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Jfe^ / ]- c aw do Aavaan ivnoiivn aiMiDiaaw jo Aavaan ivnoiivn aiMiDiaaw do Aavaan ivnoiivn 3ni > jf * WBA Sktkud, according to Act of Congress, in the year 1869,1>y M. LAFAYETTE BYRN, M.D.. eMe. 47 form. It is also very unwholesome 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 aliment 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, the 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 contrary, 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 strong 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 diges- tible or proper a diet as wether-mutton. It is, however, to jursons 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. 4 3 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 than 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 bowele, and is a very suitable food for persons troubled with costive- ness. 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 is decidedly unwholesome. Ham.—When properly cured, and when boiled, ham is a rery palatable and wholesome food. It is, however, stimulat- ing and difficult of digestion, and only suited to such persona 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 clamp 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, if a light food, adapted to many invalids and to persons conva iescent from fevers. For their use it should be prepared fron; 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 dn> Appetite. 49 eases of the skin and disorders of the bowels. ' The fat offish is still more indigestible than that of other animals, and readily tiirns rancid on the stomach. When not in season, all kinds of fish everywhere, are very indigestible and unwhole- some. The best mode of cooking fish Is bv 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 hio-hly 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, on 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 stomach. Soups.—For the laboring classes generally, there is scarcely a 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.bo 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 iumplings, 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 be 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 oata 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-mea! or fndian 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 ia not, however, a very pleasant nor wholesome food. Barley-water.—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 baked into bread, furnishes a most wholesome, nourishing, and pal- atable food, and one well adapted for the support of the active and laborious generally. Indian bread, properly prepared were it not from habit and fashion, would recommend itself tc 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, it is tc be again kneaded, and baked in the same manner aa 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, esp^ially for persons upon whose stomachs most articles of 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 And, that eating a small portion of it, will afford a grateful 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 v/uo of the most unwholesome dishee 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 watera 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. CO OKER 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 BoiW ia very properly applied to vegetables; as it renders them more soluble in-the stomach, and deprives them of a quantitv of ail and other particles which are pernicious to weak stomachs, ine quality of the water used in boiling requires some atten Cookery. 53 tion; 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 ot 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 roasting, 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 surface 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 stewing is a mode of cookery well adapted for the food eaten by those of robust 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 general, three meals, in the course of the day, seem the most desirable, and the best adapted to the wants and constitution of the human frame ; while, at the same time, this number ia 6est suited to the powers of the digestive organs. The practice which leaves the great bulk of the day without r, meal, and then crowds two or three together, is manitestlv oad, as it produces in the body a state of exhaustion and fa- 54 Cookery. tigue, which strongly tends to enfeeble the powers of digestion To confirm and preserve health, whatever may be the numbei 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 Jong fasting, and too frequent repletion, should be carefully avoided ; 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 state 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 well chosen for the active classes of society more especially. Dinner should always consist of one kind of meat, 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 wrere the same amount to be eaten of a single dish. Let it be recollected, also, that 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 may 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, la 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 perform. 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 the stomach, and thus prevents its muscular contraction^,, at the 4 Cookery. 55 rery time when it is necessary they should be brought into action, and preserved in their full vigor. To say the least of all these vuigar errors :n diet, they check the process of diges- tion, and paralyze the powers of the stomach. Supper. —As the powers of the body, and digestion anions, die rest, are diminished in their activity during sleep, it is an nnsafe 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 all 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 blood. 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 haa b 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. Aa a drink, whey is well adapted to allay thirst in hot weather.^ Buttermilk contains but little nutritious matter / but, in 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 smaJ. 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 possible noxious qualities present. Make the infusion proper- ly, 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 functiona 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 ita 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 the 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 takeu weak Cleanliness. 57 and with plenty of cream or milk and sugar, it may howevei bt indulged in sparingly, by persons in health, and who lead active 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 re'rnoval of evct? 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 t) 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 yater 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^ 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 be 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 iinen when it is worn for too long 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 ot 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 oi health. It cannot be effectually removed without the occa- sional use of soap, with which it combines without difficulty. Washing all over, writh soap and water, occasionally, is very necessary. Mechanics, and they who, from any cause, are peculiarly liable to have deposited upon their 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 /"ell foi the preservation of the skin as of their health genera*.','. If you can only get a bowl of cold water, some y-'ood soap and a rough towel, you 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 "owel, after the washing all over in soap and water. The ordinary brown and yellow kinds of soap are altoo-ether unfitted for cleansing the skin, as they irritate it, and when frequently used, most generally cause it to become rough, chapped, or covered writh painful and unsightly pimples. Most if not all, of the colored and variegated soaps, prepared express- ly for the toilet, are equally objectionable. Pu/e white soap ought, therefore, to be invariably used in ablutions of th* fac* and hands, or of the surface generally. 59 A Curved, Round-Shouldered, and Erect Spine. Old Style and 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 nhigh-bones and feet, otherwise the bones of these, bein»> soft and growing, are h»ble to become distorted, or out of shape. Fig. 2 repre' Bents a proper position, and fig. 3 an improper position, for sitting. Curvatures of the spine may be caused by too many pillows upon which tb I»*«d rests while in bed, as represented above. Young persons should lie ad nearly lev.el as possible, with the head but slightly raised if at a1!. As they ad- vance in life, a more elevated position of the head may be desirable. Most peo- ple lie upon the right side ; some lie upon the back, but this latter position is not favorable to those who are liable to nightmare. A frequent change of posi- tion is very desirable. If you awake during the night, change your position. • Sleep. 61 SLEEP. It is highly important that every body should understand that sound, refreshing sleep is of the utmost consequence to the 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, dav-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. sircum- stances to be attended to, in order to procure refreshing sleep, are, the nature and quantity of our food and exercise; the size and ventilation of the bed-chamber; the quality of the bed and of its coverings ; and the state of the mind. It is certain that a full stomach almost invariably occasiona restless nights, and it is, therefore, an important rule to make 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 the time will augment its good effects. If, notwithstanding an adherence to the preceding nilea, eleep is still found to be unsound and unrefreshing, a brisk use 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 due 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 Eersons 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. Heading in bed at night is a most per- nicious custom ; it strains the eyes, prevents sleep, and injure? 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 distortion 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. By 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 their 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, and1 even more fatal complaints may be caused by occupying a damp bed. Beds, instead of being made up soon after the persons 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 the -op sash, when practicable, or raising the lower one slightly. Dc not sleep in a very warm room. Unless there is an apprehension of damp, a bed-room should rarely have a fire in it. They who live in hot countries ought to be very particular regarding the place the}' sleep in. The apartment should be roomy, dark, shaded from the rays of the sun and moon; temperate as to heat and cold, and rathei 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 aa sufficient exercise during the day, temperance in eating and drinking, a cheerful and contented mind, and the avoidance 0/ late or heavy supper, or of strong tea or coffee during the evening. Many of the sudden deaths which take place during 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 on some incumbent pressure, or to relieve one's-self from great inconvenience. It commonly arises from an imperfect and unhealthy digestion, from heavy suppers, and from a constrained uneasy posture of the body. 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 raised. 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 l/rovidence, it is the last of the passions that forsakes us. The Passions. 65 Love is one of the strongest and most absorbing passions with which the mind is affected, and has at its commencement 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 poul 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, retardsthe motion of the blood, obstructs digestion, and prevents the proper nutrition of the body. Violent terror has been known, in an instant, to turn 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 boAvels, 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. A.nger 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 colic 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 ot the lungs, disturbs the regular circulation of the blood, and mpedes the nutrition of the system. It is a fruitful source ol chronic affections of the stomach, liver, heart, lungs and brain Even 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- sent 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, bv 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, fine 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 of the Bowels. 67 PRESERVATION OF THE SIGHT. Die 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 )i twilight, and in dark places. Avoid sitting near a dazzling or intense light, as of a lamp )i candlo, and facing a hot fire. Avoid reading or sewing much by an imperfect light, as well as b}7 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 Beasoned food, and every species of intemperance, all of which invariably injure the eyes and impaii 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 'Vise delicacy resist the calls of nature. In costiveness, besides early rising, 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 63 Feet. of the ordinary vegetables, well boiled and not to) highly sea soned. will be found a very excellent diet for those inclined to costiveness. Fresh fruits, perfectly ripe, or fruit cooked, with or without the addition of sugar or molasses, 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 rye or Indian meal, is better suited to the habitually costive than bread composed entirely of fine 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 made 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, undei 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-uud 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 perfeetly^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. Tliey should be washed at least once every day and rubbed well afterwards with a rough towel, or flesh brushj Thin shoes are killing thousands of females every year__awaj Physical Education and Diseases of Children. 69 with them at once. Females should wear thick, warm Bhoes, at all times during cold or damp weather. P HTS IC AL E DUCATION AND DISEASE*. OF CHILDREN. General Symftoms of Disease.—It is often difficult in very young children to determine the disease with which the little iufferer is afflicted,—for as we can obtain no information from the patient relative to his feelings or the history of his maiady, we arc obliged to form an opinion from external symptoms alone. The symptoms of disease are nearly the same in child- hood as in inaturer age. The sleep, motions, breathing, evacuations, pulse, appetite and mental manifestations, all afford important appearances. The countenance is in niost cases an important index of disease; when the expression ia 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 their wants and sufferings. 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 ?ougii, sneezing or lr'ccnp in sickness. The tonaw. 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 diseas3d action in some part of the system. The *kin, in health is soft, s ightly moist and warm, and has a slight crimson tint ot the blood 70 Management of Children but when it 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 >rgans ; 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, arc in most 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 evacuatione 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 costivenesa 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 enable 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 foi infants than for adults, on account of the rapidity of the en*' dilation and breathing, and the weak and irritable state of the nervous system. Children confined in badly aired rooms beome pale, feeble, irritable and finally consumptive. The air in their sleeping rooms should not be too warm, as this causes oppressive breathing, too great perspiration, feverish cess and oppression of the head. Neither should it be tot cold, for this checks the insensible perspiration which is con stantly going on during health. Very cold air also closes tho pores ou the mucus membrane of the nose, throat, windpipe and lungs, and inflammation and fever ensue. Beware how von attempt to "harden" your children by putting them to 71 Illustrations of Healthy and Unhealthy Positions of the Body. Coeeect Position. Incoeeect Position. gee how that round-shouldered youth is sitting with his shoulders against th« back of the chair, and the lower portion of his spine several inches from it, giving his body the shape of a half-hoop. Parents should regard such a position in their children with apprehension as to the result, and should rectify it at once. The other young gent, has learned a thing or two worth knowing, as you will see by his manly, dignified position in his chair. He may be President yet— who knows? Healthy Position. Unhealthy Position. An upright position, in either sitting or walking, favors a healthy action 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 unfavor- ably. There is a very " don't care" kind of look about one of these young ladies; If she lives long enough, she will care. Improper Position. Peopee Position. Learn to sit up, young man, and to imitate your opposite neighbor ; for the unnatural 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 determined "purpose to imitate some definite copy as nearly aspossible, is the only true road to success in the art of writing or good penmanship. This young- ster on the left looks as if he was "bowing his back for a heavy burthen —and so he is ; if he don't quit it, he will have burthen enough. • 86 Management of Children 73 sleep in a very cold room; croup and inflammation of the iangs 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 not judge of this by their own feelings, as a degree of ccd which to them would be comfortable, might be injurious oi 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 sooner than three hours after eating. If there is roughness or smarting «f 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 washed 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 cept 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; 74 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, ia totally useless, and very pernicious to their health and com- fort. Soft, white wroolen flannel should be worn next to the fekin during winter and the colder part of spring and autumn. When the flannel is laid off, cotton may be substituted by degrees: this may be done also, at any time when woolen ppears to be too irritating, as sometimes happens. The night clothes should be light and perfectly loose: the whole dress 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, ia 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 intense glar- 'ng light of the sun, fire or lamp. All perfumery, flowers, medicines or food, or anythihg exhaling a strong, odor, should be excluded from sleeping apartments. Children ought never to sleep with old or sicl persons : neither should they be fondled or kissed by old, di» 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 advanced age should retire early, and rise early in the mornino*. Exkkoise.— During the first few months of infancy, but Management of Children. 75 Mtle exercise is required,—nor does the organization admit oi more than a small amount of passive and gentle movement Uie mtant may be carried about in the arms within doors — or when the weather is pleasant it may be carried in the arms or :rawn in a wagon, laying on a pillow, in the open air, a tew 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 or 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 tree 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 'a^e is always injurious and unkind. Nothing is gained and much is lost try sending a child to school too young. Ko 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. Dkinks.—Infants feel the sensation of thirst, as early at 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 cordialt 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 that he is sick, and dose succeeds dose, till disease is often produced,—when a spoonfull 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 Jwt drinks should be avoided.) Diet.—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. Food.—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 y 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 same prevailing source. The custom of feeding children with inap- propriate articles of food, very soon after birth, is wrong. Kc Nourishment of Infants. 77 sooner is the infant washed and dressed, than tne nurse ia ready with her spoon and cup of gruel, pulverized crackers dissolved in water, or some such preparation, to fill its stomach to the utmost of its capacity ; and this process of stuffing is continued 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. She 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, should he sufferedto 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 first been put to the 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 whollynourished by the breast. For when, during the timi 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- nial fluid furnished by the mother will not be easily digested and acidity, flatulency, and colic, will continue to harass the child until the digestive powers gradually acquire a greater degree of vigor. Let the child's stomach be once or twice filled during the first twenty-four hours with gruel, or any of the ordinary 78 Nourishment of Infants. preparations employed by nurses for this purpose, and the chances will probably be as ten to one that sourness of the stomach, vomiting, colic, griping, &c, will supervene. # There is 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 pose ; and there is much reason for believing that the infant's digestive 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 has 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 milk and water, may be given two or three times daily, in addition to the nourishment drawn from the breasts. I do not mean to Nourishment of Infants. 79 lay 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 at 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 ia performed by the mother. No hired nurse can be depended on to give the tender care, and have the -affectionate regard, (ot a child that its own mother has. 80 Nourishment of Infwnis. Unfortunately, however, mothers are not always in a condi- tion 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's system; when suckling gives rise to pa./iful or dangerous affections in the mother, as colic, 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 ruie, therefore, the age of the milk should not vary much from that of the child, up to about the fourth month. After this period, buch ** relation between the ages of the milk and child is not of much importance—for a child five or six months old and Nourishment of Infants. 81 upwards, may be nourished by a fresh breast with entire safety. The occurrence of the'menstrual evacuation during nursing, is 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, te 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 this 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 constitutional peculiarity, or some accidental influence, the monthly turns 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 ita 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. 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 Nowishment of Infants. .character, during the fits of ill-nature and passion ; but the :most serious and alarming effects may be produced on its ten- der organization, by the milk of such a nurse. 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 tecretion 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- rrnrse. Artificial Nursing.—Under judicious management, infants 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 thu 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« elusive 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-beino* 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 wlien this it the case she ought, by all means, to continue suckling the oiiild, 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 out- Nourishment of Infanta 83 lide, 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. The 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. Rest 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 their 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- Earations do not agree with the child's stomach, they should e used with an equal portion of weak mutton, chicken, or beef broth, clear and well freed from fat. A mixture of tliia 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, slightly 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. I ried and broiled meats, and all food heated a second time, by hashing or mincing, being less 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: but 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 the 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 meat- being of much more difficult digestion, can seldom be used without impeding digestion, and finally injuring the tone of the stomach. Yeal is decidedly the most objectionable of ail the meats in common use for children. Fresh fish, boiled, ard 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 bemused. 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- stitutes the best drink for children. Candies and Sweetmeats.—Indulgence in the use of sweet- meats is a copious source of disease and mortality during childhood. Fruits preserved with their skins, as raisins, arc articularly pernicious. The skin of all fruits is of difficult igestion. The conduct of parents, in relation to this subject, is ofte» extremely irrational and pernicious in its consequences. Thei would not themselves venture on the frequent and free use of 3onfectioneries of this kind; and yet will indulge their chil I Nourishment of Infants. 85 Aren without scarcely any restraint, in the use of these pernicious luxuries. The sicklier and weakei the child is, the 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 peacties. 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 sour. When the acid or sourness prevails to such a decree 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 skm, such as grapes, whortleberries, &c, are improper articles of food for children. The pidp 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 as Btrawberries, 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, thia 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 ^6 Nourishment of Infants. use. and ought to be wholly excluded from the list of articles 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 unfrequently the case, they are capable of pro- ducing violent and even fatal diseases. Most alarming and fatal consequences have resulted from the irritation of eherrj 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. Exkecise.—Uncertain and awkward motions of the arms— stamping with the legs, and drawing them up, are the first feeble attempts which the ihVant 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 propei 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 mannei', however, in which very young children are usually carried or exercised, ia extremely reprehensible, as it is calculated to give rise to very unfortunate 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 their bodies in an erect position, before the backbone and muscles have ac- quired a sufficient degree of firmness and activity to support the body and head in this posture. The child is usually car- ried by the nurse pressing its thighs and hips, with the 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 manner i'i which the head is liable to fall from side to side, serious and oven fatal injury may be inflicted on the spinal marrow of the 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 thia position, the shoulder-blade and side of the chest are liable to Deforced upwards and outwards, which may result in perma- nent distortion. The backbone and its muscles seldom acquire sufficient strength and fimness 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 tbe 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 be 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 ot 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 h? 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. Hiding 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- uig 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 or Nourishment of Infants. 