•:<1 ^L MMift^ «&■-illfr ri"Vji; A &£7J SK*! Library Association,! \sec...\?. Shelf. J...- \j NATIONAL LIBRARY OF MEDICINE Bethesda, Maryland i // // ' ,s » COMPENDIUM of the PRACTICE OF PHYSIC; Pointing out THE 9TMPTOKS, CAUSES, DIAGNOSES, PROSKOSKS, A5U METHOD OF CUBE Of DISEASES. BYE. G. CLARKE, M. D. Of the Royal College of Physicians of London, Physician to the Forces, &c. TBAK8EATED From the original latin, with notes and additions, BY R. W. WORTHEMGTON, Late A Surgeon in the British Navy, and Practitioner of Medicine in the City of Philadelphia. „ PHILADELPHIA: PUBLISHED BY JAMES WEBSTER, NO. 24, BOOTH EIGHTH STREET. T. T0W2J, FRISTBB. 1818. PREFACE. The high estimation in which the original work is held by the faculty of Great Britain and the flattering reception it met with from those for whose service it was principally intended, hath induced the editor to present it in a translated form to his medical brethren in the United States, it appears to be particularly adapted to the students of medicine, as a kind of text book in the lecture room of their professor ; and to the ycung and country practitioner, who at a distance from other aid, may in cases of emer- gency refer to it, as to the opinion and council of an experienced and able adviser. Shall the editor be thought in any \\ i»e to have contributed to the interests and advancement of his profession, his wishes will be abundantly gratified, and his trouble amply rewarded. R. W. WORTHINGTON. a 2 Philadelphia, JVov. 17,1818. SIR, I have looked over the manuscript which you did me the favor to submit to my perusal, and find it, so far as I am able to determine, from so cursory an examination, to exhibit a very faith- ful version of the original work. A Compendium, like this, of the practice of Physic, I have no doubt would be found very convenient by the Medical Class, and among them, will probably meet with a ready sale. Yours, &c. N. CHAPMAN To Dr. R, W. IForthington. INDEX To the Classes and Orders of the Diseases. CLASS I. Pyrexias, or Febrile Diseases. order i. Febres, or Fevers, ... pabe 1 n. Phlegmasia, or Inflammations, - 29 in. Exanthemata, or Eruptive Fevers, - 75 it. Hamorrhagiae, or Involuntary Discharges of Blood, ..... 97 v. Profluvia, or Fluxes with Pyrexia - 117 CLASS II. Neuroses, or Nervous Diseases. order i. Comata, or Soporse Diseases, - 121 ii. Adynamia, or Defect of the "Vital Powers,.....127 in. Spasmi, or Spasmodic Affections, - 133 iv. Yesanise, or Mental Diseases, » - 157 CLASS III. Cachexias, or Cachectic Diseases. order i. Marcores, or Universal Emaciation, 162 n. Intumescentiac, or General Swellings, 165 rn. Impetigines, or Cutaneous Diseases, 170 CLASS IV. Locales, or Local Affections. order i. Dvsesthesiae, or Diseases of the Senses, 189 n. Apocenoses, or Increased Discharges, 193 in. Epischeses, or Obstructions, - - 194 it. Dialyses, or Solutions of Parts, - 200 INDEX To the Diseases. A Amaurosis, or Gutta Serena, - - Page 190 Amenorrhea, or Obstruction of the Menses, - 112 Anasarca, or Dropsy of the Cellular Membrane, 168 Aphtha, or Thrush, - - - - 95 Apoplexia, or Apoplexy, ... 122 Ascites, or Dropsy of the belly, - - 174 Asthma, or Asthma, .... 140 Atrophia Lactantium, or Atrophy from suckling, 163 C Carditis, or Inflammation of the heart, Catarrhus, or Catarrh, - - - - 117 Chlorosis, or Retension of the Menses, Cholera, or Vomiting and Purging, - - 148 Chorea, or St. Vitus*s dance, - 135 Colica, or Colic, .... 146 --------Pictonum, or Colic from Lead, Cynanche Maligna, or Putrid Sore Throat, - 38 --------Parotidea, or Mumps, 44 --------Pharyngea, or Inflammation of the Pharynx, 44 --------Tonsillanis, or Inflammatory Sore throat, 37 --------Trachealis, or Croup, - - 41 Cystitis, or Inflammation of the Bladder, - 63 INDBX. IX D Diabetes, or Excessive discharge of Urine, - 15 Diaphregmatis, or Inflammation of the Diaphragm, Diarrhoea, or Purging, - - - ^ 150 Dysecoea, or Deafness, ... 191 Dysenteria, or Dysentery, ... 119 Dyspepsia, or Indigestion, - - - 128 E Elephantiasis, or Leg swelled like an Elephants, 185 Emphysena, or Emphysema, - - 165 Enteritis, or Inflammation of the Intestines, 58 Enuresis, or Inemtineura of Urine, Epilepsia, or Epilepsy, - - - 136 Epistaxis, or Haemorrhage from the Nose, - 99 Erysipelas, or Erysipelatous Inflammation, - 90 Erythema, or Erythematic Do. - - 31 G Gastritis, or Inflammation of the Stomach, - 51 Gonorrhoea, or Clap, - - - - 181 H Hamatemesis, or Vomiting of Blood, - - 115 Haematuria, or Discharge of Blood by Urine, - 116 Haemoptysis, or a Spitting of Blood, - 100 Hemorrhageae, or a Flow of Blood, 97 Haemorrhois or Piles, - 107 Hectica, or Hectic Fever, - - - 21 Hepatitis, or rhflamation of the Liver, - 56 --------Chronica, orChronic Do. Do. - 58 Herpes, or Tetters, ... - 200 X INDEX. Hydrocephalus, o» Dropsy in the Head, Hydrophobia, or Canine Madness, Hydrothorax, or Dropsy of the Chest, Hypochondriasis, or The Hypochondriac Affection, Hysteria, or The Hysteric Disease, Hysteritis, of*Inflammation of the Uterus, I Icterus, or Jaundice, .... 187 Intermittentes, or Intermitting fevers, - - 14 Ischuria RenaUs, or Ischury with previous disease of the Kidnies, .... --------Ureterica, or Ischury with Disease of the Ureters, .... --------Urethralis, or Strangury with Disease of Urethra, .... ■ Vesicalis, or Strangury with Inflammation of the Bladder, L Lepra, or Leprosy, Leucorrhaea, or the Whites, M Mania, or Furious Madness, - - - 159 Melancholia, or Melancholy Madness, - 157 Menorrhagia, or Immoderate Flow of Menses, 108 Miliaria, or Miliary Fever, - - 1 92 i N Nephritis, or Inflammation of the Kidnies, - 60 170 155 173 131 153 62 186 110 INDEX. XI O Opthalmia Membranornm, or Inflammati on of the membranes of the eye, - - 32 --------Tarsi, or Inflammation of the Tarsus, 34 P Palpitatio, or Palpitation of the heart, - 139 Paralysis, or Palsy, .... 124 Pemphigus, or Aresicular Eruption, - - 94 * Peripneumonia Notha, or Spurious Venipreumony, 49 Peritonitis, or Inflammation of the Peritoneum, Pertussis, or Hooping Cough, - - 143 Pestis, or the Plague, 88 Phlegmasiae, or Inflammations, - - 29 Phlegmon, ..... 29 Phrenitis, or Inflammation of the Brain and Mem- brances, .... 34 Phthisis, or Pulmonary Consumption, - - 101 Pneumonia, or Inflammation of the Lungs, - 45 Podagra, or Gout ... - 68 ------ Aberrans, or Misplaced Gout, - 73 ------—Atonica, or Atonic Do., - - 71 --------Retrocedens, or Retrocedent Do. - 7«R Psora, or Itch, - 202 Pyrosis, or Water Brash, - - - 14S Q Quartana, or Fourth Day Ague, - - 14 Quotidiana, or Daily Ague, - - - Ibid R Rachitis, or Rickets, - - - - 175 Remittens, or Remittent Fever, xn INDEX. Rheumatismus Acutus, or Acute Rheumatism, --------Chronicus, or Chronic, Rubeola, or Measles, - 64 66 81 Scarlatina, or Scarlet Fever, - --------Anginosa, Do. with Ulcerated Sore Throat, .... Scorbutus, or Scurvy, - Scrofula, or King's Evil, Splenitis, or Inflammation of the Spleen, 84 85 183 178 60 Suppressio Mensium, or Suppression of the Menstrual Discharge, - Syncope, or Faintings, Synocha, or Inflammatory Fever, Synpohus, or Simple Continued Fever, Syphilis, or the Venereal Disease, 113 127 16 27 180 Tabes, or Atrophy, Tertiana, or Third Day Ague, Tetanus, or Cramp, Tinea, or Scald Head, Tympanitis, or Tympany, Typhus Gravior, or Putrid Fever, Typhus Mitior, or Nervous Fever, U Urticaria, orNettle Rrash, 163 133 166 23 20 94 Varicella, or Chicken Pox, Variola Benigna, or Distinct Small Pox, ...■ ■ Maligna, or Confluent, Do. 80 75 76 COMPENDIUM OF THE PRACTICE OF PHYSIC, CLASS I. Pyresia, or Febrile Diseases. CHARACTER. A frequent pulse and increased heat succeeding a fit of shivering, many of the functions being disturbed, with prostration of strength, particu- larly of the limbs. ORDER I. Febres, or Fevers, CHARACTER. Preceding languor, lassitude, and other 6igns of debility, witaoutany primary local affection B ! 4 Pyresia?, or Febrile Diseases. CHAPTER I. Intermittents.----The Tertian. SYMPTOMS. The first stage commences with yawning. stretching, lassitude, debility, shrinking of the fea- tures, pain or sense of uneasiness in the back and the extremities, to these succeed chills, shiver- ino- and a sensation of coldness, at first in the back, and gradually over the whole body ; also nausea, vomiting, pains in the head, back, and limbs ; respiration becomes difficult and anx- ious ; the pulse weak, quick, and small, and the urine colourless ; the cold stage gradually "•oino- off, the other succeeds ; intense heat now prevails, the pulse becomes full, strong, and hard, and the breathing more free, but anxious ; the skin red and swollen ; tongue white and dry, great thirst, intense pain in the head and some- times delirium attend, the urine rather red. The.-e symptoms at length subsiding, the third stage commences. A copious sweat breaks out, the urine deposits a lateritious sediment: all the se- cretions are restored, the symptoms are allevi- ated, and on the ceasing of the sweat, are entire- ly carried oft*, debility alone sometimes remain- ing. The paroxysms observe an equal interval of forty eight hours with meridian accessions. In- termittents take place in the spring and autumn. Pyresia*, or Febrile Diseases. 15 Causes. Debility, miasma arising from swamps and marshv grounds, a humid atmosphere, cold ex- ternally applied, contagion, and perhaps the in- fluence of the nioon.t Prognostic. The favourable symptoms are, the paroxysms being regular and not lasting above twelve hours, an eruption appearing about the mouth on the decline of the disease, the urine depositing a se- diment ; the unfavourable are, lethargy, deliri- um, great anxiety, hiccough, swell in j; of the tonsils, obstinate costiveness, oppression and pain in the hypochondriac and epigastric regions during the fit; an aversion to food, or debility accompanied by giddiness in the intermissions ; a thick eruption of itchy spots. -j- This has been assigned as one of the causes of the above fever, though I believe it has not generally ob- tained with practitioners. Others say that the idea is absurd, and attribute it rather to the cold and damp night air, which persons invited by the moon-light and fine nights in hot countries, usually expose themselves to. For information on this subject see Dr. Jackson on the fevers of Jamaica, and Drs. Balfour and land on putrid fevers. This subject affords ample room for much in- teresting enquiry, and will alone be determined by fu- ture experience. 16 Pyresice, or Febrile Diseases. Cure. The stomach and bowels are to be cleansed by gentle emeticst and cathartics, and in the in- termissions tonics, particularly the bark, bitters, and astringents are to be given in large doses; if these avail not, the arsenical solution, sulphate of zinc and preparations of mercury may be made use of; an end may be put to the fit, by giv- ing an emetic in the cold, and a large dose of laudanum in the commencement of the hot stage: if the patient be of a full habit, bleeding is re- quired ; if great debility supercedes, a nourish- ing diet will be requisite, if much coma or deli- Hum arise, blisters and cordials. To guard a- gainst a relapse, the cinhona bark and other medicines of this class should be given at short intervals. The exciting causes must be carefully shunned. Might not ^compression of the femo- f An emetic given immediately before the com- mencement of the cold fit, will often, by its operation, prevent the accession of it, and quickly induce the hot 6t;.ge. The antimon : tartarizat: is the best formula for this purpose, given in large doses. $ Mr. Kellie of the R. N. was the person who first intiodiiced the idea and practice of stopping the circu- lation of the arterial system in intermittents. It has Pyresiar, or Febrile Disease*. J 7 ral or brachial arteries, the §eftusion of cold wa ter, or the anthemis pyrethrun in doses of half a drachm, given frequently, be of service ? Quartan and Quotidian. In these two the paroxysms are similar, save, that in the former an interval of seventy-two hours succeeds each paroxysm ; (which takes place in the evening;) in the latter, an interval of twenty-four hours succeeds a morning parox- since been extensively employed by army and navy sur- geons, many of whom report highly in favour of the practice. The tourniquet should be applied to the fe- moral and brachial arteries of the opposite sides on the instant of the s\Tnptoms of the cold fit being observed, which will thus be suspended and the hot quickly indu- ced, which will be rendered much milder by it. § The joint use of the hot bath and cold effusion has been attended in some instances with the highest effect: on the approach of the cold fit the patient is to be put into the hot bath and to continue there until all chance of the return of the shivering is removed, and then be- ing taken out two or three pails of cold water are to be dashed over him. The cold fit is thus prevented, the hot one either entirely removed or rendered milder • nor do the profuse sweats succeed which generally hap- pen, and tend so much to the exhaustion of the patient. B2 18 Pyresice, or Febrile Disease*. ysm. The method of cure is the same in these as in the tertian, the quartan being more difficult of cure than either of the others. CHAPTER II. Synocha, or Inflammatory Fever. SYMPTOMS. This fever commences with a marked rigor, followed by intense heat, flushing of the face, he;.y the rigors being less intense, the paleness of the skin, absence of thirst, and by all the symp- toms being less severe. Prognosis. The tongue and skin moist, the pulse becoming more slow and strong, after a gentle perspiration or the administration of cordials, pimples ap- pearing about the mouth and nose, a miliary 22 Fyresia*, or Febrile Diseases. eruption without much sweat, deafness and a free flow of saliva without apthae, are favourable symptoms. Delirium appearing soon, and con- tinuing, profuse evacuations with a weak pulse, starting of the tendons, tremor of the hands and tongue, catching at the bed clothes, watchful- ness, dulness of the eyes, blindness, coma, im- peded deglutition, accompanied by hiccoughs are unfavourable symptoms. Cure. Emetics, particularly on the commencement of the attack are never to be omitted, the bow- els emptied by laxatives and' emollient clysters, a nourishing diet, cordials, particularly wine and opium, given frequently in small quantities, small repeated blisters,! foot baths, or fomenta- tions of the legs, particularly if restlessness or watching attend, the body should be sponged with warm water and vinegar -and afterwards wiped dry; oxygen gas may be made use of, the mineral acids, bottled porter, spruce beer, &c. yeast also: a remission being effected, or the f Unless they are intended to remove particular lo- cal affections, their employment had better be dispens- ed with. Pyres'uv, or Febrile Disuse*. 23 tongue and skin becoming moist, the bark is to be freely given. In the exarcerbations which arise on the approach of evening and marked by flushings of the face, increase of thirst and rest- lessness, an effusion of cold water over the na- ked body has been attended with the highest ben- efit, particularly where the heat of the body has been above the natural standard, tcold water is to be drank liberally. May not the Cayenne pepper be given in small doses every two or three hours with advantage, or small quantities of ca- lomel to keep up a gentle eftect, or the arsenical solution ? CHAPTER IV. Typhus Gravior, or Putrid Fever. SYMPTOMS. The rigors in the commencement of this ftva: are more severe than those of the nervous fever, % It is not to be drank if the patient is at all cool. In the hot state of the body nothing can be more grateful and refreshing as also beneficial, but its use must be discontinued when a general sweat breaks out on the body. 24 Pyresim, or Febrile Diseases. and are succeeded by intense acrid heat, the pulse hard, small, and weak, and often irregular, throbbing of the temporal and caroted arteries, great prostration of strength, anxiety of mind and dejection, foreboding of ill, nausea, bilious vomiting of a black or greenish colour, the eyes inflamed and painful, the countenance swollen and ghastly, pains in the limbs, back, and pit of the stomach, the skin parched, with an unplea- sant stinging heat, the tongue at first white, af- terwards black, and dry, unquenchable thirst, with an unpleasant taste in the mouth, the teeth and lips covered with a tenacious scurf, giddiness, ringing in the ears, laborious breathing interrupted by sighing, urine at first pale, afterwards of a dark colour, depositing a brownish and fetid sedi- ment. The disease progressing, delirium, or ra- ther stupor and signs of putrescency shew them- selves, such as petichise, livid spots, welts, ulcers of a black colour about the mouth and fauces, with a difficulty of swallowing, the urine and other secretions tinged with blood, the stools be- come very fetid, and hemorrhages break out from the gums and bowels. Causes. Unwholesome and putrid food, a moist and I'yresiic, or Febrile Disease*. 23 overheated atmosphere, weakness, the effluvia from putrid animal or vegetable matter, a poor diet, immoderate evacuations, excess of venery, contagion. Diagnosis. The symptoms just now detailed are sufficient to distinguish this disease from either the inflam- matory or nervous fever. Prognosis. Clay or brown coloured stools, gentle perspi- ration, a flow of saliva, suppuration of the glands in the neck, axil lee, or groins, eruptions about the mouth and nostrils, stupor, deafness, bright coloured petechise, and the urine depositing a sediment, are favourable symptoms. A want of thirst, abundance of black spots or their sudden recession, accompanied by a faint pulse, livid coloured apthae, inflammation of the fauces, dif- ficult respiration, with an expansive motion of the nostrils, great debility, liquid stools, with a tense state of the abdomen, Wing on the back with the limbs extended, profuse sweats, fetid urine, haemorrhages, deep coma, twitching of the tendons and a cadaverous smell of the body, are fatal symptom-. 