,u •' '''ir'iV'v ' •> '•' '•'Y*_rtV' ARMY MEDICAL LIBRARY WASHINGTON Founded 1836 SoCtiOl: Number 14 L*>% Fokm 113c, W. D.. S. G. O. ero 3—10543 (Revised Juno 13, 1936) I THE ' » ■** j* f& physician's POCKET SYNOPSIS: CONVEYING AN ACCURATE AND CONCISE VIEW 1 or THE HISTORY, CHARACTER, SYMPTOMS, AND TREATMENT OF THE VARIOUS MEDICAL AND SURGICAL DISEASES INCIDENT TO THE HUMAN FRAME. COMPILED FROM THE BEST AUTHORITIES, WITH REFERENCES ,, TO THE MOST APPROVED MODERN WRITERS. TOGETHER WITH THE NATURES, PROPERTIES, AND DOSES OF THE SIMPLE AND COMPOUND AGENTS EMPLOYED IN PHARMACY. AS ADOPTED EY THE NATIONAL AND FOREIGN PHARMACOPOEIAS. ALPHABETICALLY AE BY J. S. U^RTLETT, M. D., Of the Royil i. ■ " ,- of Surgeom in Lonccn, etc. -2L4i6^ SECOND EDITION. • REVISES, ENLARGED^ AND BROUGHT DOWN TO THE p'REMNT TIME, BY HENRY COLEY, Member of the Rojal College ofSurgeoni in London, of the New York Medical Society, etc. etc. NEW YORK: G. & C. & H. CARVILL. PHILADELPHIA : Carey & Hart, and Grigg <_ Elliot.— BCISTON : Monroe & Francis, and Allen & Fickir-- BALTIMORE: W. _ J. Nkal.—WASHINGTON, D. C.: Thomp- son Sl. Homans.—And other Booksellers. % ..... *• # M DCCC XXXIII. ^ «3 Entered according to the act of Congress, in the year 1833, by G. & C. & H. Oarvill, in the Clerk's Office of the Southern District of New York. »* PREFACE. The original work, of which the present publication may be consid- ered as an enlarged edition, was intended by its ingenious author to supply a want in medical literature that had frequently been experienced both by the practitioner and the student. Amongst the number of books on the sciences immediately connected with medicine, not one was to be found descriptive of the whole duty of the physician and surgeon. The works that had been published on various subjects were likewise too bulky to permit an easy reference, except in the closet of the reader, and hence the means of information vVere frequently denied to the young practitioner at a moment when they were most required. The nearest approach to this desideratum was the work of Dr. Eliot, which passed ihrough six editions in England, and three in this country, and was then nearly out of print ; but even this, although convenient for reference, was not only obsolete in its practice, but absolutely at variance with the discoveries of later times, as well as with the doctrines that had been based upon them. Under these circumstances, Dr. Bartlett was induced to submit a publication to the medical world, that should embrace all the material points of practice, serve as " a prompter to the memory of the practitioner," and as a ready guide to the student. He disregarded the objection entertained by some writers, that brief compilations had a tendency to withdraw the youthful mind from the more elaborate works on disease, properly considering that it was an indifferent compliment to the student of medicine, to suppose that he would rest satisfied with the knowledge conveyed in one volume, and abandon the stores of in- telligence that were elsewhere offered to his acceptance. The work IV of Dr. Bartlett accordingly appeared, and was valued as a pocket com- panion both by the practitioner and the student, as conveying the practical information required in the pursuits of medicine and surgery, and also in the no less important department of pharmacy. The edition being exhausted, and repeated demands still made for the work, a revision of the publication was resolved upon, with such addi- tions as the advancement in medical science required ; still, however, adhering to the first plan, of retaining the subjects under their organic order, and thus avoiding a needless repetition. This task was confided to the subscriber, who in its execution was desirous, not only of recording the improvements in practice that had taken place during the last ten years, but of supplying such omissions as rendered the first edition im- perfect ; thus forming a complete work of reference, and a useful guide to practice. The work, however, " grew under his hands," and attained a much greater magnitude than originally intended, as well from the introduction of new matter, as from the more extended notice of some diseases, upon which new light had been thrown by the researches of the French pathologists. In the present edition, as in the first, all attempts at elegant phrase- ology have been sacrificed to brevity of description ; the great aim has been, to place within the means of the medical man, the creed, as it were, of his profession, by which his recollection of its principles might be quickened, and the experience of others brought within his immediate grasp. The subjects are generally described under their common ap- pellations, together with their derivations, and the terms which science has attached to each. In some few instances the plan of the work has been departed from, when the subject was of intrinsic importance ; for instance, Aneurism, instead of being included under the diseases of the vascular system, appears in its alphabetical order, simply from the desire that more attention may be paid to so important a topic. The diseases of the respiratory system are described under the head of Lungs j and as the stethoscope is, comparatively speaking, a recent invention, the subject of course occupies a much larger space than in the first edition. Auscultation is likewise considered as a separate subject, as well from its novelty as from its importance, the details under both subjects being principally taken from the works of Laennec, the discoverer of the I v stethoscope, and Dr. William Stokes, of Dublin, who published a short but excellent treatise on auscultation. The whole of the amputations, and the principal surgical operations, are also described, the language of Averill being frequently employed, and the works of Cooper, Hey, Pott, Bell, &c. always appealed to as authorities. Wherever the experience of the subscriber was available, it has been recorded, in the desire of adding his mite to the stores of medical information. The pharmaceutical department is not exclusively devoted to the consideration of the substances claimed by the American pharmacopeia; the principal foreign works on therapeutics have also been referred to, in the history, character, use, and dose, of each important simple and compound, employed in the treatment of disease, and the class and order of every important material gathered from the vegetable kingdom for the service of pharmacy, has been likewise inserted. The subject of poisons, is treated of in the chart form, for the convenience of refer- ence, and is chiefly compiled from a work of the editor's, recently pub- lished.1*1 In the conviction that this work is the only publication of the kind, embracing as it does the whole practice of medicine, it is submitted to the profession at large, in the earnest desire that it may prove servicea- ble, and in the certainty that when it is consulted it will not mislead, HENRY COLEY. New-York, January, 1833. "Treatise on Medical Jurisprudence: Fart I. comprising the consideration of Poisons and Asphyxia. New-York. 1832. L PHYSICIAN'S ' POCKET SYNOPSIS. .....>o & e***—- ABDOMEN, Injuries of. Sec Wounds of the Abdomen. ABORTION, (from aborior, to be sterile.) This term is used, when the impregnated utorus parts with its contents before the seventh month of gestation, a period too early for the foetus to survive. See Uterus, Af- fections of. ABSCESS. (Abscessus, from Abscedo, to depart, the parts becom- ing separated or parted from each other in this process.) A collection of purulent matter in various tissues of the body, and specifically deno- minated according to its situation, as empyema, when in the cavity of the pleura, vomica in the lungs, panaris in the fingers, arthropuosis in a joint, hepatis in the liver, lumbar and psoas, when occupying the region of the loins or the psoas muscle. Abscesses may be either acute or chronic, the former occurring during the inflammatory and suppurative stages, the latter in Bubo, Mammary Abseess, Hypopium and the above Specific Affections, under which heads they will be described. See a&o Inflammation. ABSORBENTS. Those medicines, which have no acrimony in themselves, and counteract the acidities in the stomach and bowels, both by diminishing their irritability, and acting chemically upon the offending acrid matter. Magnesia, prepared chalk, crab's claws, &c. are the ab- sorbent medicines generally employed. ABSINTHIUM. See Artemisia. ACACIA, (acacia tie. omnia, from aica^o, to sharpen.) A genus of plants of the class Polygamia and order Moncecia, the Egyptian thorn, affording two varieties, much used in medicine. 1st. Acacia Catechu, commonly but erroneously termed Terra Japo- nica, or Japan Earth, growing in abundance in the East Indies. Astrin- gent in operation, given in doses of from 15 grains to 3 j. in diarrhoea, and intestinal haemorrhages ; in coughs and hoarseness from the relaxa- tion of the uvula, and locally in aphthae. 2d. Acacia vera—giem arable, principally brought from Senegal: a de- mulcent, given either in substance or dscoicljon, in coughs, strangury, g'.;i"rrhce?, &.% ad Ubf'tirn, 8 AC. ACEPHALUS. A term applied in mid v. ifl-ry to a foetus, born with- Out a head. ACETATE. A salt formed by the union of the Acetic Acid with ^salifiable base; the use of the following acetates are recognised in medicine: Acetate of Ammonia, (Acetas Ammonia?,) prepared by the addition of one part of sub-carbonate of ammonia to 32 parts of dilute acetic acid, and employed in the preparation of the liquor ammonia: acetatis, or the spirit of Mindererus—Sudorific; externally cooling and astringent, in doses of from 3 ij. to § ss. every three or four hours; when diluted, it is applied to inflamed surfaces. Incompatible with acids, alkalies, and nitrate of silver. Acetate of Potass, (Acetas Potassce.) Composition, Sub-carbonate of potass, lb j. Strong acetic acid and water, of each two parts. Gently cathartic, in doses of 3 ij. to 3 iij. diuretic 3 j. to 3 j. and administered in fevers, visceral disorders, and dropsy. Incompatible with mineral acids, the salts of silver and mercury, sul- phates of soda and magnesia, muriate of ammonia, and tartrate of potass. Acetate of Lead, (Acetas Plumbi.) Composition, Carbonate of Lead lb. j. Acetic Acid li gallons. Sedative and astringent, internally in doses from gr. i to j. combined with opium, for visceral haemorrhages. Externally, cooling and sedative in weak solutions, 5 ss. to J xvj. of distilled water, stimulant in solutions of 3 j. to § vj. employed in phlegmonous inflammations, burns, bruises, &c. Incompatible with alkalies, earths, or acids, alum, borax, soaps, lime, and undistilled waters, tartarized iron or antimony, and sulphuretted hy- drogen. ACETUM, (Acetum. i. from Acer, sour.) Vinegar refrigerant, diaphoretic, antiseptic—in doses of from 3 j. to 3 iv. Externally, sti- mulant and discutient in sprains, bruises, &c. It forms, in combination, three formulas of the pharmacopoeia: 1st. Acetum Cochici, or Vinegar of Meadow Saffron. See Colchicum. 2d. Acetum Scilla, or Vinegar of Squill. See Sauill. 3d. Acetum Opii, or Vinegar of Opium. See Opium. ACHLLLES TENDON, Rupture of. See Tendon. ACHOR. (Achor. oris, a%<»p, from a%vn, bran.) The crusta lactea, oi ecald head. See Cutaneous diseases. ACIDS. Acidum, (sharp.) Many of these substances form an im- portant class of medicinal compounds, and are derived either from the mineral or vegetable kingdoms; the acids derived from animal products^ are got employed in HWUvW.'. I AC. 3 Mineral Acids. Sulphuric, Acidum Sulphuricum, Oil of Vitriot. From the oxygenation of sulphurous acid, which is formed by the com- bustion of sulphur.—Specific gravity, 1.97. Properties and Dose*. Stimulant and escharotic externally; when internally employed, usually in a diluted form, in die proportion of jf iss. to $xiv. of distilled water, of which from m x. to Tl\. xl. may be administered in any bland fluid, as a tonic, astringent, or refrigerant, in dyspepsia, diabetes, hemoptysis, hectic, &c; when given as a gargle in cynanche, it may be made a little' stronger. It forms in combination with the metals, the sulphates of copper, iron, and zinc, and the sulphurets of antimony and mercury; with the alkalies, the sulphates of soda and potass; and with the earths, the sulphates of magnesia and barytes. Nitric, Acidum Nitrinum, Aqua Forlis.—Prepared from the nitrate of potass, by the action of sulphuric acid.—Specific gravity, l.SOOi Properties and Doses. Tonic, antiseptic, alterative, escharotic; when diluted with nine times its weight of distilled water, it forms a valuable remedy in the low stages of typhus, in hepatitis, and dyspepsia, in doses of from V\ x. to Tt\ xxx. contained in a considerable quantity of fluid ; it has also been extensively tried as an antisiphilitic in lieu of mercury, but without success. An ointment is prepared by the addition of 3 j. of this acid to J iij. of lard, which may be usefully applied to foul and obstinate ulcers. It forms but two combinations employed in medicine, the ni- trates of silver and potass. (See fumigation.) Muriatic, Acidum Muriaticum.—Obtained by the action of strong sul- phuric acid, on the muriate of soda or common salt.—Specific gravity, 1.2844. Properties and Doses. Tonic, antiseptic, diuretic. When diluted by an equal quantity of distilled water in doses of from W, x. to 1!\ xx. or in gargles from 3 ss. to 3 ij. in J vj. of fluid, administered in typhus, cutaneous eruptions, and inflammatory sore throats. A bath acidulated with this acid> was recommended by Dr. Scott, of London, for hepatic diseases, but the practice was not sufficiently successful, to entitle it to general adoption. This acid combines with the alkalies, in forming the muriates of potass, soda, and ammonia, with gold and barytes, in forming muriates of that metal and earth. (See Fumigation.) Arsenious, Acidum Arseniosum, IVMte Arsenic. Prepared by heating the oxide of arsenic in the atmospheric air; also found native.—Specific gravity, 3.7. Tooic, alterative, and escharotic, in doses of from -A-to-i gr.; this substance is now but little employed in medicine; a preparation called Fowler's Solution, was at one time in great repute in the treat- ment of intermtttent fevers: it consisted of a drachm of arsenic, and a. drachm of sub-carbonxtc of potass boiled together in a pint of distilled water, and in a glass vessel, until the arsenic was nearly dissolved; vrlrca foe svlutwa was wwi f°m diaslu&s «f t_« cvmpv4«ich the acid is disengaged by sulphuric acid, which must equal in quantity, the weight of chalk employed. Refrigerant and antiseptic in operatfon, in doses of from grs. x. to 5 ij. mixed with any bland fluid. Citrates arc formed, with earthy and alkaline bases, but which have no plflce in pharmacopoeias. Prussie, Acidum Hydro-Cyanxcum ; this is usually prepared accord- ing to the directions of Scheele, by digesting one ounce of the red oxide of mercury, with'two ounces of Prussian blue (which is a compound of the cyanide, and hydro-cyanate of iron) in six ounces of water, which is boiled for a few minutes, carefully agitating it the whole time ; it is then filtered, and to the clear solution three drachms of sulphuric acid, and an ounce and a half of iron filings are added ; when all action ceases, this liquid is exposed to heat in a retort, and the acid separated by distil- lation.—Specific gravity at 45 ° Pah. 7058. Properties and Doses—direct- ly sedative, and employed in high pulmonary and other inflammations in doses of four drops (of the prepared acid of Scheele) twice a day ; in cases of chronic catarrh, in dyspeptic affections, and as an external ap- plication in impetigines, and other cutaneous disorders, it is also of sin- gular efficacy ; it should be administered in any bland fluid. The salts formed by a combination of this acid with salifiable bases, are termed Prussiatee, of which the prussiate of iron, or Prussian blue is alone. «m> jvloyed in medicine, « AC. Tartaric, Acidum Tartaricum, is usually obtained from the bi-tartrate of potass (cream of tartar) by dissolving it in water, and then adding chalk, so long as effervescence is occasioned ; the tartrates of lime and potass are thus formed, from which the tartaric acid is disengaged by the action of sulphuric acid, in the same mode as described under the head of citric acid. Refrigerant and antiseptic in operation, given in inflam- matory affections, and scorbutus, in doses of from grs. x to 3 ss. dissolved m water, or in combination with the carbonate of soda, in preparing the saline draught. Tartrates arc formed by this acid with salifiable bases of the alkalies, soda, potass, and ammonia, and the bi-and supcr-tartrate with potass, and also with antimony (the common tartar emetic.) ACIDITY. In the stomach and bowels.—See Dyspepsia. ACNE. A small pimple or tubercle on the face.—See Cutaneous diseases. ACONITUM, Aconite, a plant, class Poly and ria, order Trigynia, the dried leaves of which (commonly called Monk's-hood leaves) are given in gradually increased doses of from one to five grains, in scrofula, schirrhus, palsy, &c. as a narcotic, or sudorific. An inspissated extract is also administered in the proportion of from grs. x. to 3 j. in pills. ACUPUNCTURATION, (acupunctura, from acus, a needle, and punctura, a prick,) a mode of treatment for various acute muscular and nervous pains, consisting of the introduction of from two to six finely pointed silver or steel needles, into the part affected, practised in China and Japan from time immemorial, under the name of zin-king, or needle- pricking. It was adopted in European practice by M. Berlioz of Paris, and Mr. Churchill of London, in 1816, for affections of the above charac- ter, but chiefly in severe chronic rheumatism ; the needle is introduced with a rotatory motion, producing very little pain, and is allowed to re- main in the part for five or six minutes ; from the published accounts of the advantages attending this operation, it is entitled to considerable at- tention, particularly from the reports of Dr. Elliotson, who has given it an extensive and, upon the whole, a successful trial in the London Hos- pitals ; his plan of procedure varies, however, from that pursued by others, in permitting the needle to remain in the part for an hour or two, instead of withdrawing it in a few minutes. The modus operandi of acupuncturation, has been explained, and pro- bably correctly, on the principle of counter-irritation; but M. Pouillet has endeavoured to prove, that electro-magnetic phenomena take place in Ihe operation. See Memoire sur lesMaladies Chroniques, les evacuations sanguines, «t I' acupuncture, par M. Belioz, Paris, 1816. A Treatise on Acupuncturation by Churchill, London, 1828. Med, and Chir. Transactions.—Vol. 18, page 467. AD. II Journal de Physiologic Exper. par Majcndie, torn. 5, art. 1. ADHESIVE INFLAMMATION, is that process which causes dif- ferent parts of the body to adhere or grow together, as in cases of recent wounds. See Wounds and Inflammation. ^EGYLOPS, (aeglyops-opis, from ail, a goat, and w^, an eye,) from the supposition that goats were subject to it.—See Eye, diseases of. AERUGO, (from aes. copper,) the rust of any metal, applied in Medi- cine to the rust of copper, or virdigris, which see. AFFUSION. (AlFusio, from ad and fundo, to pour upon,) the pouring a quantity of water over the patient's head and body, in the hot stage of. typhus or other fevers.—See Fevers. AGARIC. (Agaricus, i. ayapiKOs, from Agaria, a town in Asia.) A genus of plants of the class Cryptogamia, and order Fungi; the various edible and poisonous mushrooms, belong to this class. A fungous production, growing on the oak tree, was formerly much used, in restraining haemorrhage, and termed agaric. AGUE.—See Fevers, intermittent. ALBORA. A species of itch.—See Cutaneous diseases. ALBUGO. A white opacity of the cornea of the eye. See Eyet diseases of. ALCOHOL. Rectified spirit, a powerful and diffusive stimulant, sel- dom administered in a pure state, but advantageously used when diluted* in cases of debility and low fevers, and applied externally to the surface of the body as a refrigerant and sedative in burns, cases of low inflam- mations, &c. ALKALIES. (From Alcali, in Arabic signifying burnt.) There are) three substances commonly known by this term. Potass, Soda, and Am- monia. ALMOND. (Amygdalus Communis—Class Icosandria, order Mo- nogynia.) The almond tree is originally a native of Barbary, and yields both sweet and bitter almonds ; the amygdala dulcis, or sweet almond is demulcent, and employed in inflammatory complaints, chiefly as a medium for more active medicines; the amygdala amara or bitter al- mond, is sedative and very seldom employed. Officinal preparations.—Oil of almonds. (Oleum amygdalae) 5 ss. ta g L—Emollient and demulcent—Almond mixture (mistura amygdalae) ad libitum. ALOES.—Aloe, es., from ahlah, signifying in the Hebrew, growing near the sea. (Class Hexandria, order monogynia,) two varieties are used in medicine.—The Aloe Socotrina, from the island of Socotora in tha Indian Ocean, and from the Cape of Good Hope, and the Aloe Hepati- ca from Barbadoes, of which the former is the purest, least offensive to Itc taste, and mildest i» its operation—Cathartic, anthelmintic, emmen- S AM. agogue, in doses of from grs. v. to 3 j. for the first, and two or three gra.'i^ twice a day for the two last purposes. The employment of all medi- cines, of which aloes forms a part, should be avoided in all hemorrhoi- dal cases, as tending to irritate the rectum, and of course increase the complaint. Officinal preparaiim-.s. Tincture of aloes and myrrh. (Tinctura aloes et Myrrlios)—Cathartic stomachic, 3 j. to 5 ij. Tincture of rhubarb and aloes, (Tinctura Rhei et aloes,) same effect, increased to 3 iv. as a purgative. Powder of aloes with canella, (Polvis aloes cum canella.) Grs. x. to 3 j. Cathartic, stomachic, Pills of aloes and myrrh, (PiIuIee Aloes cum Myrrha)—same dose and operation, also an emmenagogue. ALTERATIVES. That class of medicines, administered to re-es- tablish the general health, through the secreting organs, without produ- cing any sensible evacuation. ALUM. Alumen. (Super-sulphas aluminae et potassre.) A triple salt, consisting of sulphuric acid, alumine, and potass—a powerful astrin- gent in haemorrhages and inordinate fluxes, and externally useful also as an astringent and repellant, in lotions, gargles, and collyria. Internal dose, from grs. v. to grs. xv. Officinal preparations. Dried alum. (Alumen Exsiccatum,) escharo- tic, applied to fou] and fungous ulcers. Compound solution of alum, (Liquor aluminis compositus,) for injection in fluor albus, gleet, &c. for eollyrium, well diluted, and for lotion in cutaneous eruptions, &c. Alum is incompatible with the alkalies, lime, magnesia, acetate of lead, and the infusion ofgalls. ALUM ROOT. Hcucherce Radix.—The root of the Heuchera Americana, or Sanicula Europoea. The Sanicle, a plant of the class Pentandria, and order Digynia—powerfully astringent in operation, but not much employed. ALVINE CONCRETIONS. See Calculi. AMAUROSIS, (from a/xavpouf, to darken,) a disease of the retina* See Eye. ~# AMBER. Succinum—a bituminous substance, the oil of amber. (Oleum Succini,) is stimulant, anti-hysteric, and promotes the fluid se- cretions H\ x. to xv. but little used in medicine. AMBLYOPIA, (from a/*6Aoy, dull, and _uV, the eye,) the dimnes.3 of sight of old people. See Eye. AMENORRJL3EA, a total or partial suppression of the menses. See Uterus. AMENTIA. Imbecility. See Mania. AMMONIA, an invisible gas, commonly termed the Volatile Alkali • it can easily be procured from the decomposition of apimal matter, hui AM. 9 Tor chemical purposes it is generally prepared from sal ammoniac, which is a muriate of this substance. In combination with the acids, it forms numerous salts, of which, the following are employed in medicine—aCe- fate, muriate, carbonate, and sub-carbonate, and nitrate of ammonia. Officinal preparations. See Muriate of Ammonia, under the head of Muriates. AMMONIACUM. Gum Ammoniac.