89 no 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 itself 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- clespreviously 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 their 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." If we are earnestly desirous of training up our children in Buch a manner that they may acquire a firm step and well- formed limbs, we shall gain our purpose much more certainly aud 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 lega 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 by one arm, in order to help it over some obstacle, or to hasten its progress ovc;r a rough and difficult piece of ground. It is easy to verceive that tlrs —actice must necessarily, and in no in- considerable degree, tend to draw the shoulder and side of the *hest out of their natural position ; and when frequently re- peated, to give permanent deformity to these parts. N ursery-maids seldom exercise sufficient care in this respect. Too indolent to carry the infant in their arms, as they are directed and supposed to do, they are apt, as soon as they are no 90 Nourishment of Infants. longer observed, to place the child on the ground, and to hurry 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 their legs walking is decidedly the best exercise they can take. Parents ought not to intimidate their children by inspiring them with ft constant dread of falling or hurting themselves. The custom of exaggerating the dangers incident to their usual sports—and ot plying them continually with admonitory injunctions against ac- cidents when they are engaged in their 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 childrsn fall o" hurt themselves, they should not be soothed by expr jssions ol extreme pity and sorrow; for plaintive words and erepressions of great sorrow tend very effectually to render them effeminate and timid. Children who are thus accustomed to excessive com- misseration, seldom fail to acknowledge this tender sympathy, by straining their little lungs to the utmost by crying on every slight injury they receive. After children have passed through the period of teething, they should be encouraged in the pursuit of active amusmenf out of 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 di- 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 the 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 •fcould "ie earned into the open air once or twice daily, assoor as thev are three or four weeks old. During cold and damp weath«r, they should be occasionally conveyed into an adjoin ing well-aired room: avoiding, however, strong currents of air, or sitting with them near an open window. Important as the enjoyment of fresh air is to the health and comfort of infants, care should be taken to accustom them gradually to the im- pressions of the external air—more especially when the atmosphere is cold and damp. The practice of exposing chil- dren, soon after birth, at once to the open and cold air, with the view of " hardening them," as it is called, is attended with considerable risk of injury, and should not be permitted by parents, except when the weather is clear and very mild. Even in summer, the infant should not, as a general rule, bo carried at once into the external air, without having been pre- viously accustomed to the air of a well-ventilated chamber. After the child is three or four days old, it ought to be con- veyed, several times daily, into an adjoining room having, at first, only the windows open, and in four or five days after- wards, the doors also, so as to admit a free circulation of the air through every part of the room. This having been prac- tised for ten or twelve days, the child may then be carried out of doors, and permitted to enjoy the pure and open air. At first, it should not be allowed to remain out of doors more than five or ten minutes at a time, but gradually extended. Hanging up the linen of children, or drying their diapers in the place where they sleep, is very improper. Weaning.—Tho only thing that is usually regarded by mothers, in fixing on the time for weaning, is the age of the infant. The child is suckled until it attains a certain age, without any regard to the development of its digestive powers, or the state of its health and constitutional vigor. By this course, childreu may be kept at the breast, long after the vigor oi the digestive functions, and the demands of the system re- quire a more substantial and nutritive diet; and on the other hand, they may be separated from the breast before the stom ach has acquired sufficient energy to digest with due facility a stronger and less congenial food. The progressive develop- ment of the digestive powers, and the demands of the organi- sation in relation to nourishment, are very various among different infants. It is particularly important that the con dition of 'nfants, with regard to these circumstances, should be consiuted in regulating the period of nursing. The ob vious correspondence which exists between the successive appearance of the teeth, aud the development of the diges- 92 Nourishment of Infants. rive powers, afford us a safe guide in relation to this sub Ject- * -j • The progress of teething is, doubtless, our safest guide in re gulating the nourishment of infants, and in deciding on tha period at which they may with propriety be put on the ex- clusive use of artificial food. Not unfrequently, however, circumstances of an irregular or morbid character render it expedient, or even indispensable, to wean the child, before it has attained the age and development which, under ordinary circumstances, would be deemed requisite to justify its final separation from the breast. The mother may be affected with some constitutional disease, which may so contaminate her milk, as to render it highly injurious to the child's health, if she continues to nourish it at the breast. Mothers, affected with scrofula, or ulcerated can- cer, should, on no account, suckle their infants. The mother may also be so exhausted and debilitated by an attack of some acute disease, and the measures requisite to subdue it, that she cannot continue to suckle her infant, with-' out increasing her prostration and superinducing a train of alarming and highly distressing affections. The same difficulty is apt to occur in mothers of a feeble, delicate and nervous habit of body, particularly when the digestive powers are weak, or so disordered that nourishing and substantial aliment cannot be taken. Under these circumstances, suckling can seldom be continued without producing the worst effects. Many young ladies, on becoming mothers, are incapable of supporting the constant drain to which the wants of their in fauts subject them. They lose their good looks, become gradually weaker and paler, and, as their strength declines, they become more and more afflicted with a variety of harass- ing nervous affections. Medicinal means are of no permanent advantage. They may procure more or less temporary miti- gation of the symptoms, but they are wholly inadequate to the removal of the malady. Nothing but weaning will suffice —and the entire separation of the child from the breast is generally soon followed by a progressive subsidence of the sufferings of the patient. On the part of the mother, the effects of unduly protracted nursing are sometimes extremely pernicious. We not unfre- quently see women pale, debilitated, and constantly tormented with dyspeptic and nervous affections, suckling their infanta for eighteen or twenty months, and occasionally much longer without suspecting that their sufferings and ill-health aroth« result of exhaustion from the constant drain of nursing. Nourishment of Infants. 93 Many >mothers are able to suckle their children until they arrive at the proper period of weaning without the least in- convenience, who, nevertheless, will suffer very serious de- rangements of health when the nursing is extended considera- bly beyoni the time which nature points out as the proper period for terminating it. On the part of the infant, also, suckling, when continued much beyond the proper period, is apt to exert a highly inju- rious influence. It is well known that after the eleventh or twelfth month the milk almost invariably becomes diminished in quantity, as well as more or less deteriorated in quality y and, in proportion as the nursing is protracted, so will it lose more and more its nutritious and wholesome character. In many instances, indeed, the milk begins to deteriorate as early as the ninth or tenth month, corresponding in this respect with the proper period of weaning as it is usually indicated by the progress of teething. Children who are suckled an undue length of time generally gradually lose their fresh and healthy appearance. The countenance becomes very pale, and acquires a languid, fretful, and sickly expression. In some instances the milk loses its wholesome properties at an early period, without any very serious or obvious derange- ment of health in the mother's system. When this occurs, the infant often throws up the milk, soon after nursing, and becomes harassed with colic, griping, acidity, and diarrhoea, attended with paleness, debility, emaciation, and frequently with scabby eruptions about the face and head. If the child becomes affected in this manner, when nourished exclusively at the breast, we may presume that the milk has become de- praved and injurious to its digestive organs. If any doubt exist as to the agency of the milk in the production of the disorder, the breast should be withheld from the child as long as can be done without any particular inconvenience to the mother, and artificial nourishment, or the milk of a nurse, substituted. If the mother's milk has been the cause of the child's illness, an obvious abatement of the symptoms will soon take place ; and should this occur, the child ought to bo gradually entirely separated from the mother. T/ie recurrence of the menses, during nursing, exerts, in many cases, a decidedly prejudicial influence on the proper- ties of the milk, and often renders weaning necessary before the usual period of separating the child from the breast. When the mother finds the child becoming sickly, feeble, and annoyed with disorder of the stomach and bowels, after her monthly sickness has returned, or after she finds herself in a 94 Diseases of Children. state of pregnancy, and relief is not obtained, in due time, from the use of appropriate remedial means, the child ought to be gradually weaned. Should a woman with an infant at her breast, again become pregnant, one of two things will nsually take place : either she will miscarry, or her milk will become impoverished in quality and diminished in quantity. It was not intended by nature that the processes of pregnancy and nursing should go on simultaneously; but, on the con- trary, that the one should commence when the other had ter- minated ; and experience sufficiently proves, that they will not proceed well together. Attention should also be paid to the season of the year, in fixing on the period of weaning. In general, weaning may hi accomplished with less inconvenience and risk of unpleasant consequences to the child, during the mild months of April, May, September, October, and the early part of November, than whilst the weather is inclement. Exercise in the open ah is always highly beneficial to the child at the time of weaning. It tends to fortify the system of the child, and to enable its diges- tive organs to bear, without inconvenience, the change of nou- rishment. In consequence of the peculiar tendency of war/n weather to excite summer complaint, particularly in cities 01 large towns, it is in general inexpedient to separate children from the breast during the months of June, July and August ; for the transition from the mother's milk to an exclusive arti- ficial nourishment during this season, has a decided tendency to favor the occurrence of this dangerous disease. Neverthe- less, should the child be suffering from a deteriorated state of the milk, it ought to be separated from the breast without any regard to season : for a bad condition of the milk would doubt- less be more injurious in this respect than a suitable artificial nourishment. The child should, at the same time, have the proper bathing, out-door exercise, etc. DISEASES OF CHILDREN. Difficult Tkething.—Teething is not usually attended witlj much suffering or danger ; yet when there is much predispo- sition to disease during this process, any exciting cause may produce violent and dangerous symptoms. The first teeth usually begin to penetrate the gums about the seventh month of infancy—they sometimes, however, appear as early as the third or fourth^ and in some cases as late as the twelfth or fif teenth. In difficult teething there is redness and tenderness of the gums, increased flow of saliva or spittle, thirst, looseness of the bowels, slight fever, restlessness and sometimes eruption! Diseases of Children. 95 on the skin. In the more severe cases there aie often ulcers of the gums, diarrhea or dysentery, inflammation of the brain or Dowels, spasm of the windpipe, convulsions and death. These cases require perfect cleanliness, quiet, pure air, vegetable diet, cooi drinks, mild purgatives, and lancing of the gums. Be careful not to give anything to check the^bowels suddenly, in cases of looseness during teething, as the head is apt to become the seat of very serious disease in such cases, producing spasms, and sometimes inflammation of the brain. - Giving the child, three or four times a day, a spoonful or two of blackberry root tea (cold), is about as good, in cases of diarrhea during'teeth- ing, as anything else. Flannel should be worn next the skin, and let the child live on the mildest food, or the breast-milk, accord- ing to the age. Toothache.—This may occur from decay of the tooth and ex- posure of the nerve, from inflammation of the nerve, gums or membrane lining the socket, or from ulceration at the root of the tooth. If the tooth is much decayed, dark colored, or ulcerated, it should be extracted : if the pain is caused by in- flamed gums or socket, the gums should be freely lanced, warm fomentations, such as hops and vinegar, with hot water, re- newed every half hour, applied to the face, and a gentle pur«-c administered—castor oil, one teaspoonful, syrup of rhubarb, one to two teaspoonfuls, or the same quantity of Rochelle salts m a gill of cold water. When the tooth has a cavity in it so as to expose the nerve and cause pain, the application of a piece of cotton wet in some stimulating medicine, such as oil of cloves, or cinnamon, or paregoric and camphor, or a mixture of fine salt and alum, put into the tooth on a piece of wet cotton, and renewed every half hour, will usually give relief. Inflamed Gums.—During the first teething the gums are very liable to become inflamed ; in some cases it is slight, and in others severe, and productive of serious consequences. The gums first become red, or dark-colored, swelled and painful, child languid, feverish, thirsty, tongue furred, appetite im- paired, and sleep disturbed. When the inflammation occurs before the double teeth appear, it often destroys the new teeth: and when the inflammation proceeds to ulceration—if this is not speedily checked, the other teeth become black, loose, and decayed. There is a flow of spittle, sometimes mixed with blood, the breath is unpleasant, countenance pale, and some- times severe attacks of diarrhea. This condition is caused by too much, or improper food, filthiness of the teeth, neglect to lance the gums in difficult teething, biting hard substances, and 96 Diseases of Children. disorder of the stomach. The gums should be freely scarified (lanced) the bowels regulated, and some astringent medicine, such as strong green or black tea (cold), tea made of white oak bark, etc., applied frequently to the gums, the teeth cleaned and all decayed ones extracted : the diet should be very light, and the general health improved by gentle tonics ; a tea made from a mixture of equal parts of bruised gentian root, wild cherry bark, and orange-peel or sassafras bark—say one table- spoonful of the mixture in a pint of boiling water, cover up and let stand for one hour and a half; of this one or two table- spoonfuls may be taken before each meal (cold.) Thrush.—Four or five varieties of inflamed mouth are de- scribed by authors; but the most common of these are simple inflammation and thrush. The symptoms of the first are, red- ness and dryness of the mouth, the infant manifesting pain when attempting to nurse — caused by teething, bad diet-, sharp acrid substances, cold, or over exertion of the muscles ell the tongue and mouth in attempting to nurse from a badly- formed nipple. By removing the cause, and the use of simple washes and mild purges, a cure is soon effected. Thrush ia confined in its attacks mostly to nursing infants. At the be- ginning of an attack the child is restless, the mouth red, dry, and hot, digestion is disturbed, and there is difficulty in nurs- ing: after one or two days, small wdiite spots appear on the tongue and mouth, and sometimes spread over the entire sur- face. In the course of the disease, patches of curdlike matter fall off, and the spots are again covered as before ; it sometimes extends backwards into' the throat, or ulcerates and becomes both tedious and troublesome—in some cases it proves fatal. It is caused by improper diet, filthiness, impure air, disorder of the stomach and bowels, sudden stopping of diarrhea, and nursing from a sore nipple or a diseased nurse. In mild cases, pure air, proper diet, cleanliness, mild purgatives—same as those recommended in treating toothache, and soothing washes (hor tea and sage tea mixed, is very good,) for the mouth, will remove the complaint. The first thing to be done when an infant is affected with thrush, is to correct the acid state of the bowels by a few grains of calcined magnesia—or if the bowels be relaxed, by chalk, following the magnesia by a half teaspoonful of castor oil. This may be repeated every second day. The quality of the milk, and the state of the nipple of the mother are to be exam- ined. Milk and water—two parts of the former to one of the latter—in which a little isinglass should be dissolved if there is diarrhea, is to be the sole addition to the mother's milk; aU Diseases of Children. 97 sugar is to be avoided. If the state of the bowels be corrected, the thrush will generally get well, but it is expedient to assist the cure by the use of a solution of borax in water—one teaspoon- ful to half a pint—used to wash the mouth. When the case is mild, the curd-like patches will separate in seven or eight days, leaving a healing surface below, and the mouth soon gets well, if it be not injudiciously scrubbed ("cleaned ") daily by the urse. Bleeding from the Nose.—This is sometimes a frequent and troublesome disease with cluldren, caused by injuries of the nose, fullness of the blood-vessels of the head, &e. In robust persons troubled with dizziness and headache, it is often beneficial, and, unless excessive, need not be restrained ; but in those of a pale and weak habit, it may, if long continued, produce debility and dropsy. It may usually be restrained by the application of cold water to the head and neck, snuffing cold water, or alum water, up the nose, or stopping the nos- trils with lint or cotton. When these means fail, more effi- cient ones must be employed. Gargling a strong tea, made of white oak bark, when cold, in the throat, then suddenly closing the mouth, and stooping forward, to make the liquid come out of the nostrils, repeated every few minutes, if necessary, will usually stop it. liaising both hands above the head, while the nose is kept closed by an assistant, is a good and simple remedy. To prevent a return, bathe the head in cold water, night and morning, live principally on a vegetable diet, keep the bowels regular, and avoid exposing the head to the heat of the sun. Using a rough towel or a flesh brush, night and morning, to rub the surface of the body and lower extremities, is advisa- ble. Canker of the Mouth.—This occurs in children of weak, scrofulous constitution, who are ill-fed and exposed to the in- fluences of unhealthy habitations; and most generally imme- diately after acute disease, particularly measles. The first symptom of the disease is a red, hard, angry-looking spot on the cheek, which quickly opens into a gangrenous, (mortified) ulcer inside the mouth, the gums become affected, the teeth drop out, the breath is very unpleasant, and the extending llceration goes on destroying the cheek and contiguous parts, •,ill it :'s either stopped or death ensues. As the first cause of this fearful affection is traceable to poverty of constitution, the first remedial measure is to nour- ish. The strongest meat-soup—beef-tea is the best—must be given in small quantities, frequently repeated ; milk and eggs, I PS Croup. •f the littxC patient will take them. Wine may be allowed if he debility is extreme, but scarcely, if at all, should fever run high, and there is much heat of skin. A drachm of chlorate of potash is to be dissolved in six ounces of water, and to this added twenty drops of muriatic acid. A tablespoonful of the mixture to be given to a child of six years of age every four hours; it may be slightly sweetened. Half-grain doses of ;qu>inine, or an ounce of infusion (or tea) of Peruvian bark, may be given twice or three times in the twenty-four hours. A wash made of one teaspoonful of salt, dissolved in half a pint of water, should be frequently applied. The case ought to be seen by a medical man as soon as possible. CR O UP. This is recognized as one of the most dangerous diseases of childhood. Its progress is rapid, and its treatment, to be sue cessful, admits of no delay!. Fortunately, if taken in time, il is greatly under the control of well-directed treatment. Its dangerous nature must ever make proper medical advice a necessity, but the importance of early active remedial meas- ures renders it, at the same time, highly desirable that treat* ment should be resorted to without the slightest delay. The great danger in croup arises not only from the possibility of the narrow chink in the larynx, or upper part of the wind nipe, through which the air passes, becoming closed by swell- ing, but also from the remarkable product of a peculiar in- flammation which is formed upon, or thrown out by, the lining membrane of the parts. This formation, " false membrane" as it is named, resembles thin leather of an ash color. It takes the form of the tube which it lines, and, indeed, is sometimes coughed up in perfect tubular portions. However, when this false membrane forms, death is the result usually. Croup may begin very suddenly. A child goes to bed, to all appearance perfectly well, and in the course of two or three hours comes a cough, which strikes even the most unob servant as peculiar, which falling upon the ear of the anxious parent, who has ever heard it before, tells at once of danger. The child seems as if it coughed through a brazen tube, fei- haps at first the little invalid is not awakened, and if now visited is found flushed and fevered, moaning slightly, perhaps, and restless, the breathing slightly quickened; the cough comes again, the child awakes, or is awakened; if it speaks, the voice is hoarse; if it cries, hoarser still. Should the dis* ease be neglected^ at this time, or go on uncontrolled, the cough, still retaining its peculiar character, becomes more Croup. 99 trequent; the breathing, quickened, is also accompanied by the characteristic dry wheezing occasioned by narrowing of the passage through which the air is drawn; the head ia thrown back in the efforts to breathe, respiration is insuffi- ciently performed, and the blood being insufficiently changed begins to evince its deteriorated character in the blue color of the lips, the dusky coldness of the skin, and the affection of the brain which gives rise to partial insensibility or delirium. The pulse, previously quick, becomes still quicker, but at the same time feebler, and at last the child dies in a state of almost unconscious suffocation. There may, however, in the progress of the disease, be intervals of comparative ease, alternating with paroxysms of spasmodic obstruction to the breathing, threatening, and sometimes causing, immediate suffocation. The average duration of a fatal attack of croup is from three to four days, but it may, and does, terminate much more speedily: When under proper treatment the dis- ease is checked, the first best sign is the cough beginning to " loosen," the breathing at the same time becoming tranquil, and the skin moist; the pulse changes from its hard quick beat to one of a softer and a slower character. Croup does not, however, invariably begin suddenly—frequently the child has been suffering, apparently, from common cold in the head, and the attack of croup seems to be a consequence of the in- flammatory affection of the membrane of the nose and throat extending into the windpipe, and taking on the peculiar char- acter of the more fatal disease. At other times there haa been slight drowsiness for some days previously, but not suffi- ciently well marked to attract attention, although at the same time, from hoarseness not being common among children, its occurrence should always rouse suspicion, especially if the child itself, or any of the family, have suffered from croup. Sometimes a child will have a croupy cough for some nighta in succession before the attack of the real formed disease ; and parents are apt to be lulled into security by the fact, that in children susceptible of croup any cough partakes more or less of the shrill croupy sound. Another, and highly dangerous, form of croup is that in which the inflammation commences in the throat, the tonsils, and soft palate, which quickly be- come covered with an ash-colored membrane. At first tho child is supposed to be merely suffering from sore throat, for there may be little or no cough, or embarrassment of breath- uig, but the inflammation extends downward into the air pas- sages, and the croupy symptoms become developed; by the time this stage is reached the case is all but hopeless. 1< ortu- 100 Croup. lately this dreaded disease, the most distressing, perhaps, hj 'which a parent can lose a child, is, in every form but the last, amenable to proper remedies, if adopted at once. So strik ingly, indeed, is this the case, that it is very common to find parents taking the matter in their own hands after they have seen a child treated for the disease once or twice, keeping, as they ought to do, a supply of the proper medicines constantly at hand, and by their prompt application nipping the first at- tack in the bud ; the medical attendant is either not sent for, or, if he is, it is only to find that the proper treatment has been followed and the disease checked. The great remedy in croup is emetics, or medicines which sicken the little sufferer at the stomach, and cause vomiting. A teaspoonful of the syrup of ipecac, or four grains of the powder, given at the very beginning of the disease, will usually produce vomiting in a short time ; if not, let the dosa be repeated until that effect is produced: If ipecac is not to be had, as is often the case, at that hour of the night, one tea- spoonful of powdered alum, mixed with a tablespoonful or two of sweetened water, given, will usually produce vomiting; or, if nothing better can be had, from ten to thirty drops of antimonial wine, (according to the age of the child,) give a every fifteen minutes, until it has the effect of vomiting. If the child is not better within an hour after the fii&t vomiting, the emetic should be repeated. Besides this, apply some stimulating liniment to the throat, and around the uppar part of the chest, front and back, and also keep a piece of flannel bound around the throat. A mixture of turpentine, sweet oil, spirits camphor, and whisky, (or spirits of any kind,) in equal parts, will make a good liniment, applying it with a woollen cloth or the hand, and afterwards putting on flannel next the skin. If all these ingredients are not to be had, use such as you have, even one of them alone. Let th- a large pan, pail, or dish, so that the steam arising therefrom will impart its moisture readily to the air of the room. And if the child be large enough, let it inhale frequently from an old tea-pot the vapor of hot water and mullein leaves, or some of the other ingredients mentioned above. Also, give a good dose of casto- oil or other suitable medi Croup. 