26 Pyresice, or Febrile Diseases. Cure. An emetic in the first place, and after a few hours have elapsed, three or four grains of calo- mel in a little conserve or mucilage, daily laxa- tives, as India rhubarb and the like, or mild clys- ters to clear the intestines of the offensive and putrescent matter which is generated, antisep- tics and cordials, as wine, opium, and bark, as in the nervous fever, are to be given liberally : carbonic acid gas received into the stomach and bowels by injection, trefrigerants, as the mineral acids and neutral salts, a nourishing diet, cold ablution or effusion as in typhus mitior, the strict- est cleanliness, the air of the apartment as pure as possible. The disease becoming aggravated, or great debility supervening, small repeated blisters! are to be applied ; purging arising, is to be checked by laxatives, acids, and opium. De- lirium by foot baths, blisters, and fomentations to the legs. | Medicines of this class, particularly nitre, often prove prejudicial by the irritation they produce in the stomach-, if given in such quantities as to have any ef- fect. t If signs of putridity are present, they must not be uia le use of; in fact in this fever they should seldom or Pyresim, or Febrile Diseases. CHAPTER V. Synochus, or continued Simple Fever. CHARACTER. A contagious disease, the fever composed of synocha and typhus ; in the commencement sy- nocha, in the progress and towards the close, typhus. Cure. The treatment of this disease must be guided by the type it assumes, conformably to the rules laid down under the respective heads, but bleed- ing must be resorted to with caution. CHAPTER VI. Remittent Fever. This disease commences with symptoms simi- never be employed. The tendency to gangrene must not be overlooked. Dehrium ma y here be relieved by scther, vinegar, and cold applications to the shaved head, and by camphor, mask, and ammonia internally. As to the debility, 1 do not see how blisters can relieve it. 28 Pyresim, or Febrile Diseases. lar to the intermittent. The cause, and means of cure are the same.t CHAPTER VII. Hectic Fever. CHARACTER. A fever returning daily, with morning and evening paroxysms, the remissions being most apparent in the morning; usually accompanied by profuse night sweats, the urine depositing a branny, brick coloured sediment. It is only symptomatic of jPhthisis, and will be treated of under that head. f In this fever the paroxysms abate, but the fever does not go off entirely: or rather the exacerbations being so quick in succession, time is not allowed for the patient's temporary recovery. + It is symptomatic of chlorosis, scrophula; diseases of the viscera also. ORDER II. Phlegmasia', or Inflammations. Character. Synocha fever, inflammation or topical pain, the function of some internal part, being at the same time injured ; the blood when drawn and cooled, exhibiting a leathery or buffy surface. Of this species are phlegmon and erythema, (or erysipelas.) CHAPTER I. Phlegmon. character. Svnocha, a circumscribed and generally pointed and elevated tumor, with bright redness, frequently turning into abscess ; often accompa- nied by a throbbing pain, and terminating in re- solution, suppuration or gangrene; when it tfr- 30 Pyresiaz, or Febrile Diseases. minates in resolution, the inflammation goes off, the texture of the part remaining entire and sound ; should the symptoms increase, the tu- mor becoming pointed, attended with a pulsation in the part, and frequent rigors, suppuration will ensue, and the matter being formed, the pain abates, the tumor becomes soft, white, fluc- tuating and itchy, and bursts ; gangrene is to be expected by the redness, heat, pain and tension subsiding, and gangrene being established, the part assumes a black and livid colour, with a loss of sensibility, the cuticle being at the same time beset with vesicles. Causes. The application of acrid substances to the part, external injury, extraneous substances lodged in the body, cold and the causes which produce sy- nocha. Prognostic. The greatest danger is to be apprehended, where parts important to life are affected. The disposition to gangrene is marked by the signs above enumerated: greater danger .ittends inter- nal than external inflammation. Pyresiaz, or Febrile Diseases. 31 Cure. To promote resolution, the antiphlogistic re- gimen is to be strictly enforced; bleeding, ac- cording to the strength of the patient, and vio- lence of the symptoms ; leeches to the part affec- ted, cathartics, diluent and cooling drinks, dis- cutients externally, as the acetate of lead, vine- gar, &c, suppuration to be promoted by emol- lient poultices and fomentations ; gangrene to be checked bv tonics and antiseptics, of which the most efficacious are opium, wine, bark, musk, and the subcavbonate of ammonia in large doses. CHAPTER II. Erythema, (or inflammation of the surface with- out an accompanying affection of the system. SYMPTOMS. A shining redness of the part affected, vanish- ing on pressure, but quickly returning ; a swell- ing scarcely perceptible, attended with a sharp, burning pain, spreading irregularly over the neighbouring parts, term'^ating in scales or vesi- cle*, rarely in gangrene. 32 Pyresiaz, or Febrile Diseases. Cause. Acrimonious matter applied to the skin, or thrown out on it from the internal parts; any thing that relaxes the system. Cure. A low diet; the topical application of pow- dered starch, or the impure oxide of zinc, if symptoms of inflammation arise, bleeding, lax- atives, and diluent drinks are to be employed. CHAPTER III. Opthalmia membranorum, or Inflammation of the membranes of the Eye. SYMPTOMS. Redness of the tunica adnata, heat and pain in the eye, with the sensation of a fly or thorn -.ticking in it, effusion of tears, intolerance of light, sometimes violent fever. It is idiopathic or symptomatic. Causes. External injury, foreign bodies lodged in the eye, metalic fumes, inversion of the eye-lashes, Pyresiaz, or Febrile Diseases. 33 drunkenness, a strong light, scrofula, small-pox, syphilis. Cure. If the affection be idiopathic, general and topical blood letting, scarification of the vessels of the adnata, purging, blisters behind the ears, avoid- ing all irritating causes, particularly a strong light, topical applications, as acetate of lead, preparations of zinc, &c, mixed in cold water, opium internally, and a solution of it to the eyes, the antiphlogistic regimen: should erysipelas at- tack the parts affected, tonics, as bark, the cold bath.^and ablution of the eyes in cold water &c. astringents, as alum, are to be used ; where symp- toms of lues venerea present, the preparations, of mercury; when scrofula, tonics, hemlock, cha- lybeate waters, and externally a cataplasm of the sour sorrel or of alum,t an ointment of the nitrate of mercury, and the like must be used. j The white of an egg coagulated, by stirring in.it a bit of alum, forms an excellent cataplasm for this pur- pose. 34 Pyresiaz, or Febrile Diseases. CHAPTER IV. Tnflammatio tarsi, for inflammation of the tar- sus. Character. To the signs mentioned in the preceding chap- ter are to be added, a swelling df the tarsus, an erosion and glutinous exudation, the inflamma- tion of the adnata less violent. Cure. The means of cure the same as in the former case, except that the ulcerations require the pre- parations of copper, mercury and zinc : the ad- hesion of the eyelids during sleep may be pre- vented by besmearing them with the tutty or spermaceti ointment. CHAPTER V. Phrenitis or inflammation of the brain and its membranes. SYMPTOMS. Violent fever, intense pain in the head, redness •f the face and eyes, ringing in the ears, fierce- Pyresiw, or Febrile Diseases. io ness of the countenance, intolerance of light and sound, watchings, extreme delirium, violent raving, throbbing of the temporal and'carotid ar- ticles, difficult respiration, dry and brown tongue, pulse generally quick and hard, though sometimes soft. Causes. The remote causes are all those which pro- duce svnocha, violent passions of the mind, exposure to the sun, excess of drinking, blows on the head, very hot weather, night study : the proximate cause is an affection of the brain itself or membranes. Diagnosis. It is distinguished from mania by the violent fever, and from synocha, by the excessive deli- rium attending the commencement of the attack. Prognosis. The favourable symptoms are, universal 9weats, copious diarrhoea, bleeding from the nose, the urine depositing a sediment; the unfavoura- ble are a dark coloured vomiting, white or clay coloured stools, the pupils of the eyes dilated, and insensible to light, continual mastication of the 36 Pyresiaz, or Febrile Diseases. saliva, foaming at the mouth, picking at the bed- clothes, the eyes watering as if filled with dust, determined refusal of drink, difficulty of swal- lowing, tremors, convulsions, twitching of the tendons. Succeeding to pneumonia it is fatal. Cure. Copious and repeated! bleedings, from a large orifice, that a quantity of blood may be lost in a short time; leeches and cupping glasses applied to the temples, purging, blisters to the head, pre- viously shaved, the antiphlogistic regimen, diluent drinks, external applications .as cloths wetted with vinegar and water applied to the temples; great debility supervening, a few drops of lauda- num are frequently to be given, the body to be kept in the erect posture.^ ■j- The blood had better in the first instance be drawn from the temporal arteries, (or jugular veins if possible) and in considerable quantities. + From its acknowledged action on the arterial sys- tem, may we not expect much advantage from the em- ployment of digitalis in this affection ? Pyresicc, or Febrile Diseases. 37 CHAPTER VI. Cynanche Tonsillaris, or Inflammatory Sore Throat. SYMPTOMS. Pain, swelling and redness of the mucous membrane of the fauces, particularly of the ton- sils difficulty of swallowing, a sense of con- striction of the throat, dryness of the mouth and fauces, pain in the internal ear, a constant and difficult excretion of mucus, synocha fever, or a swelling commonly appearing in one tonsil, and then disappearing and occupying the other. The inflammation sometimes proceeds to such height, that the breathing becomes impeded. Causes. All such as produce inflammation, cold applied to the neck, great vocal exercise, stimulating substances sticking in the throat, childhood. Diagnosis. It is distinguished from the malignant sore throat by the greater strength of the pulse, by the fever, which in this is synocha, in the other typhus, and by the absence of ulcers. n 38 Pyresiaz, or Febrile Diseases. Prognosis. It is most frequently terminated by resolution or suppuration, rarely by gangrene; slight fever, free respiration and external swellings, are fa- vourable symptoms. Cure. Topical blood letting, emetics, particularly in the commencement, blisters and strong liniments to the neck, cleansing the bowels, by calomel es- pecially, the antiphlogistic regimen, astringent gargles, inhaling the steams of hot vinegar and water. If suppuration should threaten, fomen- tations and cataplasms must be employed; if suffocation should be feared, scarifications of the tonsils, inhalation of aether and hot water, or bronchotomy. CHAPTER VII. Cynanche Maligna, or Putrid Sore Throat. SYMPTOMS. Frequent shiverings, nausea, anxiety, and vo- miting, are the first indications of this disease. These are very shortly followed by stifthes? in Pyrseice, or Febrile Diseases. 39 the back of the neck, uneasiness in the fauces, and hoarseness, the fauces are dry and swelled, deglutition difficult. Presently white, or ash co- loured spots spreading and running together, ap- pear on the affected parts and cover the fauces with thick scales ; these falling off, small ulcers show themselves underneath; now an acrid cory- za pouring forth a fetid humour, excoriates the lips and nostrils ; tchildren are troubled with di- arrhcea. The fever progressing, the pulse be- comes small, quick, and irregular, the breathing sonorous aud hoarse. The symptoms on the ap- proach of evening become aggravated, and remit towards morning, great prostration of strength, delirium and coma supervene ; on the 2d or 3d day the skin on the face and neck becomes co- vered with blotches of a bright red colour, spreading and at length covering the whole body, the hands and extremities of the fingers become rigid and swollen. The eruption about the fourth day generally disappears and the cuticle peels off, the fever on the accession or recession of the eruption is seldom diminished ; the disease pro- f Occasioned by their inability or unwillingness to gargle their throats, and swallowing the acrid secretion from the ulcers, which of course, in its passage through fHe intestines, will cause gripings and looseness. 40 Pyresiaz, or Febrile Diseases. ceeding, signs of putridity appear, and the pa- tient is carried off between the 3d and Tth days. Cause. Contagion.^ Diagnosis. It is distinguished from cynanche tonsillaris by the pulse, by the swallowing being less difficult, by the ash coloured spreading spots, by the hoarseness, and by the type of the fever. Prognosis. The danger is to be estimated by the violence of the fever and tendency to gangrene, a livid colour of the ulcers, the breath and discharge from the nostrils smelling fetidly, profuse diarr- ho?a, delirium and coma continuing, great anxie- ty and restlessness portend a fatal termination. The favourable symptoms are a kinder appear- ance of the ulcers, a remission of the fever on the appearance of the eruption, and another on its scaling off, slight and general perspiration, the scales falling oft* from the fauces, sleep, a de- sire for food and other such favorable signs re- turning. * Also, a moist State of the atmosphere, and a relax- od habit. Pyresiaz, or Febrile Diseases. 41 Cure. Repeated emetics, laxatives, or gentle clys- ters, should the4state of the bowels require; pu- tridity is to be prevented by bark, wine, opium, antiseptics, and stimulating gargles, especially cayenne pepper and rattle-snake-root, repeated blisters,! foot baths, the greatest cleanliness, a free admission of cool air, and the other reme- dies as spoken of in typhus. The fetor of the ulcers is best removed by the frequent injection of a solution of alum in water, half an ounce of the former to one pint of the latter. Might not the cold effusion be of benefit ? CHAPTER VIII. Cynanche Trachealis, or Croup. SYMPTOMS. It chiefly attacks children about the time of weaning, but sometimes adults, with a dull hea- f Blisters are not admissible in this disease, they are apt to give rise to pustules, which in the progress of the disease often become ulcerous from the general pu- trid tendency, and the patient is subject to danger from gangrene. Stimulating linaments or embrocations should be substituted. r/2 42 Pyresiaz, or Febrile Diseases. vy pain in the upper part of the trachea, gene- rally without any apparent swelling, a cough or a shrill hoarseness accompanying the speech as if the voice proceeded from a metalic tube, which may be compared to the sound of a French horn. To this succeeds a difficulty of respiration with a wheezing inspiration, a short, interrupted and generally dry cough; if at any time an ex- pectoration comes on, a purulent matter mixed with membranous films is thrown up, the face be- comes livid and red, great thirst prevails, with an unpleasant sensation of heat, and restlessness ; the power of sw allowing is more or less impeded, generally no morbid appearance is visible in the fauces, but sometimes a swelling or redness, the urine at first clear, afterwards turbid, the pulse quick and weak, synocha fever ; the patient en- joys his functions unimpaired, and is sometimes carried off by strangulation. Diagnosis. It is easily distinguished by the peculiar sound of the voice, and the sense of strangulation about the larynx. Prognosis. A very difficult respiration with a wheezing Pyresiaz, or Febrile Diseases. 43 sound, great restlessness, and violent fever, are bad omens ; an expectoration of the filmy mat- ter, free respiration, voice not much altered, are fav crc rabl e symptom s. Cure. Leeches are to be applied as near as possible to the part affected, emetics to excite vomiting and nausea, stimulating embrocations, refrige- rants, and gentle purgatives, inhaling the steam of warm water, the warm bath, antispasmodics, as musk, assaftetida, etc. When tadults are at- tacked with this complaint, blood letting, and the remedies under the head of synocha must be in- stantly resorted to. Might not the submuriate of mercury in frequent small doses, or the rat- tle-snake-root, or mezeron to excite at first vo- miting, and afterwards nausea, or discharge by stool, be of service ? f Bleeding has been advised only in adults, but it should be employed also in children, even the very young. Digitahs promises to be an useful remedy, and should therefore be given, though not to the preclusion of general and topical blood-letting. Small doses of Do- ver's powders when the inflammatory symptoms have subsided will be beneficial, by producing sleep, a gentle ^phoresis, and a remission of the spasmodic aiii.ctioi». 44 Pyresiaz, or Febrile Diseases. CHAPTER IX. Cynanche Pharyngea, or Inflammation of the Pharynx. SYMPTOMS. Redness in the posterior fauces, deglutition greatly impeded and very painful, respiration easy, synocha fever. It arises from the same causes as cynanche tonsillaris, and requires a similar method of cure. CHAPTER X. Cynanche Parotidea, or Mumps. SYMPTOMS. A large external swelling of the parotid and maxillary glands, appearing at first in the angles of the lower jaw, respiration and deglutition be- ing somewhat impeded, accompanied generally with synocha fever. On the iumours receding, the breasts in fema'es and the testes in males become affected. Prognosis. Violent pyresiee or phrenitis succeeding to the retrocession of the tumours in the breasts or tes- tes is a bad omen. Pyresiaz, or Febrile Diseases. 45 Cure. In general the antiphlogistic regimen is alone required, but if on the retrocession of the tu- mours in the breasts or testes, the pyresise should increase, with signs of phrenitis or stupor, fo- mentations to the head, blisters, and the other remedies adapted to those affections must be em- ployed. CHAPTER XI% Pneumonia, or Inflammation of the Lungs. SYMPTOMS. It commences with rigors, shiverings, increased heat, and the other symptoms of synocha; after the lapse of a few hours, the symptoms about to be described succeed ; a fixed pungent pain in the side, but sometimes an obtuse one with a sense of weight, most commonly between the sixth and seventh ribs, and darting through between the scapulee and thence to the clavicle and sternum, a constant difficulty of respiration, increased by inspiration, and often not to be effected un- less the body be placed in the upright posture. The lying on the affected or sound side is pain- 46 Pyresiaz, or Febrile Diseases. ful, but less so when on the back, a great or less degree of cough accompanies from the com- mencement. There is at first a trifling expecto- ration, afterwards the matter thrown up by spit- ting varies in colour and is often tinged with blood, the face becomes tumid and of a purple colour, anxiety and restlessness prevail, the pulse becomes frequent, full, hard, and increased, but sometimes soft and slow. It is terminated by resolution, suppuration, gangrene, effusion, or exudation from the internal surface of the lungs. Under the title of pneumonia are inclu- ded pleuritis and peripneumony. Causes. The remote causes are certain seasons of the year, as winter and spring, a sanguineous tem- perament, a diminished or sudden suppression of perspiration, the time of life between 40 and 60,t violent exertion of the lungs, the causes indu- cing synocha, vicissitude of heat and cold, for- mer diseases. The proximate cause is inflamma- tion of the pleura or lungs. f This will apply more particularly to peripneumom.v notha. Pyresiaz, or Febrile Diseases. 47 Diagnosis. It is distinguished from hepatitis by the pain induced by lying on the affected side, by the pain not being increased by pressure, by the hiccough, and by the situation of the part affected. Prognosis. Violent pyresia, difficult respiration, cough frequent and violent, aggravating the pain, the pain translated from the one to the other side, increased anxiety and restlessness, delirium, the respiration being suddenly checked and hurried, are unfavourable symptoms. A free expectora- tion of a thick yellow matter slightly tinged with blood,t unaccompanied by a violent cough, he- morrhages from the nostrils or hemorrhoidal veins, a bilious diarrhoea, the urine depositing a sediment, or an erysipelatous eruption coming out on the surface are favourable symptoms. The inflammatory symptoms continuing till the fourteenth day, but somewhat moderated, denote a result in suppuration, a remission of the pain and spitting, slight rigors, hectic fever, increased cough and dyspnoea, the lying on the affected j This is not exactly the case. The presence of matter although tinged with blood, may be said to be more favourable than the total absence of any expectoration. 