m ,'*.*. WW^- rr ELEMENTS OE MEDICINE. ELEMENTS OF MEDICINE: A COMPENDIOUS VIEW OF PATHOLOGY AND THERAPEUTICS; HISTORY AND TREATMENT OF DISEASES. BY SAMUEL HENRY DICKSON, M.D., LL.D., PROFESSOR OF THE PRACTICE OF PHYSIC IN JEFFERSON MEDICAL COLLEGE, PHILADELPHIA: FORMERLY PROFESSOR OF THE IXSTITCTES AND PRACTICE OF PHYSIC IN THE MEDICAL COLLEGE OF TH STATE OF SOUTH CAROLINA, AND OF THE THEORY AND PRACTICE OF MEDICINE IN THE NEW YORK UNIVERSITY. SECOND EDITION, REVISED. '.iit.i h. PHILADELPHIA: BLANCHARD AND LIA. 1859. Entered according to the Act of Congress, in the year 1855, by BLANCHARD AND LEA, in the Office of the Clerk of the District Court of the United States in and for the Eastern District of Pennsylvania. PHILADELPHIA : COLLINS, PRINTER, 705 JAYNE ST. TO TEACHERS AND STUDENTS OE MEDICINE THKOOGHOUT THE UNITED STATES, IS MOST RESPECTFULLY INSCRIBED BY THEIR FELLOW STUDENT AND COLLEAGUE, SAMUEL HENRY DICKSON. PREFACE TO THE SECOND EDITION. In preparing for the press a second edition of my "Elements of Medicine," I have gladly availed myself of the notices of the work contained in the journals at the time of its appearance. I take this occasion to acknowledge, with much gratification, their almost uni- formly courteous tenor. I have endeavored to supply the defects pointed out, to remove redundancies indicated, and to correct such errors as were commented on by my friendly critics, or discovered on my own part after the most careful revision. The faithful and conscientious performance of that labor has made me, perhaps, even more profoundly sensible of the many imperfections of the work. Yet, in the belief that it has been found useful to those for whom it was written, and that it gives them some desirable aid in the prosecution of their toilsome studies, I again offer the volume to the indulgent consideration of my professional brethren. S. HENRY DICKSON. Philadelphia, May, 1859. PREFACE TO THE FIRST EDITION. A book should be judged and appreciated with some direct reference to its declared purpose. The present volume is intended as an aid to young men who have engaged in the study of medicine, to physicians who have recently assumed the responsibilities of prac- tice, and to my fellow-professors of the institutes of medicine, and private instructors, who have felt the difficulty of communicating to the first two classes the knowledge which they are earnestly seeking to acquire. Having been a teacher of medicine for thirty years, and a student more than forty, I must have accumulated some experience in both characters. I have prepared and printed for those in attendance on my lectures, many successive manuals or text-books; I have also written and published numerous treatises upon medical subjects in general. The first I have endeavored to improve, edition after edition, to render them more available and useful to those in whose hands they were placed. Of the latter, some of which have been favorably received, I have endeavored to learn and avoid the defects, to the best of my ability. The following pages are the result of a careful colla- tion of what has been esteemed most valuable in both, with such matter as continued study and enlarged experience have enabled me to add. May I hope that they will not be altogether unworthy the approbation of my professional brethren ! It was necessary that the book should be as compendious as pos- sible or it would not have been acceptable to the student, upon whose time there are so many claims; it was also necessary that it should be written in the simplest and plainest style, that it might not be unadapted to the wants of those whose preliminary education has been hurried and X PREFACE TO THE FIEST EDITION. imperfect: yet it was absolutely necessary that nothing essential to a fair development of the whole subject attempted should be left out. While a judicious selection of topics was therefore demanded, a critical rejection of such details as might properly be omitted, was as imperatively required. A full statement of elementary principles was called for on the one hand, and all attainable brevity of discussion was equally indispensable on the other. In the execution of a task so delicate as this, I cannot hope to have attained complete success. I shall be judged most kindly