NATIONAL LIBRARY OF MEDICINE NLM QQ1Q2231 5 SURGEON GENERAL'S OFFICE LIBRARY. Section No. 113, W.D.S.G.O. NO.A1JJ-..JJ S—513 X «*■ J*-mi \ NLM001022315 is «■ ■ -.' ,t-,-'^'■4L*ffiZ5r< - t/0,;.:,,a»>;: *■•,,:■/*•» ,*. EIGHTI-FIEST EDITION-ENLARGED AND REVISED. ---*-»• TIE3I-EJ -&'<--- sanrsTby of wiiioh: EXFT-i-A-inSTIEID; —A— Family WkjBt€Mm9 -AND- HOUSEHOLD COMPANION; Prepared for the use of Families, PLANTATIONS, SHIPS, TRAVELERS, do. i. By M. LAFAYETTE EYRN, M. D., eBADUATE OF "THE UNIVERSITY OF THE CITY OF NEW YORK, ' AUTHOR OB "POISONS £ IN OUB FOOD,'' ETC., ETC. , , — ~ m^ • ^ NEW YORK: S^\h^V( '"'■'- £ "'"COAST CITY PUBLISHING CO., ~=^; _'J' ■ „ \ No. 49 Nassau Street. 1887. WBA Entered, according to Act of Congress, in the year 1869, by M. LAFAYETTE BYRN, M. D„ In the Clerk's Office of the District Court of the United States for the Southern District of New York. Entered, according to Act of Congress, in the year 1876, by M. LAFAYETTE BYRN, M. D., In the Office of the Librarian of Congress, at Washington, D. C. Copyright, 1887, by M. LAFAYETTE BYRN, M. D. PREFACE. This book has been written for the "People!"—tbsrieh, the poor, the\old, the young, maie and female, the learned and Ihe illiterate, those who are well and those who are siek ; on land and on water, in the city and in the country, in the rural country-seat of the retired merchant or the log-cabin and camp-fire of the hardy pioneer or backwoodsman ; for the clerk of sedentary habits, and for the farmer who toils in rain and in sunshine; for the young man far away from home, and for the mother who keeps watch over her loved ones through the long hours of dreary night in sickness;—in a word, for the million. It is intended as a guide for preserving health and prolong- ing life, by giving that kind of information (couched in lan- guage free from medical technicalities), which has long been needed by the masses. It has been my aim not only to sim- plify the laws of health and physical education, but to give euch plain descriptions of the various ailments which our bodies are subject to, that every one may know from the symptoms, each ailment or disease, and be enabled to give the best remedies, where a physician can not be had, or, in cases of emergency, to know what to do before the physician arrives, so as to alleviate suffering or be the means of saving life. Also, to enable the reader to treat intelligently and success nlly mary <;f the "ills which flesh is heir to,'' which ara nable to occur in a family at any time, without being under '{jo necessity of sending for a physician. Iw Preface. All the works that I have previously met with, bn this sur* ject, have invariably attempted too much, by giving directions for treatment that the great mass of tlieir readers would be unwilling to try. I have endeavored to give simple, brief and safe instructions, so no one need be afraid to follow them I have, of course, availed myself of all the sources of informa tion possible in the preparation of the work. The study of our own natures is, perhaps, the most elevating and ennobling subject which can engage the mind, and we ought to deem il as much a part of our sacred duty to promote physical health and happiness in this life, as to prepare our spirits for the fruition of a happy immortality. Knowing the weight of responsibility resting upon me ia issuing a volume like this, for the guidance, comfort, and benefit of my fellow-beings, I feel to implore the blessings of God, that my labors be not in vain. M. LAFAYETTE BYRN, M.D. 5 PLATE 1. THE FRAME OF THE HUMAN BODY. TJie Names by tvhich the different Bones in the Hitman Body are Known. Front View. i. The back-bone or spinal column. a. The skull or head of the human body. 3. The under jaw. 4. The sternum or breast-bone. 5. The ribs. 6. The cartilages which connect the ribs with the breast-bone. 7. The clavicle or collar-bone. 8. The humerus, or bone of the arm. a. The shoulder-joint. __ ,. /two bones running parallel with »o. The radius « 11. The ulna each other from the elbow to the wrist. Back View. 13. The wrist. 14. The bones of the hand. 15. The pelvis, or haunch-bone. 16. The sacrum, a wedge-shaped bone at the lower end of the back-bone. 17. The hip-joint. 18. The thigh-bone. 19. The patella or cap of the knee. 20. The knee-joint. 21 The fibula, or lesser bone of the leg. 22. The tibia, or shin-bone of the leg. 23. The ankle-joint. 24. The bones of the feet. " WTohp"'inTh"™two VUnni of th. n.mjj Fr.me ; thrill bo foond ve? -!;» In cases of fractures, dislocations, wounds, etc., will it be found ol value. (See Pages 273 to 286.) ['LATE M. The Heabt and Lungs. These are placed within the chest, at the upper end of the trunk. By breathing we draw in air, which purifies the blood, and prepares it for nourishing and sustaining the body, and the refuse matter which it separates from the blood is carried out. The air enters into the lungs where the oxygen contained therein comes in contact with the blood, impure from having circulated through the body. The oxygen of the air purifies this blood, which immediately after passes again through the body to return in like manner. The blood is carried into the lungs by small blood vessels, or tubes. These small tubes are continually poring impure Wood into the lungs from the heart, while others are carrying it back again into the heart after it is purified. As the blood passes through the body, it gathers up the decayed and waste particles or atoms, and in this way A becomes impure. It then returns to the lungs to be purified, and thus made fit again to go out into the system, to perform its life-preserving work anew. How neosBsarv, then, that we should breathe pure air I (See Pages 30, 12*, 318.) 7 PLATE m. Back-Bone, Ribs, and Collar-Bones. The Back-bone or Spinal Column, extends from the skull, behind, down the middle of the back, and is composed of twenty-four short, round, and perforated bones, called vertthra by physicians. They are held together by the cartilage 01 gristle, which is between each bone, thus allowing the spina. column to be flexible. There are twenty-four ribs, twelve on each side. They grow out of the spine, forming a hoop by meeting and being fastened to the breast-bone in front. They are the framework of that part of the human trunk called the chest, in which are the heart and lungs; they serve as a protection to those vital organs. The collar-bones are two long slender bones passing over the ribs in front from the highest part of the shoulder-bones to the head of the breast- bone. The collar-bones prevent the arms from sliding too far forward. (See Pages 276, 281, 286.) 8 PLATE IV. Bones of tiie Hand and Fingers. The wrist has eight bones, all being wedge-shaped, and otrongly united together by ligaments or gristle. In the hand and fingers there are nineteen bones, which are also strongly held together by powerful ligaments. It will be useful to examine this engraving carefully, so as to be well informed on the subject in cases of emergency, such as dislocations, sprains, etc. (See pages 249, 250.1 Bones of the Feet. luere are twenty-six bones in the foot; they are of pecuiia. *haoe, and are all held together by very strong ligamenta, forming the arch of the foot, called hollow of the foot on th« ander side, and the instep on the top. (Sa pages 122, 2&3.) 9 Natural Form and the Ribs. Fashionable Fokm and the Ursa. A dress, tight over the chest, not only binds the ribs together, and thus pro. rents the free play of the lungs, but it crowds all the vital organs upon each other, so as to derange their proper action, and obstruct the circulation in all parts of the system. Thousands die annually, the victims of consumption, pro« duced by tight lacing. Such casing and confining are deadly foes to health and life, as everything is which prevents perfect freedom of action to the vital organs. The ribs, perhaps, may be more easily changed than any of the other bones of the body. Their ln«irodi\cmg the fashion of "common sense," instead of tight-lacing? Try ^ 3 ye millions, tar it 10 PLATE VL Side View op Under Jaw-bone and Teeth. Children have twenty teeth— ten in the upper, and ten io the lower jaw; when a child becomes six or seven years of age, the teeth loosen, and, if they do not drop out, they should be removed without delay, otherwise they will prevent the proper formation and regularity of the new permanent teeth, which are growing under them. Letter a, in the engraving, ahows the position of the new teeth in the under jaw, pushing out the old ones. (See pages 69, 24.1, 251.) The Different Kinds of Teeth. to*. Internal part, or the ivory of the teeth, is a more solid * *bstance than bone, and this is covered with a smooth, while a ad still harder substance, called enamel, which wheii once decayed or destroyed, is never again restorea. This enamel gives the teeth strength, as well as hardness, for biting, chewing, and grinding the food; it also prevents injury from these ope' rations, and from the action of acids on the bone of the teeth • and adds much to their beauty and durability. Teething and the proper care of the teeth are mattera of great importance. (See pages 57, 95.) Fig. J 11 P< aTE VU The " Circulation of the Blood11 (Fig. 1) was discovered Dy Dr. Harvey. From the earliest of our being to life'e latest hour, this life-giving process must go on. Beginning in the great centre of the system, the heart, the blood is pro- pelled through the arteries to the remotest parts, giving nour- ishment and life to the system, and is then returned through the veins to the heart, and thence to the lungs, to be purified by the oxygen in the air. The blood thus makes the rounds of the circulation once in aoout four minutes. The "Brain" (Fig. 2) is the centre of the nervous system, and weighs from three to four pounds. Every nerve of the body is connected with the brain, and may be called the "Sentinels of the System," being the mediums of all our iensations, such as hunger, thirst, pain, etc (See pages 134, 194, 32P, 332.1 12 " The Tongue," and Sense of Taste, is represented in Fig. 1. The sense of taste lies chiefly on the upper surface of the tongue. Branches of the nerve of taste, are also spread over the palate or roof of the mouth, and on the inside of the cheeks and lips. The tongue, also, assists in various other little operations besides taste and talking ; by it we move the food in the mouth from side to side, or hold it in a proper position for chewing. In sickness the tongue becomes dry and hard, as there is no saliva or spittle secreted to moisten it, and at such times there is very little taste, as the tongue is covered with a fur, or coat. In such cases, the tongue should be frequently moistened. (See pages 45, 203, 208.) " The Nose," or Sense of Smell, is seen in Fig. 2. The sense of smell is situated in the lining of the nostrils. The inner surface of the nostrils are lined with a thin mucoua membrane, over which the branches of the nerve of smell are spread, and which are kept constantly moist in their natural state with a thin fluid called mucus, which keeps the branches of the nerve of smell in perfect order, and protects them from harm. It also catches the odorous or noxious particles which are drawn into the nostrils with the air, and are thereby pre« vented from being carried deeper into the lungs, where they would be injurious. By the act of sneezing these pazticlei are ejected from the nostrils. (See pages 97, 402, 121 and 231.) 13 PLATS IX. auMAN Stomach and Bowels. The Human Stomach. We here give a fine representation of the Stomach and f3owels, united together, (A) in which " 1 " is the stouten. "2" is the upper portion of the small bowels, "3" the middle portion of the small bowels, around which, in the sh^pe of an arch, is seen the large bowels; " 4" is the rectumy or lower outlet of the bowels. The food while in the stomach becomes dissolved a digested. it is then called chyme / this passes out of the stomach into what is termed the "duodenum" (or upper pa^t of small bowels), where it is then separated into two clasps, a milky fluid called chyle, or the part which enters into ai/d forms the life of the blood, and the waste or useless part, which should be ejected from the bowels regularly each morniug soon after rising. " The Stomach," detached from the bow els, is seen at "B, at figure "1" is a section of the Esophagus, or tube leading from the throat to the stomach; and figure " 2" ia the outlet into the upper portion of the bowels. {See Pages 104, 158, 41, 52, 218, 320, 341, 65, 105, 157, 180, 349 352, 134, 340.) 14 A Curved, Kound-Shaiildered, and Erect Spins. ffot» vary distressing, and yet how common it is to see curved or deformed ~. ffies. /he habits of children, especially of girls, if not corrected in time, e, aate a rfiarful frequency of this spinal defect. Nature has given to all, both d a!e and female, a sufficiency of bone and muscle to sustain them in the most gra<>iful and healthy position, and when these are correctly and faith- fully used, and their strength developed, they fulfil their intended purposes, and keep .he form erect. Look at the following illustrations of improper positions o- the body, and you will be able to tell the cause of these deformed jpines. Old Style antt New Style of Desks and Seats for Schools, Too many schools %re furnished with seats of the same uniform height. If they are high enougn for the larger scholars, they are too high for the smallei children. (See fig. 1.; In sitting, a child should find a support for the back, and rest for the entire tthigh-bones and feet, otherwise the bones of these, being soft and growing, are hmble to become distorted, or out of shape. Fig. 2 repre- sents a proper position, represented by the dark line; ciliary ligiment (4), which de- velops from its inner sut face the ciliary pro- cesses, and the iris (6), of which the opening at 7 represents the pupil. We shall go more into details presently as to the nature of these several constituents of the tunics and otber parts of the eye; at present we will keep to general outlines, as represented in the dia- gram. The third tunic, then, is the retina (8), which is carried forward to the lens (12), by the zonula ciliaris, a prolongation of its vascular layers passing along the front of the Canal »/ Petit (9), which entirely surrounds the lens. In the space marked 10. is contained the aqueous humor ; 11 is the posterior chamber ,■ 12 the lens, more convex behind than before, and enclosed in jts proper capsule; 13 marks the inner area of the globe filled with a thin membrane called the hyaloid, and containing the vitreous humor; 14 is the tubular sheath of the membrane, through which passes an artery connected with the capsule of the lens, and, at the back of the eye, with the optic nerve, as represented at 16. Of this nerve, U marks the neurilmma, or sheath. THE EYEBALL DIVESTED OF ITS FIKST TUNIC. 1, Part of the outer tunic, the sclerotic ; 2. the optic nerve, communicating with the ball at the back ; 3, 3, distinguish the out- line of the choroid coat; 4, the ciliary lig- ament, a dense white structure which surrounds, like a broad ling, the circum- ference of the iris (5). This ligament serves as a bond of union between the ex- ternal aud middle tunics of the Eyeball, and serves to conne t the cornea and scler- ota at their lines of junction with the iris and external layer of the choroid; C, 6, mark the vence vorticosce; and 7, 7, the trunks of these veins at the points wnere they have pierced the sclerotica; 8, 8, the posterior ciliary veins which ' enter the Eyeball in company with the postei ior cil- iary arteiies, by piercing the sclerotica at 9. The course of one of the long ciliary nerves, accompanied by a vein, is marked by 10. PLATE XTTT, Fig *. TRANSVERSE SECTION OF THE GLOBE OF THE EYE. 1, The divided edges of the three tis- sues, the sclerotic (outer), clioroid (mid- dle and dark), and retina, (inner), which last is composed of three membrareoHS layers, the external being serous, the middle nervous, and the internal vas- cular ; 2, the pupil, that central spot, which enlarges or contracts, according as more or less light is required to be admitted ; 3, the iris, so called from iris, a rainbow, on account of its variety of aolor in different individuals. It is composed of an anterior muscular layer, consisting of radiating fibres, which, convergring from the eentre toward the circumfereme, have the power of dilating the pupi'l ; and als 3 of circular fibres, which, surrormding the pupil like a sphincter perforr jlS the duty of contracting its area. The posterior, or hinder layer, is of a deep *purple tint, raid is hence named uvea, from its -esemblance to a ripe grape. T*his is the surface of the iris presented to view in the above section. 4, ciliary prr^essp-s ; 5, scalloped anterior border of the retina. POSTERIOR SEGMENT OF A TRANSVERSE SECTION OF THE EYE. 1, The three outer tunics; 2, the entrance of the optic nerve, with fihe vein known as the anteria centralis retince piercing its centre ; 4 is the foramen of Soemmering, situated in the middle of the axis of the eye. This is a circular spot, surrounded by a yellow halo, call ^)d the limbus Ivdeus. This halo is commonly obscured by a fold of the retina (5' 9543297 PLATE XTV. Fss. 1. Fro. 2. EYE-APPENDAGES. MEIBOMIAN GLANDS. 1 2, The inner sides of the eyelids; 3 3, the Conjunctiva; 4, the apertvres of the glands, along each corner of the lids; 5 5, 6 6, the Papillce lachrymales and the Puncta lachrymalia ; 7, the ap- ertures of the ducts ol the Lach"yma\ gland. 1, The superior or upper tarsal carli- iaqe, along the lower border of which (2) are seen the openings of the Meibo- mian glands; 3, the inferior, or lower, tarsal cartilage, along the upper edges of which are also openings of the above- named glands ; 4, the superior or oroi- tal portion of the Lachrymal gland, from which come tears ; 5, its inferior or palpebral portion ; 6, the Lachrymal ducts, or channels through which the tears pass to the outer surface of the eye ; 7, the Plica semilunaris, containing a small.^ plate of cartilage, which appears to be the rudiment of a third lid, such as/*is ieveloped in some animals ; 8, the Caruncula lachrymalis, the source of the wj/ntish secretion which so constantly collects in the corner of the eye ; it is covered with minute hairs, which can sometimes be seen without the aid of a microscope; 9, the Puncta lachrymalis, the point, or external commencement of the due* «, which terminate at the lachrymal sac, the position of which is marked by 12 ; as t^, ~& the superior and inferior lachrymal canals by 10 and 11. The nasal duct, marked b/ x*£j and 14 is its dilation with the lower meatus of the nose. 19 PLATE XV. Fig 1. MUSCLES OF THE EYE. 1. Sphenoid Bone; 2, the Optic Nerve ; 3, the Globe of the Eye; 4, the Upper Mnsclft sailed the Levator Pal^ebroe. the Lifter of the Eyelids; 5, the Superior Oblique, so called f, om the direction in which it draws the Eyeball; we see its cartilaginous pulley 16), and the reflected portion passing downward to its point of connection with the ball, beyond which the Inferior Oblique has its bony origin—the point of which is marked by the little square knob. The other four muscles are called Recti, straight; the Superior Rectus, sometimes called the Levator Oculi. erector of the eyes, and sometimes Superbus, because its action gives an expression of pride; its opposite, 13. the Inferior Rectus, sometimes called Deprimus Oculi, depressor of the eye, and Humulis, as giving an expression of humility; 10, the Rectus Internus, sometimes called Adductor Oculi. from its drawing the Eyeball toward the nose, and Bibitorious, a sort of punning name, in allusion to the cup, or orbit, towards which it directs the glance; 11 and 12. Rectus Ex- ternum, the one showing its two heads of origin, and the other its termination; the inter- vening portion of muscle [having been removed] has the name of Ahductor Oculi, because it turns the ball outward.; Indignabundus is another name for it, as giviug an expression of scorn. In our diagram the internal rectus passes behind the optic nerve, which partly conceals it; 14, the tunica, abigania, or white tunic, formed by th» expansion of the tendons of the four Recti muscles. Fig. 2. SEPTUM OP THE NOSE AND ITS NERVES. 1. Nerve of the lobe of the nose; 2, olfactory lobo; 3, nerves of the septum; 4, nerve of the palate. 20 BBCTION OF MAMMARY GLAND OR FEMALB BRZAS1 1,1, Galactophorous Ducts; 2, 2, Lobuli. Fro. 2. Fig. 3. ♦ftlGIN OS THE MILK DUCTS ULTIMATE FOLLICLES OF THK MAMMARY GLANDS. a, a, the Secreting Cells, bx b the Nuclei. 21 PLATE XVLL Flo. 1. Fig. 8. DIAGRAM OF THE STRUCTURE OF THE SKIN. a. Epidermis; b b. Pores ; c e. Lay- ers of epidermis and rete mucosum; /, Inhalent vessels; g g, Papillae of the skin ; h h, Corium or true skin ; d, d d. Bulbs of sudoriferous glands "■^eninc 'n the glands b b. Fig. 3. A SWEAT GLAND. A vertical section of the sole o* the foot—a, the Cuticle or Scarf Skin, the deeper layers of which, dark in color, being called the rete mucosum; b. the Papillae; c, the Cutis or True Skin; and d is the Sweat Gland in a cavity of oily globules. Fig. 4. VERTICAL SECTION OF THE SKL\ LARGELY FORES AND PAPILLA OF THE 6KIN magnified. On the left is a Magnified View of the Kidges of the h Sweat Gland; t. a Hair enclosed in Cuticle, as seen in the Palm of the Hand with the its Follicles, and showing its pair of Openings of the Pores in their Furrows. On the rigtot, Sebaceous Glands; v, a Sebaceous the Cuticle has been removed, leavuig corresponding G»«ia. rows oi Papill®. 577221574362804185 22 PLATE XVLIL Description of Plate 18 —1. Frontal branch of the fifth nerve of the brain whi*te bestows sensation alone. II. Superior maxillary, or that branch of the fifth nerve which supplies the upper jaw, and which, like the last, arising from the sensitive ro't, bestows sensation alone. III. Mental or inferior maxillary branch of the filth nerve. This also comes frrm the sensitive root. It is called mental. 1 ,ecause it is involved in that expression which indicates the emotions of the mind. IV Tempoial branches of the same fifth nerve. They are distributed on the temples, and are for sensation. V. The only branch of the fifth nerve which arises from the smaller or motor root, and assists in the motion of those muscles which are emplo\ ed in masticating or chewing. VI, VII, VIII, IX. These are spinal nerves—the first of the series which come out between the vertebra, in the whole length of the spine, to supply the bcdy generally with motion and sensation. A. The facial nerve. It is hituated in th* front't f the vs>r. and is the motor nerve of the features. It sends branches ia) to the must les cf the forehead and eyebrows. Branches (b) to the eyelids. Branches (c) to the must les which move the nostrils and upper lip. Branches (d) to the lower- lip. Branches le) going down to the side of the neck. Connections (/) wrth the spinal nerves of the neck. A nerve (g) to a portion of the muscle that is m the back of the head, and to muscles of the ear B. The nervus vagus, or the wandering nerve, so named from its extensive distribution. This is the grand respiratory nerve C The spinal accessory neive. D. The ninth nerve, which is the motor nerve of the tongue. E. The nerv« which supplies the diaphragm. F. lirauch of the sympathetic nerve. G. A branch of the nervus vagus which goes to the superior portion of the larynx or windpipe. H. An- other branch of the vagus which goes to the inferior portion of the larynx. I. The nerve which goes to the tongue and upper part of the gullet, ca'ied the pharynx. 23 PLATE XIX. Fig. 2. Fig. 1. MESENTERIC CIRCULATION BETWEEN THE BOWELS AND NUTRIMENT GLANDS. LONGITUDINAL SECTION OF A POR- TION OF THE SMALL INTESTINE. Fig. 3. FABOTID GLAND OF A SHEEP (UNDER THE CHIN), IXHTBrTING T IE BRANCHED AND LOBULATSD CHARACTER OF THE GLANDS OF THE HUMAN STOMACH, AND OTHER PARTS. 24 tUup'nations of Healthy and Unhealthy Positions of the Body See how that round-shouldered youth is sitting with his shoulders against the b=vik of the chair, and the lower portion of bits spine several inches from it, giving his body the shape of a half-hoop. PareDts should regard such a position m their children with apprehension as to the result, and should rectify it atonoe. The other young gent, has learned a thing or two W'jrth knowing, as you will see by his manly, dignified position in his chair. Ho may be President yet— who knows? Healthy Position. Unhealthy Position. ^n upright position, in either sitting or walking, favors a healthy ection of all the various organs of the system, and besides it gives a graceful and dignified appearance to the human form. Children and adults are more or less inclined to lean forward with their heads upon their elbows, even when their seats are provided with backs ; such a position oft-repeated must in time result unfav«nr- ably. There is a very " don't care" kind of look about one of these young ladie«; If she lives long enough, she will care. Improper Position. Proper Position. Learn to sit up, young man, and to imitate your opposite neighbor ; for the D matural position which you have assumed will never make you a good writer A bold upright position, with the pen held loosely between the fingers, and 3 termined purpose to imitate some definite copy as nearly as possible, ie the. o.Jy true road to success in the art of writing or good penmanship. This young- titx on the left looks as if he was " bowing his back for a heavy burthen —and K he is ; if he don't quit it, he will have burthen enough. D591A THE MYSTERY OF MEDICINE HOW TO PRESERVE HEALTH. The variety of tempeiaments or constitutions renders \\ r»v>ssible for health to be very different in different persons, nence \vha.t would preserve the health of one would occasion disease in another. Persons of a sanguine temperament, whose -"^sels are full, and whose fibres are firm and active, easily ex- cited to motion, and often to irregular actions, hear evacua- tions well; and have their health best promoted by abstinence and low living, by avoiding excess of every kind, and particu- larly guarding against cold after active "bodily exertions. Tho bilious temperament, with a constitution more acutely sensible, always more imtable, requires the same precautions as the sanguine; but the evacuations best adapted, which are indeed almost indispensable to this kind of constitution, are the free and frequent use of the milder laxatives. To preserve the health of the melancholic, of those whose complexion is dark, and whose powers are torpid, whose mind is dull, but perseve- ring, much exercise is lequired to assist digestion and to turn the circulating fluids to the skin. From the torpor of the bowels, to which persons of this temperament are peculiarly liable, they will demand the occasional use of purgatives of the alcetic kind; their occupations and amusements should be varied and interesting to the mind. The phlegmatic temper- ament is pale in complexion, languid in its exertions; the vessels, if full, are torpid, the constitution inactive; the mind not easily excited to exertion. The diet in this tem- perament, requires to be nutritive and somewhat stimulating, though it ought not to go the length of what would he called high living. ..... The health of females has some peculiarities arising irom the delicacy of their frame, the monthly discharge, the state of pregnancy, and of nursing. All these circumstances coo- 26 How to Preserve Health. ititute a condition very different from the robust and vigor* ous strength of man in the prime of life; yet equally perfect, relatively to the sex and the individual. The irritability of infants, and the nimble tricks of boyhood, are consistent with good health, though they would he unsuitable at a more ad« vanced period of life. I Health varies in people of different occupations. The acute- ness of the senses which is necessary in some employments* would be morbid in persons otherwise engaged. But some Lave various diseases or predispositions to disease, either de- rived from parents or acquired in the progress of life, which render health with them only a comparative term. The scrof- ulous can hardly he said in strictness ever to be in perfect health; but their disease may be dormant or undeveloped; and, in favorable circumstances, may permit the subject of it to enjoy an exemption from pain and inconvenience, to the end of a long life. Gouty and rheumatic patients ma;~ also enjoy good health during the intervals of their attacks. AIR. Atmospheric air, or that by which we are usually surround. ed, is not a simple, but a compound body, consisting of at least four distinct substances, viz : oxygen, azote, carbonic acid, and aqueous, or watery vapor. The two former substances, however, constitute almost the whole of the atmospheric air near the surface of the earth; the other two are variable in their proportions ; the first ex- ists only in minute quantities, which it is difficult to appre- ciate. Vital air, or oxygen, which constitutes about one-fourth of the atmosphere, is necessary to respiration and combustion. and an animal immersed in it will live much longer than in the same quantity of common air. The remaining three- fourths, called azote, or mephitic air, is totally incapable of supporting life or combustion for an instant. The oxygen which is received into the lungs of animal? from the atmosphere, communicates the red color to the blood, and is the principal agent which imparts heat and activity to the system. When animals die for want of oxy pen in the air, their blood is always found black. IndepenS* ently of its destruction by the respiration of men and othei animals, there is a constant consumption of the oxyo-enous ortion of atmospheric air, by the burning of combustible odies; by the fermentation and putrefaction of vegetable substances, etc Air. 27 A diminished proportion, therefore, of the oxygen of ouf atmosphere, and an increased amount of carbonic acid and other deleterious gases, is undoubtedly produced from the innumerable processes of combustion, putrefaction, and res- piration of men and animals, particularly in populous cities, the atmosphere of which Is almost constantly prejudicial to health. In the open country there are few causes to contaminate the atmosphere, and the vegetable productions continually tend to make it more pure. The winds which agitate the atmosphere, and constantly occasion its change of place, waft the pure country air to the inhabitants of the cities, and dis- sipate that from which the oxygen has been in a great meas- ure extracted. The air of any place where a numerous body of people is assembled together, especially if to the breath of the crowd there be added the vapor of a great number of candles, lamps, or gas-lights, is rendered extremely prejudi. cial, as these circumstances occasion a great consumption of oxygen. The tact is well known, that when air has been long con- fined and stagnated in mines, wells, and cellars, it becomes so^extremely poisonous as to prove immediately fatal to those who imprudently attempt to enter such places. No person should descend into a well or cellar, which has been long closed, without first letting down a lighted candle; if it burns clear there is no danger, but if it cease to burn, we may be sure that no one can enter without the utmost danger of immediate suffocation. It sometimes happens also, that when air is suffered to stagnate in rooms, hospitals, jails, ships, &c, it partakes of the same unwholesome or pernicious quality, and is a source of disease. It is obvious, therefore, that in all confined or crowded places, the correcting of vitiated air, by means of cleanliness and frequent ventilation, is of the highest importance to health, and the most effectual preser- vative from disease. No accumulation, therefore, of filth about our houses, clothes, or in the public streets, should on any pretence be suffered to continue, especially during tha heat of summer. It is a very injurious custom for a number of persons to occupy or sleep in a small apartment, and if it be very close, and a fire be kept in it, the danger is increased. The vapor of charcoal, when burnt in a close apartment, produces the. most dangerous effects. Our houses, which are made close and almost air-tight, should be ventilated daily, by admitting a free circulation of air to pass through opposite windows' 28 Air. and our beds ought to be frequently exposed to the influenw of the open air also. . Houses situated in low marshy situations, or near lakes oi ponds of stagnant water, are constantly exposed to the innin ence of damp and noxious exhalations. Among the most powerful means furnished by nature fet correcting air which has become unfit for breathing, is the growth and vegetation of plants. Animal bodies consumi oxygen, and give off carbonic acid; plants and vegetables consume carbonic acid, and give off oxygen. The generality of plants possess the property of correcting the most corrupt air within a few hours, when they are exposed to the light of the sun ; during the night or 'in the shade, however, they destroy the purity of the air, whicli renders it a dangerous practice to allow plants to vegetate in apartments occupied for sleeping. Marshes.—The neighborhood of marshes is peculiarly un- wholesome, especially towards the decline of summer and during autumn, and more particularly after sunset. The air of marshy districts is loaded with an excess of dampness, and with the various gases given out during the putrefaction of the vegetable matters contained in the waters of the marsh. Per- sons exposed to this air are liable to various diseases, but espe- cially ague, bilious fevers, diarrhoeas, and dysenteries. They who breathe it habitually exhibit a pallid countenance, a bloated appearance of the abdomen and limbs, and are affected with loss of appetite and indigestion. Health is best pre- served in marshy districts bv a regular and temperate life— exercise in the open air during the middle of the day, and by retiring as soon as the sun sets, within the house, and closing all the doors and windows except enough for ventilation. The sleeping apartment should be in the upper story, and rendered perfectly dry by a fire, lit a few hours before going to bed, and then extinguished. Exposure to the open air should, if possible, not take place in the morning before the sun Las had time to dispel the fog, which, at its rising, covers the Burface of the marsh. Persons who are intemperate, or use ardent spirits habitually, are those most liable to suffer from the unwholesome air of marshes; such generally perish from diseases of the liver and dropsy. Night Air.—Many diseases are brought on by impruden exposure of the body to the night air; and this, at all seasons, in every climate, and variety of temperature. The causes of this bad property of the night air, it is not difficult to assign The heat is almost universally several degrees lower than ii Air. 29 the daytime; the air deposits dew and other moisture; the pores of the skin are open, from the exercise and fatigues of the day; the evening feverishness leaves the body in some degree debilitated and susceptible of external impressions; and from all these concurrent causes are produced the various effects of cold acting as a check to perspiration; such aa catarrhs, sore throats, coughs, consumptions, rheumatisms, asthmas, fevers, and dysenteries. In warm climates, the night air and dews, with their tainted impregnations, act with much malignancy. In civilized life, and in crowded towns, how many fall victims to tlieir own imprudence, in exposing them- selves to the cold, the damp, and the frostiness of the flight air! Issuing from warm apartments with blazing fires, or from crowded churches, theatres, or ball-rooms, with exhausted strength, profuse perspiration, thin dresses, and much of the person uncovered, how many are attacked with a benumbing cold and universal shivering, which prove the forerunners of dangerous inflammations of the brain, of the lungs, or of the bowels, which either cut them off in a few days, or lay tlie foundation of consumption or other lingering illness. Never stand to talk, even for a moment, in the open air, after coming out of a heated or crowded room, or after active exercise. Such being the dangers of exposure to the night air, it ought to be inculcated on all, both young and old, to guard against them, by avoiding all rash and hasty changes of place and tem- perature, by hardening the frame by due exercise and walking m the open air in the daytime; and on occasions where the night air must be braved, taking care to be sufficiently clothed; and to avoid drawing in the cold air too strong or hastily with the mouth open. Always breathe through the nostrils for a short time after going out of a warm room into the cold air, keeping the mouth shut. Sea Air.—The air upon the sea and in its neighborhood is generally distinguished by its greater coldness, purity, and sharpness ; and is therefore in many cases directed to patients whose complaints do not affect their respiration, and who have vigor of constitution enough to derive benefit from the stimu- lus which such air occasions. A residence by the sea-side is beneficial to persons of a scrofulous habit and debilitated con •titution, provided they take care not to expose themselves to cold and damp; and in the fine season, when there is no reason against it, they ought to bathe. In complaints of the chest, the use of sea-bathing, and a residence near the sea, are more questionable; and by such an inland rural situation, in a mild equable climate, is to be preferred. A sea voyage bai 80 Air. long been famous for its good effects at the commencement oi consumptive complaints ; and these good effects may be as Bcribed partly to the good air at sea, partly to the affection of the stomach and skin induced by sea-sickness, and to the ex eitement of the mind, caused by change of scene and occupa- tions. Ventilation.—The air, as we have already remarked, can not become stagnant or unchanged for even a short period without its becoming unfit for breathing, and destrnctive to the health of those who breathe it. The streets of a city should therefore, be so laid out as tc insure a constant and free circulation of air; hence the unwholesomeness of a resi- dence in narrow alleys, courts and passages. Not less impor- tant is the continued renewal of the air of our apartments— the ventilation of which, however, should be so conducted as to prevent a current of air from blowing directly upon the Eersons within them. Our bed-chambers, in particular, should e freely ventilated during the day; and even at night, when the windows are closed, the chimney should be left open, or, if the room is small, and the weather sultry, a door, opening into another room, or a window partly open, or the sash pulled down to admit fresh air. No consideration of economy should prevent the most constant attention being paid to proper ven- tilation, so essential is the latter to health and comfoit. Cellars.—It is important that cellars should be perfectly dry, kept strictly clean and freely ventilated. The damp and foul air so frequently generated in cellars, where dryness, cleanliness, and ventilation are not properly attended to, is often the cause of disease, not only in the persons who inhabit the house to which the cellar is attached, but in others resid- ing in the immediate neighborhood. No house can be con- sidered a healthy residence, in the cellar of which water id allowed to stagnate: this may easily be obviated, in most situ- ations, by a sink dug to gravel. The air of cellars can be preserved sufficiently dry and wholesome by free ventilation, the removal of all filth and corruptible materials, and fre- quently white-washing the walls. Cellars, especially when entirely under ground, are improper places of residence; ap- propriating them as places of residence for the poor, or as workshops, should be prohibited by law. Climate.—Climate is considered by physicians, not with reference to geographical situation, but to the state of regioni as to the warmth and steadiness of their temperature, or the dryness or moisture of their atmosphere. The interior of con tinents and islands is generally mountainous, and, in consa Clothing. 81 quencc, cold. From the bracing qualities of the prevailing winds, the inhabitants are robust, and disposed to inflamma tory diseases: invalids, or persons coming from warm climates, ■houid .therefore, prepare themselves gradually for mountain ous regions, by not coming abruptly into those colder parts. CLOTHING. Clothing possesses no warmth in itself, but merely prevents ihe heat ot the body from being carried off by the air, and other surrounding bodies, faster than it '.an be supplied by the blood. The essential requisites for clothing are, that it be soft and pliable, so as not to obstruct the free and easy motion of the joints, or occasion inconvenience by its weight or tight- ness ; that it be adequate to protect the body from the external influence of the atmosphere, and preserve it in that degree of temperature which is most agreeable, as well as best adapted to the exercise of its different healthy functions and motions; and that it does not produce any detrimental effects, occasion any unnecessary degree of perspiration, or absorb the vapors of the atmosphere. Clothes of a light color, have the least attraction for heat; those of a black, the greatest; the first mentioned are, therefore, most proper in hot, the last in cold But besides these general properties of commodious and comfortable clothing, it should be suited in quantity and ma- terial to the climate, the season of the year, the period of life, the constitution, and the habits and mode of living. Thus, a person who is engaged in a sedentary employment, will always require warmer clothing than one who is actively engaged in manual, or other labor demanding considerable muscular ex- ertion ;' and the latter will always require an addition of Nothing, the moment he has ceased from his active labors, to what is proper whilst engaged in them. Neither do young persons, or those in the prime of life, and in robust health, require clothing in the day, or covering in the night, of so warm a nature as persons advanced in years; because the per- formance of their functions is more equal and vigorous, and of course, the generation of heat in the body is quicker, and of greater extent, than is the case in old age. One of the safest rules in the regulation of dress, is to adjust tt ta the vicissitudes or fluctuations of the season; and thii rule should be carefully attended to by the invalid, the delicate, the infirm, and the old. The winter clothing should not be left off too early in the spring, nor the summer clothing worn too late in the autumn. Neither should this rule be disregard 82 Clothing. ed by the young, and those in the enjoyment of perfect health The grand rule is, so to regulate the clothing, that, when ex posed to the external air, the difference of temperature experienced, shall not be such as to produce any unpleasant impression, whatever may be the inclemency of the weather, when we go abroad. Thinner clothing are necessary within doors than without, and a greater warmth of clothing after night, and during cold, damp weather, than during the day, and when the air is perfectly dry. Persons of delicate and irritable constitutions, whose powers of life are feeble, and whose circulation is languid and irregu- lar, are very apt to suffer severely by a very slight diminution of the temperature of their skin. This is also the case with invalids. All such persons, therefore, ought rather to exceed, than be deficient in the quantity and warmth of their clothing. But while clothing should not be too light, or too small in amount, neither should it be too heavy, or too much in quan- tity. The effects are equally mischievous. By over-clothing, too much perspiration is drawn out of the body, by which the frame is greatly weakened, and coldness and numbness of the extremities are occasioned. Tight clothes are invariably detrimental to the health, com- fort, and symmetry of the body. By the pressure they make upon the muscles, and the impediment they offer to tlieir free exercise, they produce in them an emaciation and debility which prevent them from supporting properly the natural and graceful position of the body, or effecting its active movements with sufficient vigor. They prevent also, the free circulation of the blood, and cause it to accumulate in the veins of the head, lungs, or abdomen. When the pressure of the clothes, or any part of them, is around the neck, it is apt to produce head- ache, discoloration of the face, giddiness, and apoplexy, or other diseases of the brain ; when upon the chest and waist, it prevents the full development of the lungs, impedes breathing, and interferes with the proper action of the heart, in conse- quence of which, the health of the whole system suffers; when around the abdomen, the stomach, liver, and bowels are affect- ed, and indigestion is produced, or the nutrition of the whole body is rendered imperiect. The clothes, therefore, should be perfectly loose, leaving to every part the fullest liberty, and to all their natural and unconstrained motions. Avoid muffling up the neck, head, ears, &c, when in good health. This is all important at every period of life, but particularly so, during infancy and childhood. The skm of a child> from the neck downwards, ought to b« Clothing. 33 tept warm by proper clothing; bare legs and chests, thin and insufficient clothing cause croup, inflammation of the lungs, &c. Keep flannel or woolen next their skin in cold weather. Flannels or Woolens worn next the skin, in addition to the ordinary clothing, are of very great service in preserving the healr.h. They produce a moderate warmth of the surface, promote perspiration, readily absorb the perspired fluids, and easily part with them again by evaporation, on account of the porous nature of their texture. Woolens should be worn at all seasons by the aged, and all subject to diseases of the chest or bowels, and by invalids. Flannel is also well adapted for infants and young children, especially in autumn, winter, and spring. Older children do not require it, excepting during the cold weather, and all persons under forty, in good health, should reserve it as a re- source for their declining years, during which it becomes every year more and more useful and necessary. Flannel that has been worn during the day, ought not to be habitually worn at night, but exchanged for a woolen night shirt. Always wear the same kind of materials next the skin at night as you do in day time. Many persons who wear woolen under-gar- ments during the day time, sleep in a cotton night shirt, and thereby greatly impair their health. Flannels need to be washed often. Such persons as find flannel too irritable to their skin, may obviate this, by having it lined with thin muslin. We especi- ally recommend the use of flannel drawers to females. Cotton.—Cotton, as an article of clothing, especially when worn in contact with the skin, is far better adapted for gene- ral use than linen, but is inferior to woolens. In warm weather, and in hot climates, it is the most comfortable article for an inner dress. It is cooler than linen, inasmuch as it conducts more slowly the excess of external heat to our bodies, and vrhen a sudden reduction of atmospherical temperature occurs, on *he other hand, it abstracts more slowly the heat from the body, and thus preserves the surface of a more steady and uniform temperature. Linen.—Whatever may be said in favor of the comforts of linen, and the greater ease with which it is kept clean, it is by no means a substance well adapted for the dress worn next to the skin, at any season of the year, nor by any class of persons. Head Dress.—Whatever covering is worn upon the head ■hould be light, sufficiently large, and adapted in its form to the shape of the head. Too heavy or warm a covering, or one which compresses unduly the head, is productive of pain and 84 Clothing. Inconvenience. In summer, the color of the hat or bonnet should be white, or at least some shade approaching to white, in consequence of the tendency of all dark colors to absorb and transmit the rays of heat. The brim of the hat should also be sufficiently broad to protect the face and eyes from the sun. Although the nature of a head dress may appear to be a sub *ect of very little importance in regard to health or comfort, yet every one has perhaps experienced more or less of the pain and inconvenience, occasioned by wearing a new hat, too small in the crown, and unfitted in shape to the head, and the almost immediate relief which results from exchanging it for one of more ample dimensions. Cravat.—It is important that of whatever it is composed, it be very light and loosely applied. When the neck is kept too warmly covered, it is very injurious; the throwing off of the cravat for a few moments, or exchanging it for one of lighter materials, will often give rise to a violent inflammation of the throat. Cravats and neck ties must not be worn too tightly ; this is often the cause of a " horrible headache." Corsets and Tight-lacing.—Of all the whims of fashion, no one is more absurd, or more mischievous in its effects, than that which condemns the female, under the pretence of im- proving the grace and beauty of her shape, to the torture of a tightly laced corset. Equally detrimental to comfort and to health, this portion of female attire cannot be too severely cen- sured. It is productive of not the least advantage, real or imaginary, to compensate for the injury it produces, nor to excuse the folly of females in persisting in its use. The im mediate effect of tight-lacing is, by compressing firmly the chest, to prevent its free expansion in the act of breathing; a less amount of air is taken into the lungs, and as a consequence, the blood is less perfectly changed. The impediment to breathing is increased when the corset extends so low as to compress the abdomen; by the bowels being then forced up- wards against the diaphragm, (or partition between the chest and abdomen,) the latter is prevented from descending, and the dimensions of the chest are thus contracted from below. A sense of oppression and weight is always experienced about the breast when the corset is drawn very tight around the body; the breathing is short, quick, and panting; and no*" only is the blood prevented, in a great measure, from under foing that change in the lungs by which it is adapted for the ealthy nourishment of the various organs, but the actions ol the heart are also impeded; violent palpitation is not unfre* qnently produced, accompanied with a sense of giddiness and 35 Cinchoha Tree.—From this is gathered the Peruvian Bark, of which the Quinine is made, and is one of the most valuable medicines known to man. Cbanesbill.-Grows in open woods hi aH parts of the United States, the root only used. A powerful astringent, good to maka a gargle in sore throat, or to make a wash for ulcers, sores, &c, or to use for an injec- tion for female weakness (whites), &c, or powdered, is good to mix in poultices for boils, sores, &c. Not much used internally. Blue Flag.—The root, the part used; it I Slippery Elm.—The inner bark makes a acts on the bowels, kidneys and glands. | fine poultice; useful put in water as a drink It must be used with care. Dose, of the in fevers, coughs, diseases of the kidneys^ tincture, one to two teaspoonfuls. | bladder, and for dysentery in children, &c 36 Baybebry.—Grows in damp places. The bark of root used. Ground or powdered, and mixed with flaxseed or slippery elm, as a poultice to tumors, ulcers, &c. Strong tea, cold, as a wash for spongy gums, bad breath, sore mouth, and diseases of the •kin. A stringent and stimulant. Witch Hazel.—This has fruit an ers on the same bush at the same time. A valuable American vegetable tonic, &c. Is now principally used in the form of Extract of Witch Hazel, and to be had at the drujj stores, with directions for use. Mandrake (May Apple). The root. It nets finely on the liver, and is one of the most valuable American indigenous plants. A solid extract, made into half grain pills, to be had of druggists, are very convenient to have in the house. Dose, usually one half grain pill at bed-time. Bitter Root.—A plant growing in most parts of the United States; is a good, gen- tle purgative, alterative and tonic. Make a strong tea, and use cold, taking a wineglass full before each meal, in cases of syphilis, disease of the liver, scrofula, and general debility. Clothing, 37 occasional fainting. When the corset is worn constantly from earvv youth, the growth of the ribs is prevented, and the whole capacity of the chest is permanently contracted; and hence spitting of blond, difficulty of breathing, or even more dan gerous and fatal diseases of the lungs and heart are induced. Consumption is a very common complaint, the production or aggravation of which may be traced to tight lacing. But it is not merely to the chest that the injurious effects of the corset are confined; it likewise compresses the whole of the upper portion of the abdomen (or bowels,) and by the yielding na- ture of this portion of the body, the pressure upon the organs within is even more considerable than that experienced by the heart and lungs. The liver, the stomach, and the bowels in particular, experience this pressure to a very great extent; in consequence, the free and healthy secretions of the liver are prevented from taking place, the stomach and the bowels can no longer perform their functions with proper vigor and regu- larity ; the digestion of the food is impeded, and the bowels become costive and distended with wind. In this manner, in connection with the injury inflicted upon the lungs, the vigor of the whole system becomes prostrated, the skin assumes a sal- low hue, the countenance a haggard and wrinkled appearance, and all the functions of life arc performed imperfectly. It is a fact, that nothing is better adapted to produce the pre- mature decay of beauty, and the early appearance of old age, than tight-lacing. There are two other effects produced by this article of dress, which would be sufficient of themselves to induce every pru- dent and sensible female to abandon it. The first is the great injury inflicted upon the breasts, by which tlieir proper development is prevented, and the nipple is almost entirely obliterated, so that, when called upon to fulfil the sacred office of nurse towards her offspring, the mother finds, to her sorrow, that, from her folly, she has totally incapacitated herself from performing its duties, or experiencing its pleasures. The second effect is that produced by the pressure of the corset upon the pelvis (hips) and the womb, more especially when worn in early youth, or during the first stages of pregnancy. From this cause barrenness, miscarriages, or a stunted and deformed offspring may result, or the pains, the difficulties, and the dangers" of child-birth, may be increased to a frightful degree Let no American woman talk a>out the Chinese women com pressing their feet tc it****! "«em from growing, so long as %he continues the life-destroying custom of tight-lacing. G-arters.—Tight garters are injurious by impeding the cix 38 JZxercise culatiou of the blood in the leg. Swelling and nuiabneis* of the leg, and permanent enlargement of thu veins of that liinh, ire consequences of wearing tight garters. EXERCISE. Br this means disease may often be prevented, and not nnfrequently cured, even when it has taken a very strong hold npon the constitution. Generally speaking, a slothful and sedentary life is the source of all those diseases which ara termed slow or chronic, the number of which is in our day very considerable. The exercise which is necessary to the maintenance of the health, vigor, and the perfect and full development of the human frame, is such as will bring into action every limb and muscle ; this is termed active exercise, and is produced by the exertions of the body in walking, running, and various specier of labor. The chief kinds of passive exercise are, riding, swinging, arid rowing. To derive all the advantage resulting from exer- cise, it must be regular. Little benefit need be expected, when, to occasional exercise of the muscles, a long period of inaction succeeds. Exercise, to be beneficial, must also be in the open air, and should never be carried to the length of inducing undue fatigue. The other general rules in regard to exercise, may be laid down as follows:— The effect of exercise should be as general as possible, and not confined to any particular limb or part of the body, as walking, running, riding on horseback, etc. Little benefit is to be expected from exercise, unless it be performed in a pure air. The higher and drier the situation, and the more varied the air in which exercise is performed, the more beneficial will be its effects. On commencing any exercise, we should always begin with the more gentle, and then proceed to the more laborious : and as sudden transitions are always wrong, the same rule should be followed when exercise is given up. A good appetite after exercise, is a proof that it has not been carried to any improper excess. It is a good rule, frequently to vary the exercise. Lord Bacon correctly observes, it is requisite to long life, that the body should never abide long in one posture, but every half hour at least, should change it, except during sleep. Muscular motion is most agreeable and healthful, when th« Exerewe. 39 •tomach Is neither too empty, nor too much distended. Active exercise iroper than for the sedentary and inactive. Infants require ess animal food than children, children than adults, and wo- men than men. In summer, the quantity of animal food should always be diminished, whatever may be the habits or occupa- tions of the individual. In winter, and in the more northern climates, a more permanent and stimulating nourishment ia required than under opposite circumstances: this is best afford- ed by animal food. The different kinds of animal food differ in the degree of nourishment they afford, as well as in the ease with which they are digested. Thus, the flesh of full- grown animals is much more digestible and nutritious than that of their young; and as it respects the larger animals, this rule is without exception. Beef and mutton, for example, are more easily digested, and more wholesome than veal and lamb. The sex of animals, too, influences the nature of the food; the flesh of the female being more delicate than that of the male. The mode of killing, too, gives a tenderness to the flesh. Hunted animals are more tender than those that aie Appetite. 45 killed on the spot. The flesh of animals which are allowed to range freely in the open air, is more wholesome and nutritious than of such as are stall-fed. In general, the flesh which ia dark colored, and which contains a large proportion of fibrin, is more digestible and nutritious than the white flesh of ani- mals. The black meat of fowls, so called, is more nourishing than the white meat, (the breast, &c.) Thus, the flesh of do- mestic fowls is not so readily dissolved in the stomach as that of the different kinds of game. By cooking, animal food is changed in its texture, being generally rendered softer, and easier of digestion ; but by improper modes of cooking, a re- verse effect is produced, the food being rendered indigestible, unnutritious and unwholesome. Variktirs of Animal and Vegetable Food.—Gelatine, or animal jelly, is highly nutritious; but in its separate or concentrated state, it is difficult of digestion ; hence, the im- propriety of the dyspeptic, and persons of weak stomachs generally, being fed upon strong soups, calves' feet jelly, and similar articles of food. Calves' Feet Jelly.—Plain calves'feet jelly, or that which is sweetened, is grateful to the palate, very nutritious, and not very difficult of digestion; it is sometimes a useful article of diet for convalescents; it may be taken cold, or dissolved in warm water, according to circumstances. It should, however, only be given occasionally, or in moderation ; for jelly, like all other concentrated food, is not so readily converted into blood, as many other articles which contain a less amount of nutri- ment. The addition of wine and spices to the jelly, renders b. an improper article of diet under most circumstances. Albumen.—The purest example of albumen is that presented by the white of the egg; it nevertheless enters largely into the pomposition of many of the animal fluids and solids. As an article of food, it is at once readily converted into blood, it I eing taken up by the absorbent vessels, without its being re- quired to undergo digestion, while at the same time it is highly nutritious. The injurious effects resulting from the eating of hard boiled eggs, are occasioned in a great measure by tlie effects of the heat upon the oily matter of the yolk. Milk.—This is one of the most valuable presents which ■ bountiful providence has bestowed upon man. In many in- ttances, either alone, or in combination with vegetables, it has formed the sole sustenance of life—maintaining fully the health and robustness of the system, without any of the disadvantages which result from an excess of animal food on the one hand, or the diminished strength and vigor which have been sup- 46 Appetite. posed to be the effect of a purely vegetable diet, on the other. Incalculable would be the benefits which would result to the working and laboring classes of our country, were they U mbstitute this wholesome and nourishing food in their fami lies, for the expensive and unnutritious slops, which, under the name of tea or coffee, constitute the chief of their morning and evening meals; or, to substitute a tumbler of milk for the pernicious dram of ardent spirits, beer, porter, or ale. For children, milk with bread, or a simple preparation of milk with rice, or with eggs and sugar, is perhaps the best and most wholesome food that can be devised: it should, at least, form the principal part of their nourishment for the first few years of their life. Milk, to be perfectly wholesome, should be drawn from sound, young animals, supplied with a sufficiency of their na- tural food, and allowed free exercise in the open air. The best mode of using it, is, undoubtedly, in its ?>aw state, and when it has stood about two hours after being drawn. Eggs.—Eggs contain a great deal of nourishment in a small bulk ; and when perfectly fresh, and soft boiled, they consti- tute a species of food of very easy digestion. When hard boiled, and especially when fried, they are indigestible and stimulating. Cheese.—All kinds of cheese are of difficult digestion ; and can with safety be made use of, only in very small quantities, as a condiment along with other food. The idea entertained by many, that a portion of old cheese taken with the desert aids digestion, is perfectly absurd. When cheese has advanc- ed very near to a state of putrefaction, though eaten by certain epicures, it is at once disgusting to the senses, and injurious to the stomach. Certain changes which cheese occasionally un- dergoes, impart to it poisonous properties. Roasted or cooked cheese, is very indigestible, and liable to occasion painful sen- sations in the stomach, headache, sour belchings, feverish heat of the skin, and disturbed sleep/ When eaten, cheese should always be combined with a large portion of bread. Butter.—Butter is used as a sauce to many articles of food and is frequently added to flour to be baked into cakes and pastry, and it is in both these forms injurious, for though it does not produce effects that are immediately apparent, iUayi the foundation of stomach complaints of the greatest obsti- nacy. Its use in this form is also very apt to give rise to diseases of the skin, very difficult to cure. Persons laboring under stomach complaints should not use much butter in any Appetite. 47 form. It is also very unwl>olesome when heated. It is a bad part of the management of children, to pamper their palates by frequently indulging them with butter; as it is apt to give rise to a gross and unhealthy habit of body, characterized by the frequent appearance of boils and other sores, discharges from behind the ears, &c, or eruptions on the head, and other parts of the skin. Fat affords a rich nutriment, requiring, however, strong powers of digestion, and adapted only to the healthy and la- borious; it is more wholesome, however, when eaten with a proper quantity of lean, or with a considerable addition of farinaceous aiimenf. in the form of potatoes, bread, rice, &c., &c. Beef.—Beef affords a strong, easily digested, and whole- some nourishment; it should be tender, fat, and well mixed, (lean and fat) and taken from a bullock of middle age. Of its different parts, t\\e fat is less easily digested than the lean; the tongue and also the tripe, being of a more dense texture than the other parts, are more indigestible. The best mode of preparing beef, is by roasting, or boiling. Beef-steaks appear to be the form, however, in which its nutritious quali- ties are best retained. The excessive body of fat which is accumulated upon what is called prize beef, adds nothing to its goodness, but on the contra^, renders it less wholesome and nutritious. Mutton.—Mutton is a highly nutritious and wholesome meat. It appears to be the most digestible of all animal food. The flesh of the male animal, however, has in general so strong and disagreeable a taste, and is; besides, so exceedingly coarse, and difficult of digestion, that it is only adapted to persons of strono- digestive powers. Ewe-mutton, if it is more than be- tween three and four years old, is likewise tough and coarse. Wether-mutton, or the flesh of the castrated animal, is most esteemed, and is by far the sweetest and most digestible. Lamb being less heating, and less dense than mutton, is bet- ter suited to persons convalescent from acute diseases; but by the majority of patients laboring under indigestion, or any other severe affection of the stomach, it is not found so digee fcible or proper a diet as wether-mutton. It is, however, to trtrsons in health, a light and wholesome food, especially when the lamb is not killed too young. A lamb that has been al lowed to suck five or six months, is fatter and more muscular. and in every respect better, than one which has been killed when two months old, and before it has had time to attain its proper consistency. 48 Appetite. Venisow—The flesh of the deer is reckoned a great delica cy ; it is nutritious, savory, and easy of digestion. Veal.—The flesh of the calf, like that of all young animals, abounds in gelatinous matter; it is far less easy of digestion •han the flesh of the ox, or beef. For persons in health, the most proper mode of cooking veal is by roasting or baking. Veal Broth produces a laxative effect upon the bowels and is a very suitable food for persons troubled with costive Bess. Pork.—Good pork is unquestionably a very savory food, and affords strong nourishment, well suited, as an occasional diet, to persons who lead an active or laborious life ; but it is not easily digested, nor can it be considered so wholesome as beef or mutton. The too frequent and long continued use of this meat favors obesity or fatness, and is apt to disorder the stomach and bowels, and occasions pimples or boils upon the skin. Bacon.—It is a strong, very indigestible, and stimulating food, adapted only to persons of robust frame, and accustomed to laborious occupations. The best mode of cooking bacon is by boiling it with vegetables. When fried with eggs, it ia decidedly unwholesome. Ham.—When properly cured, and when boiled, ham is a fery palatable and wholesome food. It is, however, stimulat- ing and difficult of digestion, and only suited to such persons as are in full health and exercise much in the open air. Fried ham is still more indigestible than that which is boiled. Sausages.—In whatever form they are eaten, sausages are an indigestible and unwholesome food, fitted only for the stomach of the most robust. When sausages have been long kept, particularly in a damp place, they are apt to undergo certain changes, in consequence of which they become poi- sonous. Poultry.—Poultry, in the common acceptation of the term, includes all the domesticated birds used as food, as the common fowl, turkey, duck, and goose. In point of digestibility they rank nearly in the order we have enumerated them. Chicken Soup.—Chicken soup, when properly prepared, it a light food, adapted to many invalids and to persons conva lescent from fevers. For their use it should be prepared from the fleshy or lean parts of the chicken, well boiled in water with a little salt, the scum and fat being taken off as it rises. Fish.—Fish are less nutritious than the flesh of warm-blood ed animals, while to most stomachs they are more difficult of digestion. When used habitually, they are apt to induce dia Appetite. 4? eases of the skin and disorders of the bowels. The fat offish is still more indigestible than that of other animals, and readily turns rancid on the stomach. When not in season, all kinds of fish everywhere, are very indigestible an'd unwhole- some. The best mode of cooking fish is by boiling; stewed or fried fish are very indigestible. Salted and dried fish are a still more unwholesome food than such as are eaten fresh. Butter and the acid fruits form improper sauces for fish, caus- ing it almost always to oppress and irritate the stomach : nor should fish and milk ever be taken at the same meal; this com- bination has frequently occasioned severe bowel complaints. Salt-water fish are the best. Those fish which have scales are, in general, the most easily digested, and the best. Salted Meat.—Salted meat is more difficult of digestion than that which is eaten fresh ; it is also less nutritious, both from the pickle in which it is immersed washing out, as it were, a considerable amount of its nutritive parts, and from the chemical change which it always undergoes to a greater or less extent. When used as food, salted meat should always be well boiled, and eaten with a large quantity of vegeta- bles. Crabs and Lobsters, in whatever manner cooked, are indi- gestible and decidedly unwholesome. The Mussel, a shell-fish often used as food, is highly indigestible and unwholesome. Oysters, when taken raw or after being slightly cooked by roasting, are a ight, nutritious, and easily digested food. The hard white part, or eye, should always be rejected. When thoroughly cooked, particularly when stewed or fried, oysters constitute, 011 the other hand, one of the most indigestible and pernicious articles of food in ordinary use. When out of sea- son, oysters are always unwholesome. The juice of the oyster, thickened with grated biscuit and warmed, is sometimes an excellent diet for persons laboring under great delicacy of tomach. Soups.—For the laboring classes generally, there is scarcely more wholesome and economical article of diet than soup. We allude now to the ordinary domestic soups, prepared from beef, mutton, or veal, with the addition of various vegetables. In the preparation of soup, the meat and vegetables should be well boiled, and whatever seasoning is added to increase the flavor, care should be taken that it be not thereby rendered too stimulating. The combinations of flour and butter, which are sometimes met with in soups, under the denomination of dumplings, are highly indigestible and improper. Soup should 50 Appetite. Always be eaten with plenty of bread ; this gives it that degree of consistency which, in all our food, appears to cause it tc oe the most readily acted upon by the stomach. Many suppose that soups generally are calculated only for those whose powers of digestion are weak; but this is a mis- take, the reverse being generally the case. When the digestive powers are weak or deranged, it will almost always be found that solid food agrees the best, particularly solid animal food; this the stomach seems to digest with ease and in a very short time; whereas, liquid food is apt, in such cases, unduly to dis- tend the stomach and to require a greater strength-of digestive power. Rice.—When mixed with other food, it furnishes a whole- some article of diet. Rice is supposed to be in some degree astringent; and in looseness of the bowels, the water in which it has been boiled forms an excellent drink. By its mild mu- cilaginous properties, it aids greatly also in allaying irritation in all diseases of the bowels. Oats.—The meal obtained by grinding the grain of oats affords a wholesome and nutritious food, used boiled with wa- ter, in the form of gruel, or made into thin cakes. Gruel.—By gruel is generally understood oat-meal or [ndian meal boiled in water. Thin plain oat-meal gruel, or a gruel made in the same way from Indian meal, is a useful diet for convalescents from fevers, and for those who have committed an excess in eating. Rye affords a meal, the food prepared from which, though less nutritious than wheat, is nevertheless wholesome and suf- ficiently nourishing. Rye bread is more difficult, however, of digestion, and is apt to turn sour in the stomach and to irritate the bowels. Barley.—Barley forms an excellent article of nourishment when boiled in water, or made into cakes. Barley bread is not, however, a very pleasant nor wholesome food. Barley-wateb.—The water in which barley is well boiled, forms one of our best drinks, in various fevers and other dis- eases. Maize, or Indian Corn.—The meal made by grinding Indian corn, prepared in various ways, but especially when made into mush, or with the addition of wheat flour bake* into bread, furnishes a most wholesome, nourishing, and pal stable food, and one well adapted for the support of the activa and laborious generally. Indian bread, properly prepared, were it not from habit and fashion, would recommend itself to every palate by its agreeable flavor, and the beauty of its ap- Appetite. 51 pearance; it is far preferable to the ordinary bread made from wheat alone. To make this bread, a mush should be made of the Indian meal in the usual way ; into this, when cold, with the addition of a very small quantity of warm water, and a little salt and yeast, is to be kneaded a sufficiency of wheat flour to make it into a paste; when sufficiently raised, »t is tc be again kneaded, and baked in the same manner as bread. Bread.—New bread is particularly unwholesome and indi- gestible. The only apparent exception is in the case of new rolls, which healthy stomachs manage to digest pretty well, provided they be well baked, and the crust bears a consider- able proportion to the whole. Bread slightly toasted, but not burned, is a wholesome diet, especially for persons upon whose stomachs most articles ot vegetable food, including bread in its ordinary state, are apt to turn sour. In eating toast, the butter should not be spread upon it until it is cold. Panado.—The crumb of wheaten bread softened with boil- ing water. It forms an excellent diet for children ; for those affected with fevers, and for women during the first days after delivery. Ginger-bread.—When well baked, and eaten in modera- tion, it affords, under many circumstances, a useful stimulus to the stomach. It is an excellent article for individuals going to sea; it being frequently, in cases of sea-sickness, retained on the stomach, when every other article is immediately rejected. Travelers, also, on setting out early in the morning, will find, that eating a small portion of it, will afford a gratefui stimulus to the stomach, when they have been obliged to commence their journey without breakfasting. Pastry, or dough mixed with butter, is used in a great variety of forms, and though grateful to the taste, is highly indigestible, and injurious to health. At dinner, in the shape of pies and tarts, pastry is thrown into the already loaded stomach, and the over-taxed powers of that organ are unable to digest what is difficult to manage when they are the most vigorous. To children, pastry is peculiarly unsuitable; they who use it much, are subject to runnings from the ears, dis orders of the bowels, eruptions on the skin, and inflammatory complaints of various kinds. Puddings, when composed of flour, or crumbs of bread, combined with suet and dried fruit, are extremely indiges- tible, and constitute ^o of the most unwholesome dishe* 52 Cookery. served at meals. Puddings and dumplings made of batter. baked or boiled, are also indigestible, and unwholesome. Bread and milk pudding, as well as rice pudding, is readily digested, and may be eaten in moderation, without injury. Sago, boiled with water, or milk, furnishes an agreeable and nourishing jelly; it is easy of digestion, and excites the system but little ; and is an excellent article of diet for con- valescents and for children. Potatoes constitute an article of diet, which, whether we have reference to the nourishment it affords, the agreeableness of its flavor, its wholesome qualities, and the extent to which it is consumed, is certainly of the greatest importance to man. Potatoes are the lightest and most nutritious of those vege- tables which are served at table in their natural state; and, next to bread, the very best accompaniment to every kind of animal food. The dry, mealy kinds are the best, and should always be preferred to those which are hard and waxy. The best manner of cooking the potato, is by boiling in two waters, or by roasting. Finely mashed, or fried potatoes, are indiges- tible and oppressive to the stomach. Cabbage affords but little nutriment, is very flatulent, and where the stomach is delicate or irritable, it is very apt to produce uneasy sensations, cholic, &c. Boiling in two waters deprives it, in a great degree, of that unpleasant taste and smell, which are so disagreeable to many palates. Sourcrout forms an excellent and wholesome vegetable food for the crews of ships destined for long voyages; and for all persons so situated as to be deprived of a sufficient supply of fresh vegetables. In regard to its effects upon individuals, whose powers of digestion are impaired, the same remarks will apply as to cabbage in its recent state. COOKER Y. When meat is boiled too long or too fast, if it contains much albumen, as in beef, we shall obtain a hard and indigestible mass, like an over-boiled egg; or in young meats, such as veal, where there is more gelatine, the result will be a gelatinous substance, not easily digestible. Young and viscid food, therefore, as veal, chickens, &c, are more wholesome when roasted than when boiled, and are easier digested. Boilino- ii very properly applied to vegetables; as it renders them m°or« soluble in the stomach, and deprives them of a quantitv of ail and other particles which are pernicious to weak stomachs. The quality of the water used in boiling requires some atten Cookery. 53 lion; mutton boiled in hard water is more tender and juicy than when soft water is used, while hard water renders vege- tables harder and less digestible. Roasting.—By this process, the fibre of meats is made crisp the fat melted, and the water evaporated. When underdone roasted meat may be more nourishing; but, from the close- ness of its texture, it will not be so easily digested. Meat loses more by roasting than by boiling; by boiling, mutton loses one-fifth, and beef one-fourth ; but by roastiug, they lose one-third of their weight. Frying is, perhaps, the most objectionable of all the opera- tions of cookery. The heat is applied through the medium of boiling oil or fat, which is rendered scorched, and therefore extremely Lable to disagree with the stomach. Broiling.-—By this operation, the sudden browning or hard- ening of the burface prevents the evaporation of the juices of the meat, and imparts a peculiar tenderness to it. But the over-excited health brought on by eating meats thus cooked, is peculiarly liable to become changed into disease from very slight causes. Baking.—Baked meats are not so easily digested on account of the greater retention of their oils. Such dishes, accordingly, require the stimulus of various seasonings to increase the di- gestive powers of the stomach. As there is often much pastry, made with butter, used to confine the juices of the meats baked, such accompaniments render meat pies of all kinds of food the most difficult of digestion. Stewing has a similar effect to boiling in depriving the meat of much of its nourishing juices ; but as the fluid in which the meat is stewed is made use of as food in connection with the latter, little nourishment is absolutely lost by this mode of cooking. Stewed meat is less easily digested than that which is boiled ; it is also more stimulating. Simple stewinsr is a mode of cookery well adapted for the food eaten by those of •obust frames and laborious habits. Meals.—Regularity in the number of meals, and the periods at which they are taken, is of the first importance ; on it much of the equable and pleasant enjoyment of health depends. In Seneral, three meals, in the course of the day, seem the most esirable, and the best adapted to the wants and constitution of the human frame; while, at the same time, this number is best suited to the powers of the digestive organs. The practice which leaves the great bulk of the day without a meal, and then crowds two or three together, is manifestly bad, as it produces in the body a state of exhaustion and far 54 Cookery. tigue, which strongly tends to enfeeble the powers :>f digestion To confirm and preserve health, whatever maybe the nuinbei of meals taken, they should be eaten at regular times and stat- ed periods. Six o'clock dinners, are only another way of lestroying health, and shortening life. The extremes of too /ong fasting, and too frequent repletion, should be carefully aTOided ; for the langor of exhaustion and the fever cf reple- tion are equally injurious to the healthy state of the stomach: its muscular fibres are debilitated by excess; while a collapsed itate of the organ occasions its loss of tone and energy, and superinduces constitutional weakness. And it should be re- membered, that one meal should be duly digested before the introduction of another into the stomach. Breakfast.—During sleep, the whole of the food taken the previous day has probably been digested; but, in general, it is proper to interpose some time between rising and taking breakfast, and take some light exercise. Dinner.—The period for dining appears to be wTell choseD for the active classes of society more especially. Dinner should always consist of one kind of meal, plainly cooked. Variety of food, like too much seasoning, keeps up the appe- tite after the wants of the system are satisfied ; the stomach is oppressed by too great a quantity of food, and digestion is im- peded even to a greater extent than were the same amount to be eaten of a single dish. Let it be recollected, also, tint dishes compounded of a number of ingredients, the natural qualities of which are completely disguised, by the refinements of cookery, are altogether unwholesome : many of them are little better than poisons. It is all-important that sufficient time should be allowed for this meal, in order that the food mav be properly chewed, without which its digestion will be greatly retarded. If the food be sufficiently plain and juicy, thirst will seldom be experienced ; but when a desire to drink is experienced, a moderate draught of water will be proper. But no other liquor should be taken—water is the only natural diluent of our food, every other liquor impedes its digestion. The custom in use among some people of taking drams or bit- ters before meals, for the purpose of whetting the appetite, is highly pernicious, and has quite a contrary tendency to that designed, as it relaxes the stomach, and consequently enfeebles t for the operations it has to perforin. Nor is the fashion of taking wine, or brandy and water, during dinner, less repre- hensible. The use of bottled cider, porter, or beverage, during this meal, is also injurious, as it unnecessarily distends tin stomach, and thus prevents its muscular contractions, at th« Cookery, 55 rery time whwii it is necessary they should be brought into action, and preserved in tlieir full vigor. To say the least of all these vuigar errors in diet, they check the process of diges- tion, and paralyze the powers of the stomach. Supper. —As the powers of the body, and digestion among the rest, are diminished in their activity during sleep, it is an unsafe meaeure to load the stomach at bed-time with a quan- tity or various kinds of food. Do not eat meat for supper. Under no circumstance should food of any kind be taken for two or three hours before retiring to rest. Drinks.—In warm weather a much greater quantity of drink is demanded, than when the atmosphere is temperate or cold. This arises from the stimulating effects of heat upon the sys- tem ; but chiefly by the waste of the fluid portion of the blood, occasioned by the increased perspiration. For the same rea sons, active exercise or labor augments the thirst. Salted, high-seasoned, and ail stimulating food increase the demand for drink, by stimulating the lining membrane of the mouth, throat, and digestive organs, and increasing the viscidity and exciting properties of the biood. Nature calls for water to take out the salt or other stimulating substances contained in the food, so that digestion may be more easily accom- plished. Persons in good health, generally, take a great portion of their drinks, especially at dinner, of the temperature of the atmosphere; but in weaker stomachs, the drinks may be re- quired to be a little warmed, though it is seldom safe to take them habitually very hot; and far less is it proper to chill the energies of the stomach, by cold or iced drinks. The quantity of drink taken, is also of much consequence to good digestion ; a large volume of fluid will prevent the food from being pro- perly acted upon by the stomach ; and if there be too little, the mass will be dry and hard. Different kinds of food require different quantities of liquid : animal food requires more than vegetable; roasted, more than boiled ; and baked meat, more still than roasted. To drink much before a meal, is unwise; but to drink more or less, during a meal, according to the na- ture of the food, assists digestion. Toast-water is perfectly wholesome, and agrees frequently with persons whose stomachs do not relish pure water. It has a slightly nutritive quality, and may be allowed in all the fe- verish and other cases, where cooling drinks are proper. Whey affords a bland, easily assimilated nourishment increasing the secretions, and tending to produce a beneficial change in the fluids of the body. It contains a considerable 56 Cookery. amount of sugar, which renders it sufficiently nutritious. As a drink, whey is well adapted to allay thirst in hot weather. Buttermilk contains but little nutritious matter; but, h warm weather, it forms an excellent cooling drink, and with bread, may constitute a considerable part of the diet of children. Tea.—The properties of tea seem to be those of an astrin- gent and narcotic; but like some other narcotics, in smal quantity, its first effect is that of a very gentle stimulant, and certain kinds of it, when taken pretty strong, and near the usual time of going to rest, have the effect of keeping off sleep; but when weak, and taken moderately, and tempered with cream and sugar, it acts merely as a grateful diluent, and produces a slight exhilaration. Tea and coffee, when used in moderation, are beneficial, by preventing the waste of the tissues of the body. Of course, where they disagree with the system, as we observe in some temperaments, they must be discontinued. The green and high-flavored teas are those which are the least wholesome. Tea should not be taken soon after dinner. The following rules, respecting the use of tea, will be found useful:—Carefully avoid the high-priced and high-flavored teas, more especially if green. Take with it, at all times, a good proportion of milk, and some sugar, as correctives to any {>ossible noxious qualities present. Make the infusion proper- y, with water, soft, and otherwise of a good quality, and in a boiling state. Take less tea in the morning than in the eve- ning. Coffee.—The infusion of coffee acts as a stimulant upon the stomach, the heart and the nervous system, increasing the cir- culation of the blood, augmenting the heat of the skin, and exhilarating the mind; these, its immediate effects, are follow- ed, however, by an equal degree of depression in the function! of those several organs: the excitement and subsequent depres sion being in proportion always to the strength of the infusion, and the quantity drank. Coffee bears a strong analogy, in it* effects upon the system, to wine, ardent spirits, and opium; from the latter, its effects, however, are very different in de- gree. Coffee, therefore, when drank very strong, or indulged in to excess, is unquestionably injurious; it seldom fails to disorder the stomach, impair its digestive powers, and in del ioate habits it often occasions watchfulness, palpitation of tha heart, head-ache, and many of those complaints, vaguely de- nominated nervous. To the dyspeptic and sedentary especially it forms a very improper article of diet. When taken weak. Cleanliness. 57 and with plenty of cream or milk and sugar, it may however bt indulged in sparingly, by persons in health, and who lead sciive lives, without much inconvenience. Coffee should never be taken late in the evening, in consequence of its ten- dency to prevent s.eep. CLEANLINESS. Personal cleanliness consists in the careful removal of evcxp Impurity from the surface of the body, whether generated by itself, and attached to the clothing in immediate contact wth it, or contracted from the air and other matters with which the body is accidentally or constantly surrounded. Allowing impurities to accumulate upon the surface not only gives rise to a disgusting effluvia, by which the air the individual breathes is contaminated, but occasions various eruptive dis- eases of the skin, and the internal organs sympathize with it. Whatever suspends or impedes the functions of the surface, whether cold or filth, a derangement to a greater or less ex- tent of the internal organs invariably results. By the action of the numerous blood-vessels of the skin, there is removed from out the system, in the form of an insensible perspiration, an immense amount of matter, the retention of which would be productive of uncomfortable feelings or disease. The means of preserving the purity of the skin is frequent ablutions with water, with the addition occasionally of soap and frictions. The ablution of the body should be frequent and general, and not confined simply to the face, neck and bunds. Washing the entire surface in water of a proper tempe- rature, and at short intervals, would sensibly increase the strength, health, and pleasurable feelings of all, whatever may be U leir sex, age, or condition in life. Frequent change of clothing is equally necessary. Domestic cleanliness is of scarcely less importance to the preservation of health than that of the per- son and clothing. Fiom every apartment of our dwellings, as well as from the yards, cellars, vaults, and outhouses attached to them, should every species of filth, every thing which by its decomposition is liable to contaminate the air, be immediately removed. We should prevent all accumulations of filth and stagnant arater in the streets, courts, and alleys of towns, drain marshes, and keep sinks, and privies well cleaned out, and frequently, in warm weather more especially, dissolve one pound of sul phate of iron, (common green vitriol or copperas,) in a pail of hot water, and throw some down the sinks, privies, &c.-* 58 Cleanliness. Never leave slops, or any thing offensive, in sleeping apart ments, but let them be removed at once, more especially in cases of sickness. Many families have been prostrated with various forms of fevers, dysentery, or other diseases, by the slops from the kitchen being thrown into the yard, and there decomposing, and generating poisonous gases. Unless their debility be very great, and unless it ~>q productive of much pain and suffering to move them, the bed and body linen of the sick should be kept very clean, and fre- quently changed ; their apartment should be cleaned and wel1 aired, and all offensive discharges should be very carefully and speedily removed. Soap.—In addition to the perspiration which is thrown out by the skin, a portion of which always remains upon the sur- face, the latter is constantly lubricated by an oily fluid. This oily exudation greases the linen when it is worn for too iong a time—catches the dust floating in the air, and causes it to ad- here to the skin, and likewise retains in contact with our bodies, a portion of the dead matter, which it is the office of the skin to discharge from the system. The removal of this deposit, which is constantly accumulating, is absolutely neces sary, as well for personal comfort as for the preservation o; health. It cannot be effectually removed without the occa- sional use of soap, with which it combines without difficulty. Washing all over, with soap and water, occasionally, is very necessary. Mechanics, and they who, from any cause, are peculiarly liable to have deposited upon tlieir skin, dust, dirt, or any foreign matters, should wash with soap and water often, and also rub afterwards well with a rough dry towel, as «rell for the preservation of the skin as of their health general/. If you can only get a bowl of cold water, some /.ood soap and a rough towel, yon can have all the advances to be derived from the most fashionable bath-tub—only being care- ful to avoid getting cold, by thorough rubbing of the surface with a dry vowel, after the washing all over in soap and water. The ordinary brown and yellow kinds of soap are altogether unfitted for cleansing the skin, as they irritate it, and when frequently used, most generally cause it to become rough, chapped, or covered with painful and unsightly pimples. Most if not all, of the colored and variegated soaps, prepared express- ly for the toilet, are equally objectionable. Pure white soap ought, therefore, to be invariably used in ablutions of th.3 faca and hands, or of the surface generally. 59 Pipsissewa (Prince's Pine). This is an astringent tonic and diuretic (actiDg on the kidneys). All the plant can be used. A wineglass full or more of tlie tea (cold) three times a day. STAR GRASS (Unicorn Root, Ague Root, Crow Corn). An American plant, and val- ued highly as a medicine. A fluid extract, given in doses of ten to twenty drops, three times a day, is prescribed in cases of pain- ful menstruation, dyspepsia, falling of the womb, &c. A tincture can be given in doses of one or two teaspoonfuls three times a day, instead of the fluid extract. Uva Uhsi —Grows in Europe, Asia and America. Berries do not mature till winter, but flowers appear June to September. The part used is the leaves. In diseases of the kidneys and bladder, thought to be valuable In urinary gravel, painful urine, and chronic inflammation of the bladder, kidneys, &c. A strong tea, cold, a teaspoonfnl three/ times a day. It is tonic and astringent. | Ginseng.—Used principally as a pleasant article of personal use, for chewing, much better and safer than tobacco. The Chinese used to pay fabulous prices for it. John ta _etting wiser. 60 Horehound.—Too well known as a valu- able medicine for coughs, colds and sore throats, as a syrup, gargle, etc., to need any recommendation from us. Chamomile (The Flowers). A tonic for weak stomachs; good to mix with poulti- ces ; often used in form of tea {cold) for dyspepsia, wind on the stomach, &c. STRAMONIUM (Jamestown Wood, Stink- wood, Thorn Apple, &*e.) Not fit for inter- nal use by any but physicians. This is a deadly poison. Poke Root.—A valuable American medi- cal plant An extract made from the root, in doses of one to three grains, three times a day, is given for mercurial and syphilitic diseases, rheumatism, &3. A valuable poul- tice is made by putting the root into hot ashea until soft, then applied to felons, &c. Sleep. 61 SLEEP. It is highly important that every body should understand that sound, refreshing sleep is of the utmost consequence to tha health of the body, and the vigor of the mind. Among the marks and symptoms of long life, that of being naturally a regular and sound sleeper, is considered to be one of the surest indications. Great watchfulness, by accelerating the consumption of the fluids and solids, abridges life, and a proper quantity of repose must tend to its prolongation. Quantity of Sleep.—What number of hours are necessary to be passed in sleep, is a question that has occasioned much discussion. The opinion generally entertained by the ablest physicians, is, that from seven to eight hours, in the four-and* twenty, constitute, generally speaking, the proper time, and that this period should scarcely ever be exceeded by adults, in the enjoyment of health, though the delicate require more than the vigorous, women more than men, and very young children more than either; but it is worthy of particular re- mark, that the sick and weakly seldom require more than eight hours, or at, the most, nine hours, and will rarely, if ever, fail to be injured by a longer indulgence. Proper time for Sleep.