48 Pyresiaz, or Febrile Diseases. side being most easy, with a sense of weight in the thorax, confirm the fact of suppuration. The symptoms of effusion, inducing suffocation, are the respiration being suddenly shortened and hurried, and not to be performed unless in the erect posture, the pulse being weak and very frequent. Cure. A sudden and copious substraction of blood, repeated according to the violence of the attack and strength of the patient, leeches or cupping- glasses applied to the part, repeated blisters to the thorax, gentle laxatives and mild enemas, warm diluent drinks, gratefully acidulated, mu- cilaginous demulcents, the antiphlogistic regi- men, emetic medicines, as the antimonial tartar or ipecacuanha, in such reduced doses as to create nausea only, expectorants, the steams of hot water received into the lungs by the mouth, pediluvia. If the cough be very troublesome, the difficulty of respiration and all fever being removed, opiates may be given with the highest advantage. In cases of effusion or empyema, the digitalis should be used. Might not the pre- parations of mercury with small doses of opium to excite a slight salivation, be useful ? Pyresiaz, or Febrile Diseases. 49 CHAPTER XII. Peripneumonia Notha, or Spurious Peripnixi- mony. SYMPTOMS. Alternate fits of heat and cold prevail, lassi- tude, a moist cough, an expectoration of a dark and viscid phlegm, obtuse pain, or rather a sense of weight and straitness in some part of the tho- rax, great pain in the head, sometimes a vomit- ing, difficulty of breathing, flushing of the face, vertigo or drowsiness, commonly none or a mild fever. Cause. The time of year, as spring and autumn, ad- vanced age, sudden changes of the weather, for- mer catarrhs. Diagnosis. It is distinguished from pneumonia by the mildness or total absence of the fever, by the pain, heat and thirst being less urgent, from asthma, by the difficulty of breathing being less violent, and by its not recurring by intervals* jO Pyresiaz, or Febrile Diseases. Prognosis. Violent pyresia coming on suddenly is attend- ed with the greatest danger.t Cure. Blood-letting:): is generally prejudicial unless the difficulty of breathing and sense of oppres- sion are urgent, emetic medicines in such doses as to exeite nausea, successive blisters applied to the thorax, gentle laxatives and enemas, diluents, expectorants, and the warm bath, should be used« May not digitalis be given ? Carditis is distinguished from this disease by the intermitting pulse, syncope, and palpitation. Diaphragmatis is accompanied by pain about the lower ribs, encompassing the abdomen above the lumbar region like a belt, the respiration being very difficult, the abdomen being quiescent, the thorax alone being affected, by perpetual deli- rium and by the sardonic laugh. f As also an increase of the difficulty of breathing ; lioarseness, and coldnesss of the extremities. } The inflammatory symptoms sometimes appear to demand this evacuation, whilst the tendency of the dis- ease to effusion, point out a different treatment. Our rare should be to obviate the tendency of those symp- ottis which threaten the more immediate danger, Pyresiaz, or Febrile Diseases. J i Peritonitis is accompanied by pyresiae, by u pain of the abdomen increased by the erect pos- ture, without the symptoms of the other abdoini nal inflammations being present* These diseases demand a similar mode of treatment as doe; pneumonia. CHAPTER XIII. Gastritis, or Inflammation of the Stomach. SYMPTOMS. An ardent, fixed, and pungent pain in the re- gion of the stomach, much increased by any thing being received into it, as also by pressure, severe vomiting, distressing hiccoughs, acute constant pain about the prsecordia, great prostration of strength, hard and small pulse, constant thirst,. acute continued fever ; the disease continuing, a suppression of urine takes place. Causes. Cold water drank when the body is over-heat- ed, external violence, acrid substances, over- distension of the stomach, repelled eruptions. 52 Pyresiaz, or Febrile Diseases* Diagnosis. The pathognomonic symptoms are a burn- ing pain and ttumour of the epigastric region, tormenting vomiting and eructation, great pros- tration of strength, hiccough. Prognosis. If the pain decreases gradually, and the pulse becomes more full and soft, resolution is to be expected. Suppuration is to be feared when the symptoms although more mild, (accompanied by rigors and remission of the pain) continue beyond the 7th day, the anxiety and sense of weight re- maining. If notwithstanding the employment of the proper remedies, the pyresia, pain, and heat increase, gangrene is to be expected ; the srgns of its having taken place are a cessation of the pain and heat, and a flaccidity of the epigas- tric region, a very quick and intermitting pulse, increased debility, delirium. Cure. A copious and repeated subtraction of blood, f This is not always the case, though in some instances a tumour or distension may be perceived. It would ap- ply rather to inflammation of the epigastric muscles-. Pyresiaz, or Febrile Diseases. J3 (the smallness of the pulse must not deter ust) afterwards leeches, cupping glasses and blisters, are to be applied to the part: fomentations to the abdomen, pediluvia, laxative and emollient clysters, mild diluents in small quantities,^ in those cases where the pain and vomiting return by intervals, opiates. The erysipelatous inflam- mation is accompanied by the following symp- toms : a sense of heat, pain in the stomach, vo- miting, anxiety, loss of appetite, slight fever; sometimes an erysipelatous eruption appears in the fauces, which is often diffused through the k whole alimentary canal, at the same time an un- usual sensibility exists in the stomach to all acrid ingesta; bland and warm diluents are alone re- quired, unless another species of gastritis should ■j- BloodJetting is here employed to increase the vo- lume and strength of the pulse, and it must be repeated in proportion to the effect thus produced in each former instance. ^ \ In some-cases where the irritation has been veiy se vere, the happiest effects have been produced from the administration of lime water and milk, in the dose of a wine glass full frequently; it will be found to allay the irritation, and at the same time afford some nourishment to the patient. E 9. 54 Pyresiaz, or Febrile Diseases. threaten ; if :t should attend on putrid diseases*, acids, antiseptics and tonics, must be used. All other remedies failing, may we not try the cold bathrt CHAPTER XIV. Enteritis, or Inflammation of the Intestines. SYMPTOMS. An acute, fixed, and burning pain in the ab- domen, increased by pressure, a general tension, particularly about the umbilicus, nausea, vomit- ing, great thirst, the bowels obstinately costive, acute fever, quick, hard, and contracted pulse, urine very redr sometimes a hiccough. Cause. It originates from the same causes as gastritis. from strangulated hernia, the iliac passion, colic. cold applied to the abdomen. f In cases where acrid substances taken into the stom- ach are the cause of the disease, the vomiting must be solicited, and the remedies best adapted to counteract the effect of such substance be given ; and afterwards cathartics to earn- off the offending matter from thr intestines. Pyresiaz, or Febrile Diseases. 55 Diagnosis. It is distinguished from hepatitis by the ab- sence of the darting pain at the top of the shoul- ders ; from gastritis by the twisting and turning pain about the navel; from colic by the fever and pulse. Prognosis. The pain not being stationary but ceasing gra dually, the belly less tender to the touch, the bow- els answering to the injections, hot and profuse sweats, the pulse full and soft, and a copious flow of turbid urine, are favorable symptoms. The un- favorable symptoms are, a severe twisting of the bowels, the abdomen tense and receding from the touch, the bowels obstinately bound, suppres- sion of urine, paleness about the lips, constant hiccough, delirium, twitching of the tendons, convulsions. Cure. General and topical blood-letting, laxatives, by the mouth, emollient clysters, refrigerants, fo- mentations to the abdomen, the semicupium, blis- ters, mild diluents, or opiate injections, or the cn\d bath in the last extremitw 56 Pyresiaz, or Febrile Diseases* CHAPTER XV. Hepatitis, or Inflammation of the Liver. SYMPTOMS. Fever, heat, tension and pain in the right side, often pungent, as in pleurisy, sometimes dull, and increased by pressure on the liypochondrium, pain at the clavicle and in the top of the right shoulder, pain in lying on the left side, difficulty of breathing increased on inspiration, generally a dry cough, anxiety, nausea, bilious vomiting, the bowels mostly costive, urine small in quanti- ty and very red, sallowness of the face and eyes, a frequent, strong, and hard pulse, hiccoughs. When the convex surface is the seat of the dis- ease, the pain is more severe and lancinating, greater tension, and a tumour is often observable, and the dyspneea and hiccoughs are more violent. Where the concave surface is affected, the pain •is less pungent, the breathing more free, but the anxiety, nausea, and vomiting are more urgent. Causes. Are those which produce inflammation, tuber- cles, schirrosity, adhesions of the liver, external Pyresiaz, or Febrile Diseases. 57 violence, biliary concretions in the ducts and gall bladder, depression of the mind, hot cli- mates. Diagnosis. It is distinguished from pneumonia by the pain being less acute, and by its ascendance to the clavicle and right shoulder, by the increase of pain on pressure, by the pain occasioned by ly- ing on the left side, by the bilious vomiting, the cough and dyspneea being less violent, by the formation of a tumour, and the seat of pain; from enteritis, by the absence of the contractile pain about the umbilicus. Prognosis. The danger must be estimated by the tenden- cy to suppuration or gangrene, the approach of which will be judged of by the preceding symp- toms ; haemorrhage from the nose or heemorrhoi- dal vessels, copious sweats or a bilious diarrhoea, often terminate it happily. Cure. General and topical blood-letting, blisters to the part affected, mild cathartics and enemas, fo- mentations, diluent and refrigerant drinks, an- timonial tartar in such doses as to excite nausea, the antiphlogistic regimen. The disease inclin- 58 Pyresiaz, or Febrile Diseases. ing to suppuration, if the abscess should point externally, cataplasms and fomentations are to be used. In the East Indies the mode of cure consists of the employment of tnitric acid, or the external use of Jmercury till a salivation is excited. CHAPTER XVI. Hepatitis Chronica. CHARACTER. This disease often affords no peculiar symp- toms by which it may be distinguished; some- times however, we may suspect it to be present from certain symptoms having preceded, and •}- The lutro-muriatic acid bath has been employed by some practitioners in the East Indies, and lately in Eu- rope, by many of whom it has been spoken of in the highest terms; however its use seems more adapted to the 2d or chronic stage. $ Many practitioners urge the use of mercury consti- tutionally in the early stage of acute hepatitis, but I be- lieve in this stage, its use should be confined to its ca- thartic action. Pyresiaz, or Febrile Diseases. 59 from a sense of weight and fulness about the hy- pochondrium and from pain more or less pungent being felt in the part occasionally, by pain on pressure in the right side or by lying on the left side, and lastly from some fever accompanying the above symptoms. Cure. Mercury is to be employed externally and in- ternally, until a salivation is excited, by tonics and bitters conjoined, especially the bark and preparations of iron. May not the nitrict or ni- trous acid be of service ? f Dr. Scott, who has had extensive opportunities of practice in the East Indies; remarks :—" For this chro- nic affection, it appears to me, that the nitro-muriatic acid applied to the skin is the most effectual and safest remedy. A few hours, or even a single hour, will some- times bring relief; but it is necessary to continue the remedy till the system be sufficiently affected by it, and to repeat it occasionally until the patient has recovered his usual degree of strength." The nitro muriatic acid is formed by mixing equal quantities of nitrous or nitric acid and muriatic acid. As to the strength of the bath, it should generally be as strong as weak vinegar, but it must be regulated by the effects on the skin of the pa- tient, as must also the time that he stays in the bath, by the effect on his feelings: from ten minutes to half an 60 Pyresiaz, or Febrile Diseases. CHAPTER XVII. Splenitis, or Inflammation of the Spleen. CHARACTER. Fever, tension, heat, swelling, and pain in the left hypochondrium, increased on pressure, without any signs of nephritis. It will be easily distinguished from any other disease by the symp- toms above mentioned, and the cure effected by the methods under the head of hepatitis. CHAPTER XVIII. Nephritis, or Inflammation of the Kidnies, SYMPTOMS. Fever, an acute pungent pain, but oftener an obtuse one in the region of the kidnies, frequent- ly following the course of the ureter, a frequent flow of slightly discoloured or very red urine, a vomiting of bile, frequent eructation, stupor of the legs, retraction of or pain in the testicle of the same side. hour, according to the debility or strength of thp bather. may be a proper period to regulate by. Pyresiaz, or Febrile Diseases. 61 Cause. All the general causes of inflammation pro- duce this disease, acrid diuretics, wounds and contusions of the kidnies, constant violent ex- ercise on horseback, indurated fieces in the co- lon, constant lying on the back, translated or atonic gout, calculi. Diagnosis. It is distinguished from lumbago by the fre- quent flow of urine, by the pain following the course of the ureter, and by its not being increas- ed by the erect posture; from calculus, by the fever accompanying the first attack of pain. Prognosis. The pain ceasing gradually, copious and mu- cous urine, universal sweat, a flow of blood from the hemorrhoidal vessels, portend a favora- ble termination of the disease. A pulsating pain in the part, augmented by sneezing, increased fever, a frequent desire to make water, strangu- ry, the pain ceasing suddenly, hiccough and de- lirium, are unfavorable symptoms. Cure. General and topical blood-letting, mild laxa F 62 Pyresiaz, or Febrile Dseases. fives and repeated enemee, bland diluents, ru- befacients, fomentations, the semicupium, the antiphlogistic regimen, gentle diaphoretics, as the antimonial tartar and the like, in small doses; the fever and pain being much alleviated, opiates. CHAPTER XIX. Hysteritis, or Inflammation of the Womb. SYMPTOMS. Fever, heat, tension, swelling and pain, of the hypogastrium, the mouth of the uterus pain- ful on pressure, strangury, tenesmus, vomiting, the bowels at first bound, afterwards loose. Prognosis. Great prostration of strength, flushing of'the face, frequent rigors, and a tension of the abdo- men are unfavorable symptoms : a mild perspi- ration, a flow of the lochia, the abdomen les? tense, and a secretion of milk are favorable symptoms. Cure. General and topical blood-leHino;, fomento- Pyrexias, or Febrile Diseases. 63 tions to the abdomen, mild diaphoretics, as the ipecacuanha or antimonial tartar join-id with opium, gentle laxatives, bland diluents, a mild and nourishing diet.t CHAPTER XX. Cystitis, or Inflammation of the Bladder. SYMPTOMS. Fever, a constant burning and frequent pain in the organ, a tumour, a frequent painful void- ance of urine or a strangury, vomiting and tenes- mus. Causes. All those producing inflammation, a calculus, inflammation of parts in the vicinity of the blad- der, etc. f Where the inflammation does not speedily give way to these means, we should cease the fomentations and apply a large blister to the abdomen, previously co- vered with camphor, to prevent its occasioning stran- gury ; and diluent mucilaginous drinks should be given freely, 64 Pyresiaz, or Febrile Diseases. Cure. The same means are to be employed as in he- phritis, but diluents in sparing quantities.! CHAPTER XXI. Rheumatismus, or acute Rheumatism. SYMPTOMS. Fever, acute lancinating pains about the joints, following the course of the muscles, frequently wandering, and occupying the knees and greater joints oftener than the joints of the feet or hands, increased also by heat and motion, swelling, red- ness, and tension of the affected part, urine very red, bowels constipated, pulse frequent, full, and hard, the blood when drawn exhibiting a buffy crust; on the approach of night all the symp- toms are aggravated. Causes. Plethora, sudden changes of weather, cold j If a calculus be ascertained to be the cause of the Inflammation, it should be removed by the operation of lithotomy. If we suspect schirrosity to exist, we should give the extract conii, or hyoscyami, in conjunction with our other remedies. Pyresiw, or Febrile Diseases. 65 -applied to the body when heated, spring and autumn, inflammation of the membranes and tendinous aponeuroses of the muscles. Diagnosis. It may be distinguished from gout by the^ pain following the course of the muscles, and by * no affection of the stomach existing antecedent -to the attack. Prognosis. It is in general happily carried off by a copi- ous and universal sweat, by the urine depositing a lateritious sediment, by diarrhoea, by heemorr- hage, or by a cutaneous eruption. Cure. The antiphlogistic regimen, general and topi- cal blood-letting, mild cathartics and enemee, re- frigerants, particularly the neutral salts, diluents, diaphoretics, such as the antitnonial tartar in small doses, the liq. a-.mon. acet. and Dover's powders; the pain becoming stationary, rubefa- cients and tWisters to the parts, tblood-letting f They should not be applied till the inflammation Ljj been much reduced. $ !t must be remembered that blood-letting is notin- 66 Pyresiaz, or Febrile Diseases. must not be carried beyond certain bounds, for it will then protract the recovery. Might not the digitalis be useful, or^bark particularly, if the disease should assume the intermittent type, and after the primee viae have been cleared by antimonial preparations ? t CHAPTER XXII. Rheumatismus Chronicus, or Chronic Rheuma- tism. SYMPTOMS. After acute rheumatism, violent exertions or a sprain, pains of the limbs and muscles arise, tended to remove the pain, but for the purpose of allay- ing the general excitement'; and though the pains should become more severe, yet on the abatement of the fever a further abstraction of blood is not warrantable- The buffy appearance of the blood need not be attended tcj as it is not found to be diminished by bleeding. -j- Cold applications, as the muriate of ammonia ir cold water or vinegar and water, may in cases where the inflammation is confined to particular joints, be re- sorted to with infinite advantage. Though this practice -■T-ould be dangerous in gout it is not so in this disease Pyresiaz, or Febrile Dseases. 67 greatly increased by motion, more or less wan- dering, alleviated by becoming warm in bed or by other external heat, the joints are weak, pale, rigid, easily and often becoming cold, no fever, and generally no swelling, Causes. Former acute rheumatism and most of the causes producing that disease. The proximate cause is atony, rigidity and contraction of the muscular fibres and extremities of the vessels. Cure. Internal stimulants, as rectified spirit of tur- pentine, gaiacum, anthemis pyrethrun, horse- radish and mustard: tonics, especially bark; ex- ternal stimulants-, friction, electricity, exercise, the warm bath, external heat, rubefacients, blis- ters, diaphoretics, as ipecacuanha and opium, opium and calomel, of each a grain every even- ing for the space of ten evenings ; mercury, so a> not to produce a salivation. •jS Pi/Vtiias, or Febrile Disease*. CHAPTER XXIII. Podagra or GouU SYMPTOMS. An hereditary affection arising without any external evident cause, but generally preceded by an unusual affection of the stomach, general- ly coming on about the second hour of the mor- ning, with pain in the joint of the great toe, but sometimes in the heel or ancle as if the bones were luxated, and a sensation as of warm water thrown on the affected part: presently a rigour, shivering and pyresia succeed, but the pain is increased (the cold and shivering decreasing) until a crisis is formed on the follovving.night; it then ceases gradually, and the patient covered with a light sweat, falls asleep, on awaking from which he perceives the affected part occupied by a swelling and redness ; for some days the fever and pain increasing towards evening, returns, but goes off towards morning; a loss of appetite, rigor of the whole body on the approach of eve- ning, languor, and a sense of lassitude accompa- ny the paroxysm. On the recession of the fit an Intolerable itching with a desquamation of tht Pyresiaz, or Febrile Diseases. 