l,;'4f J^> ^£i:m^: . ','i'VS a*^' + .U. ,J#rj fai •iv; .*•-•,* ■•*£. «#• rJ» <*i*s s ^ i '*/***&, £.*+** <&^ ipr/ny A-u-C^— // / fS •* % • % * *** * ■V V ^ S V-.-*. :■-■ (** FAMILY ADVISER, GREATLY ENLARGED AND AMENDED: if TO WHICH IS PREFIXED THE PHILOSOPHY OF DISEASE, WITH TABLES, FOR THE USE OF STUDENTS OF MEDICINE; OR OF GENTLEMEN WHO WISH TO BECOME ACQUAINTED WITH THE FUN- DAMENTAL PRINCIPLES OF MEDICINE. BY HENRY WILKINS, M. D. OKB OF THE TRUSTEES OF THE UNIVERSITY OF MARYLAND. " To do good and to communicate, forget not."—Paul. NEW-YORK, PUBLISHED BY B. WAUGH AND T. MASON, FOR THE METHODIST EPISCOPAL CHURCH, AT THE CONFER- ENCE OFFICE, 14 CROSBY-STREET. J. Collord, Printer. 1833. Entered, according to Act of Congress, in the year 1832, by B. Waugh and T. Mason, in the Clerk's Office of the District Court of the Southern District of New York. PREFACE. It is now thj^yj^^hL_yjears since the author of the Family Adviser first gave.a copy of it to our late venerable Bishop Asbury, as an assist- ance to him, whilst traversing the margins of our western civilization. Since then he has not attempted to make any alterations, nor amend- ments, nor additions, till the present time. At the period of its first publication, there were but two apothecaries even in the great city of Balti- more, and none in the small towns; and medicines were scarce and precious articles in the western world. But now every small town has its apo- thecary; every village its store, with essential medicines as part of its stock. There is, there- fore, no farther need of that great restriction of medical means observable in the former editions of the Family Adviser. Moreover, the condition of America, as to information, is greatly improved in the last thirty-eight years; (which may be called a generation.) At every small distance, throughout the interior country, there are to be found men of intelligence, who can well compre- hend and make use of medical instruction, so as to be of great use to those who are unable to ob- tain or employ a physician. In the mean time the author has had an oppor- tunity of comparing the European description (from which he took largely to make up his little book) with the actual diseases, and the necessary remedies used in America, and he has found that IV PREFACE. the vigour of the American constitution, its climate, and its open and free manner of life, have given a very considerable cast to many diseases varying from the best European description. He, there- fore, considers it necessary to adapt the book to its country, and to its day; for medicine is con- stantly on the advance. He flatters himself, that, if any candid, intelligent physician will take the pains to read this book in its present state, he will not hesitate to say, the author has not only attended to those things but has also given to the jworld some new ideas and a few remedies, not before advanced, that are worthy of notice. There is in this edition a considerable number of impor- tant diseases added to the book, besides many directions for accidental and surgical cases, and several chapters on other points relative to medi- cine, with a pretty large apothecarium. The chapter on typhus, which has substituted the chap- ter on nervous and putrid fevers, though novel, has been taken from the bed-side; and that not from one, but many patients: That fever (the typhus mitior) being endemic to the spot where he now resides. The constant increase of intel- ligence throughout the union has induced him to give a few pages as a general theory at the beginning of the book, which are of a philoso- phical cast; and although this liberty and a gene- ral enlargement will swell the volume; yet, the old book and its simples, much corrected, are still within the lids of the new book. If, there- fore, such corrections and additions are worth the increase in price, there will be nothing to com- plain of. The author has to acknowledge many facilities received from the writings of Dr. Robt. Thomas, with Dr. Hossack's appendix; Dr. Gregory, with PREFACE. V Drs. Potter and Calhoun's notes; Dr. Dewees and Dr. J. S. Dorsy. The author is also pretty certain that he is indebted to some medical gen- tlemen (not authors) for many practical ideas. Two of these, now living, he takes pleasure in naming: Dr. Jas. Steuart, of Baltimore, and Dr. William Murry, of West River, Maryland; with whom he closed his first studies more than forty years past 1* CONTENTS OF THE BOOK. _ . . PaSe Chap. 1. Fever's in general,.....46 Chap. 2. Fevers proper,......54 Chap. 3. Eruptive diseases,.....85 Chap. 4. Diseases in and about the head, 105 Chap. 5. Diseases of the chest and lungs, 141 Chap. 6. Diseases of the muscles, . . . 187 Chap. 7. Diseases of the primae viae, . . 223 Chap. 8. Diseases of the liver, spleen, kid- neys, and a'ppendages,......264 Chap. 9. Diseases of the bones, . . . 287 Chap. 10. Diseases of the uterus and ap- pendages, ..........294 Chap. 11. Diseases incident to the puer- peral state,..........317 Chap. 12. Diseases of children, . . . 333 Chap. 13. Accidents, or accidental diseases, 355 Chap. 14. Surgical diseases, .... 376 Apothecarium, or medicinal department, . 421 Nurse's department,.......444 Purifying articles,........ 446 Contents of the apothecarium, .... 447 Section on diet and drinks,.....451 Section on theories,....... 7 Philosophy of disease,.......10 Section on general management, ... 43 Synonyms from the London Pharmacopoeia, 449 General Glossary,........455 Relative and Specific tables of doses, . . 443 OBSERVATIONS ON THEORIES OF DISEASE. It will be seen by reading over the Family Adviser, that the author has seldom touched on what physicians call the proximate cause of dis- ease. The reason for this neglect will be given. The theory of disease, as it is called, varies every generation. A hundred years ago physicians attributed disease to a thickness or thinness of the blood and humours, or to certain fermentations, which, like the workings of beer, took an uncer- tain time to concoct and throw off the sediment or peccant humour. The following generation, being displeased with those theories, discarded the humours and charged the solids with being in error, and considered spasms of the extreme vessels as the proximate cause of fevers at least: —since then various theories have crept in, the principal of which is the Brunonean, where every thing is charged to mere Hood and ebb-tide in the system. Language was appropriated to each system; hence, we find our old books filled with inspissants, attenuants, and concoctants, to alter the state of the fluids; anti-spasmodic and sedative medicines, stenic and astenic diseases, indirect and direct debility; the former of these terms used (viz. indirect debility) to express an inundation as from an overflowing tide, prostrat- ing all before it.* If with all this jargon we take i.' * Dr. Brown simply bailed out the arteries and stomach, or filled I; up with beefsteaks and brandy, according as he had to engage a flood ' and ebb-tide; but his indirect debility rather puzzled him; he, how- ever, directed the bailing system even to restore prostration till there should be an apparent recovery, when a more temporizing plan might take place, pro re nata. Dr. Rush embraced this system so far as to mere theory, but applied the celebrated Dover's practice to it; making 8 THEORY of disease. into consideration, that the theory and language of chemistry was altered full as often, we shall have some idea of a medical consultation when pupils of each school meet togetherj* for there were always some who retained their old theories and language too; and should this babel-like lan- guage continue, it may be necessary.to give phy- sicians a course of instruction at a deaf and dumb school, or at the university of Lagado, that they may understand each other (when they come to- gether) by signs at least. The cause of all this discrepancy of sentiment and consequently of language, is this: physiology is a dwarf, it has not grown one inch since its birth. Adam knew all that is now known about the motorial power, for he could not but perceive that the heart beat without his orders, and his children grew without their intention; and, also, that the locomotive muscles were under his com- mand; and as to the essence of motion, its gene- ration, its location of reserve or store-house and its laws, he was full as wise as the present generation, who have, nevertheless, given whole systems of physiology, built on an intimate know- ledge (as one would suppose) of all these parti- culars. A simple question, however, whether this motorial power is a fluid, or a quality, like gravitation, would confound the wisest of them. Taking vain theories as facts and for a solid foun- dation, other theorists have built on this rubbish various conjectural systems of pathology, detail- ing the invisible morbid motions or actions of the same principle, a thing still more difficult; so most of Brown's ebbs to be floods. Thus whilst the latter (Brown) supposed 75 in 100 to be diseases of pure debility, the former supposed them to proceed from excess of action: no wonder amidst conflict- ing tides if the patient should sometimes sink in the whirlpool. DISEASE. 9 nidi iguuraime associating with error, it became no wonder to find confusion the result. The author of the Family Adviser discarding most of those subtle and untangible theories, has given the following chapter on Philosophy of Disease to fill up the apparant vacancy. He has, in general, confined himself to the most obvious causes of disease, however remote; has pointed them out and given them a sort of classification; and as to disease itself, he has seldom gone farther in portraying it than the dissector's knife, the eye or hand of the physician, and the expressions of the patient's feelings have led him. Thus con- fining himself to principles which can never pass away. PHILOSOPHY OF DISEASE. Of Agents.—The first possession of substance and of life in every individual, either of the vegetable or animal kingdoms, is a parental gift. This offset being insufficient of itself for further growth, and to attain to the standard ordained for such individuals, it be- comes the office of the living machine to procure the residue from the great sea of elements and its inhabi- tants that lay around, (in liquid or organic forms) com- posing the furniture of this terraqueous globe. For chemistry has taught us that all the components of the animal fabric, with exception of the sentient and vital principles, are to be found in the common elements* and inanimate organizations of nature. Although a large portion of what is necessary to build up the animal fabric (viz. ingesta) has been previously ex- tracted from other animals or from vegetables;! yet, by tracing back our ideas to only two individuals, (Adam and Eve) and to a few original plants,:]: we shall readily perceive that the substance of all the human race, and of all vegetation, has been derived from that sea of elements that surrounds us, (composed of oxygen, hy- drogen, azote, carbon, caloric in the forms of water, atmospheric air, heat,) and the solid earthy substances. And from this circumstance there is not only a relation subsisting between what is animate and what is inani- * Before the present knowledge in chymistry, water and atmos- pheric air were considered simple bodies, (which elements must necessarily be) and in this old sense we are under the necessity of using them as yet (technically.) The inconvenience will be nothing after information. Especially, as when needed for explanation, the peculiar element (viz. oxygen, nitrogen, hydrogen-caloric,) will be named. t There can be no difference in the view we are taking, whether these inhabitants are vegetable or animal, for matter of fact has taught us that vegetable matter is turned into animal by the living machinery; and probably animal recrements into vegetable fibres by the vege- table apparatus. X See Linnsus Philosophy of Plants. PHILOSOPHY OF DISEASE. 11 mate matter, but there is also a never ceasing struggle between the two; the one to build up, the other to pull down. The growth of the animal, his short duration, and subsequent decay, makes it a necessary consequence that the animal machinery should at first have a supe- riority in power over the elementary influence, and then relinquish this power in turn to the steady and perpetual operations of the elements. The space thus taken up forms the life-time of the animal. From*the time that the external elements, in their various degrees of application, begin to be a full match, and to get the better of the vital actions, the life of man is but " labour and sorrow;" and the organs of his body become like foreign matter; hence, the pains, stiffness and feebleness of old age. The faculties recede in a regular order: the eyes and the memory are the first to go, and these are soon followed by symptoms of more consequence, which assure the possessor that his body must soon be dissolved, and find its associate elements in the great sea from whence it was derived. Not only must dust return to dust, but even the caloric that warmed the blood will desert to its original home. A like fate awaits the vegetable, very soon after reaching its achme; the fruit becomes abortive, the decaying limbs the sport of winds, whilst the water (once so necessary to its existence) now by merely trickling down the riven bark, plants death in its very heart. But scarcely will it happen to either vegetable or animal to meet this natural outlet to life: "fierce diseases wait around," to hurry mortals off at every stage of life; and the vegetable is not less susceptible of disease and casu- alties.* As the action of the common elements (viz. water, air, heat) are so conspicuous in the vegetable, it will serve to elucidate so far as it goes, what takes place in the animal. When a seed is separated from the ma- * Mr. Wildenow has described, at least, 40 diseases to which plants are liable. 12 PHILOSOPHY OF DISEASE. ternal (pericarpium) or seed vessel, the vital principle derived from the parent plant lies dormant and inactive until a suitable degree of heat and moisture is applied; if then it has access to air, it begins to swell by the ' absorption and decomposition of portions of the ele- mentary materials. These agents, acting on the vital principle, cause it to perform those actions which are called circulation, by which the plant takes up the store of pabulum that composed a share of the body of the seed or wrapper of the plantule, and converts it by chemical changes into a new organic matter, constituting the increase of the plant; so that by such enlargement of the plant, and developement of its organs, it is able to take its future sustenance from the earth and the air.* But should there be more moisture than is necessary, or more heat than is requisite, or both united, the plant sickens, and unless a speedy change takes place, it dies. It is also to be particularly noted, that when dead, those very elements (that caused it first to grow and flourish when applied in due de- gree, and during the full possession and activity of the vital principle) now proceed to decompose the whole vegetable organization, and restore the decomposed elements to the great treasury from whence they were derived. It may also be noted, that when a plantule has been brought out from the seed by the application of those elements; that a recession of them will be fatal to the plant, as much so as an excess. The follow- ing inferences may be drawn from the above undeni- able facts, respecting a seed plantule, which are equally applicable to animals. 1st. That there is nothing but different degrees of the identical agents acting on the vital principle neces- * The plume and radicle of a young plant have originally different constitutions and arrangement of organs. The plume spreads a greater surface, and it has smaller vessels; thus giving it a greater relation to light and heat, which act powerfully on it; whilst, the radicle being more porous and compact, is more obedient to gravitation, when loaded with water. See Hale's Statistical Essays, and Sir H. Davy on the Growth and Position of Plants. PHILOSOPHY OF DISEASE. 13 sary.to sustain life, to produce disease, to cause death, or to effect (when acting on the corpse) dissolution. 2nd. That the full action of the elements in dissolv- ing dead animal or vegetable matter is strictly chymi- cal, and as degrees cannot change the nature of the agents, it follows of course that all the actions produced in health or in disease are of the same nature, though modified by the presence of some restraining principle. (Which here is evidently the vital principle.) 3rd. That the elements, as well as all ingesta com- posed of them, which are taken in to build up and give action to the animal, are in health acted upon by the vital machinery and decomposed; (the animal economy using such portion as are necessary, and discarding the remainder;) whereas, in or after death the external elements act on the animal fabric and decompose it. So that the vital principle is doing the office of a solvent in life and health, but the elements in its ab- sence performs the office of solvent to the animal fabric. 4th. That as disease is an approach to the death of a part or the whole body, that state must be produced by an excess of the elementary action, or a deficiency of the vital action, or both; in all which cases a chy- mical action becomes prevalent, as is evinced in gan- grene, mortification and suppurations, &c. 5th. That a par of action or a cessation of decom- position between these powerful agents, so as to restrain due action, must be a species of disease; and finally that an excess of action may be produced by great vigour on both sides, and endured for a considerable time; but such action will always shorten life and ultimately produce disease rather than a greater state of health; for the system is calculated to a given force and a set time.* * It would appear that the vital principle alone is the agent that produces all motorial action, and all organizations necessary to the system; and that the elements and their compounds excite this vital action in a salutary way only whilst they are decomposed by it, but when not decomposed, (viz. the elements.) They disorder and destroy the system by breaking up the specific arrangement that constitutes 2 14 PHILOSOPHY OF DISEASE. Classification.—A variety of attempts have, been made to elucidate disease by classification. Such classes should only be established as have strong fun- damental distinctions in the great outlines. The best are those that are most evident to the senses, (especi- ally on dissection) such as comprehend the most diseases, and such as will be of real practical use. The author proposes to make two classes, viz.— diseases of one cause, and diseases of two causes; which, for want of better technicals, he will call genuine disease and spurious disease,* applying the former term (genuine) to diseases proceeding from two causes. By genuine disease is meant all those disorders that can continue after the removal of their first cause, and of course must have a second cause for their con- tinuance. the vital machinery; or when they are more moderate in their opera- tion, by exciting the vital principle to improper actions in the animal economy. The author, however, has to acknowledge his ignorance of the vital principle, except from the facts of its operations; speculation is not his object, but he will give some opinions. Sir Isaac Newton believed that it was derived from without, as heat and oxygen are, and that it is of a planetary nature, as heat is of a solar nature;—for all the muscular actions of the vital principle may be resolved into attractions or contractions, and subsequent relaxa- tions; at least all those actions in which motion is the result—against this it might be objected that it has a decomposing power. Whether these two actions, muscular and chemical, can be associated, must be left to others to determine. Another idea is, that the vital principle is merely a quality put on by a certain organization or peculiar formation of animalized matter; just as the properties of vitriolic acid ensue from the union of sulphur and oxygen in combustion; against this its apparent power of metas- tasis and its sudden local exertion under the influence of the will, is an objection. A third idea is, that it is altogether a parental gift with the body, capable of extension ad infinitum, and of evolving from parent to child over all the animal organization that ever can be formed. In favour of this is the Scripture expression; " And God breathed into his nostrils the breath of life or lives; and man became a living soul."— Gen. ii. c. 7. v.—Thus written for singular or plural, according to Biblical critics. # These names are very objectionable, as they are no more appli- cable to medicine than to any other object; if, therefore, they are offensive to any, let them be called monophysical and diphysical diseases. PHILOSOPHY OF DISEASE. 15 By spurious disease, is meant all those disorders which depend altogether on one cause; which of course must be present to keep it up. Most all those diseases which have been induced by changes of weather, are genuine; because they continue after the patient is removed from the cold, or the heat, or the wet, &c, which have established a second cause in the system. It will become the writer's duty to point out and explain this hereafter. Nearly all proper fevers and inflammations, attended with febrile symptoms, are therefore items in this class; whilst those diseases which have been induced by some irritating material, or by temporary errors in diet, are spurious; ceasing by the removal of the only cause; hence, common cholics, most fits, worms, &c, belong to this last class. Character of Genuine Disease.—It has for its immediate or second cause an acute derangement in the substance of some organ or organs of the system, which have to go through a certain process, according to its constitution and the damage received.* This process will be called an organic paroxysm. These are caused, 1st. By some unsuitable degree and appli- cation of the elementary powers. 2nd. By acrimo- nious ingesta, either medicinal, pestilential, or alimen- tary, establishing an inflammation. 3rd. By violence. 4th. By excessive actions of particular parts; as of the muscles in a fatigue, and of the mind in intense appli- cation or violent passions, &c. An Organic Paroxysm consists in some of the following states of an organ, viz.—1st. Acute inflam- matory intumescence. 2nd. In aqueous, serous, lym- * There is a sufficient distinction between the vascular system proper to each organ, and constituting so large a portion of it, and the common extremities of the arteries that pass through these organs to supply them, for to put them under different laws. The large commixture of other organic matter—the ability to secrete different humours from mere blood—the very slow circulation of their own blood, are important items to render the former (viz. organs) more susceptible of organic or corpuscular disease, and of course more tardy to get morbid arrangements rectified. It is in these, therefore, (in their substance) that the paroxysms are located, and not in a mere acceleration of circulation in the more pervious arteries that pass through them. 16 PHILOSOPHY OF DISEASE. phatic or sanguinous effusions, (or rather in the inflam- matory grade that produces such effusions.) 3rd. In suppurative inflammation. 4th. In erysipitatious inflam- mation. 5th. In gangrene and mortification. 6th. In disorganizations from combustion and from violence. Their intensity is nearly as arranged, the first being the most simple and least disease, when the affected surface is of the same extent; a new and morbid order of actions takes place in the system, when one of these paroxysms is established. In the first place, the organ so affected loses its social arrangement or action, and becomes like a foreign body in the general system. In the next place, its secretions be- coming corrupt or unnatural, join with the aforemen- tioned cause to irritate the system. But the most obvious effect is the sympathies excited or generated over the whole system. The tout ensemble of which, with the primary injury, constitutes the peculiar dis- ease.* The most notable of these sympathies is that of the heart and arteries. These, by passing through every organ (like rods of iron whose points are in the fire) can scarcely escape a morbid impression; and this corresponds, in most cases, very exactly with the state of the organ. Thus, when there is a pure phlegmonic inflammation, the pulse is strong and quick; and when there is a verge to gangrene, the pulse indicates the low state of the primary organic affection. In this way it becomes a most important index to the general and * It will be observed that the author has made organic (genuine) local disease, the foundation of all the sympathies (or symptoms) of such disease, and not the fruit or offspring of it; this is contrary to most theories, although nothing else appears on dissection; for the sympathies scarcely leave a trait behind them; were the reactions to take place always on the organs that receive the first impressions, or were such organs to come in conspicuously in the symptoms, there would be more likelihood of organic paroxysms being the fruit, instead of the foundation of the particular disease; but, on the contrary, it is a rare case—e. g—a patient exposes his legs and feet, and perhaps gets chilblains, or an erysipelatous inflammation on his legs; but nineteen times out of twenty he gets some inflammation in the lungs or muscles, producing a specific disease, whilst the legs and feet have no local disease. &• See a note in page 22 * on the further difficulty of this point. PHILOSOPHY OF DISEASE. 17 primary affection, and even when failing in its unifor- mity, as it does in affections of the heart, the brain and the lungs, its very irregularity is highly indicative. To this office (viz. index) it seems well adapted, as holding a place between the primary affection (or or- ganic paroxysm) and the prostrated organs of the sys- tem, which form the next set of sympathies. The arterial sympathy is an active one, as before said, but in addition to this, entire disease is constituted by a large set of passive sympathies, spreading over all the rest of the system. Thus the prima? via? (unless there be a paroxysm existing there) is in perfect inability. The muscular system is prostrated, and the mind sunk in feebleness. It is both a curious and a notorious circumstance, that in extensive disease, about one half the system is in an over or superaction, whilst the rest is in a sub-action. The most rational solution of this phenomena is, that those secondary sympathies, or passive affections, are dependencies on the arterial disturbances, rather than flowing immediately from the organic paroxysm; thus they are sympathies of sym- pathies. But still there is a shade waving over this apparent gleam of perception; and it is hard to say, whether the arterial disturbance has merely interrupted the connections of the vital energy existing between the different parts of the system, or whether (taking the vita] principle for an element) an accumulated action in one part has necessarily been followed by a deficiency in others.* It is a well-known fact, that when the arterial sym- pathy runs high, it is extremely injurious to the organic paroxysm that induced it, and is then no " vis mede- catrix natures," for it extends the local affection beyond its first limits, nor can the primary affection stand any chance of recession, or of one of the more simple effusions, unless that sympathy is moderated by artifi- cial or accidental means;t and otherwise the paroxysm * There seems something like this in an intermittent, for the mo- ment the febrile paroxysm ceases, the muscles and stomach recover #■ their strength, and the patient rises and often has an appetite to eat., ■»• f Such as bleeding and puking spontaneously or practised. 2* 18 PHILOSOPHY OF DISEASE, will terminate in suppuration or gangrene, according to the general state of the system and the violence of the sympathy;* on the other hand the passive sympathies are often of singular utility. But for these a patient would continue his actions, his food, and his mental exertions, in spite of all admonition, till he was irre- coverable; and but for all the sympathies collectively, he would die more often in the street than in the bed, and seldom with any foreknowledge of his danger or exit. Moreover, trivial and mortal diseases could only be distinguished by the event. But by the sympathies the physician is directed to the character and place of disease, and even in unknown diseases has a clue to the fountain head—whilst the patient is forced to lay up, and to abstain from things indispensable to a cure. Sanative Influence.—That there is a sanative power in the system, no person can deny who has seen a wound or ulcer heal up. This power resides in a proper grade of arterial sympathy. It is, in fact, the application of the resources of the uninjured or less injured parts of the system to the local injury. The mere vital system, however, is not indued with a direct- ing power, to fix this sanative grade of arterial sympa- thy: and of course it is more ready to overleap the proper grade than to hit it—and is frequently found to fall beneath the needful force.t The intelligent prin- ciple in man is changed with the proper gradation, and even this requires much knowledge and experience to act with efficacy. But when an organ has received a very extraordinary impression, it may be beyond all sanative and artificial power, and its death must ensue. * This was Dr. Hunter's idea of gangrene and mortification, viz. that the " action was greater than the power." t The arterial sympathy, however low, never becomes a passive sympathy. It will be at any rate relatively active, and when low, indicates that the powers of the system arc not merely suspended, but exhausted, requiring artificial means, and with such help, the arterial sympathy again extends its sanative influence; for it keeps its old character, viz. primum vivens ultimum moriens. Were there any thing like a passive arterial sympathy, asphixia and death would necessarily ensue; obstructions, however, from diseases of the heart, brain, and lungs, are to be carefully distinguished from a simple, low pulse, or depressed arterial sympathy. PHILOSOPHY OF DISEASE. 19 It will then be ascertained whether or no the system can dispense with it, and live. But it is not always left to that issue, for a mortification may extend its influence so fully to the arterial sympathy as to destroy the sys- tem, even though it could do without the organ under mortification. Death may also ensue without morti- fication, and that even when the local paroxysm is quite within the sanative range, merely by the long time required exhausting the powers of the system; for every paroxysm will require a certain time to reorga- nize; nor can disease cease till this is effected. The system being full of tubes filled with fluids may, by certain simple diseases, have these fluids and their secretions so perverted as to produce death, by accu- mulations and inanitions taking place, especially on important organs, as the brain and heart. Compound Diseases.—Although the author has considered in the former pages genuine disease as arising from a single organic paroxysm, yet dissection proves that there may be more, and so much the worse; for as each diseased organ will generate a set of sym- pathies from its own root, it will at least have a ten- dency to confuse and render the disease more doubtful, as well as difficult to relieve. There are certain constitutional sympathies common to all, such as between the stomach and head, the bowels and muscles; and no doubt when disease falls on such parts, the symptoms and disease of course will be augmented. There are also peculiar sympathies belonging to the female constitution, equally natural and constitutional. These have a great range on the system through the medium of the prima? viae, which seems to be their high road. Diseases, however, of the sexual stamp, belong more frequently to the next class, viz. spurious disease. gC7* See note, page 20, marked t Character of Spurious Disease.—The causes and traits of this class are numerous, and the diseases somewhat varied. The author does not expect to exhaust the subject, or attain to any degree of per- 20 PHILOSOPHY of disease. fection; for he has not a path before him, and what are the efforts of an individual? The traits alluded to will be found in the effects of certain irritants (more or less immediately) applied either within or without the sys- tem. The irritants are as follows:— A. All the causes (though in different degree) that produce genuine disease, particularly ingesta. B. Physical matters; embracing medicines, poisons, contagious and infectious matter. C. Worms, ulcers, and small solutions of conti- nuity.* D. Congestions of water or purulent matter deposited by former disease in natural or forced cavities. E. Chronic affections and false organizations, slowly generated in the system, or left by other diseases. ' which by increase, or false secretion, or tendency-to dissolution (as in cancers) awaken up a new disease; obstructions of the liver have here an eminent place; for the system has no room for more than its own machinery, nor any appropriation for false secretions. These things, therefore, act both mechanically and physically, and not unfrequently give a hydraulic turn, of a diseased stamp, to the fluids. > . F. Natural paroxysms (of organs) that do not amount to genuine disease, such as frequently happens in gestation and catamenial irregularities.t * A small solution of continuity, when the sanative action is not extended to it, becomes a source of tremendous disease, by suffering the external elements to produce a violent action and morbid sympathy on parts naturally hid in the system, and protected by the arterial action; for the system is like an Egyptian mummy with its covers, proceeding from finer to coarser. When these are stripped off and the arterial sympathy absent, the full force of atmospheric influence is carried directly or by sympathy to the interior. The action of the muscles in lockjaw must not therefore surprise us; for the greatest action any agent can produce is but its real and just action, and all minor ones are but restraints or masked actions, on parts constituted to repel them. t The uterine organs, including their pertinents, appear to be the last work of the system in the female fabric; like the flower in the plant, they are the ultimatum; nothing but a new offspring or another individual succeeding; having thus received the actions of every * PHILOSOPHY OF DISEASE. 21 G. Splinters and fragments of hard bodies inserted into the flesh. H. Metaphysical operations on the mind in excess or duration. To these there may be many others, that have escaped the author for want of time to con- sider this arduous subject.* When any of the causes from A to H act with an undue force on the system (and many of them will always do so) some of the following results will take place. If the irritant acts on the whole system, as is the case in contagious matters, there will be a con- siderable arterial sympathy, and of course a set of secondary-or passive sympathies: this happens in measles, smafl-pox, &c. If the irritants act by pecu- liar elective action on an organ of great importance to the system, such as the brain or the heart, there will be an instantaneous prostration of the whole system; but if the poison be in less quantity, convulsions, ac- celerations, or asphixia will be the result. Such affec- tions will take place after opiates, and the bites of venomous serpents; but the most usual operation of ^irritants, is on a portion of the intestinal canal, on the muscles, or on the surface. When the parts are in- capable of motion themselves, they at least become painful, and the irritation is often extended to some parts that are capable of motion; or when immediately applied to parts that naturally have motion, such parts are accelerated, convulsed, or constricted by a spasm. By such constrictions or convulsions, the blood is part of the system in their construction, they seem to hold a retro- spective and easy connexion with every part, giving tone to body and mind, or depression in disease; hence they become an important index to the state of the system. * That the exertions.of the mental faculties, exhaust the vital principle as well as labour, is a matter of fact; and that even genuine disease can be produced thereby ,admits of proof by dissection. But there can be no conclusion from these facts, that such operations proceed from a chemical power: muscular force and steam power can operate identically on a crank or wheel. Let no infidel, therefore, conclude that the mind is material, nor any phrenologist imagine that bumps. 22 PHILOSOPHY OF DISEASE. thrown from its wonted route, and hence, other se- condary diseases are sometimes produced. All the above sympathies arising immediately from the irritant, may be called active, for they are attended with a distinct set of passive sympathies, prostrating the whole system, similar to what takes place in genuine disease.* As the arterial sympathy is often absent, in this class, and scarcely ever very severe, other causes must give rise to those passive sympathies. Where the disease is considerable, the active sympathies, though not arterial, are quite sufficient to interrupt the usual connexions existing between the different parts of the system, and of course to cause those passive sympathies observable.! The sanative influ- ence appears to have no place in spurious disease, and there is no organic paroxysm, to be benefitted or injured by it. There is, however, a great display of natural sympathies in female cases. The usual traits of spurious disease are pains, ac- celerated motions, spasms, convulsions, asphixia.— Spurious disease will sometimes continue till it changes to genuine;* some few diseases seem to partake of the nature of both spurious and genuine diseases, as inter- mittent fevers.t some uterine affections, and strictures can think!! Would these latter gentlemen settle the account between the wild goose and the whale? With a head ten thousand titties less, the goose has a hundred times the capacity of a whale, viz:—seven times the brood, two distinct operations to produce them, two zones to travel in order to perform her maternal superintendence, two senses to elude her enemies, four ways of escaping; walks, swims, flies or dives at pleasure. A phrenological tailor might surely cut out the exact contour of a goose's brain, from so much cloth of cere- brum and cerebellum, making spermaceti of the balance; and thus benefiting both the whale and mankind, he would outwit nature herself. * No person has supposed that the part primarily irritated in these spurious diseases, is the fruit of disease; and as spurious disease will often change to genuine, by an inflammation ensuing at the very spot irritated, it would be strange to make the same spot the foundation of one class and the fruit of the other. t As the muscular system is never universally affected by any one disease; it is quite possible for the active sympathies to take place in one set of them, and the passive in another. £^- By spasm is meant a concentrated action «n or in a part, more than natural, but not so great as to disorganize it and produce a paroxysm: it is always, therefore, in a part capable of motion. PHILOSOPHY OF DISEASE. 23 from cold, producing great irritation on the stomach. Spurious disease admits of easy subdivisions, into acute and chronic, general and local. The above traits will enable the reader to see pretty clearly into the arrange- ments undertaken, and to ascertain whether the two classes have real foundations, which alone can entitle them to the rank assumed in this essay. General action of agents.—As the morbid action of the external agents producing mortification, sup- puration, and all the lesser organic paroxysms, is according to the principles laid down in page 1, of a chemical nature,* some further explanation becomes necessary. Depending on the axiom that the external elements are no longer engaged in exciting the vital principle to salutary actions, than whilst such elements are decomposed and absorbed; and that when not decomposed and absorbed by the surfaces to which they are applied, they act injuriously, producing disease * Though it be a great defect in the arrangements of natural history for an article to stand under two classes, yet it is scarcely so in medicine; for, in fact, there ought to be two distinct names for such diseases as are commonly comprehended in one, when they can claim either class: thus cholic, from mere crapula, should have a different name from an inflammatory cholic, caused by cold. The blood driven inwards by a chill, engorges the heart, liver and spleen, independently of the small primary inflammation, that gave origin to the disease; the heart being most active throws off the blood, by a kind of fever, in the course of an hour, (See M'Bride.) But the liver and spleen being inactive, take one or two days to disgorge, making the time of an intermission. When that disgorgement is fully accomplished, the pulse falls off, and the primary irritations produce another chill. Perhaps when the liver and spleen do not disgorge Bynchronausly, double tertions are produced. It must be allowed that the chemical actions that produce disease, in common, are not of that complete nature as to effect an entire change or tertium quid in the animal fabric; and, therefore, we can- not speak of them as we do of oxygen and hydrogen, producing water by the electric spark, nor could we expect such operations whilst the integrity of the system was spared, nor from the actions of bodies so fully compounded and commixed as all the common elements in their various changes, operating on a body nearly as compound. Those partial chemical actions, therefore, (which are nevertheless sufficiently obvious) are termed physical actions—and we perceive their affinity to particular parts of the system in various instances;—thus heat and moisture act on the liver, and prims viae, whilst cold and moisture act on the lungs and muscles. 24 PHILOSOPHY OF DISEASE. in their minor actions, and death with dissolution in their greater operations; it follows as a consequence that they must have in general more access to the system than the relation spoken of in page 1. There is no need of proving that common ingesta have access sufficient to produce disease, when it is improper in quality or when not digested, even though of proper quality.* But, perhaps, it has not been heretofore so well noticed that most diseases which are suddenly induced, fall on parts to which the common elements have the most free access.! Thus we find that diseases of the face, mouth, lungs, prima? via? are quickly produced, and indeed of all the exposed surface; and next to the above list, diseases of the great glands, whose tubes reach the prima? vise. Whilst on the other hand the secluded organs, as the brain, heart, kidneys and blad- der, are never suddenly and primarily attacked by any elementary influence. They must be first reached by an excess of action, produced by excessive ingesta, or by mental influence, (when the brain or the heart is the seat) and being thus prepared by an enlargement of the vessels, or false formations, and depositions, they readily yield to attacks from the elementary m- * The ingesta and the external elements seem to be under the same laws; that is, if they are decomposed and absorbed, they excite healthy actions; and if not, they assume an opposite character, and begin by physical actions to disturb the system, or by more complete actions to destroy it. When digestion is effected, every article seems to lose its own peculiar physical action, and, (however diverse the articles) put on one homogenous character, which acts kindly on the peristaltic motion. Medicines are formed of articles whose physical powers are considerable, and whose components are not easy, if at all, digestible; they, therefore, retain their elective choice of parts to act on. We are much in the dark about the actions of those articles that operate more on parts that they do not approach; nor can we reach to a full knowledge of sympathies, till we are better acquainted with the laws of physiology. This, however, is pretty certain, that the agent will always act on the part to which it has immediate access at the same time it acts on distant parts. Thus canthandes operates on the stomach, or on the skin, whilst it is acting on the urinary organs by sympathy, with more apparent force than on the stomach. t Heat does sometimes aet on the brain, but this has access where elastic fluids are denied, so that it strengthens the position rather than opposes. PHILOSOPHY OF DISEASE. 25 * - fluence, or some small hydraulic change in the fluids, or other accidental cause; violence may also predispose and produce them. Although the limited actions we have termed physical, readily produce disease, and even death, yet it is more clearly shown, in cases of mortifi- cation and putrescence, that they are truly of a chemical nature. It may be objected to mortification that it is merely a rot produced by chemical operations, insolated altogether within the diseased organ, and not referable to any external influence. Let such objectors make an ex- periment with a bunch of grapes put into a jar, without excluding the external influence (by dry saw-dust or sand) and he will soon find the relation existing be- tween the elements without, and those that have originally formed the grapes. In addition to what is said above of such connexions, let us examine into what is going on in the lungs, and we shall find a complete union between the animal economy, and the atmosphere, as well as in the alimentary and external surface: water is freely imbibed on all these surfaces, and caloric decomposed. Variety of Disease.—The diversity of organic paroxysms, as before enumerated, and the effects of the different sources of spurious diseases, as mentioned in page 8, from A to H, are some small evidences of the variety of disease. To this we may add the nu- merous histories of disease, by different authors; but all these put together do not give us a full view of the variety of disease, nor do they let us so fully into the real causes of so endless a diversity. To have a comprehensive idea of this, we must examine into the number of physical agents, or rather their gradations, as also the great variety of parts they act on, according to their elective capacity or influence. Without notic- ing the great variety of common ingesta, or the various operations of the mind, we may take the following agents, viz. heat, moisture, and atmospheric air, the latter in the two capacities of chemical action and motion; (see the tables,) making thus four variable agents. Mr. Keil, an anatomist, to show what the com- 3 26 PHILOSOPHY OF DISEASE. mixture of four different secretions would amount iOf in their various compounds, puts down four vowels thus, e i o u~| and so shews how many changes of posi- i o u e ! tion they afford, which may be altered in o u e i | an immense numberof ways, by changing u e i oj and compounding. Let us then consider that every degree, or at any rate every few degrees, of the thermometer, from zero to blood heat, will, when united to any one or more of the other agencies, make just so many new operative physical compounds, each of which will have an election to some part, in prefer- ence to any other, and so of moisture. We may notice them easily in their more conspicuous operations, when heat and a certain degree of moisture produce summer diseases, and when cold, and another degree of moisture, produce winter diseases; as also in diseases from high winds, or from long calms; and again on their more innocent influence in giving a peculiar physiog- nomy and colour to nations. But we must now examine into the diversity of parts to be operated upon. Ana- tomy shows us a great diversity in the organs of the body; their coats, their vessels, their nerves, their humours, &c. Taking the prima? via?, as a large vessel, we shall see a change at every few inches in its structure, from the oesophagus to the rectum. It has its three coats; its blood vessels, its nerves, all suited to each part. And though anatomy has not shown us these changes in the extreme vessels which form the great glands of the body, there is very little doubt, if they were extended out like a tree, that good glasses would detect such changes in them, at every small dis- tance, as is seen in the prima? via?; and by such means they elaborate their humours, as they pass to the ex- treme point of animalization. When, therefore, we view this endless physical agency, and an equally great diversity and capacity in the animal system to receive these different influences; and also take into consideration the narrow compass of the salutary range, (see the tables) we shall see the cause of end- less disease, and the impossibility of preventing it. PHILOSOPHY OF DISEASE. 27 Therapia.—Cure of Genuine Disease.—The in- dications of cure pointed out by the state of the system, when under a morbid influence or impression, are not only obvious in their great outlines, but also perfectly harmonious with the best modern practice; and it may be laid down as a medical axiom, that whatever theory is now extant, or may hereafter be invented; or what- ever new names imposed; or pathological discoveries made; the main body of the practice cannot be over- turned; for it is the experience of ages.* When a patient is reported to a physician, his imme- diate duty is, if not already done, to remove any of those first causes that have deranged the system; whether they be cold or heat, or wet, or acrimonious ingesta, &c; nor is it sufficient to reduce these agents to a healthy standard, (see the tables) they must be reduced or altered so as to suit the increased debility and sus- ceptibility of the patient. In the next place, (suppos- ing the disease to be of the phlegmonic standard) the arterial sympathy requires a reducing so far as to relieve the organic or local disease from the reaction of circulation; and this reduction generally requires the pulse to be softened down below the standard of health, to meet the necessities of the primary affection, and give it a chance of recession or moderate effusion. This object is to be accomplished by various means: the principal one is bleeding, the next is the removal of all irritants within the prima? via?; for, as before said, when that canal is in a state of passive sympathy, the contents (not being dissolved and changed by digestion, &c, as in health,) excite improper actions; and hence, they are found to excite the arterial sympathy, rather than the peristaltic motion. By discharging such crapula, bile, and foreign or morbid secretions, with pro- per medicines,t a variety of objects are obtained; for the bowels being restored, in part, to their wonted action, the distribution of blood over the system is * The French pathologists have, however, made this vain attempt. See Brosais. t Care is to be taken to use such purgatives as will not excite the 28 PHILOSOPHY OF DISEASE. equalized by it; and by the removal of improper sti- mulants, the arterial sympathy subsides. It is also a well-known fact, that so long as the bowels remain in a state of passive sympathy, and the circulation kept up, that the more delicate and secluded organs are wont to suffer from the unnatural distribution of the circulation; and hence, pains in the head, in the kid- neys, aird lumbar region, and often about the heart. The arterial sympathy may also be reduced by sudori- fics. These medicines, by relaxing the surface, and promoting a discharge of humours, tend greatly to lessen the arterial sympathy; as the circulation is then temporarily distributed, more extensively than in health.* Abstinence is another means of lessening the arte- rial sympathy. The effect of twenty-four hours ab- stinence is readily perceived in the countenance, and we have every reason to believe that the effect is the same on the internal organs; so that the vessels have an opportunity of regaining their elasticity, and by contracting, propel the morbid engorgement. Blistering. By constituting an artificial disease, and set of sympathies (which experience has taught us to be safe and harmless) at a time when the arterial sympathy has been partly reduced, we gain a new distribution of actions, and the arterial sympathy is farther reduced.t The last method of reducing the active arterial sym- arterial sympathy; such as salines and antimonials, with other anti- phlogistic drug3 and medicines, kc. * The effect of a cold bath shows very plainly that the circulation may, by such artificial means, be brought farther out (for a while) on the surface; but as there is no relaxation, there is no sweat; whereas, in an intermittent febrile paroxysm, when the blood is brought out (in the hot stage) a sweat soon ensues; because the surface is so relaxed. The medicines used to procure sweat are strictly accordant with this fict; for when articles relaxing thn vessels, such as nau- seating and saline medicines are mixed with stimulating articles, such as weak ether and volatiles, they make our best sweats, and opium, winch combines both properties, by a very small addition of the nau- seating medicines, is the most sure sudorific. t It may be simply by the extension of the sanative force to the new artificial disease or blistered surface, which on the principle before stated lessens the magazine. PHILOSOPHY OF DISEASE. 29 pathy is to make incisions (when practicable) into the inflamed organ, where the organic paroxysm exists, and thus let out, at a proper time, the congested hu- mours by a shorter way; this is coming at the root of the matter; the whole system then feels an instanta- neous relief and benefit. All the aforementioned means are only applicable to the active sympathies of disease, existing in the arterial system, which required reducing; whereas, the passive sympathies would require an opposite practice. These sympathies, as before said, are found to occupy the prima? via?, the muscles, and the brain. We have already said enough as to the restoration of the actions of the prima? via?, by purgatives, and by pukes, (page 15.) The question is now, must we excite the muscles and the brain? In answer to this it may be replied, that both those organs recover their energies very rapidly when left to mere rest. But could we com- mand an excitant that would act exclusively on the muscular system; it might be used to advantage pro- vided it acted on the main body of those passively affected, with an uniform and moderate force; and was applied at such time as would ensure the command of them. But we know of no such article. The galva- nic action would only excite violent and partial actions without control; we have, therefore, to commit them (the muscles) to rest, and to general tonics when they can he administered. In such diseases as we are now speaking of, mus- cular motion, by its immediate and natural effect on the circulation, would be quite inadmissible; whilst in diseases of a low grade they would exhaust themselves and the rest of the system. On the mind there is full scope for metaphysical stimulants; but they are objec- tionable from their want of steadiness and regulation, so that the physician in most cases tries only to excite the most steady, such as cheerfulness and hope; which, however, have a great effect.* Perhaps, in some case * The most extraordinary cures of wounds, under unusual delays, made on the sailors, at Lake Erie, in the late war, are attributed by 3* I 30 PHILOSOPHY OF DISEASE. hereafter to be mentioned, more might be done in the metaphysical way. When by the united application of the above means, or whatever part of them was ne- cessary, disease is on a full retreat, the intelligent practitioner does not leave his patient to nature, or a vis medicatrix, he well knows that it will sink, in many cases, as far below the standard of health (in action) as it was above it. He, therefore, meets the coming debility on the road, and exhibits his tonics and restoratives in due time, graduated to the time and case; lest, when the disease is cured, and nature makes a dividend of the remains of strength, there be not enough for every part; and the patient dies of asphixia. This is dying by the hands of the doctor!! And further it may be remarked of organic diseases that have ensued on a general morbid state of the solids; (such as in typhus) that the point of time to support the system after depleting, &c, will be rather in the middle than in the end of the first set of symp- toms. It will be perceived that all the foregoing observa- tions relate to a phlemonic grade, and we must now attend to the indications of cure in the lower grades of genuine disease that are attended with a typhus or gangrenous disposition of parts. In some case this state of an organ will take place without any previous general debility of the whole system; but, in other instances it will be preceded by a general bad habit; generated by improper diet, or by the relaxing influ- ence of the soil or climate. In both cases, however, the organic affection institutes the same series of sym- pathies, and give the low tone to the system. But not- withstanding this latter circumstance, (viz. low tone of system,) the arterial sympathy is relatively active, as it is in the higher grades aforementioned. The indications of cure are then to raise the power of the arterial sympathy, by tonics, to a sanative height that it may [as being the first relieved] extend its the surgeon to the exhilaration of the mind. Only one surgeon being able to officiate, the other being sick. PHILOSOPHY OF DISEASE. 31 influence to the more diseased organs; and in the mean time to make topical applications to the diseased organ, if practicable, of the most antiseptic medicines. But in such cases as where the whole system has been previously sound, we are warranted in raising an arti- ficial disease on the sound parts, near to the organic affection, upoii the idea of Dr. Hunter, that the action has been greater than the po-wer; and as this action may thus be scattered without lessening the power of the diseased organ it becomes salutary, and prevents an extension of the local disease. Hence it was practised with great effect in our army on bad wounds, in the late war, by Dr. Wallis. Opiates have been used by some surgeons upon the same principle, viz., dispersing the action. Y/ith respect to the passive sympathies, in this grade, little can be done. The muscular system must depend chiefly on rest and general tonics for its recovery. Tonics, however, might reach them topi- cally.* The passive sympathy of the mind is to be watched, so that it be not farther depressed by the news of untoward circumstances, and it is to be ex- hilarating if possible, with cheerfulness and hope. Cure of Spurious Disease.—This is more complex and varied than the former class, and perhaps more difficult to accomplish in some of its forms. In such cases we experience the want of medicines of a power- ful kind to act exclusively on the organs, where the most violent sympathetic actions are located; unfor- tunately our powerful drugs act so extensively, that they are too apt to do as much mischief as good. In all those cases of spurious disease [letter A] that are identical, but of less degree than those producing genuine disease; very little more than a removal of such causes is necessary to accomplish a cure. Thus when the patient is stunned with cold, or faints from' heat, or is oppressed or choliced with crapula, irritated * The author tried a sponge bath of warm tincture of bark, for this purpose, in the yellow fever, of 1793, at Baltimore; but could not be very certain of its effects from the mortality of the disease. The yellow fever, like small-pox, seems to have established its paroxysms all over the system, but in more mortal parts. A 32 PHILOSOPHY OF DISEASE. by worms or acrimonious drugs: the cure is plainly a removal by proper means, or a neutralization if prac- ticable. But in some cases the sympathetic actions will be so strong that life will be in danger before a removal can be accomplished; or some particular im- portant organ so oppressed, that life would soon be extinguished. In such cases the indications of cure are to depress the active sympathies, or to stun them by opiates, and to excite the depressea sympathies by external, and by internal, stimulants: such as wine cordials, ether, warm bath, sinapisms, blisters, or even by electricity in some cases. It will often happen when irritants of great power are taken in, or long continued, that the disease will change its form and become genuine. Thus, when arsenic is taken, it often leaves an inflammation that continues disease after the arsenic is evacuated; in such cases the remedies for inflammation are to be substituted for the antidotes of arsenic. When either contagious matters or poisonous efflu- via (see letter B) have excited in the system a general sympathy, care must be taken that the arterial action be kept in due bounds, by the means directed in page 20, lest its excess should form an organic affection; so that when the morbific matter has passed off anew source of disease might ensue, making a genuine disease, or a secondary fever; this often happens in small pox, where the organic paroxysm consists of ulcers on the surface, the same event will take place in measles, scarlatina, and some other diseases. When an accumulation of water (letter D) becomes an irritant, the disease may be temporarily relieved by its discharge; but a permanent relief can only be at- tained by altering the state of the parts that secreted it, or otherwise forced it out of its circulation; this is as often a genuine as a spurious affection. If, however, mere relaxation has been the cause, tonics are to be used generally and freely. Obstructions in the large glands (E) that have been formed by former disease, but now have lost all connec- i PHILOSOPHY OF DISEASE. <*d tion with such disease, and still forming no independent disease of themselves,* will often by th Ax irritations excite, or cause new diseases; not only the watery collections above mentioned, but many others: such as constipation, dyspepsia, hysteria, and hypochondriasis. These indurations are not always in a perpetual state of warfare with the system, but like other enemies watch their opportunity, and when the system is weakened, or they a little vexed themselves, spread their irritations over the whole jystem, producing some of the aforementioned diseases. See the chapters on such diseases, for the proper remedies. But when those irritations are more permanent, though less formidable, exciting unpleasant sympathies, such as pains about the side and shoulder: as also giving a turn to a dejected state of mind, they are to be met by such means as will stop a farther increase of the local disorder, and reduce it, or give the obstructed gland more room for self action, and thus cause it to disturb its neighbours the less. This is to be effected by various means, (if the patient be a female) by re- moving all cramps: such as stays, corsets, and lacing; and in both sexes by reducing the volume of the body;t which may be done by fasting, thin diet, and exercise; as also by bathing in hot or cold water, according to the season, or in medicated baths, (acid or alkali) which by removing obstructions on the skin cause a greater perspiration, and emaciate the body. By this reduc- tion, not only the indurated gland is lessened, but there is more room for it. Another means of giving it more room is to use a condensed apperient food that will never generate a flatulency, or disturb the stomach:^ such as rice, mush and milk, rye mush, &c. To the above a mercurial course, with the most gentle preparations of that article, may be used, and the mineral acids also. How these operate is hard to say, but as they are found # See the different-grades of hepatites; it is only the simple indu- rated state of the glands that is here meant. f Fat persons suffer the most in obstructed liver and spleen. \ Veterinary surgeons never allow a short winded horse much hay; they know the effect of distension. 34 PHILOSOPHY OF DISEASE. to soften and stimulate the gums to discharge, we may suppose they perform the same operations on the liver. Gestation, at proper times, is also found, by experi- ment, to improve the circulation in those obstructed glands, and to help them to perform the duties they owe to the animal economy. In more urgent cases the raising of an artificial irritation, near the pained parts, (by blisters) will draw off some of the sympathies of the disease. Purulent humours, CD) from ulcers, by discharging their matter into parts of the system, or by being ab- sorbed, produce an irritation causing lax, hectic fever, &c. The healing of the ulcer, and when that cannot be effected, the removal of the limb or tumor is the only cure. And in all irritations from foreign matter, or unnatural tumors, generated in the system, perma- nent relief depends on a removal of them. Those tremendous diseases that have been induced by splinters, or small solutions of continuity, neglected and unhealed, are not as yet sufficiently under the con- trol of medicine. The most rational plan is to make a new and more extensive wound, so as to destroy the present connexion and sympathies, and by cutting a sufficient plexus of small blood vessels (avoiding sinews and nerves) to increase by stimulants of heat, and local medicines, a sanative process, or suppuration, in the wound; and then, or before, to blunt those extensive active sympathies of the muscles by opiates, exhibited in the most regular, and unremitted manner, day and night, so that their influence may be continual; taking great care, when the least advantage is gained, to push in powerful tonics; as also to remove, regularly, the passive sympathy of the bowels, by stimulants rather than mere evacuants. The exertion of the muscles debilitates the system so fast, that unless the debility is opposed in the first recess of disease, it will be too late; and an equal distribution of remaining energy, in such case, will be found insufficient for life. The menstrual changes, and gestation also, (F) have been considered by some physicians as states of PHILOSOPHY OF DISEASE. 35 disease; but this is going too far. If a luxurious and negligent practice in some females make these states disease, it is not to be imputed to nature; when, how- ever, from neglect or accident these organs fall into irregularities, (i. e. in catamenia) irritations will ensue that reach the whole system, forming a variety of diseases; and when these are removed the system must be put into the best and most natural state before another return, which is to be done by temperance, exercise, bathing, apperients, tonics, and by articles reaching in their elective actions the organs themselves, and by local applications when needed. The same remedies apply to most of the diseases of gestation; but in both cases, when violent symptoms ensue, or are likely to take place, the use of the lancet is indi- cated to equalize the circulation in the full pulse; and opiates with other stimulants in the reduced pulse; for those diseases are according to circumstances, items in both classes.* The diseases resulting from excessive metaphysical operations (H) on the mind, are of both classes. When belonging to the first class, they are to be treated as the rest of the phlegmasia; but when they belonsr to the second class, management to counteract the irrita- tion is the principal thing,—by a removal of the ob- noxious or desponding ideas, and substituting those of an opposite cast;—by travelling, and thus inserting in the mind an entire new set of ideas, much may be done. As to medical means, the regulating the bowels, and in some cases the use of cordials and opiates may have a place, as also blistering the head, and the cold bath to tone up the nerves. The diet must be suited * The essential character of genuine disease consists in a derange- ment, more or less permanent, of the economical vessels that constitute an organ; so that such derangement exists after the cause is removed; and hence it is capable of becoming a cause of general disease. The essential character of spurious general disease consists in the integri- ty of the organ; hence spasms, irritations, accelerations, convulsions, and asphixia, are the effects which are kept up by the presence of some irritant within, or by the common physical powers let in, by relax- ation, to parts from which they were naturally excluded. 36 PHILOSOPHY OF DISEASE. to the state of digestion, and emaciation, or corpulency of the patient. Local Disease may be considered as a subdivision of spurious disease. The simplicity of such diseases, and their empirical cure excludes them from a paper like this: they require mere detail. Mr. Willan and others have, however, given them a pathological ar- rangement that might entitle them to a place; but the author has no right to make a copy. A small solution of continuity may be considered as a local disease.* If it be argued that large and small ought not to be sepa- rated; we must point to the usual effects on the system as, our guide. Degrees in this system make life or death, and these are not an unit. * We may observe that lockjaw is not a symptom of a small wound, jt is a distinct disease that will happen without a wound There is no necessary connexion existing between a small wound and lockjaw; all is accidental and consequential; the wound is sometimes closed, and still lockjaw takes place. There is some difficulty in this disease, (viz. lockjaw,) for it appears in many cases to be without a cause existing either in the system or without. But by remembering what is before said, in page 20, we see that the system in the interior is protected by the coverings; and by the energy of the vital actions; and, of course, when these are reduced, or laid open, the system is exposed, in some parts at least, to the atmospheric influence. When, therefore, a warm climate has debilitated the muscular system to a certain point, the application of something extraordinary, suchasacold bath, or laying a long time on the cold ground, overthrows the remaining strength, and then the system is fairly exposed to atmospheric influence; which, in fact, is only a little more embodied in the cold of the bath or ground: so that there is but one cause, viz. the system laid open by wound, or relaxation, to the atmospheric influence on the nerves and muscles. Irritations have the same effect, in overthrowing the muscular energy, as the bath or the ground. Now if there were any necessary relation between the small wound and lockjaw, so there must be between the bath, or the ground and lockjaw, which is absurd. PHILOSOPHY OF DISEASE. 37 Tables showing that all the elementary and natural powers that produce life, produce disease and death, merely by changing of their degrees, in deficiencies or redundancies. Ji, agents acting from without on the body. 1. HEAT ESTIMATED BY THE THERMOMETER OF FAHRENHEIT. 1 to 25 morbid deficient. 25 to 80 salubrious range. 80 to 100 morbid redundant. Cold of Siberia, or Terra del Fue- go, see Cox's Travels and Cook's Voyages. The natives cannot endure the climate, out doors, for but a few hours at a time. But when in our climate, the thermometer falls to those degrees, it produces death among the old and infirm; diseases among children; and to all ages rheu- matism, pleurisy,scarlatina, influenza, catarrh; as also many local diseases, as chillblains, erysipelas, frost bites, ulcers, and itch. Changes from 25 to 80 are always salubrious when slowly and regularly made; but when they become rapid they are the source of many diseases: when falling off, producing rheuma- tism and catarrhs in particular; and when the reverse, or rising from 25 to 80 too rapidly, causing cholera, fevers, and dysentery. Imitations of such changes are, of course, very injurious; and hence, the colds and consumptions from going from a warm dancing room, into the streets, in wintry nights. All countries, under or near the equinoxial line, are not long endur- able out doors, even by the natives; but to foreigners they bring on cho- lera, dysentery, yellow fever, bilious fever, dropsy; and when these de- grees of heat happen in our temperate zone they produce the same diseases 4 38 PHILOSOPHY OF DISEASE. 2. MOISTURE, ESTIMATED IN IMAGINARY DEGREES, IN A SCALE OF 10O. 1 to 10 deficient. 20 to 60 salubrious range. 80 to 100 morbid redundant. Drought of an African sirocco, or 'Arabian desert; see Bruce, Hamur, Riley,and the African Magazine. The surface inflames and ulcerates; cho- lera, dysentery and fevers prevail, and death almost without disease to the infirm. The seams of the floor open, the earth cracks apart, and the ink dries in the pen so as to preclude writing, animals dry up instead of putrefying. It would, therefore, be impossible for the human frame to endure it long.* Upland country, sandy or porous soil, at least 4 miles from water courses,mill-dams and ponds, with all the advantages of a full and rapid draining of its waters; not subject to the overflowing of its rivers, nor to equinoxial rains, exposed to northerly land breezes, rather than to eastern, or southern, or to sea breezes. Skies filled with black clouds, hu- mid foggy atmosphere, long rains, flats covered with woods, flats with tenaceous soil that are not drainable. The neighbourhood of rivers, ponds, and dams, or large meadows, the rainy season of hot countries: pro- ducing malaria, dysentery, scurvy, catarrh, consumption, rheumatism, palsy, &.C. * It is probable the Egyptians took this hint to dry and embalm, in a slow oven, their mummies; for they would not have wanted the time for mere embalming, (viz. 40 days,) but for drying the body; and by mere long steady heats, they discovered that chickens might be produced in quantities. It was so simple that it was not described. PHILOSOPHY OF DISEASE. 39 3. ATMOSPHERIC AIR ESTIMATED BY ITS GRAVITATION, QUALITY, AND MOTION. c o a n 6 Morbid deficient. Salubrious range. Morbid excessive. Too much rarified as in high mountains, the Alps, Andes, and He-malaya, producing asthma, homoply-sis, fulness in the head, and vertigo to travellers; and in mountainous countries, as the Grisons and Swiss country, producing goiture among the inhabitants. Hills and table lands from 50 to 500 feet above the level of the sea. Mines and all deep subterraneous abodes, which, though they become endurable to sound constitutions, les-sen the period of life. >> Morbid. Salubrious. Incarcerated air of cells, close buildings, ships' holds, or effete from the respiration of numerous animals, or impregnated with water that has transuded plants, or any how become loaded with animal, vegetable, or mineral effluvia, or with contageous matter: producing cholera, typhus fever, fluxes, influenza, consumption, 8tc. Pure air of temperate dry countries, passing over woods, lawns, cultivated fields, gardens, and water falls; among hills and dales, wafted by breezes issuing from clouds, " the beauteous semblance of a flock of sheep." c o o Morbid deficient. Salubrious. Morbid, violent. West India calms, long smooth seas in warm latitudes, producing languor, fever, diarrhea, mental in-sensibility and derangement; see the accounts by sea captains. Pure western and northern breezes, of moderate force, with due interrup-tions, proceeding from a few white clouds. Storms in the north seas, Cape of Good Hope, West Indies, our own equinoxes, and in great deserts, pro-ducing sore eyes, ear ache, tooth ache, sor.e throat, rheumatism, and palsy. 