—Nature certainly intended exer- cise for the day, and rest for the night. Working at night and sleeping in the day time will, sooner or later, destroy the best constitution. Another point to be considered is, that by the custom of sitting up late at night, the eyes suffer severely, day-light being much more favorable to those delicate organs, than any artificial light whatsoever. The plan of going to bed early, and rising betimes, has been called the golden rule for the preservation of health and the attainment of long life, and it i3 a maxim sanctioned by va- rious proverbial expressions. Indulging in sleep during the day-time, and more especially after dinner, is always productive of more or less injury to health, while it is never found to produce even that temporary feeling of refreshment which results from the same amount of repose taken at night. Best Means of 'Promoting Sleep.—The principa. circum- stances to be attended to, in order to procure refreshing sleep, are, the nature and quantity of our food and exercise; the siaa and ventilation of the bed-chamber; thequality of the bed and of its coverings; and the state of the mind. It is certain that a full stomach almost invariably occasions restless nights, and it is, therefore, an important rule to inaks a very light supper. 62 Sleep. With some persons, the most effectual methods of procuring sleep will fail, unless exercise be resorted to in the open air. Pure air has of itself an exhilarating and soothing effect on the mind, conducive to sound repose. It is an excellent plan when the exercise of the day has been limited, to walk up and down a large room or passage for half an hour, or more, before going to bed, and the use of the dumb-bells for a part of tha time will augment its good effects. If, notwithstanding an adherence to the preceding -nles, sleep is still found to be unsound and unrefreshing, a brisk nse of the flesh-brush, before going to bed, or rising from the bed, and freely ventilating it, will often produce a very favor- able change. Another excellent practice, in case you have gone to bed, and cannot sleep, is to rise, shake the bed well, draw the up- per clothes down to the feet, and walk about, the room, warmly clad, till both you and the bed are aired. Opiates and sleeping draughts should never be resorted to, to procure rest—once resorted to, their habitual use will become neces- sary, as sleep will not occur without their aid; while by their prejudicial influence upon the stomach and other organs, their employment will never fail, gradually, to undermine the health of the system. The following miscellaneous rules respecting sleep deserve to be recorded in this place: Many real or imaginary inva- lids lie long in bed in the morning, to make up for a deficiency of sleep in the night time; but this ought not to be permitted, for the body must necessarily be enervated by long continu- ance in a hot and foul air. By rising early, and going to bed in clue time, their sleep will become sound and refreshing, which otherwise they cannot expect to be the case. It is an indispensable rule, that fat people should avoid soft beds, and should sleep little and rise early, this being the only chance they have of keeping their bulk within due bounds. Such ersons as are subject to cold feet, ought to have their legs etter covered than the rest of the body, when they are in bed. We should never suffer ourselves to doze, or fall asleep, before we go to bed. Reading in bed at night is a most per- nicious custom ; it strains the eyes, prevents sleep, and injures the health. Remember, sleep is sound, sweet, and refreshing, according as the mind is free from uneasiness, and the diges- tive organs are easy, quiet and clear. Beds.—The use of feather beds is very common ir this country, especially in the rural districts, yet there can be no doubt that they are highly injurious to health To the invalid. Sleep. 63 and to young persons who are disposed to distortitn of the spine and shoulder, they are particularly hurtful. Such as consider them a necessary luxury in the winter, should inva- riably exchange them for a mattress in the spring and summer. The injury resulting from feather beds is occasioned, princi- pally, by their accumulating too much heat about the body, and in this manner causing a profuse and debilitating per spiration, and predisposing the system to the influence of slight changes of temperature. l3y yielding unequally to the pressure of the body, the latter is thrown into a distorted position, which being resumed regularly almost every night, is liable to cause in the young and weakly a permanent deformity. Corn husk or shuck mattresses are superior to every other kind of bed, and it, is highly desirable they should be generally adopt- ed. By those whose means will not permit the purchase of hair mattressess, those of moss or straw will be found an excellent substitute. Feather beds are more injurious to the health of children, than even of adults, and especially if they are weakly. In very cold climates feather beds are often necessary, and the aged may often require them, in order to preserve or increase tlieir heat, which is sometimes inconsiderable, and if lessened would prevent their sleeping. Young people and invalids, in particular, ought to avoid many, and heavy, bed-clothes. The use of curtains to the bed should be avoided : they are injurious, by preventing the proper circulation of the air breathed by those who occupy the bed, and by accumulating dust, cause it to be inhaled, into and irritate the lungs. Beds and bed clothes are apt to become damp for want of proper airing when not constantly used. Colds, rheumatisms, and even more fatal complaints may be caused by occupying a damp bed. Beds, instead of being made up soon after the person s^-rise from them, should be turned down, or their cov- erings thrown separately over the backs of chairs, and thus ex- posed to the fresh air from the open windows during the day. Bed-Rooms.—A bed-room ought not to be situated on the ground floor: an elevated apartment is particularly recom- mended. It should be airy, large, and lofty. The more airy a bed-room is, the better; and it will be still better if it be also exposed to the influence of the sun. A bed-room ought to be well ventilated in the day time, as it is principally oc- cupied in the night, when all the doors and windows are shut. The windows should be kept open as much as the season will admit of, during the day. 64 The Passions. Keeping open the windows of bed-rooms during the night ought never, however, to be attempted, but with the greatest caution, except a small space for ventilation, by lowering ths ,op sash, when practicable, or raising the lower one slightly. Do not sleep in a very warm room. Unless there is an apprehension of damp, a bedroom should rarely have a fire in it. They who live in hot countries ought to be very particular regarding the place they sleep in. Tha apartment should be roomy, dark, shaded from the rays of the sun and moon; temperate as to heat and cold, and rather inclined to coolness than heat; while a free admission of air is allowed during the day time, the windows should be carefully closed as soon as the night sets in. Dreaming.—As a general rule, dreaming may be prevented by whatever causes perfect and uninterrupted sleep; such as sufficient exercise during the day, temperance in eating and drinking, a cheerful and contented mind, and the avoidance of late or heavy supper, or of strong tea or coffee during the evening. Many of the sudden deaths which take place durinj; the night, in persons apparently in the full enjoyment of health, are to be attributed to night-mare. The night-mare is a certain uneasy feeling during sleep, as of great anxiety and difficulty of breathing, and of strong but ineffectual efforts to shake off some incumbent pressure, or to relieve one's-self from great inconvenience. It commonly arises from an imperfect and unhealthy digestion, from heavy 6uppers, and from a constrained uneasy posture of the bod^. Such persons as are subject to the night-mare should take no food whatever in the evening, should keep the bowels open, and should sleep upon a mattress with the head and shoulders r&lS6Q THE PASSIONS. Joy.—Instances are not wanting, in which this passion when unexpectedly excited and violent, has produced disease, or even immediate death; but when moderate, and existing only in the form of cheerfulness, it has a beneficial effect in preserving health, as well as in the cure of disease. Hope.—Of all the passions, hope is the mildest; and, though it operates without any visible commotion of the mind or of the body, it has a most powerful influence on the health of the one, and the serenity of the other: it contributes, indeed, so much to the welfare of both, that if it were extinguished, we could neither enjoy any pleasure in this life, nor any prospect of happiness in the life to come; but by the beneficent will of Providence, it is the last of the passions that forsakes us. The Passions. 65 Lovf i? one of the strongest and most absorbing passYms with which the mind is affected, and has at its commencemen when happy, and properly guided by reason, a favorable influ ence on all the functions of the body; but being often in its progress attended with other passions, such as fear and. jeal- ousy, it is liable to become the source of infinite disquietude. No passion undermines the constitution so insidiously, as violent and unreasonable or misplaced love. While the whole soul is occupied with the thoughts of a pleasing attachment both the mind and the body become languid from the contin- uance of vehement desire ; and should there arise any prospect, real or imaginary, of being frustrated in its gratification, the person is agitated with all the horrors and pernicious effects of despair. Love, when violent and unsuccessful, frequently produces a wasting of the body, terminating sooner or later in death. Fear—When intense or habitually indulged in, it destroys the energies of both mind and body, retards the motion of the blood, obstructs digestion, and prevents the proper nutrition of the body. Violent terror has been known, in an instant, to tnrn the hair perfectly white, and in other instances, to produce loss of mind, or even instantaneous death. By weakening the energies of the system, this passion disposes greatly to disease during the prevalence of epidemics. Grief.—There is no passion more injurious to health than grief when it sinks deep into the mind. By enfeebling the whole nervous system, it depresses the motion of the heart, and retards the circulation of the blood ; it disorders the stomach and bowels, and ultimately every other organ of the body, producing indigestion, consumption, and other chronic diseases. Grief long continued, often gives a shock to the constitution that nothing can retrieve. Grief, like fear, predisposes to an attack of epidemical diseases. Anger is a passion suddenly excited, and which often no less suddenly subsides. The nerves are unduly excited ; the pulsation of the heart and arteries, and with them the motion of the blood, are sometimes so much increased, as to occasion the bursting of some of the minute vessels of the brain or lungs. The stomach, liver and bowels, are often violently affected by intense anger—digestion is always disordered, a violent colia is sometimes produced, and very often all the symptoms of jaundice. Thus it is often the immediate agent in the production of fevers, inflammations, spitting of blood, apoplexy, and other acute disorders. An essential means for their subjection, is a regular, active mode of life, a mild and moderate diet, and 66 Care of the Hair. the abandonment of all intense excitements and stimulating drinks. Anxiety of Mind, when constantly indulged in, destroys the digestive powers of the stomach, impairs the functions of the lungs, disturbs the regular circulation of the blood, and mpedes the nutrition of the system. It is a fruitful source of chronic affections of the stomach, liver, heart, lungs and brain, Evevi the anxiety induced, in a sensitive mind, by the ill-hu mor, caprice and unkind treatment of others, is deeply felt, and proves highly injurious to health. CARE OF THE HAIR. Whatever has a tendency to impede the passage of the fluids by which the hair is nourished, from the root along the cavity which exists in the centre of each hair, must necessarily pre- vent its proper growth—render it thin, and deprive it of its soft and glossy appearance. There can be little doubt that this is the effect, to a certain extent, of the practice of twisting the hair from its natural position, and of plaiting or firmly braiding it, pursued in obedience to the dictates of fashion, by most females. Whenever the hair becomes thin and irregular, or its beauty is otherwise impaired, nothing is better calculated to restore its proper growth than cutting it short. Frequently cutting the hair also prevents it from splitting at the ends. In children, keeping the hair short is a circumstance of no little importance. Nothing is more common than to see a luxuriant head of hair accompanied in children by paleness of complexion, weak eyes, and frequent complaints of headache. The hair of children should be cut short until they are eight or nine years old. There is good reason for believing, that children who have a great quantity of hair, are those most liable to eruptions, as scald head, &c.: it is at least certain, that in them eruptions are very difficult to remove. Mothers, whose vanity may be alarmed lest repeated cutting the hair for so many years should make it coarse, may be as sured they have no cause for this apprehension. When there is any tendency to sores or eruptions on the head of children, line combs are very apt to promote them The seldomer a fine comb is applied to the head of an infant the better. However, the head should be well washed witl a good lather of soap and cold water (once a week), afterward washing the soap out with clean water, rubbing with a dr) towel, and then giving the hair a good brushing. Washing the hair in cold water every day, is a great advantage to it Preservation of the Sight—Care oj the Bowels. 67 PRESERVATION OF THE SIGHT, liie following are the general rules for preserving the sight unimpaired for the longest possible period. All sudden changes from darkness to light, and the contrary, hould be avoided as much as possible. Avoid looking attentively at minute objects, either at dawn W twilight, and in dark places. Avoid sitting near a dazzling or intense light, as of a laint or candle, and facing a hot fire. Avoid reading or sewing much by an imperfect light, as well as by artificial lights of any kind. Avoid all dazzling and glaring sunshine, especially when it is reflected from snow, white sand, or other light colored bodies. Avoid rubbing or fretting the eyes in any manner, and wip- ing them with cotton handkerchiefs. Avoid all spirituous and heating liquors, rich and highly seasoned food, and every species of intemperance, all of which invariably injure the eyes and impair their sight CARE OF THE BOWELS. An evacuation once in the twenty-four hours is the best standard of frequency—this, in general, takes place whenever the digestive organs are in a state of health. Confinement to a diet composed chiefly of dry animal food, or of food highly seasoned—the use of fresh bread, and of warm rolls and cakes, very generally induce a costive state of the bowels. Costiveness is very common also in persons who use little exercise, or who pass the greater part of the day within doors in occupations of a sedentary character—females are much more subject to it than males. Lying in bed to a late hour in the morning is unfavorable to a regular condition of the bowels. . Early risers, who pass several hours of the morning walking abroad in the open air, seldom complain of any want of regu- larity in their stools. The daily use of wine, especially the red or astringent varieties, retards very materially the natural discharges from the bowels. The same effect takes place in persons who past the greater part of their time in company, and who from a false delicacy resist the calls of nature. In costiveness, besides early r.'sing, daily exercise of the bodj in the open air, and abstinence from wine and ardent spirits, the d.et should be composed principally of vegetable food Plain soups, especially of veal and mutton, with the addition 68 Feet. of the ordinary vegetables, well boiled a^d not to -> highly sea* soned, will be found a very excellent 'Iiet for those inclined to costiveness. Fresh fruits, perfectly ripe, or fruit cooked, with or without the addition of sugar or moiasses, are gently lax- ative. Spinach, when in season, and properly boiled, is also a very pleasant and wholesome vegetable for persons of costive habits. Bran bread, or wheaten bread with an admixture of lye or Indian meal, is better suited to the habitually costive than bread composed entirely of line wheat flour. For drink, those troubled with costiveness should make use of water, either alone, or with the addition of a small quantity of sugar or molasses. A very pleasant drink is mnde by dissolving currant jelly in water, or by pouring boiling water upon sliced apples or peaches, and allowing it to stand until cold. This acts gently upon the bowels. Buttermilk, or sweet whey, may likewise be occasionally drank with advantage by those whose discharges are defective: all ardent spirits and wines, especi- ally those of an astringent nature, should be carefully avoided. The method recommended by the celebrated Locke, for pro- curing a regular discharge from the bowels, is founded on correct principles, and should not be neglected; it is, " to solicit nature, by going regularly to stool every morning, whether one has a call or not." To remove costiveness, individuals should be extremely cautious in resorting to purgatives, or those medicines, under whatever name they may be sold, which have the effect of inducing evacuations from the bowels. The frequent use of these articles, however mild their operation may appear to be, tends to disturb the stomach and bowels; and consequently to vitiate or retard digestion. THE FEET. The feet are extremely subject to the impression of cold, and when chilled, in consequence of the close sympathy between them-imd other parts of the body, disease is apt to be occa- sioned in some one of the internal organs. They should be protected always from cold and damp, but when accidentally wet, the shoes and stockings should be immediately changed, and the feet bathed in cold water and rubbed perfectly dry with a coarse cloth. Tight and misshapen shoes are injurious, by preventing the circulation of the blood, causing coldness of the feet, and producing corns. The feet are generally much neglected. They should be washed at least once every dayt and rubbed well afterwards with a rough towel, or flesh brush. Thin shoes are killing thousands of females every year—away Physical Education and Diseases of Children. 69 With them at once. Females should wear thick, warm shoes, at all times during cold or damp weather. PHY SIC AL EDUCATION AND DISEASE*. OF CHILDREN. General Symptoms of Disease.—It is often difficult in very young children to determine the disease with which the little sufferer is afflicted,—for as we can obtain no information from the patient relative to his feelings or the history of his maiady, we are obliged to form an opinion from external symptoms alone. The symptoms of disease are nearly the same in child- hood as in maturer age. The sleep, motions, breathing, evacuations, pulse, appetite and mental manifestations, all afford important appearances. The countenance is in most cases an important index of disease; wrhen the expression is calm or lighted up by a smile, it indicates a state'of ease and a regular performance of all the functions: frowning or con- traction of the features, pale, red, or blue tint of the face, rolling up of the eyes, swelling of the upper lip, twitching of the muscles, dilatation or spreading of the nostrils, are all evi- dence of approaching or confirmed disease. The sleep, in a healthy infant is quiet and profound, and indicates a state of ease and comfort; but if there is sleeplessness, sudden starting during sleep, slight spasms, screaming, fright, or deep and laborious sleep, there is some disturbance of the brain or stom- ach and bowels. Crying is the natural language of infancy, and the only means by which very young infants express tlieir wants and Bufferings. Healthy infants cry but seldom, and then only to express some slight uneasiness or vexation : but violent parox- ysms of crying, (unless from anger,) plaintive moaning, short and suppressed, a hoarse or shrill cry, indicate disease. The breathing in health is full, easy and regular,—but it sometimes becomes slow, irregular, difficult, short, laboring, rattling, shrill "crowing" intermittent, or attended with sough, sneezing or hiccup in sickness. The tongue and mouth sometimes show important charac- teristics of disease: paleness or redness, brown or white fur, dryness, swelling, trembling, ulcers or cracks in the tongue are Bigns of disease. Unusual redness of the gums and throat, increased or diminished secretion of saliva, (spittle,) bitter taste or brown scum on the teeth, also point to diseased action in some part of the system. The skin, in health is soft, slightly moist and warm, and has a slight crimson tint of the blood • 70 Management of Children bnt when ft becomes harsh, dry, hot, shriveled, pale, cold, clammy, blue, red, or yellow, some disease exists. A cold profuse perspiration shows debility or other disease: many of the eruptions of the skin indicate disease of the digestive Wgans; itching and tingling of the skin are signs of irritation from worms or other causes. The breath, if rancid, sour o' unpleasant, is the result of fever, indigestion or ulceration. The evacuations from the stomach, bowels and bladder, are in nost cases peculiarly characteristic, and are important symp- toms: frequent vomiting of curdlike, green, bilious, sour, bloody or black matter, is evidence of disease of the brain, stomach, liver, kidneys or bowels. When the evacuations from the bowels are frequent, slimy, bloody, green, black, gray, or profuse and destitute of odor, or mixed with flakes of mucus or pieces of undigested food, or when great costiveness is present, there is disorder of tho digestive organs. If the urine is white, red, of unpleasant odor, or deposits a brown or gray sediment, (or settlings,) is scanty, profuse, or passed with difficulty, there is morbid action of the kidneys or some other part. The development of the bones is often indicative of some disease: narrowness of the chest and very prominent breast bone, great length of body and limbs, large joints, curvature of the bones of the legs, brittleness of the bones, large head, weak joints, open seams, (sutures,) in the skull, and crooked back, all indicate a rickety, scrofulous or debilitated state of the system. The symptoms above enumerated are sufficient to enabla the common observer to detect the existence of disease. MANAGEMENT OF CHILDREN. Air.—A constant supply of pure air is indispensable to the health of every human being, from the first moment of exist- ence to the end of life. This is even more necessary for infants than for adults, on account of the rapidity of the cir- culation and breathing, and the weak and irritable state of the nervous system. Children confined in badly aired rooms became pale, feeble, irritable and finally consumptive. The air in their sleeping rooms should not be too warm, as thia causes oppressive breathing, too great perspiration, feverish- Bess and oppression of the head. Neither should it be toe cold, for this checks the insensible perspiration which is con stantly going on during health. Very cold air also closes tha porea on the mucus membrane of the nose, throat, windpips and lungs, and inflammation and fever ensue. Beware how vou attempt to " harden" your children by putting them to 71 Fox Glove.—An European plant, and valuable in the bands of physicians, but too powerful for general use. American Helle- bore is now "ery often used instead of Fox Glove. Capsicum (Cayenne Pepper). Its name and uses are as familiar as household words but still it is a valuable article to have about the house, being a diffusive stimulant, either as a tincture, in water, or made into a tea. Nux Vomica.—From this is made the deadly Strychnine, not safe to be used ex- cept in rare cases, and by experienced phy- sicians ; but makes a first-class dog killer. Doo Wood.—The bark only. Is a good tonic, and often used instead of Feruvian Bark in fevers. A tea, cold, wine-glass or two before each meal acts weU in many cases of general weakness. 72 Papoose Root (Blue Cohosh). Common in most parts of the United States, growing in moist, rich woods. The root, the part used, has a sweetish, pungent taste, useful in rheumatism, dropsy, epilepsy, hysterics, cramps, irregular and painful monthly sick- ness. Strong tea, a wine-glass full or more. Tincture, half to one teaspoonful thvce times a day. Golden Seal.—An American plant of great value as a medicine, the root only being used, and is a fine tonic, good in dys- pepsia, typhoid fever, intermittent fever and when convalescence sets in after serious diseases. Fluid extract, half to two tea- spoonfuls three times a day, Also as a gar- fle, in sore throat, mixed with, extract of lue cohosh and witch hazel, one table- spoonful of mixture with one of honey and powdered alum in a pint of warm water, used frequently. Mountain Laurel (Big Ivy). Not safe for internal use, but when the dried leaves are powdered and mixed with flaxseed or slippery elm, they make a good poultice for boils, ulcers, sores, &c. Conium Maculatum (Poison Hemlock). Not safe for internal use except prescribed by physicians. Management of Children <3 ft.cep rn a very cold room; croup and inflammation of the Langs are often thus produced. # Children should be carried or permitted to go into the open air often, and always with their faces bare unless the weather be inclement. The face should never be muffled or covered during sleep. The temperature of the nursery and sleeping room should never exceed 65° or 70°; older persons should aot judge of this by their own feelings, as a degree of co,d which to them would be comfortable, might be injurious or dangerous to an infant. Keep a thermometer, and go by that. Bathing.—The infant may be bathed every morning during the first two or three months, in tepid water, after which the bath may be nearly or quite cold. The idea that the cold bath is best for all children, is erroneous,—it is equally wrong to suppose none but the warm bath is safe and beneficial. Some infants have not sufficient vitality and strength to bring about reaction so as to recover from the shock and regain their natural warmth, but become weak, chilly and sick, by the use of the cold bath.. Those of a robust and full habit of body on the contrary, by the use of the warm bath are affected by congestions of the stomach, lungs and brain, and suffer from indigestion, headache and convulsions. For pale, feeble and irritable children, the tepid bath is usually the best adapted: the temperature of this bath is from 80°"to 90°. For those of active circulation, good digestive powers and robust health, the temperature may be 60°, — constituting the cold bath. Immediately after bathing, the surface of the body and limbs should be well dried and rubbed with a linen napkin, and the child dressed and allowed to exercise. The cold bath should not be used during profuse perspiration, during a chill, nor eooner than three hours after eating. If there is roughness or smarting rf the skin after bathing, it may be rubbed with a very little sweet oil, or a little starch powder. Children are easily bathed by a cloth, or soft sponge and basin of water. In bathing infants, the head should always be wet, but not wished with soap, as this fades the hair. Too frequent use of the cold bath produces eruptions on the skin, debility and disease of the heart. Clothing.—Every part of the person should be covered ex eept the head, face and hands. Bare arms and low-neck dresses may be very pretty to look at, but it is a dangerous practice ; many times little children are thus sacrificed to the whims of folly and fashion. The habit of putting caps on infants is useless and injurious,; Management of Children. the habit of allowing them to go barefoot is vulgar and cruel, the practice of swathing or bandaging the bodies of children, ira totally useless, and very pernicious to tlieir health and com- fort. Soft, white woolen flannel should be worn next to the skin during winter and the colder part of spring and autumn. When the flannel is laid off, cotton may be substituted by degrees: this maybe done also, at any time when woolen ppears to be too irritating, as sometimes happens. The night flothes should be light and perfectly loose: the whole dresg should be fastened by means of buttons, hooks and eyes and tapes, to avoid wounds from pins. Sleep.—The sleep should be voluntary, and not forced or induced by medicines or rocking; neither should it be dis- turbed for the purpose of washing, nursing or dressing. Young children require a soft, warm couch in winter, but during warm weather they should lie upon beds filled with straw, cotton, curled hair, moss or corn-husks. The pillow should be of the same material as the bed, to prevent the head becoming too much heated, and avoid taking cold, earache, catarrh and snuffles. During the first three or four months it is better to allow the child to sleep with the mother,—after which it may sleep alone, (if the weather is warm,) in a cradle, cot or couch. The habit of rocking infants, if frequent or long continued, is injurious,—but if gentle and only occasionally during waking hours, it is both harmless and pleasing to the child. The bed or cradle should be high and without curtains: that old fashioned contrivance called a "trundle bed," is a vile relic of barbarism, and deserves to be totally banished from civil- ized society. The position should be occasionally changed during sleep: this prevents too much pressure on any part, accumulation of heat, deformity of the head, and fatigue. The room in which the child sleeps should be partially dark- ened : during waking, it requires the stimulus of a mellow light, this conduces both to its health and cheerfulness. The eves, however, should not be long exposed to the iutense glar- ng light of the sun, fire or lamp. All perfumery, flowers, medicines or food, or anything exhaling a strong odor, should be excluded from sleeping apartments. Children ought never to sleep with old or sici persons : neither should they be fondled or kissed by old, die- eased or strange persons, for fear of incurring some disease Young children should be protected against loud noises strong odors, and sudden frights. Children of more advance* age should retire early, and rise early in the morning. Exercise.—During the first few months of infancy, ^ul Management of Children. 75 little exercise is required,—nor does the organization admit ©f more than a small amount of passive and gentle movement. The infant may be carried about in the arms within doors,— or when the weather is pleasant it may be carried in the arms or frawn in a wagon, laying on a pillow, in the open air, a few minutes at a time, several times daily. All rough tossing, jolting^ and dandling are injurious. For the first two months, the infant cannot be placed in the erect posture Without the risk of deformity. When the infant indicates some desire to sit alone and move about, he may be allowed to sit, lie or roll about on the floor with the utmost freedom. When riding, the position should be often changed, and nursing should be done equally upon the right and left side, to avoid deformity of the head or spine. It is better that the child should not attempt to stand 01 walk before the ninth or tenth month: it should rather be encouraged to creep until it acquires sufficient strength and firmness to walk voluntarily. Children should not be con- fined to little chairs, " baby jumpers,'' or any apparatus for restraint / although it may relieve the mother or gratify the laziness of the nurse,—it is still unnatural and injurious to the delicate growing system of the child. After the age of two years, girls as well as boys should be permitted to roam free and unconfined over the wide field of nature, and inhale the " pure breath of heaven." The first six or eight years of childhood should be passed in various kinds of exercise and amusements. Confinement in school rooms or shops, or at desks, or to any laborious occupation previous to that age, is always injurious and unkind. Nothing is gained and much is lost by sending a child to school too young. No child under six years should be sent to school, and even then only a few hours at a time. Children should be indulged in pursuing little mechanical operations, and in learning to build and construct whatever their tastes may incline them to: they should be taught to admire the beauties of nature, rather than be supplied with the various little toys and expensive contrivances of art. They should be permitted to take short rambles for the pur- pose of collecting flowers, insects, minerals or fruits, or to observe the habits of animals and birds, and enjoy the pro- spect of natural scenery. Drinks.—Infants feel the sensation of thirst, as early as that of hunger, and are highly gratified and benefitted by a small quantity of cold water several times daily. 76 Nourishment of Infants. .Restlessness and crying are often caused by thirst, but mis taken for colic or hunger, and the infant is dosed with cordiali or opiates, or forced to take the breast, which only increase* its distress, perhaps surfeits the stomach and causes nausea and vomiting. This leads to the apprehension *hat he is sick, and dose succeeds dose, till disease is often produced,—when a spoonfuU of cold water would have removed all unpleasant sensations. Many people think it is a " healthy sign " for a child to throw up its milk, when the whole trouble is that the child has too much milk and too little water! (Very cold, as well as very hot drinks should be avoided.) Dikt.—As a general rule the mother's milk should be the only food for the first nine or ten months ; no solid food should be allowed until a sufficient number of teeth are developed, to enable the child to chew. When it becomes necessary to increase the amount of food derived from the breast,—or to " bring up the child by hand," cows' milk is the best substitute: it should be mixed with an equal quantity of warm water and a little loaf sugar added. All preparations of gruel, panada, broth, soup or solid food, are unfit for the diet of an infant. Animal food is too strong and stimulating for infants before the first set of teeth are complete. After teething is completed, a more solid and nutritious diet may be allowed. Foon.—Care is requisite that too much of one kind of food be not taken,—but rather a due proportion of several kinds: the food should not be taken too fast or swallowed without being well chewed. Sugar and other sweet substances are not injurious when taken in due quantity and with other arti- cles of diet; all sweet and ripe fruits, when freed from the seeds, stones and skins, are wholesome and nutritious in small quantities. Sour or green fruits are decidedly pernicious,— cherries of most kinds, and also some kinds of grapes, are peculiarly unwholesome: ripe fruits, either dried or recent, when cooked or preserved and made palatable with sugar, are not objectionable for children. NOURISHMENT OF INFANTS. The foundation of incurable chronic diseases, and of con- stitutional debility in after-life, is often laid within the first month, or even first few days, after birth, by improper man- agement ; and a great amount of the suffering and mortality which occurs during infancy must be ascribed to the sama prevailing source. The custom of feeding children with inap- propriate articles of food, very soon after birth, is wrong. No Nourishment of Infants. 71 sooner is the infant washed and dressed, than tne nurse it ready with her spoon and cup of gruel, pulverized cracken dissolved in water, or some such preparation, to fill its stomach to the utmost of its capacity ; and this process of stuffing is continred with a ruinous degree of diligence and perseverance. The digestive organs of the new-born babe are thus often seriously injured during the first twenty-four hours. Nature herself seems to point out the impropriety of this practice. Bhe withholds the nourishment which she provides (the milk) until many hours after birth. I do not mean to inculcate that nourishment is to be entirely withheld from the infant until the milk is secreted under all circumstances; but I am per- suaded that, with healthy infants, several hours, at least, Bhould be suffered to pass immediately after birth before any food is introduced into its stomach, and not, under any circum stances, give food to the child until it has jirst been put to t/te mother's breast several times, to see if the milk will not be excited to flow. In nine cases out of ten, perhaps, the griping, flatulency, diarrhoea, and colic, which so frequently harass infants, during the first half year after birth, are the results of indigestion, brought on by errors in diet. To relieve the colic, griping, flatulency, diarrhoea, &c, which ensue, recourse is had to cat-mint tea, aniseed tea, Godfrey's cordial, pare- goric, or some other palliative or nostrum, and thus an addi- tional cause of indigestion is brought into operation. The screams and restlessness of the infant occasioned by the griping and colic, are frequently regarded as manifestations of hunger. To appease this supposed craving, the stomach is almost constantly kept in a state of distension with food ; and thus the helpless babe has no chance of escaping from the tor- ments and ruinous consequences of its unfortunate situation. Great distress and suffering are sometimes witnessed during the early period of infancy from indigestion, and consequent irritation of the stomach and bowels, even where the child is wholly nourished by the breast. For when, during the tiim which intervenes between the secretion of milk and the birth of the child, crude articles of nourishment are introduced into the infant's stomach, the digestive powers are often at once so deranged and impaired, that even the wholesome and conge- uial fluid furnished by the mother will not be easily digested and acidity, flatulency, and colic, will continue to harass tha child until the digestive powers gradually acquire a greater degree of vigor. Let the child's stomach be once or twice filled during tha first twenty-four hours with gruel, or any of the ordinary 78 Nourishment of Infants. preparations employed by nurses for this purpose, and tha chances will probably be as ten to one that sourness of tha 6tomach, vomiting, colic, griping, &c, will supervene. There ie no period throughout the whole course of life in which the observance of caution, in relation to the food, is of greater moment than in the comparatively short interval which passei between the birth of the infant and the secretion of its natu- ral aliment (milk). Do not be in too great haste to give pur gative medicine to a child, soon after it is born, to open its bowels. Active purgatives are sometimes given for this pur ose; and there is much reason for believing that the infant's igestive organs are often injured in this manner. The very best thing to stimulate a secretion of milk is apply- ing the child to the breast, for a few minutes at a time, (com- mencing as soon as the mother is comfortably settled in bed,) every half an hour or so. If the child is hungry, his efforts will be the more vigorous to procure nourishment. A mixture of two parts of fresh cow's milk and one part of warm water. approaches nearer to the nature of human milk than anything else that can be conveniently procured. Of this a few tea- spoonfuls may be given in cases where the secretion nas been long delayed, carefully avoiding overcharging the stomach until the mother's breasts are ready to yield their more con genial nutriment. In order to excite the early secretion of milk, it will be proper to let the child draw the breasts, for a few minutes, soon after the mother is comfortably fixed in bed, provided her health and strength will admit of it. After the secretion of milk is once fully established, and furnished in sufficient quantity, the infant should be nourished exclusively by the breast. Not even the mild and simple fluid just men- tioned should be allowed, unless some special reason exist for the use of additional nourishment. It seldom occurs in healthy mothers, that the quantity of milk supplied by the breast is not sufficient to afford adequate nourishment to the child for the first two or three months, and, in general, much longer, without the necessity of any additional artificial food. The infant should be nourished exclusively by the breast until^ the first teeth make their appearance. No other kind of nourishment whatever should be allowed before this period, unless from deficiency of milk or some other cause, the use of additional nourishment becomes necessary. After the first teeth have come out, small portions of barley water, thinly prepared arrow-root, or a mixture of equal parts of cow's milt and water, may be given two or three times daily, in addition to the nourishment drawn from the breasts. I do not mean U) I Nourishment of Infants. 79 say that, when the child arrives at this stage, it becomes neces* sary, or even proper, as a general rule, to exhibit any addi- tional articles of food. In general, however, the simple and mild liquids just mentioned may be given at this period with very little risk of unpleasant consequences, for the digestive organs have by this time acquired a degree of power and activity sufficient to obviate the painful and disturbing effects which would arise from the use of such food during the first four or five weeks after birth. It is also of much consequence that the food should be introduced into the stomach as gradually as practicable. This can be most conveniently done by causing the infant to suck the fluid from a bottle, furnished with the usual tube, the mouth-piece of which is pierced with a small opening. By this contrivance, the child will receive its food in the same gradual manner as when nourished a4, the breast, and it will rarely take more than its appetite calls for, an error which is frequently committed when fed with a spoon After the seventh month, small portions of the preparations of food just mentioned (such as corn starch, pulverized crackers with milk and water to soften them, gruel, made of oatmeal or wheat flour, &c.,) should be given at regular periods, three or four times daily. This will prepare the infant for the sud den change which it has to undergo, in the character of its food, when it is weaned, and thereby tend to lessen the liabil- ity to unpleasant consequences from the change. Infants who have been moderately fed with suitable articles of food some time previous to weaning, almost always accommodate them- selves much more readily, and with much less uneasiness to the change, than such as have seldom or never received any other nourishment than that which they draw from the mother's or nurse's breasts. Mothers ought never to delegate the suckling of their in- fants to others. This sacred office should rest with the mother alone. The mother who submits the suckling of her infant to another, while her own breasts are ready to furnish an ample supply of milk, can scarcely possess an amiable and moral heart. It can scarcely be doubted that the mother's milk-is, in gen- eral, better adapted to the constitutional temperament of her offspring than that furnished by others. Besides, when the suckling of the infant is submitted to a nurse, it is liable to various sources of injury and disorder, which are, in a great degree, if not entirely, obviated when this important duty is performed by the mother. No hired nurse can be depended on to give the tender care, and have the affectionate regard, fa? a child that its own mother has. so Nourishment of Infants. Unfortunately, however, mothers are not always *n a oondl Hon that enables them to suckle their own infants, and the employment of a wet-nurse, or recourse to artificial nursing, is unavoidable. The causes which may prevent a mother from nursing her child are : A decided deficiency or total failure in the secretion of milk, in consequence of disease or torpor of the breasts; a bad state of milk, rendering it decidedly preju- dicial to the health of the child ; the presence of a morbid taint, or some communicable chronic diseas, in the mother'* system; when suckling gives rise to pal/iful or dangerous affections in the mother, as "olic, cough, distressing nervous affections, great weakness, epilepsy, &c. When causes of this kind render it improper or impractica- ble for the mother to nurse her child, it then becomes a ques- tion whether a wet-nurse should be employed, or artificial nursing resorted to. It would, in general, be much better to nurse the child artificially, under the eye of its mother, than to place it entirely at the mercy of the wet-nurse. Nurses, doubtless, are sometimes found to whom a child may be safely intrusted ; but experience has but too often shown that the reverse is the case. Attention must also be paid to the previous and present health of the nurse. No woman who has led a debauched course of life, even though reformed, can be regarded as a perfectly safe nurse, however careful and attentive she might otherwise be. Females of this description are apt to have their systems contaminated with some morbid taint, which may give an unwholesome quality to the milk, and injure the child's constitution. The existence of scabby or scaly erup- tions on the skin, unless they are of transient character, and of chronic ulcers, particularly on the legs, should be regarded as sufficient objections to a nurse. A manifest scrofulous habit, also, is decidedly objectionable. The age of the milk is another point of considerable importance. Milk that is six or seven months old seldom agrees well with infants during the first two or three months after birth. In general, the milk becomes -much more rich and nutritious after the fourth month than it is previous to this period; and milk of this kind, from its requiring stronger digestive powers than younger milk, often gives rise to much disturbance of the stomach and bowels in new-born infants As a general rule, therefore, the age of the milk should not vary much from that of the child, up to about the fourth month. After this period, anch a relation between the ages of the milk and child is not of much importance—for a child f» ve or six months old and Nourishment of Infants. 81 npwards, may be nourished by a fresh breast writL entire safety. The occurrence of the menstrual evacuation during nursing, fc almost invariably attended with diminution and deteriora- tion of the milk, and constitutes a well-grounded objection to a wet-nurse. This is more especially the case during the first three or four months of infancy. When a child at this early period is put to the breast of a nurse who menstruates, it rarely fails to experience derangements of the stomach and bowels. After the seventh or eighth month of age, there is much less inconvenience and disorder to be apprehended from this source; but, even at this advanced period of infancy, the milk of a nurse, thus circumstanced, may give rise to disturb- ances in the digestive organs, and should, if possible, le avoided. Nature here, as elsewhere, is a safe guide. We perceive that menstruation is almost universally suspended during the period of suckling ; and we may presume that tins arrangement of nature is designed for some useful purpose— for the well-being, doubtless, of the infant. Nature, there- fore, as well as experience, indicates the propriety of with holding the breast from the child when, from constitutions' peculiarity, or some accidental influence, the monthly turn* make their appearance in the nurse or the mother. A nurse who has but one good breast should never be se- lected. A child suckled by one breast only, is apt to contract the habit of squinting, from having its eyes constantly directed to one side. Some attention should also be paid to the nurse's nipples. If they are very small, the child will be apt to fatigue itself in sucking, without being able fully to satisfy its wants. This defect can seldom be properly remedied. The practice of drawing out the nipples by suction, with a pipe or bottle, will be of advantage; but when the nipples are veiy small, and deeply imbedded in the breast, it can scarcely re- medy the evil. In some instances the nipples yield the milk so freely, that the child is continually harassed by a sense of strangulation, while suckling, from inability to swallow as ra- pidly as the milk issues into its mouth. This may, in general, be remedied by passing a piece of fine tape or elastic pretty firmly round the base of the nipple; or the nurse may com- press the nipple moderately between the first and second fingers, while the child is suckling. t Finally, particular regard should be had to the temper and moral habits of the nurse. An irritable, passionate, and sour tempered female, is but illy suited for this important duty Not only is the child liable to be maltreated by a nurse of this 82 Nourishment of Infants. character, during the fits of ill-nature and passion ; but tha most serious and alarming effects may be produced on its ten- der organization, by the milk of such a nnrse. It is well known that violent anger, and habitual sourness of temper are peculiarly apt to give a pernicious quality to "he milk. Chil- dren have been thrown into convulsions, by suckling soon after the nurse has been agitated by violent anger, rage or fright; and alarming vomiting and purging is particularly apt to occur from this cause. Indeed, every kind of inordinate ex- citement, or depression of the mind is unfavorable to the recretion of healthy milk. Protracted grief, sorrow, or mental distress and anxiety in the nurse, seldom fail to exert a pre- judicial influence on the health of the nursling. This circumstance ought not to be overlooked, in choosing a wet- mirse. Artificial Nursing.—Under judicious management, infanta will, in general, experience no particular inconvenience from a course of artificial nursing; and, as a general rule, this mode of nourishing children, when properly conducted, is upon the whole preferable to the employment of a wet-nurse, whose competency and fitness is doubtful. This preference, however, is founded rather on the greater risk which the child incurs of being maltreated and neglected, when submitted to the ex- clusive care of a wet-nurse, than when nursed artificially, under the immediate superintendence of a parent. There are circumstances, in relation to the condition of the child, which render the employment of a wet-nurse, notwith- standing all the risks that have been mentioned, preferable to artificial nursing. Very young, and peculiarly delicate and feeble infants, seldom do well when raised by the hand. Fresh and wholesome milk from the breasts of the mother, or a healthy nurse, is almost indispensable to the well-being of an infant thus circumstanced. The same observations apply to infants, whose stomachs and bowels are peculiarly weak and irritable. Finally, if upon trial, the slightest and most appro- priate kinds of artificial food are found to disorder the stomach and bowels, the life of the infant will very probably depend on its being nursed by a fresh and wholesome breast. Sometimes the mother, though incapable of supplying a sufficient quantity of nourishment by the breast, is still able to furnish small portions of wholesome milk, and when this is the case she ought, by all means, to continue suckling the child, in conjunction with the use of artificial nourishment. Par- ticular care should be taken to keep the bottle perfectly clean and sweet. It should be well washed, both inside and cut Nourishment of Infants 83 side, with hot water, every morning and evening. The same food should not be suffered to remain in the bottle more than three hours. After the child has satisfied its appetite, no new supply of food should be added to what may have been left. ?he quantity of nourishment put into the bottle, should not'be much greater than what may be deemed fully sufficient for one nursing. By these precautions the food will always be sweet, and free from offensive or irritating qualities. Nursing bottles are now easily obtained in almost every part of the country. When the child uses the bottle, it should be taken up and supported in an easy position, on the lap or arms of the nurse, imitating the position of the mother's breast. The child should be kept quiet for at least thirty or forty minutes after having received its nourishment. Best is particularly favorable to digestion. Children, who are entirely nursed by artificial diet, should be restricted to the use of the milk-and-water mixture men- tioned above, until several teeth have made tlieir appearance. They will, in general, enjoy more perfect health and thrive better, when nourished exclusively with this simple food, than under the use of any other nourishment that can be made. After the third month, however, the proportion of milk should be somewhat increased: namely, three parts of milk to one part of water. After the first teeth are protruded, the food may be a little more varied and substantial. Grated crackers dissoled in warm water; oat-meal gruel; liquid preparations of arrow-root, tapioca, or sago; milk thickened with rice flour, and thin pap, may be allowed in moderate quantities along with the ordinary milk-and-water mixture. When these pre- parations do not agree with the child's stomach, they should be used with an equal portion of weak mutton, chicken, or beef broth, clear and well freed from fat. A mixture of this kind is, in general, easily digested, and rarely causes any un- pleasant effects, when used after the first teeth have made their appearance. After the first grinding teeth are protruded, weak broths, r>lightiy thickened with oat-meal, rice flour, arrow-root, or grat- ed crackers, mixed with milk, constitute, in general, the most appropriate articles of nourishment. A small portion of stale bread may also be allowed, two or three times daily, at this stage of infancy. The animal food given to young children should be plainly roasted or boiled. Fried and broiled meats, and all food heated a second time, by hashing or mincing, being lees digestible, should be avoided. Many people, from a mis- taken expectation of strengthening weakly children, give them 84: Nourishment of Infants. more animal food, and sometimes twice or thrice a day: bnt it will be found much more frequently to add to debility than to the increase of strength. Those children, on the whole, who eat the least animal food, are the most healthy. Nothing is more absurd than the notion that, in early life, children re quire a variety of food. The peculiarly excitable state of the system during teething and the consequent tendency to feverish irritation, render tha free use of animal food decidedly objectionable during this stage of childhood. Small portions of the more digestible meats may be allowed to healthy children, once daily, with little or no risk of injury; but they should never be permitted to form the principal part of the food. The lean parts of mut- ton, lamb, tender beef, game, and fowl, should be selected Veal, pork, pig, goose, duck, and all kinds of salted meata being of much more difficult digestion, can seldom be usea without impeding digestion, and finally injuring the tone of the stomach. Veal is decidedly the most objectionable of all the meats in common use for children. Fresh fish, boiled, and taken in moderate portions, seldom disagrees with the stom- achs of children, and may be used, occasionally, with perfect propriety. Soft boiled eggs, too, form an appropriate article of nourishment for children after the first teeth have come out. When fried, or boiled hard, they are altogether unsuitable Strongly seasoned meats, compound dishes, hashes, meat pies, and pastry, are to be wholly rejected. The introduction of fresh food into the stomach before that which was previously taken is entirely digested, seldom fails to operate injuriously. As a general rule, from three to four hours may be regarded as a suitable interval between the meals. If the child requires nourishment between the regular meals, small portions of liquid food, such as milk, &c, should be used. When solid animal food forms a part of the diet of children, it should be taken at noon, or in the forenoon. Pure water, with or without small portions of milk, con- titates the best drink for children. Canpies anp Sweetmeats.—Indulgence in the use of sweet meats is a copious source of disease and mortality during childhood. Fruits preserved with tlieir skins, as raisins, art Sarticularly pernicious. The skin of all fruits is of difficult igestion. The conduct of parents, in relation to this subject, is oftea extremely irrational and pernicious in its consequences. They would not themselves venture on the frequent and free use of aonfectioneries of this kind; and yet will indulge their chil Nourishment of Infants. 85 aren^ without scarcely any restraint, in the use of these pernicious luxuries. The sicklier and weaka the child is, tha more apt, in general, is it to be allowed these destructive gra- tifications. The pale, feeble, and sickly child, whose stomach is hardly able to digest the most simple and appropriate food, is sought to be appeased and delighted by the luscious and scarcely digestible articles of the confectioner. Indigestion. bowel irritation, terminating often in ulceration and incurable diarrhoea, are the frequent consequences of such conduct; and at best, such indulgence must prolong the feeble and sickly condition of the child, and not unfrequently eventuate in per- manent debility. With regard to the use of fresh fruits, writers, on this subject, have expressed different opinions. Apples, peaches, and apricots, (freed from the skin,) when perfectly ripe and mellow, may be occasionally allowed to children, in moderate portions, with entire safety, unless the stomach and bowels be very weak and irritable. In children of a costive habit, the temperate use of these fruits may even have a beneficial effect. by their tendency to excite the action of the bowels. Pears, even of the tenderest kinds, appear to be much more indigestible than ripe apples or peaches. Stewed or roasted fruits, par- ticularly the two latter kinds, are, in general, well adapted to the digestive powers of young children, and may be allowed occasionally, with perfect propriety, provided they are not very Bour. When the acid or sourness prevails to such a degree as to require the addition of sugar to render them sufficiently palatable, stewed or roasted fruits of this kind rarely agree well with weak and delicate stomachs, and cannot be allowed to young children without considerable risk of injury. In general, all fruits having a firm cuticle or skin, such as grapes, whortleberries, &c, are improper articles of food for children. The pulp of grapes, freed from the seeds, rarely causes disorder in the bowels when taken in modeiation..— Fruit that contains small, hard and insoluble seeds—such aa strawberries, blackberries, currants, &c, are particularly apt, when taken freely, to disorder the stomach and bowels. The seeds, resisting the digestive powers, irritate the mucous mem- brane of the bowels; and when, from previous causes, this membrane has become enfeebled and irritable, they may rea- dily excite dangerous irritation. Small insoluble bodies of this kind, frequently remain lodged in the folds of the bowels for many days and even weeks, and give rise to severe and unmanageable disorders of the bowels. Cherries are among the most pernicious fruits in common 86 Nourishment of Infants. use, and ought to be wholly excluded from the list of articlei with which children may be occasionally indulged. Even when eat without the stones, they are peculiarly apt to derange the bowels; and when swallowed with the stones, which, with children, is not nnfrequently the case, they are capable of pro- ducing violent and even fatal diseases. Most alarming and fatal consequences have resulted from the irritation of cherrj stones lodged in the bowels. Convulsions, inflammation, and harassing diarrhoea are among the affections which are apt to arise from this cause. All fresh fruits have a tendency to ex cite, more or less strongly, the action of the bowels. As a general rule, therefore, every kind of fresh fruit is improper for children whose digestive organs are weak and irritable, or who are habitually liable to disorder of the bowels. Exercise.—Uncertain and awkward motions of the arms— stamping with the legs, and drawing them up, are the first feeble attempts which the infant makes in the use of his mus cles. But even these muscular exertions appear to be indis- pensable to the preservation of its health and the propel development of its powers ; and it should be an especial object of care to allow entire freedom of motion, several hours daily, by avoiding all modes of dress and position tending to restrain the free use of the extremities. With this view, the infant should be taken from its bed two or three times a day, and laid on his back upon a soft mattress, or any other level and slightly resisting surface, and divested of every thing calcu- lated to restrain the motion of its limbs and body. Confining an infant's feet in long under-clothes is decidedly objection- able, after they get to be a few weeks old. Children who are frequently permitted to exercise their muscles in this way, will learn to use their limbs and walk earlier than those who are seldom allowed this freedom of voluntary action. Carrying.—This should be commenced as early as two weeks after birth, provided the infant be not unusually feeble; and it should be daily attended to, as one of the regular and indispensable duties of nursing. The manner, however, in which very young children are usually carried or exercised, is extremely reprehensible, as it is calculated to give rise to very anfortunate consequences in relation to the health and regular conformation of the child's body. We allude, particularly, to the common practice of carrying infants with tlieir bodies in an erect position, before the backbone and muscles have ac- quired a sufficient degree of firmness and activity to support tne body and head in this posture. The child is usually car- ried by the nurse pressing its thighs and hips, with th& left Nourishment of Infants. 87 forearm, against her body, whilst its body is balanced in an upright posture, by resting lightly against" her bosom. Thua the whole weight of the infant's body rests upon the feeble and yielding backbone, while the unsupported head is, in general, suffered to lean constantly to one side, or to roll about in every direction. This mode of carrying infants must interfere, very materially, with the regular and symmetrical development of the body. The feeble backbone, yielding to the weight of the head and body, is always curved outwards while the infant is held or carried in the erect position ; and, when this is daily repeated for several hours, as is frequently the case, the back is liable to become permanently bent*or dis- torted. A habit, too, of leaning the head to one side is some times contracted by the child; and, from the violent mannei i-i which the head is liable to fall from side to side, serious and even fatal injury may be inflicted on the spinal marrow of tha neck. But even after the spine and its muscles have acquired a sufficient degree of firmness, to enable the child to support its head and body in an erect position, without difficulty, it in- curs considerable risk of injury from the usual practice of carrying it almost exclusively on one arm. When the child Is carried almost wholly on one arm, it is apt to acquire the habit of leaning to one side, which it is always very difficult to correct. The child, also, when carried in this'manner, usually throws one of its arms around the neck of the nurse, in order to support itself more steadily in the erect position ; and of course always with the same arm, when the side on which it is carried is not changed by the nurse. In consequence of this position, the shoulder-blade and side of the chest are liable to Deforced upwards and outwards, which may result in perma- nent distortion. The baekbone and its muscles seldom acquire sufficient strength and fimriess before the end of the third month, to en- able the child to support its body in an upright position, with- out inconvenience or risk. Until this power is acquired, the infant should not be carried, or suffered to sit, with its body erect, without supporting it in such a manner as to lighten the pressure made on the spine, and aid it in maintaining the up- right posture of its head and body. But even when thus sup- ported by the nurse, it should not be kept in an erect position more than one or two minutes at a time, until it is two months old. At first (a few days after birth) the infant should be taken from its cradle or bed, two or three times daily, and laid on its back, upon a pillow, and carried gently about the chamber. The best mode of carrying very young infants is to 88 Nourishment of Infants. lay them into a small, oblong basket. By this contrivance a gentle and agreeable swinging or undulating motion will ba communicated to them ; and the sides of the basket being three or four inches higher than the child's body, a cover or netting may be thrown over it, without restraining the free motion of its limbs. After the third or fourth week, the child may be carried lying in the arms of a careful nurse, in such a way as to afford entire support to the body and head. It is painful to see the violent and generally abortive efforts which the infant makes to steady its little head, when raised into a sitting posture. It will sometimes succeed in balancing its head for a moment, to the great delight of the fond mother; but the effort is almost in- variably speedily followed by a sudden and often violent rolling of the head from side to side, which cannot but be in- jurious. All rapid, whirling and jerking or jolting motions are calcu- lated to injure the health of infants. Running or jumping with an infant in the arms, descending rapidly a flight of stairs, whirling round, etc., ought to be rigidly forbidden. The prac- tice of supporting very young infants in a sitting posture on the knee and jolting them violently cannot be to severely cen- sured. It is not uncommon to see mothers and nurses jolt in- fants in this manner, with a violence that threatens disloca- tion. Tossing them rudely on the arms, is equally reprehen- sible. _ These violent agitations " powerfully affect the delicate organization of infants, and may be productive of spasms, epi- lepsy, and apoplectic fits." Gentle and cautious tossing on the arms affords an agreeable exercise of the body, and may bo beneficial by the moderate agitation which it causes in the internal organs. With infants predisposed to diseases of the head, strong rocking should be particularly avoided. Biping in a Carriage.—This is an excellent mode of afford- ing suitable exercise to infants, and may, with great propriety, be employed as an occasional substitute for carrying in the arms. The body of the carriage should be long enough to permit the infant, when quite young, to lie down at full length , and the sides ought to be sufficiently high to prevent its falling or rolling out. Like carrying in the arms, this mode of exercis- ing infants is liable to be conducted very improperly. This duty is usually entrusted to children or young girls, who being generally more disposed to consult their own sportive inclina- tions than the comfort and safety of their cnarge, are apt to draw the carriage along with great rapidity, paying little of Nourishment of Infants. 89 ao attention to the roughness or unevenness of the ground over which they pass. After the child has acquired some de« gree of strength, it should be placed in a half sitting posture, with its head and back well supported by pillows, etc. Walking.—After the infant has acquired sufficient strength to support itt.elf in the sitting posture, it should be placed on a soft carpet several times daily, and surrounded with its toys. When thus left to the free use of its limbs, it will soon learn to crawl. The common practice of teaching children to walk by sup- porting them prematurely on their legs, and leading them for- ward w'thout allowing them the advantage of having their mus- cles previously strengthened, and in some degree brought under the commands of the will, by crawling, is objectionable on vari- ous accounts. It seldom fails to produce more or less unnatural curvature of the legs ; and in infants of a scrofulous or ricketty habit, it may readily give rise to distortion of the spine and round shoulder. Children who are permitted to exercise tlieir muscles by crawling, generally acquire a much firmer step, and enjoy more robust health than " those who have been taught to walk before the crawling exercise." It we are earnestly desirous of training up our children in such a manner that they may acquire a firm step and well- formed limbs, we shall gain our purpose much more certainty and safely by pursuing this gradual and cautious mode of teaching them the use of their legs, than by the more common practice of placing them prematurely on their feet, without permitting them first to learn to crawl. Leading-strings and go-carts, formerly so much in use, are now, very properly, almost universally abandoned. The very common practice of teaching infants to walk by holding them by one of their hands, is very wrong. When led in this way, the child's arm is continually, and often forcibly, extended up- wards : if it happen to lose its balance, or trip, or if its legs are yet too feeble to support itself long in the erect posture, the whole weight of its body is often suspended by one arm. Frequently, too, it is entirely raised from the ground ly one Arm, in order to help it over some obstacle, or to hasten its progress over a rough and difficult piece of ground. It is easy ao perceive that th;s ~?-actice must necessarily, and in no in- considerable degree, tend to draw the shoulder and side of tha chest out of tlieir natural position; and when frequently re- peated, to give permanent deformity to these parts. Nursery-maids seldom exercise sufficient care in this respect. Too indolent to cany the infant in their arms, as they are directed and supposed to do, they are apt, as soon as they are nu 90 Nourishment of Infants. longer observed, to place the child on the ground, and to hmry or rather drag it along, in the most careless and unfeeling manner. Of a similar, but still more reprehensible character. is the practice of raising infants from the ground by both arms and swinging them about in the air. After children have acquired the entire use of tlieir legs walking is decidedly the best exercise they can take. Parents onght not to intimidate their children by inspiring them with a constant dread of falling or hurting themselves. The custom of exaggerating the dangers incident to tlieir usual sports—and of plying them continually with admonitory injunctions against ac- cidents when they are engaged in tlieir amusements, is calculated to favor the occurrence of the very accidents which they are meant to obviate, by the timidity which these perpetual lessons of caution and fear almost inevitably inspire. When the ground is soft, it is much better to let the child take the chance of two or three falls, and give it full scope for the exercise of its limbs, by running about until it is satisfied. When children fall o* hurt themselves, they should not be soothed by expressions ol extreme pity and sorrow; for plaintive words and expressions of great sorrow tend very effectually to render them effeminate and timid. Children who are thus accustomed to excessive coin- misseration, seldom fail to acknowledge this tender sympathy, by straining tlieir little lungs to the utmost by crying on everv slight injury they receive. After children have passed through the period of teething, they should be encouraged in the pursuit of active amusment out 01 doors, as an essential and regular part of physical dis- cipline. The practice of obliging children t' • remain within doors, and to con over their lessons between or after school hours, is a barbarous " march of civilization." These intervals should be devoted to innocent amusement and bodily exercise. Exposure.—Infants ought to be early accustomed to the fresh and open air. The practice of confining them, during the first five or six weeks, to close and heated rooms, has a d:i rect tendency to impair the energies of the system, and to impede its healthful development. Pure air is most grateful to the feelings of children. After having been carried out, but a few times, they evince, even at a very early age, a strong desire to return to the open air. While yet on tha arms of the nurse, they anxiously point to the door, and make efforts to approach and open it. When they can scarcely crawl, they instinctively advance towards that part of the room from which they have a prospect of escaping. When the weather is clear and of a mild temperature, infant* nourishment of Infants. 91 ahonld v>e canied into the open air once or twice daily, assoo^ as they are three or four weeks old. During cold and damp weath=»=*& J0HN W' DRAPER, M. D., Prof of Chemistry and Physiology. fe:S3=2aa E.3ARTLETT, M. D., Professor of the Institutes and Practice of Medicine. G. S. BEDFORD, M. D., Professsor of Obstetrics. S. D. GOSS, M. D., Professor Surgery. (JOHNC. GREEN, President. Council, X WILLIAM B. MACLAY, Secretary. (A. C. KINGSLAND, Mayor, Inflammation of the Lungs—Stammering. 125 duced; if so, reduce the dose:—Take one table spoonful of syrup of ipecac, (or five grains of the powder,) half a gill of cold water, one table spoonful of spirits of nitre, 20 grains of shlorate of potash, and a few drops of essence of lemon or cin- namon, mix th ore uglily together and keep in a cold place, to be used while the active symptoms continue. Also, wrap the chest and neck in a flannel cloth, saturated (soaked) with this mixture :—Sweet oil, spirits of turpentine, spirits camphor, of each one ounce, to which add a table spoonful of laudanum, and shake well before using. Renew this twice a day. The child should be allowed to drink freely of cold water, in which put plenty of gum arabic, or slippery elm. The bow- els should be moved every second day, to remove the phlegm which is usually swallowed by the child. In robust children, if there is much fever and oppressed breathing, a few leeches appiied to the chest will be advisable; or the application of cupping may be tried once a day for two or three days. When the inflammation is somewhat reduced, applying a more stimu- lating liniment all over the chest will expedite the cure. A table spoonful of tincture of cayenne pepper added to the lin- iment of turpentine, &c, will be about as good as any—appli- ed twice or thrice a day. INFLAMMATION OF THE LUNGS. Among children, as well as adults, this is a frequent and dangerous disease. It begins with symptoms similar to those of bronchitis, and is produced by nearly the same causes.—• The treatment is the same as in Bronchitis. STAMMERING. Stammering in the speech cannot be said to be a disease, being rather a functional disorder. This is evident from the fact, that, under certain circumstances, an habitual stammerer does not stammer, and that cases have occurred in which most inveterate stammering has been completely cured by the exer- tion of the will. Moreover, stammering is often caused either by imitation in children or by nervousness in both children and adults. This nervousness is often the result of debility, and of weak constitution—a fact which should not be lost sight of, for, if such be the case, every means of strengthening should be used. At the same time, while the general health is sustained, much may be done by checking children, and making them speak at all times slowly. Much pains with children, and much perseverance and self-command in adults, is required in the efforts to overcome this defect. Tbe one 120 Scarlet Fever. great matter of importance in curing children or others of stammering is, as soon as the least hesitancy in speech, oi stammering, is observed, make the patient stop at once, then draw in a full breath, filling the lungs thoroughly, when they can begin again. Let this rule be observed only a short time and you will be surprised at the rapid improvement. Tha difficulty, in almost every case I have observed, has been that the person attempts to talk when he lias already exhausted thi air from the lungs. Overcome this, and the case is cured. SCARLET FEVER. In thi3 disease, usually, the first symptom complained of, in the incipient stage is sore throat, either accompa- nied or quickly succeeded by the usual symptoms of a feverish attack, shivering, headache, loss of appetite, perhaps vomiting, followed by heat of skin, quick pulse, and thirst. The eruption appears early, on the second day after the first symptoms of indisposition. It first shows itself in the form of minute red points on the chest and arms, especially about the elbows, the points becoming more numerous, till they form one diffused surface of a tolerably bright scarlet eruption. which extends to the neck, face, and abdomen, and body gen erally. On the second day, when the eruption is appearing, the symptoms of general fever, and especially the heat of skin, continue unabated, the throat is more inflamed, and tha tongue assumes the appearance characteristic of this disease. It is probably covered with a white, creamy-looking fur, through which, on its forepart, about the tip especially, pro- ject red points. This appearance may continue, but i.a many cases the fur conies off, as it were, in patches at a tlxne, and ultimately leaves the tongue preternaturally clean and red. The eruption in scarlet fever generally looks more patchy upon the extremities than it does upon the body. In a moderately favorable case of scarlet fever, the eruption begino to fade be- tween the third and fourth day from its appearance, and with it the feverish symptoms, and other general symptoms of tha disease, such as sore throat, &c. The chief care is required until the peeling off of the skin is completed. During this period also the power of communicating the disease by coita* gion appears to be retained. Favorable cases of scarlet fever pass through the course nearly as described above, but there are much severer fcrms of the disease. The feverish symptoms from the first may have a high inflammatory form; or the reverse may give evi dence of an extreme condition of bodily weakness, with a tea Scarlet Fever. 127 dcncy to malignant cr severe disease. In such cases tha eruption is slow, and, when it does appear, patchy, and dusky in color, the swelling of the throat is great, and, if they can be seen, the tonsils are evidently ulcerated, the breath offen- sive, the tongue swollen, and swallowing difficult, if not im- possible. Offensive discharges take place from the nose, and at the same time there is extreme weakness, with delirium. Scarlet fever requires confinement to bed, in a well venti- lated room; the diet should be kept low, and consist of milk. corn-starch, farina, &c, and the patient may be freely indulged with drinks, such as flax-seed tea, with a slice of lemon in it, &c. The patient must not be so warmly covered with bed- clothes as to keep up feverish heat. The first thing to he done, in all cases of scarlet fever, is, in the very outset, to give a good vomit, of ipecac, so as to clear the stomach. In a great majority of cases this will render the disease less dangeious and more easily managed, and very often will almost cut short, as it were, or break up the disease. If the-heat of skin is great, sponging the surface of the body with tepid water, with or without "the addition of a little vinegar, is at once most beneficial and grateful to the patient. A gentle purge should be repeated once or twice in the course of the disease, a tablespoonful of castor-oil, a dose of magnesia and rhubarb, or from half to a whole seidlitz powder, may be required. From five to ten grains (according to age) of chlorate of potash, given every six or eight hours, dissolved in a little sugar and water, is one of the most appropriate cooling medi- cines in this disease. If the feverish symptoms run high, of course the lowering and cooling remedies must be more actively enforced. In most cases much relief is afforded to the throat by the frequent use of warm gargles, made either with simple gruel, or with gruel with one or two tablespoonfuls of vinegar to each half- pint. Externally, hot bran or bread poultices, frequently re- newed, are also of much service to the throat. Great enlarge- ment of the glands around the jaw and in the neck must always be regarded seriously. When a case of scarlet fever presents symptoms of great severity, every method of sup porting the strength by wine, broths, &c, must be used, and the preparations of chlorate of potash employed both inter nally and as washes and gaigles to the nose, mouth, tonsils, &c. The chlorate of potash, in from five to ten grain doses, must be given every three or four hours; or muriatic acid, in five drop doses, in sweetened water. Two teaspoonsful of tha aolution of table salt, in the half-pint of water, will make a 128 Scarlet Fever. convenient wash, to be used with a syringe, if the child 01 person is unable to gargle. After the eruption has faded, the person may sit up, and gradually return to fuller diet, such as pudding, broth, fish, &c, the bowels being kept free, but not purged. At thia stage, too, much comfort and beneit will accrue from the usa of two or three warm baths, llitse relieve greatly the dis- comfort arising from the Harsh and dry state of the peeling skin, and, what is more important, encourage and keep active the perspiration, which is apt to be impaired or impeded, and thus to give rise to one of the most serious incidents con- nected with the disease in question, that is, to a dropsical con- dition connected with a disordered state of the kidneys. The occurrence of dropsy after scarlet fever is always a serious matter. It is observed that the attacks of dropsy after scarlel fever are by no means in accordance with the severity of tha attack itself, and this is supposed to be because those wfc-D have had only a mild attack are more careless as to after c: .- posure than those who have suffered a severe one. Howevc* this may be, it is certain that many, who have passed safely through the disease itself, fall victims to the subsequent dropsy, purely as the result of carelessness on their own part, or on that of others. The attacks of dropsy are most likely to occur from the end of the first fortnight to the end of the fourth week after the decline of the eruption. Its symptoms are generally those of languor and oppression, with headache, and It may be vomiting, the swelling coming on simultaneously. Usually, the face (especially the eyelids) is first affected, and the dropsical swelling may go no further, but generally the feet and legs, the hands, arms, chest, &c, become filled ; the urine is scanty, high-colored, or " smoky" in tinge. Should dropsy occur, warm baths ought to be used to re- store, if possible, the functions of the skin, hot bran poultices applied to the body, and if there is pain about the kidneys, blood taken by leeches or cupping. The bowels should be well purged. At the same time a draught, consisting of ipecac, spirits nitre, &c, the same as ordered in measles, maybe gives every four or five hours. Besides dropsy, scarlet fever is liaWt to be followed by other affections, particularly in those of weak or scrofulous constitution. If the affection of the throat has extended to the ears by the Eustachian tubes, which lead from the throat to the ear, the structure of the organs of hear ing may be materially damaged, and deafness, total or partial. be the result. Frequently, running from the ears, from tha nose, or eyes, continue long after the subsidence of scarlet Prickly Heat, 129 fever; and if the attack has been a severe one, a permanent state of impaired health may be the consequence. Of course, if a patient, after an attack of scarlet fever, remains weak tonic medicines (one grain of quinine three times a day, or a wine glass full of tea, made of Peruvian bark, cold, before each meal,) and good nourishment will be required—also warm clothing. Few diseases are more contagious than this, and few retain the power of propagation longer ; indeed, it is difficult to say when this totally ceases, at least for some weeks. Probably, when the peeling stage is complete, the risk of contagion is gone, or nearly so. The contagion from scarlet fever is very persistent, and unless the rooms which have been occupied by patients, and indeed everything which has been about them, are very freely cleansed, aired, or fumigated, there is always some risk for a considerable time. The power of belladonna, in protecting individuals against the contagion of scarlet fever, has been much discussed. It has been used extensively, and with apparent success ; at all events, the evidence is sufficient to make it worth a trial during the prevalence of a very severe or malignant form of scarlet fever. Eight grains of the ex- tract are to be rubbed up with a fluid ounce of water, and of this, from five to twenty drops, according to age, given twic** a day. It would be right to try the remedy during the pre valence of this disease, as well as measels, hooping cough, &o. Scarlet fever is generally a disease of childhood, and is usuallv passed through once in a lifetime; but adults who have es- caped it early in life, are liable to be affected. Second attacks are rare. Although those around persons suffering from scar- let fever may not nave the disease, they are very liable to suf- fer from sore-throat, often in a severe form. It is a serious thing for women to be exposed to the contagion of scarlet fe- ver soon after child-birth, and it should be avoided if possible. Where there are several children in a family, let those that are well be kept in different rooms from those that are sick with this disease, and the belladonna be used as directed, and let them be kept out in the open air, if the weather will permit. PRICKLY HEAT. The sensations arising from prickly heat are perfectly inda sciibable, being compounded of prickling, itching, tingling, and many other feelings for which there is no appropriate name. It is usually, but not invariably, accompanied by an eruption of vivid red pimples, not larger in general than a pin's head which spread over the breast, arms, thighs, neck, and occa 130 Ring Worm. sionaily along the forehead. This eruption often disappear (n great measure when the patient is sitting quiet, and the skin is cool; but any exercise that brings out a pcrspiracion, or any warm or stimuluting fluid, such as tea, soup, or wine, brings out the pimples, so as to be distinctly seen, and but too dis- tinctly felt. In reference to the imagined dangers of repelling this erup- ion, Dr. Johnson says—" I never saw it even repelled by tha cold bath, and in my own case, as well as in many others, it seemed rather to aggravate the eruption and disagreeable sen- sation, especially during the glow which succeeded immersion. It certainly disappears suddenly, sometimes on the accession of other diseases, but I never had reason to suppose that its disappearance occasioned them." An application every half hour, by means of soft linen, of a mixture of vinegar and cold water, in equal parts, to which add a few drops of laudanum to each cup full of the mixture, and afterwards applying finely powdered starch or common wheat flour, is about as good as any. Strong hop tea may ba tried. Always give a brisk purge of Pochelle salts, (one tea spoonful in a gill of water,) or Epsom salts will do. Low diet and quietude are very necessary. RING WORM. This unsightly and unpleasant disease is too often treated prematurely by stimulating applications : its symptoms are generally well marked. It consists of minute water blisters, arranged somewhat in rings: it begins with slight redness— small blisters form and are filled with a colorless fluid—these break in four or five days, and are covered by a thin brownish scab, which falls off about the eighth or ninth day, leaving a red surface which gradually disappears. The eruption seldom lasts more than ten days, but it sometimes appears a second time, and continues for several weeks: it is always attended with itching, smarting, and burning. It often appears on the face, neck and arms of children—and may be communicated by contact. A wash of white or blue vitriol (one teaspoonful to half pint of water,) or nitrate of silver, (lunar caustic) a stick half an inch long dissolved in a gill of water, and applied once a day, or an ointment made of yellow dock root, boiling two or three of the roots in half pound of lard, for one hour, wil usually effect a cure. After the first and most inflammatory stage is passed, the application once in forty-eight hours, oi tincture of iodine, or iodine ointment, applied two or three times, will thoroughly cure ring worm. Itch— Chickenpox. 131 ITCH. Tma is a very unpleasant affection. It usually comes first between the fingers and on the wrists, in small pimples filled with colorless fluid, attended by intense itching, which is al- ways increased by heat. The friction and scratching, used to allay the itching, ruptures the pimples, and they are by this means extended to the surrounding skin. In cases of long continuance, some of the vesicles (or sacks) become rilled with matter and covered with brown scabs, which extend over s ^ieat part of the body. This disease is contagious and is com- municated by contact—and probably sometimes produced hj want of cleanliness, and other causes. It seldom gets well without treatment: it is not dangerous, but may continue during the life-time of the patient, with varying degrees of tormenting nights and uneasy days. In neglected cases, an insect is to be seen in or near the vesicles. It may be seen burrowing under the skin, and when removed by the point of a needle, resembles the " cheese skipper." Whether the dis- ease is produced by this insect is not yet determined. Itch usually occurs in four or five days after exposure to its con- tagious matter. The best remedy in most cases, is sulphur, mixed with lard, (equal proportions, to which add a few drops of oil of lemon,) and applied night and morning to the parts affected: sulphur and cream tartar, mixed with molasses, may also be given in teaspoonful doses every night. The diet should be simple and digestible, the bed and cloth- ing of the patient kept perfectly clean and well ventilated. Two or three times a week:, the entire surface of the body and limbs should be washed with lukewarm water and soap, and afterwards rub well with a towel, just before going to bed. Sponging the skin all over once a week, Rafter bathing, as be- fore recommended,) with a mixture of water and cologne water, or bay rum and water (equal parts,) is of service in such cases. CHICKENPOX. A disease which is preceded by feverish symptoms, such ai chilliness, quid pulse, hot skin, restlessness, diminished appe- tite, thirst and headache. In some cases the fever is severe, and attended with distressing retching, great agitation during sleep, and even delirium. In others it is scarcely perceptible. On the third day, the eruption appears, first on the body, and then on the face, and lastly on the extremities; when tha eruption appears the fever declines. The pustules, which ara ery itchy, contain a yellow matter, and by the fifth day ara vered with scabs, which leave no pits. There are diffa» 132 Vaccination. rent varieties of this disease, for in some the pustules are larget than in others, or go off sooner. This is scarcely ever danger- ous, and is seldom even troublesome; nor is it generally ne- cessary to confine the patient, or do more than give one or two doses of some gentle purgative, such as previously recommend- ed in treating diseases of children. The fever and uneasy feelinga may be greatly mitigated, and the eruption rendered lighter by washing the surface with cold water in the commencement of the disease. The itching may be abated afterwards, by sponging the skin occasionally with cold vinegar and water. In some cases, especially if the bowels be neglected, and the child be allowed to eat freely, the fever will be greater and the pustules become much inflamed. Some of them may even end in sloughs, which leave deep marks, worse than those of the small-pox, and as in that disease, so also in this, very troublesome boils may harass the patient for a long time. VACCINATION. To Dr. Jenner, of England, belongs the credit of this great discovery, which, in the order of the providence of a merciful God, has been such a blessing to mankind. It is a well-known fact that vaccination or " cow-pox," is almost a certain pre- ventive of the contagious effects of small-pox. It is true, how- ever, that in some few cases it fails, but this should by no means prevent the vaccination of every child : it is thought by some authors, to lose its efficacy in a few years, so that a second or third vaccination may be necessary: this is, how- ever, doubtful. Children may be vaccinated at any age from three months upwards ; but there is some difficulty in securing a thorough operation of the virus in very young children, or in those affected with any disease of the skin. However, it may be performed at any time should circumstances call for k„ owing to exposure to the contagion of small-pox. The vac- cine matter may be taken in the fluid state from the arm of another person, or a bit of the scab which has been pre- served, may be used. Almost any mode of vaccination, which will secure the formation of a pustule (pock), will answer. The nsual mode is to raise a small piece of the skin on the arm, with the point of a lancet, and insert a little of the fluid or scab, and cover it with a piece of'" court plaster : " or simply taking a blunt-pointed needle and gradually scratching tha arm till it begins to show signs of bleeding : then dipping tha point of the needle into the vaccine matter a few times, and working it into the skin, will answer. If a scab is used, it Nettle-rash. 133 dxnst be softened by a dx>p of water a few minutes, till it gets the consistency of paste. Should the vaccination not take effect in four or five days, It should be repeated until it does, as there is no safety with- out it. It is always best to make one or two pocks on each arm. About the third day after the vaccination, there is a red, elevated pimple, which, on the fourth, is surrounded by a feint red circle ; on the fifth day there is a pearl-colored pim- ple filled with transparent fluid, on the eighth day the pock is at its height of development, at which time there is usually some fever, chills, lassitude, and more or less pain and swelling of the arm and glands of the arm-pit: by the tenth day the pock is led and painful, on the eleventh it begins to shrink and assumes a darker color, so that by the fourteenth day it is covered by a thick, brown scab, which falls off about the eighteenth day, leaving a white scar. All the care necessary is to see that the vaccination passes through its course without getting the part injured; and should there be much fever give a gentle purgative. To preserve a " scab," keep it in a dry bottle or vial, wrapped in paper, and the mouth well corked, with some beeswax over it. NETTLE-RASH. It cannot be better described than as an eruption which elosely resembles nettle-stings, both in appearance and in the sensations it gives rise to. When acute, it is generally accom- panied with more or less fever. The nettle-rash, in almost all cases, arises from disorder of the digestive organs, caused either by indigestible food, or, in some persons, by particular kinds of food. Kernels or seeds, such as almond, peach, &c, which contain prussic acid, seem especially apt to cause nettle- rash, and in some individuals even the pips of an apple have been known to produce the disorder. Fish, particularly shell- fish, or mushrooms, also bring it on; also certain medicines, Buch as turpentine ; teething in children, hurry and agitation of mind in adults, and other irritations, also give rise to nettle-rash. The generally known causes of this affection in- dicate the remedy—the removal from the stomach and bowels of offending matters. If there is a tendency to sickness, and if the eruption appears soon after a meal, an emetic is tha appropriate remedy ; but, whether this is administered or not a purgative should be given. As acid in the bowels often ac- companies the disease, a dose of magnesia with rhubarb ia very suitable, and, afterward, a dose of castor oil. External 134 Indigestion—Water on l fa ftrtf/r. remedies are comparatively of little servi „e in trie h toxc fori if of nettle-rash. A lotion of sugar of lead, one drachm, in Hall a pint of water, will give relief, or you may try the effect ot flour dusted over the surface. Eose-Kash.