69 cuticle attacks the affected foot: the attack go- ing off, the patient for a length of time enjoys good health. Causes. The predisposing causes are an hereditary predisposition, plethora, advanced age, excess of venery; the occasional causes are an immode- rate use of animal and high seasoned food, also a free use of wine and other spirituous liquors, in- tense study, a sedentary inactive life, suppressed evacuations, a large head, constant anxiety, vio- lent exercise, particularly walking, cold applied to the inferior extremities. Diagnosis. It is distinguished from rheumatism by the pain attacking and continuing in the lesser joints, if when it is translated from the great toe of one foot, it attacks the other; by the swelling and redness of the part affected; by the previous af- fection of the stomach. Prognosis. This disease is rarely attended by danger, un- less the stomach, head and parts essential to life, are affected. 70 Pyresiaz, or Febrile Diseases. Cure. General venesection is mostly improper. Leeches to the part affected may sometimes be useful; but the best remedies are flannel and patience, a total abstinence from all kinds of animal food and spirituous drinks, unless the for- mer habits of life, or symptoms of atony re- quire otherwise; if swelling or stiffness remain after the fit, the flesh brush is assiduously to be employed. In the intervals, abstinence from fermented liquors, moderate exercise on foot or on horseback, cathartics, of castor oil, aloes, rhubarb, sulphur, soap, and the like, to obviate costiveness; tonics, as the bark, quassia, pre- parations of iron and the alkaline salts ; the vi- olence of the symptoms being abated, opiates. The disease appearing in a young subject when the strength is not much impaired, may not blood letting, mild laxatives, emetics, and ex- posure of the part affected, to the cold air, be employed ? Pyresiaz, or Febrile Diseases. 71 CHAPTER XXIV. Podagra Atonica, or Atonic Gout. SYMPTOMS. A tonic gout, with derangement of the stomach or some other internal part, and either without the expected or accustomed inflammation of the joints, or with slight and wandering pains only, and with dispepsia and the other symptoms of atony oftentimes suddenly alternating, the bow- els sometimes bound, at others loose, with colic pains, the thoracic viscera sometimes affected, producing palpitation of the heart, syncope and asthma, the encephalon being affected, head-ache vertigo, apoplectic and paralytic, affections are produced. Cure. A studious avoidance of all the causes w hicji give rise to debility; moderate exercise, the cold bath, if the body is stimulated by its use ; a moderate use of animal food, of wine free from acid, and of spirituous liquors diluted with wa ter, tonics and cathartics, as mentioned in the preceding affection are to be employed. Symp- 72 Pyresiaz, or Febrile Diseases. toms of dyspepsia are to be relieved by the mil- dest emetics: issues should be inserted, and cold be avoided. CHAPTER XXV. Podagra Retrocedeus, or Retrocedent Gout. SYMPTOMS. The inflammation attacks the joints in a simi- lar manner as before mentioned, but the pain is not so severe, neither does it continue so long a time, nor does it decrease gradually, but cea- ses suddenly, the affection attacking some inter- nal part; than which none more commonly than the stomach, whence arise anxiety, great sick- ness, vomiting, a violent pain, and a sense of coldness; the heart is sometimes affected, whence syncope; sometimes the lungs, whence asthma; and sometimes the head, whence apo- plexy or paralysis. Cure. If the stomach is affected, it must be instant- ly relieved by warm wine and aromatics given freely: if these should not prove sufficiently Pyresiaz, or Febrile Diseases. 73 powerful, ardent spirits, sulphuric ether, spirit, ammon, succinat, and the like must be used; when the attack is not very violent, the tinct-. asafoetida, carbonate of ammonia, musk, the opi- ate confection, &c. If vomiting should accom- pany, it is at first to be excited by hot wine and water, then by pure wine, afterwards opiates must be given: if diarrhoea arises, light broth, and afterwards opiates : if the lungs are the part affected, opiates, antispasmodics and blisters; when it attacks the head, blisters are the most probable remedies, and issues or setons in the neck and extremities ; the legs should be rubbed with flour of mustard ; and aromatics, as the car- bonate of ammonia, and the like should be given. CHAPTER XXVI. Podagro Jlherrans, or Misplaced Gout. CHARACTER. Inflammation of an internal part, the inflam- mation of the joints either not preceding, or pre- ceding, and suddenly receding. c 74 Pyresiaz, or Febrile Dseases. Cure. In this case the disease is to be treated by bleeding, and the other remedies adapted to the idiopathic inflammation of such part, t f This species of gout appears to be a form of some of the phlegmasia supervening in a gouty habit. It should be treated as such, observing however that in this case evacuations must be more cautiously entployed than in other subjects. Pyresaz, or Febrile Diseases. 7.7 ORDER III. Exanthemata, or Eruptive Fevers, CHARACTER, Contagious diseases, generally affecting the subject but once in his life, commencing with fe- ver ; at a certain time numerous small eruptions appearing scattered over the skin. CHAPTER I. Variola benigna, or Distinct Small-pox. SYMPTOMS. About the middle of the day a nausea, vomiting and drowsiness come on, with chilliness, fever- ishness and languor, followed by heat and pain in t'»e head, back and epigastrium (particularly Hi Pyresiaz, or Febrile Diseases. where pressed on by the fingers;) on the ap- proach of the eruption, children are sometimes attacked with convulsions: generally on the third day, certain distinct pustules arise, at first on the face, afterwards on the other parts of the body; and the symptoms are then alleviated, on the fifth day the eruption being completed, they cease altogether; the pustules become more co- nical every day; at first they are dully white then of a yellow colour; the skin between them being very red : the face swells and the eyes are sometimes closed, about the eleventh day they attain their full size, and then fall off in crusts : the swelling of the face now subsides, and the hands and feet become swollen. When the pus- tules are very numerous, a difficulty of swallow- ing, hoarseness, and a salivation comes on about the sixth or seventh day, and the fever reappears about the tenth day; but the whole of these symptoms go off entirely on the subsidence of the swelling of the face and drying up of the pustules. Cause. Specific contagion* Pyresiaz, or Febrile Diseases. 77 Diagnosis. The pain on pressing on the epigastrium and the other symptoms will distinguish the above from all other diseases, particularly should it rage epidemically.t Cure. The antiphlogistic regimen is to be strictly enforced ; cold and pure air must be freely ad- mitted; mercurial cathartics before the sixth day are to be administered, cold water and refrige- rating diluents made grateful by acids are to be allowed liberally; fomentations to the legs; if a phlogistic diathesis be present,! venesections and | The chicken pox is the only disease likely to be confounded with the present one, in the former, the pustules generally recede without suppurating. They differ also in number size and appearance as will be noticed hereafter. * Topical blood-letting may be employed with pro- priety Jwhere coma, dehrium, severe inflammation of the eyes and great difficulty of breathing prevail, but severe bloodletting is an hazardous practice, the fever which in the first stage is synocha, will suddenly degenerate in- to typhoid if the antiphlogistic treatment be too fn*c'v ~nrc ployed. g2 T8 Pyresiaz, or Febrile Diseases. emetics; if convulsions should come on, opiates; if on the perfection of the eruption much fever should arise, mild cathartics, and antimonials to excite nausea, must be used; if the fauces should become much swollen, gargles and blisters to the neck; if great debility supervene, bark and wine; after the fifth day, opiates may be given once or twice a day, with great advantage." CHAPTER II. Variola Maligna or Confluent Small Pox. SYMPTOMS. In this a violent pyresia and an almost constant yomiting, precede the eruption, a frequent weak and contracted pulse and sometimes convulsions accompany; a diarrhoea sometimes precedes the eruption, and continues for a day or two after its appearance ; mostly on the second day nume- rous pustules show themselves irregular in shape, pale and slightly elevated, and the vesicles coales* cing, after the appearance of this eruption all the Pyresiaz, or Febrile Diseases. 711 symptoms, save the vomiting, continue, in the progress of the disease the febrile symptoms increase, and delirium or coma supervene ; the face becomes much swollen, and a great difficulty of swallowing and a salivation arises ; in chil- dren a diarrhoea supersedes the salivation ; the pustules progressing to maturity, become full and flacid; their tops are depressed and appear black ; they never proceed to true suppuration, but pour forth an humour and fall off in brown or black crusts, leaving pits in the skin ; erysipe- las often precedes or accompanies the eruption : in violent attacks of the disease, petechiae, bloody urine and haemorrhages appear. Prognosis. An acute pain in the side or stomach after tiie eruption ; the swelling of the face suddenly sub- siding, the pustules on the face and breast run- ning much together great difficulty of breathing or swallowing; great prostration of strength : haemorrhages and other signs of putridity are unfavourable symptoms. Cure. The strength is to be supported by bark, 80 Pyresiaz, or Febrile Diseases, wine, opium, the mineral acids, cordials and nourishing diet, and blisters and the other reme- dies adapted to typhus are to be freely employed. If before the eruption comes out the skin should be pieternaturally hot, and the other symptoms of the disease very violent, may not the coldt affu- sion be used, or an emetic if danger of strangula- tion exists ? CHAPTER IIL Varicella or Chicken Fo.i. SYMPTOMS. Pustules breaking out after a short febrile affection, as those of the small pox, but seldom proceeding to suppuration; after a few days continuance falling off in scabs and leaving no mark. -j- The cold regimen should be here also adopted from the first attack. The employment of it and the cold affu- sion must however be entirely regulated by the temper- ature of the patient, or by carrying it too far. we may do n.cch mischief. Pyresiaz, or Febrile Diseases. 81 Diagnosis. It is known from small pox by the lightness ol the fever, by the eruption in the first instance appearing on the back,t and by its scaling off in four or five days. Cure. This affection is devoid of danger, rarely re- quiring the aid of a physician ; the desquamation being completed, a gentle cathartic may be ad- ministered. CHAPTER IV. Rubeola or Meazles. SYMPTOMS. Pyresia; alternate chills and heat precede the attack: a want of appetite, vomiting and often a diarrhoea ; from the commencement, most gene- rally a dry cough, hoarseness, difficulty of breath- ■}■ This is not always the case, but when it occurs it is an excellent distinguishing mark, as the small pox al- ways appears first, in the face, neck or breast. 82 Pyresiaz, or Febrile Diseases. ing, sneezing, heaviness of the eyes, continual drowsiness, a discharge of an acrid humour from the eyes, with swelling heat and redness of their lids with a flow of mucus from the nose accom- pany ; anxiety, oppression of the chest, and a painful itching of the face immediately precede the eruption : small red spots resembling the bites of fleas generally appear on the face on the fourth day, gradually running together, scarcely raised above the skin, and diffusing themselves over the whole body, after six days falling off in small perfuraceous scales. The symptoms save the vomiting are not alleviated by the coming out of the eruption but continue through the course of the disease, and the desquamation being completed, the fever, dyspnaea, cough drowsiness and other symptoms become aggravated and a diarrhoea arises. Cause. Specific contagion. Diagnostic. The sneezing, discharge from the nostrils,eyes.. cough and dyspnoea will distinguish this disease from all others. Pyresiaz, or Febrile Diseases. 83 Prognosis. The fever and difficulty of breathing being slight, the eruption appearing early, a gentle diarrhoea, moderate perspiration, a liberal and copious expectoration are favourable symptoms. The unfavourable are a vomiting continuing after the appearance of the eruption; inflammation of the lungs attended by a symptomatic diarrhoea; great lassitude; severe fixed pains antecedent to the eruption, constant pain in the head and eyes; petichiae; papulae suddenly receding, especially if pneumonia, affection of the throat, or delirium should succeed. Cure. General and topical blood-letting according to the violence of the fever, cough and difficulty of breathing, but it is seldom required before the desquamation takes place; cathartics as the phosphate of soda, supertartrate of potash, and senna, tamarinds, &c, laxative enemas, mild diaphoretics, as the antimonial tartar in nausea- ting doses: the neutral salts, warm diluent drinks, bland demulcents, mild expectorants, 84 Pyresiaz, or Febrile Diseases. foot baths, tblisters to the side and between the shoulders; if an inflammatory diathesis should not exist, opiates; the disease having now its course, repeated cathartics : if symptoms of pneu- monia should supervene, venesection and the other remedies adapted to it: if a diarhraa should be troublesome,! blood-letting: if signs of putridity should appear, bark, wine, aromatic confection, &c. are to be liberally employed. CHAPTER V. Scarlatina or Scarlet Fever- SYMPTOMS. It generally appears on the approach of winter, | If we employ them under the idea of removing the fever we shall be constantly disappointed; but to re- move particular local affections as difficulty of breath- ing, pain in the side etc. their employment will be very serviceable. t It is a remarkable fact that blood-letting will often remove certain symptoms remaining after measles, which under other circumstances it has no controul over, as cough unaccompanied by inflammatory symptoms diar- rhoea etc. Pyrexiaz, or Febrile Diseases. 85 with fits of heat and cold, and the other symp- toms of synocha, on the fourth day the face be- comes somewhat swollen ; a florid redness soon after covers the whole skin at length forming large coalescing stains, after the third day chang- ing into perpuraceous scales, anasarsa then super- vening several times and generally going off quickly. Cure. The antiphlogistic regimen; the extremes of heat and cold being avoided: or the desquama- tion being perfected, purgatives ; if convulsions should arise in children, blisters and opiates* CHAPTER VI. Scarlatina Anginosa or Scarlet Fever ivith Ul* cerated sore Throat. SYMPTOMS. Unwonted lassitude, dejection, head-ache, con- striction of the throat, rigidity of the muscles of the neck; shivering chills, and the other symp- toms of pyrexia show themselves; on the second day a difficulty of swallowing; loss of appetite; K S@ Pyrexiae, or Febrile Diseases. nausea and sometimes vomiting supervene ; res- piration becomes oppressed interrupted by sighs, the breath is hot and burning, the skin dry, hot, and pungent and great restlessness prevails ; the pulse frequent, small and weak; the bowels na- tural : the tonsils become swelled, red, and some- times covered with white crusts; generally on the third day a bright redness covers the whole body, vanishing on pressure but quickly return- ing; the skin becomes glossy and swollen ; some- one s a few broad livid spots appear about the breast; after the third day a desquamation of the cuticle takes place, anasarsa then often super- vening. Cause. Contagion. Diagnosis. It is distinguished from measles by the ab- sence of cough, discharge from the nose, flow of tears and sneezing: from small pox, by the ab- ' sence of pain on pressing on the epigastrium. Prognosis. Delirium, the eyes inflamed and glossy, the efflorescence appearing suddenly, and diarrhoea, are unfavorable symptoms, Pyrexia or Febrile Diseases. 87 Cure. Blood-letting is generally prejudicial; the re- peated employment of emetics is of the highes\ advantage; cordials, as the contraycrva, cam- phorated mixture, &c, diuretics, as the carbon- ate of potash and ammonia, gargles, diaphoretics, particularly the antimonial tartar in small doses., to excite nausea; the pediluvium, warm bath and antiphlogistic regimen; afterwards the bark, and preparations of iron : if debility with coma, should continue, blisters ; in adematous swelling*, squills, submuriate of mercury, alkaline salts, and digitalis, and this affection being removed, tonics, as bark, wine, and the preparations of iron, a nourishing diet and exercise. Might not the coldt effusion or the vegetable and mineral acids be of service r a gentle diaphoresis being pre- viously excited. f The propriety of the use of the cold effusion would appear to be more doubtful in this than in other fevers. Dr. Currie however in his work on this subject men- tions his having employed it several times, by mistaking the disease and that in each case so treated, the dli ease that followed was singularly mild. 88 Pyrexiaz or Febrile Diseases. CHAPTER VII. Testis, or the Plague. SYMPTOMS. It generally commences in the same manner as Typhus Fever, the cold paroxysm generally attacks the patient more violently than in the continued fever, great heat of the internal parts prevails, the patient is affected with a writhing of the body, mental derangement, tinnitus aurium, confusion of the head like ebriety, the countenance expressive of horror, the eyest red, wandering, and prominent, violent pain in the head, watchful- ness, delirium and sometimes coma accompany, great prostration of strength, dejection and anx- iety supervene, oppression at the chest, difficult respiration, constant nausea and bilious vomitings, and a bilious fetid diarrhoea, harass the misera- ble sufferer : the pulse is frequent, weak and ir- regular, sometimes however it is more hard and full; the thirst is immoderate ; the tongue gene- f The eyes are not red as in other fevers, but assume a very remarkable and 6ingu!ar appearance, being muck dy and at the same time lustrous. Pyrexiae, or Febrile Diseases. 