40 PHILOSOPHY OF DISEASE. B.—AGENTS ACTING FROM WITHIN, INJURIOUSLY OR SALUBRIOUSLY, ACCORDING TO DEGREE OF QUANTITY AND QUALITY. Deficient, Morbid. Salubrious. Redundant, Morbid. Using articles deficient in nourish- ment and quantity, as in sieges, long passages at sea, or travelling in de- serts; producing emaciation, diarrhea, dysentery, scurvy, typhus, fainting and death. A due mixture and quantity of animal and vegetable food suited to the age, constitution, and exercise, of the person, once or twice a day at most, with light beverage of coffee, or tea, or milk, at night. Mr. Wes- ley says, old men require but one- third the food of young persons. But in our country one-half to three-fifths is nearer the point; those who dis- regard this (if hearty,) may be sure of apoplexy, angina,fistula, gout, h.c. Gormandizing, eating meat three and four times a day, with sauces aud wines, without exercise. The cer- tain end of such is apoplexy, angina, fistula, cancer, ulcerated legs, dropsy of the chest, gout, 8tc. Morbid. & Bad diet, such as meat too poor, or sickly when alive, or fed on improper food: as hogs and poultry on animal's offalls, meat killed too long, stale fish, rotten and stale vegetables, sprung wheat, ergotted rye, sour bread, unripe fruit, &tc, mixed per- haps with vile rum, or bad water. An innumerable host of diseases are the consequence: eruptions,ulcers,worms putrid fever, fluxes, Stc. Salubrious. Corn fed hogs, fat beef and mutton, just from the stacks and pasture; fat veal, at least six weeks old, just from the cow; fat game and fish, in season, recently taken and well pre- served; with a proper mixture of bread and spring water, as also a full por- tion of vegetables just from the gar- den in summer, or well preserved in winter. PHILOSOPHY OF DISEASE. 41 2nd. MENTAL INGESTA, ACTING FROM QUANTITY OR QUALITY. a a 9 Or Morbid deficient. Salubrious range. Morbid excessive. Deficient study, apathy, thought-lessness; causing idleness, nakedness, and its diseases, drunkenness, fatuity, madness, suicide. Study, suited to the age, capacity, and taste, that will give activity to the mind without injuring the body by its quantity. Excessive and protracted study. The study of difficult subjects, espe-cially when continued into the mid-night watches; more especially when riot interrupted with exercise and re-creation of mind; producing dyspep-sia, nervous diseases, piles, fee. S Salubrious. Morbid. Study of the bible, ethics, science, belles lettres, logic, arts, inventions, fcc. ' Studying wicked books and prac-tices, superstition,deism, and atheism, as also the study of nonsense: such as ancient astrology and modern phre-nology; leading to infidelity, immo-rality, derangement, suicide, and per-haps murder. 4* 42 PHILOSOPHY OF DISEASE. 3r(J_ MUSCULAR ACTION. Morbid deficient. Confinement, inactivity; by these the system loses the assistance of the muscles, to carry on the circulation; and the consequence is the circulation languishes, the feet and stomach get cold, indigestion ensues, and when digestion does take place, the disease is only transferred to the extremities, in gout, or to the heart, in obstruc-tions. Females suffer much from in-activity. The doctrine of making up the force by an increase of food and stimulants is the doctrine of death. Salutary. All exercises of a moderate kind, during the day, from an early hour: such as working, walking, riding, swimming, See., interpersed with pe-riods of rest and study every few hours; producing a light circulation, a gentle perspiration, a good appetite, cheerful spirits, and sound sleep. Morbid excessive. Excessive or too long continued exercise, producing fatigue, which lays the foundation of fevers, cold, and consumption; excessive exercise, also produces emaciation.loss of appe-tite and low spirits, as in slavery; and in some cases ruptures of tne vessels. N. B. The above tables might have been extended to all the senses; but these examples will be sufficient for the work. {£f- There are a few sections in the above tables that relate to qualities that do not depend on mere degrees; they have been inserted to make the tables a more perfect exhibit of the causes of disease; and they will, moreover, show the great preponderance of the latter, (viz. degrees:) perhaps a more minute analysis of those under letter A, 3, may show that even those qualities are dependant on degrees of the components of the common elements. We readily notice degrees of heat and moisture; and attribute many diseases to them; and there is no good reason why we may not suspect degrees of oxygen, carbon, and even azote, distinct from a proper standard to be the cause of many diseases. And as to infectious matter generated in the system, there can be no doubt that the primary cases were produced by im- proper actions, produced in the system by unsuitable combinations of some of the agents enumerated in the tables. GENERAL MANAGEMENT. DIRECTIONS. A few observations, on this most important objeet, will be well worth a place in a book of the present character; for many dreadful diseases might be avoided, and others rendered curable, by proper management. We shall divide the subject into three stages:— 1st. In the early part; as soon as a person feels him- self indisposed, he should cease from all exercise, and if the weather is cool betake himself to the fireside, and if warm retire from the sunshine and winds to the house; and if the symptoms are threatening the bed will be his best place. He ought to eat nothing solid, but merely take a little tea, or thin broth. When he is ignorant of what disease is fixing on him, he should not wait but get the advice of a physician; this, in some diseases, determines life or death, especially in natural small-pox. 2nd. Wlien disease is established. A prudent man, though he may believe himself a judge of what he may want, will consider that his faculties are soon weakened by disease, and that he should, therefore, in good time give his friends directions to act for him. The directions must extend to restrictions on company, the suppressing of noise, the cleanliness of the room and clothes, the temperature of the bed clothes and of the room, the diet, drinks, and medicine, as also the nurse; giving proper directions on each head. Even the admission of light and air should be committed to y competent judges; a room can scarcely be too cool in summer, nor too well aired; but in winter it may easily be too hot for inflammatory disorders. What is pleasant to well people is sufficient for the sick; but in diseases of the lungs, or cholic, especially in old people, more warmth will be necessary than in most other cases. 44 GENERAL MANAGEMENT. It would be well for him also to make a will, if not done before; and above all to attend to the things that make for his eternal peace. A mattrass in summer is all important in febrile cases, and the poor may have one of the typha, or cats-tail of the marshes, that will rival, in comfort, the bed of a prince. Rooms with sick should be purified by chloride of lime; and the bed in summer placed in the middle of the floor. If the floors cannot be scoured they may be rubbed with a stone and some sand, as is done in the hospital at Fortress Munroe. One of the most insiduous practices with sick people is that of talking themselves sick again, when they are on the recovery, by giving their friends an account of their disease. In diseases of the lungs, or throat, it is a frequent source of relapse. This should be stopped; and it would be a good practice in this, as in some other countries, to have signals at the door: such as a quill put through the keyhole, or a slate hung outside to receive the bulletin from within, and the compliments from without. 3rd. In the advanced stage of disease. As disease advances care must be taken to support the patient by having drinks of a nourishing kind: such as barley water, gruels, panada, rice water, milk and water; and in low cases wine-whey, milk-toddy, and broth; for want of attention to such things, in due time, the patient may sink when he has little or no disease.— When a patient has lost much strength by a continu- ance of disease, or by a sudden haemorrhage, he should not be suffered to rise from his bed, for any purpose, lest a fatal fainting ensue; bed-pans and urinals should be ready. The author saw two fatal cases in one family, in less than six months, from such neglect; and has a knowledge of some more that died from that source alone, when the disease was vanquished. There are many diseases that will require medicine to be given by night: such as quotidians that come on at nine, or ten, in the morning. A vigilant nurse is all important in such cases; as also where opium is given at stated hours: the mere failure of a pill, or two, GENERAL MANAGEMENT. 45 will derange the whole scheme. Two attendants, at night, are needful in all important cases. In dressing of blisters, and in shifting of linen, and in sweats, the patient should not be uncovered but for a moment; all things should be ready, and applied in an instant. In the more early parts of disease, where patients have to rise often, (as in dysentery) they should have socks, drawers, and gowns, and they will be very use- ful in most cases throughout the disease. After re- covery, every practice, eating, walking out, work, &c, should be recommenced by degrees; and the dress suited to the weak state of the patient. N. B. Let no person venture to put coals in a room, without a chimney, to warm a patient. It is frequently done, under a false impression that nothing but char- coal is mischievous; vertigo, nausea, apoplexy, and fainting to death, have been the result. In a tight small room it will certainly produce death, in six or eight hours; and many a poor patient has died from such cause, unknown to his friends, and unsuspected. FEVERS. CHAPTER I. OF FEVERS IN GENERAL. , Fevers admit of a twofold distinction: one as respects their duration, the other as respects the state of the system; their duration is eiiher'intermittent, remittent, or continued; their condition is either inflammatory, bilious, or typhus. Intermittents are called quotidian, when the chill, fever, and sweat, (called afebrile paroxysm) comes on every day. Tertian, when the febrile paroxysm comes on every other day, leaving an entire well day between; and quartan, when there are two well days between each paroxysm. There are also some compound forms of tertian, viz. when there are two paroxysms in one day, and only one on the ensuing day; and again, when there is a paroxysm every day, but are only alike on alternate days as to their time of accession: thus, Monday, a paroxysm at 11 o'clock; Tuesday, at 4 o'clock; Wed- nesday, at 11 o'clock; and Thursday at 4 o'clock. The former of these compounds is called a double tertian, and this last might be termed a tertio-quotidian-various; other names, however, have been given to these com- pounds: such as semi-tertian, and duplicate-tertian.* Remittent Fevers abate once in 24 hours, and that abatement is of various duration, from half an hour to 12 hours. They are more apt to have a chill at the offset than afterwards; as also to have a full sweat only at their final termination, than at any intermediate period. The common returns are marked with coldness, or some pain and restlessness; in many instances hardly perceptible. In some epidemic cases they are very * They generally become simple before they go off. OF FEVERS IN GENERAL. 47 mortal fevers; whilst in others they are as slight as in- termittents. They are, however, in solitary or sporadic cases, a dangerous fever, frequently ending in death; which generally happens from 5 to 14 days after the attack. Continued Fevers have little or no variation in the 24 hours; they are worse at night, having rather ac- cessions than remissions. Their duration is from one to three weeks. They frequently come on with a chill, and are always, when of any force, dangerous fevers. Inflammatory Fevers show no material departure from the natural state (as respects the nerves and se- cretions) till very late and near death; nor in the bile at any time. They have in most cases a strong full pulse; but are sometimes found very pertinaceous, though the pulse is under no very great excitement. They are commonly attended with pains in the head, back, and limbs; sometimes in the breast. The tongue is white at first, but as the disease advances will often change and become covered with a brownish sordes. The bowels are disposed to inactivity; but the stomach is no ways disordered, excepting by mere loss of ap- petite. Inflammatory fevers are far more common in the spring, and late fall months; and are found in high dry situations, far from water courses. The causes are as follows: intemperance, great exposure to rains, winds, or both at the same time. Heat and cold in quick succession, fatigue and all irregularities. The young and the vigorous are the subjects of this fever. They end in perspiration, effusions, haemorrhages, and suppurations discharged by the bowels, or from the surfaces of the bowels; in long continued cases exter- nal suppuration often takes place. They afflict those of the middle and northern states. Bilious Fevers attack almost wholly in summer and fall, after the system has been relaxed by the heat of the seasons. The whole prima? viae is much dis- ordered, and bile is often discharged spontaneously; but always on the use of emetics or purgatives. The 48 OF FEVERS IN GENERAL. skin, eyes, tongue, and urine, are often coloured with it. The liver, spleen, and stomach, are sometimes decidedly inflamed, and perhaps never escape entirely. The liver and spleen are often enlarged. The worst cases end in mortifications of the parts locally affected. The tongue is white in intermittents; but more often yellow or brown in remittents, with a fur or sordes.— The pulse is sometimes full in remittents, but not al- ways so; the strength and rapidity of it rises from merely more than natural, up to the highest pitch it is capable of performing; according to the degrees and violence of the disorder. In intermittents the pulse is always full and strong during the greater part of the hot stage; but quick and generally small in the chill, owing to the contraction of it. The head, and loins, and abdomen, are often affected in remittents; and when the two latter are considerable, they are considered as unfavourable symptoms; portending a severe fever. Intermittent and remittent fevers appear dependent on the same general causes. In solitary remittents, the patient is (besides the climate and place) indebted to some irregularity for his fever; such as would come near to give him fever at any time or place. But in an epidemic state of the air a very trifling cause will excite this fever. Intermittent fevers are so much indebted to predis- position, from place and season, that they will ensue often without an apparent exciting cause, and in general require nothing more than exposure to a rain shower, a cool blast of air, a little fatigue, or indigestion, to bring them on. Bilious fevers prevail in low and high lands, when near to streams, ponds, mill-dams, &c; they prevail also in shallow soils, where there is a substratum of rock, such as at Malta and Gibraltar, where the heat of the soil forces the water back, and when the air is cool the humidity is condensed and thrown down in fogs, or invisible vapours; thus macerating the surface, ob- structing the perspiration, and affecting the process of the 'ungs. OF FEVERS IN GENERAL. 49 In long dry seasons, when the shores of running rivers are extensively laid bare, we may expect malaria to reach beyond their accustomed range; and thus meeting with a people of inflammatory habits, unused to the annual visits of such fevers; and treated by physicians unexperienced, (in malaria) it becomes a mortal scourge. This has happened repeatedly, the last half century, on the Potomac and Susquehanna. Typhus Fevers are most common in the fall and spring, though follow into winter when the frosts are light and late; especially when the summer has been sickly. They observe in the country certain geo- graphical lines, just as intermittents do. Their location is the higher flats where water is retained; but from the coolness of the ground produces no fogs, only heavy dews at night; such a district is equally unsuit- able to produce the bilious or the pure inflammatory fever. In the great ascent from Baltimore towards the mountains, this fever is common at the distance of one or two miles from the water courses; and all along the water courses bilious fevers are common, whilst the elevated slopes with a porous soil have neither; (when mill-dams are at a distance,) but have instead pure in- .flammatory affections. In those elevated flats above mentioned, among poor people, or recent settlers from other soils, we may find typhus as long as the world stands; though generally of the milder cast. Typhus fevers are also prevalent in large towns, on rivers or bays. Their pavements and walls prevent malaria, except when there is a long course of winds from the waters, at the proper season; and though the citizens live so as to produce inflam- matory disease, yet they add thereto the filth, &c, that is one half the cause of typhus; an impression is therefore made producing inflammations of an effusive or relaxed kind, (instead of suppurative phlegmasia,) with a fever of the like grade, which is typhus— |0° See the chapter on typhus. The grade of typhus fevers will be fixed by the magnitude of the general and personal causes. 5 50 OF FEVERS IN GENERAL. The great sweating fever of Europe, in 1597, and some other years, was occasioned by extraordinary seasons. Mezeray, the French historian says, "that for five years the earth was abortive," from the great draught; of course an immense quantity of animal and vegetable food was imperfect. Poverty made filth and wretchedness; and the extraordinary seasons had their full influence immediately on the human person. Perhaps the worst case that ever occurred, in this country, happened to General Wilkinson's army; badly located on the Mississippi, fed with spoiled meat and damaged flour; the soldiers almost died on their feet. They could separate the flesh from their cheeks, or pull out their tongues before death. Fevers are sometimes obscure and continue a long time without showing their organic affections, or ever their usual accompaniments. Every effort should be made to find out the primary or local affection; for this purpose the patient should be examined in different positions, by pressure on different parts of the abdomen, by long inspirations; a tenderness will often be found by such means, that will give a clue to all the symp- toms. Affections of the throat are sometimes an index to disease in the lungs. In many cases, where there is no considerable organic derangement, there will be some morbific matter engendered in the system; to keep up a spurious fever till the matter is thrown out on the surface, or off by the bowels. In other cases of obscurity it will be found that the disease, by mismanagement or neglect, has forsaken its usual type, and become confused in its symptoms. In all such cases diligent enquiry must be made as to the first symptoms of the disease; which will, in general, be found the leading point to direct the physician: for what the disease was at first, it is apt to be under all its obscurity. Intermittents will sometimes become a mere train of nervous symptoms, with sinkings at the time there ought to be a chill. In vain may the phy- sician prescribe for those nervous affections and mock tokens. Rheumatism will sometimes change its type; OF FEVERS IN GENERAL. 51 and fix on the heart, changing pain for oppression, and a slow pulse for a more active one. But in such cases the pulse is no guide, and it must be treated as rheu- matism. A withholding the lancet in affections of the heart, the brain, or the lungs, merely because the pulse is not active is a fatal error in practice. The common circumstances (called in this work) personal causes because they are mostly at the will of the patient, which predispose to fevers, or after predis- position from climate, excite fevers, are as follows: " Debility induced by fatigue, or violent exertions; long fasting; want of natural rest; severe evacuations; pre- ceding disease; errors in diet and drinking; sensuality; too close attention to business; excess of attention to reading; grief; fear; anxiety; sudden change; inadequate clothing or covering; exposure to currents of air; par- tial exposure; sudden changing from heat to cold, and from cold to heat." This list of causes is taken from Dr. Thompson; though applied by him to fever and cold, will be equally applicable to most diseases; and if putrid exhalations, vegetable decomposition, and filth, are added, we shall have nearly the sum total of personal causes. These with the undue and irre- gular impressions received from climate, season, situa- tion, and soil, will embrace nearly the whole range of causes that produce fevers. Prognosis.—It is of no small importance to have a just idea of a patient's situation as to danger, both in fevers and other diseases, and much more agreeable to anticipate his recovery: " Great anxiety, loss of strength, intense heat, stupor, delirium, irregularity in the pulse, twitchings of the fingers and hands, picking at the bed clothes, starting of the tendons, hiccups, coldness of the extremities, involuntary discharges from the bowels and bladder, are fatal symptoms.— Whereas, on the contrary, when the senses remajn clear and distinct, the febrile heat abates, the skin becomes soft and moist; the pulse abates and be- comes regular, and the urine deposites flakes, a favour- able issue maybe speedily expected."—Dr. Thompson 52 OF FEVERS IX GENERAL. It has been observed by Dr. Fordyce, that when a febrile disease does not affect the whole system, but rather acts partially, leaving some organs unaffected or unimpaired, that such is a bad character in disease. It is a vulgar opinion that a good appetite in fevers is a bad and fatal symptom. The author has seen such instances in fatal cases of measles and peripneumonia notha, but at the same time the other symptoms were of that character to give a more sure indication of a fatal issue; so that nothing of great importance can be attached to such a solitary circumstance. For a continued or a remittent fever to change to an intermittent is favourable; for a remittent or an inter- mittent to change to a continued fever is unfavourable, especially when induced by cold or fatigue. For an intermittent to have a violent paroxysm whilst taking suitable remedies is a pretty certain evidence that it will not return again. Physicians have, for centuries past, tried to make a radical distinction between fevers and other diseases; particularly between the phlegmasia, attended with local and febrile disease: such as pleurisy, angina, gastritis. But it is plain that no fundamental distinction can be made between them; for both, i. e. phlegmasia and fever, depend on acute organic or structural changes (called organic paroxysms in the philosophy) which excite arterial and other sympathies over the whole system. How then can any radical distinctive definition be given? But fevers have some unessential marks of distinction, which are the following: the organic pa- roxysm is obscure, and the sympathies are manifest; whereas, in the aforementioned phlegmasia, viz. pleu- risy, quin.sy, inflamed stomach; the local affection that gave rise to the sympathies is plain, fixed and determi- nate. The inflammatory local affections that give rise to fever are perhaps, of a more moderate grade though they may be more extended, and occupy several organs. The primae viae scarcely ever escapes inflammation of that grade in fever, or perhaps the larger glands connect- ed to it. Notwithstanding their more moderate grade, so OF FEVERS IN GENERAL. 53 as to escape acute pain, yet those organic paroxysms do not always recede or simply exude, they frequently end in haemorrhage, suppuration, and mortification; and, however obscure during the fever, if it is mortal, the knife finds them out on dissection. The author has not put puerperal fever under this head, because it more properly belongs to phlegmasia, and is sexual; and he is doubtful if hectic should have a place with fevers. 5* CHAPTER II. INTERMITTENT FEVER, (commonly) FEVER AND AGUE. Causes.—The continued relaxing heat of summer, especially when accompanied with moisture; stagnant and fceculent water,* stagnant air of large flats, where the sun has full action, but the winds are excluded by the woods. Mill-dams and river sides. These causes never fail to prepare the inhabitants for intermittents in due season; so that the slightest error will bring on a chill; even the eating of an apple, in the morning, or any indigestible matter that would produce a temporary dyspepsia. Fatigue and all irregularities will do the same; but the surest, and never failing personal cause is getting wet, or suffering any exposure that would bring on a slight cold. Although far more common in the fall, it is often found in the spring; and when neg- lected extends into the winter; and then, often falling into a quartan type. The spring intermittents have frequently a cough with them, and are most frequently quotidians. The island of Malta, though a very shal- low soil, laying on a substratum of rock, only two feet beneath in many places, is subject to intermittents. Parts of the Roman territory: the islands of Minorca, and Majorca, and Walcheren, are famous for intermit- tents and remittents. The mountains of Ceylon pro- duce malaria as well as the plains. But from Bishop Heber's account, there is no place on the earth equal to the Tanai: a district of ten miles, at the foot of the Hemalaya mountains. He informs us, from the autho- * Water will become effoete or feculent by transuding plants and is then unfit for life. Hale found it to putrify quickly, and Wildenou discovered that it destroyed certain plants that absorbed it from the adjacent plant. From the tips of marsh grasses where it exudes most freely, the air (which always imbibes more or less moisture) will load itself, and then be unfit for respiration and vital purposes. Is this the true miasmata? viz. stagnant air loaded with effoete water that has just escaped from vegetable organs; or is it the gasses of rotten vege- tables? intermittent fever, &c. 55 rity of the natives, that at the proper season for malaria, every beast and bird forsakes that place. It would, ;l therefore, appear (as those animals are not known to ,■; be subject to this disease,) that their respiration must ?* be affected by the state of the air. Symptoms.—A languor with yawning and stretching, coldness, sick stomach, rigors and tremors, usually attend the commencement. The cold, with shivering, continues a considerable time; from one to three hours, when it begins to give way, first to flushes, and then to a burning fever, with a full pulse; pain of the head and joints, and frequently delirium attend the higher state of fever; eruptions of the rash kind come out in many cases. After the fever has continued for one or more hours it gives way gradually to a sweat, which becomes profuse, and this is succeeded by an intermis- sion, proportioned to the type. See the chapter on fevers. However, it frequently happens that pains, or mere coldness, substitutes the ague, and the fever is not so violent. Quotidians come on in the morning, tertians generally about noon, quartans in the afternoon, and these last are mostly confined to elderly patients, or to those who have had intermittents a long time; for each of them will occasionally change its form. Management.—In the intervals the patient should be very careful to avoid all dampness and exposure to either sun, wind, or cold; he should be attentive to his clothing, and if late in the season, put on flannel next his skin. His drinks should be wine and water, or sound porter and water; his food should be well chosen, srj as not to endanger bringing on indigestion: such as fisri without butter, game, beefsteaks, in moderate quantity! but those heavy articles must never be taken when the time of a chill is near; milk and mush would be prefer- able to tea and coffee; all pies, and sweet things, must be avoided; riding, in pleasant weather, in a carriage, will be beneficial; avoiding the middle of the day, as well as the morning and evening. If the weather is the least cool a fire is indispensible in the sitting and sleep- ing room. Some hours before a return is expected 56 intermittent fever, &c. the patient should be in bed, drinking some warm sage or camomile tea; and if the ague has returned often, or resisted the usual remedies, he should seldom leave his bed the whole period. Many experienced physi- cians, on the Eastern Shore of Maryland, make this indispensable; and it is a very judicious practice, i. e. to lay up as we do for other diseases, and not to turn out during the intermission. Cure.—One of the plainest and most common prac- tices, in the middle states, (and which seldom fails) where the constitution is pretty sound, is to give a dose of about fifteen grains of jalap, and six or eight of calomel, as soon as the disease attacks, (waiting till the fever is on,) and on the morning of the well day to take half a grain of tartar emetic, every ten or fifteen minutes, in a spoonful of water, till it operates freely; three grains will in general be sufficient. It should be completely dissolved in boiling water. The bile being thus freely evacuated both ways; the patient, if it is a quotidian, will have to abide the second chill as the time is too short for the bark to be efficacious. He should remain in bed, keep his feet warm with a brick, drink warm sage or camomile tea; and when the chill has nearly ended, and the fever commenced, he may take two teaspoonfuls of paregoric, with twenty or thirty drops of antimonial wine; which, with plenty of tea, will give him a full sweat, and perhaps lessen his fever beforehand. As soon as the sweat is off, the bark, in substance, must be used every hour, if either quotidian or tertian; and if the bark is of good quality it will seldom fail to cure the first trial. In quotidians, that come on in the forenoon, it will be necessary to take three or four doses of bark at night, for there is not time in the day. Eight doses of bark is the least that can be depended on. In quartans it is not necessary to take more than eight doses, in the interval, which should be all taken on the second well day. On the first well day, Virginia snake root tea, or portions of wine-whey, or old London porter, will be preferable, as there will be less danger of overloading the stomach. intermittent fever, &c. 57 Many persons object to tarter: to such fifteen or twenty grains of ipecacuana may be given; but it will be more efficacious if half a grain of tarter, or instead of tarter four grains of blue vitriol be added to the ipecacuana; the whole to be well dissolved, and drawn in a wine glass full of boiling water, and given at one dose. There are, again, persons who would gladly avoid puking; such persons may take ten grains of calomel and ten of jalap on the well day; and at the commence- ment of the hot stage take two grains of opium in the form of a Dover's powder, and after the sweat begin with the bark. In case bark is not to be had, or is not effica- cious, Fowler's solution of arsenic should be used; and if properly administered is as safe as other medi- cines. All the evil consequences and danger arises from giving it too concentrated, or at an improper time. Five drops of this solution, (which contains the sixth part of a quarter of a grain of arsenic) given in one table-spoonful of mint water every hour, for six times, during a perfect freedom from fever; and ap- proaching in the last dose to within one or two hours of the time of a chill, will seldom fail, and never do harm. There are cases, however, where neither simple bark nor arsenic will be effectual; and before proceeding farther, various preparations of bark should be tried. The decoction properly made will succeed, where there is a verge towards a continued fever, when the substance will not; and there may be some states of the stomach that the bark in substance is not appli- cable to, where decoctions will answer. But let no one think that such stuff as is generally made for a decoction will be effectual.* Acids sometimes aid the action of bark, either lemon juice or cream of tarter; and in quartans, spices or snake root may be advantageously added to the bark. Hot water, milk, wine, and spirit and water are used to mix the bark with; a choice may be made of either, according to the state of the patient. In a cold sluggish quartan the spiritu ous mixtures are best; and in quotidian with any de- * See the decoction of bark in the apothecarium. 58 intermittent fever, &c. gree of cough, the water or milk are more proper. To those who have no faith in decoctions, the author re- commends, in difficult cases, where things are looking badly, and no time to spare, to have the bark levigated; in a case of life and death it should never be neglected. There are cases of intermittents that resist the com- mon remedies from a peculiar sluggishness of the bowels. In such cases it will be necessary to give medicines to remove that state which will not reduce the strength of the bowels. The preparations of aloes and aromatics are extremely well adapted to this pur- pose. See the apothecarium. These purgatives should be always taken at bed time, so as not to interfere with the bark. When intermittents have continued some time neglected, or have been badly managed, or by the patient turning out too much; affections and obstructions of the liver and spleen become so considerable that all the above means are inadequate to a cure. In such eases the patient should take one and a half grains of calomel with a quarter of a grain of opium, morning and night, till he has taken eight or ten grains of calomel; or if the blue pill (which is less offensive to the stomach) be preferred let him take, morning and evening, four grains of that, for six or eight days: in either case, stopping before any symptom of sore throat, or affec- tions of the teeth and gums, appear. And when the mercurializing is finished, a blister should be laid on the right side, over the region of the liver, on the well day so as to draw and be dressed before the expected chill; and when the fever (subsequent to the ague) takes place, Dr. Lind's plan of taking two grains of opium with three of ipecacuana, in the hot stage, may be used as soon as the sweating is over. The strong de- coction of bark with a portion of wine, may then be used. The above preparations of mercury, especially the blue pill, will be often necessary after intermittents have gone off; when they have left an enlarged spleen: in such cases those pills may be taken more slowly, one of a night, or one grain of calomel and one of sulphur of antimony, may be used for a fortnight. In all cases, intermittent fever, &c. 59 but especially obstinate cases of intermittents, the bark must not be suddenly dropped, but used for some weeks in moderate quantity; for if the disease is not thoroughly removed, it is apt to debilitate the patient all the winter, and return with increased danger the next fall. Spring intermittents can seldom be cured, where there is a cough, without a blister on the breast; and there are many cases (full habits and drinkers) where a little blood might be taken away with great advantage. In more trifling coughs, the author has been inform ed by a physician of large practice, on the Patapsco, where their fishing habits expose them to coughs, and to intermittents, that sassafras tea drank freely has been a successful remedy. The bark may, therefore, be taken with this pleasant tea. It must be remem bered that in those spring quotidians, or even tertians, that we are near the borders of more inflammatory diseases; and that our remedies should be adapted: none of the heating articles are to be used, but free puking and purging, and some of the antimonial sweat mg powders used instead of the opiates. In very old, or hypochondriac patients, the chilly fit will often sink them very low, so as to alarm. In such cases a dose of tincture of assafcetida, or a moderate dose of diluted sether, should be given at the first perception of symp- toms of return: such as a coldness at the end of the nose, or a gaping. The springs of Berkley or Sara- toga, and living four miles from the water courses, may be found necessary to restore some constitutions. All those remedies have been directed for adults, but it is no uncommon thing to meet with intermittents in children who are as obstinate as the disease, and refuse to take a sufficiency of medicine. The quinine* seems well adapted to their cases; essential oils will sometimes answer, especially the oil of wormseed (chenopodium) which was successfully prescribed, in old times, in * One grain of quinine may be rubbed up with a teaspoonful of currant jelly, or a little mucilage, and given every hour during an intermission, for a patient of six or ten years of age. GO INTERMITTENT FEVER, &C. the seed for intermittents. It is to be used in the inter- mission; two drops every two or three hours. Opiates are also to be tried, and bark in decoctions may be in- jected into the bowels. Bark sewed up in flannels and applied to the skin has "also been prescribed; but, perhaps, blisters to the wrists;* and opiates after a puke is the most efficacious. Wine-whey will seldom be refused. They should be kept to the house till well, and then rode out in a carriage, or carried out till hearty. |0° Nuts, cakes, and fruit, will be sure to bring back the disease. Prevention is "better than cure in all cases.—Bark taken morning and evening, with attention to the bowels, has been found fully adequate to save from intermittents, provided the persons do not get wet; and other remedies have also been successful, especially the willow bitters of the apothecarium. * Speranza recommends quinine to be applied to the blistered parts; for a child, two or three grains may be mixed with some white of egg, and laid on the naked surface at the beginning of the intermission; this may be well in those of one or two years of age. Dr. Jackson recommends the web of the black spiders, more fre- quently found in cellars, as an excellent remedy after purging; five or ten grains may be used; and as some poor fellow may have a cljill among the fallen trees of the forest, he may get a handy remedy. f REMITTENT OR BILIOUS FEVER. Cause.—There does not appear to be a very wide difference in the general causes of this fever and inter- mittents. The same climate, the same season, the same places, or particular location, give birth to both. But in most cases of sporadic or solitary bilious fever, the patient has added exciting causes sufficient to bring on any fever: such as great fatigue from riding or walking under a burning sun; a debauch at a fish feast; and all kind of excesses and irregularities; to which may be added sudden changes of the atmosphere. These will never fail to bring on bilious fevers, especially in a hot sultry and damp season, and on subjects that have a good deal of vigour still left by the summer heats; whereas intermittents seem to require very trifl- ing causes; mere changes from warm to cold, or from dry to wet, or a little indigestion, and to attack those who are much debilitated by the continuance of the summer heat. But in many of the epidemic bilious remittents, the miasmata* from the river shores, has penetrated beyond its accustomed bounds, and having thus reached a popu- lation not regularly subject to bilious fevers; a very slight error will bring on or excite the fever in such cases, which are, nevertheless, very mortal in many in- stances: partly owing to the inflammatory habits of such people, and partly owing to the inexperience of their physicians in the treatment of such fever. And, indeed, there are many instances where no ordinary number of physicians could do justice to a country practice from the extent of the fever. However, they are not always so mortal. It is not only the river shores of flat countries that are subject to bilious fever; frequent- * That is the vapour, visible or invisible, floating with all its con- tents, that the moisture is capable of absorbing and carrying with it from living or putrid vegetables, or both. 6 62 REMITTENT OR BILIOUS FEVER. ly the running rivers when brought low, by long draughts, (and thus exposing their mud and aquatic vegetables to die and rot,) produce this fever. The rotting trees in a new and rich country, with their plashes of water, are supposed to have a similar effect. And in all the well watered countries, high or low, more especially to the south, alternate heats and rains without succeeding brisk winds, to drive off, or absorb the vapours, will induce bilious fever through the summer and fall of the year. All hot countries, either islands or continents, are subject to different grades of this fever. But Batavia is probably the worst upon earth; there if a man survive the fever he becomes dropsical from an enormous enlargement of the liver and spleen; and draws out a life of misery worthy of commiseration. Symptoms.—The patient is sometimes taken with a perfect chill, or deep long continued coldness; but at others, the fever commences with great lassitude, yawn- ing, stretching, and unwillingness to move,—at night, a fever with pains in the head, back, joints, or abdomen, prevent his rest. The head is often so affected as to cause delirium. This state is soon attended with a vomiting of bile, which continues to come up whenever the patient takes a drink to assuage his excessive thirst. After two or three days and nights in this way the fever may be perceived to abate in the morning; some- times with perceptible moisture, but after a few hours, and at farthest towards evening, it increases. In some bad cases the head has been so seriously attacked in the very offset, as to cause with the vomiting a fainting fit, or has been taken for apoplexy. In such cases the tongue is yellow or brown, the pulse contracted, the eyes and skin coloured with bile, and the bowels costive: a stupor attends the accession. In common cases the tongue remains for a while white and the pulse is quick, though not often full; after a week or more, if not mortal, the disease ends, (though in very bad cases much sooner) with a copious sweat; a change to an intermittent form, or an haemorrhage from the REMITTENT OR BILIOUS FEVER. 63 nose or lungs, leaving great debility, and the head much affected with lightness. MANAGEMENT.-The patient will demand some drinks, and although they are sure to be thrown off, yet it will be necessary to indulge him with a drink, now and then, of toast and water, tamarind water, and lemonade. But when an essential medicine is to be taken, as for instance, a purgative, he must content himself with merely washing his mouth, or sucking an orange. His bed room should be as large and airy as can be obtain- ed; kept dark «nd still with few persons in it, and all noise in and about th© house strictly prohibited. There is no fever that requires more attention: the chamber furniture should be instantly renewed, scalded, and a fresh vessel substituted; the floors may be sprinkled with vinegar and water, or with chloride of lime, or of potash; which latter articles are preferable. He should lay on a mattrass; and in this instance the poor may have all the luxury of the rich: for a typha (catstail of the marshes) bed is the best in the world; the heat of the body can scarcely warm it, and it is pleasant at all times. Barley water and rice water will be requisite as food and drink, as soon as the stomach can retain it; and as the strength and fever give way, custards, chicken water, milk and mush, weak wine-whey, birds, and little fish, seasoned with salt alone, may be used. Cure.—In solitary cases of bilious fever where the pa- tient possesses a good constitution and lives north of the Potomac, and especially if he has been used to free liv- ing, and has much pain in the different parts mentioned above; there can be no doubt of the propriety of bleeding, which in many cases requires a repetition. A puke of fif- teen or twenty grains of ipecacuana may Men be given to clear out the stomach, and this will sometimes so quiet the spontaneous vomiting, that purges and sweats may be instantly used; but when it does not, it will be neces- sary first to leach and then to lay on a blister over the region of the stomach, which often has the happy effect of stopping the vomiting, and causing an early remis- sion of the fever. If the stomach still continues irrit- 64 REMITTENT OR BILIOUS FEVER. able, an opening downwards will be more likely to relieve it than any other means. In this case no attempt should be made to give any bulky article, nor to give a full dose at once; two grains of calomel with one of aloes made into a small pill, with a drop of spirit or syrup, should be given every half hour till six or eight pills are taken, in all of which time the patient must be persuaded not to swallow one mouth- ful of any drink, but merely to wash his mouth, or suck an orange. This purge may be given before the blister is dressed, and if it delay operating-, a glyster of salts may be used. A single pur^ -will scarcely ever be sufficient in one of thos* revers, they must be re- peated: the gentler purges may then be used, and if the stomar-b can receive it, castor oil is one of the best. Every other day, unless the bowels are very free, some opening medicine ought to be used: twenty grains of rhubarb, or ten of jalap, with a teaspoonful of magnesia in mint water sweetened, is one that will set well on most people; or a little decoction of senna with half an ounce of Rochelle salts, (soda tartarizata.) This last medicine, however, should be divided into two or four doses, and given at intervals to suit the stomach, and merely flavoured with mint or cinnamon. After the exhibition of the first purge some attempt should be made to promote a perspiration, and as the stomach is so irritable no attempt should be made with any nau- seating medicine: a dose of effervescent mixture* may be given alone, at first, to which may be added after taking a dose or two, fifteen drops of antimonial wine, which may be continued every half hour for six or eight times. But in general more powerful medicines are necessary; in this case the fever powders No. 3 may be used every hour, for five or six times. Should the stomach reject one or even two of those pow- ders, it will be best to persist, as it often happens that it will finally retain them. Should these medicines fail in bringing on a free perspiration, no delay should be made, after five or six days, in laying on blisters on * See the preparation in the apothecarium. REMITTENT OR BILIOUS FEVER. 65 the ancles, and when drawn dressing them with mer- curial ointment, that the gums may become affected, still using the sudorifics; and when the fever has been brought to intermit, or when the perspiration has been extensive, no delay should be made in using the bark. In low cases, or in bad epidemics, and probably in most of those fevers far to the south, we must not wait for a very perfect remission; but begin with the strong decoction of bark* and elixir of vitriol the moment the pulse alters for the better; this is not, however, to be done before the fever has run on some days, and after the blisters have been applied to the ancles. In such cases there is great need of profound judgment, and few persons can be expected to act aright without the aid of an experienced physician, who has first to settle in his mind the probable length of the fever, from preceding cases, the symptoms, patient's constitution, and experience. If the case be of that mortal stamp that threatens to end unfavourably in five, six, or seven days, he must try the bark by the third day, or even soon^i, but if the patient and fever is likely to hold out into the second week, it would be imprudent to use the bark before six or eight days, unless the remis- sions were considerable; and,this event should be con- sidered in blistering the extremities. The first blister over the stomach is intended to quiet the stomach and relieve the pains, and reduce any local inflammation; the subsequent blisters are intended to cause a remission. Some physicians are prejudiced against decoctions of bark, and some against the bark in substance; the late eminent physician, Dr. Wiesenthall, of Baltimore, pre- ferred the decoction, when properly made. It is certain that it will remain when the substance will not, and will be effectual in many cases where the substance does Ho good; more especially when there are any remains of inflammation. The late Dr. Goodwin, of Baltimore, who ranked the first in his day, was very much pleased * See the preparation of bark in the apothecarium. f Dr. Monroe used extract of bark and a small portion of blue vitriol; about one grain of the vitriol to the dose. ft* gg REMITTENT OR BILIOUS FEVER. with the resinous extract of bark given in pills; and they should not be forgotten in cases like this we are now treating. But those who prefer the substance, may improve it much by levigating it in a mortar. When once the bark will lay on the stomach it must be continued every half hour, or hour, till the accession, and then some of the sudorifics with a little snake root tea, given till another remission; and as the bark may alter the usual times of remission, the pulse must be watched, day and night, so as not to let slip one single hour. The patient's strength must be sup- ported with gruels and barley water at first; then with chicken broth and wine-whey, or will milk toddy if very low, and wine be objectionable? Dr. Fowler has re- commended his solution of arsenic in those fevers, and it may be used under the rules laid down in intermit- tents, but never till the bark has been tried in vain. So may quinine, but never till the bark itself has been re- jected. Powder of Virginia snake root, and angustura bark, may also be used under the same restrictions, or when bark happens not to be at hand. It would ap- pear that those physicians who recommend dog-wood « bark, and black-oak bark, and quinine, as preferable to fine Peruvian bark, are either ignorant of the virtues of good bark, or happily ignorant of bad bilious fevers in their practice. Such recommendations come from the north, but bilious disease from the south!!! And as far as the east is from the west, so far should all such comparative trash be pushed from the mouth of a pa- tient that is ill with a dangerous remittent. Riding is thought to be conducive to restoration after the patient is able to bear it. Those fevers if not well cured, are apt to leave a bilious habit and reduced state of health to the spring; and if the patient gets another attack the ensuing season in that state, it is almost certain to carry him off. No means should be neglected to restore the system the same fall, by small doses of mercury, (viz. the blue pill) and a constant use of the bitters of willows and >aloes, as recommended in the apothe- carium; and, also, by flannels next the skin in the REMITTENT OR BILIOUS FEVER. o7 cold months; and the use of wine or sound porter after the mercury has been used. A visit to higher ground, and especially to the northern springs will be of great advantage to one who has been a southern patient. A INFLAMMATORY FEVER. This fever most frequently attacks those who are in the vigour of life: such as are of a rustic, sanguine, athletic constitution, who indulge at least in full and free living. It is found, however, in constitutions much less inflammatory, when the exciting causes have been great; and is more common at any other time than in the warm summer and fall months. Causes.—Heat and cold applied in quick succession; exposure to a moist atmosphere, and especially a cool one when the system is relaxed by fatigue; or when already impressed with slighter diseases; more particu- larly with catarrh. An intermittent is also changed at times by similar causes into an inflammatory fever. De- bauch and sitting up at night in warm rooms, and then passing through a current of cold air, or riding against wind are likely sources of this and all other inflamma- tory, local or general diseases. Symptoms.—It discovers itself by a lassitude and dull sensation over the body; debility, alternating chills and flushes, tremors, pains through the whole body, but more particularly through the shoulders, breast, back, head, and knees. These are succeeded by an intense and burning heat, an inextinguishable thirst, inflamed eyes, fullness and redness of the face, sick- ness, inquietude, and anxiety. Frequently a cough and some difficulty in breathing attend. The pulse becomes full, strong, and quick; the skin dry, the tongue white all over, or ruddy on the edges, but as the disease advances, it becomes brown and dry with a crust; the urine is sometimes clear, at other times red at the offset. Vigilance, delirium, and towards the end stupor are common symptoms. The bowels are generally costive. If the disease is not checked it will be found that after a week or two, according to the constitution of the patient, that the following bad symp- INFLAMMATORY FEVER. 69 toms will begin and end nearly as follows: drowsiness, tremors, subsultus, jerking of the elbows and hands, hiccough, involuntary discharges of urine and fceces, which are speedily succeeded by death. Management.—-The patient should be confined to his mattrass, in a dark still room; the temperature should be very moderate, but not so cool as to excite cough, or to be unpleasant to persons in health; his diet should be altogether fluid and vegetable; and the stomach not over burthened with these. Barley water, jelly water, molasses and water, lemonade, and cream of tartar and water, will give a choice of drinks in the early stages; but as the strength gives way, barley water, gruels, boiled custard, and chicken broths, will be more suitable. It is sometimes necessary in great weakness of stomach and low state of the system to give milk toddy freely; this is an admirable article in some cases. It is a great convenience to have such articles as will satisfy the thirst and support the system. Cure.—As this fever is generally obstinate, and of- ten of considerable duration, often lasting three weeks; and is supported by some inflammations in the large viscera or muscular tissue, or both, we must not be disheartened on finding that we cannot overthrow it in a few days. The intensity of the exciting cause and its long application will often give a clue to what may be expected, We must therefore sit down like a general before a besieged city, and be content with seeing the walls daily falling before our artillery. Free bleeding is the most important remedy. It must be performed imme- diately, and repeated for some days till the pulse feels the effect, and the lungs and head at least are free from their oppression. Purging must also be commenced from the onset, with divided doses of salts mixed with portions of tartar emetic*. After the first or second purge at farthest, some sudorific medicines will be re- quisite; the fever powders of nitre and tartar will be * Epsom salts, in fine powder, one-fifth of an ounce, tartar emetic, one-quarter of a grain; one of these every two hours in aymp. 70 INFLAMMATORY FEVER. some of the best to begin with, if the stomach will bear them; if not, some other of the fever powders com- posed of neutral salts and antimony (see the apotheca- rium) must be tried; any of them are to be used on such days as the bowels are free, (and continued alter- nately with the purges;) it not being proper to use them the day a purge is given, nor prudent to stop the ope- rations on the bowels when they have been sluggish for any other medicine. It will often happen that saline medicines after a few days use will affect the stomach with flatulency, in which case the salines must be ex- changed for some other purges and fever powders; it being very important both to get and to keep the sto- mach in a state to receive medicine. Besides castor oil, jalap and calomel, may be used; but we should be very careful how we use calomel at the commencement of any inflammatory disorder, for it will assuredly (if it gets into the system) prolong the disorder, and often so confuse it, that it will be hard to determine what is mercurial disease, and what the febrile affection. It is a good way when the stomach has an early tendency to become affected with salines to add a little magnesia, and lessen the salts; senna and manna, or magnesia and jalap, are also good purges. The same attention will be requisite in choosing the fever powders; nitre will often be inadmissable, even at the offset, and after symptoms of flatulency, should never be used. The other powders (see the apothecarium) will be more proper, and especially those with chalk and antimony. By using some of these every two hours through the day, and opening the bowels the following day, (pro- vided there is not a very free action on them) and the use of diluent drinks, the inflammatory symptoms will probably give way in a week, or ten days, so that our purges and sweats may be laid aside for mercury and antimony, in small doses: three grains of calomel and twenty of pulvis antimonialis may be formed into six powders, one of which may be given in syrup every two hours; so that they will act on the bowels gently, and also check the febrile action without any danger of INFLAMMATORY FEVER. 71 having an effect on the system before using them four or five days, at which time the stimulus of mercury will be beneficial. Blisters may be put on the ancles after the tenth day. The mercury, however, should not be extended so as to make the mouth sore. It is sufficient whenever the patient, or the physician, can perceive it by the white thick fur on the tongue, or fetor of the breath. As the patient grows weak the Vir- ginia snake root with elixir of vitriol, or with a few drops of diluted nitric acid, will be proper medicines, till he is enabled from the full absence of all inflammatory symptoms to take water bitters and decoctions of bark, acidulated with elixir of vitriol. It will sometimes hap- pen that the head or breast is so much affected that it will be necessary to apply blistering at an early period, but not till after two or three bleedings, and completely unloading the bowels. It is no uncommon thing for some of those inflammations that have supported the fever to give way by an haemorrhage from the bowels, lungs, or nose, and at other times they will concentrate on some part, usually about the ribs, and form a suppu- ration; which must be opened as soon as the matter is formed, lest it break inwardly. The moderate use of wine-whey, milk toddy, and broths, will be necessary the moment the fever puts off its inflammatory charac- ter, or changes it for debility, producing the symptoms aforementioned. When the patient is much oppressed with heat it will refresh him to have his face often cooled with a wet towel; and should the extremities, at any time, become too cool, they should be sponged with water moderately warmed, wiped dry, and then wrap- ped in flannel by drawers, or stockings, or both. Enemas may be used when purges are more doubt- ful, or when we wish to go on with fever powders; as, also, when the disease is advanced, they will then be more judicious than purgatives: and a very little will keep the bowels regular when antimony and calomel are used. TYPHUS FEVER. The author has introduced this chapter in the place of nervous fever of the old book. We have no such fever as was there described. It was taken from an European history of that disease. What is now in- troduced he has taken from the bedside. Natural causes exist in his own neighbourhood to produce ty- phus, and artificial causes are never wanting. Three parallel lines, of only two miles apart, give three dis- tinct regions, and as many fevers. Near the water (falls so called) bilious fever prevails in summer; further back on the elevated flats, three hundred feet above tide water, typhus prevails: and on the drained hills, with porous soil, more pure inflammatory affections are prevalent. It would, therefore, appear that peculiar morbid impressions are made by soil, situation, and position; and that where inflammatory diseases and malaria are interrupted by some peculiarity; that never- theless, a morbid impression may be made of a distinct character: and hence, we find in the cities, on the tide water, that when they are so dry as to exclude malaria, and the atmosphere so temperate and steady as to ex- clude pure phlegmasia; they, nevertheless, make a morbid impression somewhat of a mixed nature; which, with the personal causes, produce typhus. Causes.—These are either natural or artificial.— The natural causes are what has been before stated, viz. certain unsuitable degrees (for health) of tempera- ture and moisture in the air, or soil, or both, making undue impressions on the whole system; but particu- larly on certain organs where the foundation of the fever is located. The artificial causes which aid in this business are, damp close houses, with small rooms; wet cellars, scoops and ditches about the buildings, with stagnant water in them; filth of all kinds about the yard, in the TYPHUS FEVER. 73 house, furniture, dress, or person; crowded bed-rooms, exhalations of putrid substances, and of the bodies of persons sick or well; bad diet: such as unripe fruit, unsound meats, and bad waters; improper food: such as used in sieges, or difficult travels. To these may be added all debilitating causes, either previous disease or debauch. These two sets of causes, especially in varying weather, are sure to produce typhus, and ac- cording to the degree of them, so will be the magnitude of the disease. Symptoms.—These are so various, that to give a full detail of all the appearances, in the different species, would far exceed our limits. The author, therefore, will confine his account to the most usual, and especially to those in this part of the country. The attack begins with lassitude, head-ache, sleepless nights, and a small cough, without pain in the act of coughing, though pain is common in other parts: as the head, back, face, loins, &c. Purging is a very common symptom in the early part of the disease. The throat is sometimes sore. After a while great muscular debility is felt; the nerves and brain discover a morbid state, by starting in sleep, subsultus, despondency, sighing, and as the disease ad- vances, a comatose state. The stomach is inactive from the beginning, but the patient can take light nourish- ment, so that there is no symptom in the stomach of any note. The thirst and heat are moderate; the pulse is at first pretty active and nearly of a natural strength; but after a while gets weaker, and remissions ensue where the patient is properly treated. Both cough and diarrhea are sometimes absent, but a pain in some part shows the local disease. It is no uncommon thing for the affection of the lungs not to appear till after a while. Every night from the beginning the fever makes fresh excursions, rousing up the local symptoms, and producing delirium in many cases. When the inflammatory affections give way, which happens in about ten to fifteen days, some hysterical symptoms are apt to alarm the patient, but they are 7 74 TYPHUS FEVER. always favourable; for it is an infallible token to begin the stimulating prescriptions. When medicinal means have been neglected too much, the comatose symptoms ensue much sooner, and delirium at night is common; the pulse keeps onr though getting more feeble, and the tongue becomes brown and glazed in blotches, and the teeth are some- times covered with sordes. A great variety of appear- ances take place in the tongue, under different circum- stances; sometimes it is much furred instead of glazed; when of an ash colour it is the most favourable appear- ance. When the disease is protracted the pulse gets so feeble that the patient cannot be safely raised in his bed; frightful ulcers form on the hips and over the sacrum in tedious cases. All the aforementioned sym- toms occur in the first grade or typhus mitior; what European authors call nervous fever. TYPHUS GRAVIOR, (commonly putrid fever.) In this grade every symptom is aggravated; the de- bility takes place very early, and is very great. The tongue and gums are covered with sordes; the breast is greatly oppressed, the breath is sometimes hot and foetid, the stomach is disordered, and the bowels also affected with flatulence, and foetid bloody discharges; the eyes are red and suffused with yellow or red; violent pains are felt about the small of the back; the surface in some cases becomes cold; the pulse is generally small and quick; attended with throbbing at the temples. The spirits soon give way; petechiae appear, and death pres- ses on in all its sinking forms. From two to seven days may be the common time before a change for life or death ensues. There are, however, much variation of symptoms, especially at the offset. In some there will be a short inflammatory stage of twelve to twenty-four hours; in other cases the low and sinking state commences in- stantly; in some there will be one or two turns not to be distinguished from common intermittent or remit- tent; and in some more rare cases, there will be pain TYPHUS FEVER. 75 without much change till petechiae or mortification ensue at the pained part. CONGESTIVE FEVER. Dr. Armstrong has given this name to a species of typhus fever under the idea that it has a generic dif- ference to distinguish it from typhus mitior. It is, however, but a species of typhus mitior; and the author has seen a few cases of typhus mitior having but one stage that was wont to hold out till death, like the com- mon inflammatory fever. The Symptoms are oppression in the brain and lungs. The oppression on the brain is of a peculiar kind: for the patients will often answer you any questions rationally, and yet cannot exert their mental faculties. The pulse is active, and continues so till death is at hand. In ten to fifteen days the patient generally dies. In the case seen by the author, it was most unquestion- ably inflammatory. It was the spring 1814, at about whieh time it prevailed in the western country, and some accounts are to be found in the New York'Re- pository. Dr. Armstrong has adduced other cases in which the local symptoms, or inflammation, was in the spinal marrow: an engorgement of the vessels of the brain and lungs, rather than an active inflammation, is said to exist. In all the species of typhus some damage is apt to ensue: the loss of the hair is a common consequence, after a long continued typhus; and many other damages have been known to follow: such as loss of hearing, loss of an eye, enlargement of the veins about the face; frightful ulcers will also form in the end of a long disease. Management.—Much may be done by good man- agement. If possible the patient should be removed from the place where he took the fever, even if it be only one hundred yards; his rooms even then should be ventilated and purified by white-washing, chloride of lime, or other means. See the Apothecarium. All manner of cleanliness is here particularly necessary; 76 TYPHUS FEVER. and the patient should not have more company than what is necessary to attend him. All the acid watery drinks are useful in the first stage, and after that strong- er: such as sound porter diluted, or if this produce flatu- lency sound wine and water, wine-whey, or when those do not set well, or are insufficient, some toddy may be used. Gruel, mush and milk, and chicken broth, are suitable diet. Rice is the best article when the bowels are affected or very weak. Cure of Typhus Mitior, in its various species.— 1. Typhus Idiopathica, (i. e. where no local affection appears.) Many physicians believe that there is no fever, without some occult local affection; and they are probably right; however, as these cases are more slight, dissection can rarely take place to end the dispute. It may be well always to suspect some or- ganic derangement, and to lay on (after a bleeding) a blister on the breast, and then proceed to open the bowels with salts, castor oil, or senna and manna: these purges may be continued with the following rules: to use different ones each time, and never to purge two days successively, but to use them after a sudorific. A puke of ipecacuana will often be of great service; and this may be repeated under the same restrictions as the purges. When the prima? viae is thus far evacuated, sudorifics are to be used through the day, or night, or both if needful. The powders, No. 2 and 3, composed of neutral salts and antimonial powder are very suit- able. By the daily use of one of the above prescrip- tions, viz. purge, puke, or sweat; the febrile actions will be considerably reduced; and if they delay and the patient's strength will not admit farther evacuations from the intestinal canal, blisters are to be applied to the ancles and wrists. By this time, and not before, we may introduce small doses of calomel in the form of Plummer's pills, till nine to twelve grains of calomel are used, in six days, but not to purge. The early use of calomel always does mischief; and, therefore, it should not be given even as a purge. By shifting the kind of purge we may suit the state of the fever typhus fever. 77 and gain some other advantages. The salts should be used only in the more early part of the fever, and we should ascertain what purges suit best. As soon as there are remissions obtained, some elixir of vitriol and snake root tea may be administered, and then the decoction of bark. If there is any histeria, or nervous sinking, about the end of the second week, or sooner, the bark may be instantly given; as these symptoms show the entire recession of the inflammatory stage. But when bark will not answer, the slow use of calomel will fully prepare for it, and often supersede the use of it. The use of an enormous dose of calomel, at any time, to blow up the disease, as some express it, is the height of folly, and will never fail to do mischief. The steady perseverance in gentle means will gene- rally answer, and bleeding should always be the first thing: it may often be performed in moderate quantity one week after the disease has set in, if the pulse keeps up, or the head be much affected. If the bowels are very free we may use the pukes, and small doses of ipecacuana with the sweats, and not more than one or two doses of castor oil as a purgative. Great care must be taken to use barley water and thin gruel, pretty early in the disease, to sustain the strength; and when the tonics are used, mush, milk, and broths, should be prudently used. 2. Typhus with Diarrhea.—This is the most sim-' pie of all the species, with evident local symptoms. It is common in crowded places, especially with the same disease, even though of a different species. A puke or two of ipecacuana, small doses of the same with prepared chalk, and then a little snake root tea with ipecacuana continued is nearly all the medicine needful. But the patients must be scattered, and their clothes, beds and diet changed; rice is here an excellent diet. %CT" Blisters may be laid on the abdomen, and if much debility ensue a decoction of bark, or angustura will restore the strength. 3. Typhus with Pulmonic Affection.—This spe- cies will sometimes be so obscure as not to discover the 78 typhus fever. affection for many days.* Repeated bleeding and blister- ing are here absolutely necessary. The saline purges and antimonial powders are also to be used as in typhus idiopathica, and then if the disease continues, blistering the extremities and giving the Plummer's pills must be the practice. When the pulse gives way, and hysterical nervous symptoms ensue, the bark may be given with great advantage, as in (1.) Barley water and lemonade may be used for drink; and the rest of the management and cure as in species 1. 4. Typhus with Pulmonic Affections and Diarr- hea.—This is the most common species in Baltimore county. The diarrhea is disposed to go off as the in- flammation subsides. Bleeding, and blistering the breast are indispensable to a speedy cure, and to avoid those comatose symptoms that follow a badly treated or neglected case. After bleeding, the antimonial pow- ders, No. 3, are to be given, and a dose of castor oil will be often very useful. Emetics should be used and re- peated. The exact prescriptions and rules are to be used for blistering the extremities, mercurializing, and finally giving tonics as directed for the other species; which see. %CZF° It is often necessary to repeat the bleeding, and also the blistering on the chest. 5. Typhus with early nervous Twitchings of the Elbows.—These nervous affections at the onset are carefully to be distinguished from the nervous af- fections which reach the spirits, and happen as the disease recedes. Cases occur where such jerkings will affect the patients a day or two before they can be per- suaded to lay up. Bleeding, with the purges and anti- monials, have always succeeded with the author. The pulse was his guide. The diet and subsequent treat- ment must be as in 1. It is, however, a slight species. 6. Typhus with Cystu Symptoms; (i. e. of the kid- ney, or bladder.)—It is hard to say, at times, which of * The author attended two cases in which there was no cough, or pain m the breast, for fifteen days or more; a violent one then ensued with suppuration: one died (seventy-five years old;) the other, a young man, got well in two weeks. typhus fever. 79 these organs, viz. kidneys or bladder may be the seat. The treatment is the same, bleeding, purging, emetics, antimonials, with cooling and mucilaginous drinks, and the rest of the treatment (i. e. when inflammation is gone) the same as in 1. 7. Typhus with Angina.—It is somewhat remark- able that nearly all the author's patients with this were Africans. The treatment is bleeding, blistering the throat; alum, gargles, antimonials, purges, and then the after treatment as in other species. 8. Typhus Congestivus, with affections of the lungs and brain; very small and often repeated bleedings, with blistering the head and breast, has been recom- mended by the physicians who have seen this disease, (particularly in the spring) and to these remedies the antimonials and purgatives may be added. Dr. Arm- strong has several other varieties of it; and he may be consulted. But surely those fevers of New England, called typhus sincopalis; and those in the south of this state that begin as an intermittent, and sink after a turn or two, have no claim to the above name. They belong to the next great division of typhus. 2nd. Division, TYPHUS GRAVIOR. Cure.