101 i >ne, to purge the bowels. When the child is getting better, Le careful of a relapse. Do not suffer it to be exposed to the cold air out of doors till entirely well. If a case of incipient croup be thus treated, it will, in all probability, and may be, subdued without medical assistance, though it is certainly safer to have it; but if the fever :s ex- tremely high, and if the breathing has any approach to a crowing sound, medical attendance m,ust be procured if possi- ble, and with the shortest possible delay. Always bear in mind that this disease must he promptly treated. The causes of croup are almost invariably connected with cold and moisture, and particularly during east winds ; but it may also be occasioned by the removal of wrappings from the throat, and exposure to a cool air when a child is heated. Children liable to croup are still more so after attacks of acute or debilitating disease. The prevention of croup is, of course, of the highest im- portance, and, therefore, the causes of it must be avoided in every way. Slight colds should never be neglected in children or families thus predisposed, but should be treated by confinement to the house, or to bed if requisite, by milk diet, diluent drinks, and by the tolu (1 oz.) and mucilage (2 oz.) cough mixture, with the addition of wine of ipecac (I oz.), one teaspoonful of the mixture every four hours; paregorie should also be given to allay troublesome cough, and, in fact, those measures recommended in cold carried out. The sus- ceptibility may also be lessened by not clothing the throat too warmly, and by the regular practice of bathing the throat and chest well with cold water every morning, rubbing afterward with a rough towel, till thorough reaction ensues. This prac- tice is, of course, better commenced in warm weather, and not too soon after an attack of the disease. Flannel should always be worn next the skin, and care taken particularly that bed- chambers and rooms children habitually live in are not too vvarm, and never occupied while the floors are wet after wash- ing. A residence a distance from water is to be preferred. Spasmodic or Ckowing Croup.—This disease differs very much from the membranous croup. It is a species of convul- 6ive or spasmodic affection of the muscles of the larynx (upper part of windpipe), which, by narrowing and closing the chink in that organ, through which the air passes, occasions the sound of the breathing to resemble that of the true inflammatory dis- ease. This spurious croup is often an alarming, and sometimes a fatal disease ; it generally occurs before the end of the third year of life, and in consequence of irritations acting more or less at a distance from the affected parts which receives the 102 Colds and Snuffles. impressions through its nerves. Enlargement of the glands ol the neck, affections such as eruptions of the scalp, the irrita, tion of teething, or the presence of irritating matter in the bowels, may any of them give rise to this affection. It cornea on suddenly ; the child is seized in a moment with " catching at the breath," struggles, the face changes color, and the veina are full. If the spasm be not relaxed after a few ineffectua: efforts at breathing, the child must die ; but if the spasm gives way, the air is drawn into the chest with a crowing, croupy sound. It is of much importance that this spasmodic disease should be distinguished from real inflammatory croup, on ac- count of the very different treatment required ; it may be known by the absence of fever, the stopping of the breath be- ing much more instantaneous than that which occurs in the real disease. In an affection presenting symptoms so sudden and so alarming, immediate remedies must be used ; a little cold water should be dashed on the face at once, and, as recom- mended by Dr. Watson, a sponge dipped in hot water applied to the fore part of the throat, and after removing it apply a flannel bandage saturated with seme stimulating liniment, medical assistance being of course procured if possible. In the meantime, set the child in an upright position, with the head leaning forward, and exposed to the fresh air for a few moments, the body being at the same time well wrapped up. If not relieved, rub the spine (back bone) thoroughly with the open hand, moistened with the liniment previously mentioned, or any other which may be on hand. When the spasmodic fit is over, examine the gums, and if red and inflamed let them be lanced. Also give a mild pur- gative every day or two until well. A teaspoonful of syrup of rhubarb, or castor oil, will answer. Colds and Snuffles.—During the first month, most children are affected with colds, commonly in the nose, called snuffles. Warming the feet at the fire, will often be suffieient to cure them. But when the disease is attended with fever, it is best to administer three grains of ipecac, mixed in four table spoon- fuls of warm water, and one table spoonful to be given every twenty minutes, until vomiting is produced. The bowels should be kept open with magnesia, rhubarb, manna, or castoi oil, in small doses. Ilepeat the ipecac next day if the disease is not better. Various Eruptions of the Skin.—Children, particularly those not daily bathed, or washed in water, are very subject to a great variety of eruptions on their skin, commeneiiia' some- imes the first week of their birth. Different names, as red um and white gum are given to each kind ; but it is useleti, Eruptions of the Skin—Sore Eyes. 103 as they require nearly the same treatment. In the red gum there is a number of small, elevated red spots, scattered ovei the body, and sometimes on the cheek or forehead; on the feet the spots are still larger, and contain occasionally a clear fluid. In some stages it resembles the measles. Generally no medicine is requisite ; but if it suddenly disappears, and the child shows symptoms of internal disease, an emetic of ipecac, as men- tioned under head of Snuffles, or purgative ought to be given, and repeated, if not at first relieved. The white gum appears after the red gum, resembling itch, with white, shining little blis- ters, containing a little clear fluid. There are other varieties of these eruptions of the skin, but few of them require medical treat* ment. A vomit or purge, to clear the stomach and bowels, generally relieves. The prevention is in great cleanliness, free washing daily in soap and water, with regularity in nursing. When these affections of the skin are attended with fever, they require, besides the vomit and purging, applications to the parts inflamed, to lessen the action ; cold lead water (two or three grains of sugar of lead dissolved in one ounce of eold water), and sweet oil, are the best for this purpose applied every three hours. Sore Eyes.—Children are very subject, sometimes during the first month, to inflammation of their eyelids and eyes, par- ticularly those who are exposed to a strong light soon after birth, getting soap in the eyes by the nurse when washing them, perhaps for the first time, a draft of cold air, etc. At whatever time the inflammation comes on, in slight cases, a very weak solution of sugar of lead—fifteen grains to the pint of water, should be applied every two hours to the part, by means of a piece of linen soaked in the water and laid over the bcre eyes for a few minutes at a time. In many cases the warm breast-milk of the mother put into the child's eyes every time that it nurses, will cure them. (In cases where much thick matter is discharged from the eyes, or they are closed up, and the eyelids-puffed out, a physician should be sent for at once, for the eyesight may be lost in a few hours, if not properly attended to.) If it do not speedily subside, a purge of castor oil should be given. The inflamed eyes should never be turned towards the fire, and the hand of the infant so confined as to prevent \i from rubbing the part, and the room kept darkened. In cases where the inflammation of the ball of the eye is great, a leech should be applied to each temple, or cupped, after being scarified. Also five to ten drops of syrup of ipecac should bo given every two hours to reduce inflammation. This cold lead water alone is usually the proper application 104 Wind in the Stomach and Bowels. to the eye, and nothing should be added excepting where the eyelids adhere together. In this case, the mildest sweet oil, mild hog's lard, or any bland grease should be applied to the edges of the eyelids before the child goes to sleep. Avoid every stimulating application in inflammations of the eyes ; it- has been the cause frequently of loss of vision. Excoriation.—AVhen the skin is rubbed off (termed excori- ation), as is often the case between the legs, behind the ears, in the hair, between the toes or fingers, etc., you should make an application of sugar of lead (twenty grains dissolved in a pint of cold water) three or four times a day, with a soft linen cloth, or sweet oil, or fresh lard, will generally heal them up. Powdered starch is also good. In cases of inflammation, a poultice of Indian corn meal or flax-seed meal wet with this lead water, and kept applied to the part, will expedite the cure. When sores have been of long standing, you should, by all means, on drying them up, purge the child once or twice a week, for three or four weeks after- wards ; also diminish its food. The neglect to do this, or to make a slight issue or sore, hy means of a small blister plaster, applied and kept to some part of the body, two or three hours every day, for a week or two, has often been fatal; as the system, when the old sores are healed, not having its accus- tomed irritation, takes on violent disease in other parts. Death has often resulted from healing up old sores suddenly, without taking the precaution alluded to. WIND IN THE STOMACH AND BOWELS. When a child has wind on the stomach it may be known by wind often rising in its throat, which makes it struggle at times, as if to get its breath, and from which it is occasionally relieved by belching of wind upwards. When it often occurs it is annoying, and interrupts rest. It is most common with children dry-nursed. Different articles have been given to dispel the wind; but aone of them are to be compared to spirit of hartshorn: three drops in half a table spoonful of cold water, and repeated two or three times a day,"as may be required. Hartshorn, when it, will answer the purpose, is to be preferred to cordials, spirits, soeds, spices, and hot things of any kind; as, although it is fully as powerful in dispelling the wind as any of them, it will not, by a permanent heat, nor by repetition, injure the stomach as they do ; nor can any bad habit or other disadvantage arise from giving and repeating it as often and long as it may be necessary. It is endowed with a property which makes it a Diarrhcea or looseness of the Bowels. 105 desirable medicine for children; it corrects and removes acidr ity or sourness, a principal cause of griping with children. The dose here mentioned is the smallest that need ever bo given, and it may be increased, as a child grows older, to five or six drops. The child's bowels should be kept open with mild purgatives, such as magnesia, syrup of rhubarb, etc. Also be careful that nothing in the way of nourishment be taken except the breast-milk, until the disease is entirely cured. If the hartshorn can not be had, use a tea made Oi aniseed, catnip, mint, or cinnamon bark, (not too strong) every half hour. Some children seem naturally more subject to wina in their bowels than others ; and which can be accounted for no other- wise, than as proceeding from a particular weak and tender state of those parts. And as it is much increased by cold, a particular attention must be paid to keeping them well covered with flannel next the skin, and three or tour times a day use friction or rubbing with the dry hand over the stomach and towels. DIARRHOEA OR LOOSENESS OF THE BOWELS. This is generally brought on by too much, or unsuitable food ; in which case great attention should be paid to the diet. In other cases, it may arise from disease of the bowels, such as irritation from worms, or inflammation. In fetich cases a dose of ipecac, according to the age, should be given to produce vomiting, so as to get the stomach emptied of its contents, (unless there is already sickness at the stom- adi;) then the bowels are to be cleansed by a purge of a little rhubarb and magnesia; (four grains of each,) to be fol- lowed by small doses of chalk in some mucilage, as milk— made more palatable by a drop or two of the essence of pep- permint, cinnamon or aniseed. Flannel, soaked in whisky, should be applied to the bowels, and the child made to lie down in bed and keep as quiet as possible. If the stools con- tinue more frequent than they ought to be, and are either slimy or tinged with blood, the purge of rhubarb and magne- sia should be repeated. Cold drinks of all kinds should be allowed oniy in very small quantities at a time: small pieces >f ice taken into the mouth and allowed to melt, is better for allaying thirst. Sponging the body also once or twice a day, jrith a mixture of water and whisky, is often of signal benefit. The diet must be of the simplest kind, avoiding all kinds of solid food. Warm applications are to be made to the bowels, and the skin gently rubbed. Sometimes the application of a 106 Falling of the Fundament—Colic. small blister to the pit of the stomach is of great service. A mustard plaster applied for a few minutes at a time to the stomach and bowels, two or three times a day, is often of great service, and is always to be tried in preference to the blister, especially in small children. In cases where the strength ia fast sinking, injections of thin starch, with a few drops of laud anum or paregoric, with a teasponful of wine or whisky every two or three hours, should be given ; and laudanum may be rubbed on the stomach and bowels, with sweet oil. Falling of the Fundament.—In children of lax habits, th* lower portion of the bowel is very apt to protrude after a st»ol It is a source sometimes of great pain, and often of great un- easiness. Jn general it may be replaced by the application of a rag wet with cold water, using very moderate compression. More obstinate cases require that the child should be laid on its belly, the sides separated, and then the fingers of the hand are to be applied, so as equally to cover the protruded part; then gradually and firmly, in one continued pressure, the par* may be caused to draw up. Whenever the bowel protruded ip inflamed or painful, it should be bathed in cool wrater, cold green tea, olive oil, or hog's lard. Sometimes fomentations of mild articles, as flax-seed poultice, hops, with hot water, &c, are of service. Those children much subject to this complaint, should never be allowed to strain in evacuating the bowels. The discharge had best be made in an erect posture. The strength of the bowel may be restored by injections of tea made of oak bark or nut galls: when the irritation is great, a drop or two of lauda- num will lessen it. Pouring cold water occasionally on the parts, and always after a discharge washing in cold water will be found serviceable. Colic—Colic, which in some children is of -*ory common occurrence, is easily discovered by sudden fits of crying or screaming, which nothing can appease ; the chhd bends back the body, spurs with the feet, and then has an abatement of the pain for a few minutes, obtained sometimes by the escape of wind from the stomach or bowels. An attack may consist of one uninterrupted fit, or of repeated screaming, with inter- vening moments of ease. It may be induced by costiveness, by cold, by damp clothes, by the too liberal use of panada, particularly if made of sour bread; by passion, or some state of the nurse aflecting the milk, by collection of wind in the bowels; or it may accompany thin and slimy purging, which is sometimes produced by the injudicious use of purges. In ordinary cases, nurses give gin and water, which is a Spasms or Convulsions. 107 most injurious practice, and may in some instances kill the child. Laudanum gives speedy relief, but it weakens the stomach and nervous system, and produces costiveness. A few droos of tincture of asafoetida, mixed with oil of anise, is generally effectual, and is always safe. Two drachms of tinc- ture of asafcetida, twenty drops of oil of anise, and an ounce of mucilage of gum arabic, may be rubbed up together: and iff this mixture, from ten to twenty drops, in a little water, will be a proper dose, as often as occasion may require. The warm Dath is useful, and if these means do not give relief, rubbing the stomach and. bowels with laudanum will be safer than giving it internally. An injection of gruel and a little oil is proper, and cloths dipped in hot water and applied to the how- els is also good ; and if the child has been costive, it will be right to give a tea spoonful of castor oil, after these remedies have relieved, in order to prevent a return. When children are subject to colic, we may suspect that there is something wrong in the diet. Common panado, espe- cially if it contain much sugar, is very apt to have this effect. The nurse's milk may also be flatulent, and this bad property is sometimes increased by the use of porter or ale, intended to increase the quantity. The state of the child's bowels must be attended to, and it should not be allowed to load the stomach by taking too much at a time. If it belches up wind after sucking, it should be gently dandled, as that promotes expul- sion. SPASMS OR CONVULSIONS. This unpleasant and often dangerous disease may take place at anv age, and may occur either in the course of some other disease, under which the child has been laboring for some time, or suddenly, in apparent good health. In one case they are highly dangerous, and often indicate a fatal result; in the other, they are frequently attended with little hazard. Con- vulsions vary in degree, from a slight movement of the muscles of the face, to a rigid, or convulsed state of almost the whole body. In general, whatever be the degree of the movement, the countenance is altered, both in color and expression: the patient is insensible, and cannot follow an object with the eye In some instances, the motion is so slight, that the child may rather be said to be in a state of fainting, or stupor, than of convulsion. In very young infants, there is sometimes only a smile about the mouth; the eye, which is half closed, turns slowly round, the breathing seems occasionally to flutter, and the child starts, and throws out the arms on the least noise. 108 Spasms or Convulsions. These motions, called inward fits, frequently proceed from wind in the bowels. Convulsions sometimes go off in a few seconds ; in othei instances they continue for several minutes. The child may have only one short attack, and become well immediately afterwards, or it may remain in a languid, sleepy state; or it may have repeated attacks in a very short time, and continue insensible during the whole of the intervening period, which is always an unfavorable symptom. They may be produced by wind, or irritation in the bowels, dependent on worms, cos tiveness, indigestible food, griping, stools, &c.; or by teething; or by breathing bad or confined air; or by the striking in of some eruption; or during the coming out of others, such aa small-pox; or by affections of the brain itself; or by other spasmodic diseases, such as hooping-cough, &c. When the child has been ill for some time before convul- sions come on, especially if the pulse has been quick, the skin warm, and the head affected, whilst these symptoms could not be traced to the effect of teething, there is ground to be- lieve that the convulsions proceed from a diseased state of the brain. _ With very young infants, if there have been no preceding disease, there is great reason to attribute the convulsion to the state of the bowels: and we shall be confirmed in our opinion by finding that the stools are not of a good appearance: that there is much wind in the bowels ; that the child has not been nursed or fed properly; that the nurse has been agitated by passion, or committed some irregularity in diet; or lastly, in infants a few days old, that the meconium (or contents of the bowels,) is not expelled. When young infants have convulsions from the state of the bowels, we generally find that the face is pale and the motions slight; but if they proceed from the state of the brain, which is still more alarming, the motions are stronger, and more de- serving of the name of convulsion. After the child is two months old, irritation of the bowels, proceeding from bad stools, worms, or indigestible food, does not produce those gentle motions, or that apparently languid state, observable at an earlier period, but generally excitea pretty strong and well marked convulsions. At the period when children are teething, convulsions may be produced by irritation of the gums, more likely than by other causes; and, therefore, we should in every case which occurs at that time, examine the gums carefully and cut them if there be the slightest swelling or sign of teething Soi'e Head. im When a child is seized with convulsions, great consterna- tion immediately prevails, and without some common sense rules, either nothing will be done, or very contradictory plana may bo adopted. The first general rule in such cases is, if the child seems to Le suk, or oppressed in its breathing, or has a fulness of the stomach, or has been known to have had something which baa disordered the stomach, vomiting should be excited, by tick- ling the throat with a feather, during the fit, or by giving ipecac, (five to ten grains, in warm water, or one or two tea spoonsful of the syrup,) as soon as the child can swallow. Rub- bing the spine, or along the back-bone, with some stimulating liniment, or a mixture of one tea spoonful of ground mustard, one of salt, one gill of vinegar, and half pint of water, with a little laudanum, will be beneficial. Cold water and vinegar *nixed in equal parts, in which a cloth has been soaked, and applied to the head, is also good in cases where there is flush- ed face, fever, and insensibility between the convulsions. At the same time, give injections of warm soap-suds, or warm water and castor oil up the bowels, and as soon as the child can swallow, give a good brisk purge of castor oil, Rochelle salts, (one table spoonful in water,) or rhubard and magnesia. Rubbing chloroform on the temples and back-bone is also some times beneficial in severe cases, as also is pounded ice, wrapped "'n a bladder or piece of cloth, and applied to the head. When there is a tendency to frequent returns, it will be proper, besides keeping the bowels open, to give repeatedly a few drops of tincture of asafoetida, mixed with oil of anise. In all cases of weakness, the strength is to be supported by suit- able nourishment, even by injections of beef tea. SORE HEAD. Some children, are subject to sore head. It often be- gins on the fore part of the head, in large white scabs, which, if neglected, spread over the head, forehead and face, in large patches. In the beginning, generally, it is dry; at other times, it is moist and has a thin discharge. Medical writers have named this complaint crusta lactea, or milky crust, from its appearance. The children of the lower order of country persons, who are gross in feeding, are most subject to it; and it seems to be occasioned by a want of cleanlinesa and exercise, which children, who have a bountiful supply ot nourishment, require ; but to which parents, in this situation, are not often disposed, or seldomer have opportunity to afford L10 Scald Head—Measles. them. A cabbage leaf is a very common ^ application, as il promotes a discharge from the head, which issupposecl neces- sary, previous to the cure ; but as such a discharge is in no way necessary, and as it makes the head uncommonly offen sive, it is better not to encourage it, and the sooner the com plaint is cured the better. For that purpose, take of brandy (or whisky) and water, each equal parts ; mix them together, and bathe the parts of the head and face where the complaint is, once a day, and immediately afterwards lay on a plaster of basilicon ointment, (made of lard, eight ounces; resin, five ounces; yellow wax, two ounces; melted together,) spread upon a linen rag, which is also to be renewed every day, after each washing with the brandy and water. Two or three doses of purgative medicine must be given during the cure. Bath ing in the sea, or salt and water, will be of great use. SCALD HEAD. This is different from the preceding, as the soreness ia confined altogether to the head, but will extend to the neck if neglected. It begins in distinct brownish spots, that form a scab and discharge a thick, gluey matter, that sticks amongst the hair. The spots increase and enlarge so aa to cover a great part of the head. When these spots are dis- covered, the hair upon and about them must be cut as close aa possible, and they must be washed well, every day once or twice, with soap and water. Should that not prove sufficient to remove them, they may be daily anointed with a little tar ointment, (a mixture of tar and fresh lard, in equal propor- tions,) or Barbadoes tar mixed with sweet oil, in equal pro- portions, with the point of the finger, which rarely fails of a cure. The scald head, which is either this complaint in the extreme or nearly allied to it, may be treated in the same manner, and which will be going as far as can with propriety be attempted before consulting a physician. 31EASLES. The symptoms of the measles are, a sickness, a heaviness, a thirst, a short, dry, husky cough, with hoarseness, a sneezing, a running at the nose, and a running and thin discharge from the eyes, which appear red and much inflamed, particularly the eyelids, with sometimes cold shiverings. These symptoms are commonly slight at first, and increase till the measles coma out, which generally happens on tie fourth day from the first attack, although children will frequently be much indisposed for a week before they come out. At the first appearance ui Measles. Ill the measles, they look like flea bites upon the face and neck, in distant spots; but soon after, the face, neck and breast are covered in patches, resembling a thick rash, that does not seem to rise above the skin, although it may be discovered by the touch and feel of the hand, to be a little prominent or raised npon the face and breast, but not upon the other parts of the body. The measles, like the small-pox, come out first upon the upper part of the body, and last of all upon the feet; and they observe the same progressive regularity in going off. This disease is attended with much depression and dejec- tion, and sickness at the stomach. It 1s very common for'the most lively children to lie in a stupor, or state of heaviness and seeming insensibility, from the second day of the attack, during the whole of the complaint, which continues three days after the first coming out; on the third day the eruption begins to look paler, and, on the fourth, goes off with a mealy appearance upon the skin. During the whole of the com- plaint there is considerable fever, which often, with the cough and a difficulty of breathing, increases in proportion as the disorder advances, and will sometimes be the most violent and severe at the height, or turn, of the measles; sometimes the fever, cough, and other symptoms abate, and the child re- covers, in part, his spirits soon after the measles come out, but not generally. The patient must not be kept either very warm or very cold ; he ought not to be kept near the fire, nor yet suffered to breathe the cold air; it will be best to confine him to one room that is moderately and temperately warm. Cold air will add to his hoarseness, and make the cough worse. His drink may be water, barley water, milk and water, balm tea, saffron tea, or anything of the kind; but water, or milk and water, seems most agreeable to children at this time. What he drinks ought to be a little wanned, but not hot. Wine, cor- dials, and all stimulating drinks are improper and injurious. These precautions are always to be observed on the first at- tack of the measles. It will always be proper to give some- thing at the beginning, to procure two or three loose stools, as the infusion of senna, salts, castor oil, prunes, or manna, &c. Mustard plasters, applied between the shoulders or to the sides, havo been found of great use in abating the cough an relieving the breathing, and may safely be applied at any period cf the disease, if the cough and breathing be bad Cupping the sides and back is also of value. A fever always accompanies the measles, and is the cause of the drowsiness and stupor which children have in the be« 112 Measles. ginning, and often during the whole of the complaint. Noth. ing will so sensibly check and abate this fever, remove the drowsiness, and restore a child's spirits, as repeated doses of ipecac and spirits nitre. Mix five grains of powdered ipecac, (or cne tablespoonful of the syrup,) and one tablespoonful of spirits nitre, and two ounces of cold water, together. Of this give one teaspoonful every three or four hours, unless there is much sickness at the stomach. It may be begun with on the second or third day; and after the stools have been pro- cured, as above directed, while the fever and heaviness con- tinue, it will be particularly proper to give it in the evening, at which time the fever is most severe, and if it operates, as it generally does, both by vomit and stool, it will give most sensible relief—the fever, heat, and oppression will be con- siderably abated, and the child will be much more easy and cheerful, and more tranquil and composed, than befo; e taking it. The fever and cough will frequently continue, without much abatement, for a few days, or a week, after the measles aie entirely gone, but which may be greatly relieved, or entirely removed, by giving a gentle purgative every second day. tt may also be known that the fever continues while the dullness, thirst, and want of appetite remain, and during which time the purgatives ought to be given, at proper intervals, if no other cause forbids it. It may also as certainly be known that the fever is gone off when the child's spirits and appetite re- turn. The danger from the measles is much increased when they happen to be connected with the small-pox or hooping- cough ; and, therefore, so circumstanced, they require more medical attention than is generally bestowed upon them. The eyes, and particularly the eye-lids, will sometimes re- main sore, swelled, and inflamed after the measels. The cough also, will oftentimes continue for sometime after the fever and every other remains of the measels are gone. While either the sore eyes, or the cough remain, the child ought not to be sufferec1 to go out of doors, or to be exposed to the cold; aa the air, in cold weather particularly, is very apt to add to and greatly aggravate these complaints, and may make them very troublesome and tedious. Too much caution, therefore, in avoiding cold, cannot be observed during the disease or while there are any remains of sore e^yes, or cough. The measelb sometimes leave these symptoms for the remainder of life— which most frequently may be attributed to a too early vimtur- kuj out, which of course would have been prevented by fc<* sonable confinement within doors. Worms. 