmth, arrangements for, 135. in the sick-room, 624. Warner's cordial, 612. Warts, 827. "Wasp-sting, 883. Waste, disposal of, 176. Water, as a drink, supply of, 160. in the chest, 715, 748. living things in, 167, 170, 234. on the brain, 739. passing, affected by disease, 509, 743. Water-brash, 827. Water-closets, 185. Watermelon-seed tea, 613. Water-seal, 179. Water-stoves, 135. Weak sight, 407, 666, 673. Weaning, 417. Webb, Captain, feats of swimming, 365. Webster, Daniel, size of head, 92. Lady, pills, 584. Weights, apothecaries', 641. Wheat bread, 260. White corpuscles of the blood, 68. vitriol, 915. Whites, the, 749. Whitlow, 727. Whooping-cough, 738. Wild cherry bark, 613. Will, physiology of, 98. Wind, in the bowels, 727. Windlass, Spanish, 877. Windows, 130, 132. Winds, periodical, 208. Wine, 319, 320. whey, 638. GENERAL J A DEN. 953 Winship, Dr., strength of, 359. Wislicenus, observations of, 247. Wistar's cough lozenges, 613. Witch-hazel, 575. Womb, 53. falling of, 828. Women, diseases of, 827. Wood, as food, 253. Dr. H. C, on diphtheria, 473. Workingmen's homes, 201. Worms, 282, 831. Wounds, 875. Wrist, 39. drop, 834. Wrist, sprained, 867. Writer's cramp, 834. YEAST-FUNGUS, 468. Yellow fever, causation of, 479. Yellow fever, symptoms and treatment of, 835. -jacket's sting, 883. Springs, of Pennsylvania, 162. ZINC, sulphate of, 915. Zymotic diseases, 495. GLOSSARY. A. Abdomen. In common language, the stomach or belly. Abductor. Drawing from, or apart. Aberration. Wandering, or going away from a certain line or place. Abortion. Miscarriage; childbirth before full time. Abscess. A gathering; an inflammation, with formation of liquid matter, called pus. Absinthe. A poisonous intoxicating liquor used in France. Absorbent. Soaking up liquids readily. Absorption. The drawing or soaking up of a liquid into a tube or solid sub- stance. Acarus. A very small creeping animal, something like a tiny spider. Acclimatize. To make accustomed to a new climate. Accommodation. In the eye, the change by which sight is adapted to near things. Acid. In chemistry, a substance which reddens litmus-paper and unites with alkalies. Acne. A disease of the skin ; most com- mon on the face. Aconite. A plant whose root and leaves are poisonous; used sometimes as a med- icine. Acute. Applied to a disease, sharp, vio- lent, and not continuing long. Adductor. Drawing to or together. Adult. Grown up ; of full age. Adulterate. To add something not be- longing to a substance. Aeration. Supplying air to a person, place, or thing. ^Esthetic. Having to do with fine taste or feeling. Afferent. Bearing to or toward a centre. Affinity. Attraction between different kinds of substances. After-birth. The round flat mass to which the navel-cord is attached in childbirth. Agitans. Shaking; applied to a kind of palsy. Ague. Chills and fever; intermittent fall fever. Albumen. The white of egg. It is also found in the blood of men and animals. Albuminuria. Albumen in the urine; one of the signs of Bright's disease. Alcoholism. The general effect upon the body of alcoholic intemperance. Alkali. In chemistry, a substance which unites with acids, and changes the yel- low of turmeric to brown. Alloy. A compound of two or more metals. Allspice. Pimento; a pleasant, pepper- like article used for seasoning food. Alluvial. Deposited from rivers, lakes, or the sea. Alterative. Something which changes the condition of a part of, or the whole constitution of, the body. Altitude. Height above the level of thesea. Amalgam. A compound of mercury with some other metal. Amaurosis. Blindness from failure of the nerve of sight. Amenorrhcea. Stopping or delay of a woman's monthly courses. Amoeba. A very small animal, consisting of one cell. Amputation. Cutting off a limb. Amylaceous. Starch-like. Anaconda. A very large serpent of South America. Anaemia. Thinness or poverty of the blood. Anaesthesia. Loss of feeling; insensi- bility. Anaesthetic. Something which destroys feeling, as ether or chloroform. Analysis. In chemistry, separating the elements of a substance from each other. Anasarca. Dropsy all over the body. * Medicines or disea.ses not named in this Glossary will be found in the alphabetically arranged sections of this book, beginning on pages 553 and 661. 955 95G GLOSSA R Y. Anatomy. The study of the parts of a human or animal body. Aneurism. An enlargement of part of an artery, usually containing a clot of blood. Angina. Distress, threatening suffocation. Aniline. A substance got out of coal tar, used for the manufacture of dyes, etc. Animalcule. A very tiny animal; for instance, that which causes the itch. Annihilate. To bring to nothing; to destroy utterly. Anodyne. Capable of relieving pain. Anomalous. Aery uncommon; out of usual order. Anomaly. An extraordinary or irregular thing. Anorexia. Loss of appetite. Antacid. Something which neutralizes or destroys the effects of acids. Anteversion. Turning forward (as of the womb). Anthelmintic. Capable of killing or driving out worms. Anthrax. Carbuncle, an extremely bad sore; also, a disease of sheep. Antidote. Something given to neutral- ize or prevent the effects of a poison. Antiphlogistic. Opposed or giving re- lief to inflammation. Antipyretic. Capable of lessening the heat of the body in fever. Antiscorbutic. Preventive or curative of scurvy. Antiseptic. Preventive or corrective of rottenness or decay. Anus. The outlet from the bowels. Aorta. The largest artery in the body; going out from the heart. Aperient. Opening; applied to med- icines which move the bowels. Apex. The pointed end of anything; for example, of the heart. Aphasia. A disease of the brain, at- tended by loss of speech. Aphonia. Loss of the voice. Aphthae. Small white formations in a sore mouth. Apoplexy. A stroke of brain disease, often fatal. Appetizer. Something which improves the appetite. Aqueous. Watery. Arachnoid. Spider-web-like; applied to one of the membranes covering the brain. Areola. A small space or area; as around the nipple. Aromatic. Spicy. Artery. A blood-vessel which carries blood outward from the beart. Artesian. Named from a place, Artois; applied to a very deep will. Articulation. Pronouncing syllables and words; also, a joint. Asphyxia. Loss of pulse; suffocation. Assimilate. To make one thing like another; in physiology, to make di- gested food like the material of the body. Asthenia. Loss of strength ; weakness. Asthenopia. AVeakness of the eyes, af- fecting the sight. Asthma. A distressing disease, with dif- ficulty of breathing. Astigmatism. A defect of sight, giving things a wrong shape. Astringent. Shrinking together, so as to check a discharge. Ataxia, ataxy. Disorder, irregularity. Athletic. Active; fond of exercise and feats of strength. Atmosphere. The common air every- where around us. Atomization. Making a fine spray of a liquid. Atony. Loss of tone or energy. Atrophy. Wasting away. Auditory. Belonging to the hearing; as the auditory nerve. Auricle. One of the smaller chambers of the heart. Auscultation. Listening; a mode of ex- amination in diseases of the lungs and heart. Automatic. Going of itself; like an automaton. B. Bacillus. A very small club-shaped mi- crobe (which see). Bacterium. A kind