—It was observed that one class of typhus gravior has a short inflammatory stage of twelve to twenty-four hours. When this can be anticipated and the lungs are oppressed, there can be no doubt but a moderate bleeding will be a good beginning.* It is a practice recommended by many eminent physi- cians. The famous Dover appears to have been one of the most bold in this prescription. A blister is then to be applied, and an emetic of ipecacuana given; the bowels should be regulated; but purging is here a dangerous practice; small doses of calomel and anti- monial powders may be given, at every six hours, till they merely pass the bowels. The low stage is to be rather anticipated; to wait for it will not do: we must * This may be by leeching the breast, or venesection, as the pulse may allow. gO typhus fever. feel for it, by trying the antiseptic and stimulating articles: elixir of vitriol and snake root may be given alternately, till we find that the strong decoction of bark will be received without disturbing the lungs and bowels, and then wine-whey, or milk toddy, if the pulse be low. Sinapisms are very useful in the low state of typhus; and also artificial warmth, with blad- ders and bottles of warm water, &c. The medicine called Glutton's Febrifuge (see the apothecarium) has been used with success in some low fevers. It ap- pears to be best suited at an early period, or about the time that the first or inflammatory stage is about giving way. The purification of the rooms, and the use of diet, is here all important; wine-whey and milk toddy are both medicine and food; then broths, and mush and milk, must be used in good time. Opiates are recommended by some physicians when the sto- mach is very irritable, perhaps in such case it should be joined with a little calomel to prevent constipation. Enemas are often useful. There is a difficulty often, about the bowels: for they are apt to become very tor- pid, especially when the patient is on the recovery; re- quiring much force to open them, and purging is dangerous. If enemas will not do, a few grains of aloes and assafoetida may be given every four or six hours, stopping the moment there is an operation. This happens sometimes in typhus mitior, and must be treated the same way. 1. Typhus Syncopalis.—Having no experience of this form of typhus gravior, we must refer to Dr. Minor. He describes it as having a sudden nervous sinking, and general weakness, imitating apoplexy, fainting, hyste- ria, cholera, Sic. without reaction in the pulse; (of course it has lost, or wants, the first stage;) and the ex- tremities become cold. In some cases there is petechiae. One of the most marked general symptoms is a sense of emptiness about the stomach, not unlike great ab- stinence. What is very singular, these sinkings are periodical: returning in the morning and middle of the day. The doctor used large doses of opium imme- TYPHUS fever. 81 diately, and also sweetened wine freely as his main stay, to bring on reaction, and then treat them accord- ing to their state of reaction, or local affection. There can be no doubt of the advantage of blisters, sinapisms, and artificial heat in such cases; and a great caution in moving the bowels. The bark and nourishing diet must finish the cure. 2. Typhus Peninsula Marylandica.—In various parts of the Eastern Shore of Maryland, typhus fevers have occurred, with a simple sinking and coldness, without any marks of a first stage. The physicians have found the free and large use of brandy, instantly given, their best remedy; and having revived the pa- tient, they use bark and snake-root; and as a farther cure, blistering: especially if local symptoms ensue. 3. Typhus Petechials, (Jersey Typhus.)—Al- though petechiae are frequent at the end of various species of typhus, yet it is rare at the beginning. There were some cases about twenty years past, in Jersey, where the patients were seized with great pains in the legs, and petechiae came out, and then mortification ensued; the stimulating plan seems to be equally suited to this species, though it was in general mortal. Stand- ing long in cold flats, in election groups, was supposed to be the cause; perhaps in all petechiae, sponging the surface with a hot spirituous decoction of bark, and then sprinkling on powdered camomile, would be ag'u- dicions practice. The darker the petechiae, the worsX. 4. Typhus Malaria.—This form is probably the most extensive, being sometimes epidemic in our "state, on the upper part of the large rivers Potomac and Susquehanna. After one or two turns of intermittent, or more commonly remittent, the patient sinks very low. In the intermittent form, the physicians at Annapolis, who had some sporadic cases, experienced the use of opium and calomel, in large doses, as the best incipient means. In cases under the author's care he found an evacuant useful, but a repetition was severe; and, indeed, they seemed to operate with a roughness, that indicated some inflammation in the 82 typhus fever. stomach, and this was found to be the case (on dissec- tion) at Annapolis. Blisters after gentle evacuants, and then all the range of stimulants, with bark, are neces- sary; though calomel will come too late, in general, as a stimulant, to enter the system, it may, however, be well to apply mercurial ointment to blistered surfaces. All the jail, army, ship, and hospital fevers belong to some of those two divisions of typhus gravior, i. e. with one short inflammatory stage, or with a single low stage. The above treatment is equally applicable to them. The following table will serve to adjust the differ- ent histories of typhus, and to fix those of our own climate. f Typhus Mitior, nervous fever of European authors, with two I stages: the first inflammatory and continued, the second nervous and often remittent. 1. Typhus Ideopathica, i. e. with no visible local affections. £ ! 2. Typhus with Diarrha. 0 } 3. Typhus with Pulmonic Symptoms, i. e. of the Lungs. "E. I 4. Typhus with Rheumatic Symptoms. .§ 5. Typhus withCystic Symptoms, i.e. of the Bladder or Kidneys. <" | 6. Typhus with Cynache, i. e. with Sore Throat. L7. Typhus with Primary Nervous Symptoms, (Jerking.) f 1. Typhus with Pulmonic Symptoms and Diarrha. "c i, 2. Typhus with Cynache and Rheumatic Symptoms. o - J 3. Typhus with Pulmonic and Cystic Symptoms. g*§[ j 4, Typhus with Pulmonic and Cerebral Symptoms, (Typhus o c« j Conge6tivus.) [N. B. Dr. Armstrong has additional species of this name. ' Typhus Gravior, Putrid Fever of Old Authors. 1. Typhus with Symptoms of the Simple Species of Typhus Mitior. 2. Typhus with Symptoms of the Compound Species of | ^ Typhus Mitior. H I 3. Typhus Malaria, with Intermittent or Remittent, first stage. j= 4. Typhus with Subsequent Petechiae: Army Fever, &.C. jC I 5. Typhus with Haemorrhage from the small vessels, Yellow & I Fever. '1. Typhus with Nervous Sinking at the offset, Typhus Syn- copalis. New London Typhus. 2. Typhus with Immediate Sinking, without nervous affections, Maryland Typhus. •{ 3. Typhus with Petechia; and Mortification of the extremities, Jersey Typhus. 4. Typhus with Cholera: India Cholera? 5. Typhus with Sweating Stage, Sweating Fever of 1468 to I, 1557, of Authors. HECTIC FEVER. Causes.—Violent racks of the constitution from any cause, absorption of matter from ulcers, excessive re- laxation, and delicacy of any part that is exposed to irritation, as the lungs, stomach, and bowels; most all these causes are attended with general debility, and particular relaxation of the parts that defend the ten- der extreme vessels from the irritations which act about them. Symptoms.—The fever usually comes on in the forenoon, sometimes with considerable chills, or coldness; this is succeeded by heat, a quick, small, and weak pulse in general, though sometimes there is some hardness in it, especially in those who are not much reduced, and early in the complaint; this sometimes lessens towards evening, and again in- creases at night; at other times it continues on with- out any very obvious change till towards morning, when it intermits, or greatly remits, with a profuse sweat, which lasts a considerable time: the sweats do not appear in the early period of the fever in profusion. A head-ache usually attends the fever, as also a sick stomach, both of which go off in the intermission, or remission. The tongue is usually clean in this fever, the belly at first is often bound, but in the end a lax almost always attends. The patient wastes away gradually; his feet swell, particularly at night, his hair falls off, his nails become crooked and thick, his face sharp, and a general failing takes place in every thing but his expectations of getting better, and his understanding, which usually remains to the last. This is the most usual form; but there is some difference, owing to the variety of the parts affected, and the state of the patient. Management.—The patient should have the lightest and most nourishing food given him in small quantities 84 hectic fevee. at a time, and at such times as the fever is absent or slight; thus his breakfast, or dinner, at ten o'clock, should contain most of what he should eat. Milk is very proper when the stomach will receive it: some- times it may be most agreeable when diluted with water and sweetened, at other times it may set better when boiled. Custards, light puddings, chicken water and broth, beef tea, rye mush, corn mush, with the com- mon vegetables of the farinaceous kind, are mostly pro- per. Weak wine and water in the absence of fever; barley water and sage tea at other times, will be pro- per for drink. The patient should be kept clean, and when his strength admits, he should be aired in a car- riage, and at all times have access to pure air. See the apothecarium for articles of diet, and purification of rooms. Cure.—In many cases it will be needless to attempt any thing but a removal of the cause, when the fever will quickly cease; but in general both the one and the other are to be combatted. For treating the causes, see the places where they are treated of; though some of them have no place in this book. For the general treatment, the debility should be removed and the fever interrupted: for this purpose, (when nothing for- bids,) bitters and bark are necessary; also, elixir of vitriol, which may be given to sixty drops a day, at four doses. These are to be taken whilst the fever is off, or when it has greatly remitted, just before the return is expected. After it has commenced, one of the following powders may be given; ipecacuana, two grains, magnesia, one teaspoonful, mix them and give it in a little camomile tea. When a lax comes on there is little hope; but the fol- lowing may be given: columbo root, two drachms, pour one gill of boiling water upon it, and in a quarter of an hour strain it off; to this add twenty drops of laudanum; this quantity may be used in the course of eight hours and repeated, or in place of the columbo, ten grains of the powder of kino, with the opium, may be used as often. See the apothecarium. ERUPTIVE DISEASES. CHAPTER III.—SMALL POX. About eight days after an exposure to infection, the patient is taken with all the common symptoms of fever: chills, nausea, head ache, and pains in the small of the back. The throat is sometimes sore, and the eyes red. After three days, and sometimes more, an eruption like flea-bites appears on the forehead, and extends over the face, breast, and then to the extremi- ties. About the time the eruption has extended over the face, the fever ceases. The pustules grow and fill with good matter, are distinct, with red margins, and in one week are ripe and burst; or the matter is absorbed, and in another week quite gone. About the fifth day of the effusion a gentle salivation comes on, and increases, with the commencement of a swelling in the face, which always does or ought to take place, just before . the pocks are fully ripe. A swelling of the wrists, and then of the ancles, succeed this swelling in the face. Children are liable to have a slight fit before the erup- tion, especially if not well aired and kept cool. The above is the most common routine of a mild disease from contagion. But unfortunately some pe- culiar condition, or bad management, or the disease not being foreknown, more often bring on a confluent, and perhaps a malignant, disease. In such case the fever commences with stronger symptoms: the pulse is quick and contracted, the pains in the back sudden and severe, the head is affected with coma and delirium, the stomach is disordered, and is sore on pressure. After two days the face looks like an erysipelas, and the pocks come out as thick as they can stand; they are not extended like the former, but flat and sunk in the middle, spreading into one another, and when se- parate, the skin is corrugated, and the whole face is 86 eruptive diseases. doughy in appearance. These have a white, brown, or black watery matter, which corrodes and unite all the pustules over the face, into one great sore. The fever does not go off when the pocks are out on the face, as in the former grade; it merely remits and gets on again about the fifth day. But when the disease has arrived at maturity, (the eighth) a secondary fever, often with a strong pulse, is formed by the irritation of the external ulceration. The face begins to swell sooner than in the distinct kind, and swells more; producing blindness, and forms altogether a horrid spectacle. The salivation grows more and more troublesome, for the spittle becomes so thick that the patient can scarcely void it from his swollen fauces. On inspection of the tongue many pustules will be found, and the number of these are said by Dr. Gregory to portend the danger from this source. When there is no peculiar malig- nancy, the great danger lies in the state of the passage to the lungs, where there is such a push.* The eleventh day is about the critical time, and the patient is then often suffocated by the effusion into the wind pipe; it is, in fact, then much like a croup. But often a different cause takes place, and the fever about the fifth day, or later, from its commencement, is found to be of a low stamp: the eruption looking black, or bleed- ing. Blood is also discharged from various parts, and the patient seldom reaches even the maturity of disease. On the eighth day of eruption, children are apt to have violent and dangerous convulsions; and if they are not taken off by them, the disease is apt to become malig- nant. A confluent malignant case is nearly hopeless. There are some cases that turn malignant before the pocks come out; nothing but petechiae or haemorrhage appear in such, with a feeble pulse, coma and death. But such persons have manifestly a bad constitution. Management.—The patient should have a mattrass to lay on, and an airy room with his bed in the middle, and he should not use it much. His diet should be vegetable, and his drinks acidulated: such as jelly * The Trachea. ERUPTIVE DISEASES. 87 water, lemonade, tamarind tea, and barley water acidu- lated. The temperature of his room should be cool, but not disagreeably so, and the same rule applies to his clothing, and bed clothes. The room should be purified with chloride of lime daily, when the disease has become offensive, and all possible cleanliness at- tended to: for there is a great tendency to a malignant state, in summer especially. Barley water, gruel, and milk and water will be sufficient for nourishment. Cure.—A great deal will depend on an early percep- tion that the patient has taken the small pox; for he may then be aired, and his face cooled with a wet towel, often in the day, and he will of course be kept from the fire- side, or indulging in the bed. Purges should be given of salts, not only when the fever is on, but whilst the eruption is forming in the face; and if the fever con- tinues, five grains of pulvis antimonialis may be given every two or three hours. But should the stomach be much disordered about the time of eruption, a puke of eighteen grains of ipecacuana will be of service. The fever powders and cool drinks may be pursued; keep- ing the bowels perfectly regular, till the patient begins to suffer from irritation and want of sleep; say the third or fourth day of the eruption. It will then be necessary to give a Dover's powder, containing one grain of opium, every night, to each of which two grains of calomel may be added for four times. The bowels are to be watched, and castor oil or clysters used. If the fever runs high in the day the pulvis an- timonialis is to be continued, and the Dover's powder at night. As the disease advances we are to look well to the state of the fever and the lungs. If the fever keeps up very high when the face is so much swelled and the lungs so much oppressed, and especially if the patient be of an inflammatory habit, bleeding may be used with propriety, and blistering on the side always: these being the two remedies necessary. The feet may also be bathed to draw the swelling into them, as recommended by Tissot. Barley water, with the con- tinuance of the antimonial powders, are to be used 88 ERUPTIVE DISEASES. till the face begins to subside, and the spittle to be free and thin. Children have a lax instead of the spitting, and it must not be interrupted unless it begins to de- bilitate too much, for it is part of the disease. A rice diet will be enough, in general. But if about the third day after the pocks are out the pulse is not strong but weak, and the pocks begin to look discoloured, we may expect some malignancy, and then the elixir of vitriol is to be drank, as Syden- ham directs, i. e. merely to acidulate a quart of water, and take it as drink; and bark in decoction must be speedily used if petechiae or any haemorrhage ensue. Wine-whey will be necessary to sustain the flagging pulse. It would be hardly worth while to say that this plan would cure if the pocks are confluent as well as malignant. But sometimes this malignant disposition takes place in cases not so very thick set, and then life may be saved. There will be no need of much cool- ness when the quantity of the pocks is ascertained, and not at all in a malignant case. Perhaps sponging the parts with a strong decoction of camomile, and when open, sprinkling them with the powder, might be useful in such malignant cases. As some physicians are very partial to camphor, in small pox, it may be used as a sti- mulant in the malignant kind. The most simple way is to rub it down with new milk, and give it in four grain doses with the bark. As the patient gets weak in any case, we are to support him with gruels, panada,^>roths, &c. 10° If any undulating motion of the muscles suc- ceeds small pox, a few blue pills should be taken; say four or six grains daily, for a week. CHICKEN POX. The causes of this are unknown. Symptoms.—A slight fever attends for a day or two. About the third day the pocks appear over the person, not numerous, but large. In four days they fill with whitish or yellowish matter. They are rather larger than a large Bristol duck shot. They vary, however, in the time of coming out, and filling more or less slowly. ERUPTIVE DISEASES. 89 Management.—The patient should be kept cool, especially when in bed; light watery drinks and vege- table food should alone be used. Treatment.—If the febrile symptoms are of any account, or great irritation prevents sleep, some gentle purges, such as Sedlitz Powders, may be used for a day or two. It would be highly improper for any person to go to laborious work whilst this disease is on him. Slight diseases may be made serious by disregarding them. MEASLES. This disorder arises from a specific contagion, and but rarely attacks a second time. It usually appears, as an epidemic, about January, and recedes in summer, though cases are found at all times. Symptoms.—It comes on like a commo/i fever, with a cold stage, succeeded by a hot one,- a nausea, anx^ iety, pains and vomiting, usually attend. The head and sides are most usually the places of pain. Some- times, at the very onset, the fever is sharp and violent; but before the eruption is fully out, it is always con- siderable. On the fouufch day'the eruption in general appears, though there is occasionally considerable dif- ference in the length of time. With the eruption a hoarseness, cough, difficult breathing, swelling of the eyelids, acrid discharge from the eyes and nose, with sneezing, take**place; generally a drowsiness attends the beginning. The eruption appears at first like flea bites, and ex- tends to the breast, and over the whole body. The face becomes a little tingfd, and then the eruptions change from red to brown,and go off; though sometimes those eruptions are foupd to fill with water, from a secondary kind of fever. In a moderate case, the fever declines when the erupdon does, but more commonly hangs on with a cougX. A diarrhea succeeds, and this, with an increase q/pulmonary affections, show that there exists an inflammation brought on by the disease, which must be attended to as much as if it was a distinct disease. 8* gQ ERUPTIVE DISEASES. Thousands lose their health, if not their lives, by suf- fering the disease to wear itself off, as they term it. Management.—The patient should avoid a heated room, but should not be as much exposed to cold as in small pox. He should have a low vegetable diet. Indeed, his drinks of barley water, jelly water, Sic, will be sufficient; for it is truly an inflammatory Cure.—Adults with much fever should be bled freely, and have repeated doses of salts, especially if there is pain in the side; and a blister should be laid on the part. Fever powders of nitre and tartar may be given daily, and solutions of cream of tartar used as or* of his drinks; and when the disease should naturally cease.Ahat is, at the time of desquamation of the eruption; if the fevX rises, and the uneasiness in the breast in- creases, moK bleeding will be requisite; and fresh blistering, with rxjutral salts and fever powders of the most cooling kind> Children-bear bleeding remarkably well, and if the symptoms about the lungs do not greatly abate, as the eruption recedes, it should never be omitted. And it may be well to wait to this period, or longer, before any opiates .are given to allay the cough;°for we must be sure that no considerable in- flammation exists when \e use anodynes. When this is ascertained, some paregoric, with a few drops of antimonial wine, may be givhn, every four hours, if the cough prevents rest. A soft jvulse will generally suc- ceed a hard one, when things a\e going on well. It is no uncommon thing for a stimulating plan to force the disease out of its usual character. People are much alarmed about the eruption going in, and give cordials and drugs, of which they know no\. the operation.* It is an excellent practice to give a dtse of salts on the first day of the fever. When the disease gets into a family it is easily accomplished, and diminishes the disorder greatly. Patients, if they are able., had as well be kept up as in bed. If, in reality, the powers of the * Great quantities of carthamus (of the gardens) ar» sold for saffron, to drive out measles. ERUPTIVE diseases. 91 system are so weak as not to sustain an eruption, or if the disappearing of the eruptions are attended with any particular disorder of the chest, or with spasm, and the pulse be weak and low, the patient should be put into a warm bath, wiped well, put between blankets, and a little laudanum and ether given, and this followed by some draughts of warm snake root tea. But this is very sel- dom the case. When blisters have been used, and such a state of lowness ensues, it will be well to dress them with powdered camomile, as they may become gangrenous. Many varieties of this disease are recorded; and pa- tients have had measles a second time, but it is rare. The lax that follows is sometimes troublesome. Small doses of ipecacuana: say one grain for a child, five years old, every two hours, will generally succeed, when as- sisted with a rice diet; if not, opiates must be added to the ipecacuana. But if the patient is an adult, or nearly so, and full of flesh, and has not been bled, he may be cupped, or leached, on the abdomen; and the ipeca- cuana used first, and then some mild astringents. Measles is a great trial to weak lungs, and the phy- sician should have his eye on the issue of measles: haemoptoe, croup, consumption, hectic, and marasmus, affections of the eyes and glands, &c, show themselves in weakly patients. It is a very easy matter to mis- take a bad case of measles, in a grown person, before the eruption. The physician will be sure to call it pneumonia, or highly inflammatory, or rheumatic fever; and it is well if he prescribes boldly for such cases; he will never repent. According to authors, the erup- tion has varied from two to eight days; some of the epidemic measles have been at times accompanied with a typhus fever; but, says Dr. Potter, this must Hot sheath the lancet when there are untoward symptoms in the lungs; the child must have a chance, and this is (£f- Infants at the breast, when affected in the bowels, after measles, should nothave more than one half the mother's milk; when they cry, let them have thin rice water (in place .of the breast) from the bottle. And a similar abstinence should be enjoined, on all other ages, in like cases. 92 eruptive diseases. the only one to be relied on: to this, all persons well acquainted with our degrees of typhus, must subscribe. SCARLATINA AND PUTRID SORE THROAT. This disease is an epidemic, returning at very un- certain periods, and is supposed to be personally con- tagious: and some German physicians prescribe the atropa bella donna as a certain preventive. Separation in another story of the house, and cleanliness, will do better. But one of the most prudent precautions when this epidemic has a bad cast, and is in the family and neighbourhood, is to take two doses of bark daily, by which means what would be a highly malignant disease will most likely become a mere eruption on the sur- face. Another highly important precaution is to guard those who have a slight disease from exposure; let them have their throats tied up with flannels, or hand- kerchiefs, and keep out of currents of air, lest the eruptive matter fall on the trachea, and produce an in- curable croup.* The disease is called scarlatina where the throat is little affected and the eruption consider- able; scarlatina anginosa where the throat is ulcerous, with some eruptions on the skin; and scarlatina maligna where the fever is typhus; the throat filled with malig- nant ulcers; and every part of the system verging to dissolution, by diarrhea, haemorrhage, stupor, sunk pulse, and sordid mouth. Patients frequently die with the second degree, viz. scarlatina anginosa, from mere febrile exhaustion, with- out the ulcers becoming gangrenous; and the physician is often puzzled, in this grade, to know whether he may use the lancet. His rule must be to consider the general tendency of the epidemic, the state of the pa- tient before he was attacked, and the advantages of living he has been used to, that might either save him from a typhus state, or push him on towards it; both as to his place of residence, his diet, clothing, and * The author saw a family with two grades of this disease; and all who were slightly affected, died with croup, and the others, though so much worse, recovered. ERUPTIVE DISEASES. 93 cleanliness. To these clues he must add the symptoms. If the pulse has considerable strength; if the muscular strength is not gone; if a delirium attends before com- plete exhaustion; and also the bowels are in a pretty good state, he may then conclude that it is in his power, by early arresting the inflammatory actions, by bleeding, and by prudent purging, either to prevent the patient from slipping into the third grade, or to save him from death by febrile exhaustion. Children are more sub- ject to this disease than adults; and persons over forty are seldom known to have it. Symptoms.—It begins with chills, which are followed with an intensely burning heat; a swimming and pain in the head; a troublesome sensation in the throat; sick- ness and vomiting; looseness, inflamed watery eyes; tumid and flushed face, with stiffness in the neck; a small, frequent, and irregular pulse; foetid breath, and a disagreeable taste. Very soon white spots appear on the glands situated on each side of the palate; and these, with the adjacent parts, appear swollen and glassy. These spots spread and unite, covering almost the whole interior mouth with thick sloughs; which falling off, leave ulcers. In some cases an intense redness and some swelling extends into the apertures of the nose; on which case the brain seems more liable to be inflamed. On the second day, or later, of the fever, spots begin to appear on the skin, either distinct or in patches, covering (though unequally) the whole surface from the face downwards, giving a stiffness to the skin; they are sometimes not very plain to the eye, though at others much more conspicuous. They go off with a peeling of the skin. The glands about the neck are sometimes swelled to an alarming height. Though the patient's voice is hoarse and flat, the swallowing is not impeded. If the complaint is on the advance, for want of attention, discharges of blood from various parts will show the tendency to dissolution: the teeth and tongue will be covered with a dark sordes; a gangrene will commence in the upper part of the wind-pipe; the pulse will be countless and sink; coma and death soon 94 ERUPTIVE DISEASES. follow; and this generally from the third to the seventh day. In some very bad cases, which nosologists might have made into a fourth variety, all the bad symptoms in the fauces and other parts take place before any disturbances are perceived in the pulse.— Eruptions on the tongue, and the earliness of its com- ing out on the surface, with a fulness of the fingers, will readily mark this disease, so that it be not con- founded with measles, (see measles.) It is seldom the case that a person is infected a second time. Management.—Great attention should be paid in all bad cases to purifying the rooms, by quickly removing all chamber furniture after use; by preventing more than two persons to be in the room at a time; by free access of air in all temperate or warm seasons; by changing of bed and body clothes often; and by sprink- ling the floors, after making them very clean with chloride of lime. At foiftress Monroe, the hospital floor is kept clean by rubbing it with a small marble slab and some sand, instead of wetting it. The patient should make no effort to talk: antiseptic drinks, such as lemonade and tamarind water, must be given when thirsty. And for diet: gruel, barley and rice waters; and when getting better, or growing weaker from dis- ease, broths, wine-whey, mush and milk. In cold weather the room must be kept rather cool, but al- ways pleasant, with some fire. The frequent wash- ing of the face with a cool towel is very refreshing when the heat is great. Some physicians have extended it, in the first days of disease, to wash- ing the whole body; so as to keep down all preter- natural heat. How this will do in our country, and the exact grade that will be benefited, has not yet been suf- ficiently tested, for the author to recommend it to the patient. But where he has a disposition to delirium with- out proceeding from exhaustion of the pulse, he would readily extend it over the whole head. It is important to keep the head raised, especially in children, so that the matter of the ulcers cannot be swallowed. Cure.—In the most simple scarlatina, a purge, low ERUPTIVE DISEASES. w3 diet, drinks of cream of tartar, confinement to the room, and tying up the throat, are sufficient. In scarlatina anginosa, we may begin with a puke of twenty grains Of ipecacuana, as soon as possible, and unload the bowels next day by a dose of castor oil. If the disease holds its own in energy and much redness of the eyes and nostrils, with delirium at night ensue; blood must be drawn, and in all cases antimonial powders, with a small quantity of calomel, administered every three or four hours, from day to day: one grain of calomel and three or four of pulvis antimonialis will be sufficient. If these do not keep the bowels open, castor oil may be used. A blister in most cases, (the second day after the throat is ulcerated,) on the neck, will be necessary; which must be dressed with a camomile poultice, going all round the neck. This poultice (merely scalded flowers) may be continued during the whole time that the blister is open. Good topical applications are all important; nothing is better than decoctions of bark, and acids of sea salt, vitriol, and alum candy.* In the interim of using these, the patient may keep in his mouth a quid of scalded camomile flowers, chang- ing them often. When the throat has become ulce- rous, instead of the acid gargles, a weak gargle of corrosive sublimate may be used: one grain, with a pinch of salt to an ounce of camomile tea, or decoc- tion of oak bark, will be sufficient. In applying the gargles the patient must not throw them in, and work his throat, as is usual in common sore throat, but apply them with all gentleness: a soft piece of sponge at the end of a stick may be used, or a syringe. For children alum candy will be of great use, in addition to the gargles. When the inflammation is passing off, some gentle tonics: such as elixir of vitriol, camomile, and decoction of bark will be found necessary. If a purging comes on, it must not be suffered to debilitate the patient, but must be arrested with astringents and opiates: five grains of gum kino and one-quarter of a grain of opium, mixed with a little syrup, may be given * See the apothecarium. 9.5 ERUPTIVE DISEASES. every two hours to an adult. But the bowels must not pass a day without some discharge by enema or other means: for the morbid collections are irritating. In angina maligna, we may begin with a puke of ipecacuana, and merely unload the bowels, with an enema, or a little rheubarb. A cup of serpentaria, or camomile tea, with one to one and a half grains of ipe- cacuana to the dose, may be used every hour, alter- nately, with doses of elixir of vitriol. If the patient seems to sink under these more gentle tonics, the levi- gated bark* and port wine should be resorted to, and a spirituous decoction of bark, applied by a sponge (not more than milk warm, if so much) over the whole frame, rubbing it dry with the hand: first going from limb to limb, and then over the body. The astringent and acid gargles, with the camomile (as before directed,) must be used; or warm washes of the decoction of bark, or of quercitron, and camomile poultices, may also be applied externally to the throat. If the glands about the throat swell externally, they may be rubbed with mer- curial ointment. This was the practice of Dr. Gilder, who had much to do with this disease in the army, and in the city of Baltimore. He also used the mercurial gargles in all cases of angina.t In those cases where the pulse is not affected, though the fauces are so ma- lignant, in addition to the bark and wine, and a diet of milk-toddy or wine-whey, the use of red pepper would be advisable, as practised in the West Indies: viz. red pepper two spoonfuls, salt the same quantity, beat them fine, and pour on half a pint of boiling water; draw well; adding eight ounces of vinegar. One table- spoonful must be given every half hour. It may be also used as a gargle. Sinapisms might be used in angina maligna, particularly to the feet, when the disease be- comes comatose. The bowels are to be strictly watched, and treated as in scarlatina anginosa, with astringents. There being a wide difference in the opinion of phy- sicians respecting the use of blisters in scarlatina ma- * See the article bark, in the apothecarium, at the end of the book. t One to two grains of corrosive sublimate to an ounce of water. ERUPTIVE DISEASES. 9? ligna, we may (after the following observations) leave it to the choice of the practitioner to use them or not. Dr. Thomas objects to them, and uses sinapisms in their place. Dr. Rush acknowledges that he has seen them produce great benefit in this disease, and Dr. Gregory prescribes them. It would appear that there are opportunities of using them with great advantage; and that at other times no more benefit might be ex- pected than from sinapisms, and much more incon- venience and risk. In the early part of the ulcera- tion of the throat, before the whole system has fallen into a corresponding condition, we may certainly apply blisters to the throat. The use of them in erysipelas, and their power of arresting the progress of mortifica- tion, fully justifies their use. By it we may expect to produce a better condition, and a diminution in the extent of the ulcers; and by the discharge on the sur- face to prevent the enlargement of the glands on the exterior surface. Moreover, the febrile action may be somewhat equalized by it. But when the ulcers have gained their worst condition, and arrived at a state of enlargement, so as to occupy the whole surface, they require only simple and powerful astringents, and an- tiseptics as the last hope. And the system when so brought down, by the progress of disease, requires only simple stimulants and antiseptics to preserve life. Blisters may then give place to sinapisms. A camo- mile poultice and washes of decoction of oak bark will keep the sore from the blister in good condition. The author, therefore, advises them under the above circum- stances. When patients are affected with stranguary in any of these grades, warm camomile injections into the bowels are to be used first, and then some of the artificial aerated alkaline waters;* but when very obsti- nate, the catheter will be necessary. Very troublesome dropsical affections follow in some cases after the dis- ease has passed off. These are to be treated with * When these are not to be had, the effervescent draughts may be used. See apothecarium, at the end of the book, for the preparations of it. 9 Q8 ERUPTIVE DISEASES. cream of tartar and saline diuretics: such as the aerat- ed alkaline draught, artificial mineral water, acetated potash, spirit of mindereus, with an excess of acid in it, Sic. In some cases of great debility the bark and steel are necessary additionals. Perhaps a good deal of the subsequent diseases, here mentioned, are owing to the patient returning too quickly to a full animal diet, which is too stimulating for the weak vessels; or has neglected to keep his bowels in a regular natural order, by diet and medicines. Children are often troublesome patients, refusing every thing by the mouth. They may have enemas of bark, as well as the embrocation of the spirituous decoction of bark. They will in general take freely of acid drinks a little sweetened: whether quinine will substitute bark as an antiseptic, is very doubtful. In the small haemorrhages, or bleedings from the mouth, it is usual to apply finely powdered galls. Wild geraneum will do as well. If the parts cannot be reached, a decoction of the same may be injected, or some alum water, with a few drops of elixir of vitriol.* ERYSIPELAS, OR ST. ANTHONY'S FIRE. Causes.—A hereditary disposition thereto, or a pe- culiar delicacy of the part that suffers in the inflam- mation; passions of the mind; a sudden cooling of the body after being heated by the sun; spirituous liquors taken freely; hot drinks, or hot baths, checked evacua- tions, moist air, perspiration any how stopped, and severe cold, generally excite the disease, in those pre- disposed, and sometimes in any person. Symptoms.—It commonly comes on with shivering, and succeeding heat with fever. The pulse is generally quick, sometimes hard and full; a confusion of the head, * An astringent—alum ten grains, blue vitriol two grains, elixir of vitriol five drops, water ten ounces; to be used with a syringe, to stop small bleedings from the nose and throat. gf- The preparation of bella donna is as follows: three grains of extract dissolved in an ounce of mint or cinnamon water; three drops for an infant of one year, four for one of two years, adding a drop for a year; take it nine days. ERUPT1VK UIStASta. 99 and some degree of delirium frequently attend; but a drowsiness almost always, which sometimes increases to a comatose state. After these symptoms have con- tinued from one to three days, a redness, most com- monly on the face, appears, which increases with a swelling, that turns white upon pressing it with the flnger. This goes on to increase, though it commonly abates in one part to increase in another; in this manner it sometimes extends all over the head, and swells the eyelids so as to produce temporary blind- ness. Other parts are sometimes the seat of disease; as the legs, back of the hands, &c. It is not an uncommon case for blisters to arise on the swelling, filled with yellow or whitish serum, which break after a while, and leave the part underneath blackish, and very ready to turn gangrenous. The skin between these blisters peels off. Matter is sometimes discharged from the eyelids. The inflammation afttf fever usually continue about ten days, and then go off. When the fever goes on violently, and the inflammation extends, it is apt to produce an apoplexy in some constitutions. These are the symptoms of a perfect disease, but slighter affections are not unfrequent, with little or no fever. Management.—The patient should be kept cool, in proportion to the greatness of the fever; acid drinks and vegetable diet should be used throughout. Treatment.—When the case is general and febrile, agreeing with what is laid down above; a pint of blood should be taken away, which may be repeated if the habit allow, and the pulse and inflammation require it. After bleeding, cooling purgatives should be administer- ed: one drachm of salts and one-quarter of a grain of tartar should be given every two hours, mixing it with lemon juice, which covers the bad taste. The parts inflamed should be washed with lead water made pretty strong. This practice of administering salts may be followed for some days; they not only open the bowels, but temperate the heat and fever. In slighter cases, bleeding need not be practised, but the medicines given, as directed in severe cases. 100 ERUPTIVE DISEASES. Whenever there are symptoms of putrifaction, as a low, weak pulse, dark covering of the tongue and mouth, acrid and black spots underneath where the blisters stood; then, all evacuations (except keeping the bowels regular with a little rhubarb) should be laid aside, and decoctions of bark given, and the dose in- creased as necessity requires, or as it will sit on the patient. Wine and water, and vitriol and water, made by putting two teaspoonfuls of elixir of vitriol to a pint of water, may be drank alternately and freely.— The patient is almost always wanting some topical application; for this, physicians have thought that meal sprinkled on the part is the only proper application. This, when the inflammation is considerable, sits agree- ably, and has some effect in softening the skin, and if sprinkled on very slightly, when the blisters discharge, it dries up the humour. However, patients are not content with it; therefore, apply ekher of the follow- ing: half a pint of strong tea of camomile flowers, fif- teen grains of white vitriol, and a teaspoonful of laud- anum. Or use a solution of alum, as below.* Sometimes, from neglect, the part suppurates; when so disposed, it should be poulticed, with bread and milk, till it is ripe, when it should be opened and dressed with lint, spread over with some simple cerate; and this need only be applied over the sore. In addition to what is said above, we may remark that the application of blisters is revived, of late, in erysipelas; and as they are so potent in arresting mor- tification, may often be used with advantage; and, per- haps, even in those external inflammatory cases, if applied near the parts, would be followed by the same effects as when applied in phlegmonous inflammation; that is, they would lessen the extent of the local affec- tion, and hasten the suppuration. When applied to arrest a gangrenous tendency, slips of the blister plaster are to be placed all round the edges of the eruption, three-quarters of an inch deep, and extending upon the sound flesh—the interstice, or area of the eruption, * Re. allum ten grains, water one ounce. ERUPTIVE diseases. 1U1 may be sprinkled with finely powdered camomile, and confined on by a covering of gauze or fine linen. In the more phlegmonous cases, when suppuration is formed deep, the matter should not be trusted to break through, but the parts scarified to reach it. Some physicians recommend mercurial ointment as a topical application: if it be of use, it must be in such cases as are of an intermediate cast; that is, inflammatory only to a certain degree, and not highly so. These being very common and not dangerous, many things may have a good character without deserving it. Bark and vitriol, with fresh air, gentle exercise in a carriage in fair weather, will be proper to brace up the system. URTICARIA, OR NETTLE RASH. Causes.—This disease is also called essera. It at- tacks those of a delicate constitution, and those who have been made delicate by other diseases; particularly by intermittents. It is frequently found to accompany the febrile paroxysms of an intermittent fever. See Cul- len's Nosology. Women and children, from their fine skins, are more liable to it. It is also said to be produced by certain diets: such as fish in bad order, or naturally unwholesome. Indeed, all the aquatic articles of diet seem to have been accused. A glass of wine will pro- duce it in some habits, and even the white of an egg applied to the skin will produce it in some instances; but the first mentioned causes are the most common. Symptoms.—Some febrile symptoms precede for a day or two, and the eruption generally comes out in the night. It will often recede, especially in the day, when the skin is cool, and come out when heated by the bed. It will last from a week to months. The form of the eruption will always distinguish it. Some- times it will be all in raised lumps, like musquitto bites; at others, it will be in wheals, or like the stroke of a whip; quite solid, never suppurating, or forming ves- sicles. The upper arms, neck, breast, and sides, are 9* 102 eruptive diseases. the most usual places of eruption. The itching is very troublesome. CURE.—The patient should take a little cream of tartar and sulphur to keep his bowels regular, and drink plenty of sassafras tea. For more chronic cases mercury seems most effectual. The blue pill is suf- ficient.' Virginia snake root has been recommended. Perhaps the nitro muriatic acid might do as well as the mercury. For topical applications starch is used; but when the eruptions are very distressing, a mixture of one ounce of sweet oil, one teaspoonful of laudanum, and as much extract of lead may be used frequently. A tepid bath should be used, once in a while, to clean off all perspiration from the parts. But when the eruptions have disappeared for a while, the patient should try to invigorate his constitution, and to avoid returns: by travelling, by taking bark and steel in moderate quantity, but by not using any spirituous mix- tures. Infusions of bark, and pills of the rust of steel, will be the best. Bathing in a salt bath will also harden the skin. It would be well for the patient to sleep on a mattrass, especially during the eruption. ICP A quarter of an ounce of snake root makes a pint of tea; this may be used in a day or two, at most. In using the blue pill one may be taken morning and night, till fourteen are taken, using the sassafras tea at the same time. After waiting a week, the same number of pills may be used again. ITCH. Causes.—This troublesome and loathsome disease is in general the effect of filth and cold. It is fre- quently communicated by sleeping in beds where itch patients have laid, at inns, on the public roads. It is also no uncommon disease at boarding schools. In long spells of cold weather it will attack persons who have lived comfortable and clean. A fish diet, without a full portion of vegetables, has been supposed a source of this disease. ERUPTIVE DISEASES. 103 Symptoms.—Small red itching pimples break out between the fingers and other parts, and fill with an irritating water at top, which becomes so intolerable by the heat of the fire or bed, that the tops are scratched off, and little ulcers are left. The disease is thus ex- tended; and it will last a long time when no means are used to remove it. Management.—Cleanliness, bathing in tepid water, and a low diet of vegetables, are necessary to a cure; sleeping on a mattrass, keeping from the fire and from ardent spirits, are also necessary. Cure.—There is nothing so effectual as an ointment made with sulphur and lard, rubbed over the whole body, for four or five nights, taking great care not to take cold; but this is a very disagreeable remedy.— Some soap dissolved in rose water to a jelly, and mixed with a teaspoonful of fine white precipitated sulphur to each ounce, is the most agreeable of the sulphurs. Though some persons think that in an early affection a glass of sulphur* is sufficient. A flannel shirt may be boiled in a pot of water, in which a roll of sulphur, and a tea-cup of common ley is put; it is then dried in the shade, and worn at night. This was nearly the plan of a celebrated traveller, who assured the author that after adopting it he had no farther trouble. Mercury is the next most usual application. The white pre- cipitate ointment, and the weak red precipitate oint- ment, and citrine ointment, are the most effectual. Weak solutions of corrosive sublimate, say four grains to an ounce of water, with a pinch of salt to dissolve it, may also be used. Those mercurials are well suited when there are little ulcers; but in all their applications, only the eruptions must be touched, morn- ing and evening, and even then some care used to prevent salivation. The ointment of white helebore is used much as a nostrum. It will, however, if freely used, produce a temporary paralysis in a feeble patient. Fowler's solution of arsenic is sometimes used; it * The French put some sulphur and nitre in a cup of coals, and put the cup into a warming pan, and thus fumigate the bed. 104 eruptive diseases. must be diluted with forty times the quantity of water. There is no question but what a purge or two of salts will facilitate the cure, and in most obstinate cases both sulphur and mercury have been used internally with advantage. Tepid bathing and the decoction of sar- saparilla, may be then joined in aid. CHAPTER IV. INFLAMMATION OF THE BRAIN, (PHRE- NITIS.) Causes.—The excessive use of spirituous liquors, sitting up at night, violent passions, grief, exposure to intense light and heat; exposure of the head to a hot sun whilst the feet are on cold ground, as in digging of cellars or marching of armies; suppressed discharges; as of the piles, menses, lochia. It is also sympto- matic in some fevers, and in erysipelas; and has been found to form a metastasis with some diseases: par- ticularly with pleurisy. It is not unfrequently the effect of a contusion of the head. Symptoms.—It sometimes takes place instantaneous- ly, at others it has premonitory symptoms; such as pains running up the back of the neck, head ache, con- fused ideas, forgetfulness, dreaming, sparkling of the eyes, noise in the ears. But in common it commences with rigours, violent head ache, fullness of the face and neck, with dropping of blood from the nose; red eyes, throbbing of the temples, inability to bear light, or sound, disturbed sleep, and restlessness. A fever more or less violent ensues; the pulse is oppressed and quick; and at other times it is hard and full. The patient continues without sleep, sometimes a week, and becomes delirious, and disposed to suicide; re- fusing obstinately his medicines. Sometimes very early convulsions take him off; at others he sinks into coma, or dies by febrile exhaustion. It is a dangerous disease, and requires instant and powerful remedies to prevent effusions or partial suppurations in the brain, with their concomitants. Studious persons, in youth and full habits, are said to be most subject to this disease. Management.—Perfect darkness and stillness is 106 DISEASES IN AND ABOUT THE HEAD. here necessary; and mere drinks of water are all that is wanted in the first days; after which, barley water and gruels will be necessary. A strong nurse must attend to watch the patient; and all knives and means of injury put out of his reach; the windows should have bars. Cure.—There is no disease that requires more, if so much bleeding, in a short time, as this: twenty ounces should be taken away from a good large orifice, and repeated in a few hours; or if the patient is found unable to bear more in that way, and the disease con- tinues, leaches or cupping the head and neck must be resorted to.* The bowels must be well emptied by a full purge of jalap and calomel, with a little nitre and tartar in it. If the patient can bear no more bleeding a large blister may be immediately laid on the neck; or whenever there is a reduction of symptoms, produc- ed by bleeding and purging, it may be applied. There is much difference of opinion about using cold appli- cations to the head, and they are certainly dubious; for they will at all events check all perspiration from the surface where they are applied; but this is not all, if they are applied without producing (in conjunction with the other remedies) a permanent reduction of the inflammation, the inevitable consequence is, an in- creased reaction: just as when a well man retires from a cold bath. This is common to all cold applications made of that temperature which will not merely ab- stract heat, but cause the circulation to retreat from the part. To obviate this, some recommend a tepid ablu- tion of vinegar and water; perhaps the best application would be what the author finds his best topical appli- cation to severe rheumatic inflammations; viz. a very strong lead water, made with half an ounce of sugar of lead to a quart of vinegar and water, which may be brought up to the temperature of the body, or nearly * Some physicians are of the opinion that half the quantity of blood taken from the temporal artery will answer; and in old topers this may be most prudent, as they faint very quickly. A piece of gum elastic pressed over the orifice will stop the artery. DISEASES IN AND ABOUT THE HEAD. 107 so, and applied in doubled folds of linen to the shaved head. If the feet are cold they must be sponged with warm water, and sinapisms applied to the ankles.— Powders of nitre and antimony may be regularly given, and strong enemas of salts used in a few hours after purging has ceased, as also before it begins. Fox- glove would seem, in cases verging to chronic inflam- mation, to be useful; as also a gentle salivation. When the disease arises from suppressed evacuations, all attention must be given to restore them, if possible. In piles and in obstructed menses, irritating enemas will be of use: such as may be made with aloes and balsam copaiva, dissolved in sugar and mixed with a com- mon soap clyster. Great attention is necessary to be given to the convalescent, that he expose himself very gradually to the light and air; and he must return very cautiously even to a plain diet. A little elixir of vitriol and camomile may be necessary, if he has been much reduced. His bowels must be attended to for months. A relapse is e'asy. APOPLEXY. This disease attacks from middle to old age: more commonly men, with large heads and abdomen, short necks, and strong large pulse, who have obstructions (especially in their liver,) and are subject to head ache. Those who live a luxurious indolent life: feeding high, and drinking hard, laying in bed, or sitting in a chair or sofa, the whole twenty-four hours; or what is worse, sitting up and carousing at night, will add a moral to a physical cause of apoplexy. To this latter list we may add another set of a different cast; viz. grief and care. When any of the above causes, single or combined, have predisposed the system to this disease, there is only wanting some occasional cause (which would be insignificant, if alone) to bring on apoplexy; such as an accustomed head ache, too long exposure to cold, a concussion of the head, a fit of passion, a long speech, or any fatigue, suppressed evacuations, 108 DISEASES IN AND ABOUT THE HEAD. any great effort of the muscles, stooping down a long time, and finally a frolic* There can be no doubt but what it will march, pari passu, with the increase of our large cities, and the low price of spirituous liquors. But it must be confessed that the care which attaches itself to the modes and trade of a great city, is the source of a very great portion of this disease, and its recent increase. A comparison of the present with fifty years back, taking the same number of inhabitants, will satisfy the most incredulous on this point.t And it were well if care and drink were here to end; but whence comes moping melancholy, pining atrophy, or raging mania? Women, children, and the coloured race, though these latter are intemperate, nearly escape this disease; because they have comparatively no care. The servant is fed and clothed, and whilst he sleeps like a top, his master is tossing on the midnight bed, either pro- jecting schemes to make his fortune, or what is more common, how he may (like the general mentioned in scripture) with ten thousand, meet his enemy who is approaching with twenty thousand; or how he may make terms with him. Symptoms.—Sometimes ahead-ache, drowsiness and swimming of the eyes, or a faultering of the tongue and memory precede; or some disturbance of the sto- mach or nerves. At other times it gives no warning: the patient bows his head over his plate, or falls from his standing; losing the power of motion. His face is flushed, his eyes become swollen and red, his breathing laborious, with snoring. The pulse, if not immediately, is soon full and slow. Partial cases are not unfrequent, where the sensibility of some part is blunted, or its * It is no uncommon thing for twenty toasts, at a feast, to be publicly announced, in which every body's health is drank, while the guests are destroying their own; and although some merely sip the glass, others are taking bumpers to expiate the sins (against Bacchus) of the timorous. Is not this a species of suicide? t In a medical practice in the city of Annapolis and its neighbour- hood, for ten miles round, embracing at least three thousand inhabi- tants, or more, there were not, from 1788 to 1793, more than one or two cases, per annum, of apoplexy. The author was then a student there. DISEASES IN AND ABUUi mii HEAD. 109 motion impeded by a paralysis. The length of one of the perfect fits is from one or two hours, to as many days. Death is sometimes instantaneous, and at others takes place after a day or two. A vomiting, sweating, purg- ing, or evacuation of blood, generally attend recovery. It is not long, however, before the patient experiences that he is travelling on to another attack, (especially if he returns to his old way of living,) which most of them, from blunted sensibility of mind, seem more readily to do. It is seldom that the third attack is needed to carry the patient off. Though some have resisted four or five. Management.—Every means must be used to give the patient breath: his head must be a little elevated, his shirt collar unbuttoned, his waistcoat and gallowses loosened; a little water must be frequently put into his mouth; and if he recovers from his fit, every cause that can be removed must be attended to. If he is a towns- man, he had perhaps better remove to the country, where work is daily offering to relieve him, and absti- nence and frugality no sin; and where he may soon fix what customs he pleases on his new visitors and acquaintances. Cure.—If the patient is of a robust and sanguine habit, at least one quart of blood must be taken in- stantly, and not much less in any other cases. A re- petition of bleeding, in less quantity, will be needed, if there is any delay in arousing him, and this must be followed up till the pulse feels the evacuation. A blis- ter of large size must be laid on the neck, reaching down between the shoulders, and whilst this is inac- tive, sinapisms (which act quickly) must be laid on the ankles and feet. A strong purge of jalap and calomel, or aloes and calomel, must be given; and whilst that is inactive, very strong enemas of soft soap, with water, must be given. As the patient, at first, may be unable to swallow, four ounces of castor oil and fifteen grains of calomel, mixed and warmed, may be injected down the throat, with a long elastic tube fixed to a syringe; or some salts and tartar, say two ounces salts 10 110 DISEASES IN AND ABOUT THE HEAD. and one grain of tartar dissolved and used the same way* The enemas must be often repeated, and the purges also, till he revives sufficiently. Issues in the neck are used to prevent returns, as also purges and bleeding: this last remedy must be regularly performed, as it will become habitual; and then, if neglected, would be a source of disease. Physicians have divided apoplexy into san- guineus and serous; but the distinction is null and use- less in practice, because the same remedies are neces- sary in both; and they cannot be distinguished but by dissection. The author has omitted many of the premonitory symptoms of less note, because they are common to other diseases; and might, therefore, give great un- easiness when there is no cause; such as the following: noise in the ears, flashes of light before the eyes, spasms of the eyelids and lips, nightmare, temporary blindness, torpor and inaction of mind and muscles, throbbing of the vessels about the temples, and bleed- ing at the nose. But when the patient has an apo- plectic constitution, and is using the means to induce it, such symptoms should awaken him to a retrench- ment and depletion. Two table spoonfuls of soft soap to one pint of water make an ene- ma, or twenty grains of finely powdered gambouge, and half an ounce of spirits of turpentine, in some broth or milk, is also a very stimulat- ing clyster. The following table, taken from a French author, by Dr. Dewees, may be worthy of notice, though foreign tables are not to be consider- ed as good as those that might be drawn up in our own country. From 20 to 30---- 2 30 to 40---- 8 40 to 50---- 7 50 to 60----10 60 to 70----23 70 to 80----12 80 to 90---- 1 63 Patients. It is probable that a table drawn up at this place would enlarge the numbers from 50 to 60, and lessen them from 30 to 40, and from 70 DISEASES IN AND ABOUT THE HEAD. Ill INFLAMMATION OF THE EYES. Causes.—These are external and internal: frequently both unite. The external are, violence, dust, lime, mineral fumes, smoke, insects, cold, strong winds or air directed against the face; very brilliant light, too long applied; sudden changes of weather from heat to cold; viewing (too long) minute objects, or straining the sight to accomplish a full vision of objects naturally obscure, or made so by a dull light; night reading and night watching; passing through woods when the pol- len of the flowers or the down of the leaves are dis- charging; an epidemic state of the atmosphere, and perhaps contagion. The internal causes are checked or retained secretions; as scald head, itch, Sic; long con- tinued ulcers dried up without issues being put in; im- moderate use of spirituous liquors and of spices; fevers, measles, small-pox, scrophula, venereal disease, Sic Symptoms.—An uneasiness of the eye as if it were dry or had sand in it; redness of the vessels, swelling of the lids, pain, discharges of different kinds: watery, gummy, or purulent. In many cases a feverishness attends. Management.—All causes, if possible, are to be re- moved. If dust, &c. by simple washes, or oil applied with a syringe. If diseases are the cause, remedies must be applied for them, if they are still accompanying the local disease. A green silk shade, or green glasses, must be used according to the degree of disease; if bad, total darkness is necessary. The diet must be entirely of vegetables; and the drinks acids: such as for fevers, and no spirituous or fermented liquors used. Goggles will be necessary in riding after getting well, as the eyes will be weak; and on this account reading must be omitted for a while, especially at night. All other sources must be avoided, as a habit of disease may easily be acquired. Cure.—If there be any fever, bleeding will be neces- sary, and repeated doses of salts, or other cooling purges: such as nitre and jalap. A blister behind the 112 DISEASES IN AND ABOUT THE HEAD. ears will often have a powerful effect. Washes for the eyes are made of sugar of lead and white vitriol: fifteen grains of either may be put to a pint of rose water, or eight grains of each to the same quantity of very thin mucillage of gum arabic; these are best applied with an eye glass, or with folds of fine linen, and must be applied very frequently. Sometimes these affections are obstinate and painful, requiring a trial of many remedies. Sometimes poultices will answer; bread and milk, or elder flowers are used. Sometimes mercurials are needful, especially when the affection is of long standing: one grain of corrosive sublimate must be boiled in a glass, or china cup, with three ounces of water, and the eyes washed frequently. Dr. Shippen used to make incisions across the inflamed vessels. The point of a lancet may be guarded with two pieces of polished ivory put on the blade of the lancet, but shorter, letting one-sixteenth of an inch of the lancet project beyond the smooth rounded ivory; and the ves- sel then cut. Little or no pain will ensue: so that the patient will request the operation after once feeling the insignificance of the pain. Opiates are sometimes found useful. Either poppy heads or a watery tincture of opium may be used.* The late Dr. Gilder, of Balti- more, in his extensive practice, used flowers of zinc, in most cases, from the beginning: as much as will go on the sixteenth of a dollar may be put to two or three ounces of elm or flaxseed tea, or of thin mucillage of gum arabic, and applied. Astringents will sometimes answer the best, such as alum curd, made by beating the whites of two eggs with a lump of alum till it coaju- lates; it is then to be laid between a fold of gauze and applied to the eye. In all cases where the eyes are glued up during sleep, some simple ointment, such as nice fresh lard, beat up with rose water, should be laid on before going to sleep. Issues in the arm are used in chronic sore eyes; and waters in which iron has often been quenched, is used to strengthen them, when merely • One table spoonful of the watery tincture to half a pint of water: this and the poultices are needful in great pain. DISEASES IN AND ABOUT THE HEAD. 113 weak. Some of the faculty have great faith in emetics, and no doubt when the disease is febrile, they will be useful. After the eyes have been sore a long time, and especially when affecting the tarsi, the eye lashes will pass their roots through and scratch the eye ball, and thus keep up disease: they must be extracted. Many of the chronic diseases are, in fact, an eruptive disease of the tarsi; such are easily cured by sulphur. See the ointment. The eyes are subject to a purulent discharge in in- fants. This yields to astringents and corrosive subli- mate washes, using a little castor oil frequently; one grain of this (mercury) boiled in five or six ounces of rose water will be sufficient. It may be applied morn- ing and night, or oftener. The Egyptian sore eyes is of this kind; bleeding and blistering are recommended. Perhaps the corrosive sublimate washes would be useful. However, we hope that we shall not be visit- ed with it. One of the British officers, who had it in Egypt, told the author that the British physician gave him salts daily. Some consider the purulency depend- ing on the magnitude of the inflammation; whilst others consider it to depend on the particular part of the eye affected. From children being as it were born with it, there could not be such an intense inflamma- tion; but there may be something constitutional giving the peculiarity. Films and opacities are often consequences of sore eyes; they will sometimes yield to strong lead water; if not, they will to calomel* ointment. Mr. Abernethy recommends aether to be applied for opacities following blows. Preparations of copper, as also of red pre- cipitate, are recommended for specks and films; where small ulcers form, the mercurials will be the best.. 10° Lime is one of the worst articles to get in the * See the apothecarium, how to prepare it. Fifteen grains of livigated red precipitate may be mixed with one ounce of oil, or thin lard, and a little applied night and morning. Three grains of ammoniate of copper may be dissolved in a table spoonful of water, and a little applied morning and night to the opacity w film. But the calomel is far the safest and best. 10* 114 DISEASES IN AND ABOUT THE HEAD. eye* not a moment should be lost to syringe it out, first with water, and then with sweet oil; perhaps a weak solution of oxalic acid, so as not to affect the eye with inflammation, used before the oil, might unite with some of the particles of lime, and take off its causticity. Insects will sometimes get into the eyes of children, at night, and the whole external parts be so swollen as to retain a spider, or small beetle. Strong syringing and inspection by opening the parts with tenderness, is needful. QUINCY (CYNANCHE TONSILLARIS.) Causes.—The application of cold to the neck in riding, or sitting in currents of air; fatiguing the parts by long speaking* or singing. Longstanding in cold, damp fields. These causes are pretty sure to cause quincy, or some degree of sore throat, in those of an inflammatory habit; and more especially if any natural or artificial evacuations have been retained. It is said to be found most frequently in the young, and in red haired people. Symptoms.—An uneasiness is felt in the glands of the throat, which, on examination, are found to be en- larged; the inflammation extending to the palate. A chill often takes place, and a very considerable fever follows. After a while, the inflammation extends, and then the throat is so completely stopped, that what the patient attempts (with great difficulty and pain) to swallow, is forced through the nose. The whole arch of the roof of the mouth seems to bag down and fill up the fauces in bad cases. In this way the disease runs on from three to seven days, and then suppu- rates; giving full and instantaneous relief. Some- times the whole external throat will also swell, and the obstructed circulation make the patient look fright- ful. Sometimes the aspect of the inflammation of the * Perhaps no person ever suffered more, or oftener, than bishop Asbury, with this disease, always on horseback, in all weathers; and gouty or rheumatic, by habit. DISEASES IN AND ABOUT THE HEAD. 115 fauces will be purple, like an erysipelas; and some- times the glands of the throat will be hard and firm for a long time, without any disposition to suppurate: like a scrophulous inflammation. The extent of this disease, at times, is so considerable, that it will enter the gullet, or the windpipe, or inflame the exterior muscles of the face and neck. In the erysipelatous kind, the suppuration or discharges are rather super- ficial. Few patients die with it, though at times it is very distressing. Management.—The patient should be propped up; so that when there is a discharge of phlegm it may issue outwards, and not provoke him to vomit. Some washes may be used to put in his mouth, made of barley water. His room should be pleasant, but not warm, and well ventilated. No attempts should be made to talk; all communications must be done by signs or a slate. Cure.—It is true that the disease seldom ends but by suppuration; nevertheless, it is prudent to bleed pretty freely, and purge very briskly with salts, before swallowing is impeded. A large blister on the neck will often reduce the extent of the disease, and hasten the suppuration. Poultices may be put to the neck, on the parts that the blister did not occupy: bread and milk, bran and vinegar, bran and lead water, make good poultices. The lead water may be used as long as there is any hope of preventing suppuration, after which the other poultices are preferable. When it is found that suppuration must ensue, the steams of vine- gar and water may be inhaled; but if the swelling threat- ens suffocation, these steams had better be let alone; and in an extremity, a large incision or two may be made in the most prominent parts. Dr. Gregory ad- vises small incisions in the palate, at first, to prevent suppuration. When chills have taken place, we may be sure of finding matter, if the tonsils are lanced. The use of the cold bath, or at any rate washing the neck in cold water daily, and the tying up the throat with a handkerchief, in windy cold weather, is recom- 116 DISEASES IN AND ABOUT THE HEAD. mended; which, with thick soled shoes, used early in the fall, is among the best preventives. In habitual relaxation of the throat, chewing Peruvian bark has been very useful. This disease will sometimes leave enlargements of the tonsils; which, if very troublesome, are to be at- tempted first with astringents, and if not removed that way, must be extirpated by a wire tied round them, so that they may slough off.* MUMPS. Cause.—Contagion is supposed to be the cause. Symptoms.—It makes its appearance with common- febrile symptoms, viz. chills and heats, with an in- crease of pulse. This is soon followed by a swelling at the corner, or angle, of the lower jaw, of a movable, glandular appearance; which in a little while diffuses itself over the whole neck, on that side. Sometimes both sides are affected. It continues to increase till about the fourth day, and then declines with the fever. As the aboye recedes, some intumescence is apt to affect the breasts of females, or testes of males. In some cases where these latter swellings have receded, or have never taken place, the febrile symptoms become extended; and even delirium will sometimes ensue. Management and Cure.—The patient should be kept on a vegetable diet, and watery drinks; and also remain within doors. When no untoward symptoms ensue, ve-ry little need be done: a dose of salts, or castor oil, may be taken, and the parts swollen wrap- ped up with a flaxseed, or bitter herb poultice, to soothe it. But should delirium ensue, bleeding and purging will be necessary; and some volatile linament may be applied to the breasts, or testes, after a warm bathing; provided there has been no observable secon--. dary affection in these parts. * The author has experienced inflammatory quincy; not only suppu- rative, but that species with a hard unyielding polished tumor; and he found no application to the latter but what irritated, except strong warm hyson tea without milk; this always produced an exudation, and relieved the difficulty in swallowing. DISEASES IN AND ABOUT THE HEAD. 117 HEAD ACHE. Though this is symptomatic in a great variety of diseases, yet it is often both an independent and a severe disorder; requiring in such idiopathic cases a separate chapter. For the better management, as well as perspicuity, it will be considered under four heads: viz. Inflammatory, Rheumatic, Nervous, and Dyspeptic or Stomachic, Head Ache. Inflammatory Head Ache proceeds from intemper- ance, night watching, costiveness, long exposure to sun, heat or severe cold, suppressed evacuations, and gouty diathesis. The pulse is always full and strong, the eyes com- monly inflamed, the bowels inactive, the stomach not much disturbed; merely a loss of appetite at times. Cure.