and indulg- ently, I am sure, by those best qualified to appreciate the actual diffi- culties encountered. Chabxeston, August, 1855. CONTENTS. PART I. GENERAL PATHOLOGY. SECTION I. THE NATURE OF DISEASE. Introductory remarks; definitions unsatisfactory, from the difficulty of apprehend- ing and selecting the essential elements. Diseases are necessarily abnormal, or departures from normal and regular conditions; but all abnormal conditions are not to be regarded as diseases, some of them being more properly defects and deformities : latent periods, and the stage of incubation, on the other hand, though apparently normal, are essentially diseased conditions ; so also, we say, of diatheses and predispositions definite and indefinite ... 35 Diseases variously divided—functional and organic, local and general, and so on; all manifest themselves in perversion of the natural and normal actions, or in alteration of structure or composition, progressive, and tending to further change 36—37 SECTION II. ETIOLOGY. Causes of disease variously distinguished ; proximate and remote ; predisposing and exciting; incidental and specific ..... 38 Proximate or Constituent Cause—defined to be the peculiar contingency or modi- fying circumstance which gives form and character to the present disorder 38 Remote or Efficient Cause, is the agency which disturbs or deranges the system, interfering in any manner with its normal movements ... 39 Predisposing Causes—predisposition truly a passive state; not to be regarded, therefore, as causative in the ordinary sense; may be original or acquired, per- manent or temporary; of internal constitution, or external source ; hereditary, or of race, or tribal; of temperament, idiosyncrasy, or personal habit; of sex, or age, or color, or climate; not easily distinguished always from the idea or conception of proximate cause, as impressing often the nature or form of in- vading disease ........ 39—44 Xll CONTENTS. Exciting Causes—the immediate contingencies which bring on an attack, almost synonymous with remote, as the books call them, efficient causes ; divided into the incidental and specific ...••• Incidental Causes, include all such contingencies as may become injurious by excess, intensity of effect, unfitness or abruptness of application, though in themselves innocent, useful, or even necessary; treated of under the several heads of the Climatic or Geographical, Dietetic, Personal, and Social 46 1. The Climatic comprise all atmospheric, topographical, and geological conditions ; the prevailing winds, temperature, moisture, alternations, and migrations ; the geographical distribution of diseases—a topic not yet sufficiently investigated ..... 46—49 2. The Dietetic—all food and drinks, and the methods of preparing and using them ....... 50—52 3. The Personal—individual habits, dress, mode of life, the senses, and the passions ....... 53—56 4. The Social Condition—civilized and savage, in town and country, in high and low life; occupations, amusement—sedentary and active— exposure, confinement ...... 57—61 Specific Causes—such agents as are, in their own nature, noxious. Poisons: classed as the Vegetable, Mineral, Animal, and Aerial. . . 62 1. The Vegetable Poisons are numerous, many of them familiarly known as medicines, emetics, cathartics, narcotics, acids, alkalies, and alka- loids . . . . . . . . 62—63 2. Mineral Poisons—not abundant in nature, but multiplied by art, as the oxyds and salts of metals, acids, &c.; these too received into our Materia Medica ....... 64 3. Animal Poisons—normal secretions, such as the venom of the serpent, the wasp, hornet, &c.; natural secretions, changed by disease—as the saliva in hydrophobia; solids and fluids, similarly altered—as in ma- lignant pustule ; new productions, secretions or excretions. Contagion —a new and peculiar product of diseased action, capable of reproducing that action—therefore germinative, and probably organic ; in form, palpable and impalpable; diffusible in the blood, pus, and lymph ; coincident with both animalcular and vegetable growth; disseminated in the atmosphere; concentrated in, and adherent to, fomites ; tests of its presence and influence sought for ; quarantines discussed 65__82 4. Aerial Poisons—inordinate proportion of any of the