—Occurs both in children and adults, in the form of rose-red patches of various sizes, somewhat resembling measles in many cases, but of a redder hue. The disease is fenerally accompanied with slight fever, but the symptoms iffer from those which accompany measles. It is devoid ot danger, and generally subsides after the administration of a simple purgative. If either rose-rash or nettle-rash are thought to be connected with teething, the gums should be scarified. Wheat flour, applied to the affected parts, or pow dered starch, is beneficial. • INDIGESTION. This is manifested by the food being imperfectly, or not at all, digested, but is discharged by vomiting or stool without being changed; there are often no symptoms of inflammation. Indigestion in infants is almost invariably caused by too much or improper food. The most common symptoms of indigestion are, nausea, vomiting, sour odor of the breath, the milk discharged ia sometimes curdled, and at others unaltered, and there are more or less griping colic pains. Children who are weaned early, or reared without the breast, are liable to attacks of in ■ digestion, and often become pale, weak, emaciated, the tongue furred, bowels bloated and tender, mouth sore, thirst, fretful- ness, moaning, eyes glassy, and finally, in some cases, death ends the suffering. In older children, indigestion is caused by unripe fruits, too much food, confectionery, pastry, impro- perly cooked or hard food, eating too often and at irregular and unsuitable hours. Affections of the brain, convulsions, spasm of the windpipe and inflammation, sometimes result from this disease. The child should be carried or permitted to go into the open air; the tepid bath and flesh brush should also be used every morning. Also give from four to six grains of rhubarb and magnesia, or a teaspoonful pf castor oil, once every second day, and let the child's diet be so regulated as to avoid those thing! which have caused the disease. WATER ON THE BRAIN. Children of scrofulous constitution are most liable to thii disease, and should be close\y watched, especially from ths Water on the Brain. 135 second to the sixth or seventh year of life, the most genera. period of attack, and particularly after the child has suffered from any of ihe diseases i icidental to childhood. At first, the patient is languid, looks heavy, is subject to irregular heat? and chills; the appetite is variable, the bowels irregular, and the discharges from them unnatural in color. The sleep is disturbed ; there is frequent starting, moaning, perhaps scream- ing; the teeth are grated, and the thumbs folded across the palm of the hand. When awake the brow is contracted ; the nose is continually picked, and the child, if able to speak, com- plains of the head, which is hot. As the disease advances be- yond the first stage, all these symptoms become more marked, and probably obstinate vomiting, and when the stomach ia empty, retching occurs. Toward the termination of the dis- ease, insensibility, dilated pupils, convulsions, etc., come on; but long before the latter stages, the case should be under proper medical treatment. The object here is to put parents on their guard as to the advances of an insidious and very fatal malady—not to induce them to incur the responsibility of its treatment. Many of the symptoms above detailed undoubt- edly occur, in less alarming combination, in many of the dis- eases of children ; but come as they may, and when they may, they should not be neglected. Some amount of treatment ought however to be employed to save time, and the most im- portant and safest indication is to give a brisk purgative, say one teaspoonful or two of ftochelle salts in a teacupful of wa- ter. The head is to be kept cold, and quiet strictly to be ob- served. One or two leeches may be applied to the temples, and then obtain proper medical advice soon as possible. Ita causes are numerous, but sometimes the disease arises without any being distinctly traceable ; the irritation of teething, long- continued disorder of the digestive organs, falls or blows on the head, exposure of the child's head to the heat of the sun, and fevers, may any of them give the first impetus to the dis- eased tendencies. Those children who are most liable to its at- tack are often the most endowed intellectually; and there is a morbid tendency to excitement in the brain, which gives it power beyond what is natural to its age. If permitted or en- couraged, the child will give up the sports and exercises o+* its time of life, for the sake of mental employment, and sometbues a parent's pride permits the erroneous system, which, in all probability leads either to early death from active disease of the brain, or to the possession in after life of a sickly bod> and morbid mind. In no children is it so necessary to insistup^a atrict observance of all the laws of physical health, previous f 136 Diet for Sick Children. treated of in this work, as in those who exhibit precocious d* velopment of mind. DIET FOR SICK CHILDREN. Under this head will be found many valuable recipes for preparing suitable diet for the sick room. They can be relied on, as they have been prepared with a view to their adapta- tion to the delicate stomachs of children during sickness, be aides being "not bad to take," many of them, by well children or grown people. Panada.—Pour boiling water on toasted bread, and season with butter, white sugar, lemon and nutmeg. Boiled Custard.—Beat one egg in one pint of milk, add salt and sugar to the taste, and boil two minutes. Starch Pudding.—To one pint of boiling milk, add two tablespoonfuls of starch, and one egg, beaten together ; season with sugar, salt, wine and nutmeg, and boil one minute. Rice Caudle.—Make a paste of two tablespoonfuls of rice flour in a little cold water, boil in one pint of water, and season with salt and nutmeg. Dyspepsia Bread.—Mix together three quarts of unbolted wheat flour, one quart of warm water, one gill of fresh yeast, one gill of molasses, and two teaspoonfuls of salt; let it rise, and bake. Lemonade.—To one pint of water add the juice of one lemon, and the beaten whites of two eggs; sweeten with white sugar. Orange Jelly.—Squeeze the juice from six oranges and half a lemon, add half a pound of white sugar, half a pint of water, boil, and strain through flannel; then add one ounce of isinglass, and, when this is well dissolved, put it into a mould or dish to cool. Biscuit Jelly.—Soak one biscuit or Boston cracker in one {>int of water, boil, and add white sugar, wine and nutmeg or emon to the taste. Sago Jelly.—Soak two tablespoonfuls of sago in water one hour; pour off the water and boil the sago in half a pint of water, until it is transparent; then season with salt, lemon, wine and sugar to the taste. Tapioca Jelly.—Soak the tapioca eight hours, and then pre pare like sago jelly. Isinglass Jelly.—Boil two ounces of isinglass in one quart of water down to one pint, and add one ounce of white lemon oandv. Rtee Jelly.—Boil three tablespoonfuls of rice and three of Diet for Sick Children. 137 srhite sugar, in just sufficient water to cover it, until it be* comes a jelly, and season to the taste. Calves* Feet Jelly.—Boil one calf's foot in two quarts of water till reduced to one pint, strain, and, when cold, skim carefully, and add one teaspoonful of salt, the whites of three eggs, beaten with four ounces of white sugar, one gill of wine, and the juice of two lemons; boil the whole, stirring con- stantly, for four minutes, then strain through flannel. Moss Jelly.—Soak half an ounce of Irish moss a few min- dtes in cold water, then drain it off, and boil it in one quart of water until it becomes a jelly ; strain, and season with cin- namon, wine and white sugar. Rice Pudding.—Boil one teacupful of soaked rice in one quart of milk, then add two tablespoonfuls of white sugar and one egg, beaten together, and one teaspoonful of salt; bake one hour. Milk Toast.—Toast a thin slice of wheaten bread slightly brown, pour on to it some boiling milk, and season With nut- meg and salt. Boston Cracker Toast.—Split Boston crackers, toast them brown, pour on boiling water, and drain it off; then season with butter, sugar, lemon juice, and nutmeg or orange peel. Broiled Meat.—Broil the lean round or sirloin of beef or mutton, on the coals, until tender, and season with salt or tomato catsup. Boiled Eggs.—Boil eggs until the white is partly cooked, and the yolk slightly turned; remove from the shell, and sea- son with salt. Roast Potatoes.—Roast pink-eyed potatoes in the fire until well done, remove the outside crust, mash, and season with salt and cream. Oaten Gruel.—Boil two tablespoonfuls of sifted oat meal in one quart of water for ten minutes, then add a teaspoonful of 3alt, one of wine, one of lemon juice, and a little nutmeg. Indian Gruel. Boil two tablespoonfuls of Indian meal in one quart of water for twenty minutes, add salt, sugar and nutmeg, or lemon to suit the taste. Sweet Coru Gruel.—Boil three tablespoonfuls of dried sweet oorn in one quart of water for half an hour, season with salt and strain through linen. Sago Milk.—Soak a teaspoonful of sago in a pint of cold water one hour; pour off the water and boil the sago in a pint and a half of milk fifteen minutes, stirring constantly. Season with salt, sugar, ginger or nutmeg, and sometimes wine. 138 Diet for Sick Children. Sago Mucilage.—Soak a teaspoonful of sago in a pint of warm water two hours, then boil the same fifteen minutea stirring constantly; season with salt, lemon juice, sugar, nut meg and wine. Arrow root and tapioca may be prepared ia the same way as sago. Beef Tea.—Cut one pound of lean fresh beef into shreds, and boil in one quart of water for twenty minutes; add one teaspoonful of salt and strain through linen. Mutton Broth.—Boil the same quantity of lean fresh mut ton and water as above, for one hour; add a few crusts ol bread—season with salt and parsley, and strain. Milk Porridge.—Boil one pint of water and one of milk ; add one tablespoonful of wheat flour made into a thin paste, season with salt and boil five minutes. Oyster Soup.—Boil four oysters in one pint of water foi five minutes, add one small cracker and a little salt. Barley Water.—Boil two ounces of pearl barley in o*\e quart of water down to one pint—season with salt, lemon a^d sugar, and strain through linen. Apple Tea.—Boil a middle-sized sour apple in one pint of wa- ter, strain and sweeten with white sugar. Peach tea may be made in the same way after removing the stone. Wine Whey.—Boil one pint of new milk, and while boiling, add a large wine glass full of sherry or madeira wine; let it boil a few minutes, remove it from the fire, let it cool a few minutes, then strain from the curd and sweeten with whito sugar. Tamarind Water.—Boil six tamarinds in one pint of water for ten minutes, and strain through linen. This is a gentle purgative. Currant Water.—Boil equal quantities of currant juice and water a few minutes; strain through flannel and season with orange peel and loaf sugar. Cherry water, may be made in the same way. Chicken Water.—Take half a chicken, remove the fat, break the bones, and boil in two quarts of water for half an hour; add two teaspoonfuls of salt, and strain througa linen Diseases of Females. 139 DISEASES OF EE3XA.LES. MONTHLY TURNS, OR MENSTRUATION. This important function should be well understood by both aaale and female, as by so doing many of the ills of life could be avoided, and things which otherwise would be mysterious are rendered intelligible. From the womb of every healthy woman who is not preg- nant, or who does not give suck, there is a discharge of a fluid having the appearance of blood, at certain periods, from the time of puberty to old age, called menstruation, or courses. Some few menstruate while they continue to give suck, more frequently after having suckled over six months. Some are said to menstruate during pregnancy, but which latter is very doubtful, for it will be borne in mind that the menstrual dis- charge is not blood, but a secretion resembling blood, and that every such discharge from the womb is not menstrual, but may be blood, dependent on morbid action. Although the term unwell, is by common acceptance used among women, yet, a woman during menstruation cannot from that cause alone be said to be unwell, for that is a process of health, and which, when regular, requires very seldom more than to be let alone. This is a very important process to females, and ought to be particularly so to mothers who have daughters coining to ma- turity : that mother is very remiss in her duty who does not inform her child that menstruation is expected, and point out to her what it is, so that the child may not be taken by sur- prise, and through fear and alarm do things, which may lay the foundation of disease and unhappiness during life. The delicacy attendant on the subject too frequently prevents the afflicted from obtaining the necessary information, and gives rise to groping in the dark, and administering medicine at random. It should be borne in mind that the time of life at which menstruation commences, depends some upon the climate, much upon the constitution, and delicacy of living; in thi country, girls begin to menstruate from the fourteenth to tha> eighteenth year of their age, but seldom later without incon venience; but if they are luxuriously educated, menstruation Usually commences at a more early period. About the time that the constitution is establishing menstruation, a variety^ of important changes show themselves: the complexion is in* 140 Diseases of Females. proved; the countenance is more expressive and animate!; the attitudes more graceful; the tone of the voice more har- monious ; the whole frame expands; the breasts are enlarged; the nipples protrude, &c. Generally there are symptoms which indicate the change that is about to take place; these are usually more severe at the first than in the succeeding periods, such as a sense of full- ness at the lower region of the belly; pains in the back and inferior extremities; a slight head-ache, ringing in the ears; a sensation of choking or a lump in the throat; palpitation of the heart; easily affrighted by slight and unexpected noise; irregular appetite, twitching of the limbs, sometimes convul- sions, all of which cease soon after the flow commences. The first discharge is sometimes very small and not colored; for Beveral times it is apt to be irregular, both as to the quantity discharged and period of its return, but after these it usually observes stated times, and nearly the same quantity at each visitation. The time occupied and quantity discharged, vary much in different women, from two to five days, and from ona to five ounces may be stated as the average. Frequently it occurs when the time for menstruation has ar- rived and it does not appear, or when a girl begins to menstru ate in small quantities, or when it wants color, that instead ot being let alone, she is compelled to swallow one nauseous por- tion after another, until that process by which nature wa« about gradually establishing an important and necessary change, is interrupted, and a train of morbid actions laid, which entail upon her a great amount of suffering. When about to commence, or having commenced, being small in quantity, the girl should be directed, during the time it is upon her to avoid the extremes of either heat or cold; if cold weather, should add some clothing, keep dry and warm feet, abstain from laborious exercise, such as violent running, jumping, dancing, lifting or carrying heavy burdens, or any thing else by which the body may be strained, or the system over-heated; avoid sudden exposures to currents of cold air when heated, or fatigued ; she should also be taught to have a command over her temper, so as to avoid violent outbreaking^ of anger, and paroxysms of excitement from terror or fright; and siie should wear flannel next the skin. Observing these directions, together with a moderate, rather low diet, avoiding all high seasoned victuals, hot aromatic teas, spiced stews, afl and every intoxicating liquor, she should continue much hei usual indoor employments; and thus, the principle of letting well enough alone being observed, a few periods will generally Diseases of Females. 141 establish tlie regularity of their return, on- a healthy and per manent basis. In general, no medicine is required, except she be costive; it should be removed by purgatives, such as small portions of Epsom salts, or castor oil, but the more violent and drastic purgatives should be strictly avoided. But when it occurs that the courses are either retarded in their progress, or do not appear, and symptoms of ill health be present, great eare and attention will be required, that proper remedies be administered. RETENTION OF THE MENSES OR COURSES. This is a condition in which the courses do not appear at the proper age, in consequence of which the health suffers. The general rules for the treatment of which are, that when robust, florid girls, about the age of fifteen or sixteen, begin to com- plain of flushings, headache, and general uneasiness, they should observe a spare diet, consisting chiefly of vegetables; use moderate exercise, carefully avoid all that is violent, par- ticularly in crowded and heated rooms; should carefully attend to the state of their bowels, and keep them freely open by saline purgatives; such as cream of tartar, Epsom salts, Rochelle salts, one tablespoonful, of either, in a glass of water before breakfast, every second or third morning, or a seidlitz powder. If the symptoms continue or increase, and the dis- charge of the menses does not take place, take a tablespoonful of Epsom salts every two hours, beginning in the morning, until freely purged; bathe the feet and legs, or rather sit awhile in warm water for several evenings; after the bathing remove all moisture, and rub the feet and legs freely with a coarse cloth. In obstinate cases this proceeding will require to be repeated, for two or three times, at the end of every four weeks. On the other hand, relaxed and feeble young women, with pale complexions, when they are subject to delay in the ap- Eearance of the menstrual evacuation, and are suffering in ealth in consequence thereof, should make use of such reme- dies as strengtlien the system in general. One grain of quinine, taken night and morning, on an empty stomach, is an excellent tonic, or mix together the following: Gentian root, half an ounce; Columbo root, half an ounce; orange peel and wild cherry bark, each, half an ounce ; all to be beat or1 ground fine, and put with half a pint of whisky and same quantity of water. Let stand for ten .days, then strain, and take a tablespoonful half an hour before each meal, during the use of which the bowels must be kept open, and a more nutri- tious yet easily digested diet allowed. Take sufficient exercise 142 Diseases of Females. in the open air, such as riding on horseback, jumping the rope in moderation, or walking with agreeable persons, so that cheerfulness is blended with exercise. For the same reason, a journey, a short residence at watering-places of public resort, fntfependent of the quality of their springs, contribute greatlv to their relief; and when the impregnation of such springs is chalybeate, (iron,) they may be drank with moderation, re- membering to precede their use by an active purge, by which eLalybeates and all tonics are rendered not only more safe, but more beneficial. When the young girl thinks, from her feeling, that nature if making an effort to bring forth the discharge, which is known by an increase of uneasy feeling in the back, hips, or lower part of the belly, she is to use the warm bath as before directed. Owing to previous debility, or other diseases, the courses are sometimes retained or obstructed, and no medicine or treat- ment will avail until the disease under which the person labors be removed. Retention of the menses for a length of time soon under- mines the general health, even in the best constitutions, and degenerates into what is called green sickness, a very danger- ous disease, and difficult to cure. Every symptom of feeble- ness prevails—a pale skin, and even a greenish complexion, succeeds to the rosy hue of health; the lips and gums become almost white, the breath offensive, the skin under the eyes puffy, and of a leaden color, the whole body lax, swollen and doughy; the judgment, memory and natural cheerfulness im- paired ; the pulse is generally slow and feeble, but easily ex- cited, and it is then accompanied by shortness of breath, a palpitation of the heart, and an almost unconquerable disin- clination to motion ; the appetite is destroyed, and the stomach so deranged that the food, instead of being digested, sours on the stomach. Hence the patient finds gratification in chalk, lime, pieces of old wall, and other impropor oubstances; there is also costiveness. The treatment should be more energetic under such circum- stances ; it should be commenced by removing the costiveness by repeated dones of active purgatives, such as ten grains of ialap with four grains of aloes well mixed, and made into a bolus, or pills, with some syrup, and followed, in six houn after, by one tablespoonful of castor oil, or a gill of senna tea, which should be repeated every four hours, until free evacua- tions take place; to be repeated every two or three days, ac- cording to the effect of the preceding, until the feverish or inflammatory symptoms have been removed ; after which the Diseases of Females. U9 tonic mixture may be used, as formerly prescribed. During the use of either of these, the bowels must be prevented from becoming costive; but, should sourness of the stomach be present, which is known by a burning sensation at the stomach, sour belchings, sour taste in the mouth, soreness or tenderness of the stomach, particularly on external pressure, the follow- ing preparation should be used occasionally with the above: Loaf-sugar, four teaspoonsful; essence of cinnamon or pep- permint, two teaspoonsful; powdered rhubarb, two teaspoons- ful; carbonate of soda, one teaspoonful; carbonate of mag- nesia, four teaspoonsful; mix well in a bowl, adding half a pint of cold water. The dose is, one tablespoonful night and morning. Wearing flannel drawers, using moderate exercise, never going to the length of fatigue, and the aversion to motion to be overcome, by proposing such exercise as may be most agreeable, a nourishing diet, such as may agree best with the stomach, is the proper course to pursue ; and at such times as the menstrual efforts are felt, to assist them by the hip bath, and friction of the feet and legs. SUPPRESSION O.F THE MENSES. After being fully established, if the courses are arrested, or do not return at their usual period, when not caused by preg- nancy or suckling, it is called a suppression. The most fruit- ful sources of these derangements are exposure to cold, in some form or other, violent exercise, great mental agitation during their flow or immediately before their appearance. As soon as it is discovered that they are arrested, remedies should be immediately employed ; if tlieir suppression be not compli- cated with general disease, it is not difficult to induce their re- turn. The feet and legs should be bathed, or the person should sit in warm water; an anodyne may be given, such as a tea- spoonful of elixir paregoric, or anodyne cordial; promoting its operation by catmint, penneroyal, or spruce pine tea. Should these remedies fail, and there is pain in the head, back, and lower extremities, and the circulation excited, you should purge the bowels freely. After the free operation, give fifteen drops of antimonial wine, with five of laudanum, or ten of paregoric, in a spoonful of water, repeated every two hours, antil nausea be produced; then reduce the dose to one-half. If the feverish symptoms still continue the purging must be repeated on the third day following, and either of the medi- cines again used as before directed; during which time a verv iow diet is necessary. This treatment must be pursued until she fever shall be abated and the pain relieved. 144 Diseases of Females. Ton must not expect the courses immediately to return, bat probably they will at the next period be restored; and in order to facilitate their re-appearance, an active purge should be administered about four days before they are expected, Also bathe in warm water, etc., as before. DEFICIENT AND PAINFUL MENSTRUATION. Few persons have an idea of the amount of suffering among females from this disease. It seldom attacks any until they have menstruated some time with considerable regularity, and little or no pain ; afterwards, they begin to suffer more or less pain, which increases until it becomes grinding and severe as those in labor. It soon affects the general health; the patient loses her com- plexion, and becomes very irritable ana fretful. At the ap- proach of each menstrual period, the pain generally begins in the back, extends to the loins and hips, to which soon ensues an alternate and pressing down pain resembling in severity and suffering those of labor. At first a slight discharge takes place, but which suddenly ceases, after some time is renewed and becomes more plentiful, which, together with the pain, gradually ceases. The appearance of the discharge differs from that of a healthy menstruation, being mixed with lumps, and clots of flaky matter, having the appearance of membrane or skin. The breasts sympathizing with the womb, frequently swell and become painful. Women are mostly barren who have this disease in a severe form. Painful menstruation must be treated by having the bowel well opened a few days before the anticipated attack, in bein& confined to a very light vegetable diet, strictly avoiding tha use of all spiritous liquors. The patient should be kept in bed, drink freely of tea made either of penneroyal, catmint, sage, or the leaves of spruce pine, until the discharge be fully estab- lished ; after which the pain seldom returns for that period. Bateman's drops, or tea made of the bark of the root of tulip poplar tree, lovage, tansy, hops, or black snake root, may be used. What I have found the best in my own practice is this: Get at a drug store four ounces of tincture of ergot; com- science about a day or two before the expected return of the monthly sickness, and take a teaspoonful every four hours, until the discharge is fully established. Take a purgative before commencing with the ergot. Do the same way for two or three periods of the courses. The directions heretofore given as re- gards diet, clothing, and exercise, keeping the feet warm and 2ry, and the bowels open, together with an occasional use of Diseases of Females. 145 the warm bath should be strictly adhered to, and persevered in for a considerable length of time. Sometimes one or two grains of powdered ipecac, or half a teaspoonfnl of the syrup taken every two hours, will bring on the flow freely, when other means fail. Keep warm in bed while using the ipecac. PROFUSE MENSTRUATION. There is a great difference in different women as to the amount of the discharge during their courses. When a scanty evacuation is followed by a general uneasiness, a sense of fullness, flushing and headache, it is to be considered a suppression ; and when a considerable flow is followed by lan- guor, paleness and general weakness, it is to be considered as profuse, and should be checked. If feverish symptoms, such as headache, oppressed breath- ing, increased heat, and a full, firm pulse, precede or accom- pany a sudden and profuse flow of menses, the evacuation fre- quently becomes its own cure ; and if the woman be careful to keep her bowels open by moderate purgatives, to observe a spare diet, to drink only cold water, to keep her person cool by thin clothing, sleep on a hard bed, and have free exposure to the open air, she may not only moderate the evacuation in future, but probably will derive considerable advantage frorc its present excess. But if, notwithstanding these precautions, the flow continue or return, still accompanied with the above febrile symptoms, she must take a brisk purgative of Epsom salts, or senna and salts, to be repeated until full and free evacuations from the bowels take place. Also if necessary, take one or two grains of ipecac, or a half teaspoonful of the syrup of ipecac every two hours until sickness at the stomach is produced, but not vomiting. Should there be such a profuse flow as to cause great pros- tration, faintness, vomiting, the lips becoming pale, nails blue, extremities cold, with convulsive twitchings, the danger is great, and it is then no longer profuse menstruation, but must be considered a true uterine hemorrhage ; she must lie down on a hard bed, and be kept perfectly quiet. Motion of every kind must be forbidden, not even permit her to turn herself; she must be freely supplied with fresh air, or the use of the fan drink cold, or even iced water; bladders half filled with cold water, or cloths wrung out of cold water, applied to the belly, and frequently renewed, provided there is no chill on her at the time. These, together with oak bark tea, or alum whey every hour or two, with the addition of from ten to fifteen drops of laudanum to each dose ; all to be given cold. These 146 Diseases of Females. proceedings gencrahy give relief, or at least will co itrol the dia ease, and probably preserve life until medical aid can be pro- cured, which should always be had if possible. After the hemorrhage has been moderated, she must for many days avoid exertion, remaining in bed, be confined to a strictly vegetable diet, and avoid every kind of spices, and also all spiritous and fermented liquors. Keep her bowels open bytha use of purgatives, such as Rochelle salts—one teaspoonful in a glass of water—castor oil or magnesia, taking three times a day some light tonic bitters, such as cold watery infusion or tea made of wild cherry bark, thorough wort (boneset) or dog-wood bark, and while the body is to be kept cool, the feet are to be kept warm and dry ; if they are cold, they must be frequently rubbed with a woolen cloth or flesh-brush. CESSATION OF THE MENSES. As a general rule, a woman ceases to have the menstrua, flow between the age of forty and fifty; in some women gradu- ally, in others more suddenly. This is an important and criti- cal period of a woman's life, and great care is to be exercised that the health of the patient be not injured by improper treat- ment. The greater number of cases require only to be 1st alone ; many, particularly the weakly, will probably be bene- fited by the cessation, and will enjoy better health. When. therefore, this discharge shall decline or altogether cease, and not be succeeded by other disease, it will require no other at- tention than a strict regard to temperance, so as not to inter- rupt nature in effecting an important change. But in constitu- tions in which there is a predisposition to some disease, the cessation, more particularly the sudden stoppage of the courses will expose the woman to an attack of that disease. Therefore, ii upon the decline of menstruation there shall occur general feverish uneasiness, such as flushings, restlessness, headache, throbbing, either in the head or under the ears, singing or ringing in the ears, dizziness, darting pain through the head, {>alpitation of the heart, piles, hard or painful swelling of tha egs, it will then be necessary in addition to strict temperance, both as regards body and mind, to keep the bowels fieely open by the occasional use of salts, seidlitz powders, castor oil, senna, or if necessary, more active purgatives, such as cream cf taitar and jalap, etc. These remedies and precautions will have to' be persisted in for some time, at such intervals as the urgency of the symptoms may require, and should be so timed as to anticipate the attacks, until the system becomes used to the change. Diseases of Females. 14T At this time of life, soma women, instead of the menses ceasing, become subject to repeated and excessive discharges; In such cases, before the patient becomes weakened by ex- haustion, and if the discharge be accompanied by fever, it will be necessary to use gentle laxatives and anodynes, suck as a teaspoonful, each, of cream of tartar and sulphur in a glas3 of water before breakfast. Also put one tablespoonful of spirits nitre in a tumbler of cold water, and take one tablespoonfil every three hours. As an anodyne, take half a teaspoonful of paregoric in a little water at bed time. But if such dischargee become so excessive as to come under the denomination of uterine hemorrhage as formerly described, the case should be treated the same as advised in that disease. If it occurs that a woman, after menstruation has ceased for a few periods, becomes again subject to discharges either of blood, or matter resembling that from a boil, especially if it be accompanied with pain at a particular spot, darting from thence across the abdomen, through the hips or down the thighs, there is reason to apprehend cancer, or other serious ulcers in the womb or adjacent parts. It is advisable to have such case* placed under medical advice. Nothing has a greater tendency to retard the progress of these cases, than a strict regard to temperance, and nothing will more surely hasten their ad- vancement into incurable disease than the opposite course. UTERINE OR WOMB DISEASES. Fluor Albus, or Whites.—Female weakness, (as this dis- ease is often called,) is among the most prevalent ailments among women: even young girls before marriage, are often troubled with it without applying for medical aid, owing to false notions of modesty. It is a discharge from the privates, not colored with blood; in general, if the disease be not the consequence of falling down of the womb, or other organic derangement of that organ, the discharge is easily arrested, when taken in the first stage. At first, it is in most cases strictly local, but if suffered to run on, its necessary conse- quence is to undermine the constitution, and ruin the general health. The discharge is at first mild and semi-transparent, resembling in appearauce that of the white of eggs, or thin starch made by boiling; but becomes in its progress opaque or milky, yellow, greenish, and scalding—so much so as to ir ritate and inflame the parts over which it passes. In the first Btage it is accompanied by little or no pain, but as it progress- es towards the second, and succeeding stages, the person suf- fers from loss of appetite, pain in the back and loins, wearineai 148 Diseases of Females. and fever. When persons of a robust and full habit are sub- ject to this disease, or when it occurs in more delicate con- stitutions, but accompanied by a feverish state of the system, the treatment should be commenced by a purgative of tec grains of rhubarb, a dose of senna, or castor oil. A cooling and spare diet is absolutely necessary, and cleanlint'Se must be strictly enforced. In order to secure this latter requisite, (which is all important to the speedy termination of the dia ease,) injections of luke-warm water, or milk and water of the aame temperature, should be thrown up the privates three or four times a day : this may be accomplished by the use of tha female syringe, to be obtained at most drug-stores. When the feverish state of the system is thus in some degree subdued, gentle astringent injections will be proper; such as weak tea of white oak bark, with or without a small portion of alum; or 20 grains of white vitriol, 100 drops of laudanum, and half a pint of water, to be used three times daily. Injections of green or black tea, very strong, or tea made from sassafras, sage, or dogwood bark, (cold) thrown up the private parts three or four times a day; also, at the same time, washing the outer parts in cold water, and always keep the bowels open, is ad- visable. When the disease has already progressed until it has passed the inflammatory stage, or is not originally attended by a feverish state of the system, but by general weakness; an ina- bility or disinclination to exercise; pain in the back and loins, want of appetite, &c,—after the purging, as above directed, and during the use of the astringent injections, the tonic bit- ters previously mentioned, (of wild cherry bark, &c.) together with bathing the outer parts in cold water thoroughly three or four times a day, should be used. In those cases in which the discharge is offensive and of a greenish color, or re sembling matter discharged from a boil and streaked with blood, it is advisable for the purpose of cleansing out the va- gina, {or canal,) first, immediately preceding each astringent injection, to throw up a few syringes full of weak soapsuds. Too great attention cannot be paid to cleanliness, and indeed all other directions are useless if that be neglected. The outer parts should be well washed with soap and water two or threa times a week. If this course of treatment does not effect a cure, make no delay in seeking advice of a physician. FALLING OF THE WOMB. When a prolapsus takes place, an uneasy dragging sensatioa is felt in the loins while standing or walking; a mucous dia Diseases of Females. 149 charge is perceived, sometimes bloody, accompanied with a kind oi pressing or bearing down ; an inclination to go to stool, frequently a light slimy purging and a sense of numbness shooting down the thighs ; when first rising from a lying to a standing position, a sensation of falling from above into the passage below, which prevents the free evacuation of urine ; these symptoms all subside, or are much mitigated by lying down. Whatever weakens the parts concerned, has a tenden- cy to produce this disease: such as, frequent miscarriages: improper treatment during labor; severe and protracted labor; the use of instruments in delivery; too early rising, and too violent exercise after delivery; improper treatment of profuse menstruation; long continued whites; violent exertion during menstruation, such as jumping, dancing, lifting heavy weights ; blows on the abdomen, &c, are the most frequent causes. The means of cure, in those cases in which the womb will not return to its place on lying down, is to lower the head and shoulders, whilst the hips are somewhat elevated, then with the finger oiled, gently press the prolapsed part into its proper situation, and fie down for many days, or in severe cases, weeks, and two or three times a day make use of astringent injections as men- tioned in treating whites. If the bowels are costive, some gentle cathartic, such as castor oil, seidlitz powders, magnesia, &c, should be administered, but all irritating purgatives, as well as stimulating diet aud drinks, strictly avoided. If these means fail, recourse must be had to the use of "a pessary, which can be obtained at most any drug-store. The " Ring Pessary" we consider preferable. It should be taken out once or twice a week, and washed in soap and water; and at the same time, inject a pint of cold green tea up the privates. PREGNANCY—Its Signs and Diseases. During pregnancy, the natural irritability of the womb being increased, manifests itself by a variety of symptoms and sympathies. Although such symptoms may, and frequently do, arise from other causes than pregnancy, still, when a healthy married woman finds that the menstrual discharge does not return at its usual period, finds her breasts enlarge, and the circle which surrounds the nipple change from a light Dink to a dark brown color, and that she soon after becomes subject to languor, nausea, and vomiting in the morning, heart-burn during the day, and some degree of restlessness and want of sleep during the night, she may with confidence attribute those symptoms to pregnancy. Women who hava 150 Diseases of Females. borne children will, in consequence of their peculiar feelings formerly experienced, seldom be mistaken in tlieir judgment whilst those who wish to hide their pregnancy, and others from an overweening anxiety to have children, will be led into many ridiculous and frequently dangerous errors. As all, or at least most, of the symptoms above mentioned may be pre- sent, yet no pregnancy exist, therefore, in cases of doubt, it would be most expedient to act as though it did, for, about the end of the third and beginning of the fourth month, the rising of the womb, and the feeling of a tumor or fullness below the stomach—and, between the fourth and fifth month, the motion of the child, termed " quickening"—will, generally, put the matter beyond doubt; no risk can be encountered by thus de- laying any measures which might have an injurious tendency in case of pregnancy. Diseases of Pregnancy.—A common attendant on early pregnancy is a slight degree of feverishness, but which-unless excessive or accompanied with other diseases, will seldom re- quire any other remedy than to open the bowels, and a low diet, of which fruit and vegetables should form the principal part; there is generally a dislike to animal food of every kind, and it should be avoided as much as possible, for, if indulged in, it gives rise to much inconvenience. Another means of keeping up a healthy action, and thereby obviating the effects of iever, is moderate exercise in the open air. It is a mistake to suppose that pregnant women should be encouraged in living more luxuriously and indolently than what is habitual to them; they should, therefore, not be confined to close or heated apartments, but bo allowed a full share of out-door ex- ercise, yet be cautioned to guard against extremes, such as carrying or lifting heavy burthens, running, jumping, dancing, &c. The irritation of the fever will cause them to be fretful, peevish, and desponding, which is often by others mistaken for ill-temper, which erroneous opinion only leads to further inconvenience and unhappiness. Women, whose happiness always is a matter of deep interest to the civilized man and Christian, are, during the state of pregnancy, more than at any other time, entitled to the tender regard and affectionate consolation of their friends, particularly of those who claim the title of husband. The desires and dislikes of pregnant women should not be overlooked, and the effects of despond- ency prevented by kind words and by everything calculated to encourage them. Frequently the feverish heat, full pulse, headache, uneasinesi rnd restlessness continue to increase as pregnancy advancea, Diseases of Females. 151 becoming sometime*) very distressing and alarming; recourse should then be had. to purgatives, after which two or three doses of soda powders, during the day, or cooling drink of water, acidulated with lemon juice, vinegar, cream of tartar, tamarinds, cherries, plums, &c. The mild purging may be ■epeated as occasion requires, but should not be excessive, or uuch as produces griping. Morning sickness is one of the early symptoms of preg- nancy, which generally ceases after quickening, and returns towards the conclusion, sometimes at intervals during the whole period, which, when moderate and confined to the earl) part of the day, should be left to nature, not being of a dan- gerous tendency, but generally found serviceable, as a woman will generally find she enjoys more ease during the remainder of the day after having vomited in the morning than when she has not. When sickness and vomiting prove more severe, and the stomach continues to reject the food taken during the day, re- course should be had to medicine. When the vomiting is ac- companied by a costive state of the bowels, a tablespoonful of carbonate of magnesia should be given several times during the day, until they are moved, and continued once or twice a day for some time ; or the following: water, one gill; loaf sugar, two teaspoonsful; essence of cinnamon, one teaspoon- ful; rhubarb, one teaspoonful; calcined magnesia, one tea- spoonful—mix together. Of this mixture one tablespoonful may be given every four hours. A seidlitz powder taken occasionally will be found useful. If the vomiting be accompanied by a diarrhoea, a tea- spoonful of prepared chalk, diffused in cold water, three or four times a day, soda powders, lime water and sweet milk, or a piece of flannel moistened with laudanum and camphor ap- plied to the pit of the stomach, will all prove very service- able. Heartburn is a painful sensation of heat in the throat and stomach, attended with a sudden coming up of thin, sour froth into the mouth. There is often reason to think that it is occasioned by food highly seasoned, or not easily digested, and by fermented liquors—and sometimes by sleeping in a sitting posture after a meal—but it most frequently depends upon some sympathy of the stomach with the womb, and although more disagreeable and difficult to remove than dangerous, and always removed by delivery, yet there are some cases which are extremely distiessing, and cannot be considered as entirely void of danger. 112 Diseases of Females. Even if we cannot remove this unpleasant attendant on pregnancy until after delivery, it maybe much mitigated by fiving, two or three times a day, a large teaspoonful of car- onate of magnesia, or prepared chalk, in cold water; a table- spoonful of lime water, or ten grains of carbonate of soda in a gill of fresh water. In obstinate cases, the following wil: be found a very beneficial piescription: Water, half a gill; essence of cinnamon, one teaspoonful; calcined magnesia, ona teaspoonful; hartshorn, ten drops ; mix and put into a bottle. Two or three teaspoonsful may be given occasionally, particu- larly after meals, each dose to be taken in a large tablespoon- ful of water. If costiveness prevails, it should b'e removed by gentle purgatives. Magnesia is among the best in this case. Costiveness is one of the most prevalent, as well as the most obstinate, diseases of pregnancy, and is, generally, most ne- glected. When excessive, it gives rise to many other affec- tions, such as colicy pains, headache, flushing of the face, frequent desire to make water, unavailing straining at stool, piles, palpitation of the heart. Costiveness, if not the cause of vomiting, heartburn, and flatulence, is known much to in- crease them; and there is much reason to believe it is frequentl.v the cause of abortion, and therefore of much importance that it should be removed. But, in accomplishing this, care should be used to select proper purgatives, strictly avoiding all such as are griping, as profuse purging is hurtful in pregnancy. Small doses of Epsom salts, seidlitz powders, manna, senna and manna, castor oil, rhubarb, sulphur and cream of tartar, are the most proper purgatives. These ought to be used in rather small and repeated doses than given largely. Much may be done to remove this unpleasant state of tho bowels by a suitable diet. Bread made of unbolted ground flour, (called sometimes " Graham flour,") and bran tea, sweet- ened with molasses, or manna, deservedly rank high; also such other articles as are known to have a laxative effect upon the bowels should not be neglected. Stewed fruits at meals, or ripe fruit uncooked, once or twice a day, or a roasted apple at bed time, assist in keeping the bowels open. If the bowels have been in a costive state for many days, it will always bo advisable to assist the operation of the medicines by an injec- tion, composed of a pint of milk and water, with the addition ef a tablespoonful of melted lard, or sweet oil, which will facilitate the evacuation, and cause the medicines to operate with less pain and sickness. Piles.—They are a cause of much suffering to pregnant women, and, in consequence of the delicacy attendant, they Diseases of Females. 153 will generally suffer a long time in silence rather than apply for aid. The treatment proper for this disease will be found unde. the head of Piles, in another part of this work. Strangury, or Pain and Difficulty in Urinating.—This is a frequent desire to pass the urine, and painful discharge in small quantities. It is sometimes caused by not complying with the calls of nature, and retaining the urine toe long, but most frequently arises, during the early period of pregnancy, from the sympathy which exists between the womb and blad- der ; subsequently, from the pressure of the enlarged womb, a retroversion or falling down of the womb, from its pressure against the neck of the bladder, may also give rise to it; in such cases, a tumor in the passage will be evident. For the relief of'strangury, the bowels should be moved by laxatives, assisted by injections up the bowels of lukewarm water, in the meantime drinking frequently of tea made either of elm bark, marsh mallows, flax-seed, parsley root, or lovage, adding three or four times a day, to some of the tea, twenty drops of spirits of nitre, and five drops of laudanum, or, in the place of the laudanum, twenty of paregoric. Should the strangury be caused by the falling down of the womb, it must be re- moved by replacing it according to the directions formerly given, and, while so attempting to replace the womb, let her make effort to void urine ; and if the bladder be thus emptied the tumor will probably return by further gentle pressure up- wards, and, if so, she should keep her bed for some days. Itching of the Outer Parts, with an irresistible desire to Bcratch, is, in some cases, a very distressing complaint, more so, as women will suffer intense misery in silence, and, even when forced to consult medical men, will not make it known, unless drawn from them by close and repeated questioning. Women are liable to this affection at any time of life; it ia frequently dependent on some disease of the bladder or womb, and when so no treatment will avail as a cure, unless the primary disease be first removed; it is also sometimes an original disease, and sometimes appears to be caused by the pregnant state, and in all cases where having previously ex- teteu is much increased during pregnancy. Use the following rr.ixture: Water, half a pint; borax, three tablespoonsful tir.cture of myrrh, one tablespoonful; laudanum, one tea- spoonful. To be injected into the passage, two, three, or four times a day, and during the intervals to keep pledgets of old linen, or a soft sponge, moistened with the same, in close com tact with the outer parts, where there is the most itching 154 Diseases of Females. Avoid scratching as much as possible. The bowels should bs kept well opened by proper purgatives. _ Wet tea leaves oi hops applied to the parts are often beneficial. Cramps, in the legs, which are very troublesome sometimes may generally be relieved by some stimulating liniment oj mixture of vinegar and mustard rubbed on the parts. More exercise should be taken. ABORTION, OR MISCARRIAGE, Is the expulsion of the contents of the pregnan" womb, at a {>eriod of pregnancy so early as to render it impossible for tha ife of the child to continue. Although in many cases no evident cause can be assigned for the production of this unpleasant occurrence, it may be mostly traced to some of the following: violent exercise; severe fatigue; sudden exertion; contusions or shocks on tie body ; heating and stimulating food ; indulgence in spiritoi > and other intoxicating liquors; violent operations of emetic fa and purgatives; fear, grief, and excessive joy ; a full gross hab :t and feverish state of the system ; exciting and debilitating dis- eases. A delicate frame, and weakly constitution, will prj dispose to it, yet, there are some in whom there exists a predisposition to abortion, and who nevertheless appear other- wise healthy; in such, the slightest causes will excite the womb to cast off the contents; and having once done so, are apt to miscarry again, and if the habit be once acquired, it becomes very difficult to remove—ruining the health of women, and disappointing the fondest hopes of parents. The first symptoms are, the absence of the usual morning sickness, a subsidence of the breasts, discharge of water or of blood from the womb, commonly known by the name of flood- ing ; pains in the back, loins, and lower parts of the belly coming on in paroxysms with intervals of ease, resembling those of labor. The hemorrhage being the surest symptom of abortion, de- mands our first regard, for if it continues, abortion must ensue. If then, this alarming symptom be present, our only hope lies in restraining it. Yet it must be borne in mind that frequent- ly the hemorrhage is the effect of the aborting process already going on, and therefore the discharge cannot be stopped until the contents of the womb have been cast off; but still we can generally, by correct conduct, so modsrate it that the woinaK will be sustained, and her life be preserved. The bowels must be attended to • if costive, to be opened by some gentle purgative, (Rochelle salts or captor wil,) and Diseases of Females. 155 if diarrr.cea be present, it must be relieved by a few drops of laudanum or of paregoric. She must lie down and ke°p quiet, on a hard bed with light covering; every thing that will heat the body and quicken the circulation must be carefully avoided, cold air freely admitted into the room, and she be kept perfectly still, every kind of exertion strictly forbidden even to conversing with her friends ; the diet must consist whoJy of vegetables, fruits, butter milk, cold water, lemon- ade ; all cordials, spiritous liquors, spices, and stimulating food must be rejected. Cloths wrung out of cold water, or vinegar and water, should be applied to the back, bowels, thighs, and external parts ; and when the heat of the body is considerable, and the hemorrhage profuse, the coldness of these applications may be increased by ice or snow ; but these cold applications are limited to the stage of excitement, and to be discontinued dn their producing pain or a continued chill. If the fever is reduced, and the system brought rather below the natural heat, then, if there be a continued pain, thirty or fifty drops of laudanum, given in a spoonful of vinegar, or one-fourth of a grain of opium, with half a grain of ipecac made into a bolus, two, three, or four times a day, will abate it. But if the paina be in paroxysms, with ease between them, and bearing down with expulsive effort, and more particularly if this kind of pains have preceded the flooding, then opium and laudanum a''*e improper, as they will prolong the suffering. Very little expectation can be had of saving the child, our attention must then be directed chiefly to the saving of the mother ; for if the contents of the womb must be parted with, the sooner the better—which laudanum and opium retard. The aforesaid treatment to be pursued steadily from day to day, until all appearance of abortion shall have vanished, and then to try, by rising slowly and without exertion, whether she is safe in bo doing ; but on the least appearance of the return of flood- ing or pain, again resume the bed as before. During all thii time the bowels must be kept gently open. If the case be one of exhaustion, of which if the reader will judge by the symptoms before mentioned as indicative of that etate, the treatment must be varied accordingly. Before she has been brought into this state, she will probably have flood ed much, and the hemorrhage will be considerably diminished at least for the time. Fainting, or disposition to it, will then be the most prominent and alarming symptom, which is not oidy a consequence of the loss of much blood, but is the i<* medy which nature makes use of to check the further effusion. This, although very alarming to those unacquainted with its 1M Diseases of Females. good effects, should not in recent flooding be interfered with j no efforts should be made to rouse her, or prevent a recurrence of fainting by administering cordials or other stimulants ; but she should be left in that languid state which always accompa- nies fainting : during which the blood moves slowly through the vessels, and an opportunity is afforded for the mouths of the bleeding vessels to contract, the blood to coagulate, and the bleeding to be stopped. When some time has been allow- ed for the contraction of the blood vessels, and coagulation of the blood, and the fainting should still continue to an alarm- ing degree, dash cold water on the face, give a tablespoonful of wine, or a teaspoonful of brandy, or camphorated spirits, or twenty drops of ether, in fresh water, which repeat every ten, twenty, or thirty minutes, as the recovery may be quick oi slow, having regard to the hemorrhage ; if it show a disposi- tion to return, desist from the brandy, &c, which, at all events, must be used no longer than absolutely necessary to call back the powers of life, which, when recovered, must be left to themselves; keep her perfectly quiet, not permitting her to speak or move hand or foot. After being somewhat restored, having still hopes of averting the abortion, and there be pain, opiates may be given, as before mentioned, a soda powder, in the state of effervescence, given a few times at in- tervals of a few hours, and if there be still a slight discharge, alum whey may be given. Occasionally cases of pregnancy occur, accompanied by a slow or chronic hemorrhage, continuing for many days in a small degree, sometimes being scarcely perceptible, at other times more profuse, but not sufficient to excite much alarm, until some new excitement or exertion, suddenly brings on for- midable hemorrhage, and abortion with great risk of life to the woman, takes place. A dull, heavy, aching pain in the back, at all times easily excited into a sharp, pungent pain, darting through the womb, in different directions, and down the thighs is commonly attendant. In such cases the most perfect quietude in bed must be ob- served, and the mind kept tranquil, and free from every excite- ment or care. Also injections of cold green tea two or three times a day up the privates, may be employed, and cloths wrung out of the same laid across the bowels, renewing the application frequently. Abortion from External Violence.—External violence is very frequent cause of miscarriage. A pregnant woman hav ing received an injury from which abortion might be appre- hended, should immediately be put to bed, and kept perfectly Diseases of Females. 157. quiet; if chilly, some warm.j not hot tea, be givv?n her for drink, and moderately warm covering, but no longer than the chill may continue; as soon as that is off, or if no chill has taken place, then to be kept cool, admitting the fresh air freely, and cold water for drink, and when fever shall succeed such injury, give a dose of Epsom salts, or Rochelle salts. When the bowels have been freely moved, put one teaspoonful of spirits aitre, one of paregoric, and twenty drops of essence of pepper- ment into a tumbler of cold water, and of this mixture let a tableBpoonful be taken every hour or two. Of course, rest in bed must be enjoined, and perfect quiet, etc., as before mentioned. Also the cold green tea to the Dowels. In all cases where there is reason to fear abortion, a state of absolute rest in bed is to be enforced with great perseverance, as the first rule of practice. By rest alone, without any other assistance, hemorrhages may be restrained and abortion pre- vented ; but without it, no woman can be safe. All other means will be unavailing unless assisted by rest. Even after the immediate alarm of the attack is over, and she be in a pros- perous state of recovery, she must still recollect her danger. She should be confined to a hard bed, for several days alter, and keep her room for a much longer period. If an abortion does take place even after all that can be done, the case must be treated the same as after an ordinary confine- ment. Swelling of the Lower Limbs.— This is sometimes very troublesome; it can, to a certain extent, be relieved by keep- ing the bowels open, and giving fifteen drops of spirits of nitre in half a glass of cold water three times a day. Palpitation of the Heart—When it occurs in pregnant women, may be relieved by taking fifteen drops every four hours of a mixture composed of equal parts of tincture of vale- rian and spirits of lavender in a little water. Take more exer- cise and avoid costiveness of the bowels. Bandaging the Bowels, for a length of time before confine- ment, is of very great benefit, with delicate females, or in cases of unusual enlargement. The Nipples.—During the last months of pregnancy they should be daily bathed in a tea made of oak bark, borax, or alum waier, or strong green or black tea (cold). This will harden or toughen them so that they are not near as likely to become sore, soon after confinement. And women who are subject to having sore nipples, should draw them out with a breast-pump, or get a friend to do it for her once every day 158 Midwifery. during the last four or five weeks before confinement. They thus become hardened beforehand. Too much on the Feet.—It is not good for either the mother or her child, for her to be too much in the erect posture, more especially those of a delicate constitution. Sitting down or lying down for a few minutes at a time, several times during the day, will be of signal benefit, as it keeps the womb from settling down too low. Cramps in the Stomach, may be relieved by drinking a few spoonfuls of a tea made of cloves and cinnamon, repeated as occasion may require. MIDWIFERY. LAB OR. This takes place at the completion of the term of pregnancy, a period of about forty weeks, or nine months. At this period, the child being able to live without its connection with the mother, the womb begins to contract itself so as to lessen its cavity, and tnereby expel or thrust off its contents, which are propelled downwards, towards the mouth of the womb, which opens and dilates so as to give them a ready exit, at the same time those parts through which they are required to pass, assume a disposition to dilate or open. Natural Labor.—All such as come on at the full period of nine months, in which the head of the child presents or comes drst, and which are completed by the unaided efforts of na- ture ; are so denominated from the frequency of their occur- rence, and the regularity w ith which they proceed. The first stage of labor commences with the true labor pains, and ends when the mouth of the womb is completely opened, »bout the time the membranes usually burst and the waters ■re discharged. The second stage is occupied in the passage of the child's head so low as to begin to press upon, and to dilate the external parts. These two stages frequently go on together, although the mouth of the womb is usually d dated before the head has descended low down; yet it scirjetimea happens that it is unyielding and not disposed to dilate, and therefore descends before the head, which is thus covered by the neck of the womb, presents at the external opening. The third stage of labor commences with the distention of the ex- Vsrnal parts into the form of a large protuberant tumor, and continues until the external orifice shall be so far dilated as tc The Female Pelvis. We have here a front view of the Pelvis. 1.1. The ossa im nominata, or hip bones. 2. The sacrum, perforated with two rows of holes, for the transmission of nerves. 3. The rjmphysis pubis, or os pubis. 4. The coccyx. 5. 5. Articula- tions for the th'gh bones. The antero-posterior diameter of the brim, from symphysis pubis to middle of sacrum, measures four inches and a half. The transverse, from the middle of the briar on one side, to the same point on the opposite, five inches a.rd quai'tei The obligue diameter measures about five inches. Tha miero-posteyior and transverse diameters of the outlet measure, each four inches. The cavity of the pelvis measures, in depth, c::e inch %nd a half in front, and four inches and a half poo tertarty. 160 THE "WOMB. This most important organ in woman is situated in the cavity of the pelvis—from whence, when distended, in preg- nancy, it rises into the abdomen, with the general lining membrane of which and the pelvis, called the peritoneum, it is covered. It is of a flattened pear-shape, and it is held in its place by elastic ligaments. In its unimpregnated state it is about three inches in length by two in breadth across the broadest part, and one in thickness. At the period of puberty it weighs about one and a half ounces; after parturition, from two to three ounces; and in the ninth month of utero-gestation, from two to four pounds. It is supplied with glands, vessels THE WOMB AND ITS APPENDAGES. a, Right Ovary; 6, 6, the Fimbria; c, e, the Fallo- pian Tubes; d, an Ovum being grasped by the Fimbriae; e. an Ovum descending the Fallopian Tube to the Womb; /, Cavity of the Womb; g. g, Walls of the Womb; h. Wail of the Vagina; k, h, Ligaments of the Organs. and nerves, the latter of which constitute an extensive net* work over its entire surface. The ovaries are two in number—one on each side of the uterus, in the groin. They are nearly as large as the male testicles, and perform a corresponding function. When the germ (or ovum) has been perfected in the ovary, it is cast out, and seized by the extremity of one of the fallopian tubes, through which it is conducted to the uterus. Midwifery. 161 suffer the child to pass through it. The last stage is taken up in the care of the infant, in tying and cutting the navel string, and in receiving or gently aiding the delivery of the after birth. Midwives should keep this division of labor into four stages constantly in their minds, and perfectly understand what is going on during eaah, by which they will avoid all unneeoe- sary hurry and confusion, and they will expect no more in any one period than is intended by nature to be then performed. Examination of the Passage.—To perforin this properly, and to draw from it certain conclusions in intricate cases, can be acquired only by attentive practice and experience, aided by previous anatomical knowledge of the parts. But we hope to be able to give a few plain directions, which may teach others how to judge of their progress, and to direct them in the conduct of a natural labor ; and also to discover those which are unnatural, and are likely to be difficult. It is a rule among physicians never to perform the operation except in the presence of the nurse, or some otner married woman ; but with female midwives, this delicacy is not absolutely necessary; still it ia advisable that some other woman be present. The patient should lie on her side or back on the edge of the bed, with hei knees drawn up, and a light covering should be thrown over her. The midwife sitting at the side of the bed, the forefinger anointed with lard or sweet oil, is to be carried up to the outer parts into which tne finger is to be cautiously introduced. The introduction should be made with all possible tenderness, care- fully avoiding all hurry, force or rudeness, by which the parts may be irritated or wounded; and, above all things, take care not to break or burst the membranes. The finger will probably first reach the neck of the womb, covering the head of the child, and pressing down into the vagina, or birth passage; passing the finger toward the back- bone, and upward, the mouth of the womb will generally be found (in the beginning of labor) far back and high up, very different in different women. In some, hard and irregular; in others, thick, soft, and smooth, a little open, and beginning to discharge a thick mucus ; whilst in some few it is worn quite away, although still close shut. The examination is to be com- menced a little before the time that a pain is expected, and should be continued during the pain, and until it ceases, so that the effect of the pains upon the internal orifice or opening may be noticed; and having the finger introduced, continue it until satisfied of all that is desired, or can then be discovered. If the mouth of the womb be pressed down tight, and begins to open during the pain; if this general tightness relax during 162 Midwifery. the intermission, and especially if those parts remain soft and slippery, and a thick mucus, with or without some tinge of blood, begin to ooze from them, we conclude the labor to be actually begun. But if, on the contrary, we discover no extraordinary pressure, and the mouth of the womb be neither opened during the pain nor relaxed again as the pain goes off, we may conclude the present pains to be false—that labor has not yet begun. False Pains—Frequently resemble true labor-pains so ex- actly as to be mistaken for them, particularly by young women with their first child. But they are carefully to be distin- guished from true labor, or the mistake may.lead to error and mismanagement. If it is ascertained that the pains are false, the woman, if she be feverish, with a full pulse, and hot skin, should be put to rest in bed; if costive, the bowels should be moved by a gentle purgative, assisted by an injection nn the bowels, of warm water, and perspiration to be promote\ by drinking frequent draughts of weak tea. By such means false pains will generally be removed; but if they still con- tinue after the fever has been moderated, and the bowels opened, a teaspoonful of paregoric, or twenty drops of lauda- num given (and repeated if necessary, in two hours), assisted by rest and quiet, will seldom fail in suppressing them. Fdjst Signs of Labor.—Some days before the time, a wo- man begins to feel the symptoms of her approaching labor, she moves with difficulty, and frequently complains of restlessness and pain in her back and loins. As the period approaches she becomes smaller around the abdomen. Sometimes a diarrhea comes on, but generally she is rather costive; she perceives some enlargement, relaxation, and a degree of forcing down of the external parts, and frequently a glairy mucus tinged with blood, is discharged; but this latter symptom more frequently comes on after labor has actually begun. It is often the case that the anxiety, restlessness and uneasi- ness of this period prompt many women to wish it over; and some are so imprudent as to attempt to shorten it by rough exercise, with a view to bring on tlieir labor. But no conduct can be more faulty or absurd; at any rate, they increase the present uneasiness, and should they succeed in their attempts to precipitate their labor, before nature is properly prepared for it, they will unquestionably render it more tedious, more painful, and more difficult. On the contrary, let them, accord- ing to the dictates of nature, give themselves more rest than usual attend carefully to the state of their bowels, keeping them freely open. The subsidence of the belly which denotes the approach of Midwifery. 162 labor, is caused by the womb beginning to contract at the up- per part, and proves, not only that the womb has begun to act, but, that it is prepared to act in a favorable manner. In like manner, the discharge of mucus, and the relaxation and distension of the external parts, show that they are prepared to dilate. The difficulty in urinating is owing to the pressure of the child's head upon the neck of the bladder ; the constant desire to pass the urine, to the same pressure upon the body of the bladder ; both are favorable symptoms, and indicate a natural presentation of the child. Diarrhea is sometimes a sign of labor, which, if moderate, is always favorable and should not be interfered with ; if pro- fuse, a few drops of laudanum will generally check it. Costiveness, when it exists, is not only distressing for the resent, by increasing heat, restlessness and pain, but may ecome very inconvenient during labor. If, therefore, a preg- nant woman has neglected to pay attention to this circum- stance before, she must now take care to remove it, by mild laxatives, or rather by repeated injections of warm water, which is the best mode at this late period, when all active medi- cines are improper. FiRbT Stage of Labor.—The first stage of natural labor, which is occupied in opening the internal orifice of the womb, frequently commences with a slight shivering, which, when connected with regular pains, is rather a favorable symptom; but, if succeeded by fever, is unfavorable. But most common- ly, labor begins with pain in the back and loins, stretching from thence across the belly, and ending at the upper part of the thighs. It soon leaves the woman free, and returns again pe- riodically, at longer or shorter intervals. These pains, at first, are slight, and return at long intervals; but soon the intervals grow shorter, and the pains become exceedingly sharp and cut- ting, and, at the same time, the mucus discharge from the outer parts is generally discolored by some blood; after which, the very sharp and cutting sensation commonly abates; and, although the pains grow stronger, return at shorter intervals, and the pressing down increases, they become less distressing, and are borne with less impatience. On making an examination at this period, (which should be very seldom, and always with the greatest caution, for fear of breaking the membranes,) this variety of the severity and aharpness of the pains, will be found connected with the situa- tion, and to depend on the state of the mouth of the womb. At first, it is found far back, and high up, with edges mora thick and hard, and the opening small and hardly perceptible; 164 Midwifery. as the pains continue, the internal orifice or mouth of the womb descends, and comes forward; the edges become thia and soft, the opening enlarges, and after some time, will admit the finger—a small bag is then felt within, which, during the pain, tightens, and is distended, but, as the pain goes off, be- comes loose. As the internal orifice enlarges, this bag passes through, and assists in dilating it, until the thick edges of the erifice, or mouth, being entirely obliterated, the membraneous bag, no longer supported by them, gives way, and the waters are discharged. Sickness and vomiting are frequent and salu- tary symptoms of this stage of labor, the nausea contributes to the entire relaxation of the whole system, and the retching adds somewhat to the dilating effects of the pains. The duration of this first stage of labor is very different in different women, and in the same women at different labors— but, in general, it requires more time with the first child than with those which follow—and in all women, it commonly takes up more time than any other stage of labor. If the mem- branes burst early, before the labor begins, or very soon after, then, the mouth of the womb, requiring to be dilated by the child's head, the pains in the back are more grinding, and the dilation or opening, in all respects, more tedious and more painful, but still requires only more time, patience, and cau- tion. And, if the neck of the womb descends very low, before the mouth begins to dilate, as it sometimes does, it likewise tends to protract this stage of labor. Bear in mind, that in this stage, no skill or art of the mid- wife, no exertion of the woman, can in the least contribute either to lessen the severity of the pains or shorten their dura- tion. They are intended by nature to accomplish a necessary and important object, that is, the complete opening of the in- ternal orifice of the womb, which, from a hard ring of some considerable thickness, and generally close shut, is to be soft< ened, relaxed, and worn away, until it is entirely obliterated, and so astonishingly enlarged, as to permit t'he child to pass through. Nevertheless, if we can during this stage neither lessen tha woman's pain, nor shorten its duration; and, although we ara forbid interfering in any manner with the progress of natural labor, yet the presence of a midwife, or such other woman aa may be selected to officiate, is far from being useless, but ia very necessary. They should inquire into the state of tha patient's bowels, and, unless they be in a laxative state, ad- minister an injection; indeed, whenever there is time for it, it ia a good rule always to do this, as by its effects the injection Midwifery. 16s has in all respects a tendency to promote and render labor easy, and is particularly useful in the case of a first child. She must likewise pay attention to the evacuation of the urine— direct her patient to discharge it frequently, and if she fail in one posture to try another; sitting over warm water, or lying on either side, on her back with her hips' raised; on her knees with the head low. Should all these efforts fail, the midwife should, while the patient is lying on her back, her head and shoulders lower than her hips, and during the remission of pain, introduce a finger under the pubes, or front part, and endeavor to raise the child's head a little from its pressure on the neck of the bladder ; and while so raised let the patient make effort to void urine ; and if notwithstanding these efforts, a total suppression should take place, she must be relieved early in labor b}T the catheter. For, as labor advances, the difficulty of discharging the urine will increase—the pain of the distended bladder may become so great, as to intercept and suspend those of labor—and the bladder being over dis- tended, may lose its power of contracting ever after; and may inflame, and bring on fever, convulsions, mortification and death. Such are the evils which may follow neglect—but which can very generally be avoided by proper care. But, we would here remark, that the above suppression must not be mistaken and confounded with that suppression, which takes Elace towards the conclusion of the labor, when the child shall ave descended low down, the pains being forcing with con- siderable effort, and there is reason to hope that the labor will soon be completed—this latter suppression will soon be reliev- ed by delivery. After such attentions as before mentioned, the labor is to b<* suffered to go on without any interference—the pains continu- ing gradually to open the internal orifice of the womb, and force the membranes through it, in the form of a purse, which, acting as a soft wedge, contributes in the easiest way to its further dilation. Of tiiis, the midwife may now and then as- sure herself by examination. Although the finger may be introduced on the accession of a pain, no accurate examination must be made until it remits, lest the membranes should be burst, and the waters let out before the internal orifice be fully iilated, which accident always protracts labor, and renders it more painful and more difficult. Do not make too frequent examination; it is injurious, by removing the mucus from the soft parts, intended by nature for lubricating them, and causes irritation. The abominable practice of stretching the soft parts of tha 166 Midwifery. mother by the midwife, under the idea of makingroom for the child to pass, is preposterous and cruel. It is impossible to censure this idle, indecent, and dangerous practice too se- verely ; it is always wrong, nor can there be any one period in any labor, the most easy and natural, the most tedious and dif- ficult, in which it can be of the least use, and in which it will not unavoidably do great mischief. Therefore, leaving nature to her own unassisted and undis- turbed efforts, the midwife is to encourage her patient, by appearing perfectly calm and easy herself, without hurry oi assumed importance—by assuring her, that as far as can now be discovered, all matters are natural; by encouraging cheer- ful conversation with those around, permitting her to walk about the chamber, or from room to room, to sit or lie down, as she finds most agreeable, and if she can, to sleep between the pains—but although inclined to it, she should not lie constant, until the mouth of the womb shall be completely opened. The midwife should excite the hopes and confidence of the patient, by manifesting her own ease and firm belief in the natural progress and happy termination of the labor; hope and confidence will very much tend to give regularity and strength to the pains, whilst on the contrary, fear and despon- dency will tend to disturb and protract the labor. Let there be no " hobgoblin" stories, " ghost tales," nor superstitious nonsense in the room of a woman in confinement. Partaking of food at the proper time during labor, is allow- able, but it should always be light and sparing. There is great impropriety in directing the patient, at this period, to assist her pains, as it is called, by holding her breath, and exerting her strength; by forcing, straining, and bearing down—which inevitably will exhaust and waste her strength. now in the beginning of labor, which may be necessary for her support at the conclusion. Young women, with their first la- bor, are most apt, from impatience, to be guilty of this error, by which they necessarily overheat themselves, and may bring on a fever; it may likewise occasion a premature bursting of the membranes. A still more dangerous practice is that of giving strong aromatic teas, cordial, and spiritous liquors, with a view to strengthen the pains; but which can only increase the resist- ance to their proper effect, by heating the patient, bringing on fever, and checking the natural secretions; on the contrary, let the patient's food, if she take any, consist of cooling fruits, thin gruel, and weak broths; and her drink, lemonade, apple water, weak tea, or what is still better, fresh water. In sum Midwifery. 161 mer, let her chamber be kept cool bj open doors and win- dows : and in winter, comfortable but m»t too warm. The pationt should be strongly impressed with the fact, that the best state of mind she can be in at the time of labor, i* that of submission to the necessities of her situation ; that those who are most patient, actually suffer the least—that, if they are resigned to their pains, it is impossible for them to do wrong—and that attention is far more frequently required to prevent hurry, than to forward a labor. Instead, therefore, of despairing, and thinking they are abandoned in the hour of their distiess, all women should believe, and find comfort in the reflection, that they are at those times under the peculiar care of Providence—and that their safety in child-birth is en- sured by more numerous and powerful resources than under any other circumstances, though to appearances less dan- gerous. The practice of gathering many attendants, is certainly very improper, and is one from which serious inconvenience has re- sulted ; yet, the presence of a few elderly women is of very great service. If tlieir attendance is requested, it becomes them to consider for what purpose—most assuredly, to assist in an important business, in which the welfare of one of tlieir sex is at stake ; and not by indulging in idle gossip, and mag- nified reports and misrepresentations of unfortunate cases, and perhaps such as never occurred, to overwhelm the sick wo- men in gloom, fear, and despondency. All questioning and unnecessary inquiry, all smothered and mysterious conversa- tions, should be carefully abstained from, as highly injurious. On the other hand, all levity of conduct, and unfeeling mirth, Bhould be as strictly guarded against, as having an equally in- jurious tendency, by creating excitement in the mind of the patient, owing to its annoyance. The first stage of labor is thus to be passed, now and the** cautiously examining its progress ; in doing which, when th* internal orifice is sufficiently open to admit the finger, the head of the child may frequently be felt and distinguished by its regular shape, smoothness, and hardness, through the mem- branes ; and may be made another source of consolation and encouragement to the patient, by assuring her of it. But w must oe cautious how we predict a speedy termination of tht labor, for many circumstances which we can not at the time discover, may concur to deceive us, and nothing will tend more to render the patient anxious, and robs us of her confidence, than disappointment in this respect. It will now be proper to arrange the patient's dress and b?4 168 Midwifery A flannel petticoat, and short-gown, with the shift turned up over the hips, so as to preserve it dry; but any dress will do if it be not too cumbersome, and the under side of which can be dou- bled up under her hips as she lies on the bed. On the middle of the bed lay a quilt or blanket, four double; over this the sheet, doubled back toward the head of the bed. Near the foot of the bed, on that place where the patient will lie when she is being delivered, put down upon the under bed a folded sheet with one end hanging over, so that the midwife may take the edge of it on her lap ; over this latter sheet, a blanket or quilt doubled and redoubled, but not hanging over. A piece of thin oil-cloth under all these, is also advisable, to keep all moisture, etc., from getting on the bed. This arrangement will be found very convenient during labor, and by means of which the patient, after she has been delivered, may be mado dry and comfortable with very little fatigue—it being a matter of very considerable importance to have the woman put to bed dry. If another bed is intended for her lying-in, it should be prepared as was first above directed, but without the sheet being reflected upward ; and after delivery, she is to be lifted from one to the other, without being suffered to rise up. Second Stage of Labor.—This stage of labor commences with a full and complete dilatation or opening of the internal orifice of the womb, and is ended when the child's head has sunk through the brim of the pelvis (or bones) so low as to begin to rest upon and distend the soft parts of the mother. These cir- cumstances can be certainly known only by examination ; but there is, likewise, a remarkable change in the patient's manner of expressing them. Whilst the internal orifice of the womb is opening, the pains are cutting, sharp, and grinding—the patient is restless, bears them with impatience, and expresses her sense of them by sharp and shrill cries; but when this is accomplished, or nearly so, the pains become more supportable, and the patient finds herself instinctively called upon to make some voluntary exertion. She lies quiet, holds her breath, and expresses her sense of pain in a grave tone of voice, or fre- quently bears them in silence. About the commencement of this stage of labor, as pre- viously stated, the membranes frequently break, and tha water is discharged. This in well-formed women, especially such as have borne several ahildren, is generally a period of some little alarm; as, when the child is small, the head falls almost by its own gravity through the pelvis, and delivery succeeds immediately; for this circumstance the midwife should always be prepared; and for some time previous at Midwifery. 169 .east, the patient shot d be laid on her bed, that at all events, the necessary assistance maybe afforded, and that no accident may happen from hurry, confusion, or mismanagement. But more frequently this stage of labor takes up a longer time; and although in a well-formed woman and a small child, it may end in a few minutes after the perfect opening of the in- ternal orifice, in others it may sometimes require many hours. Of course the duration of this stage of labor depends on the proportion which exists between the size of the child's head and the openings of the bones, or upon some irregularity in its shape, or some awkwardness in the presentation of the head— circumstances which nature, when left to herself, most fre- quently will vary, so as wonderfully to adapt one to the other in every stage and progress of the labor. The imperfect hard- ening of the bones in the child, and the loose manner in which they are connected by membranes, is the provision which na- ture has made for overcoming these difficulties. Where the head is large and the pelvis or bony passage narrow, the bones ride over one another as the head is forced through the brim, and the shape becomes more oval and pointed, entering the brim of the pelvis or outer bony passage, with one ear towards the lowest portion of the back-bone, and the other toward the pubes or front part, that is, with the narrowest part of the head to the narrowest part of the mother; it turns as it descends, where it finds most room, until the face is brought into the hol- ow of the sacrum, or lower part of the back-bone, and the vei»' tex, or smallest and most pointed part of the head, to the ex> ternal orifice. Our great care in this stage of labor, especially when it proves tedious, is to regulate our patient's conduct, to soothe her sufferings, to calm her fears, and above all things, make her to avoid fatigue by over exertion. Although the woman feels some disposition to voluntary efforts, she is not to be en- couraged to exert herself during her pains, more than she can veil avoid. The bursting of the membranes, likewise, is a circumstance of great uncertainty: it most frequently happens at the end of the first stage, or during the second stage; but it sometimes occurs with the first pain, sometimes many days, or even weeks before the commencement of labor—at other times, after hav- •ng, in the form of a distended sack, contributed to dilate the internal orifice of the womb, they continue in the same man- oer to dilate the vagina, or canal leading to the outer parts, and external orifice ; and now and then are expelled entire, cover ing the child's head with the placenta (afterbirth), and water 170 Midwifery. but this is a circumstance by no means to be wished, and ought not to be permitted, as it may be followed bv a dan gerous flooding, or by an inversion of the womb. Whenever therefore, the bag appears at the external parts, it ought to be ruptured, and the water let out, which is now easily done by keeping the finger hard against them, or by placing the end of the finger firmly on the presenting part of the child covered by the membranes, in the absence of the pain, and keeping it in contact during the succeeding pain, which will seldom fail to rupture the membranes; for that point on which the finger i« kept will have to bear the whole of the pressure of the water urged upon it by the effort of the womb. During this stage of labor women are less inclined to move than during the first stage; still they are not to be confined to one posture, but in- dulged, and permitted to rise from the bed, to walk about, and endure some pains by leaning over the back of a chair, sup- ported by their friends, or kneeling at the side of the bed. It is just at this time that the impatience and apprehensions of the patient are frequently much excited, the pains return at short intervals, and are strong and bearing; she longs and hopes, and strives for a speedy termination, and it require? much prudence and no little management to check her im- patience, at the same time that we support her hopes. She maybe assured of her safety, but must be informed that much of that will depend upon her proper conduct, and longer time, and above all things, the midwife must not appear too busy iv any apparent or real efforts to shorten it. Third Stage of Labor.—This begins at the time when th^ head of the child, having sunk through the pelvis, or bones, begins to rest on, and distends the soft parts of the mother, at which time the vertex, or central top of the head, presents a* the external parts, and the forehead and face occupy the hol- low of the sacrum, or curved lower part of the back-bone, and continues until the perineum, or space between the pri- vates and the fundament, being stretched and distended inte the form of a large protuberant tumor, the external parts is so far dilated as to suffer the head and body of the child to pasa through without injury. The pains during this period, whilst, the perineum and soft parts are undergoing so great distension, become more severe, and at last, when the child's head is pass- ing the external parts, are most exquisite. But they always are least when the labor has been suffered to go on from the first with little or no interference, and much more excruciat- ing and dangerous, when these tender parts have been frettod and inflamed by improper conduct at the beginning. Midwifery. 171 The part which is most apt to suffer during this period, U the perineum, or space between the privates and the funda ment, which, from the extent of one inch, or an inch and a half, and thickness of the hand, is stretched to that of four or five inches, and reduced to the thinness of paper, so that in the most natural and well-conducted labor, it will sometimes give way at this extremely thin edge. The perineum and adjoin- big parts are relaxed, and prepared for so great a change by the secretion jf a large quantity of mucus, by which the parts are softened, and a disposition to yield and stretch, is given to them, at the same time that they are lubricated by it, so as to suffer the child to slide through them ; and whenever there happens to be a deficiency of this mucus, or when, by impro- per handling, it has been rubbed off, and its secretion checked, or when a violent and sudden labor does not allow sufficient time for this secretion to take place and give to those parts a proper disposition to dilate, the perineum is apt to be torn, always an unfortunate accident, and one which, if extensive, subjects the woman to great misery and inconvenience during the rest, of her life. It should be your great care in a natural labor, to prevent this, and to which attention should be directed, from the very commencement of labor to the complete delivery of the patient. With this view, avoid irritating these extremely tender parts by too frequent and unnecessary examination, or rude and pre- Eosterous attempts to stretch and extend them, as well as avoid eating the patient by improper diet, cordials, and spiritous liquors in the commencement. During this stage of labor, a woman becomes less inclined and less ablo to move, and the delivery may be expected to be accomplish sd in a short time. She is, therefore, now, or rather before, £ she was not there already, to be laid on her bed in a proper posture for delivery; that is, on the folded blanket or quilt, ui the foot of the bed, on her back, her clothes being turned up under her, and she laid near the edge of the bed, and her knees moderately drawn up and her feet sup- ported against the bed post, or against some person sitting oil the bed, taking care not to draw her legs too much up toward the belly, nor to separate the knees very wide ; both of which put the perineum on the stretch, and increase the danger of its oeing torn. The bed being prepared, and the woman laid on it as directed, the midwife is to sit herself behind on a low chair, taking the end of the folded sheet, which had been laid across the bed, on he] knees; she will then find herself most ecu- 172 Midwifery. veniently placed to afford every assistance. Still, however she has nothing to do, and it may require some time before she will perceive the perineum sufficiently distended, and the ex ternal parts so far dilated that the crown of the child's head shall begin, during each pain, to protrude. She is then to take into her left hand a soft linen or cotton cloth, which, being several times folded, and placing it over the tumor, with hei fingers extended, and the r>alm over the perineum, make a gentle pressure on the tumor during each pain, so as in soma measure to retard the sudden advance of the child's head, or rather, to be ready to retard it, when a violent pain shall threaten too suddeD a delivery ; for, let it again be recollected that in a slow labor, well managed from the beginning, where the soft parts are properly prepared to yield, the perineum never is torn, and that all the danger of this unfortunate acci- dent arises from a sudden and violent labor, or one that has been mismanaged in the beginning, or the patient throwing herself beyond the reach and support of the midwife. Any considerable resistance is seldom necessary ; but as the child's head passes through the external orifice, it is always proper, whilst one hand is kept in the position just now de- scribed, to place the fingers and thumb of the other hand col- lected together, upon the protruding part of the child's head; in this position, the midwife has it in her power to make such resistance with her hand as the rapidity with which it advances may require ; and to make it on the head, rather than on the perineum, the dilatation of which by too great pressure may be prevented, and the perineum itself bruised. Experience alone can teach the degree of resistance required, and until the midwife has acquired this experience, she must exercise her judgment, and be cautious not to make more than is necessary, for by too much, mischief may also be done, and where the labor has been well conducted from the beginning much ia seldom required. The direction in which the pressure on the perineum ia made, is likewise of some consequence; it must not be directed upward and backward, but it must be directed unward and forward toward the pubes, or front; by which, as the centre of the head advances under the arch of that bone, the nape of the child's neck will be pressed up against it, and immediately relieve the perineum. When it is perceived towards the last, that from early mismanagement, or from any other cause, these parts are not properly prepared to dilate, and there is a dry- ness and rigidity about them, we are directed to anoint the parts with hog's lard or sweet oil, once or twice, and over that, Midwifery. 