—Abstinence, rest, brisk purging with salts; and if severe, or likely to last, bleeding at the arm, or leeching, are necessary. There is always danger of this ending in apoplexy, in full habits; and if the pulse has a remarkable strength, and hardness, and fulness, as if the artery were actually increased in its volume, (no matter how thin in flesh) the patient may rest as- sured that apoplexy is not far off, unless every means are used to prevent it. Gouty head ache is only relieved, finally, by ab- stinence, exercise, and a warm climate. Lusty and plethoric women, that are pregnant, have this head ache. They should not wait for an attack, but bleed beforehand. Rheumatic Head Ache.—This does not differ so much in symptoms and causes from the foregoing, as it does in the habit and constitution of the patient. The leanest person is as much, or more, subject to it, as the fullest and more sanguine. There is generally some feverishness, though not always. Other parts beside the head are often affected: such as the neck, jaws, and shoulders: such persons have rheumatic affections, often without the head being disordered. 118 DISEASES IN AND ABOUT THE HEAD. A very common source of this species of head ache is too thin a covering of hair. But damp weather will always test this species. Getting the feet wet or cold, exposure to north-east weather, indigestion, costive- ness, Sic, are sources and aids to bring it on. The stomach is always unaffected in this species. Cure.—When very bad it will require bleeding, but in general an early purging with salts, will be sufficient; after which the patient should try to bring on a per- spiration. A large bowl fullof balm, or hyssop tea, with twenty-five grains of nitre, and thirty drops of antimonial wine, may be drank in bed, after soaking the feet in moderately warm water; or in a mustard bath, prepared by putting a tablespoonful of prepared mustard into a gallon of water. If it resist this, and the pulse is not full, a dose of Dover's powder will gene- rally have effect. Shaving the head, and wearing a cap, or wig, will, in a great portion of cases, prevent returns. The patient's room should be warmed during the attack with a stove, in winter, night and day, with a steady agreeable heat; this is all important. A fur cap, and a flannel pillow case, will also be useful. And flannels next the skin are indispensable in winter. The cold bath in summer, especially if the head is shaved, will be excellent. Patients should always keep near them a box of good aperient pills, and never suffer a day, (especially in bad weather,) to pass without an evacuation. His \ j diet should conspire to this: rye mush and molasses are very aperient. The dyspepsia bread, or bran bread, is also aperient. One of the greatest means to prevent those severe attacks (so common on the first cold weather in the fall) is to anticipate the change, by putting on flannels, tying up the neck, using a cap, when out in the weather, and to have a very thick soled pair of shoes, with worsted stockings, to put on when the ground becomes wet, or cold. The various topical applications are seldom of any use; but should the patient insist on them, spirits of DISEASES IN AND ABOUT THE HEAD. 119 camphor, and preparations of ether,* or laudanum, may be used. Such articles as tincture of guiacum, turpen- tine, and mustard seed, are only suitable when the case -is decidedly chronic. The tincture of stramonium has also had a share of praise in habitual cases. Pukes will sometimes bring on a perspiration, and put an end to it when other things fail. Nervous Head Ache.—This species is found in two very distinct habits; one of a gross, hypochondriacal habit, generally males; the other feeble, delicate fe- males. In the former the pulse is full, the bowels costive, the stomach windy, though not irritable.-— Haemorrhoidal obstructions in these, (gross patients) and irregularities of the catamenia, in the females, are always times of head ache. And in these latter, even their most regular catamenia begin, or close, with head ache. Females feel at times a tenseness over the whole surface, and at others the pain will be concen- trated to the size of a dollar. Neither the stomach nor the pulse will be very much affected in general. The patient will lay as if dead, stupified with the pain. In these it lasts two or three days, but in the gross con- stitutions it will continue sometimes a week. In this case bleeding will often be the speediest relief, followed by brisk purging, with jalap and calomel. The use of assafoetida and stimulants are injurious in such cases, often prolonging the disease. It runs much in families. In females, after a dose of castor oil, senna tea, or magnesia and jalap, some warm Virginia snake root, or valerian tea, may be drank, and then an opiate used in the form of Dover's powder. The tincture of assa- foetida, say a teaspoonful, or as much spirit of laven- der, may be used after the other remedies, if the pulse is low. Warm enemas are very useful, and the stove heat, when the pulse is low, must not be neglected. , The stimulating topicals may here be useful. A little * One ounce of ether and one of brandy may be mixed, and one or two of strong vinegar added, for an embrocation to the head. Lauda- num may be put on paper and applied. A mustard plaster is often of great benefit. Camphor is a very common application; as also a horse radish leaf, all of which suit nervous head ache. 120 DISEASES IN AND ABOUT THE HEAD. camomile tea, when recovered, will not be amiss, and pills of aloes and salt of steel, with cold bathing, may be used in the intervals. Those gross hypochondriacs (who are in some in- stances females) may find a preventive in a low diet, and purges of tincture of aloes to keep up their hae- morrhoids; not neglecting free exercise. This will be better than trying to evacuate their surplus fat and flesh by chewing, or smoking tobacco. Dyspeptic, or Stomachic Head Ache.—This is the most common species. It comes on after every irre- gularity of diet, or exposure; and in females, associates with the catamenial period. It seldom leaves the pa- tient a whole month of health: a fatigue is sure to end in stomachic head ache. Its duration is from one to three days. Patients are frequently aware of its ap- proach; and if they have fortitude enough to begin at that moment, to take it in hand, it becomes a short and sufferable disease: but when neglected, is a dread- ful affliction. It is attended not only with excruciat- ing pains, but also with vomiting of undigested food, and wind, strong acidities, and phlegm; which for the moment augments the distress, but certainly shortens the disease. There is often considerable fever attends. The distinguishing symptom of this species, is the great disorder of the stomach, from first to last; and the sudden restoration, to full health, in a few hours after it recedes. Cure.—The method of cure is to refrain from all meats, teas and coffee, from the moment the disorder is discovered to be advancing, taking only some very simple articles to satisfy the appetite: such as a little thin broth, toast and water, or soft egg, and one dish of tea, morning or evening. A purge should be taken as soon as possible: a large tea spoonful of magnesia, with ten grains of jalap, is a very good one; when this is about ceasing to act, the patient must either.take a second . one, or a pill of aloes and calomel. Duplicate[purging ' is the main thing,- one purge, unless ffehtirely removes the disease, makes it worse when it ceases to operate. DISEASES IN AND ABOUT THE HEAD. 121 After this duplicate purging, if the disease continues, an opiate will be sufficient: a teaspoonful of pare- goric, and twenty-five drops of antimonial wine, will be enough. The head must be covered, and the room warmed with a stove, night and day, in winter. The mere going out of the fire reinstates all the pains. Bathing the feet, is sometimes useful as a preventive. When a patient is pregnant, and has this species badly, she may be bled with advantage. Piles that do not bleed, and procidentia, are often connected with this species of head ache. EAR ACHE. The great severity of this pain makes it worthy of medical attention. Causes.—A current of air applied to the ear, or to any part of the face, especially when the gums are relaxed and liable to inflammation, or the teeth in bad order: for by a sympathy, the ear will take off the affection from the gums and teeth. Also, small boils and ulcers in the meatus of the ear: extraneous matter lodged in the ear; the entry of various insects, particu- larly of the beetle kind, with strong sharp claws and forceps, with which they lacerate the tender organs of the ear, trying to penetrate deeper. Management.—When it proceeds from cold, the patient should cover his ears with a handkerchief, and if attended with fever, return to bed, drinking only warm herb teas, with a little nitre, and keeping silence, as talking is very injurious, from the proximity of the joint of the jaw to the ear. A stove heat in winter will be very useful. Cure.—When there is a considerable fever, the patient should be bled, take a dose of salts, and apply a poultice of flaxseed to the ear. A blister should be applied behind his neck. Every effort should be made to prevent suppuration. When small boils are the gf- Pukes are useful in nervous and rheumatic head ache; but not so in this. 11 122 DISEASES IN AND ABOUT THE HEAD. cause, a warm poultice, and injections of warm oil, or milk, and steaming with vinegar and water, will be sufficient; for they will suppurate. When ulcers are the cause, the injection of oil, and the application of a very weak solution, made with two grains of corro- sive sublimate and five grains of common salt to three ounces of water, should be frequently applied by means of a camel's hair pencil, and the ear well covered from the air by a common poultice, or some cotton. This precaution is absolutely necessary in all cases. When an insect has entered, some brandy, or to- bacco tea, or spirits of turpentine and oil, should be poured into the ear, to destroy it. And when peas, or small sticks, are put in by chil- dren, they must be extracted: a piece of silver wire, a little turned at the end, like the letter r, (in print) may be used to pass beyond the body, and bring it out. Prevention is always better than cure. And when a patient has repeated attacks of ear ache, he should examine his gums and teeth, and remove every defect,* and also keep a little wool in the ear, when riding through the wind, or a handkerchief over the face and ears, which is still better. There are, now and then, some suspicions of a nervous habit being concerned; in such cases, and in children, as also in some extreme cases of pain, laudanum must be used as the only means of bearing it: this may be injected, and also taken internally, if the topical application is not suffi- cient. Washing all around the ears with cold water, every morning, will be peculiarly serviceable, in feeble, nervous habits. Molasses, onion juice, burning the external ear, and dropping in oil of almonds, ether, and camphor dissolved in cream, are family medicines. But when the inflammation is visible, none of the warm articles should be applied, or great mischief may ensue; * The author, after attending a lady repeatedly, for a severe ear ache, without discovering any inflammation, recommended her to rub her gums with bark, every morning. The advice was not readily com- plied with at first; but was finally adopted, with relief; which was tested by her having the ear ache to return, regularly, on neglecting the remedy. DISEASES IN AND ABOUT THE HEAD. 123 even the loss of hearing, by forcing an extensive sup- puration. The ear should be well examined by means of a strong light, at night, and by holding it so that the sun may shine into it, by day; which will often discover the true cause. TOOTH ACHE. Causes.—A general cold; cold air applied to the eheeks in an unusual and sudden manner; acrids, sweets, or acids applied to the teeth; the acrid matter of a rotten tooth; extraordinary violence, as in breaking with the teeth hard substances: blows, &c. Besides these, there are certain disposing causes, under which, the usual exposure we are constandy liable to, is a suf- ficient cause: as a nerve being laid bare, by rotting, or partial extraction of a tooth; pregnancy, hysteric dis- positions, Sic Symptoms.—These are various in different circum- stances. In the tooth ache that proceeds from com- mon cold, there are frequently symptoms of rheumatic affections of the adjacent parts: the pain extending from the tooth to the face, and along up to the temple, with a throbbing of the arteries, redness of the face, and sometimes a little swelling, and feverishness. In most other cases a violent pain of the tooth, with a little in- flammation of the gum, are the only symptoms; except that about the termination, the face (in relaxed habits) is apt to swell extensively, or a gumboil forms. Management.—The patient should carefully avoid every cause, and confine himself to his room. In the case of rheumatic symptoms, his food and drink should be of the weakest and lightest kind; and a silk hand- kerchief should be applied over his face. In the other cases the face should be wrapped in flannel, and no change need be made in the food, or drink. The tooth should be stopped with lint, or a composition of wax, tar, and alum, made to a proper consistence. Cure.—In the first case it will be the best way to aim at the removal of the cold, by giving a dose of 124 DISEASES in and about the head. salts, and taking a sweat of weak whey, with a small teaspoonful of salt petre, or of antimonial wine. After this, a small blister or sinapism, applied near to the part, will be most effectual. Or instead of this, sweating the part with hot water and herbs, or a hot stone wrap- ped in moist, or dry rags, may be useful. Generally, in such a case, it will be of little use to apply any thing to the tooth itself, till the above has been done; then a little laudanum and spirits may be held in the mouth. In all the other cases, topical applications are more effectual. The chief of these are opium, cam- phor, oil of cloves, and other warm essential oils; with these, electricity, burning the tooth with caustics, ap- plying a hot iron to the ear, and many other means, have been at times effectual. But it is often necessary with these to give small doses of laudanum, and apply a blister, or sinapism; and when these fail, to extract the tooth; which may be done at any time, by a care- ful, trusty operator. But if this does not relieve, (the pain passing to another tooth,) the patient should not insist upon that being drawn, but commit all to patience. The best manner of applying topicals is to insert the medicine into the hollow, and cover it with lint, or a wax composition.* In some severe cases of tooth ache, with fever, bleed- ing before blistering is necessary; more especially if the patient be pregnant. Gumboils frequently termi- nate tooth ache. When they are perceived they should be brought forward, by warm fomentations applied internally to them, and externally on the cheeks. If persons would clean their teeth daily, with best Peruvian bark, they would never ache but after some severe cause.t The best compound of laudanum and ether, is the • Wax, one table spoonful, tar, one teaspoonful; melt, and mix a little fine alum, whilst hot. It sticks very well after drying the hollow. t The following is a good tooth powder:—Best Lima bark, in finest powder, one ounce.—Myrrh, or orris root, in fine powder, one drachm.—Prepared chalk, or cream of tartar, one diachm.—The one will be a little acid, the other the reverse. The taste may be consulted for choice. diseases in and about the head. 125 following, which has been often tried with admirable success, by the author. Take spirit of turpentine, half an ounce—camphor, one drachm—ether, half an ounce —opium, twenty grains. Dissolve the camphor in the spirit of turpentine; rub the opium to a paste, with some oil of cloves, or sassafras, and put it to the ether: after a day, add all together. Put some of this mixture on a piece of good lint, and lay it entirely over the aching tooth. A preparation of finely powdered alum alone, or with ether, has been much extolled, and used here. Dr. Thomas recommends, in cold obstinate cases, to use pills made with pellitory and gum arabic; one at a time, to be held in the mouth till dissolved. Our red pepper, in small pills, would be nearly the same in effect. NEURALGIA FASCIALIS, OR TIC DOULO- REUX. This disease is somewhat allied to the ear ache and tooth ache. It consists in the most sudden and excru- ciating pains, along the cheek bone, spreading over the face, on one side. The attack is not of long continu- ance, but the returns are frequent. It has baffled medical skill to a great extent; probably for want of better information as to its cause. Delicate, and preg- nant women, are most subject to it; though it is to be found in men with apparent good constitutions. The nerves are said to be the seat of disease, though their destruction, or separation, has not always cured it. There is perhaps a general cause: as for instance, that state which we find in some delicate women, when breeding. There can be no doubt but what there is a local cause also: thus we see such women tormented with tooth ache. Whilst both general and local causes exist, a cure is hopeless. The local causes are most always referable to the teeth or gums. In one instance, a gentleman who had travelled to different cities, to consult physicians, was finally relieved by his own 11* 126 DISEASES IN AND ABOUT THE HEAD. directions: which was to pull out the tooth over which the pain centered. This, though it gave but partial relief, induced him to pull the next one that appeared most affected, which gave him farther relief; and by extracting a third, he was entirely relieved for many years. The teeth were sound to appearance. In some female cases, the application of the cold bath to the face, several times a day; the cleaning the teeth and gums with bark, Sic, and an advanced state of pregnancy, has brought relief. The whole materia medica has been exhausted for local applications. Some temporary medicine is anxiously called for to give a momentary relief: laudanum taken inwardly, with opium, and gum plasters outwardly; or spirits of tur- pentine and cotton, are the chief in use. Prevention is certainly better than cure, if it can be accomplished. The author recommends the following plan to those who are threatened with this most trying affliction. That the teeth be well examined by a dentist, cleaned, plugged, or extracted, when carious; that the gums be daily, or oftener, rubbed with the best Peruvian bark; that some wool, or cotton, be worn in the ears, and the face rubbed, two or three times a day, with a coarse towel, till a free circulation is perceived over the parts; that in walking out, the weather be attended to, and \he whole body well protected; especially the feet, by thick soled shoes. Should the patient be delicate, the internal use of bark and preparations of steel, \ will be advisable. If the patient is pregnant, great at- tention m\stbe paid to the bowels; and she should loose a little bloftd at a proper time. Perhaps, in some cases, the disease may invade from a thin suit of hair, as well • as by the ears and teeth. In such cases, shaving the head, bathing it in cold water, and wearing a cap, or wig, will be the best remedies. Or if the patient is opposed to this, the use of a fur cap, in cold weather, may do. This should be made with lappets to cover the face when out a riding, or walking. Plasters are a good defence during the pain. The consistence of a plaster so as to be comfortable, and to produce some DISEASES IN AND ABOUT THE HEAD. 127 perspiration, is half its value: a very good one may be made, simply by adding a teaspoonful of tar to a table- spoonful of melted beeswax. Let it be spread whilst so liquid as not to run through the linen; and after rubbing the pained parts with a mixture of equal parts of laudanum and ether till dry, put on the above plas- ter. If the tar is disagreeable, the plaster of the shops, called gum ammoniac plaster, may be used. Some physicians have recommended small doses of calomel, combined with antimonials or squills, so as to act a little on the stomach and bowels. And no doubt when any cold has been taken so as to augment, or bring on fresh attacks, the plan is a good one. And, indeed, in such cases, any of the anti-phlogistic reme- dies must be useful; and emetics particularly. Bella donna has also been used, externally and internally; but from the success of stramonium in rheumatism, and in other irritations, and its greater safety, there is a probability that it might answer better, and be worthy of a trial. This might be made with a saturated tinc- ture of the seed; beginning with five or ten drops; or even by smoking the dried roots of the plant.* CATARRHAL LOCK-JAW. This is another of those severe affections that arise from inattention to the teeth and gums. It is generally brought pn by a cold in the face. It will often resist » every remedy, and after remaining nearly a month, suppurate externally, and leave an ugly scar, and adhe- sion of flesh to the jaw. It begins with more or less tooth ache; which soon ' produces a stiffness about the jaws, and some swelling. The action of the jaws become more and more diffi- cult; closing a little each day, till they are finally brought together, and are immovable. After which, the patient is confined to nourishing drinks for suste- g^ * An elderly lady who had not a tooth had this complaint; but it was quite sufferable, consisting in twinges, as she termed it; which showed that it had a general as well as a local cause; and that both were necessary to form a severe case. 128 DISEASES IN AND ABOUT THE HEAD. nance; and even these are badly managed. Almost every remedy that could acton inflammation has been fairly tried, with little effect: such as bleeding, general and topical; purging and blistering. Salivation has also been attempted. It will be well, therefore, not to extend these remedies too far, as they only debilitate the patient. Local applications of a stimulating kind have been useful after a moderate course of evacuations. The spirit of turpentine is the most efficacious: a table- spoonful of this is to be put to a large bread poultice, and laid over the face daily. As soon as the patient finds he is getting this disease, he should send for a dentist, to take out the carious tooth; but if the dis- ease has gone on, and suppuration is about taking place, an opening should be made perpendicularly alongside the tooth, quite down to the insertion in the jaw; that the matter may make its way out, and thus prevent its getting through the flesh of the cheek. Persons of a scrophulous habit, with swelled glands about the neck, and weakly constitutions, seem most disposed to it. It is a great pity that dentists are so extravagant as to deter almost all people, in moderate circumstances, from employing them. The author has known a den- tist, for three hours work, and not fifty cents expenses, charge as much as a common countryman can lay up in a month. BLEEDING AT THE NOSE, (EPISTAXIS.) Causes and Symptoms.—Although this complaint is most common to youth, it is supposed to be the most dangerous in middle and advanced age. It will sometimes recur so often as to deprive the patient of his red blood, and to induce dropsy from mere debility. There is very seldom any danger from a single dis- charge; unless there is something in the patient's habit, independent of a mere congestion in the vessels of the membrane of the nose. A particular state will often cause a troublesome haemorrhage, from drawing a V DISEASES in and about THE HEAD. 129 tooth, or getting a small wound in a fleshy part. Drink, and a low marshy habitation, will bring on the state (of constitution) alluded to; though there be many other causes. The use of alkali, and bad cured meat, or too long use of salted meats, and low fevers, are accused. When a general and topical cause exist, every haemorr- hage is troublesome, if not dangerous. There is often no previous warning; whilst in other cases the patient feels a fulness about the head and nose, head ache and throbbing; his eyes appear red,- his feet are cold, his bowels costive, and sometimes a chill ushers in the discharge. And if he has been exer- cising freely in the hot sun, or been stooping long, he may expect a stout discharge, when most of the above symptoms have preceded. In a great many instances there is some obstruction in the system, that hinders a free circulation of the blood: such as enlarged liver and spleen, obstruction of the catamenia, haemorrhoids, or simple fulness from flatulency, or costiveness. Long sitting has the same effect: by the resistance and compression it produces, the blood is forced upon the most yielding vessels. In febrile cases there is often a discharge from the nose; and in all inflammatory complaints, it is salutary, and should not be interrupted: for there is no safer place than the nose for blood to issue from. Physi- cians have often, not only had a hint, but a help, from spontaneous epistaxis. » Management.—The patient should be supported erect, and remain without talking, or blowing his nose. Some cold ice water may be sprinkled on his face, and some wet salt, a cold key, or a lump of ice, in a bag, put down his back. And some cold lemonade may be given him as drink. If it is a trifling case, this will do without medicine. In the intervals he should be careful to avoid every cause; paying great attention to his bowels, sleeping on a mattrass with a high bolster, living lightly, taking care to avoid fruits, cakes, and sweets, and food that produce flatulency. The cold ^ 130 diseases in and about the head. bath will be an excellent preventive.* All obstructions must be strictly attended to. Cure.—When the patient has reason to expect a discharge of some magnitude, he should take an ounce of salts, and twenty grains of alum, directly. The coagulating mixture should be applied without delay. But in all cases, if there has not been a smart discharge beforehand, or great debility, it will be best to suffer four ounces to escape; as it will give the remedies a better chance, and nature also, to relieve herself; for the blood that forms the local congestion must come away. Dr. Thomas recommends a dossil of lint to be sprinkled with finely powdered charcoal, and pushed up the nose. There is, however, some danger in introducing fine dry powders, lest they be inhaled into the lungs.t Some finely powdered galls, sprinkled on a fine rag, and rolled up so as to fit the nostrils tightly, and pushed up with care, is a good article. The roller may be damped on the outside, so as to make the galls adhere. Some physicians use a com- pound solution of alum and blue vitriol, to inject into the nostrils, or push up on lint. But one of the best plans that the author has tried, is to make dossils of new dry sponge, thus: take a piece of new sponge, (that has not been washed out) cut it so as to fit the nostril, say about as thick as the largest sized quill, or rather thicker, and two inches long; (worm shape) make an incision nearly the whole length of it, suffi- cient to receive a small wire, or piece of whalebone, or a piece of wood, to give it firmness for introduction. Bind this entirely within the sponge, (in the slit) by strong threads, at three places, leaving some of the threads at the extremity, half an inch or more, to hang out of the nose, to extract the sponge. When these are ready, syringe the nostrils with the coagulating mix- * This alone enabled the author to pursue his studies: it never failed him, though he was before subject to three, and even five dis- charges a day, if he sat down to read. t A young man was lately destroyed by inhaling puff-ball mushroom for cpittaxis. See the public papers. DISEASES IN AND ABOUT THE HEAD. 131 ture; then dip the sponges in the same mixture, and push them up each nostril; trying first the one that appears to discharge the blood. They are to remain there two or three days, if the case was dangerous; and then be cautiously extracted, by syringing alongside of them first with aVim water, and then moving them very slowly; stopping, if there be any appearance of blood. Should the blood, after these are introduced, still come out into the throat, (for it cannot come out in front) Dr. Darwin's plan can be used without taking out the dossils; which is to immerse the head into a bucket of water cooled down with ice, or with a handful of alum salt. But it will be more convenient to apply a very large sponge full of the cold mixture; and as it may remain some time, it will do better than one immer- sion. In some cases of insensibility, or bad constitu- tion, or fulness, or febrile obstinacy, none of these will do. Our only plan is then to stop up the nares, both front and rear. This is done as follows: take an elastic bougee, and having made a slit in the end like the eye of a needle, it is to be threaded with two, or more threads of silk, or very strong thread, (just as a needle and thread) this is to be pushed through the nostril till it reaches the posterior fauces, or throat, where it can be seen. Then with a pair of forceps, old blunt scissors, or a knitting needle bent at the point, the thread must be drawn to the mouth, and a stout dossil of firm good lint, or a piece of close sponge, dipped in the coagulated mixture, tied to the end of the thread. When that is done, the bougee and other end of the thread are to be drawn out of the nostril, and the lint pulled carefully to the aperture.* Having done both nostrils the same way, the front apertures may then be closed with lint; so that the passage is me- chanically stopped, both front and rear, and the patient prevented from choaking whilst asleep, or from bleed- * A piece of stiff catgut, that may always be procured at a hatter's shop, will make a good bougee; even a duck's feather would do, if eight inches long, turning the quill end in, and making a little side hole. 132 DISEASES IN AND ABOUT THE HEAD. ing to death. The operator, if ignorant of anatomy, may remember in pushing in the bougee, to aim for the eleva- tion of the aperture of the ear, and not up to the fore- head, as the external nares seem to point. Dr. Thomas mentions the use of a hog's gut to compress the ves- sels. If the gut is dry it must be soaked, and then tied at the end. A feather, or wire, is then put in the gut, to push it to the throat. It is then cut off, an inch or more from the nose, and a strong syringe, with cold vinegar and water, is applied, and the gut is thus filled; pressing every part. It must be tied, and left so for a while; and if the blood still issues, a colder injection may be used. Perhaps the mere filling of the gut with air might do in many cases. As other remedies may be used whilst these surgical means are preparing, or trying, we may apply a blister between the shoulders; give nauseating doses of ipecacuana,* or use Dr. Thatcher's astringent. Or if it can be obtained, Ruspini's famous styptick, internally and externally, as by his directions. Cold enemas may also be used, of salts. When there is much phlethora, and the pulse is hard, we must re- duce the febrile symptoms; and an early bleeding at the arm will be very necessary. The purges and nau- seating doses of ipecacuana will then be more needful. Dr. Miner has recommended small doses, of three to five grains, of red pepper, every ten minutes, as a sovereign remedy. In cases of insensibility, and low weak state of the system, they may be tried after the other remedies have failed. Astringents,—One teaspoonful of extract of lead to one ounce of strong decoction of galls, may be in- jected or applied by a dossil of lint. Wild geranium will substitute galls. Astringent lotions, to be put on lint and applied topically,—Re. allum, blue vitriol, white vitriol, each ten grains; water, one ounce and a half. Another topical astringent,—Re. copperas, twenty * Three grains of ipecacuana, every hour, will be enough. (£?- See the apothecarium, for the coajulating mixture, &c. DISEASES IN AND ABOUT THE HEAD. 133 grains; alum, ten grains; elixir of vitriol, fifteen drops; water, one and a half ounces. OZjENA. This is properly a limb of the scrofula. It consists in an inflammation of the glands, on the surface of the interior nostrils, which distils a corroding humour, that swells the upper lip, excoriates the skin, and even threatens the destruction of the thin bones within. When considerable, the discharge becomes offensive. It is most common from infancy to puberty. The dis- ease increases by every cold the patient takes, and moderates in warmer and steady weather. Of course, great attention should be paid to keep the children well clad, and warm, and in-doors; when the weather is disagreeably raw and cold. As general remedies, mu- riate of lime, and tincture of iron; as also Peruvian bark, and bathing (in warm weather) are recommended. But tonics should not be given when the disease is under an increase by cold; on the contrary, the patient should live on vegetables, and take purges at such times. All spirituous liquors, and even cider, should be avoided. As a local application, the following will be found to have a good effect; especially in removing the fcetor, which alone is sufficient to debar the children from school and company. Take a carrot and slice it thin, and bake it slowly (but not burn) till it will powder. To three teaspoonsful of this powder, add an equal quantity of Peruvian bark, and one drachm of orris root. Let a little of this composition be put up the nose frequently. The impure pyrolignous acid,* diluted so as to be taken inwardly, and applied to the parts, is worthy of a trial. The taste will be the best criterion; what can be swallowed may be ap- plied as a wash. A teaspoonful of the acid will be enough the first day, for internal use. Children of five years may take five drops of muriate of lime, in a teaspoonful of water, three times a day. By this, older and younger may be regulated. The tincture of flakes * See the domestic preparation of pyrolignous acid, in the chapter on fetid breath. 12 134 DISEASES IN AND ABOUT THE HEAD. of iron in port wine, may be- taken three times a day; for a child ten years old, a desert spoonful will be a dose. Bark may be used as often, but not on the same days. FGETID BREATH. This is a too common, and a very offensive com- plaint. No pains should be spared to get rid of it. Perhaps one of the causes of its being endured is the want of a remedy, or the ignorance of its cause. The person may for a while be insensible to it himself. It arises from various causes: such as carious teeth, un- cleaned teeth; ulcers in the gums, in the tonsils, or in the lungs. Diseases of the stomach; as indigestion and worms. Chewing certain preparations of tobacco, will give the breath a stercoraceous flavour; which, though the chewer may be insensible to, yet the bye- stander is greviously offended. Every man who chews tobacco, or has bad teeth, ought to inquire of his family if his breath is offensive. Cure.—Carious teeth must be extracted, filed, or plugged; and if any of them have tartar on them, they must be scraped, cleaned, and afterwards kept so by occasional scowerings with charcoal; and daily cleaned with a good tooth powder.* Ulcers in the gums will generally get well when the above has been done faith- fully. But extraction alone must be depended on for an ulcer, as plugging will not do in such cases. In bad constitutions it may be necessary to take out pieces of the carious jaw, if the ulcer continues after the tooth is drawn. Ulcers in the tonsils require astringent washes of oak bark, and weak additions of corrosive sublimate to those washes: say one grain to an ounce. Extirpa- tion is sometimes necessary when they are much en- larged; but they should be first healed. The chewing Peruvian bark is a good remedy for habitually relaxed throats. As to tobacco, the remedy is simple if not easy, and if the chewer could be permitted to see the composi- * See the tooth powder, in the chapter on tooth ache. DISEASES IN AND ABOUT THE HEAD. 135 tions put in, to mellow and work the quids, he would be soundly cured. He would find some other waters beside those of rose and jassamine, used! Worms and crapula require their proper remedies. See worms and dyspepsia. When the lungs are the causes, either consumption or syphilis are the sources. In this latter case, small concretions are sometimes coughed up of a most odious flavour; and salivation always produces foetid breath. See the chapter on these diseases.— Hopeless, however, as these cases of foetid breath seem of curing, there may be some palliation. The pyrolignous acid is said to remove it. It must be used frequently: a wine glass of water may be acidu- lated with it, and taken three or four times a day. It is said to change the worst flavours to that of bacon. A concentrated preparation of this, called a balsam, is sold in Baltimore for tooth ache. The impure acid is preferable to the purified. When this cannot be had, some corn may be put on a shovel, and pressed with a hot iron, till the empyreumatic oil runs out freely; this must be dissolved in some vinegar, and used as a sub- stitute. Charcoal taken internally, and used as a dentrifice, is also recommended, where the system, as well as the mouth, is a source of this horrible disease. A febrile habit, or a broken down constitution, is sometimes apparently the cause. In such cases, bark, elixir of vitriol, and tincture of iron, should be used internally. \CJ* The odour of an old toper's breath is very ob- noxious; but the odour of his skin is still worse. The whiskey seems to change the nature of the perspirative matter, and make it like rancid grease. Water is the cure. BITE OF A MAD DOG, OR HYDROPHOBIA. It is a very singular circumstance, that only the .canine species are subject to this disease, naturally, though men, and birds, and beasts, receive it by ino- culation. Although it has been long known, very little progress has been made, (before the present day) 130 DISEASES IN AND ABOUT THE HEAD. even towards a prevention; and as to a cure, it re- mains as far off as ever. Nevertheless, quackery and superstition have exerted themselves on this point. In the days of Pliny, it was given out that the separation of a certain joint in the dog's tail was a sure preventive. But this trick wearing out, certain German quacks proposed the cruel expedient of extracting two ver- mifoom ligaments that pass longitudinally, under the surface of the tongue of the dog. If these are peculiar to the canine species, there might have been some sus- picion; but, surely, there never was a dog saved by the practice. It would, however, be well for comparative anatomy to point out what marks more than mere gene- ric characters are peculiar to the canine species. The anagallis of late days, and the liverwort of former days, and various other nostrums, have long since sunk be- neath the notice of common sense. Dogs are more frequently found mad about the in- tensity of winter, or of summer; by which it would appear that suffering had some hand in creating the disease; yet, at Cairo, where there are immense num- bers of half starved dogs, and a raging sun, they are not found mad oftener than in other places. It will be noted, however, that these Egyptian dogs are common property, and treated with a certain respect, if not reverence; and it is mere necessity that causes them not to be better fed. There is another observation worthy of attention, viz. that the proportion of dogs that go mad in our large cities is small, compared with the same number in villages, and in the country. If a dog is badly treated in town, he can go the next house and find shelter and food, and meet with good treatment. Not so in the country; the dog, if ill treated, resorts to some lonely place, and there remains. And it is believed in such cases without any evacuation: for if a dog is confined, he will retain his faeces and his urine a week. Here then is a situation that if applied to the human subject, would make him a hy- pochondriac, and maybe a suicide. And although this neglect (of an animal proverbial for friendship, associ- DISEASES IN AND ABOUT THE HEAD. 137 ation, and good humour) and forcing from his natural habits, may not be the sum total of the cause of this disease, yet it goes a great way in the business: for we may suppose of him, what happens to the human subject, viz. that it is a rare case where disease takes place, in which both general and personal causes have not united to accomplish it. Dogs, when first affected with hydrophobia, begin to be cross to their more slight acquaintances, and have intervals of gloom. This state is succeeded by one of more restlessness and activity. They come out from their recesses, and feel disposed to go from home. Their eyes appear more or less swollen; and they fre- quently have an intoxicated appearance and action. At every few minutes they have paroxysms of madness: attacking every person and every thing near them. The violence of this passion may be readily conceived from the circumstance of hogs, when mad, breaking their own jaws in biting the logs of their pen. They now trot off, not knowing whither they are going, though in general they go to some lonely recess of woods, or streams, and there die. It frequently happens that they will take water through the first part of the dis- ease. The disease should therefore have another name. Dissections have shown the throat to be much in- flamed in hydrophobia; but the danger of dissection has prevented a full examination. It generally hap- pens that in a week or ten days, after the patient is bitten, that he feels the first symptoms; generally a low desponding state (even if it be an unsuspicious boy;) but at other times his first perception is a spas- modic state of the fauces, or the muscles of the face, at fjhe sight of a shining body, or of water: giving him a complete dread of it. This increases till a violent raging paroxysm ensues, which lasts a few minutes, and then goes off to return again. In the interim the patient has his senses, so as to warn the bystanders against his fury. In this state, their actions are performed with a quickness that exceeds comprehension. The 12* 138 DISEASES IN AND ABOUT THE HEAD. author has seen a patient take a pill, that was put into his hand, with such a rapid motion that none but the patient could say what he had done; so that there is no safety in their presence, unless they are properly secured. But it has frequently happened that the time between the bite and the disease has been months; and even then coming on after the system had been debilitated by some common disease: showing very plainly that the disease had first to form a local disease, and then be generated from that source. Just as when we sow a single seed, a plant is raised from it, and from that plant's product our garden is overspread. It is, therefore, all important to attend to this first deposit; and it is in all probability never too late, till the dread- ful general symptoms appear in the system. It is a pity that physicians had not applied themselves at an earlier period to a rational method of prevention, by attending to the wound; and thus prevented what they could not cure. Method of treating the wound.—The wound, it open and superficial, should be washed with a sponge for half an hour, in strong soap suds. After this, a little diluted common vegetable caustic should be applied with a feather, (see the preparation) and then washed off with vinegar, and the wound dressed with red precipi- tate ointment, and kept open from twenty to thirty days. When the wound is deeper, it should be washed with common ley injected from a syringe, with all the force that can be applied for ten or fifteen successive times; and after that, a little diluted caustic, pushed in by means of a little bougee, made by rolling up a piece of linen to fit the wound. After a minute or two some vinegar must be injected; and if the wound is not en- larged by the caustic, it must be applied again (having washed out the vinegar with some soap suds) and so go on till the wound is twice the size that it was; being sure to get to the bottom, and deeper. It is then to be dressed with red precipitate ointment, pushed in to the bottom with a little lint, and kept open three or four weeks. If it seems strongly disposed to heal up before diseases in and about the head. 139 this time, some peas may be pushed in, and secured, from time to time; thus making an issue of it. If the bite has healed, let nothing deter the physician from opening it, and corroding out all the impressions first made. These marks may be often seen, by look- ing at the wound, when open, with a magnifying glass. To open the wound, a small piece of common caustic is to be put into a hole of proper size, made in a plaster that has been laid over the spot, and this caustic secured with another plaster laid over it. A piece as big as a small green pea will make a smart hole. This is to be taken off in two minutes, and vinegar applied, and the place inspected. If it need be deeper, put in a very small piece of caustic into the hole, and put a pea on the top of it, which will make it sink deep enough in general; but this must be the rule, to go as deep as the tooth went. Dress the wound as before, but keep it open one month with peas, Sic If the wound is over a blood vessel, a surgeon should do the operation with a knife. And although we are so ignorant of the disease; yet, as many cases of lockjaw have been removed by causing the wound to suppurate, we should not hesitate to make an extensive opening of some inches wide, and quite deep, with caustic about the place of the wound, on the first appearance of hydrophobia, and apply hot suppurating ointments. This has never been done yet, and it is far the most likely to arrest the disease. Nor would there be any impropriety in trying the perpetual influence of opium, by giving it every three hours, joined with calomel. Dogs should be well treated, and if not out of regard to them; at least for the owners and community. They should have medicine administered to them when sick. They are so every now and then. A good strong pur- gative of ten grains of calomel and three or four of gambouge, will clear out their bowels, and often relieve them, when they might go mad, if neglected. This medicine should be put into the centre of a piece of meat; and after giving him one or two similar pieces without medicine, he will snap at the other by merely 140 DISEASES IN AND ABOUT THE HEAD. throwing it to him. But if his stomach is squeamish, so that he refuses the meat; bring up another dog near to him, and he will eat it, merely to prevent the other dog from getting it. To prepare vegetable caustic for to eat away a wound: take a small roll of caustic, and putting it into a marble mortar; break it, and add as much water as will dilute it to the consistence of very thin cream. It must then be kept closely stopped in a vial. To make a strong red precipitate ointment, see the apothecarium. All towns should have a society composed of a few physicians, a surgeon, a clergyman for their president, and many honorary members; who may subscribe a small sum to pay the board of a poor patient. And this society should send handbills out; giving notice that they would receive any patients that have been bitten, gratis. By this means many valuable lives would be saved, and quackery put down. DISEASES OF THE CHEST AND LUNGS. CHAPTER V.—PLEURISY. This disease is most prevalent in spring and winter. It attacks the robust who work hard, or ride in cold, windy, changeable weather. Those who neglect to put on their coats, after working, when in full perspiration, will seldom fail to have a pleuritic attack; more espe- cially if they are drinkers of ardent spirits. This ar- ticle not only predisposes to pleurisy, but makes it much harder to cure. Twice the quantity of blood must be taken in strong subjects of this description, that would be necessary in others. Symptoms.—A severe chill often ushers in this dis- ease; which is followed by a high fever, pain in the side, cough, spitting of mucous, tinged with blood; at other times it commences more insidiously, and ap- pears to grow out of a common cough from cold, or from a simple pain in the side. Management.—This in all respects must be the same as for an inflammatory fever; (which, see chapter 2nd) with the addition of plenty of barley water, sweetened with boiled raisins, to allay the cough. Cure.—A pint or more of blood should be taken away from a large orifice, without delay. If the fever runs very high, and the cough and pain be severe, this must be repeated in six hours; but if not, a second bleeding may be postponed till a blister has drawn, but no longer, if the pain continues. A large dose of salts should be given on the first day, and small doses (every two or three hours) of the same, with a quarter of a grain of tartar to each dose. About every other day, the fever powders, No. 1, may be given on such days as the salts are not used. The first blister must be laid on the pained part directly after the first dose of salts 142 DISEASES OF THE CHEST AND LUNGS. have operated; and when the pain continues after a repetition of bleeding and purging, a second blister will be advisably placed on the breast, or even on the op- posite side. There will be few cases, where two or three bleedings, with blistering and purging, as above directed, will leave any fever or bad symptoms; but occasionally there will be an obstinacy that will require more bleeding: either from the arm, or from the side, or breast, by cupping, or leeching. And as long as the patient has fever, and feels pain in coughing; so long must bleeding be continued. No procrastination must be allowed; for pleurisy soon runs on to suppu- ration or effusion. But when we have commenced remedies in time, and with a proper depleting plan, we may bleed much later than is generally supposed; and also later than can be done where the physician is called in, after the disease has been of some days standing. When we have continued this practice as long as seems prudent, and some disease remains; the plan now in use, in Italy, may be tried, viz. giving as much tartar emetic, in divided doses, every two or three hours, as the stomach and bowels will bear; or what is more usual with us, rubbing the last blister with mer- curial ointment to produce aptyalism. There are, how- ever, pains that will sometimes be troublesome without any pressing danger, arising from different causes: first, from some rheumatic associations, with pleurisy. These are not uncommon; secondly, from an excessive use of mercury in the early part of the disease; and thirdly, from a ph,thesical constitution. It would not do, therefore, to extend our bleeding to reach the full removal of such pains; but we must as- sare ourselves that such are the causes, and that we have depleted to the full, and removed all febrile symptoms. Such pains will yield to liniments, plasters, a moderate warm bath, a tartar plaster, and to riding in good weather. The mercury, if not used before, may be always applied for the first and third causes. DISEASES OF THE CHEST AND LUNGS. 143 PERIPNEUMONY. This is but a variety of pleurisy. In this, the pains are less acute, and not confined to a rib, but spread over the breast. The oppression is greater, and the discharge from the lungs more considerable. The obtuseness of the pain, however, must not mislead the practitioner; for this disease will require all the re- medies in full for pleurisy; and nothing must stay the lancet, till fever, oppression, and excessive discharges are fully removed. Drinkers are mostly the subjects of it; and their habits and inflamed vessels, must not be forgotten. PERIPNEUMONIA NOTHA, OR BASTARD PLEURISY. This is another, and a very distinct variety, or species of pleurisy. It mostly attacks elderly women, who have been very hearty; as also those who are advanced in life, subject to catarrhal discharges, and somewhat broken down by drink; but still retaining an inflamma- tory habit. It begins with a very harassing deep cough, attended with pain and spitting. The head is, in gene- ral, much affected with pain, and the stomach dis- turbed; though, at times, the patient has a ravenous appetite. The pulse is febrile, but softer than in pleu- risy. One, or both cheeks, are sure to have a round red blotch on them, as if an eruption were coming out. This symptom, the habit and age of the patient, and the great head ache, will always distinguish it from the other species of pulmonary inflammations. Management.—The same as for inflammatory fever; only the patient should be kept rather warmer, and have, as in pleurisy, plenty of softening drinks: such as barley water, with lemon juice and prunes, flaxseed tea, elm bark, apple tea, &c. Cure.—Bleeding in moderate quantity at a time must be began early, and repeated three or four times. Blisters must be laid on the breast, after the first or 144 DISEASES OF THE CHEST AND LUNGS. second bleeding. The bowels must be kept well open with castor oil; but strong and brisk purging is injuri- ous. Some fever powders must be daily administered: first No. 1, and after the two days No. 3, which may be taken with some weak snake root tea. This last addition is most suitable as the strength gives way. The blisters will require a second and a third application. When bleeding has been performed twice or thrice, if there is no chance of the disease giving way, some mercury should be used with the pulvis antimonialis; so that by an application of a little mercurial ointment on the blisters, we may speedily touch the gums. This must be our hope when the antiphlogistic plan of bleed- ing, blistering, purging, &c. seems to fail in having full effect. The cough, then, may be treated with more stimu- lating articles: such as small doses of powdered squills, and alkali: say two grains of the former, and four of the latter, in syrup, every two hours. If this is too stimulating, or even if not, the gum ammoniac mixture, with syrup of squills, may be substituted for it. Pa- regoric and syrup of squills may be used to induce sleep when the patient is harassed; but opiates are not to be used too soon, nor too frequently. See the apo- thecarium, for prescriptions. The debility that is left requires elixir of vitriol, baccharis tea, and finally, de- coction of bark, to remove it. Riding on fine days is useful. jCT* Remark—There are certain slighter cases of peupneumonia notha, especially in delicate elderly women (not plethoric) who have lived temperate, and in most cases have weak lungs. These cases are not so febrile, and if they have not those blotches of red on their cheeks, as above, and the pulse but a little dis- turbed, they may be treated by leeching, cupping, and by repeated emetics, blisters, and castor oil; and the cough arrested by the gum ammoniac mixture; squill and calomel pills; and a free use of paregoric and syrup of squills, as the disease declines. DISEASES OF THE CHEST AND LUNGS. 145 SPITTING OF BLOOD, (HAEMOPTYSIS.) Causes.—These are generally of a constitutional nature; but they may be so slightly of that cast as to require great exciting causes. At other times, when there is much of the predisposition, very trifling causes, such as cannot be avoided, will bring on a spit- ting of blood. Cold, exertions of the lungs or body, sudden changes of weather, and obstructions, are the chief exciting causes. Symptoms.—Not much need be said on this head, but it is well to know directly where the blood comes from, that is discharged. When it issues slowly from the lungs, it is brought up by coughing, mixed with air, like froth; but when it flows rapidly, it will be puked off, and be pure blood: this last is dangerous. In most cases the spitting goes off in some hours, or lasts a day or so: leaving a cough. If there are no febrile symp- toms, nor any preceding chill, there will not be much blood discharged; but at times it will assume (by fever, chill, &c.) the form of a full morbid paroxysm, and may then be of great importance, requiring attention to it without delay. Men very seldom discharge blood from the stomach; women often do when obstructed in their discharges. Management.—The patient should be kept cool and quiet, and given some cool drinks, of lemonade, or vinegar and water; and when relieved, should attend very particularly to his diet, dress, bowels, changes of weather, and exercises; for if he exerta his lungs, or makes strong efforts of any kind, he will bring on re- turns. There is nothing worse than night air for weak lungs. Dust, damp, and strong winds, are to be avoid- ed. Also loud speaking, and walking up steep places. Cure.—If this disease be trifling, a dose of salts, and a few pinches of common salt, repeatedly swal- lowed, will be sufficient. When a little more con- siderable, some of Dr. Thatcher's astringent may be used. (See the apothecarium;) or some alum whey 13 146 DISEASES OF THE CHEST AND LUNGS. drank cold; taking the salts, with twenty grains of alum dissolved together. But when febrile symptoms precede, some blood should be quickly drawn; a purge of salts and alum, as before directed, administered; and as soon as that has operated, some small doses of ipecacuana, say two grains, and one of blue vitriol, given every half hour, •so as to sicken the patient. Ice may be applied in a bag between the thighs. It will not be necessary to bleed, if the effusion of blood from the lungs relieves the fever, or if it has been very profuse. In some cases of great haemorrhage, the pulse will be small and fainty, and the urine clear, and very alarming symptoms ensue. In such cases, some opiates should be instantly used, to quiet the irritations. These may be given, from every half hour to every three hours: say one and a half grains (or thirty drops of laudanum)wilh four of sugar of lead, if needed. Where there is any protraction of the bleeding, or; where the feet become cold, sinapisms, and then blUters, should be laid on them. Dr. Minor has recommended three to five grains of red pepper, to be given every quarter or half hour, as a valu- able remedy. In cases where opium does not an- swer, this may be tried, especially to the south, and in a feeble pulse, or case of exhaustion. Enemas of salt and water, quite cold, will sometimes be useful, if used before there is too much exhaustion. It is only now and then that homoptoe has any dangerous symp- toms. It is mostly to be feared as the forerunner of consumption. When the patient has some warning beforehand, he should, (especially if plethoric,) loose a little blood; and if not, take a purge of salts, live very abstemiously and quiet. The lycopus Virginius (coltrops) a plant some- what like motherwort, but smaller, growing in ditches, is said by some to make a bitter tea, that is a great preventive of homoptoe; but of all the remedies that have been used, there seems none more efficacious than Ruspini's styptic; and patients should be supplied with DISEASES OF THE CHEST AND LUNGS. 147 it, who fear large discharges; and also have with them, when travelling, some pills composed of opium and sugar of lead; and a lancet. Whether the coadjulating mixture taken internally would have effect is uncertain. It is worth trying; as no degree of coadjulation could ensue at the lungs, that would be inimical. It is now admitted that many of these haemorrhages ensue with- out a rupture of the vessels; and therefore must depend on a certain condition of the extreme vessels, or of the fluids, or of both. CONSUMPTION. Causes.—A hereditary, natural, or acquired debility of the lungs may be looked upon as causes of this fatal disorder. Under such circumstances almost any per- manent irritation upon those parts will establish the consumption; and it is somewhat doubtful if any cause will do the same without the predisposition. Symptoms.—A paralytic appearance of the whole surface, adunc nails, cough, pain about the breast; spit- ting of nauseus matter, at all times of the day: which is sometimes streaked with blood. A fever which comes on at noon: frequently with shivering, and almost al- ways with coldness; remitting towards the afternoon, to exacerbate, or renew its violence at night: continu- ing with the other affections, and after awhile, being lullowed in its second fit, (towards morning,) with a copious sweat. The pulse in this fever, which is a hectic, is quick, and generally weak; though in its first attack some degree of hardness is to be felt. The fever is always kindled by taking much food at a time. Towards the end of the consumption, a lax takes place, which gene- rally carries off the patient. It may be as well here to enumerate the following premonitory symptoms of the disease as given by Dr. Rush:—" They are a dry cough, which is increased by the least exercise; a burning and dryness in the palms of the hands, more especially to- wards evening; rheumy eyes upon waking from sleep; 148 DISEASES of the chest AND LUNGS. an increase of urine, a dryness of the skin, more especi- ally in the morning; an occasional flushing in one, and sometimes in both cheeks; a hoarseness, a slight or acute pain in the breast, a fixed pain in one side, or shooting pains in both sides; also head ache, occa-^ sional sick and fainty fits, a deficiency of appetite, and a general indisposition to exercise, or to motion of every kind." Cure.—This should be attempted with every means in our power. 1st. By lessening the inflammation of the lungs; by means of diet, bleeding, blistering, mercurializing, and the use of antiphlogistic alteratives, or what we deno- minate cooling medicines. 2d. By interrupting the sympathetic fever, and other associate affections, active and passive; with the use of emetics and tonics of a moderate grade; as also by exercise and change of air. 3d. By soothing the lungs, and preventing the pa- tient from being exhausted by mere coughing: with anodynes, mucillages, and palliatives. 4th. By arresting the rapidity of the pulse, with sedatives. 5th. By diverting the irritations of the system from centering in the lungs: by means of counter agents. 6th. By moderating the pressing inconveniences, (accidental or natural) of the disease throughout. 7th. By attending to concomitant diseases. 8th. By opposing instantly the first admonitions of the disease, and removing the accidental causes. To descend to particulars in corresponding numbers. 1st. Notwithstanding the disease is so debilitating, yet as we cannot act on the lungs alone, we are obliged to act on the whole system, and reduce the inflamma- tory state of the lungs, and arterial system, by a strict diet, which should be mostly of vegetables. Mush and milk has been justly supposed to give the greatest energy of any diet, without inflaming either the sto- mach, lungs, or blood-vessels. Eggs and small fish dressed without sauces, are the least stimulating of any DISEASES 0* THE CHEST AND LUNGS. 149 animal food. The stomach, however, must not be thrown into dyspepsia by a large proportion of vegetable food too long continued. Bleeding should be early employed, and done twice a week, in moderate quantity, till the pulse becomes somewhat natural. But even this reme- dy must be within bounds: for it must be laid down as an axiom, that no remedy whatever must be continued so as to debilitate. Blistering must go hand in hand with bleeding in the early stage of the disease. The 'f flies and tartar blisters may be both tried; the flies first. ■"?>$ < There is room on the breast and sides for three large plasters; and as soon as one dries up another should succeed it, in a new place. Mercurializing is best done with the blue pill: being so harmless to the sto- mach. When there is pain and tough phlegm in the early part of the disease, and there remains a doubt whether it be consumption, this medicine will be use- ful after bleeding and blistering; for it will concoct the phlegm, and make it discharge easily, and reduce the inflammatory symptoms. A four grain blue pill may be used two or three times a day. Each pill is supposed to have two grains of mercury. In addition to the above means of reducing the inflammation, we may use antimonials, and some inoffensive neutral salts. The fever powders, No. 3, or the mixture of soluble tartar and antimonial wine, are probably the most agree- able and innocent, and may be used when the febrile symptoms are most considerable, for three or four times in the day, or night. 2d. It is very important to interrupt the association that exists between the whole system and the local point of the disease in the lungs. This may be attempt- ed by emetics: ipecacuana in doses of fifteen grains taken at once, is the most usual. Some physicians are partial to the blue vitriol (cuprum vitriolatum) in doses of ten grains, or the two may be combined: ten'grains of ipecacuana, and five grains of blue vitriol, is an ef- ficacious and safe puke. The vitriol must be very finely powdered, and taken in molasses, using warm water when it operates. These may be often repeated 13* 150 DISEASES OF THE CHEST AND LUNGS. in the early part of the disease, before ulceration is established. .,. . -i Exercise in the open air by riding in carnages, sail- ing in steam-boats, and riding on rail roads, are very beneficial to give a stir to the whole system; and per- haps the days are at hand, when riding on rail roads, every good day, will be regularly practised, and a hundred dollars a year, so laid out, will be better than for one hundred visits of the physician. But when the patient gets stronger, riding on horseback is preferable. Dr. Rush was of opinion that even when sailing, bodily exercise was also requisite. Tonics of a moderate class used in the recess of fever, answer the same end. They rank as follows: elixir of vitriol the mildest, bac- charis tea the next, wild cherry tree bark, in decoction, the most stimulating. The vitriol should not be used too freely, as it is apt to move off on the bowels. Five or six doses of either of the above is all that can be used in twenty-four hours; and should be used when the pulse is least active. 3d. The cough that is so necessary to relieve the lungs from the extra discharge, often exceeds its office, from the irritation on them; and the patient is worried by its incessance. Mucillages are the most harmless antidotes. A mixture of these with syrups are useful, but are apt to pall the stomach. Gum arabic, flaxseed tea, barley water, elm bark tea, bran tea, and Iceland moss, are all useful to this purpose. Mr. Wesley has recommended, in his primitive physic, in cases of con- sumption, a cow heel porridge, which might be con- sidered both medicinal and nutritious. The bitter gums, extracts, and herbs, as also tar water, are more in use after the first period; and opiates towards the last. The gum ammoniac, gum myrrh, and hoarhound, are the chief of the bitter medicines; and paragoric, with an addition of syrup of squills, the usual form of the opiate. 4th. Foxglove is the only medicine yet known, that will reduce the number of the pulse; and when this is quick and threatens haemorrhage, and in any stage, but DISEASES OF THE CHEST AND LUNGS. 151 especially the stage preceding suppuration, it should be tried: the experience of Dr. Beddoes is greatly in its favour. Fifteen drops of a saturated tincture, twice or thrice a day, will be sufficient to try its use. But as it may by its continuance produce a fatal fainting, it should be laid aside as soon as the pulse falls to 60 or 70. 5th. As the irritations produced by the reaction of the arterial system are pointed at the lungs alone, before the hectic sweats ensue; physicians have used issues and setons to divert part of this irritation. And it is certain, they have at times counteracted the disorder of the lungs. But like all the other remedies, they succeed best before there is a suppuration. Setons in the side are the most effectual; but as they are rather formi- dable, they are much substituted by plasters of tartar emetic. These laid on the breast will in a period of one or two days raise a number of pustules, that will discharge a matter; these may be easily kept open a length of time. The counter irritation produced by a state of pregnancy, will sometimes arrek the disease during gestation; but the author could no^ venture to recommend the remedy. \ 6th. Very unpleasant irritations are apt toensue from sudden changes of weather: either cold, orlcleudy, or both: bringing on asthma, or increased cough. In such cases the patient should bathe up to the knees in very warm water, smoke a cigar, or apply a sinapism, or blister to the side: as experience may direk him to either as the best. But the most unpleasant Vccompa- niment is a diarrhea at the end of the disease.| Besides a diet chiefly of rice and arrow root, the patient may use astringents and opiates: 5 grains of finely powder- ed galls may be taken in a cup of decoction *'• Dewees. Re. senna and cream of tart^. See the apothe- carium. Re. elaterium, from » quarter to half a grain; rub it fine and well, with some loaf sugar, and add ten grains of jalap. Take it in syrup of ginger. Begin with smaller doses, and increase slowly.* It is powerful, and one of the most effectual. From the above large assortment, there may be a choice to suit the nature of the disease: whether from inflammation, or debility, as also to suit the palate; and, moreover, to change about, which may often be of great benefit. Alteratives, i. e. medicines that reduce the actions without perceptible evacuations. They are few: viz. mercury, antimony, squills, and salines, and their com- binations. Re. blue pills, three grains; powder of digitalis, one grain; of squills, one grain, mix; to be taken four times a day.—Dr. Gregory. Re. powdered squills, three grains; calomel, one grain; to be taken three times a day: four days, and then desist. Re. powdered squills, five grains; nitre, ten grains; about twice a day, so as to nauseate. Re. oxymel squills, one ounce; tartarized antimony, one to two grains; water, half an ounce; a teaspoonful of this may be used every two hours, or oftener.— These alteratives are said to be particularly suitable to dropsy of the chest. * Perhaps one and a half grains is the most that ever should be used for a dose. DISEASES OF THE CHEST AND LUNGS. 185 9CT' Dr. Whethering and Dr. Thomas think that foxglove suits best in dropsies of a low tone; but yet where there is some soundness of constitution. PALPITATION OF THE HEART. Palpitation is a perceptible effort of the heart, made to disburthen itself from an irregular transmission of the blood. Symptoms.—The actions of the heart are sometimes soft and rolling; sometimes fluttering; sometimes acute; and again, they will be found powerful and thumping; or very feeble. They will be transitory, or permanent, in the course of the day, and last from a day to years. The patient is put into very disagreeable feelings of body and mind, with oppression or dyspnoea; and sometimes the colour of the lips are blueish, or stag- nant. The pulse varies as much as the heart; but does not always accord with the exertions of that or- gan. It will be hard and regular, in some gouty and phlethoric cases; and assume many varieties, accord- ing to the causes. Laenec mentions cases where the pulse beat from 160 to 180 in a minute, and was very feeble. Causes.—First, obstructions in and about the heart, or large blood-vessels near to it; proceeding from a great variety of causes: viz. ossification of the valves and vessels; fatty, lymphatic, and polypous formations; adhesions from the remains of inflammation; contrac- tions; dropsical collections in the chest, or pericardium; malformations of the chest, Sic Second, plethora, or over fulness of blood, gouty diathesis, dilations of the cavities of the heart, and excessive exertions. Third, diseases of other parts; either extending their sympathies to the heart, or producing an irregu- lar circulation: as dyspepsia, constipation, and hepatic obstruction.—-Dr. Gregory. Rheumatism, (Dr. Bade)* hypochondriasis, chlorosis, and hysteria. * The only cases of rheumatism making a metastasis to the heart, known to the author, were so acute that immediate relief became ne- 16* 186 DtSEASES OF THE CnEST AND LUNGS. Fourth, peculiar irritability of the heart, or of the whole system; manifested in a variable temper of mind, subject to fear, despondency, anger, or exstacy. Fifth, inanition, and pure debility; from loss of blood, diarrhea, starvation, and exhaustion of every sort. Cure.—In those cases of organic obstruction, no- thing but a palliation can take place; for there is no cure. And so of the enlargement of the cavity of the heart; however, by rest, a quiet mind, temperate diet and drink, avoiding exertions, the disease may be moderated, and life protracted. This plan may be ap- plied to all cases. If the patients are full, some blood may be drawn. In cases of plethora, gouty, and rheumatic habits; bleeding and purging, with low diet, will generally relieve, when applied early in the dis- ease. When it proceeds from other diseases: such must be cured by the means recommended in this book. In those cases of exquisite sensibility, not only rest must be attended to, but a firm resolution made to oppose great emotions of mind; and to avoid their ex- citing causes. Tonics will be very useful: such as steel and bark; and Dr. Thomas recommends the cold bath also. The bowels should be well attended to, and the dress made comfortable, and suited to the season. A nourishing diet will be necessary in exhaustions. Many cases in youth will last long, and be cured per- fectly at last, by attending to the above directions. From fifteen to twenty-five, or thirty, is generally the age most subject to those cases, whilst a more advanced age is liable to the structural changes of the heart and blood-vessels. In the hysterical cases, when such habit is fixed, and cannot be cured, the use of lavender, ether, musk, castor,, valerian, and assafcetida, will often be useful. cessary; and it is difficult to conceive how such disease could be en- dured so as to enlarge the heart; but Dr. Baillie has Dr. Pitcaim to support him DISEASES OF THE MUSCLES. CHAPTER VI. ACUTE RHEUMATISM. This disease attacks at all seasons; but more rarely in summer. When there are rapid changes of weather, from warm to cold; and especially if damp, we may expect rheumatism. Persons from twelve to forty, are most subject to this species. Causes.—Cold and wet applied to the body when heated, or an exposure to a current of air; too thin clothing, (day or night,) partial exposures; as the cool damp of cellar floors to the feet, sitting near a broken pain of glass, riding briskly against the wind, and reading in an airy passage. Young people, by im- prudently bathing, (i. e. when the body is made warm by fast walking, or playing,) frequently contract the worst cases of acute rheumatism. Symptoms.