of microfce (which see). Benign. Favorable; not destructive. Beverage. A drink (as distinguished from a medicine). Bicarbonate. A compound of two por- tions of carbonic acid with another substance. Biceps. Two-headed: the name of a large muscle of the arm. Bicuspid. Having two cusps or projec- tions: the name of one of the valves of the heart. Bile. A yellowish-green liquid secreted by the liver. Bilious. Belonging to the bile; often applied to a disorder of digestion. GLOSSAR Y. 957 Bitartrate. A compound of two por- tions of tartaric acid with another substance. Bituminous. Pitch-like; applied to soft coal, etc. Blonde. Of a fair complexion. Blue vitriol. Sulphate of copper. Botany. The science of plants. Bright's Disease. A disorder chiefly affecting the kidueys, named after Dr. Bright. Bronchia. The larger windpipe, branch- ing into the lungs. Bronchitis. Inflammation of the bron- chial air-tubes. Bronchocele. Goitre; a swelling in'front of the throat. Brunette. Of a dark or brown com- plexion. Bunion. A swelling on one of the toe- joints, larger than a corn. c. Cachexia. An unhealthy condition or habit of body. Caffein. The strongest active principle of coffee. Calcify. To bring to a condition like chalk or lime. Calcium. The metal of which lime is the oxide. Calculus. In medical language, stone in the bladder. Calisthenics. Light exercises to pro- mote beauty and strength. Calomel. A drug containing chlorine and mercury. Cancer. A diseased growth, usually fa- tal unless early removed. Canine. Belonging to or resembling a dog. Canker. A bad kind of sore mouth. Cannabis. Indian hemp. Capillary. Like a hair; applied to very small blood-vessels. Capsule. A small sac or bag. Carbohydrate. Made of carbon and wa- ter ; examples, sugar and starch. Carbolic acid. A substance got out of coal tar, used as a disinfectant. Carbonic acid. A gas given out in breathing and from burning wood, coal, etc. Carbuncle. A very bad gathering, larger and worse than a boil. Cardiac. Belonging to or near the heart. Cardialgia. Heart-burn ; pain near the heart. Caries. Decay of a tooth or bone from inflammation. Carminative. Something used to relieve colicky pain. Carnivorous. Living on flesh as food. Carotid. One of the large arteries of the neck. Carpus. The wrist. Cartilage. Hard gristle; for example, the ear. Casein. The curdy part of milk or cheese. Casualty. An accident or a disaster. Catalepsy. A disease in which the mus- cles become fixed in one position. Cataplasm. A poultice. Cataract. A film or opacity in the lens of the eye, causing blindness. Catarrh. A running of phlegm from the nose, windpipe, etc. Cathartic. A medicine acting on the bowels; purgative. Catheter. An instrument used to draw water from the urinary bladder. Caustic. Something which burns and destroys a part. Cell. A very small sac or bag (seen through the microscope). Centenarian. One who lives a hundred years. Cephalalgia. Headache. Cerate. An ointment partly made with wax. Cerebellum. The smaller brain. Cerebro-spinal. Belonging to the brain and spinal cord. Cerebrum. The larger part of the brain (in man and the higher animals). Cesspool. A privy well. Chalybeate. A name given to medicines containing iron. Chilblain. Frost-bite. Chloral. A medicine used to promote sleep or relieve pain. Chlorate. A substance containing chlo- ric acid. Chloride. A compound of chlorine with another substance. Chloroform. A liquid drug sometimes breathed to prevent pain under sur- gical operations. Chlorohydric acid. A compound of chlo- rine and hydrogen; muriatic acid. Chlorosis. A disease of women or girls, sometimes called " green sickness." Cholaemia. Bile in the blood. Chorea. A jerking disease: St. Vitus' dance. Choroid. One of the coats or layers of the eyeball. 958 GLOSSAR Y. C h r o in a t e. A compound of chromic acid. Chronic. Lasting for a considerable time. Chrysalis. The cocoon stage of an in- sect's life. Chyle. What food becomes when perfect- ly digested in the small intestine. Chyme. What food becomes under the action of the gastric juice in the stomach. Cilia. Eyelashes; also, very small lash- like hairs seen ouly through a micro- scope. Circulation. Moving of a fluid round and round; for example, that of the blood in the body. Citrate. A compound of citric acid, the acid of lemon-juice. Clavicle. The collar-bone. Clonic. Fixed, rigid; not jerking. Coagulate. To clot. Cochlea. A part of the internal ear. Co-education. Education of boys and girls, or men and women, in the same schools or colleges. Colitis. Inflammation of the colon or large intestine. Collapse. Giving wray; a state of ex- treme weakness. Collodion. A solution of gun-cotton in ether. Colloid. Jelly-like. Colon. The large intestine; the lower part of the bowels. Color-blind. Unable to tell one color from another. Colostrum. The first milk from the breast after childbirth. Coma. Deep stupor, from which a per- son cannot be roused. Complementary. Making the set full: red and green light together make full white light; they are complementary to each other. Compose. To quiet and make comfortable. Composite. Made up of several things. Compound. Made of two or more ele- ments or parts. In surgery, a com- pound fracture is one in which a piece of bone sticks out through the skin. Concave. Hollowed out, like the inside of a watch-glass. Conception. The first beginning of life in a child in the womb. Concussion. A shaking up or jarring. Condiment. Something used to season food, as pepper, etc. Conductor. Something which carries; for example, copper wire is a conductor of electricity. Congenital. Beginning with birth. Congestion. Settling of blood in a part. Conjunctiva. The outermost coat or covering of the eyeball. Consanguineous. Nearly related; as brother and sister, etc. Conscious. Knowing what is going on. Conservancy. Foul matter of privies, slops, etc. which has to be removed. Constipation. Stoppage or slow action of the bowels. Constituent. Something which is a part of something else. Consumption. A wasting disease, in which the lungs are commonly most affected. Contagious. Catching, from person to person. Contaminate. To make foul; to defile. Convalesce. To get well of a disease. Convection. Conveying, as of heat, through a medium, as air. Converge. To come together toward one point. Convex. Rounded outward; as the out- side of a watch-glass. Convolution. A rolled or rolling part of the outside of the brain. Convulsion. A fit. Copperas. Green vitriol; sulphate of iron. Cordial. An agreeable warming or stim- ulating drink. Cornea. The transparent coat or covering of the eyeball under the conjunctiva. Corolla. The showy part of a flower; composed of petals. Corpus. A body. Corpuscle. A very tiny body. Corrode. To eat or wear away; as strong acids do metals. Cortex. The bark or outer covering. Cosmoline. Another name for vaseline, a soft material used instead of ointment. Cosmopolitan. At home in any part of the world. Costive. Slow, tight, not easily moved; applied to the state of the bowels. Counter-irritant. Something used to heat up the outside of the body, to relieve an irritation within it. Coxalgia. Hip joint disease. Cranium. The skull. Creasote. A liquid obtained from tar; used as a medicine and to relieve toothache. Cremometer. An instrument to meas- ure the cream on milk. Cretaceous. Chalky or chalk-like. GLOSSARY. 