113 WORMS. When a child gets sick, and the mother can find no other solution of the difficulty, she is almost sure to attribute it to worms. She is oftener wrong than right. Worms of dif- ferent kinds are often found in the bowels; but there are chiefly two met with in children, the lumbricus, or long worm, having a great resemblance to the common earth worm, and the ascaris, or small white worm, like a bit of thread. These two kinds inhabit different parts of the bowels, the small worms being confined to the lower part, whilst the other is found much higher. It is extremely difficult to account for the production of worms. It is observable, that few infants have worms till after they are weaned, which is to be account- ed for on the principle that the bowels are in better order during suckling than afterwards, when the diet is more varied and indigestible. Worms may exist without producing any symptoms, until they either accumulate in considerable quantity, when they cause more or less irritation in the bowels, or some slight in- disposition takes place, and they, by their irritation, increase it. All the injury they produce, is that of irritation: but the degree of this, and the effects of it, must vary, not merely ac- cording to the number of worms, and their movements, but also according to the state of the bowels themselves. It is also to be remembered, that as a weakened state of the bowels is fa- forable for the accumulation of worms, many of the symptoms may proceed from that state alone, independent of the new irritation from worms. The long worms may be suspected to exist, when the child complains of frequent griping or pain in the belly, has repeat- ed and unexpected attacks of looseness, variable appetite, be- ing sometimes seized suddenly with extreme hunger, has swelling of the belly, especially at night, disturbed sleep, frightful dreams, and grinding of the teeth. Always give chil- dren something to eat at once when they thus cry out with hunger. A failure to do this has caused the worms to pierce the bowels through, and cause death, when a slice of bread and butt er Would have saved its life. Besides these symptoms, we also observe that the countenance is alternately pale and flush- ed ; the child picks its nose, has bad breath, dry cough, and sometimes slow fever, or convulsive affections. These symp- toms may exist in different degrees, and are ultimately attend- ed with the expulsion of worms, either by vomiting or stool. It has been supposed that a very obstinate and protracted fe- ver, called " worm fever" might also be produced: but thia a 114 Hooping Cough. generally depends more upon costiveness, or a deranged state of the bowels, than simply upon worms. It resembles a most formidable disease, " water on the brain." A variety of worm medicines have been employed, such aa tin powder, tansey, sulphur, hellebore, worm seed, cowage, In- dian pink root, &c, besides the thousand and one nostrums •sold by druggists. In general, however, we find that with ■children, the most successful plan is to give frequent and re- peated purgatives, to expel both the worms and morbid stools, and also to excite and support the due and vigorous action of the bowels. Castor oil, in tea spoonful doses, in which a tew drop of oil of lemon are put, given about three times a week, is better than all the nostrums you can buy. The extent to which this plan is to be carried, and the period for which it must be* continued, will depend upon the effects produced. As long as the stools are unnatural, the purging should be con tinued. In cases of a third species of worms, called taenia, or tape worm, it is sometimes difficult to cause the expulsion. It ia most common to adults. Large doses of the spirit of turpen tine have been recommended, (taken in milk,) on an empty stomach in the morning. The dose to be from two to three table spoonfuls for a robust grown person. An infusion of tobacco, applied to the stomach, has often caused the expulsion of worms, when other remedies failed.— But I never knew a case of failure when the patient was freely purged with calomel, and then given either the worm-seed oil, or the pink root in tea. The oil should be given on an empty stomach in the morning, (ten to twenty drops,) or the tea ot pink root taken occasionally throughout the day, in doses to suit the age of the patient. About ten grains of the powder ma-^ be given to a child of eight or ten years old, two or three times a day. When in o-ver doses, it is apt to affect the head, and the quantity is to be lessened. The generation of worms may be prevented by whatever will strengthen the bowels. A good, healthy diet, exercise in the open air, and an infusion of tea made from Peruvian barks, (a wine glass before each meal) are advisable. HOOPING COUGH. This disease is generally treated improperly by parents In the beginning it is always an inflammatory complaint, re- quiring evacuations and determination of blood to the surface of the body, by giving warm teas or ipecac in small dosei every two hours to produce sweating. Instead of the variety 4 Costiveness. 115 of prescriptions in daily use, give the child an emetic (or vomit), of ipecac in the usual dose, to be repeated every day or other day for four or five days, unless the symptoms lessen. For a violent fit of coughing, the best remedy is, to pour in the back of the mouth a teaspoonful of melted hog's lard or sweet oil, which sheathes the part, and lessens the irritation. The tinc- ture of asafoetida, twenty to thirty drops every four hours, is highly recommended. A child grown enough for the purpose, will find some relief in holding warm water in the back of the throat. It is of great importance to children in this complaint, to keep the skin in good condition. A coarse flannel shirt around the breast, has been of great service by keeping up friction on the surface. With the flesh brush or a ball of wool, the surface of the body should be rubbed every nig^it. Exer- cise in the open air, while the body is kept comfortable, is ad- visable, as well as change of residence for a few weeks, which scarcely ever fails to afford relief. The juice of garlic sweet- ened, lessens the cough. A solution of soda, also of alum, in doses of three or four grains, and sweetened with liquorice given night and morning, is a valuable remedy. A mixture of twenty grains of tartar emetic and an ounce of tincture of Spanish flies, nightly rubbed on the stomach, is a remedy highly extolled. COS TI VENESS. This complaint is sometimes hereditary, or natural to the child; when this is the case, and it does not exceed proper bounds, it may not require the use of any remedy; but should the infant's health begin to suffer from frequent attacks of colic, flatulence, etc., it should be attended to, as it may produce convulsions or fits, inflammation of the bowels, or other diseases of a difficult and lingering nature, or establish a costive habit for life. If the predisposition has descended from the mother of tho same habit, or in other words, if the mother herself is subject to costiveness, the child may be relieved for a short time, but 't will again return. When this is the case, the mother, if pos- sible, should change the quality of the milk, by being atten- tive to her diet, and take occasionally some mild purgative, which will alter the quality of her milk ; for this purpose there is no medicine superior, or more innocent than magnesia and Epsom salts, of equal quantities, mixed and ground very fine in a mortar. Of this, take a teaspoonful or two in a tumbler of water every morning on an empty stomach. When the cos- tiveness originates from the child's food, it must be changed 116 Diseases of the Ear. and simple medicines given occasionally, to act as a mild purgq such as five or ten grains of magnesia, rhubarb or manna, a tea spoonful of sweet oil, or castor oil. But the best plan in such cases is to allow the mother, if the child is nursing, or the child itself if it has been weaned, a plentiful supply of syrup, mo- lasses, and stewed fruit, at meals, and ripe fruit uncooked, be- tween meals, and teaching the child to go to stool at regular hours. Children often have a disposition to go to stool but pui it off till the effort of nature passes. The mother should be attentive in these matters if she wants her children to be healthy in body, happy in mind, and sound sleepers at night. DISEASES OF THE EAR. Acute inflammation of the ear is known by the swelling, acute pain and noise in the head, and pain in swallowing or moving the lower jaw. Chronic inflammation is at- tended by some degree of deafness and discharge of mail- ter. The disease is caused by colds, foreign bodies in the ear, measles, scarlet fever and scrofula. Nervous earache oc- curs in paroxysms of severe pain in the ear, and shooting over the face, head, neck and shoulder. It is caused by sudden cold, decayed teeth, and sometimes by fullness of blood. The warm foot bath, with some ground mustard and salt in the water, and hot applications to the ear and face, usually give relief. A drop or two, each, of laudanum and sweet oil put into the ear on a piece of warm wool, is an old and valuable remedy, to be repeated every hour or two if necessary. Hold- ing hot coffee or tea in the mouth is also good, or gargling the throat well with tea or coffee, and then spirting the liquid out through the nose by stooping forward with the mouth closed. A bag of hops steamed over boiling water, then allowed to cool sufficiently to be agreeable, and applied to the ear, often affords relief in a short time. If an insect is in the ear pour warm sweet oil into it; this will generally cause it to come out to get air. Foreign bodies, such as beans, coffee, dust, etc., sometimes get into the ear and cause intense pain : they may be removed by syringing the ear with water, or by a small probe or blount wire, doubled, or bent into the proper shape. Great care must be exercised not to hurt the drum of the ear. Running from the Ears.—When the discharge after an abscess does not disappear, or when running from the ears shows itself after acute diseases, sueh as measles, scarlet fever, etc., the symptom must not be neglected-, and should be ex- amined into by a medical man. It is most common in chil- dren of a weak or scrofulous constitution, and may be with 01 Malignant Sore Throat. 117 without disease of the bone ; in the latter case the discharge ii extremely offensive, and often stains the linen black. These discharges must not be too quickly stopped, neither can they De allowed to go on without risk; in the former case, the sud- den stoppage may throw back the disease upon the brain ; in the latter, this organ or its membranes may become affected by its gradual extension to them through the bones. Counter- irritation, by blisters, or tartar emetic ointment, (ten grains of the powder to one teaspoonful of lard, well mixed, and applied once a day till little pimples appear) behind the ears; Keep the bowels open regularly. The general tonic treatment as re- commended in some other diseases of children already treated of, and syringing with slightly astringent washes, such as one grain of lunar caustic, or two of white vitriol, to the ounce of water, or a wash of strong green tea will constitute the most appropriate treatment. MALIGNANT SORE THROAT. This species of sore throat differs from that which at- tends malignant scarlet fever. It is usually limited to the upper part of the throat. It begins with redness, swell- ing of the tonsils, bloated face, flow of tears, chills and flashes of fever: the redness of the throat soon changes to a dull ash color, and then to brown or black—there is thirst, hoarseness, difficulty in swallowing, nausea, sometimes vomit- ing and diarrhoea. In the more severe cases there is a bloody or watery discharge from the nose, and an offensive discharge from the throat—the tongue becomes brown, dry, and coated, there is often an eruption on the skin, sinking of the powers of life, and finally death in severe cases. Most medical writers consider this disease contagious—it ia caused also by cold, wet, insufficient clothing and food, bad air, and want of personal neatness: it is a very dangerous dis- ease, and requires prompt and efficient treatment. A phy- sician should be immediately called in; in the meantime, or in cases where one can not be had, give the patient an emetic of ipecac ; then give a purgative of one teaspoonful or two of Rochelle salts, in half a gill of luke-warm water. Apply a mustard plaster to the throat, and give every hour or two .a gargle of sweet oil or melted lard, mixed with a few drops of •pirits camphor and a little sulphate of iron (green vitriol) dis solved in water. A gargle made of Cayenne pepper and oak bark tea*, not too •trong, with a little salt in it, is also good. Also a gargle made of yeast and finely powdered charcoal has been used 118 Choking—Cholera Infantum. with great benefit. When the patient is weak the strength must be supported by tonics, such as wine and infusion (or tea) of Peruvian barks, or one grain of quinine, three times a day Where there is a feeling of suffocation or choking, it is advis- able to produce vomiting, either by tickling the throat with a feather, or giving a dose of ipecac, to clear the throat. CHOKING. Children sometimes get choked by bits of food or stones of fruit, which produce cough, blueness of the face,_ gagging, sometimes nose-bleed and convulsions—and if relief is not given, death ensues. When a child is choked, he should he held with the head downwards and receive two or three smart blows on the back between the shoulders : if this does not give relief, the mouth should be thrown wide open, and some person should endeavor to dislodge the substance, either bringing it out of the mouth or gently pushing it downwards; a few swallows of water may enable it to pass into the stomach. CHOLERA INFANTU3I. (Summer Complaint.) This is one of the most fatal diseases to which the period of infancy is subject: it occurs mostly among children under the age of two years, and during the warmer part of the season. This is said by authors to be a disease peculiar to the United States. It usually commences with a profuse discharge from the bowels of a light-colored fluid ; after a short time the extreme irritability of the stomach is manifested by the constant vomit- ing of everything swallowed. The discharges from the bowels sometimes contain flakes of mucus: the passages are often involuntary, and attended by much irritability and debility: the tongue is coated with a white slimy matter, the skin dry, pulse quick and small, much thirst, bowels hot, sometimes bloated and tender: there is, at times, moaning or sudden screeching, indicating acute pain. Digestion is so far suspended that whatever is eaten passes unchanged. In some cases delirium comes on early, and the little sufferer dies in one or two days from the attack: at other times the disease continues until extreme emaciation is pro- duced ; the skin has a wrinkled, dirty appearance, bathed in cold perspiration, the features sharp, eyes large and glaring, the whole countenance has the appearance of old a^e. The cholera of infants is mostly a disease of the mucus coat and glands of the bowels— often accompanied by eulargemeut o\ Dysentery. 119 the livei. It is caused by impure, stagnant, or confined air, coming in contact with the sensitive surface of the air passages, skin and digestive organs, and improper food. The disease maybe produced by all the causes which pro- duce diarrhoea: it seems mostly to prevail in low, damp situ- ations, in towns and cities. Perfect cleanliness, pure air, good diet, and change of location when it depends on that, are in- dispensable in addition to medical skill. When the child can not be taken to the country, take it often into the open air, in the cool of the day in good weather It should be confined entirely to the breast-milk when nursing or if weaned, let its food be arrow-root, tapioca, corn starch rice flour, and milk. Put it in the warm bath once a day ; keep flannel next the skin, and the bowels moistened out- wardly frequently by vinegar and water, and the arms, hands, feet and legs, frequently rubbed with whisky or any kind of spirits. Give small pieces of ice to melt in the mouth in pre- ference to water. For the vomiting, give a few clrops of es- sence of peppermint in water frequently, or essence of cinna- mon, or a tea made of allspice (cold), in which there is a little gum arabic and a teaspoonful or two of prepared chalk to the cupful of tea. . Of this give a teaspoonful every hour. Acidity or sourness of the stomach seems to be the great difficulty in this disease, and, as a consequence, suddenly checking the bowels will not do until the preparation of chalk has to some extent corrected this sourness. If the discharges become very offensive, a mixture of charcoal, finely powdered, with chalk and white sugar, equal parts, and thick mucilage of gum ara- bic given three or four times a day will be advisable. Mucilage of gum arabic or thick slippery elm water, made by putting the slippery elm in cold water, to which add one teaspoonful of spirits of nitre to the half pint, given in tea- spoonful doses, is also a good remedy. Sometimes nothing will afford relief as quick as one half grain of calomel given every four hours, and continued until the passages are more natural. DYSENTERY. This disease consists of inflammation, which is confined mostly to the large bowels. In some cases, however, the in {Ummation extends to the small bowels and even the stomach. The symptoms are griping, frequent and small discharges of slimy matter (mucus,) mixed with blood : the first discharges are usually, however, thin and watery, the bowels are tender, dry and hot, there is some fever, furred tongue, and sometimea vomiting. When these symptoms are not abated by timely 120 Incontinence of Urine. remedies they are apt to increase in intensity until terminated by death. Dysentery is caused by changes of weather, improper diet, worms, hot wet weather, impure air, want of sufficient food, unhealthy milk, etc. When the attack is attended by profuse discharge of blood the case is more favorable than if no blood appears. The diet should be restricted to animal broths, .boiled rice, and the like; the clothes kept clean, the child put into the warm bath once or twice a day, fomentations of hops and vine- gar, stimulating liniment applied to the bowels ; the drinks should be barley water, gum arabic water and flax-seed or slippery elm tea : injections of tea of oak bark, or starch and laudanum, four to ten drops, according to the age, and repeat- ed three times a day if needed, are also of much value. The allspice tea, etc., recommended under the head of Summer Complaint, will be found advisable also in this disease. Also the flannel next the skin, bathing with vinegar, etc. INCONTINENCE OF URINE. This is a common disease among young children—and ia often the result of a careless and filthy habit of neglecting the calls of nature, and not endeavoring to restrain their de- sires. It usually occurs at night, the child allowing the urine to pass even while awake, rather than to rise and evacuate the bladder. It is also caused by palsy of the bladder or some of its appendages, or by an irritable state of that organ. The discharge of urine is most apt to take place when the child is lying on his back : the urine sometimes scalda and irritates the legs and produces sores. Incontinence of urine is caused by the improper use of irritating medicines, certain articles of food, and by diseases of other parts of the body. The habit of incontinence, although an unpleasant one, demands indulgence and pity, rather than blame and punish- ment in most cases. Children thus afflicted should not be allowed much drink or fluid food; they should be made to urinate immediately before retiring, and also to rise at stated hours of the night for the same purpose The best position in bed, in order to prevent involuntary discharge, is on the side. The diet should be digestible ana nutricious, and the bowels regular—the cold hip bath at night will be of service. A tea made of uva ursi, or buchu leaves, a table spoonful of which may be given three times a day often cures the irritability of the bladder, on which the habit depends, or alters the quality of the urine, which causes its in- voluntary flow. Rickets—Foreign Bodies in the Nose. 121 RICKETS. Rtckf/is depend upon disordered nutrition, and some alter* ation of the blood from its healthy standard. It has usually however, been supposed to depend upon a deficiency of phos- phate and carbonate of lime in the food, to furnish the necessary earthy matter to the bones—and therefore has been considered peculiarly a disease of the bones. But recent investigations show that it does sometimes occur when there is no deficiency of lime—and that the whole system, particularly the muscles, brain and nerves, are equally implicated with the bones. It is an affection peculiar to childhood, and supposed to depend upon the action of the causes which favor the development of acrofula. The signs of rickets are, a softened gristly state of the bones, large joints, large head, prominent forehead, straightness of the ribs and flatness of the sides of the chest, prominent breast bone, looseness of texture in the bones, crook- ed legs and distorted spine : many other symptoms of scrofula ere sometimes also present. This, like scrofula, disposes the system to other diseases: the treatment of rickets is nearly the same as that of scrofula, (which you will find in its proper place in another part of this work,)—rickets, however, is a more curable disease, and less apt to continue after adult age. FOREIGN BODIES IN THE NOSE. The nose, like the ear, is very liable to be made by children the receptacle for any thing that will pass into it; beans, but- tons, stones, &c. Sometimes they nave been in the nose, unnoticed, for days or weeks, and are not discovered until in- flammation of, and perhaps discharge of matter from, the L ning membrane attracts attention; a reason, when such symp- I oms occur in a child, for always examining the nose for the i.resence of foreign bodies. The extraction of a foreign body from the nostril is always best done by a surgeon. If, how- ever, circumstances render it desirable to attempt the extrac- tion without waiting, it must be done by means of the flat end of a probe, or of a bodkin, bent about the eighth of an inch, •early at right angles with the rest of the instrument, which bent eni being carefully passed beyond the body, must be ased as a scoop to take it out. The flat end of a pair of tweezeKS also answers for this purpose, or use them as a pair of forceps, if the foreign substance can be got hold of. Some- times, when the foreign body is not very far in the one nostril, if that on the opposite side be closed, anU the child can be made to blow forcibly through the other, the obstruction wilJ be shot out. 122 Weak Ankles— Bronchitis. The lining membrane of the nose is liable to become inflam- ed and ulcerated. In a mild case, washing with warm watei — if necessary, by means of a syringe—containing a little car bonate cf soda in solution, will be of service: soap and watei is also good. It is a common popular error to suppose that the cose communicates with the brain: it is sufficient to remark that it does not. WEAK ANKLES. If children are put on their feet when too young, before hav ing requisite strength, or who are allowed or taught to turr their toes outward too much, or those who are of a weak and relaxed muscular system, are apt to have weak and crooked ankles, or bowed legs. The soles of the feet are flat, the an- kles turn inward so that the child walks almost on the ankle joint, and with lameness and difficulty. The general health should be improved by a good diet, cold bathing, and exercise in the open air: the child should also wear high boots madt of leather sufficiently stiff to support the ankles in the proper form and position. Also use friction with the hand or rough towel to the legs and feet every day, BRONCHITIS. This is an inflammation of the bronchial, or air tubes of the lungs, and is common to childhood. It commences with chills, flashes of heat, slight cough, oppression and tightness in the chest, breathing difficult, wheezing and rattling, and hoarse- ness of the voice. Breathing is more distressing when the patient is lying down—the cough is at first dry, but a copious discharge of stringy phlegm, resembling white of eggs, soon appears, with some relief to the cough: the skin is dry, and the tongue is covered with a white mucus. In more severe cases, these symptoms may all be augmented and attended with much danger. The disease is caused by cold, wet, sud- den changes of weather, insufficient clothing, loud speaking. crying, dust, and noxious vapors. When a physician can be procured, in cases of this kind, as well as in inflammation of the lungs, by all means do so ; but as delays are always dan- gerous, while you may be endeavoring to procure a physician, or if yen can not obtain one, the following course of treatment is advisable:—In the first place, give the child a purge 01 say, one or two tea spoonsful of Rochelle sa^ts in a wine glasa (or half gill) of cold water; or castor oil will answer as well, made more palatable by a little essence of lemon, peppermint, or cinnamon. Also, of the following mixture, let the child take one tea spoonful every four hours, unless vomiting is pro- 123 Cultivation and Carelessness. A form repre- senting a full- chested woman.— Such a person would naturally have a strong con- stitution,and could endure a great amount of labor, either mentally or physically. The European ladies are more generally of the above form than the Ameri- can, because they take more interest in cultivating a full chest and fine torm. In future let it be truthfully fwid that the American ladies not only have " pretty faces " but healthy forms. FORMS THAT CAN CULTIVATED, Tliis is a fac-9imil6 in form of a great many women that are daily met with. Such persons are usually troubled with that sinking sensation, or " goneness " at the pit of the stomach, which is always pro- duced by the pressure upon it in stooping, and might be prevent- ed by care in keeping back the shoulders, expanding the chest, and taking that kind of exercise so much needed, but so much neglected, called "House-work!" FORMS CONTRACT ED BY CARELESS- NESS OK HABIT. We here see re- presented a fall- chested and erect man, one so rarely seen, although it is no more than can be obtained in near- ly every person by cultivation. A per- son with such a chest would usually be free from disease of the Lungs or the ,„ Heart, and would Ip have all the indica- tions of being a ro- bust and long-lived person. It is as Ms? to have this form as an improper «•«, by a little timely training. This represents a man of stooping form, with small Lungs and Chest. Such a per- son would be almost sure to have some disease of the Lungs, .Heart, or Stomach,. | and would naturally be Consumptive and short-lived, because the vital powers are small. Care should be taken to avoid con- tracting such a form. It is simply the result of carelessness and habit. 