89 rally white, but sometimes black; the urine pale and bloody or red and turbid : buboes sooner or later, (with a preceding itching of the part) vibi- ces, carbuncles and petechia appear, and the patient is seized with faintings, twitching of the tendons and convulsions. Cause. Contagion. Prognosis: The favourable symptoms are, the patient's strength not being much depressed, a light univer- sal sweat with a strong and regular pulse, allay- ing the anxiety nausea and vomiting; the ap- pearance of buboes and carbuncles attended by a remission of the feve*: The unfavourable symp- toms are; immoderately intense heat, profuse debilitating sweats; an early appearance of large black petechice; great and sudden prostration. Cure. Bleeding is to be cautiously employed; emetic medicines at first to excite vomiting and after- wards nausea ;t diluents ; refrigerants ; the anti- t Siline cathartics should now be administered, ii 2 90 Pyrexia? or Febrile Diseases. phlogistic regimen ; the greatest cleanliness and continual ventilation of the apartment; bark wine, and other tonics adapted to Typhus gravior; cold water is to be drank liberally ; anointing the whole body with olive oil: or perhaps the cold effusion ? or mercury so as to produce a light salivation ? CHAPTER VIIL Erysipelas. SYMPTOMS. Pyrexia, accompanied by drowsiness, delirium or coma; the pulse frequent full and hard: on the second or third day an eruption of a florid colour appears, vanishing on pressure, its course being irregular, spreading over the face and cov- ering the neck, an evident swelling sometimes closing the eyelids, a burning pain terminating in scales or serous vesicles of the cuticle; on the appearance of the inflammation in the face, the fever does not always remit, but often increases with the inflammation, and continues for eight or ten day*; the eyelids sometimes suppurate; the coma and delirium increasing, the patient dies on the seventh, ninth, or eleventh day- Pyrexiae or Febi*ile Diseases. 9\ Cause. Increased sensibility and irritability; cold; acrid substances applied to the surface, suppres- sion of accustomed evacuations, former attacks of erysipelas. Diagnosis. It is distinguished from scarlatina auginosa, by the pain, redness and swelling of the fauces and tonsils. Prognosis. Violent fever; coma or delirium are unfavoura- ble symptoms ; the disease is favourably termina- ted without any evident crisis taking place. Cure. If an inflammatory diathesis prevails, blood- letting; emetics to excite vomitingt and nausea; the antiphlogistic regimen, diluents, topical appli- cations as oatmeal, starch, cabbage leaves, etc. if delirium or stupor should prevail fomentations f In erysipelas of the face emetics are perhaps dan- gerous or at. best very dpubtful remedies. ^2 Pyrexiae or Febrile Diseases. and blisters to the head, if signs of putridity ap- pear, wine, opium and bark, the head must be kept erect, if gangrene should threaten, may not musk and the carbonate of ammonia in large doses ? or bark in considerable quantities in every stage of the disease be given with advantage? CHAPTER IX. Miliaria or Miliary Fever. SYMPTOMS. Synochus ; oppression at the chest, anxiety, frequent sighing, rank sweat, a pricking sensation of the skin ; on an uncertain day of the disease numerous small red spots of the size of millet seeds, break out on all parts of the body except j the face, their points after a day or two forming into little, white pustules which continue a short time and fall off in scales. Causes. Debility : a stimulating regimen, the period of child-birth. Pyrexia or Febrile Diseases. 93 Diagnosis. It may be distinguished from all the other exanthemata by the rank odour of the sweat. Prognosis. Petechiee appearing between the pustules great debility or signs of putridity, the eruption strik- ing in, and delirium or coma supervening, are un- favourable symptoms. Cure. The low regimen ; a free admission of cool air, if debility or putrid symptoms attend, bark, wine, opium and blisters, if an inflammatory diathesis is present,! venesection &c. ■J- Mild cathartics will answer our intention in this case, particularly when aided by laxative injections, which will be far preferable to blood-letting, as not tending so much to induce that debility which we wish particularly to guard against 94 Pyrexiaz or Febrile-DicaseSi CHAPTER X. Urticaria or Nettle Rash. CHARACTER. On the second day of the fever red blotches like the stings of nettles, disappearing in the day time and returning with fever in the evening and after a few days terminating in minute scales. Cure. The antiphlogistic regimen; it scarcely ever requires the aid of medicine, after the desquama- tion has taken place, a gentle purgative should be given. CHAPTER XI. Pemphigus or vesicular Eruption. SYMPTOMS. Pyrexia; on thet second or third day of the attack small vesicles arise on the internal and ex- f The vesicles are not as regular in their appearance and course as the above sentence woidd imply. In some cases they have not appeared till the fourth and fifth days disappearing aftfir some days ^on+iriuanco. Pyrexicc or Febrile Diseases. 95 ternal parts, of the size of almonds, preceded by an itching and filled with a yellow matter, con- tinuing three or four days, and at lengtht pour- ing out a thin ichor. Cure. The primae viae are to be evacuated by an emetic and purgative ; afterwards tonics, cordials, antiseptics, and gargles are to be administered. CHAPTER XII. Apthaz or the Thrush. CHARACTER. The tongue somewhat swollen; a purple co- lour of the tongue and fauces, eschars at first ap- pearing in the throat and on the outer edges of the tongue, occupying the whole of the inside of the f The ichor is as often absorbed as discharged. A decoction of radishes sweetened with honey may be given to children with a two-fold advantage, as it will act on the eschar in the mouth and all through the alimentary canal and will be taken by them v, itholit trc: ble or disgust. 96 Pyrexiae or Febrile Diseases. mouth, and sometimes the alimentary canal, of a white colour, sometimes distinct, often running together, falling off and quickly reforming and continuing for an uncertain period, generally attended with slight fever. Cure. Absorbents ; mild laxatives; emetics are some- times useful, topical applications, as two scruples or a drachm of borax to an ounce of honey, of which a little is to be applied frequently with a camel's hair pencil: should the disease become worse, cordials, bark, opiates, and blister? Pyrexiaz, or Febrile Diseases. 9' ORDER IV. Hemorrhagic or Involuntary discharge? of Bfood. CHARACTER. Pyrexia with a flow of blood not caused by external violence ; the blood discharged exhibit- ing similar appearances, as in Phlegmasia. CHAPTER I. Hemorrhagia or^a Flow of Blood. SYMPTOM9. More or le^s of the following symptoms pre- cede the flow of blood ; fullness, tightness, heat, or sense of weight in the part, or its vicinity, sometimes a slight, at others a severe sense of t 98 Pyrexiae, or Febrile Diseases: coldness comes on, accompanied by rigors and shivering, sometimes by nausea and vomiting: these symptoms gradually subside and a preterna- tural increase of heat succeeds, the pulse becomes full, frequent, hard and strong, and a gush of blood takes place, which exhibits an inflamed appearance. Cause. Universal plethora; diminution or suppression of the accustomed evacuations; a depraved forma- tion of the parts, violent passions of the mind, external heat, violent exercise, ligatures, every thin"- which accelerates the circulation of the blood, the external application of cold. Cure. The antiphlogistic regimen is to be strictly enforced ; external heat must be carefully avoid- ed, refrigerants, particularly acids, the nitrate of potash and infusion of roses, cold drinks, blood- letting, emetics, blisters., astringents^, particularly | The acetate and other preparations of lead should have been noticed, they being the most powerful and valuable astringents we know of, but caution is neces* sary against a long continuan( <* of them they should I5e Pyrexia?, or Febrile Diseases. 99 alum, catechu, and external cold, must be employ- ed, the inflammatory symptoms being allayed, oph ates: its return is to be guarded against by a more spare and less nourishing diet, by moderate ex- ercise, particularly on horseback, or sailing; by gentle purgatives, avoiding the remote causes, and by equanimity of temper. CHAPTER II. Epistaxis or Haemorrhage from the Nose. CHARACTER. Pain or a sense of weight in the head, red- ness of the face, itching of the nostrils, with a flow of blood from the nose. Cure. When it is not critical it is to be restrained by »n erect posture of the body and head, by pres- sure on the nostrils, by immersion of the head in combined with some tenacious substance to guard against their effects on the stomach and bowels. Digitahs is also a valuable remedy and should be used in doses suited tc fhe urgency of the symptoms-. 100 Pyrexke, or Febrile Diseases. cold water, in which some muriate of soda has been dissolved, by bits of rags sprinkled with flower Or alum and* inserted into the nostrils, by- avoiding all irritation, its return is to be pre- vented by issues and by the methods before* 'tientioned.t CHAPTER III. Hemoptysis or a Spitting of Blood. CHARACTER. Redness of the cheeks; a sense of oppression or pain and sometimes of heat in the breast, espe- f A blister to the back of the neck will put a stop to a violent and obstinate haemorrhage from the nostrils and should therefore be early employed. Though we may succeed in stopping the external flow of blood, the patient is often in danger of suffocation from the inward haemorrhage continuing, or vomiting will be induced in consequence of the quantity of blood received into the stomach; here it is necessary to employ pressure from behind, we must pass a pliable eyed ptobe armed with strong silk threads through the nostrils into the throat and eatching the thread with the forceps tie bits of sponge firmly to them and draw them up behind the uvula, till we find they are in contact with the bleed- ing vessels, then with-draw the probe and cut away the ^breads fronrit. Pyrexiae, or Febrile Diseases. 101 cially under the sternum, a saltish taste in the mouth, difficult breathing, tickling in the fauces, sometimes nausea and vomiting, a severe cough, or a short one throwing up florid and often frothy blood. Causes, The predisposing are a certain time of life, viz. between the 16th and 35th year; a sangui- neous temperament, over sensibility, suppres- sion of accustomed evacuations, former haemorr- hages, hereditary predisposition, marked by a long neck, tall stature, flat and narrow chest, depressed scapula, and all the remote causes of haemorrhages. Diagnosis, A flow of blood from the fauces is not attended by cough; a vomiting of blood is known by its blackness, by the contents of the stomach being mixed with it and by the absence of cough. Prognosis. The prognosis is more favourable, if on the ceasing of the spitting no pain in the thorax, difli- culty of breathing or cough should remain, or if it should arise from external violence, or in con- i 2 10:2 Pyrexiae, or Febrile Diseases. sequence of some suppressed evacuation without the predisposing causes. Cure. The antiphlogistic regimen is to be strictly em- ployed ; bleeding according to the violence of the symptoms, cooling aperients, blisters, gentlet emetic medicines, a spoonfull of common salt, astringents, quietude of the body and mind, and the other remedies spoken of in the cure of he- morrhages : after the febrile symptoms have sub- sided, may not the bark, sulphuric acid and opium? or the immersion of the body to the pubes in cold water be of service ? CHAPTER IV. Phthisis or Pulmonary Consumption. SYMPTOMS. More or less of the symptoms now to be enu- merated often precede the attack of Phthisis, slight fever increased by the least exertion, the palms of the hands are hot and void of sweat, f By " vomitoria," the author of course rte'ans them to be given m such doses as only to excite diaphoresis' Pyrexiae, or Febrile Diseases. 106 especially on the approach of evening, the eyes moist after sleep ; the quantity of urine increa- sed; the skin of the feet dry, particularly to- wards morning; flushing of the cheeks ; hoarse- ness ; slight or acute pain in the breast; a fixed pain in one side, or a lancinating one in both; head ache ; great dejection of spirits ; loss of ap- petite ; universal dislike to exercise or motion : afterwards the symptoms denoting the confirmed disease come on, namely, a more or less violent cough, increased by the slightest cause; hoarse- ness ; a sense of weight and constriction in the anterior part of the thorax, particularly after mo- tion : the lying on one side is more difficult than on the other, and the respiration is more impe- ded ; the pulse from the commencement is full, quick and hard, respiration much quicker than in health and performed with a sound like sigh- ing ; the cough becomes gradually worse towards evening, is very troublesome through the night, and an expectoration of mucus and afterwards of pus takes place. These symptoms are accom- panied by wandering pains through the side and thorax; by lassitude and asperity of temper; the appetite for food is diminished and vomiting of- ten arises after meals : and now the body is ema- ciated, a quantity of purulent spit is thrown up, varying in colour, white, yellowish, greenisb, 104 Pyrexiae, or Febrile Diseases. sometimes streaked with blood and tasting as if a putrid substance, and the true hectic super- venes, exacerbations of which occur twice in the twenty-four hours; one less marked about noon,the other before midnight, a sense of languor and cold- ness preceding them; these accessions continue for some hours, accompanied by heat and intense thirst; the cough becoming more troublesome, and the spitting less free; towards morning sweats more or less profuse break out, weaken- ing the patient extremely; the urine deposits a light branny sediment, and all the symptoms are somewhat alleviated, the skin only remaining dry: the tongue and fauces become red as if slightly inflamed, or are covered with apthse; a cadaverous paleness occupies the face excepting a small circumscribed spot on each cheek; the disease proceeding, the tunica adnata appears of a pearly colour, a colliquative diarrhoea alterna- ting with sweats arises; the feet become ade- matous, the hair falling off, the nails becoming incurvated, (the mind still elated with hope) de- monstrate the total loss of strength, and friendly death 6teps in to close the scene. Causes. The predisposing causes are an hereditary predisposition ; malformation of the thorax ; a Pyrexiae, or Febrile Diseases. 103 long neck; high shoulders; narrow chest; a san- guineous temperament; scrofula ; over-sensibili- ty; measles; repel?ed eruptions; immoderate evac- uations ; the blood being superoxygenated; ex- traneous substances in the lungs.t The occa- sional causes are heemoptysis, catarrh, asthma, pneumonia, tubercles, and contagion. Prognosis. In incipient phthisis the prognosis is doubtful, our opinion must be formed by the violence of the hectic fever, the debility, the nature oi the matter spit up, and by the other symptoms be- ing more or less urgent. Cure. Blood letting in the first stage according to the strength of the patient; a diet composed of milk and vegetables; emetics of ipecacuanha and the sulphate of zinc in every stage of the dis- ease ; the low regimen; blisters ; setons: the nitrate of potash in doses often or fifteen grains ; exercise in a cold and dry air: in the second stage the diet should be cordial and stimulating, principally consisting of Iceland moss, shell-fish and the like; digitalis; exercise, as sailing or on horseback; change of climate; avoidance of \ Syph.'as , t'imours and other affections of the abdo- minal viscera occasioning pressure on the diaphragm K)6 Pyrexiae, or Febrile Diseases*. crowded rooms, &c: inhalation of the vapour of sulphuric ether and hemlock ; factitious airs ; in the third stage natural balsams; the mineral acids; solutions of the supercarbonate of potash and soda; opiates, and the other remedies, before mentioned or tbark, or lime water, or digitalis and mercury, given in such doses as that the increased action of the arterial system may in the first place be lessened, and the system be afterwards lightly affected by the Jmercury. § f Where the remissions are well marked, the disease assuming more of the intermittent than the hectic type, the bark will be found serviceable ; when we find the exacerbations dyspnaea and anxiety increased, we must desist from the use of it. i In those cases occasioned by induration or enlarge- ment of the abdominal viscera, or in the incipient stage of phthisis attended with a scrofulous affection of the me- senteric glands, an alterative course of mercury will probably be of much benefit -. it may also tend to dis- perse indolent tubercles. § In incipient phthisis the solution of the muriate of Barytes has been much extolled by some practitioners. Its good effects have been proved in cases of scrofula, and it is therefore reasonable to expect much benefit from it in this complaint. The dose of the solution is at first, five or six drops, increased gradually to thirty, 'wice or three times a day. Pyrexiaz, or Febrile Diseases. 10/ CHAPTER V. Hazmorrhois, or Piles. SYMPTOMS, A sense of weight or pain in the head, giddi- ness, nausea, pain in the back and anus, vivid painful tubercles about the anus, from which there is generally a flow of blood: it sometimes also trickles from the anus when there is no apparent tumour, the bowels are generally costive and attended with fever. Causes. Advanced age, plethora, costiveness, immo- derate eating and drinking, gout, biliary obstruc- tions, prolapsus ani, immoderate use of purging medicine and whatever impedes the return of the venous blood, relaxation of the rectum and tor- por of its vessels. Cure. If the pain should be violent and the parts swelled, leeches should be applied to them, and fomentations afterwards : if costiveness prevail, the boywrfs must be opened by laxatives, of which 108 Pyrexiae, or Febrile Diseases. the best are sulphur, castor oil, supertartrate of potash, balsam of Copaiba, electuary of senna, and the like; external astringents, as galls, oak bark, cold bathing; internal astringents : if it should arise from the protrusion of the rectum it must in the first instance be returned to its proper situation, and its further descent pre- vented by remedies suited to the cause of its pro- duction : plethora is to be removed by the me- thod as spoken of under hsemorrhagia and the re- mote causes are to be avoided. CHAPTER VI. Menorrhagia, or immoderate flow of the Menses. SYMPTOMS. Pains in the back, loins and uterus, like those of child birth; a more than ordinarily copious flow of the menstrual discharge from the vagina, accompanied by fever, dyspnsea and pain in the head, together with great debility of the sv« t(«m. Pyrexiae, or Febrile Diseases. 100 Causes. Plethora, spirituous liquors, highly seasoned' food, violent exercise, contusions on the lower belly, violent sprains, strong emotions of the mind, laxity and debility of the system, excess of venery, frequent abortions, difficult labour, constipated bowels, cold applied to the feet, im- moderate tea drinking; the proximate cause is an increased action of the vessels of the uterus, their laxity and rupture. Prognosis. A great quantity of blood suddenly discharged, cold sweats, and convulsions portend the great- est danger. Cure. If symptoms of Plethora exist, bloodletting, the antiphlogistic regimen, quietude of the body and mind, and avoidance of heat, spare diet, mild laxatives, injections, refrigerants, the bed should be hard and lightly covered with clothes, inter- nal astringents as the acetate of lead, alum, kino, K 1 JO Pyrexiaz, or Febrile Diseases. catechu, bark and infusion of roses, external applications as cloths wetted in cold water and vinegar, or a strong decoction of oak bark applied to the back and pudendee; sedatives combined with astringents, blisters to the abdomen; in the intervals the remote causes are to be avoided, and tonics, as bark, preparations of iron, moderate exercise and the cold bath are to be employed. CHAPTER VII. Leucorrhea or the White?. SYMFrOMS. A flow of various coloured fluid from the vagi- na without any topical affection of the uterus, accompanied by continual pain in the back and hips, conjoined with or presently followed by menorrhagia, debilitating the whole system, par- ticularly the functions of the stomach, pyrexiae, dyspneea, or a swelling of the eyelids accompa* nying. Pyrexiae, or Febrile Diseases. 