—After a chill, a pain affects the great joints of the limbs; at other times some of the muscles of the shoulder blade, or the breast, head, and neck, are the seat of disease. In the former location, the joints swell, and become more or less red; and the local symptoms often shift about: the inflammation in the elbows, or wrists, will change to a similar affection of the knees, or ancles; relieving the upper joints entirely. This disposition to change of place is noticed, even in the more serious affections. Rheumatism of the head, with fever, (and of other parts also) will some- times make a total departure from the more external muscles and fix on the heart, depressing the pulse; and in some cases where the rheumatic fever is of an in- 188 DISEASES OF THE MUSCLES. termittent form, the change will be made to the sto- mach, with oppression like gout in this organ.* The rheumatic fever increases at night; but the pulse is not so rapid as in most pure fevers. Unless proper anti- phlogistic remedies are used in time, the limbs will be seriously injured; the affection become chronic, and sometimes the mind weakened. This disease, when chronic, seems to be a connect- ing link between genuine and spurious disease. Management.—The diet should be altogether vege- table, so long as the fever and inflammation last; the drinks, teas, and toast water. The room should be very temperate, so as to be barely pleasant to the at- tendants. It is often difficult to adjust the bed clothes to suit rheumatics: when sufficiently warm, it is too heavy; and when cool enough to the patient, too thin; and an inadequate defence from the external air. The author is indebted to an old rheumatic friend of his for a remedy so difficult: a pair of half worn sheets are to be quilted with a layer of cotton between them. Thus a good defence, without weight, is obtained; in all cases of rheumatism this may be used in part.— Great attention must be paid to the weather, and to the bowels, when recovered from rheumatism. Without flannels and thick shoes early in the fall, an attack will be certain. Cure.—The patient should be bled freely, three or fpur times, if the disease is violent; though in minor cases one bleeding will do. By bleeding every other day, it will be known how often the operation is needed. In the meantime purgatives must be given: jalap and nitre, say twenty grains of each, will be a good purge, to be given the same day the blood is drawn. In the intermediate days, sweating must be tried, with the fever powders, No. 1. After the reductions as above, we may make an attempt with the colchicum, so strongly recommended by Dr. Gregory. Thirty drops of the wine of colchicum may be given every six hours, * In either kind, viz. of the heart or stomach the low pulse must not prevent bleeding or purging. DISEASES OF THE MUSCLES. 189 for a few times. It had best be given with some other purgative. A drachm of senna leaves may be drawn with four ounces of water, and half, or one-third, of this, given with each dose of colchicum. Should the febrile symptoms keep up, after all these reductions, recourse must be had to Dover's powders; given three times, or four times, in twelve hours.* When by such means, the fever is pretty well reduced, and the local inflammations continue, there is reason to believe that these latter alone, are then the source of the pulse continuing in any degree more than natural; and we should change our practice, and attack the visible local disease. There is nothing so effectual as very strong lead water: half an ounce of sugar of lead must be dissolved in a porter bottle, of equal parts of vinegar and water, which is to be applied to the.parts every two or three hours. If the weather is not very cold, rags should be kept constantly wet with it, and laid on the inflamed parts. The author has repeatedly tested this prescription with a success beyond expectation. Em- brocations of tepid sweet oil are also used; and thick solutions of soap; but these seem rather to drive the inflammation from joint to joint; whereas the lead destroys it, and the remains of fever cease. Great good has sometimes followed the use of zinc and cup- rum amoniacum, given every four hours, in similar states, i. e. where the local inflammation continued to keep up the fever. It will be necessary in the free use of nitre and salines to take care not to extend them so as to pro- duce a flatulence of the stomach, which would render the stomach incapable of taking such other medicines as are needed. fc^T* One grain of cuprum amoniacum, and one of zinc, may be made into a pill, and given three times a day, or oftener, as the stomach will bear it. * See the new formula, in the apothecarium. 190 DISEASES OF THE MUSCLES. CHRONIC RHEUMATISM. This is generally the companion of advanced age, or the remains of inflammatory rheumatism neglected. Warmth is comfortable to the pains in this species; and though- the jtrirrts may swell, they do not inflame. There is little or no fever. Persons subject to chronic rheumatism are perfect barometers: often feeling a cloud before seeing it; and, like Darwin's sensitive plant, " tremble at the moving shade." Management.—The limbs are to be perfectly pro- tected by flannels, and layers of carded cotton applied to the pained joints. The drink and diet may be as in health. A stove heat in winter, continued through the night, will give great relief. Cure.—The bowels are here to be kept extremely regular by medicine; for no person can expect any relief in rheumatism without free bowels. But saline medicines are not proper. A teaspoonful of guiacum, in fine powder, mixed with two grains of gambouge, or with two grains of blue vitriol, and some syrup of ginger, is one of the best purges. Jalap and magnesia, or jalap and calomel, may also be used. Applications to the surface is here more depended on than in acute rheumatism. Friction is very neces- sary, and motion of the limbs to help them from suf- fering. Embrocations of all stimulating articles are used: such as spirit of turpentine, with sweet oil, from one-tenth to one-fifth of the former: some camphor may be mixed to improve the flavour. Tincture of red pepper is much used. A good liniment may be made by rubbing half a drachm, to a drachm, of carbonate of ammonia very fine, and then levigating it with thirty drops of oil of sassafras; after which it may be incor- porated with one ounce of stiff lard, or simple cerate, and kept in a tin box: a portion of this may be applied to the pained parts, morning and night, or oftener. The internal remedies consist of the following ar- ticles: viz. mercury; a salivation has often cured it. DISEASES OF THE MUSCLES. 191 Warm decoctions of a compound drink, made with sar- saparilla, lignumvitae, and sassafras, used in large quan- tities. Scalded mustard seed is a popular remedy, taking a large spoonful three or four times a day. Also turpen- tine pills, or spirit of turpentine; this last may be taken in doses of fifteen to thirty drops, in milk, three times a day. Horseradish is also used, and a spirituous tincture of the prickly ash,* (zanthoxilum fraxinifo- lium.) Besides those means, a warm steam bath is recommended; and the warm springs of Virginia are frequently used with great success. A perpetual blis- ter has been used; and when the disease is very much confined to one part, it may have a great effect; more especially in the more full and corpulent, or young patients. Opiates, in form of Dover's powder, is often necessary to give rest. Where there is fever, the state of remission is the best time to give opiates; be that day or night, as sleep is good at any time to. the weary. But the bowels must be moved after every opiate, if needful. There are a great many cases of rheumatism that will at first puzzle the practitioner to say, to which species a case belongs; but those that are increased by heat, or stimulating medicines, are sure to be acute. In some of those dubious cases, the dashing of cold water on the parts, brings great relief; and blisters, purging, and sweating, must be used in all such cases. Indeed, there is nothing but a practical distinction be- tween the two rheumatisms: for acute rheumatism will sometimes hurry into chronic. From this circumstance, Dr. Potter, and others, say there is but one rheuma- tism. Nothing proves this so well as strained ancles, which are (though differing in cause) first, a true acute rheumatism, and then become chronic, sooner or later; having often an intermediate state also, and then re- g^- * Tincture of prickly ash is made by a handful of berries, or as much bark scraped fine, to one quart of spirit. Oniy a teaspoonful in a glass of water can be used at first; the quantity may be increased as the person can take it, to four times that quantity, three times a day. This most pungent article is the zanthoxilum fraxinifolium; and not the aralia spinosa, as Drs. Cox and Gregory have it 192 DISEASES OF THE MUSCLES. fusing both stimulants and sedatives; but yielding to blisters, issues, and rest. SCIATICA. This is a rheumatism of the hip. Cupping, or leech- ing the parts, and purging, will often cure it very expeditiously; if not, ten to twenty drops of spirit of turpentine, in some milk, twice or thrice a day, will be nearly infallible. But if it delays after the above means, a little calomel must be introduced, and then the turpentine used again. Issues, or tartar plasters, are necessary in protracted cases. Where the bedding is not sufficient, and persons have to turn out and work, this disease will sometimes end in what Dr. Cullen calls arthrapousis, i. e. a suppuration and fistula of the hip joint, producing hectic and death. LUMBAGO. This is a rheumatism of the small of the back; and al- though fever scarcely ever attends sciatica, it does some- times attend lumbago. It has been found in the form of an intermittent fever, in bilious countries; and after purging with calomel, needs bark in the intermissions. Embrocations and strengthening plasters are to be used, after opening the bowels with oil, or calomel and jalap. Leeches may sometimes be requisite; but re- peated purging is the main thing. All the stimu- lating external applications may (after purging and leeching) be used that are recommended for chronic rheumatism. Flannels and warmth are necessary, in both this and sciatica, for that they appear to partake of the nature of both acute and chronic rheumatism. In those important cases where inflammatory rheu- matism leaves the head, and fixes on the heart, we must bleed and blister, be the pulse what it may. It is generally slow; and in those cases where it fixes on the stomach, we must purge briskly, and as soon as an operation is produced, use a little ether: say, twenty- DISEASES OF THE MUSCLES. 193 five drops, in a cup of toddy, every half hour; and apply first a sinapism, and then a blister, over the stomach, till that organ is relieved: using for some time the most mild and moderate diet and drinks: such as rice and mush, milk and water; for the digestion will be completely overthrown. INTERCOSTAL RHEUMATISM This complaint is most prevalent when the changes of weather are frequent: as in spring and fall; but it has been seen in summer, and is occasionally an epi- demic of small extent. It rather attacks the delicate than the robust: females are the subjects of it as often as men. It is a disease that is much confined to early life, say from fifteen to forty-five. The Causes are exposure to damp and cold, as in common rheumatism; and when more extended, an epidemic proceeds from long continued rainy, or cloudy weather. Perhaps a gouty habit disposes to it. Symptoms.—It begins with sharp stitches, and pains about the side and ribs, interrupting the respiration by catches. They are sometimes so severe, as not only to cause the patient to scream out, but to be- come fainty. A continued fever attends in the cool seasons, but of less degree than in pleurisy. It has been known to attack in the intermittent form, in the su'mrry?r months; like other rheumatic affections, it is liable to a metastasis, or change of place. It will sometimes fix on the stomach, with all the oppression of gout; with a quick, small pulse. In this state it is severe and alarming. It will then attack the breast, knees, and other muscles, flying about, back to its first place, then again to the stomach; though with less severity, if properly treated. A cough attends in all severe cases; but does not produce as much pain as a pleuritic cough; often no pain at all. This is a very important distinction between it and pleurisy; more- over, no blood is coughed up, nor any phlegm of note, till the disease has lasted some time, when white or 17 194 diseases of the muscles. yellow tough mucous will be discharged. The diffi- culty of breathing, in pleurisy, is of a deep uniform motion, and so is the pain; but in this disease there is often no difficulty in breathing, except at the moment of a stitch, and then the breathing is quite interrupted; nor is the pain always constant in intercostal rheuma- tism. By the above it may readily be distinguished from pleurisy, which is some satisfaction; though the remedies are nearly the same. The febrile symptoms increase at night, and are attended with more or less head ache. It generally shows its rheumatic connec- tions more and more, as it extends or declines, by the attacks on other parts; but these attacks are not a pro- per metastasis of the disease, like what is before stated. When it is extending, the first pains in the side remain; but when it is declining, they go off to other parts. Management.—In fall and spring, or winter, it will be well to keep up a moderate warmth in the room. A thin diet of vegetables, and mucillageous drinks, are requisite: such as elm bark tea, with acids, barley water and lime juice, drank warm. Persons subject to this disease must wear flannels. Cure.—In all cases attended with fever (even if it be an intermittent) bleeding will be necessary: ten or twelve ounces once, or at most twice, will be suffi- cient. A blister must be laid over the pained part, and an attempt made to sweat the patient by cooling medicines at first; and if they fail, by warmer ones. But from the beginning, free purging must be practised. Take jalap, fifteen grains, nitre, ten grains, calomel, five grains; mix them in molasses, or any preserve. A dose of castor oil may be used as a second purge. The following order of using the remedies will be a guide: on the first day bleed, and give the purge of jalap, Sic; as soon as that has finished its opera- tion, let a blister be put on the side, allowing this to be on all night. The patient may drink, through the night, his rnucillagenous warm drinks; having first bathed his feet and legs in warm water. In the morn- ing let him begin with the fever powders, No. 1, and DISEASES OF THE MUSCLES. 195 take them every two hours, through the day. If they pass through the bowels by night, nothing more may be done than to bathe and drink tea, or mucillages, through the night; but if they have not operated that way, let a dose of castor oil be given. Should the fever and pain continue, more blood may be taken; but if much reduced, and the pains less, one of the Dover's powders may be used every two or three hours, for three times. Should these sweat well, there will be only occasion for a little paregoric and antimonial wine, every two hours, to keep up the perspiration. But if the disease is still obstinate, some of Plummer's pills may be used, three times a day, till the mouth begins to feel it. In those oppressions of the stomach noted, the castor oil, with a drachm of spirit of nitre dul- cified, or some diluted ether, may be given, every two hours, till an operation is produced. A sinapism must also be laid on the stomach. Some bark in decoction, will be necessary, when much debility has been pro- duced, to brace up the system. After using Dover's powders, some oil, or an aloetic pill, must be given, to prevent constipation. N. B. If a cough follows the disease, the mixture of syrup of squills and paregoric will subdue it; which should be aided by elm bark tea, Sic PALSY. 0 This disease may invade the system from three distinct and more general sources, independently of various local causes, violence and debility. First, from cerebral affections, or those connected with the brain, and its diseases. Secondly, from affections and impressions on the primae viae, or on the lungs. Thirdly, from impressions on the surface. The more local and minor causes consist in tumours, obstructions and compressions in the course of the nerves; or spinal debility in the back bone. These are the subjects of surgical operations, or peculiar treatment. 196 DISEASES OF THE MUSCLES. Palsy of the first class (or source) either succeeds, or precedes, apoplexy. The latter, however, is the more genuine, as it may last some years; whereas the former, though more frequent, is mostly of short dura- tion. There are cases, no doubt, where no apoplexy succeeds; though the compression be in the brain. Most of these cases are either hemiplegias, or para- plegias, i. e. divide the person by a loss of motion of one side, or of the lower extremities. Palsy of the second chiss, proceeds from crude in- gesta, from metallic exhalations and abrasions being swallowed, or inhaled; hence printers, paint makers, gilders, miners, &c, are the subjects of it. Certain acrid medicines taken too long, or even applied to the skin, will produce a temporary, or partial palsy: among these medicines we may notice tobacco. Palsy of the third class has also been known to follow the external application of some drugs: as the white helebore, when applied to cure the itch on deli- cate persons; and arsenic. It has taken place from imprudently plunging into cool water, when the per- son was warm; from standing out long in damp fields, without exercise; it has succeeded rheumatism brought on by the same means. But one of the most obvious causes is exposure to a degree of weather beyond what the system can bear; hence it is found in captains of vessels, that sail packets in broad waters and long rivers, where they have to be up and out, in all wea- thers, day and night successively. Nearly all parts are subject to palsy: the ear, the eyelids, the optic nerve, the tongue, the arms, legs, fingers, Sic, as well as large portions of the body. There is sometimes a strong hereditary inclination; as some families easily drop into this disease: two or three children in one family have been known to have half the body, viz. extremities affected after some sickness, or other in- sufficient cause: though such cases are rare. Management.—This must depend on the state of the patient. So long as any apparent signs of inflamma- tion exist in the pulse, the diet and drinks must be of DISEASES OF THE MUSCLES. 197 antiphlogistic, or of a cooling kind. But when there is no inflammatory symptoms, or those have entirely sub- sided, a good natural diet may be allowed: taking care to remember, that not much is required where there is no exercise. Where the primae viae has primarily suffered, the diet should be rice, milk and mush, and very light articles. So far from inattention to this rule, the author assures his readers that he has seen a child paralyzed by eating freely of half dressed pump- kins; and the affection lasted for a year. Roasting ears have repeatedly produced very disagreeable in- sensibilities of the extremities: even turnips have some- times, when first eaten, shook the whole nervous sys- tem till they passed off. No cure can therefore be expected in these (most curable cases) when there is not the greatest attention paid to the diet. Cure.—It is well observed by Dr. Dewees, that " it is easy to make palsy worse," and it would be well for mankind if it were more curable^ In all cases of an apoplectic nature, or where cold has excited the disease in a good constitution; or wherever the pulse is good, we may bleed and purge with advantage, till the pulse is brought to a proper state. Repeated blis- tering may also be practised about the spine. After those remedies, mercury may be introduced so as to affect the gums. Issues have been recommended; and in cerebral cases should not be neglected. As the case becomes more cold and chronic, stimulating linaments may be applied to the limbs; and the bowels opened with stimulating enemas, used daily. The bowels, in all cases, must be kept up to their natural action. The gum guiacum and aloes will make good pills for that purpose. A small dose of jalap and ginger, or Rufus* pills, or the bitter tincture of rhubarb; making occa^ sional changes, are suitable. Electricity and galvanhm have both been useful. The Virginia (Berkley) springs alone have cured some cases. The aerated waters seem to expand the circulation without inflaming. Extensive and repeated frictions have done much good. Chaly- beate medicines have been used with advantage; espe- 17* 198 DISEASES OF THE MUSCLES. especially where the bowels have been primarily af- fected. Mustard seed, taken daily, in considerable quantity, and horseradish, so as to act on the bowels, have been praised by some physicians. In those cases that have followed rheumatism, and in all cases where the arterial system is languid, the above stimulants may be used. See painters' cholic. IdT Tremors are of the same nature as palsies. GOUT. Some of the causes of gout are very obvious: such as pampered living, indolence, the free use of ardent spirits and wines; to these we may add a conformity in appetites and living to gouty parents. Gout seems to be a declining disease, in this country. It is pro- bably substituted by agina pectoris, apoplexy, fistula, dropsy, and perhaps we might add cancer: all of which depend, more or less, on the same exciting causes as gout. Gout seldom waits for its seeds to be perfected, so as to bring on a spontaneous disease. It is most always accelerated by some of those personal causes of febrile disease enumerated in chapter the first. More especially the following selection of them: debauch, indigestion, cold applied to the feet, much application of mind, night watching, passions, excessive evacua- tions, sudden changes in the habit of living, and the debility of some previous disease; to which may be added violences, or a strain of the parts. Symptoms of regular Gout.—The ceasing of sweat to which the feet have been accustomed; an unusual coldness of the legs; a numbness, alternating with a prickling sensation along the course of the extremities; frequent cramp of the legs; swelling of the veins. Whilst those symptoms are taking place on the parts mentioned, the whole body is affected with a degree of torpor and languor; the appetite is diminished, and flatulence, with other symptoms of indigestion, are felt. Some days before the fit comes on, but more often DISEASES OF THE MUSCLES. 199 the very day before, the appetite frequently becomes greater than usual. Many authors, however, agree that all these symptoms may be absent, and the fit begin just as if they had preceded. In common, the attack commences about three o'clock in the morning, with pain affecting one foot, or both more rarely; fixing its point in the ball of the great toe. With the access of pain there is some shivering; which, as the pain increases, gives way to heat and fever, lasting as long as the pain does: usually about twenty-four hours; when sweat produces a remission. The topical affec- tion in the foot declines more slowly; continuing its swelling and redness, but wearing away regularly. The patient feels rather recruited than debilitated by such a paroxysm. There is often a return of fever for some days, which must then be included in the term paroxysm of gout. One of the features of gout, is its regular returns; but the intervals are shorter, and shorter, as the disease fastens on the system, and the paroxysms longer and longer. Nor will the gout be content with one toe! every joint will be visited; and when these are sufficiently broken down to warrant the enemy to leave them awhile, (to attack the more vital organs,) the stomach or the kidneys will feel the in- fluence of disease. Saline concretions, in"old cases, are deposited on the bones, tendons, and other places, which harden into a substance like chalk: said to be the urate of soda; these impede the motion and stiffen the joint. Spring and fall are the usual seasons of attack, when gout is a new disease. GOUT IN THE STOMACH, or Dyspeptic Gout. Symptoms.—Loss of appetite, indigestion, flatulence, nausea and vomiting; acid irritations, pains and cramps in different parts; irregular bowels, hypochondriac symptoms, and the absence of inflammatory symptoms in the joints. In such patients as have rode in car- riages from their infancy, and have been pampered with fifty covers a day, of Mrs. Raffald's, or Henrietta 200 DISEASES OF THE MUSCLES. Glass' compound messes; washed down with about three bottles of ascescent wines, imported from as many quarters of the globe; we may expect gout (after a very few turns) to erect its empire in the harassed organ of the stomach. And even when it affects the limbs of such individuals, to have a very different com- plexion from gout, in our hardy Americans; who exer- cise and walk as long as they can; but, unfortunately, carry simple stimulating diet to a great excess. In these last, dyspeptic gout never gets to the stomach till a complete reduction of the energy of every other part is obtained; and then it is a finishing job. From this diversity, we find the old English authors recom- mending a very different practice to what experience has taught us. It is only by the greatness of the dys- pepsy, and the gouty habit of the patient, that this spe- cies can be known from simple dyspepsia. RETROCEDENT GOUT. When the gout begins in the regular way, and then suddenly quits the limbs and fixes on the heart, the lungs, the brain, or the stomach, it is called retrocedent; and is an alarming change, requiring instantaneous relief. MISPLACED GOUT. This is a more rare species of gout, and is known by the general gouty habit, as well as peculiarities at the time, differing from the simple form of disease which it puts on. It will attack, offhand, the different organs that are affected by retrocedent gout; and it will also affect the muscles like rheumatism. Whatever disease it imitates, little or no attention is to be paid to its being gout; we must bleed, purge, and blister, as in other inflammations. Management.—In all inflammatory gouts, the sim- plest and lightest diet, and that in small quantity, must be prescribed. The patient, in general, well knows what will suit him: rice and mush are among the very DISEASES OF THE MUSCLES. 201 best. Nothing but water should be used as long as the stomach is unaffected; when that is the case, broths and puddings may be used, and some spirit and water drank; especially when the patient has been used to it. In the intervals between fits of gout, we may prescribe with- out fear of medical opposition: temperance, exercise, and a quiet mind. The stiffness of the joints is to be remedied by steaming and swathing In flannel, as well as by the use of the flesh brush. Cure.—Perhaps there is nothing medicinal that may be strictly called a cure. Poverty claims that honour. But the low price of spirituous liquors, and laziness, have put in a bar to this claim. However, when an industrious, gouty man, with a large family, loses his fortune, he generally gets the comfort of losing the gout with it. The doctors are mere temporary allevi- ations of the paroxysm. In inflammatory gout, the practice most approved is to bleed repeatedly, and to purge freely, when the disease is of any magnitude. Jalap and calomel, epsom salts and magnesia combined, castor oil, senna and salts made into an infusion, are all good purges. Dr. Gregory, Dr. Chapman, and various other practitioners, are much pleased with the colchi- cum, or meadow saffron, an article of great power, affecting the whole system when in an over dose. It should be given joined with a purgative: thirty to sixty drops of the wine, or eight of the powder, are a dose. It may be given with an infusion of senna leaves, every six hours, for three or four times. It is given as the fit approaches, or after it is on. The opinion of Dr. Hossack is rather against this medicine; and, although the author knows but little of this, and the famous eau medicinale; yet from its character as a materia medica article, he thinks that none but good constitutions (for gouts) should venture to use it freely; and then it would not be worth its risk, except it were used in the approach, so as to prevent a whole paroxysm. After the patient has experienced an attack, we would re- commend bleeding and purging, with safe and more simple articles. The legs and feet of a patient with 202 DISEASES OF THE MUSCLES. the gout, are to be lightly covered, (so as not to heat them,) with fine wool or cotton. Applications of linseed have been used by some, with various compounds add- ed: such as saffron, bark, &c; and such was the famous poultice bought by Bonaparte. A very strange reme- dy was proposed by a physician some time past, of eating one or more herrings at bed time. Whether this cured by the animal phosphate in the herring, by the salt, or whether it were a joke on poverty, is hard to say. Some gouty gentlemen, who have always had regular attack's, have immersed their legs in cold water, with impunity and relief; but it is hazardous. The late Dr. Ezekiel Dorsey, of Baltimore county, used this method on himself for many years. In gout of the stomach, that happens in course, from previous long continued gout, the remedies used for dyspepsia are to be applied: such as apperients of magnesia and rhubarb in mint water, gentle emetics of ipecacuana, small doses of ether, or spirit of ammonia, (compound) but where gout of the stomach is retro- cedent, we must apply sinapisms, use purgatives of more power, and even bleed, if the previous gout had much of inflammation: this may be done by cup- ping, or leeching. Blisters may succeed sinapisms. It is a great mistake to suppose that any disorder, highly inflammatory, by passing from one organ to another, can reverse its character; though it may alter the pulse. Hence, when the heart, the lungs, the brain, or stomach, are attacked by an inflammatory gout, we must use all the means of relieving inflammation speedily: by bleeding, purging, blistering. And in what is called the misplaced gout, if the characters are inflammatory, the same remedies must be applied as in retrocedent gout. After all attacks of gout, some tonics are necessary: the preparations of steel, good bitters, and strong decoctions of Peruvian bark, are to be used as necessity may require. DISEASES OF THE MUSCLES. 203 ST. VITUS'S DANCE, (Chorea.) This is a convulsive and nervous affection of the limbs, which still being, in part, under the obedience of the will, perform strange motions, in attempting to walk or take a drink of water. It is confined to youths from seven to eighteen years of age. Causes.—Some secret, or known, constitutional causes, acting on the habit peculiar to youth, will most probably produce it, without farther causes; but there can be no doubt but what that habit may be increased by the manner of living, &c. Dr. Cullen's ideas of the development of different parts, at different ages, might have come in here; but the most marked constitutional state of youth, is irritability; and what we may term an unfixed state of the vis insita of the muscles, necessarily arising from growth.* Jumping off a horse, and other concussions, have repeatedly produced chorea; the ir- regular commencement of catamenia has also produced it. Improper exercises for children (i. e. fatiguing them by work, hunting, &c.) are known causes. The confine- ment of them too much; especially when they have an appetite to take an excess of food, is most probably a very common cause. No wonder there should be such discrepancy in the opinions of the faculty; some attri- buting it to plethora, some to mere debility, and others to nervous or cerebral derangement. An inspection of the immediate or exciting causes will at once satisfy any candid examiner, that the irritations may invade from different quarters. Thus those concussions in jumping, and fatigue in hunting, evidently act first on the muscular system; an excessive diet, improper diet, minerals, worms, Sic, act on the primae viae; catamenial derangement will act on the nerves, and on the imagi- * Vis insita. By this the author means to convey an idea that.the new growth of parts will be subject to have their nervous actions more readily perverted, than when long used and fixed by mature age; just as the voluntary actions become more perfect by long and Bteady use. It is a term used by physiologists, to designate the per- manent nervous energy of the organ, which is, probably, always more or less disturbed in the local point of disease. 204 diseases of the muscles. nation of the mind: but all will centre on some one part where the disease fixes its head quarters. The disease will sometimes end spontaneously; and it will sometimes return after being cured. A continuance of it is very injurious: the voice is sometimes tempo- rarily injured during a very short period of the disease; and other paralytic symptoms are frequent. A long continuance brings on emaciation, fatuity, epilepsy; and at best spoils the constitution. Management.—It is thought to be improper to call the patient's attention to his own irregular motions: his cheerfulness must not be disturbed, his diet must be spare and wholesome: rice and broths are very proper. At first, nothing but water should be drank; and when debilitated, plenty of port wine, or old porter, may be used. Exercise, especially riding, is one of the best means of cure, when there has been no concussion to produce the disease. Cure.—This must correspond to a certain degree with the exciting causes and general state of the sys- tem, independently of the peculiarity of youth. There- fore, when there is plethora, when the exciting cause has been a jar, or excessive exercise, or overfulness from eating and inactivity, or irregularity of catamenia, (not depending on a pure debility) there can be no question about taking some blood, and purging, to re- duce the system; this, however, is not to be carried to any great extent. After this, the purging medicines may be continued merely to keep the bowels in action. But should bleeding be omitted, the purging system may be more extended. Our next object should be to arrest that vagrant action which causes the muscular or nervous symptoms. This is best done by blistering over the spine; and if needful, by applying issues of tartar emetic, or simply rubbing the ointment on the same parts. Mercury, by giving its own action to the system, has often been used with great success, both in males and females. It may succeed a trial of the tartar ointment. The proper time to use this powerful article is after depletion; but before debility. Should DISEASES OF THE MUSCLES. 205 the disease still continue, resort must be had to bark and steel, to the cold bath, (after giving time for the mercury to go off,) and travelling, or the use of the Virginia and other springs, impregnated with fixed air. The diet may then be a moderate quantity of meat, with port wine, or old sound porter. In such cases as where there is much debility at the commencement, the nervous medicines will be proper to begin with: such as valerian tea, assafcetida, and then tincture of steel and bark. But in all cases a regular action of the bowels must be kept up, so as to insure against indigestion, worms, or scybila, being a source. In such cases, the aloes and salt of steel will be one of the best apperients. Fowler's solution has been used by some physicians in preference to bark as atonic; but where a removal of debility is the object, the bark is preferable. The spirit of turpentine has been used with success as a stimulant. Perhaps in catamenial cases from pure debility, this with aloes and steel; and a little calomel, about the wanted period, might be ad- vantageous. The tincture of lytta, or flies, might here have a place, and some opiates, when the disease affects the spirits; guarding against its constipating effects by a pill of aloes and assafcetida. But travelling in such cases of debility, with the use of bark, are indis- pensable. There are no cases where blistering, and especially the plasters of tartar, should be neglected; for they will seldom fail when the system has been brought to a proper general standard. When the patient has recovered, an attention to the bowels, with tonics of bitters and steel, will be necessary for some time: and the cold bath, and temperance in diet, may be used till manhood. The plan of such extreme purging, as is recom- mended by Dr. Hamilton, the author thinks injudici- ous; inasmuch as such harassing of the bowels might lay the foundation of other more permanent diseases. And although such plans have often removed chorea of a certain cast; yet it is to be attributed to the ar- resting the* growth of the subject, or to simple reduc- 18 206 DISEASES OF THE MUSCLES. tion, rather than to any evacuations of an extraordinary kind; and this reduction may be more judiciously accomplished by a bleeding, moderate purging, low diet, and issues. EPILEPSY, OR FALLING SICKNESS. Causes.—We shall here enumerate such causes as authors have known, or supposed to have given rise, to epilepsy: viz. violence done to the bones of the skull, excrescences within the cranium, all accumula- tions of blood, serum, water, pus, or hydatids, either within the cavities, or on the surface of the brain; particular affections of the nerves: as partial divisions, excrescences and tumours, pressing, or irritating them. Irritations in the primae viae, from foreign matters of various kinds; acting either physically, or mechani- cally: among which may be considered as far the most common, the irritation of strong liquors, eruptions driven in; also irritations proceeding from various membranes and glands: such as the effects of teething, and hysterical, or uterine disorder. It is usual also among authors to rank as either general or partial causes, the interruptions, or diver- sions, of the circulation, exhibited in the effects of a hot sun on the head; intemperance, great pain, great muscular exertions, long stooping, long fits of cough- ing, great culinary heat, intense application of mind,* suffocation, or strangulation; and haemorrhages, espe- cially in decapitations.'.' To this list may be added the convulsions that so often finish fever, cholera, and some other diseases. Besides the above extensive list of causes that act either physically, or mechanically, making in most cases sensible changes on the parts where they are situated, there are others of a still more subtle nature, acting on the senses, making no change on their organization. Whilst a third set, pass- ing as it were the inlet of the senses, act metaphysi- * Many eminent statesmen have brought on epilepsy by intense application of mind; also ancient and modern generals; and 6ome of our eminent lawyers. DISEASES OF THE MUSCLES. 207 cally on the mind, and then on the parts where the disease has its head quarters. Of the causes that act on the senses, the most notorious are tickling on the skin, and other irritations: offensive smells acting on olfactory nerves. Tastes are seldom known to con- vulse more than the stomach. As instances of causes acting on the mind through the medium of the senses, we may enumerate, dreadful sights, surprizes, doleful tidings, and the long contemplation of distressing sights, particularly of the same disease. The whole of the above causes, of whatever kind, or wherever acting at first, are divisible into two grades: one where the magnitude of the cause enables it to over- come nature in her sound state; the other where the causes would have no effect but for the extreme mobi- lity, or debility of the system. There is no doubt but what a few repetitions of the greater causes will often bring the system to act morbidly with the lesser causes. An inspection of the great variety of the aforementioned causes, and their places of attack, will readily convince a candid mind that there must be some one central point, or foundation point, where all the above causes have access to, in order to produce this disease; and that as it takes place in decapitation, that the brain cannot either be the fountain head, nor even an indispensable way to get to it. Symptoms.—According to Dr. Gregory, the warning symptoms are head ache, giddiness, dimness of sight, flashes of light before the eyes, tickling in the ears, coldness in the extremities; and in some patients spectral appearances, (or false vision.) To these may be added, palpitations, flatulences, and stupor. But one of the most notorious symptoms, mentioned by all authors, is an airlike sensation moving from the extre- mities (in general) regularly up to the head: on arriv- ing there, the fit quickly succeeds. It is called the auna epileptica. It would appear to be of the nature of a chill, acting on the interior, as an intermittent chill does on the surface. During the fit, the convulsive agitations are violent. The eyes are riveted and fixed, 208 DISEASES OF THE MUSCLES. the pupils contracted, the teeth gnash together, the tongue is thrust out, and frequently bitten; there is a foaming at the mouth, the countenance is that of a dark chill, yet full; the breathing is irregular and la- borious. During the fit there is a total insensibility, which in some cases continues with apoplectic symp- toms. When the agitations cease, the patient is left in an apparently sound sleep, for a short time, and then recovers by degrees; being ignorant of what has pas- sed, but from mere circumstantial things. The debility and bad feelings are some time in wearing off. A fit lasts from a quarter to one-third of an hour; and they frequently commence whilst the patient is asleep. Youth are subject to this complaint; and in some few instances it goes off, and leaves the patient, on his reaching the adult state. There are some varieties of this disease, when the muscles are not agitated, but stiff, or relaxed. Management.—During the fit, the neckcloth, waist- coat, and gallowses, are to be loosened; the head should be raised a little, if possible; a piece of leather rolled up, or a soft piece of wood, should be put into the jaws, and held there to save the tongue. Some salt may be cautiously put into the mouth. During the intervals, the patient should avoid climbing, or looking into wells; he ought to have incombustible clothes, and not have any thing to do about the fire. When he finds a fit coming on, he would do well to sit on the floor, or ground, far from any thing that might injure him. A companion should always attend him. Riding alone, on horseback, is very improper. Cure.—Unfortunately many cases admit of no cure: such as bony excrescences, deformed head, original, or rather previously formed hydatids, and permanent collections in the brain, various other mus- cles; drawing the patient backward or forward. These spasms return, at first, every quarter to half an hour; 19 218 DISEASES OF THE MUSCLES. and at length at every attempt to move. In some cases only the jaws are affected. The disease lasts from two to ten or twelve days; and ends in a fit, or in pure debility and death. The commencement of this disease, after an exposure to cold, is generally pretty quick, often the next day, and so in some few injuries; but in general it takes place in about five to ten days after. A good deal will (in some cases) depend on the state of the wound: for this may suppurate well at first, and then (perhaps through neglect) fall off, and bring on lockjaw. It has been said that about twenty-two days will insure safety; but nothing will do this whilst there is an open wound, that may be thrown back by neglect. Cure.—Under this head we may introduce precau- tion. When a wound has been inflicted, leaving some suspicions, every means should be used to prevent the expected disease. Great attention should be paid to the bowels; they have a great propensity to become costive with this disease, and by getting them free beforehand, there is much good to be expected; and, as a great many cases (as before said) must depend on constitutional weakness, it would be well to use plenty of good bark, with wine, daily; by which wounds of any size would be brought to a good suppuration, and others hindered from mortification; to which there seems, in some cases, a tendency previously to the lockjaw. The wounds should always be dressed with a strong suppurating salve, where they are not very large.* If large, they should have a common poultice applied on the first two days, and they should be laid over (especially if ragged) with a dressing of equal par's of laudanum and Turlington's balsam: this is to be put on with light lint, and over this a warm poul- tice of scalded camomile. These dressings are to be renewed night and morning: and when suppuration is fairly formed, it may be kept up with basilicon oint- ment, or white varnish.t In all small wounds, or closed * See the apothecarium. t This may be had at the paint stores, and is an excellent dressing. DISEASES OF THE MUSCLES. 219 wounds, the opening of them freely, and dressing with the suppurating ointment, is indispensable. Bladders of warm water, or hot bricks, will greatly aid in keeping up suppuration; and in all bad cuts or bruises of the foot, which are so apt to produce lockjaw, a foot-stove by day, and warm bricks by night, are indispensable in cool or cold weather, or even in hot weather, if the feet become cold. The application of blisters near the edges of wounds that have no disposition to suppurate, would be a good practice. When lockjaw has commenced, if the member wounded is a toe, or finger, or even two or three, and they can be well amputated, (that is, far above all in- jury) it should be done, as such practice is advised by high authority; and has succeeded in the hands of Dr. Potter in two cases. There is no one medicine in which all medical men seem to agree, as being the main dependance, so much as opium; which must be administered in smart doses, of about two grains or more, every three or four hours, so as to keep up a constant action; and Dr. Baker, (professor of materia medica, in the Maryland college of physicians,) recom- mends it to be used the same way, as a preventive, in suspicious cases. If the jaws are closed, so that the opium, or even laudanum, cannot be taken that way, one hundred to one hundred and fifty drops may be injected into the bowels, every three or four hours. It is said that it will have a considerable effect if ap- plied in laudanum, on the surface; or in piasters on the soles of the feet. Perhaps a plaster made with two drachms of opium, mixed up with some honey, and thickened a little with flour, and laid on a part that has been denuded by a blister, or liquid caustic, would be one of the best methods of applying an opiate exter- nally. One of the greatest inconveniences of using opiates internally, is the disposition to increase the constipation that attends this disease. This must be met by adding a full dose of calomel, once a day, to the opiate; and where wounds have induced lockjaw, if not in other cases, the mercury may be considered 220 DISEASES OF THE MUSCLES. as a remedy, having a strong tendency to produce a good suppuration; and when the calomel cannot be taken by the mouth, to open the bowels, enemas of salts, or strong soapsuds, with a little aloes, or gam- bouge in them, may be used;* and mercurial ointment be rubbed on the thighs, or laid on a part that has been blistered or cauterized. When the opium has made a good impression by lessening the spasms, we must not forget to introduce the bark and wine freely, if not done before. And as the patient gets better, to with- draw the opium very gradually; but not the bark and wine for one or two weeks after the patient has got rid of his spasms, or of the constriction of his jaws. But should the opiate not succeed in reducing the spasm, the next best remedy will be the spirit of turpentine, taken inwardly, and aided by topical applications. Dr. Mott, of New York, gave a teaspoonful of spirit of turpentine in some broth, every fifteen minutes, till it had some effect, and then lengthened the time; but gave one hundred and twenty-three teaspoonsful, in thirty-six hours, with success. The topical applications of most note, are either caustic, or spirit of turpentine: a drachm of caustic may be dissolved in an ounce of water; and this may be applied for some inches on the sides of the spine, either by a sponge fastened to a fork, or by cutting a piece of old soft pasteboard, of the proper size, and laying it in a plate where the caustic is dissolved; it may be taken out with a pair of forceps, and layed on the part, for a quarter of a minute or more, till the skin is much inflamed. The spirit of turpentine may be applied, as was done by Dr. Stevenson, of Baltimore: that is, by cutting over the part where the wound was, and laying in a piece of lint, dipped in spirit of turpen- tine. When there has been no wound, the fleshy part of the arm, or thigh, may be used to insert the spirit of turpentine; and when there are wounds already * Re. soap, one drachm, scraped and dissolved so as to pass the syringe; take ten grains of gambouge, or thirty of aloes, and grind it fine, with a little of the enema; and add it to the rest. DISEASES OF THE MUSCLES. 221 opened, the incisions may be very near to them, if the parts will admit; if not, the caustio must answer. Embrocations are sometimes rubbed, extensively and frequently, over the abdomen and contracted mus- cles. One of the best is the following, taken from Dr. Thomas's work: Re. oil of amber, half an ounce; opium, two drachms, made very fine; lard, one ounce; mix. It may be well to mention here, that opiates in a compound form are recommended by some physicians. The Dover's powder is one form; salt of tartar and opium, in the proportion of three of the former to one of the latter, has its advocates; as also compositions of opium, camphor, and ether. The following will serve very well: Re. paregoric, one and a half drachms, ether, one drachm; to be taken in wine, every three or four hours. In cases from the application of cold, in warm coun- tries, or in the summer, in any country, the cold bath, as advised by Dr. Thomas, should have a trial; which is warranted by his great success. A large bucket of cold water is to be thrown on every two hours; the pa- tient is then to be wiped dry and put to bed. Maybe, a bath prepared with acid, so as to stimulate the skin, might be useful. If the patient recovers heat after the cold bathing, it may be continued, otherwise not. But the doctor still administered opiates, bark, Sic during the use of the bath. No means are mentioned, in this paper, but what have been successful at times. Some physicians have ventured to bleed in this dis- ease; but in a pure idiopathica case, the pulse seldom alters, till a debility, that will be fatal, affects it with a smallness and frequency. There is no proof that bleeding ever did good, even though it was pretty well sustained. tCI* When a patient can swallow, but cannot get entrance into his mouth, one of the most decayed teeth may be punched out, or a dentist can file a place be- tween two that will admit fluids. In all gunshot wounds, the wads must be removed, and shot or ball, when not firmly and deeply fixed, 19* 222 DISEASES OF THE MUSCLES. must be extracted as quick as possible, and some warm water injected to wash out the powder, if any is in the wound; and all splinters, glass, Sic, must be taken away from the wound by incisions, if they cannot be otherways removed. DISEASES OF THE STOMACH AND BOWELS. CHAPTER VII. CHOLERA MORBUS. This disease is strictly confined to our summer, and first fall months; at any rate north of the James's river, in the Atlantic states. It consists in a vomiting| and purging of crapula and bile, without much inter- mission. Causes.—Taking into consideration, the predispo- sition brought on by close sultry weather; and espe-j. cially when very hot days are succeeded by cool nights; there seems but two sets of general exciting causes,' necessary to produce cholera. One, where the patient has made too free with indigestible articles, for some time, of a debilitating and acidifying nature; or where he has simply played the gormand with good eatables. The other, where the patient has fatigued himself, or been exposed all day to a hot sun, and then impru- dently courted the cool breeze, at evening, or slept with his window open, or perhaps taken a cool bath- ing, or a large drink of cool water, or ice punch; and not unfrequently added the first set of causes to these more serious. It may be taken as a pretty sure rule, that when a predisposition exists, that any causes, whatever, that would bring on a cold, or a fever, will in those instances bring on cholera. It is, in fact, a short way of getting rid of a longer disease, though a severe one. Symptoms.—The disease will sometimes be threat* ening for a day or two; and the issue will much de- pend on the patient's prudence during that time. But in a great many cases the attack is very sudden, and often unexpected, and very frequently at night. Some 224 DISEASES OF THE STOMACH AND BOWELS. languour, nausea, and griping, usually precede, heats and feverishness; and then a discharge or so down- wards; which is soon succeeded by other discharges, both ways, in rapid succession: all the undigested matter first comes off, and then the bde. The thirst is intolerable, and the heat of the skin like fire, in most cases; though it is cold in some others. When the heat ends in profuse sweat, the patient feels easy for a while; but he is not long quiet: the puking and purging return till he is like a child in strength. The pulse becomes quick and small, and the head is some- times affected with dizziness; the eyes look sunken, the face wan, the calves of the legs are drawn up with spasms; which sometimes extend to the thighs and diaphragm. Hiccup, cold extremities, and a sinking pulse, generally close the scene, after an immense dis- charge from the primae viae. It is not always so very rapid and severe, but will extend to a day or two; there are many cases, however, where a single night has consumed all the vital powers. Management.—The patient should have good assis- tance; and though he is so thirsty and craving of drink, care must be taken, when it becomes necessary to stop the vomiting, not to take much more toast water, or green tea, than will wet the mouth. The bed-pan must be at hand, and though the patient be so heated, he must take care to have a light blanket, or flannel gown, to cover him when he rises, epecially after there is a probability of a free perspiration, which must be en- couraged. And when the disease has lost its teriffic features, no temptation must induce the patient to tamper with his stomach: his judgment, and not his appetite, should save him from another attack. He should live like a child for some days: & little rice, or custard, or some thin chicken broth, will be good food; and toast and water, or a little very weak toddy, his beverage. His clothing must also be attended to; and finally, his exposure to hot suns, or marsh effluvia, be forbidden. Cure.—After the stomach and bowels have disch^rg- DISEASES OF THE STOMACH AND BOWELS. 225 ed the undigested food and bile, which may be aided at first with draughts of camomile tea, we may pro- ceed to check the evacuations. If the disease threatens to be severe at the offset, a blister should be applied over the stomach, and carefully kept on with a flannel band, as the first article; remembering that it will be some hours before it draws. After the camomile draughts, a total abstinence from all fluids, except what little may be in the medicine, should be enjoined. Twenty or twenty-five drops of laudanum, in a little mint or cinnamon water, may be administered every half hour; or a still stronger portion if this is not sufficient. Some- times a little elixir of -vitriol will quiet the stomach very rapidly, and so will small portions of soda; they may be given alternately with the opiate. In slighter affections, or when the vomiting has longer periods, the saline draught may be used, or a little fine chalk and cinnamon water. Green mint toddy, and a toddy made with common gentian bitters, are occasionally very grateful, and useful. It has been a practice in mere vomiting to throw the disease entirely on the bowels, by giving thin broths highly salted, and using enemas: perhaps a pill of sal ammoniac might have the same effect. But the opiates are the main stay. If the feet are cold, a warm bath, or bladders of warm water, should be applied, and sinapisms applied afterwards.* Care must be taken to renew directly such opiates as are cast off the sto- mach. Some columbo will be necessary to strengthen the stomach after an attack; and the bowels should be kept open with powders of rhubarb and magnesia. There can be no doubt, from the nature of the dis- ease, as well as from dissections, that there is an inflam- mation in the stomach and bowels: often communicat- ing the same state to the liver and neighbouring glands. Nor is it any argument against this, that stimulants are used with success to check it; for the nature of the * A mustard bath, or rubbing some mustard over the calves of the legs, and drawing over them long stockings, is often useful for the cramps of the legs. 226 DISEASES OF THE STOMACH AND BOWELS. disease, in many cases, precludes medicinal evacua- tions;* it becomes its own rough medicine; whilst the physician's prescriptions are but secondary things. INFLAMMATION OF THE STOMACH. Causes.—External violence, potent and over doses of acrid medicines, large draughts of spirituous liquors, water drank too cold whilst the body is heated, expos- ing the stomach to a cool current of air, after hard exercise; as often happens after a gust in harvest. In- flammations extending from adjacent parts: as the bowels and the liver. Beside these causes, the sto- mach is liable to be inflamed in eruptive fevers, and in gout. These, with poisons, will be noted in their proper places in this book. Symptoms.—A violent, pungent, throbbing pain, and burning in the stomach; pain on pressure, inability to lay in some postures. But the pain is not always very severe; a rejection of every thing taken into the stomach is a main symptom; especially when the simplest thing swallowed becomes so intolerable, as to be voluntarily thrown off. The pulse is generally febrile; sometimes small, sometimes intermittent. * Dr. Hossack, nevertheless, recommends in full habits, with pain on pressure, the use of the lancet, and when the system has been sound at the commencement of the disease, especially in our states north of the Potomac, such practice may be justified. It will be more so if the patient has stood the disease ten or twelve hours without that great reduction that it sometimes effects in a few hours. In advanced pregnancy it would be highly judicious. $f~ It is too soon for an author to introduce, in print, a disease that is so little known as the Indian cholera. The mere seeing of thousands of patients may end in full ignorance of it. But from what little knowledge has been gained, the author would recommend all persons near to infected places and persons, to keep their attention on such diseases as partly coincide with Indian cholera; and oppose their causes, and remove them speedily if set in. These are common cholera, inflammation of the stomach, dysentery, and a typhoid pre- disposition. The road to these may be learned by examining each of' those diseases, (in this book.) It is the typhoid disposition that arms the foreign disease with the shafts of deal^; and next to that, the in- flammatory broken down habit which attends drunkenness. Peruvian bark, taken daily, and clear dry sweet air and soil, will remove the former, as certainly as pure water will the latter. This much may be worth a place, as this book may be in circulation before the disease quits these United Stales. DISEASES OF THE STOMACH AND BOWELS. 227 Management.—Nothing but small quantities of barley water should be drank, when there is no foreign matter in the stomach; and even this will excite fresh vomiting. Great care to live in the simplest manner, for some time after, will be necessary: a little rice and milk, and mush will be sufficient. Cure.—Bleeding is indispensably necessary in all cases: and must be often, and quickly, repeated. A large blister must be laid on the region of the stomach. An operation downward is of great importance. Two grains of calomel may be given, every quarter of an hour, directly after vomiting, taking no drinks; fifteen or twenty grains, or more, may be thus given; and some enemas given of glauber salts. But should this not lay on the stomach, calomel joined with opium may be given in stout quantity, say ten grains of calo- mel, and one or more of opium, every two or three hours, till we judge enough has been used to ensure a passage; and as soon as castor oil can be retained it must be used. But should there be a spontaneous purging, the calomel and opium must not be used; but fine sweet oil if it can be retained; if not, the whites of eggs.' Enemas of oil will always be useful. If the vomiting continues after free bleeding at the arm, cup- ping over the stomach should be tried. If the feet are cold, a warm sponging will be useful.* INFLAMMATION OF THE BOWELS. Nearly the same causes produce this as produce inflammation of the stomach; but we may add, as causes, costiveness, cholic, and hernia. See the article cholic. Cure.—This is exactly as for inflammation in the stomach, viz. bleeding, blistering, enemas, purging, and to this may be added warm bathing after bleeding. After removing all the immediate obstructions in the bowels, though there are many cases where no extra costiveness takes place, it becomes necessary to keep the bowels loose; for this, if castor oil cannot be re- * See the chapter on accidental diseases. ^ 228 DISEASES OF THE STOMACH AND BOWELS. tained, some magnesia, say ten grains, with one grain of ipecacuana, every half hour, will often answer the purpose. Hernia requires immediate surgical aid; but when this cannot be had, large bleeding, enemas, castor oil, and bathing, for one or two hours, in water moderately warm, will often enable the parts to be reduced, by the hand, if not of too long standing VOMITING OF BLOOD. Causes.—Obstructed menses, and other suppressed evacuations, obstructions of the liver, enlargements of the spleen, pregnancy, passions, costive state of the body, erosions by poisonous articles swallowed, and violent straining to vomit. To these we may add the petechial state of low fevers, and of pruptive diseases. Symptoms.—A discharge of grumous blood, though sometimes pure, or very thin, and mixed with the usual contents of the stomach, and not frothy and light. Though there is often some cough, it is not of that action which takes place when the lungs is diseased. Some pain and weight is generally felt about the pit of the stomach, and a vertigo, before the blood comes up. Management.—During the intervals, the patient should live abstemiously, take all pains to remove every cause, make no great or sudden exertions, keep from great heats; and whatever may be the cause, attend well to his bowels. When the effusions of blood take place, he should retire to a cool open place, and un- button his waistcoat and collar. Sitting up will be preferable to laying down. Cure.—In putrid, or low fevers, the cure must be in a general way, as for such febrile states, as well as by applying styptics to the stomach. In case of acrids swallowed, they must be counteracted by the means directed in the chapter on accidental disease. In most obstructions, whilst the constitution is good, and the discharges not considerable, bleeding at the arm will be useful. Enlargements of the liver and spleen DISEASES OF THE STOMACH AND BOWELS. 229 produ-ce the worst cases, as they will recur; and all that can be done is to keep the intestinal canal as empty as it can be, by using a small nourishing diet: such as mush and milk; and when the vomiting takes place to use opiates and astringents. When the discharge is too free, we must use astrin- gents, be the cause what it may: for this purpose alum whey is a good article. A purge of salts, with fifteen grains of alum to each quarter of an ounce, may be given at the offset, or on the first cessation, administer- ing it in divided doses. In the more violent cases opium will be necessary; it may be joined with sugar of lead: thus, laudanum, twenty drops, gaulards ex- tract, ten to twenty drops, every hour or oftener, in a little water. Ruspini's styptic is the most effectual, and should be kept on hand. Dr. Thomas thinks the tincture of steel in spirit of salt, say fifteen or twenty- drops (diluted so as to be not too rough) given every two hours, singularly adapted. Glysters of cold water are always proper. Blisters are also recommended over the stomach; perhaps a pinch of salt may be as effectual in this as in hoemoptoe. Dr. Hamilton con- siders purges, in obstinate cases, as the best remedy. 10° When any discharges of blood from the bowels, are not the consequence of piles, they are to be con- sidered of the same nature as vomiting of blood. Glysters of cold salt and water may be used in all cases. FAINTING. Causes.—Excessive exertions, heat, large evacua- tions, excessive passions, as fear, anger, joy; suddenly depriving the body of any compressions, distensions, or pains that it has been for a time used to; also vio- lent pain, affections of the stomach, disagreeable and strong odours, debility from fevers, loss of blood, &c. Symptoms.—A languor, anxiety, or giddiness, and dimness of sight, precede; at other times the fainting comes on suddenly. The patient turns pale, and sinks 20 230 DISEASES OF THE STOMACH AND BOWELS. away, appearing dead; the pulse fails altogether, or nearly so, and there is little or no respiration; a cold sweat often breaks out, standing in large drops on the face, which is as cold as death. After a few minutes the patient comes to himself, vomits, or is sick at the stomach, and feeble. Management.—The patient should be suffered to lay horizontally, in a stream of air; a little cold water may be sprinkled on the face, and all causes removed. Thus, when in a close room, with company, an in- stantaneous removal is necessary; and when the causes are of a more permanent nature, as haemorrhage, and long fevers, he should not be permitted to sit up, or get up, for many days, till his strength is greatly re- cruited. These latter kind of faintings often end in death. Cure.—The limbs should be rubbed in a direction to force the blood to the heart, i. e. from the fingers and toes upwards, towards the heart; some hartshorn should be applied to the nose, and as soon as he can swallow, a teaspoonful of volatile spirit given in a wine glass full of water, or in a little wine and water. In a long fainting, where these remedies do not answer, ar- tificial heat should be applied to the feet and bowels, and a stimulating glyster given. Dr. Dewees recom- mends a few drops of spirit of hartshorn to be used in that way; say forty drops to four ounces of water. It will be well to take some gentle tonics for a while: such as an infusion of bark, bacchons tea, Sic, to re- store the strength. DYSPEPSIA, OR CONFIRMED INDIGESTION. Causes.—The free use of coffee and tea, untimely eating, as at bedtime; using too much thin watery diet, such as broths; or eating very rich diet, such as fat meat, and rich spiced soups; the excessive use of but- ter, too great a variety of diet, at one mess; exhausting the digestive fluids before regular mealtimes, with por- ter, cheese, cakes, wine, Sic The large use of ardent spirits, the use of tobacco in any way, sugary desserts, DISEASES OF THE STOMACH AND BOWELS. 231 and oily or hard nuts, after dinner. The frequent use of saline acid, acrid, and narcotic drugs; also of mer- curials. The frequent, and unnecessary use of pukes and purges. Inaction of the muscles, long laying in soft beds, and in warm close chambers; especially with many inmates. A sedentary life, in studying, or for other purposes. Confinement in banks, offices, jails, and subterraneous abodes; especially in large public, or company buildings; which, when of stone or brick, retain a moisture, and a temperature of their own,* discordant with the atmosphere. The inmates become strangers to sunshine, and the usual tempera- ture of the air. To these causes may be added, the compression of the primae viae, by dress: as in stays, lacing, corsets, and by various modes of business, or trade. Previous and concomitant disorders: as in- termittents, obstructed liver, schirrus of the stomach, dysentery. Various uterine diseases, (structural, or functional.) All great, and continued, natural, or ac- cidental, evacuations; a moist seaside habitation, warm or cold; but especially the latter. Long exposure to raw bleak winds; cold long applied to the feet, by standing in damp places; riding hard for any distance, immediately after eating; neglecting to anticipate, or follow, the changes of weather, by a timely use of flannels and thick shoes; all enervating habits and customs; too extended suckling; a gouty diathesis: constitutioual disposition to a relaxed inflamed state of the surface of the primae viae, nearly as in piles;t neg- lecting the calls of nature as to the bowels, which should be evacuated once in twenty-four hours. All low passions: such as grief, care, anxiety, fear. The above causes, more or less, combined, and applied for any length of time, will be sure to produce first, a tem- porary, and then a permanent dyspepsia. * The temperature of the atmosphere varies every two or three days in most seasons, and it will take, at least, two days of one tem- perature to pervade the walls of a large house. t Dr. Parry's opinion was, that all dyspepsia depended on a morbid fullness of the villous coat of the stomach. 232 DISEASES OF THE STOMACH AND BOWELS. Symptoms.—These vary according to the causes: (external and internal) as well as from the peculiar part of the primae viae that suffers from the incarcerated air. It being sometimes in the stomach, at other times higher up, or lower down, the intestinal canal; just as we find it in cholic, The sympathies connected with the organs that give rise to many of the species of dyspepsia (see the tabular arrangement) will also give additional symptoms. But the most usual symptoms are, distensions and pains of the stomach, or bowels, costiveness, loss of appetite, heart burn, eructations of acid or oily crapula, water brash, unnatural discharges: sometimes of undigested aliment and bile, at others of ash coloured fceces, or small flattened, or compressed, excrements. It will sometimes happen that the appe- tite is so good that the patient is led into continual errors in eating. In some species the patient will do pretty well during the day, but as soon as warm in bed, he becomes restless, feverish, nervous, and full • of pain; he will be often afraid of turning in the morning, for fear of a lacinating pain through the small of the back, or bowels. It would be needless to say more to characterize the disease. It may be well, however, to apprize the patient that dyspepsia will frequently alternate, and associate with rheumatic pains; more rarely with piles, and with asthma. In most cases, the pallor of countenance is a strong mark of its becoming an obstinate dyspepsia, and though it is not considered a mortal disease, yet it sometimes induces dyspnoea, and dropsical swellings (in the more severe protracted cases) that terminates the patient's sufferings in death. Management.—Every cause, that is at the patient's will, must be removed. His diet and drink must be plain and simple, adjusted to the weakened digestion; and, moreover, taken at a proper time: never at a late hour. Let the stomach sleep! Bread made of all the contents of the wheat, is fashionable; no doubt that it is more apperient; but it certainly is not so digestible as fine bolted flour, properly prepared; neither is bis- DISEASES OF THE STOMACH AND BOWELS. 233 cuit so digestible, and free from acidulating, as good fermented bread, used the day after baking.- Rice well boiled with milk, and milk and mush, are the best of all diets for a disordered stomach and bowels. But a dyspeptic may use any fresh lean meat, in small quantity, or small fish without butter. All the dishes made of eggs and flour, without butter, and a moderate portion of sugar, are good diet for him. As to vegetables he must make his own selection from experience, taking care, not to use much, and especi- ally when first coming in season. Fruits can scarcely be used, but in very small portions: cherries, melons, and peathes, are the worst; some patients can, not only eat an apple, but with advantage; as it will keep them regular in their bowels. A mattrass is necessary at all times, but particularly in summer: early rising, bathing, walking, sailing, riding, and,.visiting the springs, will be of great service to him. The York, Berkley, Rockingham, white sulphur springs of Vir- ginia, and Saratoga, are all good waters. The springs about Baltimore, impregnated with iron and sulphurated hydrogen gas, might be advantageous- ly used by adding one or two grains of salt of steel, to each pint, to make them more aperient. It should be- come an undeviating practice to keep in, when the weather is wet, or raw, and to turn out in all good weather.. Cure,—Although, in many of the species of dys- pepsia, there may be no periods of good health; yet, in general, dyspepsia is not incessant; and paroxysms of a few, or more days, are relieved by returns of a pretty good digestion, and relief from pain. The cure, therefore, may be palliative for the present, oppression, or it may be suited to prevent returns of those pa- roxysms. The palliative is, in most cases, easily ac- complished, by immediately abstaining from tea and coffee, and avoiding all other causes, or perhaps by a total abstinence for a day, and by cleaning out the crapula, and incarcerated wind that has produced the uneasiness. This is done by a purgative: such as a 20* 234 DISEASES OF THE STOMACH AND BOWELS. pill of aloes and calomel, or a little jalap and magnesia. If the acid is considerable, a few grains of soda may be added. When the pains are so frequent, or violent, as to demand speedy relief, or where they return after purging: twenty drops of diluted ether, with ten of laudanum may be used, and repeated. Some of the chalk julaps (see the apothecarium) are well suited tc dispel the wind, and correct the acid. The patient should return very cautiously to his diet, taking only a little rice and milk, or some very light article, for the first day; for all purgative medi- cine weaken for a while the digestive powers. As to the preventive, or radical cure, it must be evident, that it is impossible in all such cases as are enumerated in the table under No. 1; which see. And in such, a palliative course is all that can be used. However, in cases of abstricted liver, it will be well to try the blue pill occasionally, as that organ may, besides the permanent affection, have temporary in- creases of sluggishness, or interruptions in the dis- charge of bile. In all those cases represented in No. 2, of the tables, the primary cause must be removed before a cure can be expected. Nevertheless, as there may be an asso- ciation of causes, and reciprocal sympathies, an attempt should be made on the stomach at the same time that it is made on the primary affection; and this attempt should embrace not only the medicines beforemention- ed for a palliative cure, but especially those named hereafter for a radical cure of other species. All the remaining causes of dyspepsia, which, in- deed, are the true disease, or idiopathic dyspepsia, so called in contradistinction to sympathetic, may be considered as affecting the primae viae in two distinct ways: one producing a certain degree of inflammation of the relaxed kind, similar to the first formation of haemorrhoids;* and the other a state of irritation and * The author thinks Dr. Parry was too confined, in fixing on the stomach alone, and too general in supposing it the whole source of idiopathica dyspepsia. DISEASES OF THE STOMACH AND BOWELS. 