—A gun>rcsin—stimulant, an- tispasmodic, expectorant in doses of from grs. x, to xxx, in pill, combined with squill or myrrh, or in mixture rubbed up with water. Externally, discutient and resolvent. Officinal preparations, Ammoniacum mixture, (Mistura Ammoni- aci.) Compound squill pills, (Pilulas Scillas Composite.) Ammonia^ cum plaster, (Emplastrum Ammoniaci.) Plaster of ammoniacum and mercury, (Emplastrum Ammoniaci cum Hydrargyro.) AMPUTATION. (Amputatio, from amputo, to cut off,) the opera- tion of removing a limb, or other part of the body ; it may be convenient to commence with those amputations practised on the upper extremity ; in removing the second or third phalanx of a finger, a circular incision should be made, a quarter of an inch nearer its extremity than the joint, at which you amputate ; then an incision on each sjde extending from the first, to the joint, forming two flaps which are to be dissected back, previously to the tendons, and the lateral and capsular ligaments being cut through, which finishes the operation; no ligatures arc in general required for the divided vessels, the haemorrhage being restrained, when the flaps are brought over the stump. In amputating a finger at its first phalanx or junction with the metacarpal bone, the hand should be placed prone, and the situation of the joint accurately ascertained, when the finger being bent, the thumb of the left hand of the surgeon upon its dorsal, and his fore finger upon its palmar surface, an incision should be commenced about the middle of the head or knuckle of the metacar- pal bone, and extended almost parallel to the bone of the finger, lower-? ing the hand till the knife is perpendicular, then cutting directly from him, till he is opposite the joint, he turns the edge of the knife and cuts through it, and then passing the knife between the bone and integuments, cutting towards himself, by which means, he forms two flaps ; no liga- tures will be required after this amputation, unless the finger be much enlarged by disease, when the arteries also increased in size, must bo secured. Where amputation is necessary in the second or third phalan- ges, it is desirable to perform it at the metacarpal joint, as the first phalanx, when left, is not only useless, but a deformity and an inconve- nience ; whereas the total removal of the one finger, gives mora room for the motions of the others, and can scarcely be perceived by a casuaj ooserv.r. 10 AM. In the articulation of the metacarpal hone of the little finger, the hand should be kept prone, and the muscles on the side drawn towards the palm, in order to find the carpal ond of the bone, on which the operator's left thumb is placed; then allowing the muscles to return to their situa- tion, and applying his left index finger beneath, exactly opposed to his thumb, the muscles being now pressed outwards, the bistoury hold per- peodicularlj', is thrust from above downwards, completely through the integuments and muscles opposite the joint, and close to the bone, along which he continues his incision, till he conies to its other extremity, where he cuts out: the flap thus formed, is held aside while the integu- ments are dissected from the dorsum of the bone, the tendon being left; the joint is now cut into, in an oblique direction towards the thumb: the surgeon then, thrusting the knife from above downwards, between the fourth and fifth metacarpal bones, avoiding any injury to the palmar integuments, separates the two bones from each other by cutting out to- wards himself, and drawing the bone apart from its fellow, divides the uncut dorsal and lateral ligaments, finishing the operation, by turning the knife upwards, and cutting through the palmar muscles and liga- ments. The vessels should be secured, and the divided surfaces kept in con- tact by adhesive plaster. In amputation of the right metacarpal bone of the thumb, the hand should be placed supine, and vice versa, when the left requires amputa- tion ; the hand being firmly held by an assistant, and the thumb separa- ted from the index finger, the heel of a strong bistoury is applied to the middle of the space between them ; then, keeping the point perpendicu- larly upwards, the surgeon cuts forwards, between the metacarpal bones of the thumb and fore finger, until his knife striking against the trapezium, he turns the point of the bistoury towards the joint, and opens if, by dividing the capsular ligament; ho now glides the knife through the joint, at the same time pressing the head of the bono towards the hand, and forms a flap from the side of the bone, by cutting towards himself, the proper extent of the flap being ascertained by approximating the thumb to the index finger. The haemorrhage, if considerable, must be suppressed by ligature. The amputation of the lower third of the fore arm with two flaps, is pre- ferred to that by the circular incision by many practitioners ; it is thus performed. The brachial artery being compressed by the tourniquet, the hand as before in a medium state between pronation and supina- tion, and the operator standing on the inner side of the arm, be thrusts a catl'm beneath the integuments from below upwards, introducing it at the anterior and inner edge of the ulna, close to the bone, and pushing It on till it appears at a corresponding point on the outer edge of the ra« AM. 11 eius, when he forms a flap half an inch or a little more in length, by cutting towards the wrist; he then passes the knife under the ifttegu- racnts, behind the bones, from the point where it came out before the radius, to that on the inner edge of the ulna, where it was first intro- duced, and forms a flap posteriorly of the same length as the former; these flaps being held back by the assistant, the knife is passed between the radius and ulna—from the anterior side, dividing the muscular fibres and interosscal ligament, and drawn out by cutting round the ulna, and then repassed between the bones from the posterior surface, and with- drawn by cutting round the radius, severing by this figure of eight inci- sion, all the muscular fibres, interosseous ligament, and periosteum, pre- viously to putting the arm in a state of pronation, when the radius and ulna are sawn through, commencing with the former bone, as well from its larger size in this situation as from the circumstance of the ulna owing to its connections with the humerus, being better able to bear the weight of the saw : four arteries generally require ligatures, the radial and ulna, and the two interosseal between the bones ; all loose portions of tendons remaining should be cut oft', and the flaps approximated as usual. It only remains to be observed, that the above is the mode in which this amputation is performed on the right arm; when the left arm is thus removed, the knife must be thrust from above downwards anteri- orly, or from the radius to the ulna, and the reverse posteriorly. The circular amputation at the middle of the fore arm, is performed in the same manner, with the exception that one flap only is formed from the reflected integuments, instead of two, by the separate introductions of the catlin. In the amputation of the arm at the middle or lower third of the humerus, the patient should be seated on a low chair, the extremity raised from the side, and carefully supported above the intended line of incision, and at the elbow ; the tourniquet Deing applied over the bra- chial artery, the operator places himself on the outer side of the patient, and kneels on his right knee, keeping his left bent in advance; then directing the point of the amputating knife towards his right shoulder, the assistant drawing the skin upwards, he makes a circular incision, gradually rising from his knee as he completes it; then dissecting back, the skin for about an inch, while it is kept reflected, he stoops as be- fore, and level with its base, again makes a circular cut through the muscles noarly down to the bone ; a third incision divides the deeper seated muscles, and being directed obliquely upwards, exposes the bone a. little higher up, to which part, the periosteum being cut through, and all the soft parts carefully held back, and defended by a retractor or fold of Un'ni, the saw is applied and the bone sawn through; the brachial 12 AM. artery, the deep humeral and occasionally other vessels are then tied, the edges of the wound approximated, and a rolle- applied. W e may now proceed to the consideration of Amputations of the lower extremity, and firstly of the toes; the practice recommended in the removal ot the fingers, may with the necessary modifications, be acted upon m ampu- tations of the toes, but when it is necessary to remove the metatarsal bones of the great or little toe, it is better to saw them off than to cut into the joints of the tarsus. The late Mr. Hey, of Leeds, in his Practi- cal Observations in Surgery, recommends, however, tfie partial amputation of the foot, at the junction of the tarsal with the metatarsal bones, when the disease has not extended to the former part; and M. Lisfranc of Paris, has repeatedly performed the same operation. M. Chopart has ampu- tated at the articulation of the Astragalus and Oscalcis with the scaphoid and cuboid bones, whence this operation has been named after him. It is thus performed: The articulation is found, by tracing with the index finger from the inner malleolus, forwards and downwards, till the projecting part of the scaphoid bone is felt, which marks the situation of the joint on the inner side of the foot. On the outer side, it is found an inch from the tarsal head of the metatarsal bone, which supports the little toe. These two opposed points being marked, one by the thumb of the left hand, and the other by the index finger, while the sole of the foot is grasped firmly in the palm, and the leg fixed by an assistant; the operator with a cat- lin, makes a semilunar incision through the integuments and tendons, extending from the point before his thumb, across the dorsum of the foot, to thaj. before his index finger. Then bending the foot, he opens the joint by dividing the ligament which connects the astragalus to the scaphoid bone; he then cuts through the strong ligaments which join the calcis to the cuboid bone, with the point of his knife, holding it per- pendicularly, cutting transversely, and bending the part to be removed further backwards. Having cut through the articulation, he forms a flap of sufficient length to cover the stump, from the sole of the foot, by cut- ting towards the toes, between the muscles and metatarsal bones. The bleeding arteries being tied, the edges of the flap are to be kept in con- tact with the integuments surrounding the dorsum of the foot, by straps of adhesive plaster or sutures. Amputation, a little below the middle of the lr(r, with a flap. The femo- ral artery being compressed, the limb is raised and supported at the foot and the upper part of the leg; the surgeon on the inner sidb of the limb placing the thumb of his left hand on the inner border of the tibia, and his fingers on the fibula, majics an incision through the integuments with a catlin, across the fore part of the leg, extending from the outer pdge of the fibula to the inner of the tibia, and pushing it behind and AM. 13 fhwc to the bones, from the rimer to the outer extremity of this incision, he forms a flap of the desired length, by cutting down tho leg ; this being held bark, the operator places the edge of the knife on the posterior surface of the fibula, and cuts across it till its point reaches the interos- seal space, through which he pushes it, dividing the muscles and liga- ment between tho bones; without raising the knife from the tibia, he draws it round that bone, dividing the muscular fibres and periosteum, till he reaches its anterior border, where he again passes it between the bones from above downwardsf cutting through such fibres as have not been divided, and withdraws the instrument by cutting to the posterior and outer edge of the fibula; the saw is then used, first upon the tibia for about a third of its substance, and then cutting both bones at the same time. The anterior and posterior tibial and peroneal arteries being se- cured, the cut surfaces are covered by tho flap, and the edges approxi- mated by plaster, and sutures if judged necessary. The Circular Amputation below the knee, or four inches from the point of the patclia, and also the circular amputation immediately below the tu- berosity of the tibia, aie also occasionally performed, and the practice, of the latter is much extolled by Mr. Guthrie. Amputation of the thigh, at the lower or upper third. The patient should be seated on a table, his back supported by pillows, with the tourniquet applied over the femoral artery as high up as possible, or the artery pressed against the pubes, a mode of restraining the circulation justly preferred by many practitioners; the extremity supported by two assistants, one at the upper part of the limb, and another holding the leg. The surgeon, on the outer side of the limb, and kneeling on his right knee, then makes a circular incision through the integuments round the thigh; then loosening the skin for about three inches, by cutting through the cellular texture, connecting it to the fascia and muscles be- neath ; the skin being drawn upwards with a moderate degree of force, he makes another circular incision higher up the limb, through the more superficial muscles, while those deeper seated, he divides by a third in- cision still higher, which lays the bone bare at the part, where it is to be sawn through. A linen retractor is now applied, and held by the assis- tant to shield the muscles during the use of the saw; the femoral artery, and other branches are secured, and the operation finished by bringing the cut edges together. M. Dupuytren performs this operation in a very different manner; at one circular incision, he cuts through the integuments and muscles superficial and deep, to the bone; then allow- ing the divided muscles to contract, in which they are added by the as- sistant, he again carries the knife round the bone to cut such fibres as may still be attached to it, before he applies the saw ; this mode of ope- rating is perhaps, advisable, v.'k/.-;•■: no. attempt ^ a_',d'.: t° k°al by.tlia r:-V H AM. intention, as in the Parisian hospitals, but if the adhesive process be en- couraged, it will be difficult, if not impossible, to keep the cut edges in contact where such a mass of muscle is left, as there must be after this operation. The amputation at the middle of the thigh is occasionally performed in Great Britain, and very generally on the continent of Europe, with two flaps ; this operation is conducted upon the usual prin- ciples of flap operations, which have been already sufficiently alluded to. AMPUTATIONS AT THE JOINTS. At the shoulder-joint. The subclavian artery being firmly compressed by an assistant, from above the clavicle, as the vessel passes over the first rib, a semicircular incision is to be made with its convexity downward, across the integuments covering the deltoid muscle, about four inches below the acromion. The skin should not be detached, but the surgeon at once proceed to raise the muscle from the bone, quite up to the joint ;■ if much haemorrhage ensue from the circumflex arteries, they should at once be secured, before the operation proceeds further; the tendons pass- ing over the joint and also the capsular ligament should now be cut, and the head of the bone dislocated from its cavity, when by one stroke of the amputating knife, the skin, muscles, and other parts beneath the joint, should be divided, thus completing the separation of the limb; the ope- ration is finished by applying a ligature to the axillary artery, and bringing the integuments together. Several other modes of performing this ope- ration have been devised, but the one described appears to unite quick- ness and simplicity m a remarkable degree. At the elbow-joint, as performed by M. Dupuytren, of Paris. The brachial artery being compressed by the tourniquet, and the extremities fixed and supported, the operator thrusts a catlin beneath the integu- ments and muscles of the fore arm, just below the condyles of the hu- merus at the bend of the elbow, and forms a flap three inches in length by cutting towards the hand; this flap being held back, he exits through the integuments and muscles, on the posterior side of the arm, by an in- cision level With the extremity of the olecranon , then feeling with his left thumb, for the head of the radius, he separates it from the^umerus by directing his knife obliquely between the two bones, and removes the' nlna by cutting round its sigmoid cavity, taking away as much of tho capsular ligament as possible. The bleeding vessels being tied, the con- dyles of the humerus are covered by the-flap, and the edges of tho wound approximated. For an Amputation at the wrist-joint, the tourniquet should be ap- plied to the lower part of the upper arm, the fore arm being kept in a state between pronation and supination; the operator, with his left hand f-akes hft and yielding ; any application of it to the fUK-e 3tt AN. aneurism, where it remains hard and knotty is inappropriate, as tending rather to increase the chance of mortification, than to diminish the size ■of the tumour. In internal aneurisms we can of course command but one description of remedy, and that precisely the same as recommended by Valsalva, and followed so extensively and successfully by Pelletan in the Hospital of the Hotel Dieu in Paris, and consisting of the most rigid antiphlogistic treatment, in frequent bleedings, restricting to small quantities of light food, applications of powdered ice or cold lotions to the tumours when visible, and the observance of silence and quietude ; in external aneurism, where compression may be tried without a risk of injury by irritation, and ge- nerally speaking, where the tumour is small, the same precautions must accompany a trial by pressure, as directed in cases of internal aneurism; when this mode of cure is attempted, a firm compress should be applied over the tumour, confined by a bandage extended some distance above and below it, sufficiently tight to command a strong pressure, but not bo much as to retard the whole circulation of the member; the ban- dage and compress may frequently be moistened with a cool lotion, tho usual antiphlogistic measures pursued to the necessary extent, and the individual kept as quiet as possible.—In all cases of aneu- rism, however, both in those where the milder means have been used without success, and where the nature of the disease may have forbidden their employment, the use of the ligature is imperiously demanded ; be- fore the operation upon the femoral artery for popliteal aneurism by John Hunter, the usual course pursued was to cut into the tumour, remove the cxtravasated blood, and tie the artery both above and below it, hut modern practice rejects this mode, in following the example of that great master, in securing the artery between the tumour and the heart, leaving the former to the process of gradual absorption when the channel through which its support was derived, has been obliterated.— It may occasionally happen in aneurisms, and especially in those about the head and neck requiring the obliteration of the carotid artery, that the tumour having increased to an enormous magnitude, may present unusual obstacles to the passage of a ligature round the vessel at the car- diac side of the tumour : in addition to other evidence, there is a most interesting case related by Dr. Bushe, of New York, proving the possi- bility and propriety of tying the artery on the distal side of the aneurismt with the same probability of success. Several instruments have been invented for the purpose of compressing the artery above the aneurism, such as the compressor of Assalini, the pincers of Percy, the presse-aHtire of Dcschamps, and the scrre-nceud of Desault, &c. but they have fallen jnto disuse, as well as the .old customs of loosening the Kgatw* some hours after its application, and the application of a. cylinder of linen b«" AN. 21 twecn the artery and the ligature ; the distinguished success that attends the majority of cases, where the simple operation of cutting down to the vessel and tying it, is performed, is sufficient to recommend it to general adoption. The former plans of dividing an aneurismal artery after tho application of two ligatures, and the employment of the ligatures of re- serve, as they were called, have also been discontinued. VENOUS ANEURISM, or ANEURISMAL VARIX. This term is applied to a tumour, arising from a direct communication, formed between a large vein and a subjacent artery. It is generally the result of vene- section when improperly performed, the vein being transfixed, and the artery under it wounded. Scarpa describes two circumstances as neces- sary for the production of this varicose aneurism. 1st. That the incisions in the vein and in the artery must exactly correspond ; 2d. That the up- per wound of the vein must heal, while the lower one, and the puncture in the artery must remain open, and communicate so readily, that the ar- terial blood finds greater facility in entering from the artery into the vein, than in being effused from the artery into the surrounding cellular sub- stance. We may generally be aware, that the artery is wounded, by the blood flowing with a jerking force, and the difficulty of restraining it after venesection ; when the upper wound of the vein is closed, (and the basi- lic vein is perhaps engaged more frequently that any other, in this affec- tion,) a general swelling at the bend of the arm, and extending towards the wrist ensues, the vein being particularly dilated ; by the application of the ear on the stethoscope to the tumour, a pulsating jarring motion is experienced, together with a peculiar hissing sound, occasioned by the rushing of the blood from the artery into the vein; the veins empty by pressure and lose the varicose appearance, which however immediately returns, directly the pressure is discontinued. Varicose aneurism differs from the common false aneurism of an artery, solely in the circum- stance of an opening existing in the lower part of the vein, which receives the arterial stream, and thereby prevents its diffusion in the neighbouring parts. It is of no little consequence, to distinguish between these two af- fections, especially, when it is considered that the false aneurism requires immediate attention, and that the aneurismal varix is comparatively in- significant ;—the nature of the accident, the appearances described, and the hissing noise, will hardly permit a mistake to arise. Where the tumour is small, and especially in thin persons, at an early age, compression may be tried with advantage, but where the tumour has advanced to a considerable size, any pressure will only expose the pa- tient to the danger of a complication of the disease with a false aneurism ; the wisest course undoubtedly is to abstain from interfering, unless, but which is not probable, the tumour increases to an alarming size, when (ho artery may be secured above. If immediate aid bo given, after tiio 22 AN. accident, a bandage and graduated compress, will fulfil every reasonable expectation of cure. ANEURISM FROM ANASTOMOSIS. This is a term applied by the late John Bell of Edinburgh to a species of aneurism resembling the N, to strangle,' and pectirs-oris, AN. Zi the brejiKi, or tliora\.) A disease frequently associated with, but not di- rectly depending upon, disorganization of the heart. It is described by Dr. Parry under the name of Syncope Anginosa, and as arising exclu- sively from ossification of the coronary arteries of the heart; but experi- ence has proved the incorrectness of this opinion, many cases having occurred where an examination post mortem, has discovered the coronary arteries in a state of ossification, without having given rise to one thoracic affection during life ; while on the other hand, the most intense symptoms have prevailed from cases of enlarged liver (as recorded by Dr. Latham) or from other causes, without the structure of these arteries being affect- ed in the slightest degree; hence we may rather consider this disease as a chronic functional derangement of the thoracic organs, without pre- cisely limiting its origin ; it is characterized by violent paroxysms of pain and oppression in the chest, in or near the region of the heart, occurring after exercise, particularly on ascending an eminence, or eating a hearty meal, and it is also produced by any strong emotion of the mind, as an- ger, grief, excessive joy, &c.: the pain is violent and constrictory, ac- companied by a sense of suffocation, and referred to the sternum, a little inclined to the left sido, shooting from thence to the left breast, and ter- minating at the elbow, or insertion of the deltoid muscle : the right side being similarly, but less frequently affected. The agony experienced is occasionally so acute, as to excite the apprehension of immediate death, and as the disease advances (constant cough and expectoration superve- ning) the paroxysms become more frequent, attacking the sufferer in any position, and at any time, until at length, one, more than usually violent, terminates his existence : during the continuance of an attack, the face and extremities arc bathed in perspiration, the pulse becomes fre- quent and irregular, and the powers of sense and voluntary motion are for a time, lost. The design of medical treatment is to afford relief du- ring the paroxysm, and if possible, to prevent its recurrence by a control of the circumstances occasioning it; to offect the first object, small quantities of blood may be withdrawn, either from the arm, or from the cardiac region, by cupping, and opium, and either may be administered ; to counteract the disposition to the disease, every possible attention must be paid to diet and regimen, avoiding the use of fermented liquors, re- moving from observation all objects having a tendency to excite the emo- tions of tho mind, and enjoining the most perfect tranquillity : the use of aromatics, bitters, gentle laxatives, and opiates, (such as hyoscyamus and opium when the rest is disturbed,) must be persevered in ; a seton may also bo introduced inside of each thigh, or a blister kept open in the s.amc situation, in accordance with the plan of Dr. M'Bridc, who found such practice of singular efficacy in this complaint. ANGINA, Vrdc Cj-aanche. 