173 to apply a soft flannel wrung out of warm water; this, we have reason to believe, is of advantage, as it promotes the secretion of the mucus, and otherwise relaxes the parts. At this moment the sufferings are at the highest—extremely severe, and sometimes almost beyond endurance; and, in hopes of shortening their continuance, she is often inclined, and too frequently called on to exert her utmost strength. Still, how- ever, her present safety and future comfort may very much de- pend upon submission, patience, and gaining a little Triors Hme; and all extraordinary exertion beyond what she is in some measure compelled to make, is hazardous. Therefore, do not discourage her crying out, but encourage her to speak, by asking questions, which will check the bearing down efforts, and gain a little more time, which may be necessary, not only to the safety of the perineum, but to the preservation of her life. Just before the birth, the head is often found to advance during the pains, and to retire again as they remit; and this alternate advancing and retiring is frequently of much conse- quence to the perineum, by the strength and elasticity of which it is generally occasioned, and which, after some little time, will thereby become perfectly relaxed, and easily distended. If, however, it should lodge upon the chin of the child, by in- troducing a finger within, between the pains, it may easily be slipped over it, and the next pain the head will generally be delivered; but this must not be attempted whilst the perineum is tense, nor during a pain, but only when it is relaxed and easily distended. As the head emerges from the external parts, it should be received by the midwife on the extended fingers and palm of the hand, stretching the fingers round, so as to ex- amine whether the mouth and nose be covered by any of the membranes, or any part of the clothing, by which its breath- ing might be obstructed, still keeping the hand in contact with the perineum, and under the child's chin. A short respite ensues when the head is delivered; but the pains soon returning, the shoulders of the child are perceived as they descend, to make the same turns as the head had done before; and after a pain or two, they are delivered, the one toward the abdomen, and the other toward the back of the mother. While they are passing the external orifice, the same attention is to be paid to the perineum which the passage of the head rendered necessary, as the distension is rather greater, and the danger of laceration not diminished, which, in fact, has frequently taken place at this period, through neglect of the midwife, induced by the supposition that the danger wai 174. Midwifery. all over as soon as the head was delivered. The next pair ad- vances it to the hips, so that the arms of the child are delivered with little or no assistance. Another short respite again takea place, whilst the hips of the child advance, of which one of two pains effect the delivery, and the birth of the child is ac- complished. In this gradual way, time is allowed for the regular con- tractions of the womb, from the top, around the afterbirth, pressing it down before it; whereas, in a more sudden delivery, when the head, shoulders, and body of the child are ejected by a single pain, the womb may, and frequently does, contract from its sides, expelling the child, but retaining the afterbirth high up in the top. The midwife should, therefore, never, as it is too frequently done, take hold of the child's head, and drag it forth: a most dangerous practice—generally the cause of severe after-pains, and frequently the cause of much worse consequences, as a ruptured perineum, retained afterbirth, flooding, inversion (turning inside out), or falling of the womb, by which many women have lost their lives. At the time of the child's emerging from the external parts, the extreme suffering of women will impel them to implore anxiously for relief; her friends also will call upon the mid- wife and expect her to assist in the delivery, and not unfro- quently medical aid is sent for at this stage when it is utterly impossible for the physician to arrive before the case has ter- minated, unless he be very convenient; but no entreaties should cause the midwife to deviate from correct principles, and make her endeavor to hasten the expulsion of the head; after that event there is not so much inducement. Should there, how- ever, be a considerable interval betwixt the expulsion of the head and of new pains, she may press gently on the belly, or cause gentle pressure to be made by some assistant. Or she may gently insinuate the finger into the arm pit, and slightly pull or agitate the child, so as to excite the womb to contract —even this assistance is rarely required. But on no account is she to attempt the delivery by pulling the head. The birth of the child is always followed by the discharge of what water had been retained in the womb, frequently by some clots of blood, and generally by some fresh blood flowing from those parts of the womb from which the afterbirth has been wholly, or in part detached. Fourth Stage of Labor.—After the child has been delivered it should be laid in an easy posture on its side, a little inclined towards the back, and close to the mother; its head and body should be covered, with its face and mouth exposed to the air, Midwifery. 175 The mother at this time is generally in great heat, and wet with perspiration; and in consequence of her exertions suddenly ceasing, and being much fatigued, she is very apt to suffer from a chill, often followed by disease, which, if not dangerous, will yet delay her recovery; some additional covering should, there- fore, be carefully spread over her, without causing a current oi air. The doors and windows should now be shut, if the wea- ther be cool, and some dry clothes slipped under, should the part of the bed on which she is lying, be wet: whilst, however, these directions are being executed by the nurse and other assistants, our attention should be directed to the child. Duties relative to the child.—Our first object is to ascer- tain whether breathing be established. Should this be fully es- tablished, and the pulsation or beating in the cord have ceased, the midwife may at once separate it from the mother. This is done by applying two strings, one about two inches from the umbilicus or navel of the child, the other about one inch further and cut between them ; this should not be done under the bed- clothes, but uncovered, that she may see distinctly what she is doing, for fear of cutting some part of the child, which has happened with careless midwives. Sometimes a finger or a toe has been thus cut off. The child should not be separated from the mother, until the pulsation in the cord has ceased. Any strong piece of string, tape or ribbon, will answer, and it should be tied sufficiently tight to prevent the blood from escaping. But if the child fail to cry, or breathe freely soon after delivery, our attention should be directed to ascertain the cause—and to the use of proper means for inducing breathing. In determining the treatment necessary to be pursued, the first thing to be ascer- tained, is, whether circulation is still going on in the cord; which is done by squeezing it between the thumb and fingers, to see whether it continues to beat or pulsate. In cases in which this is going on, we need in general apprehend no great danger, as long as it continues; some cold water or spirits should be dashed on the child's breast; if this does not succeed, the little finger, surrounded by a piece of fine rag, should be made use of, to re- move any mucus that may have collected in the mouth or throat of the infant. If we have reason to infer that the impediment ia situated in the wind-pipe, the hips and the body of the child should be elevated higher than the head with the mouth down ward, at the same time gently shaking, so as to assist the mucus in flowing out of the mouth. As soon as this takes place, the child generally cries lustily. But, should the child be still-born, and file pulsation in the cord have ceased, it should immediately be aeperated from the mother, as above directed, as no good can arias 176 Midwife/y. 'from suffering it to remain any longer in connection with her. In these cases, after having carefully removed any mucus that may have collected in the mouth or throat as formerly directed, we should endeavor to imitate natural breathing by placing the mouth immediately in contact with that of the child, and forcibly breathing into it, whilst, at the same time, the nostrils are held, to prevent the air from passing through them. Should we be successful in forcing air into the chest, which will be known by the elevation of it, and should it not je immediately returned, gentle pressure must be made upon the breast of the child, so as to cause its expulsion—occasionally elevating the hips and body to permit any mucus which may have collected in the throat or wind-pipe to flow out. In addition to this, warm ap- plications should be made, by applying heated clothes to the child, with gentle friction upon the chest. Should breathing not be immediately established by this method of proceeding, it should not be at once relinquished, for in many cases, persever- ence in properly directed efforts will prove successful. After the ahild has been separated from the mother, accord- ing to the above directions, it should at once be delivered over to an assistant, who should proceed to wash it immediately, but if no such assistance be present, it may be wrapped up in a warm, soft cloth, (flannel is preferable,) leaving an opening, only suffix cient to admit the air necessary for its breathing, and laid on its side in a warm place, until the mother be safely put to bed. The delivery of the after-birth.—This should also ba left to the efforts of nature, unless some deviation call for our interference. If the delivery has been properly conducted, the womb will have contracted successively, upon the body, hips and lower extremities of the child—so that by the time they are de- livered, it will be only sufficient to contain the after birth; and the succeeding contractions not only contribute to separate it from the womb, but press it out into the passage and from thenca it is delivered, and thus prevents any serious hemorrhage. Some blood is generally discharged from the womb after the birth of the child, and always after the delivery of the after-birth. A small quantity, therefore, to the amount of even a pound, is no reason for alarm. A short interval, however, generally hap- pens after the birth of the child, before the contractions of the womb are manifested by actual pains, which time is required in the care of the child. No interference is necessary, if strong pains come on in half an hour. The contractions of the womb will throw the after-birth out of the passage, which is the very best security against either flooding or after-pains. But, if within that time, there be no Midwifery. 177 contractile force exerted by the womb, the mid-wife should take the cord in the left hand, and pass a finger of the right hand up along the passage ; if she can, with the end of the finger, reach that part of the after-birth to which the cord is attached, she may rest satisfied that all is safe ; and that the womb has be- gun to contract and throw it off; but if, on the contrary, she cannot reach the root of the string, the after-birth is probably still attached to the womb. Under these circumstances, she should place her open hand upon the patient's belly, and if she find the womb soft and resting on the lower side, she must take it in the hollow of her hand, and raise it towards the middle of the belly, press it moderately and rub the surface of the belly over gently, and change the patient's posture from side to back or from back to side; she will then very probably so^n perceive the womb to contract, by its assuming the form of a ball of considerable firmness. She may now again take the cord in her left hand, putting it just so much on the stretch, as to pre- vent the after-birth (which descends a little during inspiration) from ascending again during expiration, still holding the end in her hand, pass the fingers of the other hand as high as possible toward the root of the cord, and pull gently while at the same time, an assistant should make gentle pressure upon the belly with the open hand, by which the womb is frequently excited to make vigorous contractions. Whenthe after-birth shall have le- scended into the passage, and is somewhat protruding from the external parts, it is best then to leave it entirely to the expulsive efforts of the womb. The most common cause of delay in tne delivery of the after- birhis this want of expulsive pains; and this inaction of the womb is a very common consequence of fatigue after a severe or tedious labor, especially if mismanaged. But this weakness, so far from being a reason for haste and precipitancy, is a most powerful argument for waiting, and making no attempts to sep- arate and extract the after-birth; a hasty delivery of which, be- fore the womb has begun to contract with some degree of vigor, will expose the patient to great danger ot a flooding or inversion of the womb. Under such circumstances, therefore, our efforts must be directed to compose the patient's mind, and attempt to excite the action of the womb as previously directed. Great care should be taken by the mid-wife how she exerts any considerable force on the cord, which in some instances is small; in others, inserted by several branches into the after-birth, and easily torn from it—-at all times an inconvenience, and on some occasions a very serious accident. Or, if the string should be so strong as to endure much force, more terrible accidents may ibi- 178 Midwifery. low; the after-birth may be torn from its attachment to tha womb, of which a violent flooding will be the consequence, or the womb may be in part or wholly inverted, turned in side out and actually brought out of the body, which has been the unhap- py consequence of imprudent force applied to the cord. Let it, therefore, be an invariable rule, never to tighten the cord, and put it on the stretch, until the womb can be felt like a hard lump or ball under the hand applied to the woman's belly; on the same principle, coughing, sneezing, or blowing into the hands, and every such exertion of the woman, are likewise improper as they tend to cause flooding. Should the after-birth however be retained or flooding ensue, directions for the treat- ment of them will be found under those different heads when treating of the dangers of difficult or tedious labor. The after-birth being delivered, carry the finger into the passage up along the membranes, which are continued from the edge of the after-birth, and slowly and cautiously assist them in coming away; for if they are left, they cause after-pains, and in a few days a very offensive smell. Putting to bed.—The external parts should be annointed with lard or sweet oil, and a soft cloth applied; and lift her to the upper part of the bed, having previously brought down the reflected part of the sheet ; while sh° is being lifted let some assistant bring down her clothes which had been for security tuck- ed up over her hips; if she has lain in a petticoat, it ought now to be removed, and the clothes from above supply its place. When laid in her place she should be covered with bed-clothes, more or less, as she may be inclined to be chilly. A towel, four or five double, is then to be applied to the belly, and over that a broad bandage round the waist, is pinned so low, as to take in the bottom of the belly, and afford some support to its loose and relaxed sides, but not so tight as to give the least pain or uneasi- ness. The use of such a bandage is evident, but a twistedhand- kerchief, applied in the form of a cord, and drawn down tight, as is frequently done, (to keep down the mother, as the women express it,) is the very extreme of absurdity and must do harm, yet, when a broad bandage is skillfully applied, as here directed, it will be found very agreeable and very comfortable by the woman, and has a tendency to prevent and relieve that faintness, which is sometimes very alarming to women, recently deliv- ered. We would observe, that with regard to putting to bed,> if the patient be much exhausted and fainty, it had better not be attempted to move her before some hours, only change her posture so as to extend her limbs, putting dry clothes under her; give her some nourishment until she is somewhat recruited. For Midwifery. 179 Immediate nourishment we would advise as the best, a cup of coffee, with plenty of milk, and as much sugar as may be agree- able, or chocolate, either with a few mouthfuls of bread and butter, or rusk or boiled milk with some stale bread in it, yet, if the exhaustion be very great, a small portion of wine and water, or a tea-spoonful of brandy, with some fresh water, may be al- lowed, or panada, with the same quantity of wine or brandy in it; but unless the feebleness be very great, we would advise th< abstinence from all and every intoxicating liquor. After-pains.—Very few women but who will be troubled with after-pains, harassing them, and disturbing that repose so accessary to their comfort. Those pains, however, very much depend for their severity, upon the manner in which the after- birth has been delivered, yet it must be considered that they sometimes follow the best conducted and most natural deliveries. They come on soon after delivery, resembling in some manner those of labor, returning in paroxysms, though with longer inter- vals between them, throwing off during their action whatever lumps of blood may remain in the cavity of the womb. If these are in a moderate degree, and not of very frequent recurrence, they demand no remedy—but, more frequently, they are very excruciating, and therefore call for remedies. Opiates, are the surest means to be relied on; two tea-spoon- fulls of Paregoric, or twenty drops of Laudanum, with thirty of Sp. Camphor, or thirty drops of Laudanum by itself: either of these, given in fresh water, repeated in half doses for a few times at intervals of an hour or so, will seldom fail to give relief.— There will be some who cannot use Laudanum ; for such, use fomentations of Hops and Vinegar or Camphor to the bowels, occasionally, just warm enough to be agreeable. A horizontal position, laying down in bed, should be observed for nine days or more, and a low diet is always necessary. Every indication of pain and soreness, should be early attended to; directions for which will be hereafter prescribed. If the woman ahould have no evacution from her bowels within three days, one should be procured by the use of Castor Oil, Sedlitz Powders, or injections of warm water up the bowels And, if within tenor twelve hours, she passes no urine, she should be solicited to do so, and, if necessary, be aided by fomentation of clothes wrung out of warm water. The following will be found very beneficial: Spirits of Nitre, four tahle-spoonfulls; Laudanum, half a tea- spoonfull, forty drops of which, may be given every hour in wa- ter until relief be obtained: but should these also fail after a fair trial, recourse must be had to the catheter. Washing the child.—Children when born are frequently 180 Midwifery coated with a tenacious unctious substance, wnich is somewhat difficult to remove. It has been found by experience, that rub- bing the child over with hog's lard, until it becomes completely incorporated and mixed with this substance, and then making use of soft dry flannel to remove it, is the most simple, expedi- tious and perfect manner of getting rid of it. Afterwards, warm soap-suds may be used. The process of washing should be per- formed, so as not to unnecessarily expose the child to the influ- ence of cold ; if in the winter it should be done near the fire. ^ It may also be well enough here, to insist upon the person having charge of this office, to use as much despatch as is compatible with the proper execution of her duty, as it is to be feared, much injury is frequently done the child by too long exposure. After washing, it should be carefully dried. The highly injudici- ous and culpable practice which some nurses have, of using spir- its to bathe the body and head, especially the latter, should ba strictly prohibited, as it tends to carry off the heat by evapora- tion. Be careful not to expose the child to a strong light or to get any soap in its eyes. After having performed the necessary cleansing and washing of the child, the next thing to be at- tended to, is, dressing the naval. Nothing more is necessary, than after examining if it be properly secured, to pass the remain- der of the cord through a hole made in the centre of a piece of linen or cotton rag, with the extremity of the cord toward.1? the breast, fold the cloth over it so as to envelope it, and secure it by a bandage about two inches broad, pinned round the belly. Be careful not to pin the bandage too tight. Dressing the child.—Let its clothes be put on loose, as every thing like lacing, or tight clothing, prevents the proper exercise of the lungs, impedes the circulation,—and sometimes entails impaired health, and a bad shape for life. Nothing is needed on the head except the weather is very cold. The rest of tha child's clothing should consist of a shift, and a wrapper of fine flannel, with a diaper. All children cry when shifted and dressed, therefore the more short and simple the process can be, the better. Also, be careful of pins, always using those with elastic and protected points. First operations from the Bowels.—The bowels of all newly born infants are loaded with a mattter, technically called the meconium. It has been found, that it conduces much to the health and comfort of the child to carry off this substance, and its retention has even been known to give rise to fatal disea- ses. But dangerous as its presence may be, it should not lead to the administration of active and violent purges to remove it; for. there is no practice fraught with worse and more dangeroua Midwifery. 181 jonseqnences than this. The mother's milk is the best purge foran Infant, or a little molasses and water. If this, however, should Dot be sufficient to produce the desired effect, the child generally shows symptoms of being ill at ease ; will become sleepy ; fre- quently starting up ; moan and cry loudly. As soon as we find this to be the case, and especially if the stools still possess a tena- cious and greenish appearance, resort must be had to a tea- spoonful of Caster oil, administered warm, and repeated in four hours, should the first not produce the necessary evacuations. A mild injection of warm milk and water, with some molasses dissolved in it, will also assist much; as soon as the evacuations assume their proper color and consistence, which might be com- pared to tolerably thick mustard, all purgative medicines should be immediately relinquished. We have now described the process of an ordinary natural labor, and any woman endowed with com- mon understanding, may, by a careful study of these remarks, ea- sily qualify herself to give every necessary assistance in ordinary cases of natural labor, and distinguish most of those of difficultf in time to have a physician sent for. DISEASES AFTER DELIVERY. FLOODING.-If after the woman is put to bed, she loses too much blood it will manifest itself by a faintness; it will be neces- sary to observe that, if she has been over heated by too much clothing, or the temperature of the room, this should be remedied jy the removal of some of the clothes, and fresh air freely ad- mitted, cold water should be freely and repeatedly sprinkled on her face, a cold hand rubbed over her belly, a towel or napkin several times doubled and wet with cold water applied to the belly confined by a broad bandage, and to be renewed if it becomes warm; frequent drinks of cold water must be given her; if she has repeated vomiting, a dose of soda powders after every motion, «rill have a good effect; if these should fail, and the case become alarming, a lump of alum, about the size and shape of a hen's egg, and a nick cut around the middle, so that a tape can be se- curely tied round it, which is then to be pushed (enclosed in the hand) into the womb, and left there for sometime; and when it has accomplished the restraining of the flooding, it should be s7owly withdrawn by pulling the tape. The applications of col? have their limits: they must be discontinued when they have .ccom- plished the restraining of the hemorrhage; or, if they fail, and are productive of continued chills, it may then be supposed that all the advantages to be expected from them are obtained; they must, therefore, then be omitted. If the system does not show signs of returning life, and the patient continues to become 189 Midwifery. colder, and appears in imminent danger of dying, stimnlanta are then administered in small quantities and often repeated, as the urgency of the symptoms may require. Wine or brandy, diluted with water and made warm, will answer; a jnlep made of the yolk of eggs and warm wine, or part of brandy or whisky, di- luted with three parts of water, sweetened with loaf sugar, flavor- ed with a few drops of Ess. Cinnamon, is also an excellent cordial If there be pain, fifty drops of Laudanum, or teaspoonful of Pa- regoric, may occasionally be added to the stimulents; but the exhibition of these must cease as the patient shows signs of the return of life. Above all, she is not to be disturbed, or raised to an erect posture, but with perfect quiet—the small por» tion of life is to be carefully husbanded; for there is often a power of living in a quiescent state, or when laying down, when the patient would be destroyed by the least exertion, or by be- ing raised to an erect position; she ought, therefore, not to be raised or even moved, before she is quite revived ; and then, only with the utmost care. Persons have suddenly and unex- pectedly died through want of attention to this matter. And when immediate danger is no longer apprehended, the flooding ceased, it will still not be prudent to replenish the emptied ves- sels too hastily by high living, for, by so doing, the blood ves- sels may be easily again stimulated to immoderate action, and the hemorrhage renewed. Fainting.—Sometimes this comes on immediately after de- livery ; but, more frequently, not before an hour after. Some person ought, therefore, have the special observance of the pa- tient during that time, as the fainting may come on suddenly and unexpectedly; if it be caused by flooding, the method to be pursued has been considered in the preceding paragraph: but if it proceed from other causes which we are perhaps unable satis- factorily to assign, a tea-spoonfull of Paregoric, two tea spoon- fuls of Bateman's Drops, twenty drops of Ether or Spirits of Camphor, or either of these in some fresh water, together with fresh air, and forcibly sprinkling fresh water on the face, will fenerally soon be found to afford relief; frequently the fit will e terminated by vomiting. Fainting appears in some manner connected with the sudden evacuation of the contents of the abdomen; as a preventive from this cause, the bandage should be applied; this should, in all cases of fainting after delivery, be examined, and if it has moved, so as not to give the necessary support, it should be rectified and tightened. Inflammation and soreness of the external parts — After delivery there is sometimes much inflammation and swell- ing of the external parts: by washing and bathing with warm milk and water, and annointing with fresh lard, it will in general Midwifery. 183 go off in a few days; but if it continue to get worse, so as to re- quire attention, the parts are to be several times a day anointed with *he following cerate: Beeswax 4 ounces, Lard 6 ounces, add to this. Sugar of Lead 20 grains, dissolved in two table spoon- fuls of vinegar, melted over a fire, and simmer for half an hour: strain, and stir until cool. If the parts be hot and tender the fol- lowing poultice will be found very useful:—one handfuU of Hops with three of Wheat Bran, pour over them boiling water sufficient to make them into a poultice, which wrap in a piece of fine muslin, and apply it warm over the parts after putting on the above cerate. Milp fever.—The secretion of milk is usually accompanied with a slight fever, often amounting to a considerable degree of inflammatory action, preceded by shivering, and going off with perspiration; it is in general more severe, and of longer continuance with the first than with subsequent children. If properly managed, it will seldom continue longer than twenty- four hours; during its continuance the breasts are full, hard, and painful, which distinguishes this from fever. A tea-spoonful of Spirits of Nitre, in a gill of toast water, should be given every two hours; balm, sage, mint, or elder flower tea should be freely drank about luke-warm, and a poultice of bread and milk freely spread with lard and applied warm to the breasts. Sore Nipples.—These are the immediate result of some in- flammatory state of the system. The inflammation impeding the evacuation of the milk, the suction of the child peels the outer skin from the nipple,—the inner skin cracks, from which blood is discharged. As a means of prevention, when the important and highly interesting duties of a mother are about to devolve on her, she should, during the last two months of her preg- nancy, have her nipples drawn out by some other person or by breast-pump—at first, very gently and but once a-day; and, as Bhe approaches towards the completion of her time, more force Bhould be used, (but at no time so much as to cause pain,) and the frequency of the operation increased to three times a day. After each suction the nipple should be washed with cold water, and exposed for a few minutes to the air. As soon as the mother gets settled in b^d and rested, the child should be put to the breasts. When the nipples become Sore or tender a Poultice of Flaxseed meal anointed with sweet oil or Lard, should be kept to the nipple all the time except when necessary to remove it long enough for the child to nurse. This is bettei than any other application. When the nipple feels tender on the child sucking it, the attention should immediately be di- rected to the state of the system ; if costiveness prevail, to have 184 Midwifery. the bowels moved; and if fever prevail either general, or local % the breast, then to live on low diet. Always attend to gently drawing out the nipple for the child before putting it to the breast, and immediately after the child has finished its suction, to wash the nipple with cool Sassafras or Sage Tea. By care and at- tention to this treatment on the occurrence of sore nipples, they will in general be relieved. Sore Breasts.—Sore nipples, and their consequent disten- tion from milk, are perhaps the most fruitful source of inflam- mation of the breast, and also the most uncontrollable kind: those which arise from cold or from that feverish state called the weed, will generally be more under the control of remedies. Sometimes, a chill will precede affections of the breast; at other times, a painful swelling, without a chill. In either case, fever is soon excited—pain and swelling increase rapidly. There are two varieties: one is confined to the cellular or spongy sub- stance between the skin and the breast, and is soon brought to an issue; the other is within the substance of the breast, and is more slow in its progress, and frequently renders the breast, ever after, useless—which the first variety, of itself never does. The patient should be put to bed, and under the most rigid restrictions of diet—allowed no kind of animal food, nor any kind of spices, or stimulants; toasted bread, and water only should be allowed unless the patient has been previously much reduced; then bread and milk, mush and milk, tea or coffee, may be taken. Her drink should be water, or coci tea of tam- arinds, apples, cherries, peaches, or cream of tai tor whey: she should be kept in a room not too warm, and a jrwge of Castor oil, Rochelle or Epsom salts, be given so as to open the bowels freely. Local bleeding, by cupping or leaching, on the body, near the circular margin of the breast, will answer a good pur- pose. For a local application to the breaat, take hot vm-sgar, pour it over some hops, let it stand for a few miaates, strain out the hops, soak fine linen or muslin cloths in ic, and apply them frequently warm to the breast. They will be found particularly useful when the breast becomes much distended with milk, and cannot be drawn: it will diminish the secretion, and relieve the swelling. The breast, however, should be tf/aws as long as it can be done, always washing the nipph» clea* before the child is put to it. This treatment is to be continued through the whols eourse, until we have no more hopes of a resolution or scatter- ing the hardness, and suppuration or coming to a head is con- sidered inevitable; then the further reduction of the system. % purgatives and low diet, will be unnecessary. At tiw Midwifery. 185 rtage a plaster of honey, lard and floar, is among the best ap- plications. If we have reason to believe that matter is formed, and is ready for its exit, then a small poultice of bread and milk, smeared with lard, should be applied, slightly warm, to that part where we think it will burst or have to be opened. As soon as there appears a small, elevated, soft, rather dark spot, which elevation is easily indented with the finger, but which also quickly reappears upon the withdrawal of the fingei and gives the sensation of having a fluid enclosed; that should be punctured with a lancet, and the matter discharged. The bread and milk poultice should then be again applied: after a few days, it may be dressed with basilicon ointment, or some other cerate, until the part be healed. If there remain a hard lump in the breast, it should be rubbed with camphorated oil, opodeldoc, or volatile liniment, keeping the parts covered with fine flannel. Ephemeral fever, or weed.—This is a fever of common occurrence to lying-in women. It is usually of short duration, the paroxysm being completed generally within twenty-four hours, and always within forty-eight. It consists of a cold, a hot, and a sweating stage; but if care be not taken, the paroxysm is apt to return, and we either have a distinct inter- mitting fever established, or sometimes, from the co-operation of additional causes, a continued and a very troublesome fever io produced. It is generally caused by exposure to cold, irregu- larities of diet, fatigue, want of rest, &c. It is ushered in by a shivering fit, accompanied by pains in the back. When the cold stage has continued for some time, the hot one commences, and this ends in profuse perspiration, which either carries ofl the disease completely, or procures great remission of the symp- toms. The head is usually pained, often intensely, especially over the eyes, in the first two stages, and in some instances ac- companied by a slight delirium. The thirst is considerable, the stomach generally oppressed with wind, and the bowels bound. The pulse, until the third stage has somewhat advanced, is ex- tremely rapid. In the cold stage, we give frequent small quanti- ties of warm tea, such as Virginia snakeroot, balm, mint, or sage; and apply a bladder filled with warm water, or a dry warm flan- nel, to the stomach and back, and something warm to the feet; by tnis, we shorten the cold stage, and hasten on the hot stage. When the chilliness is gone off, and the hot stage is fully estab- lished, we then gradually remove the warm application and lessen the quantity of bed-clothes. We now also, in the place of warm drink, give cooler, about lukewarm, such as toast wa- ter, lemonade or apple water, If the heat of the body be ver? 186 Midwifery. great, and the thirst distressing, soda powders will be found to bt very grateful; but the water in which the powders are dissolved should be previously made about lukewarm: these may be repeated every half hour during the continuance of the hut stage. When we find the heat of the system considerably diminished, the paic and restlessness much abated, together with other symptoms oi of perspiration about the breast, we then add some covering, and again resort to the free use of the teas, fresh made, and given warm, but not hot; keeping the patient perfectly quiet, in a state of gentle perspiration, for the space of five or six hours. We then refrain from the use of the teas; and, when the piocess is over, the patient is to be cautiously shifted, the clothes being previously well dried and warmed; and, if she have an inclination, let her have something to eat. During the whole course of the paroxysm, we must carefully guard against the sudden applica- tion qf cold—it renews the shivering and prolongs the disease; but, at the same time, we must also avoid too much heat. A com- fortable room, with a moderate quantity of bed-clothes, ia what we are to have for the patient. Do not give purgatives until the sweating stage is over, for fear of giving the patient fresh cold, but then a dose of Castor oil or Epsom Salts may be given.—■ By the foregoing treatment we shall frequently be able to confine the disease to one paroxysm; it however will in some cases return at irregular periods; if the intermission become longer it is favorable, but if they become shorter it is unfavorable; if it does return the same treatment must again be pursued. Lochia and its derangements.—We mean by the termfo- chia those bloody discharges from the womb after delivery, which continue for some days, becoming greenish, and lastly pale, then decrease in quantity, and disappear altogether within a month, and often in a shorter time. The variableness of this evacuation should prevent it from becoming an object of very great solicitude; for it differs very much in different women, and in the same woman at different confinements. If the quantity discharged is small, therefore, or its entirely ceasing to flow at a very early period, need not create any degree of alarm, if the woman be, otherwise, in as good a condition as may be expected from her situation; and, no irritating or propelling medicines should be used : they cannot do any good, and may be productive of many evils. In those cases in which no very ob- vious cause can be assigned for the derangement, and which nevertheless appear to be producing injurious effects, some mild purgative should be administered, and, after its operation, some weak Cammomile or Sage tea : these, with occasionally sitting ip, will frequently restore the discharge. 1 Midwifery. 187 SWELLED OR MILK LEG OF LYING-IN WOMEN. During or after confinement, women are liable to a swelling ot the legs, called milk leg; its first symptoms are great pain and difficulty in moving the leg. The disease does not appear to b* connected with any peculiarity of constitution or preceding com- !>laint, nor the kino, uf preceding labor, or on the treatment, be- bre or after child.-birth. It occurs at any period from the first or second day, to two or three weeks after delivery; it is preceded by general uneasiness, lowness of spirits, slight pains about the womb, with a discharge from it peculiarly offensive. These symptoms seldom command much attention, until the patient is seized with pain on the inside of the limb, commonly about the calf of the leg, wlrch soon extends from the heel to the groin, along the course of the vessels called absorbents. The limb soon after begins to swell: the soreness extends all over it, so that it cannot bear the slightest touch, and every attempt to move gives exquisite pain ; the skin becomes glossy and pale, the countenance is expressive of great anguish and dejection, the pulse is quick, the heat of the skin increased, the tongue white, and the urine muddy. These symptoms strongly mark the presence of some irritating matter; and no doubt it is in the womb. The prevention must depend on cleansing the birth-place, by injecting water so as to enter and cleanse it: also injecting powdered charcoal and water (one tea-spoonfull to the pint of cold water) up the birth-place three or four times a day. The cure of this complaint is often tedious; sometimes the other leg takes on the disease, as the first subsides. The bowels should be opened by some good purgatives once in every two days The leg may be rubbed with a mixture in equal parts of Sweet oil, Laudanum, and Spirits of Camphor, frequently through the day, and poultices of Bread or Flaxseed meal applied du- ring the night to the groin and upper part of the leg. When the soreness has somewhat subsided, bathe the leg in a mixture of half a pint of Whiskey and one quart of cold water, night and morning, while at the same time the leg must be tightly bandaged, beginning at the toes and going up entirely to the groin, the bandaging to be renewed, night and morning, as the swelling decreases. Keep the affected leg elevated on pillows, higher than the body, and give a wine glass of Tea of Wild Cherry bark, Dog wood bark, or Culumbo root, before each meal, when the patient La getting better, 188 Pimples or Worms in the Face. VARIOUS DISEASES. PI3IPLES OR WORMS IN THE FACE. This is an affection usually met with in young personi of both sexes. It is characterized by small, more or less, red pimples, which penetrate the tissue of the skin to a greater or less depth, and is slow in coming to a head. There are seve- ral varieties mentioned by dermatologists; acne simplex, which appears on the forehead, face and shoulders, the pustule in tha form of small, hard, red elevations, inflamed at the lower portion, in which pus forms, which is thin and mixed with a thick seb- aceous (sticky) matter. They dry off, leaving a dark red rais- ed mark. When the pustules are mixed with a number of black circular points, which are the orifices of follices (or bags) filled with sebaceous matter, and are often converted into pustules, it is what is known as acne punctata or maggot pimple—worms in the skin. These follices are the habitation of a small parasi- tic insect, called Acarus folliculorum. If not attended to, they are liable to spread and accumulate, and disfigure the face sim- ilar to marks from a mild form of small pox. If let alone two or three weeks, the tops of the pustule become yellow, break and suffer a yellowish pus to escape, and, by pressure, a kind of " core" looking substance is forced out. It mostly appears on the face, but may extend to the back, and become \ ery severe and troublesome. A similar trouble is often produced by the continued use of intoxicating drinks, and known by the name of " copper nose," " grog nose," " grog-blossoms," &c. As this disease is usually produced by too rich food, the remedy consists in living on less meat and more vegetable food, taking once or twice a week a Seidlitz powder, and washing the face two or three times a day in Bay rum, Cologne water, or, if noth- ing better, common whiskey. SHINGLES. Shingles is usually situated near the waist, surrounding one-half of the trunk of the body, like a zone or belt : it may however, extend in other directions over the trunk; it ia always situated on one side, and that, generally, the right. The eruption of shingles is generally preceded by symptoms of general indisposition, and especially by severe darting pain in the parts where it is about to appear. At first red patches ihow themselves at the extremities of the site of future eruption, Small Pox. 189 and gradually become more numerous till they form a line—up- on these patches, shining points form, wjlich gradually enlarge into vehicles, or blisters, a little under the size of small peas, these vesicles containing a clear fluid, which gradually becomes thick and cloudy in appearance. At length in the course of eight or ten days, the vesicles burst, discharge and dry off in ths form of scabs, or, it may be, in very weak subjects, leaves sores or ulcerations. The belief was formerly entertained among physi- cians, and still retains its hold of the popular mind, that if the belt of the eruption of shingles was continued round the body, so as to meet, the disease proved fatal. This is perfectly erro- neous. When the disease occurs in the young and robust, the diet must be reduced to milk and bread, or vegetables, and all sources of heat and excitement avoided. Five grainsof blue pill at night, followed by a dose of senna or Seidlitz powder in the morn- ing, may be repeated once or twice ; and, in the course of the disease, if there is much fever, five grains each of the carbon- ate and nitrate of potash, may be taken twice or three times a day, dissolved in half a tumblerfull of water; or the proportion of carbonate of potash may be doubled, and a teaspoonful of le- mon-juice used to form the effervescing draught. The painful itching of shingles often causes much distress. It may some- times be allayed by simply keeping the eruption covered with a cloth soaked in tepid water, or by using the common lead lotion, (half a teaspoonfull of sugar of lead to a cup of water) in the same way. Pencilling the shingly eruption with a strong solu- tion of lunar caustic (ten grains to the ounce of water,) as re- commended in erysipelas, is found to relieve the severe pain.— Applying Tincture of Iodine with a Camel's hair brush, or soft linen mop, once a day, is also highly recommended by medical men. When shingles occurs in the aged and debilitated, instead of the diet being reduced, it requires, perhaps, to be improved ; at all events, the system must be sustained with nourishing broths, and with one grain of quinine three times a day. S3IALL POX. The small pox attacks people of all ages ; but the young of both sexes are more liable to it than those who are much ad- vanced in life; and it may prevail at all seasons of the year ; but in general is most prevalent in the spring and summer. It very seldom happens that a person is attacked a second time with the disease, however afterwards exposed to its infection. Ths disease is divided into two kinds—the distinct and confluent. Ia the distinct, the eruptions are quite separate from eachother^ 190 Small Pox. but in the confluent kind, they run much into one another.—* The distinct may be distinguished from the confluent, before the eruption appears, by the mildness of its attack, by the in- flammatory state of the fever, and by the late appearance of the eruption. The disease commences with shivering and languor, followed by heat, thirst, and headache; there is usually either pain or great oppression at the pit of the stomach, and not unfrequently vomiting; there is severe pain in the back or loins, and in children not uncommonly, and more rarely in adults, convulsions On the third day after the setting in of the above symptoms, usual- ly toward evening, minute red spots, somewhat resembling flea bites, show themselves on the forehead, the neck, the wrists, and arms, the chest and abdomen, and finally on the extremi- ties : this, is the course of the eruption, but it does not reach the lower extremities till at least the fourth day. If the erup- tion on the parts first mentioned is discovered over night, by morning it is much more distinct, and the spots are much more numerous than they first appeared to be; they are, too, slight- ly elevated—from this they continue enlarging ; on the third day after their appearance, they contain a little fluid on their summits, which gradually increases in quantity. Towards the fifth or sixth day, they contain pus or matter. About the sev- enth or eighth day of the eruption they begin to " crust," that is, to break, allowing their contents to escape, and then to har- den into a crust or scale. At this period of the disease, that of " maturation," the eighth day of the eruption, the eleventh of the disease, what is called the secondary fever comes on; the fever, which had more or less abated after the eruption appear- ed, becomes again aggravated, and continues so for a few days. At length, if the disease has progressed favorably, toward the end of the third week from the first showing of the eruption, some of the scabs begin to separate and fall off, leaving either a pit or a stain of a deep red color. Such are some of the most prominent characteristics of small- pox. This disease is to be treated, by avoiding every thing of a heating, inflammatory nature; and by keening the subject of it in a cool, quiescent state. The diet shoui.t be of the vegetable and mildest kind; and the drinks of a similar kind, made agree- able by the addition of the most palatable acids. The bowels are to be kept open by a table spoonfuU of Rochelle salts, or Epsom salts, in a glass of cold water, once every two or three days, or a Seidlitz powder will answer ; and, above all, the pa tient is to have cool and pure air—never oppressed by clothing Warts. 191 or a heated room. The temperature of the chamber should al- ways be such that he may experience no disagreeable degree of heat; but rather a sensation of cold: and, except he complains of being chilly, no fear need be entertained of carrying the cool- ing regimen too far. His bed should be a mattrass covered only with a few bed clothes. ^ But although the bowels should be kept open throughout the disease, when the eruption is coming out all attempts at purging ihould be dropped, cooling drinks, such as lemonade, toast wa- ter, &c. being given. If the surface is very hard and dry, spong- ing with tepid water is very useful and agreeable. When the secondary fever comes on, it may be requisite to act more freely on the bowels by means of the purgatives already mentioned, while at the same time the distressing restlessness requires opia- ates; twenty to forty drops of Laudanum or a tea-spoonfull or two of Paregoric, may be given at bed time. In some cases, if signs of sinking come on, with weak pulse, tardy eruptions, and pustules not filling, all lowering measures are to be avoided, and good broths, wine, wine whey, &c. administered, as the case may require. The principles of treatment are, in the onset of the disease to moderate the fever and through it the erup- tion, by cooling purgatives, (such as mentioned above,) when the eruption is coming out, to interfere but little beyond keep- ing the bowels easy, regulating the diet according to the strength; and, again, in the stage of secondary fever, to purge moderately. If much swelling and distress about the throat should result in the course of the disease, leeches ought to be applied, in num- ber proportioned to the age and constitution of the patient.— This treatment employed in a case far distant from medical aid might save life. To prevent being "Poc-marked" or scarred by the disease, keep the face, neck, hands, &e., well anointed with Sweet oil or Lard, until the inflammatory stage, and fever is passed, and guard against scratching or picking the scabs. WARTS. These are enlargements and thickening of the different coats of the skin, or one part growing into or through the other, caus- ing the skin to break, and admitting this unnatural growth to protrude through. They are most common with children, and generally occur on the hands, sometimes on the face. In tha latter situation they are better not interfered with. When si- tuated on the hands, they often disappear of themselves.— When their removal is desired, strong acetic acid, or very strong vinegar, applied every two or three days, is the best re- medy. Nitric acid is sometimes applied, or caustic, with ths same beneficial effect. . The iuice of the green rind of the com- 19* Corns mon black walnut, applied once a day for a week or two, will usually remove warts. When warts have a narrow neck, a horse hair or silk string, tied tight around them near the skin, will soon make them fall off. When a wart on the face, especially in those advanced in life, appears inclined to become ulcerated, or irritated, it ought not to be interfered with, but show it to a physician. CORNS. Tight shoes are one of the most frequent causes of corns; they are often troublesome to females and others who are particularly attentive to appearance, and who wish to exhibit a neat and small foot, by compressing it in a shoe of too narrow dimen- sions. ' Corns sometimes exist without giving much pain or trouble; but in other cases, they give so much uneasiness, as absolutely to incapacitate for walking. They are made more particularly intolerable, by every thing that quickens the circulation, or which heats the feet, or causes the corn to press on the neighboring parts. Tight shoes, much walking, warm weather, heating li- quors, all tend to render the uneasiness of corns very great, and they are generally worse in summer than in winter; and persons ate frequently obliged to sit down to take off their shoes, and rest the foot in a horizontal posture. Corns may often be readily cured, by avoiding the above ex- citing causes, by wearing large soft shoes, adapted in form to the shape of the feet, and by continuing for some time at rest. It is useful to take a consideiable number of folds of linen, covered with some softening ointment, cut a hole in the middle for the corn to lie in, and to apply them to the foot; and if it be on the sole of the foot, it may be useful to have an additional moveable sole, with a hole cut in it in like manner. If, along with this mechanical and palliative treatment, we use the fol- lowing method, a corn will be easily and quickly eradicated : it is to be touched with lunar caustic, and wrapped round with adhesive plaster ; and generally at the end of a fortnight, the dead skin will be removed, with the corn adherent to it. If the corn does not come away, the operation is to be repeated. Se- veral other remedies of the same kind are recommended, of which the principal are, soap plasters or mercurial plasters, or blistering ointment. The following plan may also be tried: every night and morning the foot is to be put into warm watei for half an hour, while there, the corn is to be well rubbed with soap. All the soft white out side of the corn is afterwardi to be scraped off with a blunt knife, or what is better, with a p»*o* of numice-stone; but we must not persist in this scrapings Barber's Itch. 193 if there is pain in any part of it. This treatment is to be contin- ued without intermission till the corn is totally eradicated, which it will be in about a fortnight. Strong vinegar, applied to corns, after bathing in warm water, once a day, is also a good remedy. It is generally a difficult and painful operation to cut out a corn. Unless it be completely taken out, it is apt to grow again, and this it does faster than if it had been let alone. In old people, it is highly dangerous to cut a corn, as this fre quently excites an inflammation, and consequent mortification which carry off the patient unless carefully treated. Bunions.—This is the result of chronic inflammation of tha Mucous Bag (or Bursa) which is situated over the front of the great toe, and is generally caused by tight shoes. It ought to be attended to at once; one or two leeches, warm fomenta- tions of hops and hot water with vinegar and a poultice used to allay irritation, and the offending shoe being at once discarded. A wrong position of the bones at the joint is a frequent attendant. and, perhaps, an antecedent cause of bunion. When the disease is fully formed, the best plan is to avoid, by the make of the shoe, &c. &c., every source of irritant pressure. [Bathing of- ten in salt and water is advisable. BARBER'S ITCH. This is an eruption of inflamed but not very hard tubercle* (or pimples) appearing on the hairy parts of the face—the chin, upper lip and whiskers—sometimes in the eyebrows or the neck, and on the scalp. It usually clusters together in ir- regular patches, with the hair passing through the little eleva- ted points. The pimples are of a pale yellow color, and in a few days they burst; matter then runs out forming a hard brownish crust, which fall off in a few days, leaving pimples of a purple color, which are slow in healing. Before the appearance of the eruption, there is heat, pain and a tingling sensation in the parts. In the treatment avoid the use of a razor altogether, live on a low diet, and bathe the parts in a solution of sugar of lead in water, [one Teaspoonfull to the half-pint of water] three or four times a day. Give a mild purgative of Rochelle Salts, a dose of Senna or a Seidlitz Powder, about twice a week. Also wash the parts thoroughly in soap and water twice a week. Also take one giD of Tea made from Sarsaparilla root before each meaL 194 Inflammation on the Brain. INFLAMMATION OF THE BRAIN. Its characteristics are violent fever, severe pain in the head, redness of the face and eyes, great intolerance of light and sound, watchfulness, and delirium. It is usually preceded by long continued watching, pains in the neck and crown of the head, defect of memory, diminution of urine, and irregular pulse. As the disease advances, the eyes sparkle greatly, there is ferocity in the countenance, restlessness, deafness, ravings, and increased pulsation in the arteries of the neck and temples. The tongue is dry and of a yellow or black color, the face of a deep red, and the pulse becomes small, quick and hard. It is always a most alarming disease, and often terminates fatally about the third or seventh day. It is produced by all causes which tend to excite apoplexy or fullness of the blood vessels of the head,—such as exposure to the hot sun, &c. The patient should be bled from the arm freely ; and it ought to be done, if practicable, while he is sitting up. Bleeding by cupping the temples, and by the application of several leeches, should not be neglected if the symptoms are violent. Cold ap- plications of ice, or iced water to the head are to be made and renewed frequently. Powerful purgatives are to be adminis- tered ; applied to the back o^ the neck. Anyhow the experiment i3 worth trying. It has been stated that applying ice in bags or sacks to the backbone, has checked the disease ; when it can be had of course give it a trial. LOCK-JAW, OR TETANUS. This is an involuntary and almost constant contraction of the several muscles of the body, while the senses remain perfect. It is called Lock Jaw on account of the Jaws being locked together, as it were by the contraction of the muscles. The set of muscles most generally affected, after those of the jawm, are those of the back; the patient, by the spasm, is bent like an arch, so that the back of the head and the heels alone touch the bed ; occasionally the body is bent forward. The disease most frequently commences with a sensation of stiffness and soreness of the muscles of the neck and jaws ; the latter be- come fixed, and the spasm extends more or less over the body. This extensive cramp is attended with the most severe pain, which is also, in most cases, experienced severely about the pit of the stomach, being dependent doubtless on the spasm of the diaphragm. The most usual exciting causes of lock-jaw or tetanus are wounds, especially of a punctured character, but in some per- sons the very slightest injury is sufficient to develope the disease. It is liable to prevail among the wounded after battles, if ex- posed to much bad weather; indeed cold will occasionally give rise to lock-jaw independent of injury. When lock-jaw arises from a wound, it shows itself in from four days to three weeks after the injury. It is a very fatal disease, the greater portion ot those affected by it dying; some, however, recover. In the treatment of lock-jaw, begin by giving large dose* of Laudanum, say, from thirty to sixty drops if it can possibly be swallowed, and repeated at intervals of from half an hour to an hour, as long as the system remains unaffected by the drug: Sterility or Barrenness. 203 if the medicine cannot be given by the mouth, it must be by injection. In addition to the above, the affusion with cold water may relieve. The patient having been taken out of bed ; and a quantity of cold water dashed over the body and down the spine, is immediately to be rubbed dry and replaced in bed quiet sleep may possibly follow. While the jaws are firmly closed, nourishment cannot of course be given in the usual way; it medical man will probably administer it by means of a tube passed into the stomach, either by tlie nose or by mouth, pass- ing it behind the teeth ; until his arrival, should that be de- layed, the administration of small injections of meat-broth will assist in keeping up the strength. Mustard plasters applied the entire length of the back-bone or spine, until pain and redness is produced, and after their re- moval, the application of cloths soaked in a mixture of equal parts of Sweet oil, Laudanum and Chloroform, and over them oil silk or writing paper, is a treatment I would by all means advise. Sometimes large doses of Ipecac or Antimonial wine, given until nausea is produced, will relax the muscles; the bow- els should first be moved, however, by injections. STERILITY, OR BARRENNESS. This, sometimes, proceeds from defecuve organization. These cases are, however, very rare, and cannot be cured by art The next general cause is a torpor, and irregular action in the womb and its appendages, which by proper management ought to be cured. The most important means of rousing the womb, will be found in exciting the breasts to their natural action. The con- nection between the womb and the breasts, has often been re- marked : it is scarcely possible to excite an action in the one, without affecting the other. The most natural action for the breasts, is the secretion of milk. They have often been excited to the discharge, without pregrancy. A child losing its mother, and sleeping with a female friend, has been known in the night to get the nipple in the mouth, and to excite the flow of milk by the morning, and the child was abundantly nourished afterwards at the breast of the maid. The idea wished to be conveyed is, that to stimulate the womb of a woman who has been barren or unfruitful, it is only necessary to cause a flow of milk for a short time in her breasts by applying a child, (as in the case just cited) and that the stimulus thus brought to bear on the womb and its appenda- ges, will cause the woman to conceive and bear children. I give this not as my own opinion, but as the opinion of justly 204 Chills, or Fever and Ague. celebrated medical men. To those who have been barren and who desire the companionship and blessings of children oo whom they may lavish their love, and perchance their property, the experiment is worth trying. • CHILLS, OR FEVER AND AGUE. This disease prevails mostly in the fall of the year, and near lowlands, marshes, and on the water courses of rivers. The dis- ease occurs at stated and very various intervals—either daily, or every second, third or fourth day. Ague and fever, is generally divided by writers into three stages :—the cold, the hot, and the sweating, and is thus de- scribed.—The cold stage commences with a sense of languor, of weakness, and aversion to motion and to food, with frequent yawning and stretching. The face and extremities become pale; the features shrink, as do all parts of the body ; the skin appears constricted, as if it had been exposed to cold. At length, the patient feels very cold, and universal shaking comes on: breathing is small, frequent and anxious ; the urine is almost colorlesss : sensibility is impaired; the pulse is small, frequent and sometimes irregular. These symptoms abating after a short time, the second stage commences with an increase of heat over the whole body, redness of the face, dryness of the skin, thirst, pain in the head, throb- bing in the temple, anxiety, and restlessness : the breathing be- comes more full and free, but still frequent; the tongue ia furred, and the pulse becomes regular, hard and full; in cases of great severity, delirium is apt to occur. These symptoms having continued for some time, a moisture breaks out on the forehead, and by degrees becomes a sweat, which gradually extends over the whole body. As this contin- ues to flow, the heat of the body abates, the thirst ceases, the urine deposits a sediment ; breathing is free and full, and most iof the functions are restored to their ordinary state ; the patient, however, being left in a state of weakness proportion- ate to the violence of the preceding attack. Although this is the description of a common fit of ague and fever, it is subject to great variations in every stage ; de- pending on as great variety in causes and peculiarity oi consti- tutions. The treatment, whether the disease recurs every day or otherwise, is the same. Our object is to shorten the duration of the fit when it comes on, and to prevent its recurrence. The treatment when the fit comes on, is, in the cold stage, to take any weak tea as hot as possible; to apply hot appli- cations to the feet; and to lessen the shaking, it ia of service Cliills, or Fever and Ague. 20b to grapp tbe limbs very tight, or to apply tight bandages around them to compress the muscles. When this stage subsides, the drinks should be continued, and twenty drops of spirit of nitre in two tablespoonfuls of water should be given hourly, to favor the sweating. If the symptoms run alarmingly high, as is sometimes the case in congestive chills, black pepper tea with a little wine, brandy or whisky in it, should be given occasion- ally, while at the same time we try to produce vomiting by tick- ling the throat with the finger or a feather, and use friction with hot cloths, &c. During the sweating stage, the patient should not be kept very warm, but not exposed to such a current of air as might endanger the sudden suppression of the perspiration; when it ceases the patient should be wiped dry with a rough towel, have the clothes changed and partake of some suitable nourishment. Of course the great object m this disease must be to break the chilly or prevent its recurrence. For this purpose nothing is equal to Quinine. Commence six hours before the expected attacks of the chill, and take from one to three grains of the quinine every two hours, until the time for having the chill is 1 past. Do the same way the next period, or day when a chill is expected. When the chill has been broken up, then every sixth or seventh day afterwards, take the quinine, until the fourth week or twenty eighth day has passed. The quinine may be taken in powder, mixed in a tablespoonful or two of cold water, or in the form of a pill. The patient should not eat much the day that the chill is ex- pected, and must also avoid exposure to the night air, and wear flannel next the skin. Bathing with a sponge and water, (to which a little.-salt has been added) night and morning, is advisa- ble. As a strengthening bitter tonic take a wineglassful of tea, [coh) j made from wild cherry, or dogwood bark, or columbo root, before each meal. In the most obdurate cases, I have found the above treat- ment successful, in my practice in Mississippi and Tennessee, as well as since living in the city of New York. One thing should be observed, however, that before giving the quinine, in the very beginning, it is best to purge the bowels freely. Give five to ten grains of blue mass (blue pill) with half a grain of ipecac, at bedtime, to be followed the following morning by a dose of castor oil or a seidlitz powder, and repeat them, if necessary to work off the blue pill. You are then ready to begin with tha quinine treatment as above mentioned. 206 Bilious, or Remittent Fever. BILIOUS OR RE3IITTENT FEVER, This is nothing more than the Chills, or Ague and Fever, ex eept in this form of the disease there are no intermissions, (ol entire absence of the symptoms,) though there are remissions or partial suspension of the fever, followed by something like a chill or coldness of the nose, &c. The treatment consists in giving Quinine in the same dosea as ordered for Ague and Fever, only it should be given every three hours, both day and night, until the fever is broken up, and between each dose of the Quinine give twenty drops of Spirits of Nitre in half a glass of water. Cold applications to the head (cloths wrung out of cold water or water and vinegar, are about as good as any,) will be benefi- cial. Allow cool drinks of lemonade and slippery elm-water, or gum arabic water, &c. Give the blue pill, &c, as before refer- red to, before beginning the use of the Quinine, and during convalescence use the bitter tonics, &c, the same as recommended in the treatment of Ague and Fever; tea-spoonful doses of pre- pared chalk and powdered charcoal, given once a day in a little slippery elm-water, will be good to correct acidity of the stom- ach, and offensive discharges from the bowels. FAINTING FITS. These are liable to occur at any time in persons who are sub- ject to them, and always create for the time being, considerable excitement, especially when occurring in a crowded assembly or in the public streets, &c. These sometimes come on suddenly, without any visible warning; and, at others, they are preceded by sickness at the stomach—some oppression in breathing- paleness of face, &c. They are characterised by an entire suspen- sion of all the animal powers; which continuing for a short time, they become gradually restored. In rousing the system to ac- tion, we are first freely to admit fresh air, exclude all unnecessa- ry attendants, and see that no tight clothing is interfering with the breathing, &c.—especially removing tight-laced jackets, corsets or cravats. Cold water or vinegar should be sprinkled on the face : strong smelling articles should be applied to the nose—as volatile salts (hartshorn) ether, assafcetida, burnt, feathers, &c. A little wine, or spirit, should be poured into tha mouth, and the extremities rubbed with a coarse brush. The di- rect cause of fainting is diminished circulation of blood through the brain. It must be obvious, that in the endeavors to restore St. Vitus' Dance. 207 a person who has fainted, this condition must be altered as quickly as possible ; and for this purpose, the individual should be laid quite flat down, the head on a level with body, so that the feebly-acting heart may not have to propel the blood up- ward, but horizontally. After fainting from excessive evacuations, cordials and stimu- lating diets should be often given. The patient should be laid down and kept at perfect rest, with hot applications to she breast and extremities. Remember, though, that when the fainting arises from a great loss of blood, it ought not to be stopped suddenly ; [the faint- ing fit] ; because during such fainting the blood coagulates and the vessels contract—thereby tending to prevent the continu- ance of the bleeding. Persons liable to fainting, or indeed to any kind of fits, can- not be too cautious in avoiding what they have found tending to produce them ; they should never be alone ; because of the danger of falling so that respiration cannot be renewed, and con- sequently ending in death, when others are not at hand to change the position of the body. In general, persons subject to fits who are of a weakly, deli- cate nature, will find relief by leading a more energetic life, oc- casionally using some of the strengthening medicines mentioned under the head of Tonics in other parts of this work. ST. VITUS' DANCE. This is mostly a disease of youth, occurring before puberty, and usually disappearing at that period of life, if it has contin- ued so long. It may, however, continue into adult life, but rare- ly proves fatal. The most prominent symptom of St. Vitus' dance is continued involuntary actions of the muscles, to a greater or less degree—the extent of the muscles affected, and the intensity of their affection, varying with the severity of the disease. The movements, however, generally cease entirely during sleep, and in all cases certainly are diminished. The ordin- ary voluntary movements are still capable of being performed after a fashion ; that is, in an unsteady, uncertain, and somewhat grotesque manner. It seems as if, after the voluntary impulse had been communicated to them, an additional involuntary one interfered to throw the limb or other part, out of the usual steady movement. . Usually the disease commences with twitching about the face or neck, or in a particular limb, gradually extending to one side of the body, or to the whole body, as the case may be. Pain uj seldom complained of, but it does sometimes occur in the head 208 Epileptic Fits. The appetite may remain quite good, but the bowels are possibly confined, and tlieir secretions unhealthy. To this depraved state of the bowels, or to costiveness, or to the presence of worms, the disease is often traceable. In females it is not un- frequently connected with the menstrual function, (monthly turns) especially if it be delayed, or imperfect. The ir- ritation of the coming of the second teeth, has been assigned as a cause ; and there is no doubt that imitation, especially among females, may spread the disease, which is most general, as might be expected, in persons of a nervous tendency. The du- ration of the attack varies from ten days or a fortnight, to months ; but having once existed, it is, up to the age of twelve Or fourteen at least, apt to recur occasionally. A great many cases of this disease get well without any treat « ment, but it is not best to trust to nature alone. The bowels should be purged with one blue pill (three grains) at bedtime, and followed next morning by a teaspoonfull of Rochelle salts or Epsom salts in half a gill of water, so as to work off the blue pill. Some mild purgative should also be given once a week afterwards, to keep the bowels open; castor oil will answer. In all cases attention to the general health is required. Good diet, exercise, change of air, and attention to the hours of sleep, put- ting the child to bed at a stated hour every night, and to free ventilation of sleeping rooms, are all circumstances to be kept in mind in such cases. Bathing by means of a sponge, with salt and water every morning, is of great service. Also give one half to one teaspoonful three times a day of the following mixture;—tincture of Peruvian bark, tincture of valerian, spirits of lavender, tincture of henbane, orhyoscyamus, of each one once ; spirits of camphor, half an ounce, all mixed together and kept in a closely-corked bottle. EPILEPTIC FITS. This disease consists in a sudden deprivation of the senses : accompanied with a violent convulsive motion of the whole body. It attacks by fits, and after a certain time goes off; leav- ing the person in his usual state, excepting a sensation of lan- guor and exhaustion. The fits, or convulsive seizures of epilepsy, are most va- ried as to the time of their occurrence. Frequently the interval is one of months, but again, daily fits, or even two or three times a day, are the rule, in the worst ca- ses. The attack of epilepsy is for the most part sudden: the individual, in the midst of some accustomed occupation, or while holding active communion with persons around, sud- Epileptic Fits. 209 denly utters a loud—a fearful—cry, and, if unsupported, falls to the ground; the eyes are staring or rolling; the head, or rather chin, is drawn toward one shoulder, the countenance becomes dark or purple, the veins of the face and temples filled with blood, and the features are thrown into convulsive move- ment ; there is frothing at th|p mouth, while a kind of choking noise is often made in the throat; the limbs are also more or less convulsed, and the excretions are often expelled involuntarily. The tongue very often suffers from being bitten, and the teeth have even been fractured during the fit. Gradually, these con- vulsive movements diminish, and the person awakes to con- sciousness, with a heavy stupid look, or falls into a deep leth- argic sleep, which continues for some hours ; but even when roused from this, there often remains slight temporary suspen- sion of the activity of the brain. Such are the symptoms of a severe epileptic paroxysm; the disease, however, occurs in much milder forms, even in those who at other times suffer from it in greater intensity. A slight temporary unconsciousness may be the only symptom, with or without the slightest ap- proach to convulsive movement, as evidenced by the twitching of a finger, the roll of an eye, or slight spasmodic action of the muscles of the face; the patient may fall gently as in a faint, or remain standing as it were asleep for a few moments. As there is every variety in the nature of the attacks, so is there likewise in their duration; from a few moments to the average period of from five to eight minutes, but sometimes much longer. The* attack in many cases appears to bystanders to come on suddenly and without warning; but most epileptic patients are sensible for some time previously of the approach of the parox- ysm, and even for twenty-four hours are aware that a fit is at least probable, although its direct accession may not be certain- ly known until just previous to its occurrence. It may, however, happen that these symptoms will pass off without a fit, either independently of any effort of the patient to ward off the at- tack, or in consequence of some of those measures found to be efficacious, and adopted by epileptic patients for the purpose. Low spirits, or unusual irritability, sometimes an increased energy, dizziness, noises in the ears, floating specks before the eyes, and many other signs connected with disorder of the ner- vous system, are the precursors of the epileptie paroxysm. But the most generally marked and remarked precedent is the epil- eptic " aura," a sort of creeping sensation, which is described by the patient as arising at some particular part of the body, such as the extremity of a limb, and gradually ascending upward to 210 Epileptic Fits. the trunk or head, till the individual loses his consciousness in the convulsion. Epileptic seizures are very frequent in the night-time, just as the person is falling asleep ; but they may occur at any period of the twenty-four hours, and may be induced by causes affecting the nervous system ; the excitement of joy or passion, or depres- sion of grief, intoxication and sexual excesses, are most fre- quently not only actual exciters, but also predisposers, to the attack of epilepsy. Epilepsy may be a congenital disease, that is, the child is born with the tendency and becomes subject to the fits, either with or without any apparent cause, early in life. Intoxica- tion is a cause of epilepsy, and delirium tremens may be com- plicated with it. Strong and prolonged mental exertion may induce epilepsy. Fright is another and very frequent exciting cause. Worms and irritations in the bowels, indeed whatever can irritate the nervous system, may induce the disease in ques- tion. Imitation, or at least witnessing an individual in the ep- ileptic paroxysms, has been known to give rise to the fits in others; but they were most likely predisposed, or at all events of nervous and susceptible temperament; for this reason, such persons, young females and children especially, should never, if possible, be permitted to witness an epileptic fit. The pre- monitory cry is so terrifying that it has been known to affect even the lower animals. When means will allow of it, the epileptic ought to have an attendant constantly with them. When an individual is seized with a fit of epilepsy, but little can be done for its immediate relief: the chief thing was to prevent the inflicting injury up- on himself, by striking against surrounding objects, and also to protect the tongue. Those who are much in attend- ance upon the epileptic ought always to have on hand a piece of India-rubber, or a thick India-rubber ring—such as is used for children teething—to insert between the teeth. All fasten- ing about the body, such as the neckcloth, &c, ought to be loosened, and air freely admitted ; the head should be raised, and cold wet cloths may be applied to it if there is much heat. Ithas been advised to cram the mouth full of salt as soon as the fit comes on. Dr. Watson, who had the plan tried in hospital, thought it seemed to curtail the duration of the convulsion. The most important treatment is during the intervals; mix' together half a teacupful of ground mustard, two table spoon- fuls of laudanum, three table spoonfuls of tincture of cayenne pepper, half pint of vinegar, and same amount of cold water and alcohol, put into a well-stopped bottle, shake well, and apply this Drowning. 211 as a iinimmt along the backbone (or. spine) with a woollen cloth, night and morning, wearing a flannel shirt next the skin all the time. Also, take inwardly the following: tincture of extract of skullcap, tincture of valerian, tincture of hyosciamus, (henbane) spirits lavender, of each one ounce, dose, one tea- spoonful three times a day. Keep the bowels open, take plenty of exercise in the air and avoid all kinds of excitement. A sponge bath every morning, is a good remedy, also pouring water [or a shower- oath] on the head at the same time, is recommended by physicians. DROWNING. This is of such frequent occurrence that every man, woman, and child, should know what to do in cases of apparent death from drowning—in fact it should be a part of the education of our children, from the fact that it often happens that children are the only persons present when one of their little playmates falls into the water, and while going for help the sufferer dies for want of the proper attention. The first thing to be done when a person apparently drowned is rescued from the water, is to wipe and cleanse thoroughly the mouth and nostrils—the next to apply warmth to the body. This last cannot possibly he done as long as it is covered with wet clothing; and if this is the case, it should be removed, cut off, if necessary for haste—as quickly as possible. If there is a house or shelter of any kind very near the spot where the body is got out, it may be taken to it at once, and before the clothes are removed; but if such is not the case,^>ro- vided dry coverings are at hand, the wet clothes should be strip- ped off on the spot. Wrapping the body in blankets is always to be preferred. In removing the body it is best done by laying it on the back or side, on some flat board, such as a door or shut- ter, the head and shoulders being well raised; but if there is no- thing at hand on which the body can be laid, care should be taken in carrying it that the headis well supported neither allow- ed to fall back, nor forward upon the chest. As soon as may be, warmth is to be applied to the entire external surface ; if a warm bath is available, it should be used, if not, the body is to be covered up with warm things; bags of hot bran, hot salt, or sand, or any other convenient vehicles for heat, are to be placed wherever they can be without interfering with the necessary manipulations: to the pit of the stomach and to the feet espe- cially, their application is to be used. Frictions with stimulants of some kind, such as camphorated oil, brandy or any other spirit 212 Drowning. mixed with oil, of-turpentine, should any of them be used warm, and be rubbed in with a flannel; a warm stimulant in- jection, consisting of gruel, containing a tablespoonful of tur- pentine, or double the quantity of brandy, may be given, and strong-smelling salts held to the nostrils at intervals. Artifi cial breathing, recommended by some, is condemned by others. Certainly the old method of using bellows and other means to inflate the lungs was much more likely to do harm than good, particularly in the hands of the unprofessional, who would be much more likely to inflate the stomach, and thus impede the breathing. Attempts to imitate the natural process of respira- tion may, however, be made, by pressing inward the ribs and pit of the stomach, and allowing them to rise again by their own elasticity, repeating this process twenty times in the minute. External warmth and continued friction, with care taken that the shoulders and head are raised, the mouth and nostrils freed and carfully keeping the patient wrapped up in blankets, are of the greatest importance. For the more easy application of re- medies, the body should belaid on a table of convenient height It is necessary to notice also what ought not to be done; for many old and most injurious modes of treatment are still apt to be resorted to by the ignorant and prejudiced. Most of these have originated in the idea that water swallowed was, or had something to do with the cause of death; hence patients have been hung up by the heels, rolled on barrels, choked with emetics, under the idea of making them disgorge the water, If there is much water swallowed—as sometimes happens— it would be better to remove it; but any means which unpro- fessional persons can use for its removal would only be a worse evil. If a medical man is present, and thinks well to use the stomach-pump quickly, remove the water and replace it with a small quantity of hot brandy and water, it may be of service, but no attempts should be made to give any thing by the mouth , as long as unconsciousness continues. jj Never despair of these cases, for when all hope seems to have vanished and no sign of life been given for one, two, or four six, or even eight hours, the perseverance of those around ha3 been at last rewarded, and life preserved. After a person has been restored to consciousness, there may be considerable congestion of blood about the head, which may require leeches or scarifying the temples. In all cases of recov- ery, the greatest care must be taken to preserve the re-excited actions ; if stimulants are thought requisite they must be given cautiously; guard against any excitement foom friends or rela- tives ; and support the strength by tea, coffee, soups, &c, Hanging. 213 and let the patient be warmly wrapped in blankets in bed until the perspiration is started, after which they may be consid- ered safe. HANGING. This may cause death in three ways: by simply compressing the wind-pipe, by which death is caused by suffocation ; by apoplexy, from compression of the veins of the neck, or by dislo- cating the neck, which is not often the case. Recovery from hanging1 must, in some degree, depend upon the completeness or not, of the interruption to the passage of air through the wind-pipe for any time; it is not likely that resus- citation will be effected if this thing has continued four min- utes. The first thing to be done when a person is found hang- ing is, of course, to cut them down at once, to loosen the material around the neck, to dash cold water over them, and to bleed from a vein in the arm or foot, or temple. In such an emer- gency, a person would be justfied in cutting across the temple where the artery runs, (or beats), with a sharp knife of any kind, allowing the blood to flow freely. The bleeding could be checked when desired by pressing with the thumb over the part or putting burnt alum into the wound. With the except- ion of applying heat, and removing the clothing, the treatment of hanging is very much the same as in cases of apparent death from drowning. I should advise, however, that as soon as life is thoroughly restored, and after the patient has had time to think over his folly a little, in cases of attempted suicide, by whatever means may have been selected, that the person so offending should be thoroughly flogged, and then made to do the state"some service for a month or two. The prevalence of this sin, &nd the consequent notoriety that is given to deaths from this cause in the newspaper press of the day, should bo looked upon by every body with disfavor. No man or woman who thus tries to rush unbidden into the presence of God, de- serves a falling tear, or a newspaper notice, unless iusanity has been the cause. CHOKE-DAMP, Or Apparent Death from Inhaling Carbonic Acid Gas. How many sad instances of deaths from this cause every year and yet a little knowlege, such as we have tried plainly to im- part in this book, would have prevented an occurrence of this kind. Old wells, brewersWats, the holds of ships, &c, are all liable to become the receptacles for cabonic acid gas, which, formed from some decomposing vegetable matter, lies like a 214 Choke-Damp stratum of water at the bottom. Should any one incautiously descend, so as to become enveloped in the carbonic acid atmos- phere breathing is either instantly stopped by spasmodic closure of the chink at the upper portion of the windpipe, and# com- plete suffocation is the consequence; or the gas, if sufficiently diluted with air to be drawn into the lungs, speedily manifests its narcotic effects upon the system, and the person quickly falls in a complete state of stupor. The breathing becomes difficult, and after a time ceases; the countenance is purple or pale, and there may be convulsion and frothing at the moutln In such a case, the body of the individual must be removed, if possible, and as soon as possible, from the poisonous atmosphere, or the latter must be destroyed or dispersed. The many fatal accidents which have occurred from persons venturing rashly into wells, and such like places, might be a warning for the future, and prompt the invariable employ- ment of the simple test of lowering a lighted candle into the suspected place. If the flame be"cxtinguished, the atmos- phere is destructive to life ; if it burn even with a feeble and diminished intensity, there is danger. Of the various modes for destroying a carbonic acid atmosphere, none is more speedily effective than the intoduction into it of newly slaked lime cither spread upon a board, or mixed with water, and dashed into the place; fresh lime, having a powerful affinity for car- bonic acid, quickly absorbs it. In the absence of lime, a quantity of fresh water dashed freely down, so as at the same time to absorb the gas and promote the circulation of air, will be serviceable* or large bundles of combustible material, which will cause currents of air, may, when blazing freely, be thrown in. Caution in the first instance is the best preservative ;but in the event of an individual dropping in an atmosphere of choke-damp, it is perfectly useless for others to rush in to bring him out; they can no more exist in it than he could, and in stooping to lift a fallen body, they become all the more thoroughly immersed in the poisonous gas. Instead of rashly sacrificing life in the ill-directed endeavor to rescue another, let those who are present dash bucket after bucket of water or weak lime and water into the place, and on the fallen person, until the unextinguished flame tokens that the fatal atmosphere is weakened at least; and when they do venture in, tie over the mouth & cloak soaked in lime-water, or of simple water, if the other cannot be obtained. When from any cause, a person gets into choke-damp as above described, cold water should be dashed freely over the in- dividual as soon as removed into the open air, and tilts measure Stroke of Lightning. 215 succeeded by heat applied to the surface, stimulant embroca- tions to the chest, spine, &c, stimulant injections, and ammonia held at intervals to the nostrils, while artificial breathing (as described under the head of Drowning) is at the same time brought into action, and steadily persevered in for some hours. Carbonic acid is produced during fermentation, or by slow de- composition of vegetable matter, such as damp straw, sawdust, woooVchips, &c. It is the gas disengaged in effervescing liquors generally; it is also produced, along with other vapors of which carbon forms a constituent, in the burning of charcoal. Poisoning by charcoal fumes, either by design or accident, is not an unfrequent occurrence. In the latter case it usually oe- curs frompersonsignorantly retiring to sleep in a closed-up room, in which burning charcoal is used as a means of warmth. The carbonic acid and other fumes disengaged, act slowly aud insidi- ously, and exerts so powerful a narcotizing or stupifying effect, that those exposed to the influence are quickly rendered unable to remedy the circumstances, and perfect insensibility ensues. Too often it happens that the discovery of the accident does not take place until morning, long after it is too late to remedy the fa- tal effects; the sufferers being usually found dead. If living, they will probably be perfectly insensible; the countenance pale and livid. Immediate removal to the open air, and free exposure to its influence by removal of the greater part of the clothing, is the first proceeding, when the treatment recommended in cases of poisoning from choke-damp should be followed. Carbonic acid is largely given off in the process of lime burning, and per- sons who have incautiously slept in the immediate neighborhood of a lime-kiln, have been destroyed by it. STROKE OF LIGHTNING. Every summer tells the story of death from lightning. There can be no doubt that in many instances life could be preserved by the application of the proper treatment in time. Persons who are stunned, but not killed, by lightning, generally remain in a state of insensibility for some time, the breathing being slow and deep, the muscular system relaxed. In such cases it will be proper to use means for preserving the animal warmth, which has a tendency to become depressed, to keep up artificial breathing as recommended under head oi Drowning, to use mus- tard-plasters to the spine and pit of the stomach, to administer, from time to time, a little hartshorn in water, if the patient can swallow-if not, to give a warm injection, containing half an ounce of turpentine—or to use such other means as are recommended under Drowning aud Choke-damp, which may seem adapted 216 Cramps. to the case. It is a common idea, that persons who have been killed by lightning do not stiffen, and that the blood remains fluid, but this is erroneous. It would, considering how often the fact is reiterated, seem almost superfluous to point out the or- dinary precautions which those who; chance to be exposed to a storm of thunder and lightning ought to adopt; but not a sum- mer passes without lives being lost from sheer ignorance. Har- vest laborers and others will persist in sheltering under trees; people will continue to put up even iron umbrellas in the midst of a thunder-storm, and mowers walk unconcernedly home with their scythes over their shoulders. If an individual is overtaken by a thunder-storm in a place wdiere trees abound, he should avoid them as much as possible. A thorough soaking will be rather a protection than otherwise. If, on the contrary, the po- sition is on a wide plain, where the body is the highest object, lying down is the safest thing that can be done. In any case, metallic objects, such as sickles, scythes, &c, being laid aside at considerable distance- Under shelter, the most hazard- ous position appears to be in a draught or current of air, such as between a door and window, or, as is often the case, females sewing near a window or door. The fine pointed needle having, of course, a powerful attraction for the electric fluid. Every house should be protected by a lightning rod, it costs but a trifle and may save many valuable lives. CRAMPS* This is a painful contraction of various muscles, mostly of the muscles of the legs and arms. They may be confined to one or two mucles, such as those of the legs, or may be more general, as happens in cholera. The affected fibres are draw in hard, knotty contractions, and maintain this condition for a longer or shorter time. The most frequent causes are the pres- ence of indigestible food in the stomach, or of acid in the bowels, or the pressure exerted on the nerves by overloaded bowels. The weight and pressure of the child, acts in a similar manner in pregnancy and labor, and occasions painful and troublesome eramp. The disorder is also often associated with the presence of worms. When cramp affects the arms and fingers, it may be connected with diseases-of the heart and great blood-vessels of the chest. The power of the application of sudden and prolonged cold in producing cramp, is often sadly exemplified in the case of bathers. The best immediate remedy for cramp is friction with the hand, or, better still, with a mixture of half a pint of vinegar, two tablespoonfuls of ground mustard, and one of cayenne pepper, to be rubbed on with a woolen cloth. External Violence. 