235 spasm, similar to what happens in cholic; to which disease there is a great affinity in causes, symptoms, and cure. When the surface of the bowels are in this inflamed state, it may be known by the uneasiness produced by stimulants, by pain and bilious discharges during the operation of purgatives; head ache, feverish habit at night, and pain on the increase of warmth by the bed, and frequently by the colour of the face, and state of the tongue. The remedies then should be of the most soothing kind: castor oil, or sedlitz powder, may be used to unload the bowels; abstinence and the lowest diet enjoined; and when the temporary paroxysm has passed off, the tonics should not be of a warm or heat- ing kind: some of the tincture of steel in spirit of sea salt may be used, three or four times a day, and a cold infusion of camomile, or of bark. As this state is constitutional, and returns often, great caution should be used to avoid damp and cold. The gouty diathesis is so like this, that the same remedy may be used for the palliative and radical cure. Perhaps a little more abstinence and exercise would be necessary. In both those cases, small doses of one grain and a half of ipecacuana, with a teaspoonful of magnesia, every two hours, will often regulate the bowels, and with other precautions prevent an attack. On all returns the tonics must be abandoned, and the first set of medi- cines (the cooling apperients) resorted to. The numerous eases of the next class, caused by errors and impositions on the organs of digestion, or when the diet has been, as usual, by a paralytic state of the surface, communicated to the primae viae, (see No. 4 and 5 of the tables) are in most cases radically curable, provided the patient will lend all his aid to it. The palliative cure (after removing the causes) is to be as directed for other species; and the radical at- tempt will, in many cases, admit of more stimulating articles; though it will be necessary to be prudent and sparing. A little old Madeira may be used, and the bitters called compound tincture of bark; the infusion 236 DISEASES OF THE STOMACH AND BOWELS. of angustura is a fine medicine; the preparation of steel may be constantly taken: but with these every means of recreation must be added; for medicine alone cannot effect a cure. Friction, and domestic exercise should be used when the weather prevents a turn out. The peculiar symptom, called water brash, or puk- ing up a clear liquid, without the sickness, been treat- ed in an empyrical way with the oxyde of bismuth, as also with hard cider: from three to nine grains of oxyde may be used, twice a day, in some mucillage, beginning with the smallest dose; the cider must be good sound cider that has become hard, (as the far- mers term it) and then bottled before it changes to sour. It is, in fact, a low wine. It generally acts a little on the bowels. It has also been used in other cases of dyspepsia. A tabular view of the different species of dyspepsia: Dyspepsia from organic defects, viz:—Ob- structed liver and spleen, diseased pancreas, 1 -^ cancer, or schirrus in the stomach, permanent fistula, organic disease of the uterine organs, and ^such diseases of many other organs. Dyspepsia from exhaustion, viz:—Haemorr- hage, mucous and purulent discharges, diarrhea, 2 «^ remains of dysentery, suckling too long, broken down constitution, from advanced age, anxiety, _grief, and all other causes. f Dyspepsia from constitutional causes, acting \ on the primae viae, viz:—Gouty diathesis, inflam- | matory disposition of the internal coats of the Ijprimee viae. Dyspepsia from trespassing on the primse vise, viz:—Hard drinking, over eating, improper diet, using drugs too freely, interrupting the peristaltic motion of the bowels, by posture in trades, seden- tary life, childbearing, corsets, and by allowing of habitual eostiveness. DISEASES OF THE STOMACH AND BOWELS. 237 f Dyspepsia from paralysis of the surface, viz: 5 J —Dyspepsia of civil officers, and clerks, from j confinement, from inaction, or fashionable life, ^especially of females. FLUX (DYSENTERY.) Causes.—These are somewhat obscure; but seem to be nearly the same as what produces summer fever, i. e. the effluvia of stagnant waters, acted upon by a hot sun. When the system is thus prepared, a small cold falling on the bowels will produce the disease; local nuisances seem to have the same effect as mias- mata when they are near about a house; especially to south and west of it, by which position the summer winds bear the gasses along through the dwelling. The chief local affection is in the mucous membrane of the large bowels. Symptoms.—Sometimes a fever makes the attack, at other times the bowels are primarily affected, first with costiveness and flatulence, and then with griping and frequent painful efforts to have a passage; when nothing of a natural appearance is discharged. Slime, however, of a white, bloody, or dark appearance comes off in considerable quantity; at other times flux gradu- ally ensues upon what appeared to be only a diarrhea. Dr. Cullen supposed those excrementitious balls, that are formed by contractions of the bowels on retained natural discharges, to be the main source of the pain and disease. This, however, is not always so, since violent and painful cases of dysentery often recur with- out such scybila. They are, however, aggravating causes, and their discharge is a sure mark that the bowels have yielded to the medicine. The stomach is frequently much disturbed at the beginning of the disease, but that goes off as the dis- ease moves downwards. It ends in a painful contrac- tion of the orifice of the last gut, called a tenesmus. The operation of each purge, though it brings relief, 238 DISEASES OF THE STOMACH AND BOWELS. is often one of the most excruciating parts of the suf- fering. Management.—Great attention must be paid to cleanliness: in the room, in the bedding, and in the chamber furniture; which last must be hurried away, scalded, and sunned, before returning it. When the patient is weak, there must be a bed pan, for he cannot support such incessant rising from his bed. The room should be aired, and sprinkled with chloride of lime. A night gown and socks will be very conve- nient for the patient. Rice water, arrow root starch, barley water, gruel, and thin broths, will be the best diet. Slippery elm tea, toast and water, jelly waters, roast apple tea, will make good drinks: or if the patient likes acids, a little cream of tartar may be used. A marmalade of turnips, roasted, and the juice pressed out, has been used in the East Indies, in their worst cases. It is very balsamic. 10° In seasons known to produce flux, people should keep their cloth waistcoats buttoned, avoid wet, and eat little fruit. Cure.—When little or no fever attends, an alternate use of a dose of castor oil, and a dose of calomel, or a combination of them, morning and night, for two days, will nearly cure the disease. But when fever attends, we need not expect such an easy cure. It will be then necessary to take a full bleeding, which may be repeated with some advantage in most cases. Some castor oil must then be given, every four hours, till the bowels are well purged; and we must not desist purg- ing till natural discharges take the place of blood and slime. But an eye should be kept on the fever, for that must be reduced before a cure can be effected. For this purpose, and to lose no time, such articles may be used as will reduce the fever, and open the bowels: one-quarter of an ounce of glauber salts, with one-third of a grain of tartar emetic, may be given every two hours. But as the patient cannot endure so constantly the purgatives, he may use the antimonial powder, in four grain doses, or two grains of ipecacuana, every DISEASES OF THE STOMACH AND BOWELS. 239 two hours, till it be requisite to administer more oil or calomel. This last article does best at the beginning, and should not be used more than once or twice for a purge. When the pain in the abdomen continues,- it becomes necessary to put a blister on it. The disease will continue from six to nine days at least; and then end in a tenesmus, which requires warm steam from a pan, or a bath, and injections of starch and laudanum; or if these cannot be given from the great contraction of the bowels; a pill of a few grains of opium may be pushed in after sitting over steam. Should the febrile symptoms linger, blisters on the wrists are to be ap- plied; and when some fair intermissions ensue, decoc- tions of bark may be given; but this must be watched; for, as Tissot says, it will produce pains in the knees, if given too soon. Small doses of ipecacuana are then of great use, and through every part of this disease, and is the main resort when other medicines can be no further used. It may be used also with opium for the tenes- mus. Some physicians prescribe an emetic of ipecacu- ana in the beginning; and where fever prevails, and the stomach refuses purges, it is highly proper, and indeed after the first purge, it may be used, let the stomach be as it may. The bowels must not be suffered to get costive after the disease is on the decline, but must be gently moved with a little oil, or rhubarb and magnesia. In armies, the disease is apt to take on it a low ty- phus state, which adds greatly to its mortality. The cure is much the same, though the bark and camomile should not be long neglected. Purifying the rooms will be more requisite, and drinks of the acids may be allowed. Dr. Tissot thought that the use of such acid fruit as grapes, would be useful as preventives to those low putrid dysenteries. gf- Six grains of calomel may be given in a pill, and then a com- mon dose of oil after it; which is more agreeable than extremely large or repeated doses of oil. Ointments made with opium, ground up with oil or lard, are used to apply to the vent of the bowels, after each discharge, to prevent smarting and irritation. 240 diseases of the stomach and bowels. DIARRHEA, OR LAX. The distinguishing characters that divide diarrhea from flux, though not very clear at first, soon become so. The latter being attended with fever, pain, painful discharges of slime, blood and purulent mixtures, con- taining little or no natural excrements; and when such are discharged, by force of medicine, they are often in hard balls, or cartridges, called scybila. These, by some eminent physicians, have been considered as the chief cause of flux. The disease we term lax, or diarrhea, is known by excessive natural, loose, and liquid discharges, though accompanied with much slime and morbid matter, of a green, white, brown, yellow, or blackish colour. There is little pain in diarrhea. Some griping or borborigmus precedes a discharge, which passes easily without a subsequent tenesmus; and fully relieves the patient till another passage is on the way. Causes.—(In youth) the long continued, and exces- sive use of fruits, ripe or unripe; bolting of their din- ners, i. e. swallowing their food unchewed, through haste, or great appetite; excessive exercise, followed by imprudent exposure to night air, or cool day breezes, or cold bathing; drinking small beers, and eating cakes, after violent exertions, as in playing ball, bandy, Sic To these, so peculiar to them, may be added, almost all the causes that produce diarrhea in adults. Causes (in adults.) Over eating, using unsound and oily food, as when confined on ship board; certain waters of bad quality; also waters of a medical purging quality;* remaining too long on damp cold ground, without exercise, particularly after exercise, or after being in very warm apartments. Sudden changes of weather, from hot to cool, checking the perspiration, or from cool to hot, when the bile is stirred up, and inflames * Lime water, waters impregnated with magnesia, or with sulphate of iron and alum, as in some of the districts of Maryland and Virginia. DISEASES OF THE STOMACH AND BOWELS. 241 the bowels. Breaking up of long frosts;* drinking cold water, or any cold beverage whilst too warm; a dis- turbed state of mind; by which indigestion is first produced, and then diarrhea. Peculiar disorders of the liver and pancreas, by which those glands pour out acrimonious discharges instead of fluids, assisting diges- tion and animalization: thus being a double cause. Any foreign humours generated within the body, thrown upon the bowels: such as pus and the matter of eruptions. Inflammation of the folicles of the bowels, brought on by excessive strong medicines, or poisons, or by an extension of catarrhal affection. Finally, an hectical state from broken down constitution (as in hot climates) ending their paroxysms of fever on the bowels. Many of the above causes would cease to **Jt» after a day or two, and the disease cease, but fo-' the debility produced by the first causes, inducing indigestion. This latter becomes a new source; not only so, but there is good reason for believing that tr*>se crudites generated in the bowels, in its disordered state, act as a zest, turning all that comes in contact with such contents to a similar, or at least a jxbrbid quality. This seems to be most clearly proved by so many laxes being cured by a simple purgzdve, with a little prudence and ab- stinence. Management.—Milk and water, toast and water, herb teas,t port wine and water, and weak chocolate, are good drinks. A small diet, chosen from prepara- tions of rice, or arrow root; also, mush and milk, eggs, custards, light broths, made of lean meat, or chicken, will be proper; small fish and birds are very good when they can be obtained. Flannels should be used when they can be borne, and thick soled shoes always. Hot suns, damp air, and very cool weather should be avoided; and fires used whenever they are comfortable. * The breaking up of long frosts, acts by the ground keeping the feet cold, whilst a warm sun is applied to the body; as also by much incarcerated air and filth let loose. t Mint, 6age, hyssop, and baum, are the best. 21 242 DISEASES OF THE STOMACH AND BOWELS. Salted and smoked meats, beer, cider, cakes, honey, melons, pears, peaches, apples, cherries, roasting ears, and cucumbers, should be banished for one year from the table of a person who has had even two weeks diarr- hea. A mattrass will be greatly preferable to a bed, especially in summer. The patient should often recline on a sofa, as a perpendicular attitude is very trying to weak bowels. Riding and sailing are almost indis- pensable. Cure.—The mere glancing over the causes of this disease will be suflicient to convince any one that a nostrum to cure diarrhea is an absurdity. And it may be observed, that though a patient Can do so much to- wards curing himself, yet he will be very imprudent to tamper with this disease: which must often trans- cend, in cause and difficulty, all his power of discern- ment and meJical skill. In youth.—The restraining them from improper diet and exercise ure the first thing; putting them on a rice diet, at firs*, and then on broths. If the disease continues, a few doses of rhubarb and chalk, going on to astringents, if nt°dful, will be the practice: half of what is directed for •* child to take in a day, (see the apothecarium) may be used for a single dOse, add taken three or four times a u»y; the kino pre- paration, with opium, is the strongest. In laxes, the rule is, ahvays to begin with lite weakest: as very unpleasant affections sometimes arise when an astrin- gent acts too completely: such as pains, and even dropsies. A youth may take six grains of the kino, with opium, morning and night, which will contain one-quarter of a grain of opium in a dose. When lax succeeds violent exercise, Or bathing in cold streams after being heated, there is generally some inflam- mation. If, therefore, the belly is swollen, or feels painful on pressure, some castor oil must be given; and then three or four small doses of two grains of ipeca- cuana; and if the pain and soreness increase, bleeding, and blistering the belly, will be necessary, or leeching, at any rate. DISEASES OF THE STOMACH AND BOWELS. 243 The bed should be the place in such case; for even to walk about the room is imprudent. A tepid bath, after bleeding, will be of service. Astringents must not be used till the inflammation is subdued. In all other cases, the same remedies are used as for adults; remembering that the more febrile, or the more like flux, the less use must be made of astrin- gents. In adults.—Over eating must necessarily be ex- changed for moderate eating, and for those simple diets before mentioned; and then a few doses of the mixture cf chalk and rhubarb, with some laudanum, will be in general sufficient. In those necessitous cases on shipboard: the boiling of the unsound meat with a portion of powdered char- coal will be the best plan; and when only fat meat is to be had, the boiling it in small slips, enclosed in balls of meal, (called dumplings) is the best cooking: eating very little or none of the meat. Some medicine may also be used: such as rust of iron and ginger, or other spices: ten grains three times a day, and some port wine, if to be had, will strengthen the stomach: these things are to be had on shipboard most always. Where the water is bad, some lime should be sprinkled in the casks, and the water filtered through a stone, or sand, or powdered charcoal; when no sand is to be had, some bricks or stones may be broken fine, or even sawdust used. The medical purging qualities of water will some- times cease by use. For lime water (if the patient is obliged to be on the place) a little vitriolic, or oxalic acid may be added. And when he cannot use the waters of such places, enough may be distilled.* Where persons are confined to cold, damp, and sub- terraneous apartments; flannels, fires, thick shoes, and sanding the floor, are necessary, with great attention to a choice of diet. Some ginger tea, and tincture of • An iron pot, with a thick poplar, or gumwood cover, well fitted, and cemented with clay, or dough, and a tin tube, or old gun barrel, or a reed, will make a still, which will make the water pure. 244 DISEASES OF THE STOMACH AND BOWELS. flakes of iron, with rhubarb bitters, may be useful as preventives, or cure. But when the lax has proceeded from a temporary chill, after being heated, the disease is apt to be more acute, and must be treated with small doses of castor oil, or of rhubarb and magnesia, or small doses of ipecacuana, adding a few drops of laudanum to each dose of ipecacuana, as the disease becomes more chronic. In sudden changes of weather (to cooler;) warm bathing, taking an emetic of ipeca- cuana, and then using a Dover's powder, every six hours, with confinement to bed, and rice diet, will be a proper course. But if the change be to heat, some castor oil, and then a dose of ipecacuana, will, in gene- ral, prepare for small doses of rhubarb and chalk. The breaking up of long frosts should be guarded against by staying in doors, by purifying the rooms, and by wearing very thick shoes and stockings. Small emetics at first, and then doses of rhubarb and chalk, with a little alum Or laudanum, will be most suitable. The drinking cold water, or be eva- cuated into the thorax, or abdornp *n tnese two last it may be considered certain *. More or less discolouration of the eye/ and countenance happen in many cases; whilst ip others theri is no appearance of a bilious * A gentleman, who ha< an enlargement of the liver, with accele- rated strong pulse, was 'ery much troubled with vertigo; taking a ride he found it went ->ff; and he followed the custom for many months, merely to get dd of the vertigo. 23 266 DISEASES OF THE LIVER, SPLEEN, SlC tinge. Emaciation is a frequent symptom. The pulse is always accelerated at first, without any mate- rial remission; but after some time puts on the hectical character. Indigestion and hypochondriacal symptoms will afflict some. In fine, there will be much variety in the different cases, and no one set of symptoms win be constant in all cases. Dropsical swellings, apo plexy, piles, and haemorrhages, will ensue in differen cases. The affections of the liver, of this stamp, wih last a long while in many instances; so that other dis- eases sometimes carry off the patient. There is much insidiousness in these affections: some getting on very rapidly, whilst others seem never to come to an issue. It may be generally distinguished from consumption, says Dr. Gregory, by pain in the hepatitis, preceding cough; and by the patient's ability to draw a long breath, so as to give pain, without certainly exciting a cough; vhich never would fail in an inflammation of the lungs. There is sometimes in this species of hepa- titis, a dispos>ion in the face t0 a SWollen appearance, whereas, in thfcf0M0wjng one) which we are about to describe, the sw<»thy s^m seems 0flen to adhere to the bones, and to g,,e a firm nard COUntenance. But it must be confessed, ti,t ^exe are no cerlam marks in the countenance. In tu\next variety, that is, chronic hepatitis without innamn„tion or fever; the hardness of the liver may generally i« feU wit|,out pain, and an increased size be ascertained, 'phe bowels are costive to a great extent, the digestiv, powers are bad, the mind mostly dejected, the pile, ani epistaxis are common companions, and so is ^ enlarged spleen; the eyes are sometimes bilious; the ^tient often com- plains of his shoulder; the gums are lometimes very firm, and the patient has gene\ally a grea\ insensibility to the mercurial action. Blackxhaired swarthy people are said to be more subject to it\han fair light halted persons. Females suffering undo! such large obstrue- tions of liver, have, nevertheless,\orne children, and done well. There are no reasons for supposing enlargements of DISEASES OF THE LIVER, SPLEEN, &C. 267 the liver and spleen are altogether the effects of intermitr tent fever, though they are in part. They are probably included, and affected to a certain degree, in the origi- nal attack; made by marsh effluvia, or a certain com- bination of heat and effoete water, i. e. water that has transuded plants, or percolated mud, and lost its viva- city. %CT See Hale and Wildenow on those points, relative to such water, viz. its easy corruption, and injuriousness to other plants that absorb it. Cure.—The indications of cure are built on the de- gree of acuteness of the affection, and the time it has existed, in the two first varieties of hepatitis. And in the third, i. e. those without fever, merely on the time of its existence. In such cases as are attended with much pain, high fever, white dry tongue, we may expect suppuration if the disease is not directly arrest- ed: to prevent this, bleeding freely is the first opera- tion, and after a second bleeding, a large blister must be applied over the side. The bowels must be well attended to from the first day, by a free purging: one ounce of salts, and a grain of tartar emetic, will be a suitable one the first day, and afterwards the same quantity may be given, in divided doses. Castor oil, or jalap and calomel, may be used for a change. On such days as the bowels are very free, some of the powders of nitre and antimony may be used instead of purging. A second blister will often be necessary. Drinks of lemonade, and a diet of rice, barley, Sic, will be proper. If the pains, dyspnoea and fever con- tinue unabated, and rigors ensue, in spite of all this treatment, suppuration may be expected. After a full use of bleeding, purging, &c, as directed above; then, and not sooner, we may venture to introduce some calomel, in the form of Plummer's pills, morning and night; but if the anti-phlogistic plan is gaining upon the disease, the mercury had best be delayed as long as possible; though it is said, that in the West Indies it may be given in three or four days at farthest. Per- haps the rapid progress to a state of debility, and their constitutional relaxation, may justify it there; but here, 268 DISEASES OF THE LIVER, SPLEEN, &C. in our middle and northern states, it would certainly establish an additional degree of inflammation, whilst the pulse is up. This doctrine catviot be controverted by observant practitioners. When the matter is forming, nothing but merely regulating the system, and supporting the strength foi the crisis, can be done. Should the matter point be- tween the ribs, it cannot be operated on too soon. Some tonics will then be necessary: such as a decoction of bark. The diet should be such as would suit infants at first, and then increased in strength and quantity, as the exhaustion of the patient may require. In the next degree of hepatitis, i. e. where there is some fever but not severe pain, or no pain except on pressure; when the patient can generally walk about; where the system is much disturbed, and the coun- tenance, with other symptoms, assure us of an affection of the liver; (which will probably fix some chronic affection on the diseased organ: such as before stated, viz. partial suppurations, ulcers, tubercles, enlarge- ments, Sic;) we must examine well into the time and circumstances. If the feverishness has continued with- out much change; if the symptoms have been steady, except in mere increase and disease, we may expect that those organic affections are not fully established. But on the contrary, if the disease has continued long, and the patient has marked a new set of symptoms; especially if the fever has become hectical, (which see) we may expect that those Inrpies have fixed on the liver. These two states will require full attention. In the first, bleeding moderately and repeatedly, every few days; blistering, and then tartar plasters, or tartar frictions, will be requisite. The bowels must be con- stantly acted on; though not so briskly as in the most acute cases before mentioned. If the bowels are loose, alteratives must be used: such as two grain doses of ipecacuana, four times a day; and if not, the antimo- nials and nitre may be used on such days as the purges are not. We may also be less careful about the time of giving mercury. It should be introduced after the DISEASES OF THE LIVER, SPLEEN, &C. 269 above antiphlogistic remedies have been used a week. Plummer's pills, given every night and morning, till some effect is produced, will be proper; unless the bowels are loose (and they should not be checked;) in such case, a drachm of strong mercurial ointment may be used every night on the groins. It would be well for the patient to go by water to a more temperate and dry clime. His diet and drinks must be moderate, and of the mildest kind, nearly altogether vegetable. In the second stage, i. e. when there are hectical symptoms, not much can be expected from medicine; a change of climate to a cool dry country, and the use of chalybeate sulphur springs, that have an aperient quality, as those of Virginia, and York, in Pennsylva- nia, may have a good effect. The blue pills should have *. trial, using them for a week, and then desisting and recommencing after a time. Mush and milk, goats' mih\ and rice, will be proper for diet; and sailing and riding cq good roads, and in carriages, may be constantly practised. Dissections haw shown that affections of the liver associate with a lato;e number of diseases; and such as could never be supposed, were it not for the knife exposing them: such as low fevers, affections of the brain, diseases of the ovaria, Sic, besides those more closely connected with the parts: as dysentery, lay, cholera morbus, consumption, and diseases of t^e heart. It is, in fact, an organ that is easily injured >nd hard to cure. In the third, or last grade of hepatitis, i. e. tf/iere there are no febrile symptoms, nor pain on presfljiff the region of the liver, though often an evident .'i^dness and enlargement exists, there may be some hcpe of a radical cure; provided that the affection is of recen; date, or only a companion of chills and fever?. A cour/e of Plummer's pills, and a removal to a heathy, upland, dry country, using the natural sulphur vaters: suro as the sweet springs of Virginia, will open effecc ? cure. But, after a certain standing, say a year or tn*re> and 23* 270 DISEASES OF THE LIVER, SPLEEN, SlC. the subject an adult, or aged, all lhat can be expected is to palliate the inconveniences arising from it. The bowels should be regularly moved by pills of calomel and aloes: one or two of these will act on the bowels, which are not to be purged, but merely set in good peristaltic motion. Once, in a while, in bilious seasons, it will be well to take the blue pill for a week, and then desist. When piles are troublesome, sulphur and cream of tartar, and senna and figs, are more proper apperients. A few assafoetida pills must be kept for low spirits. Travelling is always beneficial; and great attention must be paid to what is eaten: as flatulence, even by mere pressure, will greatly annoy the patient. All such patients should travel annually to the York, or, if possible, to the sweet springs of Virginia, where there are fine sulphur and other springs, warm and cool. JAUNDICE. This disease most probably depends on * " Iscuria renalis is a very rare form of disease; in whicjfctheffunclions of the kidneys are suspended, and the^urine for its material) retained in the blood. The accompanying symptoms are a dull pain, or a sense of 'weight in the iliac regions, with great anxiety, nausea, vomiting, hicdu'p, cramps, general irritability, and restlessness; or sometimes delirium, lethargy, and coma. It is occasionally attended with a constant de- U *sire«to make urine; though the catheter proves, that «** nonius in the bladder. The taste of urine has been i disjt/verpd in the mouth, and in many instances a (strong" urinous smell has been perceptible in the per- spiration." Causes.—Some -local affection of the kidney: as gravel, schirrus, hydatids. It has also been supposed to be a sympathy with some affection of the brain, but it is far'more probable, that in all cases where the brain is affected, that some disorder in the kidneys had pre- ceded; so that the brain is the sympathizing organ, and the kidneys the origin of disease in all cases. The urine has," in many instances, made its way to a great variety of places in the human body, after secretion; but in this disease it never has been secreted, and the pathology of its appearing by smell, in other parts of the system, is very obscure. When suppression is entire, coma soon comes on, and death follows in a short time. Treatment.— Dr. Gregory, from whom the descrip- tion of the disease is copied, recommends the warm 286 DISEASES OF THE LIVER, SPLEEN, SlC bath, stimulating diuretics, turpentine injections, cup- ping the back of the neck, and brisk purging. But from the state of a patient, mentioned by Sir Henry Halford, which patient was a corpulent man, and taken wilh a chill (an unequivocal mark of inflammation at its onset) there could be no remedy that was so needful as copious bleeding. And the ai^hor is well •* persuaded, that stimulating diuretics, whether spirit of *• turpentine, tincture of Spanish flies, or affy essential ? oils, should be had recourse to, only avfter a full deple- ^ tion in plethoric patients. Nor is there*any goodr*. reason to forbid a blister* over the kidneys^as well as bleeding. Tobacco, both by clysters and Tdraug'rits,! is recommended. A stone will seldom occupy both kid- neys; and of course when that is not the case,*.the other kidney is affected by an extension of inflamma- tion; to prevent which, would relieve the patient: as urine sufficient for the economy of the system would be passed from one kidney. There should be no settled judgment on this disease, ^* till the catheter has proved the absence of urine i^the • bladder. ■, • * * Nineteen cases out of twenty, of strangury from blisters, pro- • oeed from the slovenly practice of putting flies loosely on a plaster. When properly made, and the patient endued with no peculiar disease * to direct its influence on the bladder, it never will affect a patient in I that way. . f Twenty drops of a saturated tincture of tobacco (ot.a decoction) \ are given every hour, in Sweden, so as to produce nausea; and an • enema made with one drachm of tobacco, and eight ounces of boiling water, may be used frequently with the same intention. If, from the habits of the patient, there is a likelihood that the disease is spasmodic, opium should be given. Perhaps sixty drops of laudanum, in each clyster, would be the safest exhibition. Warm water injected into the bladder, by giving a gentle stimulus to the bladder, might act on the kidneys. This, we presume, should always be tried, as the natural stimulus, viz. the urine, is absent. k- DISEASES OF THE BONES. CHAPTER IX.. WHITE SWELLING OF THE KNEE. It is not intended in this chapter to enter into the pathology of scrofula, (a disease so little understood,) but merely to describe a complaint pretty common, depending on a peculiar habit of the patient. A tumor without redness, or water, or much pain, arises on the whole of the knee joint; producing lameness, and an emaciation of the thigh and leg. If neglected, it some- times ulcerates, and after a long while, destroys the joint. This affection has often succeeded a fall, or some other injury done to the knee; but more often comes without any known cause. Cure.—The plan that has succeeded best with the author, is to apply blisters, in a regular succession, below the knee for a month or two, and to apply a very strong wash of lead water to the joint: made with half an ounce of sugar of lead to a quart bottle of vinegar and water. This application is to be made night and morning. The knee is then to be tightly bound j. with a #ery thick piece of buckskin, about nine inches long: it must come entirely round, saving an half inch. Strings are to be sewed to each side, to tie it. In a short time it will get the shape of the knee. The strings are to be sewed on, so that when the leather stretches, it may be brought as tight as the patient can bear it, without obstructing the circulation. With the help of a crutch and cane, the patient may keep about the room, or yard; but must not trespass on his weak knee, when he feels it getting stronger. On the thigh and leg, if fallen away, some stimulat- 288 DISEASES OF THE BONES. ing liniments may be used; such as the following: take of the spirit of turpentine, one ounce; camphor, half an ounce; dissolve and add four to six ounces of sweet oil. Or, instead of the oil, an equal quantity of castile soap, reduced to a very thick consistence, by rubbing it with warm water; say half an ounce of soap scripings, and four ounces of water. The blisters must be put on a fresh part when the first are dried tin.' The leather should be used a long while after the patient has got well, as it will b? a great support. A flesh brush will also be useful to the. emaciated muscles, and flannnel drawers always. The disease will sometimes pass for rheumatism? yet it is not febrile; though bad weather has its effect on it. But as there are no other parts showing rheu- matic affections, it will be easily distinguished. The diet may be as usual; the bowels must be kept regular. In rheumatism they are always costive. Young men are generally the subjects of this disease. CURVED SPINE. This disease is prevalent with children of different ages, though at times it attacks weakly adults. The immediate cause is supposed to be a caries, or rotting of the vertebrae of the ribs. Although so formidable, it admits of a cure; and both this, and the ascertaining of the disease by its symptoms, are within the power of those who may have no access to a physician. To ascertain the disease speedily, is of great importance; and to prevent quackery and deception, is of still more consideration; otherwise this chapter would not have been introduced into a popular work. Symptoms.—These will be taken from Mr. Potts's works. The child (if it can talk) complains of languor, exhibits a listlessness, and becomes soon tired of walk- ing: he trips and stumbles. His legs are found to be drawn across each other, by an involuntary spasm which throws him down, especially when he moves DISEASES OF THE BONES. 289 unguardedly. His knees totter when standing alone. The child complains of twitching in his thighs, parti- cularly when in bed. His legs, when sitting in a chair, are found across each other, and drawn up under the seat. In the process of disease, the ankle joints be- come stiff, and the knees difficult to bend, and the toes point downwards* so that he cannot put his foot flat on the ground. If the vertebrae of the neck are the seat of disease, the child is always endeavouring to rest his head. The functional disturbance of the sys- tem, when the back i6 the seat, are loss of appetite, hard dry cough, laborious respiration, quick pulse, and disposition to hectic. A pain in the side often precedes for a month, in lesser cases; at length the person evi- dently becomes deformed by a crooked shape, arising from the diseased bearings of the back bone, with the ribs and sternum, (or breast bone.) A shape that every person must have noticed in those unfortunate children who have been neglected. The disease attacks children before they can walk in some instances, and it is probable that the ability to walk is often deferred to a longer time, from the pre- disposition to this disease. The adult always complains of a dull heavy pain in his back, and weakness; a coldness of the thighs suc- ceeds, and a diminution of their sensibility. Involun- tary twitching of the thighs and legs, at bed-time, suc- ceeds to the above; and then an inability to walk, with a paralytic inability of bowels, bladder, and genitals. The arms are sometimes afflicted like the legs. The adult complains of a tightness in his stomach, indiges- tion, and impeded respiration. The caries of the bones are the consequence of some morbid state of the body, that has located an inflam- mation, or ulcer, in the integuments of the bones, which has destroyed them. This previous state is the cause of all the symptoms, except the simple de- formity of shape, which is caused by an actual loss of bones; the pressure of the body acting on such defect. 25 290 DISEASES OF THE BONES. The back bone pushes out at the diseased spot, which is readily felt with the hand. Cure.—The only known cure consists in applying issues, made with caustic, on each side of the spine, where the tumor appears; or if no tumor has appeared, where the pain is felt. These issues should hold two or three peas at first, and then be increased as need may be, or the size of the patient require. The part over the bone must be preserved from injury by having the issues so far apart, that when the eschar comes out after applying the caustic, there may be two inches between the openings. The discharges must be kept up by using stimulating peas, made of green oranges; or by applying some flies, red precipitate, verdigris, or blue vitriol. The issues must be deep, (reaching the bottom of the adipose membrane) and the discharge of matter considerable. By this means the internal inflamma- tion is diverted to the artificial sore, so far as to give nature a chance to reinstate the lost bone, or fill up its avenue with a healthy bony substance; making what surgeons call an anchylosis, i. e. one bone grow- ing to another. And as there are so many joints in the spine, the loss of action in one or two are not much felt. From three months to two years have been found necessary to effect this cure. But even admit- ting the larger of these times; how much better is it to be recovering for two years, than to be a dying for seven. Attention must be paid to diet, as also to the bowels, by enemas; and no other than a recumbent posture will do to relieve the spine of its burthen. Adults have frequently been injured, if not destroyed, by riding long distances for health, when attacked with this disease, for want of a knowledge of its nature. As the patient recovers, his appetite gets better, his knees more supple, he can put his feet flat to the floor; and so one symptom of the disease gives way after another, till health enables the patient to resume his wonted actions and amusements: however, he must DISEASES OF THE BONES. 291 not expect any thing, but to be mortified at his first attempts to walk, after such a long suspension of mus- cular motion. He should try his friends' shoulders, and then his crutches; remembering that he is in fact to learn again those muscles their old lessons. Children should have a three legged cricket, with bed runners on the feet, and a hole in the bottom; so that they may be put through to their armpits; and with a little as- sistance may try their legs; but not too soon, nor to fatigue them. An inspection, both of cause and effect in this dis- ease, must prove to every sound judgment, how un- suitable all the apparatus for extension of the spine are to this disease; no such operation is wanted, and it is always gained by an injurious pressure on some other parts. Laying down is all that is necessary to relieve the spine, and all other parts rest with it. It is true that a relief of the spine is wanted (i. e. as to its incumbency) long before the effects amount to a caries. If, therefore, such disease is found to be com- mencing, the recumbent posture will do all, and much better than an artificial extension, whilst up; and at that early period, perhaps blisters, and especially plas- ters of tartar, would be sufficient. We must not mistake this disease for a simple mal- formation of the spine, so common to growing girls; which too often, from mere neglect, becomes a great deformity; but here are no ulcers or caries. The bones, however, will conform to the bend; and when so, no machine can alter them. But when there is an appear- ance of such a disposition in the system, some slight apparatus, merely resting on the hips, and under the shoulders, not pressing the ribs and stomach, might be useful; provided attention was paid to other circum- stances. Thus, when a weakly girl is suffered, at school, to twist her body in writing and drawing; a mal-formation will often ensue: and what good would any apparatus do, whilst she is permitted to sit thus eschew? Some surgeons say that no caries of the bone takes 292 DISEASES OF THE BONES. place in most cases, unless it be a very advanced and neglected case. Well, if it is so: nevertheless, mere relaxations of such important ligaments as connect parts that bear the whole weight of the parts above the place, must be attended with little less in symptoms, and require the same remedies, except the deep issues. RICKETS. This disease is rare in this country, perhaps more so than it was some long period past. This latter circumstance may be owing to the foreign constitution of the inhabitants wearing out of the system. The free air and active life of the American people will prevent all hereditary dispositions, unless we get too largely into manufacturing. Causes.—Confinement to damp apartments; and a damp valley country, has been supposed the external causes; whilst a deficiency of lime (the material of bone) is said to be the intimate cause. Symptoms.—It makes its appearance between the ninth and twenty-fourth month; mostly among people who have not every conveniency of life. The child becomes sedate, and emaciated; the head enlarges, and the belly swells; whilst most other parts fall away. The bones are so materially affected, that the legs will become bandy, the breast protrude, the ribs flatten, and the spine yield to the weight of the body. The discharges from the bowels are liquid and unnatural. Dentition is slowly performed, and the teeth quickly decay. Children with rickets are very averse to motion, and when old enough to understand, will refuse to talk. It is not a mortal disease in general, but will sometimes advance, and the patient become hectic and die. But in general it moderates by age, and goes off: frequently leaving the misshape on the system, espe- cially the bandy legs. There are instances where the mind seems to have advanced greatly beyond the age. DISEASES OF THE BONES. 293 Management.—The child should not be kept very long at the breast, merely because it is feeble, or is slow in cutting teeth. A portion of lean meat is very necessary to him; but teas should not be given. Exercise, by riding or sailing, is useful; but then the child should be laid on a small mattrass, in the nurse's lap, not forgetting the weakness of the bones. A mat- trass is also needed for it to lay on at night.* A dry mountain air is preferable, and in no case should the patient be kept in a subterraneous apartment. Clean- liness is of high importance. A little port wine, or white wine and water, with nutmeg, will be necessary for drink. Cure.—If the weather is not too cool, dipping the child every night and morning will be useful. If it is too cool, washing it pretty freely and extensively, and rubbing the body with a fine flannel, must supply the place of bathing. The bowels must be regulated with small doses of rhubarb and magnesia, and occasionally with a little chalk, rhubarb, and paregoric, if too loose: given two or three times a day, till they are restored. The acid of the stomach should be subdued by bit- ters, and chalk powders. The decoction of Peruvian bark may be used with a little prepared chalk: say a dessert spoonful of the former, and four to six grains of chalk, four times a day. If there is a constant and regular use of this article, the child's antipathy will be overcome after a few days. The preparations of iron are also very useful. The tincture of flakes of iron, in port wine, is most suitable. A dessert spoonful may be used daily, divided into three doses; and if the child is over two years, three times that quantity may be used. * Cat's tail (typha,) corn husks, moss, or firn leaves, will make a good and cheap one. 25* DISEASES OF THE UTERUS, AND ITS AP- PENDAGES. CHAPTER X. HYSTERIA, OR HYSTERICS. This is a disease of females, more generally be- tween the age of sixteen and thirty-five; though in its milder form is found much later. Women who are subject to dyspepsy, or to an irritable state of body and mind, seldom escape. The habit that brings it on is also known, by nervous head ache, palpitations, short breath, an easy disposition to laugh or cry with- out adequate cause; low spirits, sympathetic disposi- tion, and fearfulness. The Causes that excite a fit, are fatigue, large eva- cuations, passions of the mind, (low or high,) obstruct- ed menses, indigestion, costiveness, and all irregula- rities; also want of exercise; and confinement. Symptoms.—Some disorder is first felt in the bowels, which is succeeded by a sensation like a ball, or globe, rising from them: first to the stomach, and then fixing in the throat. This is succeeded by violent convulsions: beating the breast with clenched fists, and such agita- tions that no assistants can control. After a while they go off, leaving the patient almost comatose. A great number of these convulsions will sometimes happen in twenty-four hours. In milder cases the patient comes to herself without a previous sleepy state, though seems nearly unconscious of her past fit. Hiccup sometimes takes the place of convulsions; and at other times, fits of screaming. Great flows of limpid urine, and great discharges of wind from the stomach, with the globe in the throat, DISEASES OF THE UTERUS, SlC. 295 and the sleepy state that follows, will distinguish it from an epilepsy. Cure.—When the patient is of a full habit, or when it proceeds from obstructed catamenia (in a good consti- tution) bleeding will be necessary as soon as it can be performed; a puke will, in most cases, also be neces- sary, and a brisk purge or two, always. Very little can be done in the fit; but as soon as it is past, if the patient is sensible, or as soon as she is; a pill of eight grains of calomel, with five of aloes, may be given; and if she is likely to have more fits, a large blister should be secured on the inside of her thigh, where it will be more likely to remain firm than on her body. Enemas of glauber salts will be useful before the purge can operate. The puke should be given, if the disease continues after the purge has pas- sed; and when both have operated, further fits may be restrained by opiates, in the form of Dover's powders, or by some assafcetida, with ether. In persons of much weakness, of lean thin habit, and in all lesser cases; instead of bleeding, the old French plan, recommmend- ed by P. Pome, of warm bathing, will be useful, be- tween the fits. And after a puke, or a purgative, or both, as may seem best, some assafcetida may be given every hour or two. The assafcetida, combined with aloes or calomel, will make a good purgative for such, and thus save time. But merely to remove an attack of this disease is gaining little, unless the habit and exciting causes are removed; and in these the patient has more to do than the physician. Where dyspepsia, or costiveness, is the forerunner, the patient must at- tend to what is said on those disorders; and so of irregular menstrual discharges. When she is full and plethoric, abstinence or a lean diet, with occasional bleeding and purging, will be necessary. All irregula- rities, as dancing, feasting, Sic, must be put away. When nervous debility is the source, the patient must set a determined resolution to resist all sudden freaks of temper. She must not suckle too long, (if a mother.) She should expose herself to the open air, in good 296 DISEASES OF THE UTERUS, SlC weather, and ride or travel when convenient. The cold bath in summer will be a good auxiliary. Moderate steady exercise is useful, if not indispensible, in all cases; especially in those from debility. A costive habit, or cold feet, must not be allowed for any time. In those cases of feebleness, and in any but full patients, a tonic plan will be requisite as a preventive. The tincture of flakes of iron, with the bitter tincture of rhubarb, (to regulate the bowels,) decoctions of bark, good bitters, elixir of vitriol, and a little good old wine, will be highly necessary. When a fit is per- ceived to be approaching, a pill of calomel and aloes, and a little of the etherial mixture, or of the tincture of assafcetida, in ether, (after the purge operates,) will often prevent a paroxysm.* The unmarried and the barren are said to be most subject to hysteria. %CJ°> Men have occasionally a mock hysteria, but not with convulsions. The author experienced a most severe one, on the giving way of the threads that sewed a large wound. There are an endless variety of minor cases, where those convulsions are more trifling, or are substituted by crying, laughing, &c, which only require free bowels, a little assafoetida, and exposure to the air in a carriage, to prevent their return. HYSTERITIS CATAMENIALIS, OR INFLAM- MATORY IRRITATIONS OF THE UTERUS. There is so great a difference between this disease and common hysteria, and common obstructed catame- nia, that the author has determined to give it the place of a distinct disease, to prevent any confusion; and to ensure it a proper treatment. * Dr. Thomas mentions, that he has arrested a paroxysm (whilst on) with enemas of spirit of turpentine: three drachms are to be used, with a pint or less of mucillage at a time. As the bystanders are always anxious to have something done, during such violent agita- tions, they may rub the temples with ether and vinegar, and burn feathers near the patient; or put some salt into her mouth, or tie a twisted handkerchief, as a ligature, round each leg, below the knee, for two er three minutes; or use the spirit of turpentine enema. DISEASES OF THE UTERUS, &C. 297 Causes.—Some of the causes are a suppression of the catamenial discharge, just when about taking place, or after taking place, by cold, or by astringents, when it has been excessive. There is in such cases a cause sufficiently great to have produced fever, or inflamma- tion in any part, if it were not destined by circum- stances to produce this species of hysteritis; which is probably not the case in common hysterics. Symptoms.—When acute, it begins with vomiting, and continues without intermission till the patient is exhausted, or till she reaches the end of the catamenial term. A fever attends, which is often ushered in with a chill. In the chronic cases, there is an incessant nausea, and rejecting of all food; a fever also attends. This reaches out the month, lessening towards the last of the term; and then begins again with additional symptoms: as subsultus, spasms in the face, and co- matose symptoms, terminating in death. This last variety, or chronic cases, may be most peculiar about the turn of life. Cure.—It will be necessary in the acute to bleed once or twice; and then, or before, to lay on a blister on the side; as it will be impossible to keep it secure over the stomach. An immediate attempt should be made to open the bowels freely: one grain of aloes, and as much calomel, may be given immediately, after every effort of vomiting ceases, till there is a proba- bility of ten or fifteen pills being retained; or a little calomel may be given the same way, mixed with a few drops of molasses. Opiates, however, will be requisite every four hours, after the first day, and with the opiates, five or six grains of calomel, may be given. But the vomiting is often so incessant, that nothing of any note is retained. Enemas should be given every hour, of salts or oil. But the main dependance is a salivation: for this purpose the blue ointment must be ruhbed on the blistered part very freely. Two small blisters may be put on the ankles, partly for this purpose, as soon as the disease proves troublesome; but the mercurializing must be began on the second 298 DISEASES OF THE UTERUS, &C. day, or there will scarcely be time to salivate. The patient must take no more drinks than will be neces- sary to wet the surface of the mouth and throat; as more than that would excite vomiting. When the mouth is the least affected by the mercury, the bowels will be easily opened, and the disease give way. Some tonics of steel and camomile will be necessary to brace up the patient. In the chronic cases, a small quantity of blood may be taken at each bleeding, (and repeated several times.) Enemas of oils, or mucillage, or soup, must be given very frequently. A perpetual blister should be kept open on the stomach. After a while, a little weak toddy may be given, to dispel the wind. No opiates must be given in these cases. The pills of aloes and calomel will be useful, if given in small quantities at a time. If these fail, we must salivate, which will not often fail; and we may do it more cautiously than in the acute cases, as there is always time enough. Great caution is necessary at the returning periods, even if the patient gets perfectly well. A little elixir of propriety should be used every day for a week, to establish a motion in the bowels; and if the patients are of a full habit, some blood should be taken two or three days beforehand. Temperate living is needed in all cases. It is probable, in both the above varieties, that an inflammation of greater intensity, and of a more ex- tended character, takes place, than what exists in the more simple obstructions of those organs. %CTB Some milk, or gruel, must be given, very re- gularly in chronic cases, to support the patient. CHLOROSIS, OR RETENSION OF THE MENSES. Causes.—When unmarried females have arrived at their seventeenth or eighteenth year* without menstru- * When a girl arrives at eighteen, or even twenty-five, without menstruating, and is in all respects hearty, let not the impatient mo- ther make her sick with physic. Temperance and regularity is all that is needed; nature will not fail when she is ready. DISEASES OF THE UTERUS, &C. 299 ating, and the symptoms enumerated below ensue, they are said to have chlorosis. It will be found in general, that inactivity, confinement, or connatural weakness, have laid the foundation of the complaint. There are, however, many particular causes that aid in bringing on the disease: such as a bad climate and soil, previous debilitating diseases, circumstances that prey on the mind, the use of improper diet, and improper use of allowable articles, viz. fruits, cakes, acids, sweets, cof- fee, tea, and the various abominations of tobacco. Also great neglect of the bowels, exposure at the time nature is about arranging this discharge, and sudden changes in the manner of living. To this last, Dr. Gregory attributes the frequency of it among girls who have moved from the country to be confined to a trade, or business, in large towns. To this list may yet be added many more causes, particularly the fashions: consisting of interruptions in the proper time of the diet, perversions in the time and quantity of sleep, lacing and corsetting, till the blood is forced from its proper rout, and the excrements not suffered to pass when needed; sudden changes of temperature on the body; produced by leaving a hot ball room for a cold street; especially in a dress not accommodated to the season (but to the eye,) and a subsequent day or two of languor and irregularities. To the above list of causes, which are mostly at the disposal of the patient, or her parents, we may add such as are not, viz. imperforated vagina, and defects in the ovaria. The former of these will require sur- gical aid; the latter is incurable. Symptoms.—Great lassitude and unwillingness to move, loss of appetite, or an unnatural appetite: such as craving for chalk, pepper, &c, dyspeptic symptoms, hysteric symptoms, palpitations, short breath, colicy affections, costiveness, vertigo, bad breath; sometimes a cough, bleeding at the nose, pains in the left side, (low down,) and pains in the small of the back; and an oc- casional association with St. Vitus' dance. The appear- ance of the patient becomes changed: the whole surface 300 DISEASES OF THE UTERUS, &C. is puffed: at first pale, and then swarthy even to a green- ish hue, which has given name to the disease. The lips are bloodless, the eyes sunken and pearly; whilst a dark circle is to be readily seen about the Orbit of the eyes. The legs swell at night, and the abdomen is also dropsical, in appearance at least. These symp- toms, at that time of life, will leave no doubt about the nature of the disease. Management.—All those neglects and practices which have induced the disease, must be attended to, and removed: exercise in the open air, by riding, is all important; a visit to the mountains and springs of Virginia, will, with cheerful company, nearly super- cede all medical attendance. Those who cannot ac- complish this, must walk out of the city in the morning to some near springs, or jump the rope on the green sod. Coffee and tea must be used very sparingly, and the diet must be such as will ensure digestion: rice, mush and milk, birds, and small fish, will be some of the best; and in #11 cases of debility, a little sound wine and water, or old London porter and water, used for a drink. Fruits must be nearly abandoned, as also cakes, sweetmeats, and pickles. A hard mattrass will be far better then a bed. To be wrapped up in a soft feather bed till ten o'clock, would defeat all the remedies! The dress must be warm in winter, and the use of flannel drawers and worsted stockings, with thick shoes, are very important; for the feet must never be suffered to get a chill. A flesh brush will be a very necessary part of the bed-room furniture. Cure.—Under the head of management, there is a large portion of the curative means; those strictly me- dicinal are the constant use of such remedies as will give tone and vigour to the system. To these, medi- cinal stimulants (called emenagous) acting on or near the organs concerned, are used. Some physicians, however, have rejected these latter; but the prudent use of them cannot be abandoned; whilst a total de- DISEASES OF THE UTERUS, &C 301 pendance on them would be inadequate, if not injuri- ous, in some cases. Bark and preparations of steel are the principal tonics; which must be regularly adminis- tered, with such additional medicine as will keep up a regular peristaltic motion; and when, by such means, the system is under an artificial and general stimulus, the partial stimuli are to be administered for a while in their place; not forgetting to bathe up to the hips when there is any effort of nature, either by pains or partial discharges. But this plan is suited to cases of debility, and not proper in some other varieties of this disease: for reten- sions are sometimes attended with a number of inflam- matory symptoms; so that it might be dangerous to stimulate: therefore, where there is an appearance of much circulation, pain in the back and abdomen, cough, head ache, vertigo, epitaxis, &c; nothing can answer so well as bleeding, smart purging, with nitrous and anti- monial sudorifics. The seneca tea, with cream of tartar, would do well in such cases; and after depletion, blisters on the inside of the thighs: keeping tip an action steadily on the bowels, with small purges of different kinds: such as aloes and soap pills, elixir of propriety, jalap and calomel, given in small portions, at night. There are also some cases of a doubtful cast, where there is a personal appearance of debility; but an ac- tion of the pulse, and bleeding at the nose, dr cough. These will do well with a small bleeding, a puke, and some gentle purgatives, continued in for a while. Blisters on the thighs may also be tried. The bath to the hips will be here very useful, and may be often repeated at bed time. The seneca tea may be also given, with the addition of a little antimonial wine, every night. Tbe guaiacum may be tried in these cases as a purgative, adding two grains of gambouge, or more if need/id, to twenty grains of guaiacum, which may be taken in syrup. But all the above remedies, in each of the three grades alluded to, may be considered as general means to put 302 DISEASES OF THE UTERUS, &C nature in a way to aid herself; and when we have improved the state of the system, and removed all other diseases, we may resort to the partial stimuli, and emrnenagogues: one of the chief, is oil of savin. Four drops of the oil may be rubbed down with a lump of loaf sugar, and diluted with a wine glass of wine and water, and taken three times a day. Or fifteen to twenty grains of the powdered leaves, in syrup, as often. During the use of any of those very stimulating oils and powders, none of the strong general tonics should be used: such as the bark and steel. The oil of penny- royal, (pulegium) may be used in the same way and quantity, as the oil of savin; as also oil of juniper. Balsam of copiava may be used in double or treble that quantity, in some honey or syrup. Pills of aloes and calomel, for a few times, when there is an effort of nature about taking place, are much to be depended on: let them be used for three or four nights. Injec- tions of spirit of turpentine are recommended by some physicians: fifteen to thirty drops may be put to three ouncei of some mucillage, and injected into the bowels every night. An immense number of other articles have been used: such as tincture of cantharides: ten to fifteen drops, two and three times a day. Tincture of black helebore, twenty to forty drops, three times a day. This last article is much esteemed in some places. Rosemary tea is a great family prescription: about six or eight ounces of the tea are to be used at bed-time, for three or four nights. In using all those stimulating articles, this rule must be observed, viz. not to continue them too long, and to desist when they produce any thing like a burning in the bowels; and, moreover, their use (if possible) should be about the period that there is some effort in the system \o restore the discharge. The preparations of bark may be either a strong decoction; or some bark in substance, with an equal bulk of magnesia, taking a teaspoonful in a little water, three times a day. The preparations of steel are either the tincture of DISEASES OF THE UTERUS, &C. 303 the flakes, with port wine, or the tincture in spirit of 6ea salt; which is one of the best when the stomach will receive it: ten to fifteen drops of this latter are a dose, which may be used three times a day at least. Hooper's pills are not a despisable article; they are said to be a compound of salt of steel, with aloes, ja- lap, myrrh, and ginger. The jalap might be omitted, as the quantity is trifling.* INTERRUPTION, OR SUPPRESSED MENSES. When this discharge has been established for only a year or two, it has made such a change in the female habit, as to be attended with disease, when interrupted. An interruption more temporary will frequently hap- pen in fevers, and other inflammatory diseases, and will come in with the treatment of such diseases; being pretty sure to return with the removal of 6uch disease, and gaining the wanted strength and appetite. It is not. therefore, our object to notice such cases; but to attend to those which have become somewhat chronic. These maybe divided:first, into such as are attended with inflammatory symptoms: such as bleeding at the nose, or from the lungs and stomach, especially at, or about, the time there should be a discharge of catame- nia. They are also attended with fever, violent head ache, pains in the back, and occasionally with hysteria, mania, or epilepsy. Secondly, into such as have been interrupted by debility, or induced by other diseases: such as consumption, dropsy, or by grief and care; and especially disappointed love. In the first grade, there can be nothing done till the patient has been somewhat reduced by a low diet, purging and bleeding; and at every period when those symptoms are about to occur, a bleeding will be abso- lutely necessary, till the plethora is removed. When the tone of the system is lowered to a proper standard, no farther reducing means should be prescribed in the * It will make no difference in the cure, if the patient has had a catamenia a few times, and they have ceased, without producing that change to womanhood which a longer time produces. 304 DISEASES OF THE UTERUS, &C. intervals; but in their place a constant, though gentle action, kept up on the bowels, by the daily use of some suitable apperients. These may be arranged in the follow- ing way: for the first week of the interval, and after the head ache, Sic, have passed off, (i. e. nature's effort,) enemas of glauber salts may be used daily. For the second week, a dose of elixir of propriety; or aloetic pills; or ten grains of jalap, with two grains of salt of steel, (in ginger syrup) may be used daily; unless there is too much action on the bowels; in which case they may be stayed, and used again when the looseness ceases. On the last week, some calomel and aloes will be likely to be the most beneficial; tak- ing about three grains of each, every other night, for three times. Having thus brought about the time of another menstrual period, the warm bath must be fre- quently used up to the hips, or the patient may sit over steams, and then retire to bed, and try a sweat of seneca tea, with a teaspoonful of nitre, and another of antimonial wine, to a small pot of it. This must be taken so as to use six or eight wine glasses of it in the day. If any of these violent affections, such as mania or epilepsy, are apt to ensue, a blister should be laid over the neck, or spine, before the attack; and an issue kept up during the intervals. There are, however, few of these severe cases, compared to the numerous cases that ensue from taking cold; which are attended with much more moderate symptoms. To such, a mo- derate bleeding at the period, with a mercurial purge; also, bathing and sweating, will generally be sufficient. But if not, by taking great care, through the subsequent intervals, to avoid cold and damp; using proper exer- cise, and taking the small purgatives of elixir of pro- priety for ten or fifteen days previous to the expected time; with a few of the pills of aloes and calomel, (for the last purgative;) they will scarcely fail to have a renewal of their discharges in a month or two at far- thest. This plan, however, is to be followed up, from month to month, till they do succeed. If the tongue should be foul, or if the stomach does not act well, a DISEASES OF THE UTERUS, SlC 305 gentle puke will be of service. By taking it in bed, it will hardly fail to sweat; and then a little rosemary, or pennyroyal tea, with a teaspoonful of antimonial wine in it, will keep up the operation. When such cases, however, become of long standing, the savin, or tincture of helebore, as directed for chlorosis, and with this, the tincture of steel, in spiritof sea salt, should be used. This latter (viz. tinctureof steel) should be used in the intervals, and some of the former about the time of an effort of nature. Blisters may also be laid, at the same time, on the inside of the thighs, or on the sacrum. All those stimulating articles will do best at the time of an effort, and the warm baths (to the hips) are then only useful. But balsam of copiava may be used at any time, especially when pains of the loins are troublesome. In the other grade of disease, where retension has been brought on by pure debility, or by other weakening diseases, or by distress of mind, a different plan may be pursued. Indeed, when following consumption, or dropsy, nothing peculiar need be done, if there is no uneasiness. But should there be symptoms of dis- turbances from this source, some of the seneca tea may be used, with bathing about the abdomen, or keeping a bladder of warm water to the part: as also stimulate ing clysters, composed of twenty or thirty drops of spirit of turpentine, in some mucillage. But where simple debility seems to be the chief source, the bark, wine, tincture of flakes of iron, the cold bath and exercise; especially travelling to the springs, are the proper remedies. The poorest girl may take a walk early in the morning, and jump the rope. In all cases, the causes must, if possible, be removed, especially those that have operated through the mind; change of( place, and travelling, will be to such the only plan of any prospect; which should always pre- cede the medicinal treatment. When the catamenia has been interrupted for a con- siderable time, it would appear that the surplus action retained in the system will choose different places to ■26* 306 DISEASES OF THE UTERUS, &C. locate: sometimes affecting the muscles with violent pains, or even with epilepsy; sometimes the lungs with discharges of blood, or with dyspnoea; sometimes the bowels with cholic; and at others, the stomach with dyspepsia; thus attacking every organ. And these things must direct the course to be pursued. The oppressing symptoms, be they what they may, must be attacked, and removed. Moderate purgatives will, in most all cases, prevent, or remove, cholic and dyspepsia. Whilst tonics will have a good effect in muscular affections, and pukes in dyspnoea. Mania has been the effect of a suppression from dis- appointed love; such cases may be considered (medi- cinally) hopeless; and in all cases it is a distressing circumstance. %CT* The following prescription has met with much attention; and may be used (when dropsy, pthesis, or any debility, accompanies obstruction;) with a view to promote the natural discharges:— Take of powdered myrrh, half a drachm; pure cop- peras, twenty grains; soda, •fifteen grains; soft extract of bark, twenty grains; make two dozen pills. Two of these may be taken every three hours. If the bark is the resinous extract, it must be softened with spirit, so as to make the pills; if not, with water. See also a watery solution of myrrh in the apothecarium. MENORRHAGIA, OR IMMODERATE FLOWING OF THE MENSES. When the menstrual discharge returns at shorter periods than the month, or continues much longer than usual, or flows too copiously; it may be considered a disease; and if permitted to continue, will lead to a state of emaciation and dropsy. It is rarely that young, or unmarried women, have this complaint; though it is sometimes "found among such, in low bilious situa- tions, where the constitution Vias been impaired. There are two very different, general, states of the system, in which menorrhagia occurs; and a third state, DISEASES OF THE UTERUS, SlC 307 more local, and often obscure. The first is a state of plethora, or fulness of blood, more incident to the rich. The second, is more likely to be found with the poor: being a state of vascular debility. The third variety, is found in various conditions of body and cir- cumstances; and consists in a local relaxation, or par- tial determination of blood, to the affected organs. This last state is brought on, at times, by very obvious causes: such as miscarriages, long and tedious labours, and debauchery. It is also said to be brought on by untimely weaning, by obstructions in the large viscera, (liver and spleen;) and by spasms, which by denying a free passage of the blood, forces it on the uterine organs. It may, therefore, be found in persons where no exter- nal marks can suggest a cause. When any of the local causes just stated, are joined to either of the general causes, it is obvious that the disease must be consider- ably increased; as well as more difficult to manage. In all the three causes, it is pretty generally helped on by some of the following accessaries, viz. costiveness, straining, blows and falls, dancing and other exercises; especially when carried to fatigue. Violent passions, frights, overheating the body, and then exposing it, so as to be partially cooled. Febrile diseases, either of high or low grade. To this catalogue may be added the unnatural practice of tight lacing. And as the natural discharges are more considerable in the hot countries, so those who use great fires, and sleep in hot close rooms, will experience that relaxation, and increase of circulation, so favourable to all haemorrhages, though living in a cold healthy climate. Menorrhagia generally begins with pain in the head and loins, bearing down, and a kind of chill. Such cases will, if the pulse is considerable, require some blood to be taken in the onset. Purgatives of a cooling kind must quickly follow; more especially if the bowels are not free: a large dose of salts may be divided into three parts, and to each of these ten grains of alum, or one grain of blue vitriol, may be added; and one of these small doses given every hour or two. 308 DISEASES OF THE UTERUS, SlC. If the feverish symptoms still kekep up, some powders of nitre and antimony, or some nauseating doses, com- posed of two or three grains of ipecacuana, should be given every hour: beginning with these immediately after the purge has ceased to operate. This plan, with quietness, and a cool room and a mattrass, with little covering, will generally succeed in reducing the pulse, and prepare for astringents.