24 AN. ANGUSTURA BARK. (Cortex Cusparia;.) Tonic, stimulant, aromatic, and febrifuge, in doses of from v. to xx. grains. Incompatible with the sulphates of iron and copper, the salts of silver, mercury, lead, and antimony, potass, infusion of galls, and the yellow cinchona bark. Officinal preparations. Infusion of angustura. (Infusum Angusturae.) o i- to § ij. Tincture of Angustura. (TinctUra Angusturoe.) 3 j. to 3iij. The operation of both preparations the same as the bark. ANIMATION suspended. See Asphyxia. ANISE. (Anisum.) The seeds, used as a stimulant or carminative, in dyspepsia, and the tormina of infants—dose, ad libitum. Officinal preparations. Oil of aniseed. (Oleum anisi.) HI iij. to V\ x. ANODYNES. Medicines given to lull pain, and procure sleep. See ^Narcotics. ANTACIDS. Medicines which destroy acidity, acting chemically, by combining with and neutralizing an acid in the stomach or intestines. The fixed and volatile alkalies, limo water, prepared chalk, and the car- bonate of magnesia. ANTHELMINTICS, (avli, against, and c\uivs, a worm.) Those remedies procuring the evacuation of worms from the intestines, whether acting mechanically by the sharpness or roughness of their particles, by their bitter qualify or cathartic influence ; of the first description, are the powder of tin, (pulvis, stanni,) cowhage, (DoHchos Pruriens); of the second, gentian, quassia, tobacco ; and of the third, mercurials, jalap, aloes, and turpentine. ANTHEMIS. Anthemidis F'ores. See Chamomile. ANTHONY'S ST. FIRE. See Erysipelas, ANTHRAX, (from avOpal, a burning coal,) commonly called carbun- cle. A hard, circumscribed, inflammatory tumour, sometimes occurring as a primary disease, at others, as a secondary symptom. In the first instance, it generally takes place in debilitated individuals, whose con- stitutions have been worn down by excess, or long infirmity, and most commonly on the neck, back, or loins; it commences with great heat and pain, in a spot, where a few small vesications are soon observable, beneath which, a deeply seated and hard tumour may be. felt; rapidly increasing in growth, with an aggravation of the heat and pain, it be- comes of a dark red or purple colour, with one or more small blisters upon its apex : these occasioning an intolerable itching, are frequently bxratched off, when a brown sanies is discharged, and an eschar formed and sometimes a little black slough appears in the middle. The pro- gress of anthrax to a gangrenous state is generally quick, dependent however, on the state of the patient's age and strength. The constitu- AN. 23 tional symptoms, are restlessness, chilliness, profuse perspirations, and frequently delirium ; loss of appetite, nausea, vomiting, low pulse, tur- bid urine, &c. The prognosis Of the physician must be governed by the state of his patient's constitution, his age, and the magnitude and situ- ation of the tumour. Anthraces may be numerous in one individual, occurring in various parts of the body at the same time, and varying, in size, from one to twenty-four inches in circumference. In all those cases where the age and debility of the patient do not forbid the hope of recovery, the treat- ment is exceedingly simple ; the grand object is to make a free and early crucial incision into the tumour,' in order that the sloughs may be readily discharged, encouraging their escape by emollient or fermenting poultices, frequently renewed ; when the sloughs have separated, and the cavity is in a granulating state, it must be dressed with pledgets of lint and a mild ointment. In France, the actual cautery is employed in destroying the prominent parts of the tumour ; and in America a practice has been pursued, sanc- tioned by the high authority of Dr. Physic, of Philadelphia, of treating this disease with emollient poultices, until a sanies is discharged, when the surface is freely covered with a caustic alkali, from the effects of which the most favourable results have been obtained. The internal treatment should consist of a liberal supply of tonics and wine, (when not contra-indicated by the presence of fever,) and a close attention to the state of the bowels. Anthrax, or carbuncle, has been divided into benign and malignant va- rieties ; the latter occasionally running into the pestilential kind ; the first is usually met with in practice, and as such, has been above descri- bed ; the last occurs in severe typhoid fevers, and the plague, to which subjects the reader is referred for further information. See Bloomfield's Chirurgical Cases, Boyer's Surgery, S. Cooper*s Works, Dr. Phy- sic's Case of Carbuncle, with remarks of the use of caustic in that dis- ease, in the 2d vol. of the Philadelphia Journal, of the Medical and Physical Sciences. ANTIMONY. Antimonium. See Metals. ANTIPHLOGISTIC, (from avjt, against, and ^Atv^to burn.) The plan pursued in medicine, to oppose an inflammatory process, or weaken the animal system, by venesection, cathartics, diuretics, diapho- ctics, dilurents, the warm bath, &c. &c. ANTISORBUTICS, (from av% against, and scorbutus, the scurvy.) That class of medicines, as the vegetable and mineral acids, nitre, &c. or that plan of diet in the form of fresh fruits or vegetables, or in short, of all these substances to the composition of which oxygen contributes largely, administered for the relief of scurvy or scorbutic diseases. 1 26 AN. ANTISEPTICS. (Antisepticus, from av7t, against, and cnnu, to pu- trefy.) Substances which resist putrefaction, and reduced to four or- ders. 1. Tonic antiseptics, as cinchona, cusparia, chamx'melu.m, &c. 2. Refrigerating antiseptics, such as acids : 3. Stimulating antiseptics, wine, alcohol, ether, and musk. 4. Antispasmodic antiseptics, as cam- phor, opium, and assafcetida. ANTISPASMODICS, (from «v7<, against, and crracuos, a spasm.) Medicines tending to relieve spasmodic action, and arranged in three orders. Proper antispasmodics, musk, castor, ammonia, assafcetida, galbanum, valerian ; narcotic antispasmodics, ether, opium, and cam- phor ; tonic antispasmodics, the preparations of copper, zinc, mercury, and cinchona. ANUS. The fundament, or lower extremity of the rectum, so called, is subject to various affections, occurring in every stage of existence, from infancy to old age ; which may be thus classed: I. Imperforate anus. II. Abscesses and Fistula of the anus. III. Prolapsus—and IV. Artificial anus. We occasionally find, in some infants, the place where the rectum ought to open externally, entirely closed by a fleshy adhesion, which is perhaps not discovered until some days after birth : no time can here be afforded for deliberation, as the immediate safety of the child is at stake ; the part producing the obstruction, is generally of a dark coloured or livid hue, from the pressure of the meconium upon it, forming a small prominence that subsides under the fingers ; into this a transverse incision must be made, and a small tent of lint afterwards in- troduced, to prevent its closure, or a small piece of bougie may be worn for a week or two, withdrawing it occasionally. When no outward ap- pearances mark the exact spot, where the anus ought to be, greater difficulties attend the operation ; an incision must be made in the proper direction of a natural opening, considerably more enlarged than tho for- mer, and continued if the rectum do not appear above the wound, directly backwards, in order to avoid the bladder, or the vagina in the female; using the fore finger as a director, this incision must be con- tinued until the gut is discovered, or if it be situated too high up to be reached, as far as the finger will extend, when the knife being withdrawn, a middle sized trochar must be plunged into the intestine, or towards the spot it ought to occupy; the canula being retained in the wound, and secured there, by tapes passing round the body ; gontle glysters should be frequently administered to prevont tho accumulation of any liard faces, a bougie or an elastic gum catheter introduced, and worn for a week or two, and the child kept as quiet as possible. In some cases, the anus although not closed, is yet so small, that tho introduction of a bougie or tent, and sometimes a slight incision is necessary, before a free outlet for the fceces is established, AN. Vmscksses or the Ani-s. An erroneous but very general impression; h.ls prevailed, that the term of fistula may be applied to every case where matter is discharged from the neighbourhood of the anus. This region in common with others, is liable to all the effects of inflammation, and to tho formation of regular abscesses, of a mild suppurative form, or of plegmonous, and sometimes of an erysipelatous character, requiring.the usual treatment, and which may be shortly described, as consisting in a moderation of existing symptoms, in advancing the suppurative process, in discharging the matter at a proper time, and in preventing a recur- rence of the disease; the attendant symptoms are sometimes violent, and rapidly reduce the patient to a very low condition, and where this occurs during an attack of erysipelatous inflammation, it is necessary to proceed to the opening of the abscess at once, without waiting for the suppurative stage, in order to prevent the slough of the cellular mem- brane ; in other cases, venesection, and the usual antiphlogistic treat- ment must be practised, while suppuration is promoted by emollient poultices and fomentations; in the discharge of the matter, the opening must be sufficiently large to permit its ready escape, and allow the in- troduction of the proper dressings afterwards; the final cure of the disease, is bost accomplished, by permitting nature to exercise her own power of reparation, instead of obeying the precepts of the old practi- tioners, who filled the cavity of the abscess with irritating or perhaps caustic applications, serving as a complete obstruction to her efforts; if any dressings be introduced into the abscess, they should be of the. lightest quality and smallest quantity, and totally removed in a few days, when the sides will collapse, and the best opportunity be afforded for the obliteration even of the smallest sinus. It will, however, frequently happen, from peculiarities of constitution, from the long continuance of an abscess, in these parts, or from early improper treatment, that al- though by judicious measures a large cavity may be nearly filled by granulations, a small sinus still exists, continuing the discharge of a thin and gleety matter, which baffles all our attempts to cure by the plan already detailed. The manner in which the contents of an abscess arc discharged, gives rise to the denomination of the complaint; thus, when it is merely ex- ternal, it is called a blind external fistula ; when only internal, having an orifice in tho gut, blind internal fistula; and when both these varieties are united, the term of complete fistula is applied. However wide the original distinction may be between abscess and fistula, it is certain, that the former may frequently be converted into the latter by improper treatment, and thus form one description of the disease, properly called fistula, and whioh consists of a deep hollow sinus, with parts so hardeued- cr diseased as to prevent any union in that state, and frequently dis« 28 AN. charging a thin and discoloured fluid. It would appear that neglect or unskilful treatment have established a new disease, in the old sinus of an abscess, which losing its former sensibility, degenerates into a posi- tively local affection, difficult to subdue, and most disagreeable in its nature. The treatment necessary either for that description of abscesses, termed blind internal and external, or complete fistulae, that is, for those affections more correctly looked upon as fistulous sores, than proper fistulae, is nearly the same as that required, when the sinus in all its characters deserves the appellation ; the great aim of the surgeon is to bring together the sides of the abscess or fistula; this is of difficult ac- complishment, even when the surface of the rectum is not eroded, and when a communication is formed with the gut, impossible, unless with the assistance of the knife in laying the two cavities in one. Much argument has been wasted in the choice of definite and relative terms, in characterizing the various peculiarities that constitute a true fistula, but leaving these speculations, we cannot too warmly insist upon tho necessity of art uniformity of practice, either as regards fistulous sores, the result of ill-conditioned abscesses, or the direct fistulae : if, then, we discover either of these circumstances, the plan to be pursued is the following:—With a probe pointed bistoury, introduced into the sinus as far as it will extend, through the erosion of the gut, if existing, and to the surface of the rectum if only denuded, the extremity of the index finger passed into the anus, must be met, and by one incision, withdrawing the knife and the finger at the same time, the two cavities of the sinus and intestine laid into one : where the intestine is not perforated, the least pressure propels the bistoury, through its tender coats, and where there is no outward opening, the only orifice being within the bowel, the addi- tional care is merely required, while the finger is engaged as before, to open the sinus as well as its situation can be ascertained, and carry tho bistoury on, to fulfil the previous object. A dossil of lint should be after- wards introduced between the lips of tho incision, to keep the wound from prematurely closing, as well as to prevent haemorrhage, and the rest of the sore dressed with soft lint; the. dossil should be allowed to remain until loosened by the suppurative process, and light and easy dressings be continued until tho parts heal; this mode of procedure will obviate any necessity for the application of escharotics, which indeed are rarely admissible in this affection, and are seldom employed by the ex- perienced surgeon. The application of a ligature, passed through the sinus is now rejected from practice, and deservedly so. Artificial Anus. This loathsome malady is the consequence of a wound of the intestine through the abdomen. It may either take place from an injury occasioned by a cutting instrument, or from spha- I AN. 29 Crlation of the intestine in strangulated hernia ; the only chance of the patient's safety in preventing an extravasation of the foeces into the abdominal cavity is to bring the upper portion of the intestine to the ex- ternal opening, and permit their discharge in that situation. For the mode of relieving this affection, if possible—see Hernia. Prolapsus of the Anus. Prolapsus Ani. There are three varie- ties of this disease. 1st. When the whole rectum and tunics fall down. 2d. When the inner coat only descends. 3d. When the upper portion of the gut descends into the lower, forming a volvulus or intussuscep- tion. The affection may originate from circumstances tending to relax and weaken the parts, which retain the rectum, or its inner membrane, in its situation ; from various kinds of irritation and pressure on the bowel itself, or from any disease or irritation, affecting the neighbouring parts. Hence, a prolapsus may be caused by long habitual crying, violent cough- ing, sitting long at stool, hardened and dry foeces, and much effort in expelling them, obstinate diarrhoea, dysentery, chronic tenesmus, vari- ous diseases of the rectum, the abuse of aloetic medicines, and emollient clysters, haemorrhoids, and excrescences, the efforts made in parturition, stone in the bladder, paralysis of the sphincter and levatores ani mus- cles, and by prolapsus vaginae. In most of the cases of prolapsus, the symptoms are not very severe, but occasionally we find it accompanied by severe constitutional disturbance, the swelling being large and giving exquisite pain ; whenever it is accompanied by strangulation of the gut, the same consequences may be apprehended as in strangulated Hernia. The indications arc to restore the part prolapsed, to effect the retention of the bowel, when restored, and to remove the causes that have led to its protrusion. The part should be returned immediately with the finger, or by gentle pressure with a warm cloth held on the palm of the hand ; if it has been protruded for some time, and much difficulty is experienced in replacing it, the application of leeches, fomentations, or cold washes, is advisable -r and if much irritation prevail, it may be prudent to abstract a few ounces of blood by venesection; when a spasmodic resistance prevents its return, the warm bath, an anodyne poultice, and the internal use of opium are demanded ; and if it is still unyielding, and the symp- toms become of a more alarming character, the particular situation of the stricture must be examined and divided ; the situation of the patient may be altered, by placing him on his hands and knee*, in returning the gut, when the above applications have been employed. After the reduc- tion, the T bandage and a compress should be applied ; and when no great irritation prevails, an astringent lotion occasionally thrown into the rectum, to give the parts tone, and prevent a relapse. The bowels should be. carefully attended to, and kept open by mild aperients, avoid- 50 APO. ing aloetic purges, and tonics and alteratives may at the same time bo administered to strengthen the system. When the bowel is returned, it is proper to introduce the finger into the rectum, in order to ascertain that no intussusception exists ; when the complaint is of frequent recur- rence, it is advisable to place a portion of an elastic gum bougie within the rectu?n, by which the protrusion will be prevented, and the gut have a fairer opportunity of recovering its powers. The inner membrane of the rectum has been sometimes removed by ligature, hut the plan of Dupuytren is perhaps preferable, as leading to less constitutional irrita- tion ; this surgeon removes the internal membrane of the rectum by taking hold of the projecting folds with a pair of forceps, and cutting them off with curved scissors, a plan that was formerly pursued by the late Mr. Hey, of Leeds. The prolapsus of the bowel so common in children, may frequently be prevented, by making them sit on a high close-stool with their legs hang- ing down, at the same time keeping their bowels in proper order, for which purpose the castor oil is one of the best medicines. The infusion of oak bark and lime water, may afterwards be used for an astringent injection. Intussusception may be occasioned in the higher parts of the bowels as well as at the rectum, and may therefore be more appropriately treated of under another head. See Intussusception. Refer to S. Cooper's Surgical Works, Hennens' Military Surgcrj'i Lawrence's Treatise on Hernia, &c. AORTA. Diseases of. See Arteries. APHTHA, (from a-xrio, to inflame.) See Thrush. APOPLEXY. (Apoplexia from airo, and TtXtjaata, to strike or knock down.) A disease of the sensorial system, excited into action by a morbid condition of the sanguineous and respiratory functions, and par- ticularly by those causes that induce a compression of the brain, either from the rupture of a vessel, or the effusion of serum. Apoplexy displays itself under two great divisions, termed sanf the Brain—Dr. Armstrong's Works, and others. APPETITE, CANINE OR INSATIABLE. (Bulimia.) Perpe- tual desire to eat, which if not indulged, is apt to produce fainting. The urine and foaces, are not much increased, but an immense exhalation from the skin, relieves the system from the recrementitious part of the aliment; the real causes of this disease are imperfectly understood ; whether proceeding, from an excess of acidity in the stomach, from a superabundance of acid in the gastric juice, from undigested sordes, or the presence of worms, or arising more from monstrosity than disease. A variety of remedies have been proposed for its cure; some of a Te- 5 volting nature, and calculated to produce nausea and disgust, as oils, fats, large quantities of boiled eggs, and even pounded shells ; some, of a sedative character, to restrain the excitability of the stomach, as opium and tobacco; and others, with far more reason for their exhibition, as tending to check any superabundant and morbid secretion, such as eme- tics, cathartics, and tonics, (of the last class, the preparations of bismuth in particular.) The application of a blister to the region of the stomach, the restriction to a plain and nourishing diet, the restraining from food except at stated periods, added to an occasional recurrence to the last description of medicines, form the most rational plan of treatment for this disgusting malady. When it is incapable of relief, life is seldom of long duration, the frame becomes gradually weakened by depraved in- dulgence, marasmus and hectic succeed, and destroy. ARMORICE RADIX. (Horse Radish Root.) The root of the Cochlearia Armoracia; class, Tetradynamia; ordev, Siliculosa. Sti- mulant and diuretic, in scorbutus, rheumatism, and dropsy, and locally in hoarseness, from relaxation of the uvula, &c. 5 i. to 5 iij. of the infusion, three times a day; of the compound spirit, (Spiritus Armo- racke Compositus,) 5 j. to 5 iv. AROMATICS. (Aromaticus, from apw/ia, an odour.) A class of medicines of agreeable smell and flavour, given as stomachics, in weak- ness of the digestive faculties and flatulence, and also to conceal the nauseous taste of more efficient remedies. Cinnamon, cloves, carda- moms, caraway, cascarilla, &c. ARTHRITIS. See Gout. ARROW ROOT. (Maranta Arundinacea.) Class, Monandria; order, Monogynia. The starch prepared from this plant or Indian arrow-root, procured from the West India islands; a highly nutritious article of food, and easy of digestion. ARTEMISIA ABSINTHIUM. Common Wormwood. A plant of the class Syngencsia; and order, Polygamia Superflua. Tonic, anti- septic, anthelmintic;—doses, in substance, 3 i. to 3 ij. daily; in infu- sion, 5 iv. to 3 xij. three or four times a day. Incompatible with thesulphates of iron and zinc, and the super-acetate of lead. ARTERIES. Diseases of. See Heart and Arteries, diseases of. ARSENIC. See Acids Arsenious. ASCARIDES. See Worms. ASCITES. See Dropsy. ASPHYXIA, (from a privative, and of the phrenic nerve, to the seat of the diaphragm, and re- peated at short intervals: unless the signs of apoplexy are unequivocal, bleeding is hardly advisable. Asphyxia from cold, is occasioned by torpor, and an exhaustion of the physical power, by the sudden abstraction of heat; the countenance is pale and contracted, the limbs rigid and unyielding, the patient insensi- ble, and apparently under the influence of deep sleep. In the employ- ment of remedies, great care is necessary; where partial asphyxia has taken place, and the extremities are thechiefsufferers,asin the common instance of frost-bitten limbs, the body should be plunged into cold water, (sea-water is perhaps preferable if it can be procured,) or rubbed with snow and then well dried and gentle friction--gradually increased, exercised Upon its surface, at the same time introducing small quantities of warm wine into the stomach, and stimulating the rectum by an enema ; the same plan may be pursued in more severe Cases, where the effects of cold have not been confined to the extremities, carefully avoiding any sud- den measures, by which warmth would be too quickly restored; too much care, indeed cannot be exercised in this particular ; the injudicious kindness of friends has too frequently led to a fatal error, and gangrcna and loss of life succeeded to their well meant but ill-employed exertions. Electrical Asphyxia, is produced by an instantaneous shock to the ner> vous system, sufficiently strong to overcome its energy ; the countenance is pale, the limbs flexible, and if life be extinct, the muscles will be found flabby and of a bloodless hue, and the blood uncoagulatcd ; the appear- ance of the passage of the lightning is sometimes visible, in the form of dark blotches or streaks, or presenting an appearance somewhat simi- lar to the marks occasioned by a charge of small shot.