959 Cretin. One who is dwarfed and stupid, as some children are iu Switzerland and other places. Cryptogamous. Having no flowers; for example, ferns. Cutaneous. Belonging to the skin. Cyanosis. The blue disease, in which the face is blue or purple. Cyst. A small bladder. Cystitis. Inflammation of the urinary bladder. D. Debility. Weakness. Decimal. A tenth part; applied to the system of counting which goes by tens, hundreds, thousands, etc. Decoction. AA'hat is got by boiling any- thing in water. Decompose. To break a thing up into its elements. Degeneration. Getting worse; going down from health and strength to weakness and disease. Deglutition. Swallowing. Delirium. Wandering in mind, flightiness. Delivery. Childbirth. Dementia. Loss of the powers of the mind. Demulcent. Something soothing. Dengue. A mild kind of fever; " break- bone fever," of the South. Dense. Thick; containing much matter in a small space. Dental. Belonging to the teeth. Dentifrice. A toothwash. Dentine. Tooth-bone. Dentition. The growth and coming out ' of the teeth. Depression. A state of low strength ; great weakness. Desiccate. To dry up, by driving water out. Dew-point. The degree of the ther- mometer at which moisture begins to settle on a cooling body. Diabetes. A disease in which an exces- sive amount of urine is passed. Diagnosis. Finding out the nature of a disease. Diagonal. A line across from one corner to another. Diagram. A figure drawn to explain something. Diameter. The shortest distance across a surface. Diaphoretic. Causing increase of sweat (perspiration). 61 Diaphragm. The rounded muscle be- tween the chest and the abdomen. Diarrhcea. Looseness of the bowels. Diathesis. Au unhealthy condition or habit of body. Dicrotous. Double. Diet. What we eat and drink. Digestion. The action of the stomach, etc. on food. Digit. A finger (in anatomy, also, a toe). Dilatation. Stretching out, enlargement. Diphtheria. A disease in which "false membrane" is formed; especially in the throat. Diplopia. Seeing double, as " cross- eyed" persons do. Dipsomania. Insane thirst for intox- icating drink. Disgorge. To throw up or out. Disinfect. To purify air, water, etc. from things which cause disease. Dislocate. To put out of joint. Disorganize. To break up the structure or organization of anything. Distil. To drive off by heat, and collect a part in a cold vessel. Diuretic. Acting on the kidneys, in- creasing the flow of urine. Drastic. Very strong and severe. Dropsy. Swelling from water collecting under the skin or inside of the body. Duct. A tube or channel through which a liquid passes. Duodenum. The first twelve inches of the bowel next to the stomach Dysentery. A disease of the bowels with pain and bloody discharges. Dysmenorrhoea. Pain at the time of a woman's monthly courses. Dyspepsia. Difficult and painful diges- tion. Dyspnoea. Difficulty of breathing. Dysuria. Obstruction of the passage of urine from the bladder. E. Eccentric. Going out from a centre; applied to a person odd, peculiar. Eczema. A disease of the skin, a kind of tetter. Efferent. Carrying something outward from a centre. Effervesce. To bubble up, as soda-water, beer, etc. do. Effete. Worn out; used up; done with. Effusion. A pouring or flowing out. Elephant leg. Large and hard swelling of the leg; elephantiasis. 960 GLOSSAR Y. Emaciation. Wasting away; loss of fat and flesh. Embryo. A very young, unborn child or animal. Emetic. A drug which will, when taken, cause vomiting. Emmenagogue. Promotive of monthly flow from the womb. Emotional. Belonging to the feelings. Emphysema. Swelling of the skin with air under it. Empyema. A collection of pus (matter) in the chest. Empyreuinatic. Produced by the action of fire. Encephaloid. Brain-like. Encephalon. The contents of the head; the brain. Endemic. Applied to a disease prevail- ing in a certain place. Endocarditis. Inflammation of the in- ner lining of the heart. Endosperm. The inside lining of a seed or ovum. Enema. An injection into the bowels. Enteric. Belong to an intestine (bowel). Enteritis. Inflammation of the bowels. Enthetic. Introduced into the body from outside of it. Entomology. The science or study of insects. Ephemeral. Living but a day or a short time. Epicure. One who is very fond of pleas- ant living. Epidemic. Prevailing or spreading from place to place. Epilepsy. A disease in which convulsions (fits) occur habitually or frequently. Eruption. A breaking out on the skin. Erysipelas. A spreading inflammation of the skin. Espionage. A French word meaning spying out or close inspection. Etherize. To put one under the action of ether. Etiology. The study of causation. Eustachian tube. The small channel connecting the ear with the nose. Evacuation. Emptying; clearing out (as of the bowels). Evaporate. To pass or drive off in vapor. Exanthema. An eruption or .eruptive disease. (See Eruption.) Excito-motor. Belonging to a move- ment resulting from excitation or stimulation. Excrement. The "stools" or passages from the bowels. Excrete. To throw or pass out waste matter from the body. Excretion. That which is passed out as waste matter. Exhale. To breathe out. Exophthalmic. Accompanied by en- largement of the eye. Exotic. Not native; brought from some other country. Expectorate. To cough up or discharge something from the chest. Expiration. Breathing out, exhalation. Extract. Something got by a process out of a bulky or complex substance. Extremity. One of the limbs of a man or animal. Exudation. A material oozing out of some of the blood-vessels of the body. F. Fahrenheit. The name of the inventor of the thermometer most in use in this country. Faradization. Application to the body of an interrupted current of electricity. Farinaceous. Starch-containing, as ar- rowroot, rice, etc. Febrile. Feverish. Feces. The " stools " or passages from the bowels. Felon. In surgical language, a severe in- flammation of a finger. Femur. The thigh-bone. Fermentation. A change in a substance, one result of which is giving out gas. Fertilize. In physiology, to so act upon a germ that it will develop into a plant or animal. Fibrin. The substance in the blood which makes it clot. Filament. A thread or thread-like, deli- cate form. Filter. To pass a liquid through some- thing which keeps back the particles and impurities. Fissure. A crack or slit. Fistula. An opening in a part which, when sound, is closed. Flatulence. Wind in the stomach or bowels. Flexible. Easily bent. Flexion. The act of bending or being bent. Flexor. Bending; for example, one of the muscles which bend the fingers to the hand. Florid. Applied to the complexion, red, flushed. GLOSSARY. 