constituents of at- mosphere, as of carbonic acid in wells ; change of condition, as in the allotropic state of oxygen known as ozone; irrespirable gases produced naturally or artificially, and mingled in the air, as sulphuretted and carburetted hydrogen; effluvia of animal origin: a, exhalations from living and healthy bodies—ochlesis—the " crowd poison" of Gregory— 6, from collected excretions, as in privies—c, from putrefaction of ordi- nary animal matters: miasmata of uncertain origin. Malaria—the existence of such specific poison, matter of clear and rational inference, however disputed; its principal source, the decay of vegetable matter; it is probably organic, cryptogamous, or animalcular; abundant in known localities; not found in others; gives rise directly to periodical fevers—indirectly, to many familiar maladies. . . 83—108 CONTENTS. Xlll The Endemic and Epidemic Etiology of Disease next treated of separately as not susceptible, in many instances, of being included under the heads above discussed. Endemics, characterized by obvious local relations ; often exclusive, as of Pellagra in Lombardy, Plica in Poland. Epidemics spread widely, owing to unexplained diffusion and activity of the cause producing them ; this cause often obscure or unknown, whether endemic, or locally or generally epidemic ...... 108—120 Living Parasites—described as alleged causes of disease ; not yet settled whether their presence is cause or effect, or mere coincidence ; the vegetable Endophytes and Ectophytes, are of the lowest forms—Algae and Fungi; the animal parasites are greatly more varied, and belong to several orders—of Ectozoa, the Acari, Pe- diculi, &c.—of Entozoa, the Taenia, Ascaris, Hydatid, Haematozoou, kc. 121—124 SECTION III. THE SEATS OF DISEASE. Humoralism and solidism discussed ; vitiations of the composition of fluids and impairment of the integrity of tissues ; derangement of nervous function on one hand, and poisoning of the blood, probably the earliest or primary movement; impossible to decide upon either to the exclusion of the other; hsematology 125—127 Diagnosis—empirical and scientific ; doubly related to Prognosis and Therapeutics ; scientific methods progressive and much improved; aid us most in special diagnosis, the separation of each case from every other by its individual pecu- liarities and complications ; general diagnosis greatly dependent on, and pro- moted by, pathological anatomy, the true value of which, its application, and its limitations, briefly considered . . . . . 12b SECTION I Y. THE PHENOMENA OF DISEASE. Some of the more familiar and important described and investigated in their rela- tions to Diagnosis and Prognosis ; the distinction between the objective and the subjective, signs and symptoms; the importance of a careful study of the first, the cautions necessary in trusting to the latter ; malingering—cases of infants, mutes, and idiots ; of hysterical affections, and of maladies in which suffering is the prominent part; taken up in order as they affect the physiological systems ......••• 132 The Circulatory—the pulse commented on; a comparison instituted between its healthy and morbid movements, and the rationale of some of the latter sug- gested ; palpitation, syncope, plethora, hyperaemia, anaemia, hemorrhages, effu- sions, or exosmoses, referred to . . . • • . 133—137 The Digestive—the morbid appearances of the tongue ; nausea, vomiting ; explo- ration of the abdomen, and observation of matters ejected and alvine actions enjoined ..••••••• 138—139 The Respiratory—dyspnoea, orthopncea, cough, and expectoration ; exploration of the thorax ; percussion, auscultation, mediate and immediate ; the stethoscope described • respiratory and vocal sounds, natural and morbid ; rhonchi, or rales ; metallic tinkling, &c. ...... 140 XIV CONTENTS. The Sensorial—pain, in its several modes ; hyperaesthesia, and anaesthesia ; sleep, coma, disorders of sense and intelligence ; sympathies, direct and illusory ; ri- gor, and chilliness .....•• 1^0 143 The Motory—not readily separable from the last in pathological conditions and manifestations; common to the two are cramp, spasm, convulsion, paralysis, prostration, and relaxation of sphincters . 