* Stimulants of an active, nature must at once be resorted to, where any appearance of life remains, in .the form of cordials, camphor, ammonia, &c to the stomach, and spirits of turpentine as an enema. Upon the continent, a dose of two or three grains of Phosphorus has been strongly recommend- ed, and if that substance may ever be administered, ^iis probably is the case for its exhibition. It is necessary to notice the strange opinion, that electricity is an agent of wonderful power, in this variety of asphyxia, as a cqunter-irritant, passing the shocks in the same manner as direct- ed in asphyxia from unrespirable gases : if this opinion be correct, it af- fords a singular instance of the destructive and saving ability of this mighty power. Aspliyxia in new-born infants, may arise from three causes ; 1st. Weakness of tho vital functions, when it will be improper to cut the cord immediately ; the nostrils should be stimulated with volatiles, the hums inflated, friction employed, and the child immersed in a warm bath. 2d. From the mouth and throat being filled with the liquor amnii, or a glairy fluid, which must directly be washed out, and the above means resorted to, if necessary. 3d. From congestion of blood in the brain, by the cord being compressed as in breech and feet presentations, where it is; entangled round the child's neck, or from compression of the head by the use of instruments, or pressure of the pelvis, in labour. In this case it will be proper to allow a small quantity of blood to escape from the cord before it is tied, and then to proceed as in the former instances. When asphyxia and death so frequently occur in new-born children, the necessity of caution in giving an opinion in a case where a parent is suspected of the murder of her offspring, cannot too strongly be incul- cated. ASSAFG5T1DA. Assafoetida Gummi Resina. A gum-resin pro- cured by exudation from the Ferula Assafoetida ; a plant,, the growth of Persia and India ; of the class Pentandna, and order Digynia. Stimulant, antispasmodic, expectorant and anthelmintic in doses of from grs. v. to 3 j. in cases of hysteria, asthma, dyspnoea, pertussis, and worms. Officinal preparations. Assafoetida mixture (mistura assafostidae) § ss. * In a case of a boy struck by lightning in England, some years ago, I par- liculiirlv remarked this appearance.—Editor. AU&. i* to J iss. frequently repeated during hysteria or ah attack of spasm. Tincture of assafoetida (tinctura assafostidae) Tt\. x. to 3 j. the same oper- ation as the gum. Foetid Spirit of Ammonia. See Ammonia. Compound Assafoetida Pills. (Pilula; assafcetidas comp.) grs. x. to 3 j- in chlorosis, hysteria and hypochondriasis. Pills of aloes and assafoetida (Pilueae aloes et assafectidae) grs. x. twice a day, in dyspepsia, hysteria amenorrhaea. ASTHMA, (from acQjia\o>, to breathe with difficulty. See Diseases of the Lungs—Emphysema. ASTRINGENTS, (from astringo, to constringe.) That class of me- dicines, possessing the power of contracting muscular fibres, and at the same time exerting a tonic influence through the medium of the living principle ; the princij a' astringents employed in medicine, are lead, copper, iron, zinc, opium, logwood, oak galls, Peruvian, Augustura, and oak barks, cinnamon, catechu, kino, lime, &c.; externally the same sub- stances, and also, vinegar, cold water, muriate of ammonia, &c. ATROPHY. (Atrophia, x, from a, without, and rp£0a>, to nourish.) See Marasmus. AURANTII CORTEX. Bitter, or Smille orange peel: the rind of the Ciir . Aurantium. Carminative and Stomachic. See Citrus. AUSCULTATION, (Auscultatio, hearing,) is a process, employed in medical elimination of the diflerent sounds, which the circulation of the air, the reverberation of the voice, or the beatings of the heart, produce in the cavity of the chest. Auscultation may be mediate ot immediate, the latter when the naked ear is placed upon the thorax, the former when the stethoscope is employed; it may be asked, what advan- tage has the instrument over the natural organ of hearing, that it should be used in preference; to which it may be replied, that in addition to the unpleasantness of the task in approaching so near to some patients, and the indecency of this mode of procedure when applied to females, we do not gain by immediate auscultation that correct knowledge afford- ed by the stethoscope; the sounds transmitted from the whole surface of the head, applied to the chest, appear to possess so much intensity, that we cannot appreciate their shades of difference, and are so confounded with one another, as to render it impossible to distinguish exactly the place where each is produced; and the rubbing of the head during the elevation and depression of the chest, also adds to the confusion. Mediate auscultation, as far as the lungs are concerned, makes us ac- quainted with the natural and. pathological phenomena of respiration; the natural phenomena consist in the motions of the thorax, and the peculiar sound of the respiratory murmur. In health, there are aboul twenty complete respirations in the minute, performed slowly and regu- 40 AI>. larly,with a constant and uniform rhythine, the dilatation au_*'"iilraction of the ribs being equally marked on both sides; upon the application of the stethoscope, we hear a slight, but distinct murmur, caused by the penetration of the air into, and its expulsion from the cells of the lungs; this murmur te more distinctly heard in the superior lateral, and the poi- tero-inferior parts, where the lungs are nearest to the surface, that is, in the axilla, and in the space comprised between the clavicle, and the edge of the trapezius muscle; over the larynx, the trachea, and the roots of the lungs, the murmur assumes a particular character, indicating that the air is passing through a canal of considerable diameter, and tho sound which is termed tracheal, may be compared to that produced by a pair of bellows. The distinctness of the respiratory murmur, corresponds to its fre- quency, and hence it is necessary to desire the patient to breathe quick- ly when under examination; it is more apparent in children, women, and men of an irritable habit, and is generally stronger during inspiration. The pathological phenomena may also be divided into those relating to the motions, of the thorax, and those derived from the character of the respiratory murmur. The motions of the thorax, under disease, may be frequent or unfrequent, quick or slow, irregular, intermittent, or interrupted, great, small, or unequal, difficult in various degrees, incom- plete, solely abdominal, or completely thoracic. Respiration is frequent when more than twenty inspirations are made in a minute, and is natural to infants or persons of a nervous tempera- ment; it occurs after exercise, or strong mental emotions, in hot cli- mates, and generally speaking in the whole class of the pyrexia; respi- ration is unfrequent when the inspiratory motions are less than eighteen in the minute, and generally accompanies comatose and hysteric affec- tions. Respiration is quick, when the inspirations are short, rapid, and sud- den, and may be allied to frequency, when it is termed accelerated or even panting respiration, according to its degree; it is met with in most acute diseases, and in the last moments of existence ; the slowness of respiration may be remarked when the inspirations are long and gradual, and appears under the same circumstances as unfrequency, which it often accompanies. Respiration is irregular, when the inspirations and expirations succeed each other at unequal intervals; intermittent, when one or more inspira- tions take.place later or fail altogether ; and interrupted, when the expi- ration takes place before the inspiration is finished: these varieties oc- curring in inflammations of the chest and abdomen, and also in nervous affections. Respiration is termed treat, when a perfect expiration i, succeeded by at as. 41 * slow or quick inspiration, accompanied by a considerable enlargement of the chest; great, and unfrequent respiration is observed in cerebral fevers, at the approach of phrenitic delirium ; small, when the dilatation is hardly perceptible ; high, when the chest, remains elevated, the inspi- ration not having been preceded by a complete expiration, as occurs in pneumonia, in addition to a frequency, smallness, and quickness of res- piration. Respiration is unequal, when either an inspiratory or expiratory mo- tion is stronger or more prolonged than the other, as frequently observed in typhoid and spasmodic affections, and always in acute attacks of pleurisy and pr.eumonia. Respiration is difficult, when the great accessory muscles are called into action, or when the proper respiratory muscles contract forcibly; of this state their are different degrees, from oppressive to suffocating, the latter termed ortliopncea, and attendant upon asthma, diseases of the heart, and most of the affections of the lungs, or indeed upon any condition, in which an obstacle to the entrance of air into the lungs, or to the dilatation of the thorax, is created. Incomplete respiration occurs, where one lung remains partially or wholly inactive during the respiratory motion of the other, and is one of the most constant symptoms of pleurisy and pneumonia; when occa- sionally met with in a state of health, it can only be regarded as the result of a former disease, which has caused adhesions between the two pleurae. Abdominal respiration (when existing alone, during which the ribs perform no motion) is observed, when the lungs have, from disease, become incapable of performing their functions, and is generally a fatal symptom; in old age, however, it occurs solely from the ossification of the costal cartilages, the elevation and depression of the ribs being thereby prevented. Thoracic respiration, or that where the diaphragm lends no concur- rence, is recognised in all cases of intense abdominal inflammation, oc- casionally in pregnancy, or ascites. Such are the changes produced in the motions of the thorax; wo have now to consider the pathological phenomena, observed in ex- amining the respiratory murmur. The sound or murmur of respiration may be stronger or weaker than natural, altogether inaudible, or similar to that produced by the.passage of air through the trachea; it may also be cavernous, as when the air passes into an excavation of the lung, and lastly, it is heard in combina- tion with the different rales.* * Rale.—There is no English expression which can give a definite idea of the meaning of this word. much irritation, they may be properly removed with Hey's saw; n lotion formed by a mixture of nitric acid and water, has been occasion-' ally employed to excite the action of the surrounding absorbents, and hasten the separation of the dead parts. Exostosis, (from c\, out, and oajsov, a bone.)—A bony excrescence, or tmnour, srowing out of some part of a bone, or according to Boyer, the enlargement of a part, or the whole of a bone. The morbid growth may arise, 1st. from an osseous deposition, seated between the external sur- face of the bone, and the internal surface of the periosteum, and adhe- rent to both ; 2d, from a similar formation originating in the medullary membrane, and cancellated structure of a bone. Sir Astley Cooper, from whom the above divisions are derived, describes also the cartila- ginous, and the fungous exostosis ; the first, where the enlargement is preceded by the formation of cartilage, which forms the nidus for the ossific deposit; the second, where the tumour is softer than cartilage, yet firmer than fungus in other parts of the body, containing spiculae of bone, being of a i;.*jgna\i! nature, and depending upon a peculiar state of the constitution, and action of vessels, somewhat similar to fungous hsnmatodes, but modified by the structure of the part in which it origin- ates, (this latter form of disease, will be treated of under the head of Ostt isarcoma.) The hoaes principally affected by exostosis are those of the cranium, the lower jaw, sternum, humerus, radius, ulna, bones of the carpus, the femur, and tibia. In size, strurture, and consistence, exostoses present great differences ; the small enlargements are gene- rally situated in the cancellated structure of the bone, while those tumours of a large description, and occasionally of an enormous size, are more commonly seated between the bone and the periosteum, and hence denominated false exostoses, in distinction to the former, which are termed true; the structure may be a mass as hard as ivory, it may be of a cellular texture and formed of broad laminae, intercepting exten- sive spaces filled with matter, different from the medulla, or it may co?i- sirt of a sort of hollow sphere, with thick hard walls, and the cavity filled with cartilaginous or fungous substance. An exostosis, when not very large, causes little inconvenience, but when it has extended itself, the surrounding soft parts become affected ; the muscles being stretched and emaciated, the cellular substance thickened, and perhaps the func- tions of the nerves and arteries interrupted; the action of the flexor muscles of the leg may be interfered with, by an exostosis in the vicinity of the knee ; the functions of the urethra be disturbed by one near the symphisis pubis ; an exostosis in the orbit, may destroy vision, and dis- place the eye ; in short, wherever these enlargements occur in th« neighbourhood of important organs, and increase to any size, a loss of power must be experienced in their functions. Venereal exostoses, or 58 BON. nodes, arise chiefly on compact bones, and such as are superficially covered, such as the bones of the cranium and the anterior surface of the tibia. (See Venereal Disease.) What are the positive causes of exostosis is a matter of some uncertainty ; we are aware that the venereal taint is one source ; the French surgeons in general, impute the disease wholly to internal causes, and imagine that scrofula is frequently the source of its origin : the ease with which it is produced in some habits from slight injuries which occasion no effects in others, renders it probable, that it is mainly dependent on constitutional causes. Symptoms.—Exostosis may be cither chronic or acute, and the symp- toms, of course, vary with its nature; in the former kind, which usu- ally accompanies the hardest enlargement of the bone, the tumour is preceded by no pain, increases very slowly, is attended with little sen- sibility, and only becomes alarming when its size occasions a disturbance of the surrounding parts ; in the acute form, and where the cartilaginous precedes the ossific deposit, the enlargement is also-gradual for a con- siderable period, and attended with no great degree of pain; the surface of the tumour, however, at length becoming tubcrculated, ulceration ensues, a bloody serum is discharged, a fungous forms, and the usual train of hectic symptoms sets in, by which the patient is destroyed; this latter form of the disease is rare, exostosis being generally characterized by a peculiar indolence of growth, and a want of those symptoms that accompany active inflammation. A hard exostosis, when it has gained a large size, will sometimes terminate in necrosis, from a mortification of the enlarged bone, which separates it from the sound portion ; this is a favourable, but unfortunately, a rare termination of the disease. Treatment.—Whenever an exostosis is not productive of great distress, it is unwise to undertake any operation for their removal ; this must be laid down as a positive rule ; for as Boyer justly remarks, the local affection is much less to be dreaded in most cases, than the means used for removing it. When any constitutional cause can be traced, the as- sistance of the physician is of course required in the administration of such remedies as will correct it; and when the disease is attended with much pain, the outward use of opium will frequently afford great relief. Boyer strongly recommends a linseed-meal poultice, made with a decoction of nightshade and henbane, to which laudanum may be added ; when the pain is not considerable, the soap and mercurial plasters, volatile lini- ment,washesofsodaor potass, may be applied as resolvents. Sir A.Coopcr has given the oxymuriate of mercury in small doses, together with tho compound extract of sarsaparilla, and in some cases with considerable. benefit. Mr. Samuel Cooper draws the attention of the profession to the propriety of keening a blister open over an exostosis, in order tq BON. 59 promote its absorption, and leeches may be applied with the same in- tention. Mr. Abernethy in the treatment of a peculiar case, where a boy was strangely predisposed to this disease, administered the muri- atic and acetic acids, in order to dissolve the lime, which he thought too abundant in the system, but as IWr. S. Cooper properly demands, how could it be expected, even admitting the correctness of the theory, and that the acids could, by possibility, after entering the circulation, act upon the tumour, that the redundant depositions of the phosphate of lime should alone be dissolved, and at the same time, the skeleton itself remain undissolved. Caustics and the cautery have been applied to exostosis, but generally with a bad effect. When the system is much affected by exostosis, and the situation of the tumour allows of its safe removal, the operation may be undertaken ; but in some cases, the bases of the tu- mours are so extensive and deep, that amputation may be preferred to their extirpation. When it proposed to remove a tumour of this nature, it must be exposed by the knife as much as possible, and cut away by one of Hey's saws, or what is still better, a saw invented by Mr. Machell, and described in the surgical essays of Sir A. Cooper, as a small, fine, perpendicular, wheel-like saw, turned by a handle ; the orbicular saw or Graefe, of Berlin, may also be advantageously employed, and also the rotation saw of Professor Thai, of Copenhagen ; a strong pair of bone nippers, or Liston's cutting forceps, will also bo found ser- viceable during the operation. Spina Ventosa.—(A term first employed by the Arabian writers, Spina signifying a thorn, on account of the prickling sensation experi- enced, and Ventosa, being added, because upon touching the tumour, it seems to be filled with wind, though this is not the cause of the dis- tention.—Hooper.) A disease in which matter is formed in the interior of a bone, and afterwards makes its way outward beneath the skin; the term spina ventosa has been erroneously employed to signify the affection, termed white swelling, which in fact, it in no way resembles, as the accumulated matter passes from the interior of the bone under the integuments, and as it attacks the middle portion of the long bones, as well as the joints, where it is of rarer occurrence. It may be occasioned by a blow or other violence, capable of injuring the bone, or arise as a con- stitutional affection in weak or debilitated habits, particularly after fever. Symptoms.—A dull and heavy deep seated pain is complained of in the part, while the external appearance is unaffected; the nature of the disorder may not be suspected for a considerable time, nor until the bone becomes extensively diseased, and the periosteum thickened, when the enlargement will present the appearance of a node ; or sometimes a red swelling of the integuments, with a soft, spongy feel ; at length matter accumulates under the communicating periosteum: with tb« GO BOX. bone by one or more small apertures; the bone then becomes in- tensively carious, the periosteum gives way, and ulceration extends through the skin, so that a probe can readily be passed into the interior of the bone ; excessive pain occurs as the disease advances, and renders either the removal of the cause of irritation or amputation necessary. It most frequently occurs in the carpus, tarsus, and tibia. Treatment.—The abscess must be laid open, the soft parts dissected off, and, where the aperture in the bone is discovered, a trephine applied, and carried through the lamella ; this exposes the discard cancelli, which must also be removed, cither with the knit••', gouge, or other instruments ; the part should afterwards be dressed with dry lint, when the cavity will gradually be filled with good granulations, and a Cure follow, probably without exfoliation ; if necessary, the strength of the patient must be supported, by a judicious administration of wine and tonics. Mr. Hey, of Leeds, in an exostosis of the parietal bone,-by which an absorption of both tables was occasioned, and an extravasation of the matter caused under the pericranium and upon the Dura-mater, applied the trephine, and removed the whole of the diseased mass. Molltiies Ossium.—A softening of the Bones. This disease consists in a great softening of the bones, so much so as to admit of their division by a knife, and at tiic same time occasioning so great a flexibility, that they may readily be bent in any direction ; it depends directly upon an inordinate absorption of the phosphate of lime, a due proportion of which is necessary in the economy of every healthy bone, and of so great a weakness of the vital functions, that they are unable to repair the loss thus occasioned ; this is fortunately an uncommon disc^e, and one, of which the remote causes are unknown ; in the cases recorded, we are only put in possession of the melancholy fact of its occurrence, without a sufficient reason being advanced for its cause, or a remedy prescribed for its cure. It may affect individuals at any period of life, and is usually accompanied by a soft and flabby condition of the muscles, and sometimes by a partial disorganization of the viscera. The most re- markable case on record is that of Madame Supiot, whose thigh bones were so flexible, that her feet could be laid on each side of her head, her other bones corresponding to this flexibilty, and at her death, she was two feet two inches shorter, than when in a slate of health. This disease differs materially from Rickets, as we shall show, when treating of that subject. Frugilitax 0.