961 Fluctuation. A wave-like movement. Flush. In sanitary arrangements, to pour a stream of water through a tube or channel. Focus. A point at which rays of light or heat come together. Foetus. An unborn child. Fontanelle. A soft place where the bones meet in the head of a newborn child. Foot-ton. One ton lifted a foot; a term used in measuring powers of different kinds. G. Gall-bladder. The bag under the liver which receives and stores away the bile. Gall-duct. The tube which carries bile from the gall-bladder to the bowel. Galvanize. To apply galvanic electricity to anything. Ganglion (plural, ganglia). A nerve- centre. Gangrene. Mortification; death of part of a living body. Garbage. Kitchen and table refuse. Gargle. To hold a liquid in the throat a while without swallowing it. Gastric. Belonging to the stomach. Gastritis. Inflammation of the stomach. Generation. Begetting offspring. Genitals. Private parts of the body. Germ. A seed or spore; the first begin- ning of a living plant or animal. Gestation. Pregnancy; carrying a child in the womb. Gin-liver. The diseased liver caused by excessive drinking of spirits. Gland. An organ in the body which sep- arates something from the blood; as the liver, kidneys, etc. Glanders. A disease of the horse, some- times conveyed to men. Glaucoma. A painful and serious dis- ease of the eyeball. Glucose. Grape-sugar. Gluten. The pasty matter in wheat and other grains. Goitre. A swelling in front of the throat; called also bronchocele. Gonorrhoea. A nasty disease caught in impure intercourse. Graduated. Marked to degrees or other- wise, as thermometers, etc. are. Gramme. A little more than 15 grains. Granulate. To break up into a coarse "grainy" powder. Graphite. Black lead, a kind of mineral. Gravel. In medical language, small pieces of stone in the urinary bladder. Gravitation. Weight. Gravity, specific. The weight of a cer- tain bulk of a substance, compared to that of an equal bulk of something else. Green vitriol. Sulphate of iron. Gullet. The swallowing part of the throat. Gustatory. Having to do with taste. Gynaecology. The science or study of the diseases of women. H. Haematemesis. Vomiting of blood. Haemophilia. A tendency to bleed from the slightest wound. Hard water. Water which will not easily make suds with soap. Hasheesh (Hashish or Haschish). In- dian hemp. Heartburn. Pain in the neighborhood of the heart; often from indigestion. Heat-stroke. Sudden illness from ex- posure to great heat. Hemiopia. Seeing only half of anything looked at. Hemiplegia. Palsy of one half of the body. Hemisphere. Half of a globe or sphere; for example, of the earth. Hemorrhage. Loss of blood from any cause. Hemorrhoids. Piles; small swellings near the outlet from the bowels. Hepatic. Belonging to the liver. Herbivorous. Eating plants, as grass, grains, etc. Hereditary. Passing from parents to children. Hermaphrodite. Having both sexes at once. Hernia. Rupture; a part of a bowel, etc. being forced out of its natural place. Hiccough (pronounced hiccup). A quick, jerking kind of breathing, from dis- order of the stomach or from great weakness. Humerus. The arm-bone between the shoulder and elbow. Humidity. Moisture, dampness. Humus. Soil; earth in which plants will grow. Hydatid. A watery bladder-like growth in some part of an animal's body Hydrate. A compound of water with some other substance. Hydraulic. Belonging to or acting by means of water. 962 GLOSSARY. Hydrocephalus. Dropsy in the head; water on the brain. Hydrochloric acid. Muriatic acid. Hydrocyanic acid. Prussic acid; a deadly poison. Hydrometer. An instrument to show how much water a substance (as spirits) con- tains ; also used to find the specific grav- ity (which see) of liquids. Hydrophobia. The disease caused by the bite of a mad dog. Hydrothorax. Water in the chest. Hygiene. The science of the preserva- tion of health. Hygrometer. An instrument to show the amount of moisture in the air of a place. Hyoid. Shaped like the letter U. Hypaesthetic. Lessening sensibility; partly benumbing feeling. Hyperaemia. Too much blood in a part of the body. Hyperaesthesia. Tenderness to the touch, beyond what is natural in health. Hypermetropia. Long-sightedness; in- ability to see very near objects. Hyperopia. Same as Hypermetropia. Hypertrophy. Overgrowth. Hypnotic. Promotive of sleep. Hypnotism. A kind of artificial or un- natural sleep or somnambulism. Hypochondriac. One who suffers from imaginary disease. Hypodermic (Hypodermatic). Under the skin. Hysteria. A disorder of the neTvous sys- _ tern, most common in young women; sometimes connected with disorders of the womb. Hysterical. In a state of nervous dis- turbance, beyond the control of the will. Hysterics. Violent laughter, crying, or convulsions, etc., which the person cannot help. I. Idiosyncrasy. A personal peculiarity; something in which one person dif- fers from almost all others. Idiot. A simpleton, a natural dummy. Ileum. A part of the bowel or "small intestine." Ileo-colic. Belonging to the ileum (see above) and the colon (large intestine). Ilium. The hip-bone. Illuminate. To light up. Imago. A perfectly-formed insect, as, for example, a butterfly. Imbecile. Silly; without sense. Immersion. Dipping or plunging, Impermeable. Not allowing anything (water, for instance) to soak through it. Impervious. Same as Impermeable. Incidence. The act of striking or fall- ing upon anything. Incisor. Cutting or nipping. Incontinent. Not able to hold in (as, for example, water in the bladder). Indigestion. Failure in the disposal of food in the stomach. Inebriant. Having an intoxicating effect. Inebriate. A drunkard. Inebriety. Drunkenness. Infection. Prevalence of the cause of a disease in a place, which may then be said to be infected. Inflammation. Bedness, heat, swelling, and pain in any part of the body. Influenza. An epidemic of "bad colds." Infusion. A mixture made by soaking something in water without boiling. Infusoria. Tiny living things seen by the microscope in infusions of various kinds. Ingredient. Something contained in a substance. Inhalation. Inbreathing; drawing in breath, either of air or of other gases or vapors. Inoculate. To put something under the skin, so as to affect the condition of the body. Insalubrious. Not healthy. Insane. Crazy; unsound in mind. Insoluble. Not capable of being dis- solved. Insomnia. Sleeplessness. Instinct. An impulse shown by an an- imal to do something in a certain way. Insular. Belonging to or like an island. Intellect. The mind; the thinking pow- er or powers. Intercostal. Between the ribs. Interment. Burial. Intermittent. Having regular changes; for instance, chills, one every day or every other day. Intestine. A bowel, Intussusception. Catching of one part of the bowels in another (like a stove- pipe). Iodide. A compound of iodine with an- other substance. Iodine. A violet-colored element, ob- tained from sea-weed. GLOSSARY. 