1U Causes. The causes are frequent child-hearing without suckling; difficult parturitions, menorrhagia, and all the causes producing it.t Cure. Astringents, as logwood and the others spoken of in the preceding chapter: astringent injec- tions into the vagina, stimulants as cantharides, oil of turpentine, balsam of Copaiba &c. tonics, particularly bark, preparations of iron, sulphate of zinc, and the cold bath ; a few grains of Rhu- barb with a grain of opium every night for some months, a burgundy-pitch plaister should be ap- plied to the loins, and the patient wear a flannel petticoat. f A diagnosis between this disease and blenorhagia appears necessarry. In blenorhagia the dischargeo matter is constant; attended with ardor urinx, inclina- tion to venerv-, itching of the pudenda, and swelling of the labiae, sometimes, or frequently with swellings in the groins. In leucorrhaea the discharge is not con- stant, often coming away in lumps andlarge quantities, and not accompanied nor preceded by inflammation o*. the pudendac. 112 Pyrexia?, or Febrile Diseases. CHAPTER VIII. *Jlmenorrhaza or obstruction of the menstrual discharge. symptoms. Dyspepsia; the desire for food is either di- minished or depraved, paleness and discoloura- tion of the skin, the eyes appear sunk and sur- rounded by a dark circle, the lips lose their healthy redness, the veins appear flacid, an cede- matous swelling of the body, extreme debility, hurried respiration, particularly on motion, pains in the loins, hips and head, palpitation, faintings, retension of the menses : (chlorosis of authors.) Causes. A weakened action of the uterine vessels ari- sing from debility and relaxation of the system. t Amenorrhea is of two kinds, the one called retention, where the menstrual flud does not appear at the period of life when it should naturally appear ; the other sup- pression, where having appeared it ceases to return at the usual periods. The former of these we are now considering. Pyrexiae, or Febrile Diseases. 113 Cure. The tone of the system is to be restored by all kinds of exercise, by the cold bath, by tonics, particularly preparations of iron, myrrh, carbo- nate of potash conjoined with aromatics, the action of the uterus is to be excited by cathar- tics, as aloes, submuriate of mercury, and the like, by walking, dancing, foot baths, friction, tepid fomentations to the hypogastric region, by electricity, compression of the iliac arteries, and above all by marriage : or diluted oxygen gas f The madder appears to me to possess some efiicacy.t CHAPTER IX. Suppressip Mensium or Suppression of the Menses. SYMPTOMS. Pain in the back and loins ; symptoms of dys- pepsia and hysteria, costive bowels, colic pains, hemorrhages from various parts of the body. f May not the ergol be employed with advantage in these cases ? *2 114 Pyrexiae, or Febrile Diseases. Causes. Spasm or too great rigidity of the extremities of the uterine vessels: atony and debility of the whole system. Cure. If plethora should exist, bleeding, but not otherwise; the constriction of the vessels is to be removed by the hot bath, by fomentations to the region of the pubes, by cathartics, opiates, and antispasmodics ; these not availing, the medi- cines prescribed in the foregoing chapter are to be employed;! these medicines will prove of more service if they are employed at the time that the efforts, of the system concur 4 In cases of dysmenorrhfea or (difficult mensturation) opiates, the hot bath, the general foot bath and warm diluents must be used. ■\ The tincture of canlharides is an excellent irritating emmenagogue and may be employed in doses of, from 30 to 100 drops, twice or thrice a day. + We must be cateful to discriminate between those cases v.'hich are dependent on a relaxed habit, and those consequent on a constriction of the vessels of the uterus. In the former, forcing or emmenagogue medi- cines will be highly improper. They can alone be re. rieved by chalybeates and other tonic?. Pyrexiae, or Febrile Diseases. IIS « CHAPTER X. Hazmatemesis or Vomiting of blood. CHARACTER. A rejection by vomiting of a dark coloured grv.mous blood mixed with the contents of the stomach, nausea, a sense of pain and weight preceding the attack. Causes. Plethora; suppressed evacuations of blood, tumors pressiug on the spleen or liver, external violence. Cure. This disease is generally symptomatic ; if the heemorrhage should be violent and plethora exist, venesection and the other remedies adapted to haemorrhages must be employed ; in general, as- tringents, and tonics, as bark, preparations of iron, and opium are useful; if it arises from sup- pressed evacuations, they must be restored; if from tumors pressing on the liver or spleen; mercury, hemlock, &o. 116 Pyrexiaz, or Febrile Diseases CHAPTER XI. Haematuria or voiding of blood by Urim. CHARACTER. This is generally a symptomatic disease, ari- sing from a calculus lacerating the kidney, from suppressed haemorrhoids or from a putres- cent state of the Wood. Cure. If it should arise from a calculus; mild laxa- tives, the antiphlogistic regimen, demulcents and alkaline waters are to be used : if from sup- pressed hsemorrhoids, the remedies suited to that disease: if from putridity, antiseptics : a bit of rag dipped in the urine will be tinged of a red colour. Pyrexiaz, or Febrile Diseases. 117 ORDER V. P. fluvia or Fluxes with Pyrexia. CHARACTER. Fever; with an increased excretion not natu- rally bloody. CHAPTER I. Catarrhas, or Catbrrh. SYMPTOMS. Pyrexia, oftentimes contagious, heaviness or pain in the head, the nostrils stuffed up, impeding the passage of the air through them, an increased excretion of mucus from the glands of the mem- branes of the nostrils, fauces and bronchiae; sometimes a Sneezing, and a distension, (as it 118 Pyrexiae, or Febrile Diseases. were) of the eyes; a flow of tears ; redness, heat, swelling of the fauces; soreness of the trachea; hoarseness; a sense of tightness in the thorax; difficulty of breathing; a severe cough, at first dry, afterwards moist, attended with a discharge of mucus, Cause. The remote causes are cold applied to the ^o- dy, and sometimes contagion : the proximate, is an increased afflux of humours to the mucous glands of the nostrils, fauces and bronchise, ac- companied by an inflammatory disposition. Prognosis. Catarrh is for the most part devoid of danger, but in old persons it sometimes induces chronic pneumonia, and in those predisposed it appears tq create phthisis. Cure. Generally nothing further is requisite than ab- stinence from animal food ; mild warm diluents; but if an inflammatory diathesis should exist, blood letting; the antiphlogistic regimen, laxa- tives, demulcents; diaphoretics, as Dover's pow- ders or the antimonial tartar; to excite nausea Pyrexiae, or Febrile Diseases.. 119 only, mild expectorants and blisters are to be employed: the phlogistic diathesis being removed opiates; a little oil should be rubbed into the nose. CHAPTER1L Dysenteria or Dysentery. SYMPTOMS. Contagious fever, nausea, vomiting, inflation of the intestines, severe gripings, small, frequent mucous, and slimy discharges, or greasy and bloody mixed with membraneous particles, the faeces being generally retained or appearing with shaall indurated pieces, called (scybala :) tenes* reus and sometimes hiceough. Cause. The remote cause is specific contagion, and thcproximate appears to be a spasmodic con- striction of the colon. Prognosis. The tenesmus and griping being very severe; the pain suddenly ceasing, with a weak aad in* r20 Pyrexia?, or Febrile Disecuses.- terrv/.iing pulse, the faeces very fetid, great de- bility, petechia, and hiccough are bad omens; a gentle perspiration, the stools less frequent, and the strength not much reduced are favorable symptoms. Care. If a phlogistic diathesis should exist, bleed- ing; emetics; ■ they will be more efficacious, if they act, not only by vomiting, but by stool also; repeated cathartics, especially the sul- phate of soda and castor oil; phosphate of soda, 8cc.: and each night after the use of the cathar- tics, opiates, and above all, Dover's powders or opium, and ,'arge enemas of starch or lintseed ; mucilaginous demulcents, fomentations, semicu- pia, blisters, milk and rice diet; before the in- flammatory symptoms are removed, the tone of the intestines is to be restored by tonics, as bark, simarauba, quassia, camomile, columbo, gentian, and the like. The disease resisting these means, 1 may we not try the submuriate of mercury, so as to excite a slight salivation ? or the extract of nux vomica in doses of a grain and a half every second hour ? If the fever should assume the in- termittent type, the bark must be freely given.! .-j-It is. proper in this place to mention Dr. Moseley's plan of treating dysentery in as much as it differs mate- CLASS II. NEUROSES or NERVOUS DISEASES. CHARACTER. The powers of sense and motion affected, with- out any primary fever, and without local disease. ORDER I. COMOTA OR SOPOROSE DISEASES. Character. Diminution of the powers of voluntary motion with sleep or suspension of the senses. rially from the above as well as from the general treat- ment of this complaint. His plan is in the first place to clear the primae vise and then to accomplish the cure by sudorifics. He found it univeraally successful, and many eminent practitioners after him kave made trial of and reported highly in its favour—the reader is referred to hia •« Treatise" on the subject. L 122 Neuroses or Nervous Diseases, CHAPTER I. Apoplexia or Apoplexy. CHARACTER. All the voluntary motions generally abolished, with sleep more or less profound, stertor, swel- ling and redness of the face, the action of the heart and arteries remaining ; sometimes prece- ded by vertigo, pain in the head, haemorrhage from the nose, a ringing in the ears, night-mare, and loss of sight, or stupor. Causes. The predisposing causes are advanced age, a large head, short neck, great corpulence, a seden- tary and slothful life, a too free use of vinous and spirituous liquors, suppression of accustomed evacuations, and intense study: the occasional causes are severe exercise, violent mental affec- tions, external heat, external pressure on the neck, external violence, deep and long inspira- tion, over distinction and laceration of the ves- sels of the brain.! f The fumes of narcotic and metallic substances, as opium, charcoal, mephitic airs, &c. Neuroses, or Nervous Diseases. 125 Diagnosis. It will be distinguished from palsy by the ster- tor, profound sleep, and diminution of all the voluntary motions.! Prognosis. The favorable or unfavorable prognosis is to be determined by the violence, of the attack; it is sometimes happily carried off by, an haemorr- hage or diarrhoea. Cure. A too free use of tgeneral blood-letting is pre- j udicial, but cupping glasses applied to the tem- ples are very useful, also fomentations to the head, sliglit electric shocks sent through the head, brisk cathartics of colocyntKf aloes, ex- tract of jalap and the like; active enemee; blis- ters to the head, back and extremities ; mustard cataplasms ; the antiphlogistic regimen; an erect + From epilepsy by the above mentioned symptoms, and by the absence of convulsions. \ In sanguineous apoplexy no time should be lost in drawing off blood from the temporal arteries or jugular veins. In serous apoplexy it may be wholly omitted or very sparingly employed, trusting to purgatives and sternutatories, &c. 124 Neuroses, or Nervous Diseases. posture: to prevent its return, the exciting cau- ses are to be avoided and the diet must be less nutritious than usual; abstinence from spirituous liquors; moderate exercise ; mild purgatives; setons or issues near the head, or errhines, or opium, or mercury to induce & gentle saliva* tion.t CHAPTER IL Paralysis, or Palsy. SYMPTOMS. Sorne of the voluntary motions alone diminish?* ed, often attended with sleep; the pulse slow and soft; one ^ide of the' body generally affected, hence called hemiphlegiat; most commonly pre- ceded by universal torpor, vertigo, heaviness of the head, mental imbecility, loss of memory, a sense of numbness in the side or part about to be attacked, and sometimes by tremor and pain. | When the affection arises from narcotics taken into the stomach they must be evacuated as quick as possible by active emetics. i When the complaint occupies a transverse half of *be body, it is termed paraphlegia-. Neuroses, or Nervous Diseases. ltlt> Causes. Compression of the brain from sanguineous or serous effusion orUumors, diminution of the ner- vous energy ; poisons received into the system : colica pictonum; apoplexy and advanced age. Diagnosis. It is to be easily distinguished from apoplexy and other diseases by the pulse and other symp- toms. Prognosis. Heat of the affected part; the pain slight, a ^ense of pricking or stinging : Fever or diarrhoea -arising, are favourable symptoms. Cure. If it should arise from compression of the brain, venesection and the other remedies adapted to apoplexy are to be employed ; when hemiphlegifi. alone remains, external stimulants as blisters4 rubefacients; for instance, tincture of cantharides ! Pressure on the nerves caused by luxations, frac- tures, distortion of the spine and thickening of the ver- tebral Hgaments, exposure to the fumes of metals and minerals, handling white lead, See. 126 Neuroses, or Nervous Diseases. liniment of ammonia, sulphuric edier, &c. are to be used, friction, urtication, electricity and the cold bath, internal stimulants, as pyrethrum, white mustard, horse radish, the-arnica montana, volatile salts and mercury, the diet should be nourishing and stimulating, afterwards chaly- beate waters.! f In those ca9es depending on deformity of the spine, Mr. Pott recommended drains, as issues, &c, to be pla- ced in the vicinity of the part as near to the tumor as possible. This practice in his hands and many other eminent surgeons, has been more successful than any other mode of treatment. Where the poison of lead received into the system is the cause of the disease, mercury should be quickly and actively employed, be- ing the best antidete to that poison., Neuroses,.or Nervous Diseases. 127 ORDER II. Adynamiaz or defect of the Vital Powers. CHARACTER. . A defective state of the involuntary powers, whether vital or natural. CHAPTER I. Syncope or Fainting. SYMPTOMS. The motion of the heart diminished or some- times quiescent, often returning without any manifest cause, with violent palpitations of the Ifeart in the intervals, arising from some defect 128 Neuroses, or Nervous Diseases. of the heart itself, or neighbouring vessels, or from an affection of the whole system, sometimes terminated by vomiting, convulsions, or epilepsy. Cause. The proximate cause appears to be a diminish- ed or suspended action of the heart and arteries. « Cure. During the paroxysm stimulants are to be ap- plied to the nostrils; afterwards tonics; if it should arise from some evident cause, the reme- dies suited to it must be employed. CHAPTER II. Dyspepsia or Indigestion. CHARACTER. Loss of appetite, nausea, vomiting, distension of the stomach, acid eructations, heart burn, pain in the stomach, anxiety, languor, and low spirits ; more or less of these symptoms attacking the patient at once, generally with constipated bow- els, and without any other disease of the sto'mach itself or neighbouring parts. Neuroses, or Nervous Diseases. 129 Causes. The remote causes are of twokinds,first, those which act immediately on the stomach itself, and secondly those which at first act on the other parts, and at length diffuse their atony to the stomach. Of the first kind are sedatives or nar- cotics, as opium, spirituous liquors, henbane, tea and coffee, acids, aromatics, excessive eating, frequent vomitings, bitters, hot liquors drank to excess: too great excretion of the saliva. Those which act primarily on the system, are violent af- fections of the mind, a sedentary life, intense stu- dy, excess-of venery, moist, cold weather and want of exercise, and ebriety : the proximate cause is atony and debility of the muscular fibres of the. stomach. Cure. Emetics; alkaline salts and absorbents, par- ticularly lime water, soap, cathartics composed of aloes, rhubarb or senna conjoined with aroma- tics or bitters, blisters to the back : afterwards to restore the tone of the stomach, tonics ; such as the preparations of iron, quassia, bark, columbo and gentian : certain symptoms must be allevi- ated, as distension of the stomach by sulphuric ether, heart burn by sulphuric acid, soap, seltz*" 130 Neuroses, or Nervous Diseases. waters or opium ; vomiting! by opiate clysters, anxiety and oppression after eating, by aromatics, as ten grains of black pepper taken immediately} after each meal: the diet should consist of ani- mal food ; moderate exercise and the cold bath accelerate the cure : chalybeate and tar-waters are very beneficial; the occasional causes are to be shunned.§ ! Tf the vomiting is severe the stomach should be first washed out with large draughts of Camomile tea and then a saline draught should be given in the act of effer- vescence, and repeated occasionally with a few drops of opium or ether. $ Will not the effect be moTe certain if the pepper be given some minutes before the meal ? by giving it after the meal we remove the unpleasant sensation, but by giving it previously, we prevent it. § In the memoirs of the " London Medical Society" vol. 5th. and in " Medical jReports*' by "Dr. Bardsly" the oxyd of bismuth is spoken of in high terms in the cure of Cardialgia, Pyrosis, gastrodyniaand such other affec- tions of the stomach. I have lately employed it in two or three cases, in one where the symptoms were highly aggravated and the disease of some years standing it has been wonderfully successful. Many physicians in this country have also spoken of it in high terms. Neuroses, or Nervous Diseases. 131 CHAPTER III. Hypochondriasis. CHARACTER. Dyspepsia with languor, sadness, a great fear of death, peevishness, and all kinds of groundless apprehensions from trifling causes or originating in the melancholy imagination, the bowels some- times bound, sometimes loose. Diagnosis. Hypochondriasis is distinguished from dyspep- sia, by the languor, fear of death, the depraved ideas that constantly attend, and by the symp- toms of dyspepsia being less violent or altogether absent; in dyspepsia the symptoms are more urgent and those above mentioned are less vio- lent or altogether wanting, hypochondriasis does not arise in youth, but about or after the thirty fifth year and generally increases with age. Cure. A blister is to be applied to the epigastric re- gion or a burgundy pitch plaister to the abdomen, chalybeate waters, the warm bath : but in this 132 Neuroses or Nervous Diseases. disease (a mental one) the spirits are to be sup- ported by associating with agreeable and lively companions, by exercise particularly on horse- back, by field sports, constant change of scene, sailing, by all kinds of pleasing recreation and by guarding against anxiety, the symptoms oh dys- pepsia are to be removed by the before mention- ed methods: a powder containing six grains of rhubarb and one of opium should be given every night and some very simple formula through the day. Neuroses or Nervous Diseases. 