«;»m, or Brittleness of the Bones. Arises according to the definition of Boyer, from a deficiency of the soft matter naturally entering into the texture of bones; to a certain degree, it necessarily en".. IV. Hydatid Tumour. See Hydatid and Tumours. V. Scirrhus and Cancer. See dancer. VI. Fungoid Tumour. See Fu/gcvs HmmntodeS. BRONCHITIS. See Lungs, diseases of. BRONCHOCELE, (from fipoyxof, the wind-pipe, and *>;>;/, a tumour.) An enlargement of the thyroid gland, or a tumour generally, of a steatomatous character, and indolent in its nature, occupying the whole or part of that body; it generally commences about the eighth or twelfth year, is very sldvr in its progress for a considerable period afterwards, when it increases more rapidly, and at length forms a bulky pendulous mass, which may fill up the space from the angle of one jaw to that of the other, and form a considerable projection on each side of the neck, or even hang down upon the chest. It may exist simply as an enlargement of the thyroid gland, without the slightest malignancy, and only occasioning distress, by an interference with the respiratory functions from its size and pressure upon the trachea, or upper parts of the thorax, or by a slight interruption to the circulation by compression of the jugular veins, when headache and other un- pleasant symptoms may be produced ; or it may appear in a compound form, in which a more or less voluminous cyst is formed round it, filled with a pultaceous or purulent matter, or in which calcareous and other substances have formed. The precise causes of Broncho,-!,., are but little understood; its frequency in some of tho valleys of the Alps, Appcnines, and Pyrc.iicr-r, where it is called Goitre, led to the supposition that it was occasioned by the constant use of snow water ; but its frequent occurrence in Derbyshire, where it is known by the name of the Derby neck, ant! in various districts of Kngloird besides, i's existence in the island BRO. «id of Sumatra, and in Sor.ih America, where snow is unknown, all prcva that this vcircumstance cannot account for its production. It has been supposed to be allied to scrofula, but the single fact of the constitution remaining unaffected during its continuance proves the contrary. There is one peculiar circumstance attending this disease, that females aro more subject to its invasion than men, and the fact may probably lead us to the clearest interpretation of its real cause. It ..- probably de- pendent upon excessive moisture, and that of a peculiar nature, such as valleys enclosed by mountains might be supposed to generate and determined to an organ peculiarly susceptible of its influence, and ex- posed to its operation, as in the case of females. Treatment.—A remedy proposed by M. Alibert of Paris, and acted upon with advantage under Ins direction, will confirm the above re- marks ; that eminent physician has directed an immediate change of air as the surest cure of thi3 affection, in its incipient stage, in tho persons of Swiss ladies, who accordingly repaired to the French capital, and where the tumour subsided. A few years ago, and at the time when the first edition of this work appeared, burnt sponge was recom- mended as a specific for'bronchocele, administered in the form of a troche or lozenge, in combination with burnt cork or pumice stone, and placed under the tongue, and there suffered gradually to dissolve ; tho reason for which this remedy was selected, was undoubtedly on account of the alkaline salts it held in combination, as the sub-carbonate of soda, together with tho phosphate and carbonate of lime. Calooiel, cicuta, belladonna, &c. have also had their advocates, until modern science suggested the use of a substance, the effects of which have exceeded all that have been hitherto employed, in the shape of Iodine, a new pro- duct of chemistry. (See Iodine.) This novel medicine has been em- ployed both internally and externally, in the arrest of the progress of Bronchocele ; when designed to act through the medium of the system at large, it may be administered in doses of from one quarter to one half a grain three times a day, carefully watching its effects, and discon- tinuing it if leading to disturbance of the general health; when designed as merely a local application, the substance may be mixed with lard in the proportion of from ten to twenty grains to art ounce. The extirpation of the thyroid gland has been proposed by French surgeons, in this disease, and Desault and tfedenus of Dresden havo succeeded in the operation ; but the performance of it is attended by no common difficulties, and perhaps except in the event of an aneurismal enlargement of the organ, is unjustifiable, particularly after the dis- covery of Iodine as a means of cure. The thyroid arteries also havo been tied with a view of cutting off" the supply of blood to the tumour, for the mode oftloing which, the reader is referred to the subject, Diseases of the Heart and Arteries. 9 tit> .in BRONCHOTOMV. (Bronchotomia ; from (iaoyxoi, the wmu-pipo, and re/ivb), to cut.) An operation required when respiration becomes impeded by disease, as in severe cases of croup, or when some foreign substance has made its way into the trachea; occasionally performed also in cases of suspended animation, to allow the introduction of a tube for the inflation of the lungs, if the passage by the mouth bo Spasmodically closed. When disease or accident requires this ope- ration, the patient should be placed on his back with his head resting oh pillows, and inclined backwards, as far as the difficulty of breathing will permit; the surgeon, sitting on his right-hand side, feels for the Bpace between the thyroid and cricoid cartilages, directly over which, in the intermuscular division, he makes a perpendicular incision from half an inch to an inch in length, and then placing his left fore-finger on the ligament connecting the two cartilages to each other (the crico- thyroid) he uses this as a director for a straight-bladed bistoury, into the air-tube, cutting a little laterally, on each side between the two cartilages ; the opening may be farther enlarged, if insufficient for the purpose of free respiration, by continuing the incision downwards, so as to divide the cricoid cartilage. Mr. Lawrence has occasionally cut away a piece of this cartilage, to prevent the premature closure of tho wound, preferring this plan to the insertion of a tube as in general prac- tice, and which, he justly conceives causes excessive irritation and pain. When a foreign body is impacted in the trachea, the opening for its removal must be made in the same manner; but the incision should be carried through the first two or three rings of the trachea, according to the size of the substance to be withdrawn, carefully avoiding the su- perior branch of the thyroideal artery or the thyroid gland, and ascer- taining their exact situation, with the point of the fore-finger, when they may readily be protected from the knife. If the substance be not immediately expelled by the force of the air passing from the lungs, through the artificial opening, which is frequently the case, it should be seized if possible by a small pair of forceps and brought away ; the bps of the wound should then be brought together, and perfect rest enjoined for a few days. In cases of suspena»d animation, the opening into the larynx may be made, as directed m ihe operation required in disease ; a pipe then inserted, and attached to *e proper apparatus, or even the nozzle of a pair of bellows, and the process of artificial respiration commenced. BUBO—(from 0ou/W, the groin.)—By this term is meant a swelling of the lymphatic glands, particularly in the groin and axilla. This affection may proceed from three different causes: irritation, absorption, _(ld general affection of the system ; the first, which is also called Sympathetic, arises from a local cause, such as the irritation of a violent waorrhgea; the uutttm occasionally produced alter venesection, Bfjta\ M When a bubo will form in the axilla, or from a slight wound in the knee or leg, when it will appear in the groin; the second cause, absorption, produces the true Venereal Bubo, which generally proceeds to suppura- tion, while the former readily yields to cooling regimen and applications-j tho bubo occasioned by general affection of the system,., appears in scrofula, in fever and plague, to all which subjects, as well as the vene- real disease, the reader is referred for further information on the subject. BUBONOCELE (from (iovfiwv, the groin, and nnXn, a, tumour.) Inguinal Hernia. See Hernia. BUCKTHORN BERRIES. Rhamni Baccw. The berries of the Rhamnus Catharticus; class, Pcntandria; order, Monogynia. Cathar- tic, in doses of the fresh berries 3 j., of the dried, 5 j. Syrup of Buck- thorn, (Syrupus Rhamni) 5 ss. to 5 i. BUCNEMIA, (from fiov, a Greek augment, and Kvnuy, the leg.) T7ie swelled or tumid leg. This disease has been introduced into tho nosolo- gy of Dr. Mason Good, and is divided into two species : the puerperal tumid leg (Bucnemia Sparganosis) and the tumid leg of hot climates, (Bucncmia Tropica.) For a description of the first of these maladies, we Uterus, diseases and affections of; with respect to the second, com- monly known in the West Indies, by the name of the Barbadoes-leg, from its being indigenous to that island, although by no means confined to it; it was, in former days, confounded with the Arabian swellcd-leg^ elephant leg or elephantiasis, to which, however, it bears no resemblance, The tropical bucncmia, is occasioned by an effusion of coagulable lymph into the cellular membrane, under the skin of the part affected, in con- sequence of inflammation of the lymphatics of the lower limb, and espe- cially of the inguinal glands, the cause of which is quite unknown.' It is by no means clear, that this disease is essentially the result ofinflamma- tory action in the lymphatics and glands, as we frequently see these organs affected by inflammation, without any symptoms occurring that resemble Bucnemia. In the works of Dr. Hillary, and in the observa- tions of Dr. Graves, of Dublin, in the Transactions of the King's and Queen's College of Physicians in that city, Vol. v, several instances are given of enormous chronic growths, not only in the leg, but in tho arm, scalp, ears, neck, loins, &c. where it has appeared that the lym* phatics and glands could not be affected, and that the disease was occa- sioned rather from an inflammation of the skin, and subjacent cellular- tissue. In the tumid leg of hot climates, the skin becomes of a deep red, or purple hue, while the exuding fluid from the cutaneous exhalents, con- cretes into rough and sordid scales, and the skin itself becomes enor- mously thickened ; the effusion is preceded by a febrile paroxysm, which ui^l'v ,v.b. rucufs at irrcsuiar periods, every fcegh attack ivi'.'Ji'^ to tha f.8 BLlL effusion and size of the limb; the inflammation gradually extends up (lie thigh, invading the genital and pubic regions, and in a few instance's, tho glands of the upper extremity participate with those of the lower, wh mucous bags, or small membranous sacs, of different sizes and firmness, situated about the various joints of the body, and for the most, parr, lying under tendons whore they pour out an oily kind of fluid, to lubri- cate the surfaces upon which the tendons play, in their passage over joints. Th?se sacs occasionally become much enlarged, from a preter- natural accumulation of this fluid, or obstruction of their mouths ; indu- ced by sprains, bruises, rheumatism, scrofula, &c. The swellings are generally unattended with pain, or redness, and are clastic. The contents of the sac, when enlarged from rheumatism, are fluid; from a scrofu- lous cause, of athicker or mucous consistence ; and of a concrete or car- tilaginous nature, when occasioned by injury. When the swellings are not painful, or productive of much inconvenience, an attempt may be made to promote their resolution by fomentations, frictions with campho- rated mercurial ointment, or blisters kept open with the savin ointment; but if these endeavours are found unequal to their cure, they may be opened cither by puncture or seton, and their contents evacuated, taking- care not to wound any tendons in so doing; the re-accumulation of fluid in the sac, may be prevented by. the use of a firm compress and bandage. CACHEXIA, (from koko;, bad, and tin, a habit.)—A term used to denote a morbid state of the blood, or blood-vessels, alone, or connected v-ith a morbid state of the fluids, producing a diseased habit, ft CAL. CACHEXY, NEGRO. Cachexia Africana.-\ disease common ^ among the negroes in the West India islands, where it has been termed by the French, "mal d'estomac," and by the Engteii, dirt eating, from the singular propensity of the'sufferers to eat dirt. Sonnim and Humboldt, describe the custom of eating dirt and clay, as existing in Egypt; and there, as elsewhere, it appears difficult to draw the line between unnatural appetite and actual disease. There may probably be some aualogy between the affection and chlorosis, when the former occurs in the female sex. Dr. Thomas, in his practice of physic, traces an analogy between it and nostalgia, and thinks, that it is occasioned by hard labour, bad food, cruel treatment, and grief, in being separated from their friends and country ; but this can hardly be a correct supposition; it attacks individuals in Egypt, not exposed to the evils alluded to, and also the inhabitants of the West Indies, who do not suffer from such an excess of feeling, having been born on the island. It may perhaps depend upon a morbid propensity, which acquires a triumph over tho natural taste, and disposes the imagination to fancy disgusting articles as proper for food ; from whatever cause, however, it exists, it should be met, by giving a counter-action to the organ in which it exists,by emetic and purgative medicines, and afterwards strengthening it with tonics; where acidity prevails, absorbent medicines may be resorted to with the best effect; indeed, one eminent writer imagines the possibility of an instinctive call for the dry earths, as direct absorbents, when this malady, or whatever else it may be termed, exists. CAESARIAN OPERATION.—See Uterus. CAJEPUT OIL. Oleum C» it melts at a considerable heat, giving out a smell, resembling that of H wax, and on cooling recrystallizcs ; when suddenly exposed to a strong P,'". heat, it evaporates altogether in a thick smoke. Soluble in pure alkalies, "»■ and the solution has all the properties of a soap. This substance closely N: resembles spermaceti, in properties as well as appearance. ^ 2d. A species of a gray colour externally, and brown within, formed of "Haii concentric layers of inspissated bile, round a nucleus of white crystalline *» matter; there arc Usually several of these substances in the gall bladder ^ together,* they are light and friable, and are also of the nature of spcr- -a march. ?'c- 3d. These are the most numerous, of a deep brown, or green colour, ;,'»a and presenting when broken, a number of crystals, of a substance like- ffiv<. wise resembling spermaceti; these are soluble in alkalies, soap-ley, «CJ alkohol, and the oils. Bortif 4th. Concerning this species, but little is known; they are described hep** as being insoluble in alkohol, and turpentine; not flaming when burnt, '8ts,o but becoming red, and consuming to ashes like charcoal. For the causes and symptoms of the formation of these substances, sec Hepatic diseases. latiosfi Intestinal Calculi, are more common in animals, especially those of heciisi the ruminating kind, Or those which possess along complicated digestive iodic,]! organ, than in man ; when, however, they appear in the human subject, ericife they are generally dependent upon an accidental origin, occurring ii>ti, alter an injudicious use of prepared chalk, magnesia, or other calca- yikr. reous earths, that have been employed to check a prevailing acidity. [ order,D Calculi, thus formed, have been discharged by stool, and sometimes with great pain, when they have been rough or pointed at their edges; By in' their composition, of course, depends upon the cause of their formation ; M'8 " * In a post-mortem examination that fell under my observation, some years «*ago, of a case of hepatitis, where general jaundice prevailed with anasarca of the lower extremities, the gall-bladder was not discovered, but upon cutting .1 .riinlo the liver, a cvst was opened, containing 40 gall-stones of this character ;■ a :'the cyst was surrounded by a mass of white substance, resembling the for- 'omeWmation of tubercles; in the ductus communis, which appeared to be the only se sufctremnant of the biliary apparatus, five similar stones were found. In different , puts of the intestinal canal, were hardened fasces of a chalky whiteness; the lia™5 arch of the colon was adherent to the liver, which viscus was not much c"lar~ tps,te-evrt, but presented on its surface, several white round tubercles; Eomc aulu;. . astliN ;jU3ofuic intestines were also observe,!.—ii.,7."". Kt'Sir iP 14 CAL. the nucleus consisting of a concrete mass of any of the calcareous oartlis before named, with concentric layers of renewed materials, and animul matter deposited round. Renal Calculi.—The calculous particles formed in the kidney, either pass off imperceptibly, or with considerable uneasiness to the patient, in the form of gravel or sand, or concrete and form masses in the pelvis of that organ ; the sand that is so frequently observed in a cham- ber utensil, is either white or red, each proceeding from different causes, and naturally requiring a different treatment. The urine in a healthy state, is essentially acid, holding earthy salts in solution ; when this acid is diminished from any cause, the earthy salts are no longer held in solution, and separate,, in the form of a white sand. When the acid is in great excess, and the secretion of the earths is deficient, the acid forms a deposit, crystallizing into minute and red spiculae, thus occasioning the production of red sand. I The gravel, so called, when tho particles of sand congregate into a mass, may also either pass into the bladder, or remain impacted in tho pelvis of the kidney ; a specimen is preserved in the Museum of the Royal College of Surgeons, in London, of a calculus, removed from the kidney after death, that weighed seven ounces and a half. Renal Cal- culi, to deserve that name, must exist in the kidney, becoming Vesical Calculi, when they are expelled therefrom ; their composition has been accurately ascertained by Drs. Marcet and Prout, which will be better treated of under the next division. Vesical or Urinary Calculi, vary from the weight of half a drachm, to that of several pounds, a stone of the weight of forty-four ounces, and sixteen inches in length, having been removed from the body after death after an ineffectual attempt to extract it, during life ; the composition of these substances varies as much as their size ; they have been arranged by Dr. Marcet, in the following eleven varieties: 1st. Lithic Calculus, composed chiefly of lithic or uric acid; hard, inodorous, of a reddish brown or fawn colour, sometimes smooth, at others, studded with fine and regular tubercles ; with concentric lamel- la? in the interior, and presenting an imperfectly crystallized texture when broken; soluble in caustic potash, and precipitable again, in the form of a fine powder, by the action of any acid ; it blackens by exposure to heat; the smoke having a very strong odour, and leaving a small quantity of white alkaline ash after fusion; by adding a minute quantity of nitric acid to the powdered calculus, and then submitting the mass to heat, the lithic acid is dissolved, and, on evaporation, we obtain a carmine coloured residue. 2d. Earth-bone Calculus, consisting chiefly of phosphate of lime, is of ftpale brown, and polished sufja.ee : laminated and easily separated into CAL. 7- distinct layers; it is hot fusible, becoming black upon exposure to heat, and then turning white, undergoing no change afterwards ; by increas- ing the temperature after its solution in muriatic acid, which readily dis- solves it, the lime may be precipitated by the oxalate of ammonia. 3d. Ammoniaco-magncsian-phosphale, or triple Calculus, is formed, as its name denotes, of the phosphate of ammonia and magnesia ; its sur- face is nearly white, uneven, and covered with minute shining crystals of a short trilateral prism; it is less compact than the calculus of phos- phate of lime, not laminated and easily broken; it emits an odour of ammonia before the blow-pipe, and becomes opaque. It is soluble in dilute acids. 4th. Fusible Calculus, is composed of a mixture of phosphate of lime, and the triple phosphate of ammonia and magnesia; it is next to the lithic calculus in frequency, is white and friable, easily melts, and is readily dissolved by acids. The blow-pipe will reduce a large portion of it into a white vitreous globule ; the lamina; are not obvious. 5th. Mulberry, or Oxalate of Lime Calculus, was first described by the late Dr. Wollaston; it is of a dark brown colour, with a rough and tubcrculatcd surface, hard and imperfectly laminated ; before the blow- pipe, it expands into a kind of white efflorescence, which when moisten- ed, turns paper of syrup of violets, green, and paper of turmeric, red. Cth. Cystic Calculus, or Cystic Oxide Calculus, also first described by Dr. Wollaston, is of rare occurrence; it is of a white or yellowish colour, semi-transparent, and generally smooth on the surface ; it somewhat resembles the triple phosphate of ammonia, and magnesia calculus, but is more compact, and possesses no distinct lamina? ; when broken, it presents a waxy and confused crystalline mass, and when exposed to heat, it yields a faint and peculiar smell. This substance is soluble both in acids and alkalies. 7th. Alternating Calculus, is a concretion formed of two or moro different species, arranged in alternate layers ; its general composition consists of a nucleus of the lithic or mulberry calculus, surrounded with the formation of the fusible calculus, but in some instances three, or even four varieties, may enter into the formation of nuclei, as well as of the surrounding deposits. 8th. Compound Calculus. This term has been affixed to a variety, when thore has been a greater confusion observed in its composition than is recognizable in most cases of alternate calculus. 9th. Calculus of the P mutate Gland, consists of the phosphate of lime, not distinctly stratified, and tinged by the secretion of the prostate gland ; it was first described by Dr. Wollaston, 10. Xanlhir Acid Calculus, makes an approach to the Cystic Oxide Calculus, from which it is hardly to be distinguished ; it differs, how-* 56 CAM. ever, in one chemical quality, that of giving a bright lemon rcsiduum.on evaporating its nitric acid solution. 11. Fibrinous Calculus, is so . called from its possessing properties exactly similar to those of the fibrine of the blood, and is doubtless form- ed by a deposit from that fluid. To all these varieties, Dr. Prout adds another, which he terms The Lithate of Ammonia Calculus ; he describes it as being generally small, of a clay colour, and either smooth or lubcrculated ; it has concentric laminae and when fractured, resembles a compact limestone ; it is more soluble than any of the other calculi, and gives off a strong smell of ammonia, on being heated with caustic potass. Dr. Prout, in his arrangement, does not afford such an extensive list of varieties, hut in referring all calculi to their elementary proportions, describes only four classes. 1st. Those of Lithic Acid and its compounds. 