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 chlorate of potash, and a few drops of essence of lemon or cin- namon, mix thoroughly 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 applied 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 Bhould 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. The one 126 Scarlet Fever. great matter of importance in curing children or others of stammering is, as soon as the least hesitancy in speech, ol stammering, is observed, make the patient slop 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. The difficulty, in almost every case I have observed, has been that the person attempts to talk when he has already exhausted the. air from the lungs. Overcome this, and the case is cured. SCARLET FEVER. In this 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, perhapa 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 the 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 Li many cases the fur comes off, as it were, in patches at a time, 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 begins to fade be- tween the third and fourth day from its appearance, and with it the feverish symptoms, and other general symptoms of the disease, such as sore throat, and morbid mind. In no children is it so necessary to insistup^n strict observance of all the laws of physical health, previous 7 136 Diet for Sick Children. treated of in this work, as in those who exhibit precocious de velopment of mind. DIET FOR SICK CHILDREN. Under this head will be found many valuable recipes fbi 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 sides 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. Bice 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 {unt 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 candy. Rice Jelly.—Boil three tablespoonfuls of rice and three of Diet for Sick Children. lVt ffhite 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- utes 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 salt, 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 Corn Gruel.—Boil three tablespoonfuls of dried sweet corn 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 aud 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 minutes. stirring constantly; season with salt, lemon juice, sugar, nut meg and wine. Arrow root and tapioca may be prepared in 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 oi 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 wTith 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 ard 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 white 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 through linen Diseases of Females. 139 « Ol&JD:ASSIES OF FEMALES, MONTHLY TURNS, OR MENSTRUATION. This important function should be well understood by both male 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 coming 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 eountry, girls begin to menstruate from the fourteenth to thi eighteenth year of their age, but seldom later without incon venience; but if they are luxuriously educated, menstruatioa usually commences at a more early periods About the time tliat the constitution is establishing menstruation, a variety^of important changes show themselves: the complexion is im- 140 Diseases of Females. proved; the countenance is more expressive and animated; 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 several 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 one 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 waa 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 outbreakinga of anger, and paroxysms of excitement from terror or fright; and she 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, all and every intoxicating liquor, she should continue much hei usual indoor employments; and thus, the principle of lettiug well enough alone being observed, a few periods will generally Diseases of Females. 141 establish the regularity of their return, on a healthy and per mai.ent basis. In general, no medicine is required, except she be costive; it should be removed by purgatives, such as small portion* 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 care 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- pearance of the menstrual evacuation, and are suffering in health in consequence thereof, should make use of such reme- dies as strengthen 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; Colnmbo root, half an ounce; orange peel and wild cherry bark, each, half an ounce ; all to be beat or 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. c 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, .^dependent of the quality of their springs, contribute greatly Lo fieir relief; and when the impregnation of such springs ia chalybeate, (iron,) they may be drank with moderation, re- membering to precede their use by an active purge, by which chalybeates and all tonics are rendered not only more safe, but more beneficial. When the young girl thinks, from her feeling, that nature n 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 eyea 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 improper substances; there is also costiveness. The treatment should be more energetic under such circum- stauces ; it should be commenced by removing the costivenesa by repeated closes of active purgatives, such as ten grains of jalap with four grains of aloes well mixed, and made into s bolus, or pills, with some syrup, and followed, in six houre 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. 143 eonic 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 aa the menstrual efforts are felt, to assist them by the hip bath, and friction of the feet and legs. SUPPRESSION OF THE MENSES. Afier 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 their 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 ;>f 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 very «ow diet is necessary. This treatment must be pursued until the fever shall be abated and the pain relieved. 144 Diseases of Females. You must not expect the courses immediately to return, but 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 and 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 takea 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 differ! 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 the 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- mence 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 dry, and the bowels open, together with an occasional use of Disease* 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 teaspoonful 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 3IENS TRUATION. There is a great difference in different women as to the amount of the discharge during their courses. When a Bcanty 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 from 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 lo fifteen drop's of laudanum to each dose ; all to be given cold. These 146 Diseases of Females. proceedings generally give relief, or at least will control the dis 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 bythe mixture of vinegar and mustard rubbed on the parts. Mort exercise should be taken. ABORTION, OR MISCARRIAGE, Is the' expulsion of the contents of the pregnan* womb, at * {)eriod of pregnancy so early as to render it impossible for the 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 tr e body ; heating and stimulating food ; indulgence in spiritoi t and other intoxicating liquors; violent operations of emeth b and purgatives; fear, grief, and excessive joy ; a full gross hab it and feverish state of the system ; exciting and debilitating dis- eases. A delicate frame, and weakly constitution, will pre 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 becomea 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 liea 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, sfnioderate it that the womas 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 castor oil,) and Diseases of Females. loA if diam.cea be present, it must be relieved by a few drops of laudanum or of paregoric. She must lie down and keep 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 bf kept perfectly still, every kind of exertion strictly forbidden even to conversing with her friends; the diet must consist who.ly 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 6n their producing pain or a continued chill. If the fever ia 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 pains 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 are improper, as they will prolong the suffering. Yery 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 tieatment 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 so 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 state, 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 only a consequence of the loss of much blood, but is the re- medy which nature makes use of to check the further effusion. This, although very alarming to those unacquainted with its 156 Diseases of Females. good effects, should not in recent flooding be interfered with; 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 or 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, not hot tea, be given 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, tnen 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 nitre, one of paregoric, and twenty drops of essence of pepper- ment into a tumbler of cold water, and of this mixture let s tablespoonful 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 oowels. 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 after, 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 casee 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 water, 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 nipp!es, 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 cither 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 ai occasion may require. MIDWIFERY. LABOR. 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 ita cavity, and thereby 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 cornea first, and which are completed by the unaided efforts of na- ture ; are so denominated from the frequency of their occur- rence, and the regularity with 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, about the time the membranes usually burst and the watera are 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 dilated before the head has descended low down; yet it sometimes 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- ■sernal 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 it> r%ominata, or hip bones. 2. The sacrum,, perforated with two rows of holes, for the transmission of nerves. 3. The symphysis pubis, or os pubis. 4. The coccyx. 5. 5. Articula- tions for the thigh bones. The antero-posterior diameter of the brim, from symphysis pubis to middle of sacrum, measures four niches and a half. The transverse, from the middle of the brim on one side, to the same point on the opposite, five inches and , quartei The obligue diameter measures about five inches. The antero-posterior and transverse diameters of the outlet measure, each, four inches. The cavity of the pelvis measures, in depth, one inch and a half in front, and four inches and a half poo teriorK 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; b, b, the Fimbriae; c, c, the Fallo- pian Tabes; 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. Wall of the Vagina; k, \ 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. 1G1 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 ea3h, by which they will avoid all unneces- 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 perform 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 is advisable that some other woman be present. The patient should lie on her side or back on the edge of the bed, with her 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 opea, 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 find slippery, and a thick mucus, with or without some tinge of blood. beo-in to ooze from them, we conclude the labor to be actually be°un. 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 u,*» the bowels, of warm water, and perspiration to be promote) by drinking frequent draughts of weak tea. By such meana false pains will generally be removed; but if they still con- tinue after the fever has been moderated, and the bowela 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. First 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 their'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 that usual, attend carefully to the state of their bowels, keeping them freely open. The subsidence of the belly, which denotes the approach of Midwifery. 163 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 present, by increasing heat, restlessness and pain, but may become 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. First 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 sharpness 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 more 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 thin and soft, the opening enlarges, and after some time, will admil 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 orifice, 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 ehild'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 rin°- 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 fhe child to pasa through. Nevertheless, if we can during this stage neither lessen the woman's pain, nor shorten its duration; and, although we are forbid interfering in any manner with the progress of natural labor, yet the presence of a midwife, or such other woman as may be selected to officiate, is far from being useless but is very necessary. They should inquire into the state'of the patients bowels, and, unless they be in a laxative state ad- minister an injection; indeed, whenever there is time for it it is a good rule always to do this, as by its effects the injection Midwifery. 165 Las 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 by 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 place towards the conclusion of the labor, when the child shall have 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 be suffered to go on without anv interference—the pains continu- ing jmuluaily to open the internal orifice of the womb, and fo?ce the membranes through it, in the form ot a purse, which, actino- as a soft wedge, contributes in the easiest way to its fnrtheY dilation. Of this, the midwife may now and then as- Biire 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 dilated, 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 60ft uM-ts, intended by nature for Iubmutrng them, and causea ^TheTbom'.uable practice of stretching the soft parts of the 160 Midwifery. mother by the midwife, under the idea of making room 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 01 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. 167 mer, let her chamber be kept cool bj open doors and win- dows : and in winter, comfortable but n^t too warm. The patient should be strongly impressed with the fact, that the best state of mind she can be in at the time of labor, is 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 their 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 theii 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, should 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 then cautiously examining its progress ; in doing which, when the 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 be 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 bed 168 Midwifery. A flannel petticoat, and short-gown, with the shift turned up ovoi the hips, so as to preserve it dry; but any dress will do it 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 made 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 v Huntary 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 the water is discharged. This in well-formed women, especially such as have borne several ©hildren, 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 least, the patient should be laid on her bed, that at all events, the necessary assistance may be 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 liead— 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 Co 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 ver- 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 well 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- ing in the form of a distended sack, contributed to dilate the internal orifice of the womb, they continue in the same man- ner 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 by a dan gcrous 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 is 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 requires 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 in any apparent or real efforts to shorten it. Third Stage of Labor.—This begins at the time when the 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 at 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 into 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 pass 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 fretted and inflamed by improper conduct at the beginning. Midwifery. 171 Tho part which is most apt to suffer during this period, ia (he 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 tvay at this extremely thin edge. The perineum and adjoin- ing parts are relaxed, and prepared for so great a change by the secretion of a large quantity of mucus, by which the parts aie 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, 6iibjects 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- posterous attempts to stretch and extend them, as well as avoid heating 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 accomplished 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, Ji 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 on the bed, taking care not to draw her legs too much up toward the oelly, nor to separate the knees very wide; both of which put the perineUm on the stretch, and increase the danger of its [»eing torn. The bed being prepared, and the woman laid on it aa 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 her knees; she will then find herself most cim- 172 Midwifery. veniently placed to afford every assistance. Still, how«,',er 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 palm over the perineum, make a gentle pressure on the tumor during each pain, so as in some 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 sudden a delivery ; for, let it again be recollected that in a slow labor, well managed from the beginning, vvhere the soft parts are properly prepared to yield, the penneum 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 erineum, the dilatation of which by too great pressure may e 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 is made, is likewise of some consequence; it must not be directed upward and backward, but it must be directed no ward and forward toward the pubes, or front; by which, as'the cerjtre 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 anobit 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—extremelv 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 more time; and all extraordinary exertion beyond what she is in 6ome 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 thi a 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, indiced by the supposition that the danger was 174 Midwifery. all over as soon as the head was delivered. The next pal:: ad- vances it to the hips, so that the arms of the child are delivered with little or no assistance. Another short respite again takes place, whilst the hips of the child advance, of which one or 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 unfre- 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 shou Id 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 discha-o-e ot 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 towardsi the back and close to the mother; its head and bodj 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 deasing, and being much fatigued, she is very opt 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 of 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 clanger, 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 is situated in the wind-pipe, the hips and the body of the child Bhould 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 the pulsation in the cord have ceased, it should immediately be geperated from the mother, as above directed, as no geod can arise 176 Midwifery. 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 ye 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 child 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 suffi- 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 be 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 thence 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 eithei flooding or after-pains. But, if within that time, there be no Llidivifery. 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 soon 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 de- 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- birh is 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 \i\ar him and run away from his presence. This is quite unfounded. Equally mistaken are the notions that the mad dog exhales a peculiar and offensive smell, and that he may be known by hia running with his tail between his legs ; except when weary and exhausted he seeks his home. The earliest symptoms of madness in the dog, are sullenness, fidgetiness, continual shifting of posture, a steadfast gaze, expressive of suspicion, an earnest licking of some part, on which a scar may generally be found. It the ear be the affected nart. Hydrophobia, or. Bite of Mad Dog. 201 the dog is incessantly and violently scratching it. If it be the foot, he gnaws it till the integuments are destroyed. Occasion- ally vomiting and a depraved appetite are very early noticeable. The dog will pick up and swallow bits of thread or silk from the carpet, hair, straw, and frequently he will lap his own urine, and devour his own excrement. Then the animal becomes irascible, and flies fiercely at strangers, is impatient of correction, Beizes the whip or stick, # quarrels with his own companions, eagerly hunts and worries cats, demolishes his bed, and, if chained up, makes violent efforts to escape, tearing his kennel to pieces with his teeth. If he be at large, he usually attacks only those dogs that come in his way; but if he be naturally ferocious, he will diligently and perseveringly seek his enemy. Many cautions are annually put forth about the dog days, for muzzling dogs, and so on. Very good and proper advice; but if those who have noticed the statistics of the disease may be depended upon, it would be as appropriate at one period ot the year as at another. Some people think this disorder in dogs is produced in warm weather on account of a want of water, the notion is a mistaken one. When an individual has been bitten by an animal respecting which the slightest suspicion of hydrophobia exists, the one remedy cannot be to quickly resorted to—complete excision of the bitten part. Some persons have possessed sufficient nerve to do this for themselves—few perhaps could— but it has been effected by unprofessional persons for others : in- deed, there might be more danger in waiting many hours for a surgeon than in submitting to an unprofessional operation. The method of excision most to be trusted, is the insertion of a 6kewer ot wood, made to fit into the wound caused by the tooth, and carrying the incision so far round, that the entire hollow or cone of flesh is cut out along with the piece of wood. This might be done with safety in the thick part of the calves of the legs or the back part of the thighs, &c. Where excision is not resorted to, the free application of lunar caustic or aquafortis, whichever may be most readily procured, would be advisable ; or, in lieu of these, a piece of iron, heated to white- ness, may be inserted into the wound, so as thoroughly to de- stroy the surface which may have been poisoned. In the event of none of the above measures being submitted to, or available, the wound may be thoroughly washed for hours, by means of a stream of warm water poured upon it from a height; a cup- ping-glass being applied at intervals, and of course in the meantime procure the services of a physician. When an indi- vidual is thought to be attacked with the hydrophobia, if the 202 Lock-Jaw, or Tetanus. hope of saving life is small, much may be done to alleviate so terrible an infliction by proper care. The most perfect quiet- ness possible must be observed to prevent as much as may be the recurrence of the paroxysms of suffering. Thirty or forty drops of laudanum given as the occasion may require, are ad- visable—if the patient can swallow : if not we must depend on chloroform, which can be inhaled without difficulty, until rest is obtained—and repeated as may be needed. If ice can be taken, it is said to afford relief put into the mouth in small morsels ; it has also been found of service applied to the back o^ the neck. Anyhow the experiment is 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 jaw*, 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 weeka after the injury. It is a very fatal disease, the greater portioD ot those affected by it dying; some, however, recover. In the treatment of lock-jaw, begin by giving large doses 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 dra^ 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; a medical man will probably administer it by means of a tube passed into the stomach, either by the 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 defective 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 nregrancy. 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 on 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 neai 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 ia 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 is furred, and the pulse becomes regular, hard and full; in casea 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 of 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 of 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 is of service Chills, or Fever and Ague. 205 < lo gnpp the 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 spirits 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 chill, 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 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 fbrm 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 flanne'. 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, [colo J made from wild cherry, or dogwood bark, orcolumbo 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 the qninine treatment as above mentioned. 20U Bilious, or Remittent Fever. BILIOUS OR REMITTENT FEVER, This is nothing more than the Chills, or Ague and Fever, ex cept in this form of the disease there are no intermissions, (or 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 doses 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 or Spirits of Nitre in half a glass of water. Cold applications to the nead (cloths wrung out of cold watei 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 the 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 the 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 ia 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 their 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- ges. 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 the 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- son 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 intensely. A slight temporary unconsciousness may be the only symptom, with or without the slightest ap- proach to convulsive movement, as evidenced by the twiching 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 paiox- ysm, and even for twenty-four hours are aware that a fit is at least probable, although its direct accession may not be certainly 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 attack, or in consequence of some of those measures found to be effa- cious, 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 nervous system, are the precursors of the epileptic paroxysm. But the most generally marked and remarked precedent is the epil- eptic " aura," a sort ot creeping sensation, which is described by the patient as arising at some particular part of the body, such as the extremity of a Hmb, 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," intoxcation and sexual excesses, are most fre- quently not only actual exciters, but also predisposers, to' tha saattack of epilepsy. .Epilepsy may be a congenital disease, that is, the child ia ^born with the tendency, and becomes subject to the fits, either with or without any apparent cause, early in life. Into'xiea- rtion.is a cause of epilepsy, and delirium tremens may be com- plicated with it. Strong and prolonged mental exertion may I 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 aaimals. When means wiJl 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 loos- ened, and air freely admitted ; the head should be raised, and cold wet cloths may be applied to it if there is much heat. It has been advised to cram the mouth full of salt as soon as tha 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 treament is duriug the intervals ; mix together half a teacupful of ground mustard, two table spoonfuls of laudanum, three table spoonfuls of tincture of cayenne pep- per, half pint of vinegar, and same amount of cold water and alcohol, put into a well-stopped bottle—shake well and apply thi? Drowning. 