963 Iris. The ring around the pupil of the eye. Iritis. Inflammation of the iris. Irrigate. To flood or pour water over land, etc. Isothermal line. One marking equal temperatures in different places on the earth. J. Jamestown weed. A poisonous wild plant, the Datura Stramonium. Jaundice. A disease in which the body becomes yellow all over. Jugular vein. A large vein on each side of the neck. K. Kakelung. A large stove or heater used in Sweden and Norway. Kilogramme. A weight, according to the metrical system, equal to some- what more than 2 pounds. Kindergarten. A school for young chil- dren, where play is turned into drill and instructive work. L.. Laudanum. A strong medicine, the tinc- ture of opium; poisonous in large doses. Lavatory. A wash-room. Laxative. Something which acts gently on the bowels. Leaven. Yeast; a material used in rais- ing bread. Lens. A form of glass (or other transpa- rent material) used in spectacles, mi- croscopes, etc. Leprosy. A severe disease of the skin, met with only in certain countries. Leucocyte. A white blood-corpuscle; seen by aid of the microscope in great numbers in the blood. Leucocythaemia. White-cell blood; a dis- ease attended by an excessive number of white corpuscles in the blood. Leucorrhoea. The "whites;" a kind of discharge not uncommon in wo- men. Leukaemia. Same as Leucocythsemia. Lichen. A pimply disease of the skin. Ligamentt A tough fibrous band, such as gives strength to the joints, etc. Liniment. Something used to bathe or rub the surface of the body for sprains, rheumatism, etc. Litmus-paper. Paper so prepared that it is reddened by acids, for which it is therefore a test. Lobe. A more or less regular part or di- vision of anything; as of a leaf, a lung, or the liver. Lochia. The flow which women have for a time after childbirth. Lockjaw. A fixed condition of the jaws from disease; trismus or tetanus. Locomotor ataxy. A disease in which the legs are not perfectly under con- trol of the will. Longevity. Length of life. Longitude. Distance of a place east or west of a certain line. Lumbago. A painful affection of the back and loins; most common in elderly people. Lumbar. Belonging to the lower part of the back. Lumbricoid. Eesembling the earth- worm. Lymph. A clear liquid found in the lym- phatic vessels of the body; resembling the watery part of the blood. Lymphatics. The small vessels which take up lymph from various parts of the body, so that it can be returned to the blood. Labor. In medical language, the process of childbirth. Labyrinth. In anatomy, the bony struc- ture of the internal ear. Lacerate. To tear. Lachrymal gland. The tear-gland, within the bony socket of the eye. Lacteals. In anatomy, the small ves- sels which take up chyle from the intestine. Lactic acid. The principal acid of sour milk. Lactin. Sugar of milk. Lactodensimeter. An instrument to show the density (specific gravity, which see) of milk. Lactometer. An instrument to show the quality of milk. Laparotomy. Opening the belly by a surgical operation. Larva. The grub or worm-like state of an insect. Laryngitis. Inflammation of the upper part of the windpipe. Larynx. The organ of the voice; first part of the windpipe. Latitude. Distance of a place from the equator. 964 GLOSSARY. M. Maize. Indian corn. Malady. Disease of any kind. Malar. The anatomical name of the cheek-bone. Malaria. Literally, " bad air;" common- ly applied to the atmospheric cause of autumnal fevers. Malignant. Destructive; tending con- stantly toward death. Mammal. The name describing a class of animals, all of which suckle their young. Mania. The most common kind of in- sanity. Maniac. An insane person. Manipulation. Working with the hands, often used for massage. Marasmus. A wasting disease, chiefly affecting the bowels. Maritime. Belonging to the sea. Marrow. The fatty matter inside of bones. Spinal marrow, the nervous cord within the backbone. Masculine. Belonging to man; con- trasted with feminine, belonging to woman. Massage. Subbing and kneading the skin and flesh, to improve the circu- lation, relieve pain, etc. Masseur. A man who practises massage; a manipulator. Masseuse. A woman who practises mas- sage. Masticate. To chew. Maternity. Motherhood. Maximum. The greatest sum, degree, etc. of any series of things or events. Medium. Literally, the middle; applied variously in medicine and in connec- tion with other subjects. Medulla. Marrow. Megrim. Neuralgia of one side of the head and face. Melancholy. Lowness of spirits; tend- ency toward despair. Mellitus. Honeyed. Membranous. Spread out in a flat, thin layer (membrane). Meningitis. Inflammation of the men- inges, the membranes covering the brain. Menorrhagia. Excessive flow of month- ly discharge in a woman. Menses. The monthly "courses" of women. Menstrual. Belonging to the " menses" of women. Menstruation. The occurrence of the monthly flow in women. Menthol. A solid preparation of the oil of mint. Mesentery. The thin serous membrane covering the bowels. Mesmerism. Animal magnetism. Metacarpus. The bony part of the hand next above the fingers. Metamorphosis. A change of form and condition in anything. Metatarsus. The bony part of the foot next above the toes. Meter. A measure nearly equal to 3^ feet. Meteorology. The science or study of the weather. Methomania. An insane craving for in- toxicating drink. Metrical. The name given to the decimal system of weights and measures. Microbe. A very minute living thing, seen only by aid of the microscope. Micrococcus. One form of microbe (plu- ral, micrococci). Microphyte. A very minute vegetable form (microbe). Microscopic. So small as to be seen only by aid of a microscope. Milk leg. A swelling of the leg follow- ing childbirth. Milk sickness. Illness caused by drink- ing the milk of cows which have eaten poisonous food. Milliard. A thousand millions. Milligramme. One-thousandth of a gramme; a gramme is about 15 grains. Minim. One-sixtieth part of a fluid- drachm ; about an average drop. Miscarriage. Abortion; birth of a child before its time. Molar tooth. A back or jaw tooth; a grinder. Mole. A red or brown mark on the face or elsewhere on the body. Molecule. A very tiny particle. Mollusk. A soft-bodied animal, as an oys- ter, clam, etc. Monomania. Insanity on one subject. Monotony. Continued going over and over the same thing. Monsoon. A wind which blows half the year in one, and the other half of the year in the opposite, direction. Monstrosity. Something strange and un- like anything common or natural. Morbid. Diseased. Morphia. The principal agent contained in opium. GLOSSAR Y. 965 Mortality. The liability to or actual oc- currence of death. Mortification. Death of a part; slough- ing, gangrene. Motor. Having to do with motion. Mucus. Phlegm; the thick liquid formed in the nostrils, windpipe, etc. on mucous membranes. Muriatic acid. A strong acid liquid, called also hydrochloric or chlorohydric acid. M u sea? volitantes. Flying specks, rings, etc. before the eyes. Myalgia. Pain in the muscles; most com- mon in the back. Myosin. A substance obtained by chem- ists from flesh. N. Narcotic. Something which stupefies, as opium, chloral, etc. Naturalize. To enable an animal or plant to live in a different country from its own. Nausea. Sickness of stomach short of vomiting. Necrosis. The death of a part; applied especially to decaying bones or teeth. Nephritis. Inflammation of the kidney. Nervine. Acting favorably on the nerv- ous system. Neuralgia. Nerve-pain. Neurasthenia. Nervous debility. Neurataxia. Disorder of the nervous system. Neurotic. Acting as a medicine on the nervous system. Neutralize. To oppose and stop the action of anything. Nicotine. The chief poisonous principle in tobacco. Nitrate. A compound of nitric acid with some other substance. Nitrite. A compound of nitrous acid with something. Nitrogenous. Containing a portion of the element nitrogen. Nocturnal. Belonging to or occurring in the night. Non-conductor. Not