* Dr. Thatcher's astringent, and the kino astringent, may be used as directed in the apothecarium; and topical applications may be applied to the parts: such as bags of powdered ice, or of salt in a dissolving state; though vinegar and water should first be used. Alum whey may also be used, internally; and injections made into the vagina of alum water, or of infusions of galls, when the case is alarming. In extreme cases, a lump of ice may be introduced into the vagina. Ruspini's styptic is an excellent article, which should be kept on hand. Cold water, or cold alum whey, may also be injected into the bowels. Such persons as have been alarmed with two or three profuse discharges, should be on the watch, and lose a little blood near the period: live low, and keep cool and quiet, till the time has passed. And if a little feverish, drink freely of cream of tartar and water, cold lemonade, Sic In the second set of patients (where debility prevails) we shall generally find a pale countenance, dejected mind, and every mark of vascular debility; and in a great number of patients evident proofs of a want of the comforts and temporary relaxations necessary to good health. We cannot, therefore, prescribe for them many things necessary for their relief: such as visiting of chalybeate springs, or trips in steam boats, and sea bathing. But, however poor, they may lay aside rum, opiates, tobacco, and be attentive to cleanliness, and use a topical cold bath. But such as can afford it, should * It is well to know when the inflammation is gone: which is to be ascertained by the absence of the white on the tongue; the natural appearance of the eyes; thirst being gone; the urine natural in colour, as well as quantity; and the pulse soft and slow. DISEASES 'OF THE UTERUS, SlC. 309 pay all attention, in the intervals, to regain a proper state of health; not only by such means as are men- tioned, but by a daily use of bark, and tincture of steel. Some good bitters may do in the morning, when the stomach might reject the bark and steel. If these things are well attended to, and cold bathing, either partial* or general, be used regularly; the bowels kept free by enemas of cold water, and rest in a horizontal posture adopted (when the disease is returning) it will be nearly impossible for it to become serious. But as it may still be loo profuse, some of the aforenamed astringents, or some alum whey, may be used; and if more than these are wanted: some of the injections of astringent articles (into the vagina) may be added. Cold will also be properly applied, by means of vinegar and cold water, or by powdered ice in a bladder. All those aforennmed sources are to be strictly avoid- ed (or the use of medicine will be in vain) such as straining, great fatigue, costiveness, Sic If the bowels are costive when the disease comes on, they must be evacuated by a clyster of glauber salts, or by a gentle purge: such as rhubarb, fifteen grains; blue vitriol, one grain; or by a sedlitz powder. When the legs swell, they must be bandaged with flannel, and more attention paid in the intervals to tonic remedies. And when the whites follow, the sune attention, with local injections, are requisite. See whites. In the third set of cases, viz. where there is an extra local determination to the parts, or a great relaxation of them; every means must be used to prevent the effects. If the local determinations proceed from an enlarged liver and spleen, the patient must not neglect to lay on a bed or sofa, when the catamenia comes on: using the internal and external astringents, and cold ap- plications. Every attention must be paid then, and from period to period, not to increase the obstructions, by eating flatulent food, or allowing of costiveness: long standing, violent exercise, Sic, must be strictly avoided, * The partial bath by a bidet, or any other way; even a quart water pot emptied over the loins, will be of great advantage. 310 DISEASES OF THE UTERUS, &.C. Where spasms seem to be the cause, they must be reliev- ed by opiates, combined with apperients, or in the form of Dover's powder.* But where no evident cause exists, an emetic of ipecacuana, or nauseating doses of two or three grains of the same, will be one of the best remedies to break up the determinations to the parts. Or if the pulse and constitution will warrant it, a small bleeding will be advantageous. Blisters might also be used to the wrists, with good effect. But where the parts are merely relaxed in an extraordinary manner, (besides avoiding all possible causes,) every means must be used in the intermediate time to brace up the whole system, as well as the relaxed parts. To these parts the cold bath will be one of the best means; and pre- parations of steel, and elixir of vitriol, should be used internally, from period to peiiod. But in this, as in the other cause of local determination, all the topical means, such as astringent injections, and cold, are to be applied, if necessary. The daily use of cold injections (during the inter- vals) of water into the bowels, will both keep them free, and brace the neighbouring parts. Where there is much uneasiness, or pain in the back, a strengthen- ing plaster will be useful. And when the relaxation of the parts are to be perceived by the touch, cool injec- tions, of a weak tea, of oak bark, or of Peruvian bark, may be thrown up every night, or oftener, into the vagina, from period to period. Dr. Miner has recom- mended a pill of four or five grains of red pepper to be given every ten or fifteen minutes, (during the dis- charge,) in bad cases. And where there is both a general debility, and a local relaxation, by which the sanguineous system has lost its power of contracting, such a remedy should be tried, without regard to theory. In the southern states, and when the whole * Tenesmus after purees of a drastic kind, or after flux, is said to be a frequent source of great discharges. Enemas, with opiates in them, will be proper: say twenty drops of laudanum to one gill of water. DISEASES OF THE UTERUS, &C. 311 person is cold to the touch, there would seem to be a call for some such article. DIFFICULT MENSTRUATION, (Dysmenorrhea.) This variety of the menstrual disease is known by the most violent bearing down pains attending the dis- charge, even when it is in natural quantity; though it does not always confine itself to this for a rule; being mostly less, though sometimes more. But the pain is the disease in question. It has been attributed to two very different causes: one a rheumatic association, or lumbago; the other, obstructions in the vagina, by the formation of a preternatural membrane on its sur- face: filaments of this membrane are found to pass off. This membrane, in some instances, gives great interruption to the discharge, entirely filling up the passages, and protruding. It has been supposed by some physicians, that an ignorance of this species of interruption might operate unfavourably against the character of single women, who are, perhaps, the only patients; for it soon vanishes after childbearing. But it will only require a repetition of circumstances the next month, to rectify such surmises. It is, however, an obstinate disease, as well as the former. In the first case, i. e. where lumbago, or other spasms associate, the principal remedies are the warm bath, up to the hips, emolient clysters, tincture of guaiacum, sudorifics, embrocations of turpentine, or camphor; applied all round from the loins; also spirits of turpentine, taken inwardly, and opium. If the dis- charges are sufficient after taking a dose of castor oil, a Dover's powder, containing one and a half grains of opium, may be given every four or five hours. More Green persimmons, blackberry root, and wild geranium, are good country astringents. For injections: fifty grains of .alum maybe put to eight ounces of decoction of oak bark, or half an ounce of powdered galls may be drawn with half a pint of boiling water, and strained: one ounce of either may be injected, with a syringe, into the vagina, every three or four hours: making them stronger, if needed. 312 DISEASES OF THE UTERUS, &IC may be used, if that quantity is insufficient. But where the discharges are small, some stimulants had better be first used before the opiates. One teaspoonful of volatile tincture of guaiacum, in a little milk or broth, or chocolate, may be taken four times a day: or twenty drops of spirit of turpentine, taken in milk, will do nearly as well. Should these not succeed so well, the patient may at the next time use three grains of calomel, and one of opium, at night, for four nights; beginning at the first symptom of the next month. The back maybe rubbed with spirit of camphor, or with oil of turpentine, diluted at the rate of one tablespoonful of oil, to one or two teaspoonsful of spirit of turpentine. The enemas should be continued; and the warm bath in all cases. If the patient has taken a cold that has augmented the disease, or by any other means brought on a febrile state, some blood should be taken away, and the pow- ders of nitre and antimony given; and a free use made of purging medicines. In the intervals, the patient should take great care of herself: use flannels, and drawers, with worsted stockings, and elastic over- shoes; keep out of damp and wet, live very temperately; never suffer her bowels to get sluggish; nor eat such articles as will inflate the stomach. In the second cause, i. e. where membranes are formed, if they come within reach, let them be carefully taken away. Injections of milk and water, into the vagina, may be of use. Bathing will be of some service; but in ex- treme pain, a grain or two of opium will be necessary, every four to six hours. TURN OF LIFE, OR FINAL CESSATION OF THE MENSES. Very unpleasant symptoms sometimes accompany this period. The principal one is haemorrhage, or {££• There may be a few cases where a pure debility may be acces- sary to a large discharge; and as it will be local, it may be treated with the astringent injections of bark and alum, as in the menorrhagia. But nothing can warrant this state whilst there are febrile symptoms, as a white tongue and hard pulse. DISEASES OF THE UTERUS, &C 313 enormous discharges: this is to be treated as me- norrhagia, depending on plethora. In the intervals, it would be well to lose a little blood from the arm, and use every means of precaution; especially that of abstinence: keeping the bowels open with salts, and drinking cooling acid drinks, such as lemonade, or cream of tartar, dissolved and sweetened. But if the symptoms are hysterical, or dyspeptic, they must be treated as directed for such comp aims. There are frequently some diseases of magnitude, that develop themselves on such occasions, that have been brewing in the system; to check which, if they are inflammatory, a monthly bleeding, and issues, should be made to compensate the loss of the discharge. But temperance and prudence, will do nearly every thing; especially if joined with exercise in the open air. No woman need, therefore, let that period disturb her quiet, when so much is in her power. WHITES, (Leucorrhea.) Causes.—A laxity of the parts concerned, (often with a determination more than natural to these organs) lays the foundation of this disorder. Hence, it fre- quently follows miscarriages, tedious labours, and ex- cessive menstruations. These greater causes are often assisted by other minor causes, which irritate the uterus and vagina: such as constipation, dancing, and other irregularities; standing up too long. One of the most common sources of disease, in the middle and lower ranks of life, is fatigue and confinement, without that recreation in open air, or bodily rest, that are so necessary to the human frame. In weakly women, with their poor fare, dejected minds, and so situated, there will be frequent cases of this disorder towards the close of the menstrual age. The relaxating influence of summer and hot cli- mates, is said to produce it in emigrants from tempe- rate countries. Symptoms.—Discharges of whitish mucous from the 27 314 DISEASES OF THE UTERUS, SlC vagina, following the menstrual discharge, (catamenia) and continuing longer and longer, till it occupies the whole interval; and after a long continuance, changing to a darker hue, and excoreating the parts: producing pains in the back, general debility, dyspepsia, hysteria, palpitations, bloat, dropsy, and hectic. The organs locally affected are apt to be brought into more serious disease, by the long continuance of leucorrhea and relaxations; polapsus, and ulcers, may ensue. A variety of more serious local diseases of those parts will have discharges; but they may be dis- tinguished by the symptoms, varying from what cha- racterizes whites: the darker and more foetid discharges, the habit of the patient, the absence of coagulated lumps, and more certainty by examination; which will discover disorganization, and derangement of the parts; or pain in examining them, when less diseased. The menstrual discharge is sometimes excessive, at other times deficient, in those subject to whites; which circumstances should be attended to in the gene- ral prescriptions. Management.—This must correspond with the causes: when there is much general debility, there will be occasion for a general restoration, by a nourish- ing diet: such as mush and milk, rice, custards, oys- ters, light soups, poultry, and game; with choice vegetables, to suit the weak digestion. In such cases it will be necessary to abstain from tea and coffee, and from cakes, fruits, sweets, and pickles. Port wine, and sound London porter, should be diluted and drank moderately, every day, changing about. Recreation, by riding and sailing, and due rest, is necessary; using a mattrass at night, and laying on that, or on a sofa, re- peatedly, (for half an hour,) in the day. Great cleanli- ness is needful, and much attention shpuld be paid in dressing to the season. In cases of less debility, or feverishness, the wine and porter need not be used; and the diet should be mostly of good vegetables, or preparations of eggs and flour, without butter or sugar. Cure.—After removing all predisposing causes that DISEASES OF THE UTERUS, SlC 315 ran be commanded; and putting the bowels into a regular action, by rhubarb, in small doses, and by ene- mas of cold water; it will then be necessary to ascer- tain whether there be a total absence of febrile symp- toms. If this be the case, the first prescriptions may consist of three doses of elixir of vitriol, and as many of cold camomile tea, taken daily, and alternately. If this is not sufficient, bark and rust of iron, and port wine, may be taken three times a day. If there is any delay in the restoration, some astringents may be used internally: such as alum whey, or ten grains of terra japonica, added to the bark, instead of so much rust of iron. To all the above remedies, it becomes need- ful, in many cases, to add topical remedies: cold water may be poured over the small of the back, every morn- ing, and some injections made into the vagina. Fif- teen grains of alum may be put to eight ounces of water, or a drachm of nutgalls drawn into a strong tea, or infusion, with a large tea-cup full of water: two ounees of either may be injected three times a day; in the meantime continuing the general remedies. Whilst using general astringents, the bowels must be kept regular by enemas and rhubarb. But if, instead of a simple debility, accompanied with a feeble slow pulse, there is a feverish state of the pulse, either at certain hours, or continually; we must not use any general tonics, or stimulants, at the offset; but begin by giving an emetic or two of ipeca- cuana; as well as by regulating the bowels. And if this feverishness is not carried off, it will become necessary to use some of the fever powders, No. 3, very freely, so as to loosen the bowels. The astringent injections may then have a more early application, and after the feverishness is removed, some of the more gentle tonics may be used; especially the elixir of vitriol, and camo- mile tea. In such cases, a blister over the sacrum, (rump) or on the inside of the thighs, may be advan- tageous. If the arterial disturbance is of an intermittent cast, and more especially if the patient is dwelling in a 316 DISEASES OF THE UTERUS, &C. bilious country; the bark may be used in the inter- mission. And as the disease loses its feverish habit, *" if the other remedies are insufficient, the bark and astringents of alum and japan earth should be used daily. Should the usual menstrual discharge (catamenia) be excessive at the period, it will be necessary to attend to it, by rest, light diet, acid drinks, and the use of Thatcher's astringent, and the kino astringent of the apothecarium. It may be, that the arrest of this will determine the subsequent state of these organs. But should the discharges of catamenia be very deficient, they should be encouraged by taking a few doses of balsam copiava daily; as also by preparations of aloes and tincture of steel. And in difficult menstruations, the tepid bath, and opiates, will be necessary. For pains in the back, the balsam copiava, taken in doses of fifteen to twenty drops, three times a day, in honey, may be used; and a large plaster of burgundy pitch applied over the parts, or the emplastrum roborans, or the tar plaster, may be used; as the support and perspiration occasioned, is the chief good expected from plasters. Patients who have gone to warm climates should use gentle tonics; the cold bath generally, if possible; and at any rate locally, by pouring water over the loins; and live very abstemiously, on light and appe- rient food. Patients in a plethoric slate, with this disease, are hardly objects of medical prescription; for a lower diet, and exercise sufficient to reduce their corpulence, with a little prudence and attention to their bowels, is all that is needed. DISEASES INCIDENT TO PREGNANCY, AND FOLLOWING PARTURITION. CHAPTER XL It cannot be expected that such a number of diseases as fall to the lot of females during, and subsequent to, pregnancy and parturition, could be extensively treated in a popular book of small dimensions. The witer wishes to apprise those ladies, who consult the follow- ing directions, that it is not his intention to keep them out of the hands of the physician, but merely to give them such ideas as will enable them, in due time, to distinguish those affections that require the medicinal attention of an experienced practitioner, from such as they may manage themselves. Management during pregnancy; extracted from the celebrated Dr. Hamilton, of Edinburg: "Rule 1. The strictest temperance and regularity in diet, sleeping, exercise, and amusements, are to be observed. 2. Overheating, irregular passions, and costiveness, should be constantly guarded against. 3. The hazard of shocks from falls, in walking and riding; and from bruises, in crowds; of frights, from bustle, &c, should be avoided with the utmost circum- spection. 4. The dress of pregnant women ought to be loose and easy. Jumps (corsets) secured by straps and ri- bands, without knots or buckles, should be used soon after conception, and continued till delivery. 5. Pregnant women require free pure air. Their inclinations should be gratified in all reasonable things, and their spirits kept up by a variety of objects and company. 27* 318 DISEASES INCIDENT TO PREGNANCY, &C 6. When complaints of a common kind occur, they must be treated as such: avoiding all rough medicines, especially at the time of quickening." The above rules are particularly necessary to those who fear abortion; and no less prudent in every case. But the author supposes corsets only to be needful in the feeble. SICKNESS AT THE STOMACH, LOATHING, AND VOMITING. These are very common complaints in early preg- nancy, especially in towns, where the air is close, and tittle exercise used out of doors. If riding out in the morning, and moderate doses of magnesia and rhu- barb, in mint water, be insufficient; the patient's state must be particularly inquired into. If the tongue is foul; a small puke of ipecacuana will be needful. After which a little elixir of vitriol, taken three or four times a day; or a little mint water, will generally quiet these irritations. But it may be that the patient takes more food than she can digest, or more than is proper, even if digested. These things must be regulated, to expect relief. When that is done, a dish of tea, taken before rising in the morning, will generally prevent the sickness so common at that hour. VERTIGO AND DROWSINESS. These affections are only to be feared when the patient is of full habit. In such cases, bleeding should not be delayed: repeated small doses of salts, and a retrenchment in food, with an increase of exercise, are also necessary. But in such cases as have none of the above causes, it may proceed from the state of the stomach; and if the circulation is weak, there can be no doubt of the propriety of using a gentle puke of ipecacuana, after which three doses of elixir of vitriol may be used daily, and some good bitters in the morn- ing: keeping the bowels regular, with rhubarb and magnesia. Exercise in the open air is peculiarly ne- DISEASES INCIDENT TO PREGNANCY, &C. 319 cessary; and great attention to diet: rice, and mush and milk, will be good articles, with a moderate por- tion of light meats. As this complaint is somewhat of a dyspeptic nature, it will be well for the patient to avoid such articles as are improper for dyspepsia. JCT3" See the chapter on dyspepsia. SWELLING OF THE BREASTS. These are to be treated with a perfect freedom from compression by stays, Sic A few embrocations of cream, or sweet oil, as warm as the blood; and a tepid solution of castile soap, now and then, to clean off the oil, and bathe the breast, will be useful. HYSTERICS AND FAINTING. These affections are most common about the time of quickening, (say, at four and a half months.) They are not of a serious nature unless they have been brought on by falls, blows, or violent passions. In general.it will be sufficient to keep the patient hori- zontal, on a matrass, and give her free air; and damp her face with a little vinegar and water. Thirty drops of hartshorn may be given in a table- spoonful of water; and if not sufficient, a teaspoonful of tincture of assafcetida, with half as much ether, may be taken, and repeated. A dose of elixir of vitriol, say twenty drops in a wine glass of water, will be proper, by way of a change; (when a repetition of the medicine is frequently needed,) as warm articles might be injurious, if given too often. But when the sources of fainting and hysteria, are blows, es to lay down again, or pukes. A general restlessness, aqd moving of the head ensue, with a flushed face instead of a pale one; the hand is raised frequently towards the head; at length the pupils dilate, and become insen&ible to light. Comatose symptoms now prevail. Dark discharges sometimes issue from the nose; and the patient sinks, or is per- haps carried off in a convulsive fit. Ten days to two * Like croup, it has been in some cases a family disease; and in some parts of Germany the hospitals are full of cases that scarcely ever recover: showing that there may be organic and endemic pre- dispositions to this disease. DISEASES OF CHILDREN. 339 or three weeks is the usual time of the whole range of disease. In many cases the pulse will fall off to natural, or become intermittent; in others be exces- sively quick and small, before death. Cure.—This must depend on an early intimation of the disease; for after it has advanced to any length, it will seldom yield to any plan that is now known: seeing that the brain is oppressed by an effusion made during the first, or inflammatory stage of the disease. The bowels must be purged very freely, and kept quite free, as an indispensable requisite, be the means what they may, to answer the purpose. Very large doses of medicine are sometimes requisite for this purpose: mercury should not be used at first, if it can be avoided, as a purge.* Castor oil, senna and salts, or jalap, will be good articles. Bleeding is the next great dependence: this must be large for the age, and repeated. Some physicians have ventured to bleed to fainting, and opened the temporal artery. A blister must be put on the head; the feet should be soaked, and the ankles blistered; and when purges are not given, some nitre and antimony, (in fever powders,) may be used every two hours. As soon as the deplet- ing plan is fully performed, mercurial ointment must be rubbed on the blisters, morning and night, till some effect is produced; and small doses of calomel given by the mouth. Thin drinks of gruel and barley water must be regularly administered to the child. Enemas of glauber salts may be frequently given, at any time. The head should be always elevated, and a mattrass used, and the room kept cool and still. Cold applications to the head are used by some, but they are doubtful. DENTITION, OR CUTTING OF TEETH. This is always a painful time with children, but it is only in certain cases that it amounts to disease. • There can be no question, but what mercury augments all inflam- mations in their active state; and every practitioner must have found out that mercurial purges will leave some of the metallic impression. 340 DISEASES OF CHILDREN. Much depends on the constitution of the child, the season, the place, and not a little on the advantages of good nursing and living. In a hardy child, not over fed, and kept clean, there will seldom be any thing but a local irritation, and consequent crossness: more es- pecially if it be in spring, fall, or winter, and in the country. Whilst on the other hand, a child of feeble, or irritable constitution, over fed, badly nursed, and living in town during the summer months, will be most seriously diseased. Fevers, laxes, and perhaps'epilep- tic fits, will sometimes be the consequence. Symptoms.—The child becomes cross, sleeps badly, and starts in his slumbers. He also becomes feverish, and a cough is not unfrequent. He slabbers at the mouth, introduces his fingers on his gums, which are hot, red, swollen and spreading; and on being touched show great sensibility. The bowels are much disturbed in general, arid very loose, with greenish, slimy discharges. The urinary passages are apt to feel the effects of inflammation extending to them: producing mucous discharges. Some authors have noticed a puffing of the upper part of the feet. When inflammation has so extended, epileptic fits are apt to occur. Management.—Much depends on keeping the child very clean and cool, walking and riding it out in the fresh air, defending it in its slumbers from flies, mus- quitoes and noise. A mattrass is greatly to be prefer- red to a feather bed, to lay on. The diet shouH be one half only of the mother's milk; and the rest of rice water (that is, let her waste one half of her milk.) But though it is necessary to use only one half of the usual quantity of milk, it is a fatal error to wean the child at such a time. Flannels must be used in cold and tem- perate weather. For children who are weaned, rice, mush and milk, and thin broths, will be proper for diet; no coarse or fat meats, must be given. Cure.—In much fever, and all inflammatory symp- toms of high degree, threatening fits, bleeding will be requisite. The bowels must be freely opened with DISEASES OF CHILDREN. 341 oil, if they are not so already. But if they are loose, emetics must be used: five to seven grains of ipecacu- ana is the least. After those evacuations have been made two or three times, small doses of ipecacuana, with a little soluble tartar, may be used; say one grain of the former, and five of the latter, should- be taken every two hours, in order to relieve the feverish state. If much cough worries the child, (which may be the case from a concomitant cold) a blister on the breast will be requisite. The gums must be freely and fre- quently lanced, if necessary; disregarding the fear of their becoming harder. Every cicatrix is easier broken than sound flesh, and more insensible, and this is just what is wanted. The gums may be washed very fre- quently with cold water, or with a little alum and water; and when we are sure that the inflammatory symptoms are sufficiently reduced, opiates and astringents may be used, if needful. Bathing in tepid water, at night and morning, will not only allay irritations, but induce sleep, and promote cleanliness. The jaw teeth must be lanced by a crucial incision, to let them out more freely. In case of fits, a blister must be put on the breast, the child bathed in warm water, and an opiate given immediately. Warm clysters of oil may also be injected; and then some castor oil taken. ICT3" See the section Diarrhea for astringents, as- also the apothecarium. FITS IN CHILDREN. Besides teething, worms, poisons, acrimonies, and foreign articles in the intestinal canal, children may have various other causes of fits: pin? may be sticking in them, cheeres (a small tick) have sometimes been found to produce them, after layivg with sportsmen, or from having been carried out by nurses after whortle- berries, Sic Dislocations and fractures, unnoticed, may also be causes;* so >nat a general inspection and • One of the author's cb^dren had a fit, from looking at a favourite dog whilst in fits. 29* 342 DISEASES OF CHILDREN. inquiry ought always to be made; besides ascertaining what, and how much, the child has eaten. It would be well also to inspect the sucklings nurse, (if there be one) whether she drinks rum, or has any disease, or is dreadfully passionate, or in the bad habit of fright- ening the child. There is always great alarm in such cases, and the physician has often to prescribe instantly, to satisfy the parents. The warm bath is innocent and useful, as also warm clysters of sweet oil. The stomach may be emptied by some warm water, and tickling the throat with a feather, if it contains any thing noxious; otherwise a dose of castor oil, with a drop of oil of amber, or fifteen drops of tincture of assafcetida, may be given. A blister must be put on the breast; and as soon as the oil operates, live drops of laudanum may be given, if the child is three years old or more; or two drops for an infant of one year. The enemas and bath must be often repeated. It may be well to look over the chapter on epilepsy. Dr. Thomas recommends, for children, a little diluted potash to be frequently used; and as it may be tried with any other article, it will be well to mix in a little with the opiates, Sic, three grains of salt of tartar, or as much of soda, will be a dose. In a suspicion of poi- son, this should always be used, When cheagres are suspected, not only the warm bath should be used, but when the patient is taken out, and well dried, the whole surface should be rubbed with warm sweet oil, to which ^a. few drops of laudanum, or oil of pennyroyal, may be added. When the brain appears to be affected; bleeding and the application of ice, in bladders, to the head for a few minutes, mqy be used, but not too long, nor often repeated; as the remedy will produce affections of the throat. There can be very little expectation of the fit ceasing altogether, till the cause is removed. If the fit re- mains long (or at any time) some cold water may be sprinkled in the child's face. DISEASES OF CHILDREN. 343 There are some affections, called inward fits, attack ing children, whilst asleep. There seems some agita- tion, but it is probably more of the night-mare kind: a great quantity of wind is discharged from the stomach. Some spiced toddy may be given, when put to bed, and the child often turned, and rubbed over the sto- mach. %CT* There is scarcely any case, but what a blister to the breast, as soon as the child has been bathed, will be useful, to prevent repetitions of fits. CHOLERA INFANTUM, OR SUMMER COM- PLAINT OF CHILDREN. This disease holds a middle rank between cholera morbus and diarrhea, partaking of the nature of both. It is confined, in its perfect state, to our large cities; from Boston to Charleston. It seldom commences in the large way, in the middle states, before the middle of July, and then continues till the cool nights after the equinox. When the infantile system has been relaxed by the steady heat of the summer months; and espe- cially when irritated by teething, it only requires those sultry heats, so common to July and August, through the whole twenty-four hours, to bring on cholera. And in proportion to this one circumstance, viz. heat con- tinuing through the night, we may calculate the grade and quantity of the disorder, in any of the cities where it is found. In the unventilated, close, and crowded abodes; along narrow streets, courts, and lanes, where the poor mostly dwell; and where flies, musquitoes, coarse diet, with uncleanliness, augment the oppres- sions of climate; there cholera may be said to reign. A warm sultry night, in August, is sure to finish the scene with one set, and to commence it with another. If ever death smiles, it is at such a scene; where he is rarely disappointed. And as human nature naturally seeks any relief from uncontrolled distress, he is often a welcome messenger to both child and parents. £^ Children may be bled on the back of the wrist or hand. 344 DISEASES OF CHILDREN. Symptoms.—Vomiting of undigested milk, Sic, purg- ing of the same, with abundance of hot, irritating bile and slime, created by the combined heat of fever and climate. Spasms and distensions from the irritation of such crudities; impatience from the nature of such inextricable distress; with consequent debility from the continuance of disease, and the want of rest; all of which are protracted through two or three weeks, or longer, in some cases. Strong marks of inflammation exist, not only in the arterial system, but in the whole surface of the prims viae and large viscera, connected with the intestinal canal. Cure.—This is extremely simple, if the means can be obtained in proper time. It consists merely in the early removal of the child to the country, where it can breathe a pure air by day, and at night enjoy that tem- perature so necessary to repose. This, with restrain- ing its diet, will nearly be all that is requisite. The teeth, however, will require some attention; and clean- liness, by tepid bathing, will be needful to ensure a cure. But when a removal is impracticable, something may and ought to be done to relieve the child: as a favour- able change in the weather, or in some cases great constitutional strength, or the lateness of the season, might conspire with our partial medical aid, to carry the child through. As a means of prevention, some decoction of Peruvian bark might be given, two or three times a day, from the beginning of summer, and the cold bath used daily. Children soon learn to take medicine, when given regularly. It has been found, by an experiment of this kind, that though the children will have fever, the bowels escape. It will be necessary to learn them to drink rice water from a sucking bottle, that when the cholera attacks them, they may use this and not suck the whole of the mother's milk: a practice that alone would keep up any disease of the bowels. One half of the usual diet, and that of a thinner kind, is the most that even adults should use when the bowels are affected; DISEASES OF CHILDREN. 345 how much more such restraint is needful to children. The teeth should be lanced, again and again, without fear: for to render them insensible, by a cicatrix, would be gaining an advantage; especially as such places would give way sooner than the original cover- ing. Great cleanliness, personal as well as in bedding and rooms, are requisite. Some chloride of lime might be used with advantage. A good vigilant nurse, with a fan and musquitoe curtains, are here highly impor- tant. A mattrass of some kind, is necessary: a cat's tail (typha) is one of the coolest. Flannels may be advantageous when the weather becomes cool, before the disease is cured. The medical attention is chiefly requisite to regulate the disease. Thus when it commences with severe puking and purging, it will be necessary to administer a lit tie laudanum, in some mint water, to arrest its violence, least the strength be exhausted. But this stage is often absent, or so small, that instead of re- straining it with opiates, we may encourage it a mo- ment with some camomile tea, till We are sure that all undigested nourishment has been thrown off. A dis- charge of all the acid, and offending matter, is abso- lutely necessary; so that we must aid it by castor oil, or some of the rhubarb julap, in sufficient doses to purge; or with the syrup of manna, with portions of magnesia. The febrile symptoms must also be attended to: for this purpose, some give small doses of neutral salts. The soluble tartar is one of the nicest: five grains of this, with a little sugar, and a quarter of a grain of ipecacuana, or three drops of antimonial wine, may be used every two hours. Other physicians try to ac- complish every purpose by small doses of calomel; a grain every two hours: but although this medicine may be used as a change with the aWe. the continual use of calomel will, especially if given soon, increase the inflammatory diathesis, and extend the length of the disease. 346 DISEASES OF CHILDREN. Blisters may be applied to the wrists, if the febrile symptoms continue, after a due use of the articles above prescribed. Mucillages are always used, both as food and as a sheathing to the irritations on the bowels. Arrow root starch, elm bark, and gum arabic, are the chief. Starch clysters are often useful, and towards the end of the disease, a drop or two of laudanum may be added to each clyster. Should the looseness con- tinue after the febrile symptoms have abated, some astringents and opiates will be useful: small quantities of tincture of gum kino and prepared chalk, or two or three teaspoonsful of a weak decoction of logwood, may be used frequently. A little finely prepared chalk, with a drop of laudanum or less, may be used every three or four hours. A little alum whey is also a good astringent: a dessert spoonful, once in three hours, may be used before using the other astringents. It is recommended as one of the noblest charities that could be offered to the sufferings of the human family, for every large city from Boston to Charleston, to have a place of refuge for such helpless little suf- ferers, who are literally stewed to death by the burn- ing atmosphere of the summer months, and consequent fever, acting with an unremitting heat, both day and night. The plan would be to have about forty airy huts, with two rooms to each, and a kitchen shed to every four houses. These houses should be scattered over five acres of ground, shaded with umbrageous ornamental trees, at a distance from one to two miles from town, on an elevated ridge. The city of Balti- more abounds with such sites, from east to west. From the proximity of the city, the father of a family might do his daily work in the city, and walk out at night. These rooms should be under a strict regula- tion, bv trustees. The physician in attendance, should give tickets of admission and discharge, so that a new set might come in: for in .general, ten to fifteen days would be sufficient, in most cases, for a cure, if the disease was taken in time. And as many children would escape by attending their mother to the country, DISEASES OF CHILDREN. 347 there would at least be four hundred patients relieved annually; which number would absorb all the poor of any one city; among whom the great mass of mortality prevails. And in this relief we might safely say, that from fifty to one hundred were saved from a most horrible state of suffering and death. And let the question be put, where is the hospital, or any other institution, that saves that number of human beings? There would be necessary to such an establishment, a soup house, on a small scale, to give a dinner to the most indigent; also two good cows for the childrens' use; also a horse and cart, with a driver. One of our noble spirited citizens of Baltimore, has given ten acres of ground, in the vicinity, for pleasure grounds and ornamental walks, with a view also to health. And it is to be hoped that some other will be found, whom God hath blessed with riches and a feel- ing heart; equally liberal for this great purpose. Me- thinks I see a marble column ready to spring from the quarry, to receive his imperishable name. Forty huts might be built for$5000or $6000; and an annual subscription of $300 would then accomplish the whole business. Who among the single and childless will take tickets in this heavenly lottery, where all are prizes? Who, that has none, will become the parents of hundreds; nay, in the course of time, of thousands? and thus leave an everlasting memorial behind them. To save is next to create. fCJ* There is scarcely a large city but what has its rich bachelors, its wealthy maidens, and its liberal citizens, who might almost contend for this honour. LAX IN CHILDREN. Although a variety of circumstances in the cause, management, and cure of diarrhea in children, differ from the disease of the same name in adults; yet it will be well to look into the chapter on that dis- ease. Causes.—In addition to the same causes that are 348 DISEASES OF CHILDREN. common to adults, may be added: unhealthiness of the mother's milk; meals given too largely to the suckling; and all indigestible articles that children eat so freely: such as green fruit, or too much ripe fruit. A disposi- tion in the stomach to produce acid, is a frequent cause; which in fact is an indigestion from feebleness of the stomach. A lax is common when measles are declin- ing. See chapter third, on eruptive diseases. Symptoms.—Thin discharges of various colours, made from four to twelve times a day; speedily fol- lowed by great emaciation. The absence of blood, slime, and straining, will designate it from flux. The state of the stomach, fever, and impatience in cholera, (and often the season) will mark out the lines between these two diseases. Management.—The child must be kept warm and dry in cold weather, and always with thin flannels next to the skin; and be kept cool in summer, with the greatest attention to cleanliness. A most important regulation is to allow it but one half the diet that is usual in health. When a suckling, thin rice water may be given to pacify the appetite. If it is past sucking, arrow root, rice alone, or with a portion of milk, or thickened milk, chicken broth may be used as food, and a very weak drink of port wine and water, with nutmeg, allowed. Cure.—Some of the chalk julep of the apotheca- rium, will be a good medicine to begin with; which will destroy the acid of indigestion; then small doses of one or two grains of rhubarb, to eight grains of pre- pared chalk, may be given through the day, every two hours, mixed in mint water. If these do not restrain the discharges in a few days sufficiently, ten drops of paregoric may be given with every other dose, (of the chalk and rhubarb) or one drop of laudanum. Should the disease still continue, more of the opiates, and also astringents, must be added: a few teaspoonsful of alum whey for four or five times through the day, or fifteen drops of tincture of kino, in a little water, or a dessert spoonful of weak tea of logwood, every three hours, DISEASES OF CHILDREN. 349 will be some of the best for this purpose. When there is any disturbance in the pulse, a small puke of ipeca- cuana will greatly facilitate the cure; especially when there is much bile in the passages, and marks of in- flammation and feverishness; or when cutting of teeth. The teeth must always be lanced when the gums are swelled. And if the child is kept from sleep by the irritation of the gums, a few drops of laudanum should be added to one of the powders of chalk and rhubarb, and given at night. WORMS. These are seldom the cause of any disease, compar- ed with the frequency of accusation against them. Every writer seems to enumerate a certain set of symptoms of his own selection, which are often more appropriate to other diseases, or to a peculiarity of con- stitution. Occasional nausea, a cough without a cold, fits, emaciation, bloatedness, with the discharge of a worm or two, are pretty sure marks. But at times there are more severe symptoms: such as sudden pros- tration, an almost imperceptible pulse, blindness, deafness, with discharges of blood from the bowels; it would appear, in these last cases, that the worms were engaged in perforating the bowels. In fevers, where the patient has taken no food for a week, worms are apt to come away; though they have not been the cause of either the beginning or continu- ance of the fever. Cure.—In those cases where life seems almost sus- pended, it becomes necessary to administer wine and cordials, to keep the patient up; and when the pulse is restored, to administer a dose of calomel and jalap, to discharge the worms. All the essential volatile oils are justly considered as anthelmintics, both from their flavour and physical action. Worms may also be poisoned by the use of certain articles, which the patient may take, in most cases, with impunity: such as snigelia, (the Maryland 30 350 DISEASES OF CHILDREN. pink root;) melia azederach, (pride of China;) powder of tin, heleboraster, Sic But these articles should never be used as a first course, nor at any time with very young children. t / Worms may also be irritated away mechanically, by /- \ large doses of iron filings,* by pounded glass,! and by Dolichos pruriens, (cowitch.) But since the discovery of the high rank of the oil of chenopbdium anthelmin- ticum, (oil of wormseed;) as an offensive article to worms; they have met with little quarter in this part of the world, where it is plentifully and neatly dis- tilled. Five drops of the pure oil dropped on a lump of sugar, and grated into a large spoonful of water, and given morning and evening, is sufficient for a child of five or six years of age; and ten drops is a sufficient dose for any age whatever. Spirits of turpentine has also been used in doses of from ten to forty drops, for the same ages: taken in milk. The syrup of cowjcfr is a very innocent and powerful vermifuge. After taking this, or the oil of wormseed, for three or four days; the patient should take a brisk purge of either calomel and aloes, calomel and jalap, or castor oil and calomel. Of all the other medicines before mentioned, (poisonous medicines) the Maryland pink root is probably the best: a quarter of an ounce of the whole plant is to be made into three small tea-cups full of tea: one of which is to be taken every two hours; and after the whole has been used, a purge of castor oil, or salts, must be given. But should a vertigo, or any other untoward symptom ensue whilst taking it, the tea must be laid aside, and a purge instantly given. iC7° No child, under seven years of age, should take pink root. Tape worms are very difficult to dislodge. After taking pink root, or spirit of turpentine, for a week, the patient (if of a pretty good constitution) may take f * The iron filings, in large doses, have been mentioned by Dr. Rush. jf t The pounded glass was used by the late Dr. Moore, of Baltimore, X £ who probably got the prescription from Dr. Archer, sen., of Harford, ^^ Maryland. DISEASES OF CHILDREN. 351 a dose of tartar emetic, (say two or three grains in divided doses) and as soon as it begins to operate, turn it downwards, into a powerful purge, by drinking very salt broth, or salt and water. This plan has suc- ceeded without the essential oils. The male fern root, once so famous, is not now in credit. Those who are too weakly to take the tartar, may take the essential oils for some time, and then a portion of pink, root; purging it off with calomel and castor oil, or aloetic tinctures, often repeated. Ascaridesare small worms that infest the rectum, or last gut. If they cannot be discharged by means of the wormseed and purges, injections of weak tobac- co tea will be necessary, followed by an enema of salt and water. SCf Ten to fifteen drops of a saturated tincture, made with the inner bark of melia azederach, (or the pride of China,) may be given twice a day to a child of seven years old; or a teaspoonful of a strong decoction. Ten to fifteen grains of powder of tin, may be used twice a day for one of the same age. From a teaspoonful to a tablespoonful of syrup of cowich, in the morning fasting, is a dose. After tak- ing three or four doses, the worms begin to appear. PROLAPSUS ANI, OR FALLING DOWN OF THE GUT. Causes.—It is hard to say in some cases, with children, who are more especially subject to this com- plaint, what is the cause, more than some connatural laxity of the bowels or the muscles, connected in their action. In some instances it may be traced (in adults) to costiveness, or to great straining, as in dysentery: to piles, hard labours, and all weakening diseases. In some instances the bowel may remain out a con- siderable time without damage, whilst in others it will inflame very soon. No time should be lost in replac- ing it. By putting the child on his knees, and his head down, it may soon be replaced with the fingers. 352 DISEASES OF CHILDREN. When pain follows this operation, (and it has to be fre- quently done,) the gut may be smeared with an opiate.* But when it has remained out some time, and become inflamed, it will be requisite to poultice it with a lead water poultice; and even to bleed from the parts with leeches, and from the arm. To prevent a return of the disease is the greatest difficulty: for it may come down at every passage from the bowels. Clysters of cold water, or a cold decoction of oak bark, and.tonic reme- dies: such as steel, elixir of vitriol, and bark, with the general cold bath, are proper; with great attention to the bowels. Dr. Physic has recommended a diet of rye mush and sugar, which, from its apperient nature, keeps the bowels free and easy; and such diet will be proper during the existence of the disease. The cold water clysters will generally unload the bowels as well as tone them. When it is inconvenient to use a general cold bath, a small watering pot of water may be poured over the back and hips, beginning with some that has been drawn all night, and so increasing the cold by degrees; taking care to wipe the child well, and dress it quickly. In some very relaxed cases, bandages have been useful, and in all cases the child should have some assistance; so that when there is an appearance he may have an enema of water or oil instantly. PERVERTED CIRCULATION, EVINCED BY A LIVID COLOUR IN WHITE CHILDREN. The circulation of the blood, before birth, is not car- ried on through the lungs, but finds it way from one side of the heart to the other, by the foramen ovale; which hole in the heart begins to close up (as useless) after the blood circulates through the expanded lungs. When any spasmodic action of the lungs, or other part, * Galls, in fine powder, one drachm; opium, ten grains; let them be made excessively fine, and added to two ounces of lard. A very little -nay be smeared on the parts, once or twice a day, for children of jur to seven years of age. DISEASES OF CHILDREN. 353 denies the route by the lungs, it is then forced into the foetal route by the above hole, so long as it is unclosed; and being thus deprived of the operation of oxygen on the surface of the lungs, it retains its venous hue, and gives this blue appearance, instead of a fine red to the child's face. What appearances children of colour (negroes) have, is not known; they do not seem to have been noticed in this disorder. The foramen ovale will sometimes remain open, and transmit blood, till the tenth or twelfth year, and then the child will go off suddenly, by fainting, or a fit of some kind. The doctrine, therefore, of some medical gentlemen, as to the immediate destruction produced by venous blood entering the brain, is fallacious. We every now and then meet discoloured white children, as above described. Dr. Hossack has given two cases, where it would appear such a state was wont to form so suddenly as to produce immediate death. Though the question might be asked, whether the dis- ease he describes is not another? though attended with a livid colour; and no doubt from the blood finding the passage through the foramen ovale. Perhaps in those cases where death does not immediately ensue, the spasms in the respiratory organs are not the cause, but a relaxation and want of formative power in the fora- men, by which means the route is gained by degrees; and the change imperceptible for some time. In two cases related by Dr. Hossack, the children appeared to become breathless and livid, and lose their circulation; when from pain, or some alarming sensation, they screamed out, and it would seem thus to open the lungs, and admit the blood again into its proper route. These fits soon return again, and the child quickly sinks under them, unless relieved. The only knowa relief has been suggested and prescribed by Dr. Hos- sack. He takes four ounces of Peruvian bark, and boils it in two gallons of water, adding one pint of spirit, and occasionally a little spirit of sal ammoniac, to make it more stimulating; perhaps an ounce in all. The child is dipped in this, when of proper warmth, 30* 354 DISEASES OF CHILDREN. up to the chin. He used it a little warmer than the skin, and continued it till the symptoms went off, and then wiped the child dry, and put it in flannels. If the symptoms recurred, he bathed it again; and always with relief, and lessening of the disorder till it was cured. These were infants of a few days, or a few weeks old. Although every minutiae of the doctor's remedy should be attended to; it might be prudent to use warm water, even alone, at the offset, if the other articles were not at hand, or quite ready. The effect of a warm bath is so general in altering the circulation in children, that it is often a dangerous thing when the child has been much debilitated by disease, medicine, or bleeding: producing fatal syncope, and when it suits, is, of course, equally powerful and salutary. ACCIDENTAL DISEASES. CHAPTER XIII. POISONING, FROM TAKING ACRIMONIOUS VEGETABLES AND MINERALS. The word poison, has been applied to the action of such articles as speedily overcome the vital energies of the system; whether by a direct action on the primae viae, as in those which inflame and corrode the parts, or by their peculiar physical action reaching the more sentient organs of the system: such as the brain, nerves, heart, or lungs. It has also been applied more vaguely to those articles which interfere with the ele- ments of life: as the gasses, when inhaled; and finally to articles that act in an extraordinary manner, even when applied to the surface. The difficulty of a good definition is great, because most of those physical articles, in small doses, are medicines, and some are salutary (as carbonic acid gas) when applied to the stomach. The symptoms of poisonous articles, are mostly as follows: dilated pupils, blindness, oppression, vertigo, nausea, vomiting and griping, with great pains; sense of burning in the fauces and stomach, sense of bursting, drought, strangury, discharges of blood from the bowels and other parts; sudden sinking and failure of all the vital functions: hiccup, cold extremities, cold sweats, spasms of the face, legs, and abdomen; swelling of the face, tongue, and whole body; tremours, convulsions, coma, and mania; sometimes miliary, and purple eruptions, Sic. 356 ACCIDENTAL DISEASES. In external poisoning, there are eruptions of an erysipelatous appearance. Many of the aforenamed symptoms attend in any case of poisoning. The pulse in all bad cases is affected: mostly quick and small, or interrupted. Management.—When it is found that a patient has swallowed some poison, especially if not known, the first thing to be attempted, is to puke it off, provided it is a very recent accident. If the patient can swallow, he should drink freely of warm water, with thirty grains of ipecacuana in it, and in a few minutes begin, with his finger, to excite the stomach to throw it off. When persons are too insensible for this, a feather should be introduced into his throat and moved about. Or if a stouvich pump can be obtained, or a good tight syringe, with an elastic tube, water may be thrown into the stomach, and then drawn out again, for several times. Every attempt must be made to ascertain from what is thrown up, what the poisonous article may be. If there is any likelihood of \:s being a mineral poison, it will be well to give, or inject into the stomach, a pint of water, in which there are two table spoonsful of common ley, or a drachm of salt of tartar; repeating it after drawing out the first injection. A quantity of the whites of eggs may then be given, or injected. The following list of articles, liable to do mischief, are kept about most dwellings, or found in their gar- dens: corrosive sublimate mercury, arsenic, cobalt, tartar emetic, verdigris; red, white^ and sugar of lead; opium, mushrooms, night shade, (solatium) wild car- rot, goosefoot, James-town weed, poke root, palrna christi seed; on each of which we shall insert a short section. Corrosive sublimate mercury, is one of the most common poisons that we have to prescribe for. Spiri- tuous solutions of it are used for to destroy bed bugs. When the bottles stand any time, there is a crystalli- zation forms at bottom, not very easily washed out with water; so that if this double poison is not drank by some drinker, through mistake, he has another ACCIDENTAL DISEASES. o07 chance at the beer cellar, where those bottles, when empty, find their way, and then poison the cider, or beer. The glass houses should facture bottles ex- pressly for the purpose, with a peculiar form, and with letters thus: POISON. And no solutions allowed to be made with spirit, for family purposes.* The mayors of cities should attend to these things! When corrosive sublimate is taken, the patient feels a burning from the throat to the stomach, with violent pain and vomiting, frequently of a bloody appearance. The quantity, and length of time it has been taken, will vary the symptoms; but he will, if it is not discharged, have many of the symptoms detailed before in the gene- ral statement of poisonous symptoms. The potash, or common ley in water, as before mentioned, will be one of the best antidotes. After using some pints of it, and drawing it, or puking it off, whites of eggs may be given: and finally a large draught of prepared chalk, or whitening and water; say an ounce of whitening. If some of what is puked up, is mixed with a little lime water, made even by rubbing some of the plaster of the house, in a mortar for a minute, it will change the corrosive sublimate to an orange colour. If any other test is wanted, the nitrate of tin will make a dark brown precipitate. If after the patient has thrown off much of the poison, it is found that an inflammation of the stomach has been produced, bleeding and leech- ing over the stomach, and oily purges will be necessary. By the above tests we can ascertain not only the article, but also when all the poison is thrown Qff; and then (if much pain follows and a fever) ascertain that the stomach is inflamed. Arsenic.— Next to the corrosive sublimate, this is the most usual article met with in poisoning. When * A watery solution, viz. Re. corrosive sublimate, two drachms; common salt, half an ounce; to one bottle of water add a few filings of copper. No drinker would touch a green nauseous poison such as this, for bed bugs, made with water. {£f- Fowler's solution of arsenic might be precipitated with lime water, (after throwing off as much as possible) forming an inert arseinate. 358 ACCIDENTAL DISEASES. taken largely, it produces burning, thirst, sense of bursting, straining to vomit, sinking and death; some- times in thirty minutes. But when in less doses, there will be also some of the symptoms in general that are before noticed. This article, unfortunately, cannot be readily or fully decomposed in the stomach, like the former: puking and pumping the stomach are the main remedies: after which, the stomach may be well co- vered with some inert article that will envelope some of the particles, and also prevent any acids from acting on the arsenic: such as an ounce or two of prepared chalk, or whiting, in a pint of water, and then puked off: after which, the whites of eggs may be taken freely. When there is no chance of getting off more from the stomach, and there is still uneasiness, purges of castor oil, with portions of sweet oil, may be used. The appearance of the stomach, on dissection, is often spotted; the stomach being- made red, and the glands on its surface darkish. If inflammation of the stomach is produced after the arsenic is evacuated, it is to be treated as before directed, for inflammation after corrosive sublimate. Arsenic, when thrown on a red hot iron, or on a strong coal of fire, is volatilized, and smells like garlic. But in a case of life and death, {%. e. before a jury) the mass should be inclosed in a tube, with equal parts of charcoal and potash, and then calcined, so that the arsenic may be sublimed; which sticking to the sides of the glass, will be seen in a metallic coating. A so- lution of lunar caustic, in diluted volatile alkali, will make a yellow precipitate, with arsenic, for a tempo- rary test.* Cobalt, commonly called fly stone, is an ore from which white arsenic is obtained; and of course is nearly the same thing. It is used to kill flies, as also in glass factories. The remedies are the same as for arsenic. Tartar emetic.—This is sometimes taken by mis- * Caustic, one drachm; water, one drachm; pour off, when dissolr- ed, and add volatile ammonia, till the silver is re-dissolved. mnh r^y ACCIDENTAL DISEASES. 359 take, in a pretty large quantity. It produces severe vomiting and purging, burning at the stomach, violent spasms of the abdomen and calves of the legs; and afterwards leaves a burning about the throat, and a salivation in some cases: even in doses of seven to fifteen grains, it will produce this effect. It is said that it has much less effect on the stomach of old sots. The stomach must be well rinsed with warm water; after which some portion of warm water, with a drachm of carbonate of potash in it, may be given. The de- coction of yellow bark is said to be a specific. The limbs should be rubbed with warm spirit, as also the abdomen, and then a sinapism laid on. Opiates may be freely used to allay the spasms. Salt broth will throw the action on the bowels. The calcining the tartar with charcoal and potash, as for arsenic, is the surest test. The hydrosulphurets precipitate it from a solution, of a brown orange. Verdigris.—AH the preparations of copper, except the sulphate, (blue vitriol) may be considered poison- ous. Neither vinegar, nor salt, nor spices, nor syrups, nor fats, nor fruits, should be left to cool in copper vessels; as they will form poisons. They will then produce a bad taste in the mouth, dry tongue, sense of strangulation, pains in the stomach and bowels, anxiety, Sic After giving it a chance to come off by the stomach, (if recently taken) a purge of salts may be used. Some diluted vitriolic acid may then be ad- ministered, to the amount of a drachm or two of elixir of vitriol, in a pint or less of water. Sugar and water may be used at the offset, to rinse the stomach, espe- cially when the sugar has not been the article that has acted on the copper. Repeated doses of oil will be useful, as also plenty of mucilaginous drinks. The whites of eggs should be freely used, when the above are ineffectual; and perhaps it may be as well to give some of them immediately after rinsing the stomach. Tin.—This is said to be dissolved by some of the esculent sauces and gravies in use, and is then a poi- son. The peculiar symptoms are not well ascertained, 360 ACCIDENTAL DISEASES. but are some of those in the general list; perhaps more like arsenic than any of the others. It would be well not to let soups, or any spiced broths, or other article, remain in tins all night, (to be warmed up next day.) After a purge, milk must be used freely. It is said to be a perfect antidote. Lead.—See painters' cholic. But if taken in large quantity, by mistake, it must be purged off with salts, or puked off, if possible. Opium.—This article, in large doses, produces vo- miting, and then stupor; in less doses, it produces convulsions. It becomes more dangerous, where there is no speedy assistance in the smaller doses, by its laying longer on the stomach. It also has a strong tendency to produce apoplexy; and when this is per- ceived, or the patient is of that habit, some blood should be taken. Every method to clear out the opiate should be used: by tickling the throat with a feather, and by giving strong emetics, or by the pump, if it be laudanum. If the person is very insensible, so as to prevent the administration of medicine, some water as hot as we can soak our feet in, say 110 or 112 of the thermometer, may be thrown on him; and whilst re- vived, he may swallow the puke, or other articles. When pukes cannot be taken in the usual way, an in- jection of two drachms of ipecacuana, well drawn in a pint of boiling water, may be injected warm into the bowels; which will puke freely in some cases. Stir- ring the patient about (and if a boy) taking him on a horse, and trotting about in the open air, is useful, after all chance of evacuation is over. Strong acids should be given very frequently, every quarter of an hour: such as lime juice, or vinegar. Some small doses of ipecacuana, say three to five grains, may be given with drinks of cream of tartar, every hour: by-forming a kind of Dover's powders, they open the pores, produce sweat, and thus relieve the brain.* They are not to be given till the chief danger is over. * Persons may take twice and thrice the usual quantity of opium, when united with an emetic. ACCIDENTAL DISEASES. 361 When the person seems to yield to apopletic symptoms, and has been bled freely, cold water should be applied to the head, and sinapisms to the extremities. Mushrooms.—It is no wonder that people are often poisoned by mushrooms, when children are the gather- ers, and the cooks seldom the eaters. Moreover,- be- cause there are three distinct sources of mischief: first, over eating. They are very heavy food; that is, such as will not puke off when too much is taken, but para- lyze the stomach like an opiate. Those who suffer, are generally epicures: the mushrooms are highly seasoned, and often eaten at night. A peck of the fresh vegetables will make two quarts of stew, which will be eaten by one man; who, perhaps, has already diseases of the heart, or brain, underweigh. No wonder he sinks before morning, when so loaded! Secondly, the esculent mushroom will become diseas- ed in shady places and very rich soils, and attain an acrimony or a putrescent disposition; so that an ordi- nary mess will poison. Thirdly, children that gather them may often take up other species by carelessness or mistake. The club mushroom may pass very well for a stem of the esculent. No persons are ever injured by the pickles, when made of the proper kind; because they are then used only in moderate quantity: few persons using more than what is made from a pint of the fresh plants. One quart of the fresh mushrooms (making less than a pint when dressed) is the largest quantity that any hearty man should attempt to use for his dinner. Healthy mushrooms grow in sunny flats, and in a thin soil: they have a thick white hat, with pink coloured parallel gills. The hat is slow in expanding. They should be eaten before this is fully expanded and turned in colour. The skin of the hat is always thin, with small ruptures, and disposed to peeling. Trie stipe, or stem, is short and perfectly strait, of equal thickness. All mushrooms should have the hat and stem together, when chosen. No mushrooms that have a mucillaginous and dark 362 ACCIDENTAL DISEASES. appearance should be touched; nor those with a thin flat hat. Vertigo, dyspnoea, oppression, and soporous symp- toms, attend the over eating of good mushrooms; and when poisonous mushrooms are used, some of the symptoms mentioned in the general list of symptoms: differing, perhaps, according to different species and the quantity eaten. Vomiting, by tickling the throat with a feather, and by injecting an infusion of ipecacuana into the bowels, as directed for opium, are first to be tried; and then powerful purges of jalap, with enemas of soap suds, with a few grains of gambouge, are to be used. Acids may also be tried, as in the case of opium: with bleed- ing, and cooling the head, when the patient is soporous. Perhaps, as the mushroom is the natural food of hogs, and they eat all sorts with impunity, some of their gastric juice, forced into the stomach by a long elastic pipe and syringe, might digest the mass, and cause it to become harmless. Conium macculatum, vulgarly called cicuta, and hemlock.—This is a stout umbeliferous plant, two or three feet high, spreading its large, deep green, shining foliage, over two feet or more, on each side, quite down to the ground. The leaves are compound and winged. Each proper foliole, or leaflet, has little or no stalk. They are about three inches long, and are lance-shaped and notched. But the chief botanical character is the seed. Two growing together become like coffee: that is, flat on one side and rounded on the other: the round back has several rough ridges. The spots from which it takes the name of macculatum, are on the main stem; small, brownish, and thick set. There can be no fear of this plant being mistaken for any garden plant, so that design or simple mistake must be the source of poisoning. It grows most abundantly on the hill sides of the wet rich ravine, near Easton, Maryland; and £^- The cicuta is a virulent plant also. The cicuta bulbifera grows in the marshes of Canada. There are no likenesses of habit be- tween the two plants. ACCIDENTAL DISEASES. 363 although up to the gardens in some parts of the town, the oldest physician could not recollect of any accident from it. Venigo, dimness, palsy of the tongue and extremities, are said to be the chief symptoms. The vomiting of it off, by the aforementioned means, and then using oily purges, are the first plan; sinapisms, liniments, and blisters to the paralyzed parts, are then to be applied. Night shade, (solanum nigrum.)—This plant is easily known by its blackish green, polished and round berries, as large as a green pea. The leaves are lanced, dark coloured, and generally perforated by worms. The aspect is something of the Irish potatoe, to which family it belongs. It first purges by inflaming the bowels: spasms will then pass from place to place, over the whole system, imitating croup, cramp colic, Sic. All this the author has seen in a child. Evacuants are the only means, and then sweet oil, by injection. If not thrown off in time, the morbid symptoms will con- tinue for three or four days, and then destroy the pa- tient. Wild carrot.—This is not the daucus pusillus of the southern states, but our own garden carrot, grow- ing in damp fields, where it gains a great top, though little root, and much acrimony. It produces incessant spasms of the face, in children, and then stupor and death. Adults drink a tea of it with impunity, in cases of gravel, and often with much relief. Evacuants can scarcely be of use when a decoction has been drank, unless it be in a half hour, or less, after taking it. Oils may be given by injections into the stomach, and gentle diuretics, such as aerated waters. Blisters may be used to draw the irritations to the surface. But we know of no specific. Chenopodium muriale, (goose foot.)—This plant grows about the ruinous heaps of old dwellings. It is about eighteen inches to two feet high; has the aspect of lamb's quarter; and the fruit like this, or the Jeru- salem oak; the smell is rancid. The leaves are egg- shaped, glossy toothed and acute. It produced (by 364 ACCIDENTAL DISEASES. eating the bunches of green flowers,) in two boys, at Baltimore, purging, griping, and incessant convulsions of the whole frame for many hours. Large quantities of oil were used by the mouth and anus, when it was too late to puke; and with success. Datura stramonium, (James-town weed.) The small unripe seeds, given to a child in Baltimore, (to destroy it) produced great griping, slimy stools, with a little blood, and the seed came with it. They are engraved and polished, and may be easily distinguished by these marks. In some adult subjects, that made too free with a tincture, it produced mania, rather of an harmless cast: the drinker supposing himself a cat, in pursuit of mice; and from other accounts, this ridicu- lous mania is the common turn. But like oxyde of azote, it may at times take a mischievous turn. Eva- cuation, low diet, and blistering, may be used, taking good care of the patient, and keeping him to a vege- table and watery diet. Phytolacca decandria, (poke root.) Violent grip- ings, slimy purging, and disorders of the primae viae, attend, when a root as big as the finger has been used. But the author saw a case of delirium from the appli- cation of a poultice, made of a very large root, which was merely applied to the neck, to discuss a tumour. Evacuations are the only sure means, and then oils and mucillages: no specific being known. Palma christi seed.— Only ten or twelve of these have acted on the bowels of grown people, so as to lay them up for days. Sweet oil is the best remedy. They might be fatal to children, as they are to fowls. External poisoning is done by poison ash and poi- son oak* plants, well known in the country. Eruptions, with thickening of the skin, are the consequence, with violent itching. The eruptions have a dry scaly dis- position. Applying poultices of vinegar and bran, or of soap and bran, till they are white, and then a little * Rhus vernix. Rhus Radicans and Rhus Foxicidendrum, of Mar- shall, are our poisonous plants. The first, a little tree; the second, a vine; and the third, a shrub. ACCIDENTAL DISEASES, 365 mercurial ointment, or weak red precipitate salve, cures them speedily. BITE OF A VENOMOUS SNAKE. We have but two species of snakes, in this part of the world, that inflict a wound, and transmit a poison through a hollow groove in the tooth, that commu- nicates with a sack in the jaw, somewhat like a gum- boil. The rattle snake and the copper head are of this description. This latter snake is probably the one called by Dr. Mead a viper. But the snake we name a viper has not those fangs that fall back into the mouth, and are again elevated at will. A multitude of falsities have been published on Indian and negro au- thority, about prevention and cures; whilst too little has been published by physicians, as to either the symptoms produced by the poison, or on a rational method of arresting its destructive force. Svmptoms (from fact.) A woman was lately bitten on the foot by a copper head, in this neighbourhood, whilst walking in her garden. Such was the rapidity of the poison, over the system, that she fell by the time she reached the door of her dwelling. Pains instantly ensued in almost every part of the body; but more particularly in the abdomen. The tongue swelled so as to prevent speech. As no medical aid was to be obtained for some time, she was indebted to her consti- tution, in a great measure, for surviving the injury. The pains and swelling of the tongue abated slowly, and in three days she was relieved. The case of Mr. Bobbit, at Person Court-house, North Carolina, in November last, was as follows: Mr. Bobbit was bitten on the finger by a caged rattle snake. In three minutes his eyes became red, his lips swollen and quivering. In about ten minutes more, £js- There are a few instances of spiders having inflicted a mortal wound on some delicate individuals; but such things are so rare and the species of spider not being certainly known, nothing can be'said that will apply to them in particular; and they may be treated accord- ing to the plan for the venomous bite of a snake. 