211 as a liniment along the backbone (or spine) with a woolen cloth, night and morning, wearing a flannel shirt next the skin all the time. Also, take inwardly the following ; tincture or 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- bath] 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 ot the education of our chidren, 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 be done as long as it is covered with wet clothing ; and it 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, pro- 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 shutter, the head and shoulders beinsr well raised ; but if there is nothing at hand on which the body can be laid, care should be taken in carrying it that the head is well supported neither allowed 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 man- ipulations : to the pit of the stomach and to the feet especially, their application is to be used. Frictions with stimulants of gome kind, such as camphorated oil, brandy or any other spirit ojo Drowning. mixed with oil, of-turpentine, should, any of them, br. used warm, and be rubbed in with a flannel; a warm stimulant injec- tion, 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. Artific- ial breathing, °recommended by some, is condemned by others. Certainly the old method ot using bellows and other means ta 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 fre€^ and carefully keeping the patient wrapped up in blankets, are of the greatest importance. For the more easy application of reme - dies, the body should be laid on a table of convenient height. It is necessary to notice also what ought not to be done ; for many old and most injurions 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 emet- ics, 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 ot service, but no attempts should be made to give any thing by the month as long as unconsciousness continues. 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 has 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- ary, 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 from friends or rela- tives ; and support the strength by tea, coffee, soups, &c., Hanging. 213 tvnd 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 hanging 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 resusci- tation will be effected if this thing has continued four minutes. The first thing to be done when a person is found hanging 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 justified 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 what- ever means may have been selected, that the person so offend- ing should be thoroughly flogged, and then made to do the state some service for a month or two. The prevalence of this sin, and the consequent notoriety that is given to deaths from this cause in the newspaper press of the day, should be looked upon by every body with disfavor. No man or woman who thus tries to rush unbidden into the presence of God, deserves a falling tear, or a newspaper notice, unless insanity has been the cause. CHOKE-DAMP, Or Apparent "Death from Inhaling, Carbonic jlcid Gas. How many sad instances of deaths from this cause every year, and vet a little knowledge ,such as we have tried plainly to im- part in this book, would have prevented an occurrence of this kind. Old wells, brewers' vats, the holds of ships, &c, are all liable to become the receptacles for carbonic acid gas, which, formed form 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 lalla 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 mouth. In such a case, the body of the individual must be removed, if possible, and as soon as possible, from the poisonous atmosphere, ot 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 ei^ploy- ment of the simple test of lowering a lighted candle into the suspected place. If the flame be extinguished, 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 moie speedily effective than the introduction into it of newly slaked lime, either 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 circulation or air, will he 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..j^and when they do venture in, tie over the mouth a cloth 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 this 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 Drought into action, and steadily persevered in for some hours. Carbonic acid is produced during fermentation, or by slow de- coinposition uf vegetable matter, such as damp straw, sawdust, wood-chips, &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 hot an unfrequent occurrence. In the latter case it usually oc- curs from persons ignorantly 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 and insidi- ously, and exert so powerful a narcotizing or stupifying effect, that those exposed to the influence are quickly rendered unable to re- medy the circumstances, and perfect insensibility ensues. Too of- ten it happens that the discovery ot the accident does not take place until morning, long after it is too late to remedy* the fatal 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, ia the first proceeding, when the treatment recommended in cases 01 poisoning from choke-damp should be followed. Carbonic acid is largely given oft 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 ot Drowning, to use mus- tard-plasters to the spine and pit 01 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 and 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 ordinaiy precautions which those who chance to be exposed to a storm ol thunder and lightning ought to adopt; but not a summer pas- ses without lives being lost from sheer ignorance. Harvest 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 where 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 betweea a door anel window, or, as is often the case, femalea 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 muscles, such as those of the legs, "or may be more general, as happens in cholera. The affected fibres nre drawn 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 cramp. The disorder is also often associated with the .presence of worms. When cramp affects the arms and fingers, it may be connected with disease 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 cayennne pepper, to be rubbed on with a woolen cloth. External Violence. 217 Shake well before using—one tablepoonsful 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 immediate \. 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. Active 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 ad- vice, at once. EXTERNAL VTVLENCE. This is likely to occur from evident or design, at any time, aad 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 bead may cause merely bruising of the scalp ; if more aovere, concussion or injury to the brain, or fracture of the skull. The latter accident is most likely to happen at the side of the temple, where the bone is thin, ; but severe injury to the brain frequently 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) of the lower limbs,' with or without fracturing the bones. When a blow, even comparatively slight, is inflicted upon a spot immediately over a collection of nerves, most distressing effects, and sometimes immediate death, may re- sult. Suoji is the case from blows on the neck, on the pit of the sto- mach, or over the region of the heart. The deadly faintness 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 Drouming, employed along with external heat, mustard-plasters to the back and pit of the stomach, and stimulating injections 218 Cramp in the Stomach from drinking Cold Water. of two or three tablespoonsful of whiskey, or brandy or spirits turpentine, with a like amount of sweet oil and a gill of wam- water. CRAMP IN THE STOMACH FROM DllINKING COLP WATER. There are a great many diseases, properly speaking, broughl on by drinking ice-water and eating water-ices and ice cream, "when the body is over heated, such as diarrhoea, 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 walk, 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 a pnrple color ; his extremities be- come cold, and his pulse impercep table ; 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 sal.mns, when drank under the same circumstances aa cold water, have all been known toproducethe 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 teaspoonful, 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 VEN03IOUS SNAKES. This may very properly be called a poisoned wound, for the the poison is inserted at the same time the bite or wound ia inflicted. 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 pois- on being aborbed 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 de- pression. Of course, any stimulant first attainable should be used; but hartshorn, is most highly recommended, taken in teaspoonful 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, hartshorn may not be so handy to get at. Then take half a glassful 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 forgotten that the part bitten should in a moment be cut out, and then freely washed with water until hartshorn or caustic can be applied, which can not always be obtained on the spot, but as coon as they can 1*3, 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 taunted with playing " Old Soldier,"—a most cruel and unkind proce- dure. After a severe attack of neuralgia, the skin is often left tender, and when the pain has recurred frequently, exquisitely 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 du- ring 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 indivi- dual is heated. Debility of constitution renders the individual much more susceptible 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, Rhubarb, 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 va- luable 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 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. SEA-SI CKNESS. 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 short 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 grains of cayenne peper, with two or three 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* 522 Sea-sickness. ness if they take food freely—with others the reverse is the ease; 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-aff'ection, who are the subjects of rupture, prolapsus, &c, how far they should incur the risk of these being aggravated by the mechanical act- ion 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, du?, to a partial 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. WTith 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. Varicocele.—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 numf> 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. This disease requires a properly constructed bandage etc. Send $2.00 and 1 will forward my improved Ventilated Bandage, free by mail, with directions for treatment. Address M. Lafayette Byrn, M. D.; P. O. Box 4669, N. Y. You should not neglect this disease, or it may cause you much trouble and inconvenience. 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 Dy real or imaginary causes, which should be remedied aa speedily as possible, before it gets too firm a hold on the system. The common symptoms are, loss of, or a variable appetite, a troublesome flatulency in the stomach or bowels, sour belch ings, costiveness, a copious discharge of pale urine, spasmodic 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 ia 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, weep, 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 of melting; others, that they were continually in some place 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 enlivec the spirits; and one of the best plans with which we are acquainted, 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 medieine. 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. Traveling 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 shoula 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, such 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 bettei 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 vE 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 ha= been heated by exercise, or by cording 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 wardering pains about them at that period. Chronic Rheumatism is attended with pains in the head, shoulders and other large joints, which at times are confined to one paiticnlar 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 st^te of debility, and liable to fresh impressions on the approach of bad weather. Acute Rheuniaiism 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- viously occupied, swollen, red and extremely tender to the touch. The pulse now becomes full and hard; the tongue preserves a steady whiteness; the bowels are commonly very costive; the urine 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 uricli increased on the slightest motion requiring the action of the muscles affect ed, and are most severe, as well as most apt to shift their place, in the night time. The fever abates sooner than the local syTmptoms, 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 i'vee 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 absen ie 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 : the mode of administration, as laid down by Dr. Basham, is to dissolve two ounces ot the saltpetre in two quarts of water, and to give this quantity in the course of twenty-four hours Thif 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 has 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 as 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 wTill 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 in 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. Persons of spare or feeble habit, may live better, and indeed require to keep up the condition of the body to as good a pitch aa possible. In chronic rheumatism, instead of heat, there is often a sen sation 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 hj means of warm 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 chronic rheumatism, warmth of climate is of much importance, and as much should be done toward the attainment of this u circumstances will permit. Chronic rheumatism, properly so called, is such as above described; but the term rheumatism, or rheumatic pam, 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 r its virtues in gravel and stone, by physicans of high authority It may be combined or alternated with the alkar S02 Gravd. lies; and where general debility exists, or there is 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 inutriatic acid, ten drops to the pint of uva nrsi 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 pre- 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 cf from five to twenty drops, twice or three times a day, in a wineglassful of water; and the 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 urgenct 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 unti the pain is relieved. Opium seems generally preferaHe in thf Gravel. 803 white 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 orgalbanum 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 stono 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 Btool; 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 the 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 of the bellv ; and a large quantity of mucus (or slime) is mixed with the urine, and sometimes the latter is tinged with blood, especially 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 differense between gravel and Btone, that, in the former, active exercise is highly advisable; 304 Strangulated Hernia, or Bupture. whereas, -during the actual presence of stone in the bladder, 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 tha 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 three 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 bowel 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 ttiong 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 pro- 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 an Ulcers, or Sores. 305 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 practition.er. 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. RurTURES 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 which readily separates from the surface of the sore. There is a number of little eminences covering the bottom of the ulcer, called granulations, which are small, red, and point- ed at the top. As soon as they have risen to the level of the Burrounding 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 (several 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 dao-es sometimes irritate the sore, and disturb the healing pro- cess; but when 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 parti 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 tho 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 ulctrs, which may bo called irritable ulcers. The margin of the surrounding skin is jagged, and terminating in an edge which is sharp aud 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 comes on in paroxysms, and causes convulsive mo tions of the limb. Such ulcers seldom do well without a fro quent change of treatment. Fomentations with peppy heads, hops, chamomile flowers, or hemlock leaves, are sometimes of use in irritable ulcers. When poultices are prescribed, the} Wens. 307 « should never be allowed to rest or bear weight on the sore limb. 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, will 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- quired for indolent ulcers are those of a stimulating nature, as the 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 ibeing 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 be removed at all, or cut, without the utmost risk. Sometimea 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 Leal and leave very little deformity; in other cases, the tumor is fungus h&matodes, 308 Wry Neck—Varicose. or bloody cancer, which pretty certainly destroys the patient, The bronchocele, or goitre, (oil 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 arises 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 tho 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 lar^-t reins of the abdomen. In this way, pregnancy, if frequent, Foreign Substances in the Eyes. 309 it. a most common exciter of the condition : habitual costive ness, diseases of the liver, tumors of any kind within the ab- iotnen, 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 some 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, lrable 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 amount 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 discov- 310 Stye—Sore Eyes. ered without much difficulty by a second party examining the 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 fhe ball; they cause much ii ritation, 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), or magnetized piece of iron : bringing it in contact with the foreign substance, it attracts it, and. adhering to the magnet is takeD out. Never rub the eye when there is dust or other foreign substance in it, it may injure the dull 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 they 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., or poultices in a m,uslin bag, lest the particles get into the eye. When it breaks and gets well, bathe the eye three or foui times a day in cold water. SORE EYES. This being a disease of such frequent occurrence, and by 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 eye 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 superficial form of inflammation to which the eye is sub;ect; if neglected it may extend itself over the corccs* or ir&xi/pttrt Sore Eyes. 311 of the eye-ball and produce permanent blindness. It is undis- tinguishable from the next form, or inflammation of the sole- rotic coat, or whites of the eyes, by the size and winding char- acter of the small blood-vessels, and by their being slightly movable along with the conjunctiva, or membrane, itself, when tho lids are drawn down. It is important that these distinc- tive characters should be attended to in the first place, that no error may be committed between this form and a more eerious and deep-seated inflammation of the eye, and also that proper treatment may be used. A great error is committed »n 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 times 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 eveiy second night, followed the next morning by a seidlitz 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, arid the 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 best 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 ig 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 se-ious 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 ton 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 flattened, from which 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 con/vex glasses, which must be adapted to the eye by the individual affected. Short-sightedness, of course, is just the reverse, produced by the eyeball being too round or prominent; and is to be reme- died by 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 this cause have become blind. We would alsc warn the reader against the use of whal has Groioing in of.the Toenail—In/lammatLu of the Tonsils. 313 been lately brought into use, by extensive advetrising, called "eye 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 hands. GROWING IN OF THE TOE-NAIL. This is a frequent and troublesome complaint, caused by the tail presaing 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, Buch 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. JNFLA3IMATION 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 6ome degree of fever. Swallowing is greatly impeded as the disease increases, and speaking, and even breathing, are en- dered 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 (lushed 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 Buffocation is intolerable, and the patient is obliged to be sup- ported in an erect posture. When inflammation of the tonsil occurs repeatedly in the *ame individual, within a short space of time, a peculiar sus- ecpt:bility to the disease is established, so that it is produced h) 4he slightest causes afterwards. 'The active symptoms in this disease may either rapidly de- clini or produce suppuration and an abscess in the throat; or -emaininir a long time in a chronic state, cause an enlarged 314 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 emetie 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 violent 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 perspiraticn; 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, 01 the thi oat 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 or 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 swellings 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 they should be punctured with a lancet, to allow of a dhehaige of the contained matter. After this a gargle of sage teu. ahur Inflammation of tlie Larynx. 315 and h.i.ey, several times in the course of the day, will com- plete the Cute. We shoiuu bear 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 n.cjvery, against exposure to cold or damp, to 6udden transitions of temperature, &c. Bathing the th/u.«t night and morning in cold water is a good means of pre voicing a return of the disease, in those who have been subject to ii. INFLAM3IATION OF THE LARYNX; (Or top of the Windpipe.) This commences with Jie usual symptoms of fever, from irritation or local inflammation. The voice very quickly be- comes hoarse and indistinct, Bometimes 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 juost 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 the 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, &c, 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 hecked 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 efficacy of a measure directly opposed to that just 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, perhap?, more iiu Cold in the Head. 317 portant, a prevention of those coughs which commonly succeed to them. Nor :s the suffering from thirst nearly so great as migh* 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 purgath e 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 mayr 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 riiis method, would hesitate between them. Moderation in liquid food, is one of the best preventatives 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 cold. Nature seems, to some extent, to provide for these changes in the atmosphere, as in cold weather we drink but 318 Inflammation of the Lungs. little, and in warm weather drink more, as by the evaporation brought about by perspiration, the temperature of the body iff reduced or kept down. INFLAMMATION OF THE LUNGS, (Pneumonitis Inflammation of the lungs commences Avith 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 pulue. In some cases, however, there is little or no increase of heat, and the pulse is not more frequent than natural. Yery 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 ; and 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 o? five days, and if there be but little expectoration, or especially if delirium, with a soft, undulating pulse, supervenes. Where Biippuration, or abscess, has actually taken place, the symp- toms are, frequeut, slight shiverings, a mitigation or cessatior Inflammation of the Lungs. 319 of the acute pain, with a continuance of the cough and a diffi- culty of breathing; the pulse being soft, fuller, and either Blower 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 nat- 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 tablespoonful, or five grains of the powder; chlorate of potasln, one drachm, or about one tea- Bpoonful; 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 plenty 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. PLE URIS Y. Tnrc 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 rleurisy INFLA3IMATION OF THE STOMACH. Though not a very frequent disease, this is a very painfu. 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 the disease, fever, with intense heat of the skin is sometimea 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 over-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 dano-erous 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 the skin, joints or brain; therefore it is all-important that it be treated in every case with promptness and energy. Inflammation of the Bowels. 32* Thf 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 indispensable 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 oe 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 some 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 the 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 whicli spreads over the whole abdomen. The latter is somewhat swollen, and sore to the touch. Obstinate costive- ness generally attends the disease, and sometimes severe 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 difficulty. 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, these .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 ihe 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 succeeded by death. Inflammation of the intestines may be distinguished from eolic 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 in paroxysms, with distinct intervals of rest, and is 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 locd. symptoms remain, and the strength of the patient will perm' c followed by a blister. The same cold fluids internally, w l! be proper, as those ordered in inflammation of the stomaci After the violence of the inflammation has been reduce I, four grains of calomel, every two hours, should be given, coi i- bined with mucilage of gum arabic, until a copious evacuatic n from the bowels is obtained; the operation of the calomel being 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 frictior. with a rough towel, etc. Diseases of the Liver. 323 DISEASES OF THE LIVER. Acute Infla.mmati.on.