carrying elec- tricity, heat, etc. Normal. Regular; according to the rule or usual nature of things. Nutrition. Nourishment. O. Obesity. Oblique. Fatness. Slanting. Oblongata. Prolonged, extended. Obstetrics. Midwifery; the art and sci- ence of safe delivery in childbirth. Octogenarian. A person over 80 years of age. Oculist. One skilled in the care and treatment of the eyes. (Edema. Dropsy of a part of the body; water under the skin. Oesophagus. The gullet; lower part of the swallowing part of the throat. Oil of vitriol. Sulphuric acid. Oinomania. Insane craving for wine or other intoxicating drink. Oleaginous. Oily. Omnivorous. Eating all sorts of food, vegetable and animal. Opacity. Non-transmission of light. Opaque. Not allowing light to pass through; the opposite of transparent. Ophthalmic. Having to do with sight. Ophthalmoscope. A mirror arranged for looking at the interior of the eye. Optic. Belonging to the eye or sight. Organ. An instrument. Organic. Belonging to an organ or or- ganized body. Organism. An organized body; that is, an animal or a plant. Organize. To form into an organism. Figuratively, we sometimes speak of organizing a society, etc. Ornithology. The scientific study of birds. Orthopncea. Difficulty of breathing, re- quiring the person to sit up instead of lying down. Ossification. Turning into bone. Otalgia. Earache. Otolith. Ear-stone; one of the tiny stone particles found in the internal ear. Outre (French). Outlandish; extraordi- narily strange. Ovariotomy. Removal of an ovary by a surgical operation. Ovary. One of the female organs of re- production. Ovum. An egg. Oxidation. Combination of something with oxygen. Oxide. A compound of oxygen with a metal or some other elementary body. Ozaena. A disease of the interior of the nose, with an unpleasant discharge. Ozmazone. The brown outside part of roast meat. Ozone. A modification of oxygen gas, 966 GLOSSARY. present in variable quantity in the atmosphere. P. Palatable. Agreeable to the taste. Palpation. Examining by touch and gentle pressure. Palpitation. Violent beating of the heart. Palsy. Loss of feeling, or of power, or both. Pancreas. The sweetbread; a gland near the stomach. Paralysis. Palsy (which see). Paralyze. To cause paralysis (palsy). Paraplegia. Palsy (loss of power and feeling) of both legs. Parasite. An auimal or plant which lives on the substance of another. Paregoric. A tincture of opium and camphor. Parotid gland. A small gland near the angle of the jaw, which forms saliva. Paroxysm. A spell or attack of any dis- order. Parturient. Bearing a child. Pelvis. The bony basin enclosed by the large hip-bones. Penetrate. To pierce into or through. Peninsula. Land jutting out into the sea. Pepsin. A substance formed in the stom- ach and taking part in digesting food. Percussion. Knocking, tapping; amode of examination of the chest or abdo- men. Perennial. Lasting through a number of years. Perforate. To bore through. Pericarditis. Inflammation of the outer covering of the heart. Pericardium. The outer covering of the heart. Perineum. The crotch between the thighs. Periodical. Happening at regular times. Periodicity. The fact or property of re- currence at regular periods. Periphery. The outer part of anything; circumference. Peristaltic contraction. The natural movement, from above downward, of the muscular coat of the bowels. Peritoneum. The delicate membrane lining the abdomen and covering all the organs contained therein. Peritonitis. Inflammation of the peri- toneum. Permeate. To pass all through. Pernicious. Very injurious. Perspiration. Sweat. Pertussis. Hooping cough (whooping cough). Phalanges. The joints or separate pieces of the fingers and toes. Pharmacy. The business of an apothe- cary (pharmacist). Pharyngitis. Inflammation of the phar- ynx. Pharynx. The upper portion of the swal- lowing part of the throat. Phenic acid. Carbolic acid. Phlebitis. Inflammation of a vein. Phlegmatic. Languid; not sensitive or excitable; heavy. Phosphate. A compound of phosphoric acid. Photophobia. Dread of the light. Phrenology. A so-called "science" of the organs of the brain, supposed to correspond with the faculties and pro- pensities of the mind. Phthisis. Consumption. Physical. Material or bodily, as distin- guished from mental or spiritual. Physiology. The science or study of the functions (uses, operations) of the or- gans of a living being. Piles. Swellings, often sore and bleed- ing, near the outlet from the bowels. Placenta praevia. The after-birth, com- ing down before the birth of the child. Planchette. A piece of wood with a pencil attached, for involuntary writ- ing. Plethora. Excess of blood or excessive richness of the blood. Pleura. The membrane lining the chest and covering the lungs. Pleurisy. Inflammation of the pleura, Pneumatic. Having to do with air or gases. Pneumonia. Inflammation of the lungs. Polarity. The mutual relation of oppo- site things, as the north and south poles of a magnet, etc. Pons Varolii. A bridge of brain matter in the lower and back part of the head. Porous. Full of small holes. Portal. Of the gate; applied to a large vein which carries blood into the liver. Precocious. Coming forward unusually soon. Pregnant. Being with child. Premolar teeth. Those next before (nearest the front) the molar or back jaw teeth. GLOSSARY. 967 Presbyopia. Old-sight; long-sighted- ness. Prism. A five-sided solid, with two three- sided bases. Process. In anatomy, a jutting-out part of a bone. Procidentia. Falling (of the womb). Prognosis. Knowing beforehand what will happen. Prolapsus. Sliding downward. Prophylactic. Preventive. Prostate gland. A small gland at the base of the genital organs in man. Prostration. Great weakness. Proteid. Consisting mainly of protein. Protein. A substance found by chemists in blood, white of egg, muscle, etc. Protoplasm. A substance present in the blood of all animals, and in the sap, etc. of all plants. Protozoa. The lowest and simplest of all animal forms. Protrusion. Bulging or jutting out. Prussic acid. Hydrocyanic acid, a very deadly poison. Pseudo-membranous. Made of false membrane; a deposit (in the throat, for example) from disease. Psoas abscess. A large gathering under the psoas muscle, within the abdomen. Psychology. The science or study of the mind. Puerperal. Belonging to childbearing. Pulmonary. Belonging to a lung or the lungs. Pulsate. To beat or throb like a pulse. Pulse. The beating of an artery under the finger. Pulverize. To reduce to powder. Pupa. The middle stage of insect life, usually in a cocoon. Pupil (of the eye). The opening (sur- rounded by the iris) through which light passes for sight. Purgative. Acting upon the bowels; ca- thartic. Purpura. A disease in which purple blotches appear on the skin. Pus. Thick, yellow matter from an ab- scess, etc. Pustule. A small swelling containing pus. Putrefy. To rot. Putrescent. Liable to rot or decay. Pyaemia. A disease in which matter (pus) exists in the blood. Pylorus. The opening at the right-hand end of the stomach into the small in- testine. Q. Quadrigemina. Made of four nearly equal portions. Quadruped. A four-footed animal. Quarantine. Detention (of a ship, etc.) to keep out disease from a