133 ORDER III. Spasmi or Spasmodic affections. CHARACTER. Preternatural motions of the muscles or mus* cular fibres. CHAPTER I. Tetanus (TrismusJ or Locked Jaw. SYMPTOMS. An acute painful and spasmodic rigidity of the muscles particularly those of the lower jaw ; dif- ficulty of swallowing, a very acute pain under the ensiform cartilage, darting to the spine and thence to the neck and shoulders, its violence in- casing in its progress : when the body is in- 134 Neuroses, or Nervous Diseases. curvated backwards, it is called opis thotonos when foward empros thotonos. Causes. The causes are cold and moisture applied to the body, when heated, punctures, lacerations, or wounds of the nerves and tendons, various sur- gical operations. Prognosis. The spasms being very violent and frequent portend the greatest danger, the disease termi- nates favourably without any evident crisis. Cure. Wine and opium given liberally, bark, fric- tion with mercurial ointment or sulphuric ether and tincture of opium in equal parts, electricity, but above all the cold bath in the paroxysm of the convulsion: In the trismus of children which arises between the two first and seventh days af- ter birth, the meconium is first to be cleared off, and then the oil of succinum, musk, and the cold bath are to be used. Neuroses, or Nervous Diseases, 135 CHAPTER II. Chorea, or St. Vitus's dance. Character. Involuntary convulsive motions of a part, ari- sing in the youth of both sexes, generally be- tween the tenth and fourteenth years, and mostly of one side, resembling stage players in the ac- tion of their arms and hands, dragging rather than lifting their feet as they walk. Causes. Relaxation and debility of the system.! Cure. Tonics, such as bark, preparations of iron, copper, and zinc, the cold bath, electricity, dry cupping, antispasmodics, as bella donna, opium, mercurv, extract of hemlock, &c, or the carbo- nate of potash.J - | Various irritations, as worms, teething, acrid matter in the bowels, &c. t Dr. Hamilton, in his work on the " Utility of purga- tive medicines," informs us that having treated many subjects of chorea in the commen wav without success. 136 Neuroses, or Nervous Diseases. CHAPTER III. Epilepsia or Epilepsy. SYMPTOMS. It generally attacks suddenly, and sometimes whilst the patient is asleep, though most com- monly the patient previous to the paroxysm, feels a sense of universal languor, lassitude, pain in the head, giddiness; shortly after the fit com- mences with a sense of coldness, as of a cold stream of air ascending to the head, which as soon as it has reached, the patient, if standing at the time, falls, uttering a loud groan : he lies senseless : the muscles of the whole body are convulsed, but those of the face and hands most powerfully; the mouth and eyes are distorted ; a frothy matter issues from the nostrils; the pulse at the commencement is quick, slender, and scarcely preceptible, towards the close more full and slow, but still feeble : these symptoms ceasing gradually, the paroxysm goes off, the he resolved on trying a new plan, and that he conse- quently found it universally successful, viz. the employ- ment of continued purgative medicines. The reader is referred to his excellent work on the subject for much useful and interesting information. Neuroses, or Nervous Diseases. 157 patient falling asleep, in a short time he returns to his senses not remembering any thing that may have happened during the fit: it frequently terminates in apoplexy. Causes. The predisposing causes are, a certain mobility of the nervous system (or sensorium) and heredi- tary predisposition : the exciting causes are me- chanical stimuli, chemical acrid stimuli, irrita- tions of the mind, particularly joy and anger, ir- ritation caused by a distension of the blood ves- sels within the cranium, worms, dentition, com- ng out of the eruption of small pox ; whatever diminishes the tension of the vessels of the brainj profuse haemorrhages, terror, passion, noxious seem-, poisons, and the epileptic aura. Diagnosis. It mav be distinguished from all kinds of con- vulsions by the sleep and by all sense of external impressions being absent; from apoplexy by the voluntary motions being increased ; from hyste- ria by the sensation of a ball rising to the fauces, and by the other symptoms preceeding that at- tack being absent. m2 138 Neuroses, or Nervous Diseases. Prognosis. The prognosis is more favourable in the symp- tomatic than in the idiopathic disease ; the dis- ease is less dangerous in young persons than in older ones, because it is apt to go off, in boys at the age of puberty, and in girls on the appearance of the menses; an intermittent fever or cutaneous eruption often terminates it favourably. Cure. If the disease should be symptomatic of some other, that must be first attended to and the remedies adapted to it employed ; when plethora exists it is to be removed by the methods already mentioned, by issues and setons ; in the parox- ysm internal and external stimulants are to be used ; in the intervals, tonics, as preparations of copper, zinc and iron ; nitrate of silver, oxyd of arsenic, the cold bath and exercise: antispas- modics, as animal oil, rectified oil, ef succinum : mercury, sulphuric ether, musk, stramonium, di- gitalis : but the most powerful of this class is opium, which should be given often through the day for many months : if all our endeavours fail Neuroses, or Nervous Diseases. 139 •he diet, mode of life, or place of residence must be ch;m2.'ed.T CHAPTER IV. Palpitatio or Palpitation. CHARACTER. A violent and irregular motion of the heart. Cause. Some defect in the heart or its neighbouring vessels ; plethora, debility or mobility of the system. Cure. The treatment of this disease consists in find- in 2out the exciting causes, which must then be f In those cases where the attack is preceded by the epileptic aura, cutting off the communication between the brain and the limb from whence the aura arises, by means of the tourniquet, has in tnany instances checked the progress, or entirely prevented the accession of the 140 Neuroses, or Nervous Diseases. avoided ; if it should arise from plethora or de- bility the treatment necessary in those cases must be resorted to.! CHAPTER V. Asthma. SYMPTOMS. About one or two o'clock in the morning the paroxysm commences with a sense of tightness in the breast; the breathing is performed with a wheezing sound, the patient is obliged to rise from the bed and fly to the erect posture ; he re- quires a pure air, the voice becomes weak, and the exertion of speaking is more or less difficult, a cold sweat breaks out on the face and neck, the cough which if any at the commencement of tin- paroxysm, was laborious, on the approach of morning becomes free and often attended with an expectoration of mucus, the symptoms are then alleviated, but for some days or rather nights, on the approach of night suffer an exacer- bation, they afterwards go off entirely for some f When symptomatic of nervous affections, antispas modics and tonics should be used. Neuroses, or Nervous Diseases. 141 time ; the pulse is usually quick, weak and small and the urine before pale, deposits a sediment: lassitude, drowsiness, fullness of the stomach, frequent eructations, weight and pain in the head often precede the attack. Causes. A humid, cold, and foggy atmosphere ; sudden vicissitudes of weather, retrocedent gout; fevers, particularly intermittents ; suddenly repressed evacuations ; an hereditary predisposition. The proximate cause appears to depend on aspasmo- dic constriction of the muscular fibres of the bronchise.! Diagnosis. By the symptoms first mentioned asthma will be readily distinguished from other diseases. Prognosis. The youth of the patient much favours the en- deavours of the physician; the disease often ter- ! Dr. Bree, in his ingenious "treatise on asthma" dis- putes the justness of this assigned cause. His opinion is "that the true proximate cause of convulsive asthma is irritation in the air cavities arising from an effusion of sterum or aerial acrimony." See his Treatise. 142 Neuroses, or Nervous Diseases. minates in phthisis or hydrothorax: the res- piration becoming suddenly shortened and para- 1 vsis of the [arms are unfavourable symptoms. Cure. r Elood letting during the paroxysm unless plethora exists is prejudicial :J gentle emetics are very useful as also blisters to the chest; mild clysters, the warm bath, antispasmodics, particu- larly opium, sulphuric ether and asafcetida : ex- pectorants as squills, tartrite of antimony,§ sper- maceti &c. returns of the paroxysms are to be guarded against by change of situation and cli- mate, by a nourishing diet, but mild and free from all flatulent quality ; by exercise, avoiding the exciting causes, by issues, tonics, as bark, and preparations of iron: will not the digitalis be useful? | If even this be the case leeches or cupping glaisei to the chest are far preferable. t The administration of an emetic in the paroxysm will produce great danger of suffocation. <"> Oily demulcents are in general injurious. Neuroses, or Nervous Diseases. 14* CHAPTER VI. Pertussis or Hooping Cough. SYMPTOMS. A contagious disease ; a convtdsive stifling cough with sonorous inspiration (vulgarly called in England the Kirick) repeated by paroxysms, and each terminated by a quantity of mucus being discharged from the lungs, fauces, and nostrils, and again renewed after irregular intervals, py- rexia sometimes accompanying. Cause. Contagion.! Prognosis. The disease is more violent in children under ten years of age ; a very difficult respiration acute pyrexia particularly if accompanied by symptoms of pneumonia are unfavourable symp- toms : a free expectoration, the appetite never destroyed, but increased after vomiting, and a f The proximate cause is the presence of a viscid mat- ter or phlegm on the surface of the bronchis. trachea and in the fauces, its close adhesion to which, causes such violent efforts for its expulsion. 144 Neuroses, or Nervous Diseases. slight haemorrhage from the nose are favourable symptoms. Cure. If the difficulty of breathing, or pyrexia should be urgent, general or topical blood-letting: emet- ics to excite vomiting and nausea; blisters to the thorax, the warm bath, the steam of hot water received into the lungs, antispasmodics, as opium, castor, musk, asafoetida, oil of succinum; but above all, the tincture of lyttee to excite a slight dysury: tonics as bark, oxyd of zinc : Fowler's solution of arsenic, tincture of digtalis, change of air: during the complaint the bowels should be kept gently open.! f A new method of cure has been proposed by Dr Struve of Gorlitz. In the first place he gives an emetic and afterwards directs the following mixture to be rubbed into the region of the stomach every two hours in small quantities each time. The effect of it, the Dr observes, is that a gentle perspiration is induced, the vio- lence of the cough quickly abates and in a short tune the symptoms entirely disappear. In obstinate cases this method is very worthy of trial but with caution in the hands of young practitioners in reference to young an*. delicate children. Antimon tartarizat, 9ii. Aqua. pur. £ii. Ft. solut. cui adde __ Tincf. cant.ha.rid: fort. ~i Neuroses, or Nervous Diseases. 145 CHAPTER VII Pyrosis or Waterbrash. CHARACTER. A burning pain and sense of constriction in the epigastric region, increased by the erect pos- ture, generally occurring on an empty stomach, with a discharge of a watery insipid fluid, some- times acrid eructations. Causes. Cold applied to the extremities and violent passions of the mind. Cure. During the paroxysm, opium, sulphuric ether, and other antispasmodics, must be administered, afterwards nux vomica.t ! The oxyd of bismuth has of late been used with suc« cess by some practitioners in Europe. N 146 Neuroses, or Nervous Diseases, CHAPTER VIII. Colica or Colic. SYMPTOMS. Pain of the abdomen, twisting particularly around the navel, a retraction of it towards the spine ; spasms of the muscles of the abdomen with numerous lumps, feeling to the touch as a bag filled with apples ; vomiting, constipated bowels, no fever, when the peristaltic motion is inverted, It is called "Ileus" or Iliac passion. Causes. The remote causes are cold, indurated fteces, acrid bile, calcareous concretions, poisons re- ceived into the system, particularly lead ; flatu- lence. The proximate cause appears to be a spasmodic contraction of some part of the in- testines. Diagnosis. It is distinguished from enteritis by the twisting pain, the retraction of the navel, the pulse, by the absence of fever, and pain on pressure: from he- patitis and nephritis by the symptoms elsewhere spoken of and by the absence of fever. Neuroses, or Nervous Diseases. 147 m Prognosis. The pain shifting or ceasing gradually and the bowels answering to the cathartics are favourable symptoms ; the pain fixed and violent or ceasing suddenly, the bowels obstinately costive, hiccough and delirium are bad omens. Cure. Venesection if an inflammatory diathesis exists, according to the state of the pulse and strength of the patient, repeated, unless great debility is present: Antispasmodics, as opium, henbane, the warm bath, fomentations, or vessels filled with hot water and applied to the belly, blisters: gentle cathartics as the sulphate of potash and soda, supertartrite of potash, infusion of senna, castor oil, and if these do not avail, calomel and jalap, or colocynth ; enemas at first mild, after- wards of venice turpentine or the smoke or infu- sion of Tobacco : all these remedies having been tried in vain, cold water should be poured on the body and legs, or calomel be given by the mouth, or a large quantity of hot water injected per anum ; if the disease should arise from flatus, antispasmodics-. 148 Neuroses, or Nervous Diseases. The colica pictonum or (colic from lead) is known by the foregoing sense of weight and un„ easiness in the abdomen, particularly about the umbilicus; the colic pain approaching at first lightly, not constant, and particularly increased after eating, afterwards more severe and con- stant, with pain in the arms and back, at length terminating in paralysis: this affection is to be cured by mercury with opium, given in such quantity as to produce a salivation ; by a gentle catharsis the hot bath and other remedies before mentioned ; venesection is attended with great danger: in cases of paralysis natural warm springs should be resorted to. CHAPTER IX. Cholera, or Vomiting and Purging. SYMPTOMS. A vomiting of bilious matter, attended by a frequent purging of the same kind, anxiety, gri- pings, great prostrations of strength, quick, weak and fluttering pulse, cramps of the legs, general- ly appearing in the month of August: it is often fatal in twenty-four hours. Aeuroses, or Nervous Diseases. 149 Causes. The remote causes are a hot atmosphere, acrid substances in the stomach, surfeit, eating unripe fruit, miasma arising from marshy grounds, acrid bile. The proximate cause is a spasmodic con- striction of the duodenum. Prognosis. Sleep occurring on the cessation of the vomi- ting, or the disease diminishing about the seventh day are favorable indications. The rejected matter being of a dark colour, great thirst and heat, the pulse very weak and intermitting, hic- coughs, faintings and convulsions are unfavoura- ble symptoms. Cure. Diluents of hot water or chicken broth are to be given liberally, and injections of the same; afterwards antispasmodics, particularly t opium internally and in clysters; if the spasms of the legs should be violent, anodyne enemie and fric- f It is sometimes impracticable to get opium to re- main on the stomach in any quantity. In such case a large anodyne plaister may be applied to the region of the stomach, or an embrocation of opium, cumphor, and oil may be rubbed into it. n2 Neuroses, or Nervous Discuses. tions with camphorated oil: the disease decli- ning ; tonics, antispasmodics and nutritives.! CHAPTER X. J)iarrho?a, or Looseness. CHARACTER. A frequent discharge of natural faeces, mucus. or the ingesta not much changed, with griping nausea and vomiting; not a contagious disease, no primary fever and without tenesmus. Causes. The remote causes are cold applied to the feet, a diminished action of the absorbent vessels of the intestines; over-eating; acrid ingesta; sud- denly repelled perspiration ; putrid effluvia; a too free use of fruit; erythematic inflammation of the coats of the intestines; worms; retrocedent gout and rheumatism. The proximate cause is an increased peristaltic motion of the intestines. ! Diluted sulphuric acid will often allay the irritation of the stomach when nothing else can be retained; it should be employed in large doses, and when the irri- tation is abated some aperient should be given. Neuroses, or A ervous Diseases. 151 Diagnosis. Diarrhoea will be distinguished from all other diseases by the symptoms just enumerated. Cure. An emetic, and afterwards repeated in such divided doses as to create nausea; diluents, de- mulcents, aslintseed tea; barley water; decoc- tion of hartshorn, &c.: opiates; astringents, a? kino, alum, catechu, extract of logwood and the like ; tonics," as Peruvian an d angustura bark cascarilla, &c.; absorbents, a diet principally of roasted meat or broths : a diarrhoea accompany- ing typhus gravior and retrocedent gout is to be treated by the suitable remedies elsewhere men- tioned.! CHAPTER XI. Diabetes, or an immoderate flow of Urine. SYMPTOMS. A great increase of the quantity of urine, at ! When it arises from worms, the remedies adapter' to their removal must be used. 152 Neuroses, or Nervous Diseases. first insipid, afterwards of a sweet taste, a green- ish colour, equalling or exceeding in quantity the aliment introduced, constant thirst, some- times a voracious appetite, dryness of the fauces, the skin dry and harsh, feet and toes cedematous, a burning heat of the skin without the slightest perspiration, hectic fever. Causes. The causes are all such as debilitate the sys- tem, hard drinking, cold applied to the body, ex- cess of venery, too powerful diuretics, immode- rate evacuations, former diseases : the proximate cause appears to be a diseased state of the stomach impeding the natural powers of digestion and assimilation.! Cure. A diet of rich animal food, vegetables being wholly abstained from; emetics; diaphoretics, particularly ipecacuanha and opium; 1 alkaline f This was the theory of Dr. Cullen and Dr. Dobson, and is now supported by Dr. Rollo, and some other emi- nent-practitioners; I believe, however, that the majori- ty* of medical men at present consider it as depending on a primary affection of the kidnies. $ Possessing such diuretic qualities, they are likely to have an injurious eflect on the kidnies. Neu roses, or Nervous Diseases. lo>o salts; hydro-sulphuret of ammonia; small ! blis- ters applied to the region of the kidnies; mercu- rial preparations ; camphor ; astringents, as pow- dered galls with lime-water; alum; tonics, anointing the body with oil or some liniment: flannel should be worn next the skin. CHAPTER Xn. Hysteria, or the Hysteric Disease. SYMPTOMS. A murmuring and inflation of the belly; the sensation of a {ball rolling in the abdomen as- cending to the stomach, thence to the throat, and there sticking; convulsions, ^in which the patient strikes her breast violently with her hands; § sleep: these symptoms continuing for some time with alternate fits of laughing and crying a quantity of wind is expelled from the stomach, and with frequent sighs, as if awaking from sleep: the patient recovers her senses and power of mo- f Would not issues be more effectual in as much a- their benefit is more lasting. * The Globus Hystericus of authors. ^Apparent sleep. 