144 The Excretory—on the cutaneous surface we notice efflorescence or eruption, petechiae, and sweating ; the urine exhibits numerous changes in quantity and quality; alkaline, albuminous, saccharine, oxyluria, and morbid deposits 145 Miscellaneous Phenomena—the general aspect, manner, complexion, and physiog- nomy ; the risus sardonicus, and facies hippocratica, portrayed; the decubitus often important to be noticed ...... 145 Irritation, congestion, and inflammation discussed together, as concurring so gene- rally, and connected so indissolubly, that they cannot be separately appreciated 146 Irritation—seated in the nervous tissue of parts affected ; its nature various and complex ; its direct effects, spasm and fluxus .... 147—152 Congestion—a local hyperaemia; determination of blood not necessarily morbid ; may be passive or active, spontaneous or derivative ; unattended with change in the tissue ........ 152 Inflammation—a complex condition ; a fluxus, determination to a part, local hy- peraemia, irritative or congestive, or both, with tendency to definite change in the part, and certain new results, local and general; the blood is hyperfibri- nated; febrile excitement diffused, exudation takes place, pus is secreted, or serum poured out, or plastic lymph deposited; adhesions occur, induration, softening, abscess, ulceration, gangrene .... 153—164 Periodicity—the special revolution, rhythm, and duration of diseases ; self-limit- ing, paroxysmal, and recurrent maladies described, with their stage of incuba- tion, and latent and intercurrent periods: their regularity ascribed to their sources ; harmony with the corresponding movements of the external world, diurnal, septenary, monthly, annual, or of seasons ; fixed habits personal to the individual, "a second nature ;" a peculiar and characteristic rhythm of each malady whose specific cause impresses and determines its hour of access, its rate of progress, its acme, and its decline ; its acme is crisis, a marked period in acute cases ; obscure, if it exist at all, in chronic affections . . 165__175 SECTION Y. THE TENDENCY OF DISEASES. Their effects, their termination ; the dogma of a special " vis medieatrix natnrse" disputed ; disease a " forced state ;" its tendencies all evil and injurious but not all or always destructive or fatal .... \<]q__17a Death—considered pathologically ; modes of; signs of ; neither the heart nor the biceps the ultimum moriens, but the vibratory cilia fringing the mucous mem- branes : cautious disposal of dead bodies advised . . 17a__1 gi CONTENTS. XV PART II. SPECIAL PATHOLOGY AND THERAPEUTICS. In this series of essays are briefly discussed, the character, seat, diagnosis, prog- nosis, causes, and results of the varied forms of disease, and of individual examples separately and in detail; their treatment and cure, comprising the whole management of the cases, as well as the administration of medicines ; hygienic measures, relevantly applied for the protection of the general health, and prophylaxis, or the preservation of the individual. Classification of Diseases—a matter of expediency and convenience; the phy- siological nosology of Good preferred and followed; taking up in succession the several systems of organs or orders of parts engaged in the performance of the functions, and investigating the derangements which affect each of them in prominent degree and manner ...... 185—188 SECTION I. DISEASES OF THE CIRCULATORY SYSTEM. Fever—a universal malady; its incipient or primary stage manifests a concur- rence of sensorial with vascular disorder ; distinction drawn between the idio- pathic and symptomatic, the former probably implying a predominance of the humoral element, or change and deterioration in the blood itself, the latter a predominance of the neurotic element, both of which are essential to the defini- tion of fever; its causes, symptoms, and history, tendency and curability; its periodical revolutions, stage of incubation, latent and intercurrent periods ; crisis defined, and the doctrine of " critical days" examined ; anatomical lesions collated.........189—201 Types of Fever—the word type too vaguely and carelessly employed; a limitation suggested, and certain general distinctions assumed as established, viz: 1, the Periodical; 2, the Continued ; 3, the Exanthematous—the last, however, as ad- mitting a new and essential combination with cutaneous eruption or efflores- cence, not comprised in the present section—they are fevers in a special sense 202—210 These various types of fever absolutely distinct; the dogma of a " common febrile element" rejected ; the peculiarities of each owing to the nature of its cause; when these causes mingle, there may be blending of type, or a sort of hybridism ; where one substitutes or supplants another, what is called conversion of type takes place ........ 