31* 366 ACCIDENTAL DISEASES. all his muscles were in a quivering convulsive action; at this moment vomiting commenced, and lasted for an hour. A collapsed state of the pulse ensued, (in about half an hour from the time of the bite.) He was in great agony; but was sensible till the fifth hour; and died at the sixth hour from the time he was bitten. Biles of snakes have sometimes produced only local symptoms: such as inflammations of the part bitten. Dr. Jamieson, of Baltimore, says that he has seen such, and that they resemble scrophulous inflammation. Whether the venomous snakes had exhausted their sack of poison in battle, or by other means; or whe- ther some snakes of a different species were the aggres- sors, is doubtful: for the snake often evades a hasty search. Cure.—When a person is bitten by one of the above named snakes, he may take it for granted that he is seriously poisoned; and if the part can (without much damage) be instantly cut out, or off, it should be done. A ligature, sufficient to stop the circulation in the limb, above the bite, should be instantly made by any string at hand. The wound should then be bathed in water,. or in ley; and this will be better done with a syringe, forcing in the water repeatedly. The wound should then be slit open, in various directions, from without to the centre, wiping the knife and wound after every incision. But if the person can command a piece of vegetable caustic, or of silver caustic, it should be in- serted; the former will eat out the flesh, and the latter, thouo-h not so corrosive, will destroy the power of the poison: and on this account may be used in a liquid state, (subsequent to the common caustic) pounding it up with some water. If the patient has sufficient fortitude, a hot iron, which is always to be had, should be used, without waiting for other means, to burn out the wound. It might not be amiss to give a gram ot lunar caustic, dissolved in water, internally, every hall hour, as Fontana asserts its power (when in contact) of destroying the virus of the rattle snake. If, how- ever, the poison, notwithstandinf the above operations, ACCIDENTAL DISEASES ob7 has in some portion got into the circulation, and pro- duced the symptoms described; the physician should anticipate the collapsed state of the pulse, and apply sinapisms on the spine and legs largely, and adminis- ter brandy, volatile alkali, or ether, freely. Ten grains of calomel, with six of camphor, may also be given every half hour, and warmth applied by every means to the body. Electricity may also be used, and a bath of a very high temperature should also be applied momen- tarily: for the poison will not continue its influence longer than other poisonous articles; and, therefore, there is hope as long as any stimulant can raise a single pulsation. Warm oil, rubbed all over the sur- face, has had its advocates; and may be innocently used in minor cases. The artificial wound, made by the incisions, should be suppurated; and the patient kept at rest when on the recovery. DEATH FROM DRINKING COLD WATER. It seems strange that this affection should remain unnoticed, almost entirely, till the day of Dr. Rush; and that to this date little more seems to have been done, than to give a teaspoonful of laudanum, with as much ether, and then consign the patient to his fate. Symptoms.—The patient, soon after taking a full drink of water from the pump, when his body is very hot and sweating, begins to feel a dizziness and breath- lessness, and then soon falls to the earth speechless. His face becomes of a bluish hue, and his surface cold and wet, and he appears as if there was nearly a total interruption in the diaphragm and lungs, both in action and circulation. The pulse becomes merely slower than natural; but soon begins to sink away, and he dies in about thirty minutes, apparently in the greatest agony: not being able to utter a word. At other times the patient has recovered without medical relief, and has been beset with the most violent rheumatic pains; only yielding to repeated bleeding.* It is a fact, that this disease never assails a patient but when the thermo- 368 ACCIDENTAL DISEASES. meter has reached nearly the highest point, and when it is ranging between 80 or 90 degrees of Fahrenheit, in the shade. This circumstance seems to point out a rational theory. It is an established fact, that the system generates heat for its use, and distributes it in propor- tion to the atmospheric deficiency; and of course, when the thermometer approaches the freezing point, not only enough for the system is generated, but an immense surplus is given out to the atmosphere, and all cooler bodies in contact. This seems owing not only to the vigour of the system, but to the condensed slate of the atmosphere. But when the atmosphere has arrived to nearly the temperature of the blood, it would appear that little or no surplus heat is generated. This is proved by the experiments of Fordyce and others, who found, on going into a room heated greatly beyond blood heat, that the temperature of these persons was not raised like dead matter, but a process was going on of a chemical nature on their surface: generating cold enough, by evaporation, to keep the body at the proper temperature of health. The ratio, therefore, of generating surplus heat, is in inverse proportion to the external temperature: ranging from the lowest degree consistent with good health, up to blood heat; and ceasing at this point. The use of surplus heat is very great; by it all local deficiencies are quickly supplied; which are very frequent from our partial exposure, partial sweating, irregular circulation, taking in cold ingesta, being exposed to the different temperature of water, both by rain or accidental immersion. If, therefore, an imprudent person takes in a large quan- tity of cold water, when the Uiermometer is so high, and the system incapable of making and rapidly dis- tributing surplus heat; the abstraction of heat is not supplied in due time to the stomach. And if the body is much heated, and relaxed by exercise, the very free perspiration conducting off the natural heat, will con- tinue to exercise that chemical process; so that the cold taken in, instead of shutting up the pores of the surface, and thus stopping the effusion of heat, as in ACCIDENTAL DISEASES. oO» health, will paralyze the stomach, by reducing it to a temperature incompatible with the composition of the blood, and a free circulation. Spasms, therefore, of the stomach and neighbouring parts, will instantly ensue: of the diaphragm and lungs, in particular. A very trifling experiment will elucidate the effect on the system in the two different states, viz. during a low and high temperature, and an active or inactive circu- lation of heat. Let a basin of boiling water (contain- ing a pint) be put on a brisk fire, and while on, pour in a pint of cold water at 40 degrees: the consequence is, the temperature instantly falls to the medium, viz. 126 degrees, but in the next moment rises to 130, and then to 140, and so on rapidly to the boiling point again, of 212 degrees. But let the same thing be done to a pint of boiling water not on a fire, and the divi- sion is made of 126, and so remains without rising. Now these experiments show pretty nearly what is done in the human body, in a low and in a high tem- perature of the atmosphere. They also show very plainly what the system requires under such circum- stances: not only something to stimulate, far above natural, the stomach physically, but actual heat, to be embodied and forced in, by injecting it with ma- chinery. Cure.—It is therefore recommended to administer a teaspoonful of laudanum, and another of ether, mixed in a little brandy, immediately; also to inject into the bowels a teaspoonful of ethpr, or spirits of hartshorn, diluted with half a pint of water and spirit. As soon as some water sufficiently warm can be obtained, inject a gallon in the stomach and bowels with a syringe, and repeat it in fifteen minutes. It should be as hot as we can drink tea, or hotter, but not so warm as to do injury by scalding. The surface of the patient's body should be wiped perfectly dry with sponges, and kept so; nor would it be amiss to apply warm, dry astringent powders to it, such as whiting; so that no cooling process should go on there. If the above applications do not restore heat, the apparatus 370 ACCIDENTAL DISEASES. invented by Dr. Jennings, would be advisable. It con- sists-of a bent tube; a segnie.it cut out of the wide end makeVia little fire place, and in this is placed a cup of rum, or spirits of wine, and fire is put to it; so that the blaze of the alcohol heats the air, and it ascends ra- pidly, and greatly heated. The small end which con- ducts it into the bed, must be wrapped with cloths as it gets very hot, and the hand of the operator will di- rect it, so that great heat can be given to a bed, or the body, in one-half of the time it can be command- ed in any other way. Where this is not to be had, a warming pan, warm bricks, and bladders filled with warm water, must be used. The lungs might also be stimulated in the following way: take two or three small pieces of sponge; dip them in ether, and put them in- side the valve of a bellows, and used as described for drowning. (See the article drowning.) Blow very slowly and gently; keeping the bellows horizontal, or having a thread to each sponge, hanging out of the valve, to keep it from passing into the tube of the bellows. If the patient recovers, he should lay by a day or two; and if rheumatic pains follow, be repeatedly bled. Dr. Rush advised the corporation of Philadelphia to paste up notices and warnings on the pumps, in sultry weather: directing persons to cool their faces and hands before drinking; by the astringent effect of which, the heat would not escape so rapidly from the body. This notice might be improved two ways: first, by having a plate representing a widow and children fol- lowing their deceased husband and father, borne from a pump. Secondly, by tolling a hell for persons that die at the pumps in the hot season. This is the more requisite, because many cannot read the directions. SUSPENSION OF LIFE FROM DROWNING, AND OTHER CAUSES. DROWNING. A vast number of lives have been lost by the rash ACCIDENTAL DISEASES. 371 usage of persons that have been submersed, or other- wise suffocated. The small spark of life is often put out, instead of being rekindled, by pulling the body about, rolling it on a barrel, or exposing it naked to a current of cool air. The erroneous idea that the lungs were full of water, has led to this dreadful error. Dr. Goodwin has shown, by decisive experiments, such as drowning animals in black dyes, that little or no water enters the lungs; and the author knows it from his own sad personal experience.— However, a considerable quantity of water enters the stomach; which will clear itself. /JThe cause of death is merely the exclusion of atmospheric air, by which defect the principle of heat is withheld from the fluids and solids; and the quicker this defi- ciency of oxydation and heat is restored, the better. But from the paralyzed state of the muscles of respira- tion, these organs need some artificial aid. Let the body be placed on a cart, or on an old door, the head and shoulders a little elevated, and carried, without losing a moment of time, to a warm bed. Rub it dry, and place heated bricks, bladders of warm water, and hot blankets to it. The curved tin tube, invented by Dr. S. K. Jennings, for forcing up heated air, is well calculated to give heat to the body expeditiously. It requires a careful hand. If this is not to be had, a warming pan may be passed over the spine, which of course is to be covered with flannel, so as not to burn the patient. Should there be no warming pan, more hot bricks and bladders of warm water may be placed where they can, viz. between the thighs, under the armpits, and the bladders on the belly. Warm water and a little brandy may be forced into the stomach and bowels, and the whole body immersed in a dry bath, of the hottest temperature that can be borne in health.* The mouth and nostrils must be cleaned out, and the pipe of a bellows introduced into one of the nostrils; * Take a bushel of bran and pour one gallon of hot water on it and mix it well; as soon as it can be borne, spread it on a sheet and lay the patient on it. ' 372 ACCIDENTAL DISEASES. the other nostril and the mouth are to be secured with the hand of an assistant, whilst the windpipe is to be drawn downwards, and pushed gently backward by the assistance of another person, with his hand resting on what we call Adam's core; so that the air may not pass into the stomach. The assistant who has the bellows, must now blow gently till he fills the lungs, and then taking off the hands from the throat, the breast must be pressed to discharge the air. In the space of half a minute, the same operation must be repeated, and continued till signs of life appear. There are proper apparatus for this business. Humane societies should be formed in all places where such accidents often happen, with a full set of apparatus: such as bel- lows, blankets, stoves, warming pan, and spirit of wine for heating; tinder boxes, Jennings' bath, cubes of iron for heating the warming pan; hooks, drags, nets, Sic, with some suitable stimulating medicines: as also some cotton, or tow. By these latter, and the spirit of wine, and fagots, and a match box, a fire may be had in one minute, to heat water, bricks, blankets, iron cubes, Sic Two or three hours should not be considered as too long to persevere in the aforemen- tioned means. PERSONS APPARENTLY DEAD FROM COLD. Rub the body over with soft snow, or very cold water, relaxing by degrees the cold till the natural temperature is restored; but be slow in doing this; as nothing could be more injurious than a quick restora- tion of even natural blood heat. The body may be laid on a bed of cold meal, taken from a cold room, and spread on a sheet. This may also be used to rub with; keeping a parcel of it ex- posed out of doors for that use. PERSONS APPARENTLY DEAD FROM NOX- IOUS VAPOURS. It is recommended to throw some tankards of cold ACCIDENTAL DISEASES. 373 water on the face and breast; especially in summer time. But if the body be cold, and in winter, heat will be more necessary: it may be applied by injecting warm water into the stomach and bowels, and by the bath of bran. But the main object will be to extract the vapours, and supply fresh air to the lungs by the bellows. If no proper air pump, or surgeon's bellows, be at hand, a common fire bellows may be soon rigged up, to answer pretty well, as follows: bore a small gimblet firmly into the valve of the bellows, or if no gimblet is at hand, drive a tack into the valve, and tie a short string to the tack. Either of the means are for the purpose of securing the valve. Having fixed the bellows as directed in the section for drowned per- sons, excepting one variation, which is this; the bel- lows must be shut close when about to be introduced; and the first operation is to open the bellows; the ope- rator holding the valve, in the mean time, tight by the string or gimblet; so that instead of the bellows charging itself from the atmosphere through the valve, it will charge itself with air from the lungs, and thus extract the foul air that has suffocated the patient. The operator now keeping his bellows in the nostril, shuts it down, and at the same moment pushes up the valve with his finger; so that the foul air may go off by the valve, instead of being forced back into the lungs. This is the first operation; the next is to force fresh air into the lungs. To do which, he merely blows the bel- lows, as if into the fire, not touching the valve; this finishes the second operation. The first is then to be repeated as before, so as to draw back the fresh air that was injected, and the remains of the foul air. After six or eight turns in this way, the bellows may be used as for drowning, i. e. forcing in fresh air, and pressing it out with the hand on the breast. |0°> It is said that persons apparently lifeless, down a well, (with mephitic air) have been revived so as to assist themselves, merely by dashing tubs of water down the well. Some lime thrown ^down, in a fine state, (avoiding the head of the sufferer) would be 374 ACCIDENTAL DISEASES. then sufficient to keep him alive; as it would absorb the gas. But this would be most successful in a dry well. A better plan (that would answer even when there was some water) would be to sprinkle a peck of fine lime on both sides of a blanket, and let it down by two cords, and wave it about in the well. In a few minutes a person could then descend in safety, and secure the body for raising it up. IN CASES OF APPARENT DEATH FROM DRINKING RUM. The head is to be elevated, the neck cloth loosened, and cold applied to the head by ice, or cold water. Cupping and leeching are necessary; and the feet and legs are to be kept hot with bricks or water. Some warm water, acidulated with any acid, may be forced into the stomach, by a prepared syringe; and, if pos- sible, the rum extracted by a stomach pump. IN APPARENT DEATH FROM LIGHTNING. Warmth, as in the above methods, may be applied, and an electric shock, (though not severe) passed through the chest, but in no case through the head. Experiments have shown, that an electric shock pass- ing through the head of a pigeon would deprive it of motion, whilst another shock immediately afterwards passed through the heart would restore it to action. There is a probability that the shock from lightning affects the brain and nerves primarily; so that a mode- rate shock or two.of electricity through the heart might be as restorative as to the bird. If the patient be of a full habit, leeching, and cupping, and cold applications* may be applied to the head; whilst the feet should be kept warm, especially if they have lost their heat; nor could there be any harm done by inflating the lungs with fresh air, by the bellows, as in drowning. If any of the above accidents should happen in places * In cases of more moderate injury, very cold water, applied to the surface, has revived the patient. ACCIDENTAL DISEASES. 375 where no bellows can be procured, a syringe, or blad- der and pipe may be used: this latter is to be inflated by repeated breaths from the mouth of the assistant, rather than from his lungs. In all cases of suspended animation, a little wine and water should be given, by a spoonful at a time, to the patient, as soon as he can swallow; (provided he has none injected) and rest, with the lightest diet, should be prescribed, and persisted in some time. Cases of perpetual dyspnoea, (or difficult breathing) have been brought on by submersion. frj" A considerable portion of management of the above cases have been taken from the transactions of tb«; ly r?d From the above list a choice may be made to suit the grade, and state of disease. ' Powder of Kino.—Re. gum kino, two ' ounces; cinnamon, half an ounce; opium, sixty grains, all in fine powder; mix them well together. Twenty-four grains contain one of opium. From eight to twelve grains may be given every four hours in diarrhosa. Powders, Sedlitz.—Re. tartaric acid, twenty grains; soda, twen- ty-two grains; powdered rochelle salts, one large dessert spoonful. Dissolve the tartaric acid, in a wine-glass full of water, and the salts and soda, in a gill of water, (in a separate vessel) when dissolved, add them together, and as soon as the ebullition has come to itt height, take the whole for a dose. It may be sweetened. APOTHECARIUM. 439 Powders, purging.—No. 1. Re. jalap, ten grains; magnesia, pow- dered loaf sugar, each one heaping teaspoonful; mix with two ounces of water, or mint tea. This is a very nice and gentle purge. The magnesia and sugar cover the offensive taste of the jalap. No. 2. Re. jalap, fifteen grains; nitre, in fine powder, ten grains; calomel, five grains; mix. This is an active and effectual pur One pound of salts, and tnirty grains of tartar emetic, or forty grains of blue vitriol dissolved in a quart of boiling water, is a good purge for a horse. QUININE. Re. quinine, eight grains; mucillage of gum arabic, mint wa- ter, each one ounce. From one fourth to one sixth may be given every hour during an intermission in a quotidian, tertian or quar- tan ague. It may be used also in .a pill form. It should never su- persede the decoction, or pure bark, where the latter can be used. As an antiseptic or tonic, it has no claims; nevertheless, it should ne- ver be administered during a fcbrile state. RHUBARB. The best when broken exhibits a granulated surface, break- ing short without fibres. When rubbed, it loses its reddish hue and becomes of a fine buff colour. That which has lost its fine colour, is injured; of course, but a small quantity should be ground at a time. Twenty-five grains are a purge. Rhubarb julep.—Re. rhubarb, twenty grains; make this as fine as possible, and add to it six grains of soda, and twenty teaspoons- ful of spear mint tea. Sweeten it, and give one teaspoonful every hour, till it has some effect. The vial should be shaken up every time it is poured out. This.is'altogether for sucklings, in acid sto- mach, colic, or costiveness. If no mint is to be had^a teaspoonful of the strong infusion of calamus may be added to nineteen of water. Rhubarb powder with magnesia—Re. rhubarb, twenty to twen- ty-five grains; magnesia, one teaspoonful; essence of mint, four drops; water, three ounces; mix. This is a verv gentle apperient and is given to persons with relaxed bowels. 440 APOTHECARIUM. Rhubarb Tincture.—Re. rhubarb, one ounce; gentian, half an ounce; cardamon seed, two drachms. These are to be in coarse powder; (calamus may be used instead of cardamon seed.) Brandy, four ounces; wine, one pint. Digest a week. This may be used in doses of two tablespoonsful morning and evening, to correct a co- licy habit with costiveness. It is called bitter tincture of rhubarb. Rhubarb Tincture, compound.—Re. rhubarb, two ounces; liquo- rice root, half an ounce; ginger, nutmeg, English saffron, each one drachm. All but the saffron, must be pounded. Brandy, eight ounces; wine, three pints. Digest for two weeks. This may be used for the same purposes, and in the same quantity as the above. It is a cordial. SALT OF TARTAR.—See Alkalis. Seneka.—Snake root.—Re. seneka, half an ounce; boiling water, one pint. Draw a strong tea. One wine-glassful may be given every hour or two, as long as the stomach will receive it; to promote, or keep up a sweat in rhumatic fevers, and pulmonary affections. It is also recommended as a good article in female obstructions, drank warm, whilst in bed; the feet being previously well bathed. See Cox's syrup. Senna.—Good senna has very small oval leaves, with few stems, and is of a pleasant smell. Senna Infusion, or Tea.—Re. senna, cream of tartar, each one drachm; boiling water, five ounces. Draw it an hour; strain and sweeten it with syrup of ginger. It is a very neat purge. The whole may be taken for-a dose. £^> Salts, and aromatics, correct the griping quality. Senna Electuary.—Re. senna, (picked,) half an ounce; sultana raisins, or figs, half a pound; add half of a very small nutmeg. Beat the senna and nutmeg very fine, and sift them; pick off the stems from the raisins, and beat all well together. The size of a small walnut will operate twice or three times. It is one of the most pleasant apperients for ladies. Children will eat it freely. Sinapisms.—These are made by spreading mustard (as made for the table,) on linen; and when this is not to be had, some finely scraped horse-raddish, or the bruised leaves may be applied; or a plaister made by beating one ounce of black pepper, very fine, and mixing it with four ounces of lard. These are used in cases where it might be too late to wait for a blister; as also to inflame the skin. They are applied in pains, in langour, and in a collapsed state of the system, to rouse and extend the circulation. Snake root, Virginia.— (Aristolochia.)—Re. snake root, one- third of an ounce; boiling water, one pint. Draw a tea. Ono wine-glassful every hour or two, to keep up a perspiration in low fevers, or in intermittents. See Intermittents. Drank in a cold state, it is a very good tonic bitter. It is often added to decoctions of bark. With about one grain of ipecacuana, and five of nitre to each dose, it becomes a very sure sweat, that may be used in any fevers where the pulse is not very high. Soda.—See Alkalis. APOTHECARIUM. 441 Soluble Tartar— (Tartarite of Potash.)—This is a very fine neutral salt; less offensive to the taste, as also to the stomach, than nitre. It is too much neglected by physicians. When rather moist, it may have a little chalk added to it. Three or four drachms will act on the bowels; especially when a little antimonial wine is added. It forms a good fever powder, of a moderate grade. Tartar soluble mixture.—Re. soluble tartar, antimonial- wine, each two drachms; loaf sugar, half an ounce; water, five ounces; one ounce may be used every two hours, in colds with fever. Such medicines are far preferable to opiates. This mixture makes a nice medicine lor children with fevers, who may use from one- fourth to half an ounce of it at a dose, according to their age. Squills, Powders.—No. 1. Re. squills, three grains; cream of tartar in coarse powder, six grains. Rub them together till the squills are made fine. It is impossible to grind squills alone, when they are fresh. No. 2. Re. squills as above, in mixture, nine grains; calomel, one grain; mix. No. 3. Re. squills, (alone,) three grains; nitre, ten grains; grind the squills with the nitre. Any of these may be given from four to five times a day, if the stomach will bear it. They are used for dropsy of the breast in particular. They.may also be used for'other dropsies, and in severe, or protracted phlegmatic affections of the lungs. Sulphur powder.—Re. sulphur, cream of tartar, each one tea- spoonful; to be taken in molasses, or syrup. This is a famous lax- ative.in piles, taken daily. With the addition of five grains of jalap, it is very suitable for habitual costiveness. Sulphur Ointment, for the eyes.—Re. precipitate sulphur, fif- teen grains; sugar of lead in finest powder, five grains; fresh soft lard, one ounce; mix the sulphur and lead intimately, and then add the lard. This is a sovreign application for sore eyes, when the lids are inflamed, or eruptive. A little must be rubbed on morning and night on the inflamed parts, but not put into the eye. Syrup, common.—Loaf sugar, one ounce; water, half an ounce: boil and skim it. Syrup Hive, (of Dr. Cox.)--Re. seneka bruised, squills also bruised, each one ounce; water, one pint. Boil slowly till one half is con- sumed. Strain it off, and add half a pound of pure honey, and con- tinue the boiling till about one-third of the whole has evaporated. To every ounce of this syrup, add one grain of tartar emetic, which must be dissolved in a little boiling water previously. From ten drops to one and a half teaspoonsful are a dose; from every quarter to every half hour, regulating it by the age, and the difficulty of puk- ing the child. It must always be extended to free puking in croup; but need not be pushed so far in common coughs One teaspoonful contains one-third of a grain of tartar. Syrup of Manna.—Re. flake manna, loaf sugar, each four ounces; senna, one drachm; boiling water, four ounces; draw as tea. Strain the senna, and boil the sugar and manna, in the infusion of senna, to a syrup. One teaspoonful every three or four hours for infants Ladies may use from a half to one ounce. It is a very pleasant me- dicine, and well suited to open the bowels gently. 442 APOTHECARIUM. Syrup of Squills.—Re. fresh squills well bruised, two ounces; strong vinegar, one pint and a half. Put them in a stone pot, with a cover and set that in a kettle of hot water. Boil it four hours, and strain the vinegar repeatedly till it becomes quite free of all sedi- ment; and to every ounce, add two ounces of loaf, or dry Havana white sugar, and give it a boil, so as to turn the sugar into a syrup. Keep it in a close glass vessel; for both the vinegar, and the bitter principle of the squills, will evaporate. The dose is one teaspoonful every two hours. It is generally given with nearly an equal portion of paregoric in coughs. It is sometimes given to children as a puke, when oppressed with phlegm; in such case the doses are given every half hour. It might be used in any case where squills are useful. TARTAR EMETIC—See Antimonials. Turlington's Balsam, or traumatic balsam.—Re. gum benzoin, three ounces; aloes, half an ounce; balsam of Peru, two ounces; strong spirit of wine, one quart. Crack the aloes and benzoin, and having put all together, let them stand a month before using. It may be coloured or not with saunders; in which case the spirit of wine is to, be first coloured and strained. This balsam is applied on lint to bad bruises and small lacerated wounds with great effect. On the second dressing it is merely poured on the first lint, which cannot be removed till a suppuration ensues. It is often useful, when ointments disagree. It is sometimes used in doses of twenty drops on sugar, for an old cough. It is the basis of balsam of honey. Turpentine, (spirit.)—From ten to thirty drops are given in syrup, broth or milk, two to three times a day. Much larger doses have been given, but for complaints of the usual stamp, the above doses are quite sufficient, and larger will often produce disease, in- stead of curing. Its principal use is in sciatica, and it was recom- mended by Dr. Cheyne, Experience proves its clficacy. It 18 also used for worms, epilepsy, lockjaw, dysuria, &.c. and is much used when diluted with oil, as a liniment, for external pur- poses. Turpentine varnish.—Re. rosin, one pound-; linseed oil, two ounces; melt, and add spirit of turpentine sufficient to make it of the consistence of honey. This may be applied on the surface of some tow in deep ulcers, from mortification, burns, kc. It is a cheap, easy and efficacious dressing, and may be had at the paint shops, ready made. It substitutes the Kentish liniment. VALERIAN ROOT. Re. valerian, in coarso powder, two drachms; boiling water, four- teen ounces. Draw a tea, and strain it off. It must not be kept long near the fire. This quantity may be used in suitable doses, esety four to six hours, in nervous head-ache, and hysteric tremblings. Its chief place is where assafcetida and opium are too stimulating. Vitriol blue.—This is a certain puke in doses of ten grains, and a ' sure purge given in doses of a grain or two every two hours. It is more generally given with ipecacuana, than alone, in doses of five grains of each. It may be used for old drinkers, where tartar seems APOTHECARIUM. 443 sluggish. It is an excellent escharotic, sprinkled on, or applied to proud flesh in a saturated solution. See pills and powders. Vitriol white.—From fifteen to forty grains, in two ounces of wa- ter will puke freely. It is given to throw off poisons, and some- times to children in whooping cough; three or four grains every half hour may be used to children from five to seven years old. White vitriol is also used for eye water, and for injections, in portions of two to three grains to one ounce of water. Volatile alkalL—See alkali. WORMSEED, THE OIL.—(Chenopodium Anthelmintirjum) This is, unquestionably, the most certain of all the virmifuges that has ever been discovered. It may be exhibited too freely. See the specific table of doses. Five or six drops, grated betweeo two lumps of loaf sugar, inio a tablespoonful of water, and taken morning and night for a week, and then followed by a dose of •castor oil, or calomel and jalap, is sufficient for any age, and will seldom fail. But as it is an -expensive oil, and a little will give a strong flavour, it will be often adulterated. In this neighbourhood, (Baltimore County,) the seed are sown and distilled in the most simple manner, by putting a thick soap- stone on an iron pot, and passing through it a gun barrel, or cylinder of tin. Some use nothing but a poplar block, well soaked in hot water, -for the still top. A GENERAL RELATIVE TABLE OF DOSES; Supposing twenty-four grains of any.powder a dose for adult age. A child of two months, one-sixteenth, or one and a half grains, or drops, if it be a liquid of a watery kind. A child of seven months, one-twelfth, or two grains. A child of fourteen months, one-eighih, or three grains. A child.of twenty-four months, one-sixth, or four grains. A child of five years, one-third, or eight grains. A youth of fourteen years, one half, or twelve grains. A man, twenty-one to fifty, twenty-fourgrains. A man of seventy, twenty grains. A man of eighty-four, eighteen grains. SPECIFIC TABLE OF PARTICULAR ARTICLES. Lauda-num. Drops. Tartar Emetic. Grains. Ipecacu-ana. Grains. Calomel. Grains. Oil of wormseed. Grown person Youth of 12 Child of 3 Babe of 1 15 to 25 4 to 8 2 to 4 1 to 2 2 to 4 1-2 to 2 3-4tolgr 12 lo 18 j 6 to 10 € to 12 1 4 to 6 4 to 6 3 lo 4 2 to 4 | 2 grains 5 d rops 3 times a day. 4 drops twice a day. 3 drops twice a day. N. B. To check fits, a child of three or four years old may use four to six drops of laudanum, and a babe three or four. £^> Lau- danum that has become thick by evaporation, should never be given; 444 APOTHECARIUM. as one drop may become nearly equal to a grain of the extract of opium. Several children have been destroyed that way. Essential oils, as wormseed, pennyroyal, &.c. will destroy children if administered too freely. They should be dropped on sugar, and grpteli with another lump; then rubbed with a few drops o brandy, and have at least one teaspoonful of water, to each drop of essen- tial oil. A drop of laudanum, or a drop of antimonial wine, are very dif- ferent quantities compared to a drop of water. Thus sixty drops of water, are a drachm; but it takes about one hundred and thirty drops of laudanum, if made with spirit, to make a drachm, and about eighty or ninety if made with wine. About eighty drops of antimonial wine are a drachm. £^» This must be attended to in using Lane's measure glass. NURSERY DEPARTMENT. APPLE TEA. Re. red streaked apples cut into very thin slices, two apples: boil- ing water, one pint. Draw by the fire till the water becomes of a pink colour; sweeten it well with loaf sugar. It is best when made twenty-four hours. This is one of the most palatable, and beautiful drinks that can be offered to a patient with fever. Imperial drink.—Re. cream of tartar, two drachms; lemon peel, two drachms; loaf sugar, two ounces; boiling water, one quart. Dissolve, and pour off, after settling two hours. This may be drank freely in fevers and dropsies. Artificial lemonade.—Re. tartaric acid, fifty grains; water, one pint; essence of lemon, four drops. Drop the essence on a large lump of sugar, and grate it with another, and mix all together. This may be- used warm or cold, for any purposes where lemonade is used, as fevers, colds, or in dropsical cases. Bran tea.—Take a pint of new bran, sift it in a coarse sifter, to get off all the flour; pour on it two quarts of boiling water, and draw it well for two hours. Strain it, and sweeten it with honey, or liquorice. This is a fine softening drink taken warm, at bed time, for coughs, and a tight breast. Elm tea.—Re. take of the bark of slippery elm, (ulmus fulva,) dried, one ounce; boiling water, one quart. Draw till the water be- comes a mucillage, and sweeten it. This may be used for coughs, and dysentery. The patient may drink as much as he pleases. The juice of an orange will add to its pleasantness. Egg tea.—Re. one fresh egg; loaf sugar, two level tablespoonsful; beat them well together; pour on eight to ten ounces of boiling wa- ter, by dfjgrees; continuing the beating all the time. This is a very elegant drink in emaciations, and well suited for a night draught in colds. Arrow-root jelly.—Re. arrow-root starch, one dessertspoonful; beat it in a bason with a little cold water; then pour on it half a pint of APOTHECARIUM. 445 boiling water. Stir it briskly, and let it boil a few minutes. Re- move it from the fire, and add two spoonsful of Lisbon wine, some sugar, and a little lemon peel. It is also very grateful with a por- tion of orange peel. Rice milk.—Rice, one teacupful; milk, two quarts. Boil the rice soft, in some water; pour off the water and drain it; then boil the nee in the milk till perfectly soft, and sweeten it. A little nutmeg may be added. It is one of the best diets for dyspepsia, and in diarr- hreas is almost indispensable; more especially to the south. The clear rice water that first conies off is a good drink, especially for children when not taking the mother's milk. Barley water.—Re. barley, two ounces. Wash it in cold water, then boil it with half a pint of water a short time, to take out the colour; pour off this water, and add five pints of fresh water, and boil it half away. To a quart of this, add half an ounce, or more, of sultana raisins, just at the finish of the boiling, so as to plump them up. If more sweetening is needed, add sugar. Barley water is used in all coughs, in bowel complaints, and for drink and nourishment, after any disease that has continued a few days, without the patient eating. This latter circumstance is so bad- ly attended to, that patients often sink for want of natural energy, that might be easily kept up by nourishing drinks. G)tiel.—Re. corn flour sifted very fine, one heaping tablespoonful. Boil it in a pint of water, keeping up the quantity with additional boiling water, till it becomes nearly a jelly; sweeten it. When the case admits, a little wine and nutmeg may be added. This is a first rate nourishing article, and may be used to any extent, to restore persons after fevers, and in exhaustions of any kind. Panada.—Take a common hard cracker, (biscuit,) or in its stead, a slice of old (but not sour) bread, grate it fine, and boil it with a pint of water to a jelly; sweeten it, and add a little nutmeg, and some wine, if the patient is not feverish. This is used for the same purposes as the former, and may make a change with gruel, and barley water. Wine whey.—Bo\\ a pint of milk, and whilst boiling, add a wine- glass or more, of Lisbon wine, till it turns the milk; then take it off and strain it from the curd; sweeten it if required. This is both food and physic, in a low, languid state. A small teacupful may be used every hour, or as may be needed. Milk toddy.—Re. take of best old brandy, one ounce; milk, eight ounces; sugar, one ounce. Beat and dissolve the sugar in the milk, and add the spirit. This will sometimes lay on the stomach of a person reduced by long fevers, or with flatulent stomach, when no other article will be retained. In a sudden sinking from typhus, it is extremely useful. 'r ' % Alum whey.—M\\k, one pint; powdered alum, one teaspoonful. Boil the milk gently, and whilst boiling, add the alum, and stir it till the whey separates; strain it. This is very useful, especially to fe- males with excessive discharges- A cupfull may be used (cold ) fre- quently, say every hour; or as may be needed from the excess of disease. 38 446 APOTHECARIUM. PURIFYING ARTICLES. Take of chloride of liirie'j two wine glasses full; water, two quarts. Mix it first into a paste, and then add the rest of the water. Sprinkle the floors and plastering. When carpets and cloths are to be sprink- led, one pound may be put to live quarts of water, stirred and strain- ed. The clear settlings may be SpYinkled on. A gallon of fresh wa- ter may be added and preserved in bottles, using it the same way; or some may be set in stone dishes about the room. Rooms may be pu- rified when no persons are in them, by putting a teaspoonful of salt- petre, half a teaspoonful of table salt, and one large teaspoonful of black manganese, (all powdered,) into a tea cup, and placing it oil some hot ashes; add to it one teaspoonful of oil of vitriol, previously tnixed with two teaspoonsful of waten If not moist enough to fume, add a little more water. This will be necessary daily, in some cases, and the patient can be removed back again; but to prevent such daily trouble, the following mixture can be used whilst the pa- tient remains in the room. Common salt, black manganese, each two ounces, in pOwder; oil of vitriol, one ounce and a hall"; water, one ounce. The water and vitriol are to be in a separate cup. Half a teaspoonful of this dilut ed acid may be put into the cup, with the manganese and sail every three or four hours, so as to regglate the discharge of the gas in Ihe room, which can be borne by the patient, gp- The potters and paint stores keep manganese for sale. When the aforesaid articles are not to be had, lime may be used instead, either for sick rooms, or for damp apartments, and for foetid places, such as sinks, gutters, privies, and manure heaps. A quart of fine lime mixed with some sand, may be sprinkled on the floor every three days. Cellars should have a thick sprinkling once a month, and sinks much oftener. One bushel of slacked ashes should be put into privies every month, and some lime sprinkled on every week. Ma.-< nure heaps should never be suffered to remain near a dwelling. They are less injurious on the north-east side of the dwelling; and tvhen it becomes impracticable to remove them, they should be kept white with lime, which is not lost to the farmer. The above directions, though needful every summer, are particu- larly so when the season is sickly. N. B. The Apothecarium contains, in part, the identical formulas of some of the foreign Pharmacopoeias, viz: London, Edinburgh, and Dublin. Some of those now offered are altogether new, (in print,) or altered from the above named Pharmacopoeias The alterations consist in simplifying cheaper substitutes proposed, and the in- crease of articles that were important, or their rejection, when unim- portant, or expensive; and in some changes of the menstruum, for tinctures, to make the article more clear or potent, and in other cases less ardent. The author flatters himself, that neither the power nor elegance of the articles have in any case been sacrificed. The nature of the book, and his own experience, are his apology for those changes. CONTENTS OF THE APOTHECARIUM. ACIDS, viz. Elixir of vitriol, Oil of vitriol dilute, Tartaric acid, iEtlierial mixture, Antipertussis, of Letsom, ALKALI, viz. Salt of tartar, or potash, ") " soda, K Sal ammoniac volatile, J ALOES. Aloes pills, with soap, " with steel, " with assaffjetida, " with myrrh and steel, " wjth calomel, Aloes powders, with iron and myrrh, " tincture, Alum candy, " curd, " injection, " whey, " burned, Ammoniac gum, (powder,) " decoction, " infusion, ANTIMONIALS, viz. Tartar emetic, "] " ointment, j Antimonial powder, or ! Pulvis antimonialis, j Antimonial wine, of tartar, | " of Huxham, J Angostura bark, " infusion, Apple tea, Arsenic, (Fowler's solu- tion,) Arrow-root starch, Aromatic tincture, Assafcetida pills, " tincture, Astringent powders, " tincture, {t water, Balsam copaiva, Barley water, Bark, Peruvian, ' decoction, ' infusion. ' levigated, ' tincture compound, ' simple, Baechar.s'halimifolia, Bitters, gentian, " willow, Borax, Bran tea, Burgundy pitch, Cantharides plaister, " tincture, Camphor, Calomel, " pills, Castor ojl, Cerate saturnine, " spermaceti, (i Turner's, or cala- mine, Chalk, julep, Camomile tea, " poultice, Chloride of lime, Glutton's febrifuge, Coagulating mixture, Corrosive sublimate pills, " tincture, Decoction of woods, Dover's powders, Egg tea, Elixir of propriety. 448 CONTENTS OF THE APOTHF.CARIIIM. Elm tea, Ether, or .Ether, Fever powders, Flies, Spanish, Foxglove tincture, Gall's infusion, " ointment, " powder, Glysters, Goulard's extract, Gruel, Guiacum gum, " tincture volatile, Jalap, Imperial drink, Ipecacuana, Iron, powders, " wine, Kino gum, powders, " tincture, Laudanum, Lemonade, artificial, Liniment, Kentish, " soap, " turpentine, " volatile, Logwood, Mercurial ointment, " pills, Milk toddy, Mucilage of gum arabic, Nitre, sweet spirit of, Oak bark decoction, Oil of vitriol dilute, Ointment, basilicon, " citrine, new form, " calomel, " red precipitate, mercurial, " white precipitate mercury, Fanada, Paregoric, Pills, how made, with aloes, Pills, with calomel, purgine, James's imitation of, Plummer's, Plaister, blister, " soap, " tar, Potash, or salt of tartar, Powders, fever, " kino, " purging, " seidlitz, " rhubarb, Purifying articles, Rhubarb, " ju'ep, " powder, " tincture bitter, " compound, Salt of tartar, or potash, (ve- getable alkali,) Seneka snake root, Senna electuary, " infusion, Sinapisms, Snake root, Virginia, Seneka, Soda, fossil alkali, or natron, Soluble tartar, " mixture, Sulphur ointment, " powders, Squill powders, " syrup, Syrup hive, of Dr. Cox, " of manna, " squills, " sugar, Turlington's balsam, Turpentine spirit, " varnish, Valerian root tea, Vitriol, blue, " white,- Wormseed oil. gp- As the above medicines are arranged under large alphabetical letters in the Apothecarium, they may be readily found. APOTHECARIUM. 449 SYNONYMS; Or corresponding names with those used in the Family Adviser. These synonyms are taken from the London Pharmacopoeia; and as the old names in the same Pharmacopoeia, and the names in the Edinburgh and Dublin Pharmacopoeias are, in most cases, a variation from the new names of the London Pharmacopoeia, here used, it will be well when there is any doubt of the identity of the article, to con- sult a general table of those variations, which may be found in most Dispensatories. See Dr. Cox's American Dispensatory, 4tJ) edition, page 661, and following. Pharmacopoeia names. Acidum nitricum, iEther sulphuricus, Ammonia? carbonas, Antimonium sulphur precipitatum, Antimonium tartarizatum, Argenti nitras, Acidum benzoicum, Ceratum calamine, Ceratum caetacei, Cusparia, Chincona, Cuprum ammoniacum, Cupri sulphas, Calamina (lapis,) Cetaceum, Emplastrum lyttae, Emplastrum plumbi, Emplastrum resinosum, Extractum conii, Ferri carbonas, Ferri sulphas, Hellebori fcetidi, (folia,) Hydragyrum, Hydragyrum precipitatum album, Hydragyri oxydum rubrum, Hydragyri oxymurias, Hadragyri submurias, Liquor ammoniae subcarbonatis, Liquor calcis, Liquor arsenicalis, Liquor antimonii tartarizati, Lytta, Common names. f Aqua fortis, nitrous acid, or ni- i trie acid, when deprived of L its fumes and colour. ./Ether. Volatile sal ammoniac. Golden sulphur of antimony. Tartar emetic. Silver, or lunar caustic. Flowers of benzoin. Turner's cerate. Cerate of spermaceti. Angustura bark. Peruvian bark. Ammoniate of copper. Blue vitriol; blue stone. Calamine stone; ore of ziho. Spermaceti. Blister plaister. Diachylon, or litharge plaister. Sticking plaister. Extract of cicuta, extract of hem- lock. Rust of iron, (steel.) Salt of steel, copperas. Heleboraster (leaves.) Quicksilver. White precipitate mercury. Red precipitate mercury. Corrosive sublimate mercury. Calomel. Spirit of hartshorn, (viz. watery distillation.) Lime water. Fowler's solution of arsenic. Antimonial wine, (of tartar.) Spanish flies, (meloe and canthari- des.) 38* 450 APOTHECARIUM. Pharmacopoeia names. Mistura ammoniaci, Magnesias sulphas, Magnesias carbonas, Magnesia usla, Potassa cum calce, Plumbi Suhcarbonas,* Plumbi Saperacetas, Potassa? acetas, Potassae suhcarbonas, Potassa fusa, Potassae super tartras, Potassae tartras, Potassae sulphas, Pix arida, Radix rhei, Sodae subboras, Sodae murias, Sulphas sodae, Saevum, Senega radix, (polygala,) Serpcntariae radix, (aristolochia,) Sodae suhcarbonas, Spiritus aethens nitrici, Spiritus ammonia? aromaticus, Tinctura lytta?, Tinctura ferri muriatis, Zinci sulphas, Common names. Lac ammoniac, by decoction, of trituration. Epsom salt. Common magnesia. Calcined magnesia. Common vegetable caustic, (li- quid.) Dry white lead. Sugar of lead. Diurectic salt, acetate of potash. Salt of tartar, of wormwood. Common vegetable caustic, in rolla. Cream of tartar. Soluble tartar. Vitriolated tartar. Burgundy pitch. Rhubarb root. Borax, refined. Table salt. Glauber salt. Mutton suet. Seneka snake root. Virginia snake root. Soda prepared. Sweet spirit of nitre Spirit of ammonia, compound. Tincture of cantharides. Tincture of steel, in spirit of salt. White vitriol. T There seems much vnpropriety in this name. DIET ANI> DRINKS- It may be expected that a work written for popular instruction, would contain very minute directions for the use of snch articles of diet, as are necessary for the preservation of health. But the au- thor confesses that he has very little information on this point, more than his own experience and observation; for chemistry has done but little more in this way, than to develope the quantity of saccharine matter, and the starch contained in vegetables: and on these two constituents depend the quantum of nourishment. But those two may be so enveloped, so mixed with other matters, or so difficult to separate by the digestive powers, that a table of digestibility or of healthiness, could not be made out from such data. As for meats, the relative difference of nourishing principles be^- tween each kind, is so little known, that it would be presumption in an individual to give his limited experience and knowledge. But the stimulating quality of meats is rather better known, and their general nourishing qualities experienced by all. Their digestibility is very precarious, and will often depend on taste or on habit; so that some persons will digest a piece of mutton belter than they can the breast of a chicken. The United States subsistence department allow their soldiers, whilst in garrison, one pound and a quarter of beef, or three-fourths of a pound of pork, with vegetables. The quantity of pure meat, after extracting the bone, will not average more than eight ounces. It may therefore be taken as a rule, that eight ounces of meat is a full quantity for a man in the prime of life, and vigour of health; and of course, such a quantity is an excess for the inactive, feeble,,and the aged;* yet we will find many of our citizens, taking this quan- tity, or more, with a full compliment of highly seasoned vegetables without using any exercise to work off the surplus. The consequence is, that it must, sooner or later, engender disease; for few persons grow either larger or fatter after passing twenty-five years of age; and the question may be asked, what becomes of the surplus? Although no great precision can be aimed at in such things, yet the history of disease gives us a pretty clear insight of the matter. And first of all, the surplus matter is liable to disturb the prima? via? producing dyspepsia or diarrhoea. This is perhaps the least dan- gerous, and the most conspicuous event. If however the digestive powers are sufficiently strong, the aliment becomes digested, and then passes into the circulation. If it is not assimilated there it must pass off as noxious matter, either in a dropsical effusion, or in a diabetes; two diseases far more serious than the former. It is however, possible for it to pass off in a slighter way, bv night sweats' rancid sweats, and a bad breath.f Should the animating powers be' so strong as to turn the surplus into a pure blood, the consequence . « Mr. Wesley said, that one-third of what was used in youth was sufficient for old age; and no person could be a better judge We say from one-half to three-fifths for Americans. t See the chapter in Dr. R. Thomas, on Bulimia. 452 APOTHECARIUM. is, a surplus of this material, or what we term & plethora, local or general; and hence comes dreaming, drowsiness, vertigo, head-ache, feverishness, piles, hamorrhages, and apoplexy. If instead of a pure blood, a heterogeneous blood is formed, deposites take place of such foreign matter; and gravel, calcarious matter, cancers, and other indurations, ensue. It is somewhere about this point that gout makes its appearance, where there is an excess of blood somewhat heterogeneous. The formative powers, (of flesh,) seem to be wor- ried and solicited to give a place, or a consolidation to this fluid, till an inflammation ensues, and falls on those parts of the body that have been debilitated either by inaction or by over-action; as the muscles and stomach. A man may, however, so live, as to es- cape all the aforenamed locations, but yet he cannot escape disease entirely; and hence we find the surplus materies, after passing all the above outlets and inlets, finding its way to the skin, or to the adipose membrane: in the former case, causing eruptions, ulcers, fistula, and cancers; in the latter, producing angina pectoris, by large deposites of fat about the heart, and large arteries; or mak- ing an universal deposit of fat in a polysarca; in this dooming the patient to carry about him a hundred or two of useless fat; and if a female under forty-five years of age, to certain barrenness also. As to drinks, nothing but pure water is healthy, even to those in good health, Rum, pure or diluted, cannot be safely used by a person in health; it should be only used as medicine. Wine may be used in moderation, to counteract a debility of the stomach, or a general debility; provided such debility has not been brought on by over stimulating. Sound porter may be used for the same purposes as wine, provided there is no colicky, or flatulent affection of the stomach or bowels. It is far more apt to disagree, when taken with food, than wine, and especially with fish. Cider is liable to still more objections than porter, and may be considered an exhilarating drink, suited to those in perfect health, and in the habit of hard exercise. The action of spirituous liquors seems to fall mostly on the same parts that are forced by an excess of diet, and therefore produce the same diseases; i. e. becomes the cause of them, either by a direct or indirect action. Hence the excess of both meats and drinks, when united, must soon reduce the most robust system, and lay it open a prey to the all consuming powers that envelope the system on every side. (£p~ See the Philosophy of Disease. The most wholesome bread is made from sound old wheat, recent- L. ly ground, and well fermented with vegetable yeast. It should be used the next day after baking. When all the contents of the wheat are ground together, it is less digestible, but more apperient, and hence suits some stomachs the best. A well toasted piece of bread, with tea, or a little water, will set on the stomach when no other bread will. Biscuit is more apt to acidulate than bread. Corn bread is more indigestible than wheat, but more apperient) and the same may be said of rye bread, in a still greater degree. DIET AND DRINKS. 453 The following lables will exhibit, according to the author's informa- tion, the stimulating and digestible powers of most articles used for diet. Meats.—Their stimulating qualities, according to the arrange- ment. The first, being the most stimulating, and so in succession. 1. Pork. 2. Beef. 3. Mutton. 4. Veal. 5. Lamb. 6. Poultry. 7. Game. £^- Salt meats are said to be more stimulating, and less digestible than tresh meats; and roasted more stimulating than boiled. Aquatic I wbe.—The first being the most digestible. 1 I errapins. 2. Fish. 3. Crabs. 4. Oysters. Observations-.-Terrapins are certainly one of the most digestible articles of all the animal race. .,£"» f"8 !Th areJverv, c!ov'»g to ^e appetite, and hence, are always sauced and spiced so highly as to make them a stimulating food, and apt to disagree, and at best they cannot be used often without dis- gusting or disagreeing But small fish are quite the reverse, and when used w,th a Imle salt and pepper, may be continued in for a cents SeaS0"" V6ry Sma"' they make S°od food for convale*. Crubs, when in season, fresh and fat, are nutritious, and very wholesome; whole towns near the water, using them with impunity. 1 o make them certainly wholesome, they should be double dressed: first boiled, and then picked and stewed. A mere boiling them to redness, is not sufficient; the boiling must be continued one hour longer. At the same time, nothing will more surely disagree with rnniT.™? ""^'T6^ ,han a P°°r crab out of «»«">, and half cooked It would therefore be best for those who are strangers to these things, to let them alone. B Oysters are more indigestible than is generally supposed, but they make less disturbance in a half-digested state, than most other articles. Roasting them in the shell is far the most healthy way to c«»k them; and .1 health is consulted, they should never be used late at Vegetables.—Their digestibility according to the numbers; the first rank being the most digestible. 1. Snap beans symblins, spinach, sprouts, asparagus, green peas. 1. I omatoes, Irish potatoes, Lima beans, fruit of egg plants. A. Cabbage and broccoli. 4. Turnips, carrots, beets, onions. 5. Parsnips, sweet potatoes, dry pease. 6. Roasting ears, (green corn.) 454 DIET AND DRINKS. GREEN VEGETABLES. I. Celery, lettuce, corn, salad; cooling, and digestible. 2. Cucumbers; cooling, and difficult to digest. The general nourishing power of vegetables, and their relative power of nourishment, is well known by simple experience. But at the same time it may be observed, that they can be indulged in too freely, as well as meats; and they are always a vehicle to carry into the stomach a large quantity of butter or gravies, which articles are hard to digest, and readily injure the stomach. Fruits.—Their digestibility according to the numbers; the first being the most digestible. 1. Grapes, strawberries, currants, raspberries. 2. Apples. 3. Pears. 4. Plums, gooseberries. 5. Peaches. 6. Cherries. 7. Melons. All the above are cooling, and if used moderately, and in the day time, are healthy. But excepting apples, they will, by long continu- ance, bring on dyspepsia, and sometimes other diseases. §^In attributing relative degrees of digestive qualities to fruits, the common uses have been taken into consideration, rather than any fair experiment of digestibility. Thus, peaches are eaten very freely, and in a season when the stomach and bowels are prone to debility, and diarrhoea. But apples are eaten more moderately, and generally in the cool season. A fair experiment would require the same quantity, and the same season. A quantum syfTjcit of apples, would certainly be as li.ible, if not more so, than of peaches, to pro- duce a momentary dyspepsia. Nevertheless, experience proves, that a continued use of peaches, will completely overthrow the digestive powers; whereas apples, though now and then offending, will not pro- duce that permanent debility of the primae viae, that peaches do. Ap- ples are apperient, and often prove beneficial to sluggish bowels. Raspberries are disposed to produce costiveness. Grapes, when not very sugary, are somewhat astringent. Cantilopes, and wntermellons, (like peaches,) finally overthrow the digestive powers completely; so that the evacuation of them does pot produce a speedy relief. They should be abandoned before such an event. GENERAL GLOSSARY. Abdomen, the belly. Abortion, miscarriage. Absorbents, medicines destroying acids and acrimony. Absorbent (vessels,) vessels taking up fluids at their extremities, from surfaces and Cavities. Accretion, adhering together. Adam's core, the protuberance on the upper and fore part of the windpipe. Adipose, (membrane,) containing depositions of fat over the body. Acidulate, to make sour. Alterative medicines, such as eme- tics and mercurials, given in small doses for a time, so as not to puke, purge, or salivate. Alkali, medicines that ferment (when carbonated,) with acids, and always unite with them, forming a third distinct article. Antipertussis, against hooping cough. Anodyne, medicines procuring sleep, and suspension of paim Antiseptic, preventing mortifica tion. Anuerishi, a morbid enlargement of ah artery, containing blood, compressible in some cases, and pulsating. Antiphlogistic, Cooling medicines, or diet and drinks, of the same quality. Attrition, grinding against a hard substance. Aorta, the great artery rising from the heart. Apothecarium, the medicinal ap- paratus of this book. Aperient, medicines, drinks or diet, of an opening quality, act- ing on the bowels, or surface, Aquatic, growing in the water, of connected with water. Asphixia, fainting from any cause, whether stomach, heart, or brain is prostrated. Athletic, robusts Ascetic, sour, vinegar quality. Atrophy, pining away, A2ote, or nitrogen, one of the ele- mentary components of the at-1 mosphere, as also of animal, and of some vegetable substan- ces. Apparatus, tools, or machinery. Ad infinitum, endless. Acme, the summit. Aqueous, watery. Accelerations, quickening of ac- tions. Borborigmus, rolling of wind in the bowels. Bronchia?, the lower extremity of the wind pipe, that branches in- to the lungs. Calcarious, chalky. Callus, hard, insensible flesh. Calcine, the action of fire on ar- ticles, to expel their air, or to reduce them to a state of oxy- dation, as red lead is. Carbonated, charged with the air produced by burning of char- coal, or by the action of acids on chalk, &c. which is carbonic acid gas. Caries, a rotting of the bones. Caustic, substances eating live or dead flesh, as blue stone, pure potash; fresh lime, nitrate of silver, &.c. Catarrh, cold; influenza. Calamenia, monthly female dis- charges. Cellular membrane^ a membrane 456 GENERAL GLOSSARY. under the skin, passing over the whole body, so that it may be inflated. Cerebral, belonging to the brain. Chalvbeute, of an iron quality. Chronic, of long duration. Chlorosis, retention of menses. Cicatrix, a scar. Coma, a Irowsy state from an op- pressed brain. Collapse, a temporary paralysis. Combustion, act of burning. Concoction, digestion of morbific matter. Cons ricted, drawn up as by cold astringents, or spasms. Congestion, a stuffing, as fulness of blood. Concussion, a sudden jolt, or fall. Coagulate, lo thicken, congeal. Contusion, a bruise. Constipation, costivenpss. Crucial, cross like !*< thus. Cr.ipula. undigested food. Cranium, the skull. Crystallization, as salts in their va- rious appropriate shapes. Cuticle, the external thin skin. Caloric, matter of heat. Cerebrum, and cerebellum, parts of the brain. Commixed, many articles mingled. Contour, the outline of any figure. Corpus u'ar, belonging to bodies made up of'small parts. Decoction, that which is made by boiling. Deobstruent, removing obstruc- tions. • Deleterious, poisonous. Deductions, discharges of hu- mours. Denuded, laid bare, naked. Delirium, mental derangement, as in fevers. Delirium tremens, an agitation of body and mind from suddenly quitting the use of drink, or opium. Demulient, (drinks,) softening. Dentition, the cutting of teeth. Diagnosis, distinction of disease. Diaphoretics, sweating medicines. Diarrhoea, lax. Diluents, watery medicines, thin- ning the rumours. Diuretics, medicines acting on the kidneys, producing urine. Draslric, rough puryes. Ductile, soft and yielding. Diphysical, of two powers. Ebullition, bubbling up, ferment- ing. Efforescence, small eruptions of a ruddy appearance, in patches. Effluvia, exhalations. [vour. Empyrheumatic, burned wood fla- Empirical, quackish, experimen- tal. Embrocation, a topical wash, of a medicinal nature. •Emulsion, mixtures where oil and water are incorporated by some medium, as sugar mucilage, &c. Endemic, proper to a*place. Epidemic, diseases over the peo- ple generally, as influenza. Epididymis, glands on the supe- rior connection of the testes. Eruptire, diseases breaking out on the skin. Eschar, a burned surface from ap- plication of caustic, or fire. Expectorant, medicines promoting a discharge of phlegm. Exhalents, extreme vessels pour- ing out aqueous fluids. Extravasated, fluids thrown out of their proper vessels. Exacerbate, to kindle up anew, as do fevers. Exhalations, evaporations. Exostosis, enlargements of bone. Excrescence, a preternatural growth, as a wart, or tumour. Extempore, immediately done. Fatuity, weakness of mind. Fauces, the gulph of the throat from the palate to the root of the tongue. Febrifuge, driving away fevers. Flatus, wind in the prima? via?. Foeces, dung. Fomites, the inoculating effluvia, that produces infectious disease. Formula, a prescription. GKNERAL GLOSSARY. 457 Foetus, the child in the womb Fomentations, warm washes to soften tumours, spasms, Sic. Fused, melted. Fungus, spongy, mushroom-like Gangrene, a soft state of flesh, preceding mortification. Gastric, (juices,) digesting huv mours of the stomach. Gas, an aeriform, elementary fluid, Gestation, period of child bear- ing. Gleet, a chronic running of the urethra. Goitere, a tumour or enlarged gland, on the external and ante- rior part of the throat. Granules of flesh, little elevations on the bottom of healing ul- cers. Haemorrhages, discharges of blood Heterogeneous, of a foreign or un- associating nature. Homogenous, of one nature, asso- ciating as it' parts of one. Hydatids, dropsical glands filled with water. Hydrogen, one of the elementary principles of water, inrlauuna ble air. Hydrauiic, by the laws of fluids, (i. c. medicinally,) when forced. Ichor, an itching humour. Idiopathic, genuine image, true form. Idiosincrasy, peculiarity of habit. Iliac passion, colic of the small bowels, often attended with an entire obstruction. Incised, cut, wounds from sharp instruments. Induration, hardening. Intumescence, swelling. Ingesta, articles thrown into the stomach, or objects to the mind. Inanition, emptiness. Inundation, an overflowing. Lacerated, wounds that are torn. Lacteals, vessels carrying milk, and milk-like humours. Lochia, discharge after a birth. Levigated, ground to an impalpa- ble powder. 39 Lymphatic, (vessels.) carrying a watery humour. Lumbar, (region,) the loins. Malaria, bilious fevers. Macies, thinness, pining away. Marasmus, pining away with slow fever. Malignant, of a bad kind, verging to a low putrid stale. Mal-foruiatiiin, badly formed Menses, monthly female dischar- ges. Metastasis, changing of place by the disease. Metaphysical, actions of the mind. Mesentery, the membrane fasten- ing the bowels to the vertebra? of the back-bone. Miasmata, the effluvia of marshes. Mucilage, gum and water. Motorial, [power,] producing ac- tion. Mouophysical, a single power. Morbific, [action,) diseased. Narcotics, opiates. Nares, the internal parts of the nose, down to the fauces. Nidus, a nest. Nitrogen.—See Azote. Nosology, an arrangement of dis- eases into orders, classes, gene- ra, species, and varieties. Neutralization, making a third distinct article, by the operation' of two opposed in quality. Oedema, a dropsy of the legs, or any other parts that pits on pressure. Osophagus, the gullet. Omentum, the caul. Obstipation, costiveness. Optic, belonging to the eye. Ossify, becoming bone. Oxygen, one of the elements composing the atmosphere, ne- cessary to support combustion and life. Oxydated, the metalic state chang- ed to a salt, or calx, by oxygen. Organic, belonging to organized bodies. Palliative, temporizing medicines. Paralytic, affected with palsy. 458 GENERAL GLOSSARY. Pari passu, with accompanying steps. Pappus, the down of the flower, seen after the petals have fallen oft". Parturition, the act of bringing forth by birth. Pathology, the doctrine of dis- eased actions. Panicle, a compound flower stalk, the stem having many branches, irregular divisions, and termina- tions. Pericardium, a membranous bag, in which the heart plays. Pediluvium, a fool bath. Peristaltic, motion, the natural action of the primae viae, down- wards. Pelvis, (the bason,) the open space of the bones in females, from the interior of the sacrum, im- mediately across to the junction of the pubis, and a central trans- verse line. Petals, the leaf or leaves consti- tuting a flower. Peritoneum, the lining membrane of the cavity of the abdomen. Peccant, offending matter. Petechiae, small black spots ready to bleed, breaking out on the surface in low fevers. Pharmacopoeia, the book of forms to prepare medicines. Phrenitis, inflammation of the brain. Phlegmasia, class of inflammatory diseases. Pharmacy, the art of compound- ing medicine. Phthisical, consumptive. Phlegmon, a bile. Pledgets, bundles of lint to put on sores, k.c. Plethorio, full of blood. Plexus, a net work of vessels. Polysarca, obesity, fatness. Porous, spongy. Procidentia, a falling down of the gut or uterus. Pro re nata, as things turn out. Prescription, the physician's for- mula of medicines, with direfr t.ions. Prima? viae, the first passages, t. t from the stomach to the rectum. Premonitory, forewarning. Protracted, drawn out in length; of time. Pyrolignous, burned wood, flavour or quality. Puerperal, child bearing, the birth. Pupil, the central clear part of the eye that enlarges at night by the dilation of the (coloured,) iris, which surrounds it. Pus, a name for pure matter. Pustules, small elevations like boils, filled with matter. Plume, a featherTike vegetation, rising upwards from the seed in vegetating. Physiology, the doctrine of natu- ral actions and growth in the human system. Plantule, the young plant from the seed. Physical, the actions of visible and tangible powers on each other. Purulent, of a matter-like quality. Phenomena, extraordinary ap- pearances, or actions. Phrenology, the doctrine of de- termining the moral qualities of man by the contour and size of his head! Q. S. an abbreviate of quantum sufficit, or enough. Quinine, a bitter salt of Peruvian bark, procured by sulphuric acid. Quercitron, red oak with pal mated leaves. Quotidian, a daily intermittent. Quartan, an intermittent with two well days between each fit. Remittent, a fever that abates at periods, but does not interuiit. Recumbent, lying down. Rigours, a convulsive shaking. Riven, split. Radicle, little root. Rectum, the last gut. Reaction, reciprocal action. Sanguinous, full of blood. GENERAL GLOSSARY. Sanative, healing power. Saturate, to charge to the full, or to neutralize, as acids, with alkali. Sac, a bag of any shape, applied to ulcers holding matter. Saline, of the nature of salts. Scrotum, the bag holding the tes- tes. Segments, divisions. Sinus, a cavity or depression mak- ing private communications be- tween diseased parts. Slough, mortified substance. Sordes, filth. Solution, of continuity, a wound with destruction or separation of parts. Soluble, easily dissolved. Spasms, contractions of the fibres for some duration, but not per- manent. Spine, back bone. Stellated, formed like a star. Sthenic, of an inflammatory na- ture. Stupor, drowsiness. Sub sultus, a starting of the mus- cles and tendons, verging to a convulsion. Sporadic, solitary case. Spatula, a limber knife to spread plaisters. Suppuration, forming matter. Tarsi, the parts of the eye in which the eye lashes are root- ed. Technical, a term of art, rather than a description. Testes, the male glands, distin- guishing the sex. 459 Tenesmus, an ineffectual straining of the last gut, as in decline of dysentery. Tendon, the smooth pullies that unite muscles to bones. Tertian, a fever with one wel! day between each fit or paroxysm. Tepid, warm as fresh milk Thorax, the chest. Topical, local, Torpor, dulness. Tonics, medicines increasing the power, rather than the circula- tion. Tournequet, a screw and bandage to put round a limb in haemorr- hage. Trachea, the windpipe. Traumatic, vulnerary. Transuding, passing through. Tremors, tremblings. Turgid, swollen. Tubercles, morbid tumours of a glandular appearance, mostly in the lungs of phthisical patients liable to suppuration. Type, the form of a disease. Urethra, the passage for the urine, from the bladder out. Uric, (acid,) a solid concrete formed by depositions from the urine, into gravel or stone. Uterus, the womb. Vagina, the sheath or female parts from the entry to the uterus. Vertebra?, the joints composing the back-bone, or neck. Ventilate, to air, expose to wind. Vomica, an inclosed suppuration genei Jly in the lungs. THE END. INDEX OF DISEASES. Page A. Angina pectoris, .... 169 Apoplexy,......107 Asthma,.......159 B. Bastard peripnenmony, . . 143 Bite of a mad dog, . . . 135 Bite of a venomous snake, . 365 Bleeding at the nose, . . . 128 Burns and scalds, .... 387 C. Cmcer,.......357 Catarrh,.......166 Catarrhal lockjaw, . . . 127 Cessation of menses, . . 312 Choroa, or St. Vitus's dance, 203 Chicken pox,.....88 Colic,........246 Cholera morbus, .... 229 Chillblains,......410 Chlomis,.......29? Constipation,.....252 Consumption,.....147 Cracks in the joints of fin- gers, .......409 Croup,.......333 Curved spine......288 D. Dentition,......339 Diarrhoea,......v 240 Diabetes.......259 Discharges of blood from kidneys,......281 Diseases incident to the pu- erperal state, .... 317 Difficult menstruation, . . 311 J>.......l7l Dyspepsia,......£au Dysentery,......237 E. Ear ache,......121 Epilepsy,......206 Epistaxis, or bleeding at the nose,.......128 Erysipelas, .... Essera, or nettle-rash, External inflammation and mortification, F. Faintinp, . . . Fevers in general, Fever, hectic, -----, intermittent, -----, inflammatory, -----, remittent, . -----, typhus, . . Fits in children, . Foetid breath, . . Frostbitten, . . G. Gout, .... Gravel, ... H. Haemorrhoids, or piles, Haemoptysis, . . . Headache, .... Hepatitis, kc. . . . Histeria,..... Histeritis catamenialis, Hooping cough, . . Hypochondriasis, . . Hydrocephalus, . . Hydrophobia, . . . Hydrothorax, and other drop I. Jaundice,..... [mmoderale flow of menses Indurated breasts, . • Influenza,..... Interrupted menstruation, Inflammation of the brain, eyes ____.-------stomach, __-------bowels, __---------spleen, kidneys, Intercostal rheumatism, 101 INDEX OF DISEASES. 461 Page R. 292 187 ' S. 387 92 192 85 282 St. Anthony's Fire, . . . 98 Suppressed menstruation, . 303 Suspended animation from 372 Suspended animation from drinking cold water, . . (C Suspended animation from a Suspended animation from u Suspended animation from (t Suspended animation from u T. Tetanus, .... . . 216 123 Turn of life in females, . . 352 Tumours in breasts of fe- 404 U. 380 Ulcer in the lip, .... 405 Urticarca, (nettle rash,) 101 V. Venereal disease, .... 413 Vomiting of blood, . . . 228 W. Whitlow,...... 406 313 White swelling, .... 287 376 349 Page Inverted toe nail, . . . . 405 Ischuria renalis, . . . . 285 L. Lax in children, . . . . 347 Leucorrhea, or whites, . . 313 Livid colour of infants, . . 352 Lockjaw, .... 216 192 M. 30fi 89 MHk leg,..... 327 390 116 N. Nettle rash, (urticaria,) . 101 Neuralgia fasceabs, . . 125 Nephralgia, (gravel,) 277 O. Obstipated, (costiveness,) 252 133 P. 185 Palsy,....... 195 406 332 Perverted circulation of in- 352 Peripneumony, . . . . 143 Peripneumony bastard, . . 143 Phlegmasia dolens, . . . 327 142 Piles,........ 256 355 Prolapsus ani, of children, . 352 Profuse menstruation, 306 Puerperal fever, . . 328 Putrid sore throat, . . , 92 114 % y •*> * "5c* /" I «v -.«, V t w v >■« ' -f W -J*-' *$**■ V / '' d& d"^; W^^ss\^kmsss%--- ^fla/Sr ■" . »"* */r/£ ;^ $&*>• 'w >*,; trit~ *~, ■ *fcj :^,- >> r": / ..v/^ ,v, »i **: >•■ '••■ ■••■■»»i.*n..