217 Shake well before using—one tablespoonful of laudanum added to the above, will be beneficial if it is to be had. When the legs are affected, it is always expedient to take medicine,say ten grains of rhubarb and ten of magnesia, with fifteen grains of carbonate of soda and a little ginger; and afterwards, to clear out the bowels with some active aperient, such as castor-oil, especially if there is any existence of costiveness, or a possibility of their being loaded. Some persons find relief from the imme- diate attack of cramp, by tying a band of some kind tightly round the limbs, between the affected part and the body, while others are in the habit of standing upon some cold substance. The first process is perfectly safe, and may be tried; the second certainly is often effectual, but it is not devoid of danger. Ac- tive friction with the dry hand, warmed, is the best temporary remedy. Cramp affecting the arms is always to be regarded with suspicion, if it occurs often. There is reason to fear some disease of the heart, lungs, or liver, the best plan would be to get a physician's advice, at once. EXTERNAL VIOLENCE. This is likely to occur from accident or design, at any time, and we should always be ready to meet these emergencies. It is my desire that every purchaser of this book will carefully read it, especially those parts of it which treats of things requiring immediate attention. A stroke or injury on the head may cause merely bruising of the scalp; if more severe, con- cussion or injury to the brain, or fracture of the skull. The latter accident is most likely to happen at the side of the tem- ple, where the bone is thin; but severe injury to the brain fre- quently occurs from blows at the under and back parts of the head. A severe blow on the back may cause paralysis (loss of feeling or motion, or both) ef the lower limbs, with or without fracturing the bones. When a blow, even comparatively slight, is inflicted upon a spot immediatey over a collection of nerves, most distressing effects, and sometimes immediate death, may result. Such is the case from blows on the neck, on the pit of the stomach, or over the region of the heart. The deadly faintnesa which ensues, should instantly be combated by stimulants— ammonia, ether, or spirit of any kind—which can be procured. Cold water should be suddenly dashed over the surface or down the back. If this is unsuccessful, the patient is to be put into a warm bed, and artificial breathing, as mentioned under the head of Drowning, employed along with external heat, mustard- plasters to the back and pit of the stomach, and stimulating 218 Cramp in the Stomach from drinking Cold A ater. injections of two or three tablespoonsful of whiskey, or brandy or spirits turpentine, with a like amount of sweet oil and a gill of warm water. CRAMP IN THE STOMACH FROM DRINKING COLD i WATER. There are a great many diseases, properly speaking, brought on by drinking ice-water, and eating water-ices and ice-cream, when the body is over heated, such as diarrhoae, dysentery, in- flammation of the stomach, &c, but these will be treated of in their appropriate places. Our purpose here is to treat of '•cramps" in the stomach only. There are three circumstances which concur to produce disease or death from drinking cold water: the patient is extremely warm, the water is extremely cold; and a large quantity of it is suddenly taken into the body. The danger from drinking is in proportion to the degrees which occur in the three circumstances mentioned. Soon after the patient has swallowed the water, he is affected by dimness of sight; he staggers in attempting to wTalk, and, unless supported, falls to the ground; he breathes with diffi- culty ; a rattling is heard in his throat; his nostrils and cheeks expand and contract in every act of breathing; his face appears suffused with blood, and of purple color; his extremities be- come cold, and his pulse imperceptible; and unless relief be speedily obtained, the disease terminates in death in a few min- utes. This description, of course, refers to the worst cases. More frequently the patient is seized with acute spasms in the breast and stomach. These spasms are sometimes so painful as to produce fainting. In the intervals of the spasms, the patient appears to be perfectly well. The intervals between each spasm become longer or shorter, according as the disease tends to life or death. Punch, beer, toddy and various other fancy drinks fixed up in drinking saloons, when drank under the same circumstances as cold water, have all been known to produce the same dangerous and fatal effects. The means to be tried for giving relief is strong stimulation, by large doses of laudanum, ether, spirits, &c; and above all, it is necessary that the patient should not be permitted to remain for an instant in a recumbent posture; but should be kept in constant motion until relieved. A mixture of whiskey, brandy or gin, two to four tablespoonsful, cayenne pepper, half teaspoonfnl, and of laudanum thirty drops, to be taken in a little water as hot as it can be drank, will usually give speedy relief. The dose may need repeating in half an "hour. For children reduce this dose according to age. At the same time Bite of Venemous Snakes, 219 hot applications to the pit of the stomach, such as hot salt, sand, meal, ashes, &c, or a mixture of ground mustard and pep- per, with warm vinegar, applied in the same way. When heated, persons should abstain from drinking very cold water. Gargling the throat, or washing out the mouth in cold water, will allay thirst until the person has time to cool off. Where the powers of life appear to be suddenly suspended, the same remedies should be used which have been so success- fully employed in recovering persons supposed to be dead from drowning. Care should be taken in this, as in all cases of ap- parent death, to prevent the patient's suffering from being sur- rounded or attended by too many people. The act is kindly meant but it is very dangerous for the patient. BITE OF VENEMOUS SNAKES This may very properly be called a poisoned wound, for the poison is inserted at the same time the bite or wound is in- flicted. The wound in itself is generally trifling, perhaps not more than a scratch, but speedy death may follow. Immediately after being bitten by a poisonous snake, the parts begin to swell, and there is terrible and speedy depression of the vital powers of the system generally. When an individ- ual suffers from a wound known or believed to be poisonous, immediate steps should be taken to prevent if possible, the poi- son being absorbed into the system. The steps to be taken are sufficiently detailed in the article on hydrophobia. In addition to the local treatment of the wound (mentioned under head of Hydrophobia) continued friction with some oily material appears to be most generally useful, while at the same time, stimulants are freely given internally to counteract the depression. Of course, any stimulant first attainable should be used; but hartshorn, is most highly recommended, taken in tea- spoonful doses every ten minutes, in a half a gill of water, until reaction has been established, and the patient is better; being free from poison and the swelling checked. However, harts- horn may not be so handy to get at. Then take half a glass- ful of brandy, whiskey or spirits of any kind, every fifteen or twenty minutes, until the patient is fully under its influence, which will be when he is " dead drunk." It should not be for- gotten that the part bitten should in a moment be cut out, and then freely washed with water until haitshorn or caustic can be applied, which can not always be obtained on the spot, but as soon as they can be either of them, apply to the bitten part. 220 Neuralgia. NEURALGIA. This is a most prevalent disease of this fast age in which we live. Of its nature but little can be told, only that it is seated in the nerves, though having its origin, often, no doubt, in the excessive use of tea, coffee, rum and tobacco. However, some of the worst cases have been connected with diseased growth of bone in different parts of the head or face, especially about the canals through which the nerves pass : other severe cases have been found to depend upon irritation excited by foreign bodies acting upon some of the nerve branches; de- cayed teeth are not unfrequently connected with the disease. The most general seat of neuralgic pain is in the head or face; but the fingers, the chest, the abdomen, &c, may any of them become affected. Persons afflicted with this disease have described it as a "plunging," darting pain of the most intense and agonizing kind ; but, except in long-continued cases, there is no external mark—no redness, swelling, or heat, to indicate the disorder to others, and many a sufferer from this disease has been taunt- ed with playing " Old Soldier,"—a most cruel and unkind pro- cedure. After a severe attack of neuralgia, the skin is often left tender, and when the pain has recurred frequently, exqui- sitely tender swelling of the part has been known to come on. The access of the pain is usually sudden, its remission equally so, and It is generally periodical in its attacks: it is suspended during sleep. Among the exciting causes of neuralgia are damp and cold, or damp alone, if combined with malaria, such as cause ague; exposure to currents of cold air, more particularly if the indi- vidual is heated. Debility of constitution renders the indivi- dual much more susceptable to those and other exciting causes; it has often, too, been traced to anxiety of mind. It has been observed sometimes, that sudden attacks of neu- ralgic pain in various parts of the body, have been traced to temporary stomach disorders, such as superabundant acid, &c. If the patient is resident in a climate or situation likely to excite it, some change should, if possible, be made ; this will probably be most beneficial if the removal be to a dry, warm air; but should disease have commenced in a cold, dry dis- trict, change to a moist, but warm one, will probably offer most advantage. If disorder of the stomach exists, it must, of course, be rectified, by giving purgatives, such as any ordinary good purgative pill,or a dose of Rochelle salts,Rhubard, Seidlitz powder, or Castor oil, two or three times a week. After that, if Sea-sickness. 221 the disease still continues, quinine, given in one or two grain doses, every six or eight hours, will most probably be of ser- vice. Carbonate of iron, in from half drachm to drachm doses, is a most useful remedy, especially in weak constitutions. Blis- ters behind the ears, or at the back of the neck, are often val- uable aids in the treatment of neuralgia of the face. To relieve the paroxism of pain, a sponge, or piece of flannel, dipped in boiling water, or vinegar and water, and applied as hot as it can be borne over the site of the pain, will often allay its severity, or remove it altogether. Opium internally may be given in very severe cases, or rubbed on the part. Chloroform applied to the affected part by means of a piece of lint soaked in it and covered with oil Silk, is a very successful application, and should be tried if it can be procured. A liniment made of Tincture of Arnica and Laudanum, in equal parts, applied often to the part affect- ed will afford speedy relief. Five grains of morphine, thorough- ly rubbed up into a tablespoonful of lard, to make an ointment, to which add ten drops of oil of lemon, while mixing, makes a good application to the painful parts, put on with the ball of the fingers every two or three hours. Friction to the affected parts with the dry hand, three times a day, during the intervals, should be strictly attended to, with a view to break up the disease. Electricity is often beneficial when all other means fail. SEASICKNESS. I If any of my readers have ever known what it is to be " Sea- sick," they can, no doubt, say with the author, who dreads the Sea on that account more than any thing else, that a sail on the ocean wave is more sick than romantic. This sickness is considered to be dependent on some pecu- liar affection of the brain, produced by the rocking motion of the vessel. The affection is more readily caused by long heaving waves, than by a 6hort rough sea. The best preven- tives of sea-sickness seem to be the horizontal posture, as near the centre of the vessel, and therefore of the centre of motion, as possible—that is, where the motion is least. Exposure to the open air renders the liability less. Stimulants, combined with sedatives, certainly appear to have considerable effect in preventing or alleviating the affection. A pill, composed of four grainsof cayenne pepper, with two orthree of extract of henbane, taken at intervals, may be found useful. Creasote is also an excellent antidote,—one or two drops made into a pill with bread crumb, to be repeated, if necessary, once or twice during the day. Some persons find themselves less liable to sea-sick- 222 Sea-sickness. nessif they take food freely—with others the reverse is the case J the effect probably depends upon the state of the digestive pow- ers of the stomach, temporary or permanent. If these are vigor* ous, the excitement of digesting food acts probably as a coun- ter-agent to the cause of the nausea. Sea-sickness, of itself, ia rarely injurious, but it should be a subject of consideration with persons who are liable (or likely to be) to head-affection, who are the subjects of rupture, prolapsus, &c, how far they should incur the risk of these being aggravated by the mechanical ac- tion of vomiting. Some who do not suffer from sickness while on the water, experience nausea and other uncomfortable sensa- tions after landing—an effect, doubtless, due to apartial disturb- ance of the digestive organs, and probably to biliary disorder.— One or two doses, of Rochelle salts, or Castor oil, will, general- ly remove the inconvenience. Some persons have been greatly, and often permanently re- lieved of sea-sickness, by taking from three to five drops of chloroform, put on a lump of sugar and swallowed immediate- ly, then going to bed, and, if possible, going to sleep. With children, rubbing the pit of the stomach with a sponge dipped in a few drops of ether, chloroform, or laudanum, or the three mixed together, will afford relief; or a cloth with some of this mixture dropped upon it and laid on the pit of the stomach, will answer. VariCOCGlGa—Almost the first symptom that is observed in the genital organs, produced either by masturbation or ex- cessive indulgence with females or other causes is a flabby, relaxed condition of the privates; the testicles hang lower than usual, the spermatic cord is relaxed, and there is a dull, aching, heavy, dragging feeling in the parts, with sometimes, in more advanced stages, pains shooting up occasionally into the groin and lower part of the abdomen, and also a heavy aching feeling in the small of the back. There is enlargement of one side, usually the left, and the scrotum feels like a bag of worms. There is pain, and at times a coldness and numb- ness in the privates. The disease is quite prevalent; the author has had no less than three hundred cases within the last few years, and has treated them successfully. The best treatment is to use a ventilated suspensory band- age. (For further particulars see page 261.) It will not do to neglect this disease; it may cause much trouble and in- convenience, and is not free from danger. Hypochondria. 223 HYPOCHONDRIA, or Lowness of Spirits. Mild cases of this disease are called very often the " Blues? sometimes Hypo, etc. It is a condition of the mind, produced by real or imaginary causes, which should be remedied as speedily as possible, before it gets too firm a hold on the system. The common symptoms are, loss of, or a variable appetite, & troublsome flatulency in the stomach or bowels, sour belchings, costiveness, a copious discharge of pale urine, sposmodic pains in various parts of the body, giddiness, dimness of sight, palpitation of the heart, general sleeplessness, and often^ an utter inability of fixing the attention upon any subject of im- portance, or engaging in any thing that demands vigor or courage. The mental feelings, and peculiar train of ideas that haunt the imagination and overwhelm the judgment, exhibit an infinite diversity : sometimes the hypochondriac is tormented with a visionary or exaggerated sense of pain, or of some concealed disease; a whimsical dislike of particular persons, places, or things; groundless apprehensions of per- sonal danger, or poverty ; a general listlessness and disgust, or an irksomeness and weariness of life. In other instances, the disease is strikingly accompanied with peevishness and general malevolence; the patients are soon tired with all things; discontented, disquieted upon every _ light occasion, or no occasion; often tempted to make way with themselves ; they cannot die, they will not live; they complain, weap, lament, and think they lead a most miserable life: never was any one so bad. The whims that are sometimes seriously entertained under this complaint are of the most ludicrous description. Men have imagined that they were a lump of butter, and were afraid to go into the sunshine or near the fire for fear vi melting; others, that they were continually in someplace of dan- ger, and likely to be killed at any moment; some have thought they had toads, snakes, and no telling how many imaginary things in their stomach that would sooner or later destroy them. As to the causes of this disease, there may be a strong constitutional predisposition, or the disease may be the conse- quence of a sedentary life of any kind, especially severe study protracted to a late hour in the night, and rarely relieved by social intercourse or exercise; debauched; dissolute habits; great excesses in eating and drinking; the immoderate use of mercury, violent purgatives, the suppression of some habi- tual discharge or long continued eruption. Some peculiar affec- tion, such as congestion or fullness of one or more of the im« portant organs within the abdomen, is a frequent cause 224 Hiccup. The principal objects of treatment in this disease are, to re- move the indigestion, to strengthen the body, and to enliven the spirits; and one of the best plans with which we are ac- quainted, for the fulfillment of these intentions, is, constant exercise and change of place, with a sponge bath about three times a week, early hours, regular meals, and pleasant conver- sation, the bowels being at the same time carefully regulated by the occasional use of gentle purgatives, and the stomach strengthened by some appropriate tonic medicine. A tea made from gentian root, dog wood, or wild cherry bark, half a glassful before each meal, taken cold, is recommended as about the best. Exercise in the open air, whether walking or on horseback, is the best; this should be combined, if possi- ble, with agreeable company and constant change of air and scene. Travelling is a powerful remedy in this disease, since it is often one of the most effectual means in removing indi- gestion, of strengthening the body, and exhilarating the spirits; and where the patient's circumstances will permit, it ought invariably to be one of the first measures resorted to, as it will undoubtedly be found one of the best. The patient should accustom himself to early rising, and regular meals of nourish- ing and easily-digested food. The bowels are almost always torpid in this disease, and will, therefore, require constant attention in selecting articles of diet which are of an opening quality, 6uch as stewed fruits at meals, ripe fruit uncooked, between meals, roast apples after tea, etc., with an occasional employment of medicine if needed. Regular daily friction over the limbs and bowels, with the flesh-brush, is advisable. The moral management is of very great importance in this disease, for assiduous kindness and consoling conversation pro- duce a deep effect. The patient should rarely be opposed in the expression of his sentiments, and never with ridicule. A very important object is to gain the patient's confidence, and in order to effect this, we must humor his foibles, and seem to fall in with his views. When he is dwelling upon some imaginary disease, it must be prescribed for, and should his anxiety pass in succession from one complaint to another, they ought all to be prescribed for in their turn. That is better than trying to argue him out of his " notion." HICCUP, or HICCOUGH. This is an affection too well known to require any descrip. tion. It is a sudden jerking spasm of the diaphragm (or mid. riff), expelling the air from the lungs with a peculiar sound Giddiness. 225 Acidity of the stomach or eating some article of food which disagrees with the stomach is usually the cause of the disease. Generally it is a trivial and transient inconvenience, but its occurrence in the last stages of acute disease is a grave (often fatel) symptom, indicative of aproaching death. There are cases however, differing from either of the above; it some- times occurs in the persons, more especially of young females, of an hysterical tendency, and may continue for weeks with- out cessation, except during the hours of sleep, in spite of all kinds of treatment. The causes of ordinary hiccup are gene- rally fasting, or some sudden stimulant taken into the stomach, such as highly seasoned soup; and the affection generally subsides of its own accord. When inconvenient, nothing is so likely to remove it as some active emotion of the mind sud- denly excited. Startle the patient by slapping on the back, clapping the hands unexpectedly behind the head, chase around the room as if in pursuit of a rat or mouse, etc. Any ihing to engage the patient's mind quickly. The continued sipping and swallowing of cold water is a frequent domestic remedy, a few drops of pepperment in a glass of water or a teaspoonful of soda in a glass of water will often remove it. If further treatment is necessary, press firmly on the two col- lar bones for a few moments : this will often work like a charm. A few drops of laudanum, hartshorn, or paregoric, in water are also good remedies. GIDDINESS or DIZZINESS OF THE HEAD. There are a few diseases of a simple character, that are pro- ductive of more unpleasantness to an individual than a "swim- ming " in the head, as it is often called. Some disorder of the circulation of the blood in the head is a probable direct cause of giddiness, and this is most palpable after persons have been confined to bed or to the horizontal position for a short time; on first assuming the erect posture, giddiness is generally ex- perienced. Intoxication is an example to a certain extent of the same thing. A mere passing giddiness is probably owing to some cause which a little attention to the state of the stomach will correct; but repeated attacks, especially if accompanied with palpitation of the heart, or pain and heat about the head, indicate danger, and no time should be lost in consulting a physician. The treatment of course must be according to the cause of the disease. If produced by too long application of the mind to any subject or study, leave it off, and take recreation. If caused by dyspepsia, reduce the diet, and leave off the use of indigestible articles of food. If 226 Headache. costive, take purgatives two or three times a week; a dose of Rochelle salts or a Seidlitz powder on an empty stomach, of five grains of blue pill, with five of Dover's powder made into a pill at bed time, followed the next morning by the Rochelle salts or Sedilitz powder, will have a most happy effect, and eat such articles of food as will keep the bowels open, (see Hypochondria.) Abstain from the use of coffee, tea, and in- toxicating liquors, take plenty of active out-door exercise, avoid meats for supper, bathe the head often in cold water, and keep the feet warm and <\ry. HEADACHE. It is scarcely necessary for me to say that it is unwise ever to neglect headaches. They are sources of great suffering, and often lead to serious derangements of the general health. Headaches are more common among civilized than uncivilized nations, more frequent among females than males, among those of sensitive feeling than otherwise, and among the se- dentary than those who are more in the open air, or who take active bodily exercise. Headaches are of various forms, dependent on their various causes, such is Plethoric headaches in those who are stout, robust, or full-blooded; sometimes it lasts but a few hours, or it may continue for several weeks: Sick Headache—so called from the nausea or sickness at the stomach, which attends the pain in the head. i Bilious Headache—occurring most in summer or fall; it effects persons mostly who have dark complexion, dark hair and melancholy disposition. Nervous headaches are more common among females than males. The pain is usually acute and darting, and is made worse by light, and with a feeling as if the temples were being pressed together, and a "swimming" in the head. There is sometimes a sense of 8ickness, with a dread of fall-j ing and great despondency, or restlessness. The bowels are generally costive and the sight dim. The pain comes on most- ly of a morning and lasts through the day, going off in the evening. j Besides the above-named varieties, are also Hysteria, headache, headache from Exhaustion, Brow Ague, Rheuma- \ tic headache, &c. j The great point about these different varieties of headache, is, that there is a cause for them, if you will but find it out, and most of them therefore can be cured. Not merely reliev-\ ing the headache when you hawe it, but preventing tho recur- Headache. 227 pence of the disease. How many persons with premature grey hair, a care-worn and wrinkled face, an oldish look and loss of memory, &c, from some form of headache which has lasted for years. The great point in treating cases of headache, is to find out the cause if possible. However, in all cases except in head- ache from exhaustion or weakness, or during pregnancy, you can safely apply the following remedies:—As soon as it is ob- served that a headache is going to "spoil a day's work or stop a day's pleasure," take half a teacup full of water as warm as it can be comfortably swallowed every fifteen minutes, until vomiting occurs, or the headache is abated. Then take a tea- spoonful of Rochelle or Epsom salts in a glass of water, or a Seidletz Powder, every three hours until the bowels operate. When the bowels are opened, the headache will be as a gene- ral thing, cured. In most of cases, it will be necessary to live on a lower diet for a while, especially in ruddy, stout, robust persons who are full-blooded. A shower-bath over the head every morning, or a vessel of water poured from a distance, of two or three feet above, on the head, in most cases of head- ache, is a good preventive remedy. Costiveness is a very pre- valent cause of the various eases of headache, which must be avoided by purgatives and diet. Sometimes swallowing the juice of a lemon, in which is mix- ed a little sugar, will relieve an ordinary headache in a few minutes—or when a lemon is not handy, heating a little vine- gar in a sauce-pan, and inhaling the vapor as it rises, up the nose, will answer;—or a teaspoonfull of vinegar in a little water taken every hour will answer in many cases. For pro- curing sleep and rest in cases of headache use the following mixture:—Tincture of valerian, one ounce, tincture of hyos- cyamus (Henbane) one ounce, paregoric, two teaspoonsfull, spirits lavender, one ounce. Mix and take a teaspoonfull every three hours till rest is procured. Persons who are subject to headache in any form, should avoid eating between meals, and by all means avoid heartyl suppers; eating meat for supper, or^any indigestible article, or a plate of ice cream, just before going to bed, being very apt to be followed next day by an attack of headache. Meat, ice cream, &c, taken at proper times, are all good in their place, but remember that there is "a timf for all things."_, 228 Herrua. Hernia or Rupture. It is highly important that this dangerous affection should be understood, from the fact of its frequency, and that it is so often badly treated, or not treated at all. By the term Rup- ture, we understand a protrusion of any internal organ from its cavity or where it belongs; but the term is generally re- stricted so as to mean no more than a protrusion of the bowels through the walls of the belly. If the abdominal walls are weak, from any cause, no matter what—lifting, straining, or making violent muscular exertion of any kind, will then cause the bowel to force itself through at the weakest spot, and push- ing the lining of the belly, (the peritoneum,) along before it, a bag or sack is formed in which the projecting bowel is en- closed, forming an external tumor, lump or swelling. Hernia occurs in both males and females, and children are often born with it; or it may occur at any period of life, from infancy to old age. Whenever a lump or tumor appears in any part of the bel- ly, in the groin, or upper part of the thigh, or vicinity, it should at once be attended to. When there is an enlargement or fullness of the scrotum or bag, Varicocele or Heenia should at once be suspected. A swelling coming suddenly in the groin, or at the navel after considerable exertion, may be taken for rupture without much fear of mistake. Hernia, or Rupture, is never free from danger until the pa- tient obtains a properly constructed Truss—the low-priced Truss, which is too often sold in drug stores, &c, being worse than none at all. Rupture is a very common affliction; it has been estimated that every fourth person is more or less affected. Females, from motives of delicacy, are apt to conceal the misfortune, and not seek advise—this is wreng; it exposes them to danger. The complaint being discovered, the bowel should be put back in its place, and a Truss at once obtained. In the case of young persons a Truss will often effect a cure, but that it may do this it should be worn night and day. except just time enough for cleaning it, &c, and then the patient should be in bed. Pieces of old knit stockings are the best to put between the pads and the skin, renewed every few weeks. The parts should be bathed or washed in cold water night and morning, the Truss being removed at the time, and the patient lying down until the Truss is put on again. To tell a Rupture from Varicocele, let the patient lie down on the back for a few minutes, then press with the two middle fingers pretty firmly over the region each side of the genital organs, (pubes,) and 229 tiller ,«s :'»*■ ACOXITE {Monkshood Wolfsbane),— Five drops of the fluid extract, in three ounces of water; mix, and take one teaspoonful every hour or two. Useful in fevers, inflam- mation, rheumatism, &c. Prickly Ash.—The bark and berries ara used; an extract (fluid) or tincture in doses of fifteen to fifty drops three times a day, ia good for rheumatism, di4eases of the liver, I and syphilitic diseases, nervousness. &c. Camphor Tree.—Growing in the East Indies. The use of camphor gum and spirits of camphor is too well known to need any description. Marsh Mallow.—Now made into candy drops, caromels, &c. A good tea can be made from the root in cases of coughs, colds, &c. 230 M Ssuxa Caccagz,—A fluid extract made from the root and given in doses of twenty to sixty drops three times a day is useful in cases of asthma, whooping cough, bronch- itis, hysterics, nervousness, &c. Tapioca.—This is used as an article of food ; is very digestible and nourishing for convalescents. The plant grows in Brazil and the West Indies, and the root is the only part used. Ladies' Slipper.—The fibrous roots only used, for nervous headache, nervous excita- bility, hysterics, neuralgia, and pains in various parts of the body, the fluid extract being the best form to give it in; dose, one- half to two toaspoonfuls three timed a day. Lobelia —The leaves and seed are often used in spasmodic asthma, wheoping cough croup, and bronchitis. It must be used with caution, from ten to thirty drops of the fluid extract being a dose, as needed for loosening a cough, &c. Catarrh in tfie Head. 231 rising to the feet to keep up the pressure. If it is Rupture, the tumor or enlargement will not nntke its appearance in the scrotum or bag—if it is Varicocele, it will immediately be- come full again, and feel like a bag of cords or worms. Per- sons who have Rupture must not allow the bowels to become costive, as straining at stool is highly injurious. CATARRH IN THE HEAD. This disease is usually the result of a cold in the head, which through mismanagement, inattention, constitutional predis- position, an enfeebled state of the system, a scrofulous taint of the blood, or other unfavorable circumstances, runs into a chronic state. From this apparently trifling complaint, with which every one is forced to make acquaintance, at some sea- son of the year or other, is developed a disease as frequent aud offensive as it is dangerous, and which in its progress is apt to affect seriously some of the most important organs of the hu- man economy, and to be instrumental in causing the impair- ment or loss of smell, taste, or hearing, and even loss of life itself. This disease is popularly recognized by the name of Ca- tarrh in the head. The first sensation is usually a feeling of dryness and heat in the nose, and a frequent inclination to sneezing. There is an inability to breathe freely, as the nose becomes stopped up, sometimes on one side, sometimes on the other. Soon a clear, watery, irritating discharge makes its appear- ance, excoriating the nostrils and edges of the lips, which becomes red and somewhat swollen. After a few days the dis- charge becomes thick, yellowish, extremely frequent, and continues to be a marked feature of the disease, and a source of much danger and the greatest annoyance. After more or less time, it becomes thick, very disagreeable, and assumes an extremely offensive odor. It is usually so profuse as to re- quire, when confined to the nose, the frequent application of the handkerchief, or if it drops into the throat, which is more particularly the case, while laying down, a constant coughing, and sometimes both. Sleep is frequently disturbed by a sensation of choking, caused by the presence of the discharge in the throat. Owing to the heat in the head, the watery portion of the discharge often evaporates, and, assuming a condition of solidity, is de- posited upon the membrane of the nose and upper part of the throat, in the shape of crusts or hardened lumps. The accu- mulation of these incrustations produces a feeling of discom- fort, and narrows the passage so as to embarrass respiration. 232 Catarrh in the Head. ] Therefore, frequent efforts have to be made to remove them, either by forcibly blowing the nose or by persistent hawking. During sleep these incrustations accumulate more rapidly, and the feeling is therefore most uncomfortable in the morning. Sometimes all efforts to clear the throat are futile until after breakfast, or after something warm is swallowed. The dis- charge, which is at first without smell, assumes in the progress of the complaint an excessively offensive odor, the breath par- ticipates in this, and becomes occasionally so revoltingly offen- sive as to render the patient an object of disgust to himself as well as to others. Ulceration of the mucous membrane of the nose takes place occasionally. The accumulation of the dis- charge, together with the thickened condition of the mucous membrane, renders breathing through the nose very difficult, and oftentimes impossible, necessitating respiration principally through the mouth—a method very deleterious to the general health, but more particularly so to the lungs. Sometimes the voice loses its musical quality, and assumes a discordant, harsh and nasal character; the sense of smell becomes much im- paired or entirely lost, and the same effect, though less frequent is produced on the sense of taste. Occasionally, while blowing the nose, a crackling or bubbling sound will be heard in the ear, and hearing will be found quite thick and , stopped up, but returns suddenly with something like a snap- ing sound. This is sometimes repeated, until, at one time, earing does not return, and remains permanently injured. Noises in the head of every conceivable description will make their appearance and add to the distress of the sufferer, and j hearing may be lost so gradually that a considerable degree of deafness may exist before the person is really aware of the fact. The eyes are apt to become weak, irritable, and disposed j to water on exposure to cold and wind, or after the slightest' exertion. A pain, more or less acute, or a distressing feeling ■ of pressure is experienced over the eyes, and sometimes on the top or back of the head, and also pain in the face, closely re- sembling neuralgia, for which it is very often mistaken. The distress in the head weakens the memory and produces irrita- bililty and moroseness of disposition. The stomach generally , suffers more or less, is weak and irritable; the appetite is va- riable, and is nearly always bad in the morning. In severe cases, the system becomes feeble and prostrated, and there ia an aversion or inability to either physical or mental exertion.! Not unfrequently catarrh proves fatal, either by debilitating the system and wearing out the patient, or by traveling down- ward and producing throat affections, bronchitis, and finally E Catarrh in the Head. 233 consumption. It may be safely asserted that after hereditary predisposition, catarrah is the most frequent and important cause of this fatal complaint. ^ The symptons of catarrah vary considerably in different in- dividuals, and the degree of their severity depends upon con- stitutional peculiarities and various external influences. With some the complaint continues for a number of years in a mild form without causing any of the injurious results above de- scribed, while with others all the worst effects are produced in a very short space of time; and cases, apparently most harm- less, may, through imprudent exposure, additional cold, or unfavorable changes of the weather, suddenly exhibit all the violence and malignity which characterizes the severest ones. In the treatment of this disease but little can be done with- out medical treatment by a physician who can take into con- sideration the age, occupation, how long the disease has existed the condition of the general system, &c. The author of this work has had extensive experience in the treatment of this dis- ease during the last few years, having treated patients from most of the States of the Union; and I was led to examine very closely into its nature, and the best treatment adopted thereto; and having seen tried the various popular " Catarrh Remedies " sold by those who knew nothing of medicine, as well as the usual treatment of the medical profession, without satisfactory results, I came to the conclusion that the inhala- tion of medicated vapors was the best treatment. I invented an Inhaler, which is now extensively used by the profession. If you cannot get one of the Inhalers in your town, you must do the next best thing you can, dropping a few drops of Olive Oil, or oil of Sweet Almonds, into the nostrils three times a day, by laying down on the back, lowering the head and letting the oil find its way to the throat, is a valuable remedy. A gargle made of strong Sage tea, one pint; Borax, half an ounce ; Honey, two ounces ; bo be used cold, about every three hours, stooping the head forward and letting some of the gargle pass out at the nostrils, is a good remedy. (A description of the system of Medicated Inhalation, &c, will be found on page 500) The bowels should be kept open, and build up the system by giving bitter tcnics, such as a wine glass of tea made from Wild Cherry Bark; or Tincture of Columbo, one teaspoonful in water, before each meal. Avoid using irritating washes, gargles, &c, as they often do much harm. 234 Spitting of Blood. SPITTING OF BLOOD. This is a more serious discharge of blood than is generally supposed, and many cases of this kind suffered to linger along unattended to, terminate in consumption. The discharge is of a bright red color, brought up by hawking and spitting, fre- quently preceded by a saltish taste in the mouth, a sense of heaviness about the heart, difficult and painful breathing, and dry, tickling cough. It differs from blood brought from the stomach, that from the latter is of a more dark and clotted ap- pearance. It most commonly occurs at ages from fifteen to thirty, and may be occasioned by any violent action of body or mind: by the suppression of accustomed evacuations: by a rarified airuc, and most frequently takes place in persons of long . necks and narrow chests: often in families subject to similar complaints. Bleeding from the lungs may occur in every degree, from a mere tinge of the expectoration, to the copious coughing up of fluid blood. The blood is couyhed up, whereas, when it comes from the stomach, it is vomited, a distinction which appears evident enough, but which is not always readily made in prac- tice. The management of hemorrhage from the lungs must be that recommended for hemorrhage generally. Until medical assistance can be procured, perfect quiet is to be observed, cool air, especially on the chest, freely admitted, and cold, or iced and acidulated drinks given plentifully. Alum will also be found useful; either letting it dissolve in the mouth and swal- lowing it, or dissolving a teaspoonful in a little water, and tak- ing it as may be needed. Should the attact continue and med- ical assistance still be absent, cupping on the chest, or between the shoulders, might be had recourse to: or in an extreme case, when medical aid is far distant, one grain and a half of sugar of lead may be given, made into pill with crumb of bread, every two, or three, or four hours, being washed down by a draught of vinegar and water. The expressed juice of the common nettle is sometimes popularly used, and, it is said efficaciously, to check bleeding from the lungs; the dose is one teaspoonful three times a day. The inhalation of the smoke from the burning leaves of the belladonna is said to check the immediate flow of blood from the lungs. For this purpose one teaspoonful of the cut and dried leaves is to be thrown upon live coals, and the fumes inhaled. Another val- uable, because such a ready means of checking bleeding from the lungs, is to eat freely of salt, or drink salt and water every ten or fifteen minutes. When there is troublesome cough, it should be relieved by thirty or forty drops of paregoric, given Typhus Fever. 235 occasionally, as required. Persons of scrofulous constitution, or who have any malformation (imperfectly formed) of the chest, are most liable to suffer from it. It rarely occurs in children. The exciting causes of this form of hemorrhage are such as call the lungs into active, strong, or continued exer- tion, such as violent bodily movements, much loud exercise of the voice, playing on wind instruments, &c.; these things must therefore, be sedulously avoided by those who have any tendency to the disorder. Temperance and moderation, strict attention to tho condition of tho bowels, and to all things ne- cessary to preserve health, as detailed in the first part of this work, will be necessary. While treating of this subject, it should be mentioned that persons are often needlessly much alarmed, from thinking they are expectorating blood, while the fluid simply comes from the throat or gums, or, it may be, is the consequence of blood from the nose trickling down the back of the throat. To test the matter, a slight attempt at coughing should be made; if the bleeding is not from the lungs, there will be no fresh blood coughed up. TYPHUS OR TYPHOYD FEVER. This has been called by different names, such as malignant fever, continued fever, slow fever, &c.; but for all practical purposes, in a work like this, we prefer the name most famil- iar with the people, so they will better understand our mean- ing. This is an affection of the whole system, and by medical men is subdivided into several types or forms : but it would serve no good purpose to enter into these here. The manage- ment of a disease so gravely important as fever can never be legitimately undertaken by unprofessional persons, if medical assistance is procurable ; but as a provision for circumstances when this is absent, the less complicated the account both of the disease and its treatment, the more likely it is to be man- aged with advantage. The first symptons of incipient fever are usually displayed through the nervous system. The indi- vidual feels an unaccountable languor, and complains of head- ache and shivering, cannot exert his powers either in the du- ties or pleasures of life, is easily tired, sleep is disturbed, the appetite is impaired, the skin looks dusky and the eyes heavy, the pulse quickens, and at length the feeling of general illness drives the patient to bed. The attack, however, may com- mence much more suddenly—a shivering, or, as the pec pie in many places call it, an " ague fit," may be^ the first sympton; or severe headache, or vomiting, or fainting, or even convul- sion may be the first symptom of the impending malady. 236 Typhus Fever. When fever is fairly established, the pulse ranges above 100 the tongue is furred, probably brownish and dry, sleep is dis- turbed or supplanted by delirium, the muscular power is diminished, and the mind indifferent to passing circumstances; dark incrustations collect about the teeth; the patient sinks down in bed, and perhaps passes the natural evacuations un- consciously, thus displaying the most evident signs of debility. This condition may increase till it terminates in death, or tends toward recovery, either by some marked crisis, such as profuse perspiration, or by an almost imperceptible amend- ment. Tranquil sleep, improved aspect of the countenance, the skin cooler and with more tendency to moisture, the tongue cleaning at the edges, and a natural desire for food, all give signs that the disease is passing away ; on the other hand, if a fatal isssue is approaching, the general weakness increases, the patient slips down in the bed in consequence, and lies in a state of dreamy muttering; there is convulsive starting of the fingers or other parts of the body, picking at the bedclothes, the insensibility to external impressions increases, and proba- bly stupor closes life. The above are the general features of fever, whether simply continued, or when it runs out to the more serious forms of typhoid,' low, nervous, or typhus fever. There are many other indications which occur, but which it would serve no good purpose to detail here ; all that is required is that the disease should be recognizable, so that i#ts general management may be properly and unintelligently conducted when it falls to the lot of an unprofessional person to have the direction. In the first place it must be remembered, that for continued fever we have no cure, that is, we have no medicine which we can give with the tolerable certainity of removing the disease, as quinine removes ague : it must be vanquished by the pow- ers of the constitution, by the tendency to health, and our endeavor must be to place these powers in the most favorable condition possible for the struggle, and where they appear to be insufficient, assist. Sometimes the constitutional power will throw off fever at the very onset. Probably few medical men have not experienced in their own persons, when attending fever patients, that they had contracted the disease, and that after all its symptoms had been in course of development for four-and-twenty, or even eight-and-forty hours, it has been cast off, probably, by per- spiration or diarrhoea, and health restored. From this almost ephemeral attack, to the wreek after week of continued fever, the disease may be thrown off at any period of its course. A Typhus Fever. 237 person attacked with fever ought to be placed in as roomy and well-aired a situation as possible—better even in a barn than in a close or crowded room ; the greatest cleanliness as regards everything around must be observed, and perfect quietude; if thirst is present, it should be liberally indulged with simple acidulated drinks, such as lemonade and toast-water, mixed; flax-seed tea, cold, &c.; if nourishment is taken, it should be given in modern quantities, and consist principally of milk and farinaceous preparations, corn starch, farina, or grapes, oranges, and ripe fruits, if they do not create flatulence or diar- rhoea, are allowable. If the skin is hot or dry, it should be sponged with water; this practice is beneficial, more or less, in most cases. By these simple means of management, almost without medicine, beyond some gentle purgative, as castor oil, &c, at intervals, to keep the bowels perfectly free of their ne- cessarily depraved contents, many a case of fever may be well conducted to a favorable issue, with much more certainty than under a more meddlesome treatment—care being taken when signs of amendment show themselves, that there is not too great hurry in giving or permitting strong nourishment. In more serious forms of fever, the same principle of treat- ment must be kept in view, but more urgent symptoms may call for more active interference; violent delirium may require the treatment pointed out under the article devoted to the sub- ject ; difficulty of breathing and cough may render a blister on the chest desirable, or tenderness of the bowels on pressure, Earticularly in the right lower side of the abdomen, near the ip bone, may call for the application of half a dozen leeches. Diarrhoea may require to be checked, by small doses of pare- goric, or drinking occasionally a wine glassful of allspice tea, with a little prepared chalk in it, or constipation removed by gentle aperients; castor oil or rheubarb or senna will general- ly be found safest and best, or injections of weak soap-suds. Sleeplessness at night, with convulsive starting of the fingers, may require laudanum, ten to forty drops; or the general sinking of the powers, the pulse becoming feeble and easily extinguished, may call for the administration of wine or bran- dy in teaspoonful doses, every hour or two, according to symptoms, with strong meat-broth, or gravy, in frequently re- peated small quantities. At this time care must be taken to observe whether urine is passed ; if there seems to be diffi- culty, a bag of hot bran on the lower part of the body will possibly make it easier; if it dribbles away, means should be taken to protect the back and hips of the patient from beiag wetted with it. This may be done in varions ways, either by 238 Typhus Fever. waterproof material, or by constant renewal of dry cloths; it is much better effected, however, by bags of bran, or a sponge so placed as to absorb the urine as it comes away. If with every quart of bran, four ounces of the diluted sulphuric acid be mixed, it will neturalize the ammoniacal emanations which so quickly arise wherever urine collects. It is often the case, that patients who lie long in fever be- come liable to bed-sores, or ulcerations on the prominent parts of the body which are subject to pressure as they lie; these are, especially the back and hips, points of the shoulder-blades, back of the head, tips of the ears, &c. When these ulcera- tions form, they not only add materially to the sufferings of the patient, but may become the cause of a fatal termination to a case that might otherwise have recovered. They should, if possible, be prevented. The parts named above should be frequently examined, and on the slightest appearance of red- ness, the skin at the spot should be rubbed with whiskey, bran- dy, bay rum, or spirits of camphor. When the skin has ac- tually broken, it may be dressed with simple spermaceti ointment spread on linen ; lead plaster spread on soft leather is often useful, (see directions for making under head of " Me- dicines,") or the white of egg beat up with alum. Both as a preventive and as a remedy after the sores have formed, the parts should be relieved from pressure as much as possible by various arrangements of cushions, &c, the elastic ones made for the purpose being the most suitable. The foregoing are the genercd principals on which a case of fever is to be managed ; by attention to them am, unprofessional person will be much more likely to do good than by meddlesome interference. Attention to the ventilation of the room, to the perfect cleanliness of the patient and of every thing around— free supply of diluent drinks, as previously stated, and care that the bowels are duly, but not forcibly relieved of their always depraved contents, ought to constitute the chief re- sources of the domestic management of fever. Again it is repeated, fever is not a disease to be cured, but to be guided to a safe termination. In regard to the causes of fever, they may be enumerated as follows : Predisposing—whatever lowers, either temporarily or permanently, the standard of the general health; and Direct—contagion and the products of animal or vegetable decomposition. Attention is called before closing to the employment of fresh yeast in cases of fever, particularly of a low, malig- nant or putrid tendency, in which it is most useful It ia Typhus Fever. 239 iven in tablespoonful doses, repeated every three or four ours. It should also be borne in mind in the treatment of these fevers, that the patient should be allowed to partake freely of gum arabic dissolved in cold water; or slippery elm water, adding a few drops of spirits nitre occasionally. Also let him have a piece of some pleasant bark, root, or herb in his mouth constantly (if agreeable) to chew on; it promotes the flow of saliva or spittle, and saves much suffering from dryness of the mouth. A piece of orange or lemon peel, sassafras root, an- gelica root, dogwood bark, or things of that kind, are admis- sible. When in the course of the disease there is a tendency to sinking, do not be afraid to give one or two grains of quinine every three or four hours, to be given in smaller "dosea or left off entirely if much headache should follow its use. In the early period or forming stage of this disease, an emetic will often be found advantageous. A dose of ipecac may be administered, and its operation promoted by giving the patient large quantities of weak camomile tea or warm water. After the patient has rested from the effects of the emetic, a dose of castor oil should be administered, and fol- lowed by purgative injections if necessary. The purgative should be again repeated, after a short interval, provided the first dose has not the effect of producing full and free evacu= ations from the bowels. When these are obtained, they re- lieve the oppression of the stomach; render the tongue clean and soft, mitigate the thirst and restlessness, and the morbid heat of the surface, and prevent that formidable oppression of the brain and nervous system upon which the symptoms of col- apse, which attend the second stage of the disease, depend. Whenever the symptoms of excitement run high, the patient feeling hot and restless, and the skin being universally and steadily above the natural temperature, and at the same time perfectly dry, no remedy has been found to act with so much promptitude, and to be productive of greater benefit, than the application of cold water to the surface of the body. It may be used in the form of ablution, or sponging; the patient is then to be wiped perfectly dry, and covered up in bed; after which a bowl of warm tea or thin gruel is to be given him. It can only be employed, however, during the height of the fever, when the heat of the skin is steadily above the natural temperature, and no tendency to perspiration is present. When the head is much affected, cold should be applied to the scalp in the same manner as was directed in bilious fe7«r 240 Yellow Fever. YELLOW FEVER. This is a disease peculiar to warm climates, and is moTz. prevalent, and in the worst form in proportion to the greater heat of the season; however, heat alone is not sufficient to produce yellow fever. It is attended with great diversity of symptoms in different cases. In some patients it commences with symptoms which would appear to indicate a perfectly mild disease. In general, it attacks suddenly, with a chill, pain in the head, back and limbs, and occasionally with a nausea or vomiting. The eyes appear red and inflamed, and feel hot and painful, the pupils are sometimes dilated, but more generally contracted. The chill is commonly of yerv short duration ; as it goes off, the pulse becomes, in general, full and quick, the skin very hot and dry, the face flushed, the eyes red and watery. The face has an expression similar to that of a person intoxicated; there is great oppression and tightness at the pit of the stomach, with constant restlessness and frequent sighing; the bowels are costive, the tongue white and coated, or of a bright red color. The heat of the skin and pains in the head and limbs augment rapidly during the first thirty-six hours, and then gradually decrease, so that at the end of the third day there is either a very great remission of symptoms, or even complete intermission of the disease, ter- minating in the recovery of the patient. When an imperfect intermission only takes place, it is in a few hours succeeded by pain and a sense of burning in the stomach, constant nau- sea, with efforts to vomit, discharging at first only a little thick green mucus. The pulse is now small, quick, and irre- gular ; the stomach sore to the touch, the bowels costive or griped, and the tongue brown and dry. The symptoms rapidly increase, until at length the sense of heat and pain of the stomach cease, and vomiting of a black, flaky matter, re- sombling coffee-ground, takes place, called " black vomit." The patient now often feels quite easy, thinks he is getting better, rises out of bed and walks about, but soon becomes ex- hausted, and falls into convulsions, or into a state of lethargy, terminating in death. ' Some patients become drowsy, awd die without a struggle; in others, death is preceded by the discharge from the mouth, nose and ears, of a dark-colored blood. The skin of most becomes of a bright yellow before the black vomit occurs. In some instances which terminate fatally, there is no vomiting of black fluid at any period of the disease. The predisposing and exciting causes of yellow fever are tha Yellow Fever. 241 aame aa in other fevers: namely, exposure to heat, fatigue, cold, intemperance, fear, anxiety, etc. In regard to the treatment of yellow fever, this must vary according to the stage of the attack, and the violence of the symptoms by which it is attended. In the early or forming period of the disease, marked by a slight disorder of the stomach, headache, pains in the limbs, lassitude, and a sense of chilliness, much advantage may be derived from the use of the warm bath, brisk frictions of the surface, and the adminis- tration of calomel, followed in the course of a few hours by castor oil, ten to fifteen grains; injections of soap suds also will be beneficial in procuring a speedy evacuation of the con- tents of the bowels. At a later period of the disease, when all the prominent symptoms are fully developed, when there is heat of the skin, burning pain and sense of distress at the stomach, with soreness upon pressure, a mustard plaster ap- plied for a few minutes at a time, every hour, will often afford relief: or leeches or cups may be applied over the stomach. Cold water applied to the surface during the height of the fever, by sponging, should never be neglected. It is among the most powerful means we possess of reducing the violent excitement by which this fever is attended. When the head is much affected, after the application of leeches or cups to the temples or nape of the neck, keeping the head constantly wet with cold vinegar, water, or the application to the shaved scalp of a bladder partly filled with powdered ice, will be pro- ductive of the most decided benefit. The thirst of the patient is to be quenched by small and repeated draughts of some cold beverage: iced water or lemonade, toast or barley water, with the addition of ice, will be found among the best. In cases attended with great irri- tability of the stomach, we know of no remedy from which more advantage will be obtained than from a teaspoonful of powdered ice occasionally repeated. It is to be recollected, that the foregoing remedies are only adapted to the first stage of the disease, and if judiciously and vigorously employed, the danger of the second stage will be avoided, and the most unpleasant symptoms diminished within the first twenty-four hours. In the second stage of yellow fever, our hopes of arresting the fatal progress of the case are but slender. The same treat- ment as to the gum arabic and slippery elm water, for cooling drinks, etc., also, the quinine, when symptoms of sinking appear, which was recommended in typhoid fever, is as appli- cable in yellow fever. In fact, I would recommend in the 942 Vomiting of Blood. rery "beginning, as soon as the bowels have been opened, to give a mixture composed of two grains of quinine, five grains of powdered charcoal, and one grain of powdered sassafras bark, to be repeated every two hours. This will not interfere with the other treatment, and will by its power of keeping up the strength on the one hand, and its antiseptic properties on the other, be well worthy a trial. VOMITING OF BLOOD. This is usually preceded by a feeling of heaviness and pain ibout the stomach, but without cough. Generally it is pre- ceded by nausea, loss of appetite, etc. There is often pain or uneasiness in the left side, with anxiety and a sense of tight- ness in the chest. The blood discharged is generally dark colored, clotted, and often mixed with some of the contents of the stomach. In some cases there is also a discharge of dark colored blood by stool. The amount of blood vomited is various. Sometimes a large quantity is thrown up at once, when the disease ceases, and does not again occur; but in general the vomiting is repeated at short intervals, until the patient is completely exhausted. Vomiting of blood may occur in persous of a full habit and robust constitution, but is most common in those who are weakly, or who have labored for a considerable time under a disease of the digestive organs. The most frequent causes appear to be grief, or other de- pressing or violent passions ; costiveness, especially if occur- ring in a constitution in which the stomach is particularly irritable; blows on the region of the organ affected; fullness of habit, combined with an intemperate mode of life ; the use of intoxicating drinks; the suppression of the menstrual flux, or of the discharge from bleeding piles; acrid or irritating substances taken into the stomach, and the abuse of emetics and active purgatives. It is, in general, easily distinguished from spitting of blood, by the blood being here brought up by vomiting, and by its being of a darker color. It is also generally mixed with some of the contents of the stomach. In spitting of blood, on the contrary, the fluid discharged from the lungs is brought up by hawking or coughing, and is generally of a bright red color. When a person is attacked with vomiting of blood, he should be kept perfectly quiet, in a room, the air of which ia rather cold than warm, a^d ^is dress should be loosed so as to prevent ,any pressure upon the stomach. If the complaint Vomiting of Blood. 343 occur in a person of a full habit, and possessing considerable general strength, cups or leeches should be freely applied over the stomach. In cases occurring in debilitated habits, or where the discharge of blood has already lowered considerably the strength, cups alone over the stomach will be proper, and these should be applied without scarifying. If the bowels are costive, they should be opened by an in- jection of warm water mixed with thin gruel and a little soap suds. The thirst in this complaint is always considerable ; it may be allayed by the patient taking small quantities of gum arabic, slippery elm, or toast water perfectly cold. In many cases where vomiting is incessant, advantage will be derived from the administration of an occasional spoonful of iced water, or even of powdered ice. When the vomiting of blood has been produced by suppress- ed menses or a cessation of the discharge from bleeding piles, leeches should be applied about the upper part of the thighs, or to the anus (outlet of the bowels)—the patient's feet should be immersed in hot water, to which salt or mustard has been added, and afterwards mustard poultices applied to the ankles. If it be necessary, from the great discharge of blood, promptly to put a stop to the vomiting, twenty-five grains of ipecac should be taken, in a little warm water, and if the first dose fail to stop it, a second may be administered after an interval of two or three hours. Ipecac is frequently of very great ser- vice in this complaint. It is applicaDle to the case of strong as well as of weakly persons. Sugar of lead is, in many cases, a medicine of great value here, as well as in other profuse bleedings. Combining it with the ipecac is often advantageous: we may give two grains of the sugar of lead with two of the ipecac. Calomel in grain doses, every two hours, will in some instances speed- ily arrest the vomiting; it should be given combined with five grains of gum arabic, and mixed with a little water. After the blood has ceased to flow, and the patient begins to recover himself, the further treatment of the case will de- pend in a great measure upon the nature of the symptoms which remain. The occasional application of cups or mustard plasters to stomach will still be demanded, in most cases. The diet recommended under Dyspepsia will^ in general, bo the most proper. 244 Dropsy. DROPSY. The disease to which the term dropsy is most usually appli* cd, is that general swelling over the whole body, of a soft and doughy feel, accompanied with great weakness, and other symptoms to be hereafter described; or it is that swelling of the belly, from the accumulation of a watery fluid within, by which it is often distended to a prodigious size. General Dkopst is a swelling of the external parts of the body, from a collection of fluid chiefly under the skin; the swelling first appearing on particular parts only, but at length gradually extending to the whole surface. The swelling in dropsy is always soft and uniform over any member; and when pressure is made upon the skin with the finger, a pit or hollow is formed by the water being pressed out of some of the cells beneath, into the neighboring ones. Soon after the pressure is removed, the swelling returns to its former full- ness. Generally, the swelling appears first on the lower ex- tremities, and that only in the evening; it is seldom, at an early period of the disease, very perceptible in the morning. The more a person has been in the erect posture through the day, the greater is the swelling towards evening. It is easy to be seen, that this is owing to the water making its way down- wards by its own weight; while the posture during sleep allows it either to diffuse itself equally over the whole body, or if the quantity be great, and the disease far advanced, to accumulate in the upper parts of the body, and to occasion the swelled face, and closed-up eyes, which some dropsical pa- tients exhibit in the morning. Sometimes the fluid which ia accumulated immediately under the skin, oozes out through the pores of the skin; sometimes being too thick to do so, it raises the outer skin in blisters. Sometimes again, the shin not allowing the water to pass through it, is hardened by dis- tention, and gives the swelliag an unusual degree of firmness. General dropsy is almost always attended with scantiness of urine, which is generally high-colored, and after cooling, lets fall a copious reddish sediment or settlings. There is also an unusual degree of thirst; the appetite is generally bad, and there is a feeling of debility, with sluggishness, drowsiness, and disinclination to motion. Exhausting diseases of various kinds, copious and long con- tinued discharges of blood, or any other weakening cause, may produce a debility of the system, which leads to dropsy. In- temperance in the use of strong liquors, especially dram-drink- ing, is one of the most common, intractable, and fatal causes Dropsy. 245 of dropsy. Profuse bleeding has been already mentioned as causing general debility, and as producing dropsy. From the account given of the causes of dropsy, it is evident that, while they continue to act, it will be useless to attempt carrying off the accumulated fluid, and therefore one of our first objects must be to put a stop to these causes. In a dram- drinker, or an indolent, debilitated person, it will be in vain to give drugs, or to direct any particular diet, however salu- tary, till these bad habits are given up. We are next to attempt to get rid of the water already accumulated. Some- times very strong purgatives, particularly those which produce large watery stools, procure a very rapid discharge of the ac- cumulated fluid; of this kind are gamboge, scammony, and the like; or jalap in combination with aloes, scammony, gam- boge, or cream of tartar. A powder for this purpose may consist of eight grains of aloes, ten of jalap, and six of gam- boge or scammony, to be taken in a bolus, or suspended in syrup or mucilage, to be repeated, if necessary, every two or three days. Or ten grains of jalap, with a teaspoonful or two of cream tartar, may be used, given in a wine glass of cold water, on an empty stomach. Another class of remedies much used in dropsy, are medicines that act on the kidneys, and could we insure the success of their operation, we should be better pleased to carry off the dropsical waters in this way, than by any other method whatever. Cream of tartar is perhaps, one of the best diuretics in general dropsy- Dissolve a large tablespoonful of cream tartar in half pint of water, and take a tablespoonful of the mixture every hour or two. Or mix one tablespoonful of spirits nitre with half pint of water, and take one tablespoonful every two hours. It is an important improvement in the cure of dropsies, that the patient is not restricted in the quantity of fluid which he chooses to drink, but that a plentiful allowance of watery li- quors is considered rather conducive to a cure, by convey- ing to the kidneys any diuretic we mean to employ, and even as of itself greatly promoting their action. Friction is another means of promoting the action of the absorbents ; and exer- cise, if the patient can take it, may have the same effect; and when the swelling is abated in the morning, skilful and equa- ble bandaging (commencing at the toes and going upwards to the knees, or further,) will prevent the swelling of the legs towards night. When by these or other means, we have man- aged to get rid of the water already effused, our next object is to prevent its re-accumulation; and by strengthening the sys- tem, to complete the cure of the disease. Exercise, and the 246 Asthma. proper regulation of the diet, are important items in this plan ; and are to be accompanied, in the debilitated, by tonic medi- cines, as Peruvian bark tea, (one tablespoonful of the bark to half pint of hot water,) of which take, when cold, one third of this mixture before each meal. Or the tea of wild cherry bark may be given in the same way. Great attention is to be paid to the state of the bowels, to keep them open and free; and we must not neglect to keep up a proper action of the skin and of the kidneys, by wearing flannel next the skin, and giv- ing some water-melon seed tea, occasionally through the day, or a few drops of spirits of nitre in a little water, three or four times a day. Also bear in mind that the sponge-bath of salt and water, over the entire surface of the body and limbs, once a day, to be followed by a rough towel and flesh brush, must not be neglected, and should be continued for two or three months. ASTHMA, OR PHTHISIC. This disease is an affection of the lungs, which comes on by spells, most generally at night, and is attended by a frequent, difficult, and short respiration, together with a wheezing noise, tightness across the chest, and a cough; all of which symp- toms are much increased when the patient is lying down. Changes in the weather, peculiarity of situation, errors in diet, anxiety, fatigue, mental excitment, may any of them produce a paroxysm of asthma in the predisposed. The at- tack itself is indicated by feelings of indigestion and flatulence, headache, chilliness, languor, and drowsiness. After having experienced these sensations doing the day, the asthmatic individual is probably awakened from his first sleep by a dis- tressing sensation of constriction of the chest; he is forced to sit up in bed, laboring for breath, or, it may be, to seek an open window. The distressed state of the breathing, if not relieved by remedies, continues for some hours, and at last gradually subsides; the characteristic wheezing becomes less; the cough, almost impossible before, is now brought out, and sleep, never more welcome, comes on. The latter stage of the paroxysm of asthma is generally accompanied with expectora- tion of mucus—sometimes it is not; and upon this a distinction into dry and humid (or moist) asthma is founded. Confirmed asthmatics have a distressed cast of countenance, and acquire a peculiar rounding or elevation of the shoulders, perfectly characteristic. Asthma may occur at any period of life, but is more general about the middle; and men are more com- monly the subjects of it than women. The remedies are various; what gives immediate and full relief to one person Asthma. 24t totally fails in another. The practice of smoking the leaves and stems of stramonium, or thorn-apple, is now extensively and popularly resorted to ; with some it succeeds admirably ; to other it seems to be hurtful; it may be tried. .^Ether and laudanum, is a favorite combination ; half a teaspoonful of the former along with twenty drops of the latter being given in a wine-glassful of water. A teaspoonful of hartshorn may be •ubstituted for the sether, but is not so efficacious. Twenty grains of powdered ipecac, given in half a wineglassful of water, to act as an emetic, may be of service, particularly if the attack has come on after a full meal, or if there is any suspicion of the stomach being loaded. Some experience much benefit from strong coffee, drank without milk or sugar. The inhalation of chloroform, a few drops sprinkled on a pock- et-handkerchief, has lately been found to afford relief; the fumes of burning nitre (saltpetre) diffused through the air of j the apartment, by means of pieces of blotting-paper dipped in a thorough solution of the salt, and dried, is also useful. One of these, about the size of the hand, ignited and placed upon a plate in the room, quickly diffuses its fumes throughout the apartment. When there is great dryness and deficient expec- toration, steam from bitter herbs, (as in catarrh in the head,) inhaled either simply or with a few drops of sulphuric sether, is worth a trial. If there is much acidity of stomach, ten or fifteen grains of carbonate of soda with a teaspoonful of harts- horn in a little water should be given. Indeed, when an attack of asthma is threatened or has come on, care must be always taken, as far as possible, to remove any existing dis- ordered action. A cup of warm tea and retirement to a warm bed will remove the chilly sensation. Costiveness of the bowels ought to be relieved by a gentle dose of castor oil, or of rhubarb and magnesia; flatulence or acidity is corrected by a mixture of water, in which some essence of peppermint and prepared chalk have been put, given every hour. Flatu- j lence particularly must be obviated, and all sources of it avoided. Effervescing draughts, soda-water, and such-like,! are almost always hurtful. The effects of situation and of i atmospheric peculiarity upon asthmatics are most varied;1 Borne can breathe freely in clear dry air, which drives others into a damp cellar for temporary relief : a close, warm room which suits one will be unbearable to another. Individuals who are never free from asthma in some situations, lose their attack as soon as they are removed. These are peculiarities of which all should be aware. Cer- [ tain odors produce asthmatic breathing in the predisposed ;— 248 Scalds and Burns. the powdei of ipecac is notorious for this effect; and the smeL of new-made hay, so pleasant to most persons, produces hay asthma in a few unfortunate individuals. Sponging the chest and shoulders every morning with cold salt water, friction being afterwards made with a rough towel or flesh brush, is a practice to be recommended, provided no other predisposition forbids. A few drops of sether, put into a, gill of cold tar-water, and Inhaled by means of one of the Inhalers recommended in ca- tarrh in the head, will be of service in some cases. SCALDS ANDBURNS. The frequency of accidents of this kind makes it obligatory for every individual to be posted as to the best treatment in such cases, as it is necessary to apply our remedies at once, to be the most successful, for in all accidents from scalds and burns, it seems to be of the utmost importance to apply a remedy at the instant; for by this means the violent anguish is allayed, and blistering, which in scalds, at least, is usuallv so considerable as to lay the foundation for a tedious curative process, is in a great degree prevented. In the case of slight burns and of scalds, generally the best application is the cotton wadding in sheets ; it should be used to envelop the injured parts, double if possible, and bound or bandaged on with moderate firmness. If this mode of treat- ment be resorted to within the first twenty minutes after the injury, nothing more need be done; the cotton may he allowed to remain on from twenty-four hours to three or four days, according to the severity of the accident. Under its use blistering rarely occurs, and if it has commenced before the application, it subsides quickly and painlessly. For the first ten minutes after the cotton-dressing is put on, the pain of tho injured parts seems increased, but ere long it diminishes, and the inflamed skin appears to relieve itself by gentle perspira- fcon. In the cases such as above named, when cotton is to bo procured—and no house in the country ought to be without one or two sheets of it—it is perfectly unnecessary to use any ether measures. A lotion made with six tablespoonfuls of vinegar to a pint of water may with advantage be kept constantly applied to a burn, if it be not extensive—a saturated solution of carbonate of soda has likewise been recommended. Cold water ii perhaps the most directly grateful application to a burnt or scalded surface, and if continued sufficiently long, w'll undoubtedly restore the usual condition of the" part, but it Scalds and Burns. 249 must be persevered with for many hours; and when a burn of ■cald is extensive, this is a serious objection, in consequent of the extreme constitutional depression which so often follows the accident, especially in the young. We would warn pa« rents of the necessity of watching closely the effects of even slight injuries of this kind upon children, particularly when the chest or abdomen are the seat of the accident: extreme depression—requiring the use of stimulants—may unexpect eily come on, and death, from an apparently very slight cause. be the result. When cotton is not readily procurable, flour eprinkfcd over the surface is an admirable substitute, even in slight burns, but is more useful still in those severe effects of heat in which the parts are deeply destroyed by the action of fire ; in these cases, flour applied at once, and repeated again and again for days together, whatever slight moisture seems oozing through the caked covering it forms—is the most gene- rally applicable, pleasant, and safest remedy; a little fresh sweet-oil applied to the surface in the first instance will make it adhere. Applying a thick coat of white lead paint has been found an excellent remedy. It should not be washed off, but suffered to remain on until cast off by nature's own process. Whatever application is used in the treatment of a burn, should be calculated to exclude the action of the external air ; it ought to be one, also, which does not require frequent chang- ing ; the more extensive the surface involved in the accident, the greater care should be taken not to expose it to air, which increases pain, and adds to the general depression of the sys- tem. This depression must always be carefully watched, and combated by the use of ammonia, wine, or spirit, sufficient to support without stimulating. When pain is excessive, and is irritating the nervous system, a gentle opiate is required; but in some of the severest burns, the sensation, not only in the injured part, but generally, is either wholly or partially abo- lished, in consequence of the shock to the nervous system at large. This is always a bad symptom. In the less severe forms of injury from heat, if the cotton, the flour, or cold water, have been properly used, little after-treatment is neces- aary; but when a burn has been neglected or badly treated, the blisters broken, and when the true skin beneath is inflam- ed and secreting matter, a simple tepid bread and water poul- tice should, in the first place, be applied for six or eight hours, and after it an ointment composed of one tablespoonful of white lead paint, rubbed up with same amount of perfectly fresh lard. This ointment spread on linen quickly relieves the very painful condition of the injured surface. One teaspoon 250 Scalds and Burns. fhl of powdered sugar of lead will do when the paint can not be had, rubbed up with one tablespoonful of lard. In cases of deep burn, with destruction of the parts, aftei the flour has been applied some days, it begins to be pushed off by the matter formed underneath: at this time poultices are to be continued until the caked flour is separated, and the surface below exposed, after which the simple dressing with tepid water will generally be the best and safest applica- tion ; or, in a later stage, if healing is slow, use the lead oint ment recommended above. During the cure of burns involving contiguous parts, suet as the fingers, care must always be taken to keep the surface* asunder by the interposed dressings: otherwise they may grow together. After extensive burns or scalds, the constitu- tion requires attention—the stimulating treatment of the first few hour.s or days must be dropped when feverish symptoms come on, and mild and cooling diet, gentle purgatives, and cooling drinks, as lemonade, apple tea, toast-water, &c., ad- ministered : opium or laudanum, in ordinary doses, being given if requisite, to allay pain or nervous irritation. This system will again require to be changed for one of stronger nourishment—meat soups, meat and wine, or other stimuli, if there is continued discharge. The use of stimulating diet, however, requires caution, on account of the tendency to in- flammation of the lining membrane of the stomach and bowels, which exists during convalescence from injury to the skin by heat. The sores left by burns have some peculiarities. They shoot out fungous, or proud flesh, as it is vulgarly called; they are difficult to heal: and when they do heal, contract so mucli as often to produce great deformity. To arrest the growth of this over-growing fiesh, sprinkle the part with burnt alum, once or twice a day, or apply lunar caustic as often as may be required. I will state, in concluding this subject, that during my re- iidence in Mississippi, during the years 1849-50,1 had occasion in my practice very often to try the application of lunar caus- tic to recent burns and scalds, with the happiest effects—the pain ceasing almost immediately, and the parts healing in a short time. It was applied with a camel's hair brush or linen mop at once, and again in a few days, if healing did m-t seem to be going on satisfactorily. Twenty grains of caustic -lhtaohed in an ounce of water, were the proportions used. Rheumatism. 251 RHE UMA TISM. I\ ia disease is divided into the chronic and the acute; being known by the former appellation when there is no great degree of inflammation or fever, but merely pains; and by the latter when both fever and inflammation exist. It may arise at all times of the year; but the Spring and Autumn are the seasons in which it is most prevalent. It at- tacks persons of all ages, but very young people are more ex- empt from it than adults. Those whose employments subject them to exposures to great heat and cold, are particularly liable to Rheumatism. Obstructed perspiration, occasioned by wearing wet clothes, lying in damp linen, sleeping on the ground, or in damp cellars or basements, or by being exposed to cool air when the body has been heated by exercise, or by coining from a crowded room into the cool air, the causes which usually produce Rheu- matism. Those who are much afflicted with this complaint, are very apt to be sensible of the approach of wet weather, by wandering pains about them at that period. Chronic Rheumatism is attended with pains in the head, shouldtrs and other large joints, which at times are confined to one particular part, and at others shift from one joint to an- other without occasioning any inflammation or fever; and in this manner the complaint continues often for a considerable time, and at length goes off, leaving the parts which have been affected in a stote of debility, and liable to fresh impressions on the approach of bad weather. Acute Rheumatism usually commences with languor, chilli- ness, succeeded by heat, thirst, restlessness, and a quick pulse* there is also a sense of weight, coolness of the limbs, and con- fined bowels. In the course of a day or two, inflammation, with acute pain and swelling, makes its appearance in one or more of the larger joints of the body. The pain is frequently tran- sitory, and apt to shift from joint to joint, leaving the part pre- riously occupied, swollen, red and extremely tender to the touch. Fhe pulse now becomes full and hard; the tongue preserves a iteady whiteness; the bowels are commonly very costive; the nrine high-colored ; and often there is a profuse sweating, un- attended by relief. Sometimes, however, the pain is the first symptom, and the fever follows. When the pain is not very severe, and confined to a few parts, the fever is slight; when it is severe and felt in many parts, the fever is more considerable, and it is most so when the pains extend over the whole body. Both the pain and fever generally suffer an increase in the evening, and a 252 Rheumatism. remission towards morning. The pains are nrjch increased on the slightest motion requiring the action of the muscles affect ed, ana are most severe, as well as most apt to shift their place, in the night time. The fever abates sooner than the local symptoms, and is rarely protracted beyond a fortnight or three weeks. The pains, for the most part, are the last symptom which leaves the patient. When an individual who has either suffered from an attack of acute rheumatism, or is hereditarily predisposed to it, or indeed when any one, after exposure likely to produce an attack, suspects the disease to be impending, the first effort should be to excite the free action of the skin. If a warm or vapor bath can be procured, it is highly desirable; if it can- not, the best substitute will be a well-warmed bed with hot bran bags, or hot bottles, and the free use of warm drinks. A mixture composed of half an ounce of spirit of nitre, one drachm of paregoric, and fifteen drops of wine of ipecac, in a wineglassful of water, may be given every four or five hours. To the above draught, ten grains of the bicarbonate of potash may be added with advantage. Under the above circum- stances, any stimulant sweating may be given with benefit, even a little gin, or other spirit, or wine, well diluted with hot water; these stimuli being used, of course, only at first, and while fever is not yet present. When an attack of acute rheumatism is established, if medi- cal assistance is not immediately procurable, the patient must be kept in bed, moderately warm, the thirst quenched by the free use of simple warm drinks, and the diet reduced to a very low scale, any thing like alcoholic stimuli, or animal prepara- tions:, being strictly forbidden, except in the case of very debilitated persons, when animal broths, such as beef-tea, may be permitted in moderation. If fever runs high, tartar emetic, in from an eighth to a fourth of a grain dose, may be given every four, five, or six hours, and with this, from six to ten drops of laudanum may be combined, to alleviate the pain. Dover's powder, in doses from ten to twenty grains, may be given at bed time, and followed by a purgative of castor oil next morning. The above measures might with safety be adopted, under peculiar circumstances, in the absence of medi- cal assistance. There are, however, many other modes of treatment. That by large doses of nitrate of potash, or salt petre, has had its advocates, and may be tried : tlie mode of administration, as laid down by Dr. Basham, is to dissolve two ounces of the saltpetre in two quarts of water, and to give this quantity in the course of twenty-four hours. Thie Rheumatism. 253 treatment, which is said to be very successful at times, might be available in the absence at least of other remedies; of course, if symptoms indicative of irritation of the stomach or bowels came on, it would require to be abandoned. More recently the treatment of acute rheumatism by lemon-juice lias come into practice, and seems in many cases to answer extremely well. This treatment has the advantage of being perfectly safe, and therefore, where the lemon-juice can be procured, may, without danger, be pursued in the absence of a medical man. One tablespoonful, or half an ounce of lemon- juice, is to be given every four hours. The " alkaline treat- ment" of acute rheumatism is followed by some fifteen to thirty grains cf bicarbonate of potash being given, well diluted in water, every four hours. As regards the local treatment of the inflamed joints, little is to be done in a disease which shifts its site as rapidly aa acute rheumatism; for even if it can be driven from one joint, it must, as long as the poison is in the constitution, show itself elsewhere, it may be in the heart. When the joints are much swollen and painful, much ease may be given by enveloping them in a large quantity of the soft carded cotton—" cotton wool"—over which there is wrap- ped completely a piece of oiled silk, or oiled paper. By this air-tight covering, the joints are kept in a perfect vapor bath, and when it is removed after twelve or twenty-four hours, the wool will be found saturated with moisture which is strongly acid. The causes of acute rheumatism already pointed out will suggest to most persons the precautions to be adopted, espe- cially when liability to the disease exists. Cold and wet are particularly to be guarded against, and, after exposure, the preventive measures already laid down adopted. Flannel or woolen, worn next the skin, must always be regarded as one of the chief preventives; it should of course be proportioned ji thickness to the season and temperature. Persons of full habit, liable to rheumatic attacks, should avoid malt liquor generally, should take animal food sparing- ly, and avoid violent exertions which heat the body. Persona of spare or feeble habit, may live better, and indeed require to keep up the conditiDn of the body to as good a pitch aa possible. In chronic rheumatism, instead of heat, there is often a sen gation of cold around the affected parts. The chronic nature of this disease must generally place it under proper medical control; the chief efforts of the unprofessional must be to correct any slight deviations from the general health, to pro- 254 Rheumatism. tect the affected parts especially from cold by means of warrr clothing, and to use friction, either with simple oil, or by means of liniment of camphor, sweet oil, and laudanum, in equal parts. Much comfort is not only derived from friction, but, if combined with proper exercise of the joint or joints, it may do much to prevent permanent deformity. In chroni* rheumatism, warmth of climate is of much importance, and as much should be done toward the attainment of this aa circumstances will permit. Chronic rheumatism, properly so called, is such as above described; but the term rheumatism, or rheumatic pain, is also used to a great variety of anomalous pains, and from this has arisen considerable confusion. The best marked of these is " muscular rheumatism," which affects chiefly the thick muscles, such as those of the shoulders, arms, neck, loins. &c This form of rheumatism often comes on suddenly, after ex- posure to a current of cold air—sometimes after cold bathing; its chief characteristic is severe pain, when the affected mus- cles are thrown into action. This muscular rheumatism seems to be a purely local affection, and is generally removable by purely local remedies. Of these, the best is a large hot bran or other poultice, or some other means of applying heat and moisture, applied over the affected part, for a few hours; thii often at once cures—care of course must be taken to protect the part to which the heat has been applied, by a covering of flannel. After the hot application is removed, if the heat does not entirely cure, and even instead of it at times, a liniment of camphor, sweet oil and laudanum, in equal parts, or volatile liniment, mixed with laudanum, either alone or combined, with one-third of turpentine, may be used to advantage; two or three teaspoonfuls being well rubbed into the part every few hours. Any notice of rheumatism at the present day must be im- perfect, without some allusion to electric and galvanic agen- cies, galvanic rings, electric chains, &c. That these appliances are at times of apparent service in cases of chronic rheumatism is undoubted, and if such is the case, we are not justified in rejecting tlieir aid because we cannot exactly explain the why and wherefore of their action. The author has found, as a general thing, that the wine of col chicum, given in from two to five drop doses, three times a day, gradually increasing the dose until sickness at the stomach hat been produced, or looseness of the bowels, or both; and then go- ing back again to the small doses, (after a day or two,) and gra- dually increasing again if necessary, has been the most reliable remedy in rheumatism. A liniment of whisky, (or alcohol) kero Nervous Debility. 