210—222 IDIOPATHIC FEVERS—divided into Periodical and Continuous or Continued :— Periodical Fevers—are intermittent and remittent; the first consisting of pa- roxysms separated from each other by a complete interval; the second of ex- acerbations and definite periods of marked alleviation of symptoms, or remission 223 XVI CONTENTS. Intermittents—subdivided according to the time occupied by their revolutions ; they are the quotidian, the tertian, and the quartan; we meet rarely with a settiman, octoman, or a monthly variety ; sometimes of complex form—doubled or duplicated, or even triplicated, strangely and unaccountably; malaria the universal and exclusive cause of this class of fevers; paroxysm of an inter- mittent ; obscurity of its rhythm ; consequences and lesions ; treatment in pa- roxysm and apyrexia; prophylaxis . ^^ ^° Remittent Fevers—closely connected with malarious intermittents ; belong to low latitudes and hot climates ; found near flat sea-coasts, lakes, jungles, and swamps ....••••• ^38 Bilious Remittent—its significant prefix correctly applied as indicative of hepatic disorder, functional chiefly; the most familiar and unfailing summer and au- tumnal endemic over our southern country; history, tendencies, effects, ex- citing causes, prognosis, and treatment .... 238—258 Congestive Fever—a frequent and important variety of the above named, subdi- vided into four recognizable groups : 1, the cerebral, in which the cerebro-spinal axis is chiefly assailed, and the brain the seat of obvious congestive deter- mination ; 2, the thoracic, the great organs within the chest being oppressed by similar congestion; 3, the abdominal, with hyperaemia, engorgement and de- rangement of the stomach and intestines ; and 4, the necraemial, in which the blood itself is probably poisoned, and universal capillary stagnation and para- lysis present themselves ...... 258—263 Country Fever—a local phrase—significant, however, of peculiarities widely recog- nized as impressed by the contingency of removal from the unhealthy locality in which the attack is incurred, to a better and salubrious atmosphere, these peculiarities consisting in irregularity and accumulation of exacerbations 263 Mountain Fever—a similarly local phrase, denoting a variety observed on the elevated heights or mountain passes of California ; description quoted 264 Infantile Remittent—the worm fever of many authors ; modified everywhere by endemic or locally epidemic agencies; its exciting causes very various ; its history and treatment vary greatly also .... 265__269 Continued Fevers—defined and described; not connected like the periodical forms ; they differ, each essentially from every other ; arise from entirely diverse causes ; affect different organs, and impress dissimilar results or lesions 269 Yellow Fever—a specific fever of one paroxysm, running through three stadia neither of which recurs, or is repeated; its generating cause unknown ; its mode of excitement and propagation disputed; its contagiousness maintained • its immunity from second invasion ; the " only acclimating fever;" diagnosis, prog- nosis, autopsy, and treatment ..... 270__297 Typhous Fever—including two groups, Typhoid and Typhus ; the opinion main- tained of their virtual identity; their probable cause the same ; their symptoms intermingled and combined ; the lesions often complicated; the external marks very similar........297-300 Typhoid, better designated, as by Professor Wood, Enteric Fever, exhibits a tendency to abdominal disturbance, with diarrhoea and meteorism ; affects the intestinal tissue with typhosis, or deposit of pseudo-plasm in Peyer's plates, ulceration, and occasional perforation ; history, causes, duration and treatment •••... ann on CONTENTS. XV11 Typhus Fever—true typhus, Irish typhus ; distinguished controversially by absence of intestinal deposit and lesion; less prominent diarrhoea and me- teorism ; cause better marked as ochlesis ; seldom occurs sporadically; history and treatment detailed ..... 