154 Neuroses, or Nervous Diseases. fion^ a profuse flow of urine often preceding; no recollection of what occurred during the fit re- maining. Cause. The remote causes are mobility of the nervous system and many of the causes producing epilep- sy ; the proximate cause appears to depend on a spasmodic affection of the uterus. Diagnosis* It will be distinguished from epilepsy by the profuse flow of urine preceding the attack, .by the fear of death, and by the globrls hystericus, Cure. During the paroxysm if the disease shall have been of long standing, bleeding is prejudicial; but antispasmodics, as opium, castor, camphor, asafoetida internally, and enemas are to be em- ployed, enemas of cold water are to be thrown up; stimulants must be applied to the nostrils, as the spt. ammoniee, succinat, &c. Its return must be guarded against by bark, preparations of iron, antispasmodics, exercise, and the cold hath. Neuroses, or Nervous Diseases. 155 CHAPTER XIII. Hydrophobia, or Canine Madness. SYMPTOMS. At some uncertain period after the bite a pain- ful tension, redness, and heat attack the part bitten, and at the same time darting pains and spasms arise in it; the patient is seized with lan- guor, lassitude, anxiety, frequent sighing, and lore of solitude, and horrible dreams torment him: these symptoms continuing for some time and then becoming worse, a great aversion to, and dread of any kind of liquid supervenes, in as much as the sight of it causes spasms in the throat, a quantity of viscid saliva is spit up; and during the paroxysiu a desire of biting attends. Cure. To prevent the disease arising, the parts bitten should be cut out instantly, or at farthest before the fourth day, and afterwards the wound washed with hot salt and water ; it should be kept open by stimulating applications, as the nitrate of silver, or mercurial ointment rubbed in about the affected part; a gentle salivation is to be ex- 156 Neuroses, or NervGils Diseases. cited; the disease appearing, wine, musk, oil internally and externally, opium in large quanti- ties, bark: mercurial ointment must be rubbed in so as to excite a quick salivation, may not the cold bath, or the arsenical solution be em- ployed ?t !The " Alisma Plantago" has lately been reported to have proved an antidote to this disease in various parts of Europe. It is to be hoped that no opportunity will be allowed to pass in this country without having recourse to the trial at least of this'reported specific. The roots are the parts mentioned as containing the virtue of the plant. For a particular description of it, refer to "Withering's Botany," or "Smith's Flora Brittannica." Neuroses or Nervous Diseases- 157 ORDER IV. Vesanice or Mental Diseases*. CHARACTER. The judgment impaired without pyrexia or coma. CHAPTER I. Melancholia or Melancholy Madness, CHARACTER. A partial chronic insanity attended by sadness, pensiveness, generally by costiveness and symp- toms of dyspepsia; the ravings of the melan- choly are unattended by furiousness, and are not accompanied by fever, but most powerfully djreji* o 158 Neuroses, or JServous Diseases. ted to one particular subject, they talk about themselves, or their affairs, on other subjects they are generally rational, a desire of suicide attending. Cause. An hereditary predisposition : depressing pas- sions of the mind, immoderate evacuations, re- peated drunkenness : and a melancholy temper- ament. Diagnosis. Melancholy will be distinguished from hypo- chondriasis by the symptoms of dyspepsia being absent and by the melancholy delirium before mentioned. Prognosis. If it should be owing to an hereditary taint or should have been of long continuance the cure will be attended with difficulty: the disease is sometimes happily carried off by diarrhoea, haemorrhage, or a cutaneous eruption; if the patient should be refreshed by sleep, and his mind can be diverted from melancholy reftec- ■ ions. ther^ is room for hqpe, Neuroses, or Nervous Diseases. 159 Cure. In this complaint as in hypochondriasis the mind is to be amused by gaiety, music, books or light and pleasing subjects, by exercise and by conversing on those subjects that are in direct opposition to those which may have caused the disease, and by the other methods adapted to hypochondriasis; the subjects if this disease should never be left alone ; costiveness and the symptoms of dyspepsia are to be removed by the before mentioned remedies. The diet should be nourishing and easy of digestion. CHAPTER II. Mania or Furious Madness. CHARACTER. A raving about some objects with desperation and great violence of action but without fever ; maniacs generally have lucid intervals ; manja is often periodical in its attack; whence the term lunatics:. 160 Neuroses or Nervous Diseases. Causes. Too intense study; violent passions of the mind; repeated disappointments; tumors and exostoses within the cranium; exposure to the sun ; suddenly suppressed evacuations; too free a use of spirituous liquors; hereditary predispo- sition, a sanguineous temperament, continual melancholy, the proximate cause is an increased excitement of the sensorium-f Diagnosis. Mania is easily distinguished from phrenitis, the former never being accompanied by fever, on the contrary the latter is always attended by fever.| Prognosis. Profuse haemorrhages ; a diarrhoea or intermit- tent fever often restore health to the patient, -f- Many doubts have arisen on this point; the appear- ances on dissection of the brain vary exceedingly but organic injury consequent on too great a determination of blood to the part, is constantly met with. $ From delirium by the mental affection not being Oyinected with any bodily disorder. Neuroses or Nervous Diseases. lol Cure. In the first place it is necessary that the sub- ject be confined in a cool and dark situation, and if the disease shall not have been of long standing, blood is to be freely and quickly drawn, but not otherwise; the bowels are to be daily evacuated by gentle cathartics, and repeated emetics are to be given ; opium, camphor, digita- lis are to be employed largely; cold applications and blisters to the shaved head are to be applied; ten grains of the gratiola in powdt r should be given night and morning; but above all reme- dies, tire cold bath in the height of the paroxysm o 2 CLASS III CACHEXIA, or CACHECTIC DISEASES. CHARACTER. A depraved state of the whole, or a great part of the body without any primary, febrile, or ner- vous affection, ORDER I. MARCORES. Character* Universal emaciation. Cachexiaz, or Cachectic Diseases,. 163 CHAPTER I. Tabes or Atrophy. CHARACTER. A gradual wasting and debility of the whole body, hectic fever, generally a symptomatic affection. Cure. The primary disease is in the first place to be investigated and the remedies suited to it em- ployed ; if it should arise from obstruction of the mesenteric glands, preparations of mercury must be employed until the swelling and hardness of the abdomen subside, afterwards preparations of .iron; columbo and bark. CHAPTER II. Atrophia Lactantium or Atrophy consequent on Suckling. SYMPTOMS. Emaciation and debility of the whole body with a circumscribed redness of the cheeks, wander- 164 Cachexiaz, or Cachectic Diseases. ing pains in some part of the thorax, cough, diffi- culty of breathing; the pulse more than commonly quick and somewhat hard, accompanying; hectic fever at length supervening. Causes. Debility of the system arising from a defi- ciency of nourishment; and from too free a use of tea. Cure. In the first place the child must be taken from the breast, if difficulty of breathing, cough or pain in the breast prevail, a small, general or topical blood-letting will be of service; as also blisters to the thorax; mild laxatives and demul- cents, the diet should consist of milk, vegetables or broths : but if debility only should arise, tonics; as the preparations of iron, bark, and the mineral acids should be mad* use of, and the diet should be nourishing. Vaehexiaz, or Gachectic Diseases. 16? ORDER II. Intumescentiaz or Swellings. CHARACTER. The whole or a great part of the body swollen externally. FLATUOS^E OR FLATULENT SWELLINGS. CHAPTER I. Emphysema or air in the cellular membrane. CHARACTER. A tense elastic swelling of the boly, crack- ling on pressure, sometimes accompanied by great difficulty of breathing and anxiety. 166 Cachexiaz, or Cachectic Diseases. Causes. Emphysema often arises without any evident cause, but it is generally induced by wounds of the thorax. Cure. The teiiuiar membrane is to be scarified and the air expressed by the fingers ; if the difficulty of breathing should be urgent, venesection and laxatives are to be employed. CHAPTER II. Tympanites or Tympany. SYMPTOMS. A tense elastic sonorous swelling of the abdo- men, but not luctuating, preserving its state, and retaining its figure under every position of the body ; costive bowels, in violent attacks, stran- gury or ischuria supervening; pyrexia, some- times borborygmi, flatulence, and eructation* from the stomach and bowels precede the attack. Cachexia; or Cachectic Diseases. 167 Diagnosis. It is distinguished from ascites by the elastic and crackling swelling, and by the absence of fluctuation. Cure. Enemse, and gentle cathartics; antispasmo~ dies; as opium, oil of aniseed and the like, tonics joined with aromatics ; the application of snow to the abdomen ; sulphuric acid to excite an effer- vescence of the alimentaria ; surrounding the ab- domen with a roller *, a clyster pipe should be introduced into the rectum and there retained for some time; the abdomen should be rubbed with the liniment of ammonia.! f Should all our attempts be frustrated, the bowels remaining costive and the heat, thirst, distension, and pyrexia increase, we must have recourse to blood-letting to guard against the consequences of inflammatftrtn Dr. Temple proposes the cold bath, continued so as to become antispasmodic and relaxant, f6r the cirre of thir disease, as in trisrruv- "168 Cachexlaz, or Cachectic Diseases, AQUOSjE or watery swellings. CHAPTER III. Anasarca or Dropsy in the cellular membrane. SYMPTOMS. An inelastic soft swelling of the whole body, but occurring at first in the feet and toes, its first attack coming on on the approach of evening, retaining the impression of the fingers for a long time; paleness of the skin, great thirst, the quantity of urine much diminished, and reddish in colour; difficulty of breathing and a dry skin. Causes. The remote causes are debility of the system, induced by drinking spirituous liquors; obstruc- tions in the lungs, heart and liver; drinking too freely of liquids, excessive evacuations, obstruc- tion of thq heemorrhoidal discharge, internal in- flammation, rupture of the' lymphatics, of the thoracic duct or ureters inducing ascites;! the $ Aneurisms in the arteries; tumours causing pres- sure on the neighbouring parts ; hereditary p.redispoisj- (.ion, frequent salivations &c. Cachexia?, or Cachectic Diseases. 169 proximate cause is an increased effusion or di- minished absorption of the fluids, or both. Prognosis. If no signs of visceral obstruction are present; if the quantity of urine is not diminished, the thirst not great, the strength at the same time not much, impaired, a favorable opinion may be formed. Cure. The collected water is to be evacuated by small! puncture orf issues; bandages should be applied to the extremities, the legs well rubbed, particularly in the morning, repeated emetics, cathartics, as gamboge, jalap, extract of colo- cvnth, calomel bryony, gratiola, supertartrite of potash, and the inspissated juice of elaterium, but the supertartrate of potash is the most powerful, if it is given in the quantity of an ounce each or every other morning in a largo solution of water: diaphoretics as f In employing these we must be careful to let the puncture s penetrate no further than to the cellular membrane, deep incisions in dropsical subjects being apt.to become gangrenous. i The je are more dangerous than"punctures, if in- serted in parts whose tone is destroyed, they,will proba- cy induce gangrene. p 170 Cachexiaz, or Cachectic Diseases. antimonial tartar, or ipecacuanha and opium ; - diuretics, as saffron, squills, acetate of potash, tincture of lyttae, the expressed juice of arti- chokes, and digitalis : these proving fruitless, a slight salivation is to be excited by mercury; the tone of the system restored by exercise and tonics, as bark, quassia, preparations of iron and the cold bath : if the pulse should be full, hard, and tense, venesection will be highly useful, CHAPTER IV. Hydrocephalus, or Water in the Head. SYMPTOMS. At the commencement of this disease the pa- tient becomes listless : he is troubled with nau- sea and vomiting alternately, through the day; he has great pain in the head which darts to the eye-brows, crown and back of the head, some- times it alternates with affections of the stomach : the head is often inclined more to one than the other side; the eyes are impatient of light, the patient is watchful and generally moaning; if sleep should overtake him, he generally grinds his teeth, and picks his nose, and starts suddenly from his doze as if affrighted. the-bowels are Cachexia;, or Cachectic Diseases. lTt mostly costive, and the pulse from the com- mencement of the attack is fuller than in health : r the above symptoms becoming aggravated, a slight degree of squinting is induced, the pupils are somewhat dilated, the vomiting becomes more frequent, the pain in the head and difficulty of breathing increases, the heat of the body and par- ticularly of the head is augmented, a fever now comes on attended with evening exacerba- tions ; the face becomes flushe/1; the action of the arteries becomes quicker, now slower, un- equal, and intermittent, the pain appears to be somewhat mitigated and drowsiness succeeding the watchfulness of the first stage, the patient falls into a comatose state, his hands being often raised to his head; the squinting is increased, the pupils become more dilated, and at length total blindness takes place ; the food is no longer rejected by vomiting, the bowels continue cos- tive, nevertheless worms are at this time, fre- quently expelled downwards ; the disease having continued in this way for some days, the arterial action becomes regular, but so weak and frequent as scarcely to be counted ; the breathing is per- formed with difficulty and stertor; red spots break out over the whole body, particularly on the limbs, and at last severe convulsions ensue and terminate the patient's miserable existence. 172 Cachexiaz, or Cachectic Dispose?■ Cause.. The cause r.T hvlrocephalus appears to be in- flamvr;- = ->n of soiic part of tltti ieretrum, in- ducing effusion. Diagnosis. The pain in the head with vomiting; the into- lerance of light, strabismus in t he progress of the disease ; and the dilated pupils will distinguish it from all other diseases. Prognosis. Stupor, dimness of the eyes, a weak and fre- quent pulse are unfavorable symptoms. Cure. Repeated general and topical blood-letting in the commencement of the disease particularly; cathartics of calomel and gamboge; mercurial in unction ; asuccession of blisters and coldappli- cations to the head; errliines, as the yellow sub- sulphate of mercury in the proportion of one grain to fifteen of powdered sugar, to be snuffed up by portions; slight electric shocks passed through the head: in the second and last stage, wine, opium, and digitalis. Cachexia:,- or C-ae hectic Diseases. 173 CHAPTER V. Sljlrdhorux, or Dropsy of the Chest. SYMPTOMS. Difficult respiration; painful oppression at the th or 14th day, the more deeply coloured, and rapidly ex- tensive was the jaundice, the greater was the room for fear. Redness of the eyes or such, around the s 2 210 Yellow Fever. blistered places, was also a bad omen. The black vomit was commonly a fatal occurrence ; a lividness of the spots, lips, nails, redness or pallid hue of the countenance, announced ap- proaching death. Frequent, copious, and black alvine discharges, unattended with relief to the patient, were mortal—all heemorrhages, save that from the nose and uterus, were bad omens, Is- churia was also followed by death. This* is a contagious disease; it attacks only whites.t and especially strangers arriving from old countries. Indians and mulattoes, infants excepted, are only once subject to its attack.-— This diseasej never attacks negroes. This disease may be defined a fever in which the violence of the pulse lasts only for two or three days, as in the ephemera; it terminates without a critical evacuation, and there remains a high degree of debility, with a small pulse, which the least motion of the body, or a vertical posture, will immediately suspend; and then * The weight of authority in the medical world, and certainly the highest of this country, contradict this opinion. f Dr. Rush pointedly contradicts this assertion. * Seldom might, perhaps, be more proper. W: Yellow Fever. 211 an universal jaundice, without heat or frequen- cy of pulse, quickly supervenes. This disease was epidemical in the Carolinas; from the end of August until the middle of Oc- tober, in the year 1748. Of the Treatment, Sauvage tells us nothing. I think that this disease, as attacking new comers, must be regarded as an highly aggravated form of inflammatory bilious fever. When at- tacking the natives, or long residents of the cli- mate, I think we must regard it as an aggravat- ed form of Typhus. The treatment of it, un- der its first head, I subjoin as the one most con- sonant to my pathology. In the treatment of the latter, I refer to what has been said under the head of Typhus, paying due regard, however, to the peculiar and distressing gastric affection. The treatment may be divided into three stages. In the first stage, bleeding, is in general found necessary, especially where the re-action of the system is great. We must, however, be careful to limit venae section to the early part of the first stage, although it may sometimes be neces- 212 Yellow Fever. sary to bleed at a later period, especially in ple- thoric subjects. The first bleeding ought always to be copious, and taken from a large orifice ;—~ the repetition, however, of this evacuation, re- quires the most deliberate care, lest the system be suddenly prostrated, beyond the powers of medicine to redeem. At this stage of the dis- ease, the gastric distress, strongly indicates the use of emetics; and these are, indeed, general- ly followed with much relief to the patient. The violence of the gastric symptoms must determine the necessity of repeating their use. If the sto- mach be very irritable, which it sometimes is, a blister to the epigastric region, does much good in allaying the excessive irritability of this or- gan. Our attention must next be directed to the alimentary canal; which should be evacuated by a mercurial purge ; and afterward kept in a re- laxed state, by the use of lenient aperients. Af- ter the re-action is somewhat reduced; should the heat of the surface still continue very great, with a dry and parched skin, ablutions of cold or tepid water, may be resorted to with much ad- vantage, together with refrigerating and acidu- lated drinks. Calomel should now be given in ..nch doses, as to bring the system speedily un~ Yellow Fever. 215 der the mercurial influence. By these means the ! disease is sometimes happily terminated. But should the disease continue, as is too often the case, and pass on into the typhoid form, which constitutes its third stage, then the treatment be- fore spoken of under the head of typhus, must be resorted to. W. W. THE END, —HfflBlH**