—As in other forms of inflammatory diseases this is generally ushered in by a chill, succeeded by all the symptoms of fever. To these are soon added pain in the region of the liver, sometimes acute and shooting, with a sense 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 side 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 dif'er. The skin, eyes and urine have the same deep yellow tint as in jaundice. The pulse is 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 •symptoms of hectic fever. When the abscess is seated on the 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 chance of the patient's recovery will be greatly increased. When the 324 Diseases of the Liver. abscess is more deeply seated, an adhesion taking place be tween the liver and intestines, the matter may find its way 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 the body ; the excessive use of wines and spiritous liquors ; high living, and intemperance generally; violent passions of the mind, particularly anger and rage ; the suppression of varioue habitual discharges, and irritations of the stomach generally 4 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 01 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 liver, 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 sometimes takes place; and again, in other cases, from the meration^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 fatau In its early stage, local bleeding by cups or ieeches, applied over the liver and stomach, and repeated according to circum- stances, followed oy Dusters to the right side, in conjunction with a very light vegetable diet, the warm oath, and friction to tne surface: with a pill everv night and morning of th blue mass, five grains : soap, three grains ; ipecac, one grain and a»oes, two grains, aided in its operation upon the bowels by an occasional dose of castor oil, or laxative injections, wil. very speedily remove the disease, provided the patient, at the 3ame time, take gentle exercise, when the weather wil1. 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 6ide, by Inserting an issue or seton over the liver, has occa- sionally been found beneficial. In cases ot 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 open at all times. A sea voyage is sometimes of great service In this disease. Out-door exercise should be taken daily. INFLA3I3IATION OF THE KIDNEYS. The symptoms of this disease are a feeling of heat, uneasi- ness, 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, costiveness, difficulty of breathing, and cold extremities. There 326 Inflammation of the Bladder. is a painful feeling of uneasiness when the patient is sitting upright, or standing; the easiest position being that of lying on the side affected. If the inflammation of the kidney be Bevere, or occur in a broken-down constitution, it most com- monly gives rise to more or less dropsy, either externally, or of the abdomen. Inflammation of the kidneys may be induced by cold; by habits of intemperance; by the use of powerful diuretics, at spirits of turpentine, cantharides, &c.; by bruises or sprainb cf the back or loins; gravel; violent or long-continued rid Lng, &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, 01 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 nrsi 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 gili of the tea (cold) made of the same, will have sometimes \ 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 lower 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 is a dull, rneasy 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 bladder become often, when effected with chronic inflammation, thick- ened, or hardened, and otherwise disorganized, giving to the I atient great uneasiness, and causing a constant inclination to n'inate, or a total suppression of the urine. In the acute variety of the disease, the early employment o-' leeches over the region of the bladder, followed by the v arm bath and fomentations, will be required. The bowels bi ould be kept gently open by mild laxatives and emollient ii jections, as directed in inflammation of the kidneys. The Ic eching should be repeated until the pain and uneasiness of t) e bladder are subdued. During the disease, the patient should observe a very low, unirritating diet, and make use of sv me mucilaginous fluid for drink. Any of those mentioned it the preceding article may be employed. If the urine be r< tained so as to cause distension of the bladder, the catheter will 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 b :>wels should be kept open, and a warm bath taken twice a week at bed-time. Opiates, as ten drops laudanum, half tea- spoonful of paregoric, or ten grains of Dover's powders, at bed-time, will be necessary to ease pain and procure rest. 3IU3IP S. 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, aud 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 contagious, and often prevails as an epidemic. After the fourth day, the swelling gradually declines ; arxd. foi tne most part, it is unat- 328 Angina Pectoris, or Breast Pang. tended throughout with fever, and scarcely ever calls fo/ medical aid. As the swelling of the throat subsides, it not nnfrequently happens, that a swelling takes place in the pri- vates of maies, 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 cold to observe a mild diet, and to open the bowels by a very gen tie 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 Epsor 1 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, - quiring treatment suited to its different causes and symptom^ that we have thought it best to treat it under 'he following divisions: Colic from Indigestion.—Among the most common symp toms occasioned by an excess in eating, whereby the stomacL Colic. 316 rs 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, precedir^ the ejection of the contents of the stomach by vomiting; and terminating subsequently in a griping looseness of the bowels, But it is m.t only by excess of food that this species of colic is produced ; it is occasioned also by the quality of the food • various high reasoned and made dishes; certain articles of a highly indigfcjtible 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 limbs, 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 wises 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 W too long kept, may undergo a change, rendering them im- proper artie'es of food. The second variety mentioned of the colic from indigestion is produced generally by eating deleterious vegetable sub- stances, either mixed with our food or eaten in mistake for healthy articles. 346 Colic. The treatment in all the varieties of this species of colic is to be commenced with an emetic, in order to unload t)'6 stomach 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 wil. be sufficient; but in the two other varieties, a more prompl and powerful emetic is demanded, and it has been recom- mended to prescribe immediately a full dose of the sulphate of zinc (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 jmssible, 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. Flatulknt 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 is produced by every thing which occasions derangement in the stomach and bowels, and it is 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 ia 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, (fee, &c, being introduced Colic. 347 into 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*d 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 ination 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 or mint water, or the compound tincture of lavender; at the same rime we may administer injections, composed of some aromatic, a little cinnamon tea, mixed with soap suds may answer, out the one most to be depended on, is composed of a teaspoon- ful 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 promut relief. After the pain has somewhat Bubsided, it will be proper to administer an active but mild purgative; the best is probably magnesia, combined with calo- mel, to whicli 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 been taken to produce the symptoms, and is more gradual in ils attack; a feeling of uncomfortable fullness in the bowel* being felt for some days before the attack ; also loss 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 the bowels, until relief is obtained, then being careful afterwards ^;o keep the bowels regular. (See Costiveness.) 348 Colic. Bilious Coijc—This form of the disease is marked by h violent and intolerable pain of the bowels, which in some case*? 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 >e 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 iomentations of hops and vinegar, should be applied over the whole of the abdomen, and continued for some length of time. It, after a reasonable time (two or three hours), the patient is not better, the calomel and opium should be repeated. This will usually relax the spasm of the bowels, and at thesame timeexcite die healthy action of the liver, and unload the bowels of the diseased secretions by which the irritation is kept up Tk* action ot the calomel may be assisted by injections of a laxa cive nature thrown into the bowels, and frequently repeated jv, where the stomach will receive and retain it, wo may fol Costiveness of the Bowels. 349 low the calon.el 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. In every case where the symptoms are violent and obstinate, the application of a blister or mustard plaster, after the em- fdoyment of warm fomentations has been continued for some ength 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 ^rain of opium, and half grain of ipecac every four hours. Of course the diet of the patient should be light, nourishing, easv 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 thonld 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, n conjunction with this condition of the bowels, the 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 be 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 in suckling, abundant perspiration, loss of nervous power, an I 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 a a enormous extent, or contracts to a very narrow calibre in soire portion of its course. Lastly, a very common inducing caiiMe 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-s, 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 by 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 sensation, but retiring for the purpose at one set period of the day, when time 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 benefittedby 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 tew days, or once a week, as the case may be, and rest content ns ith 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 principle 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 is peculiarly well adapted to relieve certain forms of costiveness. 352 Diarrhoea, or Looseness. particularly that of sedentary persons, and may be taken in 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 eff'ect, 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 al bed time, often operates freely next morning DIARRHOEA, 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 irritating 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 of nature to free the constitution from such morbid niattei which, if retained, would produce disorder or disease. On tjns account, the simpler forms of diarrhoea are better left to right themselves, so long as they keep within moderate Diarrlma, or Looseness. 353 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 their 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 model ately 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 the 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 354 Cholera. irritatkig 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, or pieces of jelly, and are mixed with blood, the case is of than 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 as 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 should be worn next to the skin in all these cases. CHOLERA. As we do not propose making this a " historical" work, only a short chapter will be devoted to the subject of cholera, sim- ply giving its symptoms, its manner of propagation, the meant 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 intc activity. Dirt, bad air, bad water, bad food, insufficient cloth- ing, excitement of any kind, and irregular and vicious habits 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 tc Cholera. 355 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 iimbs 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 injurious 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 be ascertained, and its freedom from all decomposing organic matters made certain. Care is also to be observed not to take active purgatives, especially salines, such as Epsom or Rochelle salts, seidlitz powders, etc., which produce watery evacuations ; if aperienj 356 Cholera. medicine is required, it ought to be of a warm character, such as magnesia and rhubarb, with some aromatic, (cinnamon oi 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 one* 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- foric, two tablespoonfuls ; Cayenne pepper, half a teaspoonful. fix, 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 called 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, chloroform, turpentine, or kerosine oil, two ounces of each. Mix and rub over the affected parts with a woolen cloth. Be careful 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 J Dysentery, or Bloody Mux. 357 to k^eh up 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 tiie limbs for cramps. During the prevalence of this disease the greatest care is necessary in regard to cleanliness, ventilation, etc. (See '' How to Preserve Health" in first part of this work). It may be mentioned also that warni bricks or warm stones, irons, or hot salt should be applied to the limbs or body where there is coldness or cramps. An injection up the bowels of half a tea- Epooufnl 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 by heat and thirst, and other symptoms of fever; at others, the 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 6inall 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 is 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 faeee<=(contents of the bowelsj very rarely appearing, the pain and bearing down great, and blood often passing in large quantities. 358 Dysentery, or Bloody Flux. 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 inflammatoryT 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 their contents. In Bucb 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 Mux. 359 Uties. 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 be 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 tho blue mass, combined with ipecac and opium, with frequent frictions of the skin, rest, and properly regulated diet. Many patients, tormented for a long time by this painful malady, have 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. 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 and 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'ace 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 pain of the bowels is constant and severe, the free application of leeches or cups 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 oi essence of peppermint, to be repeated in an hour or so if necessary, will be demanded, and will often arrest the disease almost instantly. The same injection ars recommended above, will also be beneficial when the discharges from the bowels are frequent and copious. After the vomiting and purging are suspended, it will be prudent to administer a dose of calomel, or a pill composed of blue mass ten grains, and opium Diabetes, or Great Flow of Urine. 361 one gram, which may require probably to be repeated on the ensuing day ; the patient at the same time confining himself 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 have stimulants, as brandy or whisky, with small pieces of Ice, and also injections of thin starch and whisky up the bowels 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 stomach. As it is all-im- portant in these cases to put as early a stop as possible to the discharges from the bowels, whith 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, »s 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 whicli usually awakens attention, is the frequent call to pass urine abundantly, at the same time the thirst is extreme. lr. addition to the symptoms already mentioned, the mouth (s 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 svmptom, however, is the discharge of urine, which has been "known to exceed forty pints in the twenty four hours 362 Diabetes, or Great Flow of 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 tc the urine, it ferments, and alcohol is formed, the sugar 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 dietetii treatment of diabetes is probably of more importance than the. 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 spinach, are permitted. Distilled water, oi 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 oiL,' «fec, and if there is restlessness at night, twentv drops of laudanum, or a teaspoonful of paregoric, at bed time. It has been stated by some medical men of eminence that emetics o ipecac, given once a day for a few days, has checked the disease and the patient has recovered. It is worthy of a tria where you can uot have the attendance of a medical man Bloody Urine. 36? BLOODY URINE. Tuts is produced by external violence, as blows, bruises, upposed merely to labor under a strangury, (or difficulty in ?o:aing urine.) By examination of the lower part of the bel ly, and the introduction of the catheter, the disease may, however, almost always be ascertained. Retention of the urine may arise from palsy of the bladder, which is not an unusual occurrence in advanced life. Palsy of the bladder may be owi«g to a person acquiring 364 Suppression of Urine. the habit of not evacuating the bladder when nature promptt him to do so. Retention of urine occurs also in the malignanl forms of typhus fever. It comes on sometimes gradually, with a degree of debility which hinders the patient from com- Sletely emptying the bladder, so that he still feels a desire to o so. The inconvenience increases; at length, the patient is unable to discharge any urine, and the bladder becomes dis- tended. In cases of retention, the urine is to be drawn off by the catheter, and when relief is given by this means, it is not unusual for the bladder to recover its tone; pretty speedily, when the complaint has come suddenly on, and more slowly, when it has been gradual in its progress. In addition to the regular emptying of the bladder by the catheter, we are to try the effect of cold applications to the parts, and of blisters to the lower part of the back. Regularity in the times of passing the urine will have a beneficial effect also. Sometimes ten or twenty drops of tinc- ture of cantharides (Spanish fly,) taken three or four times a day, will excite the bladder to contraction, and the urine be thus thrown off. SUPPRESSION OF URINE. This is a condition of the system in which the urine is not secreted in the same quantities as usual; it is in one respect just the opposite of Diabetes, or too great a secretion of urine. It is mostly a disea^y of old persons. The symptoms are: the patient passes no water, and if the catheter should be introduc- ed, still none passes; the patient complains of feeling " un- well ;" sometimes there is nausea and restlessness at night; if there is much perspiration, it has the smell of urine. The treatment consists in putting the patient into a warm bath for fifteen or twenty minutes; the application of cups over the kidneys, followed by mustard plasters, or warm fo- mentations of hops, flaxseed meal and slippery elm. Give a dose of Epsom salts or castor oil, and also twenty drops of spi- rits nitre in a little gum-arabic water, every hour. Some times a tea (given cold) made of peach leaves, uva ursi or bu elm, and taken freely, will have the most happy effect. Or a strong tea made of Virginia snake-root, given hot, every hour, to produce perspiration, will start the secretion of the kidneys. Strangury—Diphtheria. 305 STRANG UR Y. This is ft frequent desire of making water, attended with . \huch difficulty and pain in voiding it. It arises from various causes, as an inflammation of the urethra, of the neck of the bladder, or of other neighboring parts ; the application of a blaster wdien the matter of the cantharides is taken into the body, the internal use of cantharides in powder or in tincture ; excess in drinking wines or spirituous liquors, or from gravel- ly particles in the passage. It is sometimes a symptom of gout, and very often arises from disease of the prostate gland, /'situated at the neck of the bladder.) When strangury is owing to the application of a blister, the patient should take plentifully of diluent drinks, as barley-water or thin gruel, slippery elm or gum-arabic water; to which a little spirits nitre may be added. In severe cases, fomentations or poul- tices to the urethra and neighboring parts may be required; and it will be proper to use injections to evacuate the bowels, as the accumulation in them will increase the strangury, from whatever cause it originates. If the strangury is an attend- ant on inflammation, it must be treated by local blood-letting, by leeches, by cooling purgatives, by fomentations, the warm bath, &c.; and if from spasm, an opiate (laudanum or pare- goric) by the mouth or by injections, according to age, &c, will be proper and beneficial. DIPHTHERIA. Thts is -a peculiar affection, met with mostly in children, and is characterized by a feeling of great prostration and want of appetite ; paleness, dryness, or a feeling of roughness in the throat; swelling of the tongue and at first, perhaps, a little redness about the palate, &c. This feeling may continue a day or two, or more, before more active symptoms set in. Then, on examining the throat, palate, &c, it will be observed that they exhibit small, white, or yellowish patches, having a lardy or curdy appearance ; there is also at this time swelling of the glands of the throat, some difficulty in swallowing, e tried; or, if too young, let the vapor of burnt tar be inhaled, which can be done by burning the tar in the room. Garglei of oak bark or tar water may be necessary also. A solutior o.i nitrate ot silver, fifteen grains to the ounce, is applied bj physicians, with a sponge or mop, to the affected parts. 367 Polypodium Vulgare, or Common Polypody. (THK ROOT AND TOPS.) This is found in mountains, on rocks, throughout the United States and Canada ; the root has a sweet, mucilaginous taste. This plant is good for colds, coughs, influenza, and worms. Some of the plant stewed in syrup and a tablespoonful given every hour or two, is an excellent thing in colds or chronic cough. United with an equal quantity of liverwort, and made into a syrup, it makes an excellent remedy in diseases of the lung and throat ; to be taken freely every two hours. The root powdered, and mixed with powdered rhubarb, in equal parts, and the same quantity of syrup, given once or twice a day; from ten to twenty grains at» dose, to children, will expel worms after many other remedies fail. I may be used also as a tea, iu colds, etc. 368 inula Ilelenium, or Elecampane. (THE BOOT.) This plant is possessed of pretty energetic tonic properties. It acts likewise as an excitant, owing to the camphorated oil which it contains. It is an. excellent article, in combination with others, in colds and coughs, In pulmonary irritation, (as in consumption, etc), and in some forms of indigestion, when it proceeds from a debility of the digestive organs. It may be given in powder, decoction or infusion. Dose of the powder, from half to one drachm ; decoction or infusion (tea), from half an ounce to one ounce, every three or four hours. 3o9 Hedeoma Pulegipides, or American Pennyroyal. (THE TOPS.) This is found in all parts of the United States and Canada, in dry woods, plains, etc. The fresh or dried plant chewed and the juice swallowed, is good to expel wind from the stomach; made into a tea, and taken warm, it produces perspiration very freely. In case of suppressed menstruation from cold or fright, a tea made of this plant, given warm at bed time, often assists naturj to restore it; taken as a tea, mixed with a little spirits, it is good to cure pains and cramps caused by drinking cold water, suppressed perspiration, etc. The tea should be taken strong, warm, and freely. 370 Sanguinaria Canadensis, or Blood Root. (THE ROOT.) This is an emetic (producing vomiting), narcotic (leducing the pulse and quieting the nerves), expectorant (for cough), etc. It must be used with care, to avoid taking an over dose. It ia recommended in rheumatism, diseases of the liver, typhoid— pheumonia, coughs, colds, etc. Dose, from one to five grains of the root powdered, and given in the form of a pill, every three or four hours, according to the symptoms, disease, etc. 871 Eupatorium Perfoliatum, or Boneset. (THE LEAVES AND FLOWERS.) This is a plant found in most parts of the United States. The whole plant is exceedingly bitter ; taken as a tea, warm, it pro- duces vomiting; taken cold, it acts as a gentle purgative. A wine glass or about a gill of the tea taken cold, half an hour before each meal, acts as an excellent tonic, and will act almost like a charm on some persons who can not take quinine or other tonics. The leaves may be powdered also, and given in mucilage; ten or fifteen grains three times a day, as a tonie and alterative. • Berbiris Vulgaris, or Barberry. (the bush.) This shrub blossoms in April and May; the berries ripen in June. ^The whole shrub, even the root, is acid or sour ; the bark is yellow and bitter. The berries contain a red and very sour juice, that is beneficial in chronic dysentry, or diarrhoea ; also, as a cooling drink mixed with water, sugar, and orange peel, or cinnamon bark ; it is useful in fevers for abating heat and quenching thirst. A syrup may also be made from the berries 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 of the liver. 373 Aralia Racemosa, or Common Spikenard. (the root.) . This grows in deep woods and good soils, from Kew 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 cougha and colds the root may be used freely, boiled in syrup; or i may be used as a tea, cold, mixed with flaxseed-tea, lemonade, or toast-water, when the cough is troublesome. A little piece of the root chewed and the juice swallowed is also beneficial in allaying a tickling cough Cornus Sericea, or Rose Willow (the bark.) This grows near brooks, along the banks of rivers, and on upland meadows; 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- lea, "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 substance or otherwise, in diarrhoea, and dyspepsia. In vomiting, this is an excellent remedy, given in the form of an infusion; in the vomiting particular^ arising from pregnancy. This is a valuable article. It is mostly admin- istered in the form of infusion, or tea, given cold. 375 Lsclepias Tuberosa, or Pleurisy Root. (the root.) This is a valuable popular remedy, and a mild sudorific (causing sweat ing) acting safely, without producing any stimulating effect upon the body. Its action is specifically upon the lungs, to assist suppressed expectoration, and to relieve the difficult breathing of patients laboring under pleurisy. It relieves difficulty of breathing and pains in the chest. It sometimes acts as a mild purgative, and is suitable to the complaints of children. In low 6tages of typhus sfever, and other diseases of a like nature, it has been known to excite perspiration when other medicines have failed. Front twenty grains to a drachm of the root, in powder, may be given several times a day ; but as a diaphoretic (to produce sweating), it is bee* given in decoction or infusion (tea), made in the proportion of an ounce t*. the quart of water, and given in the dose of a teacupful every two or throe hours till it operates. 376 Liatris, or Devil's Bit. Tanacetum Vulgare, or Tansey- (THE BOOT.) (THE LEAVES.) Liatris; or, Deptf's Bit. (The Root.) The root of this plant has a bitterish, pun- gent, spicy taste, and smells like turpentine or juniper. It is a powerful diuretic (acting on the kidneys) yet acting mildly, and may be used freely without danger ; it also acta 69 a diaphoretic, producing perspiration; and is also a tonic, strengthening the system; tt is also good bruised, and applied to ulcers, sores, etc. It is a useful medicine in iropsy, sore throat, gravel, scrofula, etc. A wine-glass full of the tea, or infusion (cold); given every three hours, is good to operate on the kidneys, or taken warm tc produce perspiration; or three times a day (cold) before meals as a tonic ; or ten grains of the powder may be given three times a day in syruo. TanAcetttm Vulgare ; or. Tansey. (The Leaves.) This grows in moist pastures edge of cornfields, and is cultivated in gardens. Given in the form of tea, warm, fcul not too strong, it produces perspiration freely, and is good in debilitated person*; a wine-glass may be taken, cold, three times a day in dropsy, hysterics, and disease oi the kidneys. It is good taken warm to excel wind from the stomach. 