2d, Those of Oxalate of Lime. 3d. The Cystic Oxide Calculi, and 4th. Those of the Earthy Phosphates. From a table drawn up by this author, from several museums, in which were 823 Calculi, the comparative frequency of each species was thus stated :—Lithic Acid 294, Mulberry 113, Phos- phates 3, Alternating Calculi 186, and Mixed Compound 25. For information respecting the causes, symptoms, and treatment of Calculi, Renal and Vesical, see "Diseases of the Urinary Passages." The best works on calculous disorders, are the following : " An essay on the Chemical History and Medical Treatment of Calculous Disor- ders," by Dr. Marcet, (London.) W. T. Brandens "Observations on the Medico-chemical Treatment of Gravel, Calculus, &c." Prout's '.' Inquiry ifcto the nature and treatment of Gravel, Calculus, &c." "Tho Philosophical Transactions of London of 1810," and the 8th Volume of the "Medico Chirurgica! Transactions." CALIGO. A disease of the eye, in which the sight is impaired by tho interposition of a dark object between the retina and the object. See Eye. CALLUS. The bony matter deposited at the extremities of fract—*mI bones. See Fractures. CAMPHOR. Camphora. A concrete substance prepared by distil- lation from theLaurusCamphora, or Caraphirc tree; class,Enneandria; order, Monogynia; a native of India and Japan. Narcotic, diaphoretic, sedative, internally; externally anodyne ; for the first mentioned pur- poses, in doses of from five to fifteen grains ; combined with "carbonate of ammonia, stimulant; with opium, directly sedative ; and with antimonials febrifuge. Employed in typhoid and exanthematous attacks, and also in maniacal, pneumonical, and general inflammatory affections. For external use, it is dissolved in oil, or alcohol, and applied as a liniment. Officinal preparations.—Camphor Mixture tMistuxaCamnhoro?) 5 ss C\X. to o 'j- generally united with cordial tinctures. Spin; of Camphor, (Spi- ritus Camphoras) usually employed as a discutient application. Com-" pound Tincture of Camphor, or Opiated Tincture of Camphor, (TincturaCamphoroe Composita, vel Tinctura Opii Camphorata) 3 j. to 5 iij. as an anodyne. Camphor Liniment, (Linimentum Camphora?) a discutient. CANADA BALSAM. Terebinthina Canadensis. One of the purest turpentines yielded from the Pinus Balsamca; class, Moncecia, order, Monadelphia. Similar in its properties to the other turpentines. Sec Turpentine. CANCKR, (from aapicivos, a crab.) Carcinoma. Scirrhus. Scir-* rhus, and Cancer, says Dr. Baillie, have generally been used as terms to express two stages of the same morbid affection; Scirrhus, signifying the occult, and Cancer, the ulcerated state of the disease. The question, whether Cancer is a constitutional or local, an hereditary or occasional disease, has led to much dispute in tho medical world ; that it is an inflammatory affection of a specific character, no one can doubt, and when we add, that a cancerous disposition or diathesis, is generally necessary for its production, and that it is occasionally hereditary, as proved from the numerous cases of many members of the same family having been attacked, without a sufficient cause for its occurrence un- less a constitutional predisposition existed, it is very evident to which side of tho controversy we incline, although in opposition to those great authorities, Dr. B:>illie and Mr. Abernethy, who regard it strictly as a local affection. If we dismiss the idea of a predisposition to this disease, it is most difficult to imagine how, in so many instances, the slightest blow shall be succeeded by scirrhus and rapidly approach the ulcera- tive stage, while in others, an injury more severe in its nature, and exactly in the same situation, shall not be followed by one uneasy sen- sation ; the occurrence of scirrhous tumours, in other parts of the body, when once the disposition for their formation has been called into ac- tion, will support the opinion of cancer being more a constitutional than a local affection. With respect to its hereditary nature, it is by no means intended to say that the descendants of an individual afflicted with this disease, are necessarily exposed to attack, but simply that they are more subject to its influence than others. Scirrhus in its primary form occurs in various organs, chiefly in the mammas, uterus, ovaria, testicles, and thyroid gland; and it also attacks the skin, (either in the form of a scirrhous wart or tubercle, the first being a primary and the other a secondary affection,) the mucous membrane lining the nose, mouth, and pharynx, the oeso- phagus, the stomach, the intestinal canal, and the bladder—secondarily affected, are the lungs (rarely) liver, omentum, mesentery, spleen, oincrcas, brain, and the medulla of the bones, Of all these, the payis T8 l'AN. most usualjy attacked arc the breast and uterus of the female, which appear to be peculiarly susceptible of the disease, at the time of th« cessation of the menstrual discharge. The commencement ol scirrhus in the breast is denoted by the presence of a small tumour, either brought on by a blow, or occurring, without any apparent cans,, hard in its nature, circumscribed, and moveable ; sharp lancinating pains shoot occasionally through the tumour, which gradually increases in size and weight, frequently having a knotty or irregular surface as the diseaso advances ; after some time, the pain recurring at shorter intervals than before, the skin assumes a dark lead colour, is corrugated; the tu- mour itself becomes less moveable, from an adherence to the ad- jacent parts ; while the absorbent glands in its neighbourhood begin to display a participation in the disease. By degrees the leaden hue of the skin disappears, and a redness succeeds the prelude to the commencement of the ulcerative process, which changes the name of Scirrhus to that of Cancer. "A bloody discharge now appears, a foetid ichor is secreted, the edges of the ulcer are everted and irregular, few granulations arise, and these quickly degenerate into inveterate funguses. Thus it appears in how imperfect a form the inflammation is begun and continued in this disease; in the adhesive stage, a hard matter is thrown out, instead of the usual kind of adhesive matter ; in the suppurative stage, an acrid and fcetid ichor is poured out, instead of bland pus; and the granulations are hard, insensible and everted, instead of being soft, yielding, and uniting as in a healthy intention of nature. The cancerous ulcer rapidly spreads, destroying all before it; even the bones do not escape, being frequently rendered so brittle as to fracture upon the application of the slightest force, and proving incon- testibly the great change wrought upon the system at large, by tho operations of this terrific malady. Vomiting, and other symptoms an- nouncing the mischief within, and how severely the digestive and other functions are deranged, quickly ensue with the extension of the disease, until hectic fever appears, and the sufferer sinks, under the effects of pain, anxiety, and exhaustion. Treatment.—Notwithstanding the pretensions of the empirics of former and the present times, the public are not readily deluded into a belief that any mechanical or medicinal treatment can effect a cure of this horrible disease ; numerous plans have been adopted, even by men remarkable in their profession for skill and acquirements, but without success ; the sober conviction that the knife promises the fairest chance of safety, has taken the place of former theories and remedies, and is now acted upon without reserve, by every well informed surgeon • too often, alas ! we discover that its use is not attended with final success ■ &e disease is extirpated fo;- a time only to re-appear with additional CAN, '/i) 1 malignity, or it is removed from one situation, merely to occasion its 1 appearance in another. Cicuta, belladonna, digitalis, the preparations of mercury and arsenic, of iron and barytes, have been resorted to in fruitless expectation, that their powerful action would counteract the effeots of the disease, and arrest its progress; some of them may ti occasionally be employed as palliatives, but no rational expectation may i bo indulged, that they will act further. Pressure was advised a few - years ago, and several cases were detailed, in which it had been suppo- &'■ sed to exert an uncommon advantage ; but there are two reasons why ii this recommendation has not met with much attention from the medical & world ; in the first place, it is by no means clear that in those cases, t: where it is said to have effected a cure, that cancer really existed ; it has tfe long been the practice of some surgeons, to apply pressure to a hard a fleshy tumour, with a view to its more ready absorption, and to such a la tumour, it is presumed has pressure been directed, when cancer has been said to be cured by a compress, and tight bandages : in the second place, - pressure is not applicable to an inflammatory and malignant tumour; one im very melancholy case fell under the observation of the writer, when it mm was attended with the most lamentable result; a small scirrhous tumour _ h in the breast, towards its axillary margin was subjected to this treat- to; ment ; within five weeks, the glands in the axilla became affected, ^ i ;i pidly took on the ulcerative process, and in less than two months tho d el? wretched patient sunk under hectic; effects similar to these will proba- teft Db/ be produced, whenever pressure is employed in the treatment of the bed genuine cancer; it is idle to imagine, that a constitutional predisposition jtl|ei can be overcome by the application of a bandage, and the practitioner uj „ who relics upon this mode of cure, may depend upon it, that if he ,t t, prevent thereby the growth of one solitary tumour, he does it at a risk ptom °f numerous others appearing, and taking on, with additional force, the . audi action he has endeavoured to restrain. The only plan of treatment," ie ju; besides an operation, strictly justifiable (for a perseverance in the medi- e&c ci»es bofore named, produce the worst effects upon a system already enfeebled by disease, and still needing so much vigour to sustain further ,1^ inroads,) consists in cold lotions, and the employment of leeches, with a ded e ""'^ """^ ""-irritative diet, while the tumour is yet scirrhous, and in carrot a cr poultices frequently renewed, and occasional doses of opium to allay u,suffering, when it becomes cancerous. The operation of extirpation is, . „ however, the only plan that promises success, and should we even be de- ^ceived in our expectations, which is not improbable, we have still the con- ^ solation of having attempted all that reason and sound judgment could sanction. The operation of the removal of a scirrhous tumour (of course " ' the employment of the knife is only justifiable in this stage, or while tho #!i/y5tCm d90S Wi mmT t9 be HWtcriiJIy affected) may be thus performed SO - CAN. Where a small tumour merely occupies a situation above the mam- mary gland, without being adherent to it, a perpendicular incision should be made over the tumour, the integuments dissected back, and the di»- eased part removed, together with every portion of surrounding sub- stance affected; bringing the parts together, in order to heal them by the first intention, thus finishing the operation. When, howevor, the tumour is firmly attached to the gland, or that organ itself is in a scirrhous state throughout, the operation for its removal must be performed in tho following manner: ■ The patient being seated on a chair, the operator places himself before her, when an assistant puts the pectoral muscle on the stretch by raisin; the arm from the side. The operator then, with the fingers of his left hand placed parallel to the course of his first incision, draiws the inte- guments tense, and makes the cut on the outer and under side of the tumour, of a semilunar form, extending obliquely from above downwards. The corresponding incision is then to be made, beginning and termi- nating at the same points as the former, but passing on the other side of the tumour, enclosing as much of the integument as may be deemed suf- ficient, which the operator puts on the stretch by pressing it from him with his left thumb. The dissection, commenced at the upper and outer part, is to be continued obliquely from above downwards, in the direc- tion of the fibres of the pectoral muscle, till the tumour is separated. If the dissection be attempted from below upwards, it is probahla that the lower edge of the pectoral muscle will be raised ; and if it be continued from the inner incision, the blood collects before the point of the knife, obscuring the dissection and rendering it more tedious. Should a gland in the axilla be enlarged, the incision must be extended so as to remove it with its connecting medium. It should first be raised from its seat with a double tenaculum, and then cut away ; this, pull- ing it from its situation, prevents the artery leading to it from retracting so as to escape detection after being divided. Hemorrhage occurring during the operation, may be restrained by the assistant pressing his finger on the bleeding orifices till the divided arteries can be secured by ligatures. The borders of the wound are to be approximated by ad- hesive plaster. The cancer of the uterus, occurs next in frequency to that of the breast; the cervix is generally the part affected. During the stage of scirrhous, the symptoms resemble those of polypi, and procidentia, such as a sense of weakness and pain ; leucorrheal discharge bearing down, and deep seated lancinating pains throughout the pelvis; upon exa- mination, the os tinea; is found thickened, indurated, and somewhat dilated; the digestive functions, and, of course, the general health, sympathize, and arc more or less deranged, according to the severity CAN. 81 of the disease. When the ulcerative stage commences, a constant discharge of a bloody sanies takes place, and sometimes a copious hemorrhage; the os linear; becomes more open, and beset with rugged irregular edged ulcers, which are exceedingly painful when pressed upon; the vagina is hard, and thickened, its rug.-e less distinct than natural,and tho ulceration at length extends to it. Enlargements of the glands of the groin, vomiting, hectic, and the usual train of symp- toms ensue, and rapidly terminate existence. In former days, nothing could be attempted for the cure of cancer in this part, with a prospect of success; the same treatment, as described under Cancer of tho Breast, was employed, and the same results fol- lowed; while the miserable patient was daily convinced, under their failure, that death was preferable to her life of continued suffering; tho proud distinction of being tho first successful operator, in the extirpa- tion of a cancerous uterus, must be awarded to Dr. James Blundell, of London, a man nobly distinguished in the medical circles for skill and humanity; this.physician proposed and executed the bold plan of extir- pation, in the full conviction that it was the only chance of preserving life; and although it has not been, and, in future, may not be uniformly successful, it yet presents, in common with all operations for cancer, a romedy that may stay, if it cannot totally subdue the disease. Tho operation as described by Dr. Blundell, will be found under the article, Uterus, to which it is referred, as it may be demanded in other cases as well as cancer. When cancer attacks the male, the testrele, and lip, are the situations usually selected for its ravages. In the former, it is fortunately very rare, although many diseases of that organ having been confounded with it, have given it more notoriety than it is in truth entitled to. Sir \. Cooper has seen very few instances of true scirrhous diseases of the testicle, and certainly no man has had greater opportunities of investi- gating every ailment, requiring the assistance of the surgeon. When the disease docs occur in this organ, it. may commence either at tho anterior or posterior part, or in several parts at the same time ; giving rise in the one instance to a hard and circumscribed tumour, or in tho other, occasioning several knotty and irregular masses; the testicle soon increases in size, and becomes of a stony hardness, in which con- dition it generally remains for a considerable period before the ulcera- tive stage commences ; this is also characterized, from other cancerous! affections, by the peculiar slowness of its progress; the epididymis and spermatic chord at length become contaminated, by which, the disease is conducted into the cavity of the abdomen, where it rapidly provea fttal. The surest marks of diagnosis, are the peculiar laminating pain* Jl 82 CAN. always accompanying cancer, the gradual increase, and peculiar hard- ness of the tumour. ■ The necessary treatment in this affection, consists in an extirpation of the testicle, before the disease is communicated to the spermatic cord, and the operation may be performed, in the mode directed under the head Castration. The Cancer of the Lip, is not of unfrequent occurrence ; in a largo hospital we can seldom walk the wards, without perceiving more than one example of it; the under lip is generally the sufferer, and out of forty or fifty cases, the writer has not, witnessed more- than three instances where cancer attacked the upper ; it usually commences in the form of a wart-like excrescence, which has occasionally been produced from the frequent irritation of shaving, over a slightly abraded surface, in individuals of a cancerous diathesis ; the question lias been raised in Greet Britain, whether, in such persons, tho short pipe used hi smoking, may not be considered as a cause of the disease in this part; no care is taken to wax the clay, so that, after the pipe ' has been held in the mouth for a few minutes, and suddenly removed, a small particle of the cuticle is torn away with it; the tube being again and again applied to this surface greatly irritates it, while the pipe in time becoming old, and saturated with the essential oil of the tobac- co, which extends from tho bowl, to the end placed in the mouth, adds to the irritation, and at length converts the primary sore into a secondary malignant and cancerous ulcer, especially when the system is prone to its encouragement. When the usual ulcerative process has commenced, its progress is rapid, and attended with the same symptoms as prevail in attacks of a similar nature in other parts ; the disease will gradually extend to the sub-lingual and sub-maxillary glands, and occa- sionally to the parotid, and prove fatal by its usual mode of termination, hectic. As in other cases of cancer, an operation offers the readiest mode of relief, if not of cure ; and in performing it nothing more is necessary than to include the tumour, and the parts around it that are affected, within two incisions meeting in a point below the tumour, or above it if the disease happens to be situated in the upper lip ; then to bring the divided edges together, and retain them with adhesive plaster or a suture, if it should be judged necessary from the width between theih ; some Surgeons bring the divided surfaces together by pins, as in the case of an operation for Hare-lip, (which see,) and this plan may be justifiable in many cases. Several ill-conditioned sores of the lips have been confounded with cancerous ulcers; 3. distinction must be made between the lancinating pains, the hardness, and the indolence of tjie one, and the want ul these characters ia the other, which, latter CAN. 63 will readily yield to an alterative plan of treatment, and tho exhibition of a little aperient medicine. Cancers of the Eye Lid, and in various parts of the face, are subject to the same symptoms, and should be treated in the same manner, as those already described ; the recommendation of an operation in the early stage of every cancer, where the knife can be used with safety, can hardly be too often insisted upon. There is a peculiar variety of this disease, termed the Chimney Sweep's Cancer, or Cancer Scroti, which is endemic to Great-Britain, and brought into action, solely from the irritation of the soot lodging in the rugae of the scrotum, and some- times, although very rarely, in the foot and on the back of the hand; one of the parents of modern surgery, Mr. Pott, first noticed this disease, as being of a cancerous origin ; it makes its appearance in the form of an indurated tumour, beneath the cellular substance, changes next into an ill-looking ragged ulcer, which soon extends to the testicle, is rapidly extended to the spermatic cord, and glands of the groin, destroying all beforo it, and ultimately the life of the patient. The knife is here our best friend, and if employed in the early stage, by removing the diseased skin and cellular substance, may effect a cure ; if the testicle be engaged in the disease, that organ must be removed, and in the manner directed in the article Castration; when the glands of (lie groin arc affected, tho caso is hopeless, and our treatment must be limited to palliatives. There remains but one more organ in which cancer makes its ap- pearance, and that is the Eye ; many other diseases of this organ have been mistaken no doubt for cancer, but wc can readily detect its exact nature, by the deep-seated; lancinating pain, which is frequently pe- riodical, the ragged-edged ulcer, and the foetid discharge ; when the disease is superficial, and seated over the cornea, a careful dissection may remove the cancerous mass, but abundant care must be exercised to leave nothing behind that will lead to a renewal of the affection.— When the cancer is seated deeper, no plan can be adopted but the extirpation of the' eye from the orbit ; for the manner in which this operation is performed, see Eye. See Cooper's (Samuel) works; B. Bell's surgery; Justamond "on cancerous and schirrhous disorders ;" Article " Cancer" in Recs's Cyclopcsdia; Baillies "Morbid anatomy;7' Pearson's "Practical observations on Cancerous complaints;" Aber- nethy's works, &c. &c. CANELLA BARK.— Cmtellai Cortex—from the Canella tree. Class, Dodecandria; order, Monogynia. Stimulant and carminative, in doses of from grs. x. to 5 ss. CANTHARIS.—Cant/wrides— Spanish or Blistering fly, chiefly !>rousht fjQiu the South of fiuropc, particularly from Spain; where they M CAR. arc very abundant. Internally ; stimulating, diuretic, einnu nagoguc, and jiven in cases of dropsy, gleet, leucorrharn, retention and incontinence ■of urine, in doses of gr. ss. to i. in pill. Carnally ; rubefacient and vesicant. Officinal preparations. Tincture of Cantharides, (Tinctura Cantha- ridis, fit x. to 5 j. diuretic, and stimulant, in gleet, dropsy of ihe ovaries, and leucorrhasa; externally in conjunction with soap or camphor lini- ment against rheumatic pains, &c. Plaster of Cantharides, (Emplas- trum Cantharidis.) CAPSICUM BERRIES. Capsici Baccce. Produced from the Cap- sicum Annuum, a plant of the class I'enlandria, and order Monogynia, and from which, wc derive the Cayenne, or red pepper. Stimulant, in- ternally in doses of from grs. v. fo grs. x. in pills, or 3 j. to 3 ij. of tho Tincture, (Tinctura Capsici,) in cases of atonic gout, dyspepsia, &c. Externally, it is employed as a cataplasm, in coma, and the delirium of Typhus. It forms in the following combination, one of the best gargles in Cynanche Maligna, and Scarlatina. R Capsici pulv. 3 j. Muriatis Sodae, 3 j. Aceti. 