255 sine oil, laudanum, sweet oil and turpentine in equal parts, applied as needed, is about the best local application. NERVOUS DEBILITY. ITS CAUSES AND THE CURE. IT IS PRODUCED BY EXCESSES IN MARRIED LIFE, ETC. The most potential cause by which this disease is induced is the vicious habit of youth, though it may follow more innocent causes in those of mature age. It is incomparably the most serious affection by which the male portion of the race is assailed, as by the ceaseless losses of the generative secretions the general health is not only greatly depreciated, but the virile capacity also becomes so enfeebled by its ravages, that finally the masculine attribute becomes wholly passive or destroyed. It superinduces a species of atony, or wasting away of the genital organs, which often amounts to a paralyzed condition, imparting to them the appearance of imperfect development which is often real, as the disease, if present in the early years of adolescence, effectually retards and arrests develop ment and stunts capacity. It is a fixed physiological fact that there is an intimate sympathy between the genital organs and the mind—a fact which fully explains the despondency, the gloom and misery, the loss of memory, the day dreams, the erratic visions, the hypochondria, and other evidences of mental disorder by which the sufferers from this disease are distressed. In consequence of the deterioration of the mind which the disease occasions, development of the mental functions are sadly interfered with, capacity of acquirement is lessened, progress is arrested, and hence the frequent observation of the precocious youth becoming the dull adult. The sufferer from the deplorable disease, constantly presents the evidences of his affection as the facial expression con- stantly conveys to others the fact of its existence; his skin is pale and sallow, the eyes are surrounded by dark circles and are quite lustless, the pupils are sluggish and dilated, and the countenance has a troubled, haggard and furtive expression. His manner also betrays his sufferings and decrepitude, as do what he will he cannot conquer his shyness, or retiring habit; the ease with which he becomes confused, his aversion to society, a want of steadiness and decision in locomotion, the deficient power in the lower extremities, and many peculiar movements all betray a mind ill at ease. It is not an uncommon fact for the mental troubles to be- 256 Nervous Debility. come so grave as to induce the most serious disorders, such as delusions, insanity, dementia, and epilepsy. A slight knowledge of physiology will teach the reader why this affection is so pre-eminently destructive of mental and physical vigor, and of the vitality of the procreative organs. The general functions are controlled and governed by nerves radiating from the sacred plexus—a network of ner- vous tissue situated at the posterior wall of the pelvis— precisely as taste, sight, hearing, etc., are directed by nerves arising in ganglionic centres of the brain. A constant and unnatural loss of the generative secretion invariably induces atony, or paralysis of the plexus, causing the relaxed condition of the generative vesicles and the general unmanly condition of the organs. The generative fluid is also the most highly vitalized secre- tion of the whole body, being rich in phosphorus, and the various phosphates which also constitute the principal element of the nervous tissue. It is, therefore, apparent to everyone, that the involuntary expenditure of the secretions as fast as secreted deprives the nervous system of its normal and required stock of phosphorus, and that this poverty is the cause of the debility and devita- lized condition of the nervous system and of the decadence or complete destruction of such functions immediately under the control of the nervous system as the virile capacity or power of generation. One of the most sad and deplorable fancies of some of those who suffer from this unmanly effection is to regard the invol- untary losses as an evidence of high physical power, a relief of surcharged and exuberant manhood, and a natural sequel of continence. This delusion has been the ruin of many, and no one should be guided by such a fallacious thought, should it even come in the shape of professional advice. Every discharge of the generative secretion, if not occurring in the natural orgasm, is unnatural, and the result of a dis- eased condition, and is sure to affect the general health and the tone of the virile capacity. All who give themselves up to this odious and criminal habit are not so severely punished, but there are none who arc not more or less so. The frequency of the pollution, the variety of temperament, and several circumstances indepen- dent of either, occasion considerable differences. The , symptoms we have the more frequently witnessed are a total derangement of the stomach, which occasions a loss of appetite* or an irregular loss of food; in others, acute pains, above &3 Nervous Debility. 2J>7 during the time of digestion, or habitu u Vomitings, which resist every remedy so long as they continue under their de- lusions ; a weakness of the organs of respiration, whence fre- quently result hoarseness, weakness of voice and shortness of breath, upon making any short violent exertions, and finally, total relaxation of the nervous system. Let me here be permitted to insert some fragments of letters, which united, will form a sufficiently complete picture of the physical disorders produced by the imprudent habits of youth :—" I plainly feel, " wrote one patient, " that this impru- dence has diminished the strength of my faculties, and above all, my memory. Age, assisted by reason, has for some time cured me of that wretched penchant, but the evil is done. To an affection and extroardinary sensitiveness of the nervous system, and the accidents it occasions, are added a weakness, an uneasiness, and ennui, a distress of mind which seems per- tinaciously to adhere to me; I am worn out by an almost con- tinual loss of the generative fluid; my countenance has become pale, and almost cadaverous, pimples and blotches are breaking out all over my face; the weakness of my body renders all motion a trouble to me ; that of my legs is such that I have frequently great difficulty in keeping myself on my feet, and I dare not venture to leave my room ; my di- gestion is so bad that my food passes through almost unchanged three or four hours after taking it; my chest is loaded with plegm, which keeps me in continual pain, and the expectora- tion wears me out, " This is a brief description of my miseries, which are still more aggravated by the mournful certitude I have acquired, that each succeeding day will be more painful than the pre- vious one." "Did not religion restrain me," says another, "I should already have put an end to a life so much the more cruel as it is my own fault."' In fact, there is no situation in the world worse than that of mental affliction ; pain is no comparison to it, and when joined to a crowd of physical evils, it is not astonishing that the suf- ferer should wish for death as the greatest blessing, and con- sider life (if so wretched an existence can be called life), as a real misfortune. The following case is more brief and less terrible :—"I had the misfortune to contract that habit which too soon ruined my temperament and constitution; my state of late years has been truly pitiable, my nerves are extremely weak, my hands are always trembling without power, and contiually clammy with 253 Nervous Debility. perspiration ; I am subject to violent spasms of the stomach, pains in the head, arms, legs, and in the loins and chest, fre- quently accompanied with a cough, which is very harassing ; my appetite is voracious, yet I fall away considerably, and my face becomes every day more cadavorous, and full of pimples and blotches." Nothing perhaps weakens the intellect so much as these habits, which takes possession of the whole mind and atten- tion, and prevent their victims from following their respective vocations, rendering them stupid, dull and thoughtful, and destroying their vivacity, cheerfulness and health, bringing on consumption, weakness, barrenness, and all that dreadful train of complaints which make the timid uncertain, full of whims, and ridiculous. It is the imperative duty of every sufferer from this disease, no matter how seldom the unnatural losses occur, to engage the services of a competent and experienced physician, so that the integrity of the general health and the quality of the masculine capacities will be both saved ft om further decadence, and again restored to the normal standard of excellence. The excesses of early married life are often the cause of Nervous Debility and its train of evils, simply because the parties do not know what excesses are, having never been taught a little of the common sense for the million which can be found all through this book. Unmarried men, also, who give way to wholly and unbridled passion, by tlieir associa- tion with women of a certain class, almost invariably bring about a condition of body and mind but little different from those who indulge in the vicious habits of youth. Sometimes seminal losses are caused by the presence of worms in the rectum, or lower bowel, as well as by internal piles. These things produce local irritation and excitement, caus- ing a dream of a lascivious nature, and the loss of seminal fluid during sleep. It will thus be seen that it is not only the vicious habits of youth that bring about nervous debility and all its train of evils, so that each case must be investi- gated by the physician and treated according to its cause. For further information see page 261 of this work. Few persons are aware of the embarrassment and unrest of mind produced by this disease, sometimes in persons in early life or prime of young manhood, but oftener in older persons. Impotence. 259 IMP OTENCE. This mortifying condition follows nervous debility in most of cases, where that disease is allowed full and unchecked sway. The disease (Impotence) often follows or is produced by other causes; such as sedentary habits, intense study, etc. It implies an incapacity to engage in the marital act, and not loss of procreative power, that is termed sterility. It is dependent upon atony or weakness of the nerves of the sacral plexus, a condition spoken of under the head of ner- vous debility, and frequently caused by that affection, though it may be brought about by injuries and diseases at the base of the brain or spine, and by whatever depletes the nervous system of its required stock of phosphorus. The virile capacity is the strongest of all the human forces, and remains as long as any one, and does not, as erroneously supposed, decay in advance of the other forces. While an enfeebled capacity may be perfectly natural in advanced age, complete impotence at any time is the result of a morbid process and inconsonant with the harmony of the physical economy. It is a well-established medico-psychological fact that vig- orous integrity of the virile powers is absolutely necessary for the welfare of both body and mind, and for a well-bal- anced moral sense. A loss of manhood signifies more than mere virile imbecility, it also invariably denotes a loss of physical elasticity, mental acuteness, and moral tone. These are indisputable facts and fully realized by all those who have sustained more or less loss of coitive power. Im- potence is, therefore, one of the most deplorable diseases, making the sufferer a miserable being. A man without the status and functions of his sex, depreciating his physical capacity, and mental activity. Whenever the virile capacity evinces the least degree of decadence it should excite immediate concern, as the process of decay is in all cases a progressive one, as every case of partial impotence, sooner or later becomes complete, unless arrested by the skill of a physician. No one should place confidence in the hope that the recu- perative powers of unaided nature will effect a restoration of coitive capacity, as dependence upon such means of reinvigora- tion always ends in disappointment. The only judicious course to pursue when decadence of capacity is first observed is to engage the aid of an experienced and skillful physician who will interpose the required treatment to arrest the process of deterioration, and to imbue the organs with renewed vigor. 260 Impotence. It is very frequently the case with those who have been guilty of youthful imprudence that they never attain full vigor of manhood, a fact of which they are profoundly ignor- ant. It is, therefore, of the utmost importance that such persons should consult a competent physician before a mari- tal alliance is consummated, so as to be secured against the mortifying experience of many matrimonial novitiates. Greater diagnostic skill and familiarity with pathology is required for investigation into the character of each individ- ual case of lost manhood than for any other unnatural condi- tion, and no physician, however eminently successful he may be in other professional spheres, can give decisive or reliable advice, or successfully treat the affection, unless he has made this particular disease his life-long study, or possess the skill which can only be acquired by the treatment of many thous- ands of cases. It is, therefore, the plain duty of every one of depreciated manhood to seek counsel only of the physician who makes the treatment of this condition a specialty. We are justified in giving this advice, by the fact that we have seen very many cases where the injudicious treatment of inexperienced physicians has very measurably increased the virile debility, and in not a few cases an incurable condi- tion. For this reason we do not feel disposed to give here any detailed treatment, as each case requires treatment according to age, occupation, causes, physical conditions, etc. A great many cases have been much benefited by the use of " Magneto-Electricity f and very often will need no other treat- ment. A small machine, not very expensive, can be had and used once a day or more. (See page 261.) But when one remedy fails we must resort to others; that experience has shown to be beneficial. Impotence. 261 PROFESSIONAL SERVICES. As might naturally be expected, many persons who read this book will wish to consult with us. We would state for the information of all that desire to consult with the author that they can do so either by calling in person or writing to me by mail. I have arrangements for sending medicines and all needed supplies for my patients to all parts of the world. ^To persons wishing to consult me by letter, I send a list of questions to be answered. As to my fees for professional services, they will be made so that all can avail themselves of my services—the poorest as well as the rich—particulars of which will be given on inquiry by letter. The " Magneto- Electric " machine, referred to in various places in this book, we send for $10.00; suspensory bandages for $2.00. Write to me in relation to any disease you or your friends may have and we will give you reply free of charge. Call at my office, or address M. L. Byrn, M.D., 49 Nassau Street, New York City. If we feel, after knowing your symptoms, etc., that we can do your case any good, we will so inform you; if not, we will let you know, so that you may not expend money for nothing. ABS CESS. This may be properly called the collection of pus, or matter In a cavity formed in the substance of any soft parts of the body. The contained matter, or pus, may be either of a healthy or of an unhealthy character; if the former, it is of a yellowish-white color, cream-like in consistence, and pos- sesses a faint sickly odor; in the latter case, it may resemble whey, with bits of curdy substances floating in it, or it may be bloody and offensive. Common abscess. An abscess formed on some external part of the body, which has been previously the seat of inflamma- tion. Whenever inflammation occurs, the most proper course ia to endeavor to remove it by an early resort to appropriate remedies, before it causes suppuration, (or the formation of an abscsss ;) but if this latter cannot be prevented, we muat endeavor to accelerate its progress by warm fomentations of bitter herbs, such as hops and vinegar, boneset, sage, or hore hound, and hot water, &c , and by poultices. These are to ba 262 Abscess. made of bread and milk; oat-meal or linseed-me&l and water or slippery elm ; and to promote the ripening of an abscesfl in the inside of the mouth, a roasted fig or apple may be used. When the tonsils (or almonds of the ear) are tending to sup- puration, (or coming to a head), the patient should draw into tl" e mouth the steam of boiling water, alone, or with a little vinegar and hops added to it. In general, those poultices are best which retain their heat the longest, and they should be frequently changed, to prevent their becoming cold, and thu£ having a contrary effect to what we wish them to have. The tendency to suppuration may be known by the inflammation continuing long; by the stretching pain becoming less ; by a throbbing sensation, and the patient's being affected with cold shiverings. When an abscess forms in a place under our in- spection, it is accompanied with swelling, whiteness, or yel- lowness of the skin, and a soft feel, as if there were a thickish fluid in a bag. When matter is formed, it must be discharg- ed, and nature endeavors to accomplish this by causing the matter to have a tendency to the nearest outlet: thus an ab- scess formed in a fleshy part of the body will point to the skin ; one in the lungs will burst in the air-cells; and one in the liver, either into the belly, or externally through the side. When the abscess is quite ripe, which is known by the pain being lessened, and the matter pointing or coming to a parti- cular spot, it is, in general, best to give it vent by opening it with a lancet, or other clean cutting instrument; and this, in the position or situation which is lowest, on purpose to let the abscess empty itself by the weight of the fluid. It is better to have a free vent of our own making, than to allow the mat- ter to find its way under the skin, to distant and inconvenient parts, or to allow the matter to discharge itself by a ragged and irregular opening. It is almost always proper to make the cut large, as a small one is nearly as painful, and as it is liable to close too soon, and thus occasion the necessity of repeating the operation. When the abscess is large and deep, a small piece of lint should be put between the lips of tha wound, that it may close from the bottom, and this is to be re- newed at each dressing. The poultices are snll to be con tinued till the thick yellow appearance of the matter changes into a thin watery discharge; after this it is proper to discon- tinue them, and to dress with simple cerate, made of wax, lard, and sweet oil melted together, in equal parts by weight, or any good healing ointment. When it is wished, as much as possible, to exclude the ail from the inside of an abscess, an opening is made by passing Boil. 263 a brwid cutting needle, for the purpose of bringing through the rides of the abscess a skein of silk or cotton. This is desirable, particularly in lumbar abscesses, or those collections of matter which come from the inside of the belly, and point at the up- per part of the thigh; as air admitted into them is often found to be the cause of hectic fever, and consequent generally ill healf q. The degree of danger which attends an abscess, depends on its situation and its consequences. If it is situated in the lungs, it may burst into the air cells, and prove fatal by suffocation; or if in the liver, &c, it may be effused within the cavity of the eritoneum (or lining membrane of the bowels) and excite in animation there. Large abscesses are dangerous by the wast- ing discharge with which they are accompanied ; and by the slow fever and general symptoms which, in certain constitu- tions, follow them. BOIL. A Boil is a small tumor common to every part of the surface of the body; hard, tender to the touch, and coming to a head, with a hard core in the centre. It is chiefly found in persons of a full habit, and great vigor ; but is sometimes met with al- so in debilitated patients, who are evidently suffering from ill health. When it occurs in strong and vigorous patients, they should be put on a low diet, and some cooling opening medicine should be given, as a dose of salts, or cream of tartar, or sen- na-tea with the addition of salts. If the boil be large, and at- tended with considerable swelling, pain and fever, small doses of ipecac, half grain to one grain, should be given every three hours. A common poultice should be applied to the boil till it suppurates and breaks, when it may be dressed twice a day with any good healing ointment, (see Medicines, their doses, aaes, and manner of preparation,) till it heals. If the ulcer gets into an indolent state, and wants stimulating, in order to its healing, we may apply the basilicon ointment. Boils not nnfrequently arise in weakly 1-noils, and where the constitution ia evidently in an unhealthy state ; in such cases, the patient ihould be put on a nourishing diet; he should take daily exer- cise, if possible, in the open air, and use the sponge-bath and frictions to the surface every other day. The compound de eo«'tion or toi of sarsaparilla is an excellent medicine, and may V' taken fVw times a day, in one gill dcsea. 264 Gum-Boil—Mammary Abscess. GUM-BOIL. Gum-Boii.8 are sometimes limited to the substance of the gums, and sometimes connected with the decay of a tooth, 01 its socket. In the first variety, it is a disease of only a few days' duration, and ceases almost as soon as the boil bursts, oi is opened; in the second, it will often continue troublesome till the decayed tooth is extracted. Gum-boils, when connected with decayed teeth, rarely dis- perse without coming to a head, and it is, therefore, generally better to encourage this process, by the use of warm fomenta- tions, (previously alluded to under head of Abscess,) or poul- tices, than to repel it. An early opening of the tumor is of importance, as, from the structure of the parts concerned, the walls of the abscess are mostly tough and thick, and the con- fined matter seldom obtains a natural exit with sufficient free- dom. A little mild opening medicine, as salts, cream of tartar, or senna-tea, every other day, will be found useful; and after the abscess has burst, or being opened, washing the mouth once or twice a day with an astringent lotion, will tend materi- ally to make the cure permanent. Twenty grains of sulphate of zinc, dissolved in half a pint of rosewater, will be a suitable lotion for this purpose, or cold green tea will answer. MAMMARY ABSCESS or GATHERED BREAST. This is an abscess seated in the female breast, affecting chiefly women after confinement, or during the period of suck- ling. Previous to the birth of the child, a great quantity of blood is sent to the womb to supply materials for the growth and nourishment of the child ; but when the child is born, and requires food of another sort, the blood then flows in great quantity to the breasts, and occasions, in some constitutions, teverishness, known by the name of milk-fever ; and, in others, severe local pain of the breasts, followed by suppuration, oi coming to a head. Independent of the milk-fever, inflamma- tion and abscess of the breast may arise from checking the flow of milk at too early a period ; from exposure to cold, fright, mental anxiety ; too great motion of the arm, when the breast is large and distended ; blows, and pressure from tighl clothes. But the abscess of the breast often occurs, when nr obvious cause can be assigned. The pain arising from the in flammation of so large and tender a structure" is very gieat and occasions very severe distress. The breast sometimes put< on the appearance of several distinct swellings, has a knotted feel, and the pain often extends to the armpit. At first, wc must endeavor, if possible, to put a stop to the inflammation Lumbar Abscss. 265 and to prevent its coming to a head. This is to be aone by giving frequent doses of cooling laxatives, as of salts; by ap- plying cold or tepid fomentations to the breast, and by having the milk regularly drawn off. We are also to apply leechea in great numbers, and to rub the breast gently with a little warm sweet oil and turpentine. The diet is to be very spare and cooling. If we fail in relieving the inflammatory state, our next en- deavor is, to bring it to a head, by poultices, and to discharge the matter, when ripe, by a large opening. When a suppura- ting breast is left to itself to break, it too frequently allows the matter to work itself into various winding holes, and to make its way out by different openings, occasioning a long and wast- ing discharge; to prevent this, there is no method so sure as making a large and free incision, and thus lay open, through all their depth, the hollows from which the matter flows. When a hardness remains in the breast, after inflammation and abscess, it is to be dispersed by frictions with camphorated oil and spirits of turpentine ; attention being paid to the avoiding of external injury from tight clothing, &c, and the general health and state of the bowels are to be attended to. LUMBAR ABSCESS. This is a very troublesome complaint. It is a collection of matter forming at the loins internally, and making its appear- ance at the upper part of the thigh. At the commencement of the disease, there is some difficulty in walking, and an un- easiness is felt about the loins ; but, in general, there are large collections of matter formed without much previous pain, and without any indication of disease, till it begins to show itself by an external swelling. It is sometimes connected with disease of the bones of the spine; but in many cases there is no such combination. It very often occurs in scrofulous constitutions, without any obvi- ous cause, and it may proceed from blows on the back and .oiiis, and from exposure to cold and damp, as by lying on wet ground. Should there be any symptoms to lead us to suspect the com- plaint coming on, we are to endeavor to prevent it, by keeping the patient at rest, and by the application of leeches or cups to th ©ins, b" blistors, and purgative medicines. The great difficul- ty in the treatment of this disease is, to determine on the mode of opening the abscess, when we have decided that such a measure is proper. It is found by very general experience, that when these large collections of matter are freely opened, 266 Carbuncle and admission is given to the external air, very terrible conse- quences ensue; and that the patient suffers from slow fever, wasting discharges of matter, and, at length, death is caused. A plan which has been adopted with success for opening thesa abscesses, is, to make an oblique opening, large enrugh to discharge the flakes of matter and clots of blood from tha cavity, then to cover the wound carefully, and get it to heai as quickly as possible. When the matter collects again, a fresh opening is made, and the same method pursued as before, When the abscess has been opened, or when it has burst, which we must always endeavor to anticipate and prevent, the strength of the patient is to be supported by nourishing diet, b} a liberal allowance of a tea made from Peruvian bark or one grain of Quinine, before each meal; and, in some cases, the use of wine; at the same time, moderating the slow fever, by sponging the body with vinegar and water, and by paying a proper attention to the action of the stomach and bowels. When possible, a physician should be had to attend to such a formidable disease as this. CARBUNCLE. Ik this distressing disease, for it is one attended *vith much Buffering, the first symptoms are great heat and violent pain in some part of the body, on which arises a kind of pimple, at- tended with great itching; below which a round, but very deep-seated, and extremely hard tumor may be felt with the fingers. This tumor soon assumes a dark red, or purple colcr about the centre, but is considerably paler about the edges. A little blister frequently appears on the top, which, as it oc- casions an intolerable itching, is often scratched by the patient. The blister being thus broken, a brown watery fluid is dischar- ged, and a scab makes its appearance. Many such pimples are sometimes produced upon one tumor, in consequence of the patient's scratching the part. Considerable local pain always attends the disease. As the complaint advances, several open- ings generally form in the tumor. Through these, there is discharged a greenish, bloody, offensive, irritating matter. The internal sloughing is often very extensive, even when no sign of it can be outwardly discovered. With regard to the lecal treatment of a carbuncle, the grand thing is to make an early and free incision into the tumor, ao as to allow the sloughs and matter to escape readily. As much of the contents as possible is to be at once pressed out, and then the part is to be covered with a poultice. Fomentations will also be found to afford considerable relief, both before and Sickness from Unhealthy Meats. 267 after an opening has been made. As the discharge is exceed- ingly offensive anf adhesive plaster will be sufficient to cover the broken bona. 282 Dislocations, or Out of Joint. DISLOCATIONS, or OUT OF JOINT. The necessity for the speedy reduction of a dislocation is great, from the fact that every day increases the difficulty ol Its performance; and when a certain time has elapsed, no force which can be exerted—consistent with safety to life and limb —will be adequate to return the displaced bone, partly ow;ng to the resistance of the muscles, but also to obliteration oi- doing away with the cavity which formed the one portion o' the joint. When dislocation occurs, two different actions take place; one, that by which the bone is driven from its usua; position ; the other, the action of the muscles, which tend y*.ili further to draw it from its proper site as soon as the balance oJ resistance of bone against bone is removed. It is, too, in most cases, the action of the muscles which tends to keep the bone displaced, and to resist the efforts made to replace it. This in evident from the fact, that if a person be seen immediate!} after a dislocation, and while suffering from the faintness which almost invariably accompanies the accident, and while the muscles are necessarily in a state of weakness and relaxation ; the dislocation may often be reduced with the greatest possible ease, even by the unskilled; and further, when the surgeon has to deal with a case of dislocation in a strong and muscular subject, he endeavors to produce this faintness—if that following the accident has passed away—by bleeding, nauseating medicines, warm baths, &c.; chloroform and aether inhaled are used by surgeons and physicians, but are not safe in inexperienced hands. When, therefore, a dislocation occurs, the bone is not simply pushed out of its place, but is drawn for the most part upward, or toward the body; the dislocated bone of the finger is drawn upward over its fellow; the arm-bone, in dislocation of the shoulder, may be drawn upward, or into the arm-pit—in this case downward, it is true, as regards the joint, but still toward the body; and the same will be found to be the case in most forms of dislocation. The first object, there- fore, in treating a dislocation, must be to draw it down from or out of the situation to and in which it has been drawn and is retained by the muscles of the limb, and to get it as neai the corresponding part of the joint, or, in other words, as near the part from which it has been dislocated, as possible, if tha dislocated bone is thus drawn down to, or near to the levtl oi the other portion of the joint from whicn it has been re- moved, the muscles will of themselves tend to draw it into its old position. A good deal is often said about the adjustment, &c, &c, of the bone in reducing dislocations; and though, Dislocations, or Out of Joint. 283 perhaps, useful in some cases, in many nothing of the kind it required, at least unprofessional persons should not attempt it all that is to be done is, give the muscles the chance of draw- ing the bone into its old place, by bringing it to a position in which this can be effected. This is often exemplified in cases in which much force is used in the reduction of a dislocation; if the force be kept up strongly, the bone cannot be drawn in- to its socket, because the force is stronger than the muscles of the patient; but relax the external force for a moment, and without any fitting or adjustment, the bone is instantly drawn Into its proper position by the power of its own muscles. There is yet another important principle involved in the reduction of dislocations. It has been pointed out how the bone farthest from the body—which is usually drawn up—is to be drawn down; but, that this may be done properly, the bone above it must be fixed, otherwise it will be drawn down too. This is easily effected in such cases as the ancle or the wrist, by any one grasping and holding firmly either the leg or the forearm ; but in the case of the hip or the shoulder, more management is requisite. Again, in " making the extension," that is, using the forcible effort to return the dislocated bone to its place, the extending force will best be made in the direction in which the limb is fixed, and in the manner most likely to bring the joint portion, or " articulation " of the displaced bone, as near to the old position as possible, and it must be applied directly to the bone which is displaced. Thus, in dislocation of the shoulder, the reducing force is applied to the arm-bone; in dislocation of the hip to that of the thigh. This extending power may sim ply be by the hand, but a cloth, or band of some kind, put round the member to be replaced, is often more advantageous. The particular dislocations most likely to be recognized and to be remedied by unprofessional persons, are those of the small joints, such as fingers and toes; of the wrist and ancle ; of the elbow, shoulder, and lower jaw. Dislocations of the fingers or toes may generally be made out by any person, and should, if possible, be reduced at once ; the dislocated bone being grasped, and forcibly pulled into place; or a noose, made with a piece of tape, may be used. Dis- wocatioE of the thumb, it should be known, is extremely diffi- cult of reduction, and should this not be effected at once, tha attempt ought to be given up until the surgeon's arrival; it is, moreover, one of the dislocations which may be left ume- duced with less subsequent inconvenience than many othera, T* alocation of the ancie is vary generally accompanied witb 284 Dislocations, or Out of Joint. fracture, but the distortion i's often so great and evident, and the suffering so severe, that when the accident does occur far from proper aid, some attempt ought to be made to put the displaced parts into better position. For this purpose, while one individual grasps the leg firmly, another, putting cno hand on the heel and the other on the instep, should endeavor, while steadily pulling downward, to bring the joint into its natural position. Dislocation of the Weist is produced by the forearm being tightly grasped by one individual, the surgeon laying hold ol the patient's hand in his, and endeavoring by steady pulling downward, and slight up and down movement, to bring the joint into its proper condition. Dislocation of the Elbow, if attended to quickly after the accident, may often be easily reduced by seating the person in a chair, carrying the arm well behind the back, and pulling, not very forcibly, upon the forearm. Both these dislocations—of the wrist and elbow—may be suspected, when, after violence—particularly such as is calcu- lated to push either the hand or lower arm upward—inability to use the limb below the seat of the injury, and distortion and impaired motion of the joint, are unaccompanied with any grating sensation, such as occurs when a bone is fractured. Dislocation of the Shoulder is generally occasioned by violence applied to the elbow, or by falls, while the arm is not close down to the side of the body. Sometimes the exact dis- crimination of an injury to the shoulder joint is a matter of much difficulty, for fracture alone or fractures with dislocation may occur. At other times, particularly in thin persons, it is tolerably easy made out—more so if the examination is made be- fore swelling comes on. In addition to the general symptoms of dislocation already enumerated, the injured shoulder will be perceptibly altered in shape; it will appear more depressed and flatter than the sound one, and if the hand is placed upon the spot which ought to be occupied by the round head of the arm bone—and this may be discovered by examination of the unin- jured shoulder—it will be found hollow; and further, if the arm be now gently moved about, and its bone traced up toward the shoulder, it will be found moving in some unusual position, most probably in the arm-pit. Supposing, therefore, that tha case is sufficiently clear, the means for the reduction ought to be set about as speedily as possible—if it can be, while faint- ness from the injuries continues. One method of reducing dis- location of the arm-bone into the arm-pit frequently employed ia for both patient and surgeon to lie down upon the ground side Dislocation of the Lower Jaw. 285 by aide, bat with their heads different ways, and so that tha / surgeon having previously, taken off his boot, can place hii heel in the arm-pit of the patient, while he grasps the hand, or a towel fixed to the arm of the effected side; in this way, while .tfie heel is used to push against the displaced bone in the arm pit it, combined with the pulling exerted by the surgeon upon the limb of the patient, tends to give a leverage by which the bone is so placed that it can be drawn into the socket by the muscles. This method may be a convenient one, when only one person is in company with the individual to whom the accident has happened. The following is the most useful and most generally resorted to method of reducing a dislocation of the shoulder. The patient being seated on a chair, a large towel or a table cloth, folded broad, is to be passed round the chest, close under the arm-pit of the affected side, crossed over the opposite shoulder, and held either by a strong assistant or fastened to some fixed point. By this application, the shoulder blade is fixed; the arm itself is then to be pulled, chiefly in the direction in which it has been fixed, firmly, steadily, and slow- ly ; this being done, either directly by the hands of assistants, or by a towel fastened round the arm by the hitchnoose. If »vhen this steady pull has been persevered in for some time, the displaced bone does not get into place, the effect of sud- denly taking off the attention of the patient may be tried, either by some sudden exclamation, or by dashing a little cold water in the face. By such a proceeding, the muscles which resist the reducing or pulling force applied to the arm, are for a moment, so to speak, thrown off their guard, and that moment may suffice to permit the bone to pass into its socket. DISLOCATION OF THE LOWER JAW. This accident, in most cases, is produced by yawning, or opening the mouth excessively wide. It is sometimes produced by a blow upon the chin while the mouth is opened. The symptoms of its occurrence are, an inability to close the mouth; immediately before the ears an empty hollow space is per- ceived ; the cheeks and temples are flattened; the spittle fipws from the mouth; speech and swallowing are difficult, and the chin projects forward. When the jaw continues dislocated aeveral days, these symptoms are not so strongly marked, though they are still in greater or lesser degree. To effect the reduction, the patient is to be seated on a low chair, his head supported against the head of an assistant; tha operator is to defend his thumbs with a piece of leather or linen he ia then to place them as far back on the jaw teeth as he can • 286 Dislocation of the Collar Bone—Contusions. the lingers are then placed under the chin; and while he preaaei down the back teeth with his thumbs, he at the same time raises up the chin with his fingers; and then the chin is pushed backwards, when the parts become replaced very suddenly. As this is done, the operator is as quickly to move his fingers from under the teeth to the cheek. After the operation, tha patient should for some days live on soup, &c, in order that the jaw may be at rest to recover its strength. DISLOCATION OF THE COLLAR BONE. This accident is generally occasioned by falling on the shoul- der, and is ascertained by examining with the fingers; the end of the bone being found under the skin covering the elevated point of the shoulder bone, there causing considerable projec- tion. The patient inclines his head to the affected side, and moves the arm and shoulder as little as possible. The treat- ment of this accident is precisely the same with that of fracture of the collar bone. CONTUSIONS or BRUISES. The bad consequences of bruises are not invariably propor- tioned to the force which has operated ; much depends on the nature and situation of the part. When a contusion takes place over a bone which is thinly covered with soft parts, the latter always suffer very severely, in consequence of being pressed at the time of the accident, between two hard bodies. Bruises of the shin thus frequently cause death of the soft parts, and troublesome sores. Contusions affecting the large joints are always serious cases; the inflammation occasioned is generally obstinate, and abscesses and other diseases which may follow, are consequences sufficient to excite serious alarm. In the treatment of bruises, the practitioner has three indi- cations, which ought successively to claim his attention in tho progress of such cases. The first is to prevent and diminish the inflammation, which, from the violence done, must be expected to arise. To effect this, the bruised parts should be kept perfectly at rest, and covered with linen, constantly wet with cold water, or sugar of lead and water, one teaspoonful to the pint. Wher- the muscles are bruised, these are to be kept in a relaxed poei- tion, and at rest, until the effects of the bruise are entirely removed. If the bruise has been very violent, it will be proper to apply leeches, and this repeatedly. In every instance, tha bowels should be kept well open with saline purgatives, seid grains. 287 lit* pc*/ders, Rochelle and Epsom salts, etc., and the patient put upon a low diet. A second object in the cure of bruises, is to promote the absorption of the extravasated or bruised blood by liniments, etc. These may at once be employed in all ordinary contu- sions, not attended with too much violence; for then nothing is so beneficial as maintaining a continual evaporation from the bruised purt, by means of cold applications, and at tha same time, repeatedly applying leeches. In common bruisea, however, a solution of salammoniac in water, or vinegar and water, is an excellent application ; but most surgeons are in the habit of ordering slightly stimulating liniments for all ordinary contusions, and certainly they do much good in accelerating the absorption of the bruised blood. The soap and camphorated liniments are as good as any that can be employed. In many cases, unattended with any threatening appear- ances of inflammation, but in which there is a good deal of bruised blood and fluid, bandages act very beneficially, by the remarkable power they have of exciting the action of the .ymphatics (absorbents) by means of the pressure which they produce. A third object in the treatment in contusions, is to restore the parts to their proper tone. Rubbing the parts with lini- ments has a good effect in this way. But, notwithstanding such applications, it is often observed that bruised parts con- tinue for a long while weak; and swell, when the patient takes exercise, or allows them to hang down. Pouring cold water two or three times a day, on a part thus circumstanced, is the very best measure which can be adopted. A bandage should also be worn, if the situation of the part will permit. These measures, together with perseverance in the use of lini- ments, and in exercise, giadually increased, will soon bring everything into its natural siate again. SPRAINS. Injuries of this kind generally affect the wrists, ankles, and knees, being produced by sudden or violent exertions, slipping, or falling, etc. They are followed by violent pain immediately, and then swelling and inflammation. There is generally a rupture of the blood vessels within, and consequently an effu aion of blood. The skin is not discolored for some hours after which it generally becomes of a dark bluish or red color jocreasing or disappearing, from the inflammatory state, in proportion to the extent of injury. The best remedy for lessening the effects of a sprain, ia that 288 Wounds. nearest at hand—cold water. As soon as the accident hap- pens, the part should be plunged in cold water, or a fe* pitchers of cold water poured over it. The next remedy is rest,perfect rest: the part being kept rather elevated, never hanging down. The cold applications stop the effusion of blood, and promote its absorption : the elevation of the part retards the passage of blood to it. It is customary to appljr brown paper, (rags are as good), wet with vinegar, or spirits, and water to the part, and continue them wet on the part for sov eral days. Sugar of lead and water, a teaspoonful to the ptot is also a good application. Spirits of comphor, or opodeldoc, may with advantage be rubbed over the part, and it should gently be daily rubbed with the hand or a ball of cotton. Should inflammation come on, you must purge freely, liva on low diet, and continue the cool applications of sugar of lead and water, etc. Leeches on the spot most inflamed, will do great good, and so will cupping near it. If the part be much dis- tended and painful, poultices at night of flaxseed, or elm bark, will aid in removing it. But if you will have patience in the first instance to confine yourself and follow the first directions, you will probably never have need of other advice. But from very trivial accidents of this nature, the neglect of necessary precaution has been followed by a loss of the joint, by stiff- ness, by decay of the bone, and loss of the limb in conse- quence. If pains or numbness remain after the sprained part ia otherwise relieved, the pouring of water on it from an elevated Bpout, and frequently rubbing it with camphorated spirits, two or three times a day or more, will be the proper remedies. WO UNDS. In cases of wounds, even of a trifling nature, comparatively, there is generally much excitement. This should be over- come by the exercise of good judgment and common sense. Then, the first circumstance, generally, which calls for atten tion as the consequence of a wound is the effusion of blood, but none of the consequences, perhaps, exhibit greater varia- tion. Sometimes an extensive injury may by inflicted, even the arm torn off at the shoulder, and yet the loss of blood be extreme.y small; on the other hand, a puncture with a pen- knife, if it penetrates an artery, may be sufficient to place life in the greatest immediate jeopardy. As a general rule, prob- ably, putting the opening of large vessels out of the question a greater amount of blood is lost after simple cuts than after any other description of wound. When laceration or bruising Wounds. 289 takes nlace, there is usually, by stretching, or otherwise, of the coats of the arteries, a sufficient amount of mechanical imped- iment caused to modify greatly, if not wholly to prevent, any hemorrhage. When a wound is small, the best method of treatment is to tie it up at once with a piece of linen rag; thia is usually sufficient at once to stop the bleeding, particularly if rest and position are attended to; the small quantity of blood which may exude, quickly dries upon the wound, and forms a kind of glue which effectually excludes the air. As no better dressing can be used, it may be left on till the cut is well; in some cases, before using the linen, it may be advisa- ble to draw the edges of even a small cut together, by means of adhesive plaster, or material of some kind. Although linen is mentioned in the above directions, of course, should it not be at hand, soft calico may be used, or other soft material. When a wound is extensive and the bleeding jrofuse, it will not do to bind it up in this way; first, ocscause it proba- bly would not be sufficient to arrest the flow, and if it did so ultimately, it would retain a large amount of clotted blood, either in or about the wound, in such a way as to interfere with the healing process. In a large wound, therefore, it ia necessary that the bleeding should be almost entirely arrested before it is dressed, that is, closed up, &c. It should be borne in mind that the first end in view when a wound is dressed, is to get as much of it as possible to heal by the " first intention," or by " adhesive inflammation;" that is, to get the several parts to adhere at once, without formation of matter, and thus with as little pain and trouble as may be. When the wound is a simple cut, this desirable termination may be expected, and often realized. To attain the end, how- ever, in many wounds, considerable care is requisite. In the first place, the wound must not be closed so soon as that a clot of blood will form between the exposed surfaces ; if it does, un- less extremely thin, it will prevent union. In the second place, when the wound is closed, its surfaces must be placed in aa accurate a position as possible, and must be thus kept together till the process is complete. To effect and maintain this con- tact, various agencies are employed, and of these, position is not the least important, that is, the placing of the parts so that the surfaces of the wound may, as far as possible, fall into con- tact, and that, when other dressings are applied, there may be no dragging to get things to meet. Thus, in a wound of the forepart of the neck, it is requisite to fasten the head so as to prevent its being thrown back. At the same time, position must be regulated with a view to prevent hemorrhage. Tho 290 Wounds. wounded parts being properly placed, the next object ia to iraw the surfaces into as close a position as possible ; in some cases, this is sufficiently well done by means, of strips of ad- hesive plaster, placed at such intervals as will permit discharge of matter, should any form. Frequently, however, from the nature, site, or extent of the wound, plaster is not sufficient to keep the edges together, or to counteract the natural ten dcncy of the skin to retract when severed. In such instancea, stitches are employed. These consist of a piece of a sufficient- ly stout silk or linen thread passed through the thickness of the skin, at about the distance of a line from each of the sev ered edges. The thread is passed by means of a curved surgi- cal needle, if it can be had, and the two ends being tied, bring the edges together, and retain them most effectually in contact; that is, provided the stitch is not made use of to drag parts in- to place; this it should never do. If there is a continued strain upon the stitches, not only do they cause much pain, but they quickly cause ulceration, which, by detaching, renders them perfectly useless. The surfaces of a wound having been brought into contact, a piece of thin linen, soaked in water, Bhould be placed over it, and if possible, a lightly applied bandage. This not only keeps the dressing in place, and assists to exclude air, but gives support, which is always ser- viceable, and often, in large wounds, absolutely necessary. The bandage may be kept wet with cold or tepid water, as most agreeable to the feelings of the patient. When a wound pro- gresses well toward recovery, when there is no appearance of discharge, or so little that it is neither inconvenient nor offeii eive, there should be no meddling; the less the processes of reparation are disturbed the better, and in some cases a week may be allowed to elapse before the dressings are disturbed; they may of course require it before, especially in warm weather. It ought to be remembered, that in the treatment of all wounds, it is important to exclude the action of the air aa far as possible; and, that rest, simplicity, and cleanliness, are the great promoters of healing ; the last being best attain- ed by the use of water alone. No balsams or similar applica- tions should be employed ; and, except it be a little perfectly aweet fresh lard occasionally, ointments may be entirely dil pensed with. The above observations have been directed specially to aimple incised wounds; when laceration or contusion accom panies the injury, the principle must be to get the wound a* much into the condition of a simple incision as possible. To do thia—the wound having been thoroughly cleansed from Wounds of the Joints. 291 dirt, grit, &c, by means of a soft sponge and water, and any foreign body which can be easily reached, removed—all parts not absolutely detached from the body are to be placed aa nearly as possible in the natural position, stitches and plasters being used to retain them, and free exit left for the discharge of matter; over these there must be applied either poultice, or cloths dipped in cold water, and a bandage may be necessary or not, according to circumstances, which those in attendance must direct to the best of their judgment. Punctured Wounds.—As a general rule, these require no other treatment than the extraction of any foreign substance which may be left in them, when it can be easily done ; and to lessen the chance of inflammation, by keeping a warm poultice on them, to preserve the surface relaxed, and facili- tate the discharge of any matter which may be formed at the bottom of the puncture. When inflammation is threatened, the means to prevent and lessen it have been pointed out under head of Bruises, &c, and should be pursued. These wounds sometimes end in convulsions of the muscles, and are most apt to be followed by lockjaw. # Sometimes it is found necessary to dilate the wound and fully divide any aerve or tendon which may have been punctured ; sometimes a blister over the part has succeeded without the division. WOUNDS OF THE JOINTS. In all cases of wounded joints, it is important to place the limb in such a posture as to favor the union of the sides of the wound, in order to prevent the admission of air, which seldom fails to produce general irritation. Not only absolute rest ia to be enjoined, but a very low diet, with slight laxatives. The parts should always, when practicable, be brought together, and kept so by slips of adhesive plaster, in preference to sewing thein up : and when they are to be stitched, the needle should anly pass through the skin, and never to enter the cavity of \,he joint, where they would increase the inflammation. Treat- ed in this way, they very generally speedily unite without inflammation. In order more effectually to procure absolute rest of tha joints, it is necessary to apply splints to fit the parts, which being lined with soft materials, occasion no inconvenience. Ia grounds of the knee, ankle or elbow, these splints are india- pensably necessary. When there is reason to apprehend a stiff joint, it is necessary to choose the position of the limb in adiien the stiffness will be least inconvenient to the patient, and to preserve that posture during the cure. If, for example 292 Whitlow or Felon. the elbow were to heal with the arm permanently extended, the limb would be almost useless; whereas, an arm bent al the elbow, may be useful.—And the reverse in the knee, as an extended leg would favor walking. WHITLOW OR FELON. This is a disease with which very many persons are pain fully acquainted. It is a painful and distressing inflammation, seated at the end of a finger or thumb, generally terminating in the formation of matter. The inflammation appears in dif- ferent parts, either at the root or side of the nail, or near the end of the finger, or underneath the whole of the soft parts : or underneath the immediate covering of the bone, and the bone itself. The most distressing kind is that where the ten- dons are affected, and the inflammation extends along the hand, up the arm—sometimes rendering amputation necessary. In the treatment of this affection, we should act with an en- ergy proportionate to the degree of disease. In all cases of fever, blood-letting by leeches, from the part, purges and low diet, should be enjoined. In common cases, repeatedly scald- ing the finger by suddenly dipping it in boiling water, provea sufficient. It is much better to use the strongest lye, than ■water for this purpose. Coating the entire part with caustic, (nitrate of silver) will also sometimes check the disease. A blister plaster should be applied around the whole finger, ia order to excite action on the surface, to relieve that under- neath ; and it ought to be kept continually discharging. When matter is formed under the nail, it should be scraped away over it, and a small puncture made for letting it out. When- ever there is reason to believe that matter is formed in any part, by all means, freely cut down to it, and give vent to it. Immediate relief from pain will be had, and an end be put to the danger of prolonged, distressing, and dangerous inflamma- tion : for the subsidence of the inflammation and healing of the part are very rapid; whereas, when the parts burst, as in tominon boils, these operations are very tedious and painful. Of course, after opening a felon in this manner, poultices fhould be frequently applied until the healing is nearly com- pleted, then Basilicon ointment is more proper, or some heal ing ointment twice a day. Cancer. 293 CANCER. Thib disease is not treated of here with the expectation that the unprofessional will at any time attempt the cure of thia most dreadful malady, but to point out its symptoms, that it may be guarded against in time, and also to offer such sug- gestions for the alleviation of the sufferings of the patient aa may be employed when a physician can not be had to attend to it. Cancer is of two kinds, the scirrhous, or hard, and the open or ulcerated ; but these may be more properly regarded aa different stages of the same disease. By occult or scirrhoua cancer, is meant a hard tumor, for the most part accompanied by sharp darting pains, which recur more or less frequently. This tumor, in the course of time, breaks and ulcerates; and then is more strictly denominated cancer. The parts of the body subject to cancer are the following: the female breast and the womb ; the lips, especially the lower one, the tongue, the skin, the tonsils, the lower opening of the stomach, and some other parts, chiefly glandular. Chimney-sweepers ara Bubject to a cancerous affection of the scrotum. In general, cancer begins at a small spot, and extends from thence in all directions. Its progress is more or less quick in different instances. In general, it is too true, that scirrhus is seldom or never dispersed, and that it causes, finally, the neigh- boring parts, whatever tlieir nature may be, to put on the same diseased action ; aud thus the skin, the muscle, &c, are all involved in the same destructive process. In consequence of this morbid action, the skin above a cancerous tumor be- comes attached to it, and the tumor is also attached to the muscles below. The tendency to this unhealthy action begins in the neighboring parts, even before it can be distinctly seen. As the swelling increases, it becomes knotty and unequal on Its surface, and this inequality has been considered as charac- teristic of the disease ; almost in every case a darting pain is experiencee. The hard swelling which is likely to termin- ate in cancer, is attended generally by the following assemblage of symptoms : the skin is puckered, and of a dull, livid, color, the part is knotted and uneven, occasional darting pains shoot through it; it is attached to the skin above, or to the muscles beneatli; and in some cases there is a peculiar unhealthy look about the patient. The skin generally may become the seat of cancer. Of the internal organs, the womb in the female, and the stomach, are the most frequent seats of the disease. Cancer is very rare under thirty years of age. When, from the nature of a tumor, its hardness, situation, age of the patient, and particularly if there be any hereditary bias to 294 Cancer. ward the disease, incipient cancer is suspected, there shonld be no trifling, no leechings, or rubbing, or fomentings; the advice of a skilful surgeon should be sought at once ; and neither time, distance, nor expense, should stand m the way of procuring that assistance which may not only preserve life, but save from a lingering and painful death. Should the suspicion be unfounded, the mind is restored to peace; should they be correct, the one remedy, excision, or cutting out, cannot be too soon submitted to, before the glanda adjacent to the disease, or other textures of the body, becoms tainted. In any stage of the disease, however, the advice ol the regular practitioner ought to be taken. Above all, let the sufferer and the friends beware of being tempted by the adver- tisements of quack remedies, and of wasting time of which every day is precious. Those who advertise to cure cancer, you can always set down as impostors; it cannot be done—only Dy cutting out. Many swellings and sores called cancer hava been healed by simple remedies, these are the great cures per formed by cancer doctors, and cancer remedies. If cancer has reached the stage at which hope of cure must be given up; when it has become an open, grey-looking ulcer, discharging thin, offensive matter, the seat of shooting and stinging pain, and when the constitution is affected, it only remains to make the situation of the sufferer as comfortable aa possible. Opium in its various forms is the great soother, and the other anodynes, hemlock, especially, both internally and as a poultice, are all of service. Codliver-oil in some cases allays the pain and retards the progress of the disease; but the regulation and administration of these remedies must be com- mitted to the care of the medical attendant; the domestic remedies must be the most perfect cleanliness and kindest con- sideration for the comfort and irritabilities of any one who is the victim of cancerous disease. Cancer cannot be said to be propagated by contact; but this should be avoided as much as possible—in the intimate relations of husband and wife especially, whatever the organ or structure affected. The lower lip is not unfrequently the site of cancer in old people, especially, it is said, in those who smoke much. A pain- ful sore in this situation, which will not heal ought not to be neglected, but submitted to medical examination. If there was no other reason why the use of Tobacco should be avoided than this one danger arising from smoking, this should be enough. Beware of tne poisonous weed which costs millions of money every year, and destroys so many valuable lives without being of any possible advantage to compensate for ;ts destructive properf.ea. Deafness, and Diseases of the Ear. 216 DEAFNESS, AND DISEASES OF THE EAR. The external ear may be lost by violence, as by cutting off or the bite of an animal, etc. If we see it soon after an accident, and find it much lacerated (torn), we are to at- tempt its reunion by adhesive plasters, and even by stitches, if necessary. When a bandage is applied it should be only moderately fight, as pressure in this place gives considerable uneasiness. Wounds, and loss of a part, or even the whole of the external ear, do not always occasion deafness. If thia eccure from such a cause, an ear-trumpet or similar con- trivance must be used. Foreign bodies, as peas, bits of glass, or cherry-stones, may get into the ear, and occasion great pain of the part, as well as impaired hearing. Such bodies have been known to occasion for many years excruciating pain of the head, palsy, convulsions, and other distressing symptoms, all which have speedily ceased when a skilful hand has ex- tracted the offending body. Such bodies should be forced out if possible, by the injection of warm water and the applica- tion of a small scoop or bent probe. Worms have been known to produce very violent symptoms, by being hatched in the ear. When there is disease, as ulceration or suppura- tion in the ear, insects are attracted by it, and deposit their eggs, which in time produce worms. Patients so affected Bhould take care to stop the ear wiien they go to sleep, in summer and autumn. A slight infusion of tobacco in oil of almonds may be dropped into the ear; and this proves fatal to worms. A very frequent cause of deafness or impaired hearing, is the obstruction of the passage by thickened or hardened wax. The symptoms arising from this cause are deafness, a sensation as of a noise or clash when eating, or of heavy sounds, as of a hammer. This kind of deafness is not very difficult of cure. A little olive oil, or oil of almonds is to be dropped into the ear, and retained there by a piece of cotton; and when the wax ia softened, it is to be taken out with a small scooped instrument. Injecting warm water with a little soap, by a ayringe, is a method of getting rid of the hardened wax, equally simple and efficacious. A deficiency of the wax may occasion a degiee of deafness. When this is the case we are to drop in two drops every night of the following mixture Sweet oil, spirits of turpentine, sulphuric ether, of each, equal parts. Shake well before using. The bowels must be kept fently open. When the wax is of bad quality, which ia nown by its deviation from the healthy color and consistence, it may be improved by frequently washing the passage; and 296 Deafness, and Diseases of the Ear. giving once or twice a day, a wine-glassful of the infusion 01 tea, of quassia with a teaspoonful of equal parts of rhubarb and magnesia. Discharges of matter take place from the passage in consequence of inflammation going on to suppura- tion, from scrofulous ulcers, from abscesses after fevers, from small-pox, measles, and other causes. These discharges not unfrequently are attended with the loss of the small bones j and in general, total deafness is the consequence. Exposure to cold frequently produces inflammation about the ear, at tended with very acute pain, (commonly termed ear-ache), which continues very troublesome, and even alarming, till the patient is relieved by the discharge of matter. This innam matory state is to be treated by local bleeding (leeches and cupping), the injection of tepid water, and by fomentations of hops, or hoarhound and vinegar, and the passage should be protected from cold air by the introduction of wool or cotton- Sometimes there is disease in the drum of the ear, attended with offensive, thick discharge, which makes its appearance at the internal opening, shows that the membrane of die drum is destroyed ; and so much disease is in the internal parts, thai the small bones are discharged externally. In time, a con- tinual discharge from the ear takes place, and thvj disorgan- ization is so complete, that a total loss of hearing is the con- sequence. If this disease be noticed in its early stage, if there is acute pain, followed by a discharge of matter, we know it is from inflammation, and we are to palliate or remove this by topical bleedings (leeches and cupping), purgatives, and small doses of ipecac every three hours; and are on no account to inject stimulating spirituous fluids. When the disease threat- ens to be more chronic, we are to use blisters and setons, aa auxiliaries to our cure; to employ laxative medicines, and to foment the part as before noticed; and when there is little active inflammation, to throw in a stringent injection as of sul- phate of zinc, a teaspoonful to half a pint of water. If there are fungous growths (proud flesh), they are to be touched with caustic. Sometimes there is deafness from insensibility of the nerves of hearing, though the structure of the parts may be perfect. If we can ascei tain this to be the case, we are advised to put the patient on low diet, and to give saline purgatives, seidlitz powders, salt c, etc., once or twice a week, applying blisteru occasionally beaiad the ears. The application of electricity may oe tried. Moiiification. 297 MORTIFICATION. The following symptoms will indicate that mortification haa taken place. When any part of the body loses all motion, aensibility and natural heat, and becomes of a brown, livid, or black color, it is said to be affected with sphacelus, that is, complete death or mortification. As long as any sensibi- lity, motion, and warmth continue, the state of the disorder fa termed gangrene or mortification. In inflammations of the external parts which terminate in mortification, the process observed is as follows: the pain eeases, the purulent, thick matter, becomes acrid (irritating) and sanious, (watery), bubbles of air are set at liberty, collect- ing in small blisters under the skin, or distending the whole organ by swelling. The blood is coagulated (clotted) in the vessels of the gangrened part, and the circulation can not be restored. In many cases, a slight delirium comes on, followed either by dejection of spirits or calmness of mind ; but in each case attended with a peculiarly wild expression of counte- nance ; though sometimes with a very peculiar expression of serenity, and a blackness under the eyes. The pulse is usually quick, low, and often. intermitting. In the earliest stages, deep incisions are attended with a discharge of blood, still florid (or red), but the skin, the muscles, etc., soon melt down into a brownish offensive mass. We conclude that similar processes take place in the internal parts when they become mortified. When this occurs in strangulated hernia, (rupture) or in inflammation of the bowels, a remission of the violent pain takes place, and the patient and his friends are deluded with the hope of complete relief; but the experienced physician knows the treacherous symptom, and must not deceive them with false hopes. There is a peculiar kind of mortification called dry gangrene, in which the disease begins in one of the toes, particularly in old people, and very often after a person has been paring a corn or toe-nail. It sometimes stops spon- taneously, and deprives the patient of some of his toes, or even of his foot and leg, as cleanly as if it had been amputated by a surgical operation: at other times it has been successfully treated by giving large doses of opium. In this form of mor- tification, the parts affected are perfectly dry, hard, and not liable to run into putrefaction. Mortification is brought about by general or local causes. Those which affect the general systejn, are the violent infiam- matorj fevers, or the jail and hospital fever; as also scurvy and dropsy, long-continued or intense cold, and some internai changes, which we can not trace nor explain. The local causes 298 Mortification. of mortification are numerous. Some of them are burns, ea cessive cold, the application of caustics, the strangulation ol a part, as in hernia, severe bruises, as gun-shot wounds, bad fractures, violent inflammation, pressure on large blood-vessels, by tumors, &c. Long continuance in one posture, as when a person is confined to bed, gives occasion to gangrene of the parts where the bones have the least flesh upon them, and which are therefore much exposed to pressure ; as the'shoulder blades, the haunch-bones, and the lower part of the spine. Hospital gangrene is produced by some indescribable state of the air in hospitals, jails, and ships. During its prevalence, the small- est scratch or ulcer is apt to turn to a fatal gangrene. In dropsy, occurring in a broken-down and debilitated constitu- tion, if a few punctures be made to let out the effused fluid, or a blister be applied, these are apt to run into gangrene; it is also not unusual for spontaneous blisters to form and break on such dropsical limbs, and to go on to mortification. When inflammation is so violent and strong as to give reason to fear that it will end in mortification, it is a call for us to use with great dilligence, purging, low diet, cold applications, and the other means for abating it, taking care that we do not continue them too long, lest we add to the debility and exhaus- tion which are to follow. When the mortification has fairly begun, our remedies must be very different from those which counteract inflammation. We are now to prevent debility by giving a nourishing diet and tonics. Of the class of tonics, the most efficacious is the Peruvian bark; and in a great variety of cases, the good eff'ecta of the Peruvian bark are very remarkable. Taken in the form of tea, (cold), a gill three times a day; or one tablespoonful of the tincture. When the weakness is very great, the use of quinine, two grains three or four times a day, or wine may occasionally be required, as also ammonia and other stimulants. We must be careful not to give these remedies when there is much strength of pulse and inflammatory symptoms remaining. When our remedies are successful, and the mortification is about to cease, a separation takes place at the verge of the sound part, caused by a slight degree of inflammation. Some have advised cold lotions near the verge of the morti- fied part, to check the further progress of inflammation; bu fomentations and poultices are commonly preferred. To the common poultices, in some cases, are added powdered charcoal or yeast, to correct the offensive odor and to counteract putre faction Stale beer grounds, or port wine, with linseed meal, make a good poultice. It is necessary to give vent to putrid Foreign Bodies m the Gullet or Throat. matter, and for this purpose pretty deep incisions are required through the dead parts. After the mortified parts have completely separated, and a healthy running ulcer is left, the latter is to be treated by common poultices, until healing commences, when the use of strips of adhesive plaster applied over the surface of the ulcer. and proper bandages, will, in general, cause it speedly to heal aver. Washing the parts with castile soap and tepid water, ii also advisable. FOREIGN BODIES IN THE GULLET or THROAT. It is not at all an uncommon occurrence for foreign bodies to stick in the gullet, as pieces of crust, or meat not completely chewed, or small bones, beans, stones, pins, or pieces of money. Some of these would produce a very bad effect if not quickly removed from the gullet; and perhaps still worse, if pushed down into the stomach ; but sometimes pretty large bodies have passed downwards into the stomach, and have been dis- charged by stool in a few days, without any inconvenience. Pins and other sharp bodies, when they have stuck in the throat, have been returned by swallowing a piece of tough meat tied to a strong thread, and then pulling it up again. If the detained body can be with safety pushed down, the pro- bang, a flexible piece of whalebone, with a piece of sponge se- cured to its end, is the proper instrument. If the bodies can not be easily moved up or down, endeavors should not he con- tinued long, lest inflammation come on. When endeavors fail, the patient must be treated as if laboring under an inflam- matory disease, and the same treatment will be required if an inflammation takes place in the part, after the obstructing body Is removed. A proper degree of agitation has sometimes suc- ceeded in removing the body sticking in the gullet, better than instruments. Thus, a blow on the back has often forced up a substance that has stuck in the gullet, or passed into the wind- pipe. Pins which have stuck in the gullet have been dis- charged by ridinsr on a horse or in a carriage. Above all things, in oases of this kind, try to " keep cool, as the saying is, for in the excitement more harm may be done than good. A knowledge of the nature of the substance in the throat should direct you in extracting it; always being careful in the use oi anything in the shape of a hook, that the throat may be not in- jured ; uie patent must he firmly held, to avoid accidents from nia sudden movements. 300 Gravel. GRAVEL, or STONE IN THE BLADDER. In this disease it must be observed that the urinary sand oi gravel deposited on the sides or bottom of a receiving vessel is of two kinds, red and white ; and it is of great importance to distinguish the one from the other, as they proceed from different causes, and require a different mode of treatment. The symptoms of red gravel are well known. The shade of color may vary from a reddish brown, or pink, to a perfect red In such cases the urinary secretion is generally small in quan- tity, and high colored, and the disease inflammatory: the nearer the deposit approaches to a perfect red, the more severe in general are the symptoms. White gravel is less common, but has long been observed to be attended by very distressing symptoms. These consist in great irritability of the system, and derangement of the digestive organs generally. There is often a sallow, haggard expression of countenance ; and as the disease proceeds, symp- toms somewhat analogous to those of diabetes, (or great flow of urine), begin to appear, such as great languor and depression of spirits, coldness of the legs, and other symptoms of extreme debility. The urine is invariably pale, aud voided in greater quantity than usual; and after standing, for a greater or less time, always deposits a most copious precipitate of a white fine powder. In all such cases, the urine is extremely prone to decomposition, and emits a most disgusting odor. The chief cause seems to be a want of constitutional vigor, and especially in the digestive organs; the periods of life in which this disease occurs .most frequently, are from infancy to the age of puberty, and in declining years: while it is rarely met with during the busy and restless term of the prime of life, these complaints being seldom met with in warm climates. The drinking of hard water often influences very sensibly the state of the complaint. White gravel may often be very dis- tinctly traced to an injury of the back. In a healthy state the urine is always an acid secretion, and it is the excess of its acid that holds the earthly salts it con- tains in solution. If, from any cause, it be deprived of this ex cess, or, in other words, the secretion of its acid be unduly diminished, the earthy parts are no longer held in solution, and a tendancy to form white sand or gravel immediately com- mences. If, on the contrary, the acid be in greater excess than usual, instead of deficient, or if the natural secretion of the earthy constituents of the urine be deficient, while the acid retain its usual measure, the acid itself has a tendancy tc form a deposit, and hence the modification of red sand or grave/ Gravel. 301 that ia ao frequently found coating the bottom of chambci utensils. It is proper to remark that the red gravel is by far the most frequent kind of deposit, and the most effectual lemedies for it are the alkalies, and the alkaline carbonates, such as lime- water, the carbonate of potash or soda, and magnesia. Butte be realy useful, they must be conjoined with a proper diet, ton- ics and mild purgatives; for it ought never to be forgotten, in the treatment of gravel and stone, that they owe tlieir formation chiefly to an irregular and vitiated action of the digestive or- gans, which will invariably require this conjunction, in order to the accomplishment of a permanently beneficial effect. Half a drachm, or a drachm of carbonate of potash, or soda, may be given dissolved in water, two or three times a day, with an alterative pill of blue mass, five grains, ipecac one grain, rhubarb three grains ; the following draught being taken every morning, or every other morning, as a gentle and suitable pur- gative. Take of Rochelle salt two 01 three teaspoonfuls, car- bonate of soda half-teaspoonful, water three tablespoonfuls— mix, and after adding a tablespoonful of lemon-juice, or thirty grains of tartaric acid, let it be drank immediately. Magnesia, in this species of gravel, is of considerable use. It may be taken either alone, in doses of ten grains twice a day, or combined with the carbonate of soda, in the proportion of six or eight grains of the former, to ten grains of the latter, twice or three times a day. Or ten grains of magnesia may be dissolved in a glass of soda water, which is an excellent way of administering it. Ten or fifteen grains of the carbonate of ammonia, twice a day form likewise a useful medicine, especially in cases where great languor, or weakness and coldness of the stomach, is present. The ammonia is a powerful corrector of ascidity, and a most valuable cordial. A very convenient and valuable mode of combining an al- kali with an aperient, and gentle bitter tonic, is the following; it is worthy of particular regard when weakness of the stomach, costiveness and red gravel are combined : take of carbonate of 6oda ten grains; Epsom salts half a drachm or a drachm; infusion (tea) of gentian, three tablespoonfuls; tincture of cardamon seed a teaspoonful—mix for a dose, to be taken three times a day The bowels should be kept gently open by it, and, therefore, the Epsom salt may be either increased or diminished, as needed. Uva ursi is both tonic and astringent, and has been spoken well of, for its virtues in gravel and stone, by physicans of high aathority. It may be combined or alternated with the alka- 302 Gravel. lies; and where general debility exists, or there ia a discharge >f pus-like matter from the bladder, denoting ulceration, or a faulty condition of its secreting vessels, it is at once an appro- priate and excellent medicine. The dose is from a half to one teaspoonful of the powder, twice or three times a day; or a strong tea may be made by pouring hot water upon the leaves of the plant; to three tablespoonfuls of which may be added ten grains of bi-carbonate of soda, and drank three times a day. In cases of white gravel, it may be given in conjunction with the nitric or mutriatic acid, ten drops to the pint of uva ursi tea, to be taken through a quill or straw, to protect the teeth. The diet of persons troubled with red gravel should be mod- erate in quantity, but of a nutritious and wholesome quality, consisting principally of fresh animal food and vegetables. All acids must be carefully avoided, and likewise heavy bread, fat meats, hard boiled puddings, and soups. Active exercise is of great importance in all gravelly dis orders; and flannel should be constantly worn next the skin. Now, in regard to the cases of white sand or gravel, an acid is the best medicine, and all the acids seem to answer the pur- pose, though the muriatic, nitric, and citric acids, have been in the greatest repute. The citric acid, or lemon-juice, is pr> ferable for children, as being the pleasantest, and that which may be persevered in for the longest time: it may be mixed with water in any proportion that is agreeable. The muriatic acid may be given in doses of from five to twenty drops, twice or three times a day, in a wineglassful of water; and th« nitric acid in doses of from five to twelve drops, in the sama proportion of fluid, to be sucked through a quill or straw, to prevent injury to the teeth. The diet should be nutritious, easy of digestion, and mode- rate in quantity, and be as largely as possible intermixed with acids, salads, fruits, and especially oranges and lemons. Wa- ter, saturated with carbonic acid, to be found in most of the drug-stores, in the form of " carbonated water," is the best common beverage in this kind of gravel, and, attention being paid to diet and exercise, will sometimes be alone a sufficient remedy. When pain attends the gravei, opium or extract of henbane should be occasionally administered, according to the urgency of that symptom. Thirty or forty drops of laudanum, or twen ty of the solution of sulphate of morphia, or from five to ten grains of the extract of henbane, may be given alone, or in any drink which the patient may be taking, and repeated until the pain is relieved. Opium seems generally preferaHe in thf Gravel. 303 vhite gravel; and henbane in the red. In white gravel, the solution of acetate of morphia is particularly indicated as an anodyne, since the acid it contains is an appropriate and efficient remedy for the complaint, and, at the same time, counteracts the injurious effects likely to result from the frequent use of opium, when taken in any of its common forms. In case of great pain and irritation about the urinary organs, an opiate injection will be proper, and often of much service; (ten to twenty drops of laudanum, in half pint of tepid water,) or two or three grains of opium may be made into a pill, and inserted within the lower portion of the bowel as a suppository. A burgundy pitch or galbanum plaster may be applied over the loins with advantage. Whether the gravel be white or red, when a small stone passes from the kidneys into the bladder, there is generally a fit of pain and irritation; to relieve which, the warm bath, or hot fomentations of hops, wormwood, &c, together with forty or fifty drops of laudanum every three hours, will be the most proper and effectual remedies. The passing of a small stone from the kidneys to the bladder, is denoted by a fixed pain in the region of the affected kidney, with a numbness of the thigh on the same side. The pain is sometimes very acute, and ac- companied with nausea and fainting, but the pulse is rarely accelerated. During the whole of the passage from the kid- neys, the urine is usually high colored, and frequently mixed with blood. Stone in the Bladder.—The symptoms of stone in bladder are, a sort of itching along the urethra, particularly at the extremity; frequent propensities to make water, and go to atool; great pain in voiding the urine, and difficulty in retain- ing it; the stream of urine being liable to stop suddenly, while flowing in a full current, although the bladder is not empty, so that the fluid is expelled by fits as it were; and tha pain being greatest towards the end of, and just after the eva- cuation. There is a dull pain about the neck of the bladder, together with a sense of weight, or pressure, at the lower part af the belly; and a large quantity of mucus (or slime) is mixed with the urine, and sometimes the latter is tinged with blood, aapecially after exercise. The causes of stone in the bladder are the same as thoa which give rise to gravel. The medical treatment to be employed in cases of stone is precisely the same as that for gravel, both in regard to the re- medies and diet. There is this difference between gravel and none, that, in the former, active exercise is highly advisable; 304 Strangulated Hernia, or Rupture. whereas, during the actual presence of stone in the bladdeT the patient's exercise ought, for obvious reasons, to be less ac- tive and constant. An injection of castor oil has great effect in relieving thi sufferings occasioned by stone in the bladder; the introduc- tion of a lubricating fluid into the bladder, under such circum- stances, is productive of ease and advantage. One or two ounces injected when the bladder is empty, through a catheter is about the proper quantity, used once in every two or thred days, as may be necessary. STRANGULATED HERNIA, or RUPTURE. As this is liable to occur at any time, in those who are rup- tured, if not protected by a proper truss, it should be care fully studied, so that it can be detected in time to send for medical aid. When either an old rupture from some cause has become strangulated, or when some sudden exertion has at once produced rupture and strangulation, the following symptoms occur : there is a swelling at the place of the rupture, painful to the touch, and increased by coughing, sneezing, or by the upright posture. These symptoms are followed by sickness, retching, costiveness, with a frequent hard pulse, and other attendants of fever. The cause of these symptoms is the stric- ture made on the bowel, by the part through which it pro- trudes. The object of cure, is therefore to relieve the bowei from this pressure, which is to be effected either by returning the intestine into the belly, by the same aperture through which it came out, or by enlarging the aperture by an opera- tion, which can only be done by a surgeon. Our first efforts should be to replace the bowel by the hand, if possible; and various methods are to be put in practice, to produce the relaxation necessary for that purpose: place the patient on his back, with the thighs and knees bent; and make pressure on the tumor in a direction obliquely upwards and outwards, if it be an inguinal hernia, (running obliquely a.ong the lower portion of the abdomen,) but the pressure must at first be made downwards, towards the thigh, and then apwards if the hernia be femoral, (running down into the upper part of the thigh.) In a young and strong person, bleeding is very proper, both to induce relaxation, and to pre- vent inflammatory symptoms. The warm bath may be tried also to induce relaxation. With a view to diminish the bulk of the swelling, and so to render it more easily replaced, cold has been applied to the external parts, by means of ice or of ether. An injection of the infusion of tobacco produces as Ulcers, or Sores. 505 extreme relaxation of the whole system, and so has conduced to the replacement of protruded bowels. The strength of the infusion is a drachm of the leaves to a pint of boiling Water; this is infused for ten minutes; one-half is injected at first, and the other a little afterwards, if no proper effect is produc- ed by the first. The tobacco injection is, however, a remedy of the greatest danger, and must never be administered, except by an experienced practitioner. These attempts to reduce the bowel, may be made for a longer or shorter period, according to the symptoms of each case. Much handling will add to the danger of inflammation which is already so great; and too long delay will allow the bowels to get into a state of mor- tification. Always procure a physician in these cases, if possible. Ruptures in Infants.—Ruptures in different parts, espe- cially at the navel, are not unfrequent occurrences in infancy; fortunately, they are not attended with so much danger as similar disorders in grown people. When the disease is confin- ed to the navel, a broad piece of flannel, in the form of a roller, together with pieces of adhesive plaster applied over the part with a ball of cotton, forming what has been termed by surgeons a graduated compress, by affording a safe and firm support, prove so useful, that as the infant acquires strength, the rupture commonly disappears. The other varieties of rup- ture are often cured by the natural increase of size and strength in the body, and require chiefly attention to the due regulation of the bowels, and the daily use of the cold bath. No truss ought to be employed for at least the first two years of life. ULCERS, or SORES It may seem almost unnecessary to state that there are a great many varieties of ulcers, requiring a corresponding va- riety of treatment. We have first the Simple Purulent or Running Ulcer.—Some ulcers are covered with matter of a white color, of a thick consistence, and wdiich readily separates from the surface of the sore. There is a number of little eminences covering the bottom of he ulcer, called granulations, which are small, red, and point- ed at the top. As soon as they have risen to the level of the surrounding skin, those next the old skin become smooth, and are covered with a thin film, which afterwards becomes cloudy looking, and forms skin. The principal thing to be done in the treatment of this kind of ulcer, is to keep the surface clean, by putting on a little dry lint, and a pledget (severaj folds of muslin) over it, covered with simple ointment, made of equal parts of lard, beeswax and tallow. In some patients, 306 Ulcers, or Sores. ointment irritates and inflames the neighboring skin. Ban- dages sometimes irritate the sore, and disturb the healing pro- cess; but Avhen they do not, they are useful in giving a moderate support to the parts, and in defending those that are newly formed. Ulcers in Weakened Parts. Other ulcers are in parts which are too weak to carry on the actions necessary to their re- covery. In them, the granulations are larger, more round, and less compact than those formed on ulcers in healthy parts. When they have come up to the level of the healthy parts, they do not readily form skin, but rising still higher, lose alto- gether the power of forming it. When the parts are still weaker, the granulations sometimes fill up the hollow of the ulcer, and then are suddenly absorbed, leaving the sore as deep as ever. Ulcers are very much under the influence of what- ever affects the constitution ; and change of weather, emotions of the mind, and some other agents, quickly occasion a chango in their condition. Such ulcers as we have been describing, require general as well as local treatment; one grain of quin- ine three times a day, or a tea of dogwood bark, cold, in wine- glassful doses, and nutritious diet, are to be given ; and the granulations are to be kept from rising too much, by the pru- dent application of blue vitriol, lunar caustic and burnt alum, weakened sufficiently by proper admixture of ointment to act as stimulants, and not as caustics. This will give a pro- per and healthy action to the granulating surface; whereas the destroying of the rising parts by caustics, seems rather to encourage the growth. Bandages and proper support to the parts, are highly useful. These ulcers, in weak parts, do not seem to be the better of poultices, or other relaxing applica- tions ; powders rarely do good, and perhaps the best dressing is the citrine ointment, (see " Medicines, their doses and uses), more or less diluted, if required. Irritable Ulcers.