37/ Aspidium Filix Mass, or Male Fern. (THE ROOT.) This plant grows in shady pine forests from New Jersey to Virginia ; It is likewise a native of Europe, Asia and North of Africa. It is used as a remedy against tape worm. Dose of the powdered root from one to two teaspoonfuls, given with powdered white sugar, white of egg, beat up, or the thick juice or water of slippery elm ; this dose to be re peated night and morning for two days ; then give a brisk purgative of castor oil, and should that not operate in three hours, give a dose oi Epsom or Rochelle salts 378 Cassia Senna, or Alexandria Senna. (THE LEAVES) This is a very useful cathartic, operating effectually and mildly. It is necessary to combine this article with other in- gredients, such as manna, aniseed, etc., to prevent its griping effects. It is often administered, principally in the form of in- fusion. Infusion of Senna is made thus : Take of Senna leaves. an ounce and a half; ginger root, sliced, a drachm; aniseeds or caraway seeds, a drachm; boiling water, a pint. Macerate (keep warm) for an hour in a covered vessel, and strain the liquor. Take one half for a dose, the balance to be taken in three hours if necessary. 379 Arislotochia Serpentaria, Asclepias Syriaca, o»- or Virginia Snake Root. Common Silk Weed. Arislotochia Serpentania ; or, Virginia Snake Root. (The Root.) This was firsl Introduced as a remedy against snake bites, from which it derives its name, and was used by the Indians for that purpose. It possesses powerful and lasting stimulant virtues; Dut besides this general action, it acts also on the skin, producing perspiration. It is very useful in all cases where there is not active inflammation, in promoting perspiration, especially in typhoid fevers, etc. Dose of the powder, ten to twenty grains, in syrup or flaxseed-tea; or it may be used as an infusion (or tea), which is preferable, putting half an ounce to a pint of boiling water ; of which four or five tablespoonfuls may be givex svery three or four hours. Asclepias Striaca ; or Common Silk Weed. (The Eoot.) This plant, growin plentifully throughout the United States, along roadsides and sandy grounds, is a pow •rful diuretic (operating on the kidneys), and is useful in dropsy. Boil eight ounces oi the root in six quarts of rain water down to three quarts; strain before using. For dropsy, take a gill of this decoction four times a day, increasing the dose, or otherwise, ftccording to the symptoms. It is used the same way for suppression of urine. It may b* taken in powder, twenty to thirty grains three times a day. 380 Crocus Sativus, or Garden Saffron. Ik small doses, saffron is employed as a diaphoretic, soon causing per- bpfaration; in large doses, it acts upon the whole animal economy in the same way as a stimulus. It extends its action considerably to the uterus, (woir.b.) It is useful to allay the lumbar pains (in the back) which ao- eompany menstruation in some females. It is useful also in chlorosis or jreen 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, put half U one drachm, in one pint of boiling water; let stand half an hour; give j wine glass full every two hours. It is very valuable in all eruptive distasovs, •noh as measles, small pox, dec. 381 Hyoscyamus Niger, or Black Henbane. (the plant.) Tme 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 of 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 iiedicines, their doses and uses; and also in the treatmeflt of varions forms of diseases treated of in this work. 382 Scutillaria Laterifolia, or Scull Cap. (the plant.) This is found in all parts of the United States, in meadows, woods, near water, &c, flowering in the summer. It is highly recommended for St. Titus' Dance, given in the form 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 followed the third day by a purge cf castor oil. The plant or leaves may also be powdered, axid given ir doses of from ten to fifteen grains three times 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 pneral, be given late at night, or early in the morning; the bowels not being so easily acted upon during the time of sleep; for this reason pills and other medicines which do not aot 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 hist encouraged by retiring to bed. Medicines for perspira- tion 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, as 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 necessary. 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 news,—remembering that perfect rest to the patient is of great importance. Administer with faithfulness, and in the most palatable state, tbe 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 the nauseating manner in which it is given. Have in readiness a bed-pan, and never suffer the patient hen very weak, to sit up on it long, as in that state thev 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 fuantities at a time; not very cold, as they increase thirst. )rinks 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 the 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 accustomed 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, or soap, or sugar, or oil, and the common syringe is the instru- ment generally used; but the best kind is what is called the Kubber 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 upbear the belly, and then the pipe, with the finger before it, is to be applied to the fundament; and on pushing Their Doses and Uses. 385 t m, 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 bowels by sympathy. C UPPING. This is an operation, so easily performed, and often so im- portant, that all ought to learn liow 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- ing-glass, and set on fire by a candle, when, as soon as it lazes, 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 small quantity of spirit put in the cupping-glass and set on tire 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 ipparatus 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 4cissors. and such stimulating ointment applied, as shall be directed. Basilicon ointment is often used, as also a very weak blistering plaster. 386 List of Medicines. BAND A GES. That most commonly used is a long piece of cotton, linen, or flannel, about three inches wide, rolled up smoothly; its 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 haa 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 kin4 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 will 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. PO ULTICES. The chief object of poultices is to relax the skin over which they are placed and allay irritation. When made of Indian corn 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 in a littl water. In most cases the chief good is derived from th moisture or warm water, which can be fully had by simpl dipping cloths in hot water and applying them, to be ie moved on becoming cold and soaked in hot water agaip 387 Mode of Applying Bandages. (8MBMtp«g«.) How to Apply Bandages. 889 How to Apply Bandages.—The art of applying a bandage well, that is, both neatly and efficiently, require* ■ome practice and attention, but it is often a most useful accomplishment; for a bandage, if required at all, must be properly applied, otherwise it is worse than useless. If, there- tore, 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 rollecfup 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 may be applied in simple circles (B), in spiral, etc., or in reverses (0). Tney 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 com 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 the 390 How to Apply Bandages. spiral bandage be required, the rolls are carried up very obliquely; but if, as most likely, it is the reversed bandage, then wherever the inequality of the paits prevents its being raid 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 ones>, 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 me 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 baud- 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 »oller is exhausted. As a general rule, leg bandages, habit- nally worn, ought to be put on before the individual gets out of bed in the morning. A bandage which gives pain after its 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 ful] length pulled round the limb every time. 301 CLASSIFICATION OF MEDICINES. Tirtt medicines wanted for common use are very few : although such an immense variety is to be found in apothecary shops. They are all arrang- ed under 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 dote; therefore, medi- cines of similar nature ought often, when practicable, be substituted fox the ose previously taken. The doses stated are for adults—the ratio of doses for children will be found under Tabular list of Medicines. PURGATIVES.—Medicines which 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 blue and one white paper, taken on an empty stomach, or the contents of two blue and two white papera 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 beep 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 ■ugar; 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 «vater 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. Scai/imony—In powder; dose from three to ten 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 sulphur with two of cream of tartar, to be taken in a glass of cold water on an empty stomach ; 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 two tablespoonfuls; for children, half the dose. 892 Classification of Medicines. Calomel is not often given alone as a purgative, except in cases of great 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 must always be given in twelve hours to carry off the calomel, to prevent salt- nation. . - . Active or Brisk Purgative—Jalap, ten to twenty grams; 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 teaspoonful; po * dered white sugar, two teaspoonfuls; peppermint or cinnamon water, two ounces; mix these together, and add a tablespoonful or two of castor 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 turpentine, 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, half an ounce; cream of tartar, five drachms; cinnamon bark, half an ounce* boiling water, a pint aud 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; calcined magnesia, ten grains; essence of cinnamon, ten drops. Mix. A good mixture in acidity of the stomach or bowels, when s. 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- spoonfuls 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 cf 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 Iptcac, is given in doses from one to two teaspoonfuls, everj half hour. Tarter Emetic.—Dose, dissolve two grains in four ounces of hot water; a tablespoonful every ten minutes. It is not safe for children. Antimonial Wine—Two teaspoonfuls every ten minutes. White Vitriol, (Sulphate of Zinc.)—Thirty grains dissolved in water, in cases where a speedy emetic is wanted, as in poisoning. Tickling the throat with a feather, will often produce vomiting at onoe. ic cases of poisoning, &c. Ground Mustard—A. teaspoonful or two mixed in a gill of water, ia an active emetic in cases requiring prompt vomiting. Classification of Medicines. 393 LAXATIVE AND PURGATIVE INJECTIONS. For Grown Persons. Take of common salt, a dessert-spoonful; tepid water, or water-gruel, a tnnt; 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 purgative effect, 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 tk« 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 sugar. 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 Watei; one or two teaspoonfuls every 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 * day- , Acetate of Potass—From twenty grains to a drachm three times a day. Nitrate of 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. S/uill—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 mixedin sugar and water, or molasses, and repeated. twice 01 three times a day. „ #i Diuretic Mixture.—Take of sweet spirits of nitre, one ounce; tincture of squill two drachms. Mix. Dose, a teaspoonful five or six times a 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 boll Ing water. Infusion of Juniper Berries in Cider.—Take of bruised juniper berries, mustard seed, and ginger 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. Thi« 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 inflamma.ion is 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 the 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 be 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 tha 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 be laker in an ounce of cinnamon or peppermint water. These combinations of opium should be avoided when the skin is ten 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 by the help of s little alcohol or whisky, and half a grain of opium, made into a oolus • to De repeated only once or twice at the interval of four hours.* Diluted Acetate of Amnu>nia, (Spirit of Mindererus)- From two drachm Classification of Medicines. 895 10 half an ounce, in an equal quantity of water, every three hours. (Spi- rit of mmderefus can be made by dissolving a teaspoonful of carbonate of ammonia in a teacupful of vinegar.) Saline Mixture.—Take of the fresh juioe of lemons, one ounce and t halt; and ot the sub-carbonate of potassa, or chlorate of potash, twenty grains; then add, of white sugar, one or two drachms; of tartar emetic, one grain ; and of pure water, an ounce and a half, and the same quantity of cinnamon water. Dose, a tablespoonful every two hours. This is an excellent prescription in most cases of fever. Diminished doses of Ipecac may also be used to promote perspiration. For Infants and Children. Antimonial Wine—From four to ten drops, in a teaspoonful of tepid water, 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, syrnp, 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 title 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 nitre, three drachms. Mix. A teaspoonful to be taken every three hours. Brown Mixture.—Take of the powdered extract of liquorice and oi powdered gum arabic, of each two drachms; dissolve in four ounces of warm water; then add sweet spirits of nitre, two drachms; tartar emetic, one grain; and laudanum, forty to sixty drops, or paregoric, one tea- spoonful. Mix. The dose is a table-spoonful every four hours. This is a good 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 ipecac, four grains; for eight pills Dose, one every three hoars. 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 grains, ic water. Prepared C/ialk, when the bowels are loose; from twenty grains to two drachms in cinnamon water, or milk. Calcined Magnesia, when the bowels are costive; to be taken tn the same way. The above two articles meeting with an acid in the stomach form 9 neutral salt: that with chalk is bindmg; 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, may be given in milk or any Kqnid, or mixed with the food, in doses of from three to ten grains. ANOD TNES, 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 ma*y be made also by taking equal weights of opium and powdered cinnamon, and forming them into a mass with simple syrup. This mass may be divided, so as to make the pills to contain each one grain 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 symp, 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 tincture may be 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 spoonfuls every two hours, is also good. For Infants and Children. Opiates are so hazardous, that we feel reluctant to sanction the use oi any one of them internally; but from three to ten drops of paregoric, aocording to age, given at bed time, may be considered safe. For external use, Anodyne Balsam, or the uneture of soap with opium, ■robbed on the belly or along the spine, in the quantity of a table-spoonral, 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 the Bowels; after being sure that they are cleared of all rritating matter, as much as possible. Astringent Drops.—Take of tincture of rhubarb, two teaspoonfuls; lauda nam, one teaspoonful. Mix them together. Thirty-six drops to be taken four times a day in a little water. Chalk Mixture.—Take of prepared chalk, one ounce; refined sugar, hall an ounne; mucilage of gum arabic, two ounces. Mix together, and then graduauy add, of water, two pints and a half; cinnamon water, two ounces. Of tLis, a small cupful may be taken four times a day; and if it be 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 boiling 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 hours, when necessary, during a discharge of blood. Other measures at the 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'spowder, ten grains; simple cinnamon water, half 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, fire 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. Tlie 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 ot rhubarb. White Oak and Chestnut Bark, in substance or strong decoction, arc powerful astringents. Gum Kino and Catechu come under this head. The dose of either is from five to ten grains. 398 Classification of Medicines. Lime Water, particularly when acid exists in the stomach, h.w a slmila. effect The dose is a half teacupful, with an equal quantity of milt Common Salt. A table-spoonful has been recommended to stop bleed iug of the lungs. The c-jse may be repeated. Charcoal in powder, in small doses, has an astringent effect upon the 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 Platter to the pit of the stomach. Lime water, a teaspoonful, with the same quantity of milk every tw< 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, four 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 thirty 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 in water or wine—an ounce to the quart—is a powerful t^nic, in doses of two tablespoonfuls three times a day. Gentian Root and Quassia are among the strongest bitters. A very com- mon bitter 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 day. Bitters, in general give tone to the system; and among those most used are— Chamomile Flowers, Hops, Virginia Snake Boot, Horehound, and TF. 5 Nitric Acid. Diluted. Opium...... .... ... Opium, tincture of, or Laudanum......... Paregoric, elixir...... Peppermint, essence of. Poppies, syrup of..... Quassia, tincture of... Rhnoarb Powder..... Rhubarb Tincture.... Rochelle Salt........ Roses, infus., or tea of. Roses, conserve of___ Salts, Glauber's....... Salts, Epsom, purified. Sarsaparilla Powder.. Sarsaparilla, comp'd ) decoction of......j Scammony, powder... Senna, infus. or tea of. Senna, tincture of..... Squill, powder........ Squill, tincture of.___ Sulphate of Quinine . Sulphur, flowers o'.... Tartar Emetic........ 12 to SO drops. I 4 to 6 drops. 1 to 2 grains. j 10 to 35 drops. 1 to 2 drachms. 3 to 15 drops. 2 to 4 drachms. y0 to 60 drops. 20 to 30 grains. 4 to 8 drachms. 6 to 12 drachms. 1 to 2 ounces. 1 to 2 drachms. 6 to 12 drachms. 6 to 8 drachms. 20 to 60 grains. 3 to 4 ounces. 10 to 20 grains. 2 to 3 ounces. 6 to 12 drachms. 1 to 2 grains. 15 to 30 drops. 2 to 8 grains. 1 to 2 drachms. 1 to 6 grains. 3 to 5 drops. 15 to 20 drops. 1 to 2 drops. 1 teaspoonful. 10 to 12 drops. 5 to 8 grains. 1 to 2 drachms. . 2 to 4 drachms. 3 to 4 drachms. % drachm. 1 to 2 drachms. 1 to 2 drachms." 5 to 10 grains. 1 to 2 ounces. 2 to 4 grains. 2 to 3 drachms. 2 to 3 drachms. % to 1 grain. 6 to 10 drops. 3^ to 1 grain. 10 to 20 grains. Mln a glass of water,! (Diseases of kidneys and Scro- ! i 2 or 3 times a day. I ) fula a pm. In water. In water. In water. In water. | In ginger tea, 2 or 3 { times a day. n mint-water. In mint-water. In water. 2 or 3 times a day. 2 or 3 times a day. In mint-water. In water. In mint-water, 3 ) times a day. 3 or 4 times a day. j In mint-water, 3 or 4 | times a day. On an empty stomach. In water. In a pill, twice a day. Mint-water,twice a day j In a pill, or in water, ( 3 or 4 times a day. In honey, once a day In warm water. i .Lteamessuess, Acute Pains, ) Diarrhoea, &c. | To produce sleep, when in I pain. Cough, Asthma, and Cramp. Colicky Pains and Flatulence. Spasms, Acute Pain, and Cough. Dyspepsia and Flatulency. For Costiveness. Costiveness. Costiveness. Dyspepsia, Flooding, &c. Cough. Costiveness, &c. Costiveness, &c. Scrofula, and all impurities of the blood. < Scrofula, and all impurities of ( the blood. Obstinate Costiveness. Costiveness and Worms. Costiveness. Dropsy, Asthma, Chro. Cough. Dropsy, Asthma, Chron. Cough. Ague, and general debility. Diseases of Skin, Piles, Worms. lEmetic and to produce sweat'g. Medicines. Tincture of Cantha-) rides............ ( Tincture of Gentian,) compound, Stough-> ton's Bitters......) Tincture of Gum ) Guaiacum.......j Tin cture Henbane i (Hyoscyamus)... { Tincture of Iron, mu riated.........., Tincture of Jalap.., TinctureOpium, Lau-) danum..........( Tolu, tincture of..... Turpentine, Spirits of Valerian, tincture.... Wine, Antimonial... Wine of Co'.chicum) Seeds...........| Wine of Ipecac......, Wine of Rhubarb___ Doses. How Taken. Uwm Grown Persons. Children front x to $ years. 10 to 30 drops. 1 to 2 drachms. 30 to 60 drops. 20 to 60 drops. •10 to 30 drops. '2 to 4 drachms. 10 to 30 drops. 30 to 60 drops. 15 to 20 drops. 1 to 3 drachms. 4 to 8 drachms. 5 to 50 drops. 4 to 8 drachms. 6 to 12 drachms. 6 to 8 drops. 12 to 30 drops. 5 to 6 drops. 3 to 5 drops. 3 to 6 drops. 1 drachm. 3 to 5 drops. 10 to 40 drops. 1 to 2 drachms. 2 to 3 drachms. 1 to 2 drachms. j Barley water, or in \ gruel, twice a day. In water, 3 times a day. In honey, twice a day. In mint-water. i In a glass of water, \ twice a day. In mint-water. In water. Water, sugar, or honey. In honey, twice a day. In water, 3 times a day. In water. t In mint-water, twice \ a day. In water. In mint-water. Whooping Cough, &c. Dyspepsia and Flatnlence. Rheumatism and Gout. S Spasms, Acute Pains, Nerv-\ ousness. Indigestion, Rickets, Debility. Obstinate Costiveness. 1 Spasms, Acute Pains, Diarr-I hcea, &c. Chronic Cough. Gravel, Rheumatism, Worms. Nervous Headache, &c. Emetic, &c. Rheumatism and Gout. Emetic. Costiveness and Dyspepsia. Mint Water is made by dropping a few drops of Essence of Peppermint into water, and is designed to destroy the nnpleasant taste of the medicine. Cinnamon Water is made in the same way by dropping a few drops of Essence of Cin- namon into water, and can be used the same as the Mint Water by those who prefer it, as convenient and ••leasant to take medicine in. A drachm is about one teaspoonful; a grain is the weight of a grain of black pepper or allspice The Movement Cure. 411 THE MOVEMENT CURE. This new curative treatment, so called, is nothing more than extending into minutice the old principle of the " dwnb-beUs,' Tor giving greater strength to the muscles of the arms, and thereby taking off local irritation existing in the lungs, etc. While we can not admit the wonderful cures said to be per- formed by this treatment, still we have seen cases greatly- benefited by it, and under favorable circumstances is worthy a fair trial, as it can be done in the patient's own room, either alone, or m some cases haying a friend to assist. The following is about the plainest description that can be given for popular use. Active Movements.—The purpose of an active movement, is to convey to, and concentrate upon a selected point, the nutrition and energies of the system. Such a movement may accomplish a two-fold purpose, that of supplying a part, and of relieving another part more or less distant. The mode of effecting this purpose is as follows:—The person to receive the application, is placed in an easy uncon- strained position, sitting, lying, half lying, kneeling, or any convenient position that will suitably adjust all parts of the body to the purpose. The body is fixed either by the hands of an assistant, or by means of apparatus, so as to prevent as much as possible any motion of'all parts of the body, except the acting part. The patient is in some cases directed to move the free part in a particular direction, the effort to do so is resisted by the operator, with a force proportionate to the exertion made—very nicely graduated to the particular con- dition of the part, and of the system at large. The resistance is not uniform, but varies according to the varying action of muscles, as perceived by the operator. In other cases the operator acts while the patient resists. The action is the 6ame, but in one case the patient's* acting muscles are short- ened ; in the other, lengthened. The operation is a sort of wrestle, in which a very limited portion of the organism ia engaged. The motion must be much slower than the natural movement of the part engaged, which fact strongly fixes the attention and concentrates the will. The act is repeated two Or three times with all the care and precision the operator can command, being cautious not to induce fatigue. A perfect rest in the lying position succeeds, of some ten or fifteen min- utes. The changes of matter induced by the movement continue for that length of time, producing an afliux of powei and nutritive material to the part, provided the patient *12 I'oisons and their Antidotes. remains quiet. If, however, other actions be engaged in, i< detracts from and diminishes the effect of the movement. If movements succeed each other rapidly, very much of tho peculiar effects are lost and the operation becomes to a certain extent gymnastic. The effect of a movement if properly applied and received, is to transmit the available force of the system, together with the conditions for its production to the acting part : this part receives what the whole system by the process is made to con- tribute. " Thus a lax, weak, bloodless region is reinforced with fresh supplies contributed by the whole system. Every portion of the body is, in turn, and at proper intervals, sub- jected to similar operations. Such as the fingers, arms, legs, feet, etc. The great point is to commence these manipulations gradu- ally, and end in the same way ; and always follow the partial movements by thorough friction with the hand or a rough towel, and afterwards wrap up the part in a flannel cloth; the under garments should always be flannel or woolen, also. POISONS AND THEIR ANTIDOTES. The effects produced by many poisonous substances, take place with such promptness, that but little time is allowed for the exhibition of remedies, and the patient is often destroyed before the physician arrives ; whereas, had the proper treat- ment been immediately instituted, the fatal result might have been prevented. We shall in this place confine ourselves to a brief account of the leading effects produced by the introduction into the stomach of the various classes of poisons, the antidotes pro- posed for the principal articles of these classes, and the gene- ral medical treatment demanded, in cases of poisoning. Poisons may be divided into the corrosive or acrid (which destroy the parts to which applied), the narcotic (or stupify- ing), and those acting both as corrosives and narcotics. The symptoms resulting from the first class, or acrid poisons, in addition to the particular taste of the article itself, are heat, irritation, or an extraordinary and sudden sensation of dryness, constriction (tightness) and roughness at the root of the tongue, and in the gullet; these are succeeded by vio- lent efforts to vomit, and sharp pains in the stomach and bowels; there is also great thirst, copious discharges by vomiting and stool, attended with much straining, and followed bv hiccup; a sense of constriction across the diaphragm (oi chest), and difficulty of breathing; pain is generally fell Poisons a?id theit Antidotes. 413 about the kidneys, followed by strangury (difficulty in urinat- ing i. convulsions at length come on, or cramps of the hands, troubling of the limbs, extinction of the voice, repeated faini^ iug. cold sweats, and usually a hard and irregular pulse. The narcotic poisons produce the following effects : stupor, numbness, a great inclination to sleep, coldness and stiffness of the extremities, a cold sweat of an offensive or greasy na- tuie, swelling of the neck and face, protrusion of the eyes, with a haggard cast of countenance, thickening of the tongue, frequent vertigo (giddiness), impaired or depraved vision, delirium, general debility, palpitation of the heart, the pulse at first full and strong, afterwards becomes unequal and inter- mittent ; there is also paralysis of the lower extremities, re- traction of the lips, general swelling of the body, and swelling of the veins. At the conclusion of the disease slight convul- Bions and pam are sometimes present. The effects of the narcotico-acrid poisons, such as bella- donna, aconite, etc., are distinguished by a combination of eeveral of the symptoms of both the foregoing classes. There is generally agitation, pain, acute cries, sometimes stupor, and convulsive motions of the muscles of the face, jaws and ex- tremities, and occasionally extreme stiffness of the limbs, and contraction of the muscles of the chest; the eyes are red and starting from their sockets, the pupils frequently dilated; there is often great insensibility to external impressions ; the mouth is full of foam ; the tongue and gums