312—318 Catarrhal Fever—when epidemic, Influenza: its history curious and interesting: its causes seemingly diverse; ozone suggested and considered; its spread often prodigiously rapid; its separate and idiopathic character contended for; its relations to other diseases notable; among its consequences, the painful and periodical inflammation of the frontal sinus and antrum specially referred to 318—330 Pneumonia Typhoides—recognized as a distinct form of fever, best, if not exclu- sively, known in America; history, strange anomalies, origin, progress, diag- nosis, prognosis, autopsy, and treatment .... 330—343 SYMPTOMATIC FEVER—the phrase too vaguely used to denote the febrile ex- citement in the phlegmasia proper ; in many affections pyrectic, but not phleg- masial as in bronchitis, dysentery, &c.; in severe surgical injuries, and in irritative chronic disorders involving various modes of derangement. Sympto- matic fever presents itself in two forms: 1, Continued or Inflammatory—the immediate consequence of wound or injury, operation, or violent local irritation, as from stimulant or acrid poisons; 2, Intermittent or Hectic—the ultimate result of protracted irritation, acting slowly and in chronic disorders, upon the constitution; discussed generally . • • • • 343 3j0 Cardiac Affections—the great organ of the circulation liable to, 1. Inflammation: a, of its substance, Carditis proper; b, of its external in- vesting membrane, Pericarditis; <:, of its internal lining membrane, Endo- carditis. These diagnosed as far as possible; history, causes, results, and requisite treatment attempted to be given .... 350 356 2. Valvular Alterations—deranging its structure and functions, and produc- ing hypertrophy and dilatation; the various degenerations portrayed, and their causes, symptoms, results, and treatment discussed . 356—361 3. Neuropathic Disorders—Palpitation, an affection generally of no great im- portance, and of extremely varied origin and connection with moral and physical conditions.—Syncope, a familiar malady, perhaps too lightly re- garded ; not improbably the cause of many sudden deaths. Angina Pectoris, Sternalgia, of obscure pathology; its probable seat and proxi- mate cause; history, exciting causes, diagnosis, prognosis, autopsy, man- agement during the paroxysm and in the interval . • 361—369 Hemorrhages—obviously divided into simple and cachectic ; the former treated of separately according to their local relation ; often regarded as critical; vicari- ous ; connected with many disorders consecutively; a hemorrhagic diathesis known and described as hereditary; a local hyperaemia always present; general hyperaemia alleged, but incorrectly; plethora vaguely assumed and spoken of; immediate cause often mechanical, as from deposit causing obstruction, haemos- tasis, and exudation—or irritative, as from vehement fluxus and molimen—or tissual, as where the exuding surface is disintegrated, softened, ulcerated; its alleged critical and salutary character examined and denied . , 369—377 Epistaxis—from Schneiderian membrane ; remarkable for the great amount rapidly effused from minute vessels ; often secondary and habitual 377—380 Stomatorrhagia—exudes visibly from unimpaired surface of tongue and mouth • extends strangely when a tooth has been extracted; occurs fre- ' 381 quently in fevers . • . ■ . 2 XV111 CONTENTS. Haemoptoe—its melancholy connection with phthisis ; in women vicarious ; in men occurs from violence or accident . ^° ' Haematemesis—most frequently met with in bad constitutions, and as vica- rious ....... • 38/ 389 Haemorrhagia Proctica—the melaena of the old writers when associated with visceral disease, and issuing in the upper part of the canal; exudes some- times spontaneously from the lower bowels of lighter color and more natural °.S9 appearance ......•• *Joa Haematuria—not often uncomplicated ; generally from diseased state of the kidney or bladder, or the presence of a calculus ; sometimes from violence or accident ........ 