—There are certain ulcers, which may be called irritable ulcers. The margin of the surrounding skin 18 jagged> and terminating in an edge which is sharp and undermined. There is no distinct appearance of granulations, but a whitish spongy substance, covered with a thin watery or milky discharge. Everything that touches the surface gives pain, and commonly makes the ulcer bleed. The pain sometimes conies on in paroxysms, and causes convulsive mo- tions of the limb. Such ulcers seldom do well without a fre- quent change of treatment. Fomentations with peppy heada, hops, chamomile flowers, or hemlock leaves, are sometimes of use in irritable ulcers. When poultices are prescribed, thej Wens. 307 should never be allowed to rest or bear weight on the sore lirnb. Powdered applications are generally too stimulating for irritable ulcers, and bandages also prove hurtful. Fre- quent washing with cold water, or pouring upon them a stream of cold water, will often be found beneficial in this variety of ulcers. A tea made of oak bark, mixed with tar water, wil. sometimes act like a charm in healing this kind of ulcer. Indolent Ulcers are those which have the edges of the surrounding skin thick, prominent, smooth, and rounded. The surface of the granulations is smooth and glossy ; the matter is thin and watery, and the bottom of the ulcer is nearly level. A great proportion of the ulcers in hospitals are of the most indolent kind. Indolent ulcers form granulations, but fre- quently they are all of a sudden absorbed, and in a few hours the sore becomes as much increased in size as it had been diminished for many weeks. The principal applications re- auired for indolent ulcers are those of a stimulating nature, as tlie basilicon ointment, and occasionally sprinkling with red precipitate. Pressure is to be made by a roller, and by slips of adhesive plaster. Be careful to soften the dressings always before taking them off, by means of warm water or soap suds. The tea of oak bark and tar water is also advisable in this kind of ulcer, or the application of a wash made of a tea- spoonful of blue stone in a pint of water once a day, or the lunar caustic, will sometimes be necessary. WENS. A description of these is here given for the benefit of the reader, in detecting tumors of this kind, not expecting any domestic treatment can often be successful. Tumors on the surface of the body are distinguished by surgeons according to the nature of their contents, and they require treatment varied according to circumstances. Wen is the common popular name for any fleshy excrescence or tumor growing on any part of the body ; most frequently, however, it is applied to tumors about the throat and neck. Sometimes wens are attached by a narrow neck, and may be removed by the knife, or by ligature (being tied with silk around its neck); at other times they have a broad base, and are so supplied with large blood-vessels that they cannot ba removed at all, or cut, without the utmost risk. Sometimes wens are filled with a curdy or cheese-looking matter, and are contained in a cyst or bag, which must be dissected out, along with its contents, and the cut skin will heal and leave very little deformity; in other cases, the tumor is fungus ho2matodesi 308 Wry Neck—Varicose. or bloody cancer, which pretty certainly destroys the patient The bronchocele, or goitre, (on the front part of the neck,) is to be treated with iodine ointment, or tincture of iodine, ap- plied once every day or two, and the tincture of iodine inter- nally (ten drops three times a. day in a gill of sweetened water, on an empty stomach). Sometimes very large wens contain a mixed substance, resembling fat or marrow ; they have a firm fleshy feel, and sometimes attain an enormous size. WR Y NECK. This term is generally applied to a long-continued or per- manent turning of the head to one side. It is different from the pain and stiffness which occur from cold and rheumatism, and which prevent the free motion of the head. It arisea from various morbid conditions of the part, either from distor- tions of the spine, from palsy of some of the nerves going to the muscles that move the head, or from some altered struc- ture of the muscles themselves. The removal of this affec- tion, when possible, is accomplished by treatment adapted to the particular cause inducing it. The bones of the neck may be aided by machinery, by which they can be kept in a pro- per position, if the subject is young ; blistering, friction, and shampooing, long persevered in, have been of service in the paralytic affections of the nerves and muscles ; and at one time it was a favorite practice to cut across the large muscle extending from the ear to the breast-bone, which was gene- rally supposed to be in fault. This severe measure very often was unsuccessful, and is hardly ever to be recommended, even when performed by the best surgeons. VARICOSE, or ENLARGED VEINS. This condition of the veins is found mostly in the lower ex- tremities, and is sometimes a troublesome and painful disease. Of course the longer it goes on without being cured the worse it becomes. The affection consists, essentially, in the veins becoming elongated (or stretched longer), so as to permit of their assuming a tortuous, knotted condition, while they are at the same time enlarged. This state is usually associ- ated with obliteration or deficiency, more or less, of the valves within the veins, so that the weight of the entire column of blood bears with distensive force upon the vessels, and upon those parts of them which are most dependent. The most frequent causes of the varicose veins, are such as cause impe- diment to the upward flow of the blood through the large veins of the abdomen. In this way, pregnancy, if frequent, Foreign Substances in the Eyes. 309 hs a most common exciter of the condition : habitual costive ness, diseases of the liver, tumors of any kind within the ab- iomen, act in a similar manner. The truss worn on account of rupture, or garters too tightly tied, likewise excite the vari- cose condition, which is usually more common in persons whose occupations require much standing, especially if they are tall. The veins and limbs generally should be supported by soma one of the forms of elastic stocking: these can now be ob- tained at so moderate a price, that none need be without their valuable aid. It is often surprising how immediately the use of well applied mechanical support, such as the elastic stock- ing affords, removes the uneasy and painful sensations con- nected with the condition of the veins in question. Some in- dividuals cannot, however, wear an elastic stocking of any kind; for such cases, an elastic tape or bandage fixed to the foot by a stirrup, and wound spirally round the limb, has been successfully employed. Spaces of about three inches being left between the spirals, each time the band crosses the vein, it acts like a valve. Frequently a bandage of muslin or calico, wet and rolled moderately tight, beginning at the toes and going up the limb as may be requisite, will answer all purposes. It should be put on when the patient is lying down, and reapplied twice a day. Let the limb be plunged into cold water, or laid down and cold water poured over the limb, beginning at the toes and going along above the knee, each time before the bandage is applied. FOREIGN SUBSTANCES IN THE EYES. This is often the cause of much suffering as well as uneasi- ness of mind. Persons often go a long ways to a physician on account of some little substance getting into the eye, when the exercise of a little judgment and tact on the part of by- standers would save the patient time, expense, and suffering, by removing it before it had time to produce much local irri- tation. The membrane, which covers the inside of the lids and white of the eye, is, from its exposed situation, liable to become inflamed from various causes. Minute particles of dust or other substances getting into the eye, and becoming fixed in the lining of the upper eyelid, between it and the globe, cause an amo mt of pain and irritation which could scarcely be credited from their size, but which is well ac- counted for by the accurate apposition of the two surfaces be- tween which they lie. A particle so situated may be diseov- 810 Stye—Sore Eyes. ered without much difficulty by a second party examining tha sufferer with the head thrown back, while he slightly everts, (turns inside out), the upper lid with the thumb and finger The slightest speck of foreign matter must be removed, and no better instrument can be employed for the purpose than a piece of not over-stiff writing-paper twisted, or where it can be had, a camel's hair pencil. Those who work in metals are apt to get minute scales imbedded in the forepart of the ball; they cause much iiritation, and are often so extremely difficult to remove that a surgeon's assistance is required. Pieces of iron or steel can often be removed by a magnet (loadstone), oi magnetized piece of iron : bringing it in contact with the foreign aubstanco, it attracts it, and, adhering to the magnet is taken out. Never rub the eye when there is dust or other foreign substance in it, it may injure the ball of the eye by friction. STYE. This is a boil or abscess in the lid of the eye, usually caused by the duct or opening leading from the little glands becom- ing obstructed. When once they make their appearance '-hey are troublesome, as one attack after another is apt to follow. The treatment consists in mild purgatives, a spare diet, and local applications, such as warm fomentations of hops, etc., 01 poultices in a muslin bag, lest the particles get into the eye. When it breaks and gets well, bathe the eye three or four times a day in cold water. SORE E YES. This being a disease of such frequent occurrence, and bj being neglected or improperly treated, often occasioning loss of sight, every person should understand how to treat it. The first symptom of inflammation of the eve is a sensation as if a particle of some kind had lodged in the eye, and if an examination be made there will be seen, not only an enlarge- ment of any small blood-vessels that may be generally visible on the white of the eye, but a new development of others, the appearance varying from the slightest apparent increase of vascularity or fullness, to the most intensely red inflammation. At the same time there is considerable increase in the mucous secretion—not in the tears, as is often supposed—and in bad cases this becomes purulent or mixed with matter. There is, sometimes, considerable swelling of the surface, usually dis- tinguished as the white of the eye. The above is the most auperficial form of inflammation to which the eye is subject; if neglected it may extend itself over the cynw* or ircn/f-art Sore Eyes. 311 of the eye-ball and produce permanent blindness. It is undis- tinguishable from the next form, or inflammation of the scle- rotic coat, or whites of the eyes, by the size and winding char- acter of the small blood-vessels, and by tlieir being slightly movable along with the conjunctiva, or membrane, itself, when the lids are drawn down. It is important that these distinc tive characters should be attended to in the first place, thai no error may be committed between this form and a more serious and deep-seated inflammation of the eye, and also that proper treatment may be used. A great error is committed m treating this form of inflammation by means of warm fomentations, etc., applications tending rather to keep up than to cure the disease, which is generally quickly removed by astringents and cold applications. A drop of laudanum mixed with six of cold water, put in the eye, repeated two or three t;.mes will often cure the disorder; or a lotion of sulphate of zinc, from one to three grains to the ounce of water, will be found efficient; but the best of all is the solution of nitrate of silver, or lunar caustic, of the strength of four grains to the ounce of water. Of this, a single drop may be introduced into the in- flamed eye twice or three times in the twenty-four hours. Great care should be exercised to get the exact strength here given, as it is a dangerous remedy if made too strong. The eye, of course, should be exercised as little as possible, and if the bowels are confined or the stomach disordered, five grains of blue pill every second night, followed the next morning by a Beidlitz powder or castor oil will be found useful. If the dis- ease is obstinate, a blister to the back of the neck may be applied with advantage. The disease which has just been treated of, is a compara- tively mild disorder, but under certain circumstances it be- comes much more virulent. The secretion of matter is very great, and acquires the power of propagating the disease by contagion from one person to another. Newly-born and young infants frequently suffer from a severe form of this disease, which often shows itself within three days after birth. The inflammation is intense, and tho matter often accumulates largely between the lids, gushing out when they are separated. In scrofulous children especially, the affection is often obstinate. The nitrate of silver in solu- tion, is the be3t application, and small doses of quinine the best internal remedy. Syringing between the lids with a solution of alum, four grains to the ounce of water, six or eight times a day, is also recommended. A little lard should be used on the edges to prevent them sticking together. 312 Defects of Vision. In inflammation of the sclerotic or outer coat of the ball itself (or whites of the eyes) there is more actual pain, it ia more deeply seated, and the redness seen on the white of the eye is more of a pink hue than in the other form of the disease just treated of, the vessels appear much smaller and straighter, radiate as it were from the cornea or front of the eye, and are not movable; the affection is generally a more serious one than the other. Active treatment is necessary; leeches should be freely applied to the temples, or behind the ears, or cupping on the back of the neck resorted to; the bowels must, be freely purged with ten grains of blue pill mixed with ten of rhubarb, followed next morning, if necessary, by a dose of castor oil or Rochelle salts, in the first instance, and then calomel in two- grain doses, given at intervals of six or eight hours. The diet must be reduced as low as possible, all stimulants avoided every attempt at exertion even of the unaffected eye forbidden^ and the person confined to a darkened room, the only local application being continued hot fomentation to the eye (of hops in a bag, on which hot water has been poured), and a blister between the shoulders. By a continuation of the above treat- ment, even till the gums get sore with the mercury, much may be done in cases where a physician can not be had, but where possible, a medical man should be called to attend to it. DEFECTS OF VISION. Long-Sightkdness.—This is a condition of the vision often met with in aged persons. It consists in near objects being confusedly seen, while those at a distance can be distinguished very clearly. It is thought, usually, to depend on the eye be- coming fattened, from wiiich results an alteration in the con- vergency of the rays of light, so that the "focus" is formed behind the retina, or the expanded nerve of the inner part of the eye. The defect is to be remedied by the use of convex glasses, which must be adapted to the eye by the individual affected. Short-sightedness, of course, is just the reverse, produced by tlie eyeball being too round or prominent; and is to be reme- died l>y the use of concave glasses, properly adapted to each individual case. While on this subject, we would take occasion to warn oui readers against reading; in railroad cars, or any vehicle, while in motion. It is very injurious to the sight, by the constant strain or effort to fix the " focus." Railroad conductors from tb>8 cause have become blind. $ u would also warn the reader against the use of what uai Growing in of the Toe-nail— Inflammation of the Tonsils. been lately brought into use, by extensive advetrising, called u eve sharpeners," to produce a greater convexity of the eye- ball, by applying the instrument to the front of the eyeball, Such things are very injurious to the eyes, in unprofessional bands. GROWING IN OF THE TOE-NAIL. This is a frequent and troublesome complaint, caused by the Bail pressing down into the soft parts, and kept up by its con- tinuance. It is generally the result of tight, or misshapen boots and shoes. There are many palliative methods of treating this affection, such as the use of caustics, scraping the nail away, the appli- cation of poultices, etc.; but perhaps there is no certain mode of treatment but the thorough removal of the entire half of the nail up to the root, on the offending side. This, of course, ought to be done by a physician. Wearing an " old shoe," or loose slipper, or going barefooted for a while, will afford great relief, and sometimes effect a cure, especially if the foot is often soaked in water, and the nail scraped thin in the middle. INFLAMMATION OF THE TONSILS, or Sore Throat Sore throat of this kind usually commences with chilliness, and often flushes of heat; the tonsils and back part of the throat soon become red, swollen, and painful. The pain is acute and darting, and usually extends to one or both ears. It is increased by every attempt to swallow, and by external pressure. These local symptoms are generally attended with some degree of fever. Swallowing is greatly impeded as the disease increases, and speaking, and even breathing, are en- tered difficult. In a few cases, small white spots are to be observed upon the tonsils. When the inflammation is very violent, the eyes become red, swollen and watery ; the cheeks flushed and swollen, and the patient is unable to open his mouth. Externally, large tumors can be felt, or even some- times seen by the eye, on each side the jaws. The sense of suffocation is intolerable, and the patient is obliged to be sup- ported in an erect posture. When inflammation of the tonsil occurs repeatedlyin tha same individual, within a short space of time, a peculiar sus- ceptibility to the disease is established, so that it is produced by the slightest causes afterwards. 'The active symptoms in this disease may either rapidly de« dint or produce suppuration and an abscess in the throat; or remaining a long time in a chronic state, cause an enlarged 514 Inflammation of the Tonsils. and hardened condition of the tonsils, by which sometimes breathing, swallowing and speech are so much affected as to require the removal of the organs by a surgical operation. At the very commencement of the attack, before the inflam- mation of the throat is of any considerable extent, an emetk of ipecac, ten to fifteen grains, given in warm water, will fre- quently be found to remove it at once. When, however, the disease has run some time, or is from the first of a violein frade, bleeding, by leeches to the throat, will be demanded. his should be succeeded by a dose of Epsom salts or castor oil, or when the act of swallowing is attended with great diffi- culty, a tablespoonful of the following mixture may be taken every two or three hours: Epsom salts, one ounce; nitre, (saltpetre,) one drachm; tartar emetic, two grains; and boil- ing water, twelve ounces. This, with the occasional use of the warm foot-bath, an injection of warm water, will have the effect of opening the bowels, producing a gentle perspiraticu; and reducing the inflammation. A variety of acid and astringent gargles have been proposed in this disease, but there are few cases in which the patient can make use of gargles in such a manner as to derive much ad- vantage from them. In general, more benefit will be derived from inhaling the vapor of warm water or vinegar and water, or of bitter herbs, &c, as ordered in catarrh in the head, which may readily be directed to the throat by means of a common funnel. If the inflammation should not be reduced by these means, a large blister is to be applied around the throat, oi the tlnoat may be enveloped for five or ten minutes with a cloth wet with spirits of turpentine. At the same time, the mixture directed above, with the inhalations, should be continued. Volatile and other liniments to the throat, which is so fre- quently resorted to in this disease, is productive of little good, and in some cases is even injurious, poultices seeming to afford more relief. The patient should be allowed nothing in the form of food er drink, during the disease, excepting barley, beef tea, soup, or gum water,rendered slightly acid by the addition of lemon-juice. When we discover that the swTellings in the throat appear evidently inclined to suppurate, or come to a head, this should be encouraged by the frequent inhalation of the steam of hot water, (as before recommended,) and in certain instances by poultices externally. The moment they become soft the? should be punctured with a lancet, to allow of a dischaige of the contained matter. After tliis/ a gargle of sage te;*, aluic Inflammation of tlie Larynx. 315 and h.i.ioy, several times in the course of the day, will com- plete the dtie. We shoiuu Lear in mind the great liability to a recurrence of the disease, which will point out the importance of the patient being on his guard for a considerable time subse- quently to his j'.cjvcry, against exposure to cold or damp, to sudden transitions vf temperature, &c. Bathing the th/u.*t night and morning in cold water is a ood means of pre voicing a return of the disease, in those who ave been subject to it. IN FLAMMATION OF THE LARYNX; (Or top of the Windpipe.) This commences with aic visual symptoms of fever, from irritation or local inflammation. The voice very quickly be- comes hoarse and indistinct, sometimes entirely extinct; the breathing laborious, with a painful sense of constriction in the throat; on examining the back part of the throat, we now find that every portion of it is of an intense, dark red color, and considerably swollen. The face soon becomes red and bloated, the eyes red, swollen and often protuberant, as in cases of strangulation. The pulse is very quick and frequent, and the tongue coated. Every attempt to swallow is attended with intolerable distress ; the muscles of the throat and chest being thrown into violent spasmodic action, threatening the patient with instant suffocation, and causing him to cry out for the admission of more air into the room. This disease is extremely acute and rapid in its progress, often destroying life, by suffocation, in a day or two, or even in less time, unless attacked in its very commencement by the most active remedies. In many of its symptoms it bears a close resemblance to croup, and to distinguish the in from each other is not always very easy. This, however, is not of much importance, as the treatment of the two diseases does not differ in any important particular. This is an affection which calls for the exercise of the most energetic and best-directed medical treatment as soon as it can be procured. But it is of the highest importance that no time should be lost, even while waiting for that aid, and that some properly directed means should be at once resorted to. First, from half a dozen to two dozen of leeches, according to the strength cf the patient, should be applied to the throat and uppei par*; of the chest; or, if leeches cannot be obtained 316 Cold in the Head. from six to twelve ounces of blood are to be taken from tha back of the neck by cupping. Tarter emetic, in eighth of a grain doses, or twenty drops of antimonial wine, is to be re- peated at intervals of from one to two hours, at first, and calomel given in four grain does every four hours, with a quarter of a grain of opium in every, or every second dose, should purging ensue. Hot bran poultices are to be kept constantly to the throat, the feet put in hot water, and advan- tage may be derived from breathing the steam of hot water, and bitter herbs, &e., as recommended under the head of Ca- tarrh in the Head ; the patient, of course, being kept perfectly quiet in bed. These measures will do all that can be done until the arrival of a physician. COLD IN THE HEAD. It is unnecessary to give the symptoms of this disease, as they are too well known to all by frequent and unpleasant expe- rience. However familiar we may be with this disease, yet we should not look upon it as a trivial affair. From its ten- dency to recur, and also to produce and keep up irritation of the lungs, it is not only not to be neglected, but should be kecked at first, if possible, and for this purpose various me- thods of treatment are recommended. The injection of a solution of sulphate of zinc, five grains to the ounce, into the nostrils, at the very commencement of the disorder, has been said to stop it without fail. A teaspoonful of paregoric, or six or eight grains of Dover's powder, when taken at bedtime repeated for two or three nights, will often check a cold in the head at once ; and the usual system of hot foot-baths, confine- ment to bed, low diet, and diluent drinks, along with boneset tea, is certainly calculated to mitigate the disorder, and may be followed with advantage. It is the common practice to drink copiously of tea, gruel, or, some other diluent during a cold ; as long as this promotes perspiration it is of some utility, and although it augments the flow from the nose, it has the effect of diminishing its acrimony or irritating qualities, by dilution. It is the acrimony of this discharge, which reacting on the membrane, keeps up the inflammation, and its accom- panying disagreeable symptoms. On this circumstance de- pends the efhcaey of a measure directly opposed to that juat noticed — we mean a total abstinence from liquids in any shape, water, tea, coffee, milk, beer, &c. To those who have the resolution to bear the feelings of thirst for thirty-six or forty-eight hours, we can promise a pretty certain and com- plete riddance of their colds, and what is, perhaps, more im Cold in the Bead. 81? portant, a prevention of those coughs which commonly succeed to them. Nor :s the suffering from thirst nearly so great aa rnigh+ be expected, especially when apiece of orange or lemon peel, sassafras bark, or something of the kind is kept in the mouth. This method of cure operates by diminishing the mass of fluid in the body to such a degree that it will no lon- ger supply the diseased secretion. Anything that will contri- bute to reduce the quantity of fluid in the body will assist in the plan of cure, and shorten the time necessary for it to take effect. It is therefore expedient to begin the treatment with a purgative of salts, followed by a sweat at bed-time, as is usual, and this is the more necessary when any fever attends; but beyond this no further care need be taken, and the indi- vidual can devote himself to his usual employments with much greater impunity than under the ordinary treatment. The coryza, or running from the nose, begins to be dried up about twelve hours after leaving off liquids; from that time the flowing to the eyes and fulness in the head become less and less troublesome; the secretion becomes gelatinous, and be- tween the thirtieth and the thirty-sixth hour ceases altogether: the whole period of abstinence need scarcely ever to exceed forty-eight hours. It is then as well to return to the moderate use of liquids, as the first indulgence is apt to be excessive. It is not necessary to limit the solid food any more than to that which is plain and simple, except where there is an accel- eration of the pulse, or irritation of the stomach, in which cases animal food should be avoided. For the sake of comfort in mastigation, the food should not be of the driest kind. Thick puddings and vegetables, with or without meat, will bo the best dinner; and toasted bread or biscuit merely moistened with tea or other liquid for other meals. A single cup of tea is sufficient to bring back the coryza, or watery discharge from the nose, immediately, after twelve hours' abstinence has removed it. We doubt not that it will be said that this plan of cure is worse than the disease, and so it may be in s^me instances. It may be called always a choice of evils; but we do not believe that any one who is liable to severe colds, after once experiencing the amount of good and evil resulting from this method, would hesitate between them. Moderation in liquid food, is one of the best preventative against the bad effects of exposure to cold. When there is a large quantity of liquid in the system, there must be increased perspiration, and therefore greater risk from the effects of colcf Nature seems, to some extent, to provide for these changes in the atmosphere, as in cold weather we drink but 818 Inflammation of the Lungs. little, and in warm weather drink more, as by the evaporation brought about by perspiration, the temperature of the body is ieduced or kept down. INFLAMMATION OF THE LUNGS, {Pneumoniae Inflammation of the lungs commences with the usual symp- toms of fever: a feeling of coldness or shivering, succeeded by increased heat and dryness of the skin, thirst, flushed face, furred tongue, and increased frequency of the puloe. In some cases, however, there is little or no increase of heat, and the pulse is not more frequent than natural. Very soon a diffi- culty of breathing is experienced, and a pain, more or less acute, in some part of the chest, increased upon inspiration, (taking air into the lungs,) and in particular positions of the body. Occasionally the pain is dull, or rather there is a feel- ing of weight and oppression in the chest, rather than of pain. The pain is commonly fixed, but sometimes shoots towards the shculder, or upper part of the breast. It is invariably accompanied by a short, dry, distressing cough, which greatly aggravates the disease. In the beginning of the disease, the cough is seldom accompanied with much expectoration; a little frothy mucus is generally, however, brought up by it, which, in the course of the disease, is often streaked with olood. Subsequently, however, an expectoration of yellowish thick matter takes place, which becomes whiter, softer and more easily brought up as the disease progresses. The fore- going symptoms are of greater or less violence, according to the extent and intensity of the inflammation. A favorable termination of the disease is indicated by a gradual subsidence of all the symptoms. The respiration becomes more free, the expectoration more copious, the cough less frequent and distressing; the fever disappears, and the pulse becomes softei and less frequent. The disease is some- times suddenly arrested by a spontaneous discharge of blood from the nose, or a very copious expectoration of a thick, yellow-colored mucus, brought up without much cough ; ana sometimes, but more rarely, by the appearance of an eruption or. the skin. We should fear a termination of the disease by abscess, by the obstinacy and but little violence of the symptoms, and theii not yielding to an appropriate treatment within the first four or five days, and if there be but little expectoration, or especially If delirium, with a soft, undulating pulse, supervenes. Where suppuration, or abscess, has actually taken place, the symp- toms are, frequent, slight shiverings, a mitigation or cessation Inflammation of the Lungs. 319 of the acute pain, with a continuance of the cough and a diffi- culty o^ breathing; the pulse being soft, fuller, and either slower or more frequent; by a redness of the cheeks and lips, an increase of thirst, and other symptoms of fever towards evening. An abscess being formed in the lungs, the breath- ing becomes very short and laborious, and attended with rattling in the chest; the cough short, dry and obstinate ; the patient is able to lie only on the affected side; the urine ia muddy, the countenance pale, the body becomes quickly emaciated and enfeebled, and night-sweats and diarrhoea make their appearance. When the abscess is situated on the exter- nal surface of the lung, immediately beneath the ribs, a soft, indistinct swelling may be sometimes felt externally, with an evident fluctuation of matter. In such cases, an opening may be made into the abscess, between the ribs, the matter dis- charged, and the life of the patient frequently preserved. This, of course, can only be done safely by a physician. When the abscess is deeper seated in the substance of the lungs, in may burst into the air-cells of the lungs, and if it do not imme- diately cause the death of the patient by suffocation, the mat- ter may be discharged by expectoration, and the patient be finally restored to health. This disease requires prompt treatment, and of course if possible, a physician should be called at the earliest moment. When one is not to be had conveniently, let no time be lost, but pursue the course here marked out, which in a great many cases will be the means of curing the disease, or checking it while medical aid is being procured. Open the bowels by means of an injection, and also giving some mild purgative, such as castor oil, Epsom or Rochelle salts, or rhubarb. Ap- ply leeches, ten to twenty to the side affected, if they can be procured; if not, scarify and apply the cups, after which a warm poultice of bran, Indian meal, or linseed meal or slip- pery elm, etc., to be sprinkled over with a little laudanum or paregoric ; to be applied frequently. Small doses of ipecac either in powder or the syrup, should be given every three hours, just so as to produce slight nausea but not vomiting. When this has been continued for about twelve hours, then use the following mixture: water, eight ounces (about one gill); syrup of ipecac, one table-spoonful, or five grains of the powder; chlorate of potash, one drachm, or about one tea- spoonful ; spirits of nitre, two tablespoonfuls. Dose: a teaspoonful every three hours; if much sickness of the sto- mach is produced, not so often. Let the patient have plentj of cooling drinks, such as flax-seed tea, gum arabic, or slip 320 Pleurisy—Inflammation of the Stomach. pery elm water, toast water, etc. The bowels to be moved occasionally by a dose of castor oil. PLEURISY. The symptoms of this disease are very similar to those of inflammation of the lungs, at least, requiring usually a phy sician to tell the difference. However, the treatment recom mended for that disease, is adapted in every respect for ^Ieurigj INFLAMMATION OF THE STOMACH. Though not a very frequent disease, this is a very painfti. and dangerons one. The symptoms are marked by a more or less acute pain and feeling of burning in the region of the stomach ; these symptoms are aggravated by every thing taken into the stomach, by the motions of the body, and by pressure. Inflammation may come on very gradually, or be suddenly developed, according to the causes by which it has been pro- duced. When the disease is fully developed, the pulse is very small, hard, and frequent; there exist great anxiety, oppres- sion, and a greater prostration of strength than in most other acute inflammatory affections. Every thing taken into the stomach occasions vomiting with painful Teachings. Hiccup is also an early symptom. The features of the face are con- tracted, shrunk, and altered from their natural expression. There is distressing thirst, a continual tossing of the body. constant wakefulness, and in general a costive state of the bowels. In violent cases there is difficulty of breathing, with increase of pain on a deep inspiration. In the course of tne disease, fever, with intense heat of the skin is sometimes developed, and at others, delirium, convulsions, and stupor. Inflammation of the stomach is produced by large draughts of cold fluids taken when the patient is in a profuse perspira- tion, or ever-fatigued by exercise; cold applied externally, under similar circumstances ; contusions or blows upon the abdomen, intemperance in eating; hard or irritating articles taken into the stomach, the violent operation of emetics ; or the excessive use of ardent spirits. Inflammation of the stomach is always a dangerous com- plaint, terminating fatally, when violent, in the course of a few hours, or when less acute, producing a long series of distressing and painful symptoms, and causing incurable disorganization of the stomach, or by sympathy, producing disease of tli6 skin, joints or brain; therefore it is all-important that it be treated in every case with promptness and energy. Inflammation of the Bowels. 321 Wif region of the stomach should be covered with leeches, and the flow of blood encouraged after they have fallen off, by warm fomentations. This treatment is the one adapted to the more acute cases, the important object being to reduce the inflammation with as little delay as possible. In all cases of inflammation of the stomach leeches are an important and indispensab.e remedy, and they should be repeated again and again, until the local symptoms are entirely removed; their number and the intervals of their application being adapted always to the urgency of the disease, and when some degree of inflammation still remains, the region of the stomach may De covered with a blister. In regard to internal remedies, there is none, with the exception of minute portions, frequently repeated, of cold gum arabic water, or iced water, but what would have the effect of irritating the stomach and increasing the inflammation. The vomiting and sense of burning by which the patient is often so much distressed, can be relieved only by the leeches, and by the cold fluids just alluded to. In 6ome cases, advantage has been derived from a teaspoonful of powdered ice slowly swallowed, and occasionally repeated. Bathing the feet in warm water, and the application of mustard to the ankles, will, in some cases, be found beneficial. The bowels should be kept regularly open by injections of warm milk and water, or soap suds, etc. Chronic inflammation of the stomach is to be treated by the judicious application of leeches, by a very spare diet, of barley- water, gum-arabic water, tapioca or panado ; by blisters to the region of the stomach, by the warm bath and frictions of the skin, and by gentle daily exercise in the pure open air, friction over the region of the stomach, etc. INFLAMMATION OF THE BOWELS. This disease, in its symptoms, does not differ widely from tho foregoing, and perhaps in a majority of cases, at least in a partial degree, accompanies it. Inflammation of the bowels usually commences with a slight chill, and a sense of uneasiness in some portion of the abdomen, at first intermittent, but gra- dually becoming permanent, and finally changing to a fixed pain which spreads over the whole abdomen. The latter ia Bomewhat swollen, and sore to the touch. Obstinate costive- ness generally attends the disease, and sometimes sever® vomiting. The pulse is very small, hard and frequent, and the tongue dry and furred. The thirst is extreme, the urine high- colored, small in quantity, and most commonly discharged with iifficulty. The breathing is short and laborious, and the 322 Inflammation of the Bowels. patient generally lies upon his back, with his knees drawn up towards his breast. If the disease be allowed to proceed, theec symptoms augment in violence. The abdomen becomes greatly distended with air, small mucous discharges take place from the bowels, with considerable straining; the action of the bowels sometimes becomes inverted, and the contents of the bowels are discharged by the mouth. Suddenly the gony of the patient ceases, he appears to have obtained relief from his disease, but his intermittent and scarcely per- ceptible pulse, the paleness and livid hue of his face, the icy coldness of his extremities, and other alarming symptoms, indicate that mortification has taken place, which is quickly eucceeded by death. Inflammation of the intestines may be distinguished from colic by the presence of more or less fever, by the fixed and continued pain, increased upon pressure, and by the hard, frequent pulse. In colic, there is no fever, the pain comes on (n paroxysms, with distinct intervals of rest, and ss diminished rather than increased by pressure. In the treatment of this disease leeches are to be applied over the seat of the pain, and repeated so long as the locvl symptoms remain, and the strength of the patient will perm; c followed by a blister. The same cold fluids internally, wlJ be proper, as those ordered in inflammation of the stomaci After the violence of the inflammation has been reduce 1, four grains of calomel, every two hours, should be given, con- bined with mucilage of gum arabic, until a copious evacuation from the bowels is obtained; the operation of the calomel >eing aided by laxative injections (See Medicines, their uses and doses). In some cases, fifteen grains of calomel with two of opium, will produce a very prompt evacuation, and relieve greatly the remaining symptoms of the case. During convalescence from inflammation of both stomach and bowels, the greatest caution must be observed, by a mild, well-regulated diet; abstinence from all stimulating drinks; by guarding against exposure to cold, and over exertion of the body ; by keeping the bowels regular, and using gentle daily exercise in the open air, wearing flannel next the skin, spong- ing the body with water once a day, followed by friction with a rough towel, etc. Diseases of the Liver. 823 DISEASES OF THE LIVER. Acute Inflammation.—As in other forms of inflammatory diseases this is generally ushered in by a chill, succeeded by nil the symptoms of fever. To these are soon added pain in the region of the liver, sometimes acute and shooting, with a Bense of fullness in the right side; at others, fixed and severe, or deep-seated. The pain commonly extends to the breast, collar-bone, and shoulder of the right side. The pain in the Bide is increased by pressure, especially when the patient lies upon his left side. The pain is often increased during breath- ing, and it is in consequence often impeded, more especially when the portion of the liver in contact with the diaphragm is inflamed. A severe cough is then also generally present, and in the course of the disease, hiccup commonly occurs. The cough in this disease is usually dry, short and fre- quent. From the cough and difficulty of breathing, which so often attend inflammation of the liver, it is often mistaken for in- flammation of the lungs; happily, the treatment of the two diseases does not materially differ. The skin, eyes and urine have the same deep yellow tint as in jaundice. The pulse ia various, being sometimes small and feeble, at others, full and strong; but most commonly hard. The urine is ordinarily high-colored, the heat of the skin and the thirst considerable; ' the mouth dry, and the tongue coated with a yellowish mucus, which, in the course of the disease, becomes often dark brown or even black. There is likewise wakefulness, restlessness, and in a few instances, delirium. A favorable termination is often preceded by a discharge of blood from the nose, or from piles; sometimes by a copious perspiration, or increased discharge of mucus from the lungs. A copious flow of deep-colored urine, occurring about the fourth day, and depositing, after standing, a red or whitish sediment, is also a favorable symptom; the same is true of free bilious discharges from the bowels. From the obstinancy of the symptoms, we are to fear an ab- scess. As soon as it is formed, the acute pain in the side is changed into a feeling of weight and pulsation; the former being increased when the patient lies upon the left side. There are also frequent irregular shiverings, and finally, all the bymptoms of hectic fever. When the abscess is seated on tha external surface of the liver, a tumor and fluctuation of a fluid can be detected just below the ribs, on the right side, and by an incision, the matter may be evacuated, by which the chanca of the patient's recovery will be greatly increased. When the 824 Diseases of tJie Liver. abscess is more deeply seated, an adhesion taking place be- tween the liver and intestines, the matter may find its waj into the cavity of the latter, and be discharged by stool. In this case, the patient often recovers. Its most common causes are the action of excessive heal upon the skin ; sudden changes of weather; the sudden ap plication of cold or damp to the body when heated; contu- sions or violent blows upon the head or other parts of tha body ; the excessive use of wines and spiiitous liquors; high living, and intemperance generally; violent passions of the mind, particularly anger and rage; the suppression of various habitual discharges, and irritations of the stomach generally. In the treatment of this form of liver disease, which is an inflammation, the treatment is the same as for inflammation of the lungs, bowels, &c, excepting that calomel or blue pill should be made use of freely in this disease, and the leeches, &c, applied to the region of the liver. The other general treatment is the same, as far as can be undertaken, without the advice of the attending physician. Chronic Inflammation of the Liver.—This is attended by the same symptoms as the acute, but assuming a more obscure and insidious character, and are more slow in their progress. In conjunction, also, with the peculiar symptoms produced by the disease of the liver, we have also those of ordinary dys- pepsia—wasting; defective or variable appetite; acidity; fla- tulence ; feeling of fullness or uneasiness about the stomach, dry, harsh, and discolored skin; disturbed sleep ; great de- pression of spirits, despondency, irritability of temper; irre- gular bowels; disinclination to exertion, whether mental ci bodily; indeed, all that train of symptoms to which the inde- finite term nervous is so generally applied. Ordinarily, chronic inflammation of the liver is attended with considera- ble difficulty of breathing, and a short, dry, teasing cough; sometimes, however, the cough is attended with expectoration. There is frequently a decided paroxysm of fever towards even- ing ; more or less yellowness of the skin, and when the disease has been of long continuance, night-sweats, great emaciation. and a wasting diarrhoea. Chronic inflammation of the liver may either produce a great enlargement and hardening of the Ever, perceptible to the eye and feel externally, or it may ter- minate in suppuration, (coming to a head,) the matter being discharged in the same manner as in the acute form of the disease. In most cases, chronic disease of the liver is attended with dropsy, either externally or of the abdomen, or both; a species of chronic dysentery, with ulceration of the bowels, Inflammation of the Kidneys. 325 -ometimes takes place; and again, in other cases, from tha operation of various causes, but particularly indulgence in ardent spirits, chronic inflammation of the liver may be ren- dered acute, when it is rapid in its course, and generally fata.. In its early stage, local bleeding by cups or ieecnes, applied over the liver and stomach, ana repeated according to circum- stances, followed oy ousters to the right side, in conjunction with a very light vegetable diet, me warm bath, and friction to tne surface: with a nill everv night and morning of th blue mass, five grains : soap, three grains ; ipecac, one grain. and aioee, two grains, aided in its operation upon the bowels by an occasional dose of castor oil, or laxative injections, wil, '-ery speedily remove the disease, provided the patient, at the 3ame time, take gentle exercise, when the weather will per- mit, daily, in the open air—his body being defended from any sudden diminution of temperature by appropriate clothing, especially flannel next the skin. A permanent drain from the side, by Inserting an issue or seton over the liver, has occa- Bionally been found beneficial. In cases oi chronic affection of the liver, the dandelion has been strongly recommended by various practitioners; it may be given in the form of extract, five to ten grains three times a day, or a gill of the strong decoction, or tea, cold. A bath of the nitro-muriatic acid is strongly recommended by some physicians. It may be applied either to the legs and feet, or by sponging, with the acid diluted with water, the whole surface of the body. The use of the remedy should be persevered in for a length of time. In this form of disease the food should be very light but nourishing, easy of digestion, and taken in small quantities at a time. Milk, rice, potatoes, and especially a free use of tomatoes, cooked or raw, twice a day, should be allowed. Avoid cold and dampness, and be careful to keep the bowels Qpen at all times. A sea voyage is sometimes of great service In this disease. Out-door exercise should be taken daily. INFLAMMATION OF THE KIDNEYS. The symptoms of this disease are a feeling of heat, uneasi- aess, and a dull, or sharp pain about the loins,, and often a dull pain in the thigh, of one side, and great stupor or heavi- ness. The urine is at first clear, and afterwards of a reddish color, often bloody, and voided frequently, and in small quan- tities at a time. The urine generally coagulates, or becomes lumpy by heat. The disease is often attended with vomiting, eoativeness, difficulty of breathing, and cold extremities. There S26 Inflammation of the Bladder. is ^ painful feeling of uneasiness when the patient is sitting upright, or standing; the easiest position being that of lying on She fide affected. If the inflammation of the kidney be sev-re, or occur in a broken-down constitution, it most com moTuy gives rise to more or less dropsy, either externally, or of the abdomen. 1 inanimation of the kidneys may be induced by cold; by habits of intemperance; by the use of powerful diuretics, as spivatfi of turpentine, cantharides, &c.; by bruises or sprainfe cf the back or loins; gravel; violent or long-continued rid ing. <&c. When the local symptoms are severe, the patient possessed of a considerable degree of strength, cups or leeches should be applied over the kidneys, and repeated until the disease is broken up. The use of the warm bath, or fomentations of hops, or horehound and vinegar, to the loins, constitute an im- portant remedy, after cupping or leeches, and should be re- peated daily. A mild purgative, as an ounce of castor oil, or a dose of salts, with the addition of one drachm of lemon-juice, in the dose of a table-spoonful every two hours, should be given, so as to keep the bowels regularly open, with frequent emollient injections of flaxseed-tea, infusion of slippery elm or thin starch, &c. The patient should make use plentifully of thin gum arabic, or barley water, or flaxseed tea, and abstain from all solid and irritating food, and stimulating drinks. In case of violent pain continuing after the cupping or leeches, a grain of opium, or two of hyoscyamus may be administered at bed-time. A decoction or tea of the dried leaves of the peach tree has been said, when taken to the amount of a pint a day, in many cases, to produce considerable relief. They are best given mixed with the uva ursi leaves. If the disease become chronic, the insertion of an issue or seton at the loins, and internally twenty to thirty drops of balsam copaiba, or one teaspoonful of powdered uva ursi, or a gill of the tea (cold) made of the same, will have sometimes a most happy effect. INFLAMMATION OF THE BLADDER. This disease is characterised by a feeling of fullness, un- easiness, and pain in the region of the bladder, and a frequent desire and great difficulty in discharging the urine, often a total suppression, with frequent ineffectual efforts to evacuate the bowels, occasioned by the irritation extending to the lowei part of the bowel. These symptoms are generally accompa Mumps. 327 aied with fever, sickness and vomiting ; great anxiety and restlessness: sometimes delirium, coldness of the extremities, and clammy perspiration ensue. The mucus or lining membrane of the bladder, is likewise affected with a chronic inflammation ; in these cases, there ia a dull, vneasy sensation in the part, frequent desire to pass urine, which is generally thick, from being loaded with mu- cus; sometimes bloody, or, if ulceration of the bladder has taken place, mixed with matter. The coats of the bladdei become often, when effected with chronic inflammation, thick- ened, or hardened, and otherwise disorganized, giving to the jatient great uneasiness, and causing a constant inclination to ninate, or a total suppression of the urine. In the acute variety of the disease, the early employment Of' leeches over the region of the bladder, followed by the v- arm bath and fomentations, will be required. The bowels si iould be kept gently open by mild laxatives and emollient ii jections, as directed in inflammation of the kidneys. The 1c eching should be repeated until the pain and uneasiness of t; e bladder are subdued. During the disease, the patient s) ould observe a very low, unirritating diet, and make use of s< me mucilaginous fluid for drink. Any of those mentioned ir the preceding article may be employed. If the urine be r< tained so as to cause distension of the bladder, the catheter y ill have to be used to draw it off. The patient must keep perfectly quiet, avoiding all manner of exertions of mind or b >dy, during this disease. When the case is chronic, leeches or cups, applied occasi- onally to the region of the bladder, will be advisable; the bowels should be kept open, and a warm bath taken twice a week at bed-time. Opiates, as ten drops laudanum, half tea- BDOonful of paregoric, or ten grains of Dover's powders, at bed-time, will be necessary to ease pain and procure rest. MUMPS. This is a very common affection : it is a painful imflamma- tion of the parotid glands, situated behind the angle of the jaw, and often extending lower down. Though sometimes confined to one side of the jaw, it usually occurs on both sides • it is at first clearly defined and moveable, but soon become fixed, and spreads to a considerable extent. It increases in size till the fourth day, and often involves the neighboring glands in the inflammation; it is supposed to be contagions, and often prevails as an epidemic. After the fourth day, the swelling gradually declines; and. foi tne most part, it is unat- 328 Angina Pectoris, or Breast Pang. tended throughout with fever, and scarcely ever calls foi medica" aid. As the swelling of the throat subsides, it not nnfrequently happens, that a swelling takes place in the pri rates of males, and in the breasts of females. Generally, all that is requisite in this affection is, to keep the head and face moderately warm, to avoid exposure to cola, to observe a mild diet, and to open the bowels by a very gen- tle purgative, as a dose of magnesia, rhubarb, or salts. When the privates and breasts simply enlarge, they ought not, to be interfered with; but should they be painful, and tend to suppurate or break, a purgative of Epson salts, or Rochelle salts should be given, a few leeches applied, and af- terwards a warm poultice. Should high fever occur, with other alarming symptoms, the usual means of reducing inflammation must be applied—purg- ing, small doses of ipecac, every two hours, with cooling washes, such as green tea (cold), tea of mullien leaves, &c. ANGINA PECTORIS, or BREAST PANG; (Pain in the Breast.) This disease has been called by several names, as will be seen above. It is a disease characterized by a sharp pain and oppression, seated at the lower end of the breast bone, inclin- ing to the left side; it comes on in paroxysms, and is accom- panied with great uneasiness, difficulty of breathing, violent palpitation of the heart, and a sense of impending suffoca- tion. In the first stage of the disease, the pain is felt chiefly after some exertion, as going up stairs, or up a hill, or walking quickly, particularly when the stomach is full; but in the more advanced stages, slighter exertions are sufficient to cause a paroxysm of pain, as walking, riding, coughing, sneezing, 01 speaking; passions of the mind also have the same tenden- cy. In the first stage, the uneasy and threatening symptoms soon go off; but afterwards they continue longer and are more distressing, causing the patient to fear immediate dissolution. During the paroxysm, the pulse is feeble and irregular, the ■face pale, and covered with a cold sweat, and the patient ap- pears as if in a fit of apoplexy, without the power of sense or motion. The disease makes occasional attacks, at longer ol shorter intervals, for years, and at last suddenly puts a period to the patient's life. This affection appears to be of a spasmodic or convulsive nature, as is shown by the manner of treatment, which is most Diseases of the Heart. 329 successful. It is found to attack chiefly those who are of tha make which has bee*^ supposed most liable to apoplexy, viz., those with large heads and short necks, and who lead a seden tary, luxurious and inactive life, who are disposed to be cor- pulent, and especially such as are of a gouty habit. It seldom attacks persons under fifty years of age. Our treatment should consist in preventing, as well as cur- ing, by diminishing the quantity of blood in the system, by purgatives sufficient to keep the bowels open, spare diet, and avoiding everything that would quicken the circulation. During the paroxysm, stimulants must be very cautiously em ployed; the head and temples are to be bathed with cold water and vinegar ; a slight bleeding may be necessary to relieve the overloaded heart, gentle pressure should also be employed on the left side, to empty the heart; mustard should be applied to the extremities, and on the appearance of re- turning breathing, hartshorn is to be applied to the nose at intervals. The disease has been mitigated by forming issues in some part of the body. Also by blisters, or tartar emetic ointment applied to the chest. Mustard to the ankles, and active purgatives, are almost always beneficial. Persons who are subject to this disease should be careful to shun all mental irritation, and every outburst of passion or ex- citement that would hurry the circulation. Moderate exercise should be daily taken in the open air, but no violent exertion indulged in ; and all attempts at going up a rising ground should be avoided, or if made, should be with the utmost care. The food should be plain, moderate in quantity, and easily digestible ; such as is not liable to occasion flatulence. Fer- mented and distilled liquors are altogether improper. On any appearance of fullness of blood, animal food should be entirely abandoned, and mild purgatives (epsom salts, rhubarb, castor oil, rochelle salts, &c.) frequently taken. A perpetual blister or other irritation in the region of the heart is sometimes use- ful, and warm bathing to the feet and legs will help still fur- ther to prevent the undue flow of blood to the other parts of the body. Mustard or cayenne pepper in the warm water, aril render the bath more stimulating and of greater service. DISEASES OF THE HEART. Owino to the use of tobacco and intoxicatiug drinks, which prevail to such a fearful extent at the present day, diseases of the heart are greatly on the increase. Each issue of the morning naper, almost, records the " sudden death" of some loved one, who has left homo and friends in apparent good 330 Diseases of the Heart. health " in the morning," but is brought home cold in the em brace of death. What a pity that intelligent beings should use such deadly poisons ! However, diseases of the heart are brought about by other causes; still, where there is any ten- dsncy to the disease, or it naturally exists, though unknown to the individual, rum and tobacco render it doubly dan gerous. If from any cause one or more of the valves.of the heart ahould become deficient, it is evident that each time they close, a small portion of blood will pass back, or " regurgitate," ink the heart—and this actually occurs in cases of disease. An6 the consequence of the long-continued and constantly-repeated disordered action is to cause stretching, or " dilatation," of the cavity which receives the regurgitated blcod. This one in- stance will explain how one slight derangement in the nicely- balanced machinery of this important organ gives rise to another. From somewhat analogous causes, the blood may regurgitate into, or be dammed up in the lungs, or in other parts of the body, causing hemorrhage, dropsy, &c. Sometimes there may be impediments to the circulation; the valves above alluded to, or others, may not yield as they should do, or there may be other causes which render it diffi- cult for the heart to propel the blood through the body. In such a case, the heart, like any other muscle under similar cir cumstances, acquires increase of substance, in consequence of the continued increased exertion demanded of it, to maintain the proper circulation ; and thus we have a cause and effect, Eroducing enlargement of the heart—an evil certainly, but a jsser evil to prevent a greater, for in this very enlargement— this strengthening, as it were, of the heart to do its extra work —the patient's safety lies. Of course there are many other forms of heart disease, but the above instances will convey some rational idea of the na- ture and peculiarities of the disorders of the organ in general. It would be quite profitless in this work to enter into anything like detail respecting diseases of the heart or Ifheir treatment; disorders so varied in tlieir nature and symptoms, can only be properly investigated aud managed by a medical man, con- versant with the mechanism and the functions of the human frame at large, and in their relations of mutual dependence. Affections of the heart are manifested by pain in the chest difficult breathing, cough, palpitation &c.; and at other timo by faintings, giddiness, irregular pulse, &c.; but there is not one of these symptoms, or any combination of them, which may not be \eveloped under certain bodily conditions, al Diseases of the Heart. 331 though the heart is perfectly sound. None, therefore, need alarm themselves merely because such symptoms occur ; they happen at times more or less to all; still they ought not to be neglected : if they continue to recur, a medical man should be consulted. If there is no disease the mind is set at rest, and any general disorder which may have caused the symptoms will probably be rectified. The above cautions are given, because there is no class of diseases of which people are so apt to fancy themselves the subjects as those of the heart; and the more they think of the symptoms, the moro likely are they to continue or increase, from an organ so intimately connected with the emotions of the mind as the heart. Even if the heart be unaffected, it is by no means advisable to permit it to con- tinue to be functionally disordered, ^irregular in its actions,) either by mental emotion or by sympathy with other organs, for the functional disorder may end in organic disease; that it does so sometimes is evident from the fact that there is no more fertile source of heart disease than those convulsions, either commercial or political, which occasionally agitate so- ciety. When disease of the heart, either insipient or confirmed, does exist, it cannot too soon be discovered oy examination nor the necessary precautions and regulated mode of life toe soon adopted ; for with these precautions, a large majority of persons who are the subjects of heart affection may not only continue to live for years, sometimes many years, but to enjoy life. True, the knowledge to any one that he is himself the aubject of heart disease may be uncomfortable, but it cannot pe unprofitable. He may be aware that heart diseases are sometimes apt to have a sudden termination, and that his life may be somewhat more in jeopardy than that of an unaffected person ; but surely to every right-thinking man, this fact would rather be an argument why he should know his real condition. The possibility of his being called away from the affairs of this life without warning, should be a reason for his keeping them well arranged ; and still more important, should it be a reason that in conducting his earthly stewardship, he should do it, not only with reference to this world, but to give account of it in another. And when the many chances and 3ontingencies of life are considered, the consciousness of being the subject of heart disease amounts to little more than such contingencies assuming a more prominent position in the mind • and to the individual it may be a merciful dispensation of providence, as, being reminded more frequently of the un- certainty of human life, he may be constrained to look for * 832 Diseases of the Heart. realization of true happiness only beyond this vale of tears,— the Christian's home in heaven I Besides the two already mentioned, there are other causes of disease of the heart: mental disturbance and agitation la a most frequent one ; also mental depression and grief, which, if long continued, appear to exert much influence over the organ^and to make the phrase " a broken heart" not altogether a poetical fiction. Violent passion strongly affects the heart ■—its indulgence may lay the foundation of disease, which its repetition strengthens, and may bring to a fatal termination. Rheumatism, or rather rheumatic fever, is probably another of the most fertile sources of heart affection. In this disease, inflammation of some portion of the membranes covering or lining the heart, is apt to occur, and to be followed by such effects as induce permanent change. Violent physical exer- tions, and dissipation of all kinds, are causes of disease of the heart. It has been said that persons with heart affections may continue to live and enjoy lite, but it must be under a more regulated and restricted system of living than is imperative on Eersons in health. Every thing which may be a cause of eart affection must also be a source of aggravation; all men- tal or physical excitement especially so. When these aro guarded against, the rest may be summed up in—strict atten tion to the general health. Whenever an old symptom be- comes aggravated, or a new one, such as swelling of the legs, &c, appears, medical advice should always be obtained. Palpitation of the Heart.—This is often caused by the various emotions of the mind, as fear, joy, anger, or excite- ment of the mind from any cause. When it arises, however, on every trivial occasion either of mental emotion or of physi- cal exertion, or without occasion at all, as it often does, even during rest in bed, then it requires attention, not solely on account of the discomfort it gives rise to, but because it may lay the foundation of disease of the organ which is so con- stantly subject to over-excitement. Affections of the heart become more common after seasons of much public excitement of any £ind—an effect traceable only to the frequent dis- turbance of the organ by the passions or emotions of the mind. Independent of disease, palpitation of the heart is liable to occur in the young of both sexes, and in females particularly, soon after the age of puberty—in the latter being very gene- rally associated with hysterical tendencies ; in such cases, it ia met with in its most aggravated forms, and often of such violence as to prove alarming. In any case the tendency to Diseases of the Heart. 333 palpitation is more common in the nervous temperament, and ■m increased by whatever gives undue predominance to that temperament, such as indolence, luxurious habits, and the indulgence of feelings and imagination artificially excited; and having once begun, it is kept up and aggravated by the continued attention with which the mind is apt to dwell upon the ailment. The individuals subject to it easily imagine themselves as subjects of heart disease, watch every motion almost of the heart, and thus under the influence of their own imaginary fears, produce the very symptoms they dread. This nervous condition (for it is generally nothing else) ia only to be got rid of by those measures which give a more vigorous and healthy tone both to mind and body. The false excitement of imaginative literature, I mean reading trashy flovels, etc., if it has been indulged in, must be exchanged for something which calls for some healthy mental interest. Where it can be adopted, the pursuit of some branch of natural history, botany, geology, or any other out-door occupation, are the best pursuits ; they occupy the mind, and draw it away from its own morbid fancies, even in the time of exercise, which is rendered doubly invigorating by the mental excitement which accompanies it. Along with these means, a system of diet calculated to give good nourishment should be adopted ; heated and ill-ventilated rooms, above all things, are to be avoided, early hours observed, and if a feather bed has been habitually lam upon, a firm hair or husk mattrass should be substituted. One article of diet requires especial mention, as being pecu- liarly injurious in such cases ; tea of any kind is better avoided, but green tea is absolute poison ; coffee is scarcely allowable, and cocoa or milk should invariably be substituted for either of the aboye more stimulant beverages; wine or malt liquor may be injurious, or the reverse, according to the previous habits of the patient and the nature of the case ; if depression or debility follow their withdrawal, the tendency to palpita- tion is certain to be increased. In addition to these measures, regulation of the bowels, the use of the shower-bath, cr better, of the douche, or water poured down the spine, and occasional mustard plasters on the chest or between the shoulders, are all useful, especially if, as frequently happens in cases of aggra- vated palpitation, any tenderness of the spine is found to exist. In cases of nervous palpitation, medicine is not much called for, unless to remedy other disorders, such as indigestion. Some patients derive much benefit from a teaspoonful of a mix sure of equal parts of tincture of valerian, tincture of htubaue, and spirits lavender: taken twice or three times a day in water. 334 Scurvy. Hartshorn in teaspoonful doses with cold water, is often useful, especially if there is much flatulence ; or ether may be taken in ten or fifteen drop doses, either alone or with the above- mentioned remedies given in water. The ether, however, is more generally serviceable as a remedy, during an attack of palpitation than when taken regularly. In most cases of this kind it will be found necessary to change the remedies occa sionally, or they will lose tlieir effect. SCUR VY. By medical writers, and by well-informed non-professional men, the term scurvy is now applied to that disease which ia produced by a long abstinence from fresh vegetable food, ex- posure to damp, and the influence of the depressing passions, and which is therefore frequently observed in long voyages, in camps, and in besieged towns. It comes on gradually, with heaviness and aversion to motion, with dejection of spirits, anxiety, and great debility. The countenance becomes sallow and bloated, the breathing is easily hurried, the teeth become loose, the gums are spongy, and bleed when slightly touched; and livid (or purple) spots appear on different parts of the body. A very curious circumstance sometimes occurs in scurvy: old wounds, which have been long healed, break out afresh. M the disease is not checked, the joints become swelled and stiff, the tendons (sinews) of the legs stiff and contracted; a dark colored blood issues from the nose, the eai s, and other parts ; offensive stools are discharged, and the patient dies with symptoms of diarrhoea or dysentery. The cause of scurvy is long confinement to a diet destitute of a due admixture of fresh vegetable substances. The fre- quent occurrence of scurvy in long voyages, during which the ship's crew are compelled to live much on salt provisions, and in besieged towns, where the provisions are scantyand bad, and in cold, damp and poor situations, where human life is with difficulty supported, is thus accounted for. Among other very exciting causes, we are to reckon want of cleanliness and ven* tilation, a damp and cold atmosphere, and, above all, depress- ing passions. It has been ascertained that by keeping the shijp perfectly clean and dry, by allowing the men as much recrea- tion and exercise as possible, and by taking to sea a propel' supply of lime or lemon juice, and distributing to the shir 'a com pany a portion of it every day, when their fresh provisions begin to fail, they may be kept from scurvy as effectually as any number of persons living on shore, and using fresh veg» etablss every day. This has, for a considerable number o/ Scurvy. 335 y%a*rs, been ascertained on a very extensive scale of expe- rience. From one to two ounces a day are a sufficient quantity for this salutary purpose; and it may be given diluted witn water, or made into lemonade, with sugar and water, so as to form a healthful and refreshing beverage. When in any indi- viduals the tendency to scurvy appears stronger than in others, aa indicated by the spongy and easy bleeding gums, by stiff- ness of the hamstring, by inertness and dejection of spirits, it will be proper to give an ounce of the juice three or four times a day till the tendency is diminished. Lime juice is apt to ferment, and not to keep properly, owing to the quantity of pulp and mucilage squeezed out along with it. To prevent this fermentation, it is proper to mix with it a little alcohol or carbonate of lime. It has been ascertained by experiment that the curative properties of the lemon juice depends very much on the potash which exists in combination with the acid. So that cream tartar and the carbonate of potash given in small ina repeated doses, say one teaspoonful three times a day in i glass of water, will act well where the lemon juice can not be had. And so far as our experience goes, the same powerful yet simple agent which prevents scurvy, is also fully sufficient to cure it. When circumstances admit of it, and we are able to procure for a ship's company an abundant supply of fresh meat and vegetables, this is the natural and appropriate remedy; but in the last stages of the disease, when the debility is great, it is a matter of much danger to take the sick on shore, as they not unfrequently die in the boat that carries them thither; and instances have even occurred of the land air being too oppressive for the lungs of those, who did not previously show marks of so great feebleness. It is by far the safest way to attempt the cure of the men on board their ships; and when the disease abates a little, and the strength is beginning to return, it may then be accelerated by a removal on shore, and by the usual diet and exercise to be found there. Many aux- iliary circumstances are to be called into action, both in tha cure and prevention of scurvy; the greatest attention to ven- tilation and cleanliness, frequently washing the ship in fine weather, fumigation between decks by the vapors of the nitrio or muriatic acid, by pouring either of them over a small quantity of common brown sugar, or pieces of zinc, iron, etc. attention to increase the real comfort of the men, and to check all intemperance; to promote regularity of discipline and cheerfulness of mind. Various articles are to be used in diet which counteract the pernicious tendency of a long continued use of salt provisions, as spruce or treacle beer 336 Consumption. sourcrout, preparations of oatmeal, and occasionally parboiled fresh vegetables, such as water cresses, radishes, scurvy grass, lettuce and the like, which may be eaten raw; or cabbage, turnips, spinage, cauliflowers, boiled; or ripe fruits, as oranges, melons, pine-app.es, plantain, etc. CONS U MP TION. This disease has been truly termed the " great destroyer of our race." It enters the cottage and the castle; it kills tha rich and the poor, the old and the young, and regards not sex or condition, but rushes on, slaying its tens of thousands every year. Consumption is only & portion, strictly speaking, of a constitutional malady which very frequently develops its in- tensity in the organs of respiration, (the lungs), but may do so in other modes and in other organs of the body. Its constitu- tional nature requires to be impressed upon the mind of people in general; for, regarded only as a disease of the lungs, alarm is not taken, nor are remedies generally resorted to until its effects upon these organs become manifest; the antecedent period in which the constitution is giving way is overlooked, and that time is lost in which the first indications of disease might have been successfully attended to. We may state that the causes of pulmonary consumption are all those which occasion debility generally, not excepting the most frequent of all, hereditary predisposition, or that tendency to the disease which exists so strongly in some families, that no care or precaution can ward it off, nor pre- vent it seizing in succession member after member of a house- hold. Fortunately, this intensity of hereditary transmission ia not so very frequent, but there are few families in which the tendency does not more or less exist; there are few which can- not number amid their deceased relatives some victim of con- sumption With a susceptibility so widely diffused, it becomes a serious consideration with all by what this tendency is en- couraged, and how it may be diminished. The first considera- tion that presents is marriage. There can be no question, that from errors in the contraction of this great engagement of life, much of the hereditary tendency to consumption is de- veloped, and especially when the union is between parties nearly related by blood; doubly so if the predisposition already exists in the family. Delicacy or debility of either parent, particularly of the father, is very apt to entail consumptive tendencies upon the children; and the same follows if the parents are either too young, or if the father be advanced in lyfe. The mistake is a very common one, that marriage and Consumption. 337 child-bearing act as a check upon the progress of consump- tion, and the step is often advised even to the comparatively oung with this view. The error is a serious one; nothing can e more trying even to a healthy female than having a family before the constitution is formed; and most certainly it is so to the weak. It is true, apparent temporary amendment of con- sumptive symptoms sometimes occurs, but the powers of life are sapped by the too early call on their exertions. Great care is required near the approach of the age of puberty, especially in the case of those who have displayed any scrofulous or consumptive tendency. The development of the body which is going on requires a full supply of the most nutritious food, animal food particularly. The secre- tions should, if possible, be kept in healthy activity, and, more especially, all sources of exhaustion most strictly avoided. Youths especially must be warned against the evil of prolonged physical exertion; and not less so against the mental efforts, which those especially, who partake of the nervous and exci- table constitution of the hereditary consumptive, are apt to give way to, in competitions at school or college. Along with the consumptive tendency, two very different conditions of physical development are found. In the one, there is the fair fine skin and bright red complexion, the fair hair, the light eye, with its pearly looking white, and the tapering fingers; in the other, the dark hair and skin, the latter almost dirty-looking, and the swollen-looking upper lip. Consumption varies much in its initiatory stage; sometimes it steals upon the patient most slowly and imperceptibly; at others, developed probably by some acute attack, it appears to start at once into activity. Generally, for a considerable period before marked symptoms—or at least symptoms which attract general attention—show themselves, the person has felt weak, languid, and complained much of cold, probably has sunk in flesh, and a short dry cough has come on, apparently without cause, or there has been continued dyspepsia. If the patient is a female, the monthly discharge has become irre- gular, or stopped. It may be that these symptoms have been aggravated during winter, and disappeared partially or en- tirely with the advent of warm weather. Such symptoms may go on for a longer or shorter period, ebbing and flowing, but still gaining ground, or they may progress more unremittingly, though still slowly, or become suddenly aggravated by taking cold, some unusual fatigue, or the like. The emaciation be- comes too evident to escape notice, the cough is unabated and becomes troublesome, the voice assumes a peculiar hollow 338 Consumption. Bound, the breathing is quickened, and it may be that spitting of blood, profuse night perspirations, or even diarrhoea, have 6et in before the patient's condition excites either alarm in their own mind or in that of their friends. Indeed it very frequently happens that the patient is the last to take the alarm, the last to entertain the idea of the fatality of the dis- ease, of which this hopefulness of recovery is a well-marked symptom. As regards the prospect of recovery from consumption—for recovery does undoubtedly take place—much depends upon the original and existing constitution and the habits, past or present, of the individual, and the worldly means within his power. When once the disease has become established in an indi- vidual of strong hereditary tendency to it, or in one who hue. broken down his constitution by dissipation or intemperance, or who is the subject of some other debilitating disease, hope of amendment can be but small. If, on the contrary, the affec- tion is more probably induced, and rather accidental than the result of original constitutional tendency, the probability is that under proper management, and with the aid of the gre-«t curative powers of cod-liver oil, and medicated inhalation, (sj e Catarrh in the Head in another part of this work) not only amendment, but permanent recovery may be obtained. Whc d consumption has advanced beyond its first stage, all the symp- toms already mentioned are increased, the cough and perspira- tion particularly become more distressing, and the tendency to diarrhoea, (frequently with severe spasmodic pain in the bowels,) notably increased; expectoration is often difficult, either from weakness or from the thick matter expectorated; the hair falls off, and emaciation continues. The prevention of so fatal a disease as consumption is a more important subject in a work like the present, than its treat- ment ; and in those predisposed, the preventive or " prophy- lactic " system must be continued life through, even into old age. It is a popular error, that by the time middle life is reached the liability to consumption is over. Such is not the case, for even the u three score anil ten " is sometimes termin- ated by the disease. In any condition of life, the question of tendency or not to consumptive disease should influence the choice of field for exertion, and not only of field, but also of the nature of the business of life. Any occupation which renders the inhalation of irritating substances unavoidable, is to be avoided by tha consumptively inclined man; and not less so, that which Consumption. 339 involves confinement n a constrained position or in a close room. The most eligible employments are those which require muscular exertion of not too exhausting a kind, and without too reat exposure to the weather; the gardener, the carpenter, utcher, the farm-servant, are all less likely to be the victims of the disease. In whatever situation or grade of life, however, a person may be placed who is predisposed to consumption, much may be done to keep up the powers of resistance by keeping up the general health to the highest possible stand- ard, by diet, early hours, attention to the skin, etc. (See " How to preserve Health" in the first part of this work.) The chest and shoulders should be bathed every morning with cold salt water, and rubbed afterward to promote reaction. Cheerfulness of mind and moderate mental exertion are im- portant, while perfect temperance in the use of alcoholic stimuli is indispensable; but any change to their total disuse cannot be made suddenly, if the patient has been accustomed thereto without danger. All the usual sources from which " cold is taken" are to be shunned, particularly wet feet, sitting in damp clothes, crowded ball-rooms, and public assem- blies ; and, lastly, when exposure to cold air, especially to east winds, or to the foggy atmosphere of'night, is unavoidable, the protection of a respirator to go over the mouth and nos- trils—a silk handkerchief being about the handiest—should be resorted to. Medical men are often asked their opinion as to the commu- nicability of consumption from one person to another. That it is not generally communicable is certain ; that it has been thought to be so under circumstances of predisposition, and when there has been close communication between two per- sons, should be sufficient to caution other members of a con- sumptive family from hanging too much over one affected with the disease; and certain!^ in any case forbid the occupation *y the saw£ bed. 310 Dyspepsia, or Indigestion. DYSPEPSIA or INDIGESTION. This distressing complaint has been said truly to be " nc respecter of persons ; " its symptoms are usually well known; it originates or is brought about by a great variety of causes; among which it is often found associated with a diseased state of the liv.r. Persons who have used spirits of any kind to excess, or stimulants of any description, such as spices or highly seasoned food, and those also who have used tobacco to great'excess, by which the coats and functions of the stomach nave been impaired and debilitated, are liable to indigestion. A costive habit, acquired by permitting the bowels to remain too long without evacuation, will bring on this disease, and persons who are long confined to any stationary or sedentary business, without taking the necessary exercise, are often subject to it. When the complaint is firmly seated in the stomach, it is marked by belchings of wind, gnawing and disagreeable sen- sations at the pit of the stomach, risings of sour and bitter acid into the throat, occasioned by the food not being properly digested; great irregularity of appetite, which is sometimes voracious and at other times greatly deficient, and a sinking and oppressive debility or weakness of the stomach. In addition to these symptoms of indigestion, on gratifying the appetite at any time, the stomach in a short time afterwards becomes oppressed with sensations of weight and fullness, the head becomes confused, the sleep very much disturbed, the bowels very irregular and costive, the urine high-colored, and the poor victim commences taking medicines for relief, and brooding in dejected silence over thousands of unhappy retro- spections of his past life, and countless melancholy'anticipa- tions of the future. Should disease of the liver be connected with this disease, a deadend heavy pain will be felt in the right side; the water deposited in the chamber will have, on cooling and settling,, a brick-dust colored sediment, which, if permitted to remain any length of time, will adhere in rings of a reddish hue to the inner sides of the urinal; a pain will be felt in the top of the shoulder and back of the neck; the feet and hands will frequently become benumbed, or what is called " getting to aleep," from want of regular circulation; the complexion witf become of a yellowish hue or tinge, and general uneasiness oi the whole system will be felt. The treatment of this disease consists in keeping the bowels open regularly. If they are not rendered so by the use of atewed fruit and ripe fruit uncooked, with injections of half Dint of cold water up the bowels every morning, a dose of Heartburn, or Sourness of the Stomach. 841 some mild purgative medicine should be taken. (See " Medi- cines, their doses and uses,") so that the bowels are opened every day. Friction and percussion, by striking with the oaen hand, gently over the region of the stomach for a few minutes, half an hour before each meal, should be attended to, and be sure to never eat as much as the stomach seems to crave, that is, always "get up hungry" and never eat any article of food known to disagree with the stomach. Eat slow and as regular hours. Avoid the use of intoxicating drinks, and do not eat meats for supper; sleep on a hard bed and take a spongw bath every morning, followed by the use of a dry, rough towel and the flesh-brush ; take plenty of active out- door exercise, and partake of a mixed diet; and above all avoid the poison called tobacco, in every form. HEARTBURN, or SOURNESS OF THE STOMACH. Heartburn is found to exist under very different conditions of the system. It is prevalent, frequently, with females, during pregnancy, the causes of which were explained under the head of "Pregnancy and its Diseases." It is also of the greatest consequence to the dyspeptic; and may be caused by any thing whieh interrupts the process of digestion, especially costiveness of the bowels. The symptoms of this disease con- sist of a burning sensation, felt either at the pit of the stomach or top of the throat, and occasioned by undue acidity, or by irritating substances in the stomach. It is generally relieved by soda, magnesia, or chalk, ten grains in a little water, or twenty drops of hartshorn in a wineglassful of cold water— which neutralizes the acid. It is not, however, advisable to have too frequent recurrence to these palliative remedies, for they are only palliatives,—they cannot be taken habitually without weakening, not only the stomach, but the system gen- erally. Heartburn cannot continue to recur without there ueing an error somewhere; either the diet is badly regulated, or the digestive organs require something more than simple neutralization of the superabundant acid. This acid is a badly- formed gastric juice, and if it is neutralized, whatever diges- tive, power it might possess is destroyed; consequently the stomach is called upon to secrete another supply before tha food can be digested—a call upon its powers which cannot fail to be injurious. Moreover, persons finding how quickly a dose of alkaline medicine removes the uncomfortable sen- sation of heartburn, are very apt to trust to the palliative, and continue their indulgences, rather than to practice the sell? denial requisite to effect a cure of the cause. 842 Waterbrash—Jaundice. Prevention, therefore, or removal of tho cause, is what is of most importance in this disease. The bowels must be kepf open by mild purgatives, so that there is an_ operation regu iarly every day. Every thing known to disagree with tha stomach must be avoided, exercise taken in the open air, and all the means pointed out under the head of " How to preserve Health," strictly adhered to. WA TERBRASH, Medical men have strange names for diseases, as well as those who are not medical men. Pyrosis is the medical name for this disease, but usually called Waterbrash. It is a pe- culiar affection of the stomach, in which the patient brings up frequently a considerable quantity of thin watery liquid, some- times insipid, at others intensely acid. Before the fluid ia brought up, often there is more or less pain experienced at the pit of the stomach. This complaint attacks, mostly, persona past the middle age, particularly females, and the fit comes on generally in the morning and afternoon. It usually begins with a severe pain in the pit of the stomach, attended with a feeling of constriction, or oppression, and soon after a quantity of thin watery fluid is thrown up, which is sometimes insipid, at other times it has a highly acid or burning taste. The causes of this complaint are various, but whatever disorders the stomach may give rise to it. It appears to be owing to a peculiar state of irritation of the stomach; and is most cer- tainly relieved by the use of the white oxyde of bismuth, from two to three grains made into pills with extract of gentian, three times a day. This medicine will often perfectly cure waterbrash ; but attention to the diet, as laid down under dys- pepsia, is of much consequence, and will be absolutely neces- sary in order to render the cure permanent. A diet of plain animal food may be allowed, with which may be united the use of biscuits, home-made bread, and preparations of rice and milk. Daily exercise must also be taken, and frictions, with the flesh-brush, over the region of the stomach and bowels, are of no small service. The bowels must of course be kept open by purgatives, when necessary, even wl en making use of other curative means, J A UNDICE. This disease is often improperly called " jarvders :" it is cha- racterized by yellowness of the eyes and skin, whitish or ciay- eolored stools, and saffron-colored urine, which communicatei to substances immersed in it a saffron dye. Jaundice is caua Jaundice. 343 ad by the duct or tube leading from the gall-bladder to the stomach, becoming stopped tip,—that is, something in the first place stops the flow of bile from the liver; and jaundice, which consists in an absorption of bile into the blood, is the result. Probably, gall-stones, or thickened bile, are the most com- mon obstructions; but tumors which press upon the duct, or 6pasm, may also stop the bile and induce jaundice. Jaundice has sometimes been caused by violent mental emotions, (un- easiness of mind, from various causes,) also, an irregular or sedentary mode of living will produce it as well as intemper- ance, especially continued indulgence in spirituous liquors. The presence of bile in the blood is quickly manifested by the color of the skin, and also more particularly of the white of the eye; the shade of color varying from the slightest percep- tible tinge, to deep golden yellow, or even brown. At the same time, the stools become white and chalky-looking, and the urine—sometimes the perspiration—is deeply tinged with bile; the constitutional symptoms are generally those of dis- ordered digestion, (see Dyspepsia?) headache, languor, &c. The principal objects of treatment are, to allay irritation in the stomach and bowels, and to remove the obstruction exist- ing to the free passage of the bile, through the biliary ducts, and along the bowels. It will be frequently found, that the best means of allaying irritation in these parts will be the most effectual in removing the jaundice. In the young and robust, bleeding by leeches applied over the region of the liver, will often be demanded, especially in recent cases; cupping over the stomach and region of the liver is generally an im- portant remedy. The patient should also take a warm bath at ninety-six or seven degrees, every other morning about eleven o'clock, with the following pills during the day: Castile soap, a drachm and a half; rhubarb, in powder, eight grains; ipecac, in powder, ten grains; oil of juniper, ten drops; syrup of orange peel or lemon, a sufficient quantity to make the whole into twenty- four pills. Three to be taken twice or three times a day. Or when there is a good deal of pain in the bowels, the following may be used instead: compound extract of colocynth, and extract of henbane, of each, a drachm; divide into twenty- four pills; one, two, or three to be taken as above directed. Gentle purging is perhaps the most beneficial mode in most of cases one or two tablespoonfuls of both the Epsom and Glauber's salt may be dissolved in half a pint of lukewarm water, and taken every morning for a fortnight; and resumed for another fortnight or three weeks after being laid aside foi a week. 344 Milk Sickness— Colic. If there is much pain in the affected side, mustard plasters or poultices, applied frequently, will be of much service. Sometimes giving an emetic of ipecac will cause the gall-stcne or thick bile to pass into the stomach, and thus relieve the difiioulty at once. # Many persons who have resided long in a hot climate, con tract a sallow, yellowish complexion, which hue often pervades the whole skin ; this is generally regarded as a mild sort of jaundice, or as arising from the absorption of the bile, but il is usually of a different nature. In most instances, it is not owing to this cause, but to .a peculiar alteration in the circu- lation, on the external surface of the body, in consequence of the skin's sympathizing with a weakened and irritated con- dition of the digestive organs, more especially of the stomach and bowels. MILK SICKNESS. This is a peculiar affection which occurs in many of the Southern and Western States, in the autumn. It has been called bv various names, such as " swamp sickness," " tires," "slows,""" stiff joints," " river sickness," "puking fever," &c. it affects both the cattle that eat of the herb which causes the disease, and also the persons who use the milk taken from the cow, or who eat the flesh of animals affected with the dis- ease. It has not as yet been satisfactorily settled what kind of an herb or plant causes this sickness; however, the symptoms show it to be a narcotic, or poison. There is vomiting, purg- ing, extreme nervous agitation, great prostration, trembling, &c. The treatment consists in giving plenty of warm sweet- ened water every few minutes, until the stomach has been emptied by vomiting; then a mustard plaster over the stom- ach and bowels, and injections up the bowels of lukewarm water, until the bowels operate, after which a mild purge of castor oil. The patient must be kept perfectly quiet in bed; should symptoms of sinking show themselves, give stimulants —brandy, whisky, wine, hartshorn, or whatever is handy To allay the thirst, give strong coffee (cold) without sugar oi milk. COLIC. This disease is produced by so many different causes, is ao varied in its symptoms, under different circumstances, and re- quiring treatment suited to its different causes and symptoma, that we have thought it best to treat it under the following divisions: Colio from Indigestion.-—Among the most common symp toms occasioned by an excess in eating, whereby the stomach Colic. 345 re leaded beyond what is compatible with the regular and healthy performance of its functions, is a violent pain or colic, accompanied with nausea, headache, and dizziness, preceding; tne ejection of the contents of the stomach by vomiting; and terminating (Subsequently in a griping looseness of the bowels. But it is iKt only by excess of food that this species of colic is produced; it is occasioned also by the quality of the food. • various hi^h-reasoned and made dishes; certain articles of a highly indigestible nature ; malt liquors ; cider and wines of a bad quality; the stones, kernels, husks and enveloping mem- brane of various fruits, swallowed when the latter have been eaten, &c, frequently give rise to it. We find it, however, in many instances originating after meals, from causes more obscure, and accompanied by various additional symptoms of a much more violent and distressing nature, as though the food itself had proved poisonous, or some poisonous substance had been intermixed with it. Occasionally these additional symp- toms consist of an intolerable feeling of suffocation ; a feeling of constriction in the throat; the face and eyes become swol- len ; with excessive thirst; a burning heat over the whole surface; a feeling of itching or prickling in the skin, and an eruption, sometimes in the form of minute raised points, at others in that of larger elevations'; the skin peeling off on the subsidence of the attack: in addition to which we sometimes have a species of delirium, with twitching of the muscles. At other times the symptoms consist of great anxiety; difficulty of breathing ; dejection of spirits; spasms of the liirbs, as well as of the bowels and muscles of the abdomen ; coldness of the extremities ; loss of sight and hearing ; convulsions, &c. The first of these two last varieties of colic from indigestion raises in general from a peculiarity of the individual, the con- dition of the stomach at the time of eating, or from some pecu- liar principle connected with animal food of a particular description. The articles of animal food which in general give rise to the species of colic under consideration, are various shell-fish, mussels, crabs, lobsters, &c. Animal substances, in the process of cooking, or in the dif- ferent processes to which they are subjected with the view of preserving them for future use, or from their being improperly ?r too long kept, may undergo a change, rendering them im- proper articles of food. The second variety mentioned of the colic from indigestion ia produced generally by eating deleterious vegetable sub- stances, either mixed with our food or eaten in mistake foi healthy articles. 