3 iv. Aqua; ferventis, % vj. Cola. CARAWAY SEEDS. Cand Semina, (from uapoj, so named from Caria, a province of Asia.) The seeds of a plant of the class Pcntan- dria; and order Monogynia. Carminative and stomachic in operation; chiefly employed in the following Officinal preparations: Oil of Caraway, (Oleum Carui,) tit j. to Tl\. x. Spirit of Caraway, (Spiritus Carui,) 5 i. to § ss. CARBUNCLE. See Anthrax. CARCINOMA. See Cancer. CARDIALGIA, (from tcaniia, the cardia, and a\yos, a pain,) the heart burn. An uneasy sensation experienced at the stomach, and ex- tending up the oesophagus to the palate, with inclination to vomit, when a clear though nauseous fluid is discharged. Dr. Cullcn considers this affection as a symptom of dyspepsia, although it may arise from many causes, such as flatus, worms, &c. or the pressure of acid in the sto- mach, in too large a quantity. Treatment. A dose of magnesia or the carbonate of soda, or the in- fusion of bark with lemon juice, according to some authors, will usually relieve the present symptoms, and their return must be prevented by a due regulation to diet, and an occasional recurrence to mild aperient me- dicines. CARDAMOM SEEDS. Cardamomi Semina. The seeds of the Amomum Cardamomum, of the class Monandria; and order Mono- gynia. Carminative and stomachic, in doses of grs. vj. to 3 j. Officinal preparations. Tincture of Cardamom, (Tinctura Cardamo- mi) 5 j. to 3 iy. Compound. Tincture of Cardamom. (Tinctura Car- CAS. $5 uamoini Composita) same dose, and both having the same operation as the seeds. CARDITIS, (from Kapvia, the heart,) Inflammation of the Heart. See Heart. (/'ARIES. See Bnnrs, diseases of. ■ CARMINATIVES, (from carmen, a versy or charm, from the old superstition of their operation depending upon a charm.) That class of medicines, administered to allay pain, and dispel flatulency; the- principal carminatives, are, cardamom, aniseed, caraway, cinnamon, ginger, and the whole class of aromatic stimulants. CASCARILLA, the bark, from the Croton Cascarilla; class, Mo- noecia; order, Monadelphia, (Cortex Cascarilla?.) Tonic and carmi- native in operation, and administered in doses of from grs. xij. to 3 ss. in ague as an adjunct to cinchona, in dysentery, dyspepsia, and colic. Officinal preparations. Tincture of Cascarilla, (Tinctura Cascarillaj) 3 i. to 3 iv. Infusion of Cascarilla, (Infusum Cascarilla) § iss. to § ij. twice a day. Extract of Cascarilla, (Extractum Cascarillae) grs. x. to grs. xx. all of the same operation as the bark. Incompatible, with infusion of galls and yellow cinchona, lime water, and solutions of sulphate of iron, nitrate of silver, and acetate of lead. CASSIA PULP. Cassias Pulpa. Expressed from the seeds of the Cassia Fistula, a tree of the Indies; class, Decandria; order, Mono- gynia. Mildly laxative, in doses of from 3 iv. to ^ iv. Officinal preparation. Confection of Cassia, (Confectio Cassias) 3 j, to jj i.j. a gentle cathartic for children. CASSIA MARILANDICA. American Senna. Similar to the Alexandrian, but less active; dose, J i. of the leaves, in infusion. CASTOR. Castoreum. Castor Fiber, the systematic name of the Beaver, from which animal it is procured ; the name castoreum, is ap- plied to two bags in tho inguinal regions of this animal, where the sub- stance is secreted. Antispasmodic and emmenagoguc, in doses of grs. x. to 3j. and given in cases of hysteria, epilepsy, typhus, and ame- norrhosa; sometimes administered in the form of a clyster, in the pro- portion of 3j. to iv. or vj. 5 of fluid. Tincture of Castor, (Tinctura Castorei) 3 i. to 3 iij. for the same purposes as the substance. CASTOR OIL. Oleum Ricini. An oil extracted from the seeds of the Ricinus Communis ; class, Monoecia; order, Monadelphia. Mildly purgative, in doses of from § ss. to 5 iss. administered in spasmodic affections, and colic, and very generally in the common diseases of children, where a laxative is required. CASTRATION, (from Castro, to emasculate.) The operation of removing a testicle,for cancer, fungus hcematodes, sarcoccle, &c. (Sco diseases of that organ.) The operation may be thus conducted:—Tho ?0 CAS. patient being laid upon a table of convenient height, the first incision should commence at the spot where it is intended to divide the spermatic cord, and be continued down nearly to the bottom of the scrotum ; tin- freedom of this incision will greatly tend to prevent those lodgments of matter which so frequently retard the cure, when the knife has been too timidly employed in this stage of the operation; a number of small arterial branches, from the external pudendal artery, are of course divided, and should be tied, if the hemorrhage be profuse ; the second stage of the operation is to expose and detach the spermatic cord, from the surrounding fat and cellular substance, by making a short incision on each side of it, at the point of its intended division, and then hav me, slightly raised it, dissecting it from the subjacent parts, until it can be grasped with the thumb and fore-finger. A portion of omentum, and a hernial sac, have occasionally assumed the appearance of thickened cel- lular membrane, and oven have been divided as such, either during the above dissection, or when the cord has been cut; the necessity of extreme caution is therefore evident, when the possibility of such a circumstance is considered. The third stage is the division of the cord ; this of course must be accomplished through the part higher than tlo disease has extended. The old mode of including the spermatic nerves, vas deferens, and cremaster, in a ligature before cutting the cord through, is now deservedly exploded, both from the excruciating agony it occa- sioned the patient, and from the constitutional symptoms that usually followed such barbarous treatment; in later days the vas deferens has been excluded from the ligature, but even this improvement is not deserving of imitation ; the better plan is to apply no ligature at all to tho cord previously to its division, but to hold the part between the left thumb and fore-finger, just above the point where it is to be cut through, which may be done as near the testicle as the extent of the disease will allow; the admirable procedure of Desault may now be followed; that surgeon, after the division of the cord as above related, immediately proceeded to take up the spermatic vessels (held between the thumb and fore-finger) with the tenaculum, and secure them vvith fine ligatures, and then dissected the diseased testis from the scrotum. The small artery of the vas deferens will sometimes require a ligature, when the edges of the incision may be brought together with strips of adhesive plaster, (sutures arc still, and perhaps needlessly, employed in these cases,) a pledget applied over the wound, light compresses laid on each side of the incision, and the whole supported by a T bandage. Union by the first attention, is hardly to be expected, but the attempt is infinitely pre- ferable to the French plan of stuffing the scrotum with charpie, and encouraging suppuration, and generally accomplishes a perfect cure in two orthree weeks. The great advantage of Dcsault's mode of operating consists in the command we have of the spermatic cord, by which ill r*AT. sv i (-.traction is prevented, and the ease with which the necessary ligatures arc afterwards applied. After the operation, considerable disturbance of the system may prevail, with much pain in the wound ; to counteract this, small doses of opium may be given, and leeches applied to the scrotum; and should very severe inflammation set in, venesection and the usual antiphlogistic! measures must be immediately adopted. C \TARRH. Catarrhus (from icaijapesar, to flow clown.) This disease consists of two species: I. Catarrhus a frigore, or common cold in tho head or che.;t ; and II. Catarrhus Epidemicus, or Influenza. The first variety, so common in every country, is usually caused by a sudden suppression of perspiration from cold, rapid changes of the atmosphere, and a continuance of damp weather, and which invariably furnish us with a number of examples. Symptoms. Heat, fulness, and obstruction of the nose with coryza, or increased secretion of mucous from the living membrane, or a thick acrimonious ichor, which excoriates in its passage; oppression at tho chest, with slight difficulty in breathing; cough, hoarseness, and sore- j ss of the fauces and trachea ; cold shiverings and flushings of heat alternately, and an increase of all these symptoms towards night, with slight febrile exacerbation. This affection is not at all dangerous in itself, and only becomes so from frequent renewal, when a constant irritation disposes the patient to a pulmonary attack; in consumptive habits, however, it occasionally appears as the precursor of a regular phthisis. Treatment. In the milder cases, little more is necessary than a few days of repose and abstinence, a perseverance in diluent drinks, and additional warmth, to promote perspiration ; when, however, the febrile symptoms are severe, or there is great oppression of the chest, venesec- tion, and a brisk cathartic must be resorted to, and should a difficulty of breathing continue, h blister to the chest should follow the use of the lancet, and diaphoretics administered, in conjunction with medicines of the demulcent class, such as flaxseed tea, almond or gum mixtures, &c. and should a chronic cough remain after the acute symptoms have yielded, with expectoration, restlessness and debility, which is usually the case in old persons, slight doses of opium, Dovers powder, (Pulvis Doveri,) and the application of a warm plaster to the chest may be recommended, and also very small doses of the Prussic acid. This affection is occasionally met with as a symptom in other complaints, such as measles, small pox, worms, dentition, rheumatism, &c. The second species, or Influenza, as it is commonly termed, differs from the preceding, in its cause, in the severity of its symptoms, and usually in the rapidity of its course and termination. The cause has <a\n, the head, and a'Xyog, pain,) head- ache. Symtomatic of many diseases, but rarely an original affection. CHALK—Carbonate of Lime. See Lime. CHALYBEATE, (from chalybs, iron,) a term given to any medicine into which iron enters. See Iron. CHAMOMILE—Anthemis. A plant of the class syngenesia, and order, polygamia superflua. Chamomile flowers are tonic and stomachic in operation ; externally, emollient. Infusion of chamomile, (irrfusum anthemidis,) 5 i. to J ij. tonic; and when taken warm, and hi large draughts, emetic. Extract of chamomile, (extractum anthemidis,) grs, x. to grs. ---j:. stomachic. CHANCRE. See Vekcrcal Die-case. CHARCOAL—Carbo Ligni. Antiseptic and alterative^ in doses of grs. x. to 3 j. in the eructations of dyspepsia ; also used in the prepara- tion of a cataplasm with linseed meal, to foetid ulcers. Charcoal should always be employed in a recent state ; it is perhaps the best tooth powder that can be used. CHEMOSIS. See Eye. CHICKEN POX— Varicella. See Fevers, eruptive. CH1GRE, a small sand flea, very troublesome in the West Indies, insinuating itself into the fingers and toes, particularly under the nailp, and causing much heat and itching : it soon deposits in a cyst, innume- rable ova, which become fresh animals of the same species/and soon occasion a troublesome ulcer. The remedy is, to extract the sac, with- out rupturing it, an operation in which the negro women are very expejt. CHILBLAIN—Pernio. A small inflammatory swelling, chiefly oc- CHO. 91 cnning during the winter season, upon the fingers, toes, heels, and other extreme parts of the body, and caused by exposure to the cold, or by sudden changes of temperature ; the prevalent custom of children warm- ing their feet at the fire, when very cold, is the frequent origin of this affection: individuals of a scrofulous habit, are also especially liable to it. The chilblain first assumes a red appearance, which soon changes to a deep purple or leaden hue ; the pain is not constant, and generally most troublesome towards night, accompanied by a sense of heat and an intolerable itching; in some persons the skin remains entire, and the above symptoms are not increased, whilst, in others, the skin breaks, and a small ulcer, of a singularly obstinate character, appears; in old people, the parts are apt to slough and become gangrenous, occasionally proving fatal. Treatment.—In the early stage, the treatment is very simple; little more'is necessary than to revive the action in the parts, and stimulate the languid circulation; snow, and iced water, with a moderate degreo of friction, the application of turpentine, either by itself or mixed with the balsam capivi, and additional warmth, will answer these purposes ; when the chilblains are broken, the best application, probably, is an ointment thus prepared: Gum elemi, § j.; spirits of turpentine, § ss.; prepared lard, 5 ij.; olive oil, 3 j. mix, and apply it frequently to the part. Warm vinegar, weak solutions of nitric acid, and the sub-acetate of lead, the ointment of the nitric oxyde of mercury, have had their advo- cates; but the above preparation, with the use of an emollient poultice, when required, will in general effect a ready cure. When chilblains put on a gangrenous appearance, they must be treated accordingly. See Mortification. CHINCOUGH. See Pertussis. CHOLERA, (from %o\n, and peo>, literally a flow of bile,- or bile flux.) This disease has been described by some writers, merely as a species of diarrhoea, but when we consider that it is not always accompanied with a diarrhoea, and that it also evinces a strong tendency to spasmo- dic action, the propriety of a separate arrangement is apparent. The Bilious Cholera, so common in most countries, at the close of tho summer months, is both sporadic and epidemic; the first species is usu- ally the mildest, and occasioned by suppressed perspiration, cold drinks, when the body is much heated, indigestible food, particularly unripe fruits, melons, cucumbers, &c. an excess of drastic purgatives, as well as sudden fright, or any violent emotion, that can produce an exhaustion of the sensorial power; to these, must be added a superabundancy of acrid bile, which irritates the intestinal canal, and disturbs the whole animal economy. The second species is also occasioned by an excessive secretion of bile, but its general cause may be attributed to the decora* cno. position of animal and vegetable substances, which predisposes the body to the action of the disease, or perhaps directly induces it by a particu- lar combination of'the decomposing elements, so as to produce a chole- ric miasm, as under another combination, a febrile miasm might bo generated. . Symptoms.—These differ but in degree, whether the disease is spo- radic or epidemic; violent vomiting and purging of thin and watery fluids with intense pain at stool; cardialgia, thirst, and great agony iu the bowels, heat of the surface ; anxiety of mind, nausea, and colliqua- tive sweat; a small, quick, and unequal pulse, spasms of the limbs and coldness of the extremities, all prevail, and unless the disease be promptly arrested, death ensues, and sometimes in twenty-four hours after attack. Treatment.—As the general disorder may be, in most cases, referred to a superabundance of bile in the intestines, our first efforts must be directed to its dilution and free discharge, by the administration of mild •demulcent fluids, both to the stomach and in the form of injections; tepid \vater, toast and water, which, from its slight astringency, may be preferred, the infusion of spear-mint, chicken broth, linseed tea, or barley-water, with a little gum acacia dissolved in it, will ensure the desired effect; when the alimentary canal has been well cleared, opium, or its tincture, (laudanum,) in repeated doses must be given, to abate the spasmodic action, and antimonials may be advantageously combined, on account of their relaxant power; the use of opiates must be per- sisted in as long as any vomiting continues, and where the debility is very great, warm negus, or diluted cordials, may be occasionally em- ployed; the warm bath has also been recommended, when the surface remains cold, and hot bottles afterwards applied to the feet. Blood-let- ting is inadmissible, as the depression is alarming from the first. When the disease has subsided, great care is necessary in the treatment of the patient, who must be supported by a light but nourishing diet, and a proper allowance of wine ; the aromatic tonics will also be serviceable m restoring that strength, which has been so greatly impaired. Cholera Morbus.-This dreadful disease, so emphatically termed the scourge of the East," is the true spasmodic and epidemic Cholera; whether it existed in former times, is still a matter of doubt, as the de- scriptions of Celsus, and Bontius, have been supposed to apply to another disease; it was not noticed by European writers, before tho middle of the last century, although a tradition is current among the Hindoos, of its prevalence at a very remote period. We must look to India for the most formidable examples of this disease ; there it ra°cs like a pestilence, travelling over the most extensive districts, and spa. ring few mdeed in its progress, and so far from any diminution in its viru.. CHO. 93 fence being observed at the present period, the attacks of late years, have exceeded the former ones in violence. It is most difficult to ac- count for the origin of this disease ; it prevails at all seasons of the year, and its- course has been occasionally extended to the northern countries of Europe, of which, its existence in Russia, at this time, is a striking example; it has appeared when the thermometer has stood at 40° Fahrenheit, and also when the mercury has reached 90° or 100°; hence it is impossible to regard it as solely dependent upon the condi- tion of the atmosphere ; it has visited the most salubrious spots, leaving less healthy situations untouched; can it therefore be presumed to be the consequence of miasm ? The idea that cholera morbus is depen- dent upon a specific contagion, is prevalent amongst a number of authors who have written upon the subject, and certainly the facts they advance, are sufficiently powerful to justify the conclusion; in soveral instances, the medical officer has been alone attacked, after an atten- dance upon the sick, the immediate neighbourhood remaining unaffect- ed ; the circumstance of the disease breaking out, in several previously unaffected districts, at a time corresponding with the arrival and sickening of persons, who had intercourse with the sick in an af- fected district, bears likewise very strongly on the subject; the sudden- ness of its appearance and disappearance, does not, it is true, agree with the laws of contagion, still, where we are at a loss to account for its presence, from atmospherical changes including great variations in temperature, from errors in diet, which is certainly not the case, as in (he bilious cholera, this disease attacking the temperate as well as the debauched, or from any other circumstances connected with localities, \yc must necessarily admit the cause of specific contagion, as the most reasonable orie, thai, has hitherto been advanced. Symptoms.—A reference to the symptoms described in Bilious Cholera, will be sufficient, as the only variation experienced in this disease, is in their increased severity, and a greater excess of spasm. Treatment. However the symptoms of the Bilious Cholera resemble those of this disease, the treatment is conducted upon somewhat different principles; the necessity of this will be readily admitted, when it is stated that in nearly every case, there is a total absence of the bile, from the whole range of the alimentary canal, and in those few cases where an overflow of bite has occurred, the symptoms are greatly mitigated, and the disease more manageable and more resembling the Bilious Cholera. In this Cholera the biliary ducts are spasmodically closed, and from this point the spasmodic action appears to spread in every direction, affecting every organ, and giving rise to that terrible and agonizing train of symptoms, that so speedily terminate the existence of 'he sufferer. With the exception of the plague, there is no disease sr> 94 UHO, strikingly marked by the violence of its action, and the rapid exhaustion of living power, the patient frequently expiring within ten or twelve hours after attack; it is therefore of the utmost importance to adopt a plan of treatment without the slightest delay; in the East Indies, bleeding is generally practised immediately after seizure, with the intent to moderate the violent spasms that set in; calomel in scruple doses, combined with two grains of opium, are repeated every two or three hours, until the symptoms are relieved ; to these are added a liberal use of the diffusible stimuli, such as nitric ether, ammonia, camphor, hot arrack and water, &c, the hot bath, stimulant embrocations, and some- times antimonials, in conjunction with the calomel. It would perhaps appear that, the use of the lancet could hardly be justified in cases where such extreme weakness ensues, but the fact of hardly any case occurring without an alarming congestion in one or more of the larger organs, imperatively demands its employment The Cholera, so commonly fatal to children in the southern cities of the United States, must be regarded more as a variety of the Bilious, than the Spasmodic Cholera. On this subject, the reader may consult Rush's "Inquiries and Observations"—Mr. Stuart's paper in Cox's Philadelphia Medical Museum—Scott's "Report of the Epidemic Cholera at Madras in 1824" —Orton's Essay upon the same subject—The Edinburgh Medical and Surgical Journal for June, 1823—The I2th volume of the Medico-Chir, Transactions—and Rees' Cyclopaedia, article " Cholera." CHOREA SANCTI VITI (Chorea from x«pos, a chorus, the usual accompaniment to dancing in former days.) St. Vitus' dance. "This disease is occasioned by an irritability of the nervous system, chiefly dependent upon debility, and particularly a debility of the stomach, and its collatitious organs. Most of the diseases of children are seated in this quarter ; and it is from thence that chorea generally takes its rise, and shows itself in an early period of life ; the ordinary occasional causes being bad nursing, innutritious diet, accumulated fteces, worms, or some other intestinal irritant. About the age of puberty, there is another. kind of general irritation, that pervades the system ; and when this change does not take place kindly, which is frequently the case in weakly habits, the irritation assumes a morbid character, and is exacerbated by a congestive state of the vessels that constitute its more immediate seal; and chorea lakes its effect from this cause. In fact, where the predis- ponent cause of an irritable state of the nervous system is very active and predominant, a local or temporary excitement of any organ, and almost at any period of life, will give rise to the convulsive movements of chorea; and hence wc find it so often united with an hysteric diathesis. it has been prQwVtQvd by a. fright, by a, wound. r.e„vtraUn_ tr.c brain CHO. through the orbit, by an improper use of lead or mercury, and by suppressed cutaneous eruptions." This comprehensive detail of the causes leading to chorea, is from the pen of Dr. Mason Good, to whom we have been frequently indebted in the'compilation of this work : the Doctor, however, does not state the grounds of his belief, that chorea is principally dependent upon a derangement or debility of the stomach, or why the accidents he describes produce the disease ; that in some individuals the disease does frequently occur, in consequence, is evident, but we are still without information as to the positive influence exercised in its production. Symptoms. The fits are sometimes preceded by a coldness of the feet and hands, or a tingling sensation that ascends like cold air, up the spine, and a flatulent pain in the left hypochondrium, with obstinate costiveness; at other times the attack commences with yawning, anxiety, palpitations, difficulty of swallowing, giddiness, &c. A variable, and occasionally a ravenous appetite, and obstinate constipation, are the immediate precursors of the fit, in most cases. The convulsive motions vary; the muscles of the extremities, face, lower jaw, head and trunk of the body, are affected at different times, and in a different manner ; the walk is usually of a jumping kind, the arms are thrown violently, from the side, the eyes open and shut with a convulsive quickness, and the mouth is drawn up by a sudden impulse, which as suddenly subsides. When the attacks have been frequent, the system becomes unable to resist the tendency to irregular motion, and those peculiarities, so dis- tressing to the sufferer, though frequently so ludicrous to the by-stander, which have before only been occasional or periodic, become habitual ; as the disease increases, the eyes lose their brilliancy, the appetite becomes impaired, the strength weakened, loss of speech and emaciation succeed, and too often it terminates in epilepsy or mania. Treatment. Purgatives are the most valuable class of medicines in the treatment of this disease, and of these the spirits of turpentine is perhaps one of the best, whether it is intended to act as an anthelmintic, when worms in the intestinal canal are the cause, or as a direct purgative in clearing the bowels, and also as an antispasmodic; the sub-muriate of mercury, js-lap, and other cathartics, may also be advantageously employed. When the viscera have been unloaded, a due attention to the immediate origin of the disease is required; if in the case of young children it proceeds from dentition, the gums should be freely lanced ; when a general debility prevails, it is necessary to strengthen the system by a judicious administration of wine, and the milder tonics, avoiding such as are very astringent in their operation ; a change of air, cold battling, and a well regulated, although nourishing diet, must also J.