389 Hemorrhages of Cachectic Character—Purpura and Scurvy, which closely re- semble each other, and have been variously classed ; they both involve a change in the crasis of the blood, which is defibrinated, and readily exudes through all the tissues, these being also in general obviously impaired in their integrity 390 Purpura—subdivided into simplex and ha morrhagica; P. Simplex, a mere subcutaneous effusion or ecchymosis in minute spots, with epistaxis some- times, and sometimes other hemorrhage from surfaces ; P. Haemorrhagica involves the joints, which are swollen and painful; extensive ecchymoses, with erysipelatous inflammation, occur, and universal deterioration of the system ; causes very obscure, diagnosis easy—except from scurvy; prog- nosis doubtful; treatment by eutropics, tonics, and anodynes . 390—392 Scorbutus—Scurvy—most often met with in ships on long voyages, besieged towns, and ill provided armies ; rarely occurs spontaneously without obvi- ous cause; alleged to depend upon deficiency of potass ; specific remedies and diet chosen which contain that salt—potatoes, milk, lemons, and other fresh fruit and vegetables, fresh and raw meats . . . 393—396 Hydrops—general history; constitutes a diathesis or rather a special cachexy; idiopathic ; often consecutive ; consists in exosmose of serous portion of blood, sometimes fibrinous ; sthenic and asthenic ; local examples . . 396—405 Anasarca—cellular dropsy—very often consecutive ; its relations to the exan- themata ........ 405—416 Ascites—peritoneal or abdominal dropsy; mechanically produced by visceral enlargements; follows obscure peritoneal inflammation; paracentesis ad- vised ; modern practice of injecting the sac . . . 416__422 Hydrothorax—Hydrops Pericardii, Hydropleura, Anasarca Pulmonum—effu- sion not an unfrequent result of inflammation of the pleura and pericar- dium ; diagnosis, causes, and condition of system modify the treatment; diuretics much relied on ; paracentesis .... 422__428 Hydrocephalus—less frequently than the rest a part of general dropsy; has been looked on, but incorrectly, as a mere result of tubercular meningitis ; presents itself in two forms—one, in which the effusion is unpreceded by much constitutional disturbance—the other, the ultimate result of a loner train of gastric disorders and febrile irritation ; the treatment must be relevant; the cranium punctured in the last stages, and, as is said, some- times successfully ....... 42s__441 Scrofulosis, Struma, Scrofula—a specific cachexy, or morbid diathesis, with de- posit of morbid plasma in the glands and tissues extensively ; affects the mesen- teric glands of children, whence Marasmus, or Atrophia Ablactorum; history, causes, and modes of propagation ; seats ; treatment; prophylaxis . 441—452 CONTENTS. XIX Tuberculosis—closely allied to Scrofulosis and Tvphosis; not readily or clearly distinguishable from the former. Tubercle—its several forms and localities de- scribed ; principal seat and deposit, the lung .... 452—458 SECTION II. OF THE DISEASES OF THE DIGESTIVE SYSTEM. OF THE STOMACH AND INTESTINES . . 459 Dyspepsia—not to be confounded with Indigestion, a transient disturbance or interruption of function—probably a true gastric neuralgia, in which several elements combine ; perverted and impaired innervation, secretion, peristaltic action and absorption ; remote causes, history, and effects ; treatment 460—473 Gastritis—Acute, seldom occurs alone, or idiopathically—the chronic form is more frequent; the first attends the taking of acrid poisons and indigestible and irri- tating food, the second comes on insidiously as a consequence of protracted dyspepsia, or from habits of excess ..... 473—480 Enteritis—acute or chronic, general or local; when portions of the tube are exclu- sively attacked, we have Duodenitis, Ileitis, Tuphlitis, and Colonitis, each exhi- biting its special symptoms, tendencies, history, and results . . 480—485 Milk Sickness—an epizootic and endemic in the Southwestern United States ; its existence as a separate disease doubted by many; in man, ascribed to the taking as food the milk, butter, or flesh of a diseased animal; in its herbivo- rous subjects, the cause unknown ; symptoms and history variously described —point to the stomach as the chief seat of disease ; the treatment unsettled 486—488 Constipation—may result from torpor or obstruction, spasmodic or mechanical; the various modes of the latter described; Enterotomy advised as a last resource ...