846 Colic. The treatment in all the varieties of this species of cobc is to be commeuced with an emetic, in order to unload tbs Btomach of the offending matter. Where the disease has been induced merely by a surfeit, or by too rich food, a dose of ipecac will be proper; in some cases, even warm water wilJ be sufficient; but in the two other varieties, a more prompt and powerful emetic is demanded, and it has been recom- mended to prescribe immediately a full dose of the sulphate of ainc (twenty grains, in a gill of warm water.) The emetic is to be followed by a brisk purge, which may be aided in it* operation by injections up the bowels. In the second variety, the vital powers of the system are in general rapidly, and to a most alarming extent, exhausted ; it therefore becomes neces- sary, as soon as possible after the evacuation of the stomach to rouse the system, by the administration of the most diffusible stimulants and cordials, such as sulphuric ether, ginger tea or cayenne pepper tea; and vinegar, diluted with water anc sweetened, should be drank in abundance. These remedies may be aided by stimulant applications to the extremities, and all the other means of rousing the vital powers from their state of exhaustion. In the second variety, the treatment dif- fers but little from that already laid down. The great indica- tion is to get rid of the offensive matter as quickly as possible, by active emetics and purgatives; afterwards to rouse the system by external stimulants, mustard, friction, &c.; and to subdue the irritation and general convulsions by opiates. A mixture of ether and laudanum, ten drops of each, in water, is an excellent internal remedy; and in many cases, much advantage will be derived from the plentiful use of water and vinegar, sweetened with sugar. Flatulent Colic—In addition to the general symptoms of colic, in this species we meet with a considerable and unequal distension of the abdomen, occurring suddenly. There is a rumbling of wind in the bowels, and a frequent expulsion of it both up and down. These discharges of wind in general occasion some relief to the patient, and the pain is also dimin- ished by pressure upon the abdomen, bending the body for- ward, &c. Flatulent colic i* produced by every thing which occasions derangement in the stomach and bowels, and it ia frequently complicated with dyspepsia. In many cases of the disease, the affection appears to be induced by a morbid pro- duction of air by the bowels themselves, but in general it is dependent upon the use of fermentable substances as articles of diet, particularly vegetables. The fruits of the season, cabbage, beans and peas, new cider, wines, beer and porter. honey, onions, various kinds of nuts, &c, &c, being introd'aced Colic. 347 mto the stomach when that organ is in a state of debility frequently undergo a rapid fermentation, and give rise to an enormous development of gas, producing the symptoms pecu- liar to this species of colic. in the flatulent form of colic, our indications are to relieve the spasm, exp«l the wind distending the bowels, and after- wards,^ by a proper regulation of the diet and the judicious administration of tonic remedies, to restore the healthy action of the stomach and bowels. Immediately upon an attack of flatulent colic, if we are convinced that no degree of inflam mation exists in any portion of the bowels, we should admin- ister ten drops of laudanum in combination with some aromatic or diffusible stimulant; (strong essence of peppermint being about the best, ten to twenty drops,) and at the same time apply mustard plasters or stimulating fomentations externally to the abdomen. Vinegar and hops will be found very good, or large bran poultices, frequently renewed, will answer. The best internal remedy is probably a combination of ether and laudanum, in proportions suited to the age of the patient and the violence of the case, exhibited in a draught of aniseed 01 mint water, or the compound tincture of lavender; at the same time we may administer injections, composed of some aromatic, a little cinnamon tea, mixed with soap suds may answer, but the one most to be depended on, is composed of a teaspoon- fnl or two of turpentine and a sufficient quantity of pepper- mint rubbed up with a proper portion of some thin mucilage, or thin gruel; tincture of assafcetida and laudanum, ten to twenty drops of each; assafcetida, a few drops in gruel, has also been recommended, in the form of injection. In many cases, hartshorn, in doses of twenty drops in water every half hour, will give prompt relief. After the pain has somewhat subsided, it will be proper to administer an active but mild purgative; the best is probably magnesia, combined with calo- mel, to which should be added a few drops of essence of pep- permint. There is another form of colic caused by costiveness. The disease will be known by the fact that nothing in the way of diet having beon taken to produce the symptoms, and is more gradual in its attack; a feeling of uncomfortable fullness in the bowels being felt tor some days before the attack; also losa of appetite, headache, restlessness, &c. The treatment must consist of giving an emetic, injections of soap suds up the bowels, and a brisk purgative and mustard plasters to tha bowels, until relief is obtained, then being careful afterwards to keep the bowels regular. (See Costiveness.) 349 Colic. Btliotjs Colic.—This form of the disease is marked by u violent and intolerable pain of the bowels, which in some cases seem to be, as it were, tied together, and in others closely puckered up, and with a sensation as though they were boreo through with a sharp pointed instrument; the pain occasionally abates^ but quickly returns. In the beginning, the pain is not fixed to one particular spot, as it is in the progress of the dis- order, while vomiting also is less frequent, and the bowels more easily yield to the action of purgatives; but, as the pain increases, it becomes obstinately fixed to one place. Frequent vomiting succeeds; the bowels become more and more costive, until at length the symptoms, rapidly increasing in violence, unless the patient be speedily relieved, a total inversion of the action of the bowels takes place. Every thing administered by the mouth, or injected into the bowels, is then thrown up violently by vomiting; the matters discharged from the stomach are various in appearance; sometimes of a green, yellow or dark color. In this disease there is violent irritation of the bowels, in consequence of which they are thrown into a state of spasmo- dic contraction, by the vitiated secretions poured into them from the liver and surrounding glands. Though this is a formidable disease, if taken in time it can ye successfully treated in most of cases. In every case where the symptoms are of any considerable violence, particularly if the patient be of a robust habit, it will oe proper to commence the treatment of bilious colic by apply- ing leeches to the bowels, and afterwards a warm poultice to encourage the bleeding from the parts; or if leeches are not handy, scarifying, and the application of cups will be advisable. Immediately after the leeches, or cupping, ten grains of calo- mel and one of opium in combination, should be administered by the mouth, and the patient may at the same time be im- mersed in a warm bath; or if this be not practicable, warm fomentations of hops and vinegar, should be applied over the whole of the abdomen, and continued for some length of rime. If, after a reasonable time (two or three hours), the patient is not better, the calomel and opium should be repeated. This will asually relax the spasm of the bowels, and at the same time excite the healthy action of the liver, and unload the bowels of the diseased secretions by which the irritation is kept up The action of the calomel may be assisted by injections of a laxa- tive nature thrown into the bowels, and frequently repeated or, where the stomach will receive and retain it, wo may foJ Costiveness of the Bowels. 349 low the calomel by Rochelle salts or castor oil, in repeated dopes. When the stomach is very irritable, and frequent vomiting present, these symptoms will in general be relieved by the calomel and opium; we may at the same time, however, ex- hibit the effervescing mixture (soda powders), and a large blister or mustard plaster should be applied over the stomach. [n every case where the symptoms are violent and obstinate, the application of a blister or mustard plaster, after the em- ployment of warm fomentations has been continued for some length of time, will be of advantage, and should not be neglected. After the violence of the disease has been removed, we should next direct our attention to restore to the liver, the stomach, and bowels their healthy action. This is to be done by giving small doses, say five to ten grains of rhubarb, half grain of opium, and half grain of ipecac every four hours. Of course the diet of the patient should be light, nourishing, easy of digestion, and taken in small quantities at a time. He mould particularly avoid all fat, coarse and irritating articles of food, all crude vegetables, and all stimulating liquors; he thould make use daily of moderate exercise, but above all, riding on horseback. Bilious Colic is a disease which is easily reproduced by any impropriety of diet or regimen, or by exposure to cold or damp, and all these exciting causes of the disease should be carefully guarded against by the patient for some considerable time. He should be particularly guarded against over-heating himself, either by exposure to the sun or by over-exertion, and particularly when such has been the case, should he be cau- tious not to expose himself to cold, either by throwing off any portion of his usual clothing, sitting in a draught of air, going out into the night air, or drinking cold fluids. His bowels should be kept moderately open either by the use of the ripe fruits of the season or some gentle laxative, and intoxicating drinks should be by all means avoided. COSTIVENESS OF THE BOWELS. The bowels, generally speaking, ought to operate thoroughly once in the twenty-four hours. In persons who do not expe- rience such relief it may be called a case of costiveness of the bowels. There are, however, exceptions to this rule; with some individuals, a single evacuation of the bowels once every three or four days, and even less often, seems to be sufficient, and perfectly compatible with their enjoyment of perfect health ; and when such is the case it is of course superfluous 350 Costiveness of the Bowels. to endeavor to correct it, and it is better to let well alone. If however, ir conjunction with this condition of the bowels, tha person suffers from headache, from languor, from distention of the abdomen, if the breath is disagreeable, and the tongue furred, the state is not compatible with health, and should ba corrected. There are numerous causes producing this disease, a few of which will be enumerated. The nature of the food, as might be expected, exerts considerable influence ; bread badly made, and especially if alum be mixed with it, cheese, milk with some persons, farinacious articles, such as arrow-root or ground rice, and food of too concentrated a character, all tend to pro- duce costiveness. Deficient exercise, particularly if combined with much exertion of mind; any drain upon the system, aa m suckling, abundant perspiration, loss of nervous power, and old age have the same effects. The large bowel is very frequently the seat of the costiveness ; it loses tone, allows itself to be distended, sometimes to an enormous extent, or contracts to a very narrow calibre in some portion of its course. Lastly, a very common inducing cauue of costiveness, particularly in females, is inattention to the Intimation of the laws of nature to relieve the bowels. Every effort should be made to correct the disorder without the aid of medicine. In the food, all these articles which have been enumerated, or which are known to produce costivenes«, must be avoided. The bread used should be made of unbolted flour (called " Graham flour" sometimes); if vegetables and fruits agree in other respects, they may be freely consumed, and cocoa substituted for tea or coffee : food is not to be taken in a state of too great concentration, but so that by the bulk of its refuse it may afford substance to stimulate the action of the bowels. In addition, there are various articles of diet which exert an aperient or laxative effect, and which may be used or not, according to the taste of the person : such as Scotch oatmeal in the form of porridge, honey, prunes, etc. Exercise, whether on foot or on horseback, is another valuable aid in the removal of the costive state; it not only quickens all the functions, but it assists the action of the bowels by the mechanical motion communicated to them. Friction hy rub- bing with the hand or coarse towel over the bowels, has a good effect. Another very important point is regularity in the time of evacuating the bowels ; not waiting for the urgent eensation, but retiring for the purpose at one set period of the day, when ame can be given, directly after breakfast, being the best Costiveness of the Bowels. 351 Persons who are liable to costiveness should give themselves at least a quarter of an hour, or even longer, for the daily evacuation of the bowels. In cases which are not benefitted by a diet of fruits, &c, as often recommended in this book, of course appropriate medi- cines must be used. If there is simple costiveness, without disorder of the diges- tive organs, the best remedy will be the regular use of injection of cold water every morning; if, on the other hand, furred tongue, with acidity of stomach, flatulence, pain between the shoulders, headache, &c, betoken deranged digestion, medicine will be required, at all events in the first instance: the liver is probably at fault, and five or six grains of blue pill, followed in the morning by castor-oil, will be requisite to commence the treatment; or seidlitz powders, or Rochelle salts, may be used instead of the oil occasionally. If the stomach, liver, and upper bowels have been well cleared by the above medicines, it is requisite to keep the bowels open; otherwise a few days will see all the symptoms returned—and, in fact, such is too often the case. Persons are content with taking a dose of strong opening medicine every few days, or once a week, as the case may be, and rest content with thus having a good clearing out. The practice is one incompatible with sound health, and is most injurious to the stomach and bowels themselves: many cases of obstruction, and even inflammation of the bowels are produced by it. The orinciple to be proceeded upon in the treatment of costiveness is, that, it is more easy to keep the bowels in action than to excite them to it when they have become thoroughly torpid, and therefore the individual should not rest content without the daily evacuation. If simple costiveness exists, caused by torpor or inaction of the lower bowel, injections of cold water up the bowels every morning will often cure it; but medicine may be required, perhaps daily, for some time, or it may be used alternately with the injection. Some medicines are better adapted than others to the treatment of habitual costiveness, and of these castor-oil, aloes alone, or in its combination alternately with senna, and ipecac are the principal; their great advantage is not losing their effect by continued use. When castor-oil can be taken regularly, in most cases it answers extremely well; and if taken regularly, the dose requires rather diminution than increase. It is a medicine, moreover, which never seems to injure the tone or the mucous coat of the bowels. Aloes ia peculiarly well adapted to relieve certain forms of costi venose, 352 Diarrhea, or Looseness. particularly that of sedentary persons, and may be taken ia the form of pill, in combination with soap, five grains of each at bed time. Senna, in the form of the ordinary infusion, (tea) or pow- dered, and taken with syrup, is a safe, and at some time effec- tive purgative, as it does not lose its effect, like many other medicines. Or a quarter of pound of Epsom salts, dissolved in a pint of water, of which a wineglassful or two is taken a< Ded time, often operates freely next morning, DIARRHOSA, or LOOSENESS. This complaint consists in a too frequent discharge from the bowels, in consequence of their increased secretion and motion. The appearance of the stools is various: sometimes being thick, thin, slimy, whitish, yellow, green, dark brown, &c. Each discharge is preceded by a feeling of weight in the lower part of the belly, which, for the time, is relieved by the evacuation. The causes of diarrhoea are very numerous, but may, perhaps, be classed under three heads—nervous causes, causes which act upon the surface of the body, and irritaring causes which act directly upon the bowels themselves. Influences affecting the surface of the body, particularly cold, and especially cold feet, often produce diarrhoea. Cold nights succeeding hot days are often said to occasion the dis- ease ; but it is also remarkable, that diarrhoea is apt to occur at the breaking up of a long frost—indeed to be epidemic, that is, of general prevalence. But it has been noticed that the most frequent cause of diarrhoea, however, is irritation in the bowels themselves, caused either by undigested or indigestible food, by acid, by acrid, morbid bile, or by the deficiency of that fluid permit- ting the digested food to become unduly changed. It may also be caused by costiveness, or by the lodgment of such aiatters as the skins of dried peas or beans, or of raisins, in the folds of the large bowel. Some persons habitually have a relaxed condition of the bowels, which is natural, and at the same time essential, for health, and then to check it is dangerous. It is evident, that in a disease depending upon so many and various causes, a due discrimination of these is requisite for proper treatment. It must not, either, be lost sight of, that diarrhoea is in many cases salutary—an effort oi nature to free the constitution from such morbid niattei which, if retained, would produce disorder or disease. On this account, the simpler forms of diarrhoea are better left ta right themselves, so long a» they keep within moderate Diarrhma, or Looseness. OOo bounds. This caution is particularly to be observed with regard to that which occurs in the teething of children, which, when moderate, is a safeguard; but when it becomes so fre- quent that the child is evidently weakened by it, and especi ally if the evacuations appear to be losing tlieir healthy character and become like shreds of skin, or streaked with blood—in such cases, a warm bath for six or eight minutes should be used, for two or three evenings in succession ; isinglass or gelatine given in the milk-food, and a teaspoonful of the castor-oil emulsion with the yolk of egg beat up together, in equal proportions, with a little mucilage of gum Arabic, given three or four times a day, each dose containing a drop of paregoric. In diarrhoea, resulting from exposure to cold, the best plan of treatment is to moderately re-excite the skin by giving small doses of ipecac every two hours; taking in the mean- time some ginger-tea, mixed with a little blackberry brandy. If diarrhoea is caused by irritating matters in the bowels, one thing is evident—it cannot be properly relieved unless the bowels are freed from the irritating matters. It may, it is true, be stopped under these circumstances, but it will recur, unless the irritating substances have been removed by purg- ing, previous to the use of the astringent medicine, and tho continuance of the diarrhoea is merely the consequence of the previous irritation. In many cases in which the diarrhoea is owing to irritating matters in the bowels, particularly to bile, all that is requisite is to diminish the acridity by means of drinks of slippery elm, or gum arabic water, or flax-seed tea, largely used, to which, if there is acid in the stomach, a little carbonate of soda or prepared chalk is to be added. In other cases, when the action of the bowels is constant, painful, and exhausting, it is absolutely necessary to check these symptoms in the first place, and to soothe the bowels, before means are resorted to for freeing them from the irritant cause. For the former purpose, a dose of paregoric, or a mixture of one tea- spoonful of paregoric, four tablespoonfuls of water, and one of prepared chalk, repeated if necessary, will answer as well as any; or a strong tea made of allspice and cinnamon, with a little chalk, given every hour, will answer. Mustard to the bowels will ease pain, and often helps the disease very quick ly. If the active diarrhoea does not, from its comparative mildness, require these remedies at first, or when it is suffi- ciently moderated, the bowels should be thoroughly cleared out with a tablespoonful dose of castor oil, to which ten drops of laudanum may be added; this will probably clear away the 854 Cholera. irritating matters, if they consist of indigestible substances. When castor oil cannot be, or is not taken, the best substitute is twenty grains of rhubarb and fifteen of calcined magnesia, with some aromatic, as cinnamon or allspice, or a teaspoonful of tincture of rhubarb, and, if there is much pain, five to ten drops of laudanum, the dose being repeated, if requisite. Af- ter the action of the opening medicine, one or two doses of astringent medicine, as mentioned above, may again be re- quired, as the bowels are apt to keep up acting simply from irritability. If the disease has been permitted to pass into the stage of irritation, when there is tendency to fever, the belly tender, the tongue red, and the motions resemble shreds of skin, ot pieces of jelly, and are mixed with blood, the case is of thai serious nature that medical assistance should at once be ob- tained, if it has not been so before. In the meantime, the mixture of castor oil with yolk of egg, in small doses, will bo found the safest and most effectual medicine ; two tablespoon- fuls, with five drops of laudanum, being given every four hours, and starch and laudanum injections, the diet being aa unirritating as possible, and containing abundance of gelatine. A most excellent drink in these cases is rice-water, in each pint of which from a quarter to a whole ounce of gelatine or isinglass is dissolved, with a piece of toasted bread introduced to flavor it, or a little cinnamon. Also, a blister or mustard plaster will be of very great service in some cases. Flannel Bhould be worn next to the skin in all these cases. CHOLERA. As we do not propose making this a " historical" work, onlj a short chapter will be devoted to the subject of cholera, sim- ply giving its symptoms, its manner of propagation, the means of prevention, and its treatment. The true nature of this terrible disease is not known. How- ever, such is not the case with respect, to those conditions of body, and still more with respect to the external circumstances, which favor the attacks of the scourge and foster it into activity. Dirt, bad air, bad water, bad food, insufficient cloth- ing, excitement of any kind, and irregular and vicious habita. all favor the production of cholera when the disease is pre vailing as an epidemic; and were it not for these, singly 01 combined, it would, in all probability, become a comparative- ly manageable disease. The symptoms of this disease are pretty generally known, even to the unprofessional reader. However, a reference to Cholera. 855 the principal or more prominent symptoms, will be in place here. The violence of its symptoms, and the fearful rapidity with which it often terminates life, render cholera one of our most alarming diseases. Occasionally, but more frequently in hot climates than in temperate ones, persons are, as it were, pros- trated at once by the cholera poison, and die, perhaps within an hour of the first attack, without any other symptoms than total collapse of the powers of life. More generally the sei- zure is not so sudden : probably there has been slight diarr- hoea, or rumbling movements of the bowels, with sinking sensation at the stomach, for some days previously ; or, at all events, the person has felt unwell. When the disease sets in earnestly, which in the larger proportion of cases it does dur- ing the night, the patient vomits, and is purged with more or less frequency and violence, the evacuations quickly coming to resemble thin gruel or rice-water ; cramps of the limbs suc- ceed, the surface becomes cold, blue, bathed in sweat, and has, particularly the fingers, a peculiar shrunken appearance ; the tongue is cold, the pulse imperceptible; the urine is suppress- ed, and the voice acquires a peculiar pitch of tone. Many die in this, the collapse stage of the disease ; but if it is passed through, reaction comes on, the surface gets warm, the thirst continues, the quick pulse becomes perceptible, the tongue is dry and brown, and delirium is present; in short, fever is es- tablished, and may end either in recovery or death. Many persons do wrong, during the prevalence of cholera, by making material changes in their ordinary modes of living, and, by so disordering the regularity of the functions, lay themselves open to attacks of the disease. Of course, if a man is aware that he is habitually indulging in practices injurioua to health, such as intemperance, debauchery, &c. &c, he only acts wisely as regards his physical safety in changing those habits; but it is hazardous to alter regular modes of living, which have hitherto been found compatible with good health —it being understood that whatever tends to lower the stand- ard of health favors the attack of the disease. There is, how- ever, one important precaution which ought to be observed, at all times, but more particularly during the epidemic of cho- lera : the perfect purity of the drinking water should ba ascertained, and its freedom from all decomposing organis matters made certain. Care is also to be observed not to take active purgatives, especially salines, such as Epsom or Rochelle salts, seidlita powders, etc., which produce watery evacuations ; if aperient 356 Cholera. medicine is required, it ought to be of a warm character, such aa magnesia and rhubarb, with some aromatic, (cinnamon or allspice), for whatever produces free action of the bowels apparently increases the susceptibility to attack. For this reason, too, the slightest tendency to diarrhoea should at once be arrested by a dose of paregoric, or laudanam, or what is preferable, a mixture of prepared chalk, one tablespoonful, cinnamon or allspice powdered, one tablespoonful, white sugar and flour, one tablespoonful each, water, one wine-glass; pare- goric, two tablespoonfuls ; Cayenne pepper, half a teaspoonful. Mix, and take a teaspoonful every half hour, or as may be needed, and the use of milk and farinaceous preparations (corn starch, farina, flour, etc.,) containing gelatine, for food. The speedy adoption of these measures, in places distant from medical assistance, might do much to check the disease. Should the astringents above recommended fail, use the reme- dies recommended below. As to the actual treatment of the disease itself, when fully established, many different methods have been proposed and practised, and few of them, perhaps without apparent advan- tage in some cases, but as yet no treatment which can be Galled decidedly successful (a cure), has been discovered. The treatment which would be safe in the hands of others than medical men would be about the following : When vomiting and purging have set in, with cramps, give the fol- lowing mixture: Tincture of Cayenne pepper, laudanum, spirits of camphor, of each one ounce; spirits of hartshorn, half an ounce; mix together and take one tablespoonful every hour or half hour according to the symptoms. Or give one grain of opium, one of camphor, one of Cayenne pepper, (made into a pill with a little flour and water) every hour, or as may be needed. The patient should be wrapped at once in a blanket, or flannels next the skin. For the cramps use the following as a liniment: Tincture of Cayenne pepper, spirits of hartshorn, ahloroform, turpentine, or kerosine oil, two ounces of each. liix and rub over the affected parts with a woolen cloth. Ba mreful to remove the contents of the chamber from the room immediately and bury it in the ground. Also mix with the discharges from the stomach and bowels, as soon as voided, some sulphate of iron (common green vitriol), also dissolve some of the green vitriol in hot water, and set the same in vessels around the room and in the different parts of the house • and then throw some down the sinks, privy, cellar, and such places, once every day. Keep the sick chamber well aired, and by all means try to cheer and comfort the patient, so as Dysentery, or Bloody Mux. 357 to kv,ep ap his spirits. A mixture of mustard and Cayenne pepper moistened with strong vinegar, applied to the stomach and bowels is good to check the vomiting and purging, or ap- plied to the limbs for cramps. During the prevalence of this disease the greatest care ia necessary in regard to cleanliness, ventilation, etc. (See *' How to Preserve Health," in first part of this work). It may be mentioned also that warm bricks or warm stones, irons, or hot salt should be applied to the limbs or body where there ia coldness or cramps. An injection up the bowels of half a tea- spoonful of laudanum, four or five tablespoonfuls of brandy or whisky, with a little thin starch, is often very beneficial in the active stage of this disease, to be repeated if necessary. DYSENTERY or BLOODY FLUX. This differs from diarrhoea, as may always be known by the symptoms. In dysentery there is an inflammation of the lining or mucus membrane of the large bowels; the stools are frequent and often bloody, attended with griping and bear- ing down ; the ordinary excrement being seldom discharged, and when it is, the quantity is small, and voided in the form of hard lumps. Fever very generally attends the acute form of the disease. Sometimes the disease comes on with shivering, succeeded bv heat and thirst, and other symptoms of fever; at others, tlie affection of the intestines is the first symptom observed. There exists unusual flatulence in the bowels, severe griping, frequent inclination to go to stool, loss of appetite, nausea, vomiting, frequency of pulse, and a frequent discharge of a small quantity of mucus streaked with blood, pure blood, or of a peculiarly offensive matter by stool. The matter dis- charged from the bowels in dysentery, varies very much in appearance, in different cases; being sometimes, as we have just stated, pure mucus, or mucus mixed with blood ; pure unmixed blood, and in other instances, pus, a jelly-like dark colored matter, or a putrid watery mass, which contains films of a membranous appearance, or small fatty masses, floating in a large quantity of liquid matter. Hardened excrement ie likewise sometimes passed. There is great emaciation and debility, a quick and weak pulse, a feeling of burning heat, and intolerable bearing down of the bowels. There are two forms of this disease, the acute or active, and the chronic. In the acute form, the symptoms are urgent and clearly inflammatory,the natural faeces(contents of the bowels1 very rarely appearing, the pain and bearing down great, ana blood often passing in large quantities. 358 Dysentery, or Bloody Fax. Usually the chronic species is a consequence of the acute, and is, as its name imports, of a less inflammatory and more protracted character than the latter: here the stools are often frequent, loose, and have much the appearance of the natural excrement, but mixed with blood and mucus, and passed with severe bearing down. The principal causes of dysentery, are suppressed pcrspira tion, a damp atmosphere succeeding to a high temperature, and exposure to noxious exhalations and vapors. The indica- tions of treatment in acute dysentery are to subdue the local inflammation, to allay irritation, and to restore a healthy secretion from the skin, and these objects are most certainly secured by leeches, calomel, and anodynes, especially opium, with ipecac. In the majority of cases, the application of leeches to the lower part of the belly will be very useful. In many instances a large blister or mustard plaster may be laid over the abdomen with advantage. When severe bilious symptoms are present, a dose of calo- mel or rhubarb, ten grains of each, may be advantageously employed, and followed in the course of a few hours by a dose of castor oil. A combination of calomel or blue mass and ipecac will often be found of inestimable service in this complaint. A grain of calomel or three of blue mass, a grain of powdered ipecac with a third or fourth of a grain of powdered opium, may be made into a pill, and given three times a day ; or, a grain of calomel and four grains of Dover's powder, made into a pill in the same manner, may be administered three times a day ; the other measures above prescribed being previously employed. These combinations of calomel with an anodyne are sometimes of the greatest advantage. In the commencement of acute attacks of dysentery, more especially if the inflammatory symptoms run very high, opium, however, should not be given, either in a liquid or solid state until a dose of rhubarb and calomel, followed by castor oil, has been given, and the bowels cleared of tlieir contents. In such a condition, our chief means must be directed to lessen the existing inflammation by leeches and injections of thin starch or flax-seed tea. As an anodyne in this complaint, there appears none so suitable and efficacious for general use as Dover's powder. If therefore, it is not exhibited through the day, as one of the principal remedies, a dose of eight oi ten grains may be given in the form of pills, every night. The diet should be mucilaginous and fluid, and consist chiefly of barley, rice or gum-arabic water, during the inflam- matory stage of the disease, and this only in very small quan Dysentery, or Bloody Flux. 852 Mies. Subsequently preparations of sago, rice, arrow-root, milk and the like may be allowed, and to them the patient should be confined for some time after recovery. Sometimes when the patient begins to recover, his appetite being vigorous, he is apt to eat too much ; and care must be exercised not to exceed a very moderate quantity of food, even where the appetite is keen; for if too much be indulged in, the bowels will suffer increased irritation, and a severe relapse invariably follows. Laying down in bed is the best position for the patient, and perfect rest must he constantly observed during the active stage of dysentery, and the greater the irritation the more requisite they are. The patient ought not to give way to the frequent inclinations to stool by which he is harassed, but stifle them as much as possible. The stools must be im- mediately removed from the patient's chamber, which should be freely ventilated at all times, and kept perfectly clean. For the constant griping and bearing down which attend this disease, the best remedy is frequent injections of thin starch, combined with sweet oil, to each of which, after the vio- lence of the disease has been somewhat reduced, thirty to forty drops of laudanum may be added. Flannel should be constantly worn next the skin during and after the disease, and be careful to avoid dews, damp night air, and sudden atmospherical vicissitudes, more especially in hot or unhealthy climates. If pain and irritation are still occasionally felt, four or five grains of Dover's powders may be given at bed time. In the protracted species of the disease (chronic dysentery,) in which the acute inflammatory symptoms have subsided, or been subdued, our objects are nearly the same as in the acute variety, only we are called upon constantly to remember, that debility is invariably associated with this form of the com- plaint, and therefore every means of preserving and increasing the general strength must be employed. Local bleeding by leeches or cups will, in most cases, be demanded if the strength is sufficient; in conjunction with which, one of the best reme- dies yet discovered for chronic dysentery is calomel or the blue mass, combined with ipecac and opium, with frequent frictions of the skin, rest, and properly regulated diet. Many atients, tormented for a long time by this painful malady, ave been speedily relieved and ultimately completely cured by this plan of treatment. It is equally adapted to the pro- tracted dysentery so often met with in hot climates, and to that of colder regions. I 360 Cholera Morbus. Three grains of calomel, two of ipecac, and one of opium, given three times in the 24 hours, followed next morning by a teaspoonful of oil, is a good proportion of the remedies. The patient must constantly wear a flannel bandage round the bowels, and keep the feet and legs warm by wearing woollen stockings and drawers. CHOLERA MORBUS, or VOMITING AND PURGING, This disease is occasionally ushered in by chills, pains of the head, giddiness, propensity to sleep, and a sense of numbness in the limbs. Sometimes the disease commences gradually ; at others, it attacks suddenly. At first the patient is troubled with some belchings and pains in the stomach; these symptoms are soon followed by vomiting, which is almost constant. At first the contents of the stomach are discharged ; afterwards a fluid, sometimes green, whitish or colorless, and at others, dark colored, or even black. Discharges from the bowels of a similar character occur simultaneously with the vomiting. The patient, at the same time, experiences great thirst, pains in the stomach and bowels, and tension or fullness of the abdomen. If the disease be violent and protracted, the limbs are affected with spasm, the strength is greatly prostrated, the surfaces of the body aud limbs become cold, the pulse small, frequent and often imperceptible, a cold clammy sweat breaks out, and is succeeded by continual hiccup, delirium and death. In the ordinary cases of cholera morbus, particularly when the discharges are green or tinged with bile, the best practice is to give the patient, plentifully of some mild diluent drink, as toast, gum, barley, slippery elm, or rice water; to p^ce his feet in warm water, and subsequently administer an injec- tion of a pint of thin starch, a teaspoonful of sweet oil, and forty to sixty drops of laudanum. If the case is violent, especially when the pnin of the bowels in constant and severe, the free application of leeches or cupa to the abdomen, mustard poultices to the extremities, and the administration by the mouth of a grain or two of opium, in a pill, or a teaspoonful of paregoric, with twenty drops of essence of peppermint, to be repeated in an hour or so it necessary, will be demanded, and will often arrest the disease almost instantly. The same injection as recommended above, will also be beneficial when the discharges from the bowela are frequent and copious. After the vomiting and purging are suspended, it will be prudent to administer a dose oi calomel, or a pill composed of blue mass ten grams, and opium Diabetes, or Great Flow of Urine. 361 ane grain, which may require probably to be repeated on the ensuing day ; the patient at the same time confining himsel.' strictly to thin gruel or panado, encouraging the healthy functions of the skin by the warm bath and frictions of the skin. When the powers of life appear to be sinking, the skin becoming cold, the pulse small and feeble, and a constant hiccup taking place after the vomiting, the patient should nave stimulants, as brandy or whisky, with small pieces of Ice, and also injections of thin starch and whisky up the oowels occasionally, with warm bricks, &c, to the extremities, and brisk frictions, and mustard poultices applied to the inside of his legs and arms, and over the stomaeh. As it is all-im- portant in these cases to put as early a stop as possible to the discharges from the bowels, which often continue after the vomiting has ceased, injections composed of a pint of water, in which has been dissolved twenty grains of sugar of lead, and two grains of opium, may be administered every three or four hours; or injections of allspice tea, cold, in same quantity, «e often a good remedy. DIABETES, or GREAT FLOW OF URINE. In this disease there is discharged an unusual large quantity of urine; sometimes the amount is enormous, and the urine contains a great deal of saccharine (or sweet) matter. The attack of this complaint is generally slow and gradual; the urine is clear and transparent as spring water, and accompa- nied by a faint smell, as if mixed with rosemary leaves. These bymptoms generally occur without pain, and are usually attended with a voracious or greedy appetite. The serious nature of the affection renders it one of those which should be trusted for treatment only to medical hands. The same reason renders it important that its first symptoms should be known, that they may not be neglected. It may creep on a persor insidiously, or be suddenly developed. The first and mosl prominent symptom which usually awakens attention, is tho frequent call to pass urine abundantly, at the same time the thirst ia extreme. Ir. addition to the symptoms already mentioned, the mouth (a dry, and the tongue clammy and sticky, often very red; there is flatulence and indigestion, and the bowels are generally costive. Emaciation and general debility also occur; pain and weakness in the loins, and feebleness of the limbs. The lead ing symptom, however, is the discharge of urine, which has been known to exceed forty pints in the twenty four hours 362 Diabetes, or Great Flow if Urine At the commencement of the disease the urine may still retail the urinous properties of the diluted secretion; but this passe* into the saccharine (sweet) condition. If yeast be added to the urine, it ferments, and alcohol is formed, the sagar par- taking more of the character of grape, or fermentable sugar, than of the cane. Diabetes is often accompanied by ^ other diseases, especially by pulmonary consumption. The dietetic treatment of diabetes is probably of more importance than th* medicinal; the chief precaution being the avoidance of what ever—either sugar of any kind, or vegetable starchy matter- is capable of being converted into grape or fermentable sugar This, of course, involves the prohibition of bread made from ordinary flour, which contains all the starchy matter of the grain. This privation is always much felt and complained, of, and various substitutes have been proposed. The following, by Dr. Percy, is probably the best:—" Take sixteen pounds of potatoes, washed free from starch; three-quarters of a pound of mutton suet, half a pound of fresh butter, twelve eggs, half an ounce of carbonate of soda, and two ounces of dilute (half water and half acid) hydrochloric, (muriatic) acid. This quan tity to be divided into eight cakes, and baked in a quick oven until nicely browned. " It is, as must be obvious, an expensive article, but with many diabetic patients this will not be an object of considera- tion. It is somewhat improved in taste by being slightly toasted." Animal diet is principally to be depended upon for nour- ishment, and some of the green garden vegetables, such aa ppinach, are permitted. Distilled water, 01 boiled water, but not toast-water, may be used for drink. Dr. Prout, in some cases, found porter beneficial; and, in France, claret has been given with advantage. Persons who suffer from any suspected tendency to diabetes cannot attend too strictly to the state of the digestive organs. Wet feet must be particularly avoided, and flannel should be worn next to the skin; while all sources of debility must be guarded against. All that can be done by others than medical men, will be to follow out the directions given above, as regards diet, &c; also keeping the bowels open by mild purgatives, as castor oii, &c, and if there is restlessness at night, twenty drops of laudanum, or a teaspoonful of paregoric, at bed time. It has been stated by some medical men of eminence that emetics t< ipecac, given once a day for a few days, has checked ths disease and the patient has recovered. It is worthy of a tr-ia' where you can not have the attendance of a medical man. Bloody Urine. 363 BLOODY URINE. This is produced by external violence, as blown, bruises, erries or bark ; or a tea may be made of the bark, mixing cin- namon or allspice to suit the taste, and give a wine glass, cold, every three hours. The bark or berries added to hard cider, and used freely three times a day, are recommended in diseases ef the liver. Aralia Racemosa, or Common Spikenard. (the root.) This grows in deep woods and good soils, from New England to the far South and West. The root is a healing pectoral, stimu- lant cordial, and causing gentle perspiration. It is much used by the Indians ; the roots bruised, chewed, or pulverized is used by them in all kinds of sores, bruises, and ulcers. In coughs and colds the root may be used freely, boiled in syrup; or it may be used as a tea, cold, mixed with fiaxseed-tea, lemonade, or toast-water, when the cough is troublesome. A little piece of the root chewed and the juice swallowed is also beneficial ia allaying a tickling cough 374 Cornus Sericea, or Rose Willow (the bare.) This grows near brooks, along the banks of rivers, a? d on upland Beadows; it is known throughout the United States "by vhe name of red rose-willow, which distinguishes it from the "black willow, or the puss wil- few, which grows in swamps, and along the sides of moist meadows. It is a powerful astringent and tonic—preferred by some to the Peruvian bark or Columbo Eoot, and is much employed in the Northern States, in snbstancs or otherwise, in diarrhoea and dyspepsia. In vomiting, this is an orcelleRJ wmedy, given in the form of an infusion; in the vomiting pattl thirty grains three times a day. 380 Crocus Sativus, or Garden Saffron. Is small d^ses, saffron is employed as a diaphoretic, soon causing per* upiinTion; in large doses, it acts upon the whole animal economy in ths Banie way as a stimulus. It extends its action considerably to the uterus, (wuii b) It is useful to allay the lumbar pains (in the back) which ao- crmpany menstruation in some females. It is aeeful also in ch.orcwis ol yreen sickness, hysterics, &c. It may be employed likewise as a stomachic (or cordial) and antispasmodic (for spasms, &c.) Dose —In powder, twelve grains. To make an Infusion, pat half ts one drachm, in one pint of boiling water; let stand half an hour; give a wine glass full every two hours. It is very valuable in all eruptive diabases, •Bch as measles, small pox, dec. 381 Hyoscyamus Niger, or Black Henbane. (THE PLANT.) This is an annual plant, native of Europe, but grows plentifully in this country, along road-sides and among rubbish, flowering in July. This plant applied externally, made into a poultice or fomentation, is useful to allay pain in all cases cf obstinate and painful inflammations, such as boils, fistulas, eore throat, and swelling of the breast. The dose and manner of administration, internally, will be found under the head of Medicines, their doses and uses; and also in the treatment ©f varions forms of diseases treated of in this work. 382 Scutillaria Laterifolia, or Scull Cap, (TDK PLANT.) This is found in all parts of the United States, in meadowa, woods, near water, &c, flowering in the summer. It is highly recommended for St. Yitus' Dance, given in the fonn of tea, (cold,) a wine glass full, or more, three times a day on an empty stomach. Given in the same way, it is highly re commended also for worms, to be foi1 owed the third day by s purge cf castor oil. The plant or leaves may also be powdered, aid given ii doees of from ten to fifteen grains three time* a day. 383 LIST OF MEDICINES. Their Doses and Uses. Proper Time to Give Medicines.—This is a matter of con- siderable importance, and should not be overlooked. There are certain times of the day more convenient than others for giving some medicines. Purgative medicines should, in e-eneral, be given late at night, or early in the morning; the f c>wels not being so easily acted upon during the time of sleep; t ;r this reason pills and other medicines which do not ao* speedily, when given in the evening, have time to dissolve fully, and to produce their due effect on the bowels. Saline pargatives, such as salts, &c, are best given in the day time, that the cooler state of the surface may determine their action to the kidneys. Emetics are best given in the evening, as tl ey produce tendency to sleep and perspiration, which are b ;st encouraged by retiring to bed. Medicines _ for perspira- ti m should not be given during the process of digestion. QUALIFICATIONS OF ATTENDANTS ON THE SICK. There is very little doubt but that recovery from sickness depends materially on the nurse, or attendants upon patients, ra well upon refraining from officious interference, as giving timely attention. All the necessary qualifications can seldom be found in any one ; but the nearer they can be got to follow the following directions, the better: Great attention to cleanliness of the mouth, the body, the bed, and the room ; often washing the mouth, and speedily removing all filth ; changing the clothes with as little labor to the sick as possible, being careful not to give them cold—the greater the perspiration, the more frequently changing will be accessary. Keep the room always of a moderate degree of warmth, regulated by the season, with that all-important article, more wanted in sickness than in health, fresh air, to be gently admitted without a current, and no bed-curtains being allowed. Keep quiet; disturb the sick as little as possible, by talking or making any kind of noise; never communicate any bad aews,—remembering that perfect rest to the patient is of great importance. Administer with faithfulness, and in the most palatable Ptato, the medicines prescribed, and observe their effects: which report to the prescriber. Unpalatable pills may safely be surrounded by a thin piece of paper, jelly, or gold leaf; the 384 List of Medicines, great disgust to medicine being frequently caused by tb« nauseating manner in which it is given. Have in readiness a bed-pan, and never suffer the parienl hen very weak, to sit up on it long, as in that state they may expire from exhaustion. A cheap and ready mode at all times, of making a proper pan, would be to saw down a pal1 or bucket to a depth of three inches, on which a top can be placed, with a hole in it like that of a privy. This of course applies to situations in which no better facilities are at hand. Keep constantly a supply of various articles for drink, in a proper state of the weak kind of teas, in addition to such medicinal drinks as are prescribed, which, when solely en- forced, prove disgusting; remember to give but small quantities at a time / not very cold, as they increase thirst. Drinks can be made of any of the garden herbs generally used for teas; of toasted bread, barley, of apples, cut up in water of gruel, elm-bark, flax-seed, of lemonade, of chicken, or lean fresh meats, of tamarinds, vinegar, or cream of tartar, of cur- rant jelly; in short, of any thing used in families, possessing no stimulating powers. Spirits, in any state of combination. wine, porter, cider, and the like stimulating drinks, unless particularly directed or called for from fainting or the disease of the patient, must be carefully avoided. Diet is a subject too, to which the nurse should pay th« greatest attention. As this must vary with each varying state of the system, it is impossible to give any further directions in this place, than to state that in high fevers, it should be very moderate, entirely of small quantities of vegetables, and that in low fevers, it should be of well-seasoned, palatable food ; the more like that the sick person had been accustom.ed to, the better; but take care to give it often, and little at a time, as a full meal, in such states of system, often produces death. INJECTIONS. Administer an injection when required, of whatever article directed. These often operate only by their bulk; and, un- less given as medicine, their component parts are not mate- rial ; they are generally made of warm water, with salt, oi soap, or sugar, or oil, and the common syringe is the instru- ment generally used; but the best kind is what is called the Rubber Extension Syringe, to be found now in most drug stores. In order to give it, the patient should be laid on the side at the edge of the bed, a little over the edge, the knees drawn up near the belly, and then the pipe, with the fingei before it, is to be applied to the fundament; and on pushing Their Doses and Usee. 885 t in, the finger is to be taken away. It is gently to be pushed a little backwards, or towards the back bone, and then the contents is to be forced out with one hand while with the other the syringe is firmly held. It only requires that the injection should be made stronger, to irritate and excite the lower part of the bowel, which brings on the action of the rest of the bo vvels by sympathy. C UP P ING. This is an operation, so easily performed, and often so im- portant, that all ought to learn how to do it. If blood is to be drawn, the part ought to be cut in many places, each cut about the length and distance of a finger-nail apart; the cut only deep enough for a little blood to flow; then a glass, or mug, or a gourd, of suitable mouth, is to be taken from a basin of hot water, and fitted to the part; then a bit of. paper about as large as a dollar, dipt in spirit, is to be held near the cup- ping-glass, and set on fire by a candle, when, as soon as it blazes, the cupping-glass being leant on one side, the burning paper to be quickly thrown into it, and then the glass applied close to the skin, as when first fitted. As the paper burns, the air will consume, and thereby cause the extraction of the blood. Paper burnt brown, or any inflammable article is often made to answer; but the use of spirit is to be preferred. A email quantity of spirit put in the cupping-glass and set on fire will answer without paper: and its blaze is less apt to burn. There are articles made for the purpose of cupping, to be had in drug stores, in cities, much better than the rude apparatus here referred to, but in country places they are not likely to have them. DRESSING BLISTERS. If it be desirable not to keep the blister running, then make a very small opening with a needle or scissors, and let out the water very slowly, holding cloths to absorb it; and apply to the part cabbage leaves, freed of their stem, warmed and rubbed before the fire, or paper moistened with lard. Plasters of tallow, or suet, or of hog's lard, will answer. When the blister is to be kept running, the skin should be cut off with dcissors, and such stimulating ointment applied, as shall be directed. Basilicon ointment is often used, as also a very weak blistering plaster. 886 List of Medicines. BANDAGES. That mest commonly used is a long piece of cotton, linen, or flannel, about three inches wide, rolled up smoothly; iti application is to be equal, compressing no one part more than another; and to insure this, you begin at the extremity of the toes or fingers, and wind it around, making each edge lap an inch over the other ; and when the part over which it goes is irregular, the bandage is to be so turned, edge for edge, that it shall become suited to the bulging or irregular parts it has to pass over. This properly applied, is a powerful remedy in sores, but does great harm when put on so as to produce unequal pressure, interrupting the circulation and thereby in- creasing the disease. There is another kind of bandage called the eighteen tailed bandage—because generally made of that number of slips of cotton or linen, of length sufficient to go once and a half around the part to be bound up. This is used when it is im- proper to move the limb. These detached pieces, in number sufficient to bandage the part needing it, are put under the limb at its first dressing—one to overlap the other about an inch ; then the ends are to be wound smoothly around the limb, the one end over the other; and they of course will lap half around the part and each end wTill bind the other. "When they are to be removed for dressing, and are found filthy, each can separately be pulled out, with a clean one attached to its end, and in that manner carried to replace that removed, without moving the limb. P O U L TIC E S . The chief object of poultices is to relax the skin over which they are placed and allay irritation. When made of Indian eorn meal, or bread and milk, they should be soft, and the part going in contact should be greased. The best is made from flax-seed meal, made by pounding it or grinding in a coffee-mill. The powder is gradually to be added to hot water and stirred until it is of proper* consistence. A poultice made of slippery elm bark cut small, and boiled with a little Indian meal, is very soothing, as also one of thick jelly of water-melon seed, obtained by well boiling the seed iu a Iitti water. In most cases the chief good is derived from th moisture or warm water, which can be fully had by 6impl dipping cloths in hot water and applying them, to be ra moved on becoming cold and soaked in hot water agaip H87 Mode of Applying Bandages. (See next page.) 388 DQUSLE INHALER FOE THE CUKE OF CMBES HI THE HEAD, Many years ago I became convinced that the ordinary treatment for Catarrh in the Head, prescribed by some of the very best men in the medical faculty, was of but little, if any practical utility. I therefore made it a matter of study, and made various experiments and soon satisfied myself that "Medicated Inhalation" was the only rational and successful remedy. To apply this properly I invented the Double Inhaler which is represented by the above engraving. (See page 500.) How to Apply Bandages. 889 How to Apply Bandages.—The art of applying a bandage well, that is, both neatly and efficiently, requires Borne practice and attention, but it is often a most useful accomplishment; for a bandage, if required at a.*, must be properly applied, otherwise it is worse than useless. If, there- fore, none but the surgeon can undertake the task, it neces- sitates a much more frequent attendance on his part, than might otherwise be requisite. In general, the first few appli- cations of a bandage will be made by the medical attendant himself, and ought to be in the presence of the individual to whom the duty may be afterward deputed. By careful atten- tion on the one hand, and kind explanation on the other, much may be learned and taught, but not all, as the inexpe- rienced bandager will discover on the first attempt. By all means, therefore, let the first attempt be made on some one in health, before the call is made to the invalid. Attention to the following directions will facilitate the application of the previous practical lesson, or in some measure supply its place, if from circumstances it has been wanting. Whatever the material, the width of the bandage or roller must be pro- portioned, in some degree, to the size of the part to which it is to be applied. If too narrow, it is apt to be stringy, and to cut; if too broad, it does not adapt itself readily to the inequalities, and the pressure is unequal. For an ordinary sized adult male leg, a bandage of 2| inches broad is a good proportion ; for the arm of the same person, one of two inches ought to be sufficiently well adapted. The material for bandages must neither be too strong nor too weak ; ordinary " shirting " or " calico " is a very convenient texture. The length, of course, must vary according to what is required, but rollers are usually put up in six or eight yard lengths; they are better torn in one continuous strip, free from joinings, and without selvage edge. The strip, when prepared for use, must be rolled up as firmly as possible, into a single head. If the bandage is a new one, of calico or linen, the loose threads of the roll at each end must be roved off, otherwise they become troublesome when the roller is applied. Bandages ma,y be applied in simple circles (B), in spiral, etc., or in reverses (<3). They are also applied in various other forms, to suit the differ ent portions of the body. In applying a bandage, the rolled up strip being held in the right hand, the end which is corn menced with is secured by the first turn. If it be the simple circular bandage, round the trunk of the body, or round a limb of nearly equal girth throughout, either naturally or from swelling, the roller is carried round and round, each suc- ceeding turn slightly overlapping the one before it. If thi 390 How to Apply Bandages. ipiral bandage be required, the rolls are carried up veri obliquely; but if, as most likely, it is the reversed bandage, then wherever the inequality of the parts prevents its being laid on flatly and evenly, the bandage must be turned upon itself (C), so as to become reversed, the surface of the cloth which was next the skin being turned outward, and vice versa. It is difficult to describe the manoeuvre, and it is a .ittle difficult at first to execute it neatly and well; but when practised, it becomes perfectly simple. This is by far the most useful form of bandage, and a person who can put it on well, will have but little difficulty in accomplishing the other varieties. For the purpose of retaining dressings upon the head, nothing answers better than a close-fitting calico cap ; a handkerchief will often serve every purpose, or the split cloth may be used ; applied as seen in the engraving, by the upper tails being brought beneath the under oneb, and fas- tened under the chin, the under tails being carried to the back of the head. When it is desirable to retain the head in one position, it may be done by bands attached to a cap, and fastened as required to a band going round the chest. When tor this purpose, or to fix a broken rib, such a band is requir- ed, it ought to be from eight to ten inches wide, made of toler* ably strong double calico, and sewed firmly round the body. To retain a pad or poultice in the armpit, a good sized handkerchief answers better than any bandage, the middle being placed at the armpit, the ends crossed, at the side of the neck opposite, carried under the corresponding armpit, crossed and brought and tied on the shoulder. For the groin and parts adjacent, the spica, or figure of 8 bandage, is also used. A roller eight yards long is taken, the end secured by one or two turns round the pelvis (hips), and then the band- age is brought down across the front of the thigh, carried evenly between the legs, and again brought up and carried round the pelvis: this being repeated at each turn till the roller is exhausted. As a general rule, leg bandages, habit- ually worn, ought to be put on before the individual gets out of bed in the morning. A bandage which gives pain after iti application, without obvious cause, ought to be taken off, and be reapplied. If there is reason to suspect inflammatory swelling beneath, it will be well to try the use of cold water before disturbing matters. There is some little management required in taking off a roller, as well as putting it on. As each successive turn ia unrolled, it should be gathered in a bunch in the hand, and not, as is often done, three or four yards of bandage at full length pulled round the limb every time. 391 CLASSIFICATION OF MEDICINES. Tub medicines wanted for common use are very few : although suoh ao immense variety is to be found in apothecary shops. They are all arrang- ed nnder different heads, according to their most conspicuous effects upon the system. Under each head will be mentioned those deemed most im- portant in common use. Remember that in taking medicine of any particular kind, the system becomes habituated to it, and requires an increased dose ; therefore, medi- cines of similar nature ought often, when practicable, be substituted for the c*ie previously taken. The doses stated are for adults—the ratio of doses for children will be found under Tabular list of Medicines. PURGATIVES.—Medicines wMch Open the Bowels. Saline Purgatives, (or Salts.)—Epsom salts, Glauber salts, Rochelle salts. Dose of each one ounce, (about one tablespoonful) given dissolved in a glass or cup of cold water, on an empty stomach, the morning being pre- ferable. Dose for children, about half the above quantities, or less, ac- cording to age. Seidlitz Powders.—The contents of one Hue and one white paper, taken on an empty stomach, or the contents of two blue and two white papers may be taken ; directions go with the seidlitz powders; for children about half doses. Phosphate of Soda.—This is a tasteless salt, and on that account is well adapted to children, as it can be given in soup, or beef tea ; dose from one to two teaspoonfuls. Castor Oil.—This is a standard article, the world over, almost. Dose from one to three tablespoonfuls for a grown person, and children in pro- portion to the age. To prevent castor oil from griping, let it be taken with a few drops of essence of peppermint or cinnamon and some loaf sugar; or for grown persons it may be given in some cold coffee or le- monade. Senna Leaves.—A small handful (three drachms) steeped in half pint of water for an hour, (like tea,) a few caraway seeds, some orange or lemon peel, tamarinds or sassafras bark, added to the senna, prevents it, to a great extent, from griping. This is not a suitable purge for children. Scammony—In powder; dose from three to teu grains, for grown per- sons. Jalap—In powder; dose from ten to twenty grains. Gamboge—Dose from two to five grains, in powder. Rhubarb—The powdered root; dose from ten to twenty grains. Cream of Tartar and Sulphur—Mix one tablespoonful of sulphm with li»o of cream of tartar, to be taken in a glass of cold water on an empty Btomach ; or for children, take the above quantities of each, mix thorough- ly with syrup or molasses, and give one half in the course of the day ; the balance the next day, if needed. Aloes—Dose in powder, five to fifteen grains, in tincture, one to tw« tablespoonfuls; for children, half the dose. 392 Classification of Medicines. Calomel, is not often given alone as a purgative, except in oasc? if gre*1 Irritability of the stomach ; five to ten grains, in a pill, will sometimes re- main on the stomach when nothing else will. Some other purge mnsf always he given in twelve hours to carry off the calomel, to prevent sali- vation. Active or BrisTc Purgative—Jalap, ten to twenty grains; cream of tar- tar, thirty grains, for a grown person. Manna, is a good purgative for children; dose from one lalf to two drachms, according to age. Castor Oil Mixture—Powdered gum-arabic, a heaping teaspoonfnl po v dered white sugar, two teaspoonfuls; peppermint or cinnamon water, two ounces; mix these together, and add a tablespoonful or two of cast< >r oil, or less, of course, for children. (The peppermint and cinnamon water is made by dropping a few drops of the essence into cold water.) Oil of Turpentine and Castor Oil—Take two drachms of tuipentine, and six or eight drachms of castor oil; mix them well together, for a dose. This combination is proper, when a prompt action on the bowels is re quired, as in affections of the brain, &c. Purging Draught—Take of Epsom salt, Glauber's salt, each two drachms; mint-water, an ounce and a half; antimonial wine, forty or fifty drops; tincture of senna, two drachms. Mix. This is a very valuable and effectual purgative for all acute diseases, and most common purposes. If a purgative which will operate quickly and actively be required, the following will be found useful: Compound Senna Tea—Take of senna leaves, one ounce; manna, hall an ounce; cream of tartar, five drachms; cinnamon bark, half an ounce* boiling water, a pint and a half. Infuse for two hours. The dose is a wineglassful every two or three hours. Pills of Rhubarb and Soap.—Take of powdered rhubarb, one drachm , white soap, ten grains; with water enough to mix into a soft mass. Di- vide into fifteen pills; dose, two to four at bed-time, for a gentle pur- gative. Laxative Powder.—Take of powdered rhubarb, twenty grains ; caloined magnesia, ten grains; essence of cinnamon, ten drops. Mix. A good mixture in acidity of the stomach or bowels, when a gentle purgative ia needed. EMETICS, or Medicines that produce Vomiting. Ipecac, the powder; dose, from fifteen to twenty grains. Put the ipe- cac in half pint of warm water, and let the patient take about four table- Bpoonfuls every five minutes, until vomiting is produced. Drinking freely of warm water, during the intervals, assists the effects of the medicines For children, one-fourth to two-thirds the dose, according to the age. Syrup of Ipecac, for children, is the best: half a teaspoonful every ten or twenty minutes, or oftener, if necessary, will have the desired effect. Wine of Ipecac, is given in doses from one to two teaspoonfuls, every half hour. Tarter Emetic.—Dose, dissolve two grains in four ounces of hot water j a tablespoonful every ten minutes. It is not safe for children. Antimonml Wine—Two teaspoonfuls every ten minutes. White Vitriol, (Sulphate of Zinc.)—Thirty grains dissolved in water, tn cases where a speedy emetic is wanted, as in poisoning. Tickling the throat with a feather, will often produce vomiting at jriCA in cases of poisoning, &c. Ground Mustard—A teaspoonful or two mixed in a gill of water, ia w active emetic in cases requiring prompt vomitimy. Classification of Medicines. 393 LAXATIVE AND PURGATIVE INJECTIONS. For Grown Persons. Take of common salt, a dessert-spoonful; tepid water, or water-gruel, a [Ant; add a tablespoonful of sweet oil, or melted butter. A more active injection is made as follows: Take a strong infusion (or tea) of senna, a pint; Glauber's salt, or Ep- som salt, an ounce and a half. Sometimes, to increase the purgativs affect, a spoonful of oil of turpentine may be added. For Infants and Children. Injections may be made in the same way as for adults, diminishing the quantity of fluid, and keeping out a portion of the stimulating ingredient, whether salts or senna CARMINATIVES, or Medicines to Expel Wind. For Grown Persons. Ten or fifteen drops of the Essence of Peppermint, on a small bit of •agar. Assafcetida Pills, three at bed-time. Carminative Injection.—Take of infusion of senna, eight ounces; dis- solve in this infusion, assafcetida, a teaspoonful and a half; add pepper- mint-water, one ounce. To be mixed together, and thrown up, pretty warm. For Infants and Children. Sweetened Cinnamon or Aniseed Water, one or two teaspoonfuls ever? half hour. Essence of Peppermint, from one to three drops, every half hour. A tea made of caraway, dill or fennel seeds; or calamus root, chewed and swallowed, as well as hartshorn, 10 drops in water, are all good medicines of this class. DIURETICS, or Medicines that promote the flow of Urine. For Grown Persons. Take of cream of tartar, one drachm; borax, half a drachm. Mix. Dissolve in three ounces of tepid water; this quantity to be taken three times a day. Sweet Spirits of Nitre—A teaspoonful in warm water, four or five times a day. Acetate of Potass—From twenty grains to a drachm three times a day. Nitrate ef Potass, (saltpetre)—Thirty to sixty grains in a pint of gruel This quantity to be used as a common drink in the twenty-four hours. Oil of Juniper—Four drops on white sugar, three times a day. Squill—Oue grain in powder, mixed with powdered cinnamon, three times a day; or, two grains of squill, with ten grains of powdered nitre, to be mixed in sugar and water, or molasses, and repeated twice 01 three fanes a day. Diuretic Mixture.—Take of sweet spirits of nitre, one ounce; tmctnn of squill, two drachms. Mix. Dose, a teaspoonful five or six times r day, given in a teacupful of the following, namely: juniper berries, bruised. 894 Classification of Medicines. one ounce; and cream of tartar, half an ounce; infused in a pint of boil ing water. Infusion of Juniper Berries in Cider.—Take of bruised juniper berries, Diustard seed, and giuger root, of each half an ounce; grated horse-rad- ish and parsley root, of each one ounce; and infuse them in a quart of hard cider. The dose is a wineglassful, three or four times a day. This infusion has been found useful in oases of general dropsy occurring in pa- tients very much debilitated and unconnected with inflammation, or disorganization of any internal organ. When fever or inflammation it present, it would be improper. Carbonate of Potash—Half drachm in a pint of water. Dose, two tablespoonfuls every two hours. Cream Tartar—One ounce in a gallon of water; to be drank during tho twenty-four hours. Oil of Turpentine—One to two teaspoonfuls, three times a day. For Infants and Children. Nitrate of Potass, (saltpetre) one drachm ; water, eight ounces. Dis- solve, and sweeten with refined sugar. Dose, from a teaspoonful to a tablespoonful every three hours, till the water flows freely. Sweet Spirits of Nitre, one teaspoonful; water, three ounces. To ba mixed together, and a little syrup added. A tablespoonful every two hours. A drink made by dissolving a drachm of cream of tartar in a quart of boiling water, and sweetening it with sugar, may be used, to increase the irine. DIAPHORETICS, or Medicines to produce Perspiration or Sweating. For Grown Persons. By regulating the doses of the following medicines, and the drink of ths patient, as also the quantity of his bed-clothes, we can produce a perspira- tion more or less copious. Antimonial Medicines are excellent diaphoretics. A grain of tartar emetic may be dissolved in five ounces of hot water; and a tablespoonful of this solution given every two hours, will generally occasion perspiration Or James's powder, three or four grains, in honey, jelly, or marmalade, every three hours. Diaphoretic fever powder.—Take of nitre, powdered, one drachm ; tartar emetic, one grain; gum-arabic, half a drachm ; for twelve powders; ons to be taken every three hours. _ A mixture of narcotic and emetic medicines, makes an excellent sudo- rific or sweating medicine. Such are Dover's powder, and the diaphoretic draught, made by adding thirty drops of laudanum to forty drops of anti- menial wine, and the same quantity of sweet spirits of nitre, to he takes in an ounce of cinnamon or peppermint water. These combinations of opium should be avoided when the skin is ferj hot and dry ; but they may be used in rheumatism and other feverisL dis orders, after the violent excitement is in some degree removed. Camphor.- -Two grains of camphor reduced to powder bv the help of s Rttle alcohol or whisky, and half a grain of opium, made into a bolus • to be repeated only once or twice at the interval of four hours. Diluted Acetate of Ammonia, (Spirit of Miudererus)- From two drachm Classification of Medicines. 895 10 half an ounce, in an equal quantity of water, every three hours. (8pi- "it of mindererus can be made by dissolving a teaspoonful of carbonate of ammonia in a teacupful of vinegar.) Saline Mixture.—Take of the fresh jjioe of lemons, one ounce and a half; aud of the sub-carbonate of potassa, or chlorate of potash, twenty grains ; then add, of white sugar, one or two drachms; of tartar emetic, ote grain; and of pure water, an ounce and a half, and the same quantity of cinnamon water. Dose, a tablesooonful every two hours. This is an uxoellent prescription in most cases oi fever. Diminished doses of Ipecac may aiSu be used to promote perspiration. For Infants and Children. Antimonial Wine—From four to ten drops, in a teaspoonful of tepid nrater, every two hours. Take of tartaric acid, one drachm; carbonate of potass, four scruplea Dissolve each of them separately in an ounce of water, add them together, and. when the effervescence is over, add, syrup, two drachms; cinnamon water, half an ounce ; water, four ounces. Dose, a teaspoonful every two hours. Diaphoretic Mixture.—Take of sweet spirits of nitre, four drachms; water, two ounces; cinnamon water, two ounces; sugar, four drachms; tartar emetic, one grain. Mix. Dose, a teaspoonful every three or four hours. A tea made of Virginia snake root, or pleurisy root, or boneset, is good for sweating. EXPECTORANTS, To bring Phlegm from the Lungs. Squill.—The powder of the dried root, one grain night and morning, made into pills with powdered cinnamon and ginger. Or vinegar of squill, a small teaspoonful, with simple syrup, in a litle peppermint water three times a day. Ipecac.—One grain three times a day, made into lozenges. Sulphate of Zinc.—One grain, with powdered ginger, twice a day. The Steam of Hot Water and Bitter Herbs, such as hoarehound, sage, &c, inhaled into the lungs. Expectorant Mixture.—Take of mucilage of gum arabic, four ounces, syrup of squill, four drachms; tarter emetic, two grains; sweet spirits of citrs, three drachms. Mix. A teaspoonful to be taken every three hours. Brown Mixture.—Take of the powdered extract of liquorice and of powdered gum arabic, of each two drachma; dissolve in four ounces oi warm water; then add sweet spirits of nitre, two drachms; tartar emetio, one grain; and laudanum, forty to sixty drops, or paregoric, one tea- sixionful. Mix. The dose is a table-spoonful every four hours. This is agjod prescription in cases of catarrh, towards the decline of the disease, when a troublesome cough still remains. Expectorant Pills.—Take of extract of henbane, eight grains; extract o belladonna, one grain; powdered ?oecao, four grains; for eight pills Dose, one every three hours. 396 Classification of Medicines. ABSORBENT MEDICINES, Or Correctors of Acidity in the Stomach, and of Heartburn. For Grown Persons. Carbonate of Potass, or carbonate of soda, from ten to thirty graina, U water. Prepared Chalk, when the bowels are loose; from twenty grains to tvtt drachms in cinnamon water, or milk. Calcined Magnesia, when the bowels are costive ; to be taken in the s&mt way. The above two articles meeting with an acid in the stomach form * neutral salt: that with chalk is binding; with magnesia laxative. Lime Water.—A small wine-glassful, with three table-spoonfuls of milk, three times a day For Infants and Children. Calcined Magnesia, or Prepared Chalk, mxy be given in milk or any liquid, or mixed with the food, in doses of from three to ten grains. ANOD YNES, Medicines to allay Pain, and procure Sleep. For Grown Persons. Opium.—One or two grains. It can be made into a pill without any addition. Opiate pills may be made also by taking equal weights of opium and powdered cinnamon, and forming them into amass with simple syrup. This mass may be divided, so as to make the pills to contain each one graia of opium. Paregoric may be given as an anodyne ; half to one teaspoonful. Anodyne Draught.—Take of laudanum, thirty drops; cinnamon water, one ounce. To be sweetened with dissolved jelly or syrup, and taken at once. Or, sulphate of morphia, two grains; cinnamon water, four ounces sugar, one drachm. Dose, a teaspoonful every three hours. Anodyne Injection.—To one ounce of olive oil, and three of thin made starch, add thirty, forty, or sixty drops of laudanum, and mix the whole well together. This injection is particularly useful in cases in which there is great irritation about the lower part of the bowel, bladder or urinary passages and in dysentery and diarrhoea, after proper evacuations. The reliei obtained is sometimes almost instantaneous. When opium binds the bowels too much, Henhane in extract or tincturs acay he used in larger doses than opium; three grains of the extract, or a drachm of the tincture. A strong tea made of hops, a few spoonful- every two hours, is also good. For Infants and Children. Opiates are so hazardous, that we feel reluctant to sanction the use d •ay one of them internally; but from three to ten drops of paregoric, aooording to age, given at bed time, may be considered safe. For external use, Anodyne Balsam, or the tincture of soap with opinoa, rubbed on the belly or along the spine, in the quantity of a table-spoonroiV in many cases allays pain very effectually. Classification of Medicines. 397 ASTRINGENTS, Or Medicines to lessen Discharges of Fluids. For Grown Persons. In Looseness of tie Bowels ; after being sure that they are cleared of &3 rritating matter, as much as possible. Astringent Drops.—Take of tincture of rhubarb, two teaspoonfuls; lauda acu;, one teaspoonful. Mix them together. Thirty-six drops to be takea four times a day in a little water. Chalk Mixture.—Take of prepared chalk, one ounce; refined sugar, hah an oun^e; mucilage of gum arabic, two ounces. Mix together, and thea gradujvjiy add, of water, two pints and a half; cinnamon water, two ounces, Of tl.iti, a small cupful may be taken four times a day; and if it bo thought necessary to increase its astringent power, ten drops of laudanum, or half a teaspoonful of the tincture of kino, may be added to each dose. Astringents, in discharges of Blood from the Lungs or Womb. Infuse a handful of dried Red Rose Leaves in a quart of toiling water for half an hour. Strain off the liquor, and add of diluted sulphuric acid, thirty drops; simple syrup, two ounces. A table-spoonful to be taken every two bours, when necessary, during a discharge of blood. Other measures at th* same time being employed for the cure of the disease. Astringents, to be thrown into the Vagina for the cure of Whites. Thirty grains of White Vitriol dissolved in a pint of water. Or, take of oak bark, two ounces; water, two pints. Boil to one pint; to which, when strained, add one drachm of alum. Inject half a pint up the parts three times a day. ASTRINGENTS, to check Looseness of Children. Astringent Mixture.—Take of best Turkey rhubarb, twenty grains; pre- pared chalk, one drachm; Dover's powder, ten grains; simple cinnamon water, naif an ounce; spring water, two ounces and a half. Mix them carefully. Dose, from one to two teaspoonfuls every six hours. This is found particularly useful in some cases of habitual looseness. Stronger Astringent Mixture.—Take of tincture of catechu, two drachms; prepared chalk, half an ounce; simple cinnamon water, one ounce; spring water, five ounces. Mix them. Dose, from two teaspoonfuls to a table-spoonful every three or four hours. This may be rendered still more powerful in checking debilitating looseness, by the addition of a small proportion of laudanum to each dose. For Grown Persons. Nut Galls in powder. The dose from ten to twenty grains. Black-Berry Root. That of the running brier, called Dew Berry, is tho best. An ounce of it bruised and put in a pint of boiling water. Th dose about half a cupful, three or four times a day. Alum. Dose five to ten grains : also small doses of rhubarb. White Oak and Chestnut Bark, in substance or strong decoction, ar powerful astringents. Gum Kino and Catechu come under this head. The dose of either is from five to ten grains. 393 Classification of Medicine. Lime Water, particularly when acid exists in *he stomach, has a slmiha effect. The dose is a half teacupfnl. with an equal quantity of milk. Common Salt. A table-spoonful has been recommended to stop bleed »g of the lungs. The dose may be repeated. Charcoal in powder, in small doses, has an astringent effect upon tin bowels: also when applied to bleeding parts—as the nose, gums, etc. Cold Water is ranked amongst the most useful of astringents. It is th best application for local bleedings. TO CHECK VOMITING. The Effervescing Draughts of Soda and Tartaric Acid. Toast water taken cold in table-spoonful doses every half hour. An Opium or Mustard Plaster to the pit of the stomach. Lime water, a teaspoonful, with the same quantity of milk every tvc hours. TONICS AND BITTERS. For Strengthening the System. Peruvian Bark. A teaspoonful three times a day, in milk or port wine. Sulphate of Quinia, one to two grains before each meal. The following is a good way of administering the quinine: Take of sul- phate of quinia, ten grains; elixir of vitriol, half a drachm ; white sugar, tour spoonfuls; water, four ounces. Dose, a teaspoonful. Dogwood Bark and Baric of the Wild Cherry tree, reduced to fine pow der. and taken in doses of tliirty or forty grains, or drank in strong tea will be found nearly as good as the Peruvian bark. Angustura Bark, in doses from five to twenty grains, is by some es- teemed equal to the Peruvian. ^ Columbo Root, in doses from twenty to thirty grains, or taken infused m water or wine—an ounce to the quart—is a powerful tmic, in doses of two tablespoonfuls three times a day. Gentian Root and Quassia are among the strongest bitters. A verv com- mon oitter tincture is made of two ounces of gentian, one ounce of orange- peel, and half an ounce of cascarilla bark in a quart of spirit or wine ; and it is a tonic. Dose, one tablespoonful three times a dav. Bitters, in general give tone to the system ; and "among those most used are— Chamomile Flowers, Hops, Virginia Snake Boot, Horehound, and Worm- »cod, separately, or in combination made in strong tea, or added to wir.a or spirit, make agreeable and mild bitters. Charcoal in powder, in doses of a teaspoonful once in two hours, has been found a valuable tonic. Nitric Acid. This is a most powerful tonic ; especially in chronic aFeo- tions ol the liver, etc. It is generally given a teaspoonful in the courw of a day diluted in a quart, or more of water, and sweetened to render is palatable, lo be drank through a quill, to save the teeth. Iron has long been considered as a tonic, not only when in substance but when m solution, as in the state of chalybeate waters. The filing,, of iron were once much used ; but a better form if> the Bust of Iron, in doao from nve to ten grains three times a day. Green Vitriol. Dose from two to four grains, twice a day. Classification of Medicines. 399 Tincture of Steal. Dose from fifteen to thirty drops, threa times day. Chalybeate Waters owe thtir strengthening qualities to iron, which ia dissolved by the agency of fixed air. By putting a few grains of the rust of iron in a bottle, and having it filled with the common Soda Water as il 's called, as valiable a chalybeate drink may be had as from any of our springs, to whi^h so many resort. Ionics are rot to be given in high fevers, and the following rules should be observed in recovering from sickness: Let the die*; of the patient be accommodated to the state of the system After recovering from violent disease—it should at first consist of th* lightest vegetable matter, as rice, tapioca, arrow-root, and sago, also Irish potatoes. Then eggs, oysters, wild fowl, poultry, and finally beef and Diutton, generally selecting the articles most agreeable. The patient should eat often and in small quantities, and solid food is generally pre- ferable, and should be prepared as plain as possible. WORM MEDICINES. Except RocheU'?, Epsom or Glauber Salts, almost any purgative may be osed to expel worms. Take of calomel, four grains; powdered jalap, four grains; powdered aloes, three grains. To be mixed together and given in jelly, honey, or conserve of roses, at bed time, followed next morning by a dose of castor oil. Five grains of aloes, with four of soda, taken at bed time, and followed next morning by a tea-cupful of strong infusion of senna-tea. A teaspoonful of common salt, taken in the morning, when the stomach is empty, will often expel worms. Two or three cloves of garlic may be swallowed in the morning for a length of tima, or three grains of assa/cctida made into a pill. Injections made of senna-tea, with a teaspoonful of tincture of aloes, may be thrown up the bowels, to destroy the small white worms. A teaspoonful of oil of turpentine, given in syrup, will, in many cases, carry off the tape-worm. Pink-Root.—The dose is from five to ten grains of the powder, or an ounce of it boiled in a quart of water, of which one or two tablespoonfuls may be given every two or three hours. It is to be followed by a brisk purgative after it has been taken three or four days. Worm-S<.cd O/l, extracted from the seed of the Jerusalem oak, in dose* of eight or ten drops, taken morning and night for three days, followed by a purgative. E YE- WATERS. When there is much inflammation, decoction or tea of quince seeds, or in- fusion of the pith of sassafras, applied every three hours. When the inflam- Btation is abated, twelve grains of the sulphate a" zinc, dissolved in six ounces of rose water, applied every three hours. Six to ten grains of acetate of zinc, in four ounces of rose water, applied overy three hours.. Twftlve grains of sugar of lead, dissolved in z\x ounces of spring water, with the addition of a tablespoonful of distilled vinegar, is a stimulatinj •ye-water. The quantity of sugar of lead ntey be increased if necessary. 400 Classification of Medicines. GARGLES. A good domestic gargle for sore throats is made by using vinegar, dilated with warm water, and sweetened with honey or sugar. Infusion of red rose leaves, acidulated with vinegar. Or a gargle may be made with port wine and a little vinegar, or strong sage tea, with the addition of alum and honey. Gargles should always be of such a degree of sharpness as to chum a temporary smarting of the throat. STIMULANTS. These are medicines which excite a general action ovei the whole sys- tem, but of short duration, which is exemplified in the effects of spirituous liquors. A rule respecting them, when they are required, is that they are to be frequently renewed, the quantity gradually increased, and the kind changed. The most common and the best are our much-abused intoxicat- ing liquors in the various shapes of spirituous liquors, wines, porter, ale, cider, &c. Those which are considered of the strictly medicinal kind are: Spirit or Oil of Turpentine.—The dose is thirty to sixty drops. Sulpimric Ether.—Dose from one to three teaspoonfuls, mixed in half a tea-cup of water. Spirit of Lavender.—Dose about a teaspoonful. Hartshorn, called Volatile Salts.—Dose from ten to fifteen grains, made into a pill with syrup. Of the same nature is Spirits of Hartshorn.—Dose from one to two teaspoonfuls. Tmls of Hops and opt garden herbs, as well as of those imported, aro also of this class. Garlic and Onions are stimulants as commonly used. Opium, and its preparations of Laudanum and Paregoric, in small doses, are equal in stimulating power to spirituous liquors. Blisters are often used to stimulate the whole system. Articles to irritate the nose, as volatile alkali, hartshorn, snuff, assafcetida, burnt feathers, and any thing very offensive, are sometimes properly used to rouse a momentary action. Sudden burning, and irritating the skin by whipping, have often done good in rousing the system. All the stomachics and cordials, in common use, particularly the various essential oils of peppermint, cinnamon, &c.; all our spices, as pepper, gin- ger, &c, are often used to rouse the whole system to action, and with very good effects. ANTI-SPASMODICS Abe those stimulants which are supposed to remove spasm, cr a kind ol cramp in parts of the body. Of these the most remarkable are— Opium and its preparations in large doses, depending on the urgency af the case. Tincture of Valerian, and Tincture of Hyoscyamus; dose, one half to two teaspoonfuls, three times a day. Sulphuric Ether—Dose, a small tablespoonful. Assafanida—-Dose, in substance, eight or ten grains : in tincture, thro* or four teaspoonfuls. Musk—From ten to twenty grains. Essence of Peppermint—A teaspoonful in a glass of cold water Classification of Medicines. 401 DEMUL CENTS Ark medicines supposed to sheathe or cover parts in a state of irritation j as the mouth, throat, stomach and bowels, in a state of increased sen- sibility or soreness. Of this class are all the articles which are commonly known to make a mucilage with water, as gum-arabic, and the gums of our orchard trees; teas of elm bark; of the root of the cat tail of our marshes; flax, melon, and quince seed, &c. &c. Oils of the mild kind have a similar effect; especially olive oil. LOCAL IRRITATING REMEDIES. Notwithstanding the term applied to this class of medicines, some of them produce a powerful effect on the whole system; not the least oi which may be ranked— Spanish Flies, or the potatoe fly of this country, universally used for exciting blisters. The fly should be very finely powdered, and mixed with equal quantities of beeswax and tallow, melted together, or with tallow alone ; and is to be spread on soft leather or thick ;inen—or the plaster may be spread with the tallow, and the flies sprinkled on it. In cases where it would be injurious for the flies to adhere to the skin, the plaster may be covered with thin gauze. An ounce of flies in a quart oi spirit, forms a good application to irritate the skin. Mustard Seed, reduced to powder, and mixed up into a paste with vine gar, is also a common mode of irritating the skin. Nitric-Acid—Two parts with one of water, spread by a feather on the part, spsedily destroys the skin, which can be rubbed off in a few minutes, and the raw part kept discharging by irritating ointments. Burgundy Pitch, spread on leather, and worn on the skin, makes a mo- derately stimulating plaster ; improved by sprinkling on it a little of the dust of the Spanish fly. Volatile Liniment, made by mixing equal quantities of spirit of harts- horn and olive oil. Volatile Alkali, or spirits of hartshorn, is frequently used alone, to ex- cite irritation on the surface. Spirit of Turpentine, Spirit of Camphor, Red Pepper in Spirit, each makes valuable local irritants, and they are often used to relieve rheumatic and other deep-seated pains. Tartar Emetic, twenty grains in a gill of water, with half a gill of tino- ture of Spanish flies; and common salt, with or without red pepper, an- swers a similar purpose. OINTMENTS. Those most generally used for common sores are, Simple Ointment. It is designed merely to sheathe the parts and ex llode the air. It is generally made by melting half a pint of olive, oil with four ounces of beeswax. But suet alone, or mixed with equal quantities of hog's lard, will answer equally well. Lead Ointment. This is used for sores of aa inflammatory nature. It is made by pounding one drachm of sugar of lead very fine, and intiuiatbly rubbing it ujp with five or six ounces of hog's lard. Basilicon, or Yellow Resin Ointment. This is used in common sore*, requiring a little excitement. It is made by melting one ounce of beeswax and the same quantity of yellow resin, with an ounce and a half of hog'i iard. 402 Miscellaneous Recipes. Bed Precipitate Ointment, made by rubbing up one drachm of potr dered precipitate with one ounce of hog's lard. Tar Ointment. Valuable for affections of the skin and scaid hoad; made by melting together equal quantities of tar and suet. CA USTICS. These are frequently necessary to destroy the fungous of sores or prov4 flesh, as it is vulgarly termed; and to stimulate them to greater action That most commonly used is Burnt Alum. This is common alum deprived of its water, by keeping it on a hot iron until it ceases to boil; it is then powdered and sprinkled on the sores. Powdered rhubarb is a good substitute. Lunar Caustic. This article, obtained from the druggists, is most used by surgeons. Its application is very simple, the edge of it slightly moist- ened, the sores are to be gently touched with it. Nitric Acid. When diluted freely with water, it is very commonly applied as a wash to destroy the worms or maggots of sores in warm weather. MISCELLANEOUS RECIPES. Antimonial Wine.—To make this, put twenty grains of powdered tartai emetic in ten fluid ounces of sherry wine, and shake till dissolved: foi dose, see tabular list of Medicines. Pose Water.—Mix five drops of otto of rose with a tablespoonful of powdered white sugar, rubbing well until all the oil has been taken up in the sugar; then dissolve the sugar in one quart of cold water, and strain through muslin. Spermaceti Cerate.—Melt one ounce of spermaceti, three of white wax, and six ounces of sweet oil, or lard, in a vessel over a slow fire, mixing thoroughly. This makes a good healing application to sores, ulcers, burns, &c. Resin Cerate, (or Basilicon Ointment^)—Resin, five ounces; lard, eight ounces; yellow wax, two ounces. Melt and mix together, and while hot it may be strained through a coarse cloth or sieve. Used the same as ths above. Compound Resin Cerate.—Resin, suet, wax, of each four ounces; tur- entine, two ounces; flax-seed oil, two ounces; melt and mix together, his is more sthmilatiBg than the two previously given, and is better for «ld sores and ulcers sometimes, where they have become chronic. Yeast Poultice, is made by mixing one pound of wheat, flour with on« pint of yeast, exposing to a gentle heat until it begins to rise; it is then applied. Simple Cerate, is made by melting four ounces of lard and two ounces of white wax together; it is a good healing application to simple sorea, tracked lips, chapped hands, &c. Charsoal Poultice.—A poultice made from half a pound of oatmeal thickened with water, with the addition of two ounces of finely powdered charcoal, is employed in cases of mortification, to destroy the fetor arising from the dead portions of flesh and offensive discharges. Leeches.—These are applied to various parts of the body, to draw blooa for the cure of disease. A leech attaches itself to any substance to which it wishes to fix, by an apparatus, constructed on the principle of a leather-sucker, or air-pump, \ Miscellaneous Recipes. 401 »hi«h it has at both endg; the one at the head being like a horse-shoe, with a triangular mouth in the centre, and that at the other end being oircular. When they fix on the body, they inflict a small wound of three little flaps, from which they suck blood until they are gorged, or till they are forced to quit their hold; which is best done by sprinkling on them a little salt. Enemas, or Injections.—For flatulent Colic. Assafcetida, two drachma, and thin gruel, or starch, ten ounces, well mixed together. Purgative Enema.—Senna leaves, three ounces; glauber salts, obo ous