place. Quickening. The movement of a living infant felt within the mother's womb. Quinsy. Inflammation of the tonsil (in the throat), often with formation of a gathering there. Quotidian. Occurring (as, a chill) every day. R. Rachitis. Rickets. Radiate. To throw off iu rays, as those of heat and light. Radius. In anatomy, the bone of the forearm whose lower end is nearest the thumb. Rancid. Spoiled, strong in taste and smell; as, for example, bad butter. Rectum. The last part of the lower bowel. Rectus (plural, recti). Straight. Recuperate. To restore the strength. Reflection. Turning back. Reflex. Turning back toward the start- ing-place or in another direction. Refraction. Bending out of a straight line. Refrigerant. Cooling. Regime (French). A system of usage or management. Register. In houses, the fixture through which warm air is let into a room. Relapse. To fall back. Relax. To loosen. Remittent. Lessening, without entirely stopping. Renal. Belonging to the kidneys. Reproduction. Generation; begetting offspring. Respiration. Breathing. Resuscitate. To restore to life. Retina. The innermost coat or layer of the eye. Retroversion. Turning backward. Rhythmic. Occurring in regular succes- sive movements. Rickets. A disease in which the bones are softened and weakened. Rigor. A stiffening of the muscles. Rinderpest. Cattle-plague. Ringworm. A disease of the skin, with round patches of eruption. 968 GLOSSARY. Role. A part to be performed. Roseola. A disease of the skin, with bright red patches of various forms. Rotate. To go round like a wheel. Rubeola. Measles. Ruminant. A cud-chewing animal. Ruminate. To chew the cud; that is, to chew the food once, swallow it, bring it up again, and chew it a second time. Rupture. Hernia; the bulging out of a part (knuckle of bowel, for instance) into an unnatural position. s. Saccharomyces. The minute yeast- plant found in the foam of beer, etc. Saint Vitus' dance. Chorea; the jerk- ing disease. Salaeratus. Aired salt; bicarborated pot- ash. Saline. Salty. Saliva. Spittle. Salivate. To increase the flow of saliva, as some medicines do; often with sore- ness of the mouth. Salubrious. Good for health (applied to places). Salutary. Having a good influence on health. Sane. Sound in mind. Sanguine. Full-blooded; also, cheerful, confident, hopeful. Sanitarian. One who is interested in the science of health. Sanitarium. An institution for the res- toration of invalids to health. Sanitation. Attention to the conditions of a place in regard to health. Sanity. Soundness of mind. Saturate. To make a thing take all it can of something else. Savant (French). A learned man. Scabies. The itch, a disease of the skin. Scald-head. Ringworm on the head. Scapula. The shoulder-blade. Scarlatina. Another name for scarlet fever. Sciatica. Pain along the hip and thigh. Scirrhus. Hard cancer. Sclerosis. Hardening from disease. Sclerotic. One of the coats or layers of the eyeball. Scorbutic. Of the nature of (scorbutus) scurvy. Scrofula. A constitutional disease, often inherited. Scurvy. A disease caused by deficiency of fresh food. Seat-worms. Small white worms in the lower part of the bowels. Sebaceous. Greasy or grease-producing. Secrete. To form or throw out some- thing; as the liver secretes bile, the kidneys urine, etc. Sedative. Soothing, depressing, lowering. Sedentary. Not active; living with little or no exercise. Sediment. Something settling down at the bottom of a liquid. Segregate. To separate and set apart. Selective. Picking out one thing from amongst others. Semilunar. Half-moon shaped. Sensitive. Quick to feel impressions. Sensori-motor. Moving iu response to sensations. Sensorium. The part of the brain which receives sensations by means of the nerves connecting with it. Sensory. Having to do with sensation (feeling). Septic. Of the nature of, or promotive of, decay. Septicaemia. Disease of the blood from introduction into it of products of decay. Sequela. That which follows after some- thing else. Serous membranes. Thin, delicate layers spread out within the cavities of the body; as the pleura, peritoneum, etc. Serum. A watery liquid making part of the blood; also moistening serous membranes. Sewage. The foul matter of houses, stables, streets, etc. collected in a liquid state. Sewerage. The disposal of sewage iu pipes, etc. Shingles. A disease of the skin affect- ing the middle of the body on one or both sides. Sinapism. A mustard plaster. Singultus. Hiccough. Skeleton. The bony framework of an animal body. Slough. To mortify and drop off from a living body. Sodium. The metal of soda and of com- mon salt. Soft water. Water which will easily make lather with soap. Soil-pipe. A pipe used to carry off the contents of water-closets, urinals, etc. Solarium. A room open above to receive the rays of the sun. GLOSSARY. 969 Somnambulism. Walking in one's sleep. Sonorous. Making a loud or consider- able sound. Sordes. A thick deposit on the tongue, gums, etc. in fever. Spasmodic. Occurring in spasms or spells; not continuous. Specific. Peculiar; distinct from every- thing else in nature or effect. Spectroscope. An instrument to exam- ine rays of light passiug through dif- ferent substances. Spectrum. An image produced by rays of light passing through a body; for ex- ample, that made by sunlight going through a glass prism. Sphincter. Contracting and closing an opening. Sphy gmograph. An instrument by which the pulsations of an artery may be meas- ured and recorded. Spina bifida. Cleft spine; a deformity sometimes met with in newborn infants. Spine. The backbone. Spleen. A round, slate-colored gland situated near the stomach. Splenic. Belonging to the spleen. Statistics. Facts arranged in precise fig- ures concerning any subject. Stercoraceous. Containing fecal mat- ter—i. e. that belonging to the lower bowels. Stereoscope. An instrument which gives pictures seen through it a solid appear- ance. Sternum. The breast-bone. Stertorous. Snoring. Stillborn. Born dead. Stimulant. Exciting. Stimulate. To excite; to bring out the action of a living organ or system. Stone. In medicine, a hard body found in the kidney, urinary bladder, etc. Strabismus. Squinting, cross-eyes. Strangulation. Strangling, choking, as in hanging. Strangury. Difficulty in passing water from the bladder. Striated. Striped. Stricture. A tightening or obstruction ; as of the urethra (passage from the urinary bladder). Struma. Scrofula. Stupor. A dead sleep, from which a per- son cannot be roused. Stye. An inflamed swelling on the eyelid. Styptic. Something used to check bleed- ing or other discharge. Subclavian. Under the collar-bone (clavicle). Subcutaneous. Under the skin. Subpolar. Under or near one of the poles of the earth. Subsoil. The earth underneath the sur- face of the ground. Subsultus. Jerking, irregular motion; as of the tendons (leaders) at the wrist in fever. Subterranean. Under ground. Subtropical. Near the tropics; next to the equatorial part of the earth. Sulphate. A compound of sulphuric acid. Sulphide. A compound of the element sulphur. Sulphite. A compound of sulphurous acid. Sulphuric acid. Oil of vitriol, a very strong acid liquid. Suppository. A small mass of some- thing prepared for insertion into the