-;iia our attention as auxiliaries ; musk, opiumj and camphor, may bo % CIS. exhibited when the convulsions are violent, or not prbivipt in yielding, whilst in those whose minds have suffered under a corresponding debility with their frames, the stimulus of electricity may be properly resorted to. It is occasionally discovered, that chorea has been caused from tho effects of sympathy or imitation, when a healthy child has unwittingly copied the actions of a sufferer under this disease, until mocking has become a habit; great care and salutary correction, will probably prove the best antidotes in such an instance. . CHLOROSIS, (from x*<»pos, green or pale, so called from the hue of the countenances in persons affected by it.) See Uterus—affections of. CHORDEE, (Chorde, French.) A spasmodic constriction of the Penis in gonorrhoea. See Venereal Disease. CHYLOPOETIC ORGANS. See Viscera. CICATRIZATION. See Inflammation. CINNABAR— The red sulphuret of mercury—Hydrargyri sulphun- lum rubrum ; occurs in a native state, but is generally prepared for the purposes of medicine, by the mixture of forty parts of purified mercury, with eight of sulphur. Employed in fumigation of venereal ulcers On the anus and pudendum, and also in ulcerated sore throat from the same affection. CINCHONiE CORTEX— Cinchona, or Peruvian Bark. Yielded from a plant of the class pentandria, and order, monogynia. The vari- eties of this bark are pharmaceutical^ employed. I. Yellow Cinchona Bark—Cinchona: Cordifolice Cortex; yielding the active alkaline principle termed quinia. II. Pale Cinchona Bark—Cinchona; Land folios Cortex; yielding the active alkaline principle called cinchonia. III. Red Cinchona Bark—Cinchona: Oblongifolim Cortex; containing both quinia and cinchonia. These three species, used under the general term cinchona, are pow- erfully and permanently tonic, astringent, stomachic, and antiseptic; in doses of from grs. x. to \\ ss. Officinal preparations.—Decoction of bark, (decoctum cinchonas,) ?'■ to 5 iv. three times a day ; infusion of bark, (infusum cinchonse,) § i. to 5 iij.; infusion of bark with lime water, or with lemon juice, (infusum cinchonse cum calcis liquore, vel cum succo limonum ;) extract of bark, (extractum cinchonse,) grs. x. to 3 ss ; tincture of bark, (tinctura cin- chonas,) 5 j. to 3 iv.; compound tincture of bark, (tinctura cinchonas composita,) 3 i. to 3 iij. These preparations are administered in those cases that require the bark, and occasionally with greater advantage, as being less nauseous ; the infusion with lime water, is an excellent reme- dy in cardialgia and dyspepsia, generally ; and the infusion with lemon juice, peculiarly grateful in those instances of typhus requiring the me- dicine.. COL. 04 Cincliona is incompatible with tartarized antimony, the sulphates of iron and zinc, nitrate of silver, and the muriate of mercury ; also with decoction of galls, carbonates of alkalies, and nearly all the other vege- table bitters. CINNAMON— Cinnamomi Cortex. The inner bark of the laurus cin- namomum ; class, enneandria; order, monogynia; one of the most grate- ful aromatics, stimulant, carminative, and tonic in operation. Dose* grs. x. to 3 j. Officinal preparations.—Cinnamon water, (aqua cinnamomi,) § i. to o ij.; spirits of cinnamon, (spiritus cinnamomi,) 3 i. to 3 iv; tincture of cinnamon, (tinctura cinnamomi,) compound tincture, (tinctura cinna- momi composita,) of cither, 3 i. to 3 iij.; compound powder of cinna- mon, (pulvis cinnamomi compositus,) grs. x. to 3 i.; all of the same Operation as the bark. CIRCOCELE, (from Kipcos, varix, or dilatation of a vein, and KnXrr, a tumour,) a varicose distention of the spermatic veins. See Testicle, Diseases of. CIRCUMCISION, (from circumcido, to cut round.) The cutting off a portion of the prepuce; an ancient rite of Jewish worship; tho operation is sometimes necessary in cases of natural or venereal phi- mosis ; for the mode of performing it, see Venereal Disease. CLOVES—Curyophllti. The unexpanded buds of the eugenia cary- ophillata; class, polyandria; order, monogynia ; a tree of the East Indian Archipelago; stimulant in operation, but seldom employed, except as an adjunct to other medicines. COCHINEAL—Coccus Cacti. The systematic name of the cochineal insect; the female insect is alone employed, either in medicine or the arts, and is principally procured in South America, from the opuntia, or Indian fig tree, to which they resort in great quantities. Its qualities are slightly stimulant and astringent; in the English pharmacopeias, it enters into the composition of the compound tinctures of cardamom and cin- chona, but probably rather on account of the beautiful colour conveyed, than for any intrinsic properties. COLCHICUM—Bulb of the Meadow Saffron ; Colchici Radix. The root of the colchicum autumnale, of the class hexandria, and order trigy- nia; narcotic, diuretic, cathartic, in doses of from gr. i. to grs. iv.; em- ployed in dropsies, gout, and rheumatism. The seeds, (semina colchici,) are also used for the same purpose. Officinal preparations.—Vinegar of colchicum, (acetum colchici, which see,) wine of colchicum, (vinum colchici,) VH. xxx. to 3 j. in any bland fluid; syrup of colchicum, (syrupus colchici,) 3 j. to 5 ss. It is supposed that colchicum forms the active ingredient in the cele- brated " Em Medkinale.'" 98 COL. COLD, EFFECTS OF. See Asphyxia. COLIC—Colica, (from ku>\ov, the colon.) This disease, which lias been described under so many varieties, is exceedingly common in nearly every country ; for all useful purposes in practice, we need not admit more than four species: 1st. Common or accidental colic, caused by ah- m.ents of an acrid nature, or poisonous food, such as muscles, mush- rooms, &c. which irritate the bowels without producing diarrhrpa. 2d. Bilious colic, closely allied to cholera, occurring in the autumnal ' months. 3d. The painters' colic, (colica pictonum,) arising from the poi- sonous qualities of lead. 4th. Ileus, or the Iliac passion, from disorgan- ization of the viscera, or from some impediment to the proper exercise of their functions. The common colic is attended with symptoms of indigestion, and has been sometimes denominated the flatulent colic, from the distressing ful- ness and frequent eructations of wind which accompany it; the pain in the bowels is acute, but seldom permanent, and in nearly every case is relieved by a moderate degree of pressure ; the pain is of a peculiar griping, or, as it has been termed, wringing nature, with spasmodic con- strictions of the abdominal muscle* and costiveness. These symptom?, joined to the absence of fever, are sufficient to distinguish it from the only disease with which it is likely to be confounded—enteritis, or in- flammation of the intestines. Treatment.—In most cases, the spasms will yield upon the adminis- tration of a carminative draught, or a small quantity of brandy; a mix- ture formed of grs. x. of powder of rhubarb, grs. xv. of magnesia, and twenty drops of the tincture of opium, in f i. of cinnamon water, will succeed still better, and restore the intestinal canal to its regular action. The aromatic spices, particularly nutmeg, are also available. An emol- lient clyster will sometimes afford immediate relief, after a plentiful evacuation has been obtained ; it may not however be practicable in all cases to administer it, from the spasmodic contraction prevailing and ex- tending through the whole range of viscera ; when much difficulty is experienced in the introduction of the common sized pipe into the rectum, a small gum-elastic bougie, having the end carefully cut and rounded off; may be fitted to the end of the injection apparatus, and be more easily introduced, and passed much higher up the gut than the common pipe This species of colic is sometimes observed in women of an hysterical habit, and some practitioners have therefore given it the name of hysteric colic. Where such a disposition prevails, antispasmodics are of course indicated, as well as the remedies just directed. There is one caut on necessary in the management of this affection: it must alwavs htT in mind, that the causes of colic provo also, in some cases, those ofT COL. 90 doniinal inflammation; whenever therefore any symptoms arise which may be supposed to depend upon the latter circumstance, the lancet must immediately be employed, in conjunction with the treatment laid down under the article Inflammation of the Intestines. The bilious colic is a common autumnal epidemic, and prevails after a long continuance of a hot and moist state of the atmosphere ; it some- times occurs with diarrhoea, cholera, or jaundice, and is dependent upon an increased and vitiated secretion of bile. Headache, loathing of food, a bitter taste in the mouth, and bilious vomitings, are the first symptoms, which are quickly followed by severe and griping pains in tho bowels, accompanied by great distention ; pains in the loins, and obstinate cos- tiveness, and when, as in some cases, this last symptom does not prevail, the motions are scanty and slimy, with violent tenesmus. Considerable fever exists in this variety of cholera; the tongue is loaded with a yel- lowish fur, and thirst, restlessness, and great languor prevail. The pulse is not much accelerated, nor the heat of the skin greatly increased. Treatment.—The first object is to relieve the bowels from the load which oppresses them, still bearing in mind the irritable state of the whole alimentary canal, which forbids the administration of all medicines cal- culated to increase it. Opium may hardly be recommended in the first instance ; for although it may afford relief to the existing symptoms, its use is too apt to be followed by an increase of fever. We may com- mence the treatment, by giving ten or fifteen grains of ipecacuanha, which may be followed by a dose of calomel and rhubarb, castor oil, or the common senna draught; where the stomach is very irritable, a saline purgative, in a state of effervescence, will remain when other medicines are rejected. Directly a free discharge has been »btained from the bowels, and of the proper colour and consistence, a full dose of laudanum may be given with the greatest advantage ; it then allays the irritation, and soothes the patient after the agitation and sufferings he has expe- rienced. For some days after the disease has yielded, it will be neces- sary to exhibit occasionally some mild aperient, in order to prevent any accumulation of faeces, and to restore the bowels to their wonted office. During the convalescence, which is frequently tedious, light tonics may be given; such as equal parts of camphor mixture, and the decoction of bark, &c. The painters' colic, (colica pictonum,) also called the colic of Poitou, the Devonshire colic, and colica rhachialgia, (naxia\yia, literally back-bone or spine ache.) The remote cause of this affection seems, nearly in every instance, to be lead introduced into the system, either through the stomach, the lungs, or the skin; hence, painters, who arc continually exposed to the action of the metal, potters, glaziers, gilders, and miners, are particularly affected, as the materials emnloved in their occupations 100 taOL. contain a large quantity of lead. From the same cause, the peasantry of Poitou.in France, and of Devonshire, in England, are subject to the disease, as lead was and may still be frequently used, to destroy the acidity of the weak wine and cider of those countries. In addition to this, a custom still prevails of employing leaden vats for the reception of the fluid after the fruit has been crushed, and this alone would render the beverage deleterious, from the action of the acid upon the metal. In the West Indies, this disease has also occurred; and Dr. Hunter detect- ed, after careful investigation, the presence of lead in many samples of new rum, a liquor so frequently drank by the soldiers of the garrisons. The lead appears, however, to be deposited after a certain time, when the rum loses its noxious quality, and this is undoubtedly from its being put into oak casks, or casks made of wood, containing a principle similar to that of galls ; a gallate of lead is thus formed in the place of a carbon- ate, which is insoluble, inert, and deposited at the bottom of the cask. In those individuals who are necessarily subject to the fumes, or constant handling of lead, a want of cleanliness, which is too common, renders them doubly susceptible. The pain in this disease is frequently of an agonizing nature, and is seated at the pit of the stomach : Dr. Monro describes it as an acute twisting pain about the navel, not "increased by pressure, and accompanied by a dragging inwards of tho abdominal paricties, which have a hard feel, with tenesmus and costiveness. The suffering is first of a dull kind, and more a sense of great uneasiness than positive pain; it however gradually increases in severity, and in the worst cases, shoots from the stomach to the arms, back, loins, rectum, and bladder, and some- times to the thighs and legs, until the whole external muscles appear in a state cf spasm ^ and are rendered so tender, that the weight of the bed- clothes can with difficulty be endured. Sickness, as well as vomiting, is a very constant symptom, and the discharge from the stomach of an acrid and slimy nature; this usually relieves the patient for the time, and encourages a false hope of his recovery, but which is speedily de- stroyed. Bitter eructations and violent hiccoughs, occur between the intermissions of sickness. This disease appears to possess no tendency to inflammation, and the pulse is but little affected, while in some in- stances the sphincters of the bladder and anus are so contracted that the urine and faeces are voided with the utmost difficulty, and a catheter or clyster-pipe can hardly be passed. If our efforts be successful in the removal of this colic, relieving sweats break out, sometimes accompanied with an efflorescence, a disposition to relieve the bowels is felt, and after large discharges of scybala, occasionally mixed with blood, the patient is restored to health. When our intentions are defeated, the urgency of the internal symptoms will sometimes abate, to give rise to a very characteristic mark of this disease, and especially observable in painters, COL. 101 who have been repeatedly attacked; the fingers, or the whole of the right hand and fore arm, become paralyzed, so that the fingers are con- tracted, and the hand, when the arm is extended horizontally, hangs at a right angle to the arm, the extensor muscles being always more paralyzed than the flexors; this is what is commonly termed among painters " the wrist drop." The palsied limb shrinks, and the muscles not only lose their natural size, but become converted into a kind of suetty substance; in addition to this evil, a neglected or ill treated case will not only thus terminate, but deafness, blindness, delirium, and epileptic fits succeed, and rapidly terminate a miserable life. Treatment.—A slight ca^e of this disease will usually be remedied by the use of active purgatives, but wherever its character appears formida- ble, opium must be resorted to without delay; considerable discussion has arisen among medical men as to the propriety of commencing with purgatives or opiates, but after a careful review of their opinions, it would appear that a combination of both, in any stage of the disease, promises the fairest chance of cure. When the stomach is not too irritable, liquid medicines should be preferred, as exerting a quicker action ; a draught containing ten or twelve drops of laudanum, in half an ounce of castor oil, with a little mucilage, may be repeated every six hours, or when the oil is objected to, the senna mixture may be used instead; if liquids cannot be retained on the stomach, the pills of colocynth, calomel, and opium may be substituted; fomentations to the abdomen, the warm bath, and stimulating injections are also of the most essential service. The preparations of Mercury and Silver (the submuriate of the one, and the nitrate of the other) have also been much extolled ; we are aware that in all cases of spasmodic disease, the system is easily affected by mercury, and this fact would teach us caution in its employment; still, some practitioners exhibit calomel oven to salivation, and, according to their reports, with decided success ; in many instances, indeed, a large dose of this salt (eight or ten grains) has produced a remarkable and sudden change, acting at once upon the bowels, and occasioning a very large discharge, to the infinite relief of the patient. The Nitrate of Silver (lunar caustic) is useful as a laxative, as well as an antispasmodic, and was the medicine employed successfully by Dr. Robert's (see Medico Chir. Transactions, vol. 5th) in two very severe cases of the disease ; he gave from three to five grains, three times a day, and in one of tho cases, five grains every six hours, and not only relieved the patients, but absolutely remedied the paralysis of the wrist. The essential oil of turpentine, and croton oil, have also been adminis- tered as purgatives. Iliac colic.—This is the most distressing variety of the disease, but happily it is very rare; the peculiar symptom accompanying it, and by 102 which it is distinguished from the other, is the vomiting of stercoraccous matter, that is of a slimy substance, intermixed with faeces ; it may be occasioned by repeated attacks of the common colic, by which the intes- tines have been so frequently affected with spasm, as to lose their proper peristaltic action; an involution or introsusception of the intestines, where one portion, constringed and lessened in its diameter, has fallen into another below it, is frequently the immediate cause of the most distressing symptom, that of discharging the contents of the larger intes- tines by the mouth, when the constriction is seated very low down, and in some instances, not only has introsusception existed, but portions of the intestinal canal have become twisted into knots, from the strength of spasmodic action, when strangulation and gangrene have rapidly ensued. The intestinal canal, may also be rendered impervious by mechanical obstructions, such as intestinal calculi and polypi, or a cancerous state of the stomach, or its pyloric orifice may produce analogous symptoms. It is worthy of notice, says Dr. Gregory, that occasionally after death, the intestines have been found inordinately distended, and it has hence been conjectured, that their muscular fibres may, by the over-distention either of fseces or flatu3, become paralysed. The last cause of ileus to be mentioned, is chronic inflammation and general thickening of the peritoneal coats of the intestines, by which their regular action is dis- turbed, and a contrary one established. Treatment,—The practice of venesection, however it may have been recommended with a view of relaxing the spasmodic constriction, should be avoided, unless unequivocal marks of inflammation appear ; the warm bath, emollient clysters, with occasionally a cathartic injection, opium, hyoscyamus (henbane) and stimulants to the abdomen in the form of liniment and blister, may be employed with a more reasonable chance of success; calomel, in four grain doses, has been found an efficient purgative, either in combination with other medicines, or alone. Emetics are now nearly disused in this disease, as tending to promote the irrita- tion we are anxious to subdue. Antispasmodics have met with a fair, and upon the whole a successful trial, either administered before, or alternately with purgatives ; favourable, however, as the action of some of these medicines has proved, we are not in possession of any means that produce a decided influence upon this disease, which generally defies our skill, however it may be exerted. It remains but to state, that worms in the intestinal canal have occa- sionally produced ileus, when, of course, anthelmintics must be adminis- tered, directly we are aware of the circumstance. On the subject of colic, consult the following works:—Monro's and Baillie's "Morbid Anatomy;" Dr. Warren, in the 2d vol. of Medical Transactions; "Observations on the Poison of Lead," by Percival, CON. - 163 (Dublin;) Article, Colic, in Rees's Encyclopaedia ; Pemberton "on Diseases of the Abdominal Viscera ;" Meckel's "Manuel d'Anatomie ;" the observations of Hall, Alexander, and Wood, in the 4th, 6th and 7th volumes of the Annals of Medicine ; Williamson, in the Philad. Med. Museum, vol. 1st, and others. COLLIQUATIVE, (from colliqueo, to melt)—a term employed in medicine to an excessive evacuation, and chiefly in reference to diaphore- sis and diarrhoea. In tlie former case, the perspiration is symptomatic, and is generally recognized in hectic fever, phthisis, or in a constitution suffering from the effects of a wound, &c. giving rise to excessive local action ; it is almost useless to interfere, except for the purpose of palliation, unless we can remedy the cause giving rise to it; the usual palliatives are the mineral acids, particularly the sulphuric, the sulphate of quinine, in small doses, and the lighter tonics, avoiding, at the same time, warm diluting drinks, and keeping the person and chamber as cool as possible. Jn the latter case, or colliquative diarrhoza, which occurs under the same circumstances as the former, and frequently alternates with it, it is equally unwise to attempt a cure without removing the disease of which this is but a symptom; in the intention of relieving its severity, aromatics, astringents, opiates, and a rice diet, may be beneficially resorted to. COLOC YNTH—Colocynthis. The bitter cucumber; class, moncecia; order, syngenesia. The pulp of this fruit is a drastic purgative, given im doses of from gr. iv. to x. Officinal preparations. Extract of Colocynth, and compound extract of Colocynth (extractum calocynthidis, et extractum colocynthidis com- positom) of each from grs. v. to 3 i. as cathartics and stimulants. COLUMBO ROOT— Calumbm Radix—imported from Colomba, in Ceylon. Tonic, stomachic, antiseptic ; dose grs. xv. to 3 ss. Officinal preparations. Infusion of the root (infusum calumbse) § iss. to £ iij. three times a day. Tincture of the same (tinctura calumbce) 3 ss. to 3 iv. both having the same operation as the root. COMA, (from keo>, to lie down.) Drowsiness, insensibility ; a symp- tom of many affections, particularly Apoplexy, and Injuries of the Head, which see. COMPRESSION. See Injuries of the Head. CONCEPTION. See Uterus. CONCUSSION. See Injuries of the Aead. CONDYLOMA. (Condyloma, atis, a tubercle or knot.) A wart- like excrescence, that appears about the anus and pudendum of both sexes, which may be removed cither by the application of a ligature to ihe base, or with the knife, of which modes tho lattclr is the best, as well as the least painful. m COS. CONSTIPATION—(Opslipatio)—Cco,'