•••••• 489 ^91 Colic—of its numerous varieties, three separately described:— 1. Flatulent Colic—Ileus, regarded as the type ; consists of two elements, Spasm and Pneumatosis ; this evolution of flatus is a specific morbid action too little attended to ; secretion or exhalation of air may take place in any tissue or part; in colic, thrown out from the mucous surface, and denied egress by spasmodic constriction . . • • ^ 491—499 2. Bilious colic—presents the complication of malarious poisoning, irritation of the bowels by morbid hepatic secretion, and periodical fever . 499—500 3. Colica Pictonum—Rachialgia is one of the forms of lead poisoning; in this latter the spasmodic element predominates, with no very great pneumatosis : in all, the indications are the same ; to relieve spasm and pain by anodynes and relaxants, and procure free and unobstructed peristaltic action 501—5o4 Cholera—sporadic ; Cholera Morbus, a familiar malady, of transient cause and well-known character and symptoms—violent irritation of stomach and bowels, Drofuse excretion vehement muscular contraction—readily relieved by opiates, , .....504—509 &c. • XX CONTENTS. Cholera Asphyxia—a comparatively new disease of Eastern origin, extensive spread, and pestilential mortality ; exotic, but threatening to become natural- ized among us ; characterized by profuse exosmose of serum into the stomach and bowels; universal spasm and cramps ; intense capillary paralysis ; pro- found collapse, preceded very generally by cholerine, a painless diarrhoea ; his- tory, symptoms, and lesions detailed ; treatment unsatisfactory • 510—522 Diarrikea—a neuropathic affection of the small intestines, manifested by undue peristaltic action, with abundant fluid discharges ; its character varies with the cause; relieved by astringents and anodynes when simple; occasionally as- sumes a chronic tenacity almost indomitable .... 522—528 Dysentery—seated in the larger bowels ; pyrectic, inflammatory, and hemorrhagic, with painful constriction and spasmodic action, and often ulceration; often epidemic; sometimes probably contagious; modified by climate, and season, and locality; history; autopsy; various treatment: in its chronic form most obstinate and unmanageable ...... 529—544 Cholera Infantum—regarded by several American writers as a specific disease ; the name includes all the "bowel complaints" of children of tender age, and especially under dentition; modified treatment necessary; general management of such cases ; benefit of country air ..... 544—552 Helminthia—Intestinal worms—occasion disease doubtless by increase of numbers, especially in young subjects not very robust; Taenia—the tormentor of adult life—better controlled now than formerly .... 552—560 DISEASES OF THE COLLATITIOUS VISCERA. Of the Liver—Hepatitis—acute and chronic, with their effects ; enlargement, in- duration, abscess ; Hypertrophy; atrophy; Cirrhosis—hobnail or nutmeg liver ; fatty degeneration ....... 560—570 Icterus—Jaundice—causes and nature differ much; mere torpor; inspissation of bile ; obstruction of duct by thickening, by spasm, and by gallstones or biliary calculi of diversified character and composition ; surface and tissues discolored generally yellow; a black and green jaundice recognized 570—581 Of the Spleen—Splenitis—may supervene upon malarial enlargement of the organ, or arise spontaneously; affections of this organ are apt to be tenacious 5S2-584 Of the Parotid—Mumps—Parotitis—a contagious specific malady ; attacks but once ; inflammation metastatic, or extending to testis and mamma, and, rarely, to the brain ........ 554__557 Of the Pharynx—Sore-throat—this inflammation assumes a most diversified cha- racter—simple, superficial, ulcerative, and phlegmonous—quinsy ; diphtherite ; angina maligna •.....„.. 538__592 SECTION III. DISEASES OF THE RESPIRATORY SYSTEM. Exploration of the thorax in various modes enjoined; by auscultation, mediate and immediate; by percussion, with and without the pleximeter; by palpa- tion; mensuration, &c; the vocal and respiratory sounds, normal and morbid enumerated and commented on .... »5