lower bowel. Suppression. Complete stoppage. Suppuration. Formation of matter (pus) in a part of the body. Symbol. A sign representative of some- thing; for example, in chemistry the symbol of oxygen is O; of hydrogen, H, etc. Symmetry. Equal balance or proportion of parts; as between the two arms and hands, etc. Sympathy. Feeling together; one being affected by the feeling of another. Syncope. Fainting. Syntonin. A substance obtained by chem- ists from flesh. Syphilis. An ugly disease caused by im- pure sexual intercourse. Syringe. An instrument used to inject liquids into a cavity; a small hand- pump. T. Tabes. A slow, weakening, and wasting disease. Taenia. Tape-worm. Tannin, or tannic acid. An astringent substance obtained from oak-bark, nutgalls, etc. Tartar, on the teeth. A rough, hard de- posit formed when the teeth are neg- lected. Tartaric acid. One of the acids of grape-juice. Tartrate. A compound of tartaric acid. 970 GLOSSARY. Tegument. Skin, outer covering. Temperament. Habit of body and mind; special constitution. Temperate. Moderate; not extreme either way. Temporal region. In anatomy, the temples on the two sides of the head. Tentator. One who, or that which, tries or tests something. Tertian. Occurring (as chills) on the first and third days; every other day. Tetanus. Lockjaw; a very severe and often fatal disease. Thalamus. In anatomy, a part of the base of the brain. Theine. The principal active substance contained in tea. Theobromin. Au active principle ob- tained from cacao- (cocoa) seeds. Therapeutics. The science of the action of remedies in treatment of disease. Thermic. Having to do with heat. Thermometer. An instrument to meas- ure degrees of heat. Thoracic. Belonging to the thorax or che^t. Thorax. The chest, enclosed by the ribs, breast-bone, and spine. Thrush. A disease of the mouth, most common in children. Thyroid gland. A gland in front of the throat, which is much enlarged in goitre. Tic douloureux. Neuralgia of one side of the face and head. Tincture. A preparation made with alcohol. Tinnitus aurium. Ringing or roaring in the ears. Tissue. Stuff, fabric; that of which organs are made (anatomy). Tonic. Increasing tone and strength. Tonic spasm is fixed, rigid contrac- tion of muscles. Tonsil. A small gland on each side of the throat. Tonsillitis. Inflammation of one or both of the tonsils. Torniquet. An instrument used to check bleeding from wounded arteries. Torrid. Very hot. Torula. The yeast-plant; Saccharomyces cerevisix. Toxaemia. Poisoned blood. Toxic. Having to do with poison or poisons. Toxicology. The science or study of poisons. Trachea. The windpipe below its first part, which is called the larynx. Tracheitis. Inflammation of the trachea. Translucent. Allowing light to pass through. Transparent. Capable of being seen through. Transpiration. Passing through slowly. Trap. In a house, a fixture used to keep foul air from getting back from soil- pipes, etc. Tremens. Trembling or attended by tremor. Trichina. Thread-worm, a parasite of pork. Tricuspid. Three-parted ; applied to one of the valves of the heart. Trismus. Lockjaw. Tropical. Belonging to the equatorial part of the globe. Tropics. Lines at a certain distance on each side of the equator. Tubercle. A deposit caused by disease in the lungs or other parts of the body. Tuberculosis. Tendency to formation of tubercle; the tuberculous constitution. Tympanic. Drum-like. Tympanum. A drum; in anatomy, the drum of the ear. Typhlitis. Inflammation of the larger bowel. Typhoid. Low, prostrating, stupefying, or stupefied. Typhus. Stupid or stupefying (the name of a low fever). Typical. Showing a type; a representa- tive thing or form. u. Ulcer. An open sore on any part of the body. Ulna. The bone of the forearm which connects with the wrist on the little finger side. Unconscious. Not knowing anything, as in a faint or a stupor. Undulating. Moving in waves. Unguent. Ointment. Unleavened. Made without yeast, not raised. Uraemia. Tainting of the blood with matters belonging to the urine. Urate. A compound of uric acid. Urea. One of the substances contained naturally in the urine. Ureter. One of the tubes which connect the kidneys with the bladder. GLOSSAR Y. 971 Urethra. The tube which carries out the urine from the bladder. Uric acid. A substance naturally con- tained in the urine. Urination. Passing water from the bladder. Urine. The water formed in the kidneys and passed out from the bladder. Urticaria. Nettle rash, a kind of skin disease. Uterine. Belonging to the uterus (womb). Uterus. The womb. Utilize. To make useful. Utopian. Too good to be made to happen. V. Vaccinate. To inoculate with matter from cowpox. Vaccinia. Cowpox. Vagina. The outlet from the womb. Vapor. Steam; moisture (of any liquid) rising into the air. Varicella. Chicken-pox. Varicose. Enlarged; swollen in parts (as, for example, veins). Variola. Small-pox. Varioloid. Small-pox modified by the effect of vaccination. Vaseline. Cosmoline; a substance ob- tained from coal oil, and used instead of grease. Vegetarian. One who eats only vege- table food. Vegetative. Belonging to, or like, vege- table life. Vehicle. Something which carries. Vein. A vessel conveying blood toward the heart. Vena cava (ascending and descending). The name of each of the two largest veins in the body, both entering the heart. Venesection. Opening a vein to draw blood. Venom. Poison. Venous. Belonging to a vein or the veins. Ventilate. To change the air of a place. Ventricle. One of the larger cavities or chambers of the heart. Verdigris. Copper rust; carbonate or acetate of copper. Vermifuge. A drug which will, when taken, kill or drive out worms. Vertebra. One of the natural pieces of the backbone. Vertebrates. Animals having back- bones. Vertical. Straight up and down. Vertigo. Giddiness. Vesicate. To raise a blister. Vestibule. A threshold; in anatomy, part of the internal ear. Vibrate. To quiver or move in small waves, as the metal of a bell does when struck. Vibrio. A very minute living form often found in living and dead organic bodies. Visible. That which may be seen. Vision. Sight. Visual. Belonging to sight. Vitalize. To give life to anything. Vitiate. To spoil badly. Vitrefied. Brought to a glass-like con- dition. Vitreous. Glassy; like glass. Volatile. Easily turned to vapor by heat. Voluntary. Done, or possible to be done, at the bidding of the will. Vulcanize. To harden by heating with an appropriate substance (applied to India-rubber). w. Water-brash. Water coming from the stomach into the mouth. Water-seal. The water in a trap (which see) to keep gases from going through it. Wean. To get one away from, or out of the habit of, something. White vitriol. Sulphate of zinc. Whites. A discharge from the womb or vagina in women. Whooping cough. Hooping cough. Windpipe. The tube in the throat through which we breathe. Wrist-drop. Palsy of the muscles of the arm from lead-poisoning. Z. Zest. Strong interest in something. Zone. A region of the earth—arctic, temperate, tropical, etc. Zymotic. Caused by a process in some respects like fermentation. \ ^^^r^SSSSm^^^^ '•'".*. nWf'1" "*"~~ WBA H335p 1891 